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

1.Asthma affects what percentage of women?

A.1%
B.3%
C.,5%
D.10%
E.15%

2. Mrs. Ranju , primigravida 34 year old at 32 weeks is here for regular antenatal check upShe complains of mild difficulty in breathing ,on examination , you note abnormal respiratory rate.persistent respiratory rate at rest which is abnormal is

A.10 breaths per minute
B.15 breaths per minute
C.20breaths per minute
D.24 breaths per minute
E.All of the above

3.Excaebrations in Asthma in pregnancy occur between

A.22 -24 weeks
B.24 -26 weeks
C,32 – we weeks
D.22-32 weeks
E.24-36 weeks

4.All are Physiological Factors Affecting Asthma In Pregnancy except

A.increase in cortisol
B.increase in progesterone
C.Decrease in PGF2alpha
D.decreased activity of Placental 11b-hydroxysteroid dehydrogenase type 2d

5.respiratory infections account for what % trigger for exacerbation of asthma?

A.4%
B.14%
C.24%
D.34%
E.44%

6.The following medication used in asthma is levels need to monitored throughout the pregnancy

A.corticosteroids inhaler
B.Leukotriene receptors
C.Theophylline
D,oral steroids
E,all of the above

7. In a pregnant woman complaining of abdominal pain,if the pain is sharp & she is able to point the origin of the pain with one finger,the pain is usually

a.Acute
b.Chronic
c.Peritoneal
d.Viscreal
e.Colicky

8.Lactate levels are used in the recognition of sepsis & response to treatment.Goal directed sepsis therapy is indicated if lactate levels are above

a.1 mmol/l
b.2 mmol/l
c.3 mmol/l
c.3 mmol/l
d.4 mmoll
e.5 mmol/l

9. In a pregnant lady undergoing chest X-ray with abdominal shield, the estimated fetal dose of radiation per exam is 2-7 / 10 milligray. what is the dose that has neglible risk to the developing pregnancy in any trimester.

a.3 mGy
b.10 mGy
c.15 mGy
d.1 mGy
e.20 m Gy

10. What is the most common surgical cause of acute abdominal pain in pregnancy?

a.Pancreatitiis
b.Bowel obstruction
c.Peptic ulcer disease
d.Urinary tract obstruction
e.Acute appendicitis

11. 24 years old G3P2Ao with 2 previous spontaneous vaginal deliveries,presents to emergency department at 37 weeks of gestation with nausea,occasional vomiting & severe pain in the right iliac region.She is looking unwell.On exam she is normotensive at 100/50 mmHg,with a pulse of 100 bpm & temperature of 37.8.Her abdomen shows localised rigidity & tenderness in the right iliac region.Ultrasound showed enlarged noncompressible appendix.The general surgeon decided to do an appendectomy& asks your advise regarding the need to deliver.What will be your advice to him?

a.CS would only be considered if the appendix appeared inflamed.
b.Do appendectomy & wait for sponmtaneous onset of labout.
c.She should have a CS prior to the appendectomy.
d.She should have a CS after the appendectomy.
e.She should have a CS at the time of appendectomy.

12. 23 years old lady at 22 weeks gestation is referred by her GP with flu like symptoms & temperature of 39֯c with chills & rigors.She has recently returned from Nigeria after visiting her family.Which one of the following will rule out a diagnosis of malaria?

a.Single negative blood film within 24 hrs
b.2 negative blood film 12-24 hrs apart
c.3 negative blood film 12-24 hrs apart
d.A negative rapid antigen test
e.2 rapid antigen test 12-24 hrs apart

13.You see a 26 year old primi in your day care assessment unit.She is 30 weeks pregnant & presents with sudden onset of fever,malaise & jaundice.She reports travel to Kenya.On exam- temperature-38֯c,BP 110/70 mmHg,pulse 90 bpm,& RR is 16 .You suspect malaria & arrange a rapid diagnostic test & blood film for malaria parasites.The blood film shows trophozoites of P.Falciparum & P.vivax. There are no neurologic symptoms or signs & electrolytes are normal.What is the antimalarial of choice?

a.Artesunate
b.Quinine & clindamycin
c.Chloroquine
d.Primaquine
e.Primaquine & clindamycin

14. Mrs Maria,25 years old presented with cough,sore throat & runny nose for 2 days.On enquiry she gave h/o exposure to covid 19.Her husband who is a chest physician tested positive for the virus last week.On exam since she was breathless,a CVT scan was advised.CT features of covid-19 are

a.Enlarged lymph nodes
b.Lung cavities
c.Pleural effusion
d.Crazy paving pattern
e.None of the above

15. 23 year old primi with 39 weeks pregnancy was admitted to labour suite with complaints of pain in abdomen.She was in early labour.She was a diagnosed case of covid-19 infection.As per protocols her oxygen saturation was monitored hourly.The target saturation to be maintained is

a.85%
b.90%
c.94%
d.99%
e.100%

16.When dealing with a covid -19 positive patient & carrying out aerosol generating procedures ,it is advisable to wear full personal protective equipment.Which of the following is not an aerosol generating procedure?

a.non-invasive ventilation
b.Intubation & extubation
c.High flow nasal oxygen
d.Newborn infant physical examination
e.Trachoestomy for neonate

17.38 year old woman attends for preconception counselling .She had estrogen receptor positive breast cancer 2 years ago and after a left mastectomy she started tamoxifen .Her 2 follow up appointments have been reassuring with no recurrence .How long prior to trying to conceive should she stop tamoxifen ?

A.3 months
B.6 months
C.one year
D.2 years
E.5 years

18.32 year old woman who is 30 weeks pregnant presents to the maternity assessment unit with a breast lump . It is firm & irregular in appearance and tender on palpation. .What are the most appropriate first steps in the management of this patient ?

A.arrange an urgent breast ultrasound and follow up in the antenatal clinic the following week
B.arrange an urgent mammogram and follow up in breast clinic
C.arrange an urgent mammogram and refer to specialist breast team
D.refer to breast team for mammogram and tissue diagnosis by biopsy for cytology
E.refer to breast team for ultrasound and tissue diagnosis by biopsy for Histology

19. 28 year old woman who is currently 12 weeks pregnant has been referred to a breast surgeon after finding a lump in the right breast . Following appropriate imaging and cellular analysis ,she’s thought to have a stage one cancer(no evidence of spread) that is positive for the human epidermal growth factor receptor 2 –HER2 and oestrogen receptor .She declines termination of pregnancy . what’s first line treatment most likely to be offered

A.conventional anthracycline chemotherapy
B.local radiotherapy with fetal shielding
C. primary surgery
D. tamoxifen
E. Trastuzumab

20. A pregnant woman with a BMI of 35 underwent a 2 hr 75gm OGTT at 24 weeks of gestation.According to NICE guidelines what results confirm a diagnosis of GDM?

A.Fasting GL of 5.5 mmol/L
B.1 hr glucose 6.1 mmol/L
C.1 hr glucose 7.8 mmol/L
D.2 hr glucose 7.6 mmol/L
E.2 hr glucose of 7.9 mmol/L

21.A 20 year old woman with type 1 DM presents at 32 weeks in her first pregnancy with regular painful contractions,a closed cervix & a positive fetal fibronectin test.What is the most appropriate management plan?

A.Antenatal steroids
B.Antenatal steroids with additional insulin
C.Antenatal steroids & tocolysis with atosiban
D.Antenatal steroids,additional insulin & tocolysis with atosiban
E.Tocolysis with atosiban

22.A woman is recently diagnosed with GDM.A program of exercise & dietary changes is initiated.What is the likelihood of her needing further treatment with an Oral hypoglycemic agent or insulin therapy in this pregnancy?

A.1-2 %
B.10-20%
C.30-40%
D.80%
E.90%

23.A primi who is a type 1 diabetic is admitted in labour at 37+2 weeks gestation.The midwife has commenced sliding scale insulin infusion.Between which values should the capillary blood glucose be maintained during labour?

A.3 & 8 mmol/L
B.3.5 & 5.9 mmol/L
C.4 & 7 mmol/L
D.5 & 9 mmol/L
E.6 & 8 mmol/L

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