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MRCOG PART 2 SBAs and EMQs

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HYPERTENSION SBA

HYPERTENSION SBA Posted by Purnima D.

 

A 34 year old woman with a history of chronic hypertension has a spontaneous vaginal delivery following induction of labour at term. Her BP is 138/88 mmHg on labetalol 200mg mg four times a day. She wishes to go home 18h after giving birth. The target for BP control should be

 

A.    Below 140/90 mmHg           correct one

 

B.    Below 150 mmHg systolic and 80-100 mmHg diastolic

 

C.   Below 120/80 mmHg

 

D.   Below 150/99 mmHg

 

E.    120-140/80-90 mmHg

 

A 34 year old woman with a history of chronic hypertension has a spontaneous vaginal delivery following induction of labour at term. Her BP is 138/88 mmHg on labetalol 200mg mg four times a day.

 

A.    Continue labetalol and monitor BP at least 6 hourly for the first 48h

 

B.    Continue labetalol and monitor BP daily for the first 2 days       correct one

 

C.   Stop labetalol and monitor BP 6 hourly while in hospital

 

D.   Reduce dose of labetalol to 200 mg three times a day and monitor BP 6 hourly for 48 hours

 

E.    Reduce dose of labetalol to 200 mg three times a day and monitor BP daily for the next 7 days

 

A 34 year old woman with a history of chronic hypertension attends the antenatal clinic at 34 weeks gestation. Her BP is 148/92 mmHg on labetalol 200 mg four times a day and there is no proteinuria. Fetal growth scan and umbilical artery Dopplers are normal. Delivery should be planned

 

A.    After 37 weeks        correct one

 

B.    At 37 weeks

 

C.   After a course of corticosteroids

 

D.   Within the next 24-48 hours

 

E.    At 40 weeks

 

 

A 40 year old woman with chronic hypertension attends the antenatal clinic at 14 weeks gestation. She has no other risk factors and there is no evidence of end-organ damage secondary to hypertension. Her BP is 132/65 mmHg on labetalol 200 mg four times a day and coracten 60 mg once a day. The plan for fetal monitoring should include

A.    Computerised CTG weekly from 37 weeks

B.    CTG weekly from 37 weeks

C.   CTG only if there are other fetal concerns         correct one

D.   CTG daily if induction of labour declined at 37 weeks

E.    CTG weekly if induction of labour declined at 37 weeks

 

A 40 year old woman with chronic hypertension attends the antenatal clinic at 14 weeks gestation. She has no other risk factors and there is no evidence of end-organ damage secondary to hypertension. Her BP is 132/65 mmHg on labetalol 200 mg four times a day and coracten 60 mg once a day. The plan for fetal monitoring should be

A.    Umbilical artery Doppler at 23 weeks + growth scans at 28, 32, 34 and 36 weeks ; correct one

B.    Growth scan at 28-30, 32-34 and 36-38 weeks

C.   Growth scan at 24-26, 28-30 and 32-34 weeks

D.   Growth scan at 28-30 and 32-34 weeks        

E.    Uterine artery Doppler at 23 weeks + growth scan at 28-30 and 32-34 weeks

 

 

In pregnant women with chronic hypertension

 

A.    Treatment of hypertension with methyldopa during pregnancy reduces the risk of pre-eclampsia

B.    Treatment of hypertension with alpha-blockers during pregnancy reduces the risk of pre-eclampsia

C.   Tight blood pressure control is associated with better maternal outcomes compared to less tight blood pressure control

D.   Reduction of blood pressure with anti-hypertensive drugs is associated with a reduction in birth weight        

E.    The target for blood pressure control should be higher for women with evidence of end-organ damage ; correct one

 

A 32 year old woman with a history of chronic hypertension attends the antenatal clinic at 10 weeks gestation. Her BP = 142/88 mmHg and there is no proteinuria.

 

A.    Aspirin from 12 weeks gestation       correct one

 

B.    Aspirin from 12 weeks gestation + uterine artery Dopplers at 23 weeks

 

C.   Uterine artery Dopplers at 23 weeks + aspirin if bilateral notching

 

D.   Baseline pre-eclampsia blood tests + aspirin from 10 weeks

 

E.    Aspirin from 12 weeks and increase dose if uterine artery Dopplers abnormal at 23 weeks

 

 

With respect to the potential side-effects of anti-hypertensive drugs used during pregnancy and the post-natal period

A.    Labetalol is associated with low placental weight

B.    Atenolol is associated with low birth weight       

C.   There is a recognized association between labetalol and neonatal hypoglycaemia

D.   There is a recognized association between methyldopa and neonatal jaundice ; correct one

E.    ACE inhibitors can safely be used after the second trimester

 

 

A community midwife phones you about a 34 year old woman had a spontaneous vaginal delivery following induction of labour at 39 weeks gestation because of moderate gestational hypertension. She is on labetalol 200 mg 4 times a day. On day 15 post-partum, her BP is 146/88 mmHg.

A.    Repeat BP weekly for 6 weeks

B.    Repeat BP twice a week for 6 weeks

C.   Refer to physician with interest inessential hypertension 

D.   Refer to day unit for medical review

E.    Refer to obstetric medical clinic         correct one

 

A 34 year old woman has a spontaneous vaginal delivery following induction of labour at 39 weeks gestation because of moderate gestational hypertension. She is on labetalol 200 mg twice a day. On day 2 post-partum, you are asked to review her. Her BP has been 130-135/80-88 mmHg.

 

A.    Stop anti-hypertensive drugs

B.    Increase dose to 200 mg three times a day

C.   Omit next dose of labetalol ; correct one

D.   Continue current treatment         

E.    Change labetalol to coracten

 

 

A 40 year old woman has labour induced at 39 weeks gestation because of mild gestational hypertension. She has a ventouse delivery and her post-natal BP is 145/95 mmHg. She is discharged 24h after birth and is not on any medication.

A.    Monitor BP at least once between days 3 and 5       correct one

B.    Monitor BP daily from days 3-5

C.   Monitor BP daily from days 3-7

D.   Monitor BP weekly for the next 2 weeks

E.    Monitor BP weekly for the next 6 weeks

 

 

A low risk 33 year old woman attends the assessment unit at 36 weeks gestation. The woman’s BP is 155/98 mmHg and there is no proteinuria. She has no symptoms, feels good fetal movements and the fundal height is on the 50th centile on a customized growth chart. Blood tests, CTG and fetal growth scan are normal with normal umbilical artery Dopplers.

 

A.    Deliver within 24-48h

 

B.    Deliver once corticosteroids administered

 

C.   Stabilize blood pressure and deliver

 

D.   Deliver after 37 weeks if BP well controlled         correct one

 

 

E.    Deliver at 37 weeks if BP well controlled