Mehl. repro infect (pyelo/chole/appendicitis) 03-24 (1)

Question 1

M. Pyelonephritis. USMLE wants you to know pregnant women are at ­ risk of pyelo due to two main reasons.

Answer 1

.

Question 2

M. Pyelonephritis. 1st reason?

Answer 2

1) Progesterone slows ureteral peristalsis, thereby ­ risk of urinary stasis and backup to kidney.

Question 3

M. Pyelonephritis. 2nd reason?

Answer 3

2) Compression of ureter(s) by uterus, notably in 3rd trimester, ­incr. risk of stasis.

Question 4

M. Pyelonephritis. For theses reasons, asymptomatic bacteriuria is always treated in pregnancy, even though it is not treated in non-pregnant women. What drug?

Answer 4

Nitrofurantoin is a classic drug used to treat asymptomatic bacteriuria, standard UTIs, and cystitis in pregnancy.

Question 5

M. Cholecystitis. what causes it? pacioj puslej

Answer 5

Progesterone also slows biliary peristalsis, ­incr. risk of biliary sludging and cholesterol stone formation.

Question 6

M. Cholecystitis. estrogen effect?

Answer 6

Estrogen upregulates HMG-CoA reductase, ­incr. hepatic cholesterol synthesis, thereby ­incr. risk of stone formation.

Question 7

M. Cholecystitis. CP?

Answer 7

Cholelithiasis will present as colicky epigastric pain, usually after meals.

Question 8

M. Cholecystitis. 2 presentation that means this disease?

Answer 8

Cholelithiasis + fever = cholecystitis.

Question 9

M. Cholecystitis. Dx?

Answer 9

Diagnose both (lithiasis and cystitis) with ultrasound.

Question 10

M. Cholecystitis.
For cholecystitis only, if it is strongly suspected by ultrasound is negative, the next best step is ???

Answer 10

HIDA scan.

Question 11

M. Cholecystitis. ….. can be given to pregnant women with cholelithiasis to decr. stone size. The MOA of this drug is: decr. cholesterol secretion into bile.

Answer 11

Ursodeoxycholic acid (ursodiol)

Question 12

M. Cholecystitis. Mx?

Answer 12

Laparoscopic cholecystectomy is done for cholecystitis in pregnancy.

Question 13

M. Appendicitis. Highest yield point is that appendicitis can present as ???? Cp

Answer 13

RUQ pain in pregnancy because the uterus pushes the appendix upward.

Question 14

M. Appendicitis.

The Q will say ultrasound of the gallbladder shows no abnormalities, which is how you know the RUQ pain is not due to cholecystitis

Answer 14

.

Question 15

M. Appendicitis. Mx?

Answer 15

Laparoscopic appendectomy is performed in pregnancy