First Antenatal Visit Flashcards
A 24-year-old nulliparous woman whose last menstrual period began six weeks ago has had vaginal spotting for the past four days. Menses have been regular at 28-day intervals. Ultrasound examination demonstrates an intrauterine gestational sac of expected size and fetal cardiac activity. Her chance of losing this pregnancy is:
a) Less than 10%
b) 20%
c) 30%
d) 40%
e) Greater than 50%
a) Less than 10%
You have just performed a routine pelvic examination on a patient at 10 weeks’ gestation with a normal singleton pregnancy and discovered that she has a mobile ovarian cyst about 6 cm in diameter. The most appropriate management is:
a) Ovarian cystectomy at 12 weeks’ gestation
b) Immediate ultrasound scan to assess the nature of the cyst with a view to cystectomy
c) Reassess the cyst post partum
d) Perform CA-125 and beta-HCG assays
e) Reassess the cyst at 14 weeks’ gestation
e) Reassess the cyst at 14 weeks’ gestation
Regarding the normal physiological changes that take place in early pregnancy, which of the following statements is correct:
a) Cardiac output decreases due to the increasing demands of the developing uterus
b) Gastric motility increases and results in increased reflux symptoms
c) A pansystolic flow murmur is common
d) The glomerular filtration increases by 10%
e) TSH levels are suppressed to lower end of the normal range
e) TSH levels are suppressed to lower end of the normal range
Which of the following theories has been postulated to explain hyperemesis gravidarum?
a) High hCG levels causing raised levels of cortisol and other stress hormones
b) Low grade infection with E. coli or Salmonella worsening due to reduced immunity in pregnancy
c) Nutritional deficiencies in B12 and vitamin D, explaining why vegans have higher rates of hyperemesis gravidarum
d) Slowed gastrointestinal transit time and delayed stomach emptying due to pregnancy hormones
e) Ineffective formation of the placenta leading to systemic inflammation and subsequent cytokine release
d) Slowed gastrointestinal transit time and delayed stomach emptying due to pregnancy hormones
Which of these skin pigmentation conditions is common in pregnancy?
a) Acanthosis nigricans
b) Gestationalis pigmenti
c) Lentigo simplex
d) Melasma
e) Vitiligo
d) Melasma
Arjana, a 32 year old woman at 16 weeks gestation in her third pregnancy, comes to you with advice about her gastrointestinal symptoms. She usually has a regular bowel habit and a bowel motion once a day. She has noticed that she has become more constipated over the last few weeks and asks you for advice. You advise her that:
a) Castor oil and mineral oil are suggested for constipation if she does not wish to take medication
b) Increasing dietary fibre, fluid, and exercise are sufficient measures for most women to improve bowel habit
c) Iron supplementation does not usually increase constipation during pregnancy
d) Raised oestrogen levels causing decreased activity of colonic smooth muscle is the main mechanism behind constipation
e) Up to 90% of women experience constipation during pregnancy
b) Increasing dietary fibre, fluid, and exercise are sufficient measures for most women to improve bowel habit
Which of the following statements regarding gastrointestinal reflux in pregnancy is correct?
a) Heartburn affects approximately 10-20% of women in pregnancy
b) Lowered oesophageal sphincter pressure is implicated in reflux in pregnancy
c) Low levels of motilin in gastrointestinal smooth muscle are implicated in reflux in pregnancy
d) Omeprazole is not recommended for use with severe reflux symptoms due to a lack of safety data
e) Ranitidine is not compatible in breastfeeding as it is concentrated in breast milk
b) Lowered oesophageal sphincter pressure is implicated in reflux in pregnancy
Kalauni, a 23 year old woman at 29 weeks gestation, comes to you with wrist pain. She has pain and numbness in the thumb, index, and middle fingers of both hands which began several weeks ago. You diagnose carpal tunnel syndrome. You advise her that:
a) A corticosteroid injection into the flexor retinaculum is first line treatment in pregnancy as the disease is usually progresses more quickly
b) Carpal tunnel is very uncommon in pregnant women and is unrelated to her pregnancy
c) Given her symptoms have arisen so rapidly she will likely need a carpal tunnel release
d) Her symptoms are likely to resolve after she gives birth
e) She can try regular NSAIDs as there is no risk from 28 weeks of these affecting her pregnancy
d) Her symptoms are likely to resolve after she gives birth
Which of the following answers is correct with regards to cardiovascular changes in pregnancy?
a) Cardiac output (SVxHR) remains the same between weeks 10 and 18 and then rises to 4L/min by week 24
b) Common ECG changes in pregnancy include inverted T waves in leads V5-V6 and right axis deviation
c) Stroke volume increases by 10-30% and heart rate increases to 80-90bpm
d) Systolic BP falls slightly in the first trimester and then further in the second trimester, but diastolic BP does not fall until the second trimester
e) The hyperdynamic circulation causes an ejection systolic murmur, which is heard in 50% of pregnant women
c) Stroke volume increases by 10-30% and heart rate increases to 80-90bpm
Which of the following answers is correct with regards to respiratory changes in pregnancy?
a) Both the vital capacity and the respiratory rate change to allow for physiological hyperventilation
b) Metabolic rate increases by 25% leading to an increased oxygen consumption of 50%
c) Maternal hyperventilation results in a lower pO2 level and a higher pCO2 level with a compensatory rise in serum bicarbonate
d) Progesterone acts as a respiratory stimulant on both the bronchioles and on the respiratory centre
e) In late pregnancy, diaphragmatic elevation results in decreased residual lung volume but does not change total lung capacity
d) Progesterone acts as a respiratory stimulant on both the bronchioles and on the respiratory centre
Which of the following is correct with regards to metabolic changes in pregnancy?
a) Fasting glucose is normally higher in pregnancy than in the non-pregnant state
b) Glucose crosses the placenta by pinocytosis
c) Glycosuria is an abnormal finding in pregnancy and usually points towards undiagnosed diabetes
d) In the first trimester, insulin requirements are high, leading to insulin resistance in later pregnancy
e) In the second and third trimesters there is increasing insulin resistance due to the increasing levels of insulin antagonists, including human placental lactogen
e) In the second and third trimesters there is increasing insulin resistance due to the increasing levels of insulin antagonists, including human placental lactogen
Binh, a 35 year old woman, has recently emigrated from Vietnam to New Zealand. She is 8 weeks pregnant by LMP. She returns for review after her first antenatal blood results:
EIA: reactive TPPA: reactive RPR: reactive 1:64
You explain that:
a) Her results should be rechecked in 4 weeks to confirm the diagnosis and avoid unnecessary treatment in pregnancy
b) IM penicillin is the recommended treatment in pregnancy
c) No one else needs to be informed about these results
d) Oral erythromycin should be used in pregnancy if a woman is allergic to penicillin
e) Yaws may be the cause of a false-positive reaction in her case
b) IM penicillin is the recommended treatment in pregnancy
Awhina, a 24 year old registered nurse, is 8 weeks pregnant by LMP. Awhina has come to see you for her booking bloods. You discuss HIV screening as part of her antenatal bloods. With regards to HIV transmission and screening, which of the following is correct?
a) All women having HIV screening in NZ will be tested with Western blot
b) If she has had a previously negative HIV test, she does not need this repeated in pregnancy
c) Inconclusive results requiring further testing occur in 1 in 5000 women
d) The most common method HIV transmission in NZ to women is from heterosexual contact with an infected partner
e) HIV screening requires individual consent
d) The most common method HIV transmission in NZ to women is from heterosexual contact with an infected partner
Universal screening across all NZ DHBs is “opt-off” screening and is automatic when antenatal bloods are requested
With regards to blood group and antibody screening in pregnancy, which of the following is correct?
a) 1 in 200 women screened will have a positive antibody screen
b) Anti-D is the most common antibody found in pregnancy screening
c) RBC antibodies not implicated in haemolytic disease of the newborn are of no consequence in pregnancy
d) Rhesus positive women who have had a negative antibody screen at booking do not need a repeat screen in pregnancy
e) The risk of developing a clinically significant antibody from a blood transfusion is 1 in 10,000
b) Anti-D is the most common antibody found in pregnancy screening
Ilisapesi, aged 19, is 5 weeks pregnant by USS. She has been planning a trip with her husband to South America for the last 3 months and is planning to leave next week. Her first destination is Brazil and you know there is a current outbreak of Zika virus in this country. You advise Ilisapesi that:
a) Aedes aegypti mosquitos are the only vector for the virus
b) Congenital Zika syndrome is unlikely to affect her baby if she catches Zika virus early in pregnancy
c) Her husband should prevent mosquito bites and they will need to use condoms for 2 months after their return
d) She should not travel to Brazil because of the current Zika outbreak
e) She should take hydroxchloroquine prophylaxis and ensure she uses DEET mosquito repellent as these will prevent her from contracting the Zika virus
d) She should not travel to Brazil because of the current Zika outbreak
