EBCOG_PART1_HIGH_YIELD_QUESTION_PAPAER_1

A Amniotic fluid embolism

B Peripartum cardiomyopathy

C Chest infection

D Cerebro-vascular accident

E Endocarditis

F Haemorrhage

G HELLP syndrome

H Myocardial infarction

I Placental abruption

J Placenta praevia

K Pulmonary embolism

L Pulmonary hypertension

M Sepsis

N Substance misuse

0 Thromboembolism

For each case described below, choose the single most likely cause of maternal death from the above list of options. Each option may be used once, more than once, or not at all.

1. A previously healthy 24-year-old primigravida presents at 34 weeks of pregnancy feeling unwell and tired. Her brother died unexpectedly some years ago, aged 25 years. Her chest X-ray shows an enlarged heart. While being admitted she develops increasing shortness of breath and dies despite intensive resuscitation.

 

2.  A 26-year-old woman at 30 weeks' gestation in her fifth pregnancy presents to the emergency department with breathlessness and displays severe anxiety. She has complained of left-sided pelvic pain for a week. While being assessed she collapses. It is not possible to resuscitate her.

A HELLP syndrome

B Thrombotic thrombocytopenic purpura

C Von Willebrand's disease type IIB

D Acute fatty liver of pregnancy

E Gestational thrombocytopenia

F Idiopathic thrombocytopenic purpura

G Neonatal alloimmune

thrombocytopenia

H Disseminated intravascular coagulation

I Haemolytic uraemic syndrome

J Viral infection

For each case described below, choose the single most appropriate diagnosis from above list of options. Each option may be used once, more than once, or not at all.

1. A 25-year-old pregnant woman in her first pregnancy presents at 26 weeks with hemiplegia, paresthesias, visual disturbance, fatigue and dark urine. She has an ADAMTS-13 protein deficiency and suffers from microangiopathic haemolytic anaemia and purpura.

 

2. A 19-year-old pregnant woman is in her first pregnancy. Recently she went on trip to a petting zoo. She presents at 16 weeks with nausea and vomiting, and haemorrhagic diarrhoea. A few hours after admission to hospital she becomes Irritable, oliguric and has a self-limiting seizure. Her blood picture shows mildly elevated bilirubin, reticulocytosis, low haemoglobin and platelets, and grossly abnormal renal function tests.

3. A 32-year-old pregnant woman is in her first pregnancy. She presents at 37 weeks with sudden onset severe abdominal pain and vaginal bleeding. Intrauterine fetal death is confirmed on admission. One hour after admission to the labour ward, vaginal bleeding becomes severe, and she becomes unstable. An urgent caesarean section is performed, which is complicated with atonic uterus and she loses 7.5 L of blood. A caesarean hysterectomy is eventually performed to control bleeding. She is given 32 units of different blood products.

4. A 32-year-old pregnant woman in her first pregnancy presents at 35 weeks' gestation with malaise, nausea and vomiting and severe epigastric pain. Her clinical condition deteriorates within a few hours after admission. Her blood results show hypoglycaemia, hyperuricaemia, raised creatinine, urea and grossly abnormal liver function tests.

5. An 18-year-old pregnant woman in her first pregnancy presents at 36 weeks to obstetric triage with headache, blurring vision and swelling of her feet. Her blood pressure is 180/110 mmHg with +++ protein in her urine. Her blood investigations show haemoglobin 99 g/L, platelets 80 x 10°/L, alanine aminotransferase (ALT) 265 IU/L, urea 6.7 mmol/L, creatinine 46 umol/L and uric acid 580 pmol/L.

A Postpartum cardiomyopathy

B Thromboembolism

C Amniotic fluid embolism

D Vaginal tear

E Uterine inversion

F Atonic postpartum haemorrhage

G Eclampsia

H Epilepsy

I Cervical trauma

J Fat embolism

K Anaphylaxis

L Postpartum collapse

M Torsion of an ovarian cyst

N 'Thrombosis of the sagittal sinus

0 Subarachnoid haemorrhage

For each description below, choose the single most appropriate diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

1. A 36-year-old woman in her first pregnancy has had a low-cavity forceps delivery for prolonged second stage under spinal anaesthesia. After delivery she experiences excessive vaginal bleeding. On examination she is noted to have excessive blood loss and appeared pale. Her pulse is 120 beats/minute and blood pressure 110/60 mmHg. Abdominal examination reveals a well-contracted uterus. Examination of the placenta confirms it to be complete.

2. A 28-year-old woman in her third pregnancy has been admitted to the hospital with severe abdominal pain. She had been evaluated for a suspicious adnexal during the antenatal period. She collapses in the bathroom on the first postnatal day.

3. A 34-year-old who is para 4 has a quick labour. The baby weighs 4.8 kg. Examination of the placenta is complete. On examination she is pale and clammy The maternal pulse demonstrates a tachycardia of 100 beats/minute and her blood pressure is 90/60 mmHg. The perineum is intact, but heavy vaginal bleeding was observed.

4. A 28-year-old woman in her third pregnancy has an uneventful first- and second stage labour. The placenta is delivered by continuous cord traction. Shortly after delivery of the placenta she complains of severe abdominal pain and collapses. On examination her pulse is 45 beats/minute and her blood pressure is 60/30 mmHg On abdominal examination her uterus is not palpable.

A Magnesium sulfate infusion

B No treatment required

C Start amlodipine

D Start atenolol

E Start bendroflumethiazide

F Start chlorothiazide

G Start hydralazine

H Start labetalol

I Start lisinopril

J Start losartan

K Start low-dose aspirin

L Start low-molecular-weight heparin (LMWH)

M Start vitamins C and E

N Stop all antihypertensive medication

O Switch to clopidogrel

P Switch to enalapril

For each of the following clinical scenarios, choose the single most appropriate pharmacological management from the list of options above. Each option may be chosen once, more than once or not at all.

1. A 39-year-old woman is seen on the postnatal ward just prior to discharge. She had a forceps delivery 2 days earlier. She is planning to continue breastfeeding for at least 6 months. She suffers with chronic hypertension and was taking enalapril prior to pregnancy. Her medication was changed to methyldopa once she had a positive pregnancy test and her blood pressure was stable during pregnancy.

2. A 42-year-old woman with chronic hypertension is seen in the booking clinic at 12 weeks of gestation. She was taking losartan prior to pregnancy and was switched to labetalol once she had a positive pregnancy test at 5 weeks of gestation.

3. A woman is seen in the obstetric day assessment unit at 28 weeks of gestation. She is generally fit and well. She has been referred by her community midwife because her blood pressure is persistently 150/100 mmHg. She has no proteinuria.

A Avoidable death

B Coincidental death

C Coroner’s death

D Critical death

E Direct death

F Early death

G Fetal death

H Fortuitous death

I Indirect death

J Late death

K Unavoidable death

For each of the following clinical scenarios, choose the single most appropriate category of death according to the classification by the World Health Organization from the  list of options above. Each option may be used once, more than once or not at all.

1. Following an uneventful delivery where the labour was augmented with oxytocin (Syntocinon), a woman suddenly collapses and has a cardiac arrest. Despite appropriate resuscitation, it is not possible to revive her. A post mortem examination records the cause of death as an amniotic fluid embolism.

2. A 25-year-old woman is a poor attender at the antenatal clinic and is known to be a victim of domestic violence. Four weeks after delivery, she is murdered by her ex-partner.

3. A 30-year-old woman with epilepsy that is well controlled with lamotrigine is seen regularly in the antenatal clinic. She fails to follow advice regarding showering rather than bathing. She suffers a seizure while in the bath and drowns.

A Carbamazepine

B Eslicarbazepine

C Gabapentin

D Lamotrigine

E Levetiracetam

F Oxcarbazepine

G Phenobarbital

H Phenytoin

I Pregabalin

J Primidone

K Sodium valproate

L Tiagabine

M Topiramate

N Vigabatrin

For each of the following clinical scenarios, choose the single most appropriate anti-epileptic drug from the list of options above. Each option may be used once, more than  once or not at all.

1. A woman taking anti- epileptic medication attends for a routine fetal anomaly scan at 20 weeks of gestation. The fetus is found to have spina bifida and a cleft lip. Which medication is she most likely to be taking?

 

2. 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: (1) it carries the lowest risk of congenital malformations; and (2) it does not increase the risk of haemolytic disease of the newborn. Which drug is she most likely to be taking?

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