Title OB Cardiac Disease JULY 2025 (for distribution).pdf ✅

20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 3 Give three (3) points during pregnancy that may lead to decompensation in patients with unrepaired mitral stenosis and the basis for each. (1.5 points) GIVE THREE (3) (0.5 points each) ● Mid-pregnancy with the peak of physiologic hypervolemia and increased heart rate. ● During labor due to physiologic stress (pain) and fluid shift (uterine contraction). ● Immediately post delivery due to autotransfusion of venous return from the lower extremities as the emptied uterus is no longer impeding venous return ● Postpartum period due to fluid shift into the intravascular compartment, reduced peripheral vascular resistance, and in the presence of hemorrhage, anemia or infection Give two (2) adverse fetal/neonatal outcomes from this condition. (0.5 points) GIVE TWO (2) (0.25 points each) ● Preterm delivery ● Intrauterine growth retardation ● Low birthweight baby ● Fetal or neonatal death Give the management. Give four (4) (1 point/s) GIVE FOUR (4) (0.25 points each) ● Diet and fluid restriction o Limit sodium and fluid intake o Reduce caffeine intake, if any ● Imaging: 2D echocardiography every trimester ● Medications: o Prenatal supplements: Multivitamins, Ferrous sulfate, Calcium carbonate
20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 4 o Benzathine penicillin 1.2M units IM every 3-4 weeks o Rate controller as needed o Diuretics as needed ● Referrals: Cardiology (to be seen at least once per trimester), Maternal- Fetal Medicine (every 3 – 4 weeks), OB Anesthesia ● Fetal well-being studies: Growth monitoring every 3 -4 weeks ● Advise to limit physical activity, avoid infection, have influenza and pneumococcal vaccine She comes back on her 28th week with palpitation, cough and 3 pillow orthopnea and can no longer tolerate prolonged standing Vital signs: BP 120/80 HR 110 bpm RR 25 cpm O2% 95% on room air (+) distended jugular vein, bibasal rales, Grade 3/6 diastolic murmur heard at the apex What is your consideration and basis? (0.5 points) ● Gravidocardiac functional class III secondary to valvular heart disease from rheumatic heart disease (mild mitral stenosis) in acute decompensation (0.25) ● BASIS: Comfortable only at rest, and with symptoms of palpitations, excessive/easy fatigue and orthopnea with less than ordinary activity (0.25) Give the management. Give five (5). (1 point/s) GIVE FIVE (5) (0.20 POINTS EACH) ● Admit the patient ● Insert foley catheter for adequate I/O monitoring ● Insert heplock or IV line on microset (KVO)