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Oral Boards > OB - 2 > Flashcards

OB - 2 Flashcards

1
Q

When are antibiotics recommended for ppx use for endocarditis?

A

No longer recommended!
May consider if hx endocarditis, unrepaired cyanotic disease, or prosthetic valve
Ampicillin 2g

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2
Q

What factors convey Risk Of Heart Attack?

A

Race, Obesity, HTN, Age

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3
Q

What are most common cardiac illnesses in pregnancy and postpartum?

A

Heart failure, MI, arrhythmia, aortic dissection

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4
Q

NYHA Classification of Heart Disease

A

Class 1 - no compromise
Class 2 - mild fatigue with activity
Class 3 - fatigue with less than normal activity
Class 4 - fatigue at rest

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5
Q

What is the most common rheumatic heart lesion?

A

Mitral stenosis

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6
Q

What pathology does mitral stenosis have?

A

Fixed cardiac output d/t narrowed valve
Blood accumulates in L atrium, backs up into lungs, causes heart failure

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7
Q

What is the treatment for mitral stenosis?

A

Prevent tachycardia with beta blockers

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8
Q

What strategies are employed in laboring patient with cardiac disease?

A

Vaginal delivery preferred
- Except Marfan’s > CS!
Allow to labor down
Shorten 2nd stage with OVD

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9
Q

What is the treatment of thyroid storm?

A

PTU followed by iodide
Steroids, beta blockers

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10
Q

What are the risks of epilepsy in pregnancy?

A

IUGR, IUFD, PEC

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11
Q

What are some of the adverse effects of anti-epileptics?

A

Decreased folate (give 4mg)
Decreased Vit K (give upon delivery)
Decreased Vit D

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12
Q

What are the drugs of choice for epilepsy in pregnancy?

A

Lamotrigine (textbook)
Keppra (reality)

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13
Q

What are the effects of valproate on pregnancy?

A

NTD

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14
Q

What is fetal hydantoin syndrome?

A

Growth restriction
Microcephaly
Mental retardation
Phalangeal hypoplasia

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15
Q

What are the clinical criteria for APLS?

A

Vascular
- Venous or arterial thrombosis
Pregnancy
- Loss > 10w
- SAB x3 < 10w
- Delivery at <34w for PEC/IUGR

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16
Q

What are the lab criteria for APLS?

A

On 2 occasions >= 12w apart
- Beta-2 glycoprotein
- Anti-cardiolipin
- LA

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17
Q

With APLS, what is the (percent) risk of: fetal loss?

A

50%

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18
Q

With APLS, what is the (percent) risk of: PEC?

A

50%

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19
Q

With APLS, what is the (percent) risk of: IUGR?

A

25%

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20
Q

With APLS, what is the (percent) risk of: thrombosis?

A

10%

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21
Q

What are antepartum considerations for APLS?

A

ASA + ppx AC
Surveillance for PEC and thrombosis
Growth US in 3rd tri for risk of IUGR
NST surveillance
Postpartum AC x6w

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22
Q

What are some causes of symmetric IUGR?

A

Genetics, TORCH, malaria, syphilis, congenital anomalies

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23
Q

What are some causes of asymmetric IUGR?

A

Placental insufficiency

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24
Q

When to deliver: uncomplicated IUGR (3-10%ile)?

A

38-39w

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25
Q

When to deliver: complicated IUGR (oligo, abn doppler, maternal conditions)?

A

34-38w

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26
Q

When to deliver: severe IUGR (<3%ile)?

A

37w

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27
Q

When to deliver: IUGR DCDA twins (uncomplicated)?

A

36-38w

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28
Q

When to deliver: IUGR DCDA twins (complicated)?

A

32-35w

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29
Q

What are some causes of TCP in pregnancy?

A

Gestational
Immune (ITP, TTP)
PEC
Drugs (SQH, AZT)
HIV

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30
Q

When do you treat TCP in pregnancy?

A

Plt < 50k or bleeding diathesis

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31
Q

What is the antigen implicated in NAIT?

A

HPA-1a, Plt antigen

32
Q

When to deliver: DCDA twins (uncomplicated)?

A

38-39w

33
Q

When to deliver: MCDA twins (uncomplicated)?

A

34-38w

34
Q

When to deliver: MCMA twins (uncomplicated)?

A

32-34w

35
Q

What are some maternal complications of twin gestation?

A

Hyperemesis
Anemia
DVT/PE
Pyelo
CS

36
Q

What are some OB complications of twin gestation?

A

PPROM, PTL
HTN/PEC/HELLP
Acute fatty liver
GDM
Placenta previa
PPH

37
Q

What are some fetal complications of twin gestation?

A

IUGR, Congenital anomalies /Hydramnios, Cerebral palsy, cord accident (MCMA), TT Transfusion (MCDA, MCMA)

38
Q

What are some complications of preterm labor? (RIPNS)

A

RDS, IVH, PDA, NEC, Sepsis

39
Q

When is IM progesterone (17-OHP) recommended?

A

For women with hx PTD, give 16-26w

40
Q

When is vaginal progesterone recommended?

A

Short cervix <= 20mm before 20w

41
Q

What are the criteria for US indicated cerclage?

A

<25mm before 24w GA and hx PTD < 34/mid tri loss

42
Q

What are the criteria for history indicated cerclage?

A

Hx one or more 2nd tri delivery (without labor)

43
Q

What are the criteria for exam indicated cerclage?

A

Advanced cervical dilation without labor, abruption, or infection evident

44
Q

Post term pregnancy is associated with:

A

Perinatal mortality, meconium aspiration, convulsions, low 5-min Apgars, low cord PH, oligo, dysmaturity syndrome, macrosomia

45
Q

If you don’t know the gestational age of a patient, how can you determine if they are term?

A

Early US suggesting EGA > 39w
Positive HCG x 36w
Fetal heart heard with Doppler x 30w
device x 20w

46
Q

How do you treat GBS if pt PCN allergic?

A

Normally: PCN 5mil u f/b 2.5mil u q4 hrs

If not true allergy: ancef 2g q6

If susceptible to clinda + erythromycin:
Clindamycin 900mg q8 hrs

If not: Vancomycin 20mg/kg q8 hrs

47
Q

When do you treat a pt who is GBS unk?

A

Preterm
ROM => 18 hrs
Fever => 100.4
Known GBS pos in prior pregnancy

48
Q

What is the risk of transmission for and severity of toxoplasmosis in each trimester?

A

1 - 15% (severe)
2 - 30% (mod)
3 - 60% (mild)

49
Q

What is the clinical presentation of fetal toxoplasmosis?

A

Intracranial calcifications, chorioretinitis, hearing loss, mental retardations, HSM

50
Q

What is the prevalence of acute primary CMV and risk of vertical transmission, neonatal disease, death?

A

Prevalence 3%
Vertical transmission 30% of these 3%
Neonatal disease: 30%
Death: 30%

51
Q

What is the clinical presentation of fetal CMV?

A

Chorioretinitis, HSM, IUGR, Hydrops

52
Q

What is the vertical transmission rate of Parvovirus, and what occurs in each trimester?

A

25%
1st tri - SAB
2nd/3rd tri - Hydrops, IUFD 2/2 anemia

53
Q

What fetal surveillance is required once mom tests positive for Parvovirus?

A

Serials weekly US for 2 mo after maternal infection to evaluate fetal wellbeing and signs of hydrops.

54
Q

What is the rate of survival with fetal Parvovirus?

A

With treatment - 80%
Without treatment - 20%

55
Q

What is this clinical presentation of maternal Parvovirus?

A

Rash, arthritis, flu-like illness, mostly asymptomatic

56
Q

What is the clinical presentation of maternal Varicella?

A

Primary rash or shingles, PNA, Encephalitis

57
Q

What is the clinical presentation of fetal Varicella?

A

SAB, Varicella embryopathy (eyes, limbs, skin, CNS effects), IUFD (high risk if <5d prior to delivery)

58
Q

What is PEP for Varicella?

A

Varicella immunoglobulin and Acyclovir 800mg 5x daily x7d

59
Q

What are the symptoms of Zika virus?

A

Fever, maculopapular rash, arthralgia, conjunctivitis, myalgias, pruritis, vomiting

60
Q

How do you screen for Zika virus?

A

Potential exposure, travel to endemic area by patient or partner, symptoms

61
Q

What testing is performed for Zika virus?

A

Test symptomatic pregnant people with possible exposure, up to 12w after symptoms onset, with concurrent IgM and NAT testing

If ongoing exposure, testing 3 times during pregnancy with Zika NAT of serum and urine

62
Q

If considering conception, how long must you wait after a Zika exposure?

A

Female partner - 8w
Male partner - 6mo

63
Q

What is the clinical presentation of maternal Listeria?

A

GI illness and flu-like symptoms (myalgia, N/V, diarrhea), fever

64
Q

What are the fetal and neonatal effects of Listeria?

A

Fetal - IUFD, PTL
Neonatal - Meningitis, Sepsis, Death

65
Q

How do you manage a patient exposed to a recalled Listeria product?

A

Asymptomatic - nothing, observe
Mild sx no fever - manage as asymptomatic or send blood cx, only treat if cx+
Fever +/- other sx - test and treat simultaneously (ampicillin or bactrim)

66
Q

What is the definition of AIDS?

A

HIV+ and CD4< 200

67
Q

What are the rates of vertical transmission of HSV with:
- Primary infection
- Non-primary 1st episode
- Recurrent infection?

A
  • Primary: 50%
  • Non-primary 1st: 33%
  • Recurrent: 3%
68
Q

What is the dose of Valacyclovir for
- Primary infection + non-primary 1st episode
- Recurrent infection
- Suppression?

A
  • Primary + non-p 1st: 1000mg bid x10d
  • Recurrent 500mg bid x3d
  • Suppression 500mg bid from 36w
69
Q

What the effects of obesity on pregnancy?

A

Increased risk of SAB and recurrent SAB, IUFD, PEC, macrosomia, congenital anomalies (cardiac, orofacial, limb, NTD), childhood obesity and asthma, ADHD, autism spectrum

70
Q

What micronutrients should be monitored after bariatric surgery?

A

Folate, Fe, Vit D, B12, Ca

71
Q

What is the different diagnosis of fetal hydrops?

A

Immune (Rh disease)
Non-immune
- Anemia
- Parvo or CMV
- Congenital heart defects
- Placenta problems: AV malformations, fetal maternal hemorrhage

72
Q

What vaccines are acceptable in pregnancy?

A

Tdap, Flu, Hep A + B, Pneumococcus

73
Q

What vaccines are contraindicated in pregnancy?

A

MMR, Varicella, HPV, Intranasal Flu

74
Q

What is the ddx of oligohydramnios?

A

ROM, IUGR, SGA, TORCH, renal agenesis, Idiopathic

75
Q

What is the ddx of polyhydramnios?

A

Diabetes, esophageal atresia, duodenal atresia, TORCH, syphilis, hydrops, genetic anomalies, idiopathic

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