Hypertensive Disorders in Pregnancies

 Hypertensive Disorders in Pregnancies:

1. Therapeutic termination of early pregnancy is indicated in:

A. Uterine fibroid

B. Maternal pulmonary hypertension

C. Placenta previa

D. Maternal blood sugar >12 mmol/L

E. Triplet pregnancy

2. In Pre-eclampsia, right upper quadrant part abdominal pain is due.

A. Tension of the liver capsule

B. Cholecystitis

C. Pancreatitis

D. Gastric ulcer

E. Oesophagitis

3. In eclampsia: Which is true?

A. Caesarean section must be carried out in all cases

B. Hypotensive drugs should not be used

C. Urinary output is increased

D. Antidiuretic drugs are essential in all cases

E. Ergometrine should be avoided in the third stage of labor

4. Immediate appropriate response to an initial eclamptic seizure include all of

the following, EXCEPT:

A. Ultrasound for fetal growth

B. Maintain adequate oxygenation

C. Administer magnesium sulphate

D. Prevent maternal injury

E. Monitor the fetal heart rate

5. The most important reason to give antihypertensive drug for hypertension in

pregnancy is to decrease the:

A. Incidence of IUGR

B. Incidence of oligohydraminos

C. Incidence of fetal death

D. Incidence of placental abruption

E. Risk of maternal complications such as stroke

6. Risk factors for pre- eclampsia include all of the following, EXCEPT:

A. Elderly primigravida

B. African ethnicity

C. Positive family history of hypertension

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D. Positive history of pre- eclampsia in previous pregnancies

E. Positive history of macrosomic baby

7. Pre-eclampsia is associated with an increase risk of all of the following, EXCEPT:

A. Delivery of a small for gestational age infant

B. Placental abruptio

C. Pulmonary edema

D. Prolonged duration of labor

E. Cerebral vascular accident (CVA)

8. Pregnancy induced hypertension :

A. Means high blood pressure at 10 weeks gestation.

B. Needs no treatment.

C. Pregnancy will be managed as normal.

D. Fetus will be at risk of fetal anomaly.

E. Fetus will be at risk of IUGR.

9. The following are known complications of pre-eclampsia EXCEPT :

A. Abruptio placenta.

B. Uterine rupture.

C. Prematurity.

D. Placental insufficiency.

E. IUFD.

10. Severely pre-eclamptic patients have a decrease in :

A. Response to pressor amines.

B. Plasma volume.

C. Total body sodium.

D. Uric acid.

E. None of the above.

11. What is the most common cause of acute renal failure in pregnancy ?

A. Drug abuse.

B. SLE.

C. Pre-eclampsia and eclampsia.

D. Sickle cell disease.

E. Placenta previa.

12. Regarding essential hypertension in pregnancy, all the following is true, EXCEPT

A. Commonly associated with +ve family Hx of hypertension.

B. Usually diagnosed in the 3rd trimester.*

C. More common in women over the age of 35.

D. It's usually not associated with significant proteinuria.

E. Will develop pre-eclampsia more commonly than normotensive women .

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13. A pre-eclamptic patient has just delivered and has a soft uterus with moderate

bleeding. Examination reveals no laceration. Of the options below, the BEST

choice is :

A. 0.2 mg IV ergometrine.

B. 0.5 mg oral ergometrine.

C. 5 units of oral oxytocin.

D. 0.5 mg IM ergometrine.

E. 20 units Oxytocin in a 500 ml of D5W given IV.

14. Pregnancy induced proteinuric hypertension is associated with all the following,

EXCEPT :

A. An increase in serum uric acid level.

B. Plasma volume decreases.

C. An increase in the incidence of IUGR.

D. An increase in creatinine clearance.

E. Hb concentration increases.

15. Regarding pre-eclampsia, proteinuria is defined as :

A. 100 mg/24 hour urine.

B. 200 mg/24 hour urine.

C. 300 mg/24 hour urine.

D. > 500 mg/24 hour urine.

E. < 300 mg/34 hour urine.

16. Which adverse pregnancy outcome isn't increased in pregnancies complicated

by chronic hypertension :

A. Fetal growth restriction.

B. Preterm birth.

C. Spontaneous preterm rupture of membranes.

D. Perinatal death.

E. Post term birth

17. A syndrome seen in pre-eclampsia called HELLP syndrome is characterized by

all of the following EXCEPT:

A. Elevation of Liver enzymes.

B. Hemolysis.

C. Low platelet count.

D. Prolongation of the Prothrombin time.

18. The most common presenting prodromal sign or symptom in patient with

eclampsia is:

A. Right upper quadrant pain.

B. Edema.

C. Headache.

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D. Visual disturbance.

E. Severe hypertension.

19. Appropriate response to an initial eclamptic seizure include all of the following

EXCEPT:

A. Attempt to abolish the seizure by administrating I.M. diazepam.

B. Maintain adequate Oxygenation.

C. Administer Mg sulphate by either the I.M. or I.V. route.

D. Prevent maternal injury.

E. Monitor the fetal heart rate.

20. The most consistent finding in Eclampsia patients is:

A. Hyperreflexia.

B. 4+ proteinuria.

C. Generalized edema.

D. Diastolic blood pressure greater than 110 mmHg.

E. Convulsions.

21. Eclampsia occurring prior to 20 weeks of gestation is most commonly seen in

women with:

A. A history of chronic hypertension.

B. Multiple gestation.

C. Gestational trophoblastic diseases.

D. A history of seizure disorder.

E. A history of choric renal diseases.

22. Of the following, the most common complication of eclampsia is:

A. Mg intoxication.

B. Recurrent seizures following administration of Mg sulphate.

C. Intracranial hemorrhage.

D. Maternal death.

E. Pulmonary edema

23. If a woman with pre-eclampsia is not treated prophylcatically to prevent

eclampsia, her risk of seizing is approximately:

A. 1/10.

B. 1/25.

C. 1/75.

D. 1/200.

E. 1/500.

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24. Likely contributory mechanism of the anticonvulsant action of Mg sulphate

includes all the following EXCEPT:

A. Neuronal Ca-channel blockade.

B. Peripheral neuromuscular blockade.

C. Reversal of cerebral arterial vasoconstriction.

D. Inhibition of platelet aggregation.

E. Release of endothelial prostacyclin.

25. All of the following antihypertensive drugs are considered safe for short-term

use in pregnancy EXCEPT:

A. Captopril.

B. Methyldopa.

C. Hydralazine.

D. Nifedipine.

E. Labetalol.

26. The reason to treat severe chronic hypertension in pregnancy is to decrease

the:

A. Incidence of IUGR.

B. Incidence of Placental abruption.

C. Incidence of Preeclampsia.

D. Risk of Maternal Complications such as Stroke.

27. The reason of using antihypertensive treatment in pregnancy is to:

A. Reduce the placental blood flow.

B. Reduce the risk of CVA in the fetus.

C. Reduce the risk of CVA in the mother.

D. Prevent hypertensive renal disease.

E. Prevent myocardial infarction.

28. Which of the following laboratory tests would be most suggestive of

preeclampsia?

A. Elevated bilirubin.

B. Decreased hematocrit.

C. Elevated lactate dehydrogenase (LDH).

D. Elevated uric acid.

E. Elevated creatinine.

29. HELLP Syndrome includes all the followings EXCEPT:

A. Hemolysis.

B. Increased AST.

C. Increased platelets.

D. Increased ALT.

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30. The drug of choice to prevent convulsions in eclampsia is:

A. Magnesium Sulfate.

B. Hydralazine.

C. Labetalol.

31. PET (Pre-Eclamptic Toxemia):

A. MgSO4 is the drug of choice for eclamptic convulsions.

B. Exaggerated knee jerk indicates MgSO4 toxicity.

32. The proteinuria in eclampsia contains?

A. Only albumin

B. Only globulin

C. More albumin than globulin

D. More globulin than albumin

E. Neither albumin nor globulin

33. Which adverse pregnancy outcome is not increased in pregnancies complicated

by chronic hypertension :

A. Fetal growth restriction

B. Pre-term birth

C. Spontaneous preterm rupture of membrane

D. Perinatal death

E. Post-term birth

34. Pregnancy induced proteinuria hypertension is associated with all following,

EXCEPT :

A. Increases in serum uric acid level

B. Plasma volume decreases

C. Increases in the incidence of IUGR

D. Increase in creatinine clearance

E. Hemoglobin concentration increase

35. A pre-eclamptic patient has just delivered & has a soft uterus with moderate

bleeding. Examination reveals no laceration. Of the options below, the BEST

choice :

A. 0.2 mg IV ergometrine

B. 0.5 mg oral ergometrine

C. 5 units oral oxytocin

D. 0.5 mg IM ergometrine

E. 20 units oxytocin in a 500 ml of D5W given IV

36. Of the following, the most common cause of maternal death from eclampsia is:

A. Infection.

B. Uremia.

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C. Congestive heart failure.

D. Fever.

E. Cerebral hemorrhage.

37. The criteria for severe pre-eclampsia include all the following, EXCEPT:

A. Diastolic blood pressure of 110 mmhg or more.

B. Proteinuria more than 5g/24 hours.

C. Presence of epigastric pain .

D. Decreased hematocrit.

E. Oliguria.

38. The immediate appropriate response to an eclamptic seizure includes all the

following, EXCEPT :

A. Monitor the fetal heart rate.

B. US done for fetal growth.

C. Administer Mg sulphate.

D. Maintain adequate oxygenation.

E. Prevent maternal injury.

39. All the following factors increase the risk of the development of pre-eclampsia,

EXCEPT :

A. Closed spaced pregnancies.

B. Pre-existing diabetes.

C. Multiple gestation.

D. Pre-eclampsia with a previous pregnancy.

E. Pre-existing renal disease.

40. Risk factors to preeclampsia include all the following EXCEPT:

A. Premature delivery.

B. Placenta abruption.

C. Renal failure.

D. DIC.

E. Polycythemia.

41. Pregnancy induced hypertension is more common in all the following EXCEPT:

A. Primigravida.

B. Multiple pregnancy.

C. Patients with pre-existing hypertension.

D. Women with UTI.

E. Women with diabetes mellitus.

42. Which of the following laboratory tests would be most suggestive of

preeclampsia?

A. Elevated bilirubin.

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B. Decreased Hematocrit.

C. Elevated lactate dehydrogenase (LDH).

D. Elevated uric acid.

E. Elevated creatinine.

43. 30 weeks pregnant primigravida presented with raised blood pressure of

150\95 mmHg and proteinuria +3, which one of the following is done :

A. Immediate caesarian section.

B. 24 hour urine collection for protein, CBC. LFT, uric acid and coagulation

profile.

C. Send her home and to be seen after 4 weeks.

D. Advice to not get pregnant again.

E. Macrosomia is a recognized complication of this problem.

34. Early clinical evidence of magnesium sulfate toxicity would show:

A. Flushing

B. Diplopia

C. Decreased oxygen saturation

D. Loss of deep tendon reflexes

E. Headache

35. The following are true regarding patients with essential hypertension in labor,

EXCEPT :

A. Shouldn't have epidural analgesia.

B. Can be safely given IV syntocinon.

C. Shouldn't be given ergometrin as a routine in the 3rd stage.

D. Should have continuous fetal heart rate monitoring.

E. IV labetalol is a safe drug when required.

36. Proteinuria in pregnancy may be caused by :

A. UTI.

B. Pre-eclamptic toxemia.

C. Nephrotic syndrome.

D. Contaminated with vaginal discharge.

E. All the above.

37. Markedly obese pregnant patients often experience all the following

complications, EXCEPT :

A. Hypertension.

B. Diabetes mellitus.

C. Thromboembolism.

D. Fetal growth restriction.

E. Difficult intubation during anesthesia.

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38. What is the mechanism of action of alpha methyl dopa?

A. Increase peripheral vascular resistance.

B. Increase sodium and water retention.

C. Acts centrally to decrease sympathetic activity.

D. Relaxes arterial smooth muscle.

E. Decrease the cardiac output.