Medical Conditions Flashcards
When is UTI in pregnancy treated?
100 000 or more cfus on u-mcs
How is UTI in pregnancy treated?
Nitrofurantoin 100 mg bd x 7 days or
Amoxicillin 250 mg TDS po x7 days or
Bactrim 2 tabs bd po x 7 days
Name 3 types microcytic (mcv < 80 ) anaemias and how to diagnose
DO serum iron studies
• iron deficiency anaemia.: low iron and ferritin (stores iron), high TIBC (total iron binding capacity)
• thalassaemia minor: Mentzer index MCV: RBC <13 ( abnormal hb)
• anemia of chronic disease component plus iron deficiency: low-normal iron, low-normal ferritin, low tibc
Name 7 types normocytic (mcv 80 - 100 ) anaemias and how to diagnose
Do reticulocyte count.
<2% (hypoproliferative)
• leukaemias
• aplastic anaemia
• pure red cell aplasia
• other marrow failure syndromes: ineffective haematopaesis eg myelodysplastic syndrome
> 2% (hyperproliferative)
• haemorrhage
Anaemia of chronic disease: chronic inflammation, ckD, malignancy, endocrine deficiency, liver disease, malnutrition
Name 7 types macrocytic (mcv > 100 ) anaemias and how to diagnose
Do blood smear and look at macrocytes.
Megaloblastic oval macrocytes and segmented neutrophils
• vit b12 deficiency (pernicious anaemia, ileal disease, poor intake)
• Folate deficiency (dietary, alcoholics, coeliac disease, increased cell turnover, phenytoin, methotrexate, sulfasalazine)
Non-megaloblastic round macrocytes
• alcohol
• myelodysplastic syndrome, myeloproliferative disease
• Iiver disease: cirrhosis
• congenital bone marrow failure syndromes
• hypothyroidism, reticulocytosis (haemolysis, haemorrhage)
Preconception management diabetes? (4)
- Educate: weight loss, exercise, glucose testing, manage hyperglycaemia. Aim hba1c 6-7%
- folate 5 mg / day at least 1 month prior to conception
- evaluate presence vascular disease: fundoscopy, 24h urine, ECG
- gastroparesis and IHD are contraindications to pregnant
- involve dietician
Total insulin requirements in pregnancy? (3)
First trimester: 0,7 - 0,8 iu / kg
Second: 0,8 - 1
Third: 0,9 - 1,2
When deliver infant to diabetes mother?
38 weeks.
37 if poor glucose control or macrosomia
Name 10 risk factors gestational diabetes
History
- prior unexplained stillbirth
- prior infant with congenital abnormality
- prior macrosomia
- history gestational diabetes
- family history dm
Patient factors
- obesity (weight > 80 kg, muac > 33 cm )
- chronic corticosteroid use
- glycosuria
- advanced maternal age
- Asian
Which dosing regimens of insulin should diabetics be converted to while pregnant
- Half dose short acting divided into 3 pre-prandial doses, and half long acting at bedtime
Or - 3/5 short acting in 3 divided pre-prandial doses and 2/5 long acting at bed time
Management of antepartum admission for glucose control? (3)
- 30 -50 kcal/kg/day with 45% low gi carbohydrates, 20% protein, 35% fat, and 80 g/day fibre
- monitor glucose: fasting ( aim 3,3 -5), pre prandial (3,3 - 5,6 ), 1 (7,8 or less) and 2 hour post prandial (6,7 or less), 2 am (3,3 -5)
- teach woman to measure own glucose, inject self with insulin, understand and treat hypoglycaemia. Discharge once controlled.
Antenatal care chronic diabetes? (8)
- Nutritional therapy: dietician
- Outpatient 6 point blood glucose to be recorded daily by women.
- attend ANC 2 weekly until 32 weeks, then weekly until admission at 37/38 weeks for delivery
- early sonar for Ga
- detailed anatomy scan at 18 - 22 weeks
- foetal echo at 20 - 22 weeks
- ultrasound for foetal growth at 28 and 34 weeks
- weekly ctg from 32 weeks
How deliver infant to diabetic mom (5)
- NVD at 38 weeks, except if > 4 kg (c/s)
- Iv insulin 1 unit/hour: mantain glucose 4-7 mmol/l, monitor hourly
- iv dextrose with KCI if glucose < 3,9 or ketunuria
- continuous ctg
- deliver in lithotomy position
When do 75g 2h OGTT in ANC?
- At first visit if risk factors
- At / after 24 weeks
Diagnosis gestational diabetes? (7)
Overt diabetes in pregnancy
- Random glucose 11,1 or more mmol/l or
- fasting 7 or more or
- 2 hour plasma glucose 11,1 or more after 75g OGTT or
- hba1c > 6.5%
Gestational diabetes after 75g OGTT
- fasting 5,1 or more
- 1 hour: 10 or more
- 2 hour: 8,5 or more
