Maternal Medicine Mcqs

Question 1

How should levothryoxine be adjusted at the beginning of pregnancy

Answer 1

Increase by 25 micrograms per day. Further dose adjustment may be needed as pregnancy progresses

Question 2

What is the TSH target for
1) T1
2) T2 and 3

Answer 2

1) 2.5 mU/L

2) 3

Question 3

What is the frequency of TFT prior to optimization

Answer 3

Q 4-6 weekly

Question 4

What is the management postpartum of thyroid disease

Answer 4

1) restart prepregnancy dose

2) TFT at 6 weeks

Question 5

How long should pregnancy be avoided post radioactive iodine therapy

Answer 5

6 months

Question 6

What antithyrood drugs can cause congenital aplasia cutis

Answer 6

Carbamizole
Methimazole

Question 7

What is the rate of pyelonephritis in pregnancy

Answer 7

1-2%

Question 8

Recurrence rate of pyelonephritis in pregnancy

Answer 8

20%

Question 9

What is the recommended pregnancy deferral time following allograft transplant

Answer 9

2 years

Question 10

What condition is pemphigoid gestationis linked to

Answer 10

Autoimmune disease
Esp Graves disease

Question 11

What is the pattern of the rash of PG (4)

Answer 11

• starts periumbilically
• fans outward then involves trunk extremities palms and soles
• vescicles and bullae
• mucosa spearing

Question 12

Management of PG

Answer 12

• MDT with dermatology
• emollients
• topical steroids
• ## antihistamines

Question 13

What is a pregnancy concern of PG

Answer 13

Associated with fetal growth restriction

Question 14

What is the rate of postpartum flare

Answer 14

75%

Question 15

What is the second most common dermatosis of pregnancy

Answer 15

Polymorphic eruption of pregnancy

Question 16

What are the risk factors for PEP
(3)

Answer 16

• nulliparity
• multiple pregnancy
• overdistension (fibroids, polyhydramnios)

Question 17

What is the typical features of PEP

Answer 17

• papules and plaques formed within the distribution of striae gravidarum
• umbilical sparing

Question 18

What is the recurrence rate of AFLP

Answer 18

25%

Question 19

What pre conception evaluations should be performed for HBSS within a year of pregnancy (5)

Answer 19

• pulmonary function test
• ECHO
• renal and liver function
• retinopathy screening

Question 20

What percentage of patients with beta thalassemia major develop hypogonadotrophic hypogonadism

Answer 20

66%

Question 21

What percentage of beta thal develop diabetes

Answer 21

20%

Question 22

What percentage of beta thal major develop osteoporosis

Answer 22

40%

Question 23

What percentage of beta thal develop hypothyroidism

Answer 23

10%

Question 24

What is the most common cause of death in beta thal major

Answer 24

Cardiac failure (50%)

Question 25

What is the most common cause of thrombocytopenia in pregnancy

Answer 25

Gestational thrombocytopenia 75%

Question 26

What are other causes of thrombocytopenia in pregnancy (2)

Answer 26

1- hypertensive disease 15-20% 2- immune causes 3-4%

Question 27

What percentage of neonates have thrombocytopenia due to maternal ITP

Answer 27

10%

Question 28

What are delivery condiserations for ITP (3)

Answer 28

- avoid ventouse due to risk of fetal thrombocytopenia - forceps use possible with consultant advice - section only for obstetric indications

Question 29

What is the mortality rate of congenital heart block due to maternal SLE

Answer 29

15-30%

Question 30

What auto antibodies are associated with CHB

Answer 30

Anti ro/la

Question 31

What thrombophilia has the highest VTE risk in pregnancy

Answer 31

Antithrombin deficiency type 1

Question 32

What is the neonatal hsv transmission rate for primary hsv in pregnancy

Answer 32

41%

Question 33

Placenta praevia odds ratio after one lscs

Answer 33

2.2

Question 34

Placenta praevia odds ratio after 2 lscs

Answer 34

4.1

Question 35

Placenta praevia odds ratio after 3 lscs

Answer 35

22.4

Question 36

Risk of praevia after 3 sections compared to no sections

Answer 36

More than 20 times

Question 37

What is the leading cause of maternal death

Answer 37

Cardiac disease

Question 38

What is the second most common cause of maternal death

Answer 38

Neurological : epilepsy and stroke

Question 39

What drug is safest in pregnancy for the treatment of rheumatoid arthritis

Answer 39

Certolizumab - does not cross the placenta - safe in all trimesters - safe in breastfeeding (all anti- TNF) -Rituximab should be discontinued 6months before pregnancy

Question 40

What is the rate of breast cancer in pregnancy

Answer 40

1:3000

Question 41

How is breast cancer managed in pregnancy

Answer 41

- surgical management as per non pregnant - chemotherapy safe after T1 - tamoxifen and herceptin not safe - Radiotherapy contraindicated unless life saving such as spinal compression - imaging not recommended (only chest xray and liver us) - do not breastfeed with chemo (2 weeks ) as can cause neonatal leucopenia

Question 42

Preconception pregnancy planning with history of breast cancer

Answer 42

- tamoxifen free x 3mmths - Metastatic disease should not get pregnant - chemotherapy may be gonadotoxic leading to infertility

Question 43

Medical management of HBSS in pregnancy

Answer 43

- stop ace/arbs - influenza vaccine yearly - folic acid 5mg - pneumococcal vaccine every 5 years - daily penicillin/erythromycin if allergic - asa 75mg daily from 12 weeks - LMWH if admitted

Question 44

Maternal risk of obesity

Answer 44

- miscarriage - gdm - pre eclampsia - vte - iol - lscs - anaes complications - wound infections - breastfeeding concerns

Question 45

Fetal risk of maternal obesity

Answer 45

- stillbirth - congenital anomalies - prematurity - macrosomia - neonatal death - metabolic disorders in childhood

Question 46

Antenatal adjustments in obesity

Answer 46

- high dose folic acid - vitamin D 10microgram daily - vte risk assessment - anesthesia review if bmi >40 - pre eclampsia surveillance - active management third stage

Question 47

What is the course of asthma in pregnancy

Answer 47

1/3 improve 1/3 worsen 1/3 no change

Question 48

What is the incidence od transient neonatal.myasthenia gravis

Answer 48

20%

Question 49

What is the effect of pregnancy on myasthenia gravis

Answer 49

Worsen 40% Unchanged 30% Remission 30%

Question 50

When are exacerbations of MG more common

Answer 50

T1 and postpartum up to 3 months

Question 51

What percentage of patients with MG have thyroid dysfunction

Answer 51

10-15%

Question 52

What percentage of patients with MS also have a thymoma

Answer 52

15%

Question 53

What fetal anomaly is associated with lithium use

Answer 53

Ebsteins anomaly - right ventricular outflow Obstruction

Question 54

What is the monitoring schedule if lithium continued in pregnancy

Answer 54

- monitor lithium levels every 4 weeks until 36 weeks then weekly

Question 55

How is labor managed for patients on lithium

Answer 55

- hospital birth -stop drug during labor - check lithium levels 12 hours after last dose

Question 56

Neonatal impact of lithium

Answer 56

- floppy muscles - tachycardia - lethargy - jaundice

Question 57

What is an alternative agent for bipolar disease when lithium is discontinued

Answer 57

Quetiapine