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RCPSC > Mat med > Flashcards

Mat med Flashcards

1
Q

HBsAG neg
anti-HBc neg
anti-HBs neg

A

susceptible to HBV

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2
Q

HBsAG neg
anti-HBc pos
anti-HBs pos

A

immune to HBV due to natural infection

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3
Q

HBsAG neg
anti-HBc neg
anti-HBs pos

A

immune to HBV due to vaccination

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4
Q

HBsAG pos
anti-HBc pos
IgM anti-HBc pos
anti-HBs neg

A

acute infection
(within 6 /12)

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5
Q

HBsAG pos
anti-HBc pos
IgM anti-HBc neg
anti-HBs neg

A

chronic infection

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6
Q

HBsAG neg
anti-HBc pos
anti-HBs neg

A
  1. resolved infection
  2. false positive - susceptible
  3. low level chronic infection
  4. resolving acute infection
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7
Q

HSV seropositivity in Canadian pregnant women

A

17%

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8
Q

neonatal HSV incidence in canada

A

1/17000 live births

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9
Q

neonatal HSV is diagnosed when manifestations occur after…

A

48h after delivery

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10
Q

HSV skin/eye/mouth disease; what proportion may develop neuro sequelae

A

38%

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11
Q

disseminated HSV - mortality if untreated

A

90%

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12
Q

IV acyclovir for neonatal HSV reduces mortality by

A

58 to 16%

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13
Q

third trimester HSV risk of neonatal HSV

A

30-50%

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14
Q

congenital HSV is rare, but may be manifested by

A
  1. microcephaly
  2. hepatosplenomegaly
  3. IUGR
  4. IUFD
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15
Q

recurrent HSV risk of neonatal infection if lesion present

A

2-5%

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16
Q

recurrent HSV risk of neonatal infection if no lesions present

A

0.02-0.05%

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17
Q

HSV recurrence - suppression from?

A

36/40

reduces shedding and neonatal HSV. may be considered earlier if PTB predicted.

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18
Q

acyclovir doses for HSV suppression

A
  1. 400mg TDS
  2. 200mg QDS
  3. 500mg valaciclovir BD
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19
Q

ELCS for recurrent HSV should be done within ___ of ROM

A

4h

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20
Q

early localised Lyme disease

A

3-30 days

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21
Q

early disseminated Lyme disease

timing

A

<3/12

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22
Q

late disseminated Lyme disease

A

> 3/12

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23
Q

erythema migraines (Lyme disease) usually present within

A

7/7

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24
Q

testing for Lyme disease

A

serology two tiered testing:
- enzyme immunoassay
- confirmatory immunoblot

misses up to 50% of cases in early stages

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25
Q

prophylaxis for Lyme disease

A

doxycycline 200mg PO stat

reduces risk 10x

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26
Q

who should get prophylaxis for Lyme disease

A
  1. endemic region (ixodes >20%)
  2. attached for >24h
  3. but <72h tick removed
  4. no symptoms
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27
Q

abx options for treatment of early Lyme disease

A
  1. amoxicillin 500mg TDS x14-21/7
  2. cefuroxime 500mg BD x14-21/7
  3. azithromycin 500mg OD x5/7
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28
Q

prevention of tick bites

A
  • light coloured clothes
  • long sleeves and pants
  • 20-30% DEET
  • walkways
  • shower within 2h and body check
  • 10min high heat dryer
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29
Q

toxoplasmosis is the ____ leading cause of food borne death

A

3rd

1= salmonella, 2= listeria

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30
Q

toxoplasmosis seroprevalence in canada

A

20-40%

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31
Q

toxo life cycle

A
  • oocysts (noninfectious)
  • sporozoites
  • tachyzoites
  • bradyzoites
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32
Q

toxo: main routes of transmission

A
  1. ingestion of raw or undercooked meat (30-63%)
  2. exposure to oocyst infected feces or soil
  3. vertical transmission
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33
Q

what proportion of toxo infections are asymptomatic

A

> 90%

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34
Q

incubation period for toxo

A

5-18 days following exposure

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35
Q

Toxo IgG detectable within

A

1-2 weeks

peaks 12 weeks to 6 months; usually present for life

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36
Q

what to do if toxo IgM and IgG positive

A
  1. if acute infection suspected, repeat in 2-3 weeks
  2. 4x titre of IgG indication of recent infection
  3. positive serology needs to be confirmed by a ref lab in Montreal
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37
Q

toxo tests in ref lab

A
  • sabin-fieldman dye test
  • indirect fluorescent Ab test
  • IgG avidity (if increased, at least 5/12 since infection)
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38
Q

when to do amnio for toxo

A
  • after 18 weeks
  • at least 4 weeks after time of suspected infection
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39
Q

risk of vertical transmission of toxo in 1st trimester

A

6%

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40
Q

risk of vertical transmission of toxo in 3rd trimester

A

60-80%

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41
Q

overall risk of congenital toxo without rx

A

20-50%

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42
Q

common signs of classical congenital toxoplasmosis

A
  1. chorioretinitis
  2. hydrocephalus
  3. intracranial calcification
  4. convulsions

microcephaly and IUGR also present

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43
Q

what % neonates with congenital toxo are asymptomatic at birth

A

> 90%

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44
Q

if maternal toxo infection but foetus not affected, treat with

A

SPIRAMYCIN 1g TDS PO
till end of pregnancy

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45
Q

if fetal toxo confirmed or highly suspected, treat with

A

pyrimethamine + sulfadiazine + folinic acid

do not give in 1st trimester
monitor CBC due to risk of bone marrow suppression

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46
Q

incubation period of varicella

A

10-21 days

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47
Q

varicella infectious period

A

from 48h before rash till lesions crust over

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48
Q

varicella seropositivity

A

> 90%

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49
Q

incidence of maternal VZV in pregnancy

A

2-3/1000 pregnancies

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50
Q

in pregnant women with VZV, what proportion will develop pneumonitis

A

5-10%

RFs = smoking , >100 lesions,
usually day 4 or later,
50% may require ventilation

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51
Q

congenital VZV pathognomic signs

A
  • partial limb reduction
  • congenital cataract
  • microophthalmos
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52
Q

neonatal VZV occurs …?

A

within 10/7 of life

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53
Q

rates of congenital varicella syndrome

A

1st trimester = <0.7%
2nd trimester = 2%
3rd trimester = 0%

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54
Q

VZIG should be given to susceptible women when?

A

72-96h after exposure

some protection up to 3 weeks

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55
Q

VZIG dose

A

125 units/10kg IM (max 625 units)

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56
Q

acyclovir dose for significant varicella

A

800mg 5x/day

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57
Q

incubation period for ebola

A

2-21 days
(mean 4-10)

58
Q

ebola virology

A

RNA virus
Filoviridae family
Reservoir in fruit bats

59
Q

ebola transmission

A
  • consumption or handling of meat from infected animals
  • human to human (direct contact or exposure to contaminated substances)
60
Q

ebola diagnosis

A

RT-PCR

  • positive within 3/7 of symptoms
  • repeat testing 3-4/7 if negative
61
Q

parvovirus virology

A

ssDNA virus
viremia 4-14 days after exposure

62
Q

parvovirus fetal transmission rate

A

17-33%

63
Q

risk of spontaneous misc/SB with parvovirus

A

<20/40 = 13%
>20/40 = 0.5%

64
Q

risk of hydrops fetalis in parvo

A

2.9%

(greater risk if early infection)

65
Q

parvovirus accounts for ____ of non-immune hydrops

A

8-10%

66
Q

parvovirus exposure/infection: what to do if IgM+ but IgG-

A

repeat in 1-2 weeks

67
Q

parvovirus exposure/infection: what to do if both Ig negative

A

repeat 2-4 weeks

68
Q

parvovirus exposure/infections: what to do if both Ig positive

A
  • test stored blood for ?seroconversion
    or
  • repeat blood work for ?increasing titres
69
Q

parvovirus: if confirmed infection, next steps?

A

start serial USS for 8-12 weeks after infection, every 1-2wks with MCA PSV

70
Q

human beings are the only known host for which infection

A

rubella

71
Q

seroprevalence of rubella in canada in pregnancy

A

90%

72
Q

rubella vaccination - how long to avoid pregnancy

A

28 days

73
Q

how long to delay rubella vaccination if any immunoglobulins used in pregnancy

A

3-6 months

74
Q

incubation period of rubella

A

12-23 days

75
Q

rubella infectious period

A

7 days before rash onset
5-7 days after rash

76
Q

congenital rubella syndrome transmission risks

A

1st 2 months = 65-85%

3/12 = 30-35%
usually single organ

4/12 = 10%

77
Q

spont abortion rate in rubella

A

~20% under 8/40

78
Q

highest risk for congenital rubella occurs at what GA

A

<16/40

79
Q

which foetal finding in congenital rubella seems to be only complication of late/third trimester infection

A

IUGR

80
Q

rubella serology best done

A

7-10 days after rash onset

81
Q

rubella serology: both negative

A

SUSCEPTIBLE:
repeat 4/52 after contact
or 7/7 after symptoms

82
Q

rubella serology:
IgM neg but IgG pos

A

PAST INFXN/or VAX:
repeat 4/52 after contact or 7/7 after symptoms to ensure no reinfection

83
Q

rubella serology: both positive

A

possible RECENT INFXN or Re-infection:

repeat 2-3/52 for titre levels and measure avidity

84
Q

rubella serology:
IgM pos but IgG neg

A

possible recent infection:
repeat serology

  • IgG neg = false positive IgM
  • IgG pos = seroconversion
85
Q

rubella - recent infection defined as

clinical criteria

A
  • 4x increase in IgG titres
  • IgG seroconversion
  • IgM+ with low avidity IgG
  • pos rubella culture or viral detection
86
Q

when to do amnio for rubella

A

> 6/52 post-infection, over 20/40

87
Q

if rubella infection 1-12 weeks…
(risks to fetus)

A

85% rate of fetal infection
85% risk of congenital defects

consider TOP

88
Q

if rubella infection 13-16 weeks (% risks)

A

54% rate of fetal infection
35% risk of defects

consider fetal testing +/- TOP

89
Q

if rubella infection 17-22 weeks

A

36% rate of infection
minimal to no risk defects

consider USS surveillance

90
Q

if rubella infection 23-40 weeks

A

30-100% rate of infection
minimal to no risk defect

consider USS surveillance

91
Q

rubella reinfection - asymptomatic with history of immunity

risks of infection and of fetal defects

A

risk <10% infection
<5% defects <12/40

consider USS or testing

92
Q

perinatal transmission of HBV

A

1-2% with PEP

93
Q

how infectious is HBV?

A

100x more than HIV after needlestick

94
Q

risk of perinatal HBV transmission if acute infection near time of delivery

A

60%

95
Q

neonatal HBV prophylaxis

A

HBIG + HBV vax
within 12h

(reduces infection rate to <10%)

96
Q

HBV Rx in pregnancy

A

Tenofovir 300mg OD
from 28-32/40
and for 4-12/52 PP,

if HBV >200 000 copies (10^6)

97
Q

intrapartum management for HBV

A
  • no FSE
  • avoid episiotomy, AVB, C/S if possible
  • breastfeeding ok
98
Q

5C’S for HIV testing

A
  • consent
  • confidentiality
  • counseling
  • correct test results
  • connection to prevention/care/treatment
99
Q

male partner HIV: delay conception until

A
  • partner on cART
  • at least 2 low viral loads,
  • 1 month apart
  • (3-6 months preferable)
100
Q

ribavirin should not be used for _(time)___ preconception

A

> 6/12, in both men and women

101
Q

risk of perinatal transmission without cART

A

25%

(15-40%)

102
Q

risk of perinatal transmission HIV with cART

A

<2%

if received more than 4 weeks before delivery, risk is 0.4%

103
Q

HIV MOD: if viral load >1000 copies?

A

ELCS 38-39/40

104
Q

HIV MOD : if unknown viral load or not on CART (planned)

A

ELCS 38-39/40

105
Q

intrapartum HIV management if on cART

A
  1. continue PO cART
    (except stavudine)
  2. IV ZDZ 2mg/kg/hr loading dose then 1mg/kg/hr maintenance
106
Q

intrapartum HIV management if never had cART

A
  1. ZDV infusion
  2. stat PO nivrapine 200mg ASAP
  3. 7/7 of ZDV+ lamivudine BD
107
Q

HIV: what drugs to avoid if on PI’s

A

ergotamine,
cabergoline,
bromocriptine

108
Q

HIV infant management - when to do testing

A

at birth,
4 weeks
3-4 months by PCR

109
Q

HIV infant management - when to start prophylaxis

A

ASAP, within 6-12h of life

110
Q

HIV infant management - if viral load <1000

A

PO ZDV x 6/52

111
Q

HIV infant management - if viral load >1000 copies or no cART

A

3 drug regimen with ZDV for 6wks
+
3x nevirapine
+
lamivudine x 2/52

112
Q

restesting HIV in each trimester if what high risk behaviours

A
  1. sharing needles/IVDU
  2. UPSI with multiple partners
  3. UPSI with known HIV
  4. UPSI with partner from HIV endemic area
  5. UPSI with partner engaging in high risk behaviour
113
Q

if HIV status unknown at time of labour

A

offer prophylaxis in labour if high risk,
+ give PEP to baby

114
Q

Rh Prophylaxis doses

A

300ug for 30ml fetal blood
(15ml fetal RBC)

120ug for 12ml fetal blood
(6ml fetal RBC)

within 72h of birth

115
Q

HBV: invasive testing
Procedure related risk of unintended loss

A

0.35-1.0%
(1/100-300)

116
Q

HBV: invasive testing
Overall risk of VT with a procedure

A

3%

increased with >200 000 copies (>106)

117
Q

HCV: invasive testing
Procedure related risk of unintended loss

A

0.35-1.0%

118
Q

HCV: invasive testing
Overall risk of VT with a procedure

A

uncertain, data reassuring but limited

119
Q

HIV: invasive testing
Procedure related risk of unintended loss

A

2-4%

?upto 22%?

120
Q

HIV: invasive testing
overall risk of VT with procedure

A

2%

VT depends on viral load, increased if >107 IU/ml

121
Q

CVS : spont loss rate

A

1.4%

122
Q

amnio: spont loss rate

A

0.65%

123
Q

invasive testing with BBV - where should needle go?

A

avoid going through placenta or within 1-2cm of implantation edge

124
Q

frequency of silent FMH in third trimester

A

73%

125
Q

maternal conditions account for what % of SB?

A

10%

126
Q

autopsy after SB useful in identifying cause of death in what proportion

A

42%

127
Q

chromosomal abnormalities present in what proportion of SB

A

6-12%

128
Q

aspirin for previous SB?

A
  • 81-162mg
  • start before 16/40
  • till at least 35/40

for unexplained or unexplored SB, and those related to IUGR or early/severe PET

129
Q

investigation for SB can identify cause of death in what proportion?

A

60% of cases

130
Q

SB investigation - antiRo/La should be done if…?

A

Evidence on PM of
- hydrops
- endomyocardial fibroelastosis
- AV node calcification

131
Q

SB investigation - parental karyotype should be done if

A
  • 3+ RPL
    or
  • congenital malformations or dysmorphic features
132
Q

SB investigations - HB electrophoresis should be done if…

A
  • hydrops
  • maternal anemia
  • alpha-thalassemia considered
133
Q

SB investigation - coag screen should be done if

A
  • massive abruption
  • IUFD more than 4 weeks ago
134
Q

SB investigations - basic panel

A
  • CBC
  • Blood group and Ab screen
  • HbA1c
  • kleihauer
  • serology
135
Q

SB recurrence risk

A

approx 5 fold
(2-10 fold increase)

absolute risk remains low.
Also increased risks of PTB, abruption, LBW

136
Q

standard of care for management of opioid use disorders in pregnancy

A

treatment with methadone or buprenorphine

opioid detoxification should be reserved for selected women

137
Q

what to do if pregnancy on buprenorphine/naloxone

A

switch to buprenorphine monoproduct

switch to methadone if BP not accessible or not responding

138
Q

what samples can be used for substance use screening

A
  • maternal urine & hair
  • fetal urine, hair, & meconium

urine drug screening is preferred for recent use

139
Q

management of alcohol withdrawal

A
  • thiamine + folic acid
  • diazepam
  • lorazepam during labour
  • monitor hydration status and electrolyte levels
140
Q

Benzodiazepine withdrawal management

if on doses >50mg/day

A
  • start at 2/3 to 3/4 equivalent dose
  • taper by 10% per day
141
Q

opioid withdrawal management

A
  • symptomatic Rx for N/V and pain
  • consider methadone or buprenorphine initiation
  • can use morphine 5-10mg po q4-6h as alternative

RCPSC (17 decks)

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