Pregnancy

Question 1

CV changes during pregnancy

• Blood volume
• SVR
• CO
• HR

Answer 1

↑blood volume & ↓SVR -> ↑ CO & HR

Question 2

Pulm changes during pregnancy

- What type of acid base disorder?

Answer 2

Progesterone -> changes medullary set pt and stimulates central resp center -> ↑tidal vol & men ventilation -> respiratory alkalosis w/ metabolic compensation (↑PaO2, ↓PaCO2)

Question 3

Renal/urinary changes during pregnancy

Answer 3

Progesterone -> ↑RBF w/ ↑renal excretion ->

1. ↑ GFR & renal size -> ↓ BUN & Cre
2. ↑UOP -> urinary freq and nocturia

preg hormones -> resets threshold to ↑ADH -> mild hyponatremia

Question 4

Heme changes during preganncy

Answer 4

↑plasma vol & RBC mass -> dilutional anemia

preg hormones -> ↓protein S, ↑fibrinogen and coagulation factors -> prothrombotic state

Question 5

vaccines that need to avoid conception for 28days afterwards

Answer 5

varicella

MMR

Question 6

Vaccines during pregnancy

Answer 6

Tdap
Inactivated flu
hep A/B if high risk
Pneumococcus if high risk
HiB if asplenic

Question 7

vaccines post partum

Answer 7

MMR
varicella
anti-D Ig for RhD- women

Question 8

Pregnant woman p/w +UCx but no sx

Answer 8

Asymptomatic bacteriuria

screen @ 12-16wks, tx w/ 1 of 3 options to avoid progression to UTI and complications (pre-term birth, low birth wt):

1. nitrofurantoin for 5-7 days
2. amoxicillin +/- clavulanate for 3-7 days
3. fosfomycin x1

Avoid:

1. fluoroquinolones
2. TMP/SMX in 1st and 3rd trimester

Question 9

Pregnant woman p/w +UCx and dysuria, uregency

Answer 9

Acute cystitis - considered complicated UTI

tx w/ 1 of 3 options

1. nitrofurantoin for 5-6 days
2. amoxicillin +/- clavulanate for 3-7 days
3. fosfomycin x1

Avoid:

1. fluoroquinolones
2. TMP/SMX in 1st and 3rd trimesters

Question 10

Pregnant woman p/w +UCx and flank pain +/- CVA tenderness, n/v, fever

Answer 10

Acute pyelonephritis

admit and IV abx (meropenem, b-lactam) -> oral abx x 10-14days after afebrile for 24hrs

avoid aminoglycosides unless necessary

Question 11

ROM -> vaginal bleeding + fetal tachycardia -> fetal bradycardia w/ repetitive late decels

Answer 11

Vasa Previa = ruptured fetal umbilical vessel 2/2 fetal vessels traverse the fetal membranes

Question 12

fetus p/w small body size, microcephaly, digital hypoplasia, nail hypoplasia, midfacial hypoplasia, cleft paalte and rib anomalies

Answer 12

Fetal hydantoin syndrome <- anticonvulsant use during pregnancy (phenytoin and carbamazepine)

Question 13

RLQ pain in any trimester w/ n/v, anorexia, leukocytosis and fever. Dx? Mgmt?

Answer 13

Appendicitis

Appendectomy + IV abx

Question 14

RUQ pain after 1st trimester w/ n/v, anorexia, leukocytosis and fever. Dx? Mgmt?

Answer 14

Cholecystitis

cholecystectomy

Question 15

unilateral pain @ 14 wks or immediately after delivery w/ n/v. Dx? Mgmt?

Answer 15

ovarian torsion

laparoscopy w/ attempt to un-torse and reperfuse -> oophorectomy only if ovary is dead

Question 16

midline persistent uterine pain in 2nd/3rd trimester w/ bleeding and abnormal fetal heart tracings. Dx? Mgmt?

Answer 16

placental abruption

delivery

Question 17

unilateral pain in 1st trimester w/ n/v, syncopy, spotting. Dx? Mgmt?

Answer 17

ectopic pregnancy

methotrexate / surgery

Question 18

acute, sharp lower abd pain in 1st trimester. Dx? Mgmt?

Answer 18

Ruptured corpus luteum

Observe for spontaneous hemostasis, if not, then cystectomy

Question 19

elevated LFT + n/v, icteric, coagulopathy, hypoglycemia. Dx? Mgmt?

Answer 19

AFLP. Immediate delivery

Question 20

elevated LFT (100-300 IU/L) + HTN, proteinuria. Dx? Mgmt?

Answer 20

Pre-eclampsia. Mild - expectant; severe - deliver

Question 21

elevated LFT (1000 IU/L) + hemolysis, platelet <100 000 /ul. Dx?

Answer 21

HELLP.

Question 22

elevated LFT (mild) + generalized itching, elevated bile salts

Answer 22

ICP. anti-histamine / steroids