Chapter 9 - Medical Disorders in pregnancy

  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
    • eg. 1st line: methyldopa, oxprenolol, labetalol, clonidine
    • 2nd line: hydralazine, nifedipine, przosin
    • don't use: ace-i, arbs, (fetal hypotn) diuretics (reduce impaired maternal bld V)
  10. 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
  11. 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
  12. 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
    • true: b, c, d
    • thrombophilia = hypercoagulability
    • (no warfarin during pregnancy0
  13. Which of the following statements is incorrect?

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Chapter 9 - Medical Disorders in pregnancy