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Test 7: Medical problems during pregnancy and the puerperium

Please choose the one most correct answer to each question or statement.

  1. A patient with cystitis usually complains of:
    • Headache
    • Fever and rigors
    • Dysuria and frequency
    • Backache
  2. Cystitis is treated by:
    • Asking the patient to increase her oral fluid intake
    • Prescribing a single oral dose of amoxycillin or co-trimoxazole
    • Giving 2.4 million units of benzathine penicillin intramuscularly
    • Giving ampicillin 1 g intravenously every 6 hours until the symptoms stop
  3. A patient with asymptomatic bacteriuria has:
    • No symptoms
    • Fever
    • Nocturia
    • Lower abdominal pain
  4. It is important to treat patients with asymptomatic bacteriuria in pregnancy because:
    • The patient is seriously ill
    • One third will develop septic shock during pregnancy
    • One third will develop cystitis during pregnancy
    • One third will develop acute pyelonephritis during pregnancy
  5. How is asymptomatic bacteriuria diagnosed?
    • By detecting proteinuria
    • By testing for nitrites and leucocytes in the urine
    • By examining a sample of urine under the microscope
    • By culturing a sample of midstream urine
  6. Which clinical sign suggests that the patient has acute pyelonephritis?
    • Tenderness over the bladder
    • Oedema
    • Severe tenderness to percussion over one or both renal angles
    • Severe tenderness in the upper abdomen
  7. What is the correct management of a patient with acute pyelonephritis?
    • Amoxicillin (Amoxil) 3 g as a single oral dose
    • Amoxicillin (Amoxil) 500 mg 8-hourly by mouth for seven days as an outpatient
    • The patient must be admitted to hospital and receive amoxicillin (Amoxil) 500 mg 8-hourly by mouth for seven days
    • The patient must be admitted to hospital and receive an intravenous broad-spectrum antibiotic
  8. What is the definition of anaemia in pregnancy?
    • A haemoglobin concentration of less than 12 g/dl
    • A haemoglobin concentration of less than 11 g/dl
    • A haemoglobin concentration of less than 10 g/dl
    • Any patient with shortness of breath irrespective of the haemoglobin concentration
  9. What is the commonest cause of anaemia in pregnancy?
    • Iron deficiency
    • Folic acid deficiency
    • Infection
    • Blood loss
  10. The management of anaemia in pregnancy depends on:
    • The presence or absence of oedema
    • Whether the patient is pale or not
    • The presence or absence of shortness of breath and tachycardia
    • The presence or absence of hypotension
  11. What should be the management of an anaemic patient if the haemoglobin concentration is less than 8 g/dl and the gestational age 37 weeks?
    • Admit to hospital for bed rest and a good diet
    • Admit to hospital for a blood transfusion
    • Give an intramuscular injection of iron-dextran (Imferon)
    • Prescribe 1 ferrous sulphate tablet 3 times a day until delivery
  12. What should be the management of a patient in the puerperium who has normal observations and has no bleeding, but has a haemoglobin concentration of 9 g/dl?
    • Reassure her that no treatment is needed.
    • Give her a blood transfusion.
    • Advise her to eat a good diet.
    • Prescribe an oral iron supplement.
  13. Which patients should receive supplementary iron during pregnancy?
    • All patients
    • Only patients with a haemoglobin concentration of less than 10 g/dl
    • Only patients with a full blood count suggesting iron deficiency
    • Patients from communities where iron deficiency is common or socio-economic circumstances are poor
  14. What should be done if a patient has side effects from the iron supplementation?
    • She should be reassured and the importance of taking the iron tablets should be stressed.
    • The tablets should be taken with meals.
    • The iron tablets should be stopped.
    • The iron tablets should be stopped and metoclopramide (Maxalon) given.
  15. A patient with asymptomatic heart valve disease:
    • Must be admitted to hospital for bed rest from 34 weeks gestation
    • Must be delivered in hospital because of the high risk of pulmonary oedema during labour and the first day of the puerperium
    • Should be classified as low risk and delivered in a primary perinatal-care clinic
    • Should be given Syntometrine after delivery to prevent a postpartum haemorrhage
  16. A patient with heart valve disease should:
    • Be nursed on her side during labour with her body raised with pillows to 45 degrees
    • Be nursed on her side during labour with her body flat on the bed
    • Be delivered in the lithotomy position
    • Be heavily sedated during labour
  17. Which complication is common if diabetes is not well controlled in the third trimester?
    • Anaemia
    • Pre-eclampsia
    • Oligohydramnios
    • Pulmonary oedema
  18. Which complication is common in the second stage of labour in patients with poorly controlled diabetes?
    • Precipitous (sudden, unexpected) delivery
    • Impacted shoulders
    • Hypoglycaemia
    • Hyperglycaemia
  19. A random blood glucose concentration should be done when:
    • 1+ ketonuria is detected for the first time in pregnancy.
    • 1+ glucosuria is detected for the first time in pregnancy.
    • Patients attend their first antenatal care clinic.
    • Patients attend their second antenatal care clinic.
  20. Which random blood glucose concentration is normal?
    • Less than 4 mmol/l
    • Less than 6 mmol/l
    • Less than 8 mmol/l
    • Less than 11 mmol/l