OB 8TH SHIFTING

Most common bacterial infection encountered in pregnancy:UTI

Most common cause of jaundice in pregnancy: Viral hepatitis
Most common mutation in fatty liver: LCHAD
most common presentation of MRSA: Skin and soft tissue infections
Most common pulmonary disorder in pregnancy: Chronic asthma
Most common serious medical complication of pregnancy: Acute Pyelonephritis
Most sensitive lab finding in Intrahepatic cholestasis: serum bile acids
Most serious side effect of Thionamides: Agranulocytosis
Most virulent of the staphylococcal species: MRSA
Hallmark of Nephrotic syndrome: Proteinuria >3g/day
Hallmark of pulmonary involvement in Sarcoidosis: Interstitial pneumonitis
Hallmark of Scleroderma: Overproduction of normal collagen
Hallmarks of asthma: Reversible airway obstruction, vascular congestion, tenacious mucus, and mucosal edema
Hallmarks of Inflammatory Myopathies: Inflammatory synovitis that involves peripheral joints
Primary indiation for liver transplant: Hepatitis C
Leading cause of blindness between 24-64yrs: Retinopathy
Leading cause of ESRD: Nephropathy
Best screening test for SLE: ANA
Acquired Dermal Melanocytosis: non-palpable, brown to blue-gray patches that contain spindle-shaped melanocytes
Cystic Fibrosis: mutations in a 230-kb gene on the long arm of chromosome 7
Fatty liver: due to recessively inherited mitochondrial abnormalities of fatty acid oxydation
Fetal cell microchimerism: persistence of fetal cells in the maternal circulation and organs following pregnancy
Herpes Gestationis: caused by IgG1 antibody to the basement membrane in the epidermis
Libman-Sacks endocarditis: described with lupus, due to presence of anticardiolipin antibodies
Marfan sydrome: mutation of FBN1 gene on the long arm of chromosome 15
Ogilvie syndrome: colonic psuedo-obstruction
Polyarteritis nodosa: myalgia, neuropathy, GI disorders, HPN, and renal disease
Sarcoidosis: accumulation of T lymphocytes and phagocytes within noncaseating granulomas
Scleroderma: microvascular damage, immune system activation leading to inflammation, excessive collagen in skin, lungs,
heart, GI, kidneys
Spongiform pustules of Kogoj: spongelike cavity with neutrophils in Pruritic Folliculitis
Wegener Granulomatosis: necrotizing granulomatous vasculitis of the upper and lower respiratory tract and kidney
Adult pneumonia: Pnuemococci, Chlamydophilia, Mycolasma
Fatty liver complications: Hepatic encepalopathy, Coagulopathy, Renal failure
Mitral stenosis principal features: LA and RV enlargement, Diastolic murmur at cardiac apex, Pulmonary HPN
Normal pregnancy-induced changes: Left atrial end-diastolic dimension, LV mass, TR
Screening for DM: FBS, Hba1c, RBS
Criteria to diagnose Antiphospholipid Antibody Syndrome: LAC, ACA, Anti-B2 glycoprotein I
CREST syndrome: calcinosis, Raynaus, esophageal involvement, sclerodactyly, and telangiectasia (Scleroderma)
Ehlers-Danlos Syndrome: various connective tissue changes, including skin hyperelasticity
Prurigo gestationis: small, pruritic rapidly excoriated lesions on the forearms and trunks
Dane particle: Hepatitis B intact virus
Fatty Liver: Male, twin gestation
HbeAg: high viral inoculum and viral replication
Hepatitis C: 30-49yrs old
Herpes Gestationis: Multiparas
Listerial infection: very old or young, pregnant women, immunocompromised
PUPPP: Nulliparas
Rheumatoid Arthritis: Females, 25-55yrs old
Scleroderma: 30-50yrs old
Takayasu Arteritis: Young women, before 40yrs old
UTI: Young Nulliparous
1st tri calorie intake: 30-35kcal/kg
Altered fetal growth if glucose >130mg/dL
Asthma: FEV1/FVC ratio, PEF
Basal O2 consumption from 20-40ml/min in 2nd half of pregnancy
Chest Radiograph: Fetal dose <0.01mGy
Daily Iodine Intake: Pregnant- 220mg/day, Lactating- 290mg/day
Dietary composition: 55%- CHO, 20%- CHON, 25%- Fat (<10% saturated fat)
Folate: 400ug/day
Gallblader: contractility, residual volume
Hemodialysis: Initiate if Creatinine is 5-7mg/dl
Hemodialysis: Maintain urea <20mmol/L (60mg/dl)
Hypocalcemia in DM: <8mg/dL
Iodine Supplement: 150mg in prenatal vitamins
Left-sided obstruction: MV area <2cm2, AV area <1.5cm2, Peak LV outflow tract gradient >30mmHg
Normal FBS, RBS, Hba1c and no risk factors: screen at 24-28wks using hr 75g OGTT
Optimal time delivery DM: 38.5-40wks
Over Hypothyoidism: Thyrotropin, Thyroxin
Pancreatitis Mean Amylase: 1,400 IU/L
Pancreatitis Mean Lipase: 7,000 IU/L
Pregnancy: Leucine, ALP2x, Total albumin; slightly AST, ALT transferase, bilirubin, serum albumin
Pregnancy: TSH, T4

Renal Disease: Creatinine 0.9, BUN 1.4mg/dl

Shigellosis: Secretory diarrhea >10L/day
Subclinical Hypothyroidism: Thyrotropin, Normal Thyroxin
UTI: >100,000 organisms/ml is diagnostic
Labs chorva:
Intrahepatic cholestasis: ALP, progesterone metabolites, Bilirubin, Prolong PT, Transaminase, Cholesterol, Triglycerides,
Bile acids
Pancreatitis: 3x Amylase
Hepatitis A: IgM, IgGindicates post-infection
Hyperthyroidism: TSH, T3 and T4, normochromic, normocytic anemia, liver enzymes, ALP
Leprosy: confirmed by PCR
SARS: Radiographic lung findings ground-glass opacities and consolidations
Fatty liver: Transaminase but <500IU/L, Bilirubin (5-10mg/dl)
Viral hepatitis: Transaminase (400-4,000U/L), Bilirubin (5-20mg/dl)
Presentation:
CO poisoning: headache, weakness, dizziness, physical and visual impairment, palpitations, and nausea and vomiting
Fatty liver: small, soft, yellow, greasy liver, malaise, anorexia, N&V, epigastric pain, jaundice
Herpes Gestationis:Extremely pruritic, widespread eruptions, varies: papules, vesicles, bullae
Hyperemesis Gravidarum: Vomiting, weight loss, dehydration, acidosis form starvation, alkalosis, hypokalemia
Intrahepatic cholestasis of pregnancy: Pruritus, Jaundice
Nephritic syndrome: Proteinuria, Pyuria, Hematuria, Red-cell cast
Nephrotic syndrome: Proteinuria, Hypoalbuminemia, Hypercholesterolemia, Edema, HPN, Renal insufficiency
Osteogenesis Imperfecta: blue sclerae, hearing loss, multiple fractures, and dental abnormalities
Polyarteritis nodosa: fever, weight loss, malaise, renal failure, HPN, arthralgias
Prurigo: Intensely pruritic eruptions in which excoriation predominates
Pruritic Folliculitis: Hypoparathyroidism, Hypocalcemia, Hypophosphatemia, Vit D, ESR, leukocytosis
PUPPP: Papules, plaques, urticarial lesions, begin in 3rd tri
SLE: malaise, fever, arthritis, rash, pleuropericarditis, photosensitivity, anemia, and cognitive dysfunction.
Warfarin embryopathy: Nasal hypoplasia, optic atrophy, digital abnormalities, mental impairment
Treatment:
Adult Bacterial Pneumonia: Macrolides
Anthrax: Ciprofloxacin
Antiphospholipid Antibody Syndrome: Aspirin plus heparin
Asymptomatic Bacteriuria: Nitrofurantoin
Atrial fibrillation in Mitral Stenosis: Verapamil or cadrioversion
Chloroquine-resistant P falciparum: Mefloquine or Auinine sulfate with Clindamycin
Chronic fibrillation in Mitral Stenosis:Beta-blocker, Ca-channel blocker, Digoxin
Dissemenated fungal infections: Itraconazole
Hyperemesis Gravidarum: first-line- Vitamin B6 or Vitamin B6+ Doxylamine
Hyperpigmentation: Hydroxyquinone, Trenitoin or Azelaic acid
Hyperthyroidism: PTU- Methimazole, Beta-blockers
Influenza pneumonia: Neuramidase inhibitors Oseltamivir, Zanamivir
Leprosy: Dapsone, Rifampin, Clofazimine
Listeriosis: Ampicillin plus Gentamicin
MRSA: Vancomycin
Ogilvie syndrome: Neostigmine 2mg
Pneumocystis pneumonia: Trimethoprim-sulfamethoxazole
Polyarteritis nodosa: high-dose Prednisone plus Cyclophosphamide
Pruritic Folliculitis: Prednisone 20-40mg/day
Sarcoidosis: Glucocorticoids, Methotrexate
Symptomatic Mitral Stenosis- Percutaneous Balloon Valvuloplasty
Thyphoid Fever: Fluoroquinolones and 3rd gen Cephalosporins
Toxic Shock Syndrome: Clindamycin or Penicillin
Wegener Granulomatosis: Corticosteroids
Thyroid storm: PTU 1g then 200mg q 6 hrs, Iodide, Dexamethasone, Beta-blockers
- Thionamides- inhibit iodination of thyroglobulin and thyroglobulin synthesis
- Beta-blockers- for adrenergic symtpoms
Intrahepatic Cholestasis of Pregnancy:
- Phenobarbital: induces hepatic microsomal enzymes, bile flow, bile salt secretion
- Antihistamines: for pruritus
- Cholestyramine: disrupts enterohepatic circulation and reabsorption of bile acids
- Ursodeoxycholic acid: competes with cytotoxic BA, relieves pruritus, enzymes, reverse abnormalities of BA transport
- SAMe: reverse estrogen-induced impairment of bile secretion
!!!!
PTU: Agranulocytosis
Methimazole: Aplasia cutis, Choanal atresia, Tacheoesophageal fistula, Facial anomalies
Ablation using radioactive iodide for hyperthyroidism is contraindicated
Mg-containing antacids should be avoided in late pregnancy cause they alter labor
Beta-blockers may cause bradycardia, respiratory depression, hypoglycemia
Prostaglandins and Ergonovine: Avoid in pregnancy they exacerbate Asthma
Nitrofurantoin: Avoid in late pregnancy because it may cause hemolysis
Glucocorticosteroids: Avoid in primary APS without an associated connective-tissue disorder
Methotrexate, cyclophosphamide, and mycophenolate: Avoid in APAS because of teratogenic potential

DM Fetal surveillance: High risk- 28wks; low risk- 34wks

2nd tri: 16-20wks- AFP; 18-20wks- US for NT defects
Osteogenesis Imperfecta: Type I- Mildest form; Type II- Lethal in utero
Chorvz:
Azathioprine may be used for RA cause its not teratogenic
Cardiovascular decompensation may manifest as pulmonary edema or hypotension or both
Estrogen: plays a role in hyperpigmentation
Glycosylated Hg is useful to assess early metabolic control
Heart murmur 3/6 or more suggests heart disease
Herpes Gestationis: in women with HLA-DR3, HLA-DR4
Low-grade fever is common in Hepatitis A
MRI is safe after 1st trimester
Omeprazole is category C
Pancreatitis: more common in 3rd trimester
Polyarteritis nodosa: a third of cases are associated with hepatitis B antigenemia
Pregnancy induced hypervolemia and CO are at its peak at 28 wks
Progesterone inhibits CKK-mediated smooth muscle stimulation Stasis of GB
PUPPP: Absence of C3, differentiates from herpes gestationis
White Class B or C: Do CS to avoid traumatic birth from large infant
SIMPSON RECOMMENDS CS DELIVERY FOR:
Severe CHF
Severr Aortic Stenosis
Warfarin w/in 2 wks
Aoritc root >4cm or Aortic aneurysm
Recent MI
Need for emergency valve replacement
DM: 75g OGTT at 6-12wks
FBS: >126mg/dl
2-hour: >200mg/dl
HbA1c:>6.4%
OVERT DIABETES:
FBS: 126mg/dl (7mmol/L)
RBS: 200 mg/dl (11.0 mmol/L)
Hba1c: 6.5%
2hr 75g OGTT: 200 mg/dl (11.0 mmol/L)
GESTATIONAL DIABETES:
FBS: 92mg/dl
2hr 75g OGTT: 140mg/dl
PHYSIOLOGICAL ALTERATIONS INDUCED BY PREGNANCY
1. VC and IC by 20%
2. Expiratory reserve volume 1300 mL-1100 mL
3. TD 40%
4. Minute ventilation 30- 40% due to TD. As a result, arterial Po2 from 100-105 mmHg
5. metabolic demands cause a 30% in CO2 but arterial Pco2 from 40-32 mmHg
6. RV 20% from 1500-1200 mL
7. Chest wall compliance is by a third by expanding uterus and abdominal pressure, which causes a 10-to 25% in
functional residual capacity
PHYSIOLOGIC CHANGES IN THE KIDNEYS DURING PREGNANCY
Kidney size 1.5cm longer
GFR and Renal plasma flow
Creatinine: 0.7-0.5mg/dl
Urea Nitrogen: 1.2-0.9mg/dl
Creatinine clearance 30%
CRITERIA FOR SEVERE COMMUNITY-ACQUIRED PNEUMONIA
RR >30
PaO2/FiO2 ratio 250
Mutilobar infiltrates
Confusion/Disorientation
Uremia
Leukopenia <4,000
Thrombocytopenia <100,000
Hypothermia <36
Hypotension
DIABETES
THYROID(NOT DONE)
HEPATIC-BILIARY-INTESTINAL OBSTRUCTION
DERMATOLOGIC
GI DISORDERS

CARDIO
PULMO
CONNECTIVE
RENAL
HEMA
INFECTIOUS