General/MCQs Flashcards
Causes of oligohydramnios?
From head down:
1.Postdates
2. IUGR
3.Chromosomal anomalies
4. Duodenal atresia
5.Renal agenesis/dysgenesis
6.Polycystic kidneys
7.Urinary tract obstruction
8.PPROM
9.Fetal infection
List causes of Intrauterine demise?
There are maternal, placental and fetal causes.
Maternal:
- DM
- HTNsive disorders
- HbSS
- autoimmune diseases: SLE, thyroid disease, antiphospholipid antibody syndrome
- thrombophilias ( apa, prot c/s deficiency, factor v Leiden…)
- maternal infection (septicaemia, hypotension)
Placental:
- IUGR
- Placental infarction
- placental abruption
- feto-maternal haemorrhage (can occur with ECV)
- twin-to-twin transfusion syndrome
Foetal
- chromosomal abnormalities
- congenital abnormalities
- fetal viral and bacterial infections: TORCH, listeriosis, parvovirus
- immune haemolytic disease
- cord accidents (cord prolapse)
- fetal metabolic disorders
What are the causes of non-immune hydrops?
- idiopathic (30%)
- infections (parvovirus, syphilis, cmv, toxo, herpes simplex, leptospirosis, chagas disease)
- anaemia (due to fetal infection, homozygous alpha thal)
- chronic fetomaternal haemorrhage
- twin to twin transfusion
** all are causes of intrauterine demise!!*
What are the side effects of tranexamic acid?
Nausea, vomiting, diarrhea, disturbance in colour vision
Which progesterone can virilize a female foetus?
Gestrinone
Patients should use barrier contraception
How does phaeochromoxytoma present in pregnancy?
- HTNsive crisis or paroxysmal HTN
+/- 2. cerebral haemorrhage or 3. heart failure - Circulatory collapse following delivery w/ palpitations, anxiety head ache, vomiting, glucose intolerance
What is the fetal loss rate associated with phaeochromocytoma?
15-50%
How is phaeo diagnosed?
Urinary vanil-lyl-mandelic acid
T/F. Phaeo causes preeclampsia?
FALSE
Which drugs may exacerbate myasthenia Gravis?
- Lithium salts (inhibits excitatory neurotransmission)
- magnesium salts (competitively inhibits ca)
- propranolol beta blocker, can cause fatigue
- aminoglycosides (genta/strepta/neomycin, amikagin..)
- macrolides (clinda/erythromycin)
- tetracycline
- sulfonamides (bactrim), penicillin
- fluroquinolones (ciproflox, levo/nor/ofloxacillin)
- barbiturates
- polymyxin b
- procainamide
- halothane
- quinine
T/F. In pts with APA/antiphospholipid antibody syndrome ASA alone improves live birth rates?
False. ASA + heparin improves live birth rates
T/F. Thrombocytopenia is not a recognized complication of APA?
False
Increased thrombus formation uses up platelets
T/F. Acute hydramnios and broad ligament haematoma are causes of prerenal renal failure?
False. They cause postrenal renal failure by compressing and obstructing the ureters.
How does phenylketonuria affect the foetus?
Phenylpyruvate products cross the placenta and deposit in foetal brain tissue.
What kind of inheritance is assoc with phenylketonuria?
Autosomal recessive
Risk of foetus being affected if mother has phenylketonuria?
1 in 4 (25%), if partner is a carrier
If partners not a carrier. All children would be carriers
What is phenylketonuria?
An autosomal recessive condition that causes deficiency of phenylalanine hydroxylase
Treatment for PKU
Diet low in phenylalanine and tryptophan for 20days/ into adulthood.
Has a GOOD outcome.
Patient with a viable intrauterine pregnancy presents with mild abdominal pain and difficulty passing urine for the past 12 hrs. Vitals are stable and abd exam shows a distended lower abdomen.
Justify your next step.
Immediately catheterize and reassure. It is common for patients with a retroverted uterus to have acute urinary retention in the early weeks of gestation.
Patient presents with a heterotopic pregnancy at 10 weeks gestation. Live intrauterine gestation and ectopic w/o cardiac activity. Justify your next step?
Offer laparoscopic salpingectomy as it is a minimally invasive procedure. It will allow for removal of the ectopic pregnancy with minimal disturbance to the uterus. Thus allowing the intrauterine pregnancy to continue.
Next step for a patient with a spontaneous, viable 7 week, quadruplet pregnancy?
Extensive counselling about the risk of pregnancy to both mother and the fetuses.
- Counsel about selective fetal reduction.
What is Wernicke’s encephalopathy and what are the features?
Wernicke’s encephalopathy is a medical emergency that occurs due to thiamine deficiency.
- presentation is gradual and episodic and can progress to being fatal BUT reversible.
- permanent impairment is common and complete remission occurs in 29%.
- Features:
Confusion
Drowsiness/memory problems
Blurred vision
Unsteadiness
Opthalmoplegia
Nystagmus
Hyporeflexia or areflexia
Finger to node ataxia
Gait ataxia
What is the mortality rate of Wernickes encephalopathy? What happens if it progresses?
10-15%
Can progress to KORSAKOFF’s encephalopathy
— causes 1. Antegrade & retrograde amnesia, b.Confabulation