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OBGYN > CF: 21-25 > Flashcards

CF: 21-25 Flashcards

1
Q

18 yo G2P1 @ 35 wk is taking PTU for graves. P/w 1 day hx of palpitations, nervousness, sweating, diarrhea. BP 150/110, HR 140, RR 25, temp 38.2. Anxious, disoriented, confused. Thyroid mildly tender and enlarged. DTRs 4+ w/ clonus. Leukocytosis.
Most likely Dx?
Best management?

A
  • Thyroid storm

- BB, steroids, PTU

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2
Q

32 yo woman @ 33 wk who continues to blast cigs has US showing growth restricted fetus.

  • Most likely Dx?
  • 2 other things to check on US?
  • Next step?
  • 3 potential Cpx?
A
  • IUGR
  • Determine symm vs asymm IUGR, assess amniotic fluid
  • Eval fetal well being
  • PTB, fetal stress, intrauterine fetal demise
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3
Q

20 yo G1P0 @ 29 wk is being treated for pyelo w/ appropriate Abx and now c/o SOB.

  • Dx?
  • Mechanism?
A
  • ARDS

- Endotoxin-mediated pulmonary injury

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4
Q

28 yo s/p C/S 1 wk ago p/w fever up to 102, myalgias, vomiting, hypoTN, confusion, and skin incision that’s infected with underlying tissue revealing brawniness and crepitance. Evidence of hemo-concentration and renal insufficiency.

  • Dx?
  • Next step in therapy (3)?
A
  • Nec fasc

- Isotonic IVF, broad-spec Abx, and immediate surgical debridement

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5
Q

24 yo G1P1 s/p C/S 2 days ago for arrest of labor p/w fever to 102, no cough or dysuria. No abnormalities of breasts, lungs, CVAT, or incision. Fundus is somewhat tender.

  • Dx?
  • Most likely etiology?
  • Best therapy?
A
  • Endomyometritis
  • Ascending infection of vaginal organisms (anaerobes > GNRs)
  • IV Abx (gent and clinda)
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6
Q

For IUGR, how can you use US to determine asymm vs symm?

A

Look at HC vs FL and AC. HC is spared in asymm, while all 3 are decreased symmetrically in symm.

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7
Q

MCC of asymm IUGR?

A

Maternal vascular DO, like smoking, HTN, or drug use

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8
Q

MCC of symm IUGR?

A

Constitutionally small baby with no adverse problems

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9
Q

Name 8 major maternal factors for IUGR

A
  • HTNsive disease
  • Renal disease
  • Cardiac disease
  • respiratory disease
  • Underweight and/or poor pregnancy weight gain
  • Significant anemia
  • Substances: tobacco, cocaine
  • AMA
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10
Q

Name 3 major uterine/placental factors for IUGR

A
  • Abruptio placenta
  • Placenta previa
  • Infection
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11
Q

Name 5 major fetal factors for IUGR

A
  • multiple gestation
  • aneuploidy
  • congenital syndromes
  • structural fetal malformations
  • infection
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12
Q

How do you define IUGR?

A

Birthweight <10th percentile for gestational age

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13
Q

What is a biophysical profile?

A

Combo of US criteria and NST for fetal well-being conducted over 30 min. Assesses fetal breathing, movement, tone, and amniotic fluid

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14
Q

What sort of doppler flow study is helpful with IUGR?

A

Umbilical artery

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15
Q

What does reverse end-diastolic flow through the umbilical artery signify?

A

High stillbirth rate w/in 48 hr

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16
Q

What does absent end-diastolic flow through the umbilical artery signify?

A

Moderately high stillbirth risk- can obs in some cases

17
Q

For suspected symmetric IUGR, how can you differentiate btwn dating error and actual IUGR?

A

Repeat US in 2-3 wk. If it shows adequate interval growth, then it’s probably just a dating error.

18
Q

Early insults to fetal growth typically cause which type of IUGR?

A

Symm

19
Q

How does perinatal morbidity and mortality change in infants born btwn 38-42 wk with bw 1500-2500 g?

A

30x incr from infants born btwn 10th-90th %ile

20
Q

Name 6 neonatal morbidities assoc w/ IUGR?

A
  • meconium aspiration
  • NEC
  • Hypoglycemia
  • respiratory distress
  • hypothermia
  • thrmobocytopenia
21
Q

Per the Baker hypothesis, what are 4 major long-term (adult) consequences of IUGR?

A
  • CAD
  • CVA
  • HTN
  • T2DM
22
Q

Name 4 major infections associated with IUGR. Which of these is especially assoc w/ early-onset (<20 wk) IUGR?

A
  • Toxo, hsv, parvo

- CMV is a/w early onset iugr

23
Q

Is work-up for infection a/w IUGR always high yield?

A

No- after mid-gestation, yield becomes low

24
Q

What’s often the earliest sign of IUGR detected on US?

A

Decreased AFI

25
Q

Why is AFI low in IUGR?

A

Decr perfusion of fetal kidneys and decreased UOP

26
Q

Pregnancies with the most severe ___________ have the highest perinatal mortality rate, incidence of anomalies, and incidence of IUGR

A

Oligohydramnios

27
Q

Polyhydramnios + IUGR has been a/w high rate of what 2 things?

A

Structural and chromosomal abnormalities

28
Q

How does increased resistance in the placental circulation manifest on doppler of umbilical arteries?

A

Increased doppler blood flow indices

29
Q

Use of doppler flow measurements in IUGR can significantly decr what 2 things?

A

Perinatal death

Unnecessary induction of labor

30
Q

If IUGR is diagnosed in fetus <34 wk, what drug should you give mom?

A

Steroids bc of incr risk of preterm delivery

31
Q

Indications for delivery in IUGR <32 wk?

A
  • Reverse end-diastolic flow
  • Persistent non-reassuring fetal testing despitr measures to optimize placental perfusion
  • Significant or ominous fetal testing results
32
Q

Indications for delivery in IUGR 32-36 wk?

A
  • Severe HTN despite therapy
  • Absence of growth over 2-4 wk
  • Non-reassuring fetal testing
  • Absent or reverse end-diastolic flow on doppler
33
Q

Indications for delivery in IUGR >36 wk?

A

Just deliver (risks of prematurity are low)

34
Q

First step in eval of size > dates?

A

US

OBGYN (7 decks)

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