1. 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: HR: BP: /120 O2 sats: 99%

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

3. 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,

4. 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)

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

6. 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)

7. 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.

8. 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