6.1 C) Xii) Obstetrics And Gynaecology Pih And Pre-Eclampsia

Front 1

What are the various treatment options for

Severe pre-eclampsia

Back 1

1. Magnesium Sulfate

2. Antihypertensives ( Labetolal ; Hydrallazine)
3. Corticosteroids (between 24 and 34 weeks )
4. Delivery **

Front 2

Which is incorrect regarding pre-eclampsia?

A. It is associated with widespread vascular endothelial dysfunction,

vasospasm, and end-organ damage.
B. By definition, It occurs after 24 weeks gestation
C. It is primarily a complication of first pregnancies.
D. Its incidence is 5% of pregnancies.

Back 2

B. Pre-eclampsia occurs after After 20 weeks

(Only 10% cases occur prior to 34 weeks.)

Front 3

What differentiates pre-eclampsia from

severe pre-eclampsia?

Back 3

Severe Pre-eclampsia = BP > 160/110 mmHg

Pre-eclampsia = BP > 140/90 mmHg

* On 2 separate occasions greater than 6 hours apart whilst patient at rest.

Front 4

When is Delivery imperative in pre-eclampsia?

Back 4

1. Persistent Hypertension : Failure for BP to respond to Magnesium and antihypertensives- (unable to get BP below < 160 / 90mmHg)

2. Progression to eclampsia = seizures
3. > 37 weeks gestation.
4. Abnormal CTG
5. Placental abruption
6. deteriorating blood tests ( liver ; renal ; platelets )

Front 5

In regards to uric acid in pre-eclampsia, which is incorrect ?

A. Serial levels are used to monitor disease progression
B. Increased urate is the hallmark of pre-eclampsia
C. Elevated levels are from reduced glomerular excretion.
D. Elevated levels are from increased production from ischaemic

tissue.

Back 5

C. Reduced renal tubular excretion.

Front 6

Which is incorrect regarding blood tests in

pre-eclampsia ?

A. Bilirubin can be raised from Haemolysis.
C. Thrombocytopenia is associated with increased Maternal morbidity.

C. INR and APTT can be raised: a feature of DIC.
D. ALT is usually raised before AST.

Back 6

D. AST is usually raised before ALT.

Pre-eclampsia = AST > ALT

Front 7

Which of the following is not a main risk factor for pre-eclampsia ?

A. Multigravida with a new partner
B. Primigravida
C. Hydatidiform mole
D. Smoking.

Back 7

D.

Front 8

Which is incorrect regarding pre-eclampsia ?

A. It can occur up to 28 days postpartum.
B. It may occur directly following delivery.
C. A weight gain, in the setting of generalised oedema, of > 2kg per week suggests pre-eclampsia.
D. Proteinuria 2+ suggests severe pre-eclampsia.

Back 8

A. 7 days.

Proteinuria:

1+ = moderate

2+ = severe

3+ = Imminent

Front 9

Which is incorrect regarding pre-eclampsia?

A. Delivery is the only true cure.
B. The main maternal morbidities are tissue ischaemia and seizures.
C. Hydrallazine is a first line antihypertensive: 5-10 mg IV over 5- 10

minutes.
D. Renal impairment is not a common feature.

Back 9

D. It is

- Oliguria
- Creatinine rise

Front 10

Which is not a Haematological abnormality

commonly associated with pre-eclampsia?

A. Haemolysis.
B. Thrombophilia
C. DIC
D. Thrombocytopenia.

Back 10

B.

Front 11

Which is not commonly used in the

management of blood pressure acutely,

for pre-eclampsia?

A. Nifedipine
B. Labetalol
C. Verapamil
D. Nitroprusside

Back 11

C.

Front 12

Which of the following is correct regarding

pre-eclampsia?

A. Aggressive fluid resuscitation is imperative
B. Coagulation abnormalities are corrected with prothrombin X ( PCC )
C. Steroids are given ( hydrocortisone) if 24-34 weeks gestation
D. Premonitory signs of eclampsia, requiring Magnesium IV, are brisk

reflexes , clonus, headache, or visual changes.

Back 12

D.

A. @ risk of APO / cerebral oedema
B. FFP is used for coagulopathy
C. Betamethasone 11.4 mg 12 hourly.

Front 13

In regards to the management of the HELLP

Syndrome, which is incorrect?

A. A platelet transfusion may be required.
B. Dexamethasone is given IV.
C. Cautious fluid therapy is required.
D. Avoid magnesium in this syndrome.

Back 13

D. HELLP is just a more severe variant of

pre-eclampsia, so the treatment is generally as for pre-eclampsia.

Front 14

In regards to Eclampsia, which is incorrect?

A. Eclampsia = Hypertensive encephalopathy
B. 98% of post partum eclampsia occurs on the first day post partum.
C. Maternal Intracranial haemorrhage is the most common cause of death.
D. The greatest risk is in older Mothers.

Back 14

D. Greatest risk is age < 20 years

(Younger Mothers )

Front 15

Comment on each parameter for HELLP

Syndrome:
1. Hypertension present / absent ?
2. Proteinuria present / absent?
3. Glucose low / normal / high?
4. Thrombocytopenia present / absent?
5. LDH low / normal / high?
6. Liver enzymes low / normal / high?
7. Fibrinogen low / normal / high?
8. Shistocytes ? present / absent ?
9. Ammonia low / normal / high

Back 15

1. Hypertension present always
2. Proteinuria Present always
3. Glucose = Normal
4. Thrombocytopenia = Always present
5. LDH High-elevated
6. Liver enzymes High-elevated
7. Fibrinogen normal or low
8. Shistocytes present
9. normal

Front 16

List the complications of pre-eclampsia.

Back 16

1. Eclampsia ( = seizures )
2. Intracerebral haemorrhage
3. HELLP Syndrome
4. Renal Failure
5. Posterior Reversible Encephalopathy

Syndrome (PRES)

Front 17

What are the 4 types of hypertension in

pregnancy?

Back 17

1. Chronic hypertension

Present prior to pregnancy and prior to 20 weeks gestation
2. Gestational hypertension

present only during pregnancy
3. Pre-eclampsia
4. Pre-eclampsia superimposed on

Chronic hypertension.

Front 18

Hypertension and proteinuria < 20 weeks

gestation can occur in what other conditions?

Back 18

1. Molar pregnancy
2. Haemolytic uraemic syndrome (HUS)
3. Antiphospholipid Antibody Syndrome
4. Lupus Nephritis
5. Thrombotic Thrombocytopenic Purpura (TTP)

Front 19

( ED MCQ Book 2012 )
What are the symptoms and signs suggestive of imminent eclampsia ?

Back 19

- BP > 140/90 plus
- Proteinuria
With :
1. Headache
2. Visual disturbance " scintillating scotomata"
3. Epigastric / RUQ pain
4. Hyperreflexia

5. Vaginal bleeding

6. Decreased foetal movements

Front 20

( ED MCQ Book 2012 )
In regards to magnesium sulfate and severe

pre-eclampsia , which of the following is

incorrect?
A. MgSO4 reduces the risk of seizures by 50%
B. MgSo4 reduces Maternal mortality
C. MgSo4 reduces neonatal mortality
D. Both a Cochrane review, as well as the MagPle trial showed significant reductions in eclampsia rates with the use of MgSO4.

Back 20

C. No difference in the risk of stillbirth or

neonatal death (Cochrane review)

Front 21

( ED MCQ Book 2012 )
The 3 components defining

"severe preeclampsia" are ?

Back 21

1. BP > 160/110 mmHg
2. Severe proteinuria 2+ [ > 5g / 24H ]
3. End-organ involvement :
a. Headache
b. Visual disturbance
c. epigastric / RUQ pain
d. Pulmonary oedema
e. Renal impairment / oliguria
f. Haematological disturbance.
g. IUGR / Oligohydramnios.

Front 22

( ED MCQ Book 2012 )
Which for the following is correct ?
A. Hypertension must be present to diagnose eclampsia
B. Proteinuria does not need to be present to diagnose eclampsia
C. Phenytoin should be avoided in the treatment of eclamptic seizures.
D. 1% of eclamptic women will have a second convulsion after receiving IV MgSO4.

Back 22

B.14% cases of eclampsia are absent for

proteinuria

A = no. 16% cases do not have Hypertension
C = Phenytoin is only used in patients with

persistent seizures despite Magnesium.
D = 10% have a second convulsion after

receiving MgSO4.

Front 23

( ED MCQ Book 2012 )
Which of the following is incorrect ?

A. Preeclampsia is a multisystem disorder.
B. Oedema is not in the definition of preeclampsia.
C. Proteinuria is defined as > 200 grams per 24 hours

( 1 + protein on dipstick).
D. The dose of the magnesium bolus in severe preeclampsia / eclampsia is 4-6 grams over 20 minutes .

Back 23

C. Proteinuria = > 300 grams / 24 hours

Front 24

( ED MCQ Book 2012 )
In regards to Magnesium sulfate, which of the following is incorrect ?
A. The adverse effects of MgSO4 follows a dose-response relationship.
B. Clinical monitoring avoids adverse effects and toxicity.
C. Magnesium toxicity is managed with calcium gluconate.
D. Blood pressure and respiratory rate are used as early indicators of

toxicity.

Back 24

D. Deep tendon reflexes and respiratory rate.
Both are reduced with magnesium toxicity.

10 mmol/L = loss of DTR
15 mmol/L = respiratory depression
> 15 mmol/L = cardiac arrest