Hypertension in Pregnancy – Maternal medicine part 2

Hypertension in Pregnancy Maternal medicine module part 2

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A 33-year-old primigravida presents at 34 weeks of gestation with raised BP >160/110.There
is no proteinuria and SFH is normal. She is admitted to the hospital and started on
antihypertensive therapy.

1) What is the most appropriate further management plan?

A) Keep admitted, control BP and deliver at 36 weeks of gestation

B) Admit, BP control and monitoring at least 4 times/day

C) Admit, BPcontroland monitoring 4 times/day, dailyproteinuria, weekly blood tests till delivery

D) Admit, BPcontroland monitoring 4 times/day, three times weekly blood tests

E) Give MgSO4

A 30-year-old woman presents at 34 weeks of gestation in her first pregnancy with a blood
pressure of 152/103 (blood pressure at the beginning of pregnancy – 130/60) with significant
proteinuria on urinalysis

A) Do not admit patient to hospital or treat hypertension; no indication for blood tests, but monitor blood pressure weekly.

B) Do not admit patient to hospital or treat hypertension, but take blood tests and monitor blood pressure twice per week.

C) Admit patient to hospital, treat hypertension with oral anti-hypertensives, consider steroids and early delivery.

D) Admit patient to hospital, treat hypertension with IV anti-hypertensives, take blood pressure at least four times per day and take a quantificative protein test.

E) Admit patient to hospital, treat hypertension with oral anti-hypertensives, take blood pressure every 48 hr and take a quantificative protein test.

F) Admit patient to hospital, treat hypertension with alternate including IV anti-hypertensives, take blood pressure at least four times per day and take a quantificative protein test. Consider the administration of steroids, discuss with consultant obstetrician, neonatal and anaesthetic staff with regards to delivery.

G) Do not admit patient to hospital, treat hypertension with oral anti-hypertensives, take blood pressure at least twice per week, take blood tests.

H) Do not admit patient to hospital, treat hypertension with oral anti-hypertensives, take blood pressure at least twice per week, no need for blood tests.

34 weeks pregnant. Worsening hypertension and proteinuria over 4 weeks.
Booking BP was 160/100 mmHg with 3 g proteinuria/24 h quantifi ed. Oral
labetalol therapy commenced at booking. Now BP 180/100 mmHg and 9 gproteinurea/24hr

A) Chronic hypertension

B) Chronic hypertension and superimposed pre-eclampsia

C) Chronic renal disease

D) Cushing s syndrome

E) Gestational hypertension

F) Hyperthyroidism

G) Pheochromocytoma

H) Pre-eclampsia

Your junior trainee sees a primi woman who is 8 weeks pregnant and demanding aspirin
therapy. Which of the following is an indication to start aspirin therapy?

A) BMI > 35 at booking

B) Multiple pregnancy

C) Pregnancy terval over 10 yrs

D) Primi and 39 yrs of age

E) Primi and 42 yrs of age

5) Which of the following is used to prevent hypertensive disorders during pregnancy?

A) nitric oxide donors

B) progesterone

C) diuretics

D) low molecular weight heparin

E) None

A 35-year-old G4P3 is currently 16 weeks pregnant and has uncomplicated chronic
hypertension.

6) What should be the ideal target BP with treatment?

A) Less than 200/110

B) Less than 160/100

C) Less than 150/100

D) Less than 140/100

E) 135/85

20 weeks pregnant. Episodic headaches, palpitations, sweating and tremor.
Examination shows BP 160/110 mmHg. BP tends to be highly labile.

A) Chronic hypertension

B) Chronic hypertension and superimposed pre-eclampsia

C) Chronic renal disease

D) Cushing s syndrome

E) Gestational hypertension

F) Hyperthyroidism

G) Pheochromocytoma

H) Pre-eclampsia

Which of the following statements regarding physiological blood pressure changes in
pregnancy is incorrect?

A) blood pressure begins to decrease in early pregnancy and reaches a nadir at 18-20 weeks following which there is a steady rise till term.

B) blood pressure taken in supine position during second and third trimesters of pregnancy is lower than that taken in sitting position

C) phase V rather than phase 4 of korotkoff sounds should be taken as the diastolic reading

D) previously normotensive women may become transiently hypertensive following delivery.

E) Vasodilatation is the primary change in circulation in pregnancy

10) Regarding pre-eclampsia in pregnancy, which of the following statement is correct:

A) In cases of pre-eclampsia with severe hypertension ( >160/110) sublingual nifedipine may be administered

B) Methyldopa is a very well tolerated anti hypertensive with minimal adverse side effects.

C) A protein creatinine ratio of 20 mg/mmol is equivalent is taken as threshold to quantify proteinuria

D) Signs and symptoms of magnesium sulphate overload include tachycardia and blurred vision

E) The antidote to magnesium sulphate overdose is 10 ml 10% calcium gluconate given slowly intravenously

12)

Following statements are true regarding risk prediction models for hypertension in
pregnancy;

A) fullPIERS is intended to use at anytime in pregnancy

B) fullPIERS is intended to use at anytime in pregnancy

C) PREP-S is intended to use at anytime in pregnancy

D) fullPIERS is intended to use only upto 34 weeks of pregnancy

E) fullPIERS is intended to use only after 34 weeks of pregnancy

13)

Which of the following supplements is recommended to prevent hypertensive disorders in
pregnancy?

A) Fish oils

B) Magnesium

C) Vitamin C and E

D) Folic acid

E) None

15) Moderate risk factors for pre-eclampsia are

A) Hypertension in previous pregnancy

B) Chronic HTN

C) Family history of pre-eclampsia

D) Type 1 DM

E) Type 2 DM

16) Regarding proteinuria assessment in pregnancy, all are true except;

A) Use 24 hr collection to quantify proteinuria in pregnant women

B) Do not use first morning urine to quantify proteinuria

C) 30 mg/mmol protein:creatinine ratio is considered as threshold of proteinuria

D) 8mg/mmol albumin:creatinine ratio is considered as threshold for proteinuria

E) Use an automated reagent strip reading device for quantification of proteinuria

18) A 40-year-old woman presents at 32 weeks of gestation in her first pregnancy with a blood

pressure of 143/90 mmHg. Blood pressure at the beginning of her pregnancy was 100/60 mmHg.
Quantitative testing indicated no proteinuria. She feels well, with no headaches or visual
disturbance.

A) Do not admit patient to hospital or treat hypertension; no indication for blood tests, but monitor blood pressure weekly.

B) Do not admit patient to hospital or treat hypertension, but take blood tests and monitor blood pressure twice per week.

C) Admit patient to hospital, treat hypertension with oral anti-hypertensives, consider steroids and early delivery.

D) Admit patient to hospital, treat hypertension with IV anti-hypertensives, take blood pressure at least four times per day and take a quantificative protein test.

E) Admit patient to hospital, treat hypertension with oral anti-hypertensives, take blood pressure every 48 hr and take a quantificative protein test.

G) Do not admit patient to hospital, treat hypertension with oral anti-hypertensives, take blood pressure at least twice per week, take blood tests.

H) Do not admit patient to hospital, treat hypertension with oral anti-hypertensives, take blood pressure at least twice per week, no need for blood tests.

19)

A woman with chronic hypertension was converted from Lisinopril to methyldopa in a
preconception counselling clinic.
The pregnancy was uncomplicated and she delivered spontaneously at term.
At what stage postnatally should the antihypertensive medication be switched back to
Lisinopril?

A) 2 days

B) 7days

C) 14 days

D) 6 weeks

E) 12 weeks

A 25 yr old woman has been having persistently high BP>150/100 for 3 days following
delivery with no biochemical and hematological abnormalities. She has no underlying medical
problem and was not on any antihypertensive drugs during the pregnancy. She id breastfeeding.

20) Which is the most appropriate antihypertensive drug that can be prescribed for her?

A) Amlodepine

B) Methyldopa

C) Enalapril

D) Candesartan

E) Amlodepine

21)

13 weeks pregnant with BP 160/100 mmHg. History of childhood glomerulonephritis.
Urine dipstix shows +++ proteinuria. Similar BP recorded at prepregnancy
counselling review 6 months earlier.

A) Chronic hypertension

B) Chronic hypertension and superimposed pre-eclampsia

C) Chronic renal disease

D) Cushing s syndrome

E) Gestational hypertension

F) Hyperthyroidism

G) Pheochromocytoma

H) Pre-eclampsia

22) Which is the most appropriate antihypertensive drug that can be prescribed for her?

A) Amlodepine

B) Methyldopa

C) Enalapril

D) Candesartan

E) Amlodepine

23)

40 weeks pregnant. Admitted with headache, hypertension 150/105 mmHg and
+++proteinuria on urine dipstix. Obstetric ultrasound shows fetal IUGR. At
pregnancy booking, her BP was 100/60 mmHg and her urinalysis showed no
abnormality

A) Chronic hypertension

B) Chronic hypertension and superimposed pre-eclampsia

C) Chronic renal disease

D) Cushing s syndrome

E) Gestational hypertension

F) Hyperthyroidism

G) Pheochromocytoma

H) Pre-eclampsia

24)

A 27-year-old woman presents at 28 weeks of gestation in her second pregnancy with a
blood pressure of 152/ 105 (blood pressure at the beginning of pregnancy – 132/58), but with no
evidence of proteinuria on urinalysis. She is commenced on oral labetalol and is sent home from
the triage department to return in a week for a repeat blood pressure monitoring. At this time,
she returns and her blood pressure has increased to 167/115 mmHg, with significant proteinuria
on urinalysis. She has a frontal headache and describes spots

A) Do not admit patient to hospital or treat hypertension; no indication for blood tests, but monitor blood pressure weekly.

B) Do not admit patient to hospital or treat hypertension, but take blood tests and monitor blood pressure twice per week.

C) Admit patient to hospital, treat hypertension with oral anti-hypertensives, consider steroids and early delivery.

D) Admit patient to hospital, treat hypertension with IV anti-hypertensives, take blood pressure at least four times per day and take a quantificative protein test.

E) Admit patient to hospital, treat hypertension with oral anti-hypertensives, take blood pressure every 48 hr and take a quantificative protein test.

G) Do not admit patient to hospital, treat hypertension with oral anti-hypertensives, take blood pressure at least twice per week, take blood tests.

H) Do not admit patient to hospital, treat hypertension with oral anti-hypertensives, take blood pressure at least twice per week, no need for blood tests.

26) High risk factors for pre-eclampsia

A) Anti phospholipid syndrome

B) SLE

C) Hypertension in previous pregnancy

D) Chronic kidney disease

E) All the above

27)

32 weeks pregnant with proteinuria (0.2 g/24 h) and BP of 150/100 mmHg.
Booking BP at 12 weeks was 90/60 mmHg and BP at 20 weeks 95/60 mmHg.
No urine proteinuria detected antenatally until 32w. Normal fetal growth. Mild
peripheral oedema

A) Chronic hypertension

B) Chronic hypertension and superimposed pre-eclampsia

C) Chronic renal disease

D) Cushing s syndrome

E) Gestational hypertension

F) Hyperthyroidism

G) Pheochromocytoma

H) Pre-eclampsia

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