Quiz 3: Hypertensive disorders of pregnancy

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

1. What is the definition of hypertension in pregnancy?
   • A diastolic blood pressure of 80 mm Hg or above and/or a systolic blood pressure of 120 mm Hg or above
   • A diastolic blood pressure of 90 mm Hg or above and/or a systolic blood pressure of 140 mm Hg or above
   • A diastolic blood pressure of 100 mm Hg or above and/or a systolic blood pressure of 160 mm Hg or above
   • A rise in diastolic blood pressure of 10 mm Hg.
2. What is the definition of significant proteinuria in pregnancy?
   • A trace of protein
   • 1+ protein or more
   • 2+ protein or more
   • 3+ protein
3. How should you define pre-eclampsia?
   • Hypertension and proteinuria presenting before the start of pregnancy
   • Hypertension and proteinuria presenting in the first half of pregnancy
   • Hypertension and proteinuria presenting in the second half of pregnancy
   • Hypertension and proteinuria presenting any time in pregnancy
4. What is the correct definition of chronic hypertension?
   • Hypertension, without proteinuria, that is present in the first half of pregnancy
   • Hypertension, together with proteinuria, that is present in the first second of pregnancy
   • Hypertension that is present in the first half of pregnancy, plus proteinuria that presents in the second half of pregnancy
   • Hypertension alone which is present at the time of booking at 28 weeks
5. How common is pre-eclampsia?
   • Most pregnant women develop pre-eclampsia.
   • About 25% of all pregnant women develop pre-eclampsia.
   • About 5–6% of all pregnant women develop pre-eclampsia
   • Very rare
6. Which fetal condition is common in pregnancies complicated by pre-eclampsia?
   • Congenital malformations
   • Heart failure due to hypertension
   • Haemorrhagic disease of the newborn
   • Intra-uterine growth restriction
7. Pre-eclampsia may cause fetal distress because it results in:
   • A decrease in placental blood flow
   • Fetal hypertension
   • Severe protein loss in the mother’s urine
   • Congenital abnormalities caused by antihypertensive drugs
8. A patient with pre-eclampsia who develops a diastolic blood pressure of 105 mm Hg and 2+ proteinuria at 36 weeks of pregnancy should be graded as having:
   • Pre-eclampsia
   • Pre-eclampsia with severe features
   • Chronic hypertension with superimposed pre-eclampsia
   • Eclampsia
9. What is an important sign of pre-eclampsia with severe features?
   • 3 + proteinuria
   • Increased tendon reflexes
   • A diastolic blood pressure of 100 mm Hg
   • Tenderness on palpating the calves
10. A patient with pre-eclampsia has a diastolic blood pressure of 95 mm Hg and 1+ proteinuria. She complains of flashes of light in front of her eyes and upper abdominal pain. In which of the following grades of pre-eclampsia should you put this patient?
    • Pre-eclampsia
    • Gestational hypertension
    • Pre-eclampsia with severe features
    • Eclampsia
11. Which of the following women has the highest risk of pre-eclampsia?
    • A patient with a history of pre-eclampsia starting early in the third trimester of a previous pregnancy
    • A patient with a history of a preterm delivery in her previous pregnancy
    • Grande multiparas
    • A patient who previously had a twin pregnancy
12. Which one of the following may be an early warning sign of pre-eclampsia?
    • Weight loss during the last months of pregnancy
    • Generalised oedema especially of the face
    • Oedema of the feet at the end of the day
    • Pain on passing urine
13. What is the management of a patient with pre-eclampsia ?
    • Oral antihypertensive drugs
    • Diuretics to reduce oedema
    • Hospitalisation
    • A loading dose of magnesium sulphate
14. Which one of the following is the method of delivery usually chosen in a patient with pre-eclampsia?
    • Caesarean section
    • Surgical induction followed by vaginal delivery at 32 weeks
    • Surgical induction followed by vaginal delivery if 34 weeks gestation has been reached.
    • Waiting until 40 weeks for a spontaneous onset of labour.
15. What is an important complication of pre-eclampsia?
    • Placenta praevia
    • Oedema of the face
    • Glycosuria
    • Intracerebral haemorrhage
16. Which of the following is the correct method of treatment for a patient with severe pre-eclampsia?
    • The patient should be stabilised first, then be moved to a level 2 hospital for further management.
    • The patient should immediately be rushed to the nearest level 3 hospital for stabilisation.
    • The patient should be managed at a level 1 hospital.
    • The infant must immediately be delivered by Caesarean section at a level 2 hospital.
17. What drug is used to manage a diastolic blood pressure of 110 mm Hg or more?
    • Alpha-methyldopa (Aldomet)
    • Nifedipine (Adalat)
    • Diazepam (Valium)
    • Propranolol (Inderal)
18. What is an important sign of magnesium sulphate overdosage?
    • Vomiting
    • Hyperventilation
    • A urine output of less than 20 ml per hour
    • Depressed tendon reflexes
19. What drug is used to prevent and manage eclampsia?
    • Magnesium sulphate
    • Magnesium trisilicate
    • Alpha-methyldopa (Aldomet)
    • Diazepam (Valium)
20. How should a patient, who feels well but has a diastolic blood pressure of 90 mm Hg at 36 weeks gestation, be managed? At all her previous antenatal visits, her blood pressure was normal, and she has no proteinuria.
    • She must be given an intramuscular injection of dihydralazine (Nepresol).
    • She must be hospitalised.
    • Alpha methyl dopa (Aldomed) must be prescribed and weekly antenatal visits should be arranged with additional visits if necessary.
    • A full blood count should be done to exclude a low platelet count.