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NM 706 > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

What is asymptomatic bacteriuria?

A

An asymptomatic urinary tract infection with a urine culture that has colonies of greater than or = to 2 different micro organisms obtained via clean catch midstream urine sample.

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2
Q

What is the relationship of asymptomatic bacteriuria to Foley catheter.

A

No Foley catheter within 7 days.

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3
Q

What organism count is diagnostic in asymptomatic bacteriuria?

A

Great in 100000 organisms per milliliter

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4
Q

How would you treat a symptomatic bacteriuria empirically?

A

Macrobid 100 mg at bedtime times 10 days or 100 mg BID times 7 days

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5
Q

What are additional treatment options for asymptomatic bacteriuria?

A

Amoxicillin, ampicillin, cephalospirin, nitrofurantoin, tx-smp, cipro, levofloxacin

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6
Q

What is acute cystitis?

A

An infection limited to the lower urinary tract.

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7
Q

What are the signs and symptoms of acute cystitis?

A

Dysuria, Urgency, frequency

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8
Q

How is acute cystitis diagnosed?

A

Via UA

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9
Q

How is acute cystitis treated?

A

Macrobid 100 mg at bedtime times 10 days or 100 mg BID times 7 days

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10
Q

What are alternative treatments for acute cystitis?

A

Amoxicillin, ampicillin, cephalospirin, nitrofurantoin, tx-smp, cipro, levofloxacin

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11
Q

What is pylonephritis?

A

An infection ascending to the renal system.

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12
Q

What are signs and symptoms of pylonephritis?

A

Fever, flank pain, with or without symptoms of lower urinary tract infection but with bacteriuria.

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13
Q

What are the differential diagnosis for pylonephritis?

A

Labor, chorioamnionitis, adnexal torsion, appendicitis, placental abruption, infarcted leiomyoma

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14
Q

How is pylonephritis Diagnosed?

A

Urine sample via straight cath.

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15
Q

What will you see in a urine sample of pylonephritis?

A

Leukocytes in clumps and numerous bacteria

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16
Q

How do you treat pylonephritis Empirically?

A

Ampicillin, gentamicin, cefazolin, ceftriaxone

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17
Q

What is noted on exam with pylonephritis?

A

Unilateral -z mostly right, Fever, shaking chills, aching pain in one or both lumbar regions, anorexia, nausea/vomiting, CVA tenderness

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18
Q

How is pylonephritis managed?

A

Repeat urine cultures and blood cultures if temperature is above 39ﾟC elsius.
IV to ensure adequate urinary output
Antibiotics - Initially may worsen endotoximia from bacterial lysis
Surveillance - BP, HR, temp, O2 sat
Use cooling blanket for high fever.

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19
Q

What is preterm labor?

A

Birth prior to 37 completed weeks gestation.

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20
Q

What are risk factors for preterm labor?

A

Low maternal pre pregnancy weight, smoking, substance use, shorter interpregnancy interval, history of preterm birth, vaginal bleeding, UTI, genital tract infections, periodontal disease.

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21
Q

Discuss racial and ethnic the spirities in preterm labor.

A 
Native Hawaiian/Pacific islander 11.8%
 American Indian/ Alaska native 11.5%
 Non Hispanic black women 14.4%
 50% higher than both white and Hispanic women
 Hispanic 10%
White 9.3%
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22
Q

What are the differential diagnosis for preterm labor?

A

Braxton Hicks contractions, dehydration, lax vaginal tone, round ligament pain, infection, abruption, trauma, appendicitis

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23
Q

What is fetal fibronectin?

A

A fibronectin produced by fetal cells found at the interface of the chorion and decidua. It is the adhesive or glue that binds the fetal sac to the uterine lining.

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24
Q

When is fetal fibronectin Present in cervicovaginal secretions?

A

Prior to 20 weeks and after 37 weeks.

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25
Q

When is the presence of fetal fibronectin In cervico vaginal secretions atypical?

A

Between 24 and 34 weeks.

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26
Q

What could the presence of fetal fibronectin Between 24 and 34 weeks indicate?

A

Inflammation or uterine activity which could lead to preterm birth

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27
Q

When is fetal fibronectin Testing used?

A

Between 24 and 34 weeks

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28
Q

What is the criteria for fetal fibronectin Testing?

A

It is not to be used as a screening test.

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29
Q

Is the negative predictability offetal fibronectin high or low?

A

Fetal fibronectin testing has a high negative predictability (97.6).

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30
Q

What does the high negative predictability of fetal fibronectin testing mean?

A

That birth will not occur in the next 7 days.

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31
Q

Of what use is a positive fetal fibronectin test in symptomatic women?

A

A positive fetal fibronectin test in symptomatic women has limited clinical utility and should not be used alone to determine management.

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32
Q

Of what use is a negative fetal fibronectin test?

A

A negative fetal fibronectin test can be useful in avoiding unnecessary treatment in symptomatic women.

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33
Q

What is the predictability of a positive fetal fibronectin test?

A

Only 1% to 2% chance of birth within the next 7 to 14 days.

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34
Q

What is the purpose of corticosteroid use in preterm labor?

A

Maturity of fetal lungs

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35
Q

How and when is betomethasone used?

A

Betamethasone 12 mg IM q 24 hours X 2

Use at 34 to 36 6/7 weeks

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36
Q

How and when is dexamethasone used?

A

Dexamethasone 6 mg IM q 12 hours X 4

Use prior to 34 up to 36 6/7 weeks

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37
Q

Are scheduled repeat courses of corticosteroids used?

A

No, give one course

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38
Q

When may a repeat course of corticosteroids be given?

A

May repeat course X 1 when previous course wasvgiven 7 days earlier and there was risk for preterm birth at less than 34 weeks

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39
Q

How is cervical length measured?

A

Via transvaginal ultrasound

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40
Q

What is the relationship of cervical length to preterm birth?

A

Cervical shortening in the mid trimester increases the risk of premature birth. The risk of premature birth is inversely proportional to cervical length and significantly increases with decreasing cervical length.

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41
Q

What is considered short cervical length with a history of preterm birth?

A

25 mm

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42
Q

What is considered short cervical length with no history of preterm birth?

A

20 mm

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43
Q

Is hydration effective in preventing preterm birth?

A

No

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44
Q

Is bedrest effective in preventing preterm birth?

A

No

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45
Q

What is the role of progesterone in preterm birth in patients with short cervix?

A

Progesterone has been shown to decrease the risk of preterm birth impatience with short cervix.

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46
Q

In what forms are progesterone used to decrease the risk of preterm birth?

A

Vaginal

17 alpha hydroxprogesterone caproate (17-OHPC) - injectable

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47
Q

When is vaginal progesterone used in pts with short cervix?

A

Singleton, short cervix, no prior preterm birth, asymptomatic

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48
Q

When is 17 OHPC used in pts with short cervix?

A

History of preterm birth
Between 16 and 36 weeks
Not with multifetal gestation or PROM

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49
Q

How is 17 OHPC dosed in pts with short cervix?

A

250 mg weekly from 16 to 36 weeks

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50
Q

When is cerclage used?

A

In women with very short cervical length – 10 mm or less

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51
Q

What are tocolytics?

A

Medications to slow uterine contractions

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52
Q

What is the usefulness of tocolytics?

A

They may delay birth for 2 to 7 days?

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53
Q

What is an advantage if using tocolytics?

A

May provide short term prolongation of pregnancy enabling the administration of antenatal corticosteroids and magnesium for neural protection.

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54
Q

What tocolytics are used in preterm labor?

A 
Beta adrenergic receptor agonists
Calcium channel blockers
NSAIDs
Magnesium sulfate
Indomethacin before 34 weeks with magnesium sulfate
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55
Q

What is the purpose of magnesium sulfate in preterm labor?

A

Magnesium sulfate is given for neuro protection and reduces the rusk of cerebral palsy if < 32 weeks

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56
Q

What are two assessments in preterm labor?

A

Assessment of cervical length
Assessment of the presence of fetal fibronectin in cervicovaginal secretions (low positive predictive value in asymptomatic women)

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57
Q

How can preterm labor be prevented?

A

Vaginal progesterone
IM progesterone
Cerclage
Cervical length monitoring and subsequent interventions

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58
Q

What is preterm premature rupture of membranes pPROM)?

A

PROM occurring before 37 weeks

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59
Q

What are the maternal risks of pPROM?

A

Intraamniotic infection
Post partum infection
Placenta abruption

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60
Q

What are the neonatal risks of pPROM?

A

Complications of prematurity Increasing according to gestational age

Respiratory distress
 Sepsis
Intraventricular hemorrhage
Necrotizing enterocolitis
 Increased risk of neuro developmental impairment.
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61
Q

What are differential diagnosis for pPROM?

A

Urinary incontinence
Vaginal or cervical discharge
Rarely rupture of the chorion alone

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62
Q

What are 2 things to remember about the exam for pPROM?

A

Visual cervical exam should be performed within 6 to 12 hours
No digital vaginal/cervical exam unless there are signs of active labor

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63
Q

What is the management of in a periviable pregnancy with pPROM?

A

23 to 24 weeks counseling, expectant management or induction, antibiotics

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64
Q

What is the management of a preterm pregnancy with pPROM?

A

Between 24 and 33 6/7
Expectant management, antibiotics, single corticosteroids, treat any intra amniotic infection, GBS culture, magnesium sulfate if less than 32 0/7 weeks

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65
Q

What is the management of late preterm labor with pPROM?

A

34 0/7 to 36 6/7
Expectant management or proceed toward delivery, single corticosteroids, GPS screening and prophylaxis, treat any intra amniotic infection

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66
Q

What is the management of any term pregnancy with pPROM?

A

37 0/7 or greater

GPS prophylaxis, Treat any intra amniotic infection, proceed toward delivery

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67
Q

What is intra amniotic infection (chorioamnionitis)?

A

Infection with resultant inflammation of amnionic fluid, placenta, fetus, fetal membranes, and/or decidua

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68
Q

What are the risk factors for intra amniotic infection?

A 
Prolonged rupture of membranes
 Long labors
 Manipulative vaginal or intrauterine procedures
 Frequent cervical exams
 Dehydration
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69
Q

What is the clinical presentation Of intra amniotic infection?

A

Isolated maternal fever of or greater than 39ﾟC

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70
Q

What is the clinical presentation of suspected in of suspected intra amniotic infection?

A

Maternal intra partum fever and maternal leukocytosis, purulent cervical drainage, or fetal tachycardia

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71
Q

What is the clinical presentation of confirmed intra amniotic infection?

A

Positive amniotic fluid test result or placenta pathology demonstrating hysterologic evidence of placenta infection or inflammation

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72
Q

How is intra amniotic infection managed?

A

Intra partum antibiotics and antipyretics

There should be enhanced clinical surveillance of the infant for signs of developing infection.

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73
Q

What causes hepatitis B?

A

Hepatitis B virus

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74
Q

How is hepatitis B transmitted?

A

Sexually, IV drug use, perinatally

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75
Q

When are pregnant women tested for hepatitis B?

A

Hepatitis B screening takes place at the 1st prenatal visit.

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76
Q

How is hepatitis B diagnosed

A

Hepatitis B surface antigen

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77
Q

How does hepatitis B affect the pregnant woman?

A

Acute illness

Chronic Carrier

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78
Q

How does hepatitis be affect the fetus or newborn?

A

Chronic Carrier

Can develop significant illness

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79
Q

How is hepatitis B managed in pregnancy ?

A

Adequate rest
Herbs for immune support
Education on transmission
Post partum follow up with referral to GI
The risk of preterm birth is increased
Refer to infectious diseases and hepatitis specialties
Consult with pediatric provider

80
Q

What causes hepatitis C?

A

The hepatitis C virus

81
Q

How is hepatitis C transmitted?

A

Via blood

Perinatally

82
Q

What are the screening recommendations for hepatitis C?

A

Every adult should be screened at least once

All pregnant women should be screened

83
Q

What are the risk factors for hepatitis C?

A 
I V drug use
 Sexual contacts
 Hiv positive women
 Hemodialysis patients
 Blood or Oregon recipient before 1992
 Evidence of liver disease
 None's little body tattoos
 Ingestion of raw shellfish
 International travel
 Day workers
 Immigrants from Asia, Africa, Pacific islands, Haiti, Middle East, Eastern Europe
84
Q

How is hepatitis C diagnosed?

A

IgG anti HCV

VIA EIA or CLIA

85
Q

How does appetite to see affect the pregnant woman ?

A

All cause mortality is increased by infection with hepatitis C.
Significantly increases the risk of cholestasis by 20 times

86
Q

How is Hepatitis C managed in the pregnant woman?

A

Referral to infectious disease or hepatitis specialist

Infant is referred to pediatrician.

87
Q

Is breast feeding contraindicated in hepatitis C patients?

A

Breastfeeding is not contraindicated unless the patient is taking anti viral therapy.

88
Q

What is the causative agent of Group B Strep?

A

Group B streptococcus bacteria

89
Q

How is group B strep transmitted?

A

Via the vaginal birth process

90
Q

How is group B strep diagnosed?

A

Group B strapped culture at 35 to 37 weeks of gestation
Positive group B strip in urine culture during pregnancy
Previous infant with group B strep disease
CBC
Cultures at birth of the amnion/placenta, infants axilla, groin, or earfold

91
Q

What is the effect of group be strapped on the pregnant woman?

A

It might be harmless, she might have a uti, pneumonia, sepsis

92
Q

What is the effect of group B strep on the fetus/newborn?

A

Early onset is associated with newborn sepsis and pneumonia or less frequently, meningitis which is more commonly seen in late onset and they’ve seen in late onset GBS disease

93
Q

What are maternal signs and symptoms of GPS disease disease?

A

Febrile
Significant and persistent fetal tachycardia
Odor to amniotic fluid
Uterin tenderness

94
Q

What are newborn signs and symptoms of GBS disease?

A 
Fever
 Pallor and poor tone
 Respiratory distress
 Slow irregular pulse
 Difficulty feeding
95
Q

How is GBS disease treated?

A

IV intra partum prophylaxis with penicillin or ampicillin
1st generation cephalosporins (cefazolin)
Clindamycin is for c-sections,
Not necessary if c-section is performed prelabor

96
Q

What causes HIV?

A

Human immuno deficiency virus

97
Q

How is HIV transmitted?

A

Infected blood and bodily secretions
Breastfeeding
Perinatally

98
Q

When does screening occur in pregnant women for hiv question

A

At 1st prenatal visit

99
Q

What does opt out testing refer to with HIV?

A

Testing after advising of testing and of notifying of option to refuse

100
Q

How is hiv diagnosed?

A

ELISA
western blot
Rapid
Anti retroviral drug resistance testing

101
Q

How is hiv managed?

A

Refer to OB

102
Q

What is the causative agent of Genital herpes?

A

Herpes simplex virus

103
Q

How is genital herpes transmitted?

A

Via direct contact

104
Q

What are signs and symptoms of genital herpes

A

Genital or anal blisters or ulcers

105
Q

How does genital herpes affect the pregnant woman?

A

Painful outbreaks

106
Q

How does genital herpes affect the fetus/newborn ?

A

No known effects from exposure to acyclovir?

Neonatal herpes is rare

107
Q

How is genital herpes managed in pregnancy?

A

Consult with maternal fetal medicine and infectious disease.
Antiviral therapy with acyclovir, valacyclovir, famicyclovir

Refer infant to pediatric infectious disease. Treat with acyclovir.

108
Q

What is the parvo virus?

A

Parvovirus is caused by the human parvo virus B19 which can lead to eyrthema infectiosum and is known as 5th’s disease

109
Q

How is parvovirus transmitted it?

A

Yeah respiratory droplets, blood and blood derived products, perinatally

110
Q

What are signs and symptoms of parvovirus infection?

A 
Slapped cheeks
 Lacy red rash on the cheeks, legs, belly, and neck
 Arthralgia
 Arthritis
 Fever
 Or can be asymptomatic
111
Q

What is a sequella of parvovirus infection ?

A

It is a potent inhibitor of a erythropoiesis.

112
Q

How does the powerful virus affect the pregnant woman?

A

Symptoms of viral infection
Reduced feedle movements
Hydrops fetalis

113
Q

How does the Powerful virus effect the fetus/newborn?

A 
The greatest risk is in the 1st 22 weeks
 Vertical transmission can occur within 1 to 3 weeks of maternal infection
 May resolve or not
Nonimmune hydrops
Hyperechoic bowel myocarditis
CNS damage
Encephalopathy
Cerebral migratory anomalies
Neonatal encephalitis 
Intrauterine fetal demise
114
Q

How can parvovirus be prevented?

A

Hand washing
Disposal of items with bodily fluids
Cover cough
Avoid exposure to those with 5th disease

115
Q

How is parvovirus treated?

A

Weekly ultrasound to determine hydrops which necessitates urgent referral to tertiary care center.

116
Q

What causes toxoplasmosis?

A

Toxoplasma gendii

117
Q

How is toxoplasmosis transmitted?

A

By eating raw or undercooked meat infected with tissue cysts or by contact with cocysts from cat feces
Vertical transmission

118
Q

What are signs and symptoms of toxoplasmosis infection?

A

Most maternal infections are sub clinical
Fatigue, fever, headache, muscle pain, maculopapular rash, posterior cervical lymphadenopathy.
Can be severe if immuno compromised
Encephalitis, retinal choroiditis, mass lesions

119
Q

How does toxoplasmosis affect the pregnant woman?

A

There is a 4 fold increase in preterm delivery

120
Q

How does toxoplasmosis affect the fetus/newborn?

A

There can be severe neonatal infections related to gestational age.
Risk of infection increases with pregnancy
Severity greater and early pregnancy
Low birth weight, hepatosplenamagaly, jaundice, anemia, intracranial calcifications with hydrocephaly or microcephaly, chorioretinitis, learning disabilities, convulsions

121
Q

How is toxoplasmosis diagnosed?

A

There is no prenatal screening for toxoplasmosis.
If suspected, then anti toxoplasma IgG with 2 to 3 weeks after infection.
IgM antibodies appear by 10 days
Toxoplasma serological profile
Prenatal DNA or PCR of amniotic fluid

122
Q

How is toxoplasmosis prevented?

A 
Cook me to safe temperature
 Peel or wash fruits and veggies
 Is clean all preparation surfaces
 Is where gloves win changing cat litter
 Don't feed cat
 Is keep cat indoors
123
Q

How is toxo plasmosis treated in pregnancy?

A

Spiramycin alone or with pyrimethamine - sulfonamide with folinic acid

124
Q

What is bacterial vaginosis?

A

Is a polymicrobial clinical syndrome resulting from the replacement of the normal hydrogen producing lactobacillus in the vagina with high concentrations of anaerobic bacteria.

125
Q

What are signs and symptoms of better bacterial vaginosis?

A

Vaginal irritation and itching, dysparenia, gray or white discharge, fishy odor
75 % are asymptomatic

126
Q

What is seen in BV on speculum exam?

A

Thin white/gray homogenous discharge, irritated vaginal mucosa and introitus, and possibly cervicitis

127
Q

What is the effect of BV on the pregnant woman?

A

The ibcidence of preterm birth is increased.

128
Q

How is BV diagnosed?

A 
Gram stain with Nugent - rarely available 
Saline & KOH slides for pH
Whiff test
3 of 4 Amsel's
Thin homogenous discharge adhering to vaginal walls
Clue cels on normal saline slide
pH greater than or equal to 4.5
Positive whiff test
129
Q

What is the cytomegalovirus?

A

Herpes family, varicella, Epstein-Barr

Establishes lifelong latency

130
Q

How is cytomegalovirus transmitted?

A 
Virus via body fluids
Direct contact
Sexual contact
Breast milk
Transplanted organs and transfusions
131
Q

What are signs and symptoms of cytomegalovirus?

A

Fever, sore throat, fatigue, swollen glands, it can cause Epstein Barr virus or hepatitis
. In immuno compromised persons eyes, lungs, liver, esophagus, stomach, intestines can be affected
In babies brain, liver, spleen, lung, growth, can be affected
. The most common affectation is long term congenital hearing loss.

132
Q

How does the cytomegalovirus affect the pregnant woman?

A

Fever, chills, malaise, headache, fatigue, sore throat, or they might be asymptomatic.

133
Q

How does the cytomegalovirus affect the fetus?

A

20% are born with congenital infections, hearing loss, mental and physical developmental delays

134
Q

How is the cytomegalovirus diagnosed?

A

Blood tests, saliva slash urine in newborn, serology, elisa, PCR is the standard, amnio testing for fetal

135
Q

How is the cytomegalovirus treated in pregnancy?

A

There is no treatment.

136
Q

How is the cytomegalovirus treated in the neonate?

A

Ganciclovir if they’re symptomatic the earlier the treatment starts the better the outcome
.

137
Q

How is cytomegalovirus prevented?

A

Personal hygiene and hand washing.

138
Q

What causes the zika virus?

A

Flaviviridae Aedes mosquito

Perinatal transmission

139
Q

What are signs and symptoms of a zika virus?

A

Rash, headache, joint pain, red eyes, muscle pain

140
Q

How does the zika virus affect the pregnant woman?

A

Mild illness

141
Q

How does the zika virus effect the fetus/ newborn?

A

Birth defects, microcephaly, damage to back of eyes

142
Q

What if there is possible exposure to the zika virus?

A

Get testing, evaluate and manage for possible dengue or chikungunya virus infection

143
Q

How do you prevent the zika virus?

A

Avoid mosquitoes, wear condoms

144
Q

How is the zika virus diagnosed?

A

Whole blood, serum or plasma for virus IG M and neutralizing antibodies

145
Q

What is treatment for the zika virus?

A

Supportive care

146
Q

What causes COVID-19?

A

Coronavirus SARS-Cov- 2

147
Q

How is COVID-19 transmitted?

A

Airborne droplet, close personal contact

148
Q

How is COVID-19 diognosed?

A

PCR

149
Q

How does COVID-19 affect the pregnant woman?

A

Possible preterm birth and small for gestational age

150
Q

How is rubella transmitted?

A

Nasal pharyngeal secretions

151
Q

What are the signs and symptoms of rubella?

A

Fever, maculopapular rash beginning on face spreading to trunk and extremities, arthralgias, arthritis, head and neck lymphadenopathy, conjunctivitis

152
Q

How is rubella diagnosed?

A

Serology testing
IgM antibody
ELISA from four to five days

153
Q

How is rubella prevented?

A

Avoid exposure

Screening

154
Q

When is it safe to administer the MMR?

A

One month prior to pregnancy or in postpartum

155
Q

How does rubella affect the pregnant woman?

A

Mild or no symptoms

156
Q

How does rubella affect the fetus?

A

Congenital rubella syndrome
Eye defects, heart defects, deafness, CNS defects, pigmentary retinopathy, neonatal purpura, hepatosplenomegaly, jaundice, radiolucent bone disease

157
Q

Can the neonate shed rubella virus?

A

Yes

158
Q

What is extended rubella syndrome?

A

Progressive panencephalitis and type one diabetes

159
Q

What causes varicella?

A

Varicella zoster virus

160
Q

How is varicella transmitted?

A

Direct contact, respiratory

161
Q

What are signs and symptoms of varicella?

A

One to two days of flu like symptoms prodrome
Vesicular lesions that crossed over in three to seven days
Can cause pneumonia
Fever

162
Q

How does varicella affect the pregnant woman?

A

Discomfort, itching

163
Q

How does varicella affect the newborn?

A 
The first trimester congenital varicella syndrome
Chorio right retinitis
Microphthalmia
Cerebral cortical atrophy
Growth restriction
hydro nephrosis
 limb hypoplasia
Cicatricial skin kesions
164
Q

How is varicella diagnosed?

A

Clinical diagnosis
Scrape vesical base for spell T ZANCK smear, tissue culture
Direct fluorescent antibody testing
NAATs for amniotic fluid

165
Q

How do you treat a pregnant person that has been exposed to varicella?

A 
If they have a history VZV serology testing,  if they are sero negative they should be given a varicella zoster immune globulin
Give within 96 hours of exposure
Isolate from other pregnant women
Supportive care
IV acyclovir
166
Q

When should you vaccinate for varicella?

A

Non pregnant women at least one month before they become pregnant and in postpartum

167
Q

How do you prevent varicella?

A

Vaccine, avoid exposure

168
Q

What is the difference between varicella IgG and varicella Vaccine

A

The VZIG developed from blood and antibodies, provides fast protection, but it’s not long lasting
Varicella vaccine provides long lasting protection.

169
Q

What is endometritis?

A

Inflammation of uterine lining

170
Q

When can endometritis occur?

A

Days two through 4 postpartum up to two to six weeks postpartum

171
Q

What are the signs and symptoms of endometritis?

A

Triad is fever, tachyardia, uterine tenderness

Also may have chills malaise foul smelling lochia, anorexia

172
Q

What is the treatment for endometritis?

A

Consultation
Broad spectrum antibiotics
IV Clindamycin is gold standard
Until woman is afebrile for 24 to 48 hours
If not afebrile and 48 to 72 hours, then change antibiotics

173
Q

What is the testing for endometritis?

A

Physical exam to rule out others
UA to rule out pyelonephritis
Clinical diagnosis

174
Q

Which bacteria is implicated in mastitis?

A

Staphylococcus aureus
Coagulase neg staph
Rarely strep or MRSA

175
Q

What are the signs and symptoms of mastitis?

A

One or more segment of breast is hot, red, inflamed. Fever, flu like symptoms

176
Q

How is mastitis diagnosed?

A

Clinical diagnosis

177
Q

What is the differential diagnosis for mastitis?

A

Breast candida, breast Abscess, ductal infection

178
Q

How is mastitis managed?

A

First line is dicloxacillin or cephalexin times 10 to 14 days
Clindamycin if penicillin allergy
Frequent emptying of breast
Adequate fluids and nutrition

179
Q

What are signs and symptoms of wound infection after C-section?

A

Low grade fever, localized pain and edema accompanied by red inflamed repair edges

180
Q

What is the management of wound infection in C-section?

A

Consult or refer if indicated

181
Q

Treatment for wound infection in C-section

A

Antibiotics, maybe drainage, reclose dehiscence, maybe daily debridement, packing, antibiotics, drainage

182
Q

What causes breast candida?

A

Candida albicans

183
Q

What are the signs and symptoms of breast candida?

A

Nipple and areola are shiny, red, flaking skin.

Burning, itching, or deep stabbing pain that radiates

184
Q

How do you diagnose breast candida?

A

History of infant with fresh or severe diaper rash

185
Q

Management of breast candida

A

Diflucan

Mom and infant must be treated

186
Q

What is the role of the phagocytic portion of the newborn immune system?

A

Move out of circulation
Engulf germs,
Wall off or localized infection

187
Q

Why does the newborn immune system have trouble with the phagocytic portion?

A

If the infant is stressed or immature or if bacterial load is large, then neutrophils cannot respond rapidly enough or forcefully enough for containment
This allows germs to spread
Leading to systemic infection with generalized symptoms

188
Q

What is the role of the humoral component of the newborn immune system?

A

The humoral component is antibody mediated immunity.
With assistance from helper T cells, B cells will differentiate into plasma B cells that can produce antibodies against a specific antigens
The humoral component deals with antigens from pathogens

189
Q

How does the newborn humoral component limit immune response?

A

Neonate T cells do not stimulate B cells to switch from IG M to IGA or IgG
They’re primarily IG M with little IgG or IGA

190
Q

What is the total immunoglobulin at birth?

A

55%

80% of adult value

191
Q

For how long is IG G production reduced?

A

Until age 2

192
Q

Compare neonate levels of IGA two adult levels of IGA

A

IGA is 72% of adults level

193
Q

What happens to IG M levels in the newborn?

A

Igm levels drop as newborn uses up maternal supply

194
Q

When do infants produce their own IG M?

A

Infants do not produce own IG M until six months

195
Q

What is the difficulty with infant IG M and pathogens?

A

IG M is less able to respond to specific pathogens

NM 706 (1 decks)

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