Obs + Gynae DDx

Question 1

Ddx for vomiting in pregnancy?

Answer 1

Main differential = hyperemesis gravidarum

Gastroenteritis

Diabetic ketoacidosis

Urinary tract infection

Question 2

Questions to ask in vomiting in pregnancy?

Answer 2

• What does the vomit look like? Green? Blood?
• Trigger? Eat anything unusual?
• Everytime you eat?
  
  • Are you keeping anything down?
  • Have you lost any weight? How much?
• How long has it been happening for?
• ## Previous pregnancy- did you get bad morning sickness in your previous pregnancy?Screening:
  Raised ICP - Any headache?

UTI - Fevers? Changes to urine? Pain or burning when passing urine? Is the urine cloudy? Smelly? Pain in the tummy?

DKA - Passing urine more frequently? More thirsty than usual? Pass urine at night?

Gastroenteritis - Have you had any changes to your bowel habits?

Hepatic (Acute fatty liver of pregnancy/ obstetric cholestasis/ hepatitis etc.) - Any changes to the colour of your skin? Have you been feeling particularly itchy at all? Pale urine? Dark stools?

Thyrotoxicosis (complication) - Feeling hot when others feel cold?

Question 3

Main ddx for itching in pregnancy?

Answer 3

• Main differential = obstetric cholestasis
• Acute fatty liver of pregnancy
• HELLP Syndrome
• Gallstones
• Viral Hepatitis
• Autoimmune Hepatitis
• Pemphigoid gestationis
• Polymorphic eruption of pregnancy
• eczema

Question 4

Questions to ask in itching in pregnancy?

Answer 4

Where is it? palms, soles?Face? (should spare face)

Rash? (should NOT have rash)

Have you made your skin bleed? (excoriations)

Is it particularly worse at any times of the day? Night? Effect on sleep? More tired than usual?

ICE - Triggers:
- Changes in detergents to wash clothes?

Noticed any yellowing of skin?

Any changes to urine? Dark?

Bowel habits?
    - Pale and difficult to flush?
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Screening:
Acute fatty liver of pregnancy - Nausea and vomiting? Pain in tummy?

HELLP Syndrome - How has your BP been during your pregnancy? Swelling in the body? Headache? Blurred vision? Tummy pain

Gallstones - Pain in tummy - come and go? Worse after fatty meal?

Hepatitis (viral) - Have you had a fever?

Question 5

What questions need to be asked in suspected DVT / PE?

Answer 5

Swelling - - When first noticed swelling? Worse over time? One or both legs? Painful? Red? Hot to touch?

Screening:
Pre-eclampsia - Swelling elswehere? How has your BP been? Headache?

Cellulitis - Any fevers? Rashes?

PE - Difficulty breathing? Chest pain- sharp, worse on breathing in? Cough - blood?

Question 6

What questions to ask in a patient w reduced foetal movements?

Answer 6

When did you first start feeling the baby moving?

How long has this been going for?

How often do you normally feel the baby?

How does that compare to now?

Screening:
How have you been feeling within yourself?

Infection (esp. UTI):

- Fever
- Burning when passing urine
- Passing urine more frequently
- Cloudy urine
- Has anyone around you been unwell?

Pre-eclampsia:

- Swelling elswehere?
- How has your BP been?
- Headache?

Question 7

Questions to ask about in UTI?

Answer 7

• Fever? Did you measure it?
• Pain when passing urine?
• Going to the toilet more often?
• What about at night?
• Is the urine particularly cloudy at all?
• Any pain in your tummy?
• Have you felt nauseous?
• Have you been vomiting? Is it green at all?
• Have you been able to keep any food or liquids down?

Screen for pyelonephritis:

- Any pain in your sides?
- Do you ever get the shakes?