TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Causes of Maternal Death Goto page Previous  1, 2, 3, 4  Next          TEALE FENNING Forum Index -> MRCOG Part 2: EMQs - Extended Matching Questions View previous topic :: View next topic   Author Message wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Sat Feb 17, 2007 8:34 pm    Post subject: Hypoxia not corrected with O2 is due to A/V shunt typical in PE and pulmonary edema secondary to heart failure (peripartum cardiomyopathy?). The B stimulants want to tell us that the hypoxia is probably not due to an asthmatic atack (she is asthmatic Abi! The RCOG and Raj never waste words in their questions). I think that her History (severe PET with eclampsia and em. C/S) points towards PE Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Feb 17, 2007 9:09 pm    Post subject: rpwalavalkar wrote: 42yrs old asthamatic, G4P3- 3SVD, at 34 weeks gestation, admitted with headache, visual disturbances, brisk reflexes, 3 beats clonus, total protein in ur 5gm%, right hypochondrial pain, has not passed urine in the past past 4 hrs and has a BP of 190/126. she is on a combination therapy for controll of HT. she develops an ecclamptic fit and is treated according to the unit protocol and delivered by LSCS post delivery, she starts complaining of tachycardia, increased difficulty in breathing not relieved by O2 + beta stimulants. her O2 stat keeps dropping she finally goes in to cardio - resp failure and dies. This is an excellent question Raj. Good answer wolverine - I think you have hit the nail on the head. I went back to the option list (something I would recommend to you all) looking for pulmonary oedema only to realise it was not an option. Considering the chest symptoms and underlying pre-eclampsia I think you are right with pulmonary embolus Other pointers include her parity, her age, the fact she had a caesarean. However, she is anuric and presumably received magnseium ... I guess an arrhythmia comes in to play although once again this is not an option! _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Sat Feb 17, 2007 9:30 pm    Post subject: That's clever! Anuria with MgSO4 will easily lead to toxicity! What's her resps Raj? Tendon reflexes? Would calcium gluconate have saved her life? Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Feb 17, 2007 10:12 pm    Post subject: wolverine wrote: That's clever! Anuria with MgSO4 will easily lead to toxicity! What's her resps Raj? Tendon reflexes? Would calcium gluconate have saved her life? It's too late my friend ... she has left us _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sun Feb 18, 2007 3:06 pm    Post subject: wolverine wrote: That's clever! Anuria with MgSO4 will easily lead to toxicity! What's her resps Raj? Tendon reflexes? Would calcium gluconate have saved her life? So you are saying ... H Drug related? Probably right (I do have inside info however as Raj is standing next to me. _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Sun Feb 18, 2007 7:58 pm    Post subject: yes I think it was Mg toxicity and the poor m/w and SHO that didn't recognise it.. Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Sun Feb 18, 2007 7:59 pm    Post subject: Did you have nice time by the way? Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Sun Feb 18, 2007 9:06 pm    Post subject: hi vangelis, did have an excellent weekend discussing mcqs. i got all my incidence ones wrong . but coming back to what i know........ i.e my EMQ.... the answer is ' Drug Related ' explanation -- Quote: 42yrs old asthamatic, G4P3- 3SVD, at 34 weeks gestation, admitted with headache, visual disturbances, brisk reflexes, 3 beats clonus, total protein in ur 5gm%, right hypochondrial pain, has not passed urine in the past past 4 hrs and has a BP of 190/126. she is on a combination therapy for controll of HT. she develops an ecclamptic fit and is treated according to the unit protocol and delivered by LSCS diagnosis ---- ecclampsia with severe HT. is on combination anti hypertensives ----- i was thinking, may be nifedepine. treated according unit protocol -------- will have received MgSO4. Magnesium sulfate, when combined with nifedipine, can cause neuromuscular blockade and muscular paralysis and resp failure ------- this is interaction number 1 Quote: post delivery, she starts complaining of tachycardia, increased difficulty in breathing not relieved by O2 + beta stimulants. her O2 stat keeps dropping she finally goes in to cardio - resp failure and dies. patient is an asthamatic and received beta stim to relieve her dyspnoea............ When combined with beta stimulants, magnesium sulfate can greatly increase the risk of severe complications - including pulmonary edema and cardiovascular complications. the pulmonary oedema will have increased resp morbidity and made resp depression worse failure eventually. the tachycardia is due to the CVS complications...... this will increase cardiac demand and put further stress on the resp component of the cardio resp system inability to maintain sats and failure. A study of asthmatics found that combining magnesium sulfate and beta stimulants increased the beta stimulant's cardiovascular side effects. this is interaction number 2. Quote: has not passed urine in the past past 4 hrs ----- magsulf toxicity respiratory depression. this in addition to the NM blockade + pulm oedema + cardiac complications / tachycardia / increased demand. DEATH. this is interaction number 3. hope u all enjoyed it. _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Sun Feb 18, 2007 9:32 pm    Post subject: try this one---- 43 yrs old G1P0, at 33 weeks of gestation, IVF pregnancy, asthamatic on treatment, comes to DAU with SROM and is treated according to protocol and is given erythromycin and admitted. A few hours later she develops headache, dizziness, hypotension, hallucinations, tachycardia, seizures and dies............. what is this?? _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Mon Feb 19, 2007 10:03 am    Post subject: Sounds like classic teale-fenning syndrome! Yes, I can feel the headache coming on as we speak.. good grief are those flying pigs?......cnat wirte proepryl nw.. .. .. ! Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Mon Feb 19, 2007 10:46 am    Post subject: well abi, the words for the occasion are --- '' We shall over come, We shall over come ........ Some day'' as in the song. _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top arunangsude2007 Joined: 22 Feb 2007 Posts: 18 Posted: Fri Feb 23, 2007 8:26 am    Post subject: PAINT FACTORY Q 36 yr old, 30 wks pregnant, works in a paints factory, history of febrile illness since 3 days, had progressive loss cognitive ability, subtle personality changes, inability to concentrate, lethargy, nystagmus, loss of ability to swallow, seizures and progressive loss of consciousness and sinks in the ITU................. what is this?? are we dealing with a lead poisoning? Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Fri Feb 23, 2007 9:31 am    Post subject: the paint factory question has been discussed above. please read the explanation. r _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Fri Feb 23, 2007 10:39 am    Post subject: rpwalavalkar wrote: try this one---- 43 yrs old G1P0, at 33 weeks of gestation, IVF pregnancy, asthamatic on treatment, comes to DAU with SROM and is treated according to protocol and is given erythromycin and admitted. A few hours later she develops headache, dizziness, hypotension, hallucinations, tachycardia, seizures and dies............. what is this?? What on earth....? Let's hope I'm not on-call when she comes in or she's definately a gonner!! Does she have a thrombophilia needing IVF? Maybe she's on heparin? I assume she was given steroids as well as erythromycin? Is it another drug interaction or a CVA? Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Fri Feb 23, 2007 12:45 pm    Post subject: Is it cerebral sinus thrombosis? Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Fri Feb 23, 2007 9:38 pm    Post subject: rpwalavalkar wrote: try this one---- 43 yrs old G1P0, at 33 weeks of gestation, IVF pregnancy, asthamatic on treatment, comes to DAU with SROM and is treated according to protocol and is given erythromycin and admitted. A few hours later she develops headache, dizziness, hypotension, hallucinations, tachycardia, seizures and dies............. what is this?? This sounds like pulmonary oedema due to drug interactions so I'll go for .... H Drug related _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Sat Feb 24, 2007 11:10 am    Post subject: Are these symptoms/signs characteristic of pulm odema? Headache, sezures,hallucinations - are you thinking hypoxia? I was thinking more along the lines of cerebral irritation. Isn't Raj there in London - get it out of her!!!! Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Sat Feb 24, 2007 7:01 pm    Post subject: rpwalavalkar wrote: try this one---- 43 yrs old G1P0, at 33 weeks of gestation, IVF pregnancy, asthamatic on treatment, comes to DAU with SROM and is treated according to protocol and is given erythromycin and admitted. A few hours later she develops headache, dizziness, hypotension, hallucinations, tachycardia, seizures and dies............. Nick is spot on as usual -- it is Drug Related. the woman is asthamatic on treatment ---- i presume theophyllin. Concurrent administration may lead to toxic increases in theophylline.This occurs because the hepatic metabolism of theophylline is inhibited by erythromycin via the cytochrome P-450 enzyme system. Theophylline toxicity is a serious condition; several deaths have been linked with serum concentrations as low as 25 mcg/mL. Signs of theophylline toxicity include headache, dizziness, hypotension, hallucinations, tachycardia, and seizures. _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Sat Feb 24, 2007 7:23 pm    Post subject: How annoying - why should we presume she's on theophylline? If they ask me one like that I will leave!! How was today Raj? Hope you had a good time. Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Sat Feb 24, 2007 7:36 pm    Post subject: today was good. am bubbling better today that i did on thursday. got almost 14-16 in my bubbles that is if i get them all translated in the essay. the theophyllin bit was one of my 'i hate studying' knee jerk reactions. sorrry!! have u had an ok call so far? _________________ Dr Miss. 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