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ObGyn Lecture > Lecture 13 > Flashcards

Lecture 13 Flashcards

1
Q

What is Melasma (colasma)?

A

Mask of pregnancy

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2
Q

What is PUPP?

A

Pruritic urticarial papules and plaques of pregnancy

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3
Q

How do you treat PUPP?

A

Not many- maybe run ice cubes across stomach, take a Benadryl

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4
Q

What is the ratio of the plasma to RBC?

A

3:1 (no blood loss, just a dilution effect)

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5
Q

Under what levels of Hb is considered non-physiologic anemia?

A

<10-11 g/dL

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6
Q

What is the name for the proportion of blood composed of RBCs?

A

Hematocrit

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7
Q

What hematocrit (Hct) is considered non-physiologic anemia?

A

<30%

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8
Q

Hemoglobin multiplied by what gives you about an average of what you see on the Hct?

A

3

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9
Q

What will anemia look like on a smear?

A

Pale, hollowed out in center

microcystic, hypochromic

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10
Q

What are the three main types of neural tube defects?

A

Spina bifida
Encephalocele
Anencephaly

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11
Q

What chains of Hb are normal in the adult

A

2 alpha

2 beta

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12
Q

What type Hb does a fetus up to about 24 weeks makes?

A

Hb F

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13
Q

What is the name of alpha thalassemia where they are missing all 4 genes? incompartible with life, in utero fetal demise

A

Bart’s Hb

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14
Q

In sickle cell HB A is replaced with what?

A

Hb S

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15
Q

What type crises do people with sickle cell anemia have?

A

Vaso-occlusive crisis

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16
Q

How do you diagnosis sickle cell disorders?

A

Hb electrophoresis

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17
Q

What number of colonies are considered asymptomatic bacteruria?

A

> 10^5 colonies bacteria of urine culture

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18
Q

What can asymptomatic bacteruria develop into?

A

Cystitis (UTI) –> pyelonephritis

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19
Q

When do you do a urine culture?

A

Every first prenatal visit

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20
Q

If a mom has asymptomatic bacturia what do you do? (same for if they develop UTI)

A

3 days worth of antibiotics (ampicillin, cephalexin, or nitrofurantoin) and monitor w/ periodic culture

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21
Q

What is a good way in the urine to tell if mom is dehydrated?

A

Ketones

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22
Q

How do you treat pyeloneprhitis in a pregnant women?

A

Hospitalized (at risk of premature labor)

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23
Q

If a patient has the following what do you think they have: CVA tenderness, microhematuria, malaise, dehydration, no fever?

A

Calculi

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24
Q

How do you treat renal calculi

A

hydration, strain urine, watch for infection or obstruction

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25
Q

How much should a women with a normal weight gain in pregnancy?

A

25-35 lbs

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26
Q

How much should an underweight patient gain during pregnancy?

A

28-40 lbs

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27
Q

How much should an overweight women gain during pregnancy?

A

15-25 lbs

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28
Q

How much weight should an obese women gain during pregnancy?

A

11-20 lbs

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29
Q

How much water should a pregnant women drink?

A

six 8 oz glasses plus an additional 8 oz for every hour of activity

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30
Q

How much caffeine should pregnant women have?

A

<150-300 mg/day

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31
Q

What weeks does morning sickness usually occur?

A

4-14 weeks (peaks at 7-12)

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32
Q

What can help w/ morning sickness?

A

Ice chips, popsicles, small frequent meals, avoid triggers, ginger (crystallized) 250 mg capsules, only take 1/2 of prenatal vitamins at a time

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33
Q

To help with N/V what vitamin can a pregnant women take?

A

B6 BID-TID (10-50 mg)

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34
Q

What is the name for when a pregnant women has N/V and starts to lose weight (>5%) ?

A

Hyperemesis gravidarum

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35
Q

How do you treat hyperemesis gravidarum?

A

IV hydration, possible hospitalization

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36
Q

What should you R/O with hyperemesis gravidarum?

A

Acute fatty liver of pregnancy

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37
Q

What is the ddx for N/V with weight loss?

A

appendicitis, calculi, pyelonephritis, hepatitis, GB, hyperthyroid

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38
Q

If a pregnant women has Reflux what recommendations can you give?

A

Don’t lie down after eating
Avoid ETOH, citrus, caffeine, carbonated drinks
Take OTC antacids if dietary changes not helpful

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39
Q

What are symptoms of cholecystitis?

A

F/V/RUQ pain

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40
Q

How do you treat cholecystitis?

A

Supportive or surgical w/ obstruction or acute abdomen

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41
Q

If a women has itching, particularly on hands and feet what should you suspect?

A

Intrahepatic cholestasis of pregnancy

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42
Q

What are some physical symptoms of intrahepatic cholestasis of pregnancy?

A 
Dark urine color
light color BM
fatigue or exhaustion
Loss of appetite
Depression 
itching on hands and feet
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43
Q

How do you treat intrahepatic cholestasis of pregnancy?

A

Ursodeoxycholic acid

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44
Q

What do you need to monitor w/ intrahepatic cholestasis of pregnancy?

A

NSTs, serum bile and LFTs

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45
Q

What are some risk factors of intrahepatic cholestasis of pregnancy?

A

multi-fetal gestations, previous liver damage or prior IUP w/cholestasis

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46
Q

What is the biggest concern w/ MVA & DV?

A

Placental abruption

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47
Q

What is the test for Rh status?

A

Kleihauer-Betke test (looks for fetal cells in maternal circulation)

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48
Q

IF a women has : fever, tachycardia, altered MS, V/D, arrhythmia and a history of hyperthyroidism what do you think of?

A

Thyroid storm

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49
Q

What is the Rx for hypothyroid?

A

Levothyroxine (Synthroid)

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50
Q

How often should you check TSH with a pregnant women?

A

once per trimester after TSH levels stable

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51
Q

What is thyroiditis usually associated w/

A

IUP loss

hypothyroid

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52
Q

When does GDM usually occur?

A

2nd trimester

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53
Q

What does the placenta produce that causes mom’s tissues to be less receptive to insulin?

A

HPL

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54
Q

With GDM what else does mom have more of?

A

TG and FFA (free fatty acids) and more of these go to the fetus

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55
Q

What are some risk factors of GDM?

A

AA< hispanic or Latin American, native american, family hx DM

56
Q

What do you do to test GDM?

A

1 hour glucose challenge

57
Q

What is the fetus as risk w/ GDM?

A

Sacral agenesis, cardiac anomalies, stillbrith, neonata hypoglycemia

58
Q

WHat is the name to describe a neonate >4000 gm?

A

Macrosomia

59
Q

What is the mom at risk for w/ GDM?

A

ecalmpsia, preterm delivery, C-sec, uterine atony/inertia –> PP hemorrhage

60
Q

What do you want Hgb A1c under in women w/ DM?

A

<6%

61
Q

When is the glucose challenge done if no risk factors?

A

24-28 weeks

62
Q

How many grams of sugar do you give w/ the glucose challenge test (non-fasting)?

A

50 grams oral soluation and draw 1 hour later

63
Q

What is an abnormal level for a 1 hour glucose challenge?

A

> 140 mg/DL (indication of 3 HGTT)

64
Q

For a women with GDM what do you want plasma fasting to be at?

A

90-100

65
Q

What do you want post-prandial for GDM?

A

120-140

66
Q

Do diabetic patients deliver past their due dates?

A

No, they will be scheduled before then

67
Q

When do you recheck maternal glucose levels?

A

after delivery and 6-12 weeks after

68
Q

What is the rule of 3 with asthma?

A

1/3 of women get better
1/3 worsen
1/3 stay the same

69
Q

What is monitored in pregnant women w/ asthma?

A

Monitor peak expiratory flow rate or FEV1 & symptoms

70
Q

With asthma patients when do you do Serial US & antenatal testing ?

A

> 32 weeks

71
Q

What does the NYHA classification used for?

A

Cardiac Disease classifications to show level of decompensation

72
Q

What position for L&D do you like for women w/ cardiac disease?

A

Lateral position

73
Q

What type of prophylaxis may be needed in pregnant women w/ cardiac disease?

A

Anticoagulation and antibiotic prophylaxis

74
Q

What is the most common arrhythmia in pregnant women?

A

PAT (paroxysmal atrial tachycardia)

75
Q

What should you suspect if a patient presents with fatigue, palpitations, nocturia, ankle edema, DOE, SOB/supine

A

Peri-partum cardiomyopathy

76
Q

When do you screen for Group B Strep?

A

35-37 weeks

77
Q

If a pregnant women has a positive culture for GBS what do you do?

A

antibiotic prophylaxis 4 hours pre-delivery through ROM and Labor and Delivery

78
Q

If you have unknown status of GBS and a women is in labor what should you do?

A

Antibiotic prophylaxis

79
Q

What happens to a baby w/ GBS?

A

Septic shock: Early onset: 1st week; late onset: >6 days-3 months

80
Q

What should a women who has a partner with herpes simplex do?

A

Abstinence 3rd trimester w/ prodrome or lesions

81
Q

When should you do a C-section with women w/ herpes simplex?

A

prodrome

active lesions or positive HSV glycoprotein at L&D

82
Q

What can happen if a fetus is exposed to rubella the first trimester?

A

congenital reubella syndrome (deafness, cataracts, heart defects (PDA), mental retardation) or SAB

83
Q

What labs do you for rubella?

A

IgM and IgG antibodies (if these are present = have infection)

84
Q

Is immunization for Hep A ok when pregnant?

A

Yes since it is inactivated viral protein

85
Q

What can you give if a women has been exposed to Hep A?

A

HAV Ig (immune globulin)

86
Q

Can a women w/ Hep A breastfeed?

A

Yes, with proper hygiene precautions

87
Q

Which is more serious, Hep B or Hep A?

A

Hep B can progress to chronic carrier state and can affect liver more

88
Q

What lab do you check for for Hep B?

A

HBsAG (hep B surface antigen)

89
Q

What transmission model is Hep B?

A

Vertical

90
Q

If a neonate is thought to have Hep B what do you do?

A

IZ and HB Ig w/in 12 hours of birth

91
Q

What reduces antepartum transmission of HIV/AIDS?

A

HIV + Antiretroviral, C-section

minimize duration ROM and fetal exposure to maternal blood

92
Q

Can you vaccinate for HPV while pregnant?

A

No

93
Q

How can you treat condyloma acuminata if present?

A

cyro, laster, TCA (Trichloroacetic acid)

94
Q

If a women has an abnormal PAP during pregnancy what do you do?

A

Treat post partum

95
Q

What may happen to the neonata if the mom has HPV (rare)?

A

rare laryngal papillomatosis (C-section not prevent)

96
Q

Does syphilis cross the placenta?

A

Yes

97
Q

If a women has a low titer w/ positive FTA for syphilis what has probably happened?

A

They are seroconverted

98
Q

What do you use to treat syphilis in pregnant women?

A

Benzathien LA 2.4 single or weekly x 3

99
Q

With the Jarisch-Herxheimer rxn what risk is there to the fetus?

A

Fetal demise

have patient check their temp/ make sure baby is still moving

100
Q

If a baby has the following what should you suspect? Snuffles, HSM, jaundice, LAD, chorioretinitis, Hutchinson teeth, mulberry molars, saddle nose, saber shins

A

Congenital syphilis

101
Q

What can happen with a neonate when the mom has chlamydia?

A

maternal azithromycin po

Neonate: purulent conjunctivitis at birth or pneumonia at 1-3 mos

102
Q

If a patient has a short febrile illness or a clinical suspicion of CMV what should you do?

A

Test for presence of CMV antibodies: anti-CMV IgG

103
Q

What can happen to the neonate with CMV?

A

Petechiae, HSM, jaundice, microcephaly, chorioretinitis, fetal hydrops
Long term: hearing loss, neurological disabilities

104
Q

What is fetal hydrops?

A

Collect of excess fluid (can occur in many places)

105
Q

Who do you mandatorily screen for toxoplasmosis?

A

moms with HIV/ AIDS

106
Q

If a mom has a positive IgG for toxoplasmosis what does that mean?

A

Infection at some point in time

107
Q

If a mom has a positive IgM for toxoplasmosis what does that mean?

A

Recent infection

108
Q

What are some risks to the neonate with toxoplasmosis?

A

Infants infected before birth often show no symptoms at birth but develop them later in life w/potential blindness, mental retardation, chorioretinitis, hydrocephalus & seizures
Other risks: SAB, stillbirth, congenital issue

109
Q

Can you be vaccinated for varicella while pregnant?

A

No

110
Q

What can you give a mom exposed to varciella?

A

VZIG (immunoglobulins) w/in 72 hours but doesn’t protect fetus

111
Q

For parvovirus what do you screen?

A

B19 igM and IgG

112
Q

If a women has a positivei B19 IgM what should you do for parvovirus?

A

Do a US to r/o hydrops

113
Q

What do you prescribe w/ a pregnant women w/ migraine?

A

Acetaminopehn w/ or w/o codeine

114
Q

What type women may need more folate supplements?

A

Epileptic women

115
Q

What are some risk factors for antenatal depression?

A

Unplanned/unwanted IUP, socioeconomic stressors, current/past depression, FHx

116
Q

How long does PP blues last?

A

2-4 days post birth; come and go and gone 1-2 weeks

117
Q

Asthma Severity Classification: Intermittent

A

Frequency: 2 days/week or less

Nighttime awakening: Twice/month or less

118
Q

Asthma Severity Classification: Severe persistent

A

Frequency: symptoms throughout day

Nighttime awakening: 4 times/week or more

119
Q

Asthma Severity Classification: Moderate persistent

A

Frequency: Daily Symptoms

Nighttime awakening: More than once per week

120
Q

Asthma Severity Classification: Mild persistent

A

Frequency: more than 2 days/ week, but not daily

Nighttime awakening: More than twice per month

121
Q

What do you need to confirm GDM?

A

Glucose Challenge Test (50g solution and draw 1 hour later)

If abnormal: 3 HGTT w/ 100g solution (2 of 4 values are abnormal = GDM)

122
Q

NYHA: Class I

A

No cardiac decompensation

123
Q

By NYHA, what class show no symptoms of cardiac decompensation at rest, but marked limitations of physical activity?

A

Class III

124
Q

NHYA: Class IV

A

Symptoms of cardiac decompensation at rest, increased discomfort with any physical activity

125
Q

BY NYHA, what class shows no symptoms of cardiac decompensation at rest and minor limitations of physical activity?

A

Class II

126
Q

What do you do to help with maternal cardiac function and fetal well being with a CV problematic patient?

A

Prevent maternal stress (anemia, cardiac workload, weight gain, physical activity/work)
L&D (lateral position, shorten 2nd stage, epidural)
Anticoagulation and antibiotic prophylaxis as needed
Close monitoring post partum

127
Q

What are risks of rheumatic heart disease?

A

maternal risk subacute bacterial endocarditis, heart failure, embolic events, fetal loss

128
Q

When is it common to have peri-partum cardiomyopathy?

A

Last month of IUP or 1st 6 months PP

129
Q

What signs and symptoms are common with peri-partum cardiomyopathy?

A 
fatigue
palpitations
nocturia
ankle edema
DOE
SOB/supine
130
Q

If a mom gets the live attenuated rubella vaccine, how long should she wait to get pregnant?

A

4 weeks before attempting IUP

131
Q

During the 1st prenatal visit, what test is done to confirm HIV/AIDS?

A

ELISA w/ Western blot

132
Q

If the initial HIV/AIDS test is negative, when should you repeat it?

A

3rd trimester for high risk pt (contracts STD while pregnant, HIV+ partner, adds additional partners while pregnant, high HIV prevalent region)

133
Q

What is the most likely hx for someone with toxoplasmosis?

A

cats in household and contact with infected cat feces

134
Q

What is Congenital Varicella Syndrome?

A

1st or early 2nd trimester maternal infections causes LBW, scarring on skin, limb hypoplasia, microcephaly

135
Q

If a baby has been exposed to Parvovirus and has hydrops, what should be done?

A

intrauterine transfusion and monitor fetal growth

136
Q

What are the risks of parovirus?

A

SAB, hydrops, fetal death

ObGyn Lecture (21 decks)

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