Maternal Medicine Extra Questions

Option list
A. Adriamycin
B. Carboplatin
C. Cisplatin
D. Chlorambucil
E. Cyclophosphamide
F. Etoposide
G. 5–Fluorouracil
H. Imiquimod
I. Methotrexate
J.  Melphalan
K. Paclitaxel
L. Topotecan
M. Treosulfan
N. Vincristine
Instructions: For each side effect of chemotherapy described below, choose the single most appropriate drug from the list of options above. Each option may be used once, more than once, or not at all.

1. A 49-year-old woman presents with haematuria. She has recently been diagnosed with ovarian cancer and has received two cycles of chemotherapy. Cystoscopy reveals haemorrhagic cystitis.

2. A 40-year-old woman presents with palpitations, numbness and tingling in the legs, and alopecia involving all body hair. She has recently been diagnosed with ovarian cancer and has received three cycles of chemotherapy. Clinical examination reveals pulse of 180 beats/minute and normal blood pressure. She is booked for debulking surgery in 10 days.

3.  20-year-old woman is having treatment for a high-risk gestational trophoblastic disease. She has just finished her second cycle of chemotherapy. One week later she presents with feeling unwell with motor weakness, double vision and sore throat. Clinical examination reveals lower limb power of 3/5, lateral rectus palsy of right eye and blood results show myelosuppression.

4. A 40-year-old woman has recently been diagnosed with ovarian cancer and has received two cycles of chemotherapy. She presents with decreased urine output, tingling in the lower limbs and is hard of hearing following completion of the second cycle. Her blood results show high creatinine and low magnesium.

5. A 20-year-old woman had medical treatment for an ectopic pregnancy 15 days ago. She has been told not to get pregnant for at least 1 month following this injection as the drug has an antifolate action.

Options List:
A. Intravenous artesunate
B. Antiemetic plus repeat oral quinine
C. Antiemetic plus repeat oral quinine and clindamycin
D. Intravenous quinine
E. Intravenous clindamycin
F. Intravenous quinine plus oral clindamycin
G. Intravenous quinine plus intravenous clindamycin
H. Oral quinine
I. Oral clindamycin
J. Oral quinine plus oral clindamycin
K. Oral chloroquine for 3 days
L. Oral chloroquine 300 mg weekly until delivery
M. Pyrimethamine
N. Primaquine
O. Sulphadiazine
Instructions: For each scenario described below, choose the single most appropriate treatment from the list of options above. Each option may be used once, more than once, or not at all.

6. A 28-year-old Afro-Caribbean woman, para 4, presents to the obstetric day assessment unit with these vague symptoms: malaise, fever and headache. She had travelled to Ghana 4 weeks ago and was perfectly fine. She is currently 30 weeks pregnant and has good fetal movements. Her blood tests and peripheral smear reveal anaemia, thrombocytopenia, and hyperparasitaemia with Plasmodium falciparum.

7. A 28-year-old Afro-Caribbean woman, para 2, presents to the day assessment unit at 29 weeks of gestation with fever, malaise and musculoskeletal pain. She gives a history of malaria 4 years ago during her visit to Nigeria. A peripheral blood smear shows Plasmodium falciparum. Clinically, haematologically and biochemically there are no symptoms or signs of severe complications.

8. A 28-year-old African woman, para 1, presents to the day assessment unit at 37 weeks of gestation with fever, malaise and muscle pain. She gives a history of malaria during childhood and has been a fit person so far. Peripheral blood smear shows Plasmodium falciparum. Clinically, haematologically and biochemically there are no symptoms or signs of severe complications. She vomits after receiving the first dose of oral quinine and clindamycin.

9. A 28-year-old Asian woman, para 0, presents to the day assessment unit at 20 weeks of gestation with fever, malaise and muscle pain. She returned to the UK 2 weeks ago from India. A peripheral blood smear shows Plasmodium vivax. She receives anti-malarial treatment for 7 days and is cured. Four weeks later, she comes to see her general practitioner for advice as she is about to go on holiday to Africa.

10. A 28-year-old Afro-Caribbean woman, para 3, presents to the day assessment unit at 37 weeks of gestation with fever, malaise and muscle pain. Her peripheral smear shows Plasmodium ovale. Clinically, haematologically and biochemically there are no symptoms or signs of severe complications.

Options List:
A. Vitamin A
B. Vitamin B1
C. Vitamin B2
D. Vitamin B3
E. Folic acid
F. Vitamin B5
G. Vitamin B6
H. Vitamin B7
I. Vitamin B12
J. Vitamin C
K. Vitamin D
L. Vitamin E
M. Vitamin K
N. Vitamin M
O. Vitamin I
Instructions: For each action described below, choose the single most appropriate vitamin from the list of options above. Each option may be used once, more than once, or not at all.


11. A water soluble vitamin which is involved in myelin formation, synthesis of neurotransmitters, and also reduces total plasma homocysteine concentrations.

12. A lipid soluble vitamin acting on the lipid membrane and with synergistic interaction with vitamin C.

13. A vitamin photosynthesised by ultraviolet radiation in the epidermis.

14. A lipophilic vitamin important in post-translational modifications of proteins, particularly those involved in blood coagulation.

15. An essential water-soluble vitamin which has important roles in collagen synthesis, wound healing, absorption of non-haem iron and antioxidant action.

Options List:
A. Angiotensin-converting-enzyme (ACE) inhibitors
B. Amitriptyline
C. Amiodarone
D. Bendroflumethiazide
E. Citalopram
F. Cabergoline
G. Change therapy to oral carbimazole
H. Change therapy to oral propylthiouracil
I. Commence 5 mg folic acid/day
J. Commence 0.4 mg folic acid/day
K. Commence 10 mg oral vitamin K
L. Commence thyroxine
M. Frusemide
N. Increase the dose of thyroxine
O. Propylthiouracil
P. Propranolol
Instructions: For each scenario described below, choose the single most appropriate therapy from the list of options above. Each option may be used once, more than once, or not at all.

16. A 29-year-old woman, para 1, presents to the early pregnancy assessment unit at 6 weeks of gestation with mild vaginal bleeding. She has a history of diabetes with well-controlled blood glucose levels. An ultrasound scan reveals a single intrauterine viable pregnancy. Currently, the only medication she is taking is insulin.

17. A 29-year-old woman, para 1, presents to the early pregnancy assessment unit at 6 weeks of gestation with mild vaginal bleeding. She has a history of epilepsy controlled by sodium valproate and carbamazepine. An ultrasound scan reveals a single intrauterine viable pregnancy.

18. A 29-year-old woman, para 1, attends the antenatal clinic at 16 weeks of pregnancy for review of booking (her first midwife appointment) blood tests. She suffers from hypothyroidism and is currently on 75 μg of thyroxine. Her haematological, biochemical and virology results are normal. Her thyroid-stimulating hormone (TSH) is 6.5 mU/mL and T4 is 14 pmol/L.

19. A 29-year-old woman, para 1, attends the obstetric day assessment unit at 34 weeks of gestation with itching. Fetal cardiotocograph (CTG) is normal. Her blood tests reveal raised alanine aminotransferase (48 U/L) and a normal autoimmune screen. A diagnosis of obstetric cholestasis is made.

20. A 29-year-old woman, para 1, attends the antenatal clinic at 18 weeks of gestation for review. She gives a history of Graves’ disease prior to pregnancy and had discontinued prophythiouracil as she developed a severe sore throat and agranulocytosis. At present her haematological results are normal. Her TSH is 0.5 mU/L.