446 Pregnant

Question 1

In pregnancy, cardiac output increases by how much? And the reason for such increased? Does heart rate increase?

Answer 1

Cardiac output increases by 40% due to an increase in stroke volume
Heart rate increases by about 10 beats/min during third trimester

Question 2

Define preeclampsia

Answer 2

BP more than 140/90 mmHg
Proteinuria more than 300 mg/24 hours OR
Protein Creatinine ratio more than 0.3
–after 20 weeks of gestation

Question 3

Renal Histological feature of pre eclampsia

Answer 3

Glomerular endotheliosis

Question 4

Modestly reduces risk of pre-eclampsia at high risk of developing the disease; when it is given

Answer 4

Aspirin 81 mg at end of first trimester

Question 5

Postulated pathophysiology of pre eclampsia

Answer 5

Excessive placental production of antagonist VEGF and TGF B which disrupt endothelial and renal glomerular function resulting in edema, hypertension and proteinuria

Question 6

Most commonly used to acutely managed severe hypertension in pre eclampsia

Answer 6

IV labetalol

Hydralazine

Question 7

Preferred agent for the prevention and treatment of eclamptic seizures

Answer 7

Magnesium sulfate

Question 8

How magnesium sulfate prevent seizure?

Answer 8

Magnesium sulfate interacts witb NMDA receptors in the CNS

Question 9

Most commonly used medication for the treatment of chronic hypertension in pregnancy

Answer 9

Labetalol

Nifedipine

Question 10

Target blood pressure in pregnant patient with chronic hypertension

Answer 10

SBP 130-150 mmHg

DBP 80/100 mmHg

Question 11

Development of elevated blood pressure after 20 weeks of pregnancy or in the first 24 hour post partum in the absence of pre existing chronic hypertension or proteinuria

Answer 11

Gestational hypertension

Question 12

Most common cardiac problem complicated pregnancy

Answer 12

Valvular heart disease

Question 13

Valvular heart disease most likely to cause death during pregnancy

Answer 13

Mitral stenosis

Question 14

Procedure prior to conception for patients with severe mitral stenosis with either symptomatic disease or pulmonary hypertension

Answer 14

Valvuloplasty prior to conception preferable percutaneous balloon valvotomy

Question 15

Pregnancy induced decrease in systemic vascular resistance reduced the risk of cardiac failure in these conditions

Answer 15

Mitral regurgitation
Aortic regurgitation
Aortic stenosis

Question 16

Common cardiac complication of pregnancy

Answer 16

Supra ventricular tachycardia

Question 17

What peak to peak valve gradient in severe aortic stenosis warrants treatment prior to pregnancy?

Answer 17

Peak to peak gradient more than 50 mmHg in women with severe aortic stenosis requires treatment prior to pregnancy

Question 18

What peak to peak gradient in women with aortic stenosis is pregnancy likely to be well tolerated?

Answer 18

Peak to peak gradient of less than 25 mmHg

Question 19

True or false. For women with mitral or aortic regurgitation and LV dysfunction of less than 30% pregnancy should be avoided

Answer 19

True

Question 20

True or false. Adenosine and calcium channels blockers cannot be given to pregnant women with SVT due to it harmful fetal effects

Answer 20

False. SVT are treated as if non pregnant. Fetal tolerance to CCB and adenosine are acceptable.

Question 21

True or false. Electrical caedioversion may be performed to improve cardiac performance and reduce symptoms and is generally tolerated by mother and fetus

Answer 21

True

Question 22

Peripartum cardiomyopathy carry a 10% mutation in this gene

Answer 22

Titin sarcomere protein

Question 23

Autosomal dominant disease associated with increased risk of aortic dissection and rupture in pregnancy

Answer 23

Marfan syndrome

Question 24

In patients with marfan syndrome, aortic root diameter of what is associated with favorable outcome of pregnancy?

Answer 24

Aortic root diameter of less than 40 mm

Question 25

However, patient with marfan syndrome is at increases risk of aortic dissection at what aortic root diameter?

Answer 25

Aortic root diameter of more than 40 mm

Question 26

Associated with premature labor and whic type is linked to increased risk of organ or vascular rupture that may cause death

Answer 26

Ehlers- Danlos syndrome, Type IV

Question 27

True or false. Primary pulmonary hypertension is contraindicated in pregnancy and Termination is advisable to preserve the life of the mother

Answer 27

True

Question 28

Combination of pulmonary hypertension and right to left shunting

Answer 28

Eisenmeger syndrome

Question 29

True or false. In patients with pulmonary hypertension, cesarean delivery is hemodynamically less stressful that vaginal delivery

Answer 29

False. Vaginal delivery is less stressful and cesarean delivery reserved for accepted obstetrical indications.

Question 30

True or false. Pregnancy is associated with venous stasis, endothelial injury and hypercoagulabke state.

Answer 30

True.

Question 31

VTE commonly occurs when? Which is more common in pregnancy: DVT or PE?

Answer 31

VTE commonly occurs 6 weeks post partum | DVT is more common than PE in pregnancy

Question 32

Leg most commonly involved in DVT in pregnancy and why?

Answer 32

Left leg DVT is more common because the left iliac vein is compressed by right iliac artery and the uterus compressed the Inferior vena cava

Question 33

True or false. D Dimer can be used to test for VTE in pregnant women.

Answer 33

False. D Dimer values are elevated in normal pregnancy.

Question 34

Indicated for women with DVT

Answer 34

LMWH or UFH

Question 35

LMWH is associated with what and should be discontinued when?

Answer 35

LMWH is associated with epidural hematoma in women receiving epidural anesthesia and should be discontinued 24 hrs before placement of an epidural catheter

Question 36

Why is warfarin contraindicated in the first trimester?

Answer 36

Warfarin is associated with fetal chondrodysplasia punctata during the first trimester

Question 37

Why is warfarin contraindicated in 2nd and 3rd trimester of pregnancy?

Answer 37

Fetal optic atrophy and mental retardation

Question 38

Use of warfarin in pregnancy is restricted to what?

Answer 38

Warfarin use in pregnancy is restricted to women with mechanical heart valves

Question 39

True or false. In pregnancy, glucose and amino acids are shunted to the fetus while the mother uses Ketones and Triglycerides for fuel for metabolic needs

Answer 39

True

Question 40

True or false: pregnancy is associated with accelerated ketosis, plasma hydoxybutyrate and acetoacetate rise to 2x-4x normal after a fast

Answer 40

True

Question 41

True or false. Folate supplementation is diabetic pregnant women is need to reduce fetal neural tube defects which occur with greater frequency in diabetic mothers

Answer 41

True

Question 42

True or false. Glucose control in pregnant women is same as in non pregnant state

Answer 42

False. Glucose control should be managed more aggressively in pregnant women

Question 43

Target fasting blood sugar in diabetic pregnant women

Answer 43

FBS less than 105 mg/dl or less than 5.8 mmol/L

Question 44

Why is there minimal value of HbA1c monitoring in pregnancy?

Answer 44

HbA1c is used minimally because there is a higher rate of RBC turnover during pregnancy

Question 45

Why is blood sugar difficult to control as pregnancy progresses?

Answer 45

As pregnancy progresses, there is also increase in insulin resistance

Question 46

True or false. All pregnant women should be screened for GDM

Answer 46

True

Question 47

Typical 2 step strategy in diagnosis of GDM is performed at what weeks of gestation?

Answer 47

Establishing the diagnosis of GDM is performed at 24-28 weeks gestation

Question 48

What is step one in the process of diagnosing GDM? What is the cut off value? When is step two done?

Answer 48

50 gram oral glucose challenge and single measurement of sugar at 60 min Result of plasma glucose less than 7.8 mmol/L or less than 130 mg/dl is considered normal Plasma glucose result more than 7.8 or 130 mg/dl warrants step two

Question 49

What is step two in diagnosing GDM? What are the normal values and what constitute a positive test?

Answer 49

Step two is administration of 100 grams Oral glucose challenge with plasma glucose taken at fasting, 1, 2, and 3 hours post prandial Fasting: less than 5.3 or 95 1 hr: less than 10 or 180 2 hr: less than 8.6 or 155 3 hr: less than 7.8 or 140 Two elevated values indicated positive test

Question 50

Two step strategy in GDM

Answer 50

Dietary intervention | Insulin injections

Question 51

Target glucose levels in GDM

Answer 51

FBS less than 5.6 or 100 | 2 hr: less than 7.0 or 126

Question 52

Oral hypoglycemic agents that can be used in GDM

Answer 52

Glyburide | Metformin

Question 53

Women with GDM develop to DM type 2 in 10 yrs after index pregnancy by how many percent?

Answer 53

40% of patients with GDM will develop into DM type 2 in 10 years

Question 54

GDM patients should be screen for DM type 2 at how many weeks?

Answer 54

All women with GDM should have formal glucose tolerance test to screen for T2DM at 6 weeks post partum

Question 55

What is the target weight gain based on BMI accoridng to the National Academy of Medicine

Answer 55

BMI less than 18.5- 24.9 - -12.5 - 18 kg BMI 25-29.9 - - 11.5-16 kg BMI more than 30- - 5-9 kg

Question 56

True or false. Estrogen induced increase in TBG increases circulating TT3 and TT4, placental hCG directly stimulating the thyroid to increase FT3 and FT4

Answer 56

True

Question 57

Why is methimazole not given on the first trimester?

Answer 57

Methimazole crosses the placenta and is associated with fetal aplasia cutis.

Question 58

Why is PTU not given on the 2nd or 3rd trimester of pregnancy?

Answer 58

PTU is associated with liver failure

Question 59

What is the goal of therapy for hypothyroidism in pregnancy?

Answer 59

Maintain the TSH in the normal range

Question 60

What is the drug of choice for hypothyroidism in pregnancy?

Answer 60

Thyroxine

Question 61

What is the dose of thyroxine?

Answer 61

Pre pregnancy: 0.1 mg/kg/day | Pregnancy: 0.15 mg/kg/day

Question 62

When does thyroxine requirement increase in pregnancy? And what is one approach to deal with this increase in requirement?

Answer 62

Increase in thyroxine requirement occurs on the 5th week of pregnancy and one approach is to increase thyroxine dose by 30%

Question 63

True or false. Pregnancy is a described as a state of physiologic dilutional anemia

Answer 63

True

Question 64

Four cancers that occur most commonly in pregnancy

Answer 64

Cervical cancer Breast cancer Melanoma Lymphomas

Question 65

At what weeks of gestation can definitive treatment be done in urgent cases of cancer in pregnancy?

Answer 65

Beyond 24 weeks of gestation

Question 66

True or false. Spread of cancer from mother to fetus occur frequently.

Answer 66

False. Spread from mother to fetus is exceedingly rare

Question 67

What to do if pregnant women has seizure and is maintained on valproate? Any supplements needed?

Answer 67

Valproate/valproic acid has to be stopped and switched to another anti epileptic drug as it is teratogenic Folic supplementation in these patients is increased to 4 mg/day

Question 68

What peripheral nerve disorder is more likely to occur 3x the general population? And when does it often occur

Answer 68

Bells Palsy. Likely to occurs during the 3rd trimester and immediate post partum

Question 69

Most common peripheral nerve and movment disorder in pregnancy and what is its suspected etiology

Answer 69

Restless leg syndrome; disordered iron metabolism is its suspected etiology

Question 70

Severe form of nausea and vomiting in pregnant women and when does it commonly occur?

Answer 70

Hyperemesis gravidarum is severe form of nausea and vomiting among pregnant women in the first trimester

Question 71

True or false. Exacerbation of gallbladder disease is common during pregnancy and that intra hepatic cholestasis occurs in the 3rd trimester

Answer 71

True

Question 72

Characterized by increased levels of bilirubin, ammonia, hypoglycemia in pregnancy

Answer 72

Acute fatty liver of pregnancy

Question 73

Most common bacterial infection during pregnancy involving the urinary tract

Answer 73

Bacterial vaginosis

Question 74

Cause of asymptomatic bacteruria in pregnancy?

Answer 74

Stasis is cased by progestational effect on ureteral and bladder smooth muscle Later in pregnancy, compression of the uterus on the bladder

Question 75

True or false. Pregnant woman with recurrent UTI or one episode of Pyelonephritis should consider for daily antibiotic suppressive treatment throughout remainder of pregnancy

Answer 75

True

Question 76

What should be done to pregnant women with exposure to zika virus within 2 weeks of symptom onset?

Answer 76

Serum and urine tested for ZV RNA by real time RT- PCR

Question 77

If with zika virus exposure, testing 2 to 12 weeks after symptom onset utilizes what serum measurement?

Answer 77

Zika and Dengue virus IgM

Question 78

Most common cuss eif congenital viral infection in the US? Women with this infection should delay conception for how long?

Answer 78

CMV; women with primary CMV infection should delay conception for 6 months as there is currently no accepted treatment for CMV during pregnancy

Question 79

True or false. Rubella carries a high risk of fetal anomalies on all trimester.

Answer 79

False. High risk of fetal anomalies occurs in rubella infection in the first trimester and risk decreases significantly in later trimesters

Question 80

All women who might become pregnant and who are not immune to rubella should be vaccinated at least before conception?

Answer 80

Vaccinated at least 3 months before conception

Question 81

What can reduce the risk of active genital herpes at term?

Answer 81

Acyclovir for the last 4 weeks of pregnancy in all women who had an episode of genital herpes during the pregnancy

Question 82

What is recommended for pregnant women with active genital herpes at the time time of presentation in labor?

Answer 82

Delivery by ceasarean section

Question 83

Most predominant cause of HIV infection in children?

Answer 83

Transmission of the virus from the mother to newborn during the perinatal period

Question 84

True or false. Women with less than 1000 copies of plasma HIV RNA and receiving antireteoviral therapy, risk for newborn transmission is approx 1%

Answer 84

True

Question 85

What is recommended for women with viral load of more than 1000 copies prior to 38 weeks gestation to reduce the risk of HIV transmission to newborn?

Answer 85

Scheduled for prelabor Cesarean delivery at 38 weeks

Question 86

What vaccination can be given to pregnant women?

Answer 86

Influenza Tetanus, Diphtheria and pertusis (Tdap) TIPID

Question 87

Define maternal death

Answer 87

Death occurring during pregnancy or 42 days of completion of pregnancy

Question 88

Most common causes of maternal death in the US

Answer 88

``` Pulmonary embolism Obstetric hemorrhage Hypertension Sepsus CV events including peripartum cardiomyopathy and stroke Ectopic pregnancy ```

Question 89

Most common cause of maternal death in sub Sahara and southern Asia?

Answer 89

``` Maternal hemorrhage Hypertensive disorder Infection Obstructed labor Complications from unsafe pregnancy termination ```