Ward 38

Question 1

What is alkaline phosphatase (ALP)?

Answer 1

ALP is a protein enzyme that is found in high concentration in the placenta, bone, and bile duct.

Question 2

What is high ALP a sign of?

Answer 2

Cholestasis

Question 3

Why is ALP physiologically high in pregnancy?

Answer 3

ALP is found in high concentration in the placenta, thus as the placenta grows, there is more ALP.

Question 4

What is alanine transaminase (ALT)?

Answer 4

ALT is an enzyme found in high volume within the hepatocytes.

Question 5

What is high ALT a sign of?

Answer 5

Hepatocellular injury

Question 6

What is bilirubin?

Answer 6

A breakdown product of haemoglobin

Question 7

What do pale stools and dark urine suggest about the cause of jaundice?

Answer 7

Post-hepatic cause

Question 8

What does normal stools and dark urine suggest about the cause of jaundice?

Answer 8

Hepatic cause

Question 9

What does normal stools and normal urine suggest about the cause of jaundice?

Answer 9

Pre-hepatic cause

Question 10

What does a ALT>AST suggest?

Answer 10

Chronic liver disease

Question 11

What does AST>ALT suggest?

Answer 11

Cirrhosis/acute alcoholic hepatitis

Question 12

What is a GI differential of pruitis during pregnancy?

Answer 12

Intrahepatic cholestasis of pregnancy (ICP)

Question 13

What are symptoms of pre-eclampsia?

Answer 13

Headache, visual disturbance, RUQ pain, nausea and vomiting (2nd and 3rd trimester), oedema

Question 14

What causes pre-eclampsia?

Answer 14

Vessel reorganisation to the small arteries suppling the kidney, placenta and liver (thus also the foetus)

Question 15

Why is there oedema in pre-eclampsia?

Answer 15

Vascular hyperpermeability due to low serum albumin

Question 16

What blood test can determine whether RUQ pain is due to cholestasis or something else?

Answer 16

Bile salts

Question 17

Why might you not be concerned if CRP is raised but WBC are coming down?

Answer 17

CRP lacks behind WBC

Question 18

What is CRP?

Answer 18

CRP is c-reactive protein. This is a protein made by the liver. It enters the bloodstream in response to inflammation.

Question 19

What is the reason behind physiological anaemia of pregnancy?

Answer 19

In pregnancy the circulating blood volume increases. Plasma rises proportionally more in comparison to red cells. This causes haemodilution. There are still more RBC than before pregnancy, but these red cells are more diluted.

Question 20

What happens to asthma during pregnancy?

Answer 20

1/3 get better
1/3 stay the same
1/3 get worse

Question 21

Why do some asthmatics get worse during pregnancy?

Answer 21

Dampened immune response to allergens

Question 22

When do you give iron infusion after delivery?

Answer 22

Hb < 85

Question 23

When is hypertension deemed gestational hypertension and not chronic hypertension?

Answer 23

When hypertension occurs after 20 weeks gestation.

Question 24

What BP is deemed as hypertension in pregnancy?

Answer 24

> 140/90

Question 25

What is a normal haemoglobin after delivery?

Answer 25

> 100

Question 26

What is a normal haemoglobin during pregnancy?

Answer 26

> 110

Question 27

When do you give a blood transfusion for anaemia after pregnancy?

Answer 27

Hb < 70

Question 28

What drug is first line for hypertension during pregnancy?

Answer 28

Labetalol

Question 29

What drug is second line for hypertension during pregnancy?

Answer 29

Nifedipine

Question 30

What drug is third line for hypertension during pregnancy?

Answer 30

Methyldopa

Question 31

How does labetalol work?

Answer 31

It is a beta blocker, working to reduce BP by decreasing heart rate and relaxing blood vessels

Question 32

How does nifedipine work?

Answer 32

It is a calcium channel blocker, working to reduce BP by arterial vasodilatation

Question 33

How does methyl dopa work?

Answer 33

It is a centrally-acting alpha-2 adrenergic agonist, working to reduce BP by arterial vasodilatation