Lecture 13 Flashcards Preview

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Flashcards in Lecture 13 Deck (136):
1

What is Melasma (colasma)?

Mask of pregnancy

2

What is PUPP?

Pruritic urticarial papules and plaques of pregnancy

3

How do you treat PUPP?

Not many- maybe run ice cubes across stomach, take a Benadryl

4

What is the ratio of the plasma to RBC?

3:1 (no blood loss, just a dilution effect)

5

Under what levels of Hb is considered non-physiologic anemia?

<10-11 g/dL

6

What is the name for the proportion of blood composed of RBCs?

Hematocrit

7

What hematocrit (Hct) is considered non-physiologic anemia?

<30%

8

Hemoglobin multiplied by what gives you about an average of what you see on the Hct?

3

9

What will anemia look like on a smear?

Pale, hollowed out in center
microcystic, hypochromic

10

What are the three main types of neural tube defects?

Spina bifida
Encephalocele
Anencephaly

11

What chains of Hb are normal in the adult

2 alpha
2 beta

12

What type Hb does a fetus up to about 24 weeks makes?

Hb F

13

What is the name of alpha thalassemia where they are missing all 4 genes? incompartible with life, in utero fetal demise

Bart's Hb

14

In sickle cell HB A is replaced with what?

Hb S

15

What type crises do people with sickle cell anemia have?

Vaso-occlusive crisis

16

How do you diagnosis sickle cell disorders?

Hb electrophoresis

17

What number of colonies are considered asymptomatic bacteruria?

>10^5 colonies bacteria of urine culture

18

What can asymptomatic bacteruria develop into?

Cystitis (UTI) --> pyelonephritis

19

When do you do a urine culture?

Every first prenatal visit

20

If a mom has asymptomatic bacturia what do you do? (same for if they develop UTI)

3 days worth of antibiotics (ampicillin, cephalexin, or nitrofurantoin) and monitor w/ periodic culture

21

What is a good way in the urine to tell if mom is dehydrated?

Ketones

22

How do you treat pyeloneprhitis in a pregnant women?

Hospitalized (at risk of premature labor)

23

If a patient has the following what do you think they have: CVA tenderness, microhematuria, malaise, dehydration, no fever?

Calculi

24

How do you treat renal calculi

hydration, strain urine, watch for infection or obstruction

25

How much should a women with a normal weight gain in pregnancy?

25-35 lbs

26

How much should an underweight patient gain during pregnancy?

28-40 lbs

27

How much should an overweight women gain during pregnancy?

15-25 lbs

28

How much weight should an obese women gain during pregnancy?

11-20 lbs

29

How much water should a pregnant women drink?

six 8 oz glasses plus an additional 8 oz for every hour of activity

30

How much caffeine should pregnant women have?

<150-300 mg/day

31

What weeks does morning sickness usually occur?

4-14 weeks (peaks at 7-12)

32

What can help w/ morning sickness?

Ice chips, popsicles, small frequent meals, avoid triggers, ginger (crystallized) 250 mg capsules, only take 1/2 of prenatal vitamins at a time

33

To help with N/V what vitamin can a pregnant women take?

B6 BID-TID (10-50 mg)

34

What is the name for when a pregnant women has N/V and starts to lose weight (>5%) ?

Hyperemesis gravidarum

35

How do you treat hyperemesis gravidarum?

IV hydration, possible hospitalization

36

What should you R/O with hyperemesis gravidarum?

Acute fatty liver of pregnancy

37

What is the ddx for N/V with weight loss?

appendicitis, calculi, pyelonephritis, hepatitis, GB, hyperthyroid

38

If a pregnant women has Reflux what recommendations can you give?

Don't lie down after eating
Avoid ETOH, citrus, caffeine, carbonated drinks
Take OTC antacids if dietary changes not helpful

39

What are symptoms of cholecystitis?

F/V/RUQ pain

40

How do you treat cholecystitis?

Supportive or surgical w/ obstruction or acute abdomen

41

If a women has itching, particularly on hands and feet what should you suspect?

Intrahepatic cholestasis of pregnancy

42

What are some physical symptoms of intrahepatic cholestasis of pregnancy?

Dark urine color
light color BM
fatigue or exhaustion
Loss of appetite
Depression
itching on hands and feet

43

How do you treat intrahepatic cholestasis of pregnancy?

Ursodeoxycholic acid

44

What do you need to monitor w/ intrahepatic cholestasis of pregnancy?

NSTs, serum bile and LFTs

45

What are some risk factors of intrahepatic cholestasis of pregnancy?

multi-fetal gestations, previous liver damage or prior IUP w/cholestasis

46

What is the biggest concern w/ MVA & DV?

Placental abruption

47

What is the test for Rh status?

Kleihauer-Betke test (looks for fetal cells in maternal circulation)

48

IF a women has : fever, tachycardia, altered MS, V/D, arrhythmia and a history of hyperthyroidism what do you think of?

Thyroid storm

49

What is the Rx for hypothyroid?

Levothyroxine (Synthroid)

50

How often should you check TSH with a pregnant women?

once per trimester after TSH levels stable

51

What is thyroiditis usually associated w/

IUP loss
hypothyroid

52

When does GDM usually occur?

2nd trimester

53

What does the placenta produce that causes mom's tissues to be less receptive to insulin?

HPL

54

With GDM what else does mom have more of?

TG and FFA (free fatty acids) and more of these go to the fetus

55

What are some risk factors of GDM?

AA< hispanic or Latin American, native american, family hx DM

56

What do you do to test GDM?

1 hour glucose challenge

57

What is the fetus as risk w/ GDM?

Sacral agenesis, cardiac anomalies, stillbrith, neonata hypoglycemia

58

WHat is the name to describe a neonate >4000 gm?

Macrosomia

59

What is the mom at risk for w/ GDM?

ecalmpsia, preterm delivery, C-sec, uterine atony/inertia --> PP hemorrhage

60

What do you want Hgb A1c under in women w/ DM?

<6%

61

When is the glucose challenge done if no risk factors?

24-28 weeks

62

How many grams of sugar do you give w/ the glucose challenge test (non-fasting)?

50 grams oral soluation and draw 1 hour later

63

What is an abnormal level for a 1 hour glucose challenge?

>140 mg/DL (indication of 3 HGTT)

64

For a women with GDM what do you want plasma fasting to be at?

90-100

65

What do you want post-prandial for GDM?

120-140

66

Do diabetic patients deliver past their due dates?

No, they will be scheduled before then

67

When do you recheck maternal glucose levels?

after delivery and 6-12 weeks after

68

What is the rule of 3 with asthma?

1/3 of women get better
1/3 worsen
1/3 stay the same

69

What is monitored in pregnant women w/ asthma?

Monitor peak expiratory flow rate or FEV1 & symptoms

70

With asthma patients when do you do Serial US & antenatal testing ?

>32 weeks

71

What does the NYHA classification used for?

Cardiac Disease classifications to show level of decompensation

72

What position for L&D do you like for women w/ cardiac disease?

Lateral position

73

What type of prophylaxis may be needed in pregnant women w/ cardiac disease?

Anticoagulation and antibiotic prophylaxis

74

What is the most common arrhythmia in pregnant women?

PAT (paroxysmal atrial tachycardia)

75

What should you suspect if a patient presents with fatigue, palpitations, nocturia, ankle edema, DOE, SOB/supine

Peri-partum cardiomyopathy

76

When do you screen for Group B Strep?

35-37 weeks

77

If a pregnant women has a positive culture for GBS what do you do?

antibiotic prophylaxis 4 hours pre-delivery through ROM and Labor and Delivery

78

If you have unknown status of GBS and a women is in labor what should you do?

Antibiotic prophylaxis

79

What happens to a baby w/ GBS?

Septic shock: Early onset: 1st week; late onset: >6 days-3 months

80

What should a women who has a partner with herpes simplex do?

Abstinence 3rd trimester w/ prodrome or lesions

81

When should you do a C-section with women w/ herpes simplex?

prodrome
active lesions or positive HSV glycoprotein at L&D

82

What can happen if a fetus is exposed to rubella the first trimester?

congenital reubella syndrome (deafness, cataracts, heart defects (PDA), mental retardation) or SAB

83

What labs do you for rubella?

IgM and IgG antibodies (if these are present = have infection)

84

Is immunization for Hep A ok when pregnant?

Yes since it is inactivated viral protein

85

What can you give if a women has been exposed to Hep A?

HAV Ig (immune globulin)

86

Can a women w/ Hep A breastfeed?

Yes, with proper hygiene precautions

87

Which is more serious, Hep B or Hep A?

Hep B can progress to chronic carrier state and can affect liver more

88

What lab do you check for for Hep B?

HBsAG (hep B surface antigen)

89

What transmission model is Hep B?

Vertical

90

If a neonate is thought to have Hep B what do you do?

IZ and HB Ig w/in 12 hours of birth

91

What reduces antepartum transmission of HIV/AIDS?

HIV + Antiretroviral, C-section
minimize duration ROM and fetal exposure to maternal blood

92

Can you vaccinate for HPV while pregnant?

No

93

How can you treat condyloma acuminata if present?

cyro, laster, TCA (Trichloroacetic acid)

94

If a women has an abnormal PAP during pregnancy what do you do?

Treat post partum

95

What may happen to the neonata if the mom has HPV (rare)?

rare laryngal papillomatosis (C-section not prevent)

96

Does syphilis cross the placenta?

Yes

97

If a women has a low titer w/ positive FTA for syphilis what has probably happened?

They are seroconverted

98

What do you use to treat syphilis in pregnant women?

Benzathien LA 2.4 single or weekly x 3

99

With the Jarisch-Herxheimer rxn what risk is there to the fetus?

Fetal demise
have patient check their temp/ make sure baby is still moving

100

If a baby has the following what should you suspect? Snuffles, HSM, jaundice, LAD, chorioretinitis, Hutchinson teeth, mulberry molars, saddle nose, saber shins

Congenital syphilis

101

What can happen with a neonate when the mom has chlamydia?

maternal azithromycin po
Neonate: purulent conjunctivitis at birth or pneumonia at 1-3 mos

102

If a patient has a short febrile illness or a clinical suspicion of CMV what should you do?

Test for presence of CMV antibodies: anti-CMV IgG

103

What can happen to the neonate with CMV?

Petechiae, HSM, jaundice, microcephaly, chorioretinitis, fetal hydrops
Long term: hearing loss, neurological disabilities

104

What is fetal hydrops?

Collect of excess fluid (can occur in many places)

105

Who do you mandatorily screen for toxoplasmosis?

moms with HIV/ AIDS

106

If a mom has a positive IgG for toxoplasmosis what does that mean?

Infection at some point in time

107

If a mom has a positive IgM for toxoplasmosis what does that mean?

Recent infection

108

What are some risks to the neonate with toxoplasmosis?

Infants infected before birth often show no symptoms at birth but develop them later in life w/potential blindness, mental retardation, chorioretinitis, hydrocephalus & seizures
Other risks: SAB, stillbirth, congenital issue

109

Can you be vaccinated for varicella while pregnant?

No

110

What can you give a mom exposed to varciella?

VZIG (immunoglobulins) w/in 72 hours but doesn't protect fetus

111

For parvovirus what do you screen?

B19 igM and IgG

112

If a women has a positivei B19 IgM what should you do for parvovirus?

Do a US to r/o hydrops

113

What do you prescribe w/ a pregnant women w/ migraine?

Acetaminopehn w/ or w/o codeine

114

What type women may need more folate supplements?

Epileptic women

115

What are some risk factors for antenatal depression?

Unplanned/unwanted IUP, socioeconomic stressors, current/past depression, FHx

116

How long does PP blues last?

2-4 days post birth; come and go and gone 1-2 weeks

117

Asthma Severity Classification: Intermittent

Frequency: 2 days/week or less
Nighttime awakening: Twice/month or less

118

Asthma Severity Classification: Severe persistent

Frequency: symptoms throughout day
Nighttime awakening: 4 times/week or more

119

Asthma Severity Classification: Moderate persistent

Frequency: Daily Symptoms
Nighttime awakening: More than once per week

120

Asthma Severity Classification: Mild persistent

Frequency: more than 2 days/ week, but not daily
Nighttime awakening: More than twice per month

121

What do you need to confirm GDM?

Glucose Challenge Test (50g solution and draw 1 hour later)
If abnormal: 3 HGTT w/ 100g solution (2 of 4 values are abnormal = GDM)

122

NYHA: Class I

No cardiac decompensation

123

By NYHA, what class show no symptoms of cardiac decompensation at rest, but marked limitations of physical activity?

Class III

124

NHYA: Class IV

Symptoms of cardiac decompensation at rest, increased discomfort with any physical activity

125

BY NYHA, what class shows no symptoms of cardiac decompensation at rest and minor limitations of physical activity?

Class II

126

What do you do to help with maternal cardiac function and fetal well being with a CV problematic patient?

Prevent maternal stress (anemia, cardiac workload, weight gain, physical activity/work)
L&D (lateral position, shorten 2nd stage, epidural)
Anticoagulation and antibiotic prophylaxis as needed
Close monitoring post partum

127

What are risks of rheumatic heart disease?

maternal risk subacute bacterial endocarditis, heart failure, embolic events, fetal loss

128

When is it common to have peri-partum cardiomyopathy?

Last month of IUP or 1st 6 months PP

129

What signs and symptoms are common with peri-partum cardiomyopathy?

fatigue
palpitations
nocturia
ankle edema
DOE
SOB/supine

130

If a mom gets the live attenuated rubella vaccine, how long should she wait to get pregnant?

4 weeks before attempting IUP

131

During the 1st prenatal visit, what test is done to confirm HIV/AIDS?

ELISA w/ Western blot

132

If the initial HIV/AIDS test is negative, when should you repeat it?

3rd trimester for high risk pt (contracts STD while pregnant, HIV+ partner, adds additional partners while pregnant, high HIV prevalent region)

133

What is the most likely hx for someone with toxoplasmosis?

cats in household and contact with infected cat feces

134

What is Congenital Varicella Syndrome?

1st or early 2nd trimester maternal infections causes LBW, scarring on skin, limb hypoplasia, microcephaly

135

If a baby has been exposed to Parvovirus and has hydrops, what should be done?

intrauterine transfusion and monitor fetal growth

136

What are the risks of parovirus?

SAB, hydrops, fetal death