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  #1  
Old 08-09-2013
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Default OB/GYn question #8

A 17 y/o white girl comes to the clinic for a prenatal visit. She is at 10 weeks gestation based on LMP and a 9 week USG that showed a live intrauterine pregnancy with a fetal heart rate of 156 /min. She is concerned because she has been feeling nauseus and has vomited on occasional days, she also mentions she feels a 'weird' feeling on her breasts. THe most appropriate course of action is to.
A. Admit for IV hydration.
B. Prescribe Octeotride for her nausea.
C. Check TSH and BHCG.
D. Reassurance.
E. Admit for Total parenteral nutrition
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Old 08-09-2013
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Originally Posted by XpaezX View Post
A 17 y/o white girl comes to the clinic for a prenatal visit. She is at 10 weeks gestation based on LMP and a 9 week USG that showed a live intrauterine pregnancy with a fetal heart rate of 156 /min. She is concerned because she has been feeling nauseus and has vomited on occasional days, she also mentions she feels a 'weird' feeling on her breasts. THe most appropriate course of action is to.
A. Admit for IV hydration.
B. Prescribe Octeotride for her nausea.
C. Check TSH and BHCG.
D. Reassurance.
E. Admit for Total parenteral nutrition
although its her time to be experiencing nausea in pregnancy. I would do a tsh and a bhcg quantitative to r/o related pathologies that can cause those.
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Old 08-09-2013
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hmm... i think i would go with d.... seems stable, symptoms are expected as bhcg peaks at 12 or 14 weeks... and usg showed live pregnancy with fetal heart rate, not molar...
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Old 08-09-2013
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ans D as tigerlily explained above
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Old 08-09-2013
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reassurance.....
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Matched!!!
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Old 08-10-2013
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The correct answer is D. Reassurance. Good job tiger, anomali and hitman.
Kais_MD remember the normal physiologic changes in pregnancy and the bhcg curve that we had to learn for step 1 (I will put a link to an image shortly) there you can see that the highest level is between weeks 6 through 14, which is the period where women complain of worse nausea and early vomiting.



This patient is experiencing normal and expected pregnancy changes, bhcg and tsh should be drawn if the nausea and vomiting are so severe she actually losses weight and gets dehydrated (Molar pregnancy) or extends to the 2nd and 3rd trimester (Hyperemesis gravidarum).
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