Perinatal Infections

Front 1

This organism is gram negative, diplococcic and coffee been shaped.

Back 1

Neisseria gonnorhoeae

Front 2

This organism is fastidious and requires enriched growth medium with increased concentrations of CO2 for culture.

Back 2

Neisseria gonorrhoeae

Front 3

Neisseria gonorrhoeae produces ________________, which makes it an aerobic organism.

Back 3

Cytochrome oxidase (oxidase positive)

Front 4

This organism's virulence is due to the presence of pili, variable outer membranes and IgA protease.

Back 4

Neisseria gonorrhoeae

Front 5

What are the maternal symptoms of gonorrhea?

Back 5

Purulent discharge from cervix, dysuria, frequency of urination

Front 6

Neonatal gonorrhea presents _ to _ days after birth with infection and _____________ worse than infection with chlamydia.

Back 6

2-5, edema

Front 7

Gonorrhea can be cultured after collection from the maternal ___________ and _____________ and the ________________ of the infected neonate.

Back 7

Urethra, cervix, conjunctiva

Front 8

What medium is used to culture gonorrhea?

Back 8

Thayer Martin

Front 9

The nucleic acid amplification test (Gen-Prove Aptima 2) is used to test for these two diseases.

Back 9

N. gonorrhoeae and C. trachomatis

Front 10

What is the drug of choice for treating gonorrhea?

Back 10

Ceftriaxone

Front 11

What is the most common reportable sexually transmitted disease in the US?

Back 11

Chlamydia trachomatis

Front 12

This organism is an obligate intracellular parasite that resembles Gram negative bacteria.

Back 12

Chlamydia trachomatis

Front 13

What are the two forms in which C. trachomatis exists?

Back 13

Elementary body

Reticulate body

Front 14

Which form of C. trachomatis is infectious?

Back 14

Elementary body

Front 15

What are the maternal symptoms of chlamydia?

Back 15

Mucopurulent cervicitis, salpingitis, PID

Front 16

What are the neonatal symptoms of chlamydia?

Back 16

Inclusion conjunctivitis, pneumonia

Front 17

Chlamydia can be cultured with isolation in ___________ cells.

Back 17

McCoy

Front 18

Chlamydial inclusions can be demonstrated in conjunctival scrapings via these two stains.

Back 18

Giemsa stain, DFA stain

Front 19

What is the systemic DOC for chlamydia?

Back 19

Azithromycin

Front 20

What is the topical DOC for chlamydia?

Back 20

Tetracycline

Front 21

What is the most common cause of sepsis and meningitis in a neonate?

Back 21

Group B Strep Disease

Front 22

This common colonizer of the human GI and GU tracts is a gram positive, beta hemolytic bacteria.

Back 22

Streptococcus agalactiae

Front 23

GBS serotypes Ia, II, III and V account for 90% of neonatal infections, but serotype ___ causes late onset diagnosis and early onste meningitis.

Back 23

III

Front 24

What are some risk factors associated with infant colonization with S. galactiae?

Back 24

Prematurity (<37 weeks)

Heavily colonized mothers

PROM >18 hours

Intrapartum fever >100.4

Maternal chorioamnionitis

Maternal GBS bacteruria

Maternal age <20 years

African american

Front 25

What is the most common cause of neonatal sepsis in the US?

Back 25

Early Onset GBS Disease

Front 26

Fever, breathing problems, apnea, cyanosis, seizures, heart rate and blood pressure anomalies are signs of ___________ in neonates.

Back 26

Group B Strep Infection

Front 27

The most common symptoms of early onset GBS disease are:

Back 27

Respiratory distress

Apnea

Signs of sepsis

Front 28

Risk factors for developing early onset GBS disease are:

Back 28

Colonization during labor and delivery

Preterm delivery

Prolonged ROM

Fever during labor

Previous infant with GBS

Low maternal levels of anti GBS antibodies

Front 29

Prenatal cultures early/late in pregnancy along with _________ cultures for GBS can help predict delivery status.

Back 29

Late, urine

Front 30

What are the three indications for intrapartum GBS prophylaxis?

Back 30

Delivery <37 weeks gestation

Amniotic membrane rupture >/= 18 hours

Intrapartum temperature >100.4F (>38C)

Front 31

Universal screening for GBS should be done between __ and __ weeks gestation.

Back 31

35-37

Front 32

What is the treatment for GBS?

Back 32

Penicillin

Front 33

This is an infection of the amniotic fluid, membranes and or decidua.

Back 33

Chorioamnionitis

Front 34

Mycoplasma, bacteroides, gardnerella, peptostreptococcus, enterococcus, GBS and E coli are common causes of ________________

Back 34

Chorioamnionitis

Front 35

Chorioamnionitis occurs through the migration of ______________ __________ through the cervical canal.

Back 35

Cervicovaginal flora

Front 36

Pregnant mothers in this subset have the highest incidence of chorioamnionitis.

Back 36

Preterm women

Front 37

Chorioamnionitis is associated with _/_ of cases of preterm labor with intact membranes, __% of women with preterm premature rupture of membranes and __% of women who develop labor after admission for PPROM.

Back 37

1/3, 40%, 75%

Front 38

Diagnosis of chorioamnionitis requires a maternal fever of >100.4 and two of the following:

Back 38

Maternal leukocytosis >15,000wbcs/mm3

Maternal tachycardia >100bpm

Fetal tachycardia >160bpm

Uterine tenderness

Foul odor of amniotic fluid

Front 39

__________ is the gold standard of diagnosing chorioamnionitis, but it takes too long to be clinically relevant.

Back 39

Culture of amniotic fluid

Front 40

What is the standard treatment for chorioamnionitis?

Back 40

Ampicillin-sulbactam

Front 41

Aside from ampicillin-sulbactam, what are two other drugs/drug combinations that can be used to treat chorioamnionitis?

Back 41

Ticarcillin-clavulanate

Cefoxitin

Front 42

What are two long term disabilities associated with chorioamnionitis?

Back 42

Neurodevelopmental delay

Cerebral palsy

Front 43

Perinatal death, asphysia, early onset sepsis, septic shock, pneumonia, meningitis, cerebral white matter damage and long term disability are possible adverse outcomes of _____________.

Back 43

Chorioamnionitis

Front 44

This refers to a positive urine culture in an asymptomatic person.

Back 44

Asymptomatic bacteruria

Front 45

Along with malaria, hepatitis, influenza and listeriosis, this infection is one of the more severe and problematic infections during pregnancy.

Back 45

UTI/asymptomatic bacteruria

Front 46

How is a UTI diagnosed in a pregnant woman?

Back 46

Quantitative culture of urine specimen

Front 47

___cfu/mL constitutes a positive clean catch urine specimen in a pregnant woman.

Back 47

10^5

Front 48

__cfu/mL constitutes a positive catheterized urine specimen from a pregnant woman.

Back 48

10^2

Front 49

When should a woman be screened for a UTI?

Back 49

12-16 weeks

Front 50

Smooth muscle relaxation and subsequent uretal dilation with pregnancy leads to a greater propensity for a UTI to progress to _____________.

Back 50

Pyelonephritis

Front 51

What are the two classes of drugs used to treat UTIs in pregnancy?

Back 51

Penicillins and celphalosporins

Front 52

Which STDs are screened for on the first prenatal visit?

Back 52

Chlamydia, gonorrhea, hepatitis B, HIV, syphilis

Front 53

Hard, red, swollen area of the breast and a fever of >38.3C are indicative of ____________.

Back 53

Lactational mastitis

Front 54

What are some risk factors for developing mastitis?

Back 54

Breast feeding problems

Severe prolonged engorgement

Poor milk drainage

Nipple excoriation or cracking

Front 55

What are the four bugs most commonly associated with mastitis?

Back 55

S. aureus (MSSA or MRSA)

S. pyogenes (GAS)

S. agalactiae (GBS)

E. coli

Front 56

What is the treatment for mastitis?

Back 56

Ibuprofen, ice packs

Improve breast feeding techniques

Antibiotics depending on isolated organism

Front 57

What antibiotic is used to treat MRSA in mastitis?

Back 57

Trimethoprim/sulfamethoxazole or clindamycin

Front 58

What antibiotic is used to treat MSSA in mastitis?

Back 58

Dicloxacillin, cephalexin