Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Medicine 2 > Pregnant Patient > Flashcards

Pregnant Patient Flashcards

1
Q

Tropicamide is safe for one time exam use, but is contraindicated if the patient is what?

A

Contraindicated in breast feeding mothers due to anticholinergic + hypertensive effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Are topical corticosteroids contraindicated?

A

Not in pregnancy

Yes in breastfeeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What antibiotics are contraindicated during pregnancy?

A
  1. Chrloamphenicol
  2. Systemic gentamicin
  3. Neomycin
  4. Rifampin
  5. Tetracyclne
  6. Systemic Tobramycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What antibiotics are okay for use in pregnancy?

A
  1. Erythromycin
  2. Topical tobramycin
  3. Topical gentamicin
  4. Polymyxin B
  5. FQs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

All antivirals should be avoided during pregnancy/breastfeeding mothers due to tumorigenicity, except which one?

A

Acyclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What should you instruct your patient to do after using topical medications?

A

Punctal occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What pregnancy finding is this: Blotchy, brown hypermelanosis that occurs around the eyelids and usually fades slowly postpartum?

A

Chloasma - the mask of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Chloasma is related to what?

A

elevated levels of Melanocyte Stimulating Hormone (MSH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Spider angiomas commonly develop on face and upper body related to what?

A

increased estrogen levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Does refractive error change during pregnancy?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

There will be a decrease in amplitude of accommodation by how much in the 2nd half of pregnancy?

A

greater than 1.00D

  • tell patient to get OTC readers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pregnancy causes the IOP to do what?

A

decrease - can persist several months after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 4 corneal changes found in pregnancy

A
  1. decrease sensitivity
  2. Increase thickness
  3. Increase curvature + steepening
  4. Change in tear film composition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What % of pregnant women have contact lens intolerance due to hormonal changes?

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What corneal finding is found early in pregnancy and is related to low progesterone levels? When will it resolve?

A

Krukenberg spindles

- resolves in 3rd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pre-eclampsia includes what findings? What week of gestation is it found?

A
  1. Systemic HTN
  2. General Edema
  3. Proteinuria > 300
  4. Coagulation/liver function abnormality
  • found in 20th wk of gestation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pre-eclampsia is found in how many pregnant women in the US?

A

5-10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is eclampsia?

A

Pre-eclampsia + development of seizures or unexplained coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the basic mechanism of pregnancy-induced HTN?

A

Vasospasm - spasm leads to vasoconstriction of vessels

- due to increased sensitivity to angiotensin II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the symptoms of vasospasm?

A
  1. HA
  2. Epigastric/Right upper quadrant pain
  3. Vomitting
  4. visual disturbances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

30-100% of PIH patients have visual disturbances. What are the ocular symptoms of vasospasm?

A
  1. blurred vision
  2. AF
  3. Photopsia
  4. Scotoma
  5. Diplopia
  6. Chromatopsia
  7. VF defects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the hallmark retinal sign of PIH?

A

bilateral retinal arteriolar vasospasm and narrowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the ON changes found in PIH?

A

Acute NAION
Disc Edema
Optic Atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Bilateral or Bullous Serous retinal detachments are found in what % of pre-eclampsia and eclampsia patients?

A

1% pre-eclampsia

10% eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When can we expect serous retinal detachments to resolve? What will the vision be?

A
  • resolves within first few wks after birth

- normal vision will return

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Degree of retinopathy is contingent upon the severeity of pre-eclampsia.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the medical management of PIH?

A
  1. Delivery of fetus, or

2. Controlling BP and electolyte imbalance with medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the mortality rate of PIH? What is death due to?

A

13-30%

- due to pulmonary edema, cerebrovascular lesion, cardiac/liver/renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What syndrome: Life-threatening pregnancy complication; variant of pre-eclampsia; activation of coagulatin cascade is underlying problem

A

HELLP syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the global mortality rate of HELLP syndrome?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Baby death from HELLP syndrome is due to what?

A

Placental failure/abruption, and prematurity

32
Q

What are the characteristics of HELLP syndrome?

A
  • Hemolysis
  • Elevated Liver enzymes
  • Low Platelet count
33
Q

What’s the most common reasons mothers become ill or die during pregnancy?

A
  • Liver rupture

- stroke (cerebral edema or hemorrhage)

34
Q

What is the tx for HELLP syndrome?

A

Delivery of the baby

- steroids can be used to strengthen the baby and mother

35
Q

5-8% of pregnant women in the US develop pre-eclampsia. What % of those women will develop HELLP syndrome?

A

15%, about 48,000 per year

36
Q

A pt is 7x more likely to get Central Serous Chorioretinopathy due to what 3 factors?

A
  1. Hormonal factors (increase in catecholamines)
  2. Hypercoagulability
  3. Hemodynamic changes
37
Q

What is CSC?

A

Accumulation of sub-retinal fluid resulting in neurosensory retinal detachment
- most commonly seen in 3rd trimester

38
Q

In patient’s with CSC, you will see a refractive shift towards what?

A

Hyperopia

39
Q

What is the diagnostic tool of choice for CSC?

A

OCT

- resolves near end of pregnancy or first few months after giving birth

40
Q

What occlusive vascular disorder: Reported within 24 hrs of childbirth, severe bilateral vision loss due to ischemia

A

Purtscher-like Retinopathy

41
Q

What are the funduscopic findings of purtscher-like retinopathy?

A
  • Multiple, white retinal patches (look like CWS)

- Superficial hemorrhages around ON

42
Q

PLR resolves spontaneously, but vision coverage is from 20/20 - 5/200. What is this due to?

A
  • Arteriolar narrowing
  • OD pallor
  • VF defects
43
Q

Which occlusive vascular disorder: Blood clots form in small vessels throughout the body; choroid most commonly involved; occlusion of choriocapillaris by thrombus leads to serous detachment

A

Disseminated Intravascular Coagulation

44
Q

What are the funduscopic changes in Disseminated Intravascular Coagulation?

A
  1. Choroidal Hemorrhage
  2. CME
  3. Serous retinal detachment
  4. RPE detachment
45
Q

A patient with DIC will complain about what 2 things?

A

1 Shimmering of vision

2. Visual blur

46
Q

Which occlusive disease: Catastrohic even that occurs during labor, delivery or immediate postpartum period; Embolic fluid from amniotic fluid deposits in microvasculature of heart, lung, brain and eye

A

Amniotic Fluid Embolism

47
Q

What’s the mortality rate of Amniotic Fluid Embolism?

A

60-80%

- most recently reported as 26.4%

48
Q

When does PTC appear in pregnant patient? What symptoms will she have?

A

first 20 weeks

  • 6th nerve palsy
  • disc edema
  • Increased IOP
49
Q

What is the treatment for PTC?

A
  • Acetazolamide (diuretic) after 20 wks

- Careful weight control

50
Q

If a PTC patient is losing vision, what should be done?

A
  1. Steroids
  2. ON sheath decompression
  3. Shunting
  4. Lumbar puncture
51
Q

What is the risk of permanent visual impairment in PTC?

A

10%

52
Q

A Ptosis can be found during pregnancy due to what?

A

High estrogen levels cause water molecules to infiltrate levator tendon, or

stress

53
Q

Risk of Idiopathic Facial (Bell’s) Palsy occurs in the 3rd trimester or 2 wks post partum increases ___-fold because of pregnancy

A

3-fold

54
Q

Are patients with gestational diabetes at risk for diabetic retinopathy?

A

NO

55
Q

Pregnancy is commonly associated with worsening retinopathy in type 1 more than type 2. What’s the progression rate?

A

from 8% to 70% chance or worsening

56
Q

T1 and T2 diabetics have what % chance of developing DR during pregnancy?

A

10-36%

57
Q

For a T1D having their 1st eye exam, what’s their chance of getting DR?

A

57-62%

58
Q

For a T2D having their 1st eye exam, what’s their chance of getting DR?

A

17-28%

59
Q

The DIEP study said patients without retinoaphy at conception have ___% chance of developing mild NPDR.

A

10.3%

60
Q

DIEP study: Patients with mild NPDR progressed to moderate or worse ___ % of the time.

A

21.1%

61
Q

What is the hypothesis for the development of DR?

A

Increased retinal blood flow the cause due to diminished autoregulation mechanism causing vasoconstriction

62
Q

What are the top 4 risk factors of progression of DR during pregnancy?

A
  1. Duration of DM
  2. Metabolic control
  3. Baseline Severity
  4. Presence of HTN/Renal Disease
63
Q

Retinopathy progressed to proliferative stage in what % of pts who had DM for 15 years or longer?

A

39%

64
Q

TF: Significant change in blood sugar control actually worsens the diabetic retinopathy

A

True - tell patient to only do gradual, small changes in blood sugar

65
Q

Congenital toxoplasmosis in the fetus is the result of what?

A

active infection of mother through transplacental transmission

66
Q

Severity of congenital toxoplasmosis infection is highest when? What about frequency?

A

When its acquired during the 1st trimester

Frequency is greatest during 3rd trimester

67
Q

T/F: Stresses of labor + delivery do not cause RDs in highly myopic pts w/ peripheral retinal degeneration

A

True

68
Q

Exacerbation of Grave’s disease may occur when?

A

during 1st trimester or postpartum

69
Q

T/F: Pre-existing glaucoma improves during pregnancy

A

True

70
Q

At week 36, IOP was decreased by how muh in glaucoma patient?

A

2.5mm lower

71
Q

Topical use of prostaglandins are ____ due to ___.

A

Contraindicated due to systemic use for labor induction and termination

72
Q

All CAIs are contraindicated in glaucoma except for :

A

Oral acetazolamide

73
Q

BB should be avoided or used in the lowest possible does in 1st trimester. BB should be discontinued ____ prior to deliver to avoid Beta blockade in the infant

A

2-3 days

74
Q

All BB are contraindicated in breastfeeding mothers except which one? What should we monitor the baby for?

A

Timolol - gel soln has less systemic absorption

monitor baby for apnea and bradycardia

75
Q

What is the only category B glaucoma medication? What about breastfeeding?

A

Alphagan P (Brimonidine)

  • cannot be used in breastfeeding mothers because it’s excreted in breast milk

Clinical Medicine 2 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions