MATERNAL MEDICINE – SBA

1. 30 years old Primigravida at 34+ weeks presented with severe itching including the palms and soles and is worse at night. Her liver function tests were normal, and emollients did not give her relief. Your consultant starts her on ursodeoxycholic acid (UDCA) and antihistamines. All the statements are false regarding obstetric cholestasis (OC) except,

2. A 34 year-old woman is 16 weeks pregnant in her third pregnancy. Her blood pressure is 155/105 mmHg; 4 weeks earlier, it was 160/102 mmHg. Her urine dipstick shows + protein. Her spot urinary protein/creatinine ratio is 40mg/mmol. Which one of the following is considered the most likely diagnosis?

3. 40 year old primigravida has just identified that she is pregnant at 34 days of amenorrhoea. She is a known chronic hypertensive on captopril. What is the most appropriate management?

4. 31 year old P1L1 was delivered 6 weeks before at 28 weeks of gestation due to severe pre-eclampsia and HELLP syndrome. During her postnatal review, her BP is found to be normal and she was on anti-hypertensives for 2 weeks following delivery. She is very anxious that she may develop pre-eclampsia again in the subsequent pregnancy. What is the risk of recurrence of pre-eclampsia in her subsequent pregnancy?

5. 32 year old woman has presented with obstetric cholestasis at 35 weeks of gestation. She was put on menandiol sodium phosphate of 10 mg daily in view of prolonged prothrombin time. Which of the following complications is likely to happen to the neonate in this scenario?

6. A 35 year old woman with severe pre-eclampsia has had an emergency caesarean section at 32 weeks gestation because of severe IUGR. She became hypotensive and tachycardic and was returned to theatre where 2l of blood was evacuated from the abdomen and hysterectomy was performed. One week later, she developed sudden onset of severe chest pain and breathlessness and dies despite resuscitation. What is the diagnosis?

7. A healthy 23 year old woman has been referred to the antenatal clinic at 10 weeks gestation in her second pregnancy. Her first pregnancy was complicated by intra-uterine foetal death at 41 weeks gestation and she developed DVT after delivery. Following full investigation, she was found to have APAS. Her mother and sister both suffer from essential hypertension. Her BMI is 27 kg/m2 and her BP is 120/85 mmHg. Urine analysis showed no abnormalities. How will you manage the patient in this pregnancy?

8. A 27-year-old para 1 comes to your clinic requesting contraception. She mentions that her maternal aunt had deep vein thrombosis (DVT) and is on warfarin. She is worried that if she takes hormonal contraception, she will also develop DVT. Which of the following advice regarding DVT is incorrect?

9. Which of the following is the primary diagnostic test for DVT in pregnancy?

10. A woman with an uncomplicated pregnancy of 26 weeks gestation is about to go on a long haul flight to visit relatives in America, from India. She has a BMI of 37, is a smoker and she will be returning to the UK at 30 weeks gestation. Select the best advice regarding thromboembolism prevention in her case.

11. All of the following about LMWH are true compared to UFH except:

12. What is the risk of VTE in pregnancy after IVF with OHSS?

13. A 37-year-old para1 attends the delivery suite with periodic abdominal pain at 34 weeks’ gestation. She has diabetes and is on insulin. On examination there is a closed cervix and a positive fetal fibronectin test. What is the most appropriate management plan?

14. A 30-year-old lady who had a stillbirth in her previous pregnancy has been found to have undiagnosed diabetes. She is currently on oral hypoglycaemic agents, with good glycaemic control, and attends for pre-pregnancy counselling. What is the appropriate next step?

15. A 20-year-old woman books into the antenatal clinic at 10 weeks of gestation. She is fit and well but is noted to have an increased body mass index (BMI) but no other risk factors for diabetes. What BMI and above should be offered screening for diabetes?

16.A 36 -year-old Pakistani lady has delivered her fourth baby normally. She is a known Type 2 diabetic for 5 years and was taking Metformin and isophane insulin in pregnancy for glycaemic control. The woman is planning to breast feed.

What advice should be given with regard to a hypoglycaemic agent in the postnatal period?

17. Ms Lily is 37 weeks pregnant. She has been diagnosed with gestational diabetes, which is well controlled by diet alone. Her 36-week growth scan shows a normally grown foetus with normal liquor and Doppler. She was screened for GDM in view of her ethnicity alone. Her pregnancy has been uneventful so far. Up to when can Ms Lily be offered elective birth if she remains undelivered?

18. A 29-year-old woman is 24 weeks pregnant. She has long-standing type 1 diabetes mellitus. Her 20-week foetal anatomy ultrasound showed no structural foetal abnormalities. However, she is concerned about whether her diabetes may cause congenital foetal anomalies in her unborn child.
Of the options listed below, which SINGLE action addresses her anxiety?

19. A para 1 who delivered 2 week ago, was diagnosed to have GDM (diet controlled), and her plasma glucose levels have now returned to normal.What follow-up should she have postpartum?

20. A woman who is Rhesus-negative undergoes a laparoscopic salpingectomy for an ectopic pregnancy at eight weeks gestation. What dose of anti-D immunoglobulin should she receive immediately after the operation?

21. You are asked to review the blood results of a 32-year-old woman at 28 weeks gestation in her second pregnancy. Which one of the following antibodies has significant risk of causing fetal anaemia?

22.Which of the following is true regarding anti-D prophylaxis in pregnancy?

23. You are following up a 22-week pregnant woman in the antenatal clinic. Her epileptic fits are well controlled on medications. What is the most common cause of maternal death secondary to epilepsy?

24.Pregnant women with epilepsy have the highest risk of breakthrough seizures during:

25. 17 year old female has recently been diagnosed with epilepsy. She currently takes the oral contraceptive microgynon. Which of the following anti-epileptic medications is likely to make her contraception less effective?

26. Which antiepileptic drug is least associated with the fetal anomaly shown below:

27. Which alternative AED may be considered as first line to replace seizures responsive to sodium valproate therapy (women with generalised epilepsy syndromes) in pregnancy?

28. A 32-year-old primigravida woman books at 12 weeks gestation with a BMI of 55. What management would you advocate

29. Regarding pregnancy outcome after bariatric surgery in obese reproductive agewomen, which of the following is true?

30. You are reviewing a 27 year old patient who is a known carrier for severe haemophilia and is due to undergo chorionic villous sampling. Which of the following should be checked pre-procedure?

31. A lady has hemophilia A, husband normal. She gave birth to female baby, what are the chances of her offsprings being carrier?

32. The target range for blood sugars during labour for a pregnancy complicated by pre-existing diabetes is:

33. Ms. Angel is here to meet you at the clinic, she is very anxious. She is trying for pregnancy,and one of her friendsrecently had an episode of thromboembolism during pregnancy.She has heard that pregnancy and childbirth increase the risk of thromboembolism. What is the incidence of VTE in pregnancy and puerperium?

34. Mrs. X, a 25-year-old woman is referred by midwife as she is found to have a platelet count of 90 x 10*9/l at a routine check-up at 28 weeks of gestation. Her platelet count at 12 weeks of gestation was 400 x 10*9/l. She has no history of travel, fever or any chronic conditions. What is the most likely diagnosis from the list below?

35. Both Mr and Mrs. Adams are cystic fibrosis carriers. Mrs Adams has In-vitro fertilization and preimplantation genetic diagnosis 12 embryos were formed. How many embryos will be affected?

36. Malaria in pregnancy is detrimental to the woman and her fetus.The majority of these infections are caused by

37. Mrs. Sara, 34years old, known Epileptic, para1Living1, just delivered by forceps. She was on carbamazepine, dose and frequency was increased during pregnancy. To avoid postpartum toxicity, of antiepileptics, when she should be reviewed ?

38. Mrs. Sara, is now14 weeks pregnant in her second pregnancy.She is a known case of epilepsy. Her first delivery was normal Vaughan delivery, first child is 8years old and diagnosed to have epilepsy. What is risk of this baby having epilepsy?

39. Mrs. Angel, has been diagnosed with chronic kidney disease.She is now here for her booking visit. Her creatinine level now I 175 μmol/ L. During counselling, she wants to know risk of her having preterm delivery.

40. Mrs.Fathima, 34years old, is here for pre conceptional counselling. She is known case of renal transplant. She is on Mycophenolate Mofetil.How long should she be advised to wait before conceiving?

41. Pregnant women with liver disease are associated with increased morbidity and mortality. Pregnancy with liver diseases carrying male baby is most common in which of the following conditions?

42. Mrs. Ruby is 32 weeks pregnant.She has been diagnosed with syphillis a week back. She has been prescribed Benzathine benzylpenicillin G, 2.4 mu intramuscularly day 0 and 7. What is the incidence of Jarisch –Herxheimer reaction during treatment?

43. Mrs.Lisa primigravida has presented with rash on abdomen that’s progressing to trunk and extremities sparing hands and face and umbilicus.What is the probable cause ?

44. Mrs. X is in her 32 weeks of pregnancy.This is her third pregnancy, she delivered her previous children by cesarean section, she is on etanercept for sero negative spondylising arthritis. She is asymptomatic now. When would you ask her to stop etanercept?

45. Mrs. Sweetie, now at 32 weeks, presented with neck pain,she has pre-existing hypertension with bicuspid aortic valve.Her pain is sharp and radiating to back and chest as well.History of syncope in the morning. On examination there is a pulse deficit. What is the test for definitive diagnosis?

46. Mrs. Juby, of Indian origin, isnow 33weeks pregnant. She complains of itching on the palmar aspect of the hands and plantar aspect of the feet, with the symptoms worsening at night, leading to disturbed sleep. No rashes noted. Her liver functions- normal bile acids and normal AST &ALT .
How frequently her liver functions tests need to be monitored if pruritus persists ?

47. A 29-year-old woman in her first pregnancy presents at the antenatal clinic complaining of recurrent attacks of migraine. She is now 32weeks pregnant and is concerned as she has these attacks once every 3days. She is enquiring if there is any medication that she can safely use during the pregnancy to stop these attacks. Which of the following medications would you consider most appropriate?

48.  A 25-year-old primigravida develops severe preeclampsia at 37weeks’ 3days gestation and is delivered by emergency caesarean section. She is concerned about her future pregnancies. What is the chance of her developing preeclampsia in her next pregnancy?

49. A new-born baby develops sticky eyes 5 days after a vaginal delivery. His mother did not have any vaginal discharge although she had experienced dysuria and frequency a few months before pregnancy. She was having regular sexual intercourse during pregnancy with her partner of 2 years’ duration. On examination, both the baby’s eyes are sticky and have a yellowish discharge. The conjunctiva is inflamed. What is the probable cause? 

50. A 28 year old para 1 underwent normal vaginal delivery and is breastfeeding. One week post delivery she visits her midwife who finds her temperature raised ,and difficulty in breastfeeding as her right breast is tender ,red and hot . What is the most appropriate antibiotic regime for her ?