practice exams

Question 1

list risk factors for GDM

Answer 1

BMI >30, previous LGA, previous/family hx GDM, PCOS, multiple, Aboriginal and Torres Strait Islander, Asian, Indian, Pacific Islander, mat age >40

Question 2

outline the BGL levels after OGTT that lead to diagnosis of GDM (fasting, 1 hour, 2 hours)

Answer 2

fasting: 5.1-6.9
1 hour: >10
2 hours: 8.5-11

Question 3

what is the target BGL range in GDM

Answer 3

4-7mmol/L

Question 4

what is the end product of fat metabolism?

Answer 4

ketogenesis

Question 5

when is glucagon secreted?

Answer 5

in response to drop in BGL

Question 6

list fetal/neonatal problems assoc with GDM

Answer 6

LGA, IUGR, prematurity, birth trauma, hypoglycaemia, RDS, stillbirth

Question 7

list maternal risks from GDM

Answer 7

PET, IOL, instrumental birth, CS, HTN, preterm, polyhydramnios, PPH, infection, birth trauma

Question 8

list CV changes that occur in pregnancy

Answer 8

increase in plasma vol, O2 consumption, HR, heart size, SV, CO, reduced Hb

Question 9

what is the definition of HTN in pregnancy

Answer 9

sBP of 140 or >, and/or dBP 90 or >

Question 10

list the organ systems involved in PET and a clinical symptom of each

Answer 10

renal: proteinuria >300mg
neuro: headaches
hepatic: sudden increase transaminases w or w/out RUQ pain
pulmonary: pulmonary oedema
haematological: haemolysis
uteroplacental: FGR

Question 11

what is first line treatment of acute HTN in pregnancy?

Answer 11

hydralazine 20-30mg

Question 12

what is the loading dose of mag sulf?

Answer 12

4g IV over 20mns via controlled infusion device

Question 13

what are key clinical indications of mag sulf overdose?

Answer 13

muscle weakness, loss of reflexes, vomiting, flushing

Question 14

list fetal/neonatal complications related to obesity in pregnancy

Answer 14

LGA, stillbirth, hypoglycaemia, fetal anomalies, preterm, jaundice, RDS

Question 15

list maternal complications related to obesity in pregnancy

Answer 15

miscarriage, stillbirth, GDM, HTive disorders, depression, anxiety, prolonged pregnancy, CS, IOL

Question 16

how often should pregnant women be weighed?

Answer 16

every appt

Question 17

what is the appropriate weight gain for a woman with BMI >30?

Answer 17

5-9kg

Question 18

name the steps and examples for the 5As framework

Answer 18

asses: assess for behavioural health risks and factors
advise: give specific, personalised, clear behavioural change advice
agree: collaboratively select goals and methods
assist: assist pt to achieve goals through skills, confidence and support
arrange: arrange follow up contacts for ongoing assistance and support

Question 19

identify maternal risks assoc with post-dates pregnancy

Answer 19

IOL, instrumental birth, increased risk PPH, CS, perineal tears, stress and anx

Question 20

list methods used for managing post-dates pregnancy

Answer 20

membrane sweep, IOL, CS, expectant management, fetal monitoring, cervical ripening

Question 21

list reasons for woman to contact/present to hospital when post-dates

Answer 21

ROM, PV bleeding, DFM, contractions

Question 22

list physical manifestations of tocophobia

Answer 22

SOB, tachycardia, need to remove self from situation

Question 23

identify aspects of midwife role in helping reduce/manage stress in antenatal period

Answer 23

support and prepare partner/family to support mother and baby, facilitate connections to community social support

Question 24

define trauma

Answer 24

deeply disturbing or distressing experience, physical, psychological, mental, spiritual, cultural or social

Question 25

list predisposing factors for PTSD following birth trauma

Answer 25

previous trauma, limited support, depression/anxiety, distress in labour, obstetric emergency, infant complications

Question 26

compare baby blues and PPD

Answer 26

baby blues: onset 2-5 days post birth, lasts up to 2 weeks, cry for no apparent reason, mood swings, overwhelmed PPD: onset within first 3-6 months, lasts months to years if untreated, have thoughts of harming self/baby, guilt, sleep/appetite disturbances, feel inadequate

Question 27

list observations indicating difficulty with mother/infant bonding and attachment

Answer 27

inappropriate response to baby cues, saying baby has thoughts, ignoring the baby, fear of harming the baby

Question 28

when is OGTT normally done and when can it be done if risk factors identified?

Answer 28

normally 24-28K, if risk factors can be done with first bloods or at booking-in (rpt if normal)

Question 29

compare medication management in GDM for VB and ELCS

Answer 29

VB: cease metformin/insulin when labour established CS: cease metformin 24hrs before, usual insulin the night before then cease

Question 30

how often should BGL be monitored during labour for women with GDM?

Answer 30

2/24

Question 31

when should PP OGTT be done and how often lifelong screening?

Answer 31

6-12weeks PP and lifelong every 3 years

Question 32

List maternal and neonatal risk factors for hypoglycaemia

Answer 32

maternal: GDM/DM, intrapartum glucose administration, beta blockers, valproate, family hx metabolic disorders neonatal: prematurity, SGA/IUGR, LBW, LGA, hypothermia

Question 33

list different methods of fetal monitoring

Answer 33

non-stress test CTG, fetal movement chart, biophysical profile, amniotic fluid vol est, doppler US of fetal/uteroplacental circulation

Question 34

list key components of antenatal care for GDM women

Answer 34

referral to dietician, DM educator or endocrinologist (if not managed w diet/exercise), BGL monitoring 4-7mmol/L, GWG management, keton/proteinuria

Question 35

list midwifery actions to prevent neonatal hypoglycaemia in term baby

Answer 35

keep baby dry, keep warm, early BF within 30-60mns of birth, S2S, do not separate mother and baby where possible, monitor for risk factors

Question 36

list risk factors for developing PE

Answer 36

primip, multiple, >10 years since last pregnancy, hx/family hx PE, mat age >40, BMI >35

Question 37

list adverse outcomes to mother/fetus/neonate related to HTN in pregnancy

Answer 37

mat: cerebral injury, mortality, liver/renal failure, plac abruption Fetal: prem, SGA, NICU, stillbirth

Question 38

what is a key point of postnatal monitoring for a woman with PE?

Answer 38

fluid balance monitoring

Question 39

what med should be given in third stage for woman with HTN in preg and what should be avoided?

Answer 39

give syntocinon, avoid ergo/syntometrine

Question 40

list maternal and fetal complications of acute pyelonephritis

Answer 40

maternal: renal failure, chronic kidney infection fetal: IUGR, stillbirth

Question 41

list contraindications for IOL

Answer 41

multiple, plac previa, polyhydram, mat refusal, cord prolapse, genital herpes