Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Past MCQs > Maternal medicine > Flashcards

Maternal medicine Flashcards

1
Q

A black multigravid woman who underwent a CS for failure to progress after an induction for PET complicated by endometritis, comes to see you 5/52 post partum with fatigue/dyspnoea/orthopnoea. O/E HR 110, BP 140/95, pretibial oedema, RUQ tenderness, fine crackles at both bases, CXR cardiomegaly, temp 36.7. What is Dx?

a) post partum cardiomyopathy
b) mitral stenosis
c) pulmonary hypertension
d) bacterial endocarditis

A

A - post partum cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

At routine cardiovascular examination in pregnancy, which of the following may be normal:

a) diastolic murmur
b) 3rd heart sound
c) ejection click
d) renal bruit

A

b - third heart sound

perceptible in 80% of pregnant women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A woman with severe idiopathic cardiomyopathy is having an atonic PPH. EBL 800-1000ml. You have given 10 units Syntocinon but she is still bleeding. Next agent should be?

a) further 10 units Syntocinon
b) 40 units Syntocinon in a 1L flask
c) intramyometrial PGF 2 alpha
d) IV ergometrine

A

b) 40 units Syntocinon in a 1L flask

Oxytocin in slow infusion is recommended (as per O&G magazine)

Misoprostol is OK

Avoid ergometrine as causes vasocontriction

Carboprost (PGF analogues) increases pulmonary vascular resistance therefore not suitable
- not recommended in significant cardiac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Risk of cardiac disease in a patient aged 35 who undergoes surgical castration (BSO) compared to a normal woman of the same age

a) < control
b) equal to control
c) x2 control
d) x3 control
e) x4 control

A

c) x2 control

Doubles cardiovascular risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

39 yo woman had elective rpt GA LUSCS and developed pleuritic chest pain and tachypnoea 3 days postop. WCC 11.000, CXR showed R lower lobe atelectasis. ABG showed pO2 65mmHg. Next most appropriate step:

A - pulmonary angiogram
B - ventilation perfusion lung scan
C - chest physio and deep breathing exercises
D - IV antibiotics
E - Pulmonary CT scan
A

B - ventilation perfusion lung scan

College of radiologists suggests VQ first line for PE postpartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Black multi 5 weeks following LUSCS for FTP with PET and postpartum endometritis. 4/7 history of SOB and orthopnoea. O/E pulmonary rales, tender liver, pretibial oedema. BP increase, tachycardic, CXR shows cardiomegaly. The most likely diagnosis is:

A - peripartum cardiomyopathy
b - pulmonary embolism
c - SBE

A

A - peripartum cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Mother has anti Ro detected. What is the risk of congenital complete heart block in the fetus?

a - <5%
b - 10%
c - 20%
d- 30%
e - 40%
A

a - <5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Regarding Bell’s Palsy:

a - it is caused by compression of the facial nerve in the pterygopallatine fossa
b - it responds to NSAID’s
c - it causes a sensory nerve deficit
d - it is most common in late pregnancy

A

d - it is most common in late pregnancy

Most cases in the 3rd trimester and 1st post-partum week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which is the most incorrect statement regarding the management of ITP?

a - LUSCS is of no benefit to fetus with known severe thrombocytopaenia
b - fetal risk increases if the mother has a past history of splenectomy
c - fetal scalp sampling shouldn’t be used because of the risk of bleeding
d - maternal steroids should be given if the platelet count drops below 100
e - fetal risk can be determined by maternal antibody titre

A

e - fetal risk can be determined by maternal antibody titre

Diagnosis of exclusion, we don’t do antibody titre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which of the following is most normal in a normal pregnancy?

A - MCV 105
B - WCC 12
C - Platelets 100,000
D - Reticulocytes 15%

A

B - WCC 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which of the following features is helpful in distinguishing HELLP syndrome from TTP?

A - TTP requires immediate delivery of fetus
B - DIC occurs more commonly with HELLP than TTP
C - Liver dysfunction is more common with TTP

A

B - DIC occurs more commonly with HELLP than TTP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Alloimmune thrombocytopenia, management, correct option:

a- IV immunoglobulin
b - Plasmapheresis
c - prednisolone
d- Betamethasone
e - Fetal platelet transfusion
A

a- IV immunoglobulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

TTP and HELLP, incorrect option

A - TTP more correlated with DIC
B - HELLP more associated with neurological abnormality
C- HELLP more associated with haemolysis

A

A - TTP more correlated with DIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ITP, correct option:

a - caesarean section is not helpful in known severe fetal thrombocytopenia
b - FBS should not be attempted due to risk of bleeding from puncture site
c - Splenectomy decreases the likelihood of correlation between maternal and fetal platelet counts
d - Maternal antiplatelet ab levels correlate with incidence of neonatal platelet levels

A

b - FBS should not be attempted due to risk of bleeding from puncture site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mainstay of treatment for TTP

a - steroids
b - plasmapheresis
c- Ig infusion

A

b - plasmapheresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

32 yo G4P3 with 3 previous uneventful pregnancies and deliveries arrives in labour at term and if found to have platelet count of 85. Otherwise NAD. Most acceptable management is:

a- normal delivery and neonatal platelet count
b- LUSCS
c- LUSCS to avoid mid-cavity forceps
d- Fetal blood sampling

A

a- normal delivery and neonatal platelet count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mainstay of treatment of neonatal alloimmune thrombocytopaenia is:

a - steroids
b - intrauterine platelet transfusion
c - maternal immunoglobulin

A

c - maternal immunoglobulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In comparing HELLP to TTP, which is not true?

a. liver dysfunction is more common with HELLP
b. DIC is more common with HELLP
c. Delivery of fetus in not mandatory with HELLP

A

c. Delivery of fetus in not mandatory with HELLP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

PG at 32/40 with BP 130/90, headache and epigastric pain. VE cervix long and closed. LFT’s reveal elevation of ALT?? And plt count of 70 000. MX?

a. observe
b. IOL
c. Platelet transfusion
d. LUSCS

A

d. LUSCS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MG presents unbooked in early labour. Platelet count is incidentally noted to be 90, 000. Management?

a. allow to labour and anticipate vaginal delivery
b. LUSCS
c. Assess fetal platelet count (scalp or cordocentesis)
d. Plasmapheresis

A

a. allow to labour and anticipate vaginal delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A MG presents unbooked at 38 weeks with a Hb of 6.8. If untreated the most likely cord Hb is

a - 10
b - 14
c - 16
d - 20

A

c - 16

No correlation between maternal anaemia and fetal Hb

Normal 14-22

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What compound is at the greatest concentration in blood in physiological conditions?

a- carbon dioxide
b - bicarbonate
c - carbonic acid
d - all are at equal concentrations

A

b - bicarbonate

Carbon dioxide and carbonic acid are in equilibrium in the blood

Bicarbonate ions and carbonic acid are present in the blood in a 20:1 ratio if the blood pH is within the normal range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which congenital coagulation disorder improves in pregnancy?

a - anti-thrombin 3 deficiency
b - vWB disease
c - protein C deficiency
d - protein S deficiency
e - haemophilia
A

b - vWB disease

vWF and FVIII both increase in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

A patient has an FBE with HB 10.4, MCV 70 and MCHC 28 (30-36). Which is true?

a - her film will show microcytosis
b - she should have a trial of folate
c - she will have target cells on film
d - reticulocyte count will be 10%

A

a - her film will show microcytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Iron studies show decreased ferritin, TIBC greatly increased.

a - transferrin will be low
b - reticulocyte count will be 15%

A

b - reticulocyte count will be 15%

transferrin goes up in iron deficiency
normal retic count is 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which of the following is associated with intrahepatic cholestasis of pregnancy?

a - RUQ pain
b - High risk of recurrence in future pregnancies
c - Bilirubin levels >10
d - Excessive use of antacids

A

b - High risk of recurrence in future pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Intrahepatic cholestasis associated with all except:

A - neonatal jaundice
B - pruritis with onset of jaundice
C - 3rd trimester
D - increase premature delivery

A

A - neonatal jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

A 32 yo presents at 35/40 with recent onset malaise. BP 130/84, AST + ALT elevated, bilirubin 80, plt 60. O/E cervix long and closed. Mx?

a - IOL
b - LUSCS
c- Upper abdominal US for gallstones
d - Bed rest

A

b - LUSCS

high bilirubin in HELLP with haemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Regarding Vitamin D and pregnancy - true or false for the following:

a - Insufficiency is a more serious state than deficiency
b - Deficiency can be corrected by daily administration of 10 mcg per day
c - Deficiency is detected by measuring levels of 1,25 dihydroxyvitamin D
d - Inadequate levels are associated with gestational diabetes
e - Vitamin D supplements help to prevent childhood rickets

A

a - Insufficiency is a more serious state than deficiency - FALSE
b - Deficiency can be corrected by daily administration of 10 mcg per day - FALSE 400IU OD recommended as supplement

c - Deficiency is detected by measuring levels of 1,25 dihydroxyvitamin D - FALSE - serum 25 hydroxyvitamin D levels

d - Inadequate levels are associated with gestational diabetes - TRUE
e - Vitamin D supplements help to prevent childhood rickets- TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

A 22 year old primigravida develops HELLP syndrome at 34 weeks of gestation with acute renal and liver dysfunction. After delivery she is transferred to Critical Care. Which of the following are true?

A - Intravenous N-acetylcysteine may be of benefit
B - Renal replacement therapy is not required until serum creatinine concentration exceeds 1000 micromol/L
C - Central venous access and arterial line placement is prevented by a platelet count of 75x109/L
D - Magnesium sulphate as seizure prophylaxis should not be given because of her renal impairment
E - Clotting factors such as fresh frozen plasma may be required

A

E - Clotting factors such as fresh frozen plasma may be required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

A woman is pregnant after bromocriptine treatment of a pituitary macroademoma. Management during pregnancy should include:

A - continue bromocriptine
B - visual field assessment
C - xray sella turcica
D - neurosurgery

A

B - visual field assessment

No significant tumour:

  • Stop treatment
  • No follow up needed

Significant tumour:

  • Usually stop treatment
  • Follow up with regular radiological assessment
  • Regular formal visual field checks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

A multiparous woman presents 8 weeks post partum complaining of tiredness, palpitations and tremor. She has been losing weight and is unable to sleep. Pulse is 100 bpm, BP 160/90. The most likely diagnosis is:

A - HIV
B - Anxiety
C - Drug abuse
D - Thyrotoxicosis

A

D - Thyrotoxicosis

33
Q

What woman has the best reproductive future?

A - PG Eclamptic fit with DIC, BP normal at 6/52
B - Multi with severe preeclampsia, BP normal at 3 months
C - Preeclampsia with diastolic BP 100mmHg at 3 months
D - Woman with essential hypertension
E - Woman with chronic renal failure, currently stable

A

D - Woman with essential hypertension

Prev PET - RR 7.2
Chronic HTN - RR 3.7

34
Q

1st ANC visit, 22yo primip, mother is NIDDM.
No glycosuria. You advise the patient:

A - no chance that she will get diabetes
B - need GTT in 2nd trimester
C - start prophylactic insulin
D - if doesn’t get glycosuria in pregnancy, no risk of diabetes
E -monitor her by doing fasting BSL in pregnancy

A

B - need GTT in 2nd trimester

35
Q

The CLASP trial demonstrated that aspirin 60mg daily could:

A - reduce severe early onset IUGR associated with PET
B - reduce IUGR
C - both
D - neither

A

D - neither

Overall, the use of aspirin was associated with a reduction of only 12% in the incidence of proteinuric pre-eclampsia, which was not significant. Nor was there any significant effect on the incidence of IUGR or of stillbirth and neonatal death. Aspirin did, however, significantly reduce the likelihood of preterm delivery (19·7% aspirin vs 22·2% control; absolute reduction of 2·5 [SD 0·9] per 100 women treated; 2p=0·003). There was a significant trend (p=0·004) towards progressively greater reductions in proteinuric pre-eclampsia the more preterm the delivery.

Low-dose aspirin may be justified in women judged to be especially liable to early-onset pre-eclampsia severe enough to need very preterm delivery.

36
Q

Your 16/40 patient has a Mantoux reaction of 16mm. She is asymptomatic and CXR is normal. What is the best management?

A - Vaccinate with BCG
B - Reassure and review postnatally
C - Isoniazid 300mg daily for 6 months
D - Isoniazid 300mg daily for 12 months
D - Rifampicin 100 mg daily for 12 months
A

B - Reassure and review postnatally

Doesn’t have active pulmonary disease
Can’t make diagnosis on Mantoux alone

37
Q

16 yo primip with HIV on Western blot test and 28 weeks pregnant. Risk of transmission to the fetus is:

A - 0%
B - 10%
C - 30%
D - 60%
E - 80%
A

In undiagnosed and untreated women, 20-30% risk of MTCT
With ART, appropriate mode of delivery, formula feeding, baby receiving PEP, incidence of perinatal transmission <2%

Risk decreases with decreasing levels of maternal HIV RNA (e.g. <1000 copies/ml) - <1%
2/3 of MTCT occurs during delivery

38
Q

Each of the following antibodies may cause HDFN except:

a. Anti s
b. Anti Jka
c. Anti K
d. Anti P

A

d. Anti P

39
Q

A woman in mid pregnancy develops intractable constipation which has not responded to fibre supplements. The NEXT MOST APPROPRIATE therapy is

a. Lactulose
b. Magnesium sulphate
c. Coloxyl (docusate)
d. Bisacodyl
e. Digital evacuation

A

a. Lactulose

40
Q

A G1P0 has stable Crohns disease, MCV normal range, B12 110 micromols (normal > 127). The NEXT step is to

a. Take no action
b. Give IM B12
c. Repeat B12 concentrations
d. Check homocysteine levels

A

d. Check homocysteine levels

if borderline vit b12, check homocysteine as will be high in true deficiency

41
Q

A woman who works in a childcare centre presents with flu-like symptoms at 14 weeks gestation. She has read about CMV and is worried about the risk to the baby. Which of the following statements about CMV in pregnancy is CORRECT?

a. Maternal infection is usually associated with flu-like symptoms
b. Fetal infection may be associated with echogenic bowel on a 20 week ultrasound
c. Primary and secondary maternal infection carries equal risk to the fetus
d. Spiramycin is an effective treatment in pregnancy

A

b. Fetal infection may be associated with echogenic bowel on a 20 week ultrasound

42
Q

Which is true of CMV infection in pregnancy?

a. It is the commonest known virus transmitted trans-placentally
b. It is usually symptomatic at birth
c. The usual source of infection is ingestion of undercooked meat
d. It may cause an elevation of IgG in cord blood

A

a. It is the commonest known virus transmitted trans-placentally

43
Q

A 30yo G1P0 presents with occasional palpitations and breathlessness at 35 weeks gestation. The midwife asks you about the expected pregnancy changes. You tell her the physiological changes include:

a. Blood volume increases by 10%
b. White cell count increases by 20%
c. Red cell mass and plasma volume increase by similar amounts
d. Stroke volume increases

A

d. Stroke volume increases

44
Q

Which of the following laboratory results are normal in pregnancy?

a. Renal blood flow increased, urea increased, creatinine increased
b. Renal blood flow increased, urea decreased, creatinine increased
c. Renal blood flow increased, urea increased, creatinine decreased
d. Renal blood flow increased, urea decreased, creatinine decreased

A

d. Renal blood flow increased, urea decreased, creatinine decreased

45
Q

Which of the following biochemical changes occurs MOST commonly in pregnancy, as compared with the non-pregnant patient

a. Increased urea
b. Increased Alkaline phosphatase
c. Decreased TSH
d. Increased serum lipids

A

b. Increased Alkaline phosphatase

46
Q

At 27yo woman at 29 weeks gestation complains of a swollen, cold and painful right leg. On examination the leg is cool, swollen, with sluggish venous return. There is no evidence of DVT on lower limb doppler ultrasound and normal blood flow in the leg veins. The NEXT step is:

a. CT venogram of pelvis
b. MRI pelvis
c. Commence Clexane prophylaxis
d. Reassure patient and discharge her

A

b. MRI pelvis

47
Q

Which statement regarding anticoagulation with warfarin is CORRECT

a. The drug effect is most rapidly reversed by Prothrombin Complex Concentrates
b. Paracetamol in a normal dose can cause a drug interaction
c. Treatment should be monitored with APTT
d. Breastfeeding is contraindicated
e. In pregnancy, warfarin is safe to use in the second trimester

A

a. The drug effect is most rapidly reversed by Prothrombin Complex Concentrates

If fully anticoagulated and need urgent delivery:

  • Reverse warfarin with prothombinase complex and vitamin K
  • Reverse heparin and LMWH with protamine sulphate
48
Q

The INITIAL treatment of pulmonary embolus is:

a. 5000IU heparin IV bolus then 25000-30000U/24hour IV infusion
b. 5000IU heparin SC every 12 hours
c. 5000IU heparin IV bolus then 10000-15000U/24hour IV infusion
d. 15000IU heparin IV bolus then 50000-60000U/24hour IV infusion
e. 20000IU heparin SC every 8 hours

A

answer is A in Official Feb 2010 (5000IU then 30,000 – 35,000U/24hr)

NZF
- 5000 IU as bolus, then 18U/kg/hr infusion (which equals approx 25,000 U/24h if 60kg)

49
Q

Which of the following congenital anomalies is most likely to be associated with diabetes mellitus?

a. Duodenal atresia
b. Posterior urethral valves
c. Isolated VSD (ventricular septal defect)
d. Gastroschisis

A

we think C - Isolated VSD (ventricular septal defect)
- double checked on google

Answer apparently a. Duodenal atresia
? because most likely to be associated with DM
however most VSD not related to DM

50
Q

A 32yo, G2P1, Rhesus negative woman, is found to have an anti-D titre of 1:4 at 32 weeks. Ultrasound is normal. There is no evidence of hydrops. The previous pregnancy was uncomplicated. The next most appropriate course of action would be:

a. Repeat titre in a fortnight
b. Amniocentesis
c. Fetal monitoring
d. Elective delivery at 35-36 weeks gestation

A

a. Repeat titre in a fortnight

51
Q

Which statement regarding iso-immunised pregnancies is FALSE

a. MCA doppler peak systolic velocity is a sensitive predictor of fetal anaemia
b. Maternal plasmapheresis is indicated in severe cases
c. Cordocentesis may be useful in the second trimester
d. The mortality from exchange transfusion is less than that from intrauterine transfusion

A

b. Maternal plasmapheresis is indicated in severe cases

52
Q

Which of the following statements is INCORRECT?

a. The commonest Kell phenotype is Kk
b. A fetus affected by anti-Kell antibodies and requiring IUT can be given red cells from it’s mother
c. A woman at 29 weeks with anti-Kell titre 1:2048 and a husband with KK phenotype should have a fetal blood sampling
d. The amniotic fluid bilirubin is less reliable in predicting severity of anaemia with anti-Kell antibodies compared with anti-Duffy antibodies

A

a. The commonest Kell phenotype is Kk

98% are K negative

53
Q

A Rh negative woman, G2P1, is found to have anti-D antibodies with a titre 1:64 and concentration 10IU/L. Her first child was born at term and required phototherapy. The MOST APPROPRIATE surveillance for her pregnancy is?

a. Regular assessment of maternal anti-D titre
b. Regular USS assessment of the fetal MCA PSV
c. Regular amniocentesis to assess the OD450 of the amniotic fluid
d. Regular ultrasound to exclude hydrops fetalis

A

b. Regular USS assessment of the fetal MCA PSV

54
Q

A patient is found to have anti-Fya antibody titre 1:16 at 12 weeks gestation. The MOST APPROPRIATE next step in management is:

a. Quantify the antibody concentration with radioimmunoassay
b. Perform USS at 18 weeks to exclude hydrops
c. Ascertain the partners phenotype
d. Repeat the antibody test at 16 weeks
e. Reassure the patient that anti-Fya antibodies are non-haemolytic

A

c. Ascertain the partners phenotype

55
Q

Which is LEAST TRUE of maternal alloimmunisation

a. Some maternal HLA subtypes facilitate the maternal immune response to HPA-1a antigen
b. Transplacental passage of > 0.1mL of Rh D positive fetal blood is associated with development of anti-D antibodies in 30% of Rh negative women
c. A mother who is AB negative, with a fetus of blood group B positive, is less likely to become isoimmunised than if the fetal blood group was O positive.
d. Dendritic cells present the peptide in association with HLA class II molecules to T helper cells, which in turn present antigen to B cells
e. In the absence of prophylaxis, approximately 15% of Rh negative women delivering a Rh positive ABO-compatible baby will develop anti-D antibodies.

A

c. A mother who is AB negative, with a fetus of blood group B positive, is less likely to become isoimmunised than if the fetal blood group was O positive.

56
Q

In which circumstance may the fetus have alloimmune thrombocytopenia?

a. Mother HPA-1a positive, Father HPA-1a negative
b. Mother HPA-1a positive, Father HPA-1a positive
c. Mother HPA-1a negative, Father HPA-1a negative
d. Mother HPA-1a negative, Father HPA-1a positive

A

d. Mother HPA-1a negative, Father HPA-1a positive

57
Q

The prevalence of HPA-1a negative women in the population is:

a. 0.005%
b. 0.02%
c. 0.1%
d. 0.5%
e. 2%

A

e. 2%

Of the 2% who are HPA-1a negative only a small proportion have the ability to generate anti-HPA-1a as this has a strong association with a particular HLA type

58
Q

Which is the KEY mode of current therapy for fetal alloimmune thrombocytopenia

a. Maternal Immunoglobulin infusion
b. Corticosteroid therapy with prednisolone
c. In utero platelet transfusion
d. Plasmapheresis

A

a. Maternal Immunoglobulin infusion

IVIG
- Shown to improve platelet count in fetuses at risk of FNAIT
Steroids have not be shown to improve platelet counts but could be considered for women at high risk of poor outcomes if benefits outweigh risks

59
Q

Which is NOT a recognised cause of thrombophilia?

a. Prothrombin gene 20210A gene mutation
b. Lupus anticoagulant
c. Thrombin gene mutation
d. Factor V Leiden mutation

A

c. Thrombin gene mutation

60
Q

Which condition, if treated in pregnancy, might have osteoporosis and thrombocytopenia as a result of the treatment?

a. Asthma
b. Pulmonary TB
c. Graves disease
d. Antiphospholipid syndrome

A

d. Antiphospholipid syndrome

Heparin

61
Q

Which is NOT a feature of massive pulmonary embolism?

a. Pulmonary vascular congestion on CXR
b. Right ventricular strain pattern on ECG
c. Sinus tachycardia
d. Tachypnoea

A

a. Pulmonary vascular congestion on CXR

62
Q

Which statement about rubella and pregnancy is TRUE?

a. Maternal infection in the second trimester is followed by Neonatal Rubella Syndrome less than 1% of the time
b. The Rubella haemagglutination inhibition test becomes positive within four days of infection
c. Viraemia precedes the rash
d. Treatment with immunoglobulin reduces the risk of congenital abnormality

A

c. Viraemia precedes the rash

Rubella IgG EIA

  • Level <10 IU/ml are considered susceptible
  • Usually present 1/52 after onset of rash
63
Q

Which is the most common mode of transmission of Toxoplasma gondii to women in Australia?

a. Contact with domestic cats
b. Ingestion of sheep meat
c. Ingestion of kangaroo meat
d. Ingestion of undercooked meat

A

d. Ingestion of undercooked meat

64
Q

Which of the following is TRUE of genital HSV infection?

a. Prior infection with HSV-1 significantly reduces the risk of acquiring HSV-2 in pregnancy
b. 10% of those with recurrent attacks have asymptomatic secretion at the time of delivery
c. 10% of those with a clinical recurrence at delivery will have an infected neonate
d. Most babies who develop neonatal herpes are born to women with a history of recurrent genital herpes

A

a. Prior infection with HSV-1 significantly reduces the risk of acquiring HSV-2 in pregnancy

Prior HSV-1 means HSV-2 is less likely to be symptomatic

65
Q

Pregnant women with recurrent genital herpes

a. Can be delivered vaginally if no maternal lesions are present
b. Should have serial cultures in the last weeks of pregnancy
c. Should all be delivered by Caesarean if membranes rupture prior to labour
d. Should be treated with acyclovir throughout pregnancy

A

a. Can be delivered vaginally if no maternal lesions are present

66
Q

Which is LEAST true of HIV?

a. Opportunistic infections arise when CD4 count is <200 x 10^6
b. ART lowers the risk of MTCT of HIV to 1/3 of the risk compared with no ART
c. High viral loads (>10 000 copies/mL), low CD4 (<400 x 10^6), or > 4 hours ruptured membranes will all double the risk of MTCT of HIV
d. With all available initiatives, the incidence of MTCT of HIV should be reduced to 5%.

A

d. With all available initiatives, the incidence of MTCT of HIV should be reduced to 5%.

With ART, appropriate mode of delivery, formula feeding, baby receiving PEP, incidence of perinatal transmission <2%

67
Q

Which statement is MOST CORRECT regarding malaria in pregnancy

a. Women in pregnancy and the puerperium are not at increased risk of contracting malaria
b. Doxycycline is recommended as chemoprophylaxis if travelling to chloroquine resistant areas
c. Quinine can be used if necessary to treat malaria in pregnancy
d. Mefloquine cannot be used in women with G6PD deficiency

A

c. Quinine can be used if necessary to treat malaria in pregnancy

68
Q

Which is TRUE of VZV?

a. The case mortality of varicella in adults is the same as in children
b. Seronegative pregnant women having a close recent exposure within 96 hours should receive passive Zoster immunoglobulin because this will reduce the risk of fetal varicella syndrome
c. The overall incidence of congenital varicella syndrome is approx. 2% if the mother develops chicken pox during pregnancy
d. Typical features of the Congenital varicella syndrome include limb hypoplasia and dermatome scarring, but ocular and CNS effects are rare

A

c. The overall incidence of congenital varicella syndrome is approx. 2% if the mother develops chicken pox during pregnancy

<12/40 - 0.55%

12-28/40 - 1.4%

> 28/40 - No cases of fetal varicella syndrome

If non-immune and significant exposure:
- Varicella-zoster immunoglobulin (VZIG) as soon as possible (ideally <96h - 4 days after exposure)
○ Effective up to 10 days
May prevent or attenuate chickenpox in non-immune and may reduce risk of FVS

69
Q

A 18yo has Chlamydia on endocervical swab at 30 weeks. The most appropriate antibiotic to treat her with is?

a. Ceftriaxone
b. Erythromycin
c. Azithromycin
d. Doxycycline

A

c. Azithromycin

70
Q

Which of the following statements is TRUE concerning toxoplasmosis infection in pregnancy?

a. The risk of fetal infection after maternal seroconversion is higher in early than in late pregnancy
b. Detection of IgM in the fetal blood is the preferred method for diagnosis of intrauterine infection
c. Pyramethamine/sulfadoxine is the most effective therapy but spiramycin is theoretically less embryotoxic
d. The predominant source of human infection is the domestic cat.

A

c. Pyramethamine/sulfadoxine is the most effective therapy but spiramycin is theoretically less embryotoxic

71
Q

Which is FALSE regarding toxoplasmosis in a pregnant woman

a. Toxoplasmosis is best avoided by staying clear of cats when pregnant
b. Toxoplasmosis is commonly asymptomatic
c. 25-50% of Australian women have immunity to toxoplasmosis in pregnancy
d. Toxoplasmosis is usually treated with spiramycin

A

a. Toxoplasmosis is best avoided by staying clear of cats when pregnant

Often asymptomatic (60-70%)

72
Q

A woman in the first trimester presents because her child has just developed chicken pox. The woman has never had chicken pox, and testing shows her to be non-immune. You advise her that:

a. The risk of fetal varicella syndrome is low, so no further action is warranted
b. She should have IM Zoster IgG to reduce chance of her contracting chicken pox
c. She should have IM Zoster IgG to reduce the chance of fetal varicella syndrome
d. She should start taking oral acyclovir to reduce the chance of her developing chicken pox

A

b. She should have IM Zoster IgG to reduce chance of her contracting chicken pox

73
Q

Which condition is MOST likely to have an adverse effect on pregnancy outcome?

a. Severe lower limb oedema
b. BP 140/90 in the first trimester
c. Urea 12 mmol at booking
d. Weight gain 2kg during pregnancy

A

c. Urea 12 mmol at booking

Normal urea is up to 8 mmol

74
Q

A heroin addict is started on the methadone maintenance programme at 28 weeks. She requires 40mg daily to avoid withdrawal symptoms. You see her three weeks later for review. The preferred ongoing management is:

a. Decrease methadone by 5mg per week and use promethazine to control her symptoms
b. Continue methadone until labour, then substitute promethazine at that time
c. Continue the current dose of methadone until delivery
d. Continue the current dose of methadone until delivery, and add naloxone in incremental doses from 37 weeks

A

c. Continue the current dose of methadone until delivery

75
Q

Which of the following is NOT a recognised cause of pulmonary hypertension in pregnancy?

a. Mitral stenosis
b. Pulmonary embolus
c. Left ventricular failure
d. None of the above

A

d. None of the above

76
Q

The incidence of fetal infection after maternal seroconversion of CMV in pregnancy is approximately:

a. 20%
b. 50%
c. 80%
d. 95%

A

b. 50%

1st - 30%
2nd tri - 40%
3rd tri - 60%

77
Q

A G1P0 presents at 34 weeks with 2 days of coffee ground vomiting and upper abdominal pain. For 2 weeks she has had a flu-like illness. On examination she is drowsy, BP 130/85, HR 96, Temp 36.5, mild scleral jaundice. Abdomen soft, mild epigastric tenderness, no organomegaly. Uterus contains twin pregnancy, consistent with dates, both fetal heards present. Urinalysis shows trace of protein. She has Hb 106, WCC 30, plt 155, uric acid 0.45, bilirubin 25, ALP 180, AST 315, creatinine 100, BSL 1.8mmol. The MOST LIKELY diagnosis is?

a. Cholecystitis
b. Hepatitis
c. Cholestasis of pregnancy
d. Acute fatty liver of pregnancy
e. Pre eclampsia with HELLP syndrome

A

d. Acute fatty liver of pregnancy

78
Q

Which of the following may be responsible for congenital heart block?

a. Anti SSA (anti Ro) antibodies
b. Anticardiolipin antibodies
c. Anti smooth muscle antibodies
d. Anti mitochondrial antibodies

A

a. Anti SSA (anti Ro) antibodies

Past MCQs (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions