Chapter 12: Medical Disorders Flashcards
ou are a trainee intern at an antenatal clinic seeing Mia, a 32- year-old G4P2 Pākehā woman who is 30 weeks pregnant. Mia has had an abnormal 2hr glucose tolerance test (GTT); with all of the results being above the normal range.
Which of the following third trimester complications is Mia NOT at an increased risk of developing due to her diabetes in pregnancy?
Hypertension
Proteinuria
Placenta praevia
Candida vaginitis
Urinary tract infection
Placenta praevia
Sophia, a 32-year-old G4 P2 Pākehā woman who is 30 weeks pregnant has been diagnosed with gestational diabetes after an abnormal 2 hour 75g oral glucose tolerance test (GTT).
Which of the following neonatal complications is it MOST important to monitor all babies born after pregnancies with diabetes for postnatally?
Macrosomia
Hypocalcaemia
Hypoglycaemia
Respiratory Distress Syndrome
Hyperbilirubinemia
Hypoglycaemia
Amandeep, a 28-year-old G4P2 woman originally from Bangladesh is 28 weeks pregnant. Her recent Polycose test was abnormal at 8.2mmol/L (N < 7.8mmol/L). Her HbA1C at booking was 32 (N <40mmol/mol), indicating that she did not have diabetes prior to pregnancy.
Which of the following options is the next step for Amandeep’s care?
Monitor her blood sugars for 2 weeks and review
A repeat Polycose test at 32 weeks and review
A 2 hour oral glucose tolerance test and review
See the diabetes team and start long acting insulin nocte
Start a low carbohydrate diet and metformin
A 2 hour oral glucose tolerance test and review
Charlotte, a 36 year old G1P0 Pākehā woman who is 9 weeks pregnant presents to the antenatal clinic. Two years ago Charlotte was diagnosed with Type 2 diabetes that is now well controlled with diet and metformin. Her BMI is 40. Which of the following blood tests does Charlotte NOT require in this pregnancy?
Rubella serology
Blood Group and Antibody screen
Two hour 75gm glucose tolerance test
HbA1C
FBC
Two hour 75gm glucose tolerance test
Mei is a 20-year-old woman who moved to New Zealand from China two years ago. She is considering pregnancy, and has never been pregnant before. She has had three major operations as a neonate to correct a congenital heart abnormality. She last saw her cardiologist in China two years ago. You have no notes or records.
You ask her to get her notes from China as you would like a cardiologist to be involved in her preconceptual counselling. Which of the following findings in her history or cardiovascular examination would be of most immediate concern?
Cyanosis and clubbing
A history of surgery occurring when she was a neonate
A jugular venous pressure (JVP) 2cm above the sternal angle
A systolic ejection murmur
A regular pulse rate of 72 bpm
Cyanosis and clubbing
Rachana, a 29-year-old G3P2 woman is 28 weeks pregnant. Rachana was born in India and has been in New Zealand for 7 years. Her previous two children aged two and four, weighed 4.2 and 4.6 Kg respectively, and were born via caesarean section. Rachana has a BMI of 32. Her mother developed Type 2 diabetes aged 50.
Which of the factors in her history is the LEAST likely to increase her risk of developing gestational diabetes?
BMI > 25
Asian ethnicity
Previous macrosomic infant
Age <30
Family history of diabetes
Age <30
Aria, a 32-year-old G4P2 wahine Māori is 30 weeks pregnant. After an abnormal Polycose test at 28weeks, Aria has an abnormal 2hr oral glucose tolerance test, with a fasting sugar of 5.6 and a 2 hour result of 10.3. She asks whether she is at increased risk of pregnancy complications.
Which of the following pregnancy complications is she NOT at increased risk of, given her glucose tolerance test result?
Shoulder dystocia
Assisted vaginal birth
Caesarean section
Breech presentation
Prolonged labour
Breech presentation
Olivia, a 32-year-old G4P2 NZ European woman who is 30 weeks pregnant comes to the antenatal clinic. Olivia has been diagnosed with gestational diabetes. The diabetes team have advised her of the need for meticulous management of her blood glucose levels for the remainder of her pregnancy through diet, and probably medication as the pregnancy progresses. Olivia has difficulty managing her sugars in late pregnancy and has an ultrasound showing a macrosomic baby of 4.7kg with polyhydramnios AFI of 32 (N <20). Which intrapartum risk is most elevated for Olivia and her baby?
Retained placenta
Antepartum haemorrhage
Umbilical cord prolapse
Placenta praevia
Chorioamnionitis
Umbilical cord prolapse
Janet, a 22-year-old nulliparous Pākehā woman wishes to get pregnant. She has a congenital heart problem that has not required surgery but is being followed annually with a cardiologist. When Olivia saw her cardiologist six months ago she advised the cardiologist that she wasn’t planning on a pregnancy so they haven’t given her any specific advice. Which of the following congenital heart problems would MOST require a cardiology review prior to conception?
Mitral valve prolapse - mild
Atrial Septal Defect
Small, uncomplicated patent ductus arteriosus
Mitral stenosis
Surgically repaired Ventricular Septal Defect
Mitral stenosis
Amelia, a 24 year old G1P0 Pākehā woman is 11 weeks pregnant. You take a history in antenatal history and note she has annual reviews with cardiology because of a “heart problem” that was diagnosed in infancy. Amelia is keen to attempt a vaginal delivery. You examine the cardiology notes that were sent with the GP’s booking letter to determine the type and severity of her congenital heart problem.. Amelia remains asymptomatic and well during the pregnancy.
Which of the following congenital heart problems would put Amelia MOST at risk of complications at the time of birth?
Marfan’s syndrome with known moderate dilatation of the aortic root
Small ventricular septal defect
Bicuspid aortic valve with trivial aortic stenosis
Small atrial septal defect
Mitral valve prolapse with mild mitral incompetence
Marfan’s syndrome with known moderate dilatation of the aortic root
Liliko, a 24 year old G1P0 Samoan woman who is 24 weeks pregnant presents acutely to the obstetric team with increasing breathlessness and orthopnoea over the last four days. Her symptoms are worse overnight and in the morning. She reports coughing up pink frothy sputum. Liliko has no fevers or chest pain, and no infectious symptoms.
Upon further questioning, you learn that she was diagnosed with rheumatic fever in childhood. On examination her pulse is 110. She is afebrile. Her BP is 120/70. Her SpO2 is 90% on room air. Her JVP is at +4. She has bilateral crepitations up to the midzone. When auscultating her heart you hear a loud S1, an early diastolic opening snap and a low-pitched decrescendo-crescendo rumbling diastolic murmur.
Which of the following options is the MOST likely cause of her symptoms?
Tuberculosis
Pulmonary embolus
Mitral incompetence
Mitral stenosis
Pneumonia
Mitral stenosis
Sarah is a 34-year-old Pakeha woman who lives in Dunedin. Sarah is 34 weeks pregnant in her first pregnancy, and has a BMI of 48. She presents for routine antenatal clinic, and describes becoming more breathless and tired in the last four weeks. She has noticed a gradual decrease in exercise tolerance and reports sometimes feeling faint on standing. She has not had any infectious symptoms and has no relevant past medical history. On general cardiac examination, you note her BP is 120/70 and pulse rate is 85 bpm and regular. Her oxygen saturations are 97% on room air. On auscultation, there is a soft ejection flow murmur. There is no diastolic murmur. Chest examination shows good air entry, with no crepitations or wheeze. Her ankles show mild oedema. Both of her calves are soft and symmetrical. Abdominal examination is consistent with a 34 week pregnancy, and the fetus is active with a heart rate of 120 bpm.
From the following options, what is the most likely cause of her symptoms and signs?
Pulmonary embolus
Asthma
Mitral stenosis
Pulmonary TB
Normal pregnancy
Normal pregnancy
Ruby, a 42-year-old G1P1 Pākehā woman presents for pre-conceptual counselling. Ruby has a BMI of 38. In her first pregnancy last year Ruby developed a deep vein thrombosis (DVT). The DVT occurred after Ruby was hospitalised for severe pre-eclampsia and required a caesarean section at 34 weeks. The DVT was diagnosed when Ruby developed a painful swollen calf seven days postnatally when breast feeding.
Of the following options, which has LEAST likely predisposed to her developing the DVT?
Pre-eclampsia
Recent pregnancy
BMI
Caesarean section
Age >40 years
Breastfeeding
Breastfeeding
Nina, a 24-year-old nulliparous Niuean woman presents for preconceptual counselling and wishes to review her anticonvulsant medication. Nina has been taking sodium valproate for the past 2 years for epilepsy. It was commenced after she had 2 generalised tonic-clonic seizures. She has had no subsequent seizures since starting the valproate. She is using condoms for contraception.
Of the following options, which is the most appropriate for Nina?
Stop her antiepileptic medication completely and advise against pregnancy for six months
Refer her to a neurologist for consideration of changing her medication. Provide reliable contraception in the interim.
Continue her valproate and commence high dose folic acid (5mg). When she is in the second trimester she should change to lamotrigine.
Advise her valproate dose will need to be increased during pregnancy because of her increased plasma volume in pregnancy.
Continue her sodium valproate and advise she will need to continue it through pregnancy. Commence high dose folic acid (5mg).
Refer her to a neurologist for consideration of changing her medication. Provide reliable contraception in the interim.
Chloe, a 24 year old G1P0 Pākehā woman had her booking visit last week at the antenatal clinic at 9 weeks’ gestation. She was well but a screening MSU has grown E. Coli >250,000 CFU/mL, which is sensitive only to trimethoprim and nitrofurantoin. There are >100 leucocytes/ml.
Which of the following options is the best management?
Repeat the MSU to check for resolution
No treatment required as she is asymptomatic
Arrange IV gentamicin and admit
Prescribe oral nitrofurantoin 50mg QID for 7 days
Prescribe oral trimethoprim 300mg OD for 3 days
Prescribe oral nitrofurantoin 50mg QID for 7 days
