MCQ May 2011

Question 1

Which of these congenital malformations is most likely to be associated with diabetes mellitus?
A) Duodenal atresia
B) Gastrochisis
C) Posterior urethral valves
D) Isolated VSD

Answer 1

A) Duodenal atresia

I am unsure of this answer as UpToDate says that cardiac malformations are most common diabetic anomaly however maybe duodenal atresia is more common than an isolated VSD??

Occur in 3-9% of diabetic pregnancies. 8.5 per 100 live births (diabetic mothers)
TGA
DORV
VSD
Most common cardiac anomalies
CNS 2nd most common 5 per 100 live births
Anencephaly and spina bifida are 13 and 20 times more likely to occur in diabetic pregnancies

Question 2

A 32 y/o Rh negative woman with a history of a single previous pregnancy which was uncomplicated is referred at 32/40 with an anti D antibody titre of 1:4. USS examination reveals a single live foetus and an anterior placenta. There are no signs of hydrops. The MOST APPROPRIATE next course of action with respect to her immunisation is?

A) elective delivery at 35-36/40 gestation
B) amniocentesis
C) fetal monitoring
D) repeat antibody titre in 2 weeks

Answer 2

D) repeat antibody titre in 2 weeks

Would only initiate MFM surveillance for fetal titre of 16 or greater

Question 3

Which of the following statements regarding the management of iso-immunised pregnancies is NOT TRUE?

A) MCA doppler peak flow is a sensitive predictor of fetal anaemia
B) cordocentesis may be useful in the second trimester
C) Maternal plasmapheresis is indicated for severe cases
D) the mortality from exchange transfusion is less than that from intrauterine transfusion

Answer 3

C) Plasmapharesis is NOT a treatment for iso-immunisation

The others are true

Question 4

In which of the following circumstances is it POSSIBLE for the foetus to have alloimmune thrombocytopenia

A) if the mother is HPA-1a positive and the father HPA-1a negative
B) if the mother is HPA-1a positive and the father HPA-1a positive
C) if the mother is HPA-1a negative and the father HPA-1a negative
D) if the mother is HPA-1a negative and the father HPA-1a positive

Answer 4

D) if the mother is HPA-1a negative and the father HPA-1a positive

Father HPA-1a +ve = possible HPA 1a +ve fetus = alloimmune thrombocytopenia

Question 5

which of the Congenital malformations below is MOST LIKELY to be associated with oligohydramnios?

A) Duodenal atresia
B) UPJ obstruction
C) gastroschisis
D) posterior urethral valves

Answer 5

D) posterior urethral valves

Renal causes account for 65% of anomaly related oligohydramnios
Posterior urethral valves are more common than UPJ obstruction
Posterior urethral valves (PUV) is the most common cause of urinary tract obstruction

Question 6

Which of the following programs lowers total medical costs?

A) maternal serum aFP screening in prengancy
B) complete blood count as part of annual examination
C) screening mammograms for women aged between 40-50
D) antepartum steroids given to the mother before the premature delivery of an infant

Answer 6

D) antepartum steroids given to the mother before the premature delivery of an infant