Casefiles

Question 1

What is the cause of the bacteria involved in septic abortion? What type of bacteria?

Answer 1

Ascended from lower genital tract (vagina), usually polymicrobial, particularly anaerobes

Question 2

What are the two most common complications of spontaneous abortions?

Answer 2

Hemorrhage and infection

Question 3

What are the four parts of treatment of septic abortion?

Answer 3

1. Maintain BP; 2. Monitor BP, O2, urine output; 3. Start antibiotic therapy; 4. Uterine curettage

Question 4

What antibiotics are used for septic abortion?

Answer 4

Gentamicin and clindamycin

Question 5

Why is monitoring urine output in septic abortion important?

Answer 5

Oliguria is an early sign of septic shock

Question 6

A 22 yo F had a septic abortion, was treated with 48 hr triple Abx and D&C of the uterus. After 48 hrs she is still not improved, CT scan reveals pockets of air within the muscle of the uterus. What is the likely cause? Treatment?

Answer 6

Necrotizing metritis with gas-forming bacteria such as Clostridial species. Hysterectomy should be performed.

Question 7

What level does the urine protein/creatinine ratio need to exceed for the diagnosis of preeclampsia?

Answer 7

A urine protein/creatinine ratio >0.3

Question 8

What are the key labs to draw in preeclampsia?

Answer 8

CBC (with plt count), LFTs, and serum creatinine

Question 9

What is the definition of chronic hypertension in pregnancy?

Answer 9

BP of 140/90 before pregnancy or at less than 20 weeks gestation, or persisting more than 12 weeks postpartum

Question 10

What is the definition of gestation hypertension?

Answer 10

Hypertension without proteinuria (or other features of preeclampsia) at >20 weeks’ gestation persistent for at least 4 hours

Question 11

In the absence of proteinuria, what other findings can suffice in the diagnosis of preeclampsia?

Answer 11

HTN with thrombocytopenia, impaired LFTs, renal insufficiency, pulmonary edema, cerebral disturbances, or visual impairment

Question 12

What is posterior reversible encephalopathy syndrome? What is seen on MRI?

Answer 12

Cliniconeuroroadiological syndrome with HA, encephalopathy, seizure, cortical visual disturbances; MRI shows enhancement in the posterior parietal areas

Question 13

How is posterior reversible encephalopathy syndrome treated?

Answer 13

Antihypertensives, anti-epileptics, ICU monitoring

Question 14

What is the underlying pathophysiology of preeclampsia?

Answer 14

Vasospasm and “leaky vessels” - vasospasm and endothelial damage

Question 15

What are the complications of preeclampsia?

Answer 15

Placental abruption, eclampsia, coagulopathies, renal failure, hepatic sub-capsular hematoma, hepatic rupture, uteroplacental insufficiency

Question 16

What are the risk factors for preeclampsia?

Answer 16

Nulliparity, extremes of age, African-American race, PH or FH of severe preeclampsia, CHTN, CKD, obesity, antiphospholipid syndrome diabetes, multifetal gestation

Question 17

Why is dyspnea important to monitor in a patient on Mg sulfate?

Answer 17

SE of Mg sulfate is pulm edema

Question 18

What are the first signs of magnesium toxicity?

Answer 18

Hyporeflexia

Question 19

What are the common DDx for abnormal liver function tests in pregnancy?

Answer 19

Acute fatty liver of pregnancy, preeclampsia, HELLP, intrahepatic cholestasis of pregnancy

Question 20

What are the signs and symptoms of intrahepatic cholestasis of pregnancy?

Answer 20

Generalized itching, mildly elevated LFTs, elevated bile salts

Question 21

What are the signs and symptoms of acute fatty liver of pregnancy?

Answer 21

Nausea, vomiting, icteric, hypoglycemia, coagulopathy

Question 22

What are the first line agents for acute onset severe hypertension in pregnancy?

Answer 22

IV labetalol, IV hydralazine, or oral nifedipine

Question 23

What is the most common cause of maternal death due to eclampsia?

Answer 23

Intracerebral hemorrhage

Question 24

When is the greatest risk for occurrence of eclampsia?

Answer 24

Just prior to delivery, during labor, and within the first 24 hrs postpartum

Question 25

What populations are more susceptible to candidal vulvovaginitis?

Answer 25

Women who are pregnant, taking broad spectrum antibiotics, diabetic, or immunocompromised

Question 26

What is the treatment for vulvovaginal candidiasis?

Answer 26

Fluconazole (oral) or imidazole cream

Question 27

What is the treatment for trichomoniasis?

Answer 27

Oral metronidazole (2 gram as a single dose)

Question 28

What are the most common side effects of metronidazole?

Answer 28

GI - nausea, abdominal discomfort, bloating or diarrhea

Question 29

What is the best treatment for metastatic cervical cancer?

Answer 29

Radiotherapy (brachytherapy = implants; teletherapy = whole pelvis radiation) with a chemosensitizer (such as a platinum agent)

Question 30

What HPV types ares associated with cervical cancer? Venereal warts?

Answer 30

Types 16 and 18 = cancer; types 6 and 11 = warts

Question 31

Where do the majority of cervical dysplasia and cancers arise?

Answer 31

Squamocolumnar junction

Question 32

What is the next step after an abnormal Pap smear?

Answer 32

Colposcopic examinations with directed biopsies

Question 33

How does cervical cancer spread?

Answer 33

Through the cardinal ligaments to the pelvic sidewalls

Question 34

What is the most common cause of death in metastatic cervical cancer?

Answer 34

Bilateral ureteral obstruction leading to uremia