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DM2 Prep- Obstetrics > Maternal Medicine Mcqs > Flashcards

Maternal Medicine Mcqs Flashcards

1
Q

How should levothryoxine be adjusted at the beginning of pregnancy

A

Increase by 25 micrograms per day. Further dose adjustment may be needed as pregnancy progresses

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2
Q

What is the TSH target for
1) T1
2) T2 and 3

A

1) 2.5 mU/L

2) 3

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3
Q

What is the frequency of TFT prior to optimization

A

Q 4-6 weekly

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4
Q

What is the management postpartum of thyroid disease

A

1) restart prepregnancy dose

2) TFT at 6 weeks

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5
Q

How long should pregnancy be avoided post radioactive iodine therapy

A

6 months

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6
Q

What antithyrood drugs can cause congenital aplasia cutis

A

Carbamizole
Methimazole

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7
Q

What is the rate of pyelonephritis in pregnancy

A

1-2%

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8
Q

Recurrence rate of pyelonephritis in pregnancy

A

20%

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9
Q

What is the recommended pregnancy deferral time following allograft transplant

A

2 years

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10
Q

What condition is pemphigoid gestationis linked to

A

Autoimmune disease
Esp Graves disease

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11
Q

What is the pattern of the rash of PG (4)

A
  • starts periumbilically
  • fans outward then involves trunk extremities palms and soles
  • vescicles and bullae
  • mucosa spearing
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12
Q

Management of PG

A
  • MDT with dermatology
  • emollients
  • topical steroids
  • ## antihistamines
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13
Q

What is a pregnancy concern of PG

A

Associated with fetal growth restriction

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14
Q

What is the rate of postpartum flare

A

75%

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15
Q

What is the second most common dermatosis of pregnancy

A

Polymorphic eruption of pregnancy

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16
Q

What are the risk factors for PEP
(3)

A
  • nulliparity
  • multiple pregnancy
  • overdistension (fibroids, polyhydramnios)
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17
Q

What is the typical features of PEP

A
  • papules and plaques formed within the distribution of striae gravidarum
  • umbilical sparing
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18
Q

What is the recurrence rate of AFLP

A

25%

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19
Q

What pre conception evaluations should be performed for HBSS within a year of pregnancy (5)

A
  • pulmonary function test
  • ECHO
  • renal and liver function
  • retinopathy screening
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20
Q

What percentage of patients with beta thalassemia major develop hypogonadotrophic hypogonadism

A

66%

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21
Q

What percentage of beta thal develop diabetes

A

20%

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22
Q

What percentage of beta thal major develop osteoporosis

A

40%

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23
Q

What percentage of beta thal develop hypothyroidism

A

10%

24
Q

What is the most common cause of death in beta thal major

A

Cardiac failure (50%)

25
Q

What is the most common cause of thrombocytopenia in pregnancy

A

Gestational thrombocytopenia

75%

26
Q

What are other causes of thrombocytopenia in pregnancy (2)

A

1- hypertensive disease 15-20%

2- immune causes 3-4%

27
Q

What percentage of neonates have thrombocytopenia due to maternal ITP

A

10%

28
Q

What are delivery condiserations for ITP (3)

A
  • avoid ventouse due to risk of fetal thrombocytopenia
  • forceps use possible with consultant advice
  • section only for obstetric indications
29
Q

What is the mortality rate of congenital heart block due to maternal SLE

A

15-30%

30
Q

What auto antibodies are associated with CHB

A

Anti ro/la

31
Q

What thrombophilia has the highest VTE risk in pregnancy

A

Antithrombin deficiency type 1

32
Q

What is the neonatal hsv transmission rate for primary hsv in pregnancy

A

41%

33
Q

Placenta praevia odds ratio after one lscs

A

2.2

34
Q

Placenta praevia odds ratio after 2 lscs

A

4.1

35
Q

Placenta praevia odds ratio after 3 lscs

A

22.4

36
Q

Risk of praevia after 3 sections compared to no sections

A

More than 20 times

37
Q

What is the leading cause of maternal death

A

Cardiac disease

38
Q

What is the second most common cause of maternal death

A

Neurological : epilepsy and stroke

39
Q

What drug is safest in pregnancy for the treatment of rheumatoid arthritis

A

Certolizumab
- does not cross the placenta
- safe in all trimesters
- safe in breastfeeding (all anti- TNF)

-Rituximab should be discontinued 6months before pregnancy

40
Q

What is the rate of breast cancer in pregnancy

A

1:3000

41
Q

How is breast cancer managed in pregnancy

A
  • surgical management as per non pregnant
  • chemotherapy safe after T1
  • tamoxifen and herceptin not safe
  • Radiotherapy contraindicated unless life saving such as spinal compression
  • imaging not recommended (only chest xray and liver us)
  • do not breastfeed with chemo (2 weeks ) as can cause neonatal leucopenia
42
Q

Preconception pregnancy planning with history of breast cancer

A
  • tamoxifen free x 3mmths
  • Metastatic disease should not get pregnant
  • chemotherapy may be gonadotoxic leading to infertility
43
Q

Medical management of HBSS in pregnancy

A
  • stop ace/arbs
  • influenza vaccine yearly
  • folic acid 5mg
  • pneumococcal vaccine every 5 years
  • daily penicillin/erythromycin if allergic
  • asa 75mg daily from 12 weeks
  • LMWH if admitted
44
Q

Maternal risk of obesity

A
  • miscarriage
  • gdm
  • pre eclampsia
  • vte
  • iol
  • lscs
  • anaes complications
  • wound infections
  • breastfeeding concerns
45
Q

Fetal risk of maternal obesity

A
  • stillbirth
  • congenital anomalies
  • prematurity
  • macrosomia
  • neonatal death
  • metabolic disorders in childhood
46
Q

Antenatal adjustments in obesity

A
  • high dose folic acid
  • vitamin D 10microgram daily
  • vte risk assessment
  • anesthesia review if bmi >40
  • pre eclampsia surveillance
  • active management third stage
47
Q

What is the course of asthma in pregnancy

A

1/3 improve
1/3 worsen
1/3 no change

48
Q

What is the incidence od transient neonatal.myasthenia gravis

A

20%

49
Q

What is the effect of pregnancy on myasthenia gravis

A

Worsen 40%
Unchanged 30%
Remission 30%

50
Q

When are exacerbations of MG more common

A

T1 and postpartum up to 3 months

51
Q

What percentage of patients with MG have thyroid dysfunction

A

10-15%

52
Q

What percentage of patients with MS also have a thymoma

A

15%

53
Q

What fetal anomaly is associated with lithium use

A

Ebsteins anomaly
- right ventricular outflow Obstruction

54
Q

What is the monitoring schedule if lithium continued in pregnancy

A
  • monitor lithium levels every 4 weeks until 36 weeks then weekly
55
Q

How is labor managed for patients on lithium

A
  • hospital birth
    -stop drug during labor
  • check lithium levels 12 hours after last dose
56
Q

Neonatal impact of lithium

A
  • floppy muscles
  • tachycardia
  • lethargy
  • jaundice
57
Q

What is an alternative agent for bipolar disease when lithium is discontinued

A

Quetiapine

DM2 Prep- Obstetrics (23 decks)

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