QuestionSBA
QuestionChoice
Metformin hydrochloride may have some beneficial effects on fertility in patients with polycystic ovarian syndrome, but there is nothing in the stem to suggest that the patient has PCOS
34039
e
Metformin hydrochloride 500mg PO OD
QuestionChoice
This is a selective oestrogen receptor modulator that stimulates ovulation. It should not be prescribed without a full assessment by a fertility specialist, and is not likely to be indicated as the patient is having regular bleeds which indicates she is ovulating
34036
b
Clomifene citrate 50mg PO OD
QuestionChoice
While megaloblastic anaemia can have a detrimental effect on fertility, this patient is clearly not anaemic
34038
d
Hydroxocobalamin 1mg IM monthly
QuestionChoice
All women who are attempting to conceive and low risk should be taking folic acid to reduce the risk of neural tube defects. Women at high risk (e.g. previous tube defects, family history, diabetics, on epilepsy medication, high BMI) should be on high dose folic acid (5mg OD). As this woman has diabetes she would be considered high-risk and hence 5mg is the correct answer.
34035
a
Folic acid 5mg PO OD
QuestionChoice
While iron deficiency anaemia can have a detrimental effect on fertility, this patient is clearly not anaemic
34037
c
Ferrous sulfate 200mg PO TDS
QuestionComment
Normal MCV is 80-100 
6580
QuestionComment
they're not being given folic acid because they're deficient, it's just a good thing to take before pregnancy and up to 3 months to avoid neural tube defects
60078
User
subscriber
Epidermis Benign
User
subscriber
Juice Contusion
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2751
Folic acid prior to pregnancy
Topic
76
Obstetrics and Gynaecology
6818
Case Presentation: A 34 year old woman presents to GP with her male partner to solicit advice in conceiving a child. They have been having regular unprotected penetrative sex at least twice a week for four months. She has had one previous pregnancy and termination at the age of 18, and bleeds regularly with a 28 day cycle. She has a background of T2DM which is diet-controlled. She wonders if the GP can prescribe anything that she should be taking while trying to conceive.


**Investigations**

FBC: Hb 115, WCC 5.2, Plts 240 x 10^9, MCV 91

Question: Select the most appropriate management at this stage.
a