Obstetrics

Question 1

LLN of platelets in pregnancy

Answer 1

> 100

Question 2

ERV change in pregnancy

Answer 2

fall

Question 3

RV change in pregnancy

Answer 3

Fall

Question 4

IC change in pregnancy

Answer 4

small rise

Question 5

TLC change in pregnancy

Answer 5

Overall same (IC rise and FRC fall), maybe small rise

Question 6

Why do UTIs increase in pregnancy?

Answer 6

Progesterone mediated ureteric dilation

Question 7

Why does ALP rise in pregnancy?

Answer 7

placenta produces ALP

Question 8

Normal urine PCR in pregnancy and why

Answer 8

<300, hyperfiltration

Question 9

Top medical comorbidity affecting pregnancy

Answer 9

Asthma

Question 10

Main change in respiratory physiologyin pregnancy

Answer 10

increased TV

Question 11

Safest inhaled steroid in pregnancy

Answer 11

Budesonide

Question 12

Well controlled asthma reduces the risk of what in a child..

Answer 12

Bronchiolitis and croup

Question 13

Worst AED for pregnancy

Answer 13

Valproate

Question 14

Best single agent for pregnancy

Answer 14

Keppra

Question 15

Anti-epileptic enzyme inducers x4

Answer 15

CBZ, Pheyntoin, topiramate, phenobarb

Question 16

Relationship between eGFR and fertility in prengnacy

Answer 16

Lower GFR = worse fertility

Question 17

What occurs with dialysis and fertility

Answer 17

fertility improves

Question 18

What occurs with transplant and fertility

Answer 18

returns

Question 19

How long should transplants wait until conception

Answer 19

2 years +

Question 20

consequence of early conception post transplant

Answer 20

increased graft loss

Question 21

How much dialysis is needed in pregnancy?

Answer 21

> 36 hours/ week, INTENSE

Question 22

what occurs to GFR in pregnancy in those with CKD

Answer 22

falls and often doesn’t recover

Question 23

what to supplement in obese people in pregnancy

Answer 23

folate

Question 24

potential drug to give to Anti-Ro +ve mothers in pregnancy

Answer 24

HCQ- reduces risk of heart block in future pregnancies

Question 25

When does CHB manifest in anti-ro/La +ve pregnancies?

Answer 25

16-26 weeks

Question 26

How to differentiate pre-eclampsia from lupus nephritis

Answer 26

Haematuria/active sediment -> LN Low complement -> LN Anti-dsDNA high -> LN Pre-eclampsia -> raised uric acid, deranged LFTs

Question 27

Pre-eclampsia definition

Answer 27

HTN and organ involvement

Question 28

Pre-eclampsia/eclampsia neuro involvement

Answer 28

seizures, hyperreflexia, clonus, stroke/ICH/PRES, persistent visual disturbance

Question 29

Major medical risk fx for pre-eclampsia

Answer 29

renal disease, obesity, HTN, DM, APLS

Question 30

Major persona/ Fam risk fx for pre-eclampsia

Answer 30

first degree relative, primip, previous pre-eclamp

Question 31

Preventative rx of pre-eclampsia

Answer 31

Aspirin and calcium

Question 32

Which growth factor is thought to be responsible for pre-eclampsia

Answer 32

soluble Flt-1, mopping up PIGF

Question 33

DDx of MAHA in pregnancy

Answer 33

HELLP, DIC, AFLP, aHUS, TTP

Question 34

When does HELLP occur in pregnancy?

Answer 34

3rd tri

Question 35

When does AFLP occur in pregnancy?

Answer 35

3rd tri

Question 36

When does aHUS occur in pregnancy?

Answer 36

Post delivery

Question 37

HTN targets in pregnancy

Answer 37

SBP 110-140, DBP approx. 85. NOT <80

Question 38

3 most commonly used agents for HTN in pregnancy

Answer 38

Methyldopa, labetalol, nifedipine

Question 39

Best PE imaging modality in pregnancy/ why?

Answer 39

V/Q - less radiation to breasts. Radiation dose to baby actually lower with CTPA

Question 40

What D-dimer level excludes VTE in pregnancy?

Answer 40

<0.5

Question 41

Duration of Rx VTE pregnancy

Answer 41

3-6 months until at least 6/52 post-partum

Question 42

Anticoagulants safe in breastfeeding

Answer 42

LMWH, warfarin

Question 43

VTE prophylaxis indications in pregnancy

Answer 43

Antenatal and post-partum - prev pregnancy or oestrogen provoked VTE, ATIII mutation irrespective of VTE, previous VTE and any thrombophilia Post-partum only - non-oestrogen provoked PE and no thrombophilia, thrombophilia without VTE history (homozygotes or compound heterozygotes only) No prophylaxis - heterozygote thrombophilia with no history VTE

Question 44

Define hyperemesis gravidarum

Answer 44

Electrolyte abnormality, dehydration or >5% wt loss

Question 45

Rx mild hyperemesis

Answer 45

Stop iron, continue iodine and folate, pyidoxine and ginger

Question 46

Rx for severe hyperemesis

Answer 46

Cyclizine, steroids (not <10/40)

Question 47

Key Ix for hyperemesis gravid

Answer 47

UEC, LFT, TFT, USS (?multiple gestations, GTD)

Question 48

Putative molecule responsible for peripartum cardiomyopathy

Answer 48

16kDa prolactin fragments

Question 49

Why does peri-partum CMP deteriorate post delivery?

Answer 49

Auto-transfusion of blood back from placenta

Question 50

Which Rx works for peri-partum CMP in a small study?

Answer 50

Bromocriptine

Question 51

When to anticoagulate peri-partum CMP?

Answer 51

EF<35%

Question 52

When should peri-partum CMP get ICD?

Answer 52

LV dysfunction >6/12 post-partum

Question 53

Obstetric cholestatis occurs when?

Answer 53

>30/40

Question 54

Triad of obstetric cholestasis

Answer 54

Pruritis soles and palms, elevated ALT/bile acids (>10), normal USS

Question 55

Mechanism of obstetric cholestasis

Answer 55

Defect in bile acid transport in mother, with oestrogen also disrupting transport

Question 56

Mx obstetric cholestasis

Answer 56

Urso BA > 40 - deliver 38-39 BA > 100 - deliver 35-36