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45 Cards in this Set
- Front
- Back
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Your pt comes in T3 with icterus and jaundice skin. What is your top lis tot differenteial |
DDX: Intrahepatic Cholestasis Acute Fatty Liver Viral Hepatitis AI Hepatitis |
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Your pt is complaining of very itchy palms and soles, what is your top Ddx and investigations |
Intrahepatic Cholestasis Ivx: LFT, Alkphos GGT, s Bile acid Hx dark coloured urine |
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How will you manage her |
1. Ursodeoxycholic acid (decrease risk pre mat &clotting) 2.Cholestyramine (decrease puritus) |
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What are the complications of Acute Fatty Liver of preg |
mat: hemorrhage, DIC, fulminant liver failure, death fetal: distress, meconium aspiration , moratlity |
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What is the mgt for AFL? |
Maternal: 1. Tx DIC: IV NS, glu, blood products post delivery monitoring Fetal: 1. Delivery |
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What routine Dx tests will you do for suspected Pre-ecplampsia/ HELLP |
CBC w diff Coagulopathy: PTT INR Fibrinogen Hepatic: AST ALT, s bilirubin Renal: sCr, +- BUN U/A for protienuria >5 BP: >140/90 mild >160/110 severe Fetal NST |
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your patient comes in jaundiced, febrile, malaise, what are your top two differentials |
UTI Hepatitis (A w travel, B endemic/family mbrs, AI) |
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your pt has DM1. what are some complications if glucose is not regulated? |
mat: CAD, renal dysfunction, retinopathy fetal: macrosomia, congenital malformation, spontaneous abortion |
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What can you do to help prevent these complxn |
1. 1st line=lifestyle! healthy nutrition and exercise 2. change PO meds to insulin 3.refer to an endocrinologist 4. in T2, the dose increases by doubling the frequency |
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When does a baby of a DM/GD mother deliver? |
depends on ... mat BP BG & fetal HR, size & lung maturity if >40wks, induce! to decrease risk of neonate hypoglycaemia |
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when does the mother stop and start personal DM mgt? |
Stop: during labour, when the placenta is delivered, there is a drastic decrease in demand Start: 2/3 of the dose when BG rises above 8.3mmol/L which is usually 2-3d post delivery |
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Your patient is presenting with hyperthermia , hyperhydrosis, headache, tachypnea, tachycardia, edema, BP 160/112mmHg, . what are your differentials |
Pre-eclampsia-HELLP Thyroid Storm |
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Upon return of the labs you see: elevated AST ALT, bilirubin, WBC, Cr but 0 protienuria... what are you suspecting is the DX and how will you Tx |
Thyroid Storm; Labetolol- HTN Sodium Iodide-prevent synth of T4 PTU- prevent conversion of T4-T3 Decrease Temp IV fluids |
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why is thyrotoxicosis a concerning and pertinent Hx finding |
labour can trigger a Thyroid Storm which increases the maternal mortality to >25% |
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What are some effects that treating a mother with hyperthyroidism on the fetus? |
fetal goiter fetal HYPOthyroidsm ... lowest dose of PTU as possible |
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What are 5 major infections a mother can contract/ go into a pregnancy with that have major negative consequences for the fetus? |
Toxoplasmosis Other: syphillis, parvo virus Rubella CMV Herpes Simplex Virus |
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Why is Toxoplasmosis a concern? |
Mat self limiting. Fetal micro or hydrocephaly with severe CNS consequences. This can be obtained from cat decal matter/ bites, or gardening |
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Sandra is 12 weeks pregnant and was gardening 2 weeks ago and has flu like symptoms. what are your ddx |
Flu, toxoplasmosis CMV Rubella |
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You do an s IgM and IgG panel, and find that IgM is severely elevated and IgG is beginning to increase |
Offer a TA because of the CNS manifestations have already begun to develop and will be permanent |
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What are the permanent CNS manifestations of Toxoplasmosis |
Ventricularmegaly, Intracranial calcifications, maculopapillary rash, jaundice, hepato/splenomegaly: Cataracts, blindness, chorioretinits (can present as late as 20y/o) |
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She decides to have the child, what tx can you do |
Aspiromycin post natal: US,sIgG, IgM, LP, CT scan Tx:(mgt) Aspiromycin can decrease asymptomatic CNS deficits, however symptomatic CNS are permanent |
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what is the prognosis for an infant who has toxoplasmosis |
overt CNS sym- POOR asymptomatic untreated- POOR treated- Less Poor |
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What is an STI on the rise in Canada that can have multi system effects on a fetus? |
Syphillis; treponema pallidum, can cause prematurity, fetal death or symptoms presenting at various times; fetus, infant, child. |
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How will you treat a pregnant mother who has contracted syphyillis? |
Penicillin G |
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what are the presentations of syphillis at birth and during childhood |
birth: red palms, soles Hepatosplenomegaly Jaundice anemic >2y/o frontal bossing, short maxilla, high palatal arch, TRIAD: blunted teeth, inflamed cornea, deafness |
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When is a person infected with Rubella infectious? |
7days pre rash-rash-7d post rash |
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How does this effect the fetus? the mother? |
If in T1; organogenisis- SA, IUGR, malformation,CNS defects mat: N/V, arthralgia, erythematous rash presenting trunk to extremities then disappears extremities then trunk. |
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How will you investigate for rubella? |
CVS to PCR amniocentesis mat: sIgM increased for 1 mo sIgG increased x4 over 1 wk |
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What is extended Rubella Syndrome? |
symptoms of rubella are present at birth: pt are at high risk of : DM, hearing loss, progressive paraencephalitis |
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What is the Tx for Rubella? |
NONE! if <16wks GA offer TA Vaccinate the babies immediately |
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Cytomegalovirus is most commonly contracted by pregnant women from where? |
-Occupn-Teachers/Daycare workers, - They have older children in daycare/school - |
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What are maternal S&S of CMV virus? fetal? |
mat: Asym, pharyngitis, lung crackles,FUO, lymphadenopathy fet: if passed on; IUGR, brain Ca2+, lat ventricular, hepatomegaly, fetal hydrous |
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How will you investigate to see if the infant has contracted the virus or is just constitutionally small? |
Amniocentisis (if >15wks) |
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What is the Tx for CMV? |
NONE, primary infections are not always passed on to the baby: c section? |
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HSV can cause CNS defecits in the neonate. what are they? |
Lethargy Poor Feeding Seizures |
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What is the Tx during pregnancy/ labour? |
if >= 36wks,and known HSV infxn Acyclovir if unknown Hx, visible lesions= C-section |
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In older children, this infection presents as 'slapped cheek infection'. in a fetus at GA 10-20 weeks they are at high risk of acquiring ... |
Parvovirus |
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How does this infection present in pregnant women? |
fever, arthralgia, puritus rash, |
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What are the fetal complications of Parvovirus? |
SA, SB, Hydrops, Fetal organ and tissue swelling, CHF, pericardial effusion, Renal Fail, |
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If a mother is not vaccinated for varicella, should you be concerned? b)what if she was already vaccinated? |
YES!: extremity malformation, cataracts, premat CNS: Horners Syndrome, Decreased Sensorymotor, enchephalitis, hydro/microcephaly/aplasia b)No worries |
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You have a mother to be infected with Hep B. what are the concerns around fetal health? Is there tx? |
fetal: Premature, LBW, Still Birth Tx; a) IVIG as a neonate b) if mom is HEP B + carrier, Vaccinate! |
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How can HIV be transmitted to a fetus/neonate? |
Placenta, Contact with mucosa during delivery, Breast Feeding |
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Your patient discloses she is HIV. What other tests might you also do? |
Baseline/serial: CXR, viral load TB mantouxHep A, B, C Malaria |
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Joan has been Dx with GD, what will you monitor for during each trimester? |
T1:mat: (K) BUN, Cr, (P) HbA1C& BG, (T) TSH T4 T1:fet: US dating&viability T2:mat: (K)(P) T2:fet: anatomic detail 18-20wks T3:mat: (K)(P) :fet:q4wks growth 1x @36-37wk |
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Your pt has known hypothyroidism and is taking levothyroxine. does she need to stop? |
NO! she needs to increase the dose x2 and frequency x2 with monthly TSH levels. |
