Quiz 13: 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