CF: 21-25 Flashcards
(34 cards)
18 yo G2P1 @ 35 wk is taking PTU for graves. P/w 1 day hx of palpitations, nervousness, sweating, diarrhea. BP 150/110, HR 140, RR 25, temp 38.2. Anxious, disoriented, confused. Thyroid mildly tender and enlarged. DTRs 4+ w/ clonus. Leukocytosis.
Most likely Dx?
Best management?
- Thyroid storm
- BB, steroids, PTU
32 yo woman @ 33 wk who continues to blast cigs has US showing growth restricted fetus.
- Most likely Dx?
- 2 other things to check on US?
- Next step?
- 3 potential Cpx?
- IUGR
- Determine symm vs asymm IUGR, assess amniotic fluid
- Eval fetal well being
- PTB, fetal stress, intrauterine fetal demise
20 yo G1P0 @ 29 wk is being treated for pyelo w/ appropriate Abx and now c/o SOB.
- Dx?
- Mechanism?
- ARDS
- Endotoxin-mediated pulmonary injury
28 yo s/p C/S 1 wk ago p/w fever up to 102, myalgias, vomiting, hypoTN, confusion, and skin incision that’s infected with underlying tissue revealing brawniness and crepitance. Evidence of hemo-concentration and renal insufficiency.
- Dx?
- Next step in therapy (3)?
- Nec fasc
- Isotonic IVF, broad-spec Abx, and immediate surgical debridement
24 yo G1P1 s/p C/S 2 days ago for arrest of labor p/w fever to 102, no cough or dysuria. No abnormalities of breasts, lungs, CVAT, or incision. Fundus is somewhat tender.
- Dx?
- Most likely etiology?
- Best therapy?
- Endomyometritis
- Ascending infection of vaginal organisms (anaerobes > GNRs)
- IV Abx (gent and clinda)
For IUGR, how can you use US to determine asymm vs symm?
Look at HC vs FL and AC. HC is spared in asymm, while all 3 are decreased symmetrically in symm.
MCC of asymm IUGR?
Maternal vascular DO, like smoking, HTN, or drug use
MCC of symm IUGR?
Constitutionally small baby with no adverse problems
Name 8 major maternal factors for IUGR
- HTNsive disease
- Renal disease
- Cardiac disease
- respiratory disease
- Underweight and/or poor pregnancy weight gain
- Significant anemia
- Substances: tobacco, cocaine
- AMA
Name 3 major uterine/placental factors for IUGR
- Abruptio placenta
- Placenta previa
- Infection
Name 5 major fetal factors for IUGR
- multiple gestation
- aneuploidy
- congenital syndromes
- structural fetal malformations
- infection
How do you define IUGR?
Birthweight <10th percentile for gestational age
What is a biophysical profile?
Combo of US criteria and NST for fetal well-being conducted over 30 min. Assesses fetal breathing, movement, tone, and amniotic fluid
What sort of doppler flow study is helpful with IUGR?
Umbilical artery
What does reverse end-diastolic flow through the umbilical artery signify?
High stillbirth rate w/in 48 hr
What does absent end-diastolic flow through the umbilical artery signify?
Moderately high stillbirth risk- can obs in some cases
For suspected symmetric IUGR, how can you differentiate btwn dating error and actual IUGR?
Repeat US in 2-3 wk. If it shows adequate interval growth, then it’s probably just a dating error.
Early insults to fetal growth typically cause which type of IUGR?
Symm
How does perinatal morbidity and mortality change in infants born btwn 38-42 wk with bw 1500-2500 g?
30x incr from infants born btwn 10th-90th %ile
Name 6 neonatal morbidities assoc w/ IUGR?
- meconium aspiration
- NEC
- Hypoglycemia
- respiratory distress
- hypothermia
- thrmobocytopenia
Per the Baker hypothesis, what are 4 major long-term (adult) consequences of IUGR?
- CAD
- CVA
- HTN
- T2DM
Name 4 major infections associated with IUGR. Which of these is especially assoc w/ early-onset (<20 wk) IUGR?
- Toxo, hsv, parvo
- CMV is a/w early onset iugr
Is work-up for infection a/w IUGR always high yield?
No- after mid-gestation, yield becomes low
What’s often the earliest sign of IUGR detected on US?
Decreased AFI
