Hyperemesis gravidarum — RACGP Fellowship MCQ

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HardWomen's health and O&GHyperemesis gravidarumRACGP Fellowship

A 34-year-old woman at 10 weeks’ gestation presents with persistent vomiting, a 4 kg weight loss, ketonuria, hypotension (BP 98/60 mmHg) and tachycardia (pulse 108 / min). Urinalysis is negative for infection. She is unable to tolerate oral fluids. What is the most appropriate management?

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Correct answer: C — Refer to hospital for intravenous fluids, electrolyte assessment and antiemetic therapy

**Correct answer: C** The hallmark features—ketonuria, haemodynamic instability, significant weight loss, and inability to keep fluids down—indicate severe hyperemesis gravidarum requiring inpatient care. RACGP guidance states that women unable to tolerate oral fluids require hospital admission for IV rehydration and antiemetic therapy ([racgp.org.au](https://www.racgp.org.au/getattachment/4450e7be-ee24-4a92-b4b5-c7b28a1c7fb8/200709sheenan.pdf?utm_source=openai)). The RACGP management framework for persistent hyperemesis with dehydration includes IV fluids, thiamine, and escalation to antiemetics like ondansetron if needed ([racgp.org.au](https://www.racgp.org.au/getattachment/046bf8e2-d431-4776-a989-ddc0388cb14d/Managing-nausea-and-vomiting-in-pregnancy-in-a-pri.aspx?utm_source=openai)). Distractors: D. Physiological reassurance is inappropriate given severity. E. Oral iron is irrelevant and unsuitable when oral intake fails. B. Diuretics worsen dehydration and are contraindicated. A. Delaying care until the morphology scan postpones urgent treatment and risks maternal and fetal harm.

Reference: Hyperemesis gravidarum – assessment and management (Aust Fam Physician 2007); Managing nausea and vomiting in pregnancy – AFP guideline (RACGP, circa 2016), https://www.racgp.org.au/getattachment/4450e7be-ee24-4a92-b4b5-c7b28a1c7fb8/attachment.aspx

Hyperemesis gravidarum — RACGP Fellowship MCQ

A 34-year-old woman at 10 weeks’ gestation presents with persistent vomiting, a 4 kg weight loss, ketonuria, hypotension (BP 98/60 mmHg) and tachycardia (pulse 108 / min). Urinalysis is negative for infection. She is unable to tolerate oral fluids. What is the most appropriate management?

A 34-year-old woman at 10 weeks’ gestation presents with persistent vomiting, a 4 kg weight loss, ketonuria, hypotension (BP 98/60 mmHg) and tachycardia (pulse 108 / min). Urinalysis is negative for infection. She is unable to tolerate oral fluids. What is the most appropriate management?