Mehl. repro-cardio DDx for IM 03-25 (1) Flashcards
M. he answer on USMLE for acute-onset shortness of breath and tachycardia 30 seconds to 2 minutes after delivery of the placenta. Dx?
Amniotic fluid embolism
M. Amniotic fluid embolism. Mechanism?
Amniotic fluid leaks into maternal circulation + goes to pulmonary arterioles.
M. Amniotic fluid embolism. what complication?
Can cause disseminated intravascular coagulation with bleeding from IV lines / catheter sites.
M. M. Amniotic fluid embolism. Tx?
Tx = supportive
M. The answer on USMLE for acute-onset shortness and tachycardia two days postpartum when the mother gets up to go to the bathroom, Dx?
Pulmonary embolism
(presumably a DVT that formed while in hospital bed launched off to lungs).
M. Pulmonary embolism. Tx? FIRST STEP
Tx = heparin first, followed by CT of the chest (aka spiral CT or CT angio).
M. PE. If woman is pregnant, then do V/Q scan before CT. This is in order to decrease potential radiation exposure to the fetus.
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M. PE. If V/Q scan is performed during pregnancy that shows “segmental perfusion defects” (i.e., suggestive of PE), the next best step in diagnosis is ????
CT of the chest if it’s listed.
Student says, “Wait, but I thought you just said we don’t do that in pregnancy because of radiation.” I agree with you. That’s why we did V/Q scan first. But if they force you to choose a NBS in Dx following the V/Q scan, the answer is still CT. Take it up with USMLE, not me.
M. Peripartum cardiomyopathy. trimester?
Dilated cardiomyopathy almost always during 3rd trimester or in the first few months postpartum.
M. Peripartum cardiomyopathy. Cause?
Cause is multifactorial, but some studies have identified an autoantibody- mediated process.
M. Peripartum cardiomyopathy. CP?
Will present as gradually worsening shortness of breath on exertion (i.e., LHF at a minimum). Depending on severity, can also present with JVD and significant pitting edema (RHF findings).
M. Peripartum cardiomyopathy. what changes with every pregnancy?
Peripartum cardiomyopathy tends to get worse with each subsequent pregnancy.
M. Peripartum cardiomyopathy. How make Tx?
Diagnosis is made with transthoracic echo looking for low ejection fraction.
M. Peripartum cardiomyopathy. Qs like to ask how to determine degree of maternal/fetal risk in subsequent pregnancies. answer =?
transthoracic echo (looking for EF).
In other words, the next pregnancy is going to have an even lower EF than the current, so if the EF is already significantly low (NR 55-70%), we know it’ll only be worse subsequently.
M. Normal peripheral edema. Mechanism?
Peripheral edema is common in pregnancy due to incr. plasma volume + the uterus compressing the pelvic veins and IVC;
both cause incr. venous hydrostatic pressure.
M. Atelectasis. Confusing word that refers to “lung collapse,” or “collapse of alveoli.”
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!! M. Atelectasis. - Highest yield point for USMLE is that it is the most common cause of fever within???
24 hours of post-surgery.
If this is the first time you’re reading this, that might sound weird, but this is pass-level and extremely important for 2CK.
M. Atelectasis. There is one 2CK Q where they say a woman had a C-section two days ago and the answer was ???
answer was still atelectasis, so even though it’s most common <24 hours, just be aware one Q exists where, oh em gee, it’s 2 days later
M. Atelectasis. Mechanism?
The mechanism is related to combo of pain meds + sedentation, where breathing becomes slower + shallower in hospital bed, leading to mild collapsing of some alveoli. This is why breathing exercises can be important post-surgery.
M. Atelectasis. Xray findings?
Will often present as bibasilar shadows or opacities. In other words, patient had surgery yesterday + now has fever + CXR shows mild opacity at the lung bases -> answer = atelectasis
M. Atelectasis. NBME assesses obstructive (aka resorptive) atelectasis. This is when an area of lung distal to an obstruction from, e.g., a tumor, can cause alveoli to collapse. This then increases the chance for pneumonia distal to the obstruction.
2CK IM form has “endobronchial obstruction” as answer for distal area of lung collapse (i.e., atelectasis) in patient with lung cancer; “vascular occlusion by tumor” is wrong answer (makes sense, as the tumor obstructs the respiratory tree, not blood vessel, in this case, but I’ve seen students accidentally choose the latter).
M. Budd-Chiari syndrome. definition?
Hepatic vein thrombosis due to hypercoagulable state in pregnancy.
M. Budd-Chiari syndrome. CP?
Presents as abdominal pain + hepatomegaly +/- ascites (latter indicates hydrostatic pressure backup to the portal vein).
M. Presents as abdominal pain + hepatomegaly +/- ascites (latter indicates hydrostatic pressure backup to the portal vein). Dx?
M. Budd-Chiari syndrome.
