Mehl. OGBYN bullets - INFEKCIJOS/VAKCINOS Flashcards
Herpes and pregnancy?
acyclovir indicated to reduce chance of active lesions at time of labor;
if active lesions or prodromal Sx present at parturition, C-section is indicated; acyclovir is safe during pregnancy.
- 21F + painful vesicles on vulva; do we give oral or topical acyclovir?
HSV -> always oral if asked.
HIV + pregnancy drugs?
HAART during pregnancy
in addition, administer zidovudine to mom prior to C- section, then zidovudine within 12 hours to neonate post-delivery (latter Q on peds NBME).
When is VZV IVIG advised for neonates?
maternal active lesions between 5 days prior to and 2 days post-delivery.
35F + G1P0 + exposed to child with chickenpox + never been vaccinated against VZV, next best step?
administer VZV IVIG within 96 hours (to be most effective, but still advised up to 10 days post- exposure).
Neonate born with patent ductus arteriosus; what Sx did the mom have while pregnant?
arthritis, not rash; Dx is congenital rubella syndrome in the neonate (causes PDA).
MMR vaccine and pregnancy?
vaccinate before pregnancy; do not give during pregnancy.
Arba jeigu nera imuniteto = rekomenduoti po gimdymo is karto vakcina
if mom HepB + => what to give?
give both HBIG + vaccine within 12 hours of birth;
if mom HepB negative => what to give?
give just vaccine within 12 hours of birth
if mom status unknown in terms of hepatitis B?
give vaccine within 12 hours of birth, and give HBIG within 7 days if mom’s test comes back + or remains unknown.
27F + 14 weeks’ gestation + not immune to HepB; next best step?
vaccinate to HepB now.
TB and pregnancy?
Tx for latent and active TB, yes;
Tx with RIPE for 2 months, followed by RI for 7 more months (9 months total);
if not pregnant, RI is only given for 4 more months.
Macrosomia + NRDS, what caused?
Insulin -> inhibits surfactant production; should be noted that insulin does not cross the placenta; fetus produces more endogenous insulin with maternal diabetes.
21F + VDRL positive at titer of 1:4 + physical exam shows no abnormalities + complains of no Sx +
chlamydia and gonorrhea testing negative; next best step?
fluorescent treponema antibody (syphilis).
19F + painless vulvar ulcer + rapid plasmin reagin negative + all other tests negative; next best step?
repeat rapid plasma reagin (slightly unusual answer, but can sometimes be negative early in primary syphilis).
21F + one-week Hx of 0.25-cm crusty, painless papule on the posterior fourchette; Dx?
condylomata acuminata -> HPV6+11.
22F + soft pink papillary lesions on labia minora and posterior fourchette; Tx?
NBME = podophyllum resin; student says wtf? used to treat warts.
Gardasil HPV vaccine protects against which types?
6, 11, 16, 18 (6+11 warts; 16+18 SCC).
24F + recently went backpacking in Asia + painful vulvar crater + gram (-) rods cultured; Dx + Tx?
Chancroid (haemophilus ducreyi); Tx with azithromycin
What is most effective form of emergency contraception? and second most effective?
answer = copper IUD;
second-best is ulipristal (selective progesterone-receptor modulator; SPRM).
18F + menstrual cycles with 14-40-day intervals + beta-hCG negative; next best step?
answer = “cyclic progesterone therapy” means OCPs, but this is shelf wording.
Important points about Depo vs Implanon?
what is depo?
Depo is progestin injection that is effective for three months; it can cause decreased bone density.
Important points about Depo vs Implanon?
what is impanon?
Implanon is a progestin implant contraceptive that is effective for three years; it is associated with erratic periods.
Type of cancer patient is at increased risk for if commencing Depo?
breast.
