EBCOG Part 1 – High Yield Questions – Paper A – SBA

1. A 36-year-old woman with known hypothyroidism has been taking levothyroxine 100 micrograms once a day. Her most recent thyroid function tests performed 3 months ago were normal with a thyrotropin (TSH) of 2.5 mU/L. She has come to the early pregnancy unit with abdominal pain and a positive pregnancy test. Transvaginal ultrasound confirmed an intrauterine pregnancy.  How would you advise with regards to her levothyroxine dosage?

2. A 25-year-old woman known to have hyperthyroidism is going for radioactive iodine therapy. She has been trying to conceive for the last 6 months.  How long should she avoid pregnancy after this treatment?

3. A 28-year-old para 1 woman at 40 weeks’ gestation delivered a baby with a skin condition, diagnosed as ‘Aplasia cutis congenita’. She is known to have hyperthyroidism secondary to Grave disease and has been on anti-thyroid medication throughout the pregnancy.  Which one of the medications below is known to cause the above condition?

4. A 38-year-old nulliparous woman with moderate chronic renal failure comes to the preconception clinic as she wishes to have a baby. She had renal transplantation 3 years ago and her recent creatinine is around 130 with estimated glomerular filtration rate (GFR) of approximately 45. She is currently taking prednisolone, mycophenolate, angiotensin-converting enzyme (ACE) inhibitors and aspirin. You have advised her to stop mycophenolate and to start another immunosuppressant.  Which one of the immunosuppressant drugs would be contraindicated in pregnancy?

5. A 25-year-old para 1 woman at 30 weeks’ gestation was brought in to the Obstetric day assessment unit with abdominal and back pains, vomiting and feeling unwell. Her observations are temperature 38.2°C, pulse 110 bpm, blood pressure (BP) 100/60 mm Hg, respiratory rate 18/min and oxygen saturations 98% on room air. On examination, she has suprapubic and right flank tenderness with 3+ leucocytes and positive nitrates on urine dipsticks. Foetal movements were good and cardiotocography was normal. You have admitted her and started broad spectrum intravenous antibiotics for acute pyelonephritis after doing the septic screen.  What is the recurrence rate of pyelonephritis during the pregnancy?

6. A 35-year-old nulliparous woman with chronic renal failure had a successful renal transplantation surgery recently. She wishes to have children in the future and her GP has referred for preconception advice.  What is the recommended time interval for conception after an allograft transplantation?

7. A 28-year-old woman at 32 weeks’ gestation in her first pregnancy presented with a rash and itching on the abdomen, trunk, legs and hands. On examination, there were vesicles and bullae. A diagnosis of pemphigoid gestationis was made by the dermatologists after skin biopsies.  Which one of the following statements is true about pemphigoid gestationis?

8. A 30-year-old primigravida at 35 weeks’ gestation with monochorionic diamniotic pregnancy presents with intense itching and rash on the abdomen. On examination there were erythematous papules and plaques in the striae gravidarum with umbilical sparing.  The most likely diagnosis is which one of the following?

9. A 34-year-old woman at 36 weeks’ gestation was admitted with feeling unwell, vomiting and right-sided upper abdominal pain. On examination she was tender in the right upper quadrant with BP 140/90 mm Hg, pulse 90 bpm, temperature 37.6°C and protein 1+ in the urine. Her Hb was 128 g/L, platelets 160, white blood cell (WBC) count was elevated at 18, liver function was deranged with hyperbilirubinaemia and moderately raised alanine aminotransferase (ALT) and aspartate aminotransferase (AST). She was hypoglycaemic and clotting was mildly deranged with prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT). Renal function and liver scan were normal.  What is the most likely diagnosis?

10. A 38-year-old primigravida at 36 weeks’ gestation with dichorionic diamniotic

twin pregnancy was diagnosed with acute fatty liver of pregnancy. She was

stabilised and delivered by caesarean section.

 What is the risk of recurrence in subsequent pregnancies?

11. A 26-year-old, nulliparous woman at 33 weeks’ gestation presented with severe

generalised itching that was worse at night and also present on the palms and

soles. She was diagnosed to have intrahepatic cholestasis of pregnancy (IHCP)

and was started on ursodeoxycholic acid and chlorpheniramine.

 Which one of the statements is true with regards to counselling women with

IHCP?

12. A 28-year-old nulliparous woman with sickle cell disease (SCD) attends

the preconception clinic for advice as she wishes to start her family. Her

husband’s haemoglobinopathy screen was normal, HbAA. You have reviewed

her vaccination history and noted that she had haemophilus influenza type B,

conjugated meningococcal C vaccine, pneumococcal vaccine and hepatitis B

vaccines previously (5 years ago) and influenza vaccine 8 months ago.

 Which one of the vaccines would you recommend her to have

preconceptually?

13. A 30-year-old nulliparous woman with sickle cell disease (SCD) attends your

clinic for preconception advice. You have requested the following tests to

assess for the chronic disease complications prior to stopping contraception.

 Which one of these screening tests is not indicated yearly?

14. A 25-year-old woman with transfusion-dependent beta thalassaemia has been

trying to conceive and undergoing ovulation induction.

 Which one of the statements is true with regards to young women with beta

thalassemia major?

15. A 26-year-old nulliparous woman at 36 weeks’ gestation was diagnosed as

having idiopathic immune thrombocytopenia (ITP). Her recent platelet count

was 70 × 109/L.

 Which one of the following statements is true?

16. A 28-year-old para 1 woman with systemic lupus erythematosus (SLE)

presents for a growth scan at 28 weeks’ gestation. Foetal heart (FH) rate was

80–90 beats per minute and a foetal echocardiogram confirmed a second-

degree congenital heart block (CHB).

 Which one of the following autoantibodies is associated with CHB in

women with SLE?

17. A 28-year-old nulliparous woman with anti-phospholipid syndrome (APS)

and a previous venous thromboembolism (VTE) while on oral contraceptive

pills is planning to conceive and seeks your advice.

 Which one of the options is the most appropriate with regards to her

thromboprophylaxis in pregnancy?

18. A nulliparous woman had a thrombophilia screen requested by her GP

because of the family history of VTE in her mother and sister.

 Which one of the thrombophilia defects is associated with the highest risk

of VTE in pregnancy?

19. A 29-year-old woman with bipolar affective disorder finds herself pregnant for the first time. With regards to her management all of the following statements are true except:

20. A general practitioner has asked your advice about a patient with a severe migraine. He is concerned about the safety of a drug in pregnancy. The patient has a longstanding history of migraine and is currently 20 weeks pregnant.of the following drugs which one should be avoided in the management of migraines in this patient?