Ob/gyn

Question 1

UTI

Answer 1

Ecoli , proteus, klebsiella, enterococcus, GBS, staph saprophyticus,

Tx: nitrofurantoin, bactrim, keflex, amoxicillin

Question 2

Pyelo tx

Answer 2

FQ, amp and gent, ceftriaxone, cefazolin

Question 3

Bacterial vaginosis

Answer 3

• Amsel criteria (need 3 of 4):

1. thin, white, homogeneous discharge
2. clue cells on microscopy
3. pH of vaginal fluids >4.5
4. release of fishy odor on adding 10% KOH (+ whiff test)

Can incr risk of PROM, preterm labor, intraamniotic infxn,

Tx: po flagyl 500 bid x 7 d or topical or
Po clindamycin 300 bid x 7 d

If pregnant:
» Metronidazole 500 mg PO twice daily x 7d.
» Metronidazole 250 mg PO three times a day x 7d.
» Clindamycin 300 mg PO twice daily x 7d.

Question 4

Prom

Answer 4

Fever, uterine tenderness, malodorous amniotic fluid

Amnio fluid with decr glucose, incr interleukin correlates well with infxn

Tx: amp and gent

Question 5

Cmv perinatal infxn

Answer 5

1 cause of perinatal infxn during preg

Greatest risk to infant in 1st trimester
If maternal infxn detected, get IgM and IgG ; if incr levels if IgM with rapidly decr sequential titres then primary infxn

If IgG + with concern of new exposure, recheck ab testing in 2-4 wks

Question 6

GBS

Answer 6

Tx: ampicillin, penicillin, or cefazolin

Question 7

HSV

Answer 7

Tx pregnant f with active lesions (esp 3rd trimester) with acyclovir or valtrex

If frequent outbreaks, Consider daily suppression dosing at 36 wks until delivery

If active lesions at delivery, c/S
If partner HSV + And mom HSV -, safe sex and place partner on suppression

Question 8

Parvovirus B19

Answer 8

60% of moms are immune
Infxn during 1st trimester leads to fetal loss
Infxn in 2nd and 3rd trim leads to anemia, hydrops fetalis, cardiac failure

Hydrops: transfusion, close surveillance

Question 9

Rubella

Answer 9

Infected Neonates shed for months (up to a year)

Cong dz: deafness, eye defects, heart dz, pigmentary retinopathy, CNS issues (microcephaly), MR, purpura, HSM, jaundice, bone dz

Question 10

Toxoplasmosis

Answer 10

To decr risk to mom, don’t eat undercooked meat, gloves when preparing meat, wash veggies, keep cats indoors, wear gloves when changing litter)

Infxn: Cong defects ,check infant head CT, retinal exam, CBC, lfts, csf studies

Question 11

VZV exposure?

Answer 11

Give VariZig within 96 hrs

Question 12

Septic pelvic thrombophlebitis or ovarian v thrombosis?

Answer 12

Sx: tachycardia, abd pain, palpable ropey mass (R>L)

Dx: incr WBC, pelvic ct

Tx: broad spectrum abx, heparin

Question 13

Abx to avoid in pregnancy

Answer 13

Tetracycline

Question 14

Abx ok in pregnancy?

Answer 14

Pcn, amoxicillin
Acyclovir
Azithromycin
Isoniazid