Which of the folowing are important in the Ix of severe hyperemesis gravidarum?
a. urine dipstick examination
b. haematocrit
c. Thyroid function tests
d. HCG estimation
e. An US examination
a- uti
b- haematocrit inc due to conc blood V
c- in women w clinical sxys of hyperthyroid
d- false
e- US- twin or molar pregnancy
Which of the following are recognised complications of hyperemesis gravidarum?
a. dehydration
b. oesophageal bleeding
c. intracranial bleeding
d. hypertension
e. ketosis
d is false
intracranial bleeding - wernicke's encephalopathy - due to thiamin deficiency - inflammatory aemorrhagic encephalopathy (also seen w OH abuse)
oesophageal bleeding- vomiting
e - production of ketones due to dehydration
Physiological anaemia of pregnancy:
a. results from inc plasma V
b. results from decreased RBC mass
c. is greatest at term
d. results from dec plasma V and inc RBC mass
e. results from decreased iron stores
true: a
plasma V begins to inc by 6th wk and peaks at 30wks
erythrocyte mass incr more slowly and proportionately less
:. net dilutional effect
lowest pregnancy hb occurs at 25-26wks
Microcytic anaemia:
a. results from low vit b12
b. has an MCV > 100fL
c. requires further Ix w serum iron and iron-binding capacity
d. results from iron deficiency
e. causes significant fetal morbidity
true: d
N MCV = 76-100 fl
caused by: iron deficiency, thalassaemia, sideroblastic anaemia, 'anaemia of chronic disease'
just supplement
Iron deficiency in pregnancy:
a. results from incr maternal RBC mass
b. is managed w 300mg elemental iron per day
c. is characterised by low serum ferritin
d. commonly causes a macrocytic anaemia
e. is assoc w incr fetal loss
a - decr maternal RBC
b - ferrous sulphate 300mg which has 60mg elemental iron
c- true
d- microcytic
e- no
Which of the following statements regarding isoimmunisation is true?
a. all Rh(D)-neg women should have their red-cell antibodies checked at 26-28 wks gestation
b. Rh(D)-neg women who have an ectopic pregnancy should be given Rh(D) immunoglobulin
c. A woman who is Rh(D)-neg (w no RBC antibodies) and gives birth to an infant who is Rh(D)-positive does not need anti-D immunoglobulin
d. If an Rh(D)-neg woman's partner is Rh(D)-pos, the baby will certainly be affected by HDN
e. the disease process is likely to be more severe if a woman has had antibodies in her previous pregnancy
a- true
b- true
c- false
d- 50% chance
e- true
Gestational diabetes:
a. occurs in 25% of pregnancies
b. may recur in subsequent pregnancies
c. incr the risk of pre-eclampsia
d. if treated, improves maternal survival
e. occurs more freq in women w a higher BMI before pregnancy
a- 6-8%
b- true
c- true
d- false
e-true - incr risk in women w fhx of diabetes, or hx of gest. diabetes, chronic hptn, obesity b4 preg, older maternal age
AbN glucose tolerance during pregnancy:
a. occurs because of incr insulin resistance
b. incr the risk of later T2D
c. incr perinatal morbidity
d. can be prevented
e. is assoc w an incr c-section rate
true a, b, c, e
Preeclampsia:
a. is characterised by convulsions
b. should be treated w aspirin in all pts
c. is defined as hptn plus organ involvement in pregnancy
d. is always assoc w IUGR
e. can be safely treated w ACE-I
true: c
only definitive rx is delivery of placenta.
antihypertensive meds if sys bp is persistently >=160
DVT in pregnancy:
a. occurs in 1/100 pregnancies
b. is diagnosed w D-dimer
c. may be treated w low-molecular-wt-heparin
d. is always assoc w a thrombophilia syndrome
e. is treated w 12 wks w warfarin
a- 3 per 1000
b- d-dimer usually elevated in pregnancy - can't use
c- true
d- false
e- 12wks or duration of pregnancy
Therapy for pulmonary embolus in pregnancy:
a. is commenced using therapeutic doses of warfarin
b. continues for 12/52
c. initially involves IV unfractionated heparin
d. always requires the addition of a vena caval filter
e. with heparin puts the fetus at risk as it crosses the placenta
no warfarin during pregnancy
Thromboprophylaxis in pregnancy should be:
a. offered only to women w a hx of PE
b. offered when there are multiple risk factors
c. given to pts w a thrombophilia syndrome
d. w subcut heparin
e. w low-dose warfarin