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MRCOG PART 2 SBAs and EMQs

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Week 4 - hypertensive disorders

Week 4 - hypertensive disorders Posted by PAUL A.

Question 1

With respect to the use of aspirin to reduce the risk of hypertensive disease in women at increased risk

A. Low dose aspirin reduces the risk of pre-eclampsia but not gestational hypertension 

B. Low dose aspirin reduces the risk of gestational hypertension but not pre-eclampsia

C. Low dose aspirin reduces the risk of pre-eclampsia and gestational hypertension

D. Low dose aspirin reduces the risk of pre-eclampsia but does not reduce the risk of pre-term birth before 37 weeks

E. Low dose aspirin reduces the risk of pre-eclampsia but does not reduce the risk of neonatal death

 

Question 2

Anti-platelet agents can be used to reduce the risk of hypertensive disease in women at moderate and high risk. With respect to the use of aspirin

A. The risk of pre-eclampsia is reduced in high-risk but not in moderate-risk women

B. The risk of gestational hypertension is reduced in high-risk and moderate-risk women

C. The risk of pre-eclampsia, but not gestational hypertension, is reduced in moderate-risk women  

D. The risk of pre-eclampsia and gestational hypertension are reduced in moderate-risk women

E. The risk of gestational hypertension is reduced in moderate-risk but not high-risk women

 

Question 3

In women at increased risk of pre-eclampsia, low dose aspirin reduces the risk of pre-eclampsia by

A. 5%

B. 10%  

C. 20%

D. 30%

E. 45%

 

Question 4

Low-dose aspirin is used to reduce the risk of pre-eclampsia in women at increased risk. The number of women who need to be treated in order to prevent one case of pre-eclampsia is

A. 10

B. 20

C. 40

D. 80

E. 110  

 

Question 5

A 26 year old woman attends the antenatal clinic after her anomaly scan at 21 weeks in her second pregnancy. She developed pre-eclampsia in her first pregnancy resulting in delivery by emergency caesarean section at 34 weeks. Although she booked at 8 weeks gestation, she has not been started on low dose aspirin.

A. Do not offer aspirin after 20 weeks

B. Offer aspirin but explain that it is ineffective if started after 20 weeks

C. Offer aspirin but explain that it is less effective if started after 20 weeks

D. Offer aspirin and explain that it is equally effective if started after 20 weeks 

E. Offer aspirin + recommend uterine artery Dopplers at 23 weeks

 

Question 6

A healthy 23 year old woman attends the antenatal clinic at 12 weeks in her second pregnancy. Her first pregnancy was complicated by severe pre-eclampsia resulting in delivery at 30 weeks gestation. She enquires about the risks and benefits of low-dose aspirin. In addition to a reduction in the risk of pre-eclampsia, low-dose aspirin is associated with

A. A reduction in the risk of placental abruption

B. A reduction in the risk of ante-partum haemorrhage

C. A reduction in the risk of post-partum haemorrhage

D. An increase in the risk of post-partum haemorrhage

E. A reduction in the risk of pre-term birth before 37 weeks

 

Question 7

A healthy 37 year old woman telephones for advice at 32 weeks gestation in her second pregnancy. Her first pregnancy was complicated by severe pre-eclampsia and as a result, she has been taking aspirin since 12 weeks gestation. She has seen a doctor and a midwife and has been given conflicting information about when to stop taking aspirin.


A. Continue aspirin until delivery  

B. Stop aspirin if she thinks she is in labour

C. Continue aspirin until 34 weeks

D. Continue aspirin until 36 weeks

E. Continue aspirin until 40 weeks

 

Question 8

With respect to the role of calcium supplementation in reducing the risk of pre-eclampsia

A. Calcium supplementation does not reduce the risk of pre-eclampsia

B. Calcium supplementation increases the risk of pre-eclampsia

C. Calcium supplementation reduces the risk of pre-eclampsia but the effect size is lower than that of low-dose aspirin

D. Calcium supplementation reduces the risk of pre-eclampsia in women with low dietary calcium intake  T

E. Calcium supplementation reduces the risk of pre-eclampsia in women living at high altitude

 

Question 9

Which of the following anti-hypertensive agents have been associated with fetal congenital anomalies?

A. ACE-inhibitors only

B. ACE-inhibitors and Angiotensin receptor blockers only  

C. ACE-inhibitors and Bendroflumethiazide

D. ACE-inhibitors, Angiotensin receptor blockers and furosemide

E. ACE-inhibitors and Angiotensin receptor blockers and hydralazine

 

Question 10

A 37 year old woman with a 5 year history of chronic hypertension telephones the maternity assessment unit because she has missed her period and her pregnancy test is positive. She is taking enalapril and is concerned about the potential effects on the fetus.

A. Advise her to stop taking the drug immediately

B. Take measures to replace enalapril within 2 working days  

C. Take measures to replace enalapril within 1 week

D. Advise her to stop enalapril and start taking labetalol immediately

E. Take measures to stop enalapril before 6 weeks gestation

 

Question 11

In pregnant women with mild-moderate chronic hypertension, treatment with methyldopa (compared to placebo) has been shown to be associated with

A. A reduction in the risk of super-imposed pre-eclampsia

B. A reduction in the risk of super-imposed pre-eclampsia and fetal growth restriction

C. No difference in the risk of pre-eclampsia or fetal growth restriction  

D. An increase in the risk of small-for-gestational age babies

E. A reduction in the risk of placental abruption

 

Question 12

With respect to treatment targets for BP control in pregnant women with chronic hypertension

A. BP should be kept below 140/90 mmHg

B. BP should be kept below 140/90 mmHg in women with uncomplicated chronic hypertension

C. Aim to maintain BP around 120/80 mmHg in women with uncomplicated chronic hypertension

D. BP should be kept below 150/100 mmHg in women with uncomplicated chronic hypertension 

E. BP should be kept at 130-140 / 70-90 mmHg in women with uncomplicated chronic hypertension

 

Question 13

A 37 year old woman attends the antenatal clinic at 14 weeks gestation in her first pregnancy. She has a history of chronic hypertension with hypertensive nephropathy. She was seen in the antenatal clinic at 10 weeks gestation and the dose methyldopa increased to 500 mg four times a day. Her BP = 110/52 mmHg and urine analysis shows 1+ proteinuria.

A. Continue current dose of methyldopa

B. Reduce dose of methyldopa   

C. Admit for 24h urine collection

D. Change methyldopa to labetalol

E. Discuss risks and benefits of labetalol and methyldopa

 

Question 14

A healthy 36 year old woman has been referred to the maternity assessment unit at 32 weeks gestation because of hypertension and proteinuria. She has no symptoms and is feeling good fetal movements. The most appropriate test to estimate proteinuria is

A. 24 hour urinary protein excretion

B. Spot urinary protein : creatinine ratio

C. Automated reading of reagent strip

D. Spot urinary protein : creatinine ratio or automated reading of reagent strip 

E. 24 hour urinary protein excretion or spot urinary protein : creatinine ratio

 

Question 15

Automated reading of reagent strips and spot urinary protein : creatinine ratio (PCR) are both used to estimate proteinuria during pregnancy.

A. Automated reagent strip reading has a higher sensitivity than PCR

B. PCR has a higher sensitivity than automated reagent strip reading

C. PCR has similar sensitivity to automated reagent strip reading  

D. The sensitivity of PCR is about 97%

E. The sensitivity of automated reagent strip reading is about 65%

 

Question 16

A healthy 30 year old woman is referred to the maternity assessment unit at 36 weeks gestation because of hypertension. She has no symptoms. BP = 146/97 mmHg and urine analysis shows a trace of protein on automated testing. Her further management should include

A. BP monitoring once a week  

B. Urine protein : creatinine ratio + renal and liver function tests

C. Renal + liver function tests and if normal, BP monitoring once a week

D. BP monitoring twice a week

E. Renal + liver function tests and if normal, BP monitoring twice a week

 

Question 17

A healthy 33 year old woman attends the antenatal clinic at 34 weeks gestation. She has no symptoms and is feeling good fetal movements. BP = 156/97 mmHg and urine analysis shows a trace of protein on automated testing. Fundal height is on the 50th centile on the customised growth chart and there is good interval growth.

A. Admit for BP control and 24h urine protein

B. Treat hypertension as out-patient

C. FBC, renal and liver function tests and treat hypertension as out-patient  

D. FBC, renal and liver function tests and admit for BP control

E. Admit if BP does not improve within 1 hour of antihypertensive treatment

 

Question 18

A healthy 33 year old woman attends the antenatal clinic at 34 weeks gestation. She has no symptoms and is feeling good fetal movements. BP = 156/97 mmHg and urine analysis shows a trace of protein on automated testing. Fundal height is on the 50th centile on the customised growth chart and there is good interval growth. Anti-hypertensive therapy is initiated.

A. Monitor BP at least once a week

B. Monitor BP at least twice a week  

C. Monitor BP at least 4 times a day

D. Monitor BP at least 6 times a day

E. Monitor BP every 15 minutes for 1 hour

 


Question 19

A healthy 33 year old woman attends the antenatal clinic at 34 weeks gestation. She has no symptoms and is feeling good fetal movements. BP = 156/97 mmHg and urine analysis shows a trace of protein on automated testing. Fundal height is on the 50th centile on the customised growth chart and there is good interval growth. Anti-hypertensive therapy is initiated. The target for BP control should be

A. Below 140/90 mmHg

B. 120-130 / 80-90 mmHg

C. Systolic below 150 mmHg and diastolic of 80-90 mmHg  

D. Systolic below 150 mmHg and diastolic of 80-100 mmHg  

E. Systolic below 140 mmHg and diastolic of 80-90 mmHg

 

Question 20

A healthy 33 year old woman has been admitted from the antenatal clinic at 34 weeks gestation because of hypertension. She has no symptoms and is feeling good fetal movements. BP = 166/103 mmHg and urine analysis shows a trace of protein on automated testing. Fundal height is on the 50th centile on the customised growth chart and there is good interval growth. Anti-hypertensive therapy is initiated. Her management plan would include

A. In-patient until delivery, BP checks at least 4 times a day and daily tests for proteinuria

B. BP checks at least 4 times a day, daily tests for proteinuria, discharge once BP below 140/90 mmHg

C. BP checks at least 4 times a day, blood tests twice a week, discharge once BP below 140/90 mmHg

D. BP checks at least 4 times a day, blood tests once a week, discharge once BP below 159/109 mmHg 
 
E. In-patient until delivery, BP checks at least 4 times a day, blood tests 2-3 times a week

 

 

 

 

 


  

 


 

Posted by namreen M.

1.a

2.c

3.e

4.d

5.e

6.e

7.a

8.d

9.b

10.b

11.d

12.b

13.c

14.a

15.a

16.a

17.c

18.b

19.d

20.d

 

Posted by PAUL A.

Answers

 

1)   A

2)   C

3)   B

4)   E

5)   D

6)   E

7)   A

8)   D

9)   B

10)                  B

11)                  C

12)                  D

13)                  B

14)                  D

15)                  C

16)                  A

17)                  C

18)                  B

19)                  D

20)                  D

Posted by shah M.

Question  15 ,is moderate hypertension, need bloodstest?  Is trace proteinuria in automatically strip significant.?

Posted by christian A.
I am not sure of q 5
Posted by PAUL A.
Posted by shah M.
Fri Dec 4, 2015 12:22 am

Question  15 ,is moderate hypertension, need bloodstest?  Is trace proteinuria in automatically strip significant.?

 

No it is not.

 

Posted by PAUL A.
Posted by christian A.
Sat Dec 12, 2015 09:30 am

I am not sure of q 5

 

?? what are you not sure about?

 

Source of the answers Posted by Shanthala K.

It would help greatly if you could mention the original source of information for the various topics. Eg-TOG/GTG/BJOG etc. so that we could read them again.