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REPRO 1 > beaton htn and dm > Flashcards

beaton htn and dm Flashcards

1
Q

What is the triad of pre-ecclampsia?

A

proteinuria, HTN ,edema

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2
Q

Describe the deep tendon reflexes of a pre-ecclamptic woman

A

They are hyper-reflexic, pre-ecclampsia is associated with CNS hyperexcitability

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3
Q

What is the cause of epigastric pain in pre-ecclampsia (classically)?

A

swelling of Glisson’s capsule of the liver due to edema

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4
Q

What placental disorder is correlated with Pre-ecclampsia?

A

placental abruption

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5
Q

What are 2 important fetal sequelae of pre-ecclampsia?

A

Intrauterine growth restriction, prematurity

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6
Q

Describe the blood pressure and urine protein changes associated with mild pre-ecclampsia

A

BP = 140/90, proteinuria > 0.3 g in 24 hours

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7
Q

What are the BP and urine protein in severe pre-ecclampsia?

A

160/110 and greater than 5 g in 24 hours

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8
Q

Why is increased urine output in a pre-ecclamptic woman after giving birth a “reassuring sign”?

A

Because they may become oliguric during pre-ecclampsia due to changes in the glomerulus, thus if urine output increases that is a sign that the changes of pre-ecclampsia are starting to return to normal

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9
Q

What does HELLP sydrome stand for?

A

Hemolysis, Elevated Liver enzymes, and Low Platelets

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10
Q

How does ecclampsia differ from pre-ecclampsia?

A

ecclampsia is associated with the development of convulsions

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11
Q

What fetal wellbeing tests can you order in an ecclamptic woman?

A

NST, CST, BPP; even in pre-ecclampsia you should do these 2x per week “that is the single most important thing to do”

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12
Q

If a woman has mild pre-ecclampsia when should you deliver?

A

If she is 38 weeks gestation, S/S are progressing, or if there is evidence of fetal compromise (i.e. by the wellbeing tests)

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13
Q

T/F: both mild and severe pre-ecclamptics need to be hospitalized

A

false mild pre-ecclamptics can be managed at home IF THEY ARE A RELIABLE PATIENT, severe pre-ecclamptics should be hospitalized

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14
Q

If a woman has severe pre-ecclampsia when should she deliver?

A

if the baby is after 32 weeks, with mild preeclampsia it was 38 weeks

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15
Q

Corticosteroids are beneficial to the baby of a pre-ecclamptic for what 2 reasons?

A

they help with lung maturity and they help the weak vessels of the brain mature

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16
Q

What is the DOC for preventing seizures during the intrapartum mgmt of a pre-ecclamptic woman?

A

IV magnesium sulfate, directly antagonizes calcium

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17
Q

Name 3 drugs for the antihypertensive Tx of pre-ecclamptics

A

IV labetalol, IV hydralazine, and alpha methyldopa

18
Q

What is the goal for HTN correction and why would you not want to drop below it ?

A

140/90, a drop below this can underperfuse the baby

19
Q

What is the puerperium? What if a woman is being Tx’d for pre-ecclampsia but is still hypertensive after the puerperium?

A

The 6-8 week period where a woman’s body returns to normal after a pregnancy. If she is still HTN, then it is likely that she had pre-existing HTN

20
Q

T/F: pre-ecclampsia increases the risk of developing essential HTN

A

false they usually return to normal after, and if they do not then they probably already had essential HTN

21
Q

How is gestational HTN different from pre-ecclampsia? How is it different from essential HTN?

A

It is HTN after 20 weeks of pregnancy without proteinuria. Pre-ecclamptics would have proteinuria and edema and essential HTN is what occurs without pregnancy or would have been present prior to 20 weeks gestation

22
Q

A diagnosis of chronic HTN can be made if the HTN was found during pregnancy and lasts ________ weeks post-partum

A

12

23
Q

Can you use ACE-I’s/ARB’s in pregnancy?

A

no, teratogenic

24
Q

Can you use BB’s in pregnancy?

A

You can but they can cause IUGR

25
Q

Can you use diuretics in pregnant ppl?

A

no it can compromise the fetus by depleting maternal blood volume, i.e. the fetus will be underperfused

26
Q

What is chronic HTN with superimposed pre-ecclampsia? How should it be managed?

A

Pre-existing HTN with the development of >0.3 g proteinuria, mgmt is same as pre-ecclampsia

27
Q

What 2 issues of fetal body size are associated with maternal diabetes?

A

opposite ends of spectrum = IUGR and fetal macrosomia

28
Q

What are 3 congenital anomalies associated with maternal diabetes?

A

Cardiac (first aid says transposition, especially), neural tube defects, and sacral agenesis

29
Q

How are the fetal complications of gestational diabetes different from that of pre-existing diabetes?

A

Both will have fetal macrosomia and IUGR but gestational diabetics don’t have the issues with organogenesis probably because organogenesis is complete by the time gestational DM sets in

30
Q

Why should you do a fasting blood sugar on all pregnant patients in the first trimester?

A

because they may not know they are diabetic; if they meet diabetic criteria in the FIRST TRIMESTER then they are a REAL diabetic not just gestational

31
Q

What is the screening test for gestational diabetes?

A

50 gram glucola test? Drink it, if blood glucose is > 140 one hour later then you do the diagnostic test

32
Q

What is the diagnostic test for gestational diabetes?

A

A 100 gram 3 hour glucose tolerance test (normally it would be a 75 g in a nonpregnant person)? If you get 2 abnormal values on a 3 hour (i.e. abnormal at 1, 2, or 3 hours) it is positive

33
Q

What are the White Categories for gestational diabetes?

A

A1 does not need insulin because diet and exercise return values to normal and A2 needs insulin b/c diet and exercise is not sufficient

34
Q

What is the initial treatment of gestational diabetes?

A

diet and exercise!

35
Q

Why are serial ultrasounds important in diabetic mothers?

A

because of the issues with fetal growth, you want to closely watch the fetus to make sure there is no macrosomia or IUGR

36
Q

What is the glucose goal in the intrapartum period?

A

80-120

37
Q

Why do insulin requirements drop after delivery?

A

insulin antagonists from the placenta are no longer present

38
Q

How is the treatment of a pre-existing diabetic vs. a gestational diabetic different after delivery?

A

A gestational diabetic’s levels will very likely go back to normal, a pre-existing diabetic will probably have a 2-3 day reprieve and then will need to resume Tx

39
Q

What screening test do you use in gestational diabetes? Confirmatory test?

A

50 g glucola test, 100 g GTT

40
Q

What test do you use to see if a gestational diabetic is back to normal after delivery

A

75 g GTT 6-8 weeks post partum

41
Q

T/F pre-ecclampsia increases the risk of developing essential/primary HTN

A

FALSE

42
Q

T/F gestational diabetes increases the chances of developing type II DM

A

true

REPRO 1 (10 decks)

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