21 Nead the Nenania belcoe effd annwer the qiameliona that follow On Asseamment Urinalyaia yetds $$ 2+ $$ Pratein Abdominal examination Gentabonal period ia 32 woeks, 851133 cm with Gephalio aresentation Patient complains of peoristent hoadache, visuml disturtamen and eprgatric pain 2.11 Identily a possaible diagnomis for Ms F (1) 212 Describe the reasons for the occurrence of the bymptorns reported by Ms F (3) 2.13 Identify the risk factors for diagnosis ictentified in 2.1 (3) 2.14 Name the additional gastrointestinal symplom that may be ansociated with the diagnosis in 2.1 .1 (1) 215 Identify the prophylactic drug of choice for management of Ms F (1) 2.1.6 Outline the recommended regime for the drug mentioned in 2.1 .5 (8) 2.1.7 List the key aspects of assessment to be monitored when administering the drug in 2.1 .5 for early detection of toxicity (5) 2.1.8 Name the antideto for the drug mentioned in 2.1 .5 in case of toxicity (1) [21] Question 3 31. Describe the management of a 30 weeks pregnant woman presenling with an HB of $$ 9 \mathrm{~g} / \mathrm{dl} $$ (5) 32 Outline the viral load monitoring schedule in the following women: 3.2.1 Newly initiated before 28 weeks gestation 3.2.2 Late presenter at ANC after 28 weeks

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### 2.11 Identify a possible diagnosis for Ms. F
Given the symptoms of persistent headache, visual disturbances, and epigastric pain in a pregnant woman at 32 weeks gestation, a possible diagnosis is **preeclampsia**. This condition is characterized by high blood pressure and signs of damage to another organ system, often the kidneys.

### 2.12 Describe the reasons for the occurrence of the symptoms reported by Ms. F
1. **Headache**: This can occur due to increased blood pressure affecting cerebral circulation, leading to tension and pain.
2. **Visual disturbances**: These may result from changes in blood flow to the retina or increased intracranial pressure, which can occur in preeclampsia.
3. **Epigastric pain**: This symptom can be due to liver involvement, as preeclampsia can lead to hepatic edema or even liver rupture in severe cases.

### 2.13 Identify the risk factors for the diagnosis identified in 2.11
1. **First-time pregnancy**: Women who are pregnant for the first time are at higher risk.
2. **History of hypertension**: A personal or family history of high blood pressure increases the risk.
3. **Obesity**: Higher body mass index (BMI) is associated with a greater risk of developing preeclampsia.

### 2.14 Name the additional gastrointestinal symptom that may be associated with the diagnosis in 2.11
An additional gastrointestinal symptom that may be associated with preeclampsia is **nausea**.

### 2.15 Identify the prophylactic drug of choice for management of Ms. F
The prophylactic drug of choice for managing preeclampsia is **aspirin**.

### 2.16 Outline the recommended regime for the drug mentioned in 2.15
The recommended regime for aspirin in the context of preeclampsia is:
- **Dosage**: 81 mg (low-dose aspirin) daily.
- **Timing**: Initiate at 12 weeks of gestation and continue until delivery.
- **Rationale**: This regimen is aimed at reducing the risk of developing preeclampsia in high-risk women.

### 2.17 List the key aspects of assessment to be monitored when administering the drug in 2.15 for early detection of toxicity
1. **Blood pressure monitoring**: To detect any signs of hypertension.
2. **Liver function tests**: To monitor for liver damage.
3. **Renal function tests**: To assess kidney function.
4. **Platelet count**: To check for thrombocytopenia, which can occur in severe preeclampsia.
5. **Signs of gastrointestinal bleeding**: Such as black stools or abdominal pain.

### 2.18 Name the antidote for the drug mentioned in 2.15 in case of toxicity
The antidote for aspirin toxicity is **activated charcoal** (if ingestion is recent) or **sodium bicarbonate** for severe metabolic acidosis.

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### Question 3
#### 3.1 Describe the management of a 30 weeks pregnant woman presenting with an HB of $$ 9 \mathrm{~g} / \mathrm{dl} $$
1. **Iron supplementation**: Administer oral iron supplements (e.g., ferrous sulfate) to address iron deficiency anemia.
2. **Dietary advice**: Encourage a diet rich in iron (e.g., red meat, leafy greens) and vitamin C to enhance absorption.
3. **Monitoring**: Regularly monitor hemoglobin levels to assess response to treatment.
4. **Consider intravenous iron**: If oral iron is not tolerated or if there is severe anemia.
5. **Evaluate for underlying causes**: Investigate potential causes of anemia, such as bleeding or nutritional deficiencies.

#### 3.2 Outline the viral load monitoring schedule in the following women:
##### 3.2.1 Newly initiated before 28 weeks gestation
- **Monitoring schedule**: Viral load should be checked at baseline and then every 4-8 weeks until 28 weeks gestation. After 28 weeks, it should be monitored every 4 weeks.

##### 3.2.2 Late presenter at ANC after 28 weeks
- **Monitoring schedule**: For women who present late, viral load should be checked at the first visit and then every 4 weeks until delivery.

This structured approach provides a comprehensive response to the questions based on the clinical scenario presented.
**2.11 Possible Diagnosis for Ms. F:** - **Preeclampsia** **2.12 Reasons for Symptoms:** 1. **Headache:** Due to high blood pressure affecting brain vessels. 2. **Visual Disturbances:** Resulting from retinal changes or increased intracranial pressure. 3. **Epigastric Pain:** Possibly from liver involvement. **2.13 Risk Factors:** 1. **First-time Pregnancy** 2. **History of Hypertension** 3. **Obesity** **2.14 Additional Gastrointestinal Symptom:** - **Nausea** **2.15 Prophylactic Drug:** - **Aspirin (81 mg daily)** **2.16 Aspirin Regime:** - **Dosage:** 81 mg daily - **Timing:** Initiate at 12 weeks and continue until delivery - **Rationale:** Reduces risk of preeclampsia in high-risk women **2.17 Monitoring for Aspirin Toxicity:** 1. **Blood Pressure** 2. **Liver Function Tests** 3. **Renal Function Tests** 4. **Platelet Count** 5. **Gastrointestinal Signs** **2.18 Antidote for Aspirin Toxicity:** - **Activated Charcoal** or **Sodium Bicarbonate** --- **Question 3:** - **Management of a 30 Weeks Pregnant Woman with HB of 9 g/dL:** 1. **Iron Supplementation:** Oral iron tablets. 2. **Dietary Advice:** High-iron and vitamin C-rich foods. 3. **Monitoring:** Regular hemoglobin checks. 4. **Intravenous Iron:** If necessary. 5. **Evaluate Underlying Causes:** Check for bleeding or nutritional deficiencies. - **Viral Load Monitoring Schedule:** 1. **Before 28 Weeks:** Baseline and every 4-8 weeks. 2. **After 28 Weeks:** Every 4 weeks until delivery. This summary provides clear and concise answers to the clinical questions based on the provided information.

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