Maternal medicine TOGs Flashcards
1
Q
Dose of glucocoticoids if sick
A
- Double the dose
2
Q
Fasting rules for steroids in adrenal disease
A
- Give IM hydrocortisone
3
Q
Management of gluco/mineralocorticoids in labour
A
- Hold fludrocortisone
- Give Hydrocortisone
4
Q
TB rate in UK
A
6.9/1000
5
Q
Testing for TB
A
Skin tests:
- Tine or Mantoux
- High flase positive- BCG vac, lymphoma etc
C-TB- less false positive
If skin test +, sputum culture:
- Ziehl–Neelsen staining of sputum
- Lowenstein–Jensen medium for culture
6
Q
Other tests
A
- CXR once diagnosed
- Ghon’s focus- granuloma reaction
7
Q
Treatment for TB
A
- Isoniazid, Rifampicin, pyrazinamide, ethambitol
GIVE pyridoxine 10mg with isoniazid to prevent nuerotoxicity
8
Q
HF risk with mitral stenosis
A
- 33% risk if moderate MS
- 50% risk if severe MS
9
Q
Cardiac conditions of HIGH risk in preg
A
- Severe MS- valve area <1cm
- Marfans w Aortic dilation >45mm
- Pulmonary HTN
- LVEF <30%
- Prev peripartum cardiomyopathy w residual LV impairment
10
Q
Peak levels of anti-Xa level
A
1.0-1.2IU/ml
11
Q
Uterotonics for PPH in heart disease
A
- First line- oxytocin
DO NOT USE ERGOmetrine - 2nd line- Misoprostol or oxytocin infusion or carboprost
Avoid carboprost if pulmonary HTN
12
Q
When does peripartum cardiomyopathy develop?
A
- Mostly 4 months PN
or
1 month pre-delivery
13
Q
Diagnosis of PPCM
A
- ECHO, EF<45%
- BNP >100
- ECG- non specific
14
Q
Mx of PPCM
A
- ACEi/ARB
- MDT approach
- LMWH
- Bromocriptine-
2.5mg OD 1 week, EF>25% - If EF <25% 2.5mg BD 2 weeks to stop lactation.
15
Q
Prognosis for PPCM
A
- 50-80% women get LVEF >50%
- high risk of relapse - 50% chance of LVEF drop in next preg
