MRCOG Part 2 – Maternal Medicine SBAs

Question 1 of 124

1. Question

A 20 year old woman with known epilepsy is brought into hospital after a witnessed seizure at 30 weeks gestation. Which of the following is associated with the highest risk of sudden unexpected death in epilepsy (SUDEP)?

Absence seizures

Correct Incorrect Correct answer

Juvenile myoclonic epilepsy

Correct Incorrect Correct answer

Primary focal seizures

Correct Incorrect Correct answer

Primary focal seizures with secondary generalization

Correct Incorrect Correct answer

Tonic-clonic seizures

Correct Incorrect Correct answer

Question 2 of 124

2. Question

A 20 year old woman attends the maternal medicine clinic at 12 weeks gestation. She has a history of epilepsy for which she has been on long term sodium valproate and has conceived unexpectedly. She is concerned about the risk of major congenital malformation with exposure to sodium valproate. What screening should be offered to her?

Detailed first trimester anatomy scan at 12 weeks gestation

Correct Incorrect Correct answer

Early Fetal Anomaly Screening Programme (FASP) ultrasound at 16 weeks

Correct Incorrect Correct answer

Fetal echocardiography at 16 weeks gestation

Correct Incorrect Correct answer

Fetal echocardiography at 20 weeks gestation

Correct Incorrect Correct answer

Routine Fetal Anomaly Screening Programme (FASP) ultrasound at 20 weeks

Correct Incorrect Correct answer

Question 3 of 124

3. Question

Which of the following obstetric complications are women with epilepsy not at higher risk of when compared with women without epilepsy?

Antepartum haemorrhage

Correct Incorrect Correct answer

Gestational diabetes

Correct Incorrect Correct answer

Hypertensive disorders

Correct Incorrect Correct answer

Preterm birth

Correct Incorrect Correct answer

Postpartum haemorrhage

Correct Incorrect Correct answer

Question 4 of 124

4. Question

A 20 year old woman attends the maternal medicine clinic at 12 weeks gestation. She has a history of epilepsy for which she has been on long term leviracetam and has conceived unexpectedly. What screening for fetal growth restriction should be offered to her?

Serial measurement of symphysio-fundal height

Correct Incorrect Correct answer

Uterine artery Dopplers at 20 weeks with serial ultrasound assessment of fetal growth if raised

Correct Incorrect Correct answer

Ultrasound assessment of fetal growth at 28, 32 and 36 weeks

Correct Incorrect Correct answer

Ultrasound assessment of fetal growth at 32 and 36 weeks

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Ultrasound assessment of fetal growth at 36 weeks

Correct Incorrect Correct answer

Question 5 of 124

5. Question

Which of the following anti-epileptic drugs are associated with an increased risk of haemorrhagic disease of the newborn?

Carbamazepine

Correct Incorrect Correct answer

Lamotrigine

Correct Incorrect Correct answer

Leviracetam

Correct Incorrect Correct answer

Valproate

Correct Incorrect Correct answer

Zonisamide

Correct Incorrect Correct answer

Question 6 of 124

6. Question

A 20 year old woman is seen in maternal medicine antenatal clinic at 36 weeks gestation in her first pregnancy. She has a history of epilepsy for which she has been on long term leviracetam 500mg BD but has experienced increasing tonic-clonic seizure frequency in the late third trimester. What is the most appropriate management?

Check leviracetam levels and increase dose if subtherapeutic

Correct Incorrect Correct answer

Increase leviracetam dose to 750mg BD

Correct Incorrect Correct answer

Increase leviracetam dose to 750mg BD and add clobazam

Correct Incorrect Correct answer

Increase leviracetam dose to 750mg BD and book induction of labour for 39 weeks gestation

Correct Incorrect Correct answer

Increase leviracetam dose to 750mg BD and book elective Caesarean section for 39 weeks gestation

Correct Incorrect Correct answer

Question 7 of 124

7. Question

A 25 year old woman is seen in maternal medicine antenatal clinic at 12 weeks gestation in her first pregnancy. She has a history of refractory Crohn’s disease for which she has had multiple bowel resections in the past which is currently well controlled pre-pregnancy on adalimumab. What is the most appropriate management?

Continue adalimumab throughout pregnancy and postpartum

Correct Incorrect Correct answer

Continue adalimumab until 22 weeks gestation then stop

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Continue adalimumab until 28 weeks gestation then stop

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Continue adalimumab until 32 weeks gestation then stop

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Stop adalimumab immediately

Correct Incorrect Correct answer

Question 8 of 124

8. Question

A 25 year old woman is admitted to hospital at 32 weeks gestation in her first pregnancy. She has a history of refractory Crohn’s disease for which she has had multiple bowel resections in the past which was controlled pre-pregnancy on adalimumab. Adalimumab was stopped at 28 weeks gestation to reduce the risk of neonatal immunosuppression however she has developed worsening symptoms of Crohn’s colitis since stopping passing stool with blood between 12-14 times per day with significant abdominal pain. A ultrasound sound scan shows a fetus with estimated fetal weight on 7^th centile with normal umbilical artery Dopplers and liquor volume. What is the most appropriate management?

Deliver by emergency Caesarean section then restart adalimumab

Correct Incorrect Correct answer

Give antenatal betamethasone for fetal lung maturation and deliver by emergency Caesarean section

Correct Incorrect Correct answer

Give antenatal betamethasone for fetal lung maturation and restart adalimumab

Correct Incorrect Correct answer

Start oral prednisolone

Correct Incorrect Correct answer

Start oral prednisolone and restart adalimumab

Correct Incorrect Correct answer

Question 9 of 124

9. Question

A 25 year old woman is seen in maternal medicine antenatal clinic at 12 weeks gestation in her first pregnancy. She has a history of refractory Crohn’s disease for which she has had multiple bowel resections in the past which was well controlled pre-pregnancy on adalimumab. Adalimumab was stopped at 28 weeks gestation to reduce the risk of neonatal immunosuppression and she has an uncomplicated vaginal delivery of a healthy baby at term who she is breastfeeding. What is the most appropriate postpartum management?

Restart adalimumab immediately postpartum

Correct Incorrect Correct answer

Restart adalimumab once breastfeeding stopped

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Restart adalimumab six months postpartum

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Restart adalimumab six weeks postpartum

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Restart adalimumab if develops symptoms of refractory Crohn’s disease

Correct Incorrect Correct answer

Question 10 of 124

10. Question

Which of the following biologic agents is associated with transient B-cell depletion in the neonate?

Adalimumab

Correct Incorrect Correct answer

Belimumab

Correct Incorrect Correct answer

Certolizumab

Correct Incorrect Correct answer

Etanercept

Correct Incorrect Correct answer

Infliximab

Correct Incorrect Correct answer

Question 11 of 124

11. Question

A 25 year old woman is seen in maternal medicine antenatal clinic with a history of refractory Crohn’s disease for which she has had multiple bowel resections in the past which is well controlled on adalimumab and she opts to continue this throughout pregnancy to avoid the risk of a flare. She has an uncomplicated vaginal delivery of a healthy baby at term who she is breastfeeding. Which of the following vaccinations is contraindicated for the neonate?

Diphtheria

Correct Incorrect Correct answer

Pertussis

Correct Incorrect Correct answer

Polio

Correct Incorrect Correct answer

Rotavirus

Correct Incorrect Correct answer

Tetanus

Correct Incorrect Correct answer

Question 12 of 124

12. Question

A 20 year old woman is brought into hospital by ambulance after a witnessed tonic-clonic seizure at 30 weeks gestation. She has a complex mental health history including previous admission for deliberate self harm and there are significant safeguarding concerns. Her BP is 110/80 with no proteinuria and on examination, there are no focal neurological signs or symptoms. MRI Brain is unremarkable and an EEG shows generalised spike and slow wave discharge at 3–5 Hz. What is the likely diagnosis?

Cerebral venous sinus thrombosis

Correct Incorrect Correct answer

Non-epileptic attack disorder

Correct Incorrect Correct answer

Posterior reversible leukoencephalopathy syndrome

Correct Incorrect Correct answer

Primary generalized epilepsy

Correct Incorrect Correct answer

Pre-eclampsia

Correct Incorrect Correct answer

Question 13 of 124

13. Question

A 24 year old woman presents with new onset polyuria and polydipsia at 24 weeks gestation in her first pregnancy. She reports drinking up to 3L of water per day and has no other significant past medical history. What is the most appropriate investigation?

Oral glucose tolerance test

Correct Incorrect Correct answer

Random blood glucose

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Paired serum and urine osmolality

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Serum urea and electrolytes

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Serum calcium levels

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Question 14 of 124

14. Question

A 24 year old woman presents with new onset polyuria and polydipsia at 24 weeks gestation in her first pregnancy. She reports drinking up to 3L of water per day and has no other significant past medical history. Serum osmolality is 270 mOsmol/kg with serum sodium of 130, serum calcium of 2.4 mmol/L, random blood glucose of 4.8 and urine osmolality of 600 mOsmol/kg. What is the most likely diagnosis?

Gestational diabetes insipidus

Correct Incorrect Correct answer

Gestational diabetes mellitus

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Nephrogenic diabetes insipidus

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Neurogenic diabetes insipidus

Correct Incorrect Correct answer

Psychogenic diabetes insipidus

Correct Incorrect Correct answer

Question 15 of 124

15. Question

A 24 year old woman presents with new onset polyuria and polydipsia at 24 weeks gestation in her first pregnancy. She reports drinking up to 3L of water per day and has no other significant past medical history. Serum osmolality is 290 mOsmol/kg with serum sodium of 130, serum calcium of 2.4 mmol/L, random blood glucose of 4.8 and urine osmolality of 290 mOsmol/kg. What is the most likely diagnosis?

Gestational diabetes insipidus

Correct Incorrect Correct answer

Gestational diabetes mellitus

Correct Incorrect Correct answer

Nephrogenic diabetes insipidus

Correct Incorrect Correct answer

Neurogenic diabetes insipidus

Correct Incorrect Correct answer

Psychogenic diabetes insipidus

Correct Incorrect Correct answer

Question 16 of 124

16. Question

A 24 year old woman presents with new onset polyuria and polydipsia at 24 weeks gestation in her second pregnancy. She has a history of gestational diabetes mellitus in her first pregnancy and a previous Caesarean section complicated by postpartum haemorrhage requiring multiple blood transfusions. She reports drinking up to 3L of water per day and has no other significant past medical history. Serum osmolality is 270 mOsmol/kg with serum sodium of 135, serum calcium of 2.4 mmol/L, random blood glucose of 4.8 and urine osmolality of 600 mOsmol/kg. What is the most likely diagnosis?

Gestational diabetes insipidus

Correct Incorrect Correct answer

Gestational diabetes mellitus

Correct Incorrect Correct answer

Nephrogenic diabetes insipidus

Correct Incorrect Correct answer

Neurogenic diabetes insipidus

Correct Incorrect Correct answer

Psychogenic diabetes insipidus

Correct Incorrect Correct answer

Question 17 of 124

17. Question

A 24 year old woman presents with new onset polyuria and polydipsia at 24 weeks gestation in her first pregnancy. She reports drinking up to 3L of water per day and has no other significant past medical history. Serum osmolality is 290 mOsmol/kg with serum sodium of 130 mmol/L, serum calcium of 2.4 mmol/L, random blood glucose of 4.8 and urine osmolality of 290 mOsmol/kg. What is the most appropriate management?

Correction of hypercalcaemia

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Desmopressin

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Metformin

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Thiazide diuretic

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Water restriction

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Question 18 of 124

18. Question

A 30 year old woman presents with right upper quadrant pain at 28 weeks gestation in her first pregnancy. An ultrasound scan of the abdomen shows a solid 5cm mass in the liver. What is the most appropriate next investigation?

Contrast-enhanced ultrasound

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CT Liver

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MRI Liver without contrast

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MRI Liver with gadolinium contrast

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PET-CT Liver

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Question 19 of 124

19. Question

A 30 year old woman presents with right upper quadrant pain at 28 weeks gestation in her first pregnancy. An ultrasound scan of the abdomen shows a solid 5cm mass in the liver. Contrast-enhanced MRI Liver suggests that this is highly suspicious for malignancy. What is the most appropriate next management?

Antenatal liver biopsy

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Planned preterm delivery with postnatal liver biopsy

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Planned term delivery with postnatal liver biopsy

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Tumour markers

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Staging MRI Chest / Abdomen / Pelvis

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Question 20 of 124

20. Question

A 30 year old woman presents with right upper quadrant pain at 28 weeks gestation in her first pregnancy. An ultrasound scan of the abdomen shows a solid 5cm mass in the liver. Which of the following carries the highest risk of bleeding?

Focal nodular hyperplasia

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Hepatic adenoma

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Hepatic haemangioma

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Hepatic metastases

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Hepatocellular carcinoma

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Question 21 of 124

21. Question

A 30 year old woman complains of headache two days postpartum following an emergency Caesarean section of her first baby for severe pre-eclampsia at 35 weeks gestation. The headache is severe, generalised and associated with nausea, vomiting and blurred vision. She is currently taking enalapril and nifedipine for blood pressure control and her blood pressure is 160/90. MRI Brain shows parietal and occipital lobe cortical and subcortical signal changes which are hyperintense on T2 and FLAIR sequences. What is the likely diagnosis?

Drug-related headache

Correct Incorrect Correct answer

Hypertension

Correct Incorrect Correct answer

Posterior reversible encephalopathy syndrome

Correct Incorrect Correct answer

Reversible cerebral vasoconstriction syndrome

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Subarachnoid haemorrhage

Correct Incorrect Correct answer

Question 22 of 124

22. Question

A 30 year old woman presents with headache at 22 weeks gestation in her first pregnancy. She reports a generalized headache which is worse when coughing and associated with nausea, blurred vision and diplopia. Neurological examination is normal. She has no significant past medical history but has a booking BMI of 41. What is the most appropriate next investigation?

CT Head

Correct Incorrect Correct answer

Fundoscopy

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Lumbar puncture

Correct Incorrect Correct answer

MRI Head

Correct Incorrect Correct answer

MRI Cerebral Venogram

Correct Incorrect Correct answer

Question 23 of 124

23. Question

A 20 year old woman is brought into hospital by ambulance after a witnessed tonic-clonic seizure at 30 weeks gestation. She has a complex mental health history including previous admission for deliberate self harm and there are significant safeguarding concerns. Her BP is 110/80 with no proteinuria and on examination, there are no focal neurological signs or symptoms. MRI Brain is unremarkable and an EEG shows generalised spike and slow wave discharge at 3–5 Hz. Whilst on the antenatal ward, she has a further tonic-clonic seizure. What is the most appropriate management?

Intravenous diazepam

Correct Incorrect Correct answer

Intravenous lorazepam

Correct Incorrect Correct answer

Intravenous phenytoin

Correct Incorrect Correct answer

Magnesium sulphate

Correct Incorrect Correct answer

Rectal diazepam

Correct Incorrect Correct answer

Question 24 of 124

24. Question

A 30 year old woman presents with headache at 22 weeks gestation in her first pregnancy. She reports a generalized headache which is worse when coughing and associated with nausea, blurred vision and diplopia. Neurological examination is normal. She has no significant past medical history but has a booking BMI of 41. CT Head is normal and a lumbar puncture shows an opening pressure of 300mm H2O with normal cytology and biochemistry. What is the most appropriate management?

Acetazolamide

Correct Incorrect Correct answer

Frusemide

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Paracetamol

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Prednisolone

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Ventriculoperitoneal shunt

Correct Incorrect Correct answer

Question 25 of 124

25. Question

A 34 year old woman is seen for pre-pregnancy counselling in the maternal medicine clinic. She is known to have Marfan’s syndrome and has recently had an ECHO that shows a dilated aortic root measuring 50mm. What is her modified World Health Organization classification of maternal cardiovascular risk?

mWHO I

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mWHO II

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mWHO II-III

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mWHO III

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mWHO IV

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Question 26 of 124

26. Question

A 34 year old woman is seen for pre-pregnancy counselling in the maternal medicine clinic. She has a history of a repaired Tetralogy of Fallot and her most recent ECHO shows LVEF >55%. What is her modified World Health Organization classification of maternal cardiovascular risk?

mWHO I

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mWHO II

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mWHO II-III

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mWHO III

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mWHO IV

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Question 27 of 124

27. Question

A 34 year old woman is seen for pre-pregnancy counselling in the maternal medicine clinic. She has a history of mitral valve prolapse with an ECHO that shows no other structural cardiac anomaly and LVEF >55%. What is her modified World Health Organization classification of maternal cardiovascular risk?

mWHO I

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mWHO II

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mWHO II-III

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mWHO III

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mWHO IV

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Question 28 of 124

28. Question

A 30 year old woman has an uncomplicated spontaneous vaginal delivery of her third baby at term with EBL of 200ml and early discharge from hospital. She represents 10 days postpartum complaining of productive cough, shortness of breath when lying flat and bilateral ankle oedema. She is noted to be tachycardic with normal oxygen saturations. On examination, jugular venous pressure is elevated and there are fine bilateral crepitations at both lung bases. Blood tests show Hb 100, WCC 14, Plts 250, CRP 40, D-Dimer 21628 and serum BNP 250. What is the next most appropriate test?

Cardiac MRI

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Chest X-ray

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CT Pulmonary Angiogram

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ECG

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Echocardiography

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Question 29 of 124

29. Question

What is the mortality rate of peripartum cardiomyopathy?

5%

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10%

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15%

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20%

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25%

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Question 30 of 124

30. Question

A 30 year old woman has an uncomplicated spontaneous vaginal delivery of her third baby at term with EBL of 200ml and early discharge from hospital. She represents 10 days postpartum complaining of productive cough, shortness of breath when lying flat and bilateral ankle oedema. She is diagnosed with peripartum cardiomyopathy and echocardiography shows initial LVEF of 20%. She is managed with medical therapy and repeat echocardiography at six months postnatal shows LVEF of 40%. What should she be advised regarding future pregnancy?

Further pregnancy is not advisable due to the initial LVEF at presentation

Correct Incorrect Correct answer

If LVEF returns to normal, the risk of need for transplantation is minimal

Correct Incorrect Correct answer

The risk of relapse of peripartum cardiomyopathy is small in a future pregnancy

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There is a 20% risk of further deterioration in left ventricular function with subsequent pregnancy

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There is a 10% risk of mortality in subsequent pregnancy

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Question 31 of 124

31. Question

A 28 year old woman attends the emergency department with palpitations at 17 weeks gestation in her first pregnancy. On examination, her observations are: HR 190, BP 115/85, RR 20, Sats 100% on RA and T 36.5C. An ECG shows an AV nodal re-entrant tachycardia. What is the most appropriate immediate management?

Electrical cardioversion

Correct Incorrect Correct answer

Intravenous metoprolol

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Intravenous adenosine

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Oral bisoprolol

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Vagal manoeuvres

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Question 32 of 124

32. Question

A 34 year old woman with a metallic mitral valve replacement contacts the maternal medicine antenatal clinic with a positive pregnancy test at approximately 6 weeks gestation by LMP. Pre-pregnancy, she was taking 6mg of warfarin once daily. What is the most appropriate management?

Change to therapeutic low molecular weight heparin between week 6 and 12 then restart warfarin in second trimester

Correct Incorrect Correct answer

Change to therapeutic low molecular weight heparin between week 6 and 28 then restart warfarin in third trimester

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Change to therapeutic low molecular weight heparin from week 6 onwards

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Continue warfarin at current dosage

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Continue warfarin at lower dosage

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Question 33 of 124

33. Question

A 24 year old woman is admitted at 12 weeks gestation in her second pregnancy with hyperemesis gravidarum. She has a history of poorly controlled Type 1 diabetes mellitus and previously had an antenatal stillbirth at 26 weeks gestation. On admission, venous blood gas shows pH of 7.31, potassium 4.8mmol/L, blood glucose 10mmol/L and blood ketones 4.0mmol/L. Which of the following is not a diagnostic criteria for diabetic ketoacidosis in pregnancy?

Bicarbonate <15.0 mmol/L

Correct Incorrect Correct answer

Blood ketone level >3.0mmol/L

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Blood glucose >11.0 mmol/L

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Venous pH <7.2

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Urine ketones >3+

Correct Incorrect Correct answer

Question 34 of 124

34. Question

A 20 year old woman is brought into hospital by ambulance after a witnessed tonic-clonic seizure at 30 weeks gestation. She has a complex mental health history including previous admission for deliberate self harm and there are significant safeguarding concerns. On admission, she is drowsy and post-ictal with brisk reflexes. Her BP is 130/85 with 1+ proteinuria on urinanalysis. Whilst on the antenatal ward, she has a further tonic-clonic seizure. What is the most appropriate management?

Intravenous diazepam

Correct Incorrect Correct answer

Intravenous lorazepam

Correct Incorrect Correct answer

Intravenous phenytoin

Correct Incorrect Correct answer

Magnesium sulphate

Correct Incorrect Correct answer

Rectal diazepam

Correct Incorrect Correct answer

Question 35 of 124

35. Question

Pregnant women with spinal cord injury are at risk of specific complications in pregnancy. What level of spinal cord injury is associated with a risk of autonomic dysreflexia?

Above T4

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Above T6

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Above T10

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Above T12

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Above L2

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Question 36 of 124

36. Question

Pregnant women with spinal cord injury are at risk of specific complications in pregnancy. What level of spinal cord injury is associated with a risk of altered perception of fetal movements?

Above T4

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Above T6

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Above T10

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Above T12

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Above L2

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Question 37 of 124

37. Question

A pregnant woman with pre-existing complete spinal cord injury at T4 level is admitted at 30 weeks gestation with a confirmed E. Coli UTI. Whilst an inpatient, she reports feeling unwell with nausea, headache, sweating and worsening spasms. On examination, her observations are: HR 55bpm, BP 130/85, RR 26, Sats 99% on RA and T 36.8C. Booking BP was 90/50. What is the most appropriate management?

GTN spray

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Intravenous labetalol 20mg

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Oral labetalol 200mg

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Oral nifedipine 10mg

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Sublingual nifedipine 10mg

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Question 38 of 124

38. Question

A 28 year old woman is referred to the maternal medicine clinic at 14 weeks gestation in her first pregnancy with a history of ulcerative colitis. She currently opens her bowels once a day and has no rectal bleeding, urgency or frequency. Her weight is stable and she has not been on medication for the past two years. What is her risk of relapse in pregnancy?

10%

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20%

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30%

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40%

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50%

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Question 39 of 124

39. Question

A 28 year old woman presents to the Maternity Assessment Unit at 20 weeks gestation in her first pregnancy with increasing frequency of stool and rectal bleeding associated with weight loss. She has a history of ulcerative colitis but has been in remission for the past two years and has not required any medication. What is the next most appropriate investigation?

Colonoscopy

Correct Incorrect Correct answer

Faecal calprotectin

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Faecal microscopy, culture and sensitivity

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Full blood count, serum albumin and CRP

Correct Incorrect Correct answer

MRI Abdomen

Correct Incorrect Correct answer

Question 40 of 124

40. Question

A 28 year old woman presents to the Maternity Assessment Unit at 20 weeks gestation in her first pregnancy with increasing frequency of stool and rectal bleeding associated with weight loss. She has a history of ulcerative colitis but has been in remission for the past two years and has not required any medication. She is diagnosed with a flare of her ulcerative colitis by Gastronenterology and is recommended to start medical treatment. Which of the following is contra-indicated in pregnancy?

Azathioprine

Correct Incorrect Correct answer

Ciclosporin

Correct Incorrect Correct answer

Mycophenolate mofetil

Correct Incorrect Correct answer

Sulfasalazine

Correct Incorrect Correct answer

Tacrolimus

Correct Incorrect Correct answer

Question 41 of 124

41. Question

A 28 year old woman is referred to the maternal medicine clinic at 14 weeks gestation in her first pregnancy. She has previously been diagnosed with postural tachycardia syndrome for which she takes medication for symptom control. Which of the following medications is contra-indicated in pregnancy?

Clonidine

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Ivabradine

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Octreotide

Correct Incorrect Correct answer

Propranolol

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Pyridostygmine

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Question 42 of 124

42. Question

A 30 year old woman presents to her GP at 28 weeks gestation as she has noticed the skin on her forehead and cheeks is increasingly pigmented. On examination, she is noted to have gray-brown patches in a symmetrical malar distribution over the forehead and cheeks, neck and forearms. What is the most likely diagnosis?

Eczema

Correct Incorrect Correct answer

Linea nigra

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Melasma

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Polymorphic eruption of pregnancy

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Vitiligo

Correct Incorrect Correct answer

Question 43 of 124

43. Question

A 34 year old woman presents to her Maternity Assessment Unit at 34 weeks gestation in her first pregnancy with a widespread rash which is intensely itchy. On examination, she is noted to have an erythematous papular rash extending over the torso and legs but sparing the umbilicus. What is the most likely diagnosis?

Atopic eruption of pregnancy

Correct Incorrect Correct answer

Obstetric cholestasis

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Polymorphic eruption of pregnancy

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Pemphigoid gestationis

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Striae gravidarum

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Question 44 of 124

44. Question

A 30 year old woman with a recent renal transplant is referred to the maternal medicine pre-pregnancy counselling clinic. What is the advised interval between renal transplantation and conception?

3 months

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6 months

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1 year

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2 years

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5 years

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Question 45 of 124

45. Question

A 20 year old woman attends the maternal medicine pre-pregnancy counselling service. She has a history of primary generalized epilepsy for which she has been on long term medication. Which of the following is associated with the highest risk of congenital malformations?

Lamotrigine

Correct Incorrect Correct answer

Leviracetam

Correct Incorrect Correct answer

Carbamazepine

Correct Incorrect Correct answer

Phenytoin

Correct Incorrect Correct answer

Topiramate

Correct Incorrect Correct answer

Question 46 of 124

46. Question

A 30 year old woman is referred to the maternal medicine pre-pregnancy counselling clinic. She had a renal transplant two years ago for chronic kidney disease secondary to glomerulonephritis and is currently taking tacrolimus, ramipril and mycophenolate mofetil. Her baseline pre-pregnancy urinary protein-creatinine ratio is 70. What advice should be given regarding these medications in pregnancy?

Continue tacrolimus, change mycophenolate mofetil to azathioprine and ramipril to nifedipine for 3 months pre-conception

Correct Incorrect Correct answer

Continue tacrolimus, change mycophenolate mofetil to azathioprine and ramipril to nifedipine when positive pregnancy test

Correct Incorrect Correct answer

Continue tacrolimus, change mycophenolate mofetil to azathioprine for 3 months pre-conception and change ramipril to nifedipine when positive pregnancy test

Correct Incorrect Correct answer

Stop tacrolimus, change mycophenolate mofetil to azathioprine and ramipril to nifedipine for 3 months pre-conception

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Stop tacrolimus, change mycophenolate mofetil to azathioprine for 3 months pre-conception and change ramipril to nifedipine when positive pregnancy test

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Question 47 of 124

47. Question

A 30 year old woman is referred to the maternal medicine pre-pregnancy counselling clinic. She had a renal transplant two years ago for chronic kidney disease secondary to glomerulonephritis. Which of the following obstetric complications during pregnancy is she at highest risk of?

Gestational diabetes

Correct Incorrect Correct answer

Miscarriage

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Pre-eclampsia

Correct Incorrect Correct answer

Preterm delivery <37 weeks

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Small for gestational age baby

Correct Incorrect Correct answer

Question 48 of 124

48. Question

A 30 year old woman is seen in the maternal medicine antenatal clinic at 12 weeks gestation in her first pregnancy. She had a renal transplant two years ago for chronic kidney disease secondary to glomerulonephritis and is currently taking tacrolimus, nifedipine and azathioprine. Her urinary protein-creatinine ratio at booking is 30. What is the most appropriate management?

Start aspirin 75mg once daily

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Start aspirin 150mg once daily

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Start aspirin 75mg once daily and prophylactic dose low molecular weight heparin

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Start aspirin 150mg once daily and prophylactic dose low molecular weight heparin

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Start aspirin 75mg once daily and therapeutic dose low molecular weight heparin

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Question 49 of 124

49. Question

A 30 year old woman with relapsing and remitting multiple sclerosis is referred to the maternal medicine pre-pregnancy counselling clinic. Which of the following obstetric complications are women with multiple sclerosis at increased risk of?

Congenital abnormalities

Correct Incorrect Correct answer

Fetal growth restriction

Correct Incorrect Correct answer

Miscarriage

Correct Incorrect Correct answer

Subfertility

Correct Incorrect Correct answer

Stillbirth

Correct Incorrect Correct answer

Question 50 of 124

50. Question

A 30 year old woman with relapsing and remitting multiple sclerosis is referred to the maternal medicine pre-pregnancy counselling clinic. Which of the following factors is associated with a higher risk of relapse?

Breastfeeding

Correct Incorrect Correct answer

Multiparity

Correct Incorrect Correct answer

Pre-pregnancy relapse

Correct Incorrect Correct answer

Regional anaesthesia

Correct Incorrect Correct answer

Unplanned pregnancy

Correct Incorrect Correct answer

Question 51 of 124

51. Question

What is the incidence of pregnancy-related stroke?

10 in 100000 pregnancies

Correct Incorrect Correct answer

20 in 100000 pregnancies

Correct Incorrect Correct answer

30 in 100000 pregnancies

Correct Incorrect Correct answer

40 in 100000 pregnancies

Correct Incorrect Correct answer

50 in 100000 pregnancies

Correct Incorrect Correct answer

Question 52 of 124

52. Question

Which of the following risk factors carries the highest association with antenatal stroke in pregnancy?

Gestational Diabetes

Correct Incorrect Correct answer

Maternal age >35 years

Correct Incorrect Correct answer

Migraine

Correct Incorrect Correct answer

Pre-eclampsia

Correct Incorrect Correct answer

Pre-existing hypertension

Correct Incorrect Correct answer

Question 53 of 124

53. Question

A 38 year old woman is brought in via ambulance at 33 weeks gestation in her first pregnancy. Over the last three hours, she has developed unilateral left sided leg numbness, arm weakness and left sided facial droop associated with headache and dysarthria. What is the most appropriate investigation?

CT Angiogram

Correct Incorrect Correct answer

MRI Brain

Correct Incorrect Correct answer

MRI Cerebral Angiogram

Correct Incorrect Correct answer

Non-enhanced CT Head

Correct Incorrect Correct answer

USS Carotid Dopplers

Correct Incorrect Correct answer

Question 54 of 124

54. Question

A 38 year old woman is brought in via ambulance at 33 weeks gestation in her first pregnancy. Over the last three hours, she has developed unilateral left sided leg numbness, arm weakness and left sided facial droop associated with headache and dysarthria. Non-enhanced CT shows an acute ischaemic stroke in the middle cerebral artery with no evidence of intracranial haemorrhage. What is the most appropriate management?

Aspirin 300mg orally

Correct Incorrect Correct answer

Aspirin 300mg orally with intravenous alteplase

Correct Incorrect Correct answer

Intravenous alteplase

Correct Incorrect Correct answer

Therapeutic dose low molecular weight heparin

Correct Incorrect Correct answer

Thrombectomy with intravenous alteplase

Correct Incorrect Correct answer

Question 55 of 124

55. Question

A 38 year old woman is brought in via ambulance at 33 weeks gestation in her first pregnancy. Over the last three hours, she has developed unilateral left sided leg numbness, arm weakness and left sided facial droop associated with headache and dysarthria. Non-enhanced CT shows an acute ischaemic stroke in the middle cerebral artery with no evidence of intracranial haemorrhage. Which of the following is not an absolute contra-indication to thrombolysis?

Heparin within previous 48 hours

Correct Incorrect Correct answer

Previous intracerebral haemorrhage

Correct Incorrect Correct answer

Previous stroke within last 3 months

Correct Incorrect Correct answer

Platelet count <100

Correct Incorrect Correct answer

Systolic BP >185mmHg

Correct Incorrect Correct answer

Question 56 of 124

56. Question

A 20 year old woman attends the maternal medicine pre-pregnancy counselling service. She has a history of primary generalized epilepsy for which she has been on long term medication. Which of the following is associated with the lowest risk of congenital malformations?

Carbamazepine

Correct Incorrect Correct answer

Leviracetam

Correct Incorrect Correct answer

Phenobarbital

Correct Incorrect Correct answer

Phenytoin

Correct Incorrect Correct answer

Topiramate

Correct Incorrect Correct answer

Question 57 of 124

57. Question

A 38 year old woman is brought in via ambulance at 33 weeks gestation in her first pregnancy with unilateral left sided leg numbness, arm weakness and left sided facial droop associated with headache and dysarthria. Non-enhanced CT shows an acute ischaemic stroke in the middle cerebral artery with no evidence of intracranial haemorrhage. She receives intravenous thrombolysis and makes a full recovery without complications. Which of the following investigations should be performed next?

Cardiac Holter monitoring for 24 hours

Correct Incorrect Correct answer

Lipid profile

Correct Incorrect Correct answer

Thrombophilia screening

Correct Incorrect Correct answer

Transoesophageal echocardiogram

Correct Incorrect Correct answer

Transthoracic echocardiogram with bubble test

Correct Incorrect Correct answer

Question 58 of 124

58. Question

A 39 year old woman is referred to the maternal medicine pre-pregnancy counselling clinic. In her previous pregnancy, she had a confirmed acute ischaemic stroke at 33 weeks gestation and received thrombolysis. She made a full recovery from the stroke without complications and had an uncomplicated vaginal delivery at term. Investigations showed that she had a patent foramen ovale which was closed postnatally. What is her risk of recurrence of stroke in a subsequent pregnancy?

1%

Correct Incorrect Correct answer

2%

Correct Incorrect Correct answer

5%

Correct Incorrect Correct answer

10%

Correct Incorrect Correct answer

20%

Correct Incorrect Correct answer

Question 59 of 124

59. Question

What is the risk of second trimester miscarriage after trachelectomy?

5%

Correct Incorrect Correct answer

6%

Correct Incorrect Correct answer

7%

Correct Incorrect Correct answer

8%

Correct Incorrect Correct answer

9%

Correct Incorrect Correct answer

Question 60 of 124

60. Question

What is the risk of preterm birth after trachelectomy?

15%

Correct Incorrect Correct answer

25%

Correct Incorrect Correct answer

35%

Correct Incorrect Correct answer

45%

Correct Incorrect Correct answer

55%

Correct Incorrect Correct answer

Question 61 of 124

61. Question

A 30 year old woman has a radical trachelectomy with concurrent abdominal cerclage. How long an interval is advised after this procedure before trying to conceive?

3 months

Correct Incorrect Correct answer

6 months

Correct Incorrect Correct answer

12 months

Correct Incorrect Correct answer

18 months

Correct Incorrect Correct answer

24 months

Correct Incorrect Correct answer

Question 62 of 124

62. Question

A 30 year old woman has a radical trachelectomy with concurrent abdominal cerclage. What is the most appropriate contraception post procedure?

Combined oral contraceptive pill

Correct Incorrect Correct answer

Copper IUD

Correct Incorrect Correct answer

Depo-Provera

Correct Incorrect Correct answer

Levonorgestrel IUS

Correct Incorrect Correct answer

Progesterone only pill

Correct Incorrect Correct answer

Question 63 of 124

63. Question

A 30 year old woman presents with confirmed rupture of membranes at 36 weeks gestation. She has previously had a radical trachelectomy with concurrent insertion of abdominal cervical cerclage. What is the most appropriate management?

Antenatal corticosteroids, planned Caesarean section at 37 weeks gestation

Correct Incorrect Correct answer

Antenatal corticosteroids, emergency Caesarean section after 48 hours

Correct Incorrect Correct answer

Antenatal corticosteroids, oral erythromycin, planned Caesarean section at 37 weeks gestation

Correct Incorrect Correct answer

Antenatal corticosteroids, oral erythromycin, emergency Caesarean section after 48 hours

Correct Incorrect Correct answer

Emergency Caesarean section within 6 hours

Correct Incorrect Correct answer

Question 64 of 124

64. Question

A 28 year old woman presents at 36 weeks gestation in her first pregnancy with sudden onset severe upper abdominal pain, nausea and vomiting after eating. She is known to have essential hypertension and Type 2 diabetes mellitus for which she is taking nifedipine and metformin and her BMI at booking was 50. On examination, her observations are P 100, BP 130/80, RR 28, Sats 96% on RA, T 37.8C and there is significant epigastric tenderness. Blood tests show Hb 129, WCC 17, Plts 480, ALT 68, Cr 69, CRP 200, Amylase 360, LDH 650, Glucose 13. What is the most likely diagnosis?

Acute pancreatitis

Correct Incorrect Correct answer

Biliary colic

Correct Incorrect Correct answer

Cholecystitis

Correct Incorrect Correct answer

Gastritis

Correct Incorrect Correct answer

HELLP syndrome

Correct Incorrect Correct answer

Question 65 of 124

65. Question

A 28 year old woman presents at 36 weeks gestation in her first pregnancy with sudden onset severe upper abdominal pain, nausea and vomiting after eating. She is known to have essential hypertension and Type 2 diabetes mellitus for which she is taking nifedipine and metformin and her BMI at booking was 50. On examination, her observations are P 100, BP 130/80, RR 28, Sats 96% on RA, T 37.8C and there is significant epigastric tenderness. Blood tests show Hb 129, WCC 17, Plts 480, ALT 68, Cr 69, CRP 200, Amylase 360, LDH 650, Glucose 13. A diagnosis of acute pancreatitis is made. What is the most common cause of acute pancreatitis in pregnancy?

Alcohol

Correct Incorrect Correct answer

Acute fatty liver of pregnancy

Correct Incorrect Correct answer

Idiopathic

Correct Incorrect Correct answer

Gallstones

Correct Incorrect Correct answer

Hypertriglyceridaemia

Correct Incorrect Correct answer

Question 66 of 124

66. Question

A 28 year old woman presents at 36 weeks gestation in her first pregnancy with sudden onset severe upper abdominal pain, nausea and vomiting after eating. She is known to have essential hypertension and Type 2 diabetes mellitus for which she is taking nifedipine and metformin and her BMI at booking was 50. On examination, her observations are P 100, BP 130/80, RR 28, Sats 96% on RA, T 37.8C and there is significant epigastric tenderness. Blood tests show Hb 129, WCC 17, Plts 480, ALT 68, Cr 69, CRP 200, Amylase 360, LDH 650, Glucose 13. A diagnosis of acute pancreatitis is made. Which of the following is not indicated in the initial management?

Intravenous antibiotics

Correct Incorrect Correct answer

Intravenous fluids

Correct Incorrect Correct answer

Opiate analgesia

Correct Incorrect Correct answer

Paracetamol

Correct Incorrect Correct answer

Prophylactic low molecular weight heparin

Correct Incorrect Correct answer

Question 67 of 124

67. Question

A 20 year old woman attends the maternal medicine pre-pregnancy counselling service. She has a history of primary generalized epilepsy for which she has been on long term sodium valproate. What is the incidence of congenital malformation in babies exposed to sodium valproate in utero?

5%

Correct Incorrect Correct answer

10%

Correct Incorrect Correct answer

15%

Correct Incorrect Correct answer

20%

Correct Incorrect Correct answer

25%

Correct Incorrect Correct answer

Question 68 of 124

68. Question

A 36 year old woman is referred to maternal medicine clinic at 23 weeks gestation in her second pregnancy with persistent hyperkalaemia and hyponatraemia. She previously had an uncomplicated first pregnancy and vaginal birth at term. In this current pregnancy, she has had hyperemesis gravidarum throughout pregnancy and has struggled with symptomatic low blood pressure and occasional episodes of hypoglycaemia. What is the most likely diagnosis?

Congenital adrenal hyperplasia

Correct Incorrect Correct answer

Cushings syndrome

Correct Incorrect Correct answer

Primary adrenocortical insufficiency

Correct Incorrect Correct answer

Primary hyperaldosteronism

Correct Incorrect Correct answer

Phaeochromocytoma

Correct Incorrect Correct answer

Question 69 of 124

69. Question

A 36 year old woman is referred to maternal medicine clinic at 23 weeks gestation in her second pregnancy with persistent hyperkalaemia and hyponatraemia. She previously had an uncomplicated first pregnancy and vaginal birth at term. In this current pregnancy, she has had hyperemesis gravidarum throughout pregnancy and has struggled with symptomatic low blood pressure and occasional episodes of hypoglycaemia. Short Synacthen testing confirms a diagnosis of primary adrenocortical insufficiency. What is the most appropriate treatment?

Fludrocortisone 0.1mg BD

Correct Incorrect Correct answer

Hydrocortisone 5mg TDS

Correct Incorrect Correct answer

Hydrocortisone 5mg TDS, fludrocortisone 0.1mg BD

Correct Incorrect Correct answer

Prednisolone 5mg OD

Correct Incorrect Correct answer

Prednisolone 5mg OD, fludocortisone 0.1mg BD

Correct Incorrect Correct answer

Question 70 of 124

70. Question

A 36 year old woman is diagnosed with primary adrenocortical insufficiency at 23 weeks gestation in her second pregnancy. She is commenced on hydrocortisone 5mg TDS and fludrocortisone 0,1mg BD. She contacts the maternity assessment unit because she has developed a mild flu like illness with fever and is feeling generally unwell. What advice should be given regarding her medication?

Increase dose of hydrocortisone to 10mg TDS for duration of illness

Correct Incorrect Correct answer

Increase dose of fludrocortisone to 0.2mg for duration of illness

Correct Incorrect Correct answer

Increase dose of hydrocortisone to 10mg TDS and fludrocortisone to 0.2mg for duration of illness

Correct Incorrect Correct answer

Increase dose of hydrocortisone to 10mg TDS and omit fludrocortisone for duration of illness

Correct Incorrect Correct answer

Omit hydrocortisone and fludocortisone for duration of illness

Correct Incorrect Correct answer

Question 71 of 124

71. Question

A 25 year old woman presents with generalised fatigue and increasing weakness of her legs at 16 weeks gestation. On examination, she is hypertensive with BP of 160/90 and blood glucose is 14. She has gained 12 kg of weight during pregnancy thus far. What is the most likely diagnosis?

Congenital adrenal hyperplasia

Correct Incorrect Correct answer

Cushings syndrome

Correct Incorrect Correct answer

Primary adrenocortical insufficiency

Correct Incorrect Correct answer

Primary hyperaldosteronism

Correct Incorrect Correct answer

Phaeochromocytoma

Correct Incorrect Correct answer

Question 72 of 124

72. Question

A 29 year old woman is referred to maternal medicine clinic at 14 weeks gestation with severe refractory hypertension. Her booking BP was 200/110 and baseline blood tests show Hb 120, Plts 380, Na 132, K 3.2, Ur 4.1, Cr 68, ALT 19. Urine dipstick testing is normal. What is the most likely diagnosis?

Congenital adrenal hyperplasia

Correct Incorrect Correct answer

Cushings syndrome

Correct Incorrect Correct answer

Primary adrenocortical insufficiency

Correct Incorrect Correct answer

Primary hyperaldosteronism

Correct Incorrect Correct answer

Phaeochromocytoma

Correct Incorrect Correct answer

Question 73 of 124

73. Question

A 25 year old woman is referred to the recurrent miscarriage clinic after three consecutive miscarriage. She describes early onset of pubarche and irregular menstruation with hirsutism and acne. What is the most likely diagnosis?

Congenital adrenal hyperplasia

Correct Incorrect Correct answer

Cushings syndrome

Correct Incorrect Correct answer

Primary adrenocortical insufficiency

Correct Incorrect Correct answer

Primary hyperaldosteronism

Correct Incorrect Correct answer

Phaeochromocytoma

Correct Incorrect Correct answer

Question 74 of 124

74. Question

A 30 year old woman is referred at 26 weeks gestation with increasingly labile blood pressure. She has been home blood pressure monitoring and has recorded significant variations in her BP with spikes up to 220/170 in between periods of normotension. She also reports intermittent episodes of chest pain and palpitations and has lost 4kg in weight since the first trimester. What is the most likely diagnosis?

Congenital adrenal hyperplasia

Correct Incorrect Correct answer

Cushings syndrome

Correct Incorrect Correct answer

Primary adrenocortical insufficiency

Correct Incorrect Correct answer

Primary hyperaldosteronism

Correct Incorrect Correct answer

Phaeochromocytoma

Correct Incorrect Correct answer

Question 75 of 124

75. Question

A woman is brought in by air ambulance to a regional trauma centre after a high speed road traffic accident. She is currently 23 weeks gestation in her first pregnancy and is haemodynamically unstable. What is the most appropriate imaging modality?

CT Chest

Correct Incorrect Correct answer

CT Chest / Upper abdomen

Correct Incorrect Correct answer

CT Whole Body

Correct Incorrect Correct answer

MRI Whole Body

Correct Incorrect Correct answer

Ultrasound extended focused assessment of trauma (FAST scan)

Correct Incorrect Correct answer

Question 76 of 124

76. Question

A 27 year old woman in her first pregnancy is referred to antenatal clinic at 12 weeks gestation with a history of SLE which is currently in remission but she has positive anti-Ro and anti-La antibodies. What is the risk of transient cutaneous neonatal lupus for the baby?

1%

Correct Incorrect Correct answer

2%

Correct Incorrect Correct answer

3%

Correct Incorrect Correct answer

5%

Correct Incorrect Correct answer

10%

Correct Incorrect Correct answer

Question 77 of 124

77. Question

A 27 year old woman in her first pregnancy is referred to antenatal clinic at 12 weeks gestation with a history of SLE which is currently in remission but she has positive anti-Ro and anti-La antibodies. What is the risk of congenital heart block for the baby?

1%

Correct Incorrect Correct answer

2%

Correct Incorrect Correct answer

5%

Correct Incorrect Correct answer

10%

Correct Incorrect Correct answer

20%

Correct Incorrect Correct answer

Question 78 of 124

78. Question

A 20 year old woman attends the maternal medicine pre-pregnancy counselling service. She has a history of primary generalized epilepsy for which she has been on long term sodium valproate. What is the incidence of neurodevelopmental disorders in babies exposed to sodium valproate in utero?

5%

Correct Incorrect Correct answer

15%

Correct Incorrect Correct answer

25%

Correct Incorrect Correct answer

35%

Correct Incorrect Correct answer

45%

Correct Incorrect Correct answer

Question 79 of 124

79. Question

A 27 year old woman in her first pregnancy is admitted at 28 weeks gestation to the antenatal ward with BP 160/110 and 3+ proteinuria. She has a history of lupus nephritis and her baseline PCR at booking was 21. Which of the following is most suggestive of a lupus nephritis flare?

Falling C3 and C4 levels

Correct Incorrect Correct answer

Platelets 87

Correct Incorrect Correct answer

Rising anti-DNA titre

Correct Incorrect Correct answer

Uric acid 0.19

Correct Incorrect Correct answer

Urinary protein creatinine ratio 300

Correct Incorrect Correct answer

Question 80 of 124

80. Question

A 40 year old primiparous woman is admitted for induction of labour at 40 weeks for maternal age but collapses unexpectedly on the antenatal ward and undergoes an emergency Caesarean section for suspected amniotic fluid embolism complicated by massive postpartum haemorrhage of 5L requiring multiple blood transfusions and ITU admission. She attends for a postnatal debrief appointment six months later and mentions that she has not yet had a period since birth despite bottle-feeding her baby. What is the next most appropriate investigation?

CT Head

Correct Incorrect Correct answer

FSH/LH

Correct Incorrect Correct answer

MRI Pituitary

Correct Incorrect Correct answer

Prolactin

Correct Incorrect Correct answer

Short Synacthen test

Correct Incorrect Correct answer

Question 81 of 124

81. Question

A 34 year old woman in her first pregnancy attends the Maternity Assessment Unit with a two day history of worsening shortness of breath and a non-productive cough at 26 weeks gestation. She has a history of asthma since childhood for which she takes regular salbutamol and beclometasone inhalers and she was admitted to hospital with an acute exacerbation one year ago. She reports that she has not been taking her regular asthma medication since she fell pregnant as she is worried that they may harm the baby. On examination, there is widespread wheeze on auscultation of the lungs and her PEFR is 70% of predicted but all other observations are normal and she is able to speak in full sentences. What is the most appropriate treatment?

Nebulized salbutamol

Correct Incorrect Correct answer

Nebulized salbutamol and oral prednisolone

Correct Incorrect Correct answer

Nebulized salbutamol and IV hydrocortisone

Correct Incorrect Correct answer

Oral prednisolone

Correct Incorrect Correct answer

Increase inhaled corticosteroid dose

Correct Incorrect Correct answer

Question 82 of 124

82. Question

A 29 year old woman presents with headache, back pain, dark urine and fever of 40C at 29 weeks gestation in her first pregnancy. She has recently returned from a trip to Ghana one month ago where she did not take chemoprophylaxis for malaria. What is the most appropriate investigation?

Microscopy

Correct Incorrect Correct answer

Malaria indirect fluorescent antibody (IFA) test

Correct Incorrect Correct answer

Malaria polymerase chain reaction (PCR) test

Correct Incorrect Correct answer

Malaria rapid diagnostic test

Correct Incorrect Correct answer

Malaria serology

Correct Incorrect Correct answer

Question 83 of 124

83. Question

A 29 year old woman presents with headache, back pain, dark urine and fever of 40C at 29 weeks gestation in her first pregnancy. She has recently returned from a trip to Ghana one month ago where she did not take chemoprophylaxis for malaria. What is the most likely causative organism?

Plasmodium falciparum

Correct Incorrect Correct answer

Plasmodium vivax

Correct Incorrect Correct answer

Plasmodium ovale

Correct Incorrect Correct answer

Plasmodium malariae

Correct Incorrect Correct answer

Plasmodium knowlesi

Correct Incorrect Correct answer

Question 84 of 124

84. Question

A 29 year old woman presents with headache, back pain, dark urine and fever of 40C at 29 weeks gestation in her first pregnancy. She has recently returned from a trip to Ghana one month ago where she did not take chemoprophylaxis for malaria. Thick and thin blood films confrim 3% parasitaemia (∼90,000/μL) with Plasmodium falciparum with small ring forms and appliqué cells. What is the most appropriate management?

Intravenous artesunate

Correct Incorrect Correct answer

Intravenous quinine and intravenous clindamycin

Correct Incorrect Correct answer

Oral chloroquine

Correct Incorrect Correct answer

Oral quinine and oral clindamycin

Correct Incorrect Correct answer

Oral primaquine

Correct Incorrect Correct answer

Question 85 of 124

85. Question

A 29 year old woman presents with headache, back pain, dark urine and fever of 40C at 29 weeks gestation in her first pregnancy. She is diagnosed with severe P. falciparum malaria and treated with intravenous artesunate. She makes a full recovery and has an uncomplicated vaginal birth at term of a healthy baby with normal birthweight. Histology confirms the presence of P. falciparum parasites in the placenta. What is the most appropriate neonatal management?

Cord blood film microscopy

Correct Incorrect Correct answer

Cord blood film microscopy and microscopy of neonatal blood film at birth

Correct Incorrect Correct answer

Cord blood film microscopy, microscopy of neonatal blood film at birth and weekly blood films for 28 days

Correct Incorrect Correct answer

Microscopy of neonatal blood film at birth

Correct Incorrect Correct answer

Microscopy of neonatal blood film at birth and weekly blood films for 28 days

Correct Incorrect Correct answer

Question 86 of 124

86. Question

A 29 year old woman is seen in her first pregnancy at 20 weeks gestation requesting chemoprophylaxis for malaria as she is planning to travel to Ghana for a month to visit family. What is her risk of contracting malaria without chemoprophylaxis?

1 in 20

Correct Incorrect Correct answer

1 in 50

Correct Incorrect Correct answer

1 in 500

Correct Incorrect Correct answer

1 in 2500

Correct Incorrect Correct answer

1 in 10000

Correct Incorrect Correct answer

Question 87 of 124

87. Question

A 29 year old woman is seen in her first pregnancy at 20 weeks gestation requesting chemoprophylaxis for malaria as she is planning to travel to Ghana for a month to visit family. What is the recommended chemoprophylaxis?

Atovaquone-proguanil

Correct Incorrect Correct answer

Chloroquine

Correct Incorrect Correct answer

Mefloquine

Correct Incorrect Correct answer

Primaquine

Correct Incorrect Correct answer

Proguanil and chloroquine

Correct Incorrect Correct answer

Question 88 of 124

88. Question

A 29 year old woman plans to travel to Ghana for a month to visit family at 20 weeks gestation in her first pregnancy. She is prescribed mefloquine as chemoprophylaxis for malaria. What duration should this be taken for?

During period of travel only

Correct Incorrect Correct answer

During period of travel and for one week after return

Correct Incorrect Correct answer

During period of travel and for two weeks after return

Correct Incorrect Correct answer

During period of travel and for four weeks after return

Correct Incorrect Correct answer

During period of travel and for eight weeks after return

Correct Incorrect Correct answer

Question 89 of 124

89. Question

A 20 year old woman attends the maternal medicine pre-pregnancy counselling service. She has a history of primary generalized epilepsy for which she has been on long term medication. Which of the following is most predictive of the risk of seizure deterioration in pregnancy?

Compliance with medication

Correct Incorrect Correct answer

Focal epilepsy

Correct Incorrect Correct answer

Idiopathic generalized epilepsy

Correct Incorrect Correct answer

Seizure free duration

Correct Incorrect Correct answer

Young age at onset of epilepsy

Correct Incorrect Correct answer

Question 90 of 124

90. Question

A 25 year old woman attends the maternal medicine pre-pregnancy counselling clinic. She is known to have sickle cell disease and her partner wishes to have haemoglobinopathy status testing. Which of the following carrier status in the partner is not an indication for offering prenatal diagnosis?

D-Punjab

Correct Incorrect Correct answer

DB thalassaemia

Correct Incorrect Correct answer

HbS

Correct Incorrect Correct answer

HbC

Correct Incorrect Correct answer

HbE

Correct Incorrect Correct answer

Question 91 of 124

91. Question

A 25 year old woman attends the maternal medicine pre-pregnancy counselling clinic. She is known to have sickle cell disease with a history of previous exchange transfusion for acute chest crises. What is the most important pre-pregnancy investigation?

Blood pressure measurement and urinalysis

Correct Incorrect Correct answer

Echocardiography

Correct Incorrect Correct answer

Red cell antibody screening

Correct Incorrect Correct answer

Retinal screening

Correct Incorrect Correct answer

T2 Cardiac MRI

Correct Incorrect Correct answer

Question 92 of 124

92. Question

A 25 year old woman with known sickle cell disease presents at 10 weeks gestation in her first pregnancy with persistent vomiting associated with worsening shortness of breath and chest pain. On examination, she is tachypnoeic, hypoxic and tachycardic and chest x-ray shows bilateral lung infiltrates. What is the most appropriate management?

Exchange transfusion

Correct Incorrect Correct answer

Intravenous broad spectrum antibiotics

Correct Incorrect Correct answer

Opiate analgesia

Correct Incorrect Correct answer

Therapeutic anticoagulation with low molecular weight heparin

Correct Incorrect Correct answer

Top-up blood transfusion

Correct Incorrect Correct answer

Question 93 of 124

93. Question

A 25 year old woman with known sickle cell disease presents acute chest syndrome at 10 weeks gestation. She is admitted to a high dependency unit and received exchange transfusion. Which of the following is not a requirement for blood transfusion in women with sickle cell disease?

C, D and E compatibility

Correct Incorrect Correct answer

Cytomegalovirus negative blood

Correct Incorrect Correct answer

Irradiated blood

Correct Incorrect Correct answer

Kell typing

Correct Incorrect Correct answer

Rhesus compatibility

Correct Incorrect Correct answer

Question 94 of 124

94. Question

A 25 year old woman with known sickle cell disease presents with worsening shortness of breath at 20 weeks gestation in her first pregnancy. Her observations are HR 90, BP 120/80, RR 20, Sats 98% on RA, T36.9C. Chest X-ray is normal and arterial blood gas confirms normal PaO2 with no evidence of hypoxia. Bloods show Hb 55, WCC 12, Plts 299 with MCV of 85 and reticulocyte count of 0.1%. What is the likely diagnosis?

Acute chest syndrome

Correct Incorrect Correct answer

Folate deficiency anaemia

Correct Incorrect Correct answer

Pulmonary embolus

Correct Incorrect Correct answer

Parvovirus B19 infection

Correct Incorrect Correct answer

Vitamin B12 deficiency anaemia

Correct Incorrect Correct answer

Question 95 of 124

95. Question

A 25 year old woman attends the maternal medicine pre-pregnancy counselling clinic. She is known to have beta thalassaemia major and her partner wishes to have haemoglobinopathy status testing. Which of the following partner carrier status is not associated with a risk of severe haemoglobinopathy?

HbC

Correct Incorrect Correct answer

HbE

Correct Incorrect Correct answer

HbS

Correct Incorrect Correct answer

Hb Lepore

Correct Incorrect Correct answer

HbO Arab

Correct Incorrect Correct answer

Question 96 of 124

96. Question

A 25 year old woman attends the maternal medicine pre-pregnancy counselling clinic. She is known to have beta thalassaemia major with diabetes mellitus. Which of the following is not recommended as part of pre-conception screening?

Bone density scan

Correct Incorrect Correct answer

Echocardiography

Correct Incorrect Correct answer

HbA1C

Correct Incorrect Correct answer

Thyroid function tests

Correct Incorrect Correct answer

T2 Liver MRI

Correct Incorrect Correct answer

Question 97 of 124

97. Question

A 25 year old woman with thalassaemia intermedia is reviewed in the maternal medicine antenatal clinic. She is currently 32 weeks gestation and ultrasound assessment shows an estimated fetal weight of 1.4kg which is below the 5^th centile with normal umbilical artery Dopplers. Her haemoglobin level is 90g/L and she is normotensive with no proteinuria. What is the most appropriate management?

Commence fortnightly transfusion of packed red cells with target Hb of 100g/L

Correct Incorrect Correct answer

Commence fortnightly transfusion of packed red cells with target Hb of 120g/L

Correct Incorrect Correct answer

Repeat ultrasound scan for fetal Dopplers in 3-4 days

Correct Incorrect Correct answer

Repeat ultrasound scan for fetal biometry in 2 weeks

Correct Incorrect Correct answer

Repeat ultrasound scan for fetal biometry in 4 weeks

Correct Incorrect Correct answer

Question 98 of 124

98. Question

A 25 year old woman with thalassaemia major is reviewed in the maternal medicine antenatal clinic at 12 weeks gestation in her first pregnancy. Booking bloods show a Hb of 102g/L with platelet count of 680. She has previously had a splenectomy and receives regular blood tranfusions. Her booking weight is 65kg. What is the most appropriate thromboprophylaxis?

Aspirin 75mg OD

Correct Incorrect Correct answer

Aspirin 75mg OD and 5000 units dalteparin OD

Correct Incorrect Correct answer

Aspirin 75mg OD and 5000 units dalteparin BD

Correct Incorrect Correct answer

Aspirin 75mg OD and 10000 units dalteparin OD

Correct Incorrect Correct answer

Aspirin 75mg OD and 10000 units dalteparin BD

Correct Incorrect Correct answer

Question 99 of 124

99. Question

A woman in her first pregnancy is tested for gestational diabetes due to a booking BMI of 35. Which of the following is diagnostic of gestational diabetes?

Fasting plasma glucose 4.5, 2 hour plasma glucose 6.7

Correct Incorrect Correct answer

Fasting plasma glucose 4.5, 2 hour plasma glucose 7.7

Correct Incorrect Correct answer

Fasting plasma glucose 5.5, 2 hour plasma glucose 6.7

Correct Incorrect Correct answer

Fasting plasma glucose 5.5, 2 hour plasma glucose 7.7

Correct Incorrect Correct answer

Fasting plasma glucose 5.7, 2 hour plasma glucose 7.7

Correct Incorrect Correct answer

Question 100 of 124

100. Question

A 30 year old woman is seen in the Maternal Medicine pre-conception clinic. She is known to have pulmonary sarcoidosis with a diagnosis of interstitial lung disease, as well as a history of previous lupus pernio. Her sarcoidosis has been well controlled for the last four years, with low dose prednisolone, azathioprine and methotrexate. She asks what additional risks could occur during a pregnancy if she conceives. Which complication has the strongest reported association with sarcoidosis in pregnancy?

Deep vein thrombosis

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Fetal growth restriction

Correct Incorrect Correct answer

Pre-eclampsia

Correct Incorrect Correct answer

Preterm birth

Correct Incorrect Correct answer

Pulmonary embolism

Correct Incorrect Correct answer

Question 101 of 124

101. Question

A 30 year old woman is seen in the Maternal Medicine pre-conception clinic. She is known to have pulmonary sarcoidosis with a diagnosis of interstitial lung disease (ILD), as well as a history of previous lupus pernio. Her sarcoidosis has been well controlled for the last four years, with low dose prednisolone, azathioprine and methotrexate. Her last respiratory function testing showed an FVC of 1.4L. What is the most appropriate next investigation?

Chest X-ray

Correct Incorrect Correct answer

ECG

Correct Incorrect Correct answer

Echocardiography

Correct Incorrect Correct answer

High Resolution Chest CT

Correct Incorrect Correct answer

Holter monitoring for 24 hours

Correct Incorrect Correct answer

Question 102 of 124

102. Question

A 30 year old woman is seen in the Maternal Medicine pre-conception clinic. She is known to have pulmonary sarcoidosis with a diagnosis of interstitial lung disease, as well as a history of previous lupus pernio. Her sarcoidosis has been well controlled for the last four years, with low dose prednisolone, azathioprine and methotrexate. She is recommended to stop her methotrexate before trying to conceive. What is the minimum recommended time this should be stopped for prior to trying to conceive?

2 weeks

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4 weeks

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6 weeks

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3 months

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6 months

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Question 103 of 124

103. Question

A 30 year old woman is seen in the Maternal Medicine pre-conception clinic. She is known to have pulmonary sarcoidosis with a diagnosis of interstitial lung disease, as well as a history of previous lupus pernio. Her sarcoidosis has been well controlled for the last four years, with low dose prednisolone, azathioprine and mycophenolate mofetil. She is recommended to stop her mycophenolate mofetil before trying to conceive. What is the minimum recommended time this should be stopped for prior to trying to conceive?

2 weeks

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4 weeks

Correct Incorrect Correct answer

6 weeks

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3 months

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6 months

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Question 104 of 124

104. Question

A 30 year old woman is seen in the Maternal Medicine antenatal clinic at 12 weeks gestation. She is known to have pulmonary sarcoidosis with a diagnosis of interstitial lung disease, as well as a history of previous lupus pernio. Her sarcoidosis has been well controlled for the last four years, with low dose prednisolone, azathioprine and methotrexate which she stopped pre-pregnancy. Her last respiratory function testing showed an FVC of 2.3L. Which of the following medications should be avoided in patient with sarcoidosis in pregnancy?

Aspirin

Correct Incorrect Correct answer

Ferrous sulphate

Correct Incorrect Correct answer

Folic acid

Correct Incorrect Correct answer

Low molecular weight heparin

Correct Incorrect Correct answer

Vitamin D

Correct Incorrect Correct answer

Question 105 of 124

105. Question

A 30 year old woman is seen in the Maternal Medicine antenatal clinic at 12 weeks gestation. She is known to have pulmonary sarcoidosis with a diagnosis of interstitial lung disease, as well as a history of previous lupus pernio. Her sarcoidosis has been well controlled for the last four years, with low dose prednisolone, azathioprine and methotrexate which she stopped pre-pregnancy. Her last respiratory function testing showed an FVC of 2.3L. Which of the following investigations are not recommended in patient with sarcoidosis in pregnancy?

Bronchoalveolar lavage

Correct Incorrect Correct answer

High resolution Chest CT

Correct Incorrect Correct answer

Serum angiotensin converting enzyme (ACE) levels

Correct Incorrect Correct answer

Serum calcium levels

Correct Incorrect Correct answer

Transbronchial biopsy

Correct Incorrect Correct answer

Question 106 of 124

106. Question

A 37 year old nulliparous woman presents to her GP at 16 weeks gestation with a right breast lump. She is referred urgently for a breast ultrasound scan and has a percutaneous core biopsy of the lesion which confirms a diagnosis of breast cancer. What is the incidence of new diagnosis of breast cancer in pregnancy?

1 in 1000

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1 in 3000

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1 in 5000

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1 in 10000

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1 in 20000

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Question 107 of 124

107. Question

A 29-year-old nulliparous woman presents to her GP at 16 weeks of gestation, after noticing a painless lump in her left breast for the past 3 weeks. She has no nipple discharge or skin changes. There is no personal or family history of breast or ovarian cancer. She does not smoke or drink alcohol. On examination, there is a 3 cm firm, irregular, non-tender lump in the upper outer quadrant of the left breast. The overlying skin appears normal. One palpable, mobile axillary lymph node is noted. The contralateral breast is normal. What is the most appropriate next investigation?

Contrast enhanced MRI Breast

Correct Incorrect Correct answer

Diffusion weighted MRI Breast

Correct Incorrect Correct answer

Mammography with abdominal shielding

Correct Incorrect Correct answer

Ultrasound breast with core biopsy of lesion

Correct Incorrect Correct answer

Ultrasound breast with fine needle aspiration cytology of lesion

Correct Incorrect Correct answer

Question 108 of 124

108. Question

A 37 year old woman is diagnosed with early stage ER+ve / HER+ve breast cancer at 10 weeks gestation. She is Para 2, having had two uncomplicated pregnancies and term vaginal births, and has no significant past medical history. What is the most appropriate advice regarding chemotherapy for breast cancer in pregnancy?

Administer anthracycline-based chemotherapy immediately

Correct Incorrect Correct answer

Delay chemotherapy until the second trimester

Correct Incorrect Correct answer

Offer trastuzumab until the second trimester, then switch to anthracycline-based chemotherapy

Correct Incorrect Correct answer

Start tamoxifen to bridge until later pregnancy

Correct Incorrect Correct answer

Terminate pregnancy before commencing chemotherapy

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Question 109 of 124

109. Question

A 37 year old woman is diagnosed with early stage ER+ve / HER+ve breast cancer at 10 weeks gestation. She is Para 2, having had two uncomplicated pregnancies and term vaginal births, and has no significant past medical history. She is recommended to start neoadjuvant chemotherapy prior to mastectomy. Which of the following agents has the MOST established safety profile for use in pregnancy after the first trimester?

Carboplatin

Correct Incorrect Correct answer

Cisplatin

Correct Incorrect Correct answer

Docetaxel

Correct Incorrect Correct answer

Doxorubicin

Correct Incorrect Correct answer

Paclitaxel

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Question 110 of 124

110. Question

A woman at 20 weeks’ gestation is diagnosed with HER2-positive breast cancer. What is the most appropriate management of HER2-directed therapy?

Administer trastuzumab immediately

Correct Incorrect Correct answer

Administer trastuzumab only in the third trimester

Correct Incorrect Correct answer

Avoid trastuzumab during pregnancy and for six months postpartum

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Delay trastuzumab until after birth

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Give trastuzumab only during lactation

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Question 111 of 124

111. Question

A 32-year-old woman presents 3 months after an uncomplicated vaginal delivery complaining of palpitations, anxiety, and heat intolerance. She reports difficulty sleeping and increased irritability over the past few weeks. She is breastfeeding and has no significant past medical history. On examination, her pulse is 102 bpm, blood pressure 118/72 mmHg, and she appears mildly anxious. There is no goitre, no thyroid tenderness, and no ophthalmopathy.

Blood tests show:

TSH: suppressed
Free T4: mildly elevated
TSH receptor antibodies (TRAb): negative
Thyroid peroxidase antibody (TPOAb): positive

A diagnosis of postpartum thyroiditis is made. What is the chance of developing permanent hypothyroidism?

5%

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10%

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25%

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50%

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70%

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Question 112 of 124

112. Question

A 32-year-old woman presents 3 months after an uncomplicated vaginal delivery complaining of palpitations, anxiety, and heat intolerance. She reports difficulty sleeping and increased irritability over the past few weeks. She is breastfeeding and has no significant past medical history. On examination, her pulse is 102 bpm, blood pressure 118/72 mmHg, and she appears mildly anxious. There is no goitre, no thyroid tenderness, and no ophthalmopathy.

Blood tests show:

TSH: suppressed
Free T4: mildly elevated
TSH receptor antibodies (TRAb): negative
Thyroid peroxidase antibody (TPOAb): positive

A diagnosis of postpartum thyroiditis is made. What is the risk of recurrence in a future pregnancy?

5%

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10%

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25%

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50%

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70%

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Question 113 of 124

113. Question

Which of the following is not an indication for thyroid function testing in the first trimester of pregnancy?

Current lithium treatment

Correct Incorrect Correct answer

Known anti-Ro / anti-La antibodies

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Known thyroid peroxidase antibodies (TPOAb)

Correct Incorrect Correct answer

Previous postpartum thyroiditis

Correct Incorrect Correct answer

Type 2 Diabetes Mellitus

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Question 114 of 124

114. Question

A 28-year-old woman books for antenatal care at 6 weeks gestation. She has a history of Graves’ disease for which she has been taking 25mg of carbimazole once daily for the past three months. Her most recent thyroid function tests from a month prior to conception show:

TSH: below the pregnancy-specific reference range
Free T4: elevated above the pregnancy-specific reference range
Free T3: elevated above the pregnancy-specific reference range
TSH receptor antibodies (TRAb): positive
Thyroid peroxidase antibody (TPOAb): negative

What is the most appropriate management option?

Continue carbimazole at current dose

Correct Incorrect Correct answer

Increase carbimazole to 50mg once daily

Correct Incorrect Correct answer

Stop carbimazole

Correct Incorrect Correct answer

Switch from carbimazole to propylthiouracil as soon as possible

Correct Incorrect Correct answer

Switch from carbimazole to propylthiouracil after 10 weeks gestation

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Question 115 of 124

115. Question

A 28-year-old woman books for antenatal care at 6 weeks gestation. She has a history of Graves’ disease for which she has been taking 10mg of carbimazole once daily for the past six months. Her recent thyroid function tests show that she has been euthyroid over the last six months. What is the most appropriate management option?

Continue carbimazole at current dose

Correct Incorrect Correct answer

Increase carbimazole to 50mg once daily

Correct Incorrect Correct answer

Stop carbimazole

Correct Incorrect Correct answer

Switch from carbimazole to propylthiouracil as soon as possible

Correct Incorrect Correct answer

Switch from carbimazole to propylthiouracil after 10 weeks gestation

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Question 116 of 124

116. Question

A 28-year-old woman books for antenatal care but is unsure of her dates and a dating ultrasound confirms that she is 12 weeks pregnant. She has a history of Graves’ disease for which she has been taking 25mg of carbimazole once daily for the past three months. Her most recent thyroid function tests from a month prior to conception show:

TSH: below the pregnancy-specific reference range
Free T4: elevated above the pregnancy-specific reference range
Free T3: elevated above the pregnancy-specific reference range
TSH receptor antibodies (TRAb): positive
Thyroid peroxidase antibody (TPOAb): negative

What is the most appropriate management option?

Continue carbimazole at current dose

Correct Incorrect Correct answer

Increase carbimazole to 50mg once daily

Correct Incorrect Correct answer

Stop carbimazole

Correct Incorrect Correct answer

Switch from carbimazole to propylthiouracil as soon as possible

Correct Incorrect Correct answer

Switch from carbimazole to propylthiouracil after 10 weeks gestation

Correct Incorrect Correct answer

Question 117 of 124

117. Question

A 29-year-old pregnant woman is found to be hepatitis B surface antigen (HBsAg) positive at booking. Further serological testing is performed. Which of the following serological profiles is associated with the highest risk of vertical transmission of hepatitis B virus to the infant?

HBsAg positive, anti-HBc negative, anti-HBs negative

Correct Incorrect Correct answer

HBsAg positive, anti-HBc positive, anti-HBs negative

Correct Incorrect Correct answer

HBsAg positive, anti-HBc negative, anti-HBe negative

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HBsAg positive, HBeAg negative, anti-HBe positive

Correct Incorrect Correct answer

HBsAg positive, HBeAg positive, anti-HBe negative

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Question 118 of 124

118. Question

A 29 year old primiparous woman has antenatal screening for Hepatitis B at booking at 11 weeks gestation and has a positive result with positive HBsAg. She has confirmatory serology testing which shows:

HBsAg positive
Anti-HBs negative
HBeAg positive
Anti-HBe negative
Anti-Hbc IgM positive
Anti-Hbc IgG negative
HBV DNA 270,867 IU/ml

What is the most likely diagnosis?

Acute hepatitis B infection

Correct Incorrect Correct answer

Chronic hepatitis B infection

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Cleared hepatitis B infection

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Previous hepatitis B vaccination

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Non-immune to hepatitis B

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Question 119 of 124

119. Question

A 29 year old primiparous woman has antenatal screening for Hepatitis B at booking at 11 weeks gestation and has a positive result with positive HBsAg. She has confirmatory serology testing which shows:

HBsAg positive
Anti-HBs negative
HBeAg positive
Anti-HBe negative
Anti-Hbc IgM negative
Anti-Hbc IgG positive
HBV DNA 270,867 IU/ml

What is the most likely diagnosis?

Acute hepatitis B infection

Correct Incorrect Correct answer

Chronic hepatitis B infection

Correct Incorrect Correct answer

Cleared hepatitis B infection

Correct Incorrect Correct answer

Previous hepatitis B vaccination

Correct Incorrect Correct answer

Non-immune to hepatitis B

Correct Incorrect Correct answer

Question 120 of 124

120. Question

A 29 year old primiparous woman has antenatal screening for Hepatitis B at booking at 11 weeks gestation and has a positive result with positive HBsAg. She has confirmatory serology testing which shows:

HBsAg positive
Anti-HBs negative
HBeAg positive
Anti-HBe negative
Anti-Hbc IgM negative
Anti-Hbc IgG positive
HBV DNA 270,867 IU/ml

What is the most appropriate management?

Commence tenofovir disoproxil immediately

Correct Incorrect Correct answer

Commence tenofovir disoproxil at 16 to 20 weeks gestation

Correct Incorrect Correct answer

Commence tenofovir disoproxil at 24 to 28 weeks gestation

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Commence tenofovir disoproxil at 32 to 36 weeks gestation

Correct Incorrect Correct answer

Commence tenofovir disoproxil postnatally

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Question 121 of 124

121. Question

A 29 year old primiparous woman has antenatal screening for Hepatitis B at booking at 11 weeks gestation and has a positive result with positive HBsAg. She has confirmatory serology testing which shows:

HBsAg positive
Anti-HBs negative
HBeAg positive
Anti-HBe negative
Anti-Hbc IgM negative
Anti-Hbc IgG positive
HBV DNA 270,867 IU/ml

What is the most appropriate management?

Commence tenofovir disoproxil immediately

Correct Incorrect Correct answer

Commence tenofovir disoproxil at 16 to 20 weeks gestation

Correct Incorrect Correct answer

Commence tenofovir disoproxil at 24 to 28 weeks gestation

Correct Incorrect Correct answer

Commence tenofovir disoproxil at 32 to 36 weeks gestation

Correct Incorrect Correct answer

Commence tenofovir disoproxil postnatally

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Question 122 of 124

122. Question

A 30 year old primiparous woman has antenatal screening and is HbsAg negative. Her partner is subsequently newly diagnosed with acute HBV infection. What is the most appropriate next management?

No further testing required

Correct Incorrect Correct answer

Offer HBV vaccination in pregnancy

Correct Incorrect Correct answer

Offer HBV vaccination postnatally

Correct Incorrect Correct answer

Repeat testing for HbsAg

Correct Incorrect Correct answer

Testing for Anti-HBs

Correct Incorrect Correct answer

Question 123 of 124

123. Question

A 30 year old primparous woman attends her booking antenatal appointment and reports that she is known to have chronic hepatitis B infection and is on antiviral therapy currently. What is the recommended antiviral therapy for hepatitis B in pregnancy?

Adefovir Dipivoxil

Correct Incorrect Correct answer

Entacavir

Correct Incorrect Correct answer

Lamivudine

Correct Incorrect Correct answer

Pegylated interferon alpha

Correct Incorrect Correct answer

Tenofovir disoproxil

Correct Incorrect Correct answer

Question 124 of 124

124. Question

A woman with known chronic hepatitis B with normal liver function received tenofovir disoproxil during pregnancy due to a high viral load. She has an uncomplicated vaginal birth at term and is planning to breastfeed. What is the most appropriate postnatal management of her antiviral therapy?

Continue tenofovir disoproxil indefinitely

Correct Incorrect Correct answer

Continue tenofovir disoproxil for 4–12 weeks postpartum

Correct Incorrect Correct answer

Continue tenofovir disoproxil for 12 months postpartum

Correct Incorrect Correct answer

Stop immediately tenofovir disoproxil after delivery

Correct Incorrect Correct answer

Switch to interferon therapy postpartum

Correct Incorrect Correct answer

MRCOG Part 2 – Maternal Medicine SBAs

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