Week 2

Question 1

what is and what are the changes in late pregnancy on vital capacity?

Answer 1

no change, the entire amount you can breathe in a hold

Question 2

what are the changes in late pregnancy on ventilation?

Answer 2

increases 40% with increase in RR

Question 3

what are the changes in late pregnancy on oxygen consumption?

Answer 3

increase 20-33%

Question 4

what is and what are the changes in late pregnancy on total lung capacity?

Answer 4

all the air in your lungs with a deep breathe in. Reduced by 4% due to diaphragm

Question 5

what is and what are the changes in late pregnancy on functional residual capacity?

Answer 5

how much left in the lungs when you breathe out normally, reduced 10-20%

Question 6

what is and what are the changes in late pregnancy on expiratory reserve volume?

Answer 6

the additional air you breathe out from rest to full exhalation. reduced 15-20%

Question 7

what is and what are the changes in late pregnancy on residual volume?

Answer 7

the amount in your lungs you cannot breathe out. reduced 20-25%

Question 8

what is and what are the changes in late pregnancy on inspiratory capacity?

Answer 8

the amount your breathe in from rest , unchanged

Question 9

What changes occur on ABG in pregnancy on PaCO2 and what is the pregnancy reference ranges?

Answer 9

Decreased 3.7-4.2

Question 10

What changes occur on ABG in pregnancy on pH and what is the pregnancy reference ranges?

Answer 10

increased, 7.4-7.45

Question 11

What changes occur on ABG in pregnancy on PaHCO3 and what is the pregnancy reference ranges?

Answer 11

decreased18-21

Question 12

What changes occur on ABG in pregnancy on PaO2 and what is the pregnancy reference ranges?

Answer 12

increased, >13

Question 13

What should you cover at a booking visit for asthma?

Answer 13

hx and severity
record baseline PFR
encourage breastfeeding and smoking cessation
vaccines
importance of medication continuation
vitamin D
reduce weight gain

Question 14

What regime of IV hydrocortisone in labour/CS should be given if needing repeated prednisone in pregnancy?

Answer 14

50mg IV q6hrly until 6 hours PN
elective CS - 100mg IV with anaesthetic then 50mg 6 hours PN
EmCS - top up 50mg IV then 50mg IV 6 hours PN

Question 14

What are the criteria for ARDS and what is the mortality rate?

Answer 14

acute respiratory failure +
- biltaeral chest radiographic findings
- pulmonary capillary wedge pressure <19
- impaired oxygenation PaO2/FiO2 <27mmHg

Question 15

What is the mortality rate with pregnancy related ARDS?

Answer 15

25%

Question 16

What are cystic fibrosis effects on pregnancy?

Answer 16

GDM, PTB, FGR, IUFD, poor weight gain

Question 17

What miscarriage and congenital malformation related to cystic fibrosis?

Answer 17

no

Question 18

what is the upper limit of physiological hydropnephrosis and what side is more impacted?

Answer 18

20mm
right side as it is rotated by the colon to right

Question 19

what is the prevalence of pyelo in pregnancy?

Answer 19

2%

Question 20

What is the duration of antibiotics for pyelo in pregnancy?

Answer 20

10-21 days then nocte prophylaxis

Question 21

What are the risk groups of CKD classified into? for each what is the risk of pregnancy complications for each?

Answer 21

mild creat <125, complications 26%
mod creat 125-250, 47% complications
severe creat >250 avoid pregnancy 86% complications

Question 22

What % of mild CKD will have a successful pregnancy?

Answer 22

96%

Question 23

What are the kinds of Primary gomerulonephritis?

Answer 23

Primary ( mainly effecting kidneys) - IgA nephropathy (most common), minimal change disease (children), focal segmental glomerulosclerosis

Question 24

What are the kinds of secondary glomerulonephritis?

Answer 24

secondary gomerulonephritis (from systemic disease or infection) post infection - streptococcus Lupus, HIV, Hep B, C henoch scholeins purpura (IgA) vasculitis associates GN (ANCA) diabetic, malignancy, amyloidosis good pasture (anti GBM disease, lungs bleed)

Question 25

What are the risks in pregnancy with a renal transplant?

Answer 25

PTB 40-65% PET/HTN 20-30% FGR 20-35% rejection 2% infection

Question 26

What are the causes of renal deterioration with renal transplant?

Answer 26

PET infection obstruction dehydration graft rejection calcineuron inhibtior (tacrolimus, ciclosporin) - nephrotoxicity

Question 27

What preconception counselling should you provide for T1 and T2DM?

Answer 27

Aim HbA1c <48 avoid pregnancy if HbA1c >75 high dose folic acid for increased NTD risk and iodine advice of diet and lifestyle AIm BMI ,27 outcomes better for M+B if BSL controlled review mediations screen for other associated conditions Tests

Question 28

What are the other conditions you should screen for in T1and 2DM

Answer 28

thyroid, CKD, artery disease, autonomic neuropathy, foot disease, coeliac, mental ad dental health, retinal disease

Question 29

What tests should you organised for diabetes at booking?

Answer 29

HbA1c, lipids, renal, ACR, retinal screen Type 1 - TSH, anti TPO antibodies, coeliac antibodies, B12

Question 30

What makes women at risk of worsening retinopathy in pregnancy?

Answer 30

increased angiogenic growth factor increased fluid retention increased blood volume increased glycemic control

Question 31

What does proliferative retinopathy mean?

Answer 31

new blood vessels forming which are fragile. advanced retinopathy

Question 32

in keto acidosis, What are the expected lab results for BSLs?

Answer 32

BSL >11, can be euglycemic

Question 33

in keto acidosis, What are the expected lab results for ketones?

Answer 33

urine ketones >2, capillary >3

Question 34

in keto acidosis, What are the expected lab results for pH and bicarb?

Answer 34

pH <7.3 bicarb <15

Question 35

Why are women with diabetes more prone to diabetic ketoacidosis in pregnancy?

Answer 35

increased insulin resistance, increased starvations (vomiting, NBM) reduced buffering (reduced HCO3 from excretion)

Question 36

What is the goal HbA1c for pre conception in diabetes?

Answer 36

48

Question 37

What is the goal HbA1c for T2 and T3 in diabetes?

Answer 37

42

Question 38

What is the NICE guideline HbA1c for cut off to advise against pregnancy in diabetes?

Answer 38

86

Question 39

What is the routine AN care for pre existing diabetes?

Answer 39

pre conception care as previous aspirin and calcium offer retinal screening if not done in the last 3/12 individualise weight gain advice BP and urine analysis each visit HbA1c, urine PCR and BSL review each T growth surveillance provide BSL target advice provide ketone meter manage hypoglycemia 15g 15 minutes if needs steroids, BSL will peak 24 hours after

Question 40

What is the advice for checking ketones?

Answer 40

if 0.6-1.5 retest if >1.5 seek medical advice

Question 41

When do BSLs rise after steroids?

Answer 41

4-6 hours, peak at 24

Question 42

What is the goal BSLs for fasting and 1 hour and 2 hour PP. all diabetes?

Answer 42

fasting 4.0-5.3 1hours 5.5-7.8 2 hours 5.0-6.7

Question 43

What medications would you stop and start for IBD in T1?

Answer 43

stop - MTX, mycophenalate (ideally 3/12) start iodine, high dose folic acid (if on sulfasalazine or malabsorption), aspirin correct B12, iron, vitamin D

Question 44

What are the extra intestinal manifestations of IBD?

Answer 44

1. arthritis - ankylosing spondylitis, sacral ileitis 2. skin - pyoderma gangrenosum (ulcerated areas), erythema nodosum (bruised red areas shins) 3. liver - sclerosing cholangitis, gall stones 4. eyes- anterior uveitis, conjunctivitis, episclertitis

Question 45

What is the risk of relapse or worsening of IBD in pregnancy and postnatal

Answer 45

UC - more likely to flare in T1 or 2 if in remission risk 35% if active 70% post natal flare 6x more likely crohns - no increase in pregnancy or post natal

Question 46

How can you reduce the risk of IBD flare in pregnancy?

Answer 46

concieve in remission

Question 46

What is the size of a normal appendix?

Answer 46

<6mm

Question 47

What is the rate of fetal mortality with appendix perforation and peritonitis?

Answer 47

up to 36%

Question 48

What genes and antibodies are linked to coeliacs?

Answer 48

geness - HLADQ2 and HLADQ8 antibodies - TTG tissue transglutamase antibodies and endomysial antibodies

Question 49

What exacerbates haemorrhoids in pregnancy?

Answer 49

progesterone - vessel walls relax and constipation increased pelvic pressure

Question 50

What is the RANZCOG OGTT diagnostic criteria?

Answer 50

fasting 5.1 or more 1 hour 10.0 or more 2 hour 8.5 or more

Question 51

What are the ADIPS criteria for OGTT?

Answer 51

fasting 5.3 or more 1 hour 10.6 or more 2 hour 9.0 or more

Question 52

What are the three categories for OGTT results as per ADIPS?

Answer 52

no diabetes gestational diabetes overt diabetes in pregnancy (DIP)

Question 53

What is the criteria for overt DIP?

Answer 53

HbA1c 48 or more at anytime in pregnancy fasting 7.0 or more 2 hour 11.1 or more random BSL 11.1 or more

Question 54

What would finger prick testing fasting BSL be diagnostic of GDM?

Answer 54

5.3 or more

Question 55

What post natal counselling would you offer for GDM?

Answer 55

* Contraception * Education around hyperglycemia * BSL monitoring * Educate about risks in future pregnancies OR 8-24 * Offer lifestyle advice * 3/12 HbA1c then annual Risk of developing T2DM in the next 10-25 years is 40-60%