(MCQS 374-376 ):A woman in the 30th week of gestation is found to have mild hypertension unresponsive to counseling, restricted activity and nutritional diet

Question:374
Correct Answer: I
Explanation:
Estrogens may be administered vaginally. Although most of the estrogen acts locally, some of it is rapidly absorbed into the systemic circulation and may stimulate endometrial growth. Generally, progestins should be given intermittently with vaginal estrogens for patients with an intact uterus and repeated for as long as the patient has withdrawal bleeding.

Question:375
Correct Answer: H
Explanation:
Methyldopa is the drug most commonly used to treat hypertension during pregnancy and is the standard against which other agents are compared. It lowers blood pressure by stimulation of central alpha2 -receptors via alpha-methylnorepinephrine, which is the active form of alpha-methyldopa. PIH is defined as an elevated blood pressure which begins after 20 weeks gestation. PIH is the main manifestation of preeclampsia ( a systemic disease involving maternal endothelial cell dysfunction ) and is primarily seen in the last 16 weeks of gestation. PIH occurs in 1 - 5% of all pregnancies and is 2 - 3 times more prevalent in black women. Chronic hypertensive women are 2 - 7 times more likely to develop PIH. Unfortunately there is as high as a 10% perinatal mortality rate associated with preeclampsia. Since both PIH and chronic hypertension are related to third trimester fetal death, diagnosis and treatment are very important. Misdiagnosis is an easily made mistake due to the fluctuating blood pressures in the normal physiology of pregnancy. During the first trimester there is a drop in blood pressure followed by a rise back up to pre-pregnancy levels by the 3rd trimester. This process could easily be misdiagnosed as preeclampsia. Treatment should first involve non-pharmacological means (counseling, restricted activity, nutritional diet, etc.). If that approach fails, then drug therapy may be necessary. The most commonly used drugs to treat hypertension in pregnancy are the beta-blockers, calcium channel blockers, methyldopa, and hydralazine. Methyldopa is the golden standard of treatment. It has been extensively studied and is proven safe to the fetus. However, it is not tolerated as well as beta-blockers or calcium channel blockers. Methyldopa is not as efficient at lowering blood pressure as the newer agents. ACE inhibitors and diuretics should not be used during pregnancy. ACE inhibitors can cause renal failure and death to the fetus. Diuretics should not be used because they can cause depletion of fluid volume and electrolyte deficiencies which can be harmful to the fetus.

Question:376
Correct Answer: C
Explanation:
Manifestations of salicylate poisoning: Ingestion of concentrated topical salicylic acid preparations can cause caustic mucosal injury to the GI tract. The possibility of occult salicylate overdose should be considered in any patient with an unexplained acid-base disturbance. Acute overdose: (1) Minimal symptoms--tinnitus, dizziness, and difficulty hearing. Nausea and vomiting may occur immediately as a result of local gastric irritation. (2) Phase I consists of mild manifestations. Nausea and vomiting followed by hyperventilation are usually present within 3 to 8 hours after acute overdose. Hyperventilation with an increase in both rate (tachypnea) and depth (hyperpnea) is present but may be subtle. It results in a mild respiratory alkalosis (serum pH greater than 7.4 and urine pH greater than 6.0). Some patients may have lethargy, vertigo, headache, and confusion. Diaphoresis is prominent. Phase II involves moderate manifestations (12 to 24 hours after ingestion. Serious metabolic disturbances including a marked respiratory alkalosis, followed by metabolic acidosis, and dehydration occur. Other metabolic disturbances may include hypoglycemia or hyperglycemia, hypokalemia, decreased ionized calcium, and increased BUN, creatinine, and lactate. Mental disturbances (confusion, disorientation, hallucinations) may occur. Hypotension and convulsions have been reported. (4) Phase III involves severe intoxication. In addition to the preceding clinical findings, coma and seizures develop and indicate severe intoxication. Pulmonary edema may occur. Metabolic disturbances include metabolic acidemia (pH less than 7.4) and aciduria (pH less than 6.0). In adults, alkalosis may persist until terminal respiratory failure occurs.


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