TrueLearn1 Flashcards
Dx of parvovirus in pregnancy
IgM, IgG.The IgM response indicates recent infection. IgM can be seen for 1 month up to several months after the infection. IgG antibodies indicate prior infection and immunity
Abx endocarditis ppx
augmentin
Most frequent non-rhesus antibody
The most frequently encountered non-Rhesus antibodies in pregnancy are the Lewis antibody and the I antibody. These antibodies do not cause hemolytic anemia because the immunoglobulin is type M (IgM), which does not cross the placenta.
ureter transection @ pelvic brim?
uretetroureterostomy
percentage seropositive for HSV2
26%
most common sfx external beam radiation
Atrophy of the epithelium is the most consistent side effect of radiation therapy causing diarrhea, acute cystitis, vaginal mucositis, and skin erythema.
death/neuro injury twin fetal demise
Surviving monochorionic twin
neurological injury (18%)
death (15%)
Surviving dichorionic twin
neurological injury (1%)
death (3%)
embryo implantation steps
Implantation consists of three stages. Apposition is the first step and consists of the embryo making contact with the endometrium. Adhesion is the second step, during which the embryo has further contact with the endometrium and becomes more adherent. Invasion is the final step in which the embryo becomes embedded.
protein S change during pregnancy
decrease
congenital rubella syndrome
, congenital rubella syndrome (CRS) has multiple anomalies. If exposure is suspected during the prenatal course, one should expect to see evidence of cardiac abnormalities, defects involving the central nervous system and its development, evidence of growth restriction, and hepatosplenomegaly
fetomaternal hemorrhage- most common timing
Fetomaternal hemorrhage is most likely to occur at the time of delivery.
warfarin embropathy
This includes nasal and midline facial hypoplasia and stippling of the vertebral and femoral epiphyses, which are rings noted near the epiphyseal plates on ultrasonography.
half life, steady state of oxytocin
The half-life of oxytocin is approximately 3–5 minutes, therefore, the uterus will start contracting within 3–5 minutes of beginning an oxytocin infusion. Steady-state plasma levels are reached at about 40 minute
pregnancy ABG
Maternal partial pressure of carbon dioxide drops from a range of about 36–44 mm Hg to a range of 28–32 mm Hg in pregnancy. -> “NORMAL” co2 would be a late finding
endometritis when to dc abx
Antibiotics are continued until the patient has been afebrile for 24 hours. No further antibiotics are needed,
mitral valve stenosis labr mgmt
Avoiding an increase in preload is absolutely the most important factor, so fluid restriction is key to proper management.
signs of severe malnutrition in the elderly
Risk Factor Parameter
BMI BMI <18.5
Serum albumin Serum albumin <3.0 g/dL in the absence of hepatic or renal failure
Unintentional weight loss >10–15% within the most recent 6 months
pathogenesis of endometriosis
Retrograde menstruation leading to attachment and implantation of endometrial glands and stroma on the peritoneum
Increase in cyclooxygenase-2 (COX-2) leading to local overproduction of prostaglandins
Increase in aromatase activity leading to overproduction of local estrogen
Progesterone resistance decreases the antiestrogenic effect of progesterone, which amplifies the local estrogenic effect
cardiac abnormalitiy most associated w/ epidural placement mortality
aortic stenosis (bicuspid valve)- decrease resistance leads to decreased preload
diabetes medication mgmt preop
Patients taking long-acting insulin at night or in the morning should take one-half to two-thirds of the usual dose; with intermediate-acting insulin taken twice daily, the normal dose should be given the night before and long-acting insulin should be taken at one-half to two-thirds of the usual dose.
Short-acting insulin should be held on the morning of surgery because it increases the risk of hypoglycemia.
Sulfonylureas such as glyburide increase the risk of hypoglycemia and should be held on the morning of surgery.
Thiazolidinediones may worsen fluid retention and can lead to heart failure and should be held on the morning of surgery.
Metformin increases the risk of renal hypoperfusion, lactic acidosis, and tissue hypoxia and should be held on the morning of surgery.
Sodium-glucose cotransporter 2 inhibitors increase the risk of hypovolemia and should be held on the morning of surgery.
origin of the fetal umbilical arteries
internal iliac
5a reductase deficiency- what develops abnormally, internal or external
external (penis, scrotum), urethra, prostate
most common bug for bronchitis in pregnancy
parainfluenza
what is the most sensitive test for a concealed abruption?
ctx on monitor (not coagulopathy b/c later sign)
most common congenital infection?
CMV, though often asymptomatic
what is the incidence of postterm syndrome in postterm pregnancy
10-20%
best peripartum cardiomyopathy med
metoprolol- reduces pre-post load
PTB rate in US
12%
how long exclusiveley breastfeed, how long breastfeed w/ supplementation
6 and 12 mo
uncomplicated twin gestation delivery timing
Monochorionic-monoamniotic 32–34 weeks
Monochorionic-diamniotic 34–37 w6d
Dichorionic-diamniotic 38 weeks
during menstrual cycle- what makes progesterone and what makes estrogen
progesterone: theca (incidental breast ductal prolif)
estrogen: graafian folicle (signals hypo/pit, and theca)
cause of hypotension following epidural
loss of sympathetic innervation (decreased vascular tone and increased vasodilation)
FDA approved for hirsutism in PCOS
eflurnithine
most helpful test for vW dz dx?
factor VIII (levels decreased b/c not boudn by vWf) PTT would be INCREASED d/t above (intrinsic)
most common nerve injury w/ pfannensteil
iliohypogastric
contraindication for terb
maternal cardiac arrhythmia
sickle cell dz inheritance and mode of dz
autosomal recessive, beta chain malformation
ileus vs SBO?
ileus absent bowel sounds, SBO “tinkling”
when to treat ITP? Tx modalities and time to make a difference?
clinical bleeding, plt <30 even w/o sx, epidural/spinal (needs plts >70), c/s or surgery (needs plts >50)
steroids- 4-14 days (peaks 2-3 wk)
IVIG- 1-3 days (peaks about 7 days)
AFP sensitivity for open NTD and anencephaly?
65-80% and 95%, respectively
what is the gold standard for dx of renal artery stenosis?
renal arteriography
normal cord gas values
Normal Umbilical Artery Values pH 7.28 ± 0.05 PCO2 49.2 ± 8.4 mm Hg PO2 18.0 ± 6.2 mm Hg HCO3 22.3 ± 2.5 mEq/L Base deficit 4 ± 3 mmol/L
UTI incidence young women
0.5 per person year
anticoagulation in renal insufficiency
unfractionated heparin,[ LMWH is excreted by the kidneys]
neonatal HSV infection- most common sites
Disseminated disease
~25% Central nervous system disease ~35% Disease limited to the skin, eyes, or mouth ~45%
hyst route w/ highest ureteral injury risk
laparoscopic (7/1000)
untreated hyperthyroidism in pregnancy can result in
hydrops, IUFD, IUGR
call-exner bodies path description
granulosa cell. microfollicular pattern with numerous small cavities that may contain eosinophilic fluid.
what percentage of mature teratomas will develop into squamous cell cancers?
1%
percentage of pregnancies affected by any kind of thrombocytopenia
7-12%
severe refractory mastalgia after OCP tx?
NSAIDs, danazol (high risk of hirsutism though, cant take more than 6mo)
msot common way to contract toxo?
udnercooked pork, lamb (not litter box)
By how much does breastfeeding increase maternal caloric requirements?
500 cal/day
which is the BEST time to perform hysteroscopy in a premenopausal woman?
The early proliferative phase of the menstrual cycle is when the endometrial lining is the thinnest. Performing hysteroscopy during this time of the cycle allows for better visualization of anatomical abnormalities such as polyps. The thin lining also allows for easier removal of masses noted
the MOST common lesion identified in uterine papillary serous carcinomas on microscopy
psammoma body (looks like a onion cut in half)
STI ppx post exposure (date rape etc)
gonorrhea, chlamydia, hep B, trich
What is the relative risk of developing breast cancer with a diagnosis of atypical ductal hyperplasia?
ADH conveys a substantial increase in the risk of breast cancer, both ipsilateral and contralateral. That risk is estimated at 4.5 to 5.0.
metabolic syndrome
3+ must be present, for women:
BP > 130/85 mm Hg
BG >100 mg/dL
HDL <50 mg/dL
TG >150 mg/dL
Waist circumference >35 inches (88 cm)After an eclamptic seizure, which region of the brain is MOST likely to be abnormal on MRI?
occiptial (least common is temporal)
most common lymph node upper 2/3 vagina (ca spread)
pelvic (the deep inguinal drains the lower third of vagina
protein abnormality most commonly associated w/ AFLP?
deficiency of LCHAD
heparin MOA
binds and activates antithrombin, which inhibits thrombins change of fibrinogen to fibrin
treatment of choice for varicella pneumonia during pregnancy
IV acyclovir
hep c and cholestasis of pregnancy relationship
over 20x more likely to have ICP
What is the CORRECT way to document the perinatal death rate?
live births and stillbirths/1000
ITP and steroid admin- when do you notice a difference and when is peak effect?
should notice change w/in 4-14 days, peak is 2-3 wks
most predictive of neonatal opioid CNS depression
relative infant dose in mg/kg
complete vs partial mole histology, p57 stain?
complete = diffuse villous edema, negative p57 partial = focal/variable villous edema, pos p57
Diagnosis of post molar gestational trophoblastic neoplasia is made by either:
a) hCG plateau (four values within +/- 10%) over 4 weeks or
b) hCG rise of 10% across 3 values over two weeks
Classic urethral diverticulum triad
- postvoid dribbling
- dysuria
- dyspareunia
how long after contraction of HIV does it take for a positive test? how often should you retest after assault?
it takes 3-4 wks before a pt will test positive. you should retest at 6 wks, 3 mo, and 6 mo.
sequence of the layers of the bladder from inner to outer?
transitional epithelium, lamina propia, submucosa, detrusor, adventitia
at what advanced maternal age is there an increased rate of stillbirth @ 39 wks?
40 y
how long postpartum does it take for the uterus to completely involute
4 wks
indications for cerclage
History 1 or more 2nd trimester losses due to painless cervical dilation AND absence of abruption OR prior 2nd trimester cerclage due to painless cervical dilation
Exam Finding of dilated cervix in the 2nd trimester
Ultrasound Current singleton pregnancy with a short cervical length (less than 25 mm) before 24 weeks of gestation in addition to a prior spontaneous preterm birth at less than 34 weeks of gestation
of women who are seropositive for HSV, what percentage are aware of their positivity?
15%
what is the most common cause of fistula dz in USA? what is the best dx study for identify urogenital fistula?
hysterectomy = most common cause (about 10% are d/t obstetric causes in US). best test is cystouretheroscopy
how does preeclampsia predispose pts to PPH?
exacerbates atony and coagulation, pts have RR of >3 for PPH
The borders of the femoral triangle consist of which anatomical structures?
sartorius, adductor longus, inguinal ligament
vesicovaginal space borders
anterior vagina, posterior bladder, vesicouterine ligaments
pararectal space borders
base of cardinal ligament, ureter, internal iliac a
paravesical space borders
obturator internus, internal iliac a, arcus tendineus
retropubic space borders
transversalis fascia, urethra, pubic symphisis
what percentage of moms experience postpartum blues?
40-80%
IUFD fetal workup
fetal autopsy, fetal cytogenetics, placenta pathology
lynch syndrome colonoscopy initiation and frequency
q1-2 years starting @ age 20-25 or 2-5 yr before youngest relative dx
u/s frequency after parvo exposure
q 1-2 wks for 8-12 wks after exposure
when do you vaccinate for shingles in immunocompetent pts?
age 50. two doses, give 2nd dose 2-6 mo after first
isoretinoin birth defects
Defects as a result of isotretinoin use include external ear malformations, cleft palate, micrognathia, conotruncal heart defects, ventricular septal defects, aortic-arch malformations, and certain brain malformations.
first degree relatives and NTD risk
Family History of NTD Risk of Fetal NTD 1 parent only with NTD 4.5% 1 parent with NTD 1 sibling with NTD 12% 2 parents with NTD No affected siblings 30% 2 parents with NTD 1 affected sibling 33%
pelvis shapes are their associated arrest d/o
gynecoid- normal, most favorable
anthropod- triangle shaped, least favorable
android- oval shaped, OP arrest
platypelloid- least common, transverse arrest
what are the daily recommended iodine intake values for nonpregnant, pregnant, and breastfeeding women?
150, 220, 290 respectively
What is the carrier frequency of factor V Leiden in White pts?
5%
what is the difference between surrogate and proxy consent?
surrogate= non-legal decision maker in emergency proxy= pre-arranged individual for decision making
what are the approximate changes of a preterm birth and PPROM for CKC, respectively? What about of PTD/ PPROM in the normal population?
10, 15%
12%, 3%
what is the most dangerous fetal arrythmia? why?
atrial flutter. high rates of hydrops. even if no hyrdops most will have arrhythmia later in life.
most conclusive dx and best tx
venogram, selevtive venous embolism
within what time window should HIV PEP be started?
72 hrs
