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132 Cards in this Set
- Front
- Back
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A 19y.o female had unprotected sex, she has been nervous for the last few weeks. She was expecting her period today, but didn't and bought a home preg. test and it was neg. She comes to the office, what will you tell the patient?
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Ask her to come back in 2 weeks
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When is the sensitivity of urine preg. test 100% ?
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Day 11 of missed period
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What does a hCG level of 1.500-2000 mean?
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gestation sac at 5 weeks
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what does a hCG level of 5,000-6,000 mean
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Fetal heart at 6 weeks
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Is hCG hig or low in ectopic?
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LOW
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Is hCG high or low in MOLAR?
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HIGH
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What is a complication that can occur that is associated with Chronic Villous Sampling?
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Distal limb defect
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HOmeless female comes at labor with no prenatal checkup with an ultrasound showing ossifcation of distal femoral epiphysis suggest what fetal age?
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age = 32 weeks
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What if you have an ultrasound shows ossification of proximal tibial and humeral epiphysis suggests what age?
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age= 35 weeks
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A 22 y/o Asian woman is pregnant she has low Hct and low MCV, iron studies are normal; what do you do suspect? and what will you do to confirm?
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Thalassemia b/c the MCV is low so it's either Iron def anemia or thalassemia
Confirm by Hb electrophoresis |
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If you have a pregnant pt. who has HIV, should she be treated?
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YES, regardless of CD4 count
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What is the must drug to put in the Anti-retroviral cocktail?
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Ziduvadine
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What HIV medication should be switched in a pregnant woman?
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Efavirenz and Delavirdine
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When do you do a C-section in an HIV pt?
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If the viral load > 1000
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A pregnant lady got exposed to Rubella in the first trimester, what should you do?
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Do and repeat Rubella antibody titer in 2 weeks.
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If she has antibody + for rubella, and you repeat the test how do you determine if the pregnant woman was infected?
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On the 2nd look at the antibody is the IgM or IgG high. If ther is IgM present that means there is active ds.
If IgG is there then do CVS and PCR and you may have to recommend termination. |
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If a pregnant woman is exposed to Rubella in the 2 or 3rd trimester, what should you do?
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Continue pregnancy
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What test should be performed to determine the amount of Rh antigen in the maternal blood
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Kleihauer-Betke test
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Pt. during first prenatal visit, urine culture is positive, she was treated with antibiotic, what is the next best step?
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REpeat Urine culture
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If a pregnant pt. is treated for a UTI and her repeat urine culture comes back positive...what should you do?
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Treat the patient again
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Pt. is pregnant with asymptomatic bacturia and was treated. Her first repeat urine culture was again positive and she was treated again. Her second repeat culture was now negative, what shoud you do?
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Start suppressive treatment daily with Nitrofurontoin for the duration of teh pregnancy.
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A preg. pt. comes with pyelonephritis, what should you do?
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Admit pt. and treat with IV antibiotics
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What do you do if you have just treated a preg. pt with pyelonephritis, what do you have to do?
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Start suppressive treatment daily with Nitrofurontoin for the duration of the pregnancy
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How long can a preg. pt. have sex during pregnancy
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As long as physically possible
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If a preg. mom is not immunized for Varicella and is exposed, when should she recive IgG?
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Within 72 hours
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If and infant whose mom develops varicella within 5 days before or 2-3 days after delivery, what shoud be done to the baby?
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Give teh baby Immunoglobulin
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What is the screening test for neural tube test?
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Maternal serum AFP
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What is the confirmatory test for NTD?
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Amniotic fluid acetylcholinesterase (AChE)
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A preg pt. who is 20 weeks develops a UTI with a urine culture showing GBS, you treated pt. with PCN, and repeat culture is negative, what would you do?
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Treat her with antibiotic during labor if doing a vaginal delivery
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Do you have to treat a GBS positive woman if she gets a C-section and no rupture of membranes?
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NO
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A pt. has 37wk vaginal culture has GBS + and now she is in labor with ruptured membranes, you decide to do a cesarian section, does she need prophylaxis treatment against GBS?
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YES
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How many of women will have gestational diabetes if they had it once?
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50%
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What should you do if a pt. is pregnant and develops genital herpes?
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Treat with Acyclovir
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What shoud you do if a pt. is in labor and has vulvar pain or buring and had history of herpes?
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C-section
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Pt. has h/o of genital herpes and gets pregnant, during the entire preg. she doesn't have a problem, she c/o vulvar pain and burning what do you do?
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C-section
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pt. with h/o herpes infection is in labor, membranes are ruptured and genital herpes seen on exam, what do you do?
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C-section
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Pt. is in labor with h/o genital herpes on exam there is vesicles, but you find herpetic lesions on the back of the chest, what do you do?
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Deliver vaginally
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Is there any treatment needed in preg pt. with Hep C?
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NO
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How do you diagnose hep C in baby?
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Hep C PCR
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How do you diagnose Hep C in the mom?
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Hep C Antibody
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Can Hep B and Hep C mother's breast feed?
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YEs
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When shoudl a pregnant woman not travel?
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at 32 weeks
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What vaccines can a pregnant not get?
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measles, rubella, and yellow fever
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What is the first line treatment for hyperemesis Gravidum?
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Pyridoxine-doxylamine succinate
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What if the first line drug doesn't work in hyperemesis gravidum and they are still vomiting and has nausea?
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Give promethazine
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Does bhCG high or low in ectopic preg?
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low
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What can be given to treat ectopic preg?
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MTX
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What do you do to monitor ectopic after treatment? What do you do if the levels are still High? What if the pt. is not suitable for drug treatment?
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Do repeat bhCG
if levels still high you can repeat another dose If not suitable, the pt. should go for Lap Salpingostomy/Salpingectomy or open removal |
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How do you monitor if your ectopic pregn. has been treated?
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Check hCG levels
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What should you suspect if you have grape like vesicles and b/l enlarged cystic ovaries?
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Hydatidiform mole
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What shoudl you think of when you see U/S with a snowstorm apprearance
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Hydatidiform mole
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What shoudl you order if you have a hydatidiform mole and how do you treat it?
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order a CXR to r/o mets and
Treat with suction and curretage |
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How long shoudl a pt. wait if she had a hydatidiform mole before she gets pregnant again?
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1 years
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if you have 3rd trimester bleeding shoudl you do a vaginal exam?
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NO
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What should you do first in thrid trimester bleeding before teh vaginal exam?
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Do U/S and put fetal monitoring
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Where is placenta placed in previa?
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over internal Os
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Is placenta previa painful or painless?
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Previa= painless
Abruption = painful |
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What is placenta abruption more commonly seen with?
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cocain use
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Why do you start MgSulfate in pre-eclamp and eclamp?
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Prevents seizure
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When you admit a pt. with eclampsia and sz. what shoud you make sure you order to measure urine output?
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iNSERt foley
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A pt. comes in eclampsia and treated with MgSulfate and currently pt. is on continuous magnesium drip, nurses reported that the patient's breathing has become shallow
on exam the DTR are sluggish, what will you do? |
stop the magnesium sulfate drip and measure magnesium level
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Pt. on magnesium sulfate drip and doing well with no complication; when should you stop it?
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check urine output
100-200 ml/hr: usually after 2 days |
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If you see hematuria and a h/o URI or some playing some game what should you think of?
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IgA Nephropathy
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If you see RBC cast or dismorphic RBC, what should you think of?
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Glomerunephritis
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What are some of the causes of glomerunephritis?
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IgA Nephropathy, Post-strep GN, Wegner's, Goodpast, Endocarditis, Lupus Nephritis
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How do you confirm IgA Nephropathy?
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Renal biopsy
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How do you treat IgA nephropathy?
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Mild= ACEI and ARB
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Can you give steroids in IgA nephropathy?
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Yes, in severe cases where it is progressing to marked porliferation or Nephrotic
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Will complement level be High , normal, or low in IgA nephropathy?
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Normal complement
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What if you see URI and a week later you see hematuria what shoudl you think of?
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Post-strep GN
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Will complement level be High , normal, or low in Post-strep GN?
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LOw complement
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What is the treatment of GN?
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supportive
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What if you see URI and Lower respiratory tract infections with a CXR of diffuse opacity or alveolar opacity with nodular lesion with cavity, what should you think of?
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Wegner's
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How do you confirm Wegner's?
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Bx of Nasopharyngeal lesion
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What if there is no Nasopharyngeal lesion? What shoud you do next for test Wegner's?
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renal Bx
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What if you see URI and Lower respiratory tract infections with a CXR of diffuse opacity or alveolar opacity with nodular lesion with cavity, what should you think of?
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Wegner's
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What will you see on renal bx of a wegner's granulomatosis?
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crescentric necrotizing GN
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How do you confirm Wegner's?
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Bx of Nasopharyngeal lesion
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What do you think of when you see cresentric nectrotizzing GN?
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think of Wegner's
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What if there is no Nasopharyngeal lesion? What shoud you do next for test Wegner's?
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renal Bx
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What do you think of cough of blood, hematuria, proteinuria and renal failure and anti-GM Ab?
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Goodpastures
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What will you see on renal bx of a wegner's granulomatosis?
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crescentric necrotizing GN
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What is the main treatment for Goodpast?
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Plasmapheresis
Prednisone Cyclophosphamide |
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What do you think of when you see cresentric nectrotizzing GN?
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think of Wegner's
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What happens to the complement level in endocarditis?
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LOW complement
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What do you think of cough of blood, hematuria, proteinuria and renal failure and anti-GM Ab?
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Goodpastures
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What is the worst type of Lupus Nephritis?
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Diffuse---type IV
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What is the main treatment for Goodpast?
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Plasmapheresis
Prednisone Cyclophosphamide |
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What is the treatment of Type III--Focal Prolif?
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If less than 40%--Prednisone
If more than 40%--treat like Type IV |
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What happens to the complement level in endocarditis?
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LOW complement
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What is the worst type of Lupus Nephritis?
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Diffuse---type IV
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What is the treatment of Type III--Focal Prolif?
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If less than 40%--Prednisone
If more than 40%--treat like Type IV |
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What is the treatment for Type IV lupus nephritis?
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IV pulse cyclophosphamide--monthly and
IV pulse Methylprednisone |
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What is the treatment for Type V lupus nephritis?
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Non-nephrotic proteinuria---only prednisone
Nephrotic Proteinuria---Cyclosporine + oral Prednisone |
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What should pt. get on Cyclophosphamide?
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Bactrim for PCP prophy
IV hydration and MESNA--TO prevent hemorrhagic cystitis and bladder cancer Leuprolide--to prevent ovarian failure |
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What shoud pt. on long term high dose steroid get?
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H2 blocker or PPI to prevent gastritis
Ca and Vit D or bisphos to prevent osteoporosis Nyastatin to prevent candida |
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Why are people hypercoaguable in nephrotic syndrom?
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they have loss of anti-thrombin III in the urine
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What are the causes of Nephrotic syndrome?
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Min Change Ds.
Membranous Nephr FSGS SLE DM Amyloid |
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What do you think of when you see fusion of epithelial foot processes on kidney bx?
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think of Min Change ds.
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If you see a ADULT with thoughts of minimal change disease.. what do you do to confirm?
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do kidney Bx
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If you see a KID and you suspect min change ds....what do you do to confirm?
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give trial of steroids...only in very resistant cases do you do kidney bx
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What should you treat min change disease pt. with if you have given trials of prednisone and its not working?
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cyclophosphamide
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What is the most common cause of nwephrotic syndrom in adults?
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membranous nephropathy
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What is the treatment of membranous nephropathy?
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Steroids
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What is the most common cause of nwephrotic syndrom in adults?
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membranous nephropathy
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Most common cause of nephrotic syndrome in blacks?
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FSGN
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What is the treatment of membranous nephropathy?
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Steroids
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Most common cause of nephrotic syndrome in Obese pts.
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FSGN
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Most common cause of nephrotic syndrome in blacks?
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FSGN
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Most common cause of nephrotic syndrome in IVDA, or HIV pt.
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fsgn
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Most common cause of nephrotic syndrome in Obese pts.
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FSGN
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wHAT is the treatment of FSGN>
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Prednisone
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Most common cause of nephrotic syndrome in IVDA, or HIV pt.
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fsgn
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wHAT is the treatment of FSGN>
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Prednisone
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What is the most common cause of nwephrotic syndrom in adults?
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membranous nephropathy
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What is the treatment of membranous nephropathy?
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Steroids
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Most common cause of nephrotic syndrome in blacks?
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FSGN
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Most common cause of nephrotic syndrome in Obese pts.
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FSGN
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Most common cause of nephrotic syndrome in IVDA, or HIV pt.
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fsgn
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wHAT is the treatment of FSGN>
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Prednisone
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HOw many accelerations shoudl you see in a 20 min cycle in a NST for it to be normal?
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2 accelerations
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If membranes are ruptured and you are giving steroids for prematurity....when should you stop giving steroids?
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stop at 32 weeks
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If membranes are NOT ruptured and you are giving steroids for prematurity....when should you stop giving steroids?
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34 weeks
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Why do you stop giving steroids early in a pt. with ruptured membranes in a prematurity, what is it at risk for?
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chorioamniotisis
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pt. comes with premature labor and she has had previous h/o of premature labor, whwat should you do?
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Do cervico-vaginal test and look for fibronectin
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What does it mean if Fibronectin is less than
50 ng/ml when performing a cervico-vaginal test? |
It means it is false labor
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During labor induction the prostaglandin and oxytocin administration should be separated by how long and why?
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6-12 hours
and bc to avoid hyperstimulation of the uterus |
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A pregnant lady had a MVA come to ER, fetal monitoring is normal, no pain, she wants to go home, what should you do?
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Monitor pt. for at least 4 hours
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If you see a pt. with fever, uterine tenderness, foul lochia, adn WBC within 5 days of delivery
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Endometritis
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What is the treatment of endometritis?
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IV Clinda and Gent
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What is the prophylaxis recommende for a woman undergoing and CS for prohylaxis of Endometritis?
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Cefazoline
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What should you think of if you see a baby with wide-set small eyes with epicanthal folds, flat nose bridge, hypoplastic piltrum?
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Fetal alcohol syndrome
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