Obstetric MCQ pool Flashcards
Which structures do you incise during a episiotomy?
a. Ischiocavernosus and bulbocavernosus
b. Bulbocavernosus and superficial transversus perineii
c. Ischiocavernosus and superficial transversus perineii
d. Iliococcygeus and pubococcygeus
e. Iliococcygeus and ischiococcygeus
B
Ischiocavernosus – crura of clitoris → inferior pubic ramus; Bulbocavernosus – cover vestibular bulbs,
perineal body → clitoris; Superficial transverse perineal muscle – perineal body → ischial tuberosity
Which are the muscles that are cut by a midline episiotomy
f. Iliococcygeus
g. Transverse superficial peronei
h. Bulbocavernosus
i. Pubocavernosus
g
What structures would you not meet when repairing a 3rd degree tear?
a. Bulbocavernosus
b. Ischiocavernosus
c. External anal sphincter
d. Superficial transverse perinei
e. Deep transverse perinei
B
Crossing over of chromosomes occurs in:
a. Both prophase of mitosis and meiosis
b. Meiotic prophase 1
c. Metaphase 1
d. After ovulation
B
Relaxin is produced from:
a. endometrium
b. myometrium
c. chorioamniotic membranes
d. corpus luteum
e. syncytiotrophoblast
D
Relaxin is produced by the corpus luteum, decidua and placenta (UTD). Speroff states that the major
source of relaxin is the corpus luteum although it is produced at other sites
Relaxin, incorrect option
a. Main production from corpus luteum
b. Not associated with adverse outcome if not present
c. Similar to growth hormone
d. RCT has not shown that it is useful for ripening the cervix
C
All of the following hormones have a similar structure EXCEPT:
a. inhibin A
b. inhibin B
c. TSH
d. AMF
e. Activin
C
EGF – endothelial growth factor
a. Was first isolated from frog skin
b. Reaches high levels in the fetal circulation
c. Causes respiratory distress by inducing epithelial overgrowth in neonatal lungs
d. In high doses induces excessive growth of hair or wool
e. Its receptors are stimulated by TGF- alpha
E
In pregnancy compared to the non-pregnant state:
a. Thyroxine remains the same
b. Free T3 increases
c. Total T3 increases
d. Thyroid binding globulin decreases
Thyroxine increases, T3 increases, thyroid binding globulin increases (Nelson-Piercy)
Answer C?
Which of the following is not produced by the fetus?
a. oestrogen
b. insulin
c. ACTH
d. TSH
A
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
B
Maternal blood gases in late pregnancy, all except?
a. alkalosis
b. low bicarbonate
c. base excess greater
C
Alkalosis and low bicarbonate are normal
Respiratory function in pregnancy – all except?
a. Increased tidal volume
b. Decreased functional reserve capacity
B - decrease in functional residual capacity
Respiratory function in pregnancy changes with an increase in tidal volume and reduced functional
residual capacity
In pregnancy all of the following increase except
a. Tidal volume
b. Respiratory rate
c. Minute ventilation
d. Residual volume
e. Oxygen consumption
D
Tidal volume, minute ventilation and oxygen consumption increase; respiratory rate remains stable;
residual volume (do they mean functional residual capacity?) falls
. Which hormone increased near labour, all except?
a. oxytocin
b. oestrogen
c. progesterone
d. CRH
C
Labour may be precipitated by progesterone withdrawal (C&R)
With advancing gestation the uterus gets more receptors for, or increased sensitivity to, incorrect option
a. CRH
b. Oxytocin
c. Beta agonists
C
Which is wrong in late pregnancy?
a. increase LH
b. increase oxytocin
c. increase aldosterone
d. increase CRH
A
Progressive increase in CRH, oxytocin and aldosterone
24 hr uterine activity monitoring show peak in 3rd trimester:
a. midnight
b. early am
c. ~ 5pm
B
Oxytocin : all are true except**
a. It is a nanopeptide
b. Oxytocin receptors are found in decidua
c. Stimulates influx of Ca2+ across the plasma membrane in smooth muscle
d. all are true
D
Oxytocin is made up of nine amino acids (therefore is a nanopeptide); receptors are found in the decidua;
increases the intracellular calcium concentration both from entry into the cell and release from the
sarcoplasmic reticulum
Regarding syntocinon, which is true?
e. Causes hypernatraemia
f. May cause hypotension in mother
g. Water intoxication is seen because it is given in 5% dextrose
h. Should be given in 5% dextrose to reduce risk of electrolyte incompatibility
B
May cause water intoxication due to its ADH type actions.
Regarding AVP, which is true?
a. The main determinant of fetal heart rate variability
b. Causes increased fetal urine output to protect umbilical cord with amniotic fluid
c. Is produced in the right atrium under the influence of stretch receptors
d. Causes fetal tachycardia secondary to peripheral vasoconstriction
e. Is released in response to haemorrhage
E
Which change is considered normal/physiological in preg (correct option)
a. Raised Alk phos
b. Decreased albumin
c. Increased urea
A
Placental sulphatase deficiency associated with
a. X linked
b. Premature labour
c. Psoriasis
d. All the above
e. None of the above
A
Placental sulphatase deficiency can be otherwise known as X-linked ichthyosis and usually manifests as
scaling of the skin. Can be associated with an inability to labour rather than preterm birth.
Regarding nitric oxide: which is wrong
a. Contracts smooth muscle
b. Equally effective at 48 hrs as Ventolin
c. Acts via cyclic GMP
A
Potent vasodilator; is as equally effective as a tocolytic as salbutamol at 48 hours in prolonging delivery.
Regarding smooth muscle contraction, which is wrong:
a. Voltage dependent Ca channels
b. Receptor mediated calcium channels
c. Smooth endoplasmic reticulum uptake of calcium (?release)
C
The sarcoplasmic reticulum releases calcium; the sacrolemma has both potential dependant calcium
channels and receptor mediated channels (B&L
Regarding stimulation of myometrial muscle contraction which is wrong?
a. Voltage dependant Ca channels
b. Receptor dependant Ca channels
c. Smooth endoplastic reticulum uptake of calcium
d. Myosin related calmodulin receptor kinase
C
Placentation. Which is true?
a. Complete feto-placental circulation established by 5-6 weeks post conception
b. Two waves of endothelial cytotrophoblast invasion is finished by 10/40
c. Of uterine blood flow 55% is to placenta, rest to myometrium/endometrium/deciduas
d. Blood leaves fetus to go to placenta via 2 arteries and 1 vein and flow is 350 ml/min
e. Flow in cord is 150 ml/min
A
The flow through the cord is 350ml/min; placentation is complete by 14 weeks; 85% of uterine blood
perfuses the intervillous space
Two waves of endothelial cytotrophoblast invasion is finished by 14/40
Of uterine blood flow 80% is to placenta, rest to myometrium/endometrium/deciduas
. Fetal vessels with highest p02 in utero
a. IVC at heart
b. SVC at heart
c. Umbilical artery
d. Ductus arteriosis
e. Pulmonary artery
A
Oxygenated blood flows from the umbilical vein into the IVC either via the ductus venosus or the hepatic veins. The IVC enters the right atrium and goes through the foramen ovale into the left atrium and into
the ascending aorta. The order would be – IVC at heart, SVC at heart, ductus arteriosus, pulmonary artery,
umbilical artery.
What is the fetal scalp PaO2 at term?
a. 22 mmHg
b. 32 mmHg
c. 42 mmHg
d. 52 mmHg
e. 62 mmHg
B
What is the cord pH at term immediately after a normal labour and delivery?**
a. Vein 7.3, artery 7.27
b. Vein 7.27, artery 7.3
c. Vein 7.5, artery 7.2
d. Vein 7.2, artery 7.5
A
. The vessel which carries the most oxygenated blood in the fetus is the
a. IVC as it enters the heart
b. SVC as it enters the heart
c. Pulmonary artery
d. Umbilical artery
e. Renal vein
A
. Streaming of blood in the fetal IVC result in:
a. More oxygenated blood being directed through the foramen ovale to the left atrium
b. Deoxygenated blood from the coronary sinuses being directed to the aorta
c. Deoxygenated blood being directed to the left lobe of the liver
d. Oxygenated blood travelling in the right ventral portion of the IVC
A
. Regarding fetal cardiac output:
a. Half the output of the right ventricle is directed to the ductus arteriosus
b. 40% is directed to the placenta
c. 1/3 is directed to the brain via the carotids
d. The right and left ventricles have equal outputs
e. Half the right ventricular output is directed to the pulmonary artery
B
3% goes to the heart; right 65%; left 35%:
10% to lungs
Brain gets 26%
Cardiovascular changes at birth?
a. Brain is organ which receives most dramatic increase in blood flow
b. Foramen ovale is a flap valve which becomes functionally closed when LA pressure > RA
pressure
c. Prostaglandins have minor role in physiological closure of ductus arteriosus
d. Pulmonary vascular resistance and pulmonary blood flow decrease
B
. In newborn, normal circulatory changes include all except:
a. Increased flow in pulmonary vein
b. Increase in left arterial pressure (?atrial)
c. Increase in pulmonary vascular resistance
d. Increase renal blood flow
e. Decrease ductus venosus flow
C
Circulatory transition from foetal to extrauterine life, which is true?**
a. Gas expansion leading to dramatic increase in pulmonary vascular resistance and increase
pulmonary blood flow
b. Doubling of previous return
c. Occlusion of the cord leads to a large flood of blood to the placenta is interrupted causing
decrease in systemic BP
d. PGE1 causes closure of ductus arteriosis
e. Ductus venosus oxygen tension decreases
E
PGs keep the DA open (NSAIDS inhibit PG synthesis and therefore close DA)
. How many weeks post conception does NT close?
a. 4
b. 6
c. 8
d. 10
e. 12
A
Closure occurs between the 25th and 27th day post-conception
Fetal lungs:
a. Are 80% of the volume that they will be immediately after birth
b. Lung movement is required for the production of surfactant
c. The pressure in the trachea is less than that in amniotic fluid
d. None of the above
D
Pressure is slightly higher at the trachea to prevent collapse
The fetal auditory system:
a. Is fully myelinated by term
b. Can detect sounds by the end of the first trimester
c. The basal portion of the cochlea matures before the apical portion
d. Can detect high frequency sounds better than low frequency
e. Sound is transmitted via the ossicles through the air filled middle ear
C
Fetal ear is well developed by mid-pregnancy and the fetus can hear some sounds in utero as early as 24-
26 weeks. Myelination of the spinal cord continues to occur throughout the first year of life. (Williams)
With respect to the fetal auditory system, which statement is correct?
a. High pitched sounds are heard best
b. Depends on movement of ossicles in the air-filled middle ear
c. Has completed myelination by the time of birth
d. The cochlear membrane develops from the basilar end to the apical end
D
Average weight of a 28-week neonate with no adverse factors?
a. 400 g
b. 850 g
c. 1100 g
d. 1350 g
e. 1600g
C
The average fetal weight at 28 weeks is 1196gm with 5th to 95th centiles being 670 – 1977gm.
28 1.1
32 2.2
36 3.3
. Blood volume of term neonate?
a. 200 ml
b. 400 ml
c. 600 ml
d. 800 ml
e. 1000 ml
B
78ml/kg = 234-273ml for 3-3.5kg neonate (Williams); 110-115ml/kg if you include placenta
What is the blood volume of a newborn baby weighing 3500g?
a. 150 ml
b. 250 ml
c. 300 ml
d. 350 ml
e. 400 ml
C
Blood volume of normal 3.5kg neonate:
a. 100ml
b. 150 ml
c. 400 ml
d. 500 ml
e. 1000 ml
C
A multiparous woman at 36 weeks has haemoglobin of 6.8. The fetus will have haemoglobin of?
a. 8
b. 10
c. 12
d. 16
e. 20
D
Fetal haemoglobin is 106 at 16 weeks gestation and 144 at forty weeks gestation (50th centile). At 36
weeks the fetal haemoglobin should be around 138. It should be largely unaffected by maternal
haemoglobin levels. The average term cord Hb is 160 (140-200). Normal fetal Hb is 7.8 + (0.19 x
gestation).
Predominant Hb type in neonate?
a. HbA
b. HbA2
c. HbF
d. HbH
C
What contributes most to AFI in late gestation?
a. fetal swallowing
b. fetal urination
c. transudation across membranes
B
Re amniotic fluid. Which is correct?**
a. Volume increase to a maximum of 750-1000ml at 40 weeks
b. It becomes iso-osmotic with maternal plasma by term
c. It is increasingly hypo-osmotic to maternal plasma with decreased Na, Cl and K towards term
d. Urination and lung fluid contribute equally to production near term
e. Volume is regulated by fetal swallowing which begins when skin is keratinised
C
Amniotic fluid during gestation
a. Osmolality increases throughout gestation to become iso-osmolar with maternal serum at
term
b. Has a low chloride and low protein content
c. Reaches a maximum volume of 750-1000 mls at 40 weeks
B
The fetal kidney:
a. Is just as responsive to aldosterone as the adult kidney
b. Produces hyperosmolar urine
c. Responds to hyperosmolar mannitol by increasing GFR to excrete the osmotic load
A
Fetal urine osmolality decreases towards term.
. Fetal urine amount related to?
a. fetal weight 30% of body weight
b. gestational age
B
30% of body weight
Thyroid hormone:
a. Increase immediately after birth in pre-term but not term infants
b. Increases at birth due to a surge of TSH
c. Cause shivering but not non-shivering thermogenesis
d. Is essential for normal fetal development
e. The active form in the fetus is reverse T3
B
T4 is stimulated by a surge in TSH at birth, in response to temperature and clamping the cord. Preterm
infants undergo similar changes but at a smaller magnitude. There is an reverse T3 in the fetus but it is
not active.
Behavioural state 2F is characterised by: **
a. Eye movements, fetal breathing movements and frequent heart rate accelerations
b. Absent gross body movements but frequent eye and breathing movements
c. Absent eye, breathing and gross body movements associated with decreased heart rate
variability
d. Occurs most of the time at term
e. High voltage, slow wave EEG pattern
A
Behavioural state 2F (active sleep) is characterised by frequent gross body movements, eye movement
continually present, fetal heart rate with a wide oscillation bandwidth and frequent accelerations during
body movements. Predominates at term - 40% of the time at term
The “D” antigen first appears on RBCs at
a. 5w
b. 8w
c. 12w
d. 16w
e. 22w
A
According to UTD the D antigen is expressed by 30 days gestation
Which is not true?
a. Normal non-pregnant, non-menstruating iron requirement is 1mg/day
b. Normal non-pregnant, menstruating iron requirement is 2mg/day
c. Normal pregnant requirement 8mg/day
d. 10% of iron from diet is absorbed in non-pregnant
e. Cord ferritin is higher than maternal ferritin
C
Menstruating iron requirement is between 1-2mg per day absorbed dose, male iron requirement is 1mg.
Iron requirements during pregnancy are 6-7mg/day. Iron absorption is 30% if haem and 10% in nonhaem. (UTD and Williams). Recommended intake is 30mg /day (CONSUMPTION). If deficient increase to
60mg/day
ABSORPTION requirement in preg is 4-5mg day
18% of iron is absorbed from a mixed diet (10% from a vegetarian diet)
Heme iron = iron from meat – absorption = 30%
Non heme = from iron rich foods – absorption = 10%
Which is true of iron metabolism
a. Only 5% of her daily intake of iron is absorbed
b. A pregnant woman requires 9mg/day
c. A menstruating non-pregnant woman requires 2mg/day
C
30% of haem iron is absorbed whilst less than 10% of non-haem iron is absorbed
Iron requirements during pregnancy are 6-7mg/day.
Which of these are true in pregnancy?
a. Normal pregnant requirement of iron in 9mg/day
b. Normal non-pregnant requirement of iron is 4 mg/day
c. Cord ferritin is higher than maternal ferritin
d. 10% of iron is absorbed from non-haem sources
C
With respect to iron requirements which is NOT CORRECT
a. 1mg/day in non-menstruating women is adequate
b. 2mg/day in menstruating women is adequate
c. 9mg/day is required in pregnancy
d. There is 5% absorption of iron in the GIT
C (vs D)
At routine CS the patient is noted to have pink/red excresences on the surface of the ovary. Most likely
diagnosis:
a. Decidual reaction
b. Endometriosis
c. Walthard’s nests
d. Corpus luteum of pregnancy
A
Walthard’s nests are an accumulation of epithelial cells found on the peritoneum of the tubes, ovarian
hilum, mesosalpinx and mesovarium. They appear as white-yellow nodules reaching 2mm.
What is the average weight of the term placenta?
a. 100g
b. 450g
c. 720g
d. 1000g
e. 1200g
B
Placental weight is approximately one sixth fetal weight. It is probably about 500gm (Williams). Placental
weight changes with gestation 1:4 at 27 weeks to 1:7 at term. 10th centile - 420gm; 90th centile – 632gm
(UTD).
Which is category A drug?
a. ondansetron
b. Maxalon
c. Augmentin
d. phenytoin
e. betamethasone
B and E
What is the criteria of calling a drug class B3
a. Animals study show a defect, the significance of which is unclear in humans
b. Animal studies are lacking, but no evidence of defects
c. Harmful effects in human suspected, but those effects are reversible
d. Animal studies showed reversible defect
A
Before starting isotretinoin in a 16 year old check
a. LFTs
b. Full blood count
c. Urine BHCG
C
. Which drug should not be used in lactation
a. Amiodarone
b. Warfarin
c. Digoxin
d. Propylthiouracil
A
Which is associated with increased miscarriage
a. Isotretanoin
b. Heroin
c. Marijuana
d. Heparin
e. Cocaine
A
. Which is associated with IUGR
a. Isotretanoin
b. Heroin
c. Marijuana
d. Heparin
e. Cocaine
E
Which is associated with placental abruption?
a. Isotretanoin
b. Heroin
c. Marijuana
d. Heparin
e. Cocaine
E
Unbooked at 30/40. Fundal ht consistent with 34/40, abdominal pain, on examination uterus is firm and
tender. Her friend says that she has been experimenting with street drugs recently. Most likely drug
used:
a. Heroin
b. Marijuana
c. LSD
d. Cocaine
D
Side effects to fetus of indomethacin?
a. prem closure of PDA
b. polyhydramnios
A
Antenatal administration of indomethacin has all the following effects?
a. Premature closure of ductus arteriosus
b. Fetal kidney problems
c. Reduced liquor problems
d. All of the above
e. None of the above
D
. Which drug is most likely to cause oligohydramnios?
a. Captopril
b. Verapamil
c. Prazosin
A
Propranolol: actions?
a. alpha, beta blockade
b. beta blockade
c. vasodilator
d. none of the above
B
Labetolol: actions?
a. alpha, beta blockade
b. beta blockade
c. vasodilator
d. none of the above
A
Alpha methyl dopa: actions?
a. alpha, beta blockade
b. beta blockade
c. vasodilator
d. none of the above
D (alpha 2 adrenergic antagonist)
Regarding warfarin which of the following is correct?
a. IV vitamin K reverse side effects in 15 seconds
b. Can’t breast feed
c. Can give epidural
d. Normal dose paracetamol no serious side effects
D
Regarding warfarin anticoagulation in pregnancy:
a. Reversed within 10 min of IV injection of vitamin K
b. Paracetamol in therapeutic dosage has no adverse effect
c. Monitored by whole blood clotting time
d. Associated with NTD’s
e. Breast feeding is contraindicated
B
Regarding warfarin. Which is true?
a. It is only safe in second trimester
b. It can be interfered with by therapeutic dose of paracetamol
c. It is monitored with use of APTT
d. Can be used in breast feeding
D
Side effects of oxytocin-receptor antagonist (ag atosiban)
a. headache
b. N+V
c. Arthralgia
d. None of the above
e. All of the above
D
Hypersensitivity and injection reactions only according to UTD
Most important diagnosis to know before giving PGF2a?
a. PDA
b. HT
c. Asthma
d. AV fistula
C
. All of the following patterns of inheritance are correct except:
a. von Recklinghausen’s AD
b. Huntington’s chorea AD
c. Fibrocystic disease of the newborn AR
d. Tay Sachs disease AD
D
Autosomal dominant – von Recklinghausen’s (neurofibromatosis type I), Huntington’s chorea. Autosomal
recessive – Tay Sachs disease,
Which type of inheritance is wrong?
a. Duchenne muscular dystrophy – autosomal recessive
b. Tuberous sclerosis – autosomal dominant
c. Myotonic dystrophy – autosomal dominant
d. Tay Sach’s disease – autosomal recessive
A
. Which disease is the wrong inheritance:
a. Tay Sachs – AD
b. Huntington’s – AD
c. Achondroplasia – AD
d. CF – AD
A and D
Which of the following conditions is autosomal recessive?
a. Haemophilia A
b. Cystic fibrosis
c. Tuberous sclerosis
d. Huntington’s chorea
e. Adult polycystic kidney disease
B
Haemophilia A is X-linked; Huntington’s, tuberous sclerosis and aPCKD are AD
. Which of the following is an autosomal recessive condition?
a. Cystic fibrosis
b. Huntington’s chorea
c. Duchenne muscular dystrophy
A
Which genetic condition is NOT associated with an ethnic group
a. Tay Sachs
b. Von Willebrands
c. Sickle cell
d. Alpha-thalassaemia
B
Adopted girl whose natural mother dies of Huntington’s disease. The risk of her baby having the disease
is:
a. 50%
b. 25%
c. <1%
d. none if it is a girl
e. only if a boy
B
Fragile X syndrome
a. occurs only in men
b. Mendelian inheritance
c. associated with premature menopause
d. no phenotypic features
e. none of the above
C
Pregnant woman’s brother has schizophrenia. Risk of schizophrenia in child?
a. nil
b. 1-2%
c. 2-4%
d. 5-10%
e. 25%
f. 50%
g. 100%
C
Pregnant woman’s husband has schizophrenia. Risk of schizophrenia in child?
a. nil
b. 1-2%
c. 2-4%
d. 5-10%
e. 25%
f. 50%
g. 100%
D
Lifetime risk = 0.2-0.7% increased 10 fold if a parent affected
Your patient attends for menopausal advice, mentions her son has schizophrenia as has his partner and
they are thinking of starting a family. Risk for child?
a. nil
b. 1-2%
c. 2-4%
d. 5-10%
e. 25%
f. 50%
g. 100%
F
Commonest inherited condition
a. Tay Sachs disease
b. Hurler’s syndrome
c. PKU
d. Cystic fibrosis
e. Congenital hypothyroidism
D
CF – 1:2500, ChT – 1:5000, PKU – 1:14000; TSD – 1:36,000
. The husband of a normal female has Christmas disease. She gave birth to a son. What is the probability
that he is affected?
a. none
b. 10%
c. 20%
d. 30%
e. 50%
A
Christmas disease is haemophilia B and is an X-linked recessive disorder. Therefore if the husband has the
disorder there is no chance a son will have it given that the Y is inherited from the father. A daughter
would be a carrier.
A woman’s previous son has Duchenne muscular dystrophy. What is the chance her current fetus is
affected?
a. 50%
b. 25%
c. 0%
d. 10%
e. 33%
B
Male with an X linked disease is married to a normal homozygous female. What chance do their children
have of getting the disease?**
a. 0%
b. 6.25%
c. 12.5%
d. 25%
e. 50%
A
A man has an X-linked disorder and his wife is homozygous normal. What is the chance that their two children will both be affected?
a. 0
b. 1/2
c. 1/4
d. 1/16
e. 1/32
A
Meningomyelocoele is associated with:
a. trisomy 21
b. Turner’s syndrome
c. Trisomy 18
d. Arnold Chiari malformation
e. Noonan syndrome
D
. A mother has two children, one with open spina bifida and the other with a myelomenigiocoele. What is
the likelihood of recurrence?
a. 1%
b. 5%
c. 10%
d. 15%
e. 20%
C
The risk is approximately 5% (C&R) with one affected sibling and 10% with two affected siblings (UTD).
A patient has a termination of pregnancy at 18 weeks for an open neural tube defect. What is the risk of
recurrent NTD in her next pregnancy?
a. 1%
b. 2%
c. 5%
d. 10%
e. 50%
C
A woman who has a prior child with Spina bifida comes to see you 10w. What do you recommend?
a. US 11w
b. Start folate now
c. CVS now
d. Amnio 16w
e. Reassure
A
.What is the recurrence rate of anencephaly after one affected child?
a. 3%
b. 5%
c. 10%
d. 20%
e. 25%
B
US (picture given) at 17/40 shows ‘frog’s eyes’ (anencephaly) and maternal serum AFP 4 times above
normal range. Following options in counselling parents?
a. Defect unclear as not often seen at 17/40
b. Neonatal survival is poor (<48hrs)
c. Prompt termination required to avoid serious maternal complications
d. Fetus will survive, but with significant morbidity
B
.The recurrence risk of NTD after one affected pregnancy is
a. <0.5%
b. 1 in 1000
c. 1 in 400
d. 1 in 20
e. 1 in 5
D
.Incorrect karyotype for the stated condition is
a. Klinefelters 47 XYY
b. Turners 46 XO
c. Superfemale 47 XXX
d. CAH 46 XX
A or B
FDIU at term. Most likely abnormality statistically?
a. Triploidy
b. Trisomy 21
c. Trisomy 18
d. Trisomy 13
e. Turners’ syndrome
B
Which chromosomal abnormality doesn’t increase in frequency with increased maternal age?
a. trisomy 21
b. trisomy 18
c. Turners XO
d. XXY
C
You are counselling a 40 yo lady 10/40 for prenatal diagnosis. What do you say about the triple test?
a. 1:250 is high risk, detecting 85% of Downs
b. she has a 5% risk of Downs
c. she has 4x risk of abnormal chromosomes on amniocentesis
d. best done at 15-16/40
D
The triple test has 69%-77% accuracy rate at 5%FPR. The background age risk is 1:90.
.Woman 16 weeks pregnant, requesting tests for genetic diagnosis, correct option:
a. Perform amnio as too late for CVS
b. 1/600 risk miscarriage with amnio
c. Results with CVS more reliable than amnio
A
Regarding the triple test, which is true?
a. 1% of women undergoing the test will be placed at increased risk category
b. Most accurate at 15-16w
c. Indicated for women at increased risk of Down’s syndrome
d. Will pick up 90% of affected infants
B
5% at least in high-risk group.
.A woman has decided she wants prenatal diagnosis for Down’s syndrome and comes to see you at 16/40.
In your discussion you should emphasise?
a. Increased safety of CVS over amnio
b. Increased accuracy of CVS over amnio
c. Miscarriage rate with amnio at 16/40 is 1/600
d. CVS not generally performed as late as 16/40
D
Spontaneous mid-trimester abortion with amniocentesis?
a. 1:100
b. 1:200
c. 1:350
d. 1:500
e. 1:1000
B
Triple screen is also useful to detect all except:
a. Multiple pregnancy
b. T13
c. T18
d. XO
A
Low serum AFP, oestrogen, HCG seen in?
a. Downs syndrome
b. Trisomy 18
c. Trisomy 13
d. Triploidy
B
T21 - decreased AFP, UE3, increased BhCG;
T 18 - decreased AFP, UE3 BhCG;
T 13 – no significant pattern; Triploidy – AFP not
relevant, decreased UE3 and BhCG
40yo woman in first pregnancy
a. 3% chance of T21
b. 4% chance of chromosomal abnormality on amnio
c. 2% chance of miscarriage after amnio
d. 10% chance of miscarriage after CVS
e. 1% chance NTD
B
Risk of T21 is 1 in 90. Background risk of NTD is 1 in 1000. Risk of miscarriage after CVS is 6-7%, the rate
after amnio is about 1 in 100. The rate of chromosomal abnormality is 1 in 40.
Risk of Down’s syndrome at age 40
a. 1 in 50
b. 1 in 100
c. 1 in 250
d. 1 in 20
e. 1 in 5
B
A couple presented for genetic counselling because her first child has trisomy 21. On karyotype testing,
she was found to have a balanced translocation of 14/21. What is her risk of recurrence?
a. 100%
b. 50%
c. 25%
d. 10%
e. 0%
D
10-15% according to UTD
Down’s syndrome is associated with all except
a. long femur and humerus
b. duodenal atresia
c. increased nuchal thickness
d. VSD
e. ear abnormalities
A
Which of the following conditions is most likely associated with chromosomal abnormalities?
a. PUJ obstruction
b. VSD
c. Gastroschisis
d. Duodenal atresia
e. Pulmonary stenosis
D
Renal pyelectasis occurs in 10-25% of fetuses with Trisomy 21 and 1-3% of normal fetuses. PUJ obstruction has a weak association with trisomy 21. VSD has an overall rate of 46% and pulmonary stenosis 5%. Gastroschisis is not associated with an increased prevalence of chromosomal abnormalities
(if isolated). 30% of infants with duodenal atresia have trisomy 21. (UTD).
Which of the following cannot be detected on routine US scanning?
a. Hydrocephalus
b. Exomphalos
c. Cystic fibrosis
d. Cleft palate
C
Which is not associated with aneuploidy?
a. omphalocele
b. gastroschisis
c. CVS defect
B
Which of the following is least likely to be associated with aneuploidy?
a. Duodenal atresia
b. Omphalocoele
c. Gastroschisis
d. Mental retardation
e. Congenital heart disease
C
The risk of omphalocoele being associated with a chromosomal abnormality is:
a. <20%
b. 30%
c. 60%
d. 80%
e. >80%
C
Chromosomal abnormalities are commonly associated with omphalocele, especially if there are associated
abnormalities, intracorporeal liver or abnormal liquor volumes (50-70%). Fetal medicine foundation book
states that 50%, 30% and 15% of fetuses with omphalocele at 12 weeks, 20 weeks and birth respectively
have a chromosomal defect. Gastroschisis is rarely associated with chromosomal defects.
Exomphalos (omphalocele) is associated with:
a. trisomy 21
b. Turner’s syndrome
c. Trisomy 18
d. Arnold Chiari malformation
e. Noonan syndrome
C
Associated with trisomy 18 and 13 (C&R)
.An ultrasound examination reveals that your patient has a fetus with gastroschisis. You advise her that:
a. The fetus has >30% chance of an associated chromosomal abnormality
b. Surgical repair is successful in <20% of cases
c. It is uncertain whether LUSCS confers any advantages over NVD
d. The infant is likely to have severe mental retardation
C
A CVS for advanced maternal age reveals mosaicism. Do you counsel for?
a. TOP
b. Explain what likely phenotype is and allow patient to request a TOP
c. Repeat the CVS
d. Offer amniocentesis
e. Ignore it as it is likely to be confined to the placenta
D
.USS at 28/40 shows ventriculomegaly with a cortical mantle thickness of 8mm. You advise:
a. Prognosis bleak – TOP advised
b. Prognosis is uncertain and await spontaneous labour
c. Ventriculocentesis will cause brain damage
d. Could be prevented by pre-conceptual folate
B
A 3cm unilateral choroid plexus cyst was found on routine antenatal US at 24 weeks. Which of the
following is correct?
a. reassure mother and no follow up required
b. perform serial US and reassure mother is cyst remains the same
c. cephalocentesis is indicated
d. choroid plexus cyst is most commonly found in 3rd ventricle
e. perform an amniocentesis to obtain fetal karyotype
A
Choroid plexus cysts are a common finding (0.18-3.6%) with an association with trisomy 18 and other
chromosomal abnormalities. It occurs in the lateral ventricles growing in the first trimester and have
usually disappeared by the third trimester.
On 18 weeks US see bilateral choroid plexus cysts but otherwise fetus normal. Do you?
a. Disregard as inconsequential
b. Do immediate amnio
c. Repeat scan in 4 weeks
d. Recommend TOP
A
Babe with choroid plexus cysts, missing 2 fingers on each hand and cystic hygroma?
a. Trisomy 21
b. Trisomy 18
c. Trisomy 13
d. Triploidy
A
Cystic hygromas are associated with T21 and Turner’s syndrome
.What is this syndrome – choroid plexus cysts, cystic hygroma, absent 3rd and 4th digits?
a. CMV
b. Rubella
c. T21
d. T18
e. T13
f. Turners syndrome
F
.Anechoic masses are seen in the fetal abdomen on US. Dx:
a. Intestinal obstruction
b. Cardiac abnormality
c. Downs syndrome
d. Renal aplasia
e. Oesophageal atresia
None of the above
.Fetal cystic hygroma is most commonly associated with
a. Trisomy 21
b. Trisomy 18
c. 45, X
d. mosaicism
e. 47, XXX
A
Cystic hygroma is associated with Turner’s syndrome but statistically more often found in Down’s syndrome.
To be picky – if diagnosed in 1st T the most common aneuploidy is T21 but if diagnosed in 2nd T
75% of cases are 45XO.
Which is wrong?
a. 47XXY – Klinefelters
b. 46 XO – Turners
B
A low AFP is associated with:
a. trisomy 21
b. Turner’s syndrome
c. Trisomy 18
d. Arnold Chiari malformation
e. Noonan syndrome
A
Low AFP is associated with trisomy 21, trisomy 18 and Turner’s syndrome
.Decreased AFP is seen in
a. IUGR
b. Fetal cystic fibrosis
c. Closed spina bifida
d. Rhesus isoimmunisation
e. Pre-eclampsia
E
.Lady with past Hx of baby with NTD. Now has low AFP in this pregnancy. Normal 16/40 US. Repeat
sample low AFP. Advise?
a. reassure no NTD
b. recommend amnio to check for trisomy
c. repeat US
B
.A woman found to have an AFP level 0.2-0.3 multiples of the median at 16 weeks. This level is associated
with?
a. 47 XXY
b. XXX
c. Turners
d. Trisomy 21
e. Mosaicism
D
.High AFP likely due to the following except:
a. spina bifida occulta
b. omphalocoele
c. anencephaly
d. FDIU
e. Myelomeningocoele
A
AFP does not detect closed NTDs
.Which of the following is a recognised cause of elevated serum AFP?
a. Retro-placental bleed
b. Duodenal atresia
c. Closed NTD
d. CF
B
16 weeks, AFP 4 times MoM, next step in management
a. repeat the AFP
b. amniography
c. ultrasonography
d. amniocentesis
e. intra-amniotic installation of PGF 2 alpha
C
Lady with sister who has spina bifida. Amniotic fluid AFP 4.5 MOM after 16 weeks amniocentesis. US
appeared normal and agreed with dates. Mx
a. reassure all normal on US/no risk of fetal anomalies
b. repeat blood AFP
c. repeat US at 18 weeks
d. advise TOP due to high risk of NTD
C
Which one does NOT elevate AFP in amniotic fluid?
a. dead fetus
b. myelomenigocele
c. spina bifida occulta
d. multiple pregnancy
e. fetal blood mixed in sample
C
In a primigravida with congenital heart disease the fetus is at risk of:
a. cardiac abnormality
b. venous abnormality
c. arterial abnormality such as coarctation
d. cardiac, venous or arterial anomalies
e. all abnormalities incl arterial, venous or cardiac
A
Babies of mothers with CHD (or a family history) are at significantly greater risk of cardiac abnormalities
(5% approxiamately compared to background risk of 5-8/1000 newborns). One third are the same as the
maternal lesion with outflow tract lesions being more common to be inherited. No comment is made on
arterial or venous abnormality. (UTD)
.Woman’s daughter has just had VSD successfully repaired age 18 months and asks what chance next baby
has cardiac lesion?
a. 1%
b. 2-5%
c. 10%
d. 15%
e. 50%
B
.A primigravida completed in a running marathon. On the day, the weather was very hot and she suffered
from heat stroke. She was admitted to the hospital, diagnosed with hyperthermia. She was treated
successfully with rehydration. Her last normal menstrual period was 4 weeks ago and her pregnancy test
was positive. She came to you to obtain advice about the effect of this episode on her fetus. Which of the
following is the fetus at risk of?
a. VSD
b. Gastroschisis
c. Phocomelia
d. Spina bifida
e. Anencephaly
D
Increased maternal core temperature during embryogenesis is associated with major abnormalities in
animals. These include neural tube defects, micropthalmia, arthrogryposis, abdominal wall defects and
limb deficiencies. Phocomelia is the absence of long bones with flipper like hands and feet. Four weeks
gestation is a period where the CNS is highly sensitive. (UTD)
Exercise in pregnancy – 3km running, 3x /week in woman who has been doing it for years?
a. not likely to cause fetal hypoxia
b. not likely to cause adverse neonatal outcome
B
.A woman has a CXR at 16 weeks gestation. You tell her
a. There is no proven adverse effect on the fetus
b. She is at increased risk of miscarriage
A
.Which gives the most radiation exposure in the first trimester?
a. IVP
b. CXR
c. Barium enema
d. Cholecystogram
C
Barium enema > Cholecytogram > IVP > CXR
.Which investigation delivers the greatest dose of radiation to an 8 weeks fetus?
a. IVP
b. CXR
c. Cholecystogram
d. Barium enema
e. Lumbar spine series
D
IVP – 400-900 mrad; CXR - <1 mrad; cholecystogram - ?; barium enema – 700-1600 mrad; 400-600
.What is worst advice re ETOH in pregnancy?
a. nil is safest
b. 1 drink per week is probably OK
c. 1 drink per day is probably OK
d. 2 drinks per day, 5x per week is probably OK
e. isolated occasion < or = 1x per month of < or = to 10 drinks is OK after first trimester
D
Advice re alcohol in pregnancy?
a) Only safe thing is not to have any
b) Better to have none but no increase in FAS with one standard drink per day
c) 3 standard drinks per day safe as long as there is no binge drinking
d) A constant low intake best so the fetus is exposed to constant low levels
A
.Microcephaly, flat nose, thin upper lip, large distance between nose and lip. Which drug is culprit?
a. ETOH
b. Marijuana
c. Cocaine
d. Amphetamines
e. Heroin
A
Regarding cocaine use in pregnancy, all true except?
a. IUGR caused by excessive movements on coming off drug
b. Constriction of uterine artery with cocaine
c. Increased sympathetic tone in baby
d. Decreased blood flow around baby
A
.An IV drug user on heroin first presents at 28/40 and is commenced on methadone 40mg daily. She is
seeing you at 31/40. What should ongoing Mx plan be?
a. Continue methadone at current dose until delivery
b. Wean from now on, using promethazine to treat withdrawal symptoms
c. Continue methadone but introduce low dose naloxone at 38/40
d. Continue methadone until labour then cease and use promethazine in labour
e. Continue methadone but give IV naloxone infusion in labour
A
.Regarding substance abuse in pregnancy
a. Dangerous to withhold narcotic drugs from heroin addicts
b. Do not permit alcohol in the puerperium because it is transmitted in the breast milk
c. Cocaine has less serious side effects than heroin
d. Up to 50% incidence of prem labour and IUGR in women with heroin addiction
A
.At 30 weeks with clinical abruption and FDIU. Aggressive behaviour, increase BP, PR 110:
a. Cocaine
b. LSD
c. Alcohol
d. Heroin
A
.Which substance has a dose related effect on fetus?
a. Heroin
b. Cocaine
c. Marijuana
d. Alcohol
e. Cigarettes
D
Which substance is known to cause placental abruption?
a. Heroin
b. Cocaine
c. Marijuana
d. Alcohol
e. Cigarettes
B
Which substance is considered dangerous to use during pregnancy even in small amounts?
a. Heroin
b. Cocaine
c. Marijuana
d. Alcohol
e. Cigarettes
B
Which substance decreases overall risk of preeclampsia?
a. Heroin
b. Cocaine
c. Marijuana
d. Alcohol
e. Cigarettes
E
Smoking doesn’t cause?
a. increase PET
b. unemployment
c. low attendance at ANC
A
Smoking is protective against PET
A patient has bipolar affective disorder and is on lithium 900mg/day. Risks to fetus include:
a. CNS anomalies
b. Cardiac anomalies
c. Renal anomalies
d. Post maturity
B
Lithium causes an increased risk of cardiac abnormalities (RR 1.2-7.7), no increased risk of NTDs and
goitre.
A woman with bipolar affective disorder on lithium presents at 11/40. Serum lithium is 1.0 (therapeutic
0.9-1.4). She should be told?
a. Lithium is suspected of causing heart defects
b. To cease lithium now will decrease risk to baby
c. To decrease dose will decrease risk to baby
d. Should have CVS now
e. Should have amniocentesis at 16/40
A
.Which drug has been shown to be harmful to the fetus during pregnancy?
a. Metronidazole
b. Heparin
c. Azathioprine
d. Thiazide diuretics
D
Azathioprine is safe (fetal liver does not have the enzyme to convert to active form); thiazides can cause
thrombocytopaenia, jaundice and electrolyte abnormalities.
Phenytoin is associated with all of the following except:
a. IUGR
b. Mental retardation
c. Spina bifida
d. Cardiac anomalies
e. Cleft palate
C
Phenytoin is associated with orofacial clefts, cardiac abnormalities and genitourinary defects (UTD). Some
evidence exists that children taking anti-epileptic medications have lower IQ. Fetal hydantoin syndrome
may cause IUGR. The least likely association is NTDs.
.What is phenytoin not associated with?
a. mental retardation
b. cleft palate
c. spina bifida
d. CVS defects
C
.A primigravida who is 3 months pregnant had in utero exposure to DES (herself). Advise:
a. 3 monthly Pap smears to screen for clear cell Ca vagina
b. 3 monthly Pap smears to screen for clear cell Ca cervix
c. biweekly vaginal examinations because of high risk PTL
d. elective CS at term because of high risk of cervical stenosis
e. HSG
C
Exposure to DES in-utero confers a 40 fold increased risk (1 in 1000-2000) of clear cell adenocarcinoma of
the vagina and cervix and annual screening is recommended. There is an increased risk of preterm labour
(RR 2.93), 2nd T miscarriage (RR 4.25) and 1st T miscarriage (RR 1.31) and surveillance is recommended.
They are at increased likelihood of having an abnormal HSG. No comment on needing elective CS. (UTD)
Lady at 23/40 by dates and confirmed by early US, fundus > dates. Measurements on US c/w 23 weeks
but polyhydramnios. What is the most likely diagnosis?
a. omphalocoele
b. meconium ileus
c. polycystic kidneys
d. duodenal atresia
D
Duodenal atresia is the most likely diagnosis to cause polyhydramnios but omphalocele could plausibly
create a gastrointestinal obstruction, as could polycystic kidneys if they were large enough.
.A fetus was terminated due to multiple fetal abnormalities. The body was shown to the parents.
a. This will increase marital discordance
b. Increase anger towards the obstetrician
c. Promotes the process of grief reaction
d. Increase fear of future pregnancy
C
Polyhydramnios will not be seen with?
a. Congenital myasthenia gravis
b. Myotonic dystrophy
c. Duchenne muscular dystrophy
d. Hydrocephalus
e. Arthrogryposis
C
Intra-uterine fetal death at 18/40. Safest option?
a. prostaglandins
b. D&C
c. Intra-amniotic saline/PG
A
.If you were discussing the safety aspects of ultrasound with a pregnant lawyer what would you emphasise?
a. pulsed US
b. angle of rays in = angle of rays out
c. continuous US beam
d. acoustic impedance
A
.Which of the following is true about Doppler waveform studies?
a. It can be used as a screening test to identify pregnancies at risk
b. A normal result excludes fetus compromised by hypertension and IUGR
c. Growth retarded fetus may have reduced renal systolic flow
d. It is only an indirect test for fetoplacental vascular bed
e. A single result of high resistance flow indicates the need for delivery
A or C
Use of Dopplers in pregnancy
a. assess blood flow in umbilical vein
b. assess fetoplacental resistance
c. assess blood flow in uterine artery
Strictly speaking the use of Doppler in pregnancy is used to assess blood flow in MCA, uterine artery,
umbilical artery and ductus venosus. It is used indirectly to assess fetoplacental resistance.
.Considering Doppler flow studies. The S/D ratio is inversely proportional to:
a. Maternal weight
b. Gestational age
c. Placental mass
d. Size of infant
e. None of the above
B
.Error of EFW on US at term:
a. 5%
b. 10%
c. 15%
d. 20%
e. 25%
C
Which ultrasound features are the least accurate assessment of gestational age?
a. BPD
b. FL
c. AC
d. BPD/FL ratio
C
.In a low risk population undergoing US at 18/40 which type of abnormality will have the lowest pickup
(highest false negative results)?**
a. CVS
b. Skeletal
c. Gastrointestinal
d. CNS
e. Genitourinary
A
CNS > cardiac > clefts
In a low risk population undergoing a routine 18 weeks US, which type of abnormality will have the lowest
pickup rate?
a. Cardiovascular system
b. Musculoskeletal
c. Gastrointestinal
d. Central nervous system
e. Dermatologica
E then A
.A US is performed at 28/40 and a hydrocephalic fetus with ventriculomegaly is diagnosed. The cortical
thickness is 1 cm. Which of the following is correct?
a. Ventriculoamniotic shunt
b. Cervagem termination of pregnancy now
c. Wait till 36/40 then LUSCS
d. Commence on folic acid before conceiving next time
e. Second weekly cephalocentesis to prevent further cerebral damage
C
The most commonly reported treatment of twin-twin transfusions are:
a. observation alone
b. NSAIDS
c. Amnioreduction
d. Ligation of connecting placental vessels
C
18 weeks gestation with IUGR
a. Too late for CVS
b. Risk of fetal loss with an amnio is 1/600
c. One benefit of a CVS is it may detect placental mosaicisms that may assist with the diagnosis
C
.A G4P3 with 3 NVD at term with BW approximately 3500g presents at 36w with fundal height of 31cm. US
showed single fetus with BPD and AC consistent with 31w size. Liquor volume and BPS normal. What is the
most appropriate management?
a. LUSCS
b. Cordocentesis for karyotype
c. BPP and CTG weekly
d. Reassure patient and change EDC
e. BPP and CTG weekly and repeat US in 2 weeks
E
This describes a symmetrically small baby with no history of previous placental insufficiency therefore high
likelihood of aneuploidy. Amniocentesis may be indicated (? would change Rx) but not cordocentesis
.Para 3, all SVD at term weighing > 3600g. Now 36 weeks gestation with a 31 cm fundus. US BPD = 7.9
cm, BPP normal. Mx?
a. Delivery by CS
b. Karyotype the fetus
c. Biweekly US to assess fetal growth
d. Amniocentesis for L:S ratio
B
.A woman developed increasing pressure symptoms at 30 weeks. Known to have an O+ve blood group.
On examination, fundus 35cm, fetal parts difficult to identify. The CTG has a baseline FHR of 200 bpm
with no evidence of decelerations. No clinical evidence of chorioamnionitis. USS showed fetal pleural and
pericardial effusions. What is your next step in management?
a. Fetal pericardiocentesis
b. Commence on oral digoxin
c. Amniocentesis for fetal karyotype
d. Delivery
e. Observe and repeat US 2w
B
The clinical picture is consistent with hydrops fetalis. The likely cause of the hydrops is a fetal
tachyarrhythmia given that the FH is 200. The management of this would maternal administration of
digoxin.
.What level of fetal Hb is associated with fetal hydrops
a. 2
b. 4
c. 6
d. 8
e. 10
C
Difficult question as depends on gestation! – a deficit of 7 gives hydrops
Normal fetal Hb level = 7.8 + (0.19 x K) - which is roughly 0.19 x gestation in weeks – about 4 at 24 weeks, but 7.6 at term!.
.Fetal tachycardia, confirmed as SVT. Evidence of pericardial effusion and ascites on scan. Incorrect option:
a. Steroids
b. Digoxin
c. Amiodarone
d. Flecanide
e. Delivery
E
All are appropriate medications for treatment; Generally hydropic infants do poorly if delivered so aim for
an intra-uterine fix
Suspected fetal hypothyroidism is best managed by?
a. High dose of thyroid hormone to pregnant mother
b. Intra amniotic injection of thyroid hormone
c. Nothing until delivery then thyroid hormone to neonate
C
Management in suspected fetal hypothyroidism?
a. give mother thyroxine
b. intraamniotic thyroxine
c. do nothing in utero but give thyroxine to neonate
d. none of the above
C
A woman has SLE diagnosed during her pregnancy. Which of the following maternal antibody is most
likely associated with fetal heart block?
a. Anti SSA
b. Anti SSB
c. LA
d. ACA
e. Anti Ro
E
Anti Ro (SSA) , Anti La (SSB) both cause CHB
.Which antibody is associated with congenital heart block?
a. SSA
b. Anti mitochondrial
c. Anti smooth muscle
d. Anti cardiolipin
A
.A woman with SLE consults you regarding the risk of congenital heart block if she has anti-Ro antibodies.
An estimate of this risk is?
a. <10%
b. 20%
c. 40%
d. 50%
e. >90%
A
Which of the following conditions is not associated with non-immune hydrops?
a. fetal lupus
b. trisomy 21
c. anti-c
d. parvovirus B19
e. congenital toxoplasmosis
C
Aneuploidy (10%), infections (including toxoplasmosis; 8%), and anaemia (including parvovirus; 10-27%)
all cause NIHF. Fetal lupus can cause congenital heart block which would cause NIHF. Anti-c is not associated with NIHF (does cause immune hydrops)
There is a result of 40mL of fetal cells on Kleihauer at delivery of a negative woman. How much anti-D
should be given?
a. 1 vial
b. 2 vials
c. 5 vials
d. 7 vials
e. 10 vials
D
One vial = 625 IU = 125mcg = 6ml fetal blood
What is the most correct response for a woman who is positive for Kell antibodies?**
a. If intrauterine transfusion is required, it is okay to use the mother’s blood
b. Amniocentesis with monitoring of the delta-OD 450 is an acceptable means of monitoring
disease activity
c. The commonest phenotype is Kk
d. Kell antibodies affects erythroblasts as well as causing haemolysis
D
The most common phenotype is kk (75%)
.A woman has positive Kell antibodies. Which is true?
a. Amniotic fluid levels of bilirubin are not as reliable a marker of fetal anaemia with anti Kell as
opposed to anti Duffy
b. The commonest genotype in the community is Kk
c. The baby can be given a transfusion with maternal blood
d. Fetal anaemia is due to suppression of erythropoiesis as well as haemolysis
A or D
Kell antibodies are found in a primip at 12 weeks. The first step is to:
a. Check husbands blood group
b. Repeat level at 34 weeks
c. Amniocentesis
d. Ignore as this is the first pregnancy
A
With a Kell titre of 1:2056 at 19 weeks and husband karyotype KK all true except:
a. Next step is fetal blood sampling
b. Most Kell in population is found in heterozygotes
c. Exchange transfusions have a lower mortality than intra amniotic transfusions
B
9% of whites and 2% of blacks have the kell antigen and almost all are heterozygotes
.A primigravida with a positive antibody screen shows anti-S Ab in the first trimester. Should you?
a. Obtain paternal genotype
b. Tell her not to worry as anti’s doesn’t cause haemolysis
c. Quantify the titre
d. Do US at 18/40 looking for early hydrops fetalis
e. Repeat titre at 16/40
A
Anti-S can be associated with haemolytic disease
.If woman has a titre of 1:16 at 12 weeks of anti-Fya, next step in management is
a. US at 18/40 looking for hydrops
b. Repeat titre at 16 weeks
c. Check husbands karyotype
d. Reassure that Fya is not associated with isoimmunization
C
Titres as low as 1:8 are associated with disease (C&R)
.Question about Anti D antibody receptors
a. Phagocytosis of the antibody into the cell
b. IgG 1, sometimes IgG 1 and 3
c. FuC (?) receptors
B
Anti-D IgG antibodies that are responsible for severe cases of HDN belong chiefly to IgG1 and IgG3
subclasses
With Rhesus incompatibility which is the most reflective of the fetal condition?
a. Amniocentesis to detect the concentrations of bilirubin products
b. Amniocentesis to detect anti-D antibody levels
c. An USS to detect fetal well being
d. Maternal antibody levels
e. A detailed history of past pregnancies
Probably irrelevant now
Answer: C – assuming MCA Doppler (otherwise A)
Most useful investigation of fetal condition in sensitised female who is RH negative?
a. Maternal antibodies
b. US
c. Amniocentesis antibody titre
d. Amniocentesis to measure bilirubin like compounds
Probably irrelevant now
Answer: B
You have been referred a patient who has anti-D titres of 1 in 32 at 35 weeks gestation. What would be
the most appropriate treatment?
a. Do nothing
b. Deliver at 35 weeks
c. Intrauterine transfusion
d. Amniocentesis
D
C&R states that once the critical titre is reached (usually 32) MCA-PSV should be measured weekly. If
there has been a previously affected pregnancy maternal titres are not predictive of the degree of fetal
anaemia. Optimal options not present (again)
4.Your patient has an anti-D titre of 1:256 at 6w. The OD 450 at 28w is 0.08 (zone 1). The father is
heterozygous for RhD. All of the following are correct except:
a. Decreased OD 450 may mean the fetus is RhD negative
b. Decreased OD 450 may mean the fetus is mild to moderately affected
c. OD 450 is as good as US for predicting fetal erythroblastosis
d. OD 450 levels are altered by polyhydramnios
e. OD 450 levels are altered by bloody tap
No longer relevant
Answer: C apparently
.A lady who is Rh negative has an anti-D level of 1:256 at 30 weeks. Amniocentesis was performed and
sent for OD 450 studies. A level of 0.07 was noted. What is the next appropriate step?
a. Repeat amniocentesis in 2 weeks
b. Repeat anti-D level in 2 weeks
c. Cordocentesis
d. Commence on intraperitoneal transfusion
e. Perform serial ultrasound
A
OD 450 < 0.09 suggests mild or no disease; OD 450 > 0.15 suggests severe disease; Need to plot on graph
to calculate next option
Last pregnancy complicated by Rhesus isoimmunisation and was delivered at 36 weeks. Baby required
several exchange transfusions. In her current pregnancy, FBS should be commenced at:
a. 18 weeks
b. 26 weeks
c. 28 weeks
d. 30 weeks
e. 32 weeks
B
Now irrelevant but 10 weeks prior to last affected pregnancy
.A 32 year-old woman, G2P1 with one term delivery of a live infant. Her blood group is O neg. She is in her
second pregnancy with an anti-D level of 1:32. At 30 weeks gestation. US exam is normal. What is your
next step of management?
a. Repeat anti-D level at 36 weeks
b. Amniocentesis
c. Cordocentesis
d. Check the husband’s blood group
e. Repeat the US at 36/40
D
A 32/40 multi is referred to you with an anti-D titre 1:4, last pregnancy uneventful. USS today displays a
live fetus, no hydrops and anterior placenta. Do you order?
a. CTG
b. Cordocentesis
c. Amniocentesis
d. Repeat titre in 2/52
e. Elective LUSCS at 35-36/40
D
32 yo woman G2P1 with 1 term delivery of a live infant. Her blood group is O neg and she is at her 2nd
pregnancy with an anti-D level of 1:4. At 30/40, US is normal. What is your next step?
a. Repeat anti-D level at 36/40
b. Amniocentesis
c. Cordocentesis
d. Check the husbands blood group
e. Repeat US at 36/40
D
.Which of the following antibodies is not associated with isoimmunisation?
a. anti-C
b. anti-Kell
c. anti-Lewis
d. anti-Kidd
e. anti-p
C
All a cause of haemolytic disease of newborn except:
a. Kell
b. Duffy
c. Lewis
d. ABO
C
Which Ab does not cause haemolytic disease of the newborn?
a. Anti FYa
b. Anti P
c. Anti K
B
Which of the following blood antigens are associated with fetal erythroblastosis EXCEPT:
a. Lewis
b. I
c. Kell
d. Kidd
e. Duffy
A or B
Lewis and I antibodies do not cross the placenta
4.Which is most incorrect statement regarding the accepted management of ITP?
a. LUSCS of no benefit to fetus with known severe thrombocytopenia
b. Fetal risk can be determined by maternal anti-platelet antibody titre
c. Fetal risks increased if mother has Phx of splenectomy
d. Fetal scalp sampling shouldn’t be used because of risk of bleeding
e. Maternal steroids should be given if the maternal count drops below 100
B or E
.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
C
MG presents unbooked in early labour. Platelet count is incidentally noted to be 90000. Management?
a. Allow to labour and anticipate vaginal delivery
b. LUSCS
c. Assess fetal platelet count (scalp or cordocentesis)
d. Plasmapheresis
A
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
Mainstay of treatment for neonatal allo-immune thrombocytopenia is?
a. Steroids
b. Intrauterine platelet transfusion
c. Maternal immunoglobulin
C
.Alloimmune thrombocytopenia, management, correct option:
a. IV immunoglobulin
b. Plasmapheresis
c. Prednisolone
d. Betamethasone
e. Fetal platelet transfusion
A
What is the frequency of PLA1 negative in women?
a. 0.0005%
b. 0.0002%
c. 0.002%
d. 0.02%
e. 2%
f. 20%
E
Otherwise known as HPA-1a antigen, involve in NAIT. UTD
.The common cause of non-bacterial fetal infection is?
a. Toxoplasmosis gondii
b. Rubella
c. CMV
d. Syphilis
e. HSV
C
Which state has the greatest clinical infection of Candida?
a. 1
st trimester
b. 2
nd trimester
c. 3rd trimester
d. Post partum
e. Post menopause
C
.Asymptomatic bacteruria in pregnancy – which is wrong?
a. common association with urinary tract abnormality
b. PTL
c. 5-10% incidence
d. with no treatment 20-30% acute pyelonephritis
A
Acyclovir may be used with what infection in pregnancy?
a. Rubella
b. CMV
c. Varicella
d. Toxoplasmosis
C
.A primigravida at 16 weeks develops primary genital herpes. Most important management is:
a. analgesia
b. acyclovir
c. Herpes antibodies detection
d. Serial obstetric US
e. Counselling about recurrence in pregnancy
B
Antiviral therapy will reduce pain, length of symptoms and duration of viral shedding. If primary herpes is already diagnosed serology will not add to diagnosis (analgesia would be second-line). Serial USS are probably unnecessary as although congenital infection occurs it is rare. Counselling is important but
probably not as important that treatment.
A 21 yo primigravida at 30 weeks gestation presents with an acute primary episode of HSV2 of the vulva.
Which is the most important?
a. Treat with acyclovir
b. Treat with tetracycline
c. Local symptomatic treatment
d. Counselling regarding the long term risks of recurrence
e. Plan for CS for delivery
A
A patient has a secondary attack of herpes at 38w. She is not in labour and the membranes are intact.
Which is correct?
a. expectant management
b. perform CS now
c. perform CS when in labour
d. commence acyclovir
e. expect vaginal delivery and prophylactic acyclovir to the newborn
A
You have been looking after a pregnant patient who has a past history of recurrent genital herpes. She
presents to you at 38 weeks with a herpes lesion which has been confirmed with viral culture. Your
management is?
a. Immediate CS
b. Await spontaneous labour or ROM and perform a CS then
c. Culture the cervix weekly and allow vaginal delivery when culture are negative
d. Await SROM or spontaneous labour and assess the lesion then and decide on mode of
delivery based on the lesion at the time
D
.A 20yo woman has an attack of genital herpes at 20 weeks. She is now 38w pregnant and has developed
another attack. Management:
a. CS immediately
b. Wait until 40 weeks and then do CS
c. Wait for SROM then do CS
d. Wait until 40 weeks and decide on clinical picture of eruptions
e. Expectant vaginal delivery
?E
Which of the following is correct about genital herpes in pregnancy?
a. topical acyclovir is significantly shortened the duration of viral shedding in recurrent episodes
of genital herpes
b. prophylactic acyclovir is advisable to the neonate if the mother has a recurrent attack of herpes infection in labour
c. serologic studies are effective in predicting neonatal transmission
d. those infants who develop neonatal herpes infection have documented maternal infection
e. all patients should have an amniocentesis at term if positive genital cultures in order to
determine the mode of delivery
B
HSV. Which is wrong?
a. Anti-HSV1 gives partial protection against HSV2
b. HSV2 is usually genital infection
c. HSV is more common among women with CIN
d. If pt has lesion at 38/40, not in labour, warrants CS now
e. In event of recurrent HSV, decide at time of ROM or labour on mode of delivery
D
The best indicator for the management of labour in a patient with a past history of genital herpes is
currently?
a. Culture results
b. Pap smear
c. Serological testing
d. Clinical assessment early in labour
e. Patient preference
D
?TPHA 1:8 in early pregnancy. History of treated syphilis What do you do?
a. Obtain RPR/VDRL
b. Treat with penicillin
c. Contact tracing
d. Obtain records of prior titre levels
A
TPHA once positive – always positive
A woman attends antenatal clinic in early pregnancy.
She has a positive RPR/VDRL 1:8 with a history of syphilis treatment. What do you do?
a. Obtain TPHA/FTA
b. Treat with penicillin
c. Contact tracing
d. Obtain records of prior titre levels
?
Secondary syphilis treatment
a. Procaine penicillin 5million units IV
b. Benzathine Penicillin 2.4million units IM
c. Ampicillin 500mg QID for 7 days
d. Doxycycline 100mg QID for 7 days
e. Ofloxacin 400mg BD for 7 days
B
Hepatitis serology is positive for Hep B core Ab but negative for Hep B surface antigen and antibody. This
indicates?
a. Chronic carriage
b. She will become Hep B surface Ab positive in the near future
c. Never had hepatitis B
d. Cross reaction with hepatitis A
e. She is highly infectious
B
A woman presents at 10 weeks gestation. Her partner has recently been diagnosed with acute hepatitis B.
She is negative for HBsAb, HBsAg, HBcAb, HBeAb. What do you do?
a. Commence vaccination for Hep B
b. Give Hep B IV Ig
c. Give Hep B IV Ig and commence vaccination
d. Vaccinate post partum
e. Can’t remember
C
Vaccine and Iv Ig if high risk exposure (sex, IVDU, mucosal)
.With respect to needle stick injury what is the LEAST likely?
a. Risk of transmission of Hepatitis C if the patient is positive is 2%
b. Risk of HIV infection if the patient is HIV positive is 0.3%
c. Risk of infection with Hepatitis B if the patient is sAgen positive is 30%
d. Risk of contracting hepatitis C from a blood transfusion is one in a million per unit
e. None of the above
A
What is the transmission rate to the fetus if the mother is HTLV3 (HIV) positive
a. 0 %
b. 10%
c. 30%
d. 50%
e. 100%
C
First world ?15-20%; third world 25-40%
All true of HIV except?
a. More risk from intercourse with an infected female than with an infected male
b. May develop symptoms in pregnancy in HIV positive women
c. Shown that virus carried in breast milk
d. First presentation may be with Pneumocystic carinii
A
Parvovirus B19 is associated with?
a. Rapid progression of cervical dysplasia to invasion
b. Fetal anaemia and hydrops
c. Maternal pneumonia
d. Benign condylomata
e. Hepatitis C
B
.Regarding CMV:
a. Commonest intrauterine viral infection
b. Most infected infants are symptomatic
c. Contracted from eating undercooked meat
A
5-15% of infants are symptomatic at birth (C&R). CMV is the most common intrauterine viral infection
(UTD).
CMV, fetal infection rate if the mother seroconverts in pregnancy, correct option:
a. 100%
b. 80%
c. 50%
d. 20%
e. <5%
C
.Five days after a busy obstetric clinic one of the patients develops rubella. Should all of the rest of the
patients who attended the clinic?
a. Have rubella vaccine
b. Be tested for IgM Rubella antibodies
c. Be tested for IgG Rubella antibodies
d. Be given immune globulin
e. None of the above
C
Your patient is 8w and has been exposed to Rubella. Your management should include all of the following
except:
a. Perform IgG and IgM levels
b. If IgG negative then repeat IgM in 10 days
c. Administer IgM immunoglobulin if IgM positive
d. Counsel regarding the high risk of abnormality
e. Counsel regarding the risks of hearing, eye and ear defects
C
Regarding rubella?
a. Has 100% teratogenic effect if infected <10 weeks
b. First discovered in Australia
c. Can cause PDA
C
At < 8 weeks the risk of fetal damage is 90-100%, at 8-12 weeks it is 50%. The features of congenital rubella include PDA
.All of the following occur in congenital rubella except:
a. Cataracts
b. Deafness
c. IUGR
d. Cardiac defects
e. Renal dysplasia
E
Rubella infection
a. 1% risk of fetal syndrome in 2nd trimester
b. is a killed virus
c. viraemia precedes rash
d. attenuated by blood transfusion
C
20-50% risk of congenital rubella syndrome in second trimester; vaccine is a modified live virus; not
affected by blood transfusion; viraemia precedes rash
.Rubella vaccine?
a. Seroconversion in 85% of individuals
b. Causes a viral infection which is communicable
c. Can be transmitted in breast milk
d. A killed vaccine
e. Effectiveness reduced by blood transfusion
E
95% effectiveness, not generally communicable, live vaccine
Toxoplasmosis all true except:
a. A bacteria
b. Can cause fetal loss
c. Causes cerebral calcifications
d. Causes chorioretinitis
e. Hydrocephalus
A
Toxoplasmosis in pregnancy – all except
a. IgM = acute infection
b. Spread by cats
c. Incidence in Australia in pregnancy 10/1000
d. Treat with spiramycin
e. Chrorioretinitis is most common manifestation of latent infection
A vs C
Not quite as straight forward as doing an IgM; 1-8 per 1000 pregnancies; spiramycin is appropriate and
choriretinitis is the most common manifestation of latent infection (14%)
Incidence in Australia in pregnancy 10/1000 = (probably a touch high) 0.23/1000
Toxoplasmosis, incorrect option:
a. Keep away from cats
b. Important cause of cerebral calcification
c. 25-50% are immune to toxo in Australia
d. Usually asymptomatic
e. Spiramycin is the treatment of choice
A
30% immune in Australia (MJA article -2002, 176)
Which of the following is true regarding malaria?
a. Pyrimethamine-sulfadiazine causes kernicterus in neonate
b. Chloroquine is antimalarial of choice in pregnancy
A
Which does not cause intrauterine infection?
a. CMV
b. Polio
c. Mumps
d. Toxoplasmosis
e. Malaria
C
Pregnant woman with history of 4 month chronic cough, fever, night sweats, loss of weight. Has apical
lesion on CXR. Treatment would include:
a. streptomycin
b. erythromycin
c. isoniazid
d. penicillin
C
.Your 16 week patient has a mantoux reaction of 16mm. She is asymptomatic and has a normal CXR.
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
e. Rifampicin 100 mg daily for 12 months
B
.A 38 year old woman with no history of high risk exposure and no other risk factors has a Mantoux and it
is measured as a response of 16mm. CXR normal. Would your further management be?
a. No further treatment
b. Treatment with Rifampicin (gave dosage)
c. Treatment with Isoniazid (gave dosage)
d. Treatment with Isoniazid (different dosage)
e. Give BCG
A
Patient at her first antenatal visit had MSU with mixed contamination, including GBS. Options.
a. Treat with antibiotics and swab vagina at 28/40
b. Vaginal swab at 28/40
c. Vaginal swab and MSU at 28/40 then treat with oral antibiotics
d. Swab at 28/40 and treat intrapartum if positive
e. Treat in labour
? treat UTI and then prophylactic abx in labour
.Regarding GBS:
a. Maternal carriage is 50%
b. Neonatal sepsis is rare if the mother is clinically well
c. 10% of babies born of carrier mothers are sick
d. If isolated from amniotic fluid with PPROM should give antibiotics and deliver
e. Treat and wait
D
.Referred 34/40 with GBS on swab?
a. give course of ampicillin now
b. give course at 38 weeks
c. IV ampicillin in labour
d. Treat neonate with penicillin
e. None of the above
C
?but also repeat swab within 5wks of expected delivery
.GBS – most common location?
a. low vagina
b. urethra
c. GIT
C
Which of the following is least likely to have normal pregnancy outcome?
a. booking BP 140/90
b. maternal age 40 yrs
c. serum urea of 12
C
Which of the following conditions in pregnancy, when treated, would cause thrombocytopenia and/or
osteoporosis?
a. asthma
b. hypertension
c. pneumonia
d. pulmonary TB
e. pulmonary embolus
E
Treatment with steroids and heparin will cause both osteoporosis and thrombocytopenia.
.Obesity is not related to?
a. PET
b. Eclampsia
c. GDM
d. Chronic HT
B
Appropriate management of anaphylactic reaction to penicillin?
a. adrenaline 0.3-0.5mL of 1 in 1000 sc
b. adrenaline 0.3-0.5mL of 1 in 10,000 sc
c. hydrocortisone
A
0.3-0.5mg is the appropriate dose of adrenalin. 1:1000 is 1mg/ml.
Which of the following is appropriate management for an anaphylactic reaction to penicillin with BP
80/40?
a. Adrenaline 0.3-0.5 ml of 1:1000 sc
b. Adrenaline 0.3-0.5 ml of 1:10000 sc
c. Phenergan 25mg IV
d. Hydrocortisone 100 mg IV
A
0.3-0.5mg is the appropriate dose of adrenalin. 1:1000 is 1mg/ml
Patient in septic shock, hypotension, poor urine output, peripherally shutdown despite adequate fluid
resuscitation. Which of the following is likely to improve urine output?
a. Dopamine
b. Noradrenaline
c. Nitroprusside
d. The anaesthetic reg
A
Which of the following can be considered normal in pregnancy?
a. Diastolic murmur
b. Midsystolic click
c. Third heart sound
d. Ejection click
C
Which of the following cardiac anomalies is most likely to be associated with maternal mortality?
a. VSD
b. Aortic stenosis
c. Marfan’s syndrome
d. Primary pulmonary hypertension
e. Mitral valve prolapse
D
The order from greatest to least likely to be associated with maternal mortality is primary pulmonary
hypertension, aortic stenosis / Marfan’s syndrome, VSD, mitral valve prolapse.
Most likely to cause maternal mortality
a. Mitral stenosis
b. Diabetes
c. PIH
d. Pulmonary stenosis
A
Pulmonary hypertension most likely to be associated with?
a. Mitral stenosis
b. Eisenmenger’s
c. Preeclampsia
d. Aortic stenosis
B
Regarding mitral valve prolapse in pregnancy?
a. Requires prophylactic antibiotics for prevention of bacterial endocarditis
b. Most suffer palpitations
c. Is a cause of sudden death
B
Regarding mitral stenosis?
a. It is the worst cardiac lesion to have in pregnancy
b. It is unusual to cause any problems if it is grade 1 or 2 at conception
c. If it produces cardiac failure before 32 weeks valvotomy will often be required despite
medical treatment
d. The most common cause of death is cerebral emboli from atrial thrombus
e. Bacterial endocarditis is more common in pregnancy
B
AS is the worst lesions to have during pregnancy; no cut off for valvotomy; heart failure is the cause of
death.
.Which is most likely to cause pulmonary HT?
a. Eisenmenger’s syndrome
b. MS
A
Which of the following is associated with maternal mortality?
a. cholestasis of pregnancy
b. eclampsia
c. fatty liver of pregnancy
d. Chronic active hepatitis
e. Hepatitis A
C
PG presented at 14 weeks with booking BP 160/110 at rest. Which of the following is most lethal?
a. acute glomeruonephritis
b. PIH
c. Eclampsia
d. Hydatidiform mole
e. Phaeochromocytoma
E
Phaeochromocytoma in pregnancy is associated with?
a. Paroxysmal episodes of HT
b. High urinary levels of hydroxy indole acetic acid, HIAA
c. Obstetric collapse
d. Tumour in adrenal cortex medulla
e. Glucose intolerance
A
High urinary levels of hydroxy indole acetic acid, HIAA (breakdown product of serotonin –
screen for carcinoid tumours = metabolically actove GIT tumour)
Tumour in adrenal medulla
10 weeks pregnant, essential HT, which drug contra-indicated?
a. Aldomet
b. Hydralazine
c. Labetolol
d. Oxprenolol
e. Captopril
E
.Which of the following is not associated with thrombosis?
a. activated protein C deficiency
b. protein S deficiency
c. thrombin 3 deficiency
d. factor V leiden mutation
e. antiphospholipid syndrome
C
A patient who is 26 weeks pregnant presents with a cold, swollen right leg. You suspect a DVT and doppler
ultra sound is done which shows no DVT. Her leg feels cold and has sluggish venous return. Your next
investigation would be?**
a. CT venogram
b. Duplex doppler of the pelvic veins
c. MRI pelvis
d. Pelvic ultra sound
e. Discharge home
B
Iliofemoral thrombosis is best diagnosed in pregnancy by
a. duplex Doppler studies
b. impedance plethyebogram
c. contrast venogram
d. fibrinogen uptake test
A
Impedence plethyesmogram is a complicated test for DVT now rendered obsolete by USS; likewise for
contrast venogram. Fibrinogen uptake test, similar to D-dimer is not specific enough during pregnancy.
Pulmonary Embolus – all are correct except?
a. Classical presentation in < 5%
b. Most large PE’s have clinical DVT’s
c. Symptoms depend on site, size and number
d. 60% obstruction of pulmonary vessels leads to raised right atrial P and CVP
e. Most are clinically unrecognised
B
All of the following are typical of a massive pulmonary embolism except:
a. pulmonary vascular congestion on CXR
b. retrosternal chest pain
c. evidence of right ventricular strain
d. tachypnoea
A
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
B
A woman at 32w developed sudden onset of dyspnoea and lung scan showed VQ inequality. The starting
dose of heparin would be
a. 10,000 to 15,000 U/24 hours
b. 30,000 to 35,000 U/24 hours
c. 5000U stat + a)
d. 5000U stat + b)
D
Initial dosing of IV UFH consists of an IV UFH bolus of 80 units/kg, followed a continuous infusion of 18
units/kg per hour. (UTD)
Which one crosses the placenta?
a. Heparin only
b. Warfarin only
c. Heparin and warfarin
d. None of the above
B
Which of the following is monitored by bleeding time?
a. Heparin only
b. Warfarin only
c. Heparin and warfarin
d. None of the above
D
.Which one causes stippling of the epiphysis?
a. Heparin only
b. Warfarin only
c. Heparin and warfarin
d. None of the above
B
Which one causes lysis of the thromboses?
a. Heparin only
b. Warfarin only
c. Heparin and warfarin
d. None of the above
D
.A G2P1 whose last pregnancy was 8 months ago is now 12 weeks pregnant. Her Hb is 90 and Hct 28 with
a microcytic anaemia on film. She feels tired and has had no treatment. What is the best explanation?
a. iron deficiency anaemia
A
Given the short inter-pregnancy interval
Which of the following are rich sources of Fe and Zn?
a. Meat
b. Green vegetables
c. Bread and cereals
d. Milk
e. Rice
A
Zinc deficiency causes:
a. Anaemia
b. IUGR
c. Prem labour
C
Which of the following is considered normal in the second half of pregnancy?
a. MCV 105 fl
b. WCC 12x10 (9) /l
c. Platelets 100,000
d. Reticulocytes 15% of red blood cell count
B
.In a woman who is found to have Hb 9 g/dl, MCV 70fl, MCHC 28, serum iron 6 and TIBC 109, which is most
likely?
a. A microcytic picture on blood film
b. Target cells
c. Reticulocyte count of 10%
d. She should be treated with folic acid
e. High urea levels
A
This picture is consistent with iron deficiency anaemia. Target cells occur with haemoglobinopathies
.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
.Which of the following tests is most useful in diagnosing haemoglobinopathy?
a. HbEPG
b. Bone marrow
c. DNA analysis
d. Red cell index
e. Blood film
C
Which of the following is most normal in a normal pregnancy?
a. MCV 105
b. WCC 12
c. Platelets 100,000
d. Reticulocytes 15%
B
22yo nulliparous patient has a mother with IDDM. At first visit in 1st T, her urinalysis is normal. Advise the
patient
a. no chance she will develop diabetes
b. needs a formal GTT in 2nd T
c. start prophylactic insulin
d. if does not develop glycosuria, no risk of developing DM
e. monitor her by doing fasting BSL in pregnancy
B
This patient has a substantial risk of developing GDM and as such should be screened in 2nd T.
In a RCT the proven benefits of screening for GDM are
a. Decreased PNM
b. Decreased shoulder dystocia
c. Decreased neonatal jaundice
d. All of the above
e. None of the above
D
No RCT on screening, several RCTs on treatment - Probably referring to ACHOIS
22 year-old primigravida presents in first trimester. Mother has NIDDM, urinalysis –ve glucose, no
ketones. Which is true?
a. She has 2% chance of developing GDM this pregnancy
b. She should have a GTT 6/52 post partum
c. If urinalysis shows no glycosuria the chance of GDM adversely affecting pregnancy is minimal
d. She should have a GCT now
All of the above incorrect; The risk of GDM would be >3%
Answer: none
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
B
G6P5 with 5 NVD’s of 4-4.5kg babies, presented to ANC for 1st time at 32w. Obstetric US at 18w which
showed singleton fetus consistent with gestation and no abnormalities. On palpation fundus 40cm,
gained 5 kg in last 4 weeks and GTT 7.8 mmol/l at 1 hr and 12 mmol/l at 2 hrs. What is next appropriate
step?
a. general advice on diet and rpt GTT
b. low carbohydrate diet
c. diet modification to limit her caloric intake to 2100kcal/dy
d. commence on insulin
e. admit to hospital
D
Pregnant lady in first trimester with the following GTT. Fasting BSL 6.8, 2 hrs post 100g load 12.6. Mx?
a. admit for stabilisation
b. commence on oral hypoglycaemic agent
c. commence on insulin as an outpatient
d. repeat the test in the second trimester
e. counsel on dietary measures
C
Which is not common in diabetic pregnancy?
a. hyperemesis
b. PET
c. PTL
A
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
D
Most common cause of hyperthyroidism in pregnancy?
a. toxic multinodular goitre
b. Grave’s disease
c. Toxic single adenoma
d. Iatrogenic
B
The most common cause of hypothyroidism in pregnancy is?
a. Congenital
b. Autoimmune thyroiditis
c. Previous surgery
d. Previous ablation with radioiodine
e. Drug related
B
In first trimester, a PG presents with N & V, tachycardia. TFT show slight increase in free T4, decrease in TSH, and normal RT3. This is associated with:
a. Normal
b. hyperemesis gravidarum
c. Graves disease
d. Hashimoto’s thyroiditis
e. Non-toxic goitre
B
A woman at 16 weeks at ANC, OE: small nodular goitre. TFT showed increase in total T3 and free T4 and
T3. TSH normal. Which is correct?
a. Normal
b. Hyperemesis
c. Grave’s disease
d. Hashimoto’s thyroiditis
e. Non toxic goitre
E
Normal changes in pregnancy are increased TBG with small increased total T4 and T3 to compensate. Hyperemesis and
Grave’s would have a decreased TSH whilst Hashimoto’s would be hypothyroid. A goitre is not normal.
Usually found in trophoblast associated hyperthyroidism?
a. increase free T3 and T4
b. increase total T3 and T4
c. low measurable TSH
d. all of the above
D
Which of these crosses the placenta the least?
a. TSH
b. T4
c. TRH
d. Propylthiouracil
A
What has the least effect on the fetus when given to the mother?
a. TSH
b. TRH
c. Thyroxine
A
TRH can cross the placenta and will effect the fetus whilst little TSH crosses the placenta. The effect of
thyroxine is controversial and may effect the fetus.
.Post partum thyroiditis typically begins with transient?
a. Hyperthyroidism
b. Hypothyroidism
c. Goitre
d. Exophthalmos
A
The normal outcome of post-partum thyroiditis at 12 months is?
a. Hyperthyroidism
b. Hypothyroidism
c. Euthyroidism
C
Pregnant women with thyroid nodule. Mx?
a. Observe for 3/12 then biopsy
b. Immediate FNA
c. Immediate excision biopsy
d. Suppressive therapy if persists
e. Radioactive iodine localisation
B
A woman is pregnant after bromocriptine treatment of a pituitary macroademoma. Management during
pregnancy should include:
a. Continue bromocriptine
b. Visual field assessment
c. X-ray sella turcica
d. Neurosurgery
B
Regarding inflammatory bowel disease in pregnancy?
a. Ulcerative colitis is associated with reduced fertility compared to Crohn’s disease .
b. It gets worse in pregnancy and the puerperium
c. Surgery should not be delayed due to pregnancy
d. Sulfasalazine is C/I in pregnancy
C
fertility may be decreased in active crohns
A woman with stable Crohns Disease presents in her first trimester. Her MCV is 86 and her B12 level 115
(N=>127). Your management would be:
a. No treatment
b. Give IMI B12
c. Commence on Fefol
d. Repeat the test
B
.Which dermatologic sign is not physiologic in pregnancy?
a. chloasma
b. linea nigra
c. vitiligo
C
Which of the following dermatological conditions is not associated with pruritus and papules?
a. Pruritus gravidarum
b. Herpes gestationis
c. PUPPP
d. Prurigo gestationis
e. Prurigo anularis
A
Pruritus gravidarum is the old term for obstetric cholestasis. Herpes gestationis is otherwise known as
gestational pemphigoid, a blistering, painful rash occurring typically in the 2nd or 3rd trimester of
pregnancy. PUPPP is pruritic urticarial papules and plaques of pregnancy. Prurigo gestationis is prurigo of
pregnancy consisting of erythematous, excoriated nodules or papules on the extensor surfaces of the
limbs and trunk. Unsure what prurigo anularis is.
.Herpes gestationis can be diagnosed if?
a. Similar skin lesions are noted in subsequent pregnancies
b. Similar skin lesions are noted in association with the OCP or menstruation
c. There is peripheral eosinophilia
d. Herpes serology is positive
e. On histologic examination complement and IgG is seen adjacent to the basement membrane
between the dermis and epidermis
E
Herpes gestationis is pemphigoid gestationis; it recurs with subsequent pregnancies and has 25% chance
of flare with menses and OCP. There is a peripheral eosinophilia but herpes serology is normal.
Complement and IgG is present adjacent to the basement membrane.
Which of the following dermatological conditions is associated with pruritis and bullae?
a. pruritis gravidarum
b. herpes gestationis
c. PUPPP
d. Prurigo gestationis
e. Prurigo anularis
B
.Which neurologic disorder is specific for pregnancy?
a. Bell’s palsy
b. Nystagmus
c. Meralgia paraesthetica (LFCN entrapment)
Answer: A and C occur more often in pregnancy
Regarding Bell’s palsy
a. It is caused by compression of the pterygo-pallatine fossa
b. It responds to anti-inflammatory drugs
c. It causes a sensory nerve deficit
d. It is most common in late pregnancy
D
Regarding Bell’s palsy:
a. Results from compression
b. Increased in T3
c. Is permanent
B
A 32 year-old presents at 35/40 with recent onset malaise. BP 130/84, AST + ALT elevated, bilirubin 80,
platelets 60. O/E cervix long and closed. Management?
a. IOL
b. LUSCS
c. Upper abdominal US for gallstones
d. Bed rest
B
.A woman is 31w pregnant and presented with RUQ pain for 2 days. BP 140/90. No proteinuria. Normal
reflexes. Abdominal examination revealed mild tenderness over the right hypochondrium. BSL 2.5. Plt
150. UA 0.31. Hb 11. LFT: AST 100, ALT 30, ALP 160. CTG normal. Which of the following is correct?
a. perform an USS to exclude gall stones
b. Acute fatty liver of pregnancy
c. Consistent with PET, give steroids and deliver
d. Obstetric cholestasis
e. Hepatitis
B
32 weeks gestation twins. Unwell for 2 days. Coffee ground vomitus. Appears drowsy and unwell. BP
130/85. Slightly jaundiced, tender in RUQ and epigastrium. Blood BR 30, GGT 455, AP 180, creat 100 UA
450. The most likely diagnosis is?
a. PET
b. Gallstones
c. Obstetric cholestasis
d. Acute FLP
e. Hepatitis
D
.Regarding acute fatty liver of pregnancy?
a. Prompt delivery improves prognosis
b. Avoid subsequent pregnancy due to high risk of recurrence
c. Related to a previous diagnosis of viral hepatitis
A
.PG at 32w presents with vomiting, epigastric pain. LFT’s abnormal, platelets 60. Cervix long and closed.
BP normal, no proteinuria. What do you do?
a. USS liver
b. Induction
c. Caesarean
d. Watch and wait
C
Most common cause of jaundice in pregnancy?
a. hepatitis
b. cirrhosis
c. PET
A
