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WH > HRP- nausea and vomiting and thyroid > Flashcards

HRP- nausea and vomiting and thyroid Flashcards

1
Q

what is the most likely pathogenesis associated with NVP ?

A

HCG is most likely associated with nausea and vomiting with pregnancy

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2
Q

what are the complications of HEG ?

A

SGA neonates
fetal demise
wernicke’s encephalopathy
electrolyte imbalance

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3
Q

what is the first line management regarding nausea and vomiting in pregnant woman ?

A

dietary changes and to avoid triggers
anti-emetic / anti-histamines
vitamin B pyroxidine

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4
Q

what is the triad of hyperemesis gravidarum ?

A
  1. weight loss of more than 5%
  2. dehydration
  3. ketonuria
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5
Q

given that improvement is seen after administration of vitamin B what is the next best step in management ?

A

maintenance

gradual withdrawal

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6
Q

what is the best management foe pregnant women with persistent HEG ?

A

rectal or parenteral route of antiemetics

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7
Q

what is the protocol associated with metoclopramide use ?

A

used as a second line treatment due to its extrapyramidal effects

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8
Q

what is the protocol associated with the use of ondansetron ?

A

safe and effective however used as second line treatment due to limited data

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9
Q

what is the protocol associated with corticosteroid use in NVP ?

A

cannot be used for pregnancy below 10 weeks due to teratogenic effects

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10
Q

what is the most appropriate intravenous hydration therapy for NVP ?

A

each bag should contain normal saline with additional potassium chloride

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11
Q

what is the protocol regarding dextrose infusion in NVP ?

A

dextrose is not appropriate unless the serum sodium levels are normal and thiamine has been administered

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12
Q

what is CPM associated with ?

A

central pontine myelosis associated with rapid ( too rapid) sodium correction

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13
Q

what is thiamine used to prevent the happening of in HEG ?

A

wernicke’s encephalopathy

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14
Q

if a woman is admitted for HEG what should be offered in terms of prophylaxis ?

A

thromboprophylaxis LMWH

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15
Q

when does NVP peak ?

A

weak 9

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16
Q

when can NVP be diagnosed ?

A

only in the first half of pregnancy

17
Q

which initial investigation should be done for a preg woman coming in with prolonged vomiting ?

A

serum electrolytes and urea

18
Q

what are the levels at which anemia is diagnosed at each trimester ?

A

first trimester - 110 mg/dl
second trimester - 105 mg/dl
postpartum - less than 100 mg/dl

19
Q

what are the 2 most common causes of anemia in pregnancy ?

A

physiological anemia

iron deficiency anemia

20
Q

what is the daily recommendation of supplemental iron that should be taken for all pregnant women ?

A

30 mg a day through pregnancy and 3 months postpartum

21
Q

when should screening for anemia be performed ?

A

at booking and at 28 weeks

22
Q

what is the first step management for normocytic and microcytic anemia in pregnant women ?

A

a trial of oral iron should be considered

23
Q

how should the side effects of oral iron be lessened ?

A 
use iron syrup 
mix with orange juice 
take on an empty stomach 
increase dose gradually 
double dose every other day
take a larger dose at bedtime
24
Q

when is parenteral iron indicated ?

A

when oral iron is not tolerated or absorbed

contraindicated in the first trimester

25
Q

when can blood transfusion be given in cases of anemia ?

A

severe anemia below 70 mg/dl in the postnatal period

26
Q

what is the role of rHUEPO ?

A

expensive
serious side effects
lazma

27
Q

what are the different diseases associated with hyperthyroidism ?

A

graves
active thyroid adenoma
toxic nodular goitre
transient gestational thyrotoxicosis

28
Q

what are the different diseases associated with hypothyroidism ?

A

hashimotos disease
iodine deficiency
post-thyroidectomy
post radioactive iodine ablation

29
Q

what is the management of hyperthyroidism in pregnant women ?

A

PTU in the first trimester

carbimazole or methimazole in the 2nd and 3rd trimester

30
Q

what can be added in severe cases of hyperthyroidism ?

A

propranolol

31
Q

if there is no response to propranolol and hyperthyroid drugs what is the next best step in management ?

A

thyroidectomy

32
Q

what is the management for thyrotoxicosis storm ?

A

dexamethasone
PTU
iodine
propranolol

33
Q

what is the management of hypothyroidism ?

A

levothyroxine

may increase dose by 20% in first trimester

34
Q

what is the presence of TPO antibodies associated with ?

A

autoimmiune diseases :
hashimotos
grave’s

35
Q

what are the lab findings associated with :
subclinical hypothyroidism
subclinical hyperthyroidism

A 
sub hypothyroidism :
TSH is elevated 
FT4 is normal 
sub hyperthyroidism :
TSH is decreased 
FT4 is is normal

WH (68 decks)

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