Chapter 9 - Medical Disorders in pregnancy

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elwoo4
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Chapter 9 - Medical Disorders in pregnancy
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2010-09-21 19:34:52
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Women\'s Health core curriculum
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Women's
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  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?
    a. Wernicke's encephalopathy, which is due to thiamin deficiency, is characterised by ataxia, opthalmoplegia, confusion and impairment of short-term memory.
    b. A molar pregnancy is an abN form of pregnancy- a non-viable, fertilized egg implants in the uterus & converts N pregnancy processes into pathological ones - characterized by the presence of a hydatidiform mole
    c. Anencephaly is a cephalic disorder from a NTD - occurs when cephalic (head) end of NTD fails to close btwn 23-36 day of preg - results in absence of major portio nof barin, skull and scalp
    d. Central pontine myelinolysis is a neurologic disease caused by severe damage of the myelin sheath of nerve cells in the brainstem, more precisely in the area termed the pons.
    e. none of the above
    e.

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