Set 10 Flashcards
Tx GC and Chlamydia
GC = ceftriaxone CT = azithro x1 or 10d of doxy
Fever 1–.4, leukocytosis, blood clots in vagina after delivery? worrisome sx?
NORMAL in first 24hrs post-partum
worry if high fever, foul-smelling lochia, tender uterus
Lupus patient develops NV, abd pain and hypotension and hypoglycemia post-op?
adrenal insufficiency!! 2/2 not getting steroids
What anti-Rh Ab titer level do you give rhogam for? what level is fetus at risk for hemolytic disease?
- 1:6 - mom is already sensitized - rhogam won’t help. monitor closely for hemolytic disease.
- > 1:8-1:32 - fetus at risk for hemolytic disease.
female with rash that starts on face and progresses downward + arthritis?
consider rubella
Clubbing in COPD, think…
MALINGNANCY (unlike other clubbing scenarios)
3 drugs to treat UTI in pregnancy
nitrofurantoin, amoxicillin, 1st gen cephalosporin
arm held abducted and externally rotated, which dislocation?
anterior (fall on outstretcehd arm)
arm held adducted and internally rotated, which dislocation?
posterior (seizure, electrocution)
Neonated with microcephaly, small body, hypoplastic distal phalanges, excess hair, cleft palate and developmental delay?
fetal hydantoin syndrome = phenytoin or carbamazepine during pregnancy
management of post-patum hemorrhage
bimanual uterine massage, IVF, uterotonic meds (oxytocin, methylergonovine, carboprost) +/- blood transfusion
MC age range Legg-Calve-Perthes? Tx?
boys 4-10 (5-7*)
Tx observation and bracing, surgery only if femoral head not contained well in acetabulum
boy with hip, groin, knee pain and limping gait
think Legg-Calve-Perthes
next step if amenorrheic girl has no uterus on U/S?
karyotype and serum test
- 46 XX and female test level –> abnormal mullerian devel
- 46 XY and male test level –> AIS
Timing for CVS vs. amniocentesis
CVS = 10-12wks
amnio = 16-18wks
(possible to do ~earlier amnio of CVS unavailable)
what do mom and baby’s blood types have to be for hemolytic disease of the newborn? what type of Ig? which can cross placenta?
mom = O
baby = A or B
Results in mild disease, unlike Rh incompat.
It is IgG bc only IgG can cross the placenta
dyschezia, dyspareunia, dysmenorrhea and difficulty conceiving? 3 tx?
endometriosis
Tx = OCPs (combined), leuprolide, danazol
6 indications for hemodialysis
refractory hyperK refractory edema/pulm edema refractory metabolic acidosis uremic pericarditis uremic encephalopathy/neurophathy coagulopathy 2/2 renal failure
kindey d/s a/w Hodkgkin’s lymphoma
Minimal Change Disease! (nephrotic syndrome –> decr alb, normal globulin)
(also can have FSGS)
Test for cervical incompetence? Normal value?
transvaginal US –>funneling of cervix/cervical length which should be >25mm at 24wks
Tx PID and when should you admit?
Outpt = IM cefoxitin + PO probenecid + PO doxy OR IM ceftriaxone + PO doxy
hospitalize if: high fever, N/V and cant take pill, pregnant*, teenager/low socioeconomic status
inpt = IV cefotetan or cefoxitin + doxy OR IV clinda/gent
foul-smelling sputum, think…Tx?
think anaerobic pneumonia 2/2 aspiration
Tx = clindamycin
Asian w/ epistaxis, neck swelling, sinusitis and nasal mass? RFs?
nasopharyngeal CA
RF = EBV!!!, smoking and nitrosamines too
When is cephalic version indicated?
37+ weeks
5 components of BPP
NST tone (flex/extend, extend) movement (2x/30min) breathing movement (20sec/30min) AFI (5-25)
5 indications for intubation during acute asthma exacerbation
normal/increased PaCO2 (should be decr. from hyperventilation) decreased breath sounds no wheezing AMS hypoxia +/- cyanosis
Early Tx of pre-eclampsia
Methyldopa 1st line = central alpha-agonist to decr symp outflow and vasodilate
Labetolol for HTN
Pregnant lady with severe vomiting, wt loss, ketonuria and transaminitis / bili?
hyperemesis gravidarum
can also have elevated lipase/amylase
MCC b/w 4-10wks
SE niacin? MoA, Tx?
flushing + pruritis 2/2 PG-induced periph vasodilation and histamine release
Tx = low dose ASA 30min before niacin
Acute bloody diarrhea and abd pain w/o fever? complications?
EHEC from undercooked beef
Complications = HUS, TTP
Tx vaginal SCCA
stage 1/2 = excise. If >2cm, radiation
Stage 3/4 or >4cm = combo chemo if healthy, otherwise radiation
Tx bartonella henselae
azithromycin
indications for treating hyperkalemia
cardiac toxicity (EKG), muscle paralysis/paresis, K >6.5
W/u HTN (4)
UA = hematuria, prot/cr ratio chemistry panel lipid panel (CAD) EKG (CAD/LVH)
MC renal d/s a/w cancers?
Membranous glomerulonephritis (except hodgkins –> MCD)
goal BG level in gestational DM? Tx?
75-90, low sugar diet +/- subQ insulin
Effect of E2 therapy on L-thyroxine requirements normally and during pregnancy?
Both require increase in L-thyroxine
Tx lichen sclerosis?
steroid cream (clabetasol) \+/- bx due to risk of vulvar SCCA
Tx early syphilis if penicillin allergy
azithro or doxy
6 RF for placenta previa?
multiparity, adv mat age, prior CS, smoking, mult gestation, previous hx
COPD and asthma, respiratory alkalosis or acidosis?
COPD = resp acidosis (trap air?) asthma = resp alkalosis (hyperventilate)
hexagonal crystals on UA and CN nitroprusside test positive? MoA?
cystinuria –> defective AA transport by renal tubule and GI cells. Autosomal recessive
N/V/D then splinter hemorrhages, conjunctival hemorrhages, periorbital edema, myositis and eosinophilia?
trichinosis (trichinella roundworm) from undercooked PORK (3 stage d/s)
Indications for GBS prophylaxis if status unknown?
deilvery 18hrs
GBS bacteruria at any time during current pregnancy
prior baby with GBS sepsis
palpable purpura, proteinuria, hematuria, HCV?
mixed essential cryoglobinemia
+/- arthralgias, HSM and low complement
Tx TB?
- active dz - RIPE, then just RI for 6 mos (rifampin, INH, pyrazinamide, ethambutol)
- positive PPD but asymp - INH for 9 mos
- ALWAYS give B6 with INH to prevent neuropathy*
get LFTs for INH
