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cns - maternal medicine 2 part 2

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1) A 20-yr old primigravid woman who is 18 weeks pregnant complains of sharp, left-sided

headache, particularly around the eye. This is associated with a red eye and runny nose.

2) A recently delivered multiparous woman with BMI of 45 complains on day 3 post-partum

of sudden onset of severe headache, describing it as ‘the worst headache I ever had’.

3) A woman taking anti-epileptic medication attends for a routine fetal anomaly

scan at 20 weeks of gestation. The fetus is found to have spina bifida and a cleft lip.

Which medication is she most likely to be taking?

4) When during pregnancy does exposure to anti-epileptic drugs (AEDs)

run the risk of causing harm to the fetus?

5) A 23-year-old primiparous woman is seen in clinic at ten weeks gestation. She is known

to have epilepsy, for which she takes lamotrigine. Her last fit was one year ago. When

considering her medication, what is the most appropriate management plan?

6) A pregnant woman attends antenatal clinic and is taking a single anti-epileptic

drug. She has been informed that the drug she is taking has two main advantages:

(1) it carries the lowest risk of congenital malformations; and (2) it does not

increase the risk of haemolytic disease of the newborn. Which drug is she most

likely to be taking?

7) A 32-yr old multiparous woman who is 20 weeks pregnant complaints of a pressing

bilateral headache for more than 10 days.

8) A 27-yr old primigravid woman at 24 weeks of pregnancy is complaining of throbbing pain

behind her left eye. This pain is so severe that she cannot sit still.

9) An 18-yr old primigravid woman at 36 weeks of pregnancy is complaining of sudden onset

of headaches, abdominal pain and a sensation of flashing lights in front of eyes.

10) A 35-yr old parous woman at 20 weeks of pregnancy complaints f severe headaches and

feeling tired, feverish and stiff around the neck.

11) Pregnant women with epilepsy have the highest risk of breakthrough seizures

during: -

12) A 24-yr old primigravid woman who is 24 weeks pregnant complains of a pulsating, right-

sided headache for 48hrs. This is associated with nausea and vomiting. She also complaints

of seeing ‘flickering lights’.

13) A 32-year-old woman contemplating her first pregnancy comes to see you in the pre-

pregnancy clinic. She has had epilepsy since the age of 10. The following are true about

anticonvulsants in pregnancy, except:

14) A 17-yr old woman has a history of heavy menstrual bleeding since menarche. She

complains of a left-sided headache, particularly 2-3 days before her periods.

15) A 24-yr old multiparous woman at 30 weeks of pregnancy had returned from her holidays

in Brazil. She is vomiting, feeling feverish, and complaining of severe headaches.

16) A 38-yr old multiparous woman at 36 weeks of pregnant presents with history of

headaches, vomiting, and photophobia. Her examination had signs of raised ICP.

17) A 37-year-old primigravida woman presents at ten weeks gestation to antenatal clinic.

She has been referred because she has a known diagnosis of myasthenia gravis. What is

the mainstay of treatment?

18) A woman with epilepsy has a seizure in labour. Benzodiazepines are administered,

but the seizures continue. Which second-line therapy should now be

administered?

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