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OBGYN > CF: 26-30 > Flashcards

CF: 26-30 Flashcards

1
Q

20 yo breastfeeding woman who is 3 wk post-partum c/o right breast pain and fever x2 days. Notes progressive pain, induration, and redness of R breast. Temp is 102. Significant fluctuance of R breast.

  • Dx?
  • Next step in tx?
  • Etiology?
A
  • Breast abscess
  • I&D of abscess + Abx
  • Staph aureus
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2
Q

MCC of postpartum mastitis?

A

Staph aureus

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3
Q

What test can you do if you’re unsure about mastitis vs breast abscess?

A

US to ID fluid collection

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4
Q

What’s a galactocele?

A

Non-infected collection of milk due to blocked mammary duct–> palpable mass + Sx of breast pressure and pain

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5
Q

How do harsh soap or water-soluble lotions factor into the treatment of cracked nipples?

A

They can made them worse!

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6
Q

What typically causes cracked nipples?

A

Excess dryness

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7
Q

Name 4 aspects of treatment of cracked nipples

A
  1. Air drying the nipples
  2. Washing with mild soap and water
  3. Nipple shield
  4. Lanolin-based lotion
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8
Q

When is breast engorgement first noted? 2 contributing factors?

A

1st week postpartum

Vascular congestion + milk accumulation

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9
Q

3 major sx of breast engorgement?

A

Breast pain, engorgement, low-grade fever

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10
Q

How long does fever last in breast engorgement?

A

12-24 hr

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11
Q

4 aspects of tx of breast engorgement?

A
  1. Round-the-clock feedings
  2. Breast binder
  3. Ice packs
  4. Analgesics
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12
Q

When does postpartum mastitis happen?

A

2-4 wk s/o delivery

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13
Q

Name s/s of postpartum mastitis

A

Malaise, fever, chills, tachycardia, red/tender/swollen breast

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14
Q

What PE finding differentiates btwn postpartum mastitis and abscess

A

Fluctuance (+ in abscess)

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15
Q

Where does bug come from in postpartum mastitis?

A

Infant’s nose and throat

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16
Q

Tx of postpartum mastitis?

A

Antistaph Abx (dicloxacillin) + continue feeding or pumping

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17
Q

If you want to send a Cx for postpartum mastitis, what source should you use?

A

Breast milk

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18
Q

Approx what percent of postpartum mastitis progresses to an abscess?

A

10%

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19
Q

What 2 clues should make you concerned for abscess over postpartum mastitis?

A
  • fever >48 hr after starting Abx

- fluctuant mass

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20
Q

Another name for galactocele?

A

Milk-retention cyst

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21
Q

PE finding of galactocele?

A

Non-erythematous fluctuant mass

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22
Q

Natural hx of galactocele?

A

MC resolve spontaneously, but some req aspiration

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23
Q

Neonatal benefits of breastfeeding (10)?

A 
Decreased:
-Diarrhea
-NEC
-LRI
-OM
-UTI
-Bacteremia
-SIDS
-allergies
-T1DM
Better at standardized tests
24
Q

3 maternal benefits of breastfeeding?

A

Decreased:

  • weight retention
  • breast cancer
  • DM
25
Q

CI to breastfeeding?

A 
Classic galactosemia
Maternal:
-untreated TB
-HIV
-XRT/radioactive isotopes
-chemo
-street drugs
-HSV lesions on the breast
26
Q

When should you start supplementing vitamin D in exclusively breastfed babies?

27
Q

What 2 proteins are in breastmilk? Which is present in lower concentrations that it is in formula? Why is this good?

A

Whey and casein

Casein- decr amt allowed easier digestion

28
Q

Name 4 immune substances in breast milk

A
  1. IgA
  2. WBCs
  3. Lactoferrin
  4. Lysozyme
29
Q

2 options to offer patients w/ AMA?

A

Genetic counseling

Genetic amniocentesis

30
Q

What to do if woman is HBsAg + at prenatal visit?

A

Check LFTs and hep B serology to assess for active vs carrier

31
Q

What do you do if prenatal UCx has GBS?

A

Give amp and reculture to test for cure. PCN at birth.

32
Q

What new murmur is common and benign in pregnancy?

A

Early SEM (2/2 incr CO)

33
Q

Define AMA

A

35 of older at estimated date of delivery

34
Q

Is glycosuria normal in pregnancy?

35
Q

How does GFR change in pregnancy?

36
Q

During what gestational ages should fundal height correspond to gest age?

37
Q

How do CO, plasma volume, SVR, and MAP change in pregnancy?

A

CO: incr
Plasma vol: incr
SVR: decr
MAP: no change/slight decr

38
Q

How do RR, tidal vol, minute ventilation change in pregnancy?

A

RR: no change
Vt: incr
Minute vent: incr

39
Q

Describe normal pH, PCO2, and HCO3 in pregnancy (actual numbers)

A

pH: 7.45
PCO2: 28
HCO3: 18

40
Q

Describe acid base state in pregnancy

A

Primary respiratory alkalosis with partial metabolic compensation

41
Q

How do GFR, serum Cr, and diameter of ureteral caliper change in pregnancy?

A

GFR: incr 50%
Cr: decr
Ureteral caliper: dilated

42
Q

How do Hbg, platelet count, WBC count change in preg?

A

Hb: decr
Plt: decr
WBC: incr

43
Q

How do stomach emptying, LES tone and gut motility change in pregnancy?

44
Q

What do you do if your Rh neg patient has a negative antibody screen?

A

RhoGAM at 28 wk and again after birth if baby is Rh+

45
Q

What does it mean if antibody screen is positive? What do you do next?

A

ID which antibody, then determine titer

46
Q

In pregnancy, how does your treatment of syph change based on how long the patient has been infected?

A

1 yr or unknown: 3 doses IM PCN, one per week

47
Q

2 major cpx of untx GC in pregnancy?

A

PTL

Neonatal blindness

48
Q

Tx of GC in pregnancy?

A

IM ceftriaxone

49
Q

If mom is HBsAg+, what do you do for baby?

A

HBIG and HBV vaccine at birth

50
Q

If nuchal translucency at 11-13 wk is positive, what do you offer mom?

A

Karyotype and FU ultrasounds

51
Q

Next step if trisomy screen is + at 16-20 wk?

A

US for dates, mult gestations

52
Q

Is trisomy screen is + and US shows accurate dating, next step?

A

Offer genetic amniocentesis

53
Q

What % of abnormal 1 hr OGTT will have GDM?

54
Q

When do you get GBS Cx?

55
Q

When do you get 1h OGTT?

56
Q

What gestational age does neural tube close?

57
Q

What titer is worrisome when looking at antibody screen?

A

1:8 or greater

OBGYN (7 decks)

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