Maternal medicine Flashcards
(152 cards)
1
Q
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
A - post partum cardiomyopathy
2
Q
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
A
b - third heart sound
perceptible in 80% of pregnant women
3
Q
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 oxytocin IV
b) oxytocin 40units in 1L Hartman’s over 4 hours
c) prostaglandin F2-alpha 1.5mg intramyometrially
d) ergometrine 0.25mg intravenously
e) misoprostol 200-400mcg orally
A
d) ergometrine 0.25mg intravenously
O
**Note if infusion ideally in 500mL of fluid and rate is reduced by half
Oxytocin in slow infusion is recommended (as per O&G magazine)
https: //www.ogmagazine.org.au/22/3-22/maternal-heart-disease-in-labour/
- also see NICE guideline: https://www.nice.org.uk/guidance/ng121/chapter/Recommendations#heart-disease
Misoprostol is OK
Carboprost (PGF analogues) increases pulmonary vascular resistance therefore not suitable
- not recommended in significant cardiac disease
Avoid ergometrine in HTN as causes vasoconstriction, exam answer says it is OK if context of cardiomyopathy
4
Q
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
A
c) x2 control
Doubles cardiovascular risk
5
Q
39 yo woman had elective repeat GA LSCS 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
A
B - ventilation perfusion lung scan
College of radiologists suggests VQ first line for PE postpartum
6
Q
37yo African-American multi 5 weeks following LUSCS for FTP with PET and postpartum endometritis. 4/7 history of progressive fatigue, SOB and orthopnoea. O/E pulmonary rales, third heart sound audible, tender liver, pretibial oedema. Afebrile, BP increase, tachypnoeic, tachycardic. ECG shows sinus tachycardia, CXR shows cardiomegaly. The most likely diagnosis is:
A - mitral stenosis
B - peripartum cardiomyopathy
C - pericarditis
D - pulmonary HTN
E - bacterial endocarditis
A
B - peripartum cardiomyopathy
O
7
Q
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
a - <5%
8
Q
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
A
d - it is most common in late pregnancy
Most cases in the 3rd trimester and 1st post-partum week
9
Q
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
A
e - fetal risk can be determined by maternal antibody titre
Diagnosis of exclusion, we don’t do antibody titre
10
Q
Which of the following is most normal in a normal pregnancy?
A - MCV 105
B - WCC 12
C - Platelets 100,000
D - Reticulocytes 15%
A
B - WCC 12
11
Q
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
A
B - DIC occurs more commonly with HELLP than TTP
12
Q
Alloimmune thrombocytopenia, management, correct option:
a - IV immunoglobulin
b - Plasmapheresis
c - Prednisolone
d - Betamethasone
e - Fetal platelet transfusion
A
a - IV immunoglobulin (IVIGs)
13
Q
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
A - TTP more correlated with DIC
14
Q
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
A
b - FBS should not be attempted due to risk of bleeding from puncture site
*CHECK
Similar question from M implies C would be correct.
15
Q
Mainstay of treatment for TTP
a - steroids
b - plasmapheresis
c - Ig infusion
A
b - plasmapheresis
TTP results from defective ADAMST13 enzyme. Test for the same confirms.
Reduction of ADAMTS13 enzyme - poor cleavage of von willebrand factor - hyperactive so higher plt aggregation to endothelial surfaces. Microthrombi in capillaries and arterioles. Diffuse endothelial insult.
Aggressive treatment with FFP and plasmapheresis removes and replaces defective ADAMST13 with effective enzyme to limits vascular injury and improve prognosis. Corticosteroids may be of benefit. Delivery does not affect course of TTP
M
16
Q
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- notification of blood bank to have platelet packs available for maternal transfusion
c- LUSCS rather than mid-cavity forceps to minimise fetal trauma
d- Fetal platelet count (by scalp sampling)
A
a- normal delivery and neonatal platelet count
O
17
Q
Mainstay of treatment of neonatal alloimmune thrombocytopaenia is:
a - steroids
b - intrauterine platelet transfusion
c - maternal immunoglobulin
A
c - maternal immunoglobulin (IVIGs)
18
Q
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
A
c. Delivery of fetus in not mandatory with HELLP
19
Q
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
A
d. LUSCS
20
Q
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
a. allow to labour and anticipate vaginal delivery
21
Q
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
A
c - 16
No correlation between maternal anaemia and fetal Hb
Normal 14-22
22
Q
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
A
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
Q
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
A
b - vWB disease
vWF and FVIII both increase in pregnancy
24
Q
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
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
Premature delivery is iatrogenic
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
31
A woman is pregnant after bromocriptine treatment of a pituitary macroademoma. Management during pregnancy should include:
A - continue bromocriptine
B - visual field assessment
C - xray sella turcica
D - neurosurgery
B - visual field assessment
No significant tumour:
- Stop treatment
- No follow up needed
Significant tumour:
- Usually stop treatment
- Follow up with regular radiological assessment
- Regular formal visual field checks
32
A multiparous woman presents 8 weeks post partum complaining of tiredness, palpitations and tremor. She has been losing weight and is unable to sleep. Pulse is 100 bpm, BP 160/90. The most likely diagnosis is:
A - HIV
B - Anxiety
C - Drug abuse
D - Thyrotoxicosis
D - Thyrotoxicosis
33
What woman has the best reproductive future?
A - PG Eclamptic fit with DIC, BP normal at 6/52
B - Multi with severe preeclampsia, BP normal at 3 months
C - Preeclampsia with diastolic BP 100mmHg at 3 months
D - Woman with essential hypertension
E - Woman with chronic renal failure, currently stable
D - Woman with essential hypertension
Prev PET - RR 7.2
Chronic HTN - RR 3.7
\*CHECK as other answer says A…
34
1st ANC visit, 22yo primip, mother is NIDDM.
No glycosuria. You advise the patient:
A - no chance that she will get diabetes
B - need GTT in 2nd trimester
C - start prophylactic insulin
D - if doesn’t get glycosuria in pregnancy, no risk of diabetes
E -monitor her by doing fasting BSL in pregnancy
B - need GTT in 2nd trimester
35
The CLASP trial demonstrated that aspirin 60mg daily could:
A - reduce severe early onset IUGR associated with PET
B - reduce IUGR
C - both
D - neither
D - neither
Overall, the use of aspirin was associated with a reduction of only 12% in the incidence of proteinuric pre-eclampsia, which was not significant. Nor was there any significant effect on the incidence of IUGR or of stillbirth and neonatal death. Aspirin did, however, significantly reduce the likelihood of preterm delivery (19·7% aspirin vs 22·2% control; absolute reduction of 2·5 [SD 0·9] per 100 women treated; 2p=0·003). There was a significant trend (p=0·004) towards progressively greater reductions in proteinuric pre-eclampsia the more preterm the delivery.
Low-dose aspirin may be justified in women judged to be especially liable to early-onset pre-eclampsia severe enough to need very preterm delivery.
36
Your 38yo 16/40 patient with no known exposures has a Mantoux reaction of 16mm induration. She is asymptomatic and CXR is negative for active tuberculosis. Which therapy is recommended?
A - No treatment
B - Isoniazid 300mg daily for 6 months
C - Isoniazid 300mg daily for 12 months
E - Bacillus Calmette-Guerin vaccination
D - Rifampicin 100 mg daily for 12 months
A - No treatment
O
Doesn't have active pulmonary disease
Can't make diagnosis on Mantoux alone
?Latent
37
16 yo primip with HIV on Western blot test and 28 weeks pregnant. Risk of transmission to the fetus is:
A - 0%
B - 10%
C - 30%
D - 60%
E - 80%
In undiagnosed and untreated women, 20-30% risk of MTCT
With ART, appropriate mode of delivery, formula feeding, baby receiving PEP, incidence of perinatal transmission \<2%
Risk decreases with decreasing levels of maternal HIV RNA (e.g. \<1000 copies/ml) - \<1%
2/3 of MTCT occurs during delivery
38
Each of the following antibodies may cause HDFN except:
a. Anti s
b. Anti Jka
c. Anti K
d. Anti P
d. Anti P
O
Anti JK only RARELY cause HDFN
Also not included are Anti-Lewis (non haemolytic)
39
A woman in mid pregnancy develops intractable constipation which has not responded to fibre supplements. The NEXT MOST APPROPRIATE therapy is
a. Lactulose
b. Magnesium sulphate
c. Coloxyl (docusate)
d. Bisacodyl
a. Lactulose
O
1st line - dietary fibre
2nd line - increase bulk
3rd line - osmotic - lactulose (MgSO4)
4th line - stimulant - bisadocyl, Docusate
Docusate - theoretically increase risk of PTB
40
A G1P0 has stable Crohn's disease, MCV normal range, B12 110 micromols (normal \> 127). The NEXT step is to
a. Take no action
b. Give IM B12
c. Repeat B12 concentrations
d. Check homocysteine levels
d. Check homocysteine levels
O
if borderline vit b12, check homocysteine as will be high in true deficiency.
Crohn's is associated with increased risk B12 deficiency
41
A woman who works in a childcare centre presents with flu-like symptoms at 14 weeks gestation. She has read about CMV and is worried about the risk to the baby. Which of the following statements about CMV in pregnancy is CORRECT?
a. Maternal infection is usually associated with flu-like symptoms
b. Fetal infection is associated with echogenic bowel on a 20 week ultrasound
c. Primary and secondary maternal infection carries equal risk to the fetus
d. Spiramycin is an effective treatment in pregnancy
b. Fetal infection is associated with echogenic bowel on a 20 week ultrasound
O
Most primary infections are asymptomatic
Spiramycin is the treatment for toxoplasmosis
42
Which is true of CMV infection in pregnancy?
a. It is the commonest known virus transmitted trans-placentally
b. It is usually symptomatic at birth
c. The usual source of infection is ingestion of undercooked meat
d. It may cause an elevation of IgG in cord blood
a. It is the commonest known virus transmitted trans-placentally
O
43
A 35yo primigravida presents with occasional shortness of breath and palpitations at 35 weeks. The midwife queries the "expected changes" in pregnancy. You tell her that the physiological changes in pregnancy include:
a) Blood volume increases by 10% in a normal pregnancy
b) Red cell mass and plasma volume increases by similar amounts in normal pregnancy
c) White cell count increases by 20% in normal pregnancy
d) Stroke volume increases in a normal pregnancy
d) Stroke volume increases in a normal pregnancy
O
Blood volume increases by ~50%
Red cells mass increases less so (by 20-30%)
44
Which of the following laboratory results are normal in pregnancy?
a. Renal blood flow increased, urea increased, creatinine increased
b. Renal blood flow increased, urea decreased, creatinine increased
c. Renal blood flow increased, urea increased, creatinine decreased
d. Renal blood flow increased, urea decreased, creatinine decreased
d. Renal blood flow increased, urea decreased, creatinine decreased
O
45
Which of the following biochemical changes occurs MOST commonly in pregnancy, as compared with the non-pregnant patient
a. Increased urea
b. Increased alkaline phosphatase
c. Decreased TSH
d. Increased serum lipids
b. Increased alkaline phosphatase
O
46
At 27yo woman at 29 weeks gestation complains of a swollen, cold and painful right leg. On examination the leg is cool, swollen, with sluggish venous return. There is no evidence of DVT on lower limb doppler ultrasound and normal blood flow in the leg veins. The NEXT step is:
a. Organise a CT venogram of the pelvis
b. Organise MRI of the pelvis
c. Commence on prophylactic dose of clexane
d. Reassure patient and send her home
b. Organise MRI of the pelvis
O
47
Which statement regarding anticoagulation with warfarin is CORRECT
a. The drug effect is most rapidly reversed by FFP
b. Paracetamol in a normal therapeutic dose can cause a drug interaction
c. Treatment should be monitored with partial thromboplastin time
d. Breastfeeding is contraindicated
e. In pregnancy, warfarin is safe to use in the second trimester
a. The drug effect is most rapidly reversed by FFP
O
If fully anticoagulated and need urgent delivery:
- Reverse warfarin with prothombinase complex and FFP. Vitamin K helps to sustain the reversal effect.
- Reverse heparin and LMWH with protamine sulphate
(NB there is a study that demonstrates altered INR if regular paracetamol is ingested)
48
The INITIAL treatment of pulmonary embolus is:
a. 5,000 U heparin IV bolus then 30,000-35,000 U/24hour IV infusion
b. 5,000 U heparin SC every 12 hours
c. 5,000 U heparin IV bolus then 10,000-15,000 U/24hour IV infusion
d. 15,000 U heparin IV bolus then 50,000-60,000 U/24hour IV infusion
e. 20,000 U heparin SC every 8 hours
a. 5,000 U heparin IV bolus then 30,000-35,000 U/24hour IV infusion
O
NZF
- 5000 IU as bolus, then 18U/kg/hr infusion (which equals approx 25,000 U/24h if 60kg)
49
Which of the following congenital anomalies is most likely to be associated with diabetes mellitus?
a. Duodenal atresia
b. Posterior urethral valves
c. Isolated VSD (ventricular septal defect)
d. Gastroschisis
Think C - Isolated VSD (ventricular septal defect)
RANZCOG MCQs 2020 say VSD.
\*\* BUT 2011 official exam answer said duodenal atresia.
?Incorrect answer on that exam
Sacral agenesis strong association with DM
Posterior urethral valves - assoc with oligo- or an-hydramnios, hypoplastic lungs
50
A 32yo, G2P1, Rhesus negative woman, is found to have an anti-D titre of 1:4 at 32 weeks. Ultrasound is normal. There is no evidence of hydrops. The previous pregnancy was uncomplicated. The next most appropriate course of action would be:
a. Repeat titre in a fortnight
b. Amniocentesis
c. Fetal monitoring
d. Elective delivery at 35-36 weeks gestation
a. Repeat titre in a fortnight
O
AS over 28weeks. Threshold for MFM referral is 1:16
51
Which statement regarding iso-immunised pregnancies is FALSE
a. MCA doppler peak systolic velocity is a sensitive predictor of fetal anaemia
b. Maternal plasmapheresis is indicated in severe cases
c. Cordocentesis may be useful in the second trimester
d. The mortality from exchange transfusion is less than that from intrauterine transfusion
b. Maternal plasmapheresis is indicated in severe cases
as per 2011 official answer
Cordocentesis is considered if strong suspicion fetus is affected (Fetal Medicine Guidelines)
52
Which of the following statements is INCORRECT?
a. The commonest Kell phenotype is Kk
b. A fetus affected by anti-Kell antibodies and requiring IUT can be given red cells from it’s mother
c. A woman at 19 weeks with anti-Kell titre 1:2048 and a husband with KK phenotype should have a fetal blood sampling
d. The amniotic fluid bilirubin is less reliable in predicting severity of anaemia with anti-Kell antibodies compared with anti-Duffy antibodies
e. Anti-Kell antibodies both suppress erythropoiesis and cause haemolysis
a. The commonest Kell phenotype is Kk
O
kk most common
91% are K negative
53
A Rh negative woman, G2P1, is found to have anti-D antibodies with a titre 1:64 and concentration 10IU/L. Her first child was born at term and required phototherapy. The MOST APPROPRIATE surveillance for her pregnancy is?
a. Regular assessment of maternal anti-D titre
b. Regular USS assessment of the fetal MCA PSV
c. Regular amniocentesis to assess the OD 450 of the amniotic fluid
d. Regular ultrasound to exclude hydrops fetalis
b. Regular USS assessment of the fetal MCA PSV
O
54
A patient is found to have anti-Fya antibody titre 1:16 at 12 weeks gestation. The MOST APPROPRIATE next step in management is:
a. Quantify the antibody concentration with radioimmunoassay
b. Perform USS at 18 weeks to exclude hydrops
c. Ascertain the partners phenotype
d. Repeat the antibody test at 16 weeks
e. Reassure the patient that anti-Fya antibodies are non-haemolytic
c. Ascertain the partners phenotype
O
NB best practice is to actually ascertain the fetal genotype with non invasive testing to avoid potential non-paternity concerns
RCOG guidelines say next test at 28weeks
55
Which is LEAST TRUE of maternal alloimmunisation
a. Some maternal HLA subtypes facilitate the maternal immune response to HPA-1a antigen
b. Transplacental passage of \> 0.1mL of Rh D positive fetal blood is associated with development of anti-D antibodies in 30% of Rh negative women
c. A mother who is AB negative, with a fetus of blood group B positive, is less likely to become isoimmunised than if the fetal blood group was O positive.
d. Dendritic cells present the peptide in association with HLA class II molecules to T helper cells, which in turn present antigen to B cells
e. In the absence of prophylaxis, approximately 15% of Rh negative women delivering a Rh positive ABO-compatible baby will develop anti-D antibodies.
c. A mother who is AB negative, with a fetus of blood group B positive, is less likely to become isoimmunised than if the fetal blood group was O positive.
O
Alloimmunisation is LESS common with ABO incompatibility
56
In which circumstance may the fetus have alloimmune thrombocytopenia?
a. Mother HPA-1a positive, Father HPA-1a negative
b. Mother HPA-1a positive, Father HPA-1a positive
c. Mother HPA-1a negative, Father HPA-1a negative
d. Mother HPA-1a negative, Father HPA-1a positive
d. Mother HPA-1a negative, Father HPA-1a positive
O
2% women are negative
57
The prevalence of HPA-1a negative women in the population is:
a. 0.005%
b. 0.02%
c. 0.1%
d. 0.5%
e. 2%
e. 2%
Of the 2% who are HPA-1a negative only a small proportion have the ability to generate anti-HPA-1a as this has a strong association with a particular HLA type
58
Which is the KEY mode of current therapy for fetal alloimmune thrombocytopenia?
a. Maternal Immunoglobulin infusion
b. Corticosteroid therapy with prednisolone
c. In utero platelet transfusion
d. Plasmapheresis
a. Maternal Immunoglobulin infusion
O
IVIG
- Shown to improve platelet count in fetuses at risk of FNAIT
Steroids have not be shown to improve platelet counts but could be considered for women at high risk of poor outcomes if benefits outweigh risks
59
Which is NOT a recognised cause of thrombophilia?
a. Prothrombin gene 20210A gene mutation
b. Lupus anticoagulant
c. Thrombin gene mutation
d. Factor V Leiden mutation
c. Thrombin gene mutation
O
- should be ANTIithrombin gene mutations
60
Which condition, if treated in pregnancy, might have osteoporosis and thrombocytopenia as a result of the treatment?
a. Asthma
b. Pulmonary TB
c. Graves disease
d. Antiphospholipid syndrome
d. Antiphospholipid syndrome
O
Heparin
\*Similar Q gives PE as an answer instead
61
Which is NOT a feature of massive pulmonary embolism?
a. Pulmonary vascular congestion on CXR
b. Right ventricular strain pattern on ECG
c. Sinus tachycardia
d. Tachypnoea
a. Pulmonary vascular congestion on CXR
O
62
Which statement about rubella and pregnancy is TRUE?
a. Maternal infection in the second trimester is followed by Neonatal Rubella Syndrome less than 1% of the time
b. The Rubella haemagglutination inhibition test becomes positive within four days of infection
c. Viraemia precedes the rash
d. Treatment with immunoglobulin reduces the risk of congenital abnormality
c. Viraemia precedes the rash
O
Rubella IgG EIA
- Level \<10 IU/ml are considered susceptible
- Usually present 1/52 after onset of rash
63
Which is the most common mode of transmission of Toxoplasma gondii to women in Australia?
a. Contact with domestic cats
b. Ingestion of sheep meat
c. Ingestion of kangaroo meat
d. Ingestion of undercooked meat
d. Ingestion of undercooked meat
O
64
Which of the following is TRUE of genital HSV infection?
a. Prior infection with HSV-1 significantly reduces the risk of acquiring HSV-2 in pregnancy
b. 10% of those with recurrent attacks have asymptomatic secretion at the time of delivery
c. 10% of those with a clinical recurrence at delivery will have an infected neonate
d. Most babies who develop neonatal herpes are born to women with a history of recurrent genital herpes
a. Prior infection with HSV-1 significantly reduces the risk of acquiring HSV-2 in pregnancy
O
Prior HSV-1 means HSV-2 is less likely to be symptomatic
65
Pregnant women with recurrent genital herpes
a. Can be delivered vaginally if no maternal lesions are present
b. Should have serial cultures in the last weeks of pregnancy
c. Should all be delivered by Caesarean if membranes rupture prior to labour
d. Should be treated with acyclovir throughout pregnancy
a. Can be delivered vaginally if no maternal lesions are present
O
66
Which is LEAST true of HIV?
a. Opportunistic infections arise when CD4 count is \<200 x 10^6
b. ART lowers the risk of MTCT of HIV to 1/3 of the risk compared with no ART
c. High viral loads (\>10 000 copies/mL), low CD4 (\<400 x 10^6), or \> 4 hours ruptured membranes will all double the risk of MTCT of HIV
d. With all available initiatives, the incidence of MTCT of HIV should be reduced to 5%.
d. With all available initiatives, the incidence of MTCT of HIV should be reduced to 5%.
O
With ART, appropriate mode of delivery, formula feeding, baby receiving PEP, incidence of perinatal transmission \<2%
Duration of ROM does matter
67
Which statement is MOST CORRECT regarding malaria in pregnancy
a. Women in pregnancy and the puerperium are not at increased risk of contracting malaria
b. Doxycycline is recommended as chemoprophylaxis if travelling to chloroquine resistant areas
c. Quinine can be used if necessary to treat malaria in pregnancy
d. Mefloquine cannot be used in women with G6PD deficiency
c. Quinine can be used if necessary to treat malaria in pregnancy
O
Quinine + clindamycin for non-severe infection (falciparum).
IV artesuante if severe falciparum.
In pregnancy, malaria parasites sequester in the placenta where infection is often extremely heavy. Main fetal concerns febrile illness, PTB, IUGR, fetal distress.
68
Which is TRUE of VZV?
a. The case mortality of varicella in adults is the same as in children
b. Seronegative pregnant women having a close recent exposure within 96 hours should receive passive Zoster immunoglobulin because this will reduce the risk of fetal varicella syndrome
c. The overall incidence of congenital varicella syndrome is approx. 2% if the mother develops chicken pox during pregnancy
d. Typical features of the Congenital varicella syndrome include limb hypoplasia and dermatome scarring, but ocular and CNS effects are rare
c. The overall incidence of congenital varicella syndrome is approx. 2% if the mother develops chicken pox during pregnancy
O
\<12/40 - 0.55%
12-28/40 - 1.4%
\>28/40 - No cases of fetal varicella syndrome
If non-immune and significant exposure:
- Varicella-zoster immunoglobulin (VZIG) as soon as possible (ideally \<96h - 4 days after exposure)
○ Effective up to 10 days
May prevent or attenuate chickenpox in non-immune and may reduce risk of FVS
\*Reduces maternal infection but not FVS\*
69
A 18yo has Chlamydia on endocervical swab at 30 weeks. The most appropriate antibiotic to treat her with is?
a. Ceftriaxone
b. Erythromycin
c. Azithromycin
d. Doxycycline
c. Azithromycin
O
70
Which of the following statements is TRUE concerning toxoplasmosis infection in pregnancy?
a. The risk of fetal infection after maternal seroconversion is higher in early than in late pregnancy
b. Detection of IgM in the fetal blood is the preferred method for diagnosis of intrauterine infection
c. Pyrimethamine/sulfadiazine is the most effective therapy but spiramycin is theoretically less embryotoxic
d. The predominant source of human infection is the domestic cat.
c. Pyrimethamine/sulfadiazine is the most effective therapy but spiramycin is theoretically less embryotoxic
O
In terms of reducing maternal to fetal transmission
Pyramethamine + sulfadiazine
Concerns re bone marrow suppression - hence folinic acid is also given
1st trimester
- fetal transmission 4-15%
2nd trimester
- fetal transmission 25-44%
3rd trimester
- fetal transmission 30-75%
71
Which is FALSE regarding toxoplasmosis in a pregnant woman
a. Toxoplasmosis is best avoided by staying clear of cats when pregnant
b. Toxoplasmosis is commonly asymptomatic
c. 25-50% of Australian women have immunity to toxoplasmosis in pregnancy
d. Toxoplasmosis is usually treated with spiramycin
a. Toxoplasmosis is best avoided by staying clear of cats when pregnant
O
Often asymptomatic (60-70%)
72
A woman in the first trimester presents because her child has just developed chicken pox. The woman has never had chicken pox, and testing shows her to be non-immune. You advise her that:
a. The risk of fetal varicella syndrome is low, so no further action is warranted
b. She should have IM Zoster IgG to reduce chance of her contracting chicken pox
c. She should have IM Zoster IgG to reduce the chance of fetal varicella syndrome
d. She should start taking oral acyclovir to reduce the chance of her developing chicken pox
b. She should have IM Zoster IgG to reduce chance of her contracting chicken pox
O
73
Which condition is MOST likely to have an adverse effect on pregnancy outcome?
a. Severe lower limb oedema
b. BP 140/90 in the first trimester
c. Urea 12 mmol at booking
d. Weight gain 2kg during pregnancy
c. Urea 12 mmol at booking
O
Normal urea is up to 8 mmol
If undergoing dialysis aim pre-dialysis \<12.5. Very poor outcomes predicted if \>18mmol
74
A heroin addict is started on the methadone maintenance programme at 28 weeks. She requires 40mg daily to avoid withdrawal symptoms. You see her three weeks later for review. The preferred ongoing management is:
a. Decrease methadone by 5mg per week and use promethazine to control her symptoms
b. Continue methadone until labour, then substitute promethazine at that time
c. Continue the current dose of methadone until delivery
d. Continue the current dose of methadone until delivery, and add naloxone in incremental doses from 37 weeks
c. Continue the current dose of methadone until delivery
O
75
Which of the following is NOT a recognised cause of pulmonary hypertension in pregnancy?
a. Mitral stenosis
b. Pulmonary embolus
c. Left ventricular failure
d. None of the above
d. None of the above
O
76
The incidence of fetal infection after maternal seroconversion of CMV in pregnancy is approximately:
a. 20%
b. 50%
c. 80%
d. 95%
b. 50%
O
1st - 30%
2nd tri - 40%
3rd tri - 60%
77
A G1P0 presents at 34 weeks with 2 days of coffee ground vomiting and upper abdominal pain. For 2 weeks she has had a flu-like illness. On examination she is drowsy, BP 130/85, HR 96, Temp 36.5, mild scleral jaundice. Abdomen soft, mild epigastric tenderness, no organomegaly. Uterus contains twin pregnancy, consistent with dates, both fetal heards present. Urinalysis shows trace of protein. She has Hb 106, WCC 30, plt 155, uric acid 0.45, bilirubin 25, ALP 180, AST 315, creatinine 100, BSL 1.8mmol. The MOST LIKELY diagnosis is?
a. Cholecystitis
b. Hepatitis
c. Cholestasis of pregnancy
d. Acute fatty liver of pregnancy
e. Pre eclampsia with HELLP syndrome
d. Acute fatty liver of pregnancy
O
78
Which of the following may be responsible for congenital heart block?
a. Anti SSA
b. Anticardiolipin antibodies
c. Anti smooth muscle antibodies
d. Anti mitochondrial antibodies
a. Anti SSA
O
= anti Ro antibodies. Risk of congenital heart block 1-2%
79
One hundred high-risk patients undergo a fetal biophysical profile (FBPP). Ten patients have a positive test. Two stillbirths result, both of which are from among the patients with a positive FBPP. The sensitivity of the FBPP in this population is:
A. 0%.
B. 20%.
C. 80%.
D. 100%.
D. 100%.
80
Which of the following IS FALSE regarding the use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in pregnancy?
A. Oligohydramnios is a side effect of selective COX-2 antagonists
B. Premature closure of the ductus arteriosus is less likely at an advanced gestational age than extremely premature gestations
C. NSAIDs are safe to use in the presence of maternal hepatic dysfunction
D. Sulindac has reduced concentration of the active metabolite in the fetal circulation but has been associated with premature closure of the ductus arteriosus and oligohydramnios
E. Nimesulide is a COX-2 antagonist but has still been associated with oligohydramnios, renal arterial vasoconstriction and neonatal renal impairment
B. Premature closure of the ductus arteriosus is less likely at an advanced gestational age than extremely premature gestations
81
Which of the following disorders is associated with the highest maternal mortality?
A. Hypothyroidism
B. Systemic lupus erythematosus
C. Ventricular septal defect
D. Myasthenia Gravis
E. Primary pulmonary hypertension
E. Primary pulmonary hypertension
O
10-25% mortality
82
A woman is referred to you in mid-pregnancy for review. She has quiescent rheumatoid arthritis. She is ribosmal antibody negative, lupus anticoagulant negative and anticardiolipin negative. You counsel her that:
A. her fetus is at severe risk of placental insufficiency.
B. she has a risk of postpartum exacerbation.
C. her fetus is at risk of complete heart block.
D. she should expect no problems with this pregnancy
B. she has a risk of postpartum exacerbation.
90% PP exacerbation - due to reflex in higher T-mediated immunity
83
You administer prophylactic anti-D gamma globulin to a Rhesus negative woman at 28 weeks gestation. Immediately afterwards your midwifery colleague informs you that the woman's medical record states that she is a Jehovah's Witness. The MOST APPROPRIATE response is to:
A. remove the drug chart from the medical record and destroy it.
B. inform your medical defence organisation of the incident.
C. immediately inform the patient of the error and apologise.
D. report the midwife's failure to alert you in advance
C. immediately inform the patient of the error and apologise.
O
84
Which of the following conditions is associated with the highest risk of thromboembolism in the puerperium?
A. Anti-thrombin III deficiency
B. Factor V Leiden homozygosity
C. Protein S deficiency
D. Hyperhomocysteinaemia
A. Anti-thrombin III deficiency
As per RANZCOG May 2011 Qs
Up to 51% risk of VTE recurrence in pregnancy
85
Obstetric cholestasis is associated with:
A. right upper quadrant tenderness.
B. preeclampsia.
C. pruritus without rash.
D. Gilbert's syndrome.
C. pruritus without rash.
O
86
Which of the diagnoses below is MOST LIKELY to be associated with pruritus and bullae in pregnancy?
A. Drug Eruption
B. Pruritic Urticarial Papules of Pregnancy (PUPP)
C. Bullous Pemphigoid
D. Herpes Gestationis
D. Herpes Gestationis
Answer as per RANZCOG May 2011 Qs
NB Herpes gestationis = pemphigoid gestationis
Herpes gestationis and bullous pemphigoid similar spectrum if disease but HG unique to pregnancy or GTD
87
At the routine antenatal screening tests, a 20-year-old woman from Nauru has negative RPR (Rapid Plasma Reagin) and positive TPHA (Treponema pallidum haemagglutination).
The MOST LIKELY explanation is that:
A. the patient has probably had Yaws.
B. the patient probably has early syphilis.
C. the patient probably has late latent syphilis.
D. the result is probably a biological false positive.
E. the patient has probably been treated for syphilis in the past.
E. the patient has probably been treated for syphilis in the past.
O
High risk
Yaws: chronic skin infection caused by treponema pallidum subspecies
88
A woman has an RPR/VDRL titre of 1:8 in early pregnancy and a history of documented successful treatment of syphilis. What is your NEXT course of action?
A. Perform TPHA and FTA tests
B. Check post treatment RPR/VDRL titres
C. Administer 1.8g IMI Bicillin
D. Undertake contact tracing
B. Check post treatment RPR/VDRL titres
O
4x reduction = adequate treatment
89
Which of the following conditions is NOT increased by the use of salbutamol?
A. Hypoglycaemia
B. Ventricular tachycardia
C. Pulmonary oedema
D. Hypokalaemia
E. Myocardial infarction
A. Hypoglycaemia
O
Can cause HYPERglycaemia
90
The husband of a woman who is 10 weeks pregnant is diagnosed with acute hepatitis B. The woman is tested for hepatitis B serology and is negative for hepatitis B surface antigen, hepatitis B core IgM antibody, hepatitis B core antibody and hepatitis B surface antibody. The MOST APPROPRIATE management of the patient is:
A. blood test for Hep B DNA.
B. repeat blood tests for hepatitis B in 2 weeks.
C. hepatitis B immune globulin.
D. commence hepatitis B vaccine.
E. hepatitis B immune globulin and commence hepatitis B vaccine.
E. hepatitis B immune globulin and commence hepatitis B vaccine.
O
Also need to re-test her HbsAg in 3months to ensure hasn't developed it. If +ve refer to specialist.
91
Which of the following is most likely to occur in the next week in a patient with premature rupture of membranes at 30 weeks' gestation?
a) Spontaneous sealing of the leak
b) Chorioamnionitis
c) Labour
d) Malpresentation
e) Prolapsed cord
c) Labour
O
92
Which of the following is LEAST true concerning maternal alloimmunisation?
a) Maternal IgG is taken into the syncytiotrophoblast cells by phagocytosis and binds to the Fc-gamma receptors before being transported across the cell to be released at the apical cell membrane
b) Monocytes and macrophages affect destruction of IgG-bound red cells by binding to the F of the IgG with Fc-gamma receptors
c) Heterogenous glycosylation of IgG may partly explain markedly differing effects of IgG by two individuals
d) Anti-D in pregnancy is either predominantly IgG1 or a mixture of IgG1 and IgG3
b) Monocytes and macrophages affect destruction of IgG-bound red cells by binding to the F of the IgG with Fc-gamma receptors
As per RANZCOG MCQs Feb 2008
93
Intrahepatic cholestasis is associated with:
a) RUQ tenderness
b) PET
c) An increased stillbirth rate
d) Gilbert's Syndrome
e) Systemic anti-fungal therapy
c) An increased stillbirth rate
O
94
What are the criteria for calling a drug B3?
a) Animal studies show a defect, the significance of which is unclear in humans
b) Animal studies are lacking but no evidence of defects
c) Harmful effects in humans suspected but those effects are reversible
d) Animal studies show a defect which is reversible
a) Animal studies show a defect, the significance of which is unclear in humans
https: //www.tga.gov.au/prescribing-medicines-pregnancy-database
95
A primigravid woman is seen at 30 weeks gestation with right sided abdominal pain and vomiting. Appendicitis is suspected.
What is the correct management of this instance?
a. Perform ultrasound to exclude appendicitis.
b. Perform MRI scan to exclude appendicitis.
c. Undertake appendicectomy.
d. Administer steroids for fetal lung maturation and observe.
c. Undertake appendicectomy.
If there is a prolonged wait time for MRI evaluation, the risk of potential appendiceal rupture is balanced against the potential benefits of the study, such as identifying a different cause of pain or avoiding surgery. If MRI if not readily available, then CT scan can be performed if the diagnosis is unclear. If either imaging modality is not available quickly or if the patient declines CT because of the radiation exposure, surgery should not be delayed in pregnant women with findings suggestive of appendicitis despite inconclusive ultrasound results.
96
Which one of the following is INCORRECT?
a. Iron requirement in the menstruating, non-pregnant, female is approximately 2mg/day.
b. Iron requirement in the pregnant female is approximately 9mg/day.
c. Iron absorption in the non-pregnant adult is approximately 5% of daily intake.
d. Cord blood serum ferritin is greater than maternal serum ferritin.
b. Iron requirement in the pregnant female is approximately 9mg/day.
O
Iron requirement (NZ MoH)
- breastfeeding 9mg/day
- pregnant women 27mg/day
- non-pregnant - 18mg/day → A is also wrong!
97
With respect to pregnancy in renal transplant patients:
a. pregnancy is unlikely in the first 12 months after renal transplantation.
b. pregnancy may increase graft rejection rates.
c. immunosuppressive agents should be decreased prior to pregnancy.
d. live birth rate approximates 75%.
d. live birth rate approximates 75%.
\*RANZCOG 2020 Q says correct answer
?disagree
75% if Cr\>125
\>95% of Cr \<125
Graft rejection is a risk especially if conceive \<2years after transplant
98
All of the following increase in the pregnant woman over values in the non-pregnant woman EXCEPT:
a. residual volume
b. expiratory reserve volume.
c. oxygen consumption.
d. respiratory rate.
e. tidal volume.
b. expiratory reserve volume.
O
Reduced by 15-20%
NOTE residual volume also decreases but less reliably so
99
A 30-year-old woman has a severe exacerbation of her chronic asthma. She is 16 weeks gestation. She has been using inhaled salbutamol without relief.
The next most appropriate management step is:
a. leucotriene modifiers.
b. oral prednisolone.
c. increase the frequency of inhaled salbutamol.
d. inhaled corticosteroids.
b. oral prednisolone.
Normally use normal prednisone
100
You deliver an Rh-negative patient of an Rh-positive infant at term. The blood bank reports that the Kleihauer-Betke test reveals a feto-maternal haemorrhage of 40mL of fetal red cells. The indirect Coombs' test shows no anti-D antibodies.
Which of the following statements about this situation is correct?
a. No anti-D immunoglobulin is indicated because the patient is already sensitised.
b. Seven vials (875mcg) of anti-D immunoglobulin will be necessary to prevent sensitisation.
c. The usual dose of one vial (625 IU) of anti-D immunoglobulin should be protective against sensitisation.
d. If anti-D immunoglobulin is given, the direct Coombs' test on the mother should be repeated within 24 hours
b. Seven vials (875mcg) of anti-D immunoglobulin will be necessary to prevent sensitisation.
O
One vial = 625 IU = 125mcg = 6ml fetal blood
101
A woman G2P1 and her partner are referred to the antenatal clinic. She is at 14 weeks of gestation with positive anti-D antibodies during routine screening. Her qualitative titre is 1:16. She had an SVD two years ago. The baby had no issues. Her partner is heterozygous for D-antigen.
What is the most appropriate management plan?
a. Cordocentesis
b. Amniocentesis
c. Weekly ultrasound of fetal MCA PSV (Middle cerebral artery peak systolic velocity) to detect fetal anaemia
d. Check titres fortnightly in the mother
d. Check titres fortnightly in the mother
O
I thought amniocentesis would be next as if partner heterozygote risk of fetus affected so would offer fetal genotyping (amnio OR NIPT). Tire 1:16 - 1:32 = risk HDFN
102
A 31-year-old HIV positive woman near term is on anti-retroviral therapy. Her viral load is undetectable and there is no fetal complication. She wants to have a vaginal birth rather than a caesarean section.
After explaining the risk, what is the next most appropriate step?
a. Respect the patient’s decision as the risk of transmission is low.
b. Perform the caesarean section at 38 weeks or if in labour.
c. Contact Psychiatry to evaluate the patient’s decision.
d. Contact the hospital lawyers for court orders for a caesarean section.
a. Respect the patient’s decision as the risk of transmission is low.
103
A hepatitis B screening test is positive for antibody to core protein but negative for surface antigen and antibody. This indicates that:
a. the patient is a chronic carrier
b. the surface antibody will probably become positive soon
c. the patient has a high rate of infectivity
d. the patient has probably never had hepatitis B
b. the surface antibody will probably become positive soon
O
104
Which of the drugs below is most likely to be associated with oligohydramnios?
a. Captopril
b. Verapamil
c. Lithium
c. Prazosin
e. Mannitol
a. Captopril
O
Verapamil - CCB
105
Which of the following is FALSE regarding human relaxin in pregnancy?
a. Relaxin is structurally closely related to a growth hormone.
b. Recombinant human relaxin has not been shown to be an effective cervical ripening agent in randomised controlled trials.
c. The corpus luteum of pregnancy is the most important source of circulating serum relaxin.
d. The absence of circulating serum relaxin is not known to be associated with any significant clinical sequelae.
a. Relaxin is structurally closely related to a growth hormone.
comes from the corpus luteum and placenta
protein hormone
insulin like peptide
(relaxes the ligaments in pelvis) - Williams says this is NOT true
106
Which of the following statements about pituitary prolactinomas is correct?
a. The effects of oestrogen deficiency are rarely an indication for treatment of young women with microprolactinomas and amenorrhoea.
b. Patients with microprolactinomas should be maintained on dopamine agonist therapy such as bromocriptine throughout pregnancy.
c. Patients with untreated microprolactinomas should be discouraged from breastfeeding.
d. They are found, at post-mortem examination, in approximately 10% of women who have died of non-endocrine disease.
d. They are found, at post-mortem examination, in approximately 10% of women who have died of non-endocrine disease.
O
107
A woman is 20 weeks pregnant in her second pregnancy. She terminated her first pregnancy at 14 weeks and had a haemorrhage requiring a three-unit blood transfusion. The pathologist phones you to say she has a 1:128 titre of anti-Kell present in her antibody screen.
All of the following are true EXCEPT:
a. Serial antibody titres in the mother correlate well with fetal status.
b. Peak systolic velocity in the MCA increases in the severely anaemic fetus and fetal blood sampling may be necessary.
c. If the father is Kell Ag positive, amniocentesis or fetal cordocentesis may be performed to assess fetal Kell Ag status.
d. Kell isoimmunisation is particularly severe as the antibodies affect both mature red cells and developing red cells in bone marrow.
a. Serial antibody titres in the mother correlate well with fetal status.
108
Which of the following is NOT a recognised cause of pulmonary hypertension in pregnancy?
a. Cardiomyopathy
b. Left ventricular failure
c. Mitral stenosis
d. Pulmonary embolism
a. Cardiomyopathy
109
A Chinese born woman is noted on her routine antenatal testing to have a haemoglobin concentration of 115g/L (Normal range: 110-150), MCV of 72fL (Normal range: 85-95). Her ferritin is 25mcg/L (Normal range: 20-100) and her haemoglobin electrophoresis is normal.
Which test will help most to ascertain fetal risk?
a. Test her partner's full blood examination
b. Test her partner's haemoglobin electrophoresis
c. Test her haemoglobin DNA genotype
d. Test for serum transferrin
a. Test her partner's full blood examination
O
Hemoglobin analysis and/or genetic testing is required to confirm the diagnosis of thalassemia
?unlikely he will be affected if doesn't have microcytosis
ALSO electrophoresis can be normal in alpha minor
110
The appropriate initial treatment of pulmonary thromboembolism is:
a. unfractionated heparin 10,000 units IV followed by IV infusion.
b. unfractionated heparin 5000 units BD subcutaneous injection.
c. low molecular weight heparin (LMWH) 1.5mg/kg BD subcutaneous injection.
d. low molecular weight heparin (LMWH) 1mg/kg BD subcutaneous injection.
d. low molecular weight heparin (LMWH) 1mg/kg BD subcutaneous injection.
111
Which of the following tests is most useful in diagnosing haemoglobinopathy?
a) HbEP
b) Bone marrow
c) Dna analysis
d) Red cell index
e) Blood film
c) Dna analysis
M
To DIAGNOSE
112
Which of the following parameters are reduced in the third trimester when iron supplements have been given?
a) Total WCC
b) Serum ferritin
c) Red cell mass
d) Plasma volume
e) ESR
b) Serum ferritin ?
113
Which does not cause intrauterine infection
a) CMV
b) Polio
c) Mumps
d) Toxoplasmosis
e) Malaria
c) Mumps
Aside from febrile illness, most cases in pregnancy uncomplicated
114
A 34 year old G8P1 woman presents for her first visit. Her past history is having 5 miscarriages, 1 TOP, and 1 live birth at 35 weeks with a 1.6 kg
baby. She had severe pre-eclampsia at the birth.
What would the MOST APPROPRIATE investigation be?
A. Serial serum progesterone in the first trimester
B. Clotting profile
C. Anti-Rheumatoid Factor
D. Anti-Cardiolipin Ab
D. Anti-Cardiolipin Ab
O
Would need a repeat sample (\>12weeks apart and within 5 years of events) to be able to diagnose APLS
115
A 34 year old G8P1 woman of 8 weeks gestation gives the following history. She has had 4 miscarriages, 2 terminations and 1 live birth. Her live birth was at 35 weeks when she developed severe pre-eclapmsia. The baby weighed 1.6 kg. Investigations show a high level of anti-cardiolipin IgG and IgM.
What is the IMPORTANT advice she needs to be given?
A. She will need Prednisolone to reduce antibody titres, helping implantation
B. She will need Progesterone pessaries at 13 weeks to reduce the miscarriage risk
C. The fetus requires investigation for congenital heart block
D. She is at increased risk of thromboembolism and the use of aspirin and low molecular weight Heparin is required
D. She is at increased risk of thromboembolism and the use of aspirin and low molecular weight Heparin is required
O
LMWH if: prev VTE, late loss, IUGR or early PET
116
A 30 year old woman has her 28 week visit. Her glucose challenge and FBE tests are normal, however an indirect Coombs test is positive. It will be MOST important to assess whether
A. Fetal red blood cells have entered the maternal circulation
B. The patient has idiopathic thrombocytopenia purpura
C. The patient is suffering from HIV infection
D. The patient has anti-thyroid antibodies
A. Fetal red blood cells have entered the maternal circulation
O
117
Cardiac evaluation during pregnancy is BEST accomplished using which of the following procedures?
A. Chest x-ray
B. Electrocardiogram
C. Echocardiogram
D. Cardiac catheterisation
C. Echocardiogram
O
118
Which of the following would be least desirable in a pregnant woman with a severe non hypertrophic cardiomyopathy?
A. digoxin
B. frusemide
C. labetalol
D. prazosin
C. labetalol
O
Prevents a tachycardic response
Digoxin - increased contractility
Frusemide - reduces preload
Prazosin - reduces afterload
119
Which of the following is a COMMON symptom experienced by smokers trying to quit?
A. Memory loss
B. Indigestion
C. Increase in cough
D. Skin sores
C. Increase in cough
O
120
Which of the following is LEAST true of maternal alloimmunisation?
A. The following antigens have substantially LESS antigen expressed on fetal red cells compared to adult re cells: A, B, I, Lewis, P, Lutheran.
B. A & B Antigens are expressed by tissues other than fetal blood, hence Anti-A and Anti-B bind to sites other than fetal red cells.
C. Fetuses with partial D phenotype (Du), will not be affected by haemolytic disease in the presence of maternal anti-D.
D. The Asian population is LESS likely than the Caucasian population to be affected by anti-D antibodies but MORE likely to be affected by anti-C antibodies.
C. Fetuses with partial D phenotype (Du), will not be affected by haemolytic disease in the presence of maternal anti-D.
O
121
Which of the following statements about oestrogen is INCORRECT?
A. Oestrogen administration causes vasodilation
B. Oestriol synthesis in pregnancy is enhanced by aromatisation in the fetal adrenal gland
C. Oestrogen enhances the effect of nitric oxide on vascular smooth muscle
D. Oestrogen is a positive ionotrope
B. Oestriol synthesis in pregnancy is enhanced by aromatisation in the fetal adrenal gland
O
122
Heparin in pregnancy has been causally associated with all of the following EXCEPT:
A. Mid-trimester miscarriage
B. Thrombocytopenia
C. Osteoporosis
D. PPH
E. Epistaxis
A. Mid-trimester miscarriage
O
123
Of the following, which would be considered the most common cause of syncope in pregnancy?
A. Hyperemesis Gravidarum
B. Supine Hypotension
C. Anxiety
D. Standing for a prolonged period of time
E. Pre-eclampsia
D. Standing for a prolonged period of time
As per RANZCOG MCQs August 2008
124
A Somali woman presents at 16weeks gestation with weight loss, nigh sweats, and a chronic cough. Her HIV serology is negative. CXR shows an apical calcified lesion. Appropriate initial antibiotic treatment would include:
A. Erythromycin
B. Cotrimoxazole
C. Isoniazid
D. Streptomycin
C. Isoniazid
O
As concern regarding active TB. Guidelines suggest treating with combination due to MDR
125
35yo with GDM at 32weeks on diet control presents with 2hour post prandial sugars above 6.5. She has been adhering to her diet. Her management should now involve:
A. Betamethasone injections and delivery at 34weeks
B. Commencement of oral hypoglycaemics
C. Stricter diet with attempt to lose weight
D. Commencement of insulin
D. Commencement of insulin
O
126
Which is a Category A drug?
A. Metoclopramide
B. Phenytoin
C. Ondansetron
D. Betamethasone
E. Augmentin
A. Metoclopramide
M
127
Most important diagnosis to know when administering PGF2a?
A. HTN
B. Asthma
C. Patent ductus arteriosus
D. AV fistula
B. Asthma
M
PGF2a is carboprost
128
Which substance has a dose related effect on the fetus?
a. Heroin
b. Cannabis
c. Cigarettes
d. Alcohol
e. Cocaine
d. Alcohol
M
129
A patient has bipolar affective disorder and is on lithium 900mg/day. Risks to fetus include:
a. CNS anomalies
b. Cardiac anomalies
c. Renal anomalies
d. Post maturity
b. Cardiac anomalies
Lithium causes an increased risk of cardiac abnormalities (RR 1.2-7.7), no increased risk of NTDs and goitre.
M
130
A woman with bipolar affective disorder on lithium presents at 11/40. Serum lithium is 1.0 (therapeutic 0.9-1.4). She should be told?
a. Lithium is suspected of causing heart defects
b. To cease lithium now will decrease risk to baby
c. To decrease dose will decrease risk to baby
d. Should have CVS now
e. Should have amniocentesis at 16/40
a. Lithium is suspected of causing heart defects
M
131
You have been looking after a pregnant patient who has a past history of recurrent genital herpes. She presents to you at 38 weeks with a herpes lesion which has been confirmed with viral culture. Your management is?
a. Immediate CS
b. Await spontaneous labour or ROM and perform a CS then
c. Culture the cervix weekly and allow vaginal delivery when culture are negative
d. Await SROM or spontaneous labour and assess the lesion then and decide on mode of delivery based on the lesion at the time
d. Await SROM or spontaneous labour and assess the lesion then and decide on mode of delivery based on the lesion at the time
M
132
Parvovirus B19 is associated with?
a. Rapid progression of cervical dysplasia to invasion
b. Fetal anaemia and hydrops
c. Maternal pneumonia
d. Benign condylomata
e. vHepatitis C
b. Fetal anaemia and hydrops
M
133
Five days after a busy obstetric clinic one of the patients develops rubella. Should all of the rest of the patients who attended the clinic?
a. Have rubella vaccine
b. Be tested for IgM Rubella antibodies
c. Be tested for IgG Rubella antibodies
d. Be given immune globulin
e. None of the above
c. Be tested for IgG Rubella antibodies
M
134
Your patient is 8w and has been exposed to Rubella. Your management should include all of the following except:
a. Perform IgG and IgM levels
b. If IgG negative then repeat IgM in 10 days
c. Administer IgM immunoglobulin if IgM positive
d. Counsel regarding the high risk of abnormality
e. Counsel regarding the risks of hearing, eye and ear defects
c. Administer IgM immunoglobulin if IgM positive
M
135
Toxoplasmosis all true except:
a. A bacteria
b. Can cause fetal loss
c. Causes cerebral calcifications
d. Causes chorioretinitis
e. Hydrocephalus
a. A bacteria
M
136
Which of the following is appropriate management for an anaphylactic reaction to penicillin with BP 80/40?
a. Adrenaline 0.3-0.5 ml of 1:1000 sc
b. Adrenaline 0.3-0.5 ml of 1:10000 sc
c. Phenergan 25mg IV
d. Hydrocortisone 100 mg IV
a. Adrenaline 0.3-0.5 ml of 1:1000 sc
M
137
22yo nulliparous patient has a mother with IDDM. At first visit in 1st trimester, her urinalysis is normal. Advise the patient
a. no chance she will develop diabetes
b. needs a formal GTT in 2nd trimester
c. start prophylactic insulin
d. if does not develop glycosuria, no risk of developing DM
e. monitor her by doing fasting BSL in pregnancy
b. needs a formal GTT in 2nd trimester
M
138
Regarding inflammatory bowel disease in pregnancy?
a. Ulcerative colitis is associated with reduced fertility compared to Crohn’s disease
b. It gets worse in pregnancy and the puerperium
c. Surgery should not be delayed due to pregnancy
d. Sulfasalazine is C/I in pregnancy
c. Surgery should not be delayed due to pregnancy
M
Crohn's is thought to potentially have an impact on infertility.
Overall no worse in pregnancy ~30% relapse (NB UC likely higher risk of relapse, particularly postpartum)
Surgery necessary particularly if toxic megacolon, stricture, excessive haemorrhage
Sulfasalazine is safe in pregnancy - just need to ensure high dose folate supplementation
139
Herpes gestationis can be diagnosed if?
a. Similar skin lesions are noted in subsequent pregnancies
b. Similar skin lesions are noted in association with the OCP or menstruation
c. There is peripheral eosinophilia
d. Herpes serology is positive
e. On histologic examination complement and IgG is seen adjacent to the basement membrane between the dermis and epidermis
e. On histologic examination complement and IgG is seen adjacent to the basement membrane between the dermis and epidermis
Herpes gestationis is pemphigoid gestationis; it recurs with subsequent pregnancies and has 25% chance of flare with menses and OCP. There is a peripheral eosinophilia but herpes serology is normal. Complement and IgG is present adjacent to the basement membrane, demonstrated on immunofluorescence stain
140
The disease most likely to cause jaundice when it occurs in pregnancy is?
a. Pancreatitis
b. Cholecystitis
c. Hepatitis
d. Severe pre-eclampsia
e. Cirrhosis
c. Hepatitis
M
141
Ruptured liver haematoma:
a. Pack
b. Hepaticetomy
c. Hepatic artery embolisation
d. Hepatic artery ligation
a. Pack
M
142
What is the kidney lesion with PET?
a. Increase mesangial cells
b. Fibrinoid necrosis
c. Glomerular endotheliosis
c. Glomerular endotheliosis
M
143
The commonest cause of pulmonary oedema in severe PET is:
a. Iatrogenic fluid overload
b. Left ventricular failure
c. Leaky capillaries
d. Hypoalbuminaemia
a. Iatrogenic fluid overload
M
144
A patient who is 28 year-old who is at 14 weeks has a 2cm intra-ductal carcinoma of the breast, has a mastectomy and nodes. The next appropriate management is:
a. Termination there and then
b. Termination at 16/40
c. CS at 36/40
d. IOL at 36 weeks
e. Leave until term and manage expectantly
e. Leave until term and manage expectantly
M
\*Review answer to this
145
A 28-year old woman in her first pregnancy is diagnosed with obstetric cholestasis at 34weeks' gestation. Which of the following is a characteristic of this condition?
A. placental insufficiency
B. preterm delivery
C. palmar skin rash
D. vomiting in late pregnancy
B. preterm delivery
O
Iatrogenic AND spontaneous
146
A 33-year old multiparous woman at 18 weeks is being treated with lithium for BPAD. Which if the following USS findings is hte most likely to be associated with the use of this medication in pregnancy?
A. Spina bifida
B. Dysplastic kidney
C. Cleft lip
D. Cardiac defect
E. Coarctation of the aorta
D. Cardiac defect
O
147
An antenatal patient has anti-D antibodies of 1:409 at 12 weeks. Her husband is homozygous. In her last pregnancy she was delivered at 30weeks and the baby required multiple exchange transfusions in the neonatal period. What gestation would you anticipate the development of a clinically significant anaemia?
A. 16weeks
B. 20 weeks
C. 24 weeks
D. 32 weeks
B. 20 weeks
O
148
Iliofemoral thrombosis is best diagnosed in pregnancy by
A. Duplex Doppler studies
B. Impedence plethyebogram
C. Contrast venogam
D. Fibrinogen uptake test
A. Duplex Doppler studies
\*Contrast venogram is gold standard but concern re radiation risk to pregnancy
Haven't seen official answer
149
Pulmonary embolus - all are correct except?
A. Classical presentation in \<5%
B. Most large PEs have clinical DVTs
C. Symptoms depend on site, size and number
D. 60% obstruction of pulmonary vessels leads to raise R atrial and central venous pressures
E. Most are clinically unrecognised
B. Most large PEs have clinical DVTs
150
All of the following hormones have a similar structure except?
A. Inhibin A
B. Inhibin B
C. TSH
D. AMF
E. Activin
C. TSH
151
What can you advise a patient about ursodeoxycholic acid for obstetric cholestasis?
1. Reduces the risk of IUFD
2. Improves LFTs and itch
3. Improves bile acids
Improves LFTs and itch
\*Unsure if official Q, PITCHES trial likely changes things..
152
A 21-year-old woman, who is known to have beta thalassemia major, attends the clinic for preconception counselling. What is the most relevant initial pre-pregnancy investigation to predict maternal complications of pregnancy?
A. Cardiac MRI
B. Chest X-Ray
C. ECG
D. Echocardiogram
E. Pulmonary function tests
D. Echocardiogram
RCOG SBA
