EBCOG Part 1-Maternal Medicine-Day 3(SBA)

1. 38 yrs old primi with chronic renal failure comes to the preconception clinic as she wishes to have a baby.She had a renal transplant 3 yrs ago & her recent Se.Creatinine is 130 with     GFR of 45.She is currently on prednisolone,mycophenolate,ACE inhibitors & aspirin.You have advised her to stop mycophenolate & to start another immunosuppressant.Which one of the immunosuppressant drugs would be contraindicated in pregnancy?

2. 25 yrs old primi at 30 weeks gestation was brought in to the obstetric day assessment unit with abdominal & back pain,vomiting & feeling unwell.Her observations –temp:38.2,pulse:110 bpm,BP:100/60,RR:18/min & O2 sat on air 98%.On exam,there is suprapubic & right flank tenderness.Urine dipstick-nitrates positive.Fetal movements were good & CTG was normal.You admitted her & started broad spectrum IV antibiotics for acute pyelonephritis after doing the septic screen.What is the chance of recurrence of pyelonephritis during pregnancy?

3.A 35 year old primi with chronic renal failure had a successful renal transplant surgery recently.She wishes to have children in the future & her GP has referred her to the preconception clinic.What is the recommended time interval for conception after an allograft transplant?

4.What is the most common cause of acute kidney injury in pregnancy?

5. 33 yrs old Barbara ,G3P2A0 with chronic kidney disease presents to the preconceptional clinic.She wants to know what is her chance of having a successful outcome in this pregnancy.She is in fairly good health at present.Her BP is well controlled & her recent investigations show that her Se.Creatinine is 130.What will you tell her about her chances of having a successful obstetric outcome?

6. A 30 yrs old primi is seen in the antenatal clinic.She is 24 weeks pregnant & has a history of recurrent UTI outside of pregnancy.She has been treated 3 times for UTI so far in this pregnancy.Renal usg & RFTs are normal.A recent MSU shows growth of Enterococcus with significant CFU.The organisms are sensitive to co-amoxiclav,nitrofurantoin & trimethoprim & resistant to cefalexin & cipro.She is allergic to nitrofurantoin.What is the most appropriate antimicrobial regimen to prescribe?

7. You are seeing a 28 year old woman in the preconceptional clinic with CKD stage 3 & recurrent UTIs.She is a non-smoker with BMI of 23 & is planning her first pregnancy.Her HT is controlled with ramipril.She takes nitrofurantoin 100 mg daily .Her investigations are as follows- urinalysis proteinuria 3+,Se.Create-150 & eGFR is 38.her protein creat ratio is 350mg/mmol.What will you counsel regarding change of medications at this stage?

8. A 33 year old woman with 34 weeks pregnancy was admitted to labour suite with a BP of 170/115 mmHg.Her urine dipstick showed 1+ proteinuria.What is the quickest & most convenient method to quantify her proteinuria?

9. Which of the following statements regarding physiological BP changes in pregnancy is incorrect?

10. A 35 year old primi with 33 weeks pregnancy .She has a history of headache & blurring of vision for 1 day.Her BP is 180/110 mmHg.Urinalysis shows protein 3+.One week prior,her BP was 120/70 mmHg & she had no proteinuria.Of the options listed below ,select the most appropriate initial drug to administer.

11. A 30 year G3P2 with 26 weeks pregnancy.Her BP is 155/105 mmHg.At booking her BP was  150/100 mmHg.Urinalysis shows protein 1+,spot urinary protein:creatinine ratio is 35 mg/mmol& 24 hr urine collection shows protein 0.35 g.Which one of the following is considered the most likely diagnosis?

12. In cases of pheochromocytoma in pregnancy,which of the following is true?

13. A low risk primi at 34 weeks pregnancy is referred via midwife .Her BP is 140/90 mmHg & urine protein is trace.Her booking BMI was 29.A fetal growth scan done showed AC on the 5th centile & a normal AFI & umbilical artery doppler.What is the most appropriate step at this point in her mgt?

14. A 45 year old woman is being induced at 36 weeks of pregnancy for pre-eclampsia.The midwife seeks an urgent review as the patient is now complaining of severe headache & epigastric pain.On exam her BP is 140/90 mmHg.Her reflexes are brisk & she has clonus.What is the next most appropriate management step for this woman?

15. Mrs Lucy is a known case of Type 1 diabetes & Hypertension. she is on insulin & captopril.She is  taking Folic acid 5 mg & has come to you for pre-conceptual counselling.What advise will you give her ?

16. What is the first drug of choice in pregnant women with chronic hypertension?

17. Mrs Anne 32 weeks pregnant,is 42 years old & has chronic hypertension .She is on aspirin & labetalol 200 mg twice a day.Her blood pressure is controlled at 130/80 mmHg.She wants to know what would be the ideal time after which her delivery can be planned?

18. What are the risk prediction models to help decide about place of care for pre-eclampsia?