Question 7 O&G A 38 year old women who is 33 weeks pregnant, G2P1, presents to the ED with a headache. Her vital signs are: Temp: 36.6 HR:

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Presentation transcript:

Question 7 O&G A 38 year old women who is 33 weeks pregnant, G2P1, presents to the ED with a headache. Her vital signs are: Temp: 36.6 HR: 88 BP: 170/120 O2 sats: 99%

Results Overall pass rate 80% Range 3.5 – 10 Average mark – 8.6 Overall well done and easy question

List 4 most likely differential diagnoses for this patient: (4 marks) a. Pre-eclampsia b. HT in pregnancy c. Central venous thrombosis d. SAH also accept migrane, CVA, tension headache,

List 3 criteria for diagnosing pre-eclampsia: ( 3 marks) a. Over 20/40 plus b. Raised BP -Diastolic BP >90mmHg, or systolic > 140mmHg on 2 consecutive occasions or Diastolic BP > 110 on a single measurement plus Proteinuria – 1+ on dipstick ( correlates to > 300 mg over 24 hrs)

List your anti-hypertensive of choice in this situation , dose and possible side effects to the fetus. (3 marks) Drug: hydralazine Dose: 2.5-10mg IV bolus Side effects: Fetus: thrombocytopenia/lupus like synd/ foetal distress Or more widely recommended: Labetalol 20-50 mg IV bolus – SE bradycardia/ hypotension/ hypoglycaemia/hypothermia/ resp depression.

Drug: Magnesium sulphate Dose: 4-6 grams over 15 mins ( then 2g/hr) The patients starts having a generalized seizure. What is your drug of choice to terminate and dose: ( 2 marks). Drug: Magnesium sulphate Dose: 4-6 grams over 15 mins ( then 2g/hr)

Main issues Dx of pre-eclampsia – need to be 20/40 plus criteria Drug of choice – some said oral , ideally IV - nifedipine not best choice – limited control -drug of choice is labetalol oral or IV otherwise hydralazine. Side effects – most said hypotension causing placental insufficiency which is acceptable Treatment of seizures in eclampsia very straight forward – Mg Sulphate.

General points Be specific –i.e. drugs give dose if you know Read question properly – most likely , not most obscure Don’t say the same thing twice in a different way