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MS3 > Step studying 4 > Flashcards

Step studying 4 Flashcards

1
Q

Most common cause of osteomyelitis

A

Staph aureus

If you see someone with salmonella osteo, think sickle cell (although staph is still more common in sickle cell than salmonella)

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2
Q

Cause of transient tachypnea of the newborn (TTN)

A

o Slow absorption of fetal lung fluid with resultant tachypnea
o Commonly associated with C-section deliveries

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3
Q

Diagnosis and tx of TTN

A

o Diagnosis:
♣ Hyperextended lungs
♣ Imaging reveals perihilar streaking and fluid in the fissures
o Treatment
♣ Supportive care including supplemental O2 if necessary
♣ Most infants have resolution of sx in 24-72 hours

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4
Q

Cause of respiratory distress syndrome in a newborn

A
  • Condition seen in newborn infants resulting from surfactant deficiency
  • Usually occurs in premature
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5
Q

Diagnosis and tx of RDS

A

o Diagnosis:
♣ XR shows hypo-extended lungs with atelectasis
♣ Imaging (CT) reveals characteristic reticulonodular “ground glass” pattern
o Treatment:
♣ Intubation
♣ Exogenous surfactant is available

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6
Q

Tx of Heparin induced thrombocytopenia

A

♣ Stop Heparin

♣ Need to stop clots = Synthetic heparin (Fondaparinux or Agatroban) and bridge to Coumadin

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7
Q

Diagnosis of gestational diabetes

A

1 hour glucose tolerance test (GTT)

  • Give 50 mg glucose
  • Positive if >/= 140 –> go on to 3 hour GTT

3 hour GTT

  • Give 100 mg glucose
  • 2/4 positive values = Gestational DM
  • – Fasting >90
  • – 1 hour >180
  • – 2 hour >155
  • – 3 hour >140
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8
Q

When do you give Rhogam in an Rh- mom

A
  • At 28 weeks (3rd trimester)

- Within 72 hours of delivery

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9
Q

What changes do you expect in Hgb in a pregnant mother

A

Decrease in Hgb

- RBC increase, but plasma increases more, thus diluting the blood and lowering Hgb

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10
Q

What is the lower limit of normal Hgb for a 3rd trimester mom

A

Hgb of 10

  • So Hgb <10 = anemia in pregnancy
  • Most likely iron deficiency
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11
Q

Tx of asymptomatic bacteriuria in pregnant women

A

Amoxicillin

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12
Q

Tx of pylenonephritis in pregnant women

A

Ceftriaxone + admission to hospital

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13
Q

Tx of hyperthyroidism in pregnancy

A

PTU (not Methimazole)

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14
Q

What antiepileptics are safe in pregnancy

A

L drugs: Lamotrigine, Levitericetam

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15
Q

What HTN drugs are safe in pregnancy

A

*Alpha-methyldopa, Labetalol, Hydralazine

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16
Q

What are the 3 stages of normal labor

A

Stage 1 = onset of deliver (contractions) to complete dilation (10 cm)

Stage 2 = complete dilation to delivery of baby

Stage 3 = delivery of placenta

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17
Q

What are the 2 phases of stage 1 of labor

A

Latent phase = closed cervix to 6 cm

Active phase = 6 cm to complete dilation

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18
Q

Normal length of each stage of labor

A

Stage 1 latent = 14-20 hours
Stage 1 active = 4-6 hours
Stage 2 = <3 hours
Stage 3 = <30 min

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19
Q

Define arrest of active labor

A

• No progress in the active phase of labor (>6 cm) with ruptured membranes for 4 hours with adequate contractions, or 6 hours of inadequate contractions

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20
Q

Tx of delay of stage 2 of labor

A
  • If baby is + position, can use forceps or vacuum

- If baby’s position is still negative = C-section

21
Q

Tx of delay of stage 3 of labor

A
  1. Uterine massage
  2. Oxytocin
  3. Manual extraction
22
Q

What is considered preterm?

A

24-37 weeks

23
Q

What is considered term

A

37-42 weeks

24
Q

What is the difference between PROM and pPROM

A

PROM = premature ROM = rupture occurs before onset of labor aka contractions

pPROM = preterm premature ROM = rupture occurs before 37 weeks (preterm) and before onset of contractions (premature)

25
Q

Define prolonged rupture of membranes

A

Time from ROM to time labor is over (baby and placenta out) > 18 hours

26
Q

Tx of premature ROM

A

Membrane ruptures in a term mom without contractions

  • Usually you just watch and wait and deliver
  • Give Ampicillin if GBS status is unknown or mom is GBS+
27
Q

What is the cutoff for delivery in PPROM

A

34 weeks. If baby is 34-37 weeks, you deliver

28
Q

What do you do in PPROM if baby is <34 weeks

A

If no signs of infection or fetal compromise = abx + steroids + surveillance

If signs of infection or fetal compromise = abx + steroids + delivery (+ magnesium if <32 weeks)

29
Q

What are the risks of maintaining prolonged ROM

A

Infection, of mom or of baby

  • Chorioamnionitis
  • Endometritis
30
Q

Tx of chorioamnionitis

A
  • Amp + Gentamicin + Clindamycin

- Induction of labor (C-section is not necessary)

31
Q

Definition of preterm labor

A

Cervical change + uterine contractions prior to 37 complete weeks and after 20 weeks gestation

32
Q

Definition of gestational HTN

A
  • Hypertension without proteinuria after 20 weeks gestation

* Hypertension within 48-72 hours after delivery and resolves by 12 weeks postpartum

33
Q

Tx of pre-E w/o severe features

A

Deliver at 37 weeks

34
Q

What is HELLP syndrome

A

Hemolysis, Elevated Liver enzymes, Low Platelets

Basically it is pre-eclampsia + thrombotic microangiopathy

35
Q

What are severe features of Pre-E

A

HA, vision changes, RUQ pain, pulmonary edema, BP >160/110, proteinuria >500mg, thrombocytopenia <100,000, elevated LFTs (2x normal), renal insufficiency (Cr >1.1 or double baseline)

36
Q

What do you worry about when giving Magnesium to pregnant mom

A
  • Toxicity can lead to decreased respiratory drive

- Assess toxicity by checking DTRs

37
Q

Tx for magnesium toxicity

A

Calcium

38
Q

Tx of Pre-E with severe features

A

Magnesium + induction

39
Q

Definition of postpartum hemorrhage

A

> 500 cc in vaginal delivery

>1000 cc in C-section

40
Q

Describe cause of postpartum hemorrhage based on feel of uterus:

  • Absent uterus
  • Boggy uterus
  • Firm uterus
  • Normal uterus
A
  • Absent = uterine inversion
  • Boggy = uterine atony
  • Firm = retained POC
  • Normal = vaginal lac
41
Q

Tx of placenta previa

A

C-section

42
Q

What is the cut-off fetal position to use forceps/vaccum

A

2+

43
Q

What happens to BP during pregnancy

A

Goes down due to decreased SVR

44
Q

What happens to Creatinine during pregnancy

A

Decreases - increased plasma volume increases GFR

45
Q

What will you see on imaging in meconium ileus vs Hirschsprung

A

Meconium ileus = microcolon

Hirschsprung = bad gut will be dilated with transition point where normal nerves are

46
Q

At what b-hCG level can you usually see a pregnancy on US

A

> 1500-2000

47
Q

Tx of precancer in the endometrium

A

Progesterone

48
Q

Tx of endometrial cancer

A

total abdominal hysterectomy + bilateral salpingoopherectomy

MS3 (88 decks)

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