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51 Cards in this Set
- Front
- Back
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Q250. Hyperemesis Gravidarum - What is it; Risk factors
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A250. Persistent vomiting => wt. loss > 5% (or poor wt. gain); dev. of dehydration and ketoacidosis; persists past 16-18 weeks – rare, can damage liver risk factors; nulliparity; molar pregnancy (increased B-hCG); multiple gestations
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Q251. Hyperemesis Gravidarum - Dx
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A251. Serum electrolytes; hypoK-hypoCl metab alkalosis; urine ketones; BUN/Cr
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Q252. Hyperemesis Gravidarum - Tx
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A252. IV hydration; correct electrolyte def, Mg, P; antiemetics; fluids => freq. small meals as tolerated
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Q253. Gestational DM - What is it; Risk factors
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A253. 3-5% of all pregnancies; usu due to of late pregnancy - usu Dx 24-28 weeks; hypergly in 1st trimester - usu means preexisting, may be due to insulin-antag hormones from placenta risk factors; > 25 y/o; obesity; personal or family History; prior macrosomia; congen deformed infants
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Q254. Gestational DM - History/PE
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A254. Typically asymp; edema; polyhydramnios; LGA - warning sign
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Q255. Gestational DM - Dx
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A255. UA tests done 24-28 weeks; 2 abnorm glu tests to include - fasting >= 126 mg/dL, random >= 200 or abnorm GTT; 1 hr (50g) GTT >140 suggestive, confirm with 3 hr (100g) GTT - any 2 of following:; fasting >= 95; 1 hr >= 180; 2 hr >= 155; 3 hr >= 140
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Q256. Gestational DM - Tx
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A256. Tight maternal glu control - 90; ADA diet; regular exercise; add insulin if diet insuff. no oral hypogly; periodic US and NST; intrapartum insulin and dextrose during delivery; may need to induce labor at 38-40 weeks
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Q257. Gestational DM - Complications
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A257. > 50% develop glu intolerance and/or DM Type 2
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Q258. Pregestational DM & Pregnancy- What is it
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A258. HbA1C > 10% has ↑ risk of - congen malformations; ↑ mat./fetal morbidity during L&D
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Q259. Pregestational DM & Pregnancy- Management of Mom
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A259. Prenatal care; nutrition counseling; Renal eval; ophthalmologic eval; CV eval; Strict glucose control - Type 1 get insulin to maintain; Fasting morning: ≤ 60-90 mg/dL; Prelunch: 60-105; Two-hour postprandial: < 120
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Q260. Pregestational DM & Pregnancy- Management of Fetus
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A260. 16-20 weeks - US; AFP; 20-22 weeks - echo; 3rd trimester - close surveillance, NST, CST, BPP; admit at 32-36 weeks if DM poorly controlled, fetus is of concern
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Q261. Pregestational DM & Pregnancy- Management of Delivery and; Postpartum
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A261. Maintain 80–100 during labor consider early delivery if:; poor maternal glu control; preeclampsia; macrosomia; fetal lung maturity; C-section if macrosomia; monitor glucose postpartum
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Q262. Pregestational DM & Pregnancy- Maternal Complications
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A262. DKA; HHNK; preeclampsia/eclampsia; cephalopelvic disproportion (macrosomia) and need for C- section; preterm labor; infection; polyhydramnios; postpartum hemorrhage; maternal mortality
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Q263. Pregestational DM & Pregnancy- Fetal Complications
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A263. Macrosomia; cardiac defects; renal defects; neural tube defects; hypocalcemia; polycythemia; hyperbilirubinemia; IUGR; hypoglycemia from hyperinsulinemia; RDS; birth injury; perinatal mortality
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Q264. Gestational & Chronic HTN - What is it
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A264. Both increased risk of preeclampsia & eclampsia, M&M; Chronic - high before pregnant or before 20 weeks gestation; gestational - after 20 weeks, usually after 37 weeks remits by 6 weeks postpartum; MC in multifetal
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Q265. Gestational & Chronic HTN - Dx
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A265. Monitor BP routinely; if severe for 1st time - check for other causes
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Q266. Gestational & Chronic HTN - Tx
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A266. Methyldopa; B-blocker; hydralazine; no ACEI or diuretics
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Q267. Preeclampsia - What is it; Risk factors
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A267. New-onset HTN; proteinuria; nondependent (hands & face) edema; > 20 weeks gestation Risk factors:; nulliparity; Black; extremes of age; multiple gestations; molar pregnancy; renal dis. (from SLE or DM1); family History; chronic HTN
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Q268. Mild Preeclampsia - History/PE
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A268. Often asymp; BP > 140/90 on 2 occasions, > 6 hrs. apart; proteinuria; nondependent edema
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Q269. Mild Preeclampsia - Dx
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A269. UA; 24-hour urine protein; CBC; electrolytes; BUN/Cr; uric acid; measure fetal age; amniocentesis - lung maturity; LFTs; PT/PTT; fibrinogen and FSP; urine tox screen; US; NST/CST/BPP - as needed
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Q270. Mild Preeclampsia - Tx
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A270. Only cure - delivery; induce - IV oxytocin, prostaglandins or amniotomy based on mom and fetus; if far from term - bed rest, expectant management
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Q271. Severe Preeclampsia - History/PE
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A271. Based on Sxs, organ damage, fetal growth restriction; BP > 160/110 on 2 occasions, > 6 hrs. apart; proteinuria; HELLP syndrome; RUQ/epigastric pain; oliguria; pulmonary edema/cyanosis; cerebral changes; visual changes; hyperactive reflexes; oligohydramnios or IUGR
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Q272. Severe Preeclampsia - Dx
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A272. UA; 24-hour urine protein; CBC; electrolytes; BUN/Cr; uric acid; measure fetal age; amniocentesis - lung maturity; LFTs; PT/PTT; fibrinogen and FSP; urine tox screen; US; NST/CST/BPP - as needed
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Q273. Severe Preeclampsia - Tx
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A273. Only cure - delivery; control BP – Hydralazine, labetalol, MgSO4 - prevent Seizures, postpartum - MGSO4 - 1st 24 hrs. monitor for Mg2+ toxicity: loss of DTRs, respiratory paralysis, coma, Tx with IV Ca2+ gluconate
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Q274. Preeclampsia - Complications
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A274. Prematurity; fetal distress; stillbirth; placental abruption; seizure; DIC; cerebral hemorrhage; serous retinal detachment; fetal/maternal death
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Q275. Eclampsia - What is it
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A275. Seizures in patients with preeclampsia; antepartum, intra or post; if post - MC within 48 hrs.
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Q276. Eclampsia - History/PE
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A276. MC Sxs before attack - headache; visual changes; RUQ/epigastric pain; Seizures severe if not controlled; with anticonvulsant therapy
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Q277. Eclampsia - Dx
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A277. UA; 24-hour urine protein; CBC; electrolytes; BUN/Cr; uric acid; measure fetal age; amniocentesis - lung maturity; LFTs; PT/PTT; fibrinogen and FSP; urine tox screen; US; NST/CST/BPP - as needed
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Q278. Eclampsia - Tx
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A278. Monitor ABCs, O2; control seizures - MgSO4, consider IV diazepam; control BP – Hydralazine, labetalol; limit fluids: foley catheter- monitor I/Os; monitor Mg2+ level, Mg2+ toxicity; monitor fetal status; postpartum - MgSO4 - 1st 24 hrs; monitor for Mg2+ toxicity: loss of DTRs, respiratory paralysis, coma, Tx with IV Ca2+ gluconate
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Q279. Eclampsia - Complications
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A279. Cerebral hemorrhage; aspiration pneumonia; hypoxic encephalopathy; thromboembolic events; fetal/maternal death
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Q280. Alcohol - Teratogenic Effect
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A280. Fetal alcohol syndrome; microcephaly; midfacial hypoplasia; MR; IUGR; cardiac defects
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Q281. Cocaine - Teratogenic Effect
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A281. Bowel atresia; IUGR; microcephaly
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Q282. Streptomycin - Teratogenic Effect
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A282. CN8 damage; ototoxicity
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Q283. Tetracycline - Teratogenic Effect
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A283. Tooth discoloration; bone growth inhib; small limbs; syndactyly
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Q284. Sulfonamides - Teratogenic Effect
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A284. Kernicterus
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Q285. Quinolones - Teratogenic Effect
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A285. Cartilage damage
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Q286. Isotretinoin - Teratogenic Effect
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A286. Heart and great vessel defects; craniofacial dysmorphism; deafness
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Q287. Iodide - Teratogenic Effect
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A287. Congenital goiter; hypothyroidism; MR
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Q288. Methotrexate - Teratogenic Effect
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A288. CNS malformations; craniofacial dysmorphism; IUGR
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Q289. DES (Diethylstilbestrol) - Teratogenic Effect
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A289. Clear cell adenocarcinoma of vagina/cervix; genital tract abnorm; cervical incompetence
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Q290. Thalidomide - Teratogenic Effect
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A290. Limb reduction (phocomelia); ear and nasal anomalies; cardiac and lung defects; pyloric stenosis; duodenal stenosis; GI atresia
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Q291. Coumadin - Teratogenic Effect
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A291. Stippling of bone epiphyses; IUGR; nasal hypoplasia; MR
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Q292. ACEIs - Teratogenic Effect
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A292. Oligohydramnios; fetal renal damage
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Q293. Lithium - Teratogenic Effect
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A293. Ebstein's anomaly; other cardiac diseases
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Q294. Carbamazepine - Teratogenic Effect
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A294. Fingernail hypoplasia; IUGR; microcephaly; neural tube defects
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Q295. Phenytoin - Teratogenic Effect
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A295. Nail hypoplasia; IUGR; MR; craniofacial dysmorphism; microcephaly
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Q296. Valproic Acid - Teratogenic Effect
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A296. Neural tube defects; craniofacial defects; skeletal defects
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Q297. HELLP Syndrome - What is it
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A297. Variant of pre-eclampsia; Hemolytic anemia; Elevated Liver enzymes; Low Platelet count
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Q298. Physio Changes in Pregnancy - CV
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A298. Increased HR x increased SV = increased CO; CO lowest - supine; CO highest - lt. lateral position; sys vascular resistance - decreased; normal - systolic murmur, S3; abnorm - new diastolic murmur; CVP unchanged; FVP increases; BP - decreased in 1st trimester, diastolic more than systolic, nadir at 24 weeks, increased thereafter, but never to baseline; uterus displaces heart up & Left => looks like cardiomeg on CXR
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Q299. Physio Changes in Pregnancy - Cervix
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A299. Softens and cyanosis ~ 4 weeks; "bloody show" - at or near labor; cervical mucus looks granular on slide
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Q300. Physio Changes in Pregnancy - Endocrine
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A300. Increased thyroid blood flow => thyroid increased in size; increased - TBG; increased bound T3 & T4, and total; unchanged - free T4; increased - total & free cortisol; adrenal gland unchanged in size; HPL - maintains fetal glucose levels => prolonged postprandial hyperglycemia, fasting hyperinsulinemia,; fasting Hypertriglyceridemia, exaggerated starvation ketosis
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