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OB-gyn > Case Files - Random > Flashcards

Case Files - Random Flashcards

1
Q

Nulliparous women dilate at what rate during active phase

A

1.2cm/hr

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2
Q

What features would suggest retained products of conception (i.e. after abortion)?

A

Open cervical os, lower abdominal cramping, vaginal bleeding, signs of infection

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3
Q

Why are we concerned about hemorrhage when performing curettage in an infected uterus?

A

Higher risk of perforation when infected

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4
Q

2 most common complications ass. with spontaneous abortion

A

Infection and Hemorrhage

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5
Q

Signs/sxs of septic abortion

A

Uterine bleeding and/or spotting in 1st Trimester + signs of infection. May see abdominal tenderness, cervical motion tenderness, foul-smelling vag discharge

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6
Q

In septic abortion, where does the infection come from/travel to?

A

Ascends from Vagina or Cervix. Goes to Endometrium –> Myometrium –> Perimetrium –> Peritoneum

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7
Q

Which organism causes septic abortion?

A

Polymicrobial –> Anaerobic strep, bacteroides, E coli, GBS are common

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8
Q

Bloody Show

A

A sign of impending labor that is often accompanied by the loss of the mucus plug. May present as bloody mucus in the vaginal vault.

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9
Q

What is the cutoff for ‘anemia in pregnancy’

A

10.5

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10
Q

Accelerations

A

> 15bpm above baseline for at least 15 seconds

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11
Q

Normal FHT range

A

110bpm-160bpm

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12
Q

Adequate Contractions

A

> 200 Montevideo Units in a 10min. window

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13
Q

Protracted Labor

A

Some progression but taking longer than normal (i.e. 0.5cm/hr)

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14
Q

Bloody Show

A

A sign of impending labor that is often accompanied by the loss of the mucus plug. May present as bloody mucus in the vaginal vault.

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15
Q

Combination of which 2 antibiotics works well for septic abortion tx 95% of the time

A

Gentamicin + Clindamycin (want broad spectrum with good anaerobic cover)

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16
Q

When do you begin uterine curettage for removal of retained products of conception/septic abortion?

A

4 hours after starting IV antibiotics

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17
Q

Why is urine output carefully observed in the setting of septic abortion?

A

because Oliguria = early sign of septic shock

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18
Q

Pelvic exam finding for Mullerian agenesis pt

A

blind vaginal pouch/vaginal dimple

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19
Q

Why does uterine inversion lead to PPH

A

Prevents adequate myometrial contraction

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20
Q

Absence of breast development points towards what hormonal state and condition?

A

Hypoestrogenic state –> Gonadal dysgenesis aka Turner syndrome

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21
Q

Next step in management after a shoulder dystocia has occurred

A

McRobert’s Maneuver - hyperflexion of maternal hips onto maternal abdomen and/or suprapubic pressure

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22
Q

Primary Amenorrhea = no menarche by age ____

A

16

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23
Q

Primary amenorrhea, normal breast, pubic, and axillary hair. Absent uterus

A

Mullerian agenesis

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24
Q

First dx test for any woman with primary or secondary amenorrhea?

A

Pregnancy test

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25
Q

T/F Fundal Pressure should be applied immediately following Dx of shoulder dystocia

A

False, it should be avoided due to increased risk of neonatal injury. McRoberts uses suprapubic pressure

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26
Q

+ whiff test

A

BV or Trich

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27
Q

Why do menses and intercourse exacerbate the fishy odor of BV?

A

Both introduce an alkaline substance

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28
Q

what are Amsel’s criteria?

A

3/4 indicate BV

  1. Homogenous, gray-white discharge
  2. vaginal pH>4.5
  3. Postive whiff test
  4. Clue cells on wet mount

(Gram stain is gold standard but rarely used clinically)

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29
Q

Strawberry cervix

A

Trichomonas

“Strawberries are trich-y to Cerve”

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30
Q

why does antibiotic use dispose to Candida vaginitis?

A

normal lactobacilli in vagina inhibit fungal growth (these are reduced by antibiotic)

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31
Q

which of the 3 vaginitis microscopic dx is assisted by KOH?

A

Candida: KOH lyses leukocytes and erythrocytes, can identify hypahae/pseudohyphae easier

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32
Q

Classic mammogram finding of breast cancer

A

A. Small cluster of calcifications around a small mass
or B. masses with ill-defined borders (spiculated/invasive)
or C. asymmetric increased tissue density

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33
Q

Next dx step if mammogram is suspicious for cancer

A

Stereotactic core biopsy

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34
Q

role of MRI in identifying breast cancer?

A

Can detect early breast cancers missed by mammography, especially in younger pts or BRCA pts

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35
Q

Name this method of breast cancer workup: Computerized,digital 3-D view of breast allows us to direct the needle to the biopsy site

A

Stereotactic Core Biopsy (needle localization is also acceptable)

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36
Q

Name this method of breast cancer workp: Multiple mammographic views of the breast allow us to localize the lesion with assistance of a sterile wire

A

Needle Localization

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37
Q

Digital mammogram has better sensitivity than film in which conditions:

A

Age<50, premenopausal, dense breasts

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38
Q

What is the cutoff for ‘anemia in pregnancy’

A

10.5

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39
Q

Iron Deficiency Anemia

A

Low Iron, Low Ferritin, High TIBC

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40
Q

Microcytic Anemias

A

Iron Def., Thalassemia

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41
Q

Where does vessel ligation occur to decrease pulse pressure to the uterus and help with PPH

A

Ascending Branch of Uterine Arteries, or Internal Iliac (Hypogastric) Artery

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42
Q

Genetics of Sickle Cell

A

AR

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43
Q

Pregnant woman with anemia, jaundice, and thrombocytopenia.

A

HELLP Syndrome

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44
Q

Best Method to avoid uterine inversion

A

Await spontaneous separation of the placenta

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45
Q

1 risk factor for uterine inversion

A

Placenta Accreta

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46
Q

What implantation site predisposes to uterine inversion?

A

Fundal

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47
Q

After 30min. the placenta isn’t delivered, what do you do next

A

Manual Extraction

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48
Q

Why does uterine inversion lead to PPH

A

Prevents adequate myometrial contraction

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49
Q

Best therapy to relax the uterus to reduce it so in can be “un”-inverted

A

Halothane or anesthetics like Terbutaline/Mag Sulfate

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50
Q

Next step in management after a shoulder dystocia has occurred

A

McRobert’s Maneuver - hyperflexion of maternal hips onto maternal abdomen and/or suprapubic pressure

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51
Q

Risk to the fetus of shoulder dystocia

A

Erb Palsy - Brachial Plexus Injury (C5-C6)

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52
Q

Precautionary signs that might signify an impending shoulder dystocia

A

GDM, Obesity, Fetal Macrosomia, Prolonged Second Stage of Labor

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53
Q

Turtle Sign

A

When the fetal head retracts back towards the introitus (signifies shoulder dystocia)

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54
Q

T/F Fundal Pressure should be applied immediately following Dx of shoulder dystocia

A

False, it should be avoided due to increased risk of neonatal injury. McRoberts uses suprapubic pressure

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55
Q

When is AROM contraindicated

A

Fetal Head not engaged (ballotable), Transverse Fetal Lie, Footling Breech

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56
Q

4 Steps to improving fetal bradycardia

A

1) Maternal Repositioning (usually on the side)
2) IV Fluid Bolus
3) 100% O2
4) Stop Oxytocin

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57
Q

In women with prior C/S, fetal bradycardia may manifest due to what

A

Uterine Rupture

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58
Q

Diminished variability can be due to what

A

sedating medications to the mother, or fetal acidosis

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59
Q

Epidurals can cause hypotension leading to late decels, what is the best immediate next step

A

Push IVF and give ephedrine (vasopressor)

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60
Q

Most common finding with Uterine Rupture

A

Fetal Heart Rate Abnormality (Late Decels or Bradycardia)

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61
Q

CI to Methergine

A

Hypertension

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62
Q

CI to Hemabate (Prostaglandin-F2 alpha)

A

Asthma/Bronchospasms

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63
Q

First steps in management of Uterine Atony

A

Uterine Massage and Dilute Oxytocin

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64
Q

If medical therapy fails whats the next step for Uterine Atony

A

Two Large-bore IV lines, Foley, Blood should be ordered, and patient moved to OR

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65
Q

After blood replacement and IV’s put in, whats next step in mgmt of Uterine Atony if continuous bleeding

A

Bakri Balloon or Embolization of the Uterus

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66
Q

(Uterine Atony) If continuous bleeding refractory to all prior trx (medical, IV, balloon) what are your remaining options

A

B-lynch Stitch or Ligation of Blood vessels (if future pregnancy desired); otherwise Hysterectomy

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67
Q

Late PPH defined as occurring after the first 24 hours may be caused by what

A

Involution of the Placental Site (usually occurs 10-14 days later)

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68
Q

Signs of Retained Products of Conception (PP)

A

Uterine Cramping and Bleeding, Fever, and/or foul-smelling lochia

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69
Q

Bleeding from multiple venipuncture sites following placental abruption suggests what

A

Coagulopathy

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70
Q

Where does vessel ligation occur to decrease pulse pressure to the uterus and help with PPH

A

Ascending Branch of Uterine Arteries, or Internal Iliac (Hypogastric) Artery

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71
Q

At 16 weeks gestation what is the approximate level of the fundus

A

Midway between the pubic symphysis and umbilicus

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72
Q

Elevated msAFP is associated with

A

Neural Tube Defects

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73
Q

Low msAFP is associated with

A

Down Syndrome

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74
Q

Most common cause of elevated msAFP

A

Errors with dating (underestimation of gestational age)

Other causes include: Multiple gestation, Oligo, and others

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75
Q

What level of Multiples greater than the Median (MOM) is associated with neural tube defects

A

Greater than 2.0-2.5

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76
Q

Down Syndrome Quad Screen

A

Elevated hCG, Inhibin-A; Decreased msAFP, Estriol

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77
Q

Follow-up for abnormal prenatal screen

A

US to determine correct gestational age

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78
Q

Trisomy 21 on first trimester screen

A

Elevated hCG; Decreased PAPP-A

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79
Q

Risks of amniocentesis

A

AROM, Chorioamnionitis, Fetal Demise (0.5%)

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80
Q

What percent of maternal serum is fetal cell-free DNA

A

~13%

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81
Q

Double Bubble sign (duodenal atresia) is associated with which birth defect

A

Down Syndrome; affected fetuses typically have polyhydramnios due to their inability to swallow

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82
Q

Pregnancies with unexplained elevation of msAFP are at increased risk for what

A

stillbirth, growth restriction, pre-E, and placental abruption

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83
Q

During what gestational ages are teratogenic effects considered ‘all or nothing’

A

Prior to 2 weeks teratogens either result in fetal death or recovery.

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84
Q

Zygote division within first 72 hours (type of twins)

A

Di/Di

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85
Q

Zygote division days 4-8 (type of twins)

A

Mono/Di

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86
Q

Zygote division days 8-12 (type of twins)

A

Mono/Mono

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87
Q

Zygote division after 12 days (type of twins)

A

Conjoined

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88
Q

Type of twins associated with discordant growth and more malformations

A

Monozygotic

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89
Q

All dizygotic twins have what chorion/amnionicity

A

Di/Di

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90
Q

Fetal marker associated with twin gestation

A

Increased AFP

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91
Q

Inc. nausea and vomiting in twin gestation is due to what

A

Increased hCG

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92
Q

What causes the physiologic anemia associated with pregnancy

A

Increased blood volume without increasing red cell mass

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93
Q

Treatment for TTT

A

Laser ablation of shared vessels, or serial amniocentesis for decompression

94
Q

Biggest complication of mono/mono twins

A

Cord entanglement

95
Q

Risk factors for vasa previa

A

Succenturiate lobe, Bilobed, Low-lying placenta, Multifetal gestation, IVF pregnancy

96
Q

If vasa previa is dx, when and how should u deliver

A

C/S at 35-36 weeks (before ROM)

97
Q

Two tests that can diff. maternal and fetal blood

A

Apt Test and Kleihauer-Betke Test

98
Q

If a “thin”-membrane is identified on US between twins what is the zygosity

A

Mono? (that’s what it says)

99
Q

Biggest risk of neonatal HSV infection

A

Herpes Encephalitis

100
Q

Prodromal symptoms of an HSV outbreak

A

Itching, Burning, Tingling

101
Q

T/F If a woman is suspected of having an HSV infection while in labor, you should get a PCR to confirm the diagnosis since physical signs might not be evident (at which point you would consider C/S)

A

False, use your damn clinical judgement. Ain’t nobody got time for that!

102
Q

T/F Any woman with a history of HSV infection should be instructed on the need for C/S to avoid neonatal transmission

A

False, while every patient should be counseled on the risk, unless a woman has an active infection or shedding she is still a healthy candidate for vaginal delivery

103
Q

What is the rationale for Acyclovir therapy for HSV infection

A

Decreases duration of viral shedding and infection

104
Q

Painful genital ulcers with ragged edges, a necrotic base, and inguinal adenopathy

A

Chancroid

105
Q

Marginal Placenta Previa

A

Placenta buts up to the internal os

106
Q

Partial Placenta Previa

A

Partially covers the internal os

107
Q

Complete Placenta Previa

A

Whole damn thing is covered

108
Q

Low-lying Placenta

A

Edge of placenta within 2-3 cm of internal os

109
Q

Two most common causes of antepartum bleeding (after 20 weeks)

A

Placental Abruption (painful contractions) and Placenta Previa (painless)

110
Q

Previa patients are referred for C/S at what GA

A

34 weeks

111
Q

What complication leading to PPH is associated with placenta previa

A

Placenta Accreta

112
Q

Risk factors for previa

A

Grand multip, Prior C/S, Prior D&C, Previous Previa, Multiple Gestation

113
Q

What is the next best step when any sort of previa other than a complete is identified at 20 week US

A

Reassess placental position at 32 weeks since most placentas will rise as the uterus expands

114
Q

Risk factors for placental abruption

A

Cocaine, Short umbilical cord, Trauma, UP insufficiency, Submucosal Fibroid, Hydramnios, Smoking, PPROM

115
Q

T/F Placental abruption is a common cause of coagulopaty

A

True, leads to DIC

116
Q

T/F Placenta previa is a common cause of coagulopathy

A

False

117
Q

T/F An US is the best way to diagnose placental abruption

A

False, it has poor sensitivity. The best way is by clinical diagnosis

118
Q

By what mechanism does cocaine lead to increased risk of placental abruption

A

Due to its vasospastic effect on placental vasculature

119
Q

Management of Placenta Accreta

A

Hysterectomy

120
Q

When during the pregnancy is a women most likely to present with ovarian torsion

A

14 weeks when the uterus rises above the pelvic brim, and immediately PP when the uterus rapidly involutes

121
Q

Biggest difference in identifying appendicitis vs torsion

A

Appendicitis will have Fever*, Leukocytosis, and Anorexia; both have nausea and vomiting (and pain durr)

122
Q

Where is appendicitis pain located during pregnancy

A

Superior and lateral to McBurney’s point, due to pressure from the uterus on the intestines

123
Q

Ovarian Torsion is often described as what type of pain

A

Colicky

124
Q

Progesterone is produced by the corpus luteum until when

A

Produced solely by the luteum until 7 weeks; from 7-10wk both the placenta and luteum produce it; 10wk on the placenta handles it all

125
Q

Earliest indicator of hypovolemia

A

Decreased Urine Output (even before tachycardia)

126
Q

When does cholestasis become concerning to the fetus

A

when it is accompanied by jaundice or increased bile acids ==> increased incidence of prematurity, fetal distress, and fetal loss

127
Q

Herpes Gestationis

A

IgG Autoantibody directed at the basement membrane (No relation to HSV). Limbs affected more than the trunk. Dx by immunofluorescence of biopsy.

128
Q

PUPPP

A

Pruritic Uritcarial Papules and Plaques of Pregnancy; begin on the abdomen and spread to the thighs, butt and arms. Erythematous and small surrounded by a pale halo. Trx = topical steroids and antihistamines

129
Q

Acute Fatty Liver of Pregnancy signs/symptoms

A

RUQ pain, malaise, N/V, hypoglycemia, coagulopathy, acute fulminant liver failure, hyperbilirubinemia and jaundice

130
Q

Acute onset of severe dyspnea and chest pain with a CLEAR lung exam would likely r/o what in pregnancy

A

Pulmonary Edema - would hint more towards DVT leading to PE

131
Q

Best diagnostic test for a PE

A

Spiral CT or MR Angiography; both use a contrast agent so be wary of allergies

132
Q

What studies should be ordered if we’re concerned about PE

A

Pulse Ox and Arterial Blood Gases

133
Q

Cutoff for giving oxygen

A

95% O2 sat (according to Case Files but I’ve seen lower on the floor - 92%?)

134
Q

Normal ABG changes in Pregancy

A

pH 7.4&raquo_space;> 7.45 resp. alkalosis with met. comp.
Po2 90-100&raquo_space;> 95-105 ^ tidal volume and minute vent.
Pco2 40&raquo_space;> 28 ^ tidal volume and minute vent.
HCO3 24&raquo_space;> 19 renal excretion due to met. comp.

135
Q

Trx for PE

A

IV Heparin (Lovenox - brand name LMWH)

136
Q

After dx of acute thromboembolism how long should patients be on anticoag.

A

IV for 5-7 days and then subQ for 3 months(maintained at 1.5-2.5x control PTT); after 3 months prophylactic heparin is used for the remainder of pregnancy

137
Q

Best diagnostic test for DVT

A

Doppler US

138
Q

Most common side effect of long-term Heparin use in pregnancy

A

Osteoporosis

139
Q

Main factor contributing to hypercoag. state of pregnancy

A

Venous Stasis

140
Q

Best method for preventing DVT after C/S

A

Early Ambulation

141
Q

Postpartum patient with Pre-E develops abdominal distention, syncope, hypotension, and tachycardia

A

Hepatic Rupture (ruptured hematoma that was caused due to hepatic ischemia)

142
Q

How to dx Pre-E

A

two elevated BP’s (>140 or >90) at least 4 hours apart, and after 20 wks gestation

143
Q

Proteinuria level in Pre-E

A

> 300mg/24 hours

144
Q

Severe Pre-E dx

A

> 160 or >110 or >5g Protein (24 hours) or Urine Protein Dipstick of 3+/4+ (if no time for Urine Protein collection)

145
Q

Underlying pathophys of Pre-E

A

Vasospasm and leaky vessels

146
Q

Complications of Pre-E

A

P. Abruption, Eclampsia, Coagulopathies, renal failure, hepatic capsular hematoma, hepatic rupture, uteroplacental insufficiency (late decels)

147
Q

Pre-E Labs

A

CBC (check platelets), 24-hour Urine Protein, Liver Function Tests (look for elevated enzymes), LDH (elevated with hemolysis)

148
Q

When to deliver Pre-E patients

A

Induce at 37 weeks with Mag (reduce Eclampsia), risks of pregnancy outweigh risks of prematurity

149
Q

When to deliver Severe Pre-E patients

A

Immediately regardless of Gestational Age due to risks to the fetus

150
Q

Time frame for greatest risk of Pre-E ==> Eclampsia

A

24 hours pre- and post- delivery

151
Q

What to monitor when a patient is on Mag

A

Urine Output, Resp. Depression, hyporeflexia,

152
Q

AFLP features

A

N/V, icteric, hypoglycemia, coagulopathy

153
Q

HELLP features

A

Hemolysis, LFTs up to 1000, platelets under 100k

154
Q

Intrahepatic Cholestasis features

A

Generalized itching, Elevated LFTs, Elevated Bile Salts

155
Q

Pre-E features

A

LFTs 100-300, Hypertension, Proteinuria, Hyperreflexia

156
Q

Eclamptic seizure lead to death by what mechanism

A

Intracerebral Hemorrhage

157
Q

T/F Patients with Mild Pre-E should still be treated with anti-hypertensive medications

A

False

158
Q

Cervical exam dx for preterm labor in a nulliparous woman

A

2cm dilated with 80% effacement

159
Q

What test can be done to check for preterm labor

A

Fetal Fibronectin (swab posterior vaginal fornix)

160
Q

SE of nifedipine as a tocolytic

A

pulmonary edema, resp. depression, neonatal depression

161
Q

CI to indomethacin as tocolytic

A

Premature closure of DA; leads to Oligo

162
Q

CI to mag as tocolytic

A

Myocardial damage, Myasthenia Gravis

163
Q

CI to terb as tocolytic

A

Arrhythmia, Hypertension, Seizure

164
Q

Only approved therapy for long-term tocolysis

A

17-alpha-hydroxyprogesterone injections weekly as early as 16 weeks, to 36 weeks

165
Q

T/F Suspected abruption is a relative CI to tocolysis

A

True, tocolytics can extend the separation of the placenta

166
Q

Trx of pulmonary edema

A

IV Furosemide

167
Q

Most common FHT finding in patients with PPROM

A

Variable decels due to oligo ==> cord compression

168
Q

T/F After 32 weeks any PPROM patient should be induced

A

Mostly true, as long as chorioamnionitis isn’t present.

169
Q

Most common chorio organisms that affect the fetus

A

GBS and E. Coli

170
Q

Common chorio-inducing organism affecting a mom who has not ruptured yet

A

Listeria (through unpasteurized milk and transplacental spread); may induce chorio without ROM

171
Q

Dx Chorio

A

Amniocentesis with Gram Stain

172
Q

Management of PPROM prior to 32 weeks

A

Expectant Mgmt

173
Q

Earliest sign of chorio

A

Fetal tachycardia

174
Q

T/F Chorio infection is a CI to steroid use

A

True

175
Q

How does Parvovirus present in adults

A

Malaise, Arthralgia, and Myalgia

176
Q

Earliest signs of Fetal Hydrops

A

Hydramnios leading to difficulty palpating fetal parts

177
Q

Sinusoidal FHTs are associated with what

A

Fetal anemia or asphyxia

178
Q

Treatment for Fetal Ophthalmologic Chlamydial Infection

A

14 days of Erythromycin PO

179
Q

Untreated gonococcal ophthalmia can lead to what

A

Corneal scarring and blindness

180
Q

What is the goal viral load during pregnancy

A

Under 1000 RNA copies per mL

181
Q

T/F Chlamydia is associated with late PP endometritis

A

True

182
Q

T/F Chlamydia is an obligate intracellular organism

A

True

183
Q

At what point does C/S not reduce vertical HIV transmission

A

After ROM

184
Q

Most common mode of transfer of HIV to women

A

Heterosexual Intercourse

185
Q

Hallmark of Thyroid Storm

A

Autonomic Instability (elevated BP, Temp., disorientation)

186
Q

Thyroid Storm trx

A

B-blockers (propranolol), Corticosteroids and additional PTU (both reduce peripheral conversion of T4 to T3)

187
Q

Risks of PTU for Thyroid Storm Therapy

A

Bone Marrow Aplasia ==> Leukopenia ==> Sepsis

188
Q

Thyroid Storm Symptoms

A

Altered mental status, Hyperthermia, Cardiac Arrhythmia, HTN, Vomiting and Diarrhea

189
Q

What causes Thyroid Storm

A

Usually some type of stressor in pts. with hyperthyroidism

190
Q

Pregnancy Thyroid Changes

A

Increase in Total T4 and TBG
Decrease in Active/Free T4 and TSH
*overall a EUTHYROID state

191
Q

Best screening test for hyperthyroid

A

TSH level

192
Q

Hyperthyroidism PP is most often caused by what

A

Lymphocytic Thyroiditis (would see antimicrosomal and antiperoxidase ab). Generally Graves’ disease is #1, however due to the high corticosteroid levels of pregnancy, it suppresses autoimmune antibodies

193
Q

Symmetric vs Asymmetric IUGR is in reference to what

A

Whether or not the head is spared

194
Q

Most common cause of asymmetric IUGR

A

Maternal Vascular Disorder (smoking, HTN, or drug use)

195
Q

Definition of IUGR

A

Birth weight less than the 10th percentile for GA

196
Q

Neonatal morbidities associated with IUGR

A

NEC, Meconium, Hypoglycemia, Resp. Distress, Hypothermia, and Thrombocytopenia

197
Q

Early onset IUGR (<20 weeks) is associated with what illness

A

CMV

198
Q

Polyhydramnios + IUGR

A

chromosomal and structural abnormalities

199
Q

Oligohydramnios + IUGR

A

highest perinatal mortality rate, incidence of anomalies

200
Q

What test can be used to determine morbidity

A

Doppler Flow studies of Umbilical artery. Absence or Reverse Diastolic Flow = bad.

201
Q

When to deliver IUGR patients

A

@37 weeks if no other complications

202
Q

Circumstances for delivery of a 32-36 week IUGR patient

A

Severe HTN Despite therapy, Absence of growth over 2-4 weeks, Non-reassuring fetal testing, absent or reversed EDF

203
Q

Circumstances for delivery of a <32 week IUGR patient

A

Reverse EDF, Persistent non-assuring fetal testing despite measures to optimize placental perfusion, and significant or ominous fetal testing results

204
Q

Pathophys of ARDS

A

Leaky capillaries; occurs after antibiotics have begun to lyse bacteria leading to endotoxemia

205
Q

Most common cause of septic shock in pregnancy

A

Pyelonephritis

206
Q

Crepitance

A

Gas in soft tissue

207
Q

First step in mgmt of septic shock

A

BP mgmt with IVF

208
Q

Pathophys of Septic shock

A

Vasodilation usually due to endotoxins

209
Q

Signs of Nec. Fascitis

A

Gas in the tissue (crepitance)

210
Q

Febrile morbidity post C/S

A

Endomyometritis

211
Q

Trx for endomyometritis

A

broad spectrum + anaerobic (Genta + Clinda)

212
Q

If enterococcus is i.d. for infection PP what is trx

A

Penicillins (Amp)

213
Q

Septic Thrombophlebitis dx

A

MRI or CT

214
Q

Septic Thrombophlebitis trx

A

Typically you would have already been treating with abx (genta, clinda, amp) and then you add heparin

215
Q

Most common organism associated with endomyometriits

A

Anaerobic (Bacteroides)

216
Q

Fluctuance of Breast Tissue

A

Breast Abscess

217
Q

Cause of Physiologic Breast Engorgement PP

A

Vascular Congestion and Milk Accumulation (usually during the 1st week)

218
Q

Persistent fever of 48 hours in a woman with Mastitis is suggestive of what

A

Abscess

219
Q

Difference in presentation between galactocele and abscess

A

No erythema with galactocele

220
Q

Which Vitamins does breast milk NOT contain

A

Vit. K & D

221
Q

Maternal Benefits of Breast Feeding

A

Weight Loss, Dec. Breast Cancer, Dec. DM

222
Q

Fetal Benefits of Breast Feeding

A

Dec. Diarrhea, NEC, LRI, Otitis Media, Bacteremia, UTI,

223
Q

Inflammatory Breast Disease ultimate dx

A

Biopsy

224
Q

Labs to order if suspected maternal DKA

A

ABG, Blood Sugar, Electrolytes + Gap, Serum Ketones

225
Q

Diagnostic criteria for DKA in pregnancy

A

pH < 7.35, Blood Sugar >200, Ketones >5, Bicarb <18, Ketonuria

226
Q

Type of diabetes associated with miscarriage and congenital anomalies

A

Pregestational (also at risk for vascular and renal disease)

227
Q

Hormones the placenta releases to create an insulin-resistant state

A

GH, CRH, hPL, and Progesterone

228
Q

T/F Diabetic Retinopathy is the leading cause of blindness in reproductive age women

A

True

229
Q

Glycemic control targets for fasting, 1-hour, 2-hour

A

Less than 105, 140, 120 respectively

230
Q

How long PP should gDM women get a screening test

A

6 weeks (2-hour screening test for DM)

231
Q

Risk factors for gDM

A

obesity, PCOS, family hx, previous gDM, fetal macrosomia,

232
Q

what GA do you give first dose of RhoGam

A

28weeks

OB-gyn (16 decks)

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