hyperemesis

Question 1

task

Answer 1

Your next patient is a 38-year-old woman who has come to the general practice because of
severe nausea and vomiting for the last two weeks in this, her first pregnancy. She claims that
she has been unable to keep foods or fluids down. Her last menstrual period was eight weeks
previously, and pelvic examination by your colleague in the general practice two weeks ago
showed the uterine size was appropriate for gestation and a pregnancy test was positive. She
has had no previous operations or illnesses.
YOUR TASKS ARE TO:
* Take any further relevant history you require.
* Ask the examiner about relevant findings evident on general and obstetric examination
which would assist you in making a diagnosis.
* Advise the patient of the likely diagnosis.
* Advise the patient of the care you would advise for her, including any investigations you
would arrange.

Question 2

d/d

Answer 2

‐ Multifetal pregnancy?
‐ Hydatidiform mole (complete/incomplete)
‐ UTI
‐ Infectious Gastroenteritis
‐ Brain tumor/Addison disease

Question 3

hx

Answer 3

haemodynamic stability
vitals hydration
-congratulate pt on pregnancy
-how many times, content, time,
-fever diarrhoea, abdominal pain, eat outside
-uop, burning sensation, frequency
pregnancy
-is this planned, how did you confirm, any assisted technique, fertility drugs, family hx of twins
-vaginal bleeding
-periods, pills, partner, pap smear, blood group
-SADMA
-ARE you aware increased risk downs

Question 4

exam

Answer 4

-vitals, hydration
-temp
-abdomen : uterus
-loin tenderness
-pelvic exam not repeated
-UDP -NITRITES, KEONES
-MSU-NITRITE> ADMITT
-rft/bu,

Question 5

explanation

Answer 5

-you are having a condition called hypermeis gravidarum, due to increased b hcag, settles by 14 weeks
-it is common condition about 10 percent, if severe need admission for iv fluids and antiemetics
-severeity>ketones>if positive>admit
-although it can be normal it can be due to multiple, hydatiform >USS
-UTI > need culture
-RFT and LFT done to check if kidneys affected and maternal body functioion
-if it doesn’t settle by about 14 weeks of pregnancy other cause excluded, cerebral and addisons, bowel obstruction
-38 yrs increase chance downs>i would like to differ you screening for downs

Question 6

downs screening

Answer 6

combined first trimester11-13wks
PAPPA - IS THE onlu first tirmster screening tool>if decreased>further tetsing for downs
maternl serum screening dowsn 1st trimester : free B-HCG increased, pappa-a decreased
with nuchal translucecny risk for trisomy 13,18,21
NIPT
at 10 weeks for aneuploidy 13,18,21
second trimester
increased b hcg and Inhibin a/ decreased AFP and oestrol
maybe appropriate prior to amniocentesis chorionic villus sampling 10-12
USS 16-18wks - neural tube defects
Amniocentesis 16wks - safe and reliable to exclyde downs with least risk of miscarriage(1:200)
Cordocentesis high risk miscarriage
tripple test for downs
done 15-18weeks window
there dates should be confirmed first
70percent sensitive
AFP and Oestriol decreased , BHCG increased
edwards all decreased
with 4th marker inhibin a 75%>it will be increased