1. What is a not a common risk factor for PID (pelvic inflammatory disease)?
(a) smoking
(b) tampon use
(c) multiple partners
(d) young age
(e) IUD
2. A 19 y/o G1 presents at 34 weeks gestation with BP 170/110, headache, and mild abdominal discomfort. She has no vaginal bleeding. You initiate a magnesium drip, having appropriately suspected preeclampsia. What is a not sign of magnesium toxicity?
(a) Decreased deep tendon reflexes
(b) Decreased respiratory rate
(c) Decreased level of consciousness
(d) Hyperthermia
(e) Diaphoresis
3. All of the following medications are category A or B in pregnancy EXCEPT:
(a) Benadryl
(b) Propofol
(c) Zofran
(d) Augmentin
(e) Phenytoin
1. (b)
PID is inclusive of salpingitis, endometritis, oophoritis, and TOA that can eventually progress to pelvic peritonitis. PID is most common in younger females aged 15-25, with increased risk in in those who engage in high risk behaviors and those who delay seeking medical care. History of STD, hx of IUD insertion in past 1 month, multiple sexual partners, smoking, frequent douching, and use of alcohol and/or drugs are additional major risk factors. PID is primarily caused by Chlamydia and Gonorrhea, but overall is thought to be polymicrobrial in etiology. Symptoms include pelvic pain, fever, nausea/vomiting, abnormal vaginal discharge, vaginal bleeding. Mucopurulent cervicitis is common on exam, in addition to CMT or adnexal tenderness.
2. (d)
Preeclampsia is a clinical diagnosis made > 20 weeks gestation. Diagnostic criteria are: SBP > 140 mm Hg and DBP > 90 mm Hg and Proteinuria > 0.3 g in 24 hr and 20 wk gestation. Definitive treatment is delivery of the fetus. Magnesium is used in preeclampsia to prevent progression to eclampsia, characterized by seizures. Magnesium works by slowing neuromuscular conduction and decreasing CNS irritability. Side effects include flushing, diaphoresis, hypothermia, hypotension, flaccid paralysis, and respiratory depression. At toxic levels, DTRs diminish and respirations slow.
3. (e)
Benadryl is category B during 3rd trimester. Propofol, Zofran, and Augmentin are all category B. Category A drugs include Magnesium Sulfate, Levothyroxine, Doxylamine, Folic Acid, most vitamins if within RDA, vaginal nystatin.
Category A: Well controlled human studies have failed to demonstrate risk to fetus in 1st trimester (no risk in later trimesters)
Category B: Animal studies have failed to demonstrate risk to fetus, and there are no well controlled studies in pregnant women OR animal studies have shown adverse effects, but well controlled studies in pregnant women have failed to show risk to fetus in any trimester
Category C: Animal studies have shown an adverse effect on the fetus, and there are no well controlled studies in humans, but potential benefits may warrant the use of the drug in pregnant women despite risks
Category D: There is evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Category X: Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.
