Medical Disease

Question 1

What are the medical diseases found in obstetrics?

Answer 1

Asx Bacteriuria 
Cystitis 
Pyelonephritis 
HTN 
Thyroid 
Seizure 
DM

Question 2

What are the bugs for Asx bacteriuria?

Answer 2

Gram negatives

Group B strep

Question 3

What is the symptoms, dx, Tx and F/U for asx bacteriura?

Answer 3

No symptoms
Dx- U/A positive

Tx- Amoxicillin, Nitrofurantoin (if pen all), TMP-SMX

F/U Do rescreen a pregnant woman

Question 4

What are the bugs of cystitis?

Answer 4

Gram negative

GBS

Question 5

What are the symptoms, dx, tx and F/U for cystitis?

Answer 5

Symptoms - Urgency, Frequency, Dysuria

Dx- U/A positive

Tx - treat for 7 days complicated UTI. Treat with amoxicillin, Nitrofurantion (if pen all),
TMP- SMX

F/U- rescreen pregnant woman

Question 6

What is the bugs for pyelonephritis?

Answer 6

Gram negatives,

GBS

Question 7

What the symptoms, dx and tx for pyelonephritis?

Answer 7

Symptoms - urgency, frequency, Dysuria, fever, chills, N/V, CVA tenderness

Dx- U/A positive wbc cast
Tx - ceftriaxone, if no improvement after 3 days, U/S looking for abscess

Question 8

What is the goal for HTN in pregnancy?

Answer 8

<140, <90, onset before 20 weeks before gestation

Question 9

What are the symptoms, Dx, and treatment for HTN in pregnancy?

Answer 9

ASX

Dx- ambulatory BP

Tx- alpha methyl dopa (best), Labetalol, hydralazine

F/U- strict screening for eclampsia

Question 10

What is the pathology of the thyroid?

Answer 10

Hyperthyroid - dead baby

Hypothyroid - cretinism

Question 11

What is the symptoms and dx of thyroid?

Answer 11

Hyper - decreased TSH, increased T4

HYpo - increased TSH, decreased T4

Question 12

What is the Tx and F/U of Thyroid?

Answer 12

Hyper- PTU safe in pregnancy, if surgery needed do in 2nd trimester

HYpo - levothyroxine

F/U - increase in thyroid binding Globulin means increase levothyroxine 25%

Trend TSH every 4 weeks

Question 13

How is epilepsy Dx?

Answer 13

Clinical

Question 14

What is the tx and F/U for seizures in pregnancy?

Answer 14

Remember all antiepileptics are teratogens

Risk benefit analysis
If possible avoid in first trimester
Increase in frequency = increase in treatment

Levetiracetam and Lamotrigine

F/U- phenobarbitals to abort seizures in pregnancy (Benzos ok especially late in pregnancy)

Folate for all woman

Question 15

What is the Pathology for type I and Type II DM?

Answer 15

Type I - Autoimmune destruction of the pancreas

Type II - obesity, insulin sensitivity

Question 16

What are the symptoms of DM?

Answer 16

Increased blood glucose, Fasting glucose or A1c

Question 17

What is the treatment for DM before, During ad post pregnancy?

Answer 17

Pre - weight loss, diet, excersize, oral medications (Insulin), A1c <7

During - increase insulin requirements, basal bonus, A1c is useless

Post- decrease insulin demands at delivery

Question 18

What are complications of DM during pregnancy?

Answer 18

Macrosomia, Shoulder dystocia (Tri3)

Transposition of the great vessels (Tri1)