EBCOG Part 1-Maternal Medicine-Day 2(EMQ)

A. Chloroquine 300 mg oral
B.Hospital admission ,administer oral quinine 600 mg 8 hrly & oral clindamycin 450 mg 8 hrly x7 days,administer anti-emetics & refer to MDT for future care.
C.Allow to go home with primaquine 15 mg single daily dose & anti-emetics.
D.Hospital admission,start primaquine 45-60 mg orally once a week
E.Admit to ICU & administer artesunate IV 2.4 mg/kg at 0.12 & 24 hrs ,then daily there after.involve senior obstetrician& physician
F.Admit to hospital,oral chloroquine 600 mg followed by 300 mg 6-8 hrs later,followed by 300 mg on D2 & 3.
G.Postphone any treatment until after delivery
H.Terminate pregnancy.

1.27 year old,32 weeks pregnant.complains of vomiting & flu like symptoms but no pyrexia.Gives history of recent trip abroad.Seen by Acute medical team & diagnosed with P.falciparum malaria

2.30 year old woman,28 weeks pregnant returns from a recent trip abroad with vomiting & flu like symptoms ,but no pyrexia.The diagnosis is P.vivax malaria

3. 27 years old lady with 26 weeks pregnancy.presented with vomiting & pyrexia.She is found to be hypoglycemic & severely anemic.BP is 80/50 mmHg & pulse rate is 120.P.falciparum is found on testing.

A.Mesenteric vein thrombosis
B.Pancreatitis
C.Appendicitis
D.Ureteric colic
E.Pyelonephritis
F.Torsion of an ovarian cyst
G.pre-eclampsia
H.Red degeneration
I.HELLP
J.Acute fatty liver
K.Severe constipation
L.Abruption
M.Preterm labour
N.Urinary retention
O.sickle cell crisis
P.crohns disease
Q.ulcerative colitis
R.none of the above

4. 18 year old primi with severe abdominal pain at 28 weeks gestation.Pain is radiating from her back to the groin.she was treated for an episode of fever with chills a month ago.Urinalysis shows leucocytes & blood.Blood test results are as follows-Hb-10.7 g/dI,WBC-17x 109/L,platelets 187x109/L,uric acid 0.30mmol/L,amylase 250u/dI,AST 171U/L& ALT 23 IU/L.

5. 35 year old,G4P3A0 with 32 weeks pregnancycame to the day assessment unit with abdominal pain.She gives h/o nausea & vomiting since morning.no pv bleeding or tightening.She drinks 20 units of alcohol/week.on exam pulse-100 bpm & BP-130/86 mmHg.urinalysis is normal.Blood results are as follows-Hb-13.7g/dI,WBC-14x109/L,CRP-200 units,AST-40 IU,GGT-501U,ALK-20 IU,amylase 900 IU & bilirubin 28 mmol/L.

6. 28 year primi at 14 weeks gestation,presents with lower abdominal pain.no vaginal bleeding or dysuria.There is an episode of vomiting in the morning.On exam-Temp 37.8c.There is tenderness over lower abdomen-right lower quadrant.Vaginal exam-os closed.Blood results-Hb 11.7 g/dI,WBC 17 cells/mm3,CRP-100 U,AST-30 IU,GGT 17 IU,ALP 1501U,bilirubin 22 mg/di/amylase 50 IU & SE.albumin 25 g/dI