EBCOG Part 1 2 Weeks Crash Course Early pregnancy, preconception care, Maternal Medicine Day 3

EMQ

Options for question  

A.Antenatal high-dose, low-molecular-weight heparin (LMWH)

B.Antenatal LMWH and six weeks postnatal LMWH

C.Antenatal high-dose LMWH and six weeks postnatal LMWH; involve expert haematologist in care

D.Antenatal high-dose LMWH and six weeks postnatal LMWH

E.Unfractionated heparin

F.Warfarin

GSix weeks postnatal LMWH

H.Seven days postnatal LMWH

I.Antenatal high-dose LMWH and seven days postnatal LMWH

For each of the scenario given below, Choose the most appropriate management option from the list given above. Each option may be used once or more than once or not at all.

1. A 32-year-old woman is seen for booking in early pregnancy. She has a family history of thrombophilia and testing reveals anti-thrombin 3 deficiency.

2. A 33-year-old woman is seen for booking in her second pregnancy with a history of a DVT at 20 weeks in her first pregnancy. Previous screening has indicated no known inherited thrombophilia.

3. A 28-year-old woman with a BMI of 40 presents at 12 weeks of gestation for booking in her first pregnancy. She smokes 20 cigarettes per day.

EMQ

Options for question  

A.Chest X-ray

B.Full blood count

C.D-dimer

D.Renal and hepatic function test

E.CTPA (computed tomography pulmonary angiogram)

F.V-Q scan (ventilation-perfusion lung scan)

G.Bilateral lower-limb Doppler

H.Anti-Xa level

I.Spirometry

J.Lower-limb Doppler on the suspected side

What would be the most appropriate investigation in each scenario?

4. A 25-year-old woman who is 30 weeks pregnant presents with shortness of breath, chest pain and reduced oxygen saturations. She has signs of DVT in left lower limb.You suspect a pulmonary embolism, but the chest X-ray is normal. What would be your next line investigation?

5.A 25-year-old woman who is 28 weeks pregnant is being treated for a confirmed deep vein thrombosis and weighs 95 kg. This is her second deep vein thrombosis in the last five years. The haematologist requests an investigation on this patient

EMQs
Options for questions  

Following are some scenarios -choose the drug that you think is most appropriate for that scenario.

 

A.Carbamazepine

B.eslicarbazepine

C.Gabapentin

D.Lamotrigine

E.Levetiracetam

F.Oxcarbazepine

G.Phenobarbitol

H.Phenytoin

I.Pregabalin

J.Primidone

K.sodium valproate

L.Tiagabine

M.Topiramate

N.vigabatrin

 

6.A woman taking anti epileptic medicine attends for a routine foetal anomaly scan at 20 weeks of gestation .The foetus is found to have spina bifida & a cleft lip .Which medication Is she most likely to be taking ?

7.A pregnant woman attends antenatal clinic and is taking a single anti epileptic drug .she has been informed that the drug she is taking has two main advantages i.it carries the lowest risk of congenital malformations ,& ii.it does not increase the risk of hemolytic disease of the newborn .Which drug is she most likely to be taking ?

8.A woman with epilepsy has a seizure in labour .Benzodiazepines are administered ,but the seizures continue .which second line therapy should now be administered ?

Options for questions  

Following are some management options for women with obstetric cholestasis.Choose the most appropriate option for the scenarios described below

A.LFT to be done after 10 days                 

B.LFT to be done after 7 days                   

C.LFT to be done weekly                           

D.LFT to be done biweekly                       

E.LFT to be measured fortnightly.           

F.LFT to be done in each trimester           

G.LFT to be done monthly                          

H.LFT to be done after 6 wks                   

I.LFT to be done after 6 mths

J.LFT to be done after 4 wks

K.dexamethasone

L.ursodeoxycholic acid

M.Vit K 10 mg daily parenterally

N.Vit K 10 mg daily orally

O.induce labour

P.activated charcoal

Q.chlorpheniramine

R.S-adenosyl methionine

 

 

9.A 26 year old primi with obstetric cholestasis has been delivered by LSCS at 38 wks of gestation.CS was done for secondary arrest of  cervical dilatation.Her ALT was 200 IU/ml due to obstetric cholestasis.

10.A 28 year old primi is c/o pruritis typically of the palms & soles at night.She is 32 wks pregnant.Other causes of pruritus have been excluded.Her LFT is mildly deranged.Obstetric cholestasis is diagnosed.

11.30 year old G2,c/o pruritus which is more severe at nite.She is 32 wks pregnant.All investigations –LFT & Usg are normal.She is distressed due to pruritus.

12.26 year old Primi with diagnosed obstetric cholestasis.She is 34 wks pregnant.All investigations including LFTs & Usg are normal.She is c/o frank steatorrhea.

EMQ .

With regard to connective tissue disorder in pregnancy, choose the single most appropriate option which best describes each of these connective tissue disorders:

Options for EMQs  

 

A.Acquired autoimmune disorder associated with vascular thrombotic events, pregnancy failure and clinical manifestations involving other organs, such as the heart, skin and central nervous system

B.During pregnancy, the risks are mostly cardiovascular (especially, that of aortic dissection)

C.Most likely to occur during pregnancy or in the immediate postpartum period with differential diagnosis including PET/HELLP/ AFLP/TTP

D.Fetal manifestations of passively acquired autoimmunity

E.Approximately 80–90% of patients may be rheumatoid factor-positive

F.Risk of postpartum haemorrhage due to poor uterine tone and arterial fragility

G,Vasospasm compromising perfusion of peripheral areas of circulation, especially fingers and toes can result in severe pain due to ischaemia

H.Involvement in the form of oesophageal constriction is the most common clinical feature

I.none of the above

 

13.Neonatal lupus

14.Lupus flare

15.Rheumatoid arthritis

16.Scleroderma

17.Ehlers-Danlos syndrome

18.APLS

19.Marfan syndrome

20.Raynaud’s phenomenon

Each of the following scenarios describes a pregnant woman who has come to you for antenatal care with an underlying medical problem.

 

Choose the single most appropriate option for obstetric management.

 

A.Safer to deliver by cesarean section to reduce cardiovascular risks

B.Substitute the drug for a safe antihypertensive (methyl dopa/labetalol/nifedepine). Add aspirin 75 mg once viable pregnancy is confirmed

C.High maternal morbidity and mortality risk; and hence multidisciplinary care and hence discussion on the option of medical TOP

D.Commence aspirin 75 mg once daily, LMWH prophylactic dosage from 1st trimester

E.High maternal morbidity and mortality risk; and hence multidisciplinary care and hence discussion on the option of medical TOP

F.Needs GTT testing and steroid cover in labour

G.General measures to help in symptom control such as minimise exposure to cold, avoiding precipitating factors such as smoking and treatment with vasodilators such as nifedepine

H.Check for maternal Anti Ro/La Ab, the risk of recurrence in the fetus in this pregnancy is higher. Benefit in adding hydroxychloroquine to reduce the risk of recurrence

 

 

 

21.A 26-year-old is currently 6 weeks pregnant in her first pregnancy with lupus nephritis, and is taking captopril for treatment of her underlying kidney problem.

22.30-year-old  P1, is currently 16 weeks pregnant. Her previous child had CHB, needing pacemaker insertion.

23.A G4P0A3 10 weeks pregnant is known to have APLS, on a background of lupus, with previous recurrent miscarriage.

24. G3P2 38-year-old with scleroderma. She is currently 10 weeks pregnant ,but has severe pulmonary hypertension requiring her to be on positive pressure oxygen.

25.Lola is 16 weeks pregnant with a flare-up of psoriatic arthritis. She is on high-dose prednisolone.