Test 39

Question 1

Abortion

Answer 1

Spontaneous abortion is pregnancy loss at <20 weeks gestation. Risk factors include prior spontaneous abortion, advanced maternal age, extremes in BMI, and maternal substance abuse.

Question 2

Atrial fibrillation

Answer 2

For new-onset atrial fibrillation recognized prior to emergency surgery, hemodynamically stable patients should proceed with surgery with ventricular rate control using intravenous beta blockers or nondihydropyridine calcium channel blockers.

Question 3

Bipolar disorder

Answer 3

Haloperidol is a safe and effective treatment for severe bipolar mania during pregnancy. Other treatment options include lithium and second-generation antipsychotics. Valproate and carbamazepine should be avoided. Electroconvulsive therapy is effective but typically reserved for treatment-resistant cases and for those at imminent risk to themselves or their fetus.

Question 4

Secondary HTN

Answer 4

Renal parenchymal disease is an important cause of secondary HTN in adults age <30. Glomerulonephritis, with either nephritic or nephrotic presentation, can lead to secondary HTN due to increased renal sodium reabsorption.

Question 5

Ischemic stroke

Answer 5

Eligible patients with signs of acute ischemic stroke should be treated with intravenous thrombolysis. Patients with a cardioembolic source (atrial fibrillation) have an elevated risk of recurrent stroke and require long-term anticoagulation (rather than antiplatelet therapy). To reduce the risk of intracerebral hemorrhage, initiation of oral anticoagulation is typically delayed (48 hr to 2 weeks).

Question 6

Spontaneous bacterial peritonitis

Answer 6

Spontaneous bacterial peritonitis is a serious complication of cirrhosis and is diagnosed when greater than or equal to 250 neutrophils are found in the peritoneal fluid. Empiric antibiotic therapy must be started immediately while waiting for culture results, especially if there are other clinical indicators of infection. IV albumin has been associated with improved renal function and decreased mortality.

Question 7

Cirrhosis

Answer 7

The Model for End-Stage Liver Disease (MELD) score is an objective measurement that used serum bilirubin, INR, serum creatinine, and serum sodium levels to determine 90-day mortality in patients with advanced liver disease. The MELD calculation is commonly used in assessing candidates for transplant livers.