What disease is often found among pregnant women and is dangerous to the fetus5. Химические Acute and chronic respiratory diseases Pregnant women often sick: + Аcute rhinitis, laryngitis, tracheitis Acute sinusitis, pharyngitis Acute bronchitis, pneumonia Acute tonsillitis Acute rhinitis, tonsillitis, pharyngitis How often have upper respiratory tract ill pregnant and non-pregnant women: Pregnant women suffer more + The frequency of the disease is the same Pregnant on sick less often As a rule, pregnant women do not suffer from these diseases In pregnant dramatically increases the incidence What disease is often found among pregnant women and is dangerous to the fetus + Flu Virus Cytomegalovirus infection Herpes simplex virus Bacterial infection Extra-genital chlamydia If a woman is in labor and ill with acute influenza virus, what is its danger: There is not danger both mother and fetus High risk of fetal asphyxia + High risk of septic complications High risk of bleeding in the early postpartum period High risk of late postpartum hemorrhage If a pregnant woman is ill flu during the first trimester of pregnancy, there is: + High risk of birth defects There is not risk the fetus High risk of down syndrome in the fetus High risk of preterm delivery in the second trimester of pregnancy High risk of premature detachment of placenta in the ii &iii trimester of pregnancy Where are pregnant should be treated with uncomplicated flu: + At home In the day hospital In the infectious diseases hospital In the medical ward General Hospital In a maternity hospital The pregnant lives in Almaty. She is complaining of headaches, increased body temperature during the day, chills, severe weakness, shortness of breath, muscle pain, nausea. One time there was vomit. After the examination there was diagnosis: 15-16 weeks of pregnancy. Flu. Suspected myocarditis? Where this patient should be treated: At home In the day hospital + In the infectious diseases hospital In the City General Hospital In a maternity hospital The prevention of influenza and other viral respiratory infections in the Republic of Kazakhstan are regulated by Order of the Ministry of Health of the Republic of Kazakhstan №: +722 Note the wrong answer. The flu virus: Suppresses the immune response, incidence of flu increases Leads the aggravation of chronic diseases (if any) Leads pneumonia, otitis (sometimes turning in meningitis) Leads the defeat of the cardiovascular and central nervous system + Leads the defeat of vision including blindness Where is a person vaccinated against influenza (The order MH RK № 722 of 15.09.2010): In any private medical facility In any public health facility In the establishment of an infectious + In specialized centers (grafting surgeries) for vaccination Any medical or sanatorium institutions Below is a list of the main anti-influenza drugs (The order MH RK № 722 of 15.09.2010). Note the extra point: Of Antivirals Antipyretics Immunomodulatory agents Vitamins and Minerals + Drugs for the prevention of heart failure At what stage of pregnancy women cannot be vaccinated against the flu: At any stage of pregnancy In the second trimester In the third trimester + In the first trimester In the eighth month of pregnancy When you need immunize the population, including pregnant women, against flu (order MH RK number 722 of 15.09.2010): From September 15 to November 15 From September 1 to December 1 + From October 1 to November 15 From October 1 to December 1 From October 15 to November 30 Why does the pregnant women ill primary bronchitis and aggravation to chronic bronchitis (what is the mechanism) Diaphragm movement during pregnancy is limited During pregnancy there is an edema Placental lactogen increase + The bronchial mucosa swells, the movement of the diaphragm is limited During pregnancy the immune system is reduced The patient with chronic obstructive bronchitis is diagnosed 6-7 weeks of pregnancy. What is the doctor's tactic: Pregnancy must be terminated It is necessary treating with antibiotics + Pregnancy should be terminated if there is evidence of pulmonary heart disease Pregnancy should be terminated if the patient has more children Pregnancy should be terminated if the patient is unable to give up smoking The patient was hospitalized with a diagnosis: Pregnancy of 10 weeks. Acute bronchitis. Which antibiotic (according to the evidence-based medicine) must you assign to the patient: Ceftiraxon Ofloxacin + Ampicillin Erythromycin Tetracycline Pregnant suffers from chronic bronchitis. What will happen to the fetus: Congenital heart disease + Fetal growth retardation Prenatal sepsis Malformation of the lung Neural tube defects Classification of pneumonia is based on the condition of the disease and the immunological status of the patient. From the list, select the UNNECESSARY: Community-acquired pneumonia (synonyms: home, outpatient) Nosocomial pneumonia (synonyms: hospital, in-hospital) + Unspecified pneumonia Aspiration pneumonia Pneumonia in patients with severe immune deficiencies Emergency doctor has diagnosed: Pregnancy 34-35 weeks. Community-acquired pneumonia. The patient has symptoms: Tachypnea - 30 per minute. The lungs have decreased breath sounds in the lower parts of both sides; there is single, moist and finely crepitations. BP - 90 \ 55 mm Hg, pulse 96 beats\ min. Subdued heart sounds and tachycardia. In which department the patient should be hospitalized: Department of Pathology pregnant maternity + The emergency and intensive department of maternity hospital Therapeutic department of General Hospital Department of Intensive Care General Hospital Department of Intensive Care Infectious Diseases Hospital After the X-ray light the patient was diagnosed: 33-34 weeks of pregnancy. Community-acquired pneumonia. In order MH RK № 869 02.12.2011 is a list of key diagnostic procedures for the diagnosis of pneumonia. One of the following researches is an additional: + Сoagulogram Smear microscopy of sputum Gram-stained Cultures of sputum Biochemical analysis of blood General blood analysis It is well known that pregnancy significantly increases the risk of death from varicella pneumonia. Mortality rate of 11-35%. What amount of vesicles is dangerous for the development of varicella pneumonia (Order of the Ministry of Health of the Republic of Kazakhstan № 869 dated 02.12.2011) More than 30 vesicles More than 40 vesicles More than 60 vesicles More than 90 vesicles + More than 100 vesicles What time since the beginning of varicella pneumonia in pregnancy can be detected immunoglobulin M to the virus Varicella zoster (The order MH RK number 869 dated 02.12.2011) week + 2 weeks 4 weeks 5 weeks 3 weeks Newborns will have a generalized form of chicken pox, if vesicles on the skin of the mother appear in the pregnancy \ labor: A week before giving birth - immediately after birth 2 weeks before giving birth - a week after giving birth + For 4-5 days before the birth - 2 days after giving birth During the 21 days prior to delivery - 21 days after birth A week before childbirth - a week after giving birth Treatment varicella pneumonia in pregnancy is: + Intravenous injection Acyclovir at a dose 5 mg / kg after 8 hours Acyclovir per os 200mg 5 times a day Oseltamivir per os 75 mg twice daily Rimantadine per os according to scheme Rovamycine per os 3 ml 2 IU twice daily There is а list of general principles of treatment of pneumonia in pregnancy (Order of the Ministry of Health of the Republic of Kazakhstan № 869 dated 02.12.2011). Find the extra point: Monitoring in a hospital Monitoring of blood gases: Pa2> 60-70 mm Hg, at the lowest possible level of FiO2 Monitoring of the fetus Limit the exposure tradiation and medicine + Blood pressure control Antibiotic therapy of pneumonia in pregnancy associates with the possible embryotoxic effects. One of the following antibiotics little crosses the placenta: Anti-tuberculosis agents Cephalosporins Ftorchynolons + Macrolides Aminoglycosides What medicine is used for treatment not-heavy bacterial pneumonia (purulent sputum, chest pain) in the I trimester of pregnancy (order MH PK number 869): + Penicillins Macrolides (rovamitsin) Glycopeptides (Vancocin) Carbapenem (merapenem) Cephalosporins If a pregnant woman has an atypical bacterial pneumonia (non-productive cough, symptoms of intoxication, shortness of breath), we have tassign a cure (Order of the Ministry of Health of the Republic of Kazakhstan № 869): + Macrolides (rovamitsin) Glycopeptides (Vancocin) Penicillins Carbapenem (merapenem) Cephalosporins If a pregnant woman has an atypical bacterial pneumonia (non-productive cough, symptoms of intoxication, shortness of breath), the prescription will have been (Order of the Ministry of Health of the Republic of Kazakhstan № 869): + Macrolides (Rovamicin) Glycopeptides (Vancocin) Penicillins Cephalosporins Carbapenem (Merapenem) When should be the vaccination for the prevention of chickenpox women without immunity carried out: In II and III trimester of pregnancy 3 weeks before childbirth In the II trimester of pregnancy In the I trimester of pregnancy + For 1-3 months before pregnancy When do you have to start antibiotic therapy if a pregnant woman has clinical symptoms of viral pneumonia (Order of the Ministry of Health of the Republic of Kazakhstan № 869 dated 02.12.2011) At the time of admission + Not later than the first 4 hours after hospitalization The first 12 hours of the receipt The first day of receipt If the bacterial etiology of pneumonia is proven The patient is diagnosed with influenza A. She has the following symptoms: body temperature within 38,10-40 ° C, the symptoms of intoxication. Pulse 90-120 beats / min. Systolic blood pressure less than 110 mmHg. Respiratory rate is 24\min. Dry painful cough with pain behind the breastbone. What form of the clinical course is described: Asymptomatic Mild + Moderate Extremely hard form (hypertoxic) Heavy What form of influenza is characterized by the following symptoms: fever up t38 ° C, moderate headache and catarrhal conditions. Pulse less than 90 beats / min. Systolic blood pressure of 115-120 mm Hg. Respiratory rate is less than 24 in min. Extremely hard form (hypertoxic) Heavy + Mild Asymptomatic Moderate The patient was taken to the hospital with a pregnancy of 28-29 weeks. She’s symptoms are: body temperature 40,5 ° C, intoxication symptoms - severe headache, general aches, insomnia, delirium, anorexia, meningeal symptoms. Pulse over 120 beats / min, sometimes is arrythmic. Systolic blood pressure less than 90 mmHg. Heart sounds muffles. Respiratory rate is over 28\ min. Painful, painful cough, chest pain. Diagnosis: Pregnancy 28-29 weeks. Flu. Complete... diagnosis: Extremely hard form (hypertoxic) + Heavy Moderate form Mild form Asymptomatic form The patient in 2nd days after delivery was produced fluoroscopy. Pulmonary tuberculosis was suspected. The tactics of the doctor: Make an overview of chest radiography Consultation of phthisiatrician + Perform 3 times smear microscopy of sputum for MT Conduct a non-specific antibiotic therapy for 2 weeks Conduct microbiological testing of sputum for MT If the mother has TB, the fetus has: + Growth retardation Increased risk of birth defects Usually a child is born tb patients The risk of down syndrome Increased risk of genetic diseases The typical symptom of tuberculosis in pregnancy is: + A woman stops gaining weight or losing weight The clinic does not differ from non-pregnant women suffering Pleural effusion develops quickly The disease begins with hemoptysis fetal death Особенности острых и хронических заболеваний мочевой системы у беременных. Осложнения беременности и послеродового периода. Алгоритм диагностики, лечение, профилактика. Значение скрытой бактериурии во время беременности. Renal blood flow and glomerular filtration during pregnancy increase on: 10-15% 15-20% 20-30% + 35-40% 40-50% The cause of proteinuria and cylindruria in physiological pregnancy is: Kidney glomerular filtration reduces Renal tubular reabsorption increases + Permeability of the renal epithelium increases Reabsorption of sodium and water increases Kidney glomerular filtration increases The most common causative agents of pyelonephritis in pregnancy are (Савельева Г.М. и соавторы, 2006): + Coliform organisms Candida species Microbial association Anaerobes The simplest (trichomonas) Pyelonephritis often occurs in 12-15 weeks and 23-28 weeks. The reason is: Formation and the maximum development of the placenta Compression of the ureter by growing uterus + Maximum release of corticosteroids Changes the ecosystem of the vagina A gradual rise in blood pressure The peculiarity of pyelonephritis in the I trimester of pregnancy is: Worn clinical + Acute course of the disease Lack of temperature response of pregnant women Lack pielourii Always have hematuria The peculiarity of pyelonephritis in the II and III trimester of pregnancy is: During Acute The lack of temperature + Worn clinical Often complicated anuriey Often accompanied by hematuria Which antibiotics should be prescribed for the treatment of gestational pyelonephritis in the I trimester of pregnancy: + Group penicillins Cephalosporins Nitrofurans Macrolides The aminoglycosides At what stage of pregnancy can be cephalosporins, aminoglycosides, macrolides, nitrofurans, 8-hydroxyquinoline derivatives administered for treatment pyelonephritis: From 13 weeks + From 15 weeks From 24 weeks From 28 weeks From 36 weeks Which antibiotic should be in the postpartum period administered cautiously, because its concentration in breast milk is very high: Ampicillin 2nd generation cephalosporins 5th generation cephalosporins The aminoglycosides + Erythromycin The differential diagnosis of chronic pyelonephritis should be the following complication of pregnancy carried out with: Premature detachment of placenta + Preeclampsia Pregnancy-induced hypertension The risk of preterm birth Proteinuria in physiological pregnancy If a pregnant woman has a latent (asymptomatic) bacteriuria, in 1ml. of urine has been detected: + 100 000 or more bacteria 10,000 or more bacteria 50,000 or more bacteria Not less than 90,000 bacteria Not less than 70,000 bacteria The antibiotic therapy is prescribed for pregnant patients with asymptomatic bacteriuria, because it…: Does not impact on the incidence of pyelonephritis + Reduces frequency of pyelonephritis Has a toxic effect Leads to allergies Leads to the development of pyelonephritis Asymptomatic bacteriuria increases the risk (Order of the Ministry of Health of the Republic of Kazakhstan № 239 dated 07.04.2010) + Premature birth, birth low weight infants, acute pyelonephritis Horionamnionit, acute glomerulonephritis, pyelonephritis High water, low water, premature birth Pre-eclampsia, premature detachment of placenta Acute polyhydramnios, premature labor, fetal distress All pregnant women should be screened urine (seeding midstream urine) for asymptomatic bacteriuria (Order MH RK number 239 of 07/04/2010): + 1 time when registering During the registration and gestational age of 30-32 weeks 3 times: when registering in the 30-32 weeks of pregnancy, a week before the birth 1 time in 37 weeks gestation or later 1 every 23-28 weeks of gestation For the treatment of asymptomatic bacteriuria can be used (Order MH RK number 239 of 07/04/2010): Erythromycin or other macrolides Penicillin The aminoglycosides + Ampicillin, Cephalosporins 1st generation Sulfonamides The duration of antibiotic therapy for asymptomatic bacteriuria in pregnancy (Order of the Ministry of Health of the Republic of Kazakhstan № 239 dated 07.04.2010) is: 4-day course 7-day course + single dose 3-days course 5-day course Pyelonephritis can cause severe obstetric complications. This list does not include: Pre-eclampsia Placental insufficiency Septicemia and pyosepticemia Toxic shock + Hemorrhagic insult Which of instrumental studies has adverse effects on the fetus: Renal ultrasound Doppler sonography of renal vessels Ureteral catheterization Cystoscopy + Renal scintigraphy The etiology of glomerulonephritis is: Escherichia coli Staphylococcus Proteus + Hemolytic Streptococcus Association of microbes Glomerulonephritis often occurs after: + Angina, flu Pharyngitis, acute respiratory Acute cystitis Is a complication of pyelonephritis Inflammatory diseases of the pelvic organs The most probable complication of pregnancy in glomerulonephritis is: Wasting, fetal hypoxia Fetal death + The early development of pre-eclampsia The development of cardio-renal failure Bleeding during pregnancy Treatment of acute glomerulonephritis begins with: Corticosteroids + Antibiotics Antihistamine drugs Immunomodulator Antispasmodics If the patient is ill with glomerulonephritis, pregnancy will be possibled after: Year 2-3 years + 3-5 years 6-7 years 8-9 years
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