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Question 1

what is the most common cause of 3rd trimester bleeding?

Answer 1

abruptio placentae- premature separation of a normally implanted placenta after the 20th wk of gestation

Question 2

what is the definition of 3rd trimester bleeding?

Answer 2

any bleeding that occurs after 28 wks gestation

5% of all pregnancies

Question 3

SX of 3rd trimester bleed

Answer 3

• small amounts of spotting to passage of large clots
• abdominal pain +/- uterine tenderness (suggests abruptio placentae)
• profuse, plainless bleeding is suggestive of placenta previa

Question 4

ddx of 3 trimester bleed?

Answer 4

obstretric causes: abruptio placentae (30%), placenta previa (20%), bloody show (loss of mucous plug w/in first stage of labor), uterine rupture

Question 5

ddx 3rd trimester bleed non-obstetric causes?

Answer 5

genital tract lesion, infx, intercoures, friable cervis, cervical carcinoma

Question 6

3rd trimester bleed workup?

Answer 6

CBC, PT/PTT to r/o DIC (disseminated intravascular coagulation)

type and cross

U/A, cervicl cultures to r/o infxn

US to r/o placenta previa

-if no previa is found-perform a sterile speculum exam to evaluate the source of the bleeding or ruptured membranse

Question 7

fetal well-being tests?

Answer 7

check for fetal heart tones and conduct an NST

• ? amniocentesis for fetal lung maturity
• administer RhoGAM if Rh- and send a Kleihaur-Betke test to assess for the extent of fetomaternal bleed

Question 8

Kleihauer-Betke test?

Answer 8

used to measure the amount of fetal hb transfered to maternal Hb

use in any sort of maternal trauma or if mom is Rh-

Question 9

tx for 3rd trimester bleed

Answer 9

delivery for term pts

bed rest and cautious tocolysis for stable preterm pts

Question 10

tocolysis

Answer 10

• the process of slowing down or halting labor

Question 11

what types of bites have the highest rates of infxn

Answer 11

cat and human

Question 12

most common bacteria

Answer 12

polymicorbial, pasturealla

Question 13

what is the tx for cat bites?

Answer 13

always treat cat bite prophylactically!

augmentin 500 mg po TID X 5-7days

if PCB allergy, combo of clinda and doxy, or bactrim or fluoroquilone

Question 14

when should you culutre?

Answer 14

ALWAYS

Question 15

Scorpion stings?

Answer 15

only cause local pain, but some species may cause muslce cramps, twitching and jerking, and occasionally HTN, convulsions, and pulmonary edema

Question 16

Foreign Body Aspiration

Answer 16

degree of injury is based on the substance aspirated

-episode of choking aor choughing or unexplained wheezing or hemoptysis should raise the suspicion of FBA

Question 17

lab studies for FBA

Answer 17

expiratory radiography may reveal regional hyperinflation-caused by a check valve effect

Question 18

tx of FBA

Answer 18

bronchoscopy may help establish dx but can also be tx of choice for object removal

-get cultures if postobstructive PNA suspected