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MFM Written Boards > Maternal Disease > Flashcards

Maternal Disease Flashcards

1
Q

Bad fetal SFX thiazide

A

Thrombocytopenia, electrolyte

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2
Q

Bad fetal SFX ethacrynic acid

A

Ototoxicity, HTN

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3
Q

Bad fetal SFX furosemide

A

PDA (stimulates PGE2 synthesis)

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4
Q

How to make them worse?

  • Eisenmenger
  • Aortic stenosis
  • Mitral stenosis
  • IHSS
A

In order…

  • HypoTN (need to keep pressures > pulmonary)
  • HypoTN (need the preload)
  • Fluid overload, tachycardia
  • Tachycardia
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5
Q

Refractory VTach treatment

A

Amiodarone then defibrillate then (maybe) lido

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6
Q

Refractory maternal SVT treatment

A

CCB / beta blockers then adenosine then pace

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7
Q

Preeclampsia heme changes.
What increases?
What decreases?

A
  • INCREASE
    • Platelet production, platelet activation, TXA2 (which is supposed to activate platelet aggregation and yet…)
    • Endothelin. Cellular fibronectin, GF, VCAM-1, Factor 8 antigen, thrombomodulin.
    • Ischemic placenta => shoots sFlt-1 (VEGF antagonist) into the circulation
  • DECREASE
    • Platelet aggregation. Why?
      • Exhaustion
      • Count overall
    • Prostacyclin (PGI2) (which is an aggregation inhibitor so decrease of inhibitor should see more but nope because of previous bullet)
    • Nitric oxide
    • Anti-thrombin III, Angiotensin II [though activity of them increased; see below]
    • Renin, Aldosterone, GFR, Na and Cl in urine.
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8
Q

What happens to Antithrombin III and Angiotensin II in PreE?

A

Antithrombin III levels decreased.

Angiotensin II same-ish but increased sensitivity => vasoconstriction.

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9
Q

What LDH/AST ratio predictive of HELLP over TTP? (Low or high)

A

LOW = less hemolysis more LFT elevation = HELLP.

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10
Q

Eclampsia timing

A
  • 50% week 20-30
  • 20% intrapartum
  • 21% postpartum (and of these 90% will be w/in 7 days)
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11
Q

Highest asthma risks in pregnancy

A

PreE, IUGR = 15%

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12
Q

Ristocetin-cofactor result and why for…

  • vWD
  • Bernard-Soulier
  • Glanzmann
  • Wiskott-Aldrich
A
  • Low levels/quality vWF; abnormal.
  • vWF receptor deficiency; abnormal.
  • Integrin defect. NORMAL result!!
  • Defective platelets + eczema. Abnormal.
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13
Q

Inheritance vWD Type 1, 2, 3

A

AutoD (80%)
AutoD
AutoR

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14
Q

vWD treatment options

A

DDAVP increases f8 and vWF by 3-5x baseline in 30-60 min.

Also vWF, FActor 8, cryo

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15
Q

Electrophoresis result for beta thal minor / intermedia / major?

A

80-90% A, 5-10% A2, maybe F
In between; maybe 20-40% F
NO A. Variable A2. Basically ALL F.

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16
Q

Alpha thal cis/trans ethnicities

A
  • Alpha Thalassemia
    • Blacks: trans
    • Asians: cis
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17
Q

What is Factor XIII deficiency assoc with?

A
  • AutoR. XIII: persistent even fatal bleeding from umbilical stump.
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18
Q 
Mechanism of TH storm treatment...
Beta blocker
Thionamide
Iodine
Iodinated contrast
Glucocorticoids
Bile acid sequestrant
A 
Beta blocker
Decreases adrenergic tone
* If severe asthma and want to avoid BB, can use CCB (diltiazem)
Thionamide
Decreases synthesis
Iodine
Decreases RELEASE of Th hormone
Iodinated contrast
Decreases peripheral conversion
Glucocorticoids
Decreases peripheral conversion + correct adrenal insuff
Bile acid sequestrants
Reduce recycling TH
19
Q

Fetal effect of maternal HyperPTH?

A

IN utero hypercalcemia.
=> Fetal PTH is suppressed = BONES not calcified
Plus gest hypocalcemic once born

20
Q

DDx neonatal hypocalcemia

A
  • EARLY
    • Prematurity
    • Maternal DM
    • Birth asphyxia
    • IUGR
  • LATE
    • HypoPTH (can be due to DiGeorge — CATC-H = hypocalcemia)
    • High phosphate intake [bovine milk]
    • HypoMg
    • Vitamin D deficiency
21
Q

Maternal hypOparathyroidism. Fetal effect?

A

Neo HyperPTH, bone demin, IUGR, skeletal fractures, increased Ca.

22
Q

Mechanisms oral DM Rx? What two mechanisms in common? What unique to glyburide? to metformin?

A
  • BOTH decrease hepatic glucose and increase insulin sensitivity
  • Glyburide also stimulates beta cell release
  • Metformin also decreases intestinal absorption
23
Q 
Breastfeeding and...
Active TB?
Active VZV?
CMV?
Hep B? C?
Hep A?
Syphilis?
A
  • Active TB? Wait 2 weeks on anti-tuberculin therapy before starting to breastfeed
  • Active varicella? NO breastfeeding.
  • CMV? Breastmilk has both virus and the antibodies. OK!
  • Hepatitis B and C? Both in breastmilk (but they get a vaccine for Hep B.
  • Hep A not in breastmilk. OK!
  • Syphilis not in breastmilk. OK!
24
Q

HIV CD4 prophylaxis #s and Rx.

A 
PTMC Prophylaxis Takes Much Concentration
CD4 < 200 Bactrim for PCP
CD4 < 100 Bactrim for PCP and toxo
CD4 < 75   Add azithro for MAC
CD4 < 50   Add fluconazole for crypto
25
Q

Viral load and transmission

A

Viral load > 100k has 30% transmission

< 400 = 1% transmission

26
Q

Which Rx avoid due to brain malformations (animal)

A

efavirenz

27
Q

AZT most common and most severe side effect?

A

MCC anemia; most severe liver failure

28
Q

Infection / PTB effect? How?

A
  • Bacteria produce phospholipase A2 and endotoxin

* Phospholipase A2 => PG synthesis

29
Q

Myasthenia gravis Rx to avoid

A
  • Non-depolarizing muscle relaxants
    • Aminoglycosides and several other abx
    • Quinine
    • Terbutaline, ritodrine
    • Magnesium!!
30
Q

Myasthenia fetal effect:

A

impaired swallow: poly
decreased FM/breath: pulmonary hypoP
No movement: arthrogryposis multiplex congenita

31
Q

Neonatal MG

A

10-15% but won’t show up for 1 week because maternal Rx still in system

32
Q

Guillain Barre treatment?

A

Plasmapheresis or high-dose IVIG ideally within the first 1-2 weeks of symptoms (or up to 4 weeks).

33
Q

Lab changes AFLP

A
  • Increases NH3, uric acid (AKI), LDH, PT/PTT< FDP, bili, LFTs. WBC too.
  • Drop in glucose (liver failure), antithrombin III, fibrinogen, plt, H/H
34
Q

MC complications post-bariatric surgery

A
  • Post-bariatric surgery OB risks
    • Cesarean delivery
    • (Maybe) PTB
    • (Maybe) Growth restriction
35
Q

Disrupt folate => less of what amino acid?

A

Methionine

36
Q

MC vitamin deficiency vegetarians?

A

B12

37
Q

Dermatosis of pregnancy assoc w/ Low Ca?

A

Pustular psoriasis

38
Q

Highest fetal risk dermatoses of preg?

A

Pustular psoriasis and pemphigoid gestationis

39
Q

MC adverse after renal Xplant?

A

PTB

40
Q

Pre-renal changes
BUN:Cr
FeNa
Urine Na

A
  • BUN:Cr > 20:1
  • FeNa < 1%
  • Urine Na < 20
  • Osmolality high volume low
41
Q

Asx bacteriuria occurs in __%

Among these, __% develop pyelo if no tx

A

5$

40%

42
Q

Uterine anomalies PTB. Highest risk?

A

Didelphys > UniC > BiC > Septate

43
Q

Risk w/ pre w/ IUD in situ?

A 
Chorio (7%)
Also PTB (14%) but same whether removed/not.
44
Q

MC adverse event w/ SLE?

A

PTB

MFM Written Boards (9 decks)

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