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43 Cards in this Set
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- Back
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S/S of salpingitis…
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Abdominal tenderness, cervical motion tenderness, adnexal tenderness. Also, vaginal discharge, fever, pelvic mass on exam or US
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If young female patient has lower ab pain that is hard to pin down cause, what is best confirmatory test for PID…
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Laparosopy looking for purulent discharge in fallopian tubes
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Criteria for outpt therapy for PID…
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Low-grade fever, tolerance of oral meds, absence of peritoneal signs
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If patient w/ PID gets a TOA, how does that change treatment…
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Must cover anaerobes so add clindo or metro
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Effect of OCPs and oral depot meoxyprog on STD risk… IUDs… parity…
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OCPs decrease risk because of progestin thickening cervical musucs and thinning endometrium. IUDs increase as well as nulliparity
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When does actinomycetes cause PID most often…
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In assoc with IUDs
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How does pregnancy incr hypercoaguable state…
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Increase in estrogen causes an increase in clotting factors (esp fibrinogen) and pressure from uterus on IVC
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What oxygen tension does a pulse ox of <90% correspond to…
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<60mmHg
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Tx of peripartum cardiomyopathy…
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Diuretic and inotropic therapy
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If patient has respiratory distress, clear chest radiograph and hypoxemia, what is most likely diagnosis…
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PE
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After 3 mo of heparin tx for PE in prego, what happens to duration of tx…
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Either full tx or prophylactic tx given for remainder of pregnancy and for 6 weeks post-partum
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EKG abnormalities associated with PE…
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S wave in I, Q in III, RAD, and TACHYcardia
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ABG changes in pregnancy…
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Pregnancy induced respiratory alkalosis: pH elevates to around 7.45, PO2 elevates 5 points, PCO2 DECReases to around 28 and bicarb DECREASES to around 20 (metabo compensation)
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PO2 less then what value in pregnant woman is concerning…
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80mmHg
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Neonatal herpes infxn description…
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Can be systemic or confined to skin, eyes, or mucosa. Contracted mainly thru genital tract secretions
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Maternal herpes and delivery management…
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If mother asymptomatic and has no lesions or prodromal symptoms then vaginal delivery is option. Otherwise, give C-sxn
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Why give acyclovir at primary HSV outbreak in pregnant woman…
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Decr viral shedding and duration of infxn as well as symptoms. Does NOT affect likelihood of future recurrence nor change patients immune response
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Most common cause of vulvar ulcers in US…
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HSV
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If a baby contracts HSV transplacentally then what can be said about the mother’s HSV infxn…
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It is the primary infxn with HSV
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What drug therapy when treating primary HSV in prego can decr likelihood of recurrence and need for C-sxn…
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Acyclovir SUPRESSION
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S/S of uterine fibroids…
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Menorrhagia (excessive bleeding)**, palpable midline mass in lower abdomen that is firm and nontender and moves with cervix, and if large enough: pressure on pelvis, bladder, or rectum
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Types of uterine fibroids…
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Submucosal, intramural, subserosal (knobby), pedunculated
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Carneous degeneration…
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Changes in leiomyomata due to rapid growth with center becoming red and painful
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Most common indication for hysterectomy in US…
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Uterine fibroids (symptomatic)
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MOA of menorrhagia due to fibroids…
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Incr endometrial surface area or disruption of hemostatic mechanisms during menses or ulceration of submucosal surfaces
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What are signs that leiomyomata is progressing to sarcoma…
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Incr of more than 6 weeks gestational age size in 1 year. Patient often has history of prior pelvic irradiation
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Tx for uterine fibroids…
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Initial: NSAIDS or progestin. GnRH (which reaches max at 3mo but often used pre-surgery), hysterectomy or uterine artery embolization, myomectomy is desire pregnancy
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Fibroids most commonly associated w/ spont abortions…
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Submucous fibroids
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When is surgical intervention considered in uterine fibroids…
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Symptomatic and refractory to medical therpy; asymptomatic but unexplained uterine rapid growth, ureteral obstrxn, inability to differentiate fibroid from other pelvic masses; growth in fibroids in post menopausal women
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chronic HTN vs gestational HTN...
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chronic is 140/90 before pregnancy or at least before 20 weeks; gestational is HTN w/o proteinuria at >20 weeks
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preeclampsia... what causes it...
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HTN w/ proteinuria of >300mg over 24hrs at 20+ weeks. Caused by vasospasm
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RFs for preeclampsia...
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nulliparity, previous chronic HTN, extremes of age, previous hx, family hx, chronic renal dx, APS, diabetes, multifetal gestation
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Criteria for severe preeclampsia...
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160+/90+, 24hr urine protein 5g or dipstick of 3-4+, or symptoms of HA, RUQ or epigastric pain, vision changes
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complications of preeclampsia...
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abruption, eclampsia (possible intracerebral hemorrhage), coagulopathies, renal failure, hepatic subcapuslar hematoma, hepatic rupture, uteroplacental insufficiency, African-American
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lab tests in case of possible preeclampsia...
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CBC, UA, 24 hr protein, LFTs, LDH (hemolysis), uric acid test (increased in Precl), or biophysical profile of fetal to assess for uteroplacental insufficiency
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greatest risk of eclampsia in prego occurs when...
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just prior to delivery, during labor, w/in 24 hrs postpartum
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why is it important to monitor preeclamptic patient's UOP in labor when given Mg sulfate...
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Mg exctreted by kidneys anc can cause resp depression and dyspnea also and abolition of DTRs
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Tx of preeclampsia...
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during labor: Mg sulfate for seizures, hydralazine or labetalol for HTN, delivery for definitive tx
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what are neuro and renal complicaitons of preeclampsia..
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Neuro: HA, vision change, seizures, hyperrelexic, blindness. Renal: decr GFR, proteinuria, oliguria
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what are pulm and heme/vascular complications of preeclampsia...
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pulm: pulmonary edema. Heme: thrombocytopenia, microangiopathic anemia, coagulopathy, severe HTN
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what are fetal and hepatic complications of severe preeclampsia...
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Fetal: IUGR, oligohydramnios, decr uterine perfusion. Hepatic: incr LFTs, subcapsular hematoma, hepatic rutpure
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when are hypertensive agents utilitzed in the case of preeclampsia...
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only when it is severe preeclampsia
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what is the first sign of Mg toxicity...
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loss of DTRs
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