Respiratory Disorders

Question 1

T or F: respiratory exchange is more efficient in pregnancy

Answer 1

true

Question 2

T or F: respiratory disease (e.g. asthma, pneumonia) are typically improved in pregnancy

Answer 2

false

increased oxygen requirements and adaptations

Question 3

What is the effect of estrogen and increased blood volume on respiration?

Answer 3

capillary engorgement –> swelling and increased mucous production

Question 4

What is the effect of progesterone on respiration?

Answer 4

1) relaxation of veins –> increased pooling –> swelling of mucous membranes
2) hyperventilation
3) respiratory alkalosis w/ increased expired CO2

Question 5

What is the effect of relaxin on respiration?

Answer 5

increased chest cartilage pliability –> increased chest circumference

Question 6

What is the effect of the growing uterus on respiration?

Answer 6

diaphragm rises ~4cm + thoracic circumference increases ~6gm + costal angle widens –> increased thoracic breathing + diaphragmatic breathing

Question 7

What is the effect of reduced PCO2?

Answer 7

helps move:

• fetal CO2 waste to gestational carrier
• O2 from gestational carrier to fetus

Question 8

What is the cause of bronchitis?

Answer 8

usually viral

Question 9

s/sx bronchitis

Answer 9

cough lasting median 18 days

Question 10

bronchitis tx

Answer 10

• supportive care

- sx management: humidifier, OTC cough suppressants, cough drops

Question 11

s/sx flu

Answer 11

• fever
• HA
• fatigue
• body aches
• malaise
• cough

Question 12

flu dx

Answer 12

• clinical dx
• flu swab
• CXR, depending on sx

Question 13

flu tx

Answer 13

1) tamiflu 75mg BID for 5 days

2) Zanamivor 10mg (2 inhalations) for 5 days

Question 14

What is the most significant complication of pneumonia?

Answer 14

preterm delivery

• outcome of hypoxemia and acidosis
• also poor fetal growth and perinatal loss

Question 15

T or F: pneumonia vaccine is not safe in pregnancy

Answer 15

false

Question 16

s/sx pneumonia

Answer 16

• productive, purulent cough
• pleuritic chest pain
• dyspnea
• chills
• fever! differentiate b/w bacterial and viral

Question 17

What are maternal complications of pneumonia?

Answer 17

• respiratory failure
• mechanical ventilation
• emphysema

Question 18

pneumonia dx

Answer 18

• CXR* –> +lobular pattern
• r/o flu w/ swab
• do not need to identify microbe

Question 19

What are the 2 most common pneumonia pathogen?

Answer 19

1) streptococcus pneumoniae

2) H. influenzae

Question 20

How should pneumonia be managed?

Answer 20

AGGRESSIVELY

• start abx w/in 4h of admission to hospital
• macrolide for mild illness
• add beta-lactam for severe illness
• avoid quinolones* unless life-saving (fetal cartilage damage)

Question 21

pneumonia monitoring

Answer 21

• maintain PO2 70mmHg (necessary level for fetal oxygenation)
• no fever/sx for 48h
• d/c IV –> 10-14 day course of PO tx (cephalosporin, macrolid)

Question 22

What tx of a pregnancy comorbidity can induce asthma?

Answer 22

aspirin for preeclampsia

Question 23

T or F: asthma meds are safe in breastfeeding

Answer 23

true

Question 24

T or F: fetal surveillance is necessary regardless of asthma control

Answer 24

false

not necessary if well-controlled; serial growth and NST in moderate to severe asthma

Question 25

What are the most significant poor outcomes of asthma in pregnancy?

Answer 25

1) PTB 2) increased preeclampsia if daily sx 3) increased c-section w moderate to severe disease

Question 26

What are objectives measures for assessment and monitoring of asthma?

Answer 26

1) Forced expiratory volume 1 (FEV1) = BEST measure of pulm function; <80% = poor pregnancy outcomes 2) self-monitoring using peak expiratory flow (PEF) w/ peak flow monitor; PEF does not change w/ pregnancy

Question 27

Describe monitoring w/ peak flow monitors

Answer 27

- 380-550 L/min = typical in pregnancy - should achieve at least 80% of best PEF - moderate to severe disease should test BID

Question 28

List methods to avoid/control potential asthma triggers

Answer 28

- use allergen-impermeable mattress and pillow covers - remove carpet - wash bedding weekly in hot water - avoid tobacco smoke - reduce humidity - leave house while being vacuumed - no pets/stuffed animals in bedroom

Question 29

Describe asthma rescue therapy

Answer 29

short-acting beta-agonist (e.g. albuterol) 1-2 inhalations q4-6h PRN also available as nebulizer sol'n, syrup, tablet; prednisone also acceptable

Question 30

Describe long-term asthma control

Answer 30

inhaled corticosteroids (ICS); long-acting bronchodilators - if not well-controlled, start low/medium dose ICS and refer - can be advanced to ICS + LABA (mod-severe) or ICS + LABA + PO prednisone (severe persistent)

Question 31

What populations are at high risk for TB?

Answer 31

- close contact w/ infected people - birth in country w/ high rate TB - low income - alcohol addiction - IV drug use - residency in long-term facility or prison - health professionals that work in these facilities

Question 32

What are risk factors for TB?

Answer 32

- HIV - recent TB infection - IV drug use - solid organ transplant - chronic renal failure - DM - underweight by >15%

Question 33

s/sx TB

Answer 33

- cough - weight loss - fever - malaise and fatigue - hemoptysis

Question 34

T or F: latent disease presents equal risk of poor pregnancy outcomes as active disease

Answer 34

false carries no risk

Question 35

What values indicate a positive PPD?

Answer 35

high-risk population: >5 | "normal" population: 10-15

Question 36

What is PP management of a pt w/ active TB?

Answer 36

- separate mother from newborn | - CAN breastfeed

Question 37

What is management of a newborn born to parent w/ active TB?

Answer 37

- require multivitamin supplement - must have PPD at birth and 3mo - isoniazid (INH) prophylaxis until maternal disease has been resolved for 3mo To add a row,

Question 38

What are risk factors for pulmonary embolism?

Answer 38

- age > 35yo - obesity - trauma - immobility - infection - smoking - nephrotic syndrome - hyperviscosity syndrome - cancer - surgery, esp ortho - prior DVT or PE - hospital admission

Question 39

What are pregnancy-related risk factors for pulmonary embolism?

Answer 39

- increased parity - PP endomyometritis - operative vaginal delivery - c-section

Question 40

PE dx

Answer 40

- EKG - CXR - canNOT confirm dx!! - V/Q scanning = modality of choice - no role for D-dimer - ABGs and O2 sat = limited value in assessment

Question 41

What will be seen on CXR w/ PE?

Answer 41

- pleural effusion - pulmonary infiltrates - atelectasis - elevated hemidiaphragm

Question 42

How is PE treated?

Answer 42

20wk heparin course, then prophylactic heparin PRN