Step studying 4 Flashcards
Most common cause of osteomyelitis
Staph aureus
If you see someone with salmonella osteo, think sickle cell (although staph is still more common in sickle cell than salmonella)
Cause of transient tachypnea of the newborn (TTN)
o Slow absorption of fetal lung fluid with resultant tachypnea
o Commonly associated with C-section deliveries
Diagnosis and tx of TTN
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
Cause of respiratory distress syndrome in a newborn
- Condition seen in newborn infants resulting from surfactant deficiency
- Usually occurs in premature
Diagnosis and tx of RDS
o Diagnosis:
♣ XR shows hypo-extended lungs with atelectasis
♣ Imaging (CT) reveals characteristic reticulonodular “ground glass” pattern
o Treatment:
♣ Intubation
♣ Exogenous surfactant is available
Tx of Heparin induced thrombocytopenia
♣ Stop Heparin
♣ Need to stop clots = Synthetic heparin (Fondaparinux or Agatroban) and bridge to Coumadin
Diagnosis of gestational diabetes
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
When do you give Rhogam in an Rh- mom
- At 28 weeks (3rd trimester)
- Within 72 hours of delivery
What changes do you expect in Hgb in a pregnant mother
Decrease in Hgb
- RBC increase, but plasma increases more, thus diluting the blood and lowering Hgb
What is the lower limit of normal Hgb for a 3rd trimester mom
Hgb of 10
- So Hgb <10 = anemia in pregnancy
- Most likely iron deficiency
Tx of asymptomatic bacteriuria in pregnant women
Amoxicillin
Tx of pylenonephritis in pregnant women
Ceftriaxone + admission to hospital
Tx of hyperthyroidism in pregnancy
PTU (not Methimazole)
What antiepileptics are safe in pregnancy
L drugs: Lamotrigine, Levitericetam
What HTN drugs are safe in pregnancy
*Alpha-methyldopa, Labetalol, Hydralazine
What are the 3 stages of normal labor
Stage 1 = onset of deliver (contractions) to complete dilation (10 cm)
Stage 2 = complete dilation to delivery of baby
Stage 3 = delivery of placenta
What are the 2 phases of stage 1 of labor
Latent phase = closed cervix to 6 cm
Active phase = 6 cm to complete dilation
Normal length of each stage of labor
Stage 1 latent = 14-20 hours
Stage 1 active = 4-6 hours
Stage 2 = <3 hours
Stage 3 = <30 min
Define arrest of active labor
• 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
Tx of delay of stage 2 of labor
- If baby is + position, can use forceps or vacuum
- If baby’s position is still negative = C-section
Tx of delay of stage 3 of labor
- Uterine massage
- Oxytocin
- Manual extraction
What is considered preterm?
24-37 weeks
What is considered term
37-42 weeks
What is the difference between PROM and pPROM
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)
Define prolonged rupture of membranes
Time from ROM to time labor is over (baby and placenta out) > 18 hours
Tx of premature ROM
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+
What is the cutoff for delivery in PPROM
34 weeks. If baby is 34-37 weeks, you deliver
What do you do in PPROM if baby is <34 weeks
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)
What are the risks of maintaining prolonged ROM
Infection, of mom or of baby
- Chorioamnionitis
- Endometritis
Tx of chorioamnionitis
- Amp + Gentamicin + Clindamycin
- Induction of labor (C-section is not necessary)
Definition of preterm labor
Cervical change + uterine contractions prior to 37 complete weeks and after 20 weeks gestation
Definition of gestational HTN
- Hypertension without proteinuria after 20 weeks gestation
* Hypertension within 48-72 hours after delivery and resolves by 12 weeks postpartum
Tx of pre-E w/o severe features
Deliver at 37 weeks
What is HELLP syndrome
Hemolysis, Elevated Liver enzymes, Low Platelets
Basically it is pre-eclampsia + thrombotic microangiopathy
What are severe features of Pre-E
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)
What do you worry about when giving Magnesium to pregnant mom
- Toxicity can lead to decreased respiratory drive
- Assess toxicity by checking DTRs
Tx for magnesium toxicity
Calcium
Tx of Pre-E with severe features
Magnesium + induction
Definition of postpartum hemorrhage
> 500 cc in vaginal delivery
>1000 cc in C-section
Describe cause of postpartum hemorrhage based on feel of uterus:
- Absent uterus
- Boggy uterus
- Firm uterus
- Normal uterus
- Absent = uterine inversion
- Boggy = uterine atony
- Firm = retained POC
- Normal = vaginal lac
Tx of placenta previa
C-section
What is the cut-off fetal position to use forceps/vaccum
2+
What happens to BP during pregnancy
Goes down due to decreased SVR
What happens to Creatinine during pregnancy
Decreases - increased plasma volume increases GFR
What will you see on imaging in meconium ileus vs Hirschsprung
Meconium ileus = microcolon
Hirschsprung = bad gut will be dilated with transition point where normal nerves are
At what b-hCG level can you usually see a pregnancy on US
> 1500-2000
Tx of precancer in the endometrium
Progesterone
Tx of endometrial cancer
total abdominal hysterectomy + bilateral salpingoopherectomy
