MTB3 1 Flashcards
What does quad screen look like in Trisomy 21
Decreased MSAFP, Estriol
Increased B-HCG
Painful late vaginal bleeding
Abruptio placenta
Uterine rupture
Painless vaginal bleeding
Placenta previa
Vasa previa
When is RhD given in Rh negative mothers
At 28 weeks
- W/in 72 hrs of delivery
- after miscarriage or abortion
- during amniocentesis or CVS
- w heavy vaginal bleeding
Protuberance in lower abdomen = palpable fetal parts
Uterine Rupture
Which Infxn are CI to breastfeeding
HIV Active TB HTLV -1 Hep B before infant immunized HSV if breast lesion
What is elevated LDH indicative of
Hemolysis
Management of HELLP
- Immediate delivery
- IV steroids if plateletes <50,000 w C section
- IV MgSO4
Management of HELLP
- Immediate delivery
- IV steroids if plateletes <50,000 w C section
- IV MgSO4
Adverse effect of unfractionated heparin
Osteopenia
What can cross the placenta in Grave’s
Maternal thyroid stimulating Igs
Thyroid blocking Igs
Fetal effects of maternal Grave’s
Fetal tachycardia
Growth restriction
Goiter
Tx and Dx of intrahepatic cholestasis of pregnancy
Dx: 10-100 fold increase in serum bile acids
Tx: Ursodeoxycholic acid
Tx and Dx of intrahepatic cholestasis of pregnancy
Dx: 10-100 fold increase in serum bile acids
Tx: Ursodeoxycholic acid
Pt at 7 wks gestation presents with vaginal bleeding and pelvic pain
Dx and W/U
Threatened abortion
Speculum exam in early pregnancy
If advanced - US or doppler
Painful cramps, continued bleeding and dilated cervix
Inevitable abortion
What is the difference b/t Doppler and US?
Both use sound waves
Doppler shows blood flow through vessels
US does not
How do we Dx Ectopic pregnancy
b-HCG > 1,500 mIU
AND
No IU pregnancy seen on vaginal sonogram
Amenorrhea + Vaginal bleeding + Unilateral pelvic - abdominal pain
Ectopic pregnancy
What is an incompetent cervix
Too weak to stay closed during pregnancy
PROM before 24 weeks management
Bed rest at home
PROM b/t 24-33 weeks
Hospitalize
IM betamethasone if < 32 wks
Cervical cultures
PPX Ampicillin and erythromycin 7 days
PROM greater than 34 wks
Initiate delivery
Most feared complication w PROM
Chorioamnionitis
What is an adequate CTX
- Every 2-3 mins
- Lasting 45-60 secs
- Has 50 mmHg intensity
What is the management of umbilical cord prolapse
- Place pt in knee-chest position
- Terbutaline to decrease force of CTX
- Immediate C section
Causes of nonreassuring fetal tracings
Hypoxia
Meds - Beta agonist, beta blockers
What are the causes of postpartum fever @ Day 0
Tx
Atelectasis
Rales, pt can’t take deep breath
Incentive spirometry, ambulate
What are the causes of postpartum fever @ Day 1
Tx
UTI
CVA tender, +UA, culture
IV ABX
What are the causes of postpartum fever @ Days 2-3
Tx
Endometritis
Uterine tenderness, peritoneal si’s
IV Abx - gent and clinda
What are the causes of postpartum fever @ Days 4-5
Tx
Wound Infxn
Persistent spiking fevers
Would erythema, fluctuance
IV Abx, wet to dry would packing, closure
What are the causes of postpartum fever @ Days 5-6
Tx
Septic thrombophlebitis
Persistent wide fever
IV heparin 7-10 days
What are the causes of postpartum fever @ Days 7-21
Tx
Infectious mastitis
Unilateral breast tenderness, erythema, edema
PO cloxacillin, continue breast feeds
Anterior Mediastinal mass DDX
4 T's Thymoma Teratoma Thyroid Neoplasm Terrible Lymphoma
Lab findings in Seminoma
Increased b-HCG
AFP usually normal
Lab findings in non-seminomatous germ cell tumor
High AFP
What is a normal full body respiratory quotient
0.8
High protein diet
What is a respiratory quotient > 1.0 indicative of
Carbohydrates are sole source of fuel and net lipogenesis is occurring
What CO2 and O2 values are seen with mechanical overfeeding
High CO2 production
Most important AE of raloxifene
Increased thromboembolism
Effect of raloxifene on breast cancer
Decreases risk
Tamoxifen increases risk for what cancer
Endometrial
How does a pregnancy luteoma present
Bilateral
Multinodular
Solid masses on both ovaries
Pregnancy luteoma risk factors
African American
Multiparous
30’s or 40’s
Sx’s of pregnancy luteoma
Asymptomatic
Virilization
Hirsutism
Management of Pregnancy luteoma
Reassurance
US follow up
Benign
Sx’s of pathologic vaginal discharge
Pruritis
Burning
Malodorous
Vaginal exam of pathologic vaginal discharge
Erythema
Friability of vaginal mucosa
Tenderness of cervix
Green/curd-like
Physiologic leukorrhea
Copious vaginal discharge White or yellow Nonmalodorous Absence of other sx's Predominance of Squamous cells may be seen with PMNs
Presentation of patient with acute pancreatitis w secondary ileus
Abdominal pain
Vomiting
Decreased bowel sounds, tender abdomen
Labs - high BR, ALT, AP, Lipase, leukocyte, BUN
Treatment of acute pancreatitis
IVF NG tube suction NPO Analgesia Abx if severe
What labs should be monitored in acute pancreatitis
Calcium
Magnesium
Test for gallstone detection
Endoscopic US
ERCP
TX for biliary pancreatitis in stable pt
Laparoscopic cholecystectomy
Peak airway pressure is sum of what?
Airway resistance + Plateau pressure
- Plateau pressure = Elastic pressure + PEEP
How do we calculate PEEP
End-expiratory hold maneuver
Where do we see Muddy brown granular casts
ATN
Where do we see RBC casts
Glomerulonephritis
Where do we see WBC casts
Interstitial nephritis
Pyelonephritis
Where do we see fatty casts
Nephrotic syndrome
Where do we see broad and waxy casts
Chronic Renal Failure
Pt with A fib with worsening fatigue and irregular hR - next step in management
Assess CHADS-VASc score
Warfarin if needed
Causes of transient proteinuria
Fever Exercise Seizures Stress Volume depletion
Proteinuria in child with fever, temp, myalgias, no other findings on UA - next step?
Repeat dipstick on 2 occasions
If negative -> transient proteinuria
If positive -> refer to pediatric nephrologist for renal dz assessment
Post op atelectasis Presentation
Asymptomatic
Increased work of breathing
2nd - 5th post op night
Atelectasis radiologic findings
Loss of lung volume b/c of collapsed lung tissue
Atelectasis pathophysiology
Change in lung compliance -> impaired cough and shallow breathing
Shallow inhalations limit lung base recruitment
Weak cough -> small airway mucus plugging
Hypoxia = low pO2 stimulates increased RR and low pCO2
