Maternal medicine Flashcards Preview

Past MCQs > Maternal medicine > Flashcards

Flashcards in Maternal medicine Deck (78)
Loading flashcards...
1

A black multigravid woman who underwent a CS for failure to progress after an induction for PET complicated by endometritis, comes to see you 5/52 post partum with fatigue/dyspnoea/orthopnoea. O/E HR 110, BP 140/95, pretibial oedema, RUQ tenderness, fine crackles at both bases, CXR cardiomegaly, temp 36.7. What is Dx?

a) post partum cardiomyopathy
b) mitral stenosis
c) pulmonary hypertension
d) bacterial endocarditis

A - post partum cardiomyopathy

2

At routine cardiovascular examination in pregnancy, which of the following may be normal:

a) diastolic murmur
b) 3rd heart sound
c) ejection click
d) renal bruit

b - third heart sound

perceptible in 80% of pregnant women

3

A woman with severe idiopathic cardiomyopathy is having an atonic PPH. EBL 800-1000ml. You have given 10 units Syntocinon but she is still bleeding. Next agent should be?

a) further 10 units Syntocinon
b) 40 units Syntocinon in a 1L flask
c) intramyometrial PGF 2 alpha
d) IV ergometrine

b) 40 units Syntocinon in a 1L flask

Oxytocin in slow infusion is recommended (as per O&G magazine)

Misoprostol is OK

Avoid ergometrine as causes vasocontriction

Carboprost (PGF analogues) increases pulmonary vascular resistance therefore not suitable
- not recommended in significant cardiac disease

4

Risk of cardiac disease in a patient aged 35 who undergoes surgical castration (BSO) compared to a normal woman of the same age

a) < control
b) equal to control
c) x2 control
d) x3 control
e) x4 control

c) x2 control

Doubles cardiovascular risk

5

39 yo woman had elective rpt GA LUSCS and developed pleuritic chest pain and tachypnoea 3 days postop. WCC 11.000, CXR showed R lower lobe atelectasis. ABG showed pO2 65mmHg. Next most appropriate step:

A - pulmonary angiogram
B - ventilation perfusion lung scan
C - chest physio and deep breathing exercises
D - IV antibiotics
E - Pulmonary CT scan

B - ventilation perfusion lung scan

College of radiologists suggests VQ first line for PE postpartum

6

Black multi 5 weeks following LUSCS for FTP with PET and postpartum endometritis. 4/7 history of SOB and orthopnoea. O/E pulmonary rales, tender liver, pretibial oedema. BP increase, tachycardic, CXR shows cardiomegaly. The most likely diagnosis is:

A - peripartum cardiomyopathy
b - pulmonary embolism
c - SBE

A - peripartum cardiomyopathy

7

Mother has anti Ro detected. What is the risk of congenital complete heart block in the fetus?

a - <5%
b - 10%
c - 20%
d- 30%
e - 40%

a - <5%

8

Regarding Bell’s Palsy:

a - it is caused by compression of the facial nerve in the pterygopallatine fossa
b - it responds to NSAID’s
c - it causes a sensory nerve deficit
d - it is most common in late pregnancy

d - it is most common in late pregnancy

Most cases in the 3rd trimester and 1st post-partum week

9

Which is the most incorrect statement regarding the management of ITP?

a - LUSCS is of no benefit to fetus with known severe thrombocytopaenia
b - fetal risk increases if the mother has a past history of splenectomy
c - fetal scalp sampling shouldn’t be used because of the risk of bleeding
d - maternal steroids should be given if the platelet count drops below 100
e - fetal risk can be determined by maternal antibody titre

e - fetal risk can be determined by maternal antibody titre

Diagnosis of exclusion, we don't do antibody titre

10

Which of the following is most normal in a normal pregnancy?

A - MCV 105
B - WCC 12
C - Platelets 100,000
D - Reticulocytes 15%

B - WCC 12

11

Which of the following features is helpful in distinguishing HELLP syndrome from TTP?

A - TTP requires immediate delivery of fetus
B - DIC occurs more commonly with HELLP than TTP
C - Liver dysfunction is more common with TTP

B - DIC occurs more commonly with HELLP than TTP

12

Alloimmune thrombocytopenia, management, correct option:

a- IV immunoglobulin
b - Plasmapheresis
c - prednisolone
d- Betamethasone
e - Fetal platelet transfusion

a- IV immunoglobulin

13

TTP and HELLP, incorrect option

A - TTP more correlated with DIC
B - HELLP more associated with neurological abnormality
C- HELLP more associated with haemolysis

A - TTP more correlated with DIC

14

ITP, correct option:

a - caesarean section is not helpful in known severe fetal thrombocytopenia
b - FBS should not be attempted due to risk of bleeding from puncture site
c - Splenectomy decreases the likelihood of correlation between maternal and fetal platelet counts
d - Maternal antiplatelet ab levels correlate with incidence of neonatal platelet levels

b - FBS should not be attempted due to risk of bleeding from puncture site

15

Mainstay of treatment for TTP

a - steroids
b - plasmapheresis
c- Ig infusion

b - plasmapheresis

16

32 yo G4P3 with 3 previous uneventful pregnancies and deliveries arrives in labour at term and if found to have platelet count of 85. Otherwise NAD. Most acceptable management is:

a- normal delivery and neonatal platelet count
b- LUSCS
c- LUSCS to avoid mid-cavity forceps
d- Fetal blood sampling

a- normal delivery and neonatal platelet count

17

Mainstay of treatment of neonatal alloimmune thrombocytopaenia is:

a - steroids
b - intrauterine platelet transfusion
c - maternal immunoglobulin

c - maternal immunoglobulin

18

In comparing HELLP to TTP, which is not true?

a. liver dysfunction is more common with HELLP
b. DIC is more common with HELLP
c. Delivery of fetus in not mandatory with HELLP

c. Delivery of fetus in not mandatory with HELLP

19

PG at 32/40 with BP 130/90, headache and epigastric pain. VE cervix long and closed. LFT’s reveal elevation of ALT?? And plt count of 70 000. MX?

a. observe
b. IOL
c. Platelet transfusion
d. LUSCS

d. LUSCS

20

MG presents unbooked in early labour. Platelet count is incidentally noted to be 90, 000. Management?

a. allow to labour and anticipate vaginal delivery
b. LUSCS
c. Assess fetal platelet count (scalp or cordocentesis)
d. Plasmapheresis

a. allow to labour and anticipate vaginal delivery

21

A MG presents unbooked at 38 weeks with a Hb of 6.8. If untreated the most likely cord Hb is

a - 10
b - 14
c - 16
d - 20

c - 16

No correlation between maternal anaemia and fetal Hb

Normal 14-22

22

What compound is at the greatest concentration in blood in physiological conditions?

a- carbon dioxide
b - bicarbonate
c - carbonic acid
d - all are at equal concentrations

b - bicarbonate

Carbon dioxide and carbonic acid are in equilibrium in the blood

Bicarbonate ions and carbonic acid are present in the blood in a 20:1 ratio if the blood pH is within the normal range

23

Which congenital coagulation disorder improves in pregnancy?

a - anti-thrombin 3 deficiency
b - vWB disease
c - protein C deficiency
d - protein S deficiency
e - haemophilia

b - vWB disease

vWF and FVIII both increase in pregnancy

24

A patient has an FBE with HB 10.4, MCV 70 and MCHC 28 (30-36). Which is true?

a - her film will show microcytosis
b - she should have a trial of folate
c - she will have target cells on film
d - reticulocyte count will be 10%

a - her film will show microcytosis

25

Iron studies show decreased ferritin, TIBC greatly increased.

a - transferrin will be low
b - reticulocyte count will be 15%

b - reticulocyte count will be 15%

transferrin goes up in iron deficiency
normal retic count is 10%

26

Which of the following is associated with intrahepatic cholestasis of pregnancy?

a - RUQ pain
b - High risk of recurrence in future pregnancies
c - Bilirubin levels >10
d - Excessive use of antacids

b - High risk of recurrence in future pregnancies

27

Intrahepatic cholestasis associated with all except:

A - neonatal jaundice
B - pruritis with onset of jaundice
C - 3rd trimester
D - increase premature delivery

A - neonatal jaundice

28

A 32 yo presents at 35/40 with recent onset malaise. BP 130/84, AST + ALT elevated, bilirubin 80, plt 60. O/E cervix long and closed. Mx?

a - IOL
b - LUSCS
c- Upper abdominal US for gallstones
d - Bed rest

b - LUSCS



high bilirubin in HELLP with haemolysis

29

Regarding Vitamin D and pregnancy - true or false for the following:

a - Insufficiency is a more serious state than deficiency
b - Deficiency can be corrected by daily administration of 10 mcg per day
c - Deficiency is detected by measuring levels of 1,25 dihydroxyvitamin D
d - Inadequate levels are associated with gestational diabetes
e - Vitamin D supplements help to prevent childhood rickets

a - Insufficiency is a more serious state than deficiency - FALSE
b - Deficiency can be corrected by daily administration of 10 mcg per day - FALSE 400IU OD recommended as supplement

c - Deficiency is detected by measuring levels of 1,25 dihydroxyvitamin D - FALSE - serum 25 hydroxyvitamin D levels

d - Inadequate levels are associated with gestational diabetes - TRUE
e - Vitamin D supplements help to prevent childhood rickets- TRUE

30

A 22 year old primigravida develops HELLP syndrome at 34 weeks of gestation with acute renal and liver dysfunction. After delivery she is transferred to Critical Care. Which of the following are true?

A - Intravenous N-acetylcysteine may be of benefit
B - Renal replacement therapy is not required until serum creatinine concentration exceeds 1000 micromol/L
C - Central venous access and arterial line placement is prevented by a platelet count of 75x109/L
D - Magnesium sulphate as seizure prophylaxis should not be given because of her renal impairment
E - Clotting factors such as fresh frozen plasma may be required

E - Clotting factors such as fresh frozen plasma may be required