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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

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2
Q

Are topical corticosteroids contraindicated?

A

Not in pregnancy

Yes in breastfeeding

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3
Q

What antibiotics are contraindicated during pregnancy?

A
  1. Chrloamphenicol
  2. Systemic gentamicin
  3. Neomycin
  4. Rifampin
  5. Tetracyclne
  6. Systemic Tobramycin
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4
Q

What antibiotics are okay for use in pregnancy?

A
  1. Erythromycin
  2. Topical tobramycin
  3. Topical gentamicin
  4. Polymyxin B
  5. FQs
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5
Q

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

A

Acyclovir

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6
Q

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

A

Punctal occlusion

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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

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8
Q

Chloasma is related to what?

A

elevated levels of Melanocyte Stimulating Hormone (MSH)

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9
Q

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

A

increased estrogen levels

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10
Q

Does refractive error change during pregnancy?

A

NO

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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
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12
Q

Pregnancy causes the IOP to do what?

A

decrease - can persist several months after birth

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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
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14
Q

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

A

30%

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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

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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
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17
Q

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

A

5-10%

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18
Q

What is eclampsia?

A

Pre-eclampsia + development of seizures or unexplained coma

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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

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20
Q

What are the symptoms of vasospasm?

A
  1. HA
  2. Epigastric/Right upper quadrant pain
  3. Vomitting
  4. visual disturbances
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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
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22
Q

What is the hallmark retinal sign of PIH?

A

bilateral retinal arteriolar vasospasm and narrowing

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23
Q

What are the ON changes found in PIH?

A

Acute NAION
Disc Edema
Optic Atrophy

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24
Q

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

A

1% pre-eclampsia

10% eclampsia

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25
When can we expect serous retinal detachments to resolve? What will the vision be?
- resolves within first few wks after birth | - normal vision will return
26
Degree of retinopathy is contingent upon the severeity of pre-eclampsia.
True
27
What is the medical management of PIH?
1. Delivery of fetus, or | 2. Controlling BP and electolyte imbalance with medication
28
What is the mortality rate of PIH? What is death due to?
13-30% | - due to pulmonary edema, cerebrovascular lesion, cardiac/liver/renal failure
29
What syndrome: Life-threatening pregnancy complication; variant of pre-eclampsia; activation of coagulatin cascade is underlying problem
HELLP syndrome
30
What is the global mortality rate of HELLP syndrome?
25%
31
Baby death from HELLP syndrome is due to what?
Placental failure/abruption, and prematurity
32
What are the characteristics of HELLP syndrome?
- Hemolysis - Elevated Liver enzymes - Low Platelet count
33
What's the most common reasons mothers become ill or die during pregnancy?
- Liver rupture | - stroke (cerebral edema or hemorrhage)
34
What is the tx for HELLP syndrome?
Delivery of the baby | - steroids can be used to strengthen the baby and mother
35
5-8% of pregnant women in the US develop pre-eclampsia. What % of those women will develop HELLP syndrome?
15%, about 48,000 per year
36
A pt is 7x more likely to get Central Serous Chorioretinopathy due to what 3 factors?
1. Hormonal factors (increase in catecholamines) 2. Hypercoagulability 3. Hemodynamic changes
37
What is CSC?
Accumulation of sub-retinal fluid resulting in neurosensory retinal detachment - most commonly seen in 3rd trimester
38
In patient's with CSC, you will see a refractive shift towards what?
Hyperopia
39
What is the diagnostic tool of choice for CSC?
OCT | - resolves near end of pregnancy or first few months after giving birth
40
What occlusive vascular disorder: Reported within 24 hrs of childbirth, severe bilateral vision loss due to ischemia
Purtscher-like Retinopathy
41
What are the funduscopic findings of purtscher-like retinopathy?
- Multiple, white retinal patches (look like CWS) | - Superficial hemorrhages around ON
42
PLR resolves spontaneously, but vision coverage is from 20/20 - 5/200. What is this due to?
- Arteriolar narrowing - OD pallor - VF defects
43
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
Disseminated Intravascular Coagulation
44
What are the funduscopic changes in Disseminated Intravascular Coagulation?
1. Choroidal Hemorrhage 2. CME 3. Serous retinal detachment 4. RPE detachment
45
A patient with DIC will complain about what 2 things?
1 Shimmering of vision | 2. Visual blur
46
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
Amniotic Fluid Embolism
47
What's the mortality rate of Amniotic Fluid Embolism?
60-80% | - most recently reported as 26.4%
48
When does PTC appear in pregnant patient? What symptoms will she have?
first 20 weeks - 6th nerve palsy - disc edema - Increased IOP
49
What is the treatment for PTC?
- Acetazolamide (diuretic) after 20 wks | - Careful weight control
50
If a PTC patient is losing vision, what should be done?
1. Steroids 2. ON sheath decompression 3. Shunting 4. Lumbar puncture
51
What is the risk of permanent visual impairment in PTC?
10%
52
A Ptosis can be found during pregnancy due to what?
High estrogen levels cause water molecules to infiltrate levator tendon, or stress
53
Risk of Idiopathic Facial (Bell's) Palsy occurs in the 3rd trimester or 2 wks post partum increases ___-fold because of pregnancy
3-fold
54
Are patients with gestational diabetes at risk for diabetic retinopathy?
NO
55
Pregnancy is commonly associated with worsening retinopathy in type 1 more than type 2. What's the progression rate?
from 8% to 70% chance or worsening
56
T1 and T2 diabetics have what % chance of developing DR during pregnancy?
10-36%
57
For a T1D having their 1st eye exam, what's their chance of getting DR?
57-62%
58
For a T2D having their 1st eye exam, what's their chance of getting DR?
17-28%
59
The DIEP study said patients without retinoaphy at conception have ___% chance of developing mild NPDR.
10.3%
60
DIEP study: Patients with mild NPDR progressed to moderate or worse ___ % of the time.
21.1%
61
What is the hypothesis for the development of DR?
Increased retinal blood flow the cause due to diminished autoregulation mechanism causing vasoconstriction
62
What are the top 4 risk factors of progression of DR during pregnancy?
1. Duration of DM 2. Metabolic control 3. Baseline Severity 5. Presence of HTN/Renal Disease
63
Retinopathy progressed to proliferative stage in what % of pts who had DM for 15 years or longer?
39%
64
TF: Significant change in blood sugar control actually worsens the diabetic retinopathy
True - tell patient to only do gradual, small changes in blood sugar
65
Congenital toxoplasmosis in the fetus is the result of what?
active infection of mother through transplacental transmission
66
Severity of congenital toxoplasmosis infection is highest when? What about frequency?
When its acquired during the 1st trimester Frequency is greatest during 3rd trimester
67
T/F: Stresses of labor + delivery do not cause RDs in highly myopic pts w/ peripheral retinal degeneration
True
68
Exacerbation of Grave's disease may occur when?
during 1st trimester or postpartum
69
T/F: Pre-existing glaucoma improves during pregnancy
True
70
At week 36, IOP was decreased by how muh in glaucoma patient?
2.5mm lower
71
Topical use of prostaglandins are ____ due to ___.
Contraindicated due to systemic use for labor induction and termination
72
All CAIs are contraindicated in glaucoma except for :
Oral acetazolamide
73
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
2-3 days
74
All BB are contraindicated in breastfeeding mothers except which one? What should we monitor the baby for?
Timolol - gel soln has less systemic absorption monitor baby for apnea and bradycardia
75
What is the only category B glaucoma medication? What about breastfeeding?
Alphagan P (Brimonidine) - cannot be used in breastfeeding mothers because it's excreted in breast milk

Clinical Medicine 2 (12 decks)

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