Maternal Medicine Extra Quesions Batch C – MCQ

1. You see a 31-year-old primigravida at 26 weeks’ gestation who presents with worsening fatigue, sweating, insomnia, loss of weight and palpitations. She reports good fetal movements. Physical examination shows exophthalmos, an enlarged nontender thyroid gland and ne hand tremors. Her thyroid function test results show a SH less than 0.05 mU/L (normal range 0.4–5.0) and a 4 of 70 pmol/L (normal range 10–20). You counsel her regarding the risks of poorly controlled hyperthyroidism in pregnancy. Which of the following is not a recognised ?

2. You are asked to see a woman on the postnatal ward. She sustained a grade 3B perineal tear following an instrumental delivery. The tear was appropriately repaired with an overlapping technique using 3-0 PDS suture in theatre. What advice would you give her regarding the prognosis following surgical repair?

3. You see a 22-year-old para 1 who is 35 weeks into her second pregnancy. She presents to the labour ward complaining of headache, abdominal pain, nausea, vomiting and widespread itching with no rash. On examination there is mild jaundice and bilateral lower limb oedema. Her BP is 150/95 mm Hg, and urinalysis shows 1+ protein. Your differential diagnosis includes preeclampsia, HELLP (haemolysis, elevated liver enzymes, and low platelet count) syndrome, acute fatty liver of pregnancy (AFLP) and haemolytic uraemic syndrome. You request FBC, LF , U&E, clotting screen and serum urate. What is the single most important test that could help to distinguish AFLP from the other potential problems?

4. You see a 31-year-old primigravida at 37 weeks who presents to your day assessment unit with headache and blurring of vision. Her BP is 160/110 mm Hg, and urine dipstick shows 3+ protein. Her reflexes are brisk with four beats of ankle clonus, and her abdomen is soft. The symphysio fundal height is 35 cm, the C: G  is normal and her urine protein :creatinine ratio is 90 mg/mmol.

What is the most appropriate action?

5. You see a 23-year-old woman, who is known to have beta thalassaemia major. She underwent splenectomy at the age of 7. Her platelet count is 660 × 109/L at booking.

What antenatal thromboprophylaxis is recommended?

6. A 35-year-old para 1 who is 34 weeks presents to your day assessment unit complaining of pruritus, especially in the palms and soles. She reports good fetal movements and her pregnancy has been uneventful so far. She also gives a history of induction of labour at 38 weeks for obstetric cholestasis in her first  pregnancy. Inspection of the skin shows scratch marks but no rash. The SFH is 36 cm and a C:  G is normal. Her liver function tests show an elevated alanine transaminase and bile acids. You suspect obstetric cholestasis.

How would you counsel her regarding obstetric cholestasis?

7. You see a 30-year-old para 1 in the antenatal clinic. She is found to have a platelet count of 85 × 109/L on routine screening at 28 weeks’ gestation. This is her second pregnancy; her first child was delivered at term by caesarean section for breech presentation. She reports good fetal movements and has no history of bruising or bleeding. Which of the following conditions couldn’t explain her  thrombocytopenia?

8. Normal pregnancy is associated with changes in the cardiovascular system including change in the position of the heart. The is results in changes in the ECG.

Which of the following is not a normal ECG finding during pregnancy?

9. You see a 26-year-old para 1 in your day assessment unit. She is at 30 weeks’ gestation and presents with sudden onset of fever, malaise and jaundice. She reports recent travel to Kenya. Her observations are temperature 38°C, BP 110/70 mm Hg, pulse rate 90 bpm and respiratory rate 16 per minute. You suspect malaria in pregnancy and arrange a rapid diagnostic test and blood lm for malaria parasites. The blood lm shows trophozoites of Plasmodium falciparum and P. vivax. There are no neurologic symptoms or signs, and the electrolytes are normal.

What is your antimalarial agent of choice?

10. The midwife on the postnatal ward asks you to make a thromboprophylaxis plan for a 21-year-old woman with sickle cell disease. She is day 1 postnatal following an elective caesarean section for intrauterine growth restriction and has no other risk factors.

Which of  the following is the correct plan ?

11. You see a 30-year-old who is at 17 weeks in her third pregnancy and who presents with a threatened miscarriage. Her blood group is A Rhesus negative. She had surgical management of miscarriage in her second pregnancy and anti-D immunoglobulin was not given. Screening for red cell antibodies shows an anti-D antibodies level of 7 IU/ml. The bleeding has now settled, the pregnancy is ongoing and she is pain free. What is your most appropriate next step?

12. You see a 28 year old in your antenatal clinic. She is 17 weeks into her third ongoing pregnancy. Her first pregnancy ended in a spontaneous miscarriage at 13 weeks and, in her second pregnancy, she gave birth to an anaemic baby who required exchange transfusion. Anti-E antibodies were detected at her initial screening in this pregnancy.

What is your most appropriate next step?

13. You see a 36-year-old woman with a BMI of 38 kg/m2 in your day assessment unit. She is 32 weeks into her fourth ongoing pregnancy and describes sudden onset shortness of breath with no cough or chest pain. She does, however, have right leg pain and swelling. Physical examination shows a pulse rate of 100 bpm, BP 110/70 mm Hg, temperature 37°C and respiratory rate 18 per minute. Chest auscultation is unremarkable. You suspect PE and start LMWH.

What is your next most appropriate test?

14. You see a 34-year-old primigravida at 32 weeks’ gestation in your day assessment unit. She presents with a 2-day history of nonspecific headaches, nausea, retrobulbar pain and blurring of vision. Although a neurologic examination is normal, an ophthalmologic examination shows bilateral papilledema. A magnetic resonance venogram demonstrates no mass lesion or venous thrombosis. A lumbar puncture, however, shows a raised opening pressure (greater than 250 mm H2O) but with no other cytologic or chemical abnormalities. Her BMI is 36 kg/m .

Which of the following is the drug of choice?

15. You see a 33-year-old woman in the postnatal ward. She was diagnosed with gestational diabetes this pregnancy, and her capillary blood glucose level is 4 mmol/L.

What is her risk of developing type 2 diabetes after this birth?

16. You see a 22-year-old para 0 with systemic lupus erythematosus for preconception counselling. She has had no flares for the last 12 months. Her antibodies screen is negative for anti-Ro/La antibodies, and there is no concurrent antiphospholipid syndrome. She is keen to be pregnant and asks you about the safety of immunosuppressant drugs during pregnancy.

Which of the following drugs does not cross the placenta?

17. You see a 30-year-old para 3 at 31 weeks’ gestation in your day assessment unit. She presents with skin rash and itching. On examination, there are erythematous papules and vesicles all over the abdomen including the umbilicus, limbs, palms and soles.

What is the most likely diagnosis?