OBGYN & ID Flashcards
(29 cards)
Chlamydia treatment
100mg doxy BID x7d or 1g azithro
test of cure if suboptimal treatment, pre-pubertal or pregnant or sx
complications:
- PID, infertility, ectopic pregnancy, chronic pelvic pain, Fitz Hugh Curtis (liver ix), neonatal conjuctivitis/pneumonia, reactive arthritis
Tx for gonorrhoea
1x ceftriaxone 250mg IM + azithro 1g
Most common bacterial & viral STIs in Canada
bacterial - chlamydia
viral - HPV
oncogenic vs. warts strains of HPV
HPV 16 & 18 - onco
HPV 6 & 11 - genital warts
Herpes clinical picture
prodromal itch, burning, tingling
7-10d shallow ulcers with small vesicles, inguinal LAD, fever with first eruption, subsequent are shorter, less severe and less frequent
Tx: acyclovir, famcidovir and valacyclovir 7-10d & 5d for recurrent & suppressive therapy if q2months
Transmission - avoid sex from onset of prodrome until lesions completely healed (within 3 weeks) –> bc vesicle, opens, crusts over
syph treatment & stages
primary (under a month) - ulcer & LAD & negative test
secondary (2-6mo) - malaise flu like + maculopap rash soles/palms/trunk
latent - no signs but labs
tertiary - neuro & cardiac (aneurysm, dilated aortic root, tabes, paresis)
penicillin 2.4mill units IM single dose unless prolonged latent or tertiary
PID sx & treatment
lower abdominal pain, N/V, discharge, fever > 38.3, dysuria
cervical motion tendernes, uterine & adnexal tenderness, high ESR/CRP, lab dx of c/g, TV us or MRI showing thickened fluid filled tubes/free fluid
chronic - pelvic pain, dyspareunia
tx: 2 weeks of antibiotics
Explaining antenatal course
- Dating ultrasound b/w 8-12 weeks (EDD based on FTUS)
- 11-14 weeks: NT test (fluid behind neck - screen for Downs, Turners, cardiac abnorm)
- 18-20wks: anatomy scan
Antenatal genetic screening options
- NIPT (non-invasive prenatal test- pay out of pocket) - maternal blood for circulating fetal DNA 9 weeks onwards - high accuracy & high sensitivity (false positive rate of 0.1%) - results avail in 1-2 weeks BUT not covered mostly, doesn’t screen for NTD, have to confirm with invasive test
- if concern on NIPT, can do CVS 10-12weeks for dx instead of amnio after 15wks
- 11-14 weeks: **NT test **(fluid behind neck - screen for Downs, Turners, cardiac abnorm)
- 11-14 wks: eFTS (early first tri screen)
- IPS
- MSS
Vitamins required in pregnancy
400mcg (0.4mg) folate or 5mg if high risk (DM, epilepsy, anti-folate drugs, malabsorption disorders, hx of NT defects, thal or sickle cell, obseity
iron
calcium 1200mg daily
prenatal will have all of this, choline rich foods
When to administer anti-D AB to RH- women?
sensitizing event (APH, abdominal trauma, amniocentesis) & prophylactically at 28 weeks
*dose depends on Kleihauer-Betke test post event
When can you begin assessing symphseal fundal height (SFH)
20 weeks - should be within 2cm of GA (assessing for IUGR or macrosomia)
- 12 weeks fundus @ pubic symphysis
- 20 weeks fundus @ umbilicus
lifestyle advice for pregnant women
- food: avoid raw meat, fish, eggs, unpasteruized milk, deli meat/cured meats/hot dogs, cheese or shellfish & wash fruit/veg to reduce toxo
- vitamins & nutrients: iron, calcium, folate, omega 3s (2-3 servings of fish weekly - low mercury options)
- only need 300extra calories in second trimester, 450 extra in third tri and breast feeding (need 2200-2900cals/day)
- not eating for 2, gain approx 15-35lbs depending on pre-pregnancy BMI
- caffeine limit <300mg daily
- avoid constipation - fiber & can start metamucil
- may experience heart burn, back pain and frequency, hemorrhoids and increased vaginal discharge
- exercise: continue same level as pre-pregnancy, avoid contact or high risk (scuba)
- quit smoking & alcohol & rec drugs
- pets - avoid cat litter
- before you start any meds, check with doc
- travel: increased risk of VTE (compression stockings, hydrate and active)
- decrease plastic exposure & toxin exposure if possible
What initial OB visit labs will you order?
UA (asymp bacturia)
B-HCG
CBC, TSH, lytes, BUN Cr, ABO & Rh typing
HIV/Hep/VDRL screen, Rubella/VZV antibodies
pelvic exam (G&C swabs and pap if needed)
TB if worried
Parvo B19 if around young kids
HBa1c if concerned
Trimesters in weeks & preterm vs. term
First: To the end of 13 weeks
Second: 14- end of 27
Third: 28+ weeks
Term > 37 weeks
Preterm anything 36w6d and under
Reduced fetal movement mx
GTPAL
G: number of pregnancies (twin = 1 preg)
T - term deliveries
P - preterm
A - abortions or ectopic (<20weeks)
L - living children
Early pregnancy symptoms
N/V, breast engorg & tenderness, fatigue, urinary frequency, ameno
B-HCG how should it progress?
From time it is detectable (9d post conception in serum), should double every 48h until peaks (100K @ 8-10 weeks) - if not, concern for ectopic/miscarrige or inaccurate dates
When is gestational sac visible? Heart sounds? When can you use doppler u/s in clinic?
TVUS
- 5wk GA can see sac
- 6wk GA can see fetal pole & HR
Transabdominal can see pregnancy by 6-8 weeks GA
Doppler u/s in clinic by 10-12weeks GA
Period of organogenesis?
3-8 weeks
Medical conditions to screen for
DM, thyroid, epilepsy, mental health, congenital/developmental disorders, HTN, birth defects and genetic diseases, recurrent miscarriages, AI conditions (SLE, etc), DVT hx
