Anemia, Diabetes and Heart Disease in Pregnancy MCQs

Obstetrics & Gynaecology · 113 free questions with answers & explanations.

1. A 28-year-old G2P1 at 26 weeks has a 75 g oral glucose tolerance test (OGTT). Results: fasting glucose 94 mg/dL, 1-hour glucose 198 mg/dL, 2-hour glucose 165 mg/dL. How should she be managed?
2. A pregnant woman with known rheumatic heart disease presents at 28 weeks with increasing dyspnea and orthopnea. Echocardiography shows severe mitral stenosis with mitral valve area 0.8 cm². She is classified as New York Heart Association (NYHA) Class III. Which is the MOST appropriate management?
3. A 28-year-old woman with known mitral stenosis (MVA 1.0 cm²) develops New York Heart Association Class III dyspnoea at 24 weeks. She is in sinus rhythm. The MOST appropriate immediate cardiac intervention is:
4. A gestational diabetic patient at 36 weeks has a fasting blood glucose consistently around 105 mg/dL despite dietary measures for 2 weeks. Her 2-hour post-meal glucose is 145 mg/dL. The NEXT management step per FOGSI/ADA guidelines is:
5. A 32-year-old woman with pre-gestational Type 1 diabetes mellitus is at 8 weeks gestation. Her HbA1c is 9.2%. What is the MOST important concern at this gestational age?
6. A pregnant woman is diagnosed with gestational diabetes mellitus (GDM) by DIPSI criteria at 24 weeks. Fasting blood glucose is 95 mg/dL and 2-hour post 75 g OGTT glucose is 155 mg/dL. After 2 weeks of dietary modification, 2-hour post-meal glucose is consistently 138–145 mg/dL. What is the NEXT step?
7. A 28-year-old diabetic patient with pre-gestational Type 1 DM at 10 weeks has HbA1c 9.4%. She is on multiple daily injections. Which congenital anomaly is MOST specifically associated with poor periconceptional glycemic control at this HbA1c level?
8. In rheumatic heart disease complicating pregnancy, which valvular lesion is MOST poorly tolerated during the hemodynamic changes of the third trimester and labor?
9. The Confidential Enquiry into Maternal Deaths (CEMACH) in the UK identified the leading direct and indirect causes of maternal mortality. Among cardiac causes, which condition has emerged as the leading indirect cause of maternal death in developed countries?
10. A 28-year-old G2P1 at 26 weeks undergoes a 75g oral glucose tolerance test (OGTT). Her results: fasting 88 mg/dL, 1-hour 192 mg/dL, 2-hour 158 mg/dL. Using IADPSG/WHO 2013 criteria, which diagnosis applies?
11. A 26-year-old with known rheumatic mitral stenosis (valve area 0.9 cm²) becomes pregnant. She is in New York Heart Association (NYHA) Class II. Which statement regarding management of mitral stenosis in pregnancy is most accurate?
12. A 30-year-old at 32 weeks has iron-deficiency anaemia with haemoglobin 7.2 g/dL, MCV 68 fL, serum ferritin 4 ng/mL, and transferrin saturation 8%. She reports intolerance to oral ferrous sulphate (nausea, constipation). What is the most appropriate management?
13. In the HAPO (Hyperglycaemia and Adverse Pregnancy Outcomes) study, the 75g OGTT threshold for GDM diagnosis was established. According to IADPSG/WHO 2013, which of the following fasting plasma glucose values on OGTT would ALONE diagnose GDM at 24–28 weeks?
14. A pregnant woman with peripartum cardiomyopathy (PPCM) presents at 38 weeks gestation with an ejection fraction of 25% and pulmonary oedema. She is on furosemide and digoxin. Which drug is CONTRAINDICATED in her management during pregnancy?
15. According to the modified WHO classification (mWHO) of cardiovascular risk in pregnancy, Eisenmenger syndrome is classified as:
16. A 26-year-old woman with known mitral stenosis (valve area 1.2 cm²) becomes pregnant. At 28 weeks, she develops dyspnea at rest, orthopnea, and a chest X-ray shows pulmonary venous congestion. She is in sinus rhythm. What is the underlying pathophysiology explaining why pregnancy particularly decompensates mitral stenosis at this gestational age?
17. A 32-year-old woman at 26 weeks gestation undergoes a 75g oral glucose tolerance test (OGTT) for gestational diabetes mellitus (GDM) screening. Results are: fasting 88 mg/dL, 1-hour 165 mg/dL, 2-hour 142 mg/dL. Which diagnostic criteria should be applied, and what is the diagnosis?
18. A 32-year-old woman at 28 weeks undergoes a 75g oral glucose tolerance test (OGTT). Results: fasting glucose 92 mg/dL, 1-hour 186 mg/dL, 2-hour 155 mg/dL. According to IADPSG (International Association of Diabetes and Pregnancy Study Groups) criteria adopted by WHO 2013, how is this diagnosed?
19. A 28-year-old woman with known rheumatic mitral stenosis (MVA 1.0 cm², NYHA Class II) is at 24 weeks gestation. Her echocardiogram shows moderate mitral stenosis with mean gradient 10 mmHg and pulmonary artery systolic pressure of 42 mmHg. The best management approach is:
20. Which statement about peripartum cardiomyopathy (PPCM) is correct regarding its molecular pathogenesis and treatment implications?
21. The Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study established a linear relationship between maternal glycemia and adverse outcomes. The IADPSG (2010) diagnostic criteria for GDM derived from HAPO use a 75g OGTT with which fasting glucose threshold?
22. A 26-year-old woman with a metallic mitral valve prosthesis on warfarin discovers she is 6 weeks pregnant. What is the most appropriate anticoagulation strategy during the first trimester?
23. In peripartum cardiomyopathy (PPCM), a biomarker pathway involving prolactin cleavage has been implicated in pathogenesis. Based on this mechanism, which adjunct therapy has been proposed and studied in PPCM?
24. The HAPO (Hyperglycemia and Adverse Pregnancy Outcomes) study led to revised thresholds for gestational diabetes mellitus (GDM) diagnosis. The IADPSG criteria derived from HAPO define GDM as ANY ONE of the following on a 75g OGTT EXCEPT:
25. Peripartum cardiomyopathy (PPCM) is specifically associated with which biomarker that reflects prolactin-mediated cardiac injury?
26. A primigravida at 30 weeks has mitral stenosis (MVA 0.9 cm²) with NYHA Class III symptoms despite medical therapy. The safest intervention in pregnancy is:
27. A 28-year-old woman with known rheumatic mitral stenosis (mitral valve area 1.0 cm²) becomes pregnant at 8 weeks. She is in NYHA Class II. Which statement about her hemodynamic risk during pregnancy is MOST accurate?
28. A 32-year-old woman is diagnosed with gestational diabetes (GDM) by DIPSI criteria (non-fasting 2-hour plasma glucose ≥140 mg/dL). Which of the following long-term risks has been demonstrated for her offspring, independent of maternal obesity?
29. A 30-year-old woman with iron deficiency anemia in pregnancy has hemoglobin 8.2 g/dL at 28 weeks. She is commenced on oral ferrous sulfate 200 mg three times daily. After 4 weeks, her hemoglobin is 8.9 g/dL — a rise of only 0.7 g/dL. The MOST likely reason for this suboptimal response is:
30. The HAPO study (Hyperglycemia and Adverse Pregnancy Outcomes, 2008) led to the IADPSG 2010 diagnostic criteria for gestational diabetes mellitus (GDM). The IADPSG criteria use a single-step 75g OGTT at 24–28 weeks. Which of the following correctly states the diagnostic thresholds?
31. A pregnant woman with rheumatic heart disease and mitral stenosis (mitral valve area 1.0 cm²) presents at 28 weeks with NYHA Class III symptoms and pulmonary oedema. Which of the following best describes the reason why mitral stenosis is particularly poorly tolerated in pregnancy?
32. A pregnant woman at 30 weeks with pre-gestational Type 1 diabetes presents with HbA1c of 8.5%. She is on insulin lispro and insulin detemir. Regarding insulin pharmacokinetics in pregnancy, why does insulin requirement increase progressively during the second and third trimesters?
33. A 28-year-old with pre-gestational Type 1 diabetes mellitus is booked at 8 weeks. Her HbA1c is 9.2%. Which fetal anomaly is most specifically associated with periconceptional hyperglycaemia in type 1 diabetes?
34. The HAPO study (Hyperglycemia and Adverse Pregnancy Outcomes, 2008) redefined gestational diabetes diagnostic thresholds. IADPSG criteria (2010) derived from HAPO established which 75-g OGTT threshold for GDM diagnosis?
35. A 25-year-old with rheumatic mitral stenosis (MVA 0.8 cm²) presents at 22 weeks with dyspnoea and pulmonary oedema. Percutaneous transvenous mitral commissurotomy (PTMC) is considered. What is the key radiation dose reduction strategy when performing PTMC in pregnancy under current guidance?
36. A 28-year-old woman with pre-gestational Type 2 diabetes (HbA1c 9.2% at conception) presents at 18 weeks gestation. Anomaly scan shows a ventricular septal defect and sacral agenesis. Which feature of sacral agenesis in infants of diabetic mothers (IDM) best identifies the pathophysiological timing and mechanism?
37. A pregnant woman at 28 weeks is screened for gestational diabetes mellitus (GDM) with a 75g OGTT (IADPSG/WHO criteria). Her results are: fasting 90 mg/dL, 1-hour 185 mg/dL, 2-hour 155 mg/dL. Does she have GDM, and what does the HAPO trial evidence underlying these thresholds demonstrate?
38. A 30-year-old woman with rheumatic mitral stenosis (valve area 1.0 cm², moderate-severe MS) becomes pregnant at 14 weeks. She is in NYHA Class II–III despite medical therapy with beta blockers and diuretics. She develops increasing dyspnoea at 22 weeks. What is the preferred intervention, and what is the Wilkins score's role in selecting this?
39. The HAPO (Hyperglycemia and Adverse Pregnancy Outcomes) Study established the relationship between maternal glucose levels and adverse outcomes. Based on HAPO data, the IADPSG 2010 criteria for GDM diagnosis on a 75g OGTT are thresholds exceeding which values associated with an odds ratio of 1.75 for adverse outcomes?
40. A 28-year-old with known bicuspid aortic valve (regurgitation, mild) and normal LV function becomes pregnant. She is in NYHA class I. According to the modified WHO (mWHO) cardiac risk classification for pregnancy, she falls in which class?
41. A pregnant woman at 28 weeks with pre-gestational Type 1 diabetes has HbA1c 9.2% in the first trimester. Based on the HAPO study, her offspring's risk profile is BEST characterised by which finding?
42. A 30-year-old pregnant woman at 22 weeks is diagnosed with Eisenmenger syndrome (VSD with reversed shunt, resting SpO2 84%). Her obstetrician counsels her regarding maternal mortality risk in pregnancy. What is the approximate risk of maternal mortality quoted in international guidelines?
43. A pregnant woman at 32 weeks has haemoglobin 6.5 g/dL, MCV 64 fL, serum ferritin 4 ng/mL, serum iron 28 mcg/dL. She is intolerant to oral iron. What is the most appropriate intravenous iron preparation to administer, and what is the advantage over older preparations?
44. In the HAPO (Hyperglycaemia and Adverse Pregnancy Outcomes) study, which fasting plasma glucose threshold at the OGTT was associated with a 1.75-fold increase in adverse pregnancy outcomes, forming the basis of IADPSG criteria for GDM diagnosis?
45. A 28-year-old primigravida at 20 weeks has rheumatic mitral stenosis with valve area 0.9 cm², NYHA Class III symptoms, and pulmonary artery systolic pressure 55 mmHg on echocardiography. The most appropriate intervention is:
46. The Modified WHO (mWHO) classification of cardiovascular disease in pregnancy categorises conditions by maternal mortality/morbidity risk. A woman with a mechanical prosthetic heart valve falls into which category, and what is the recommended anticoagulation in the first trimester?
47. The HAPO (Hyperglycemia and Adverse Pregnancy Outcomes) study established thresholds for gestational diabetes diagnosis. What glucose thresholds (fasting/1-h/2-h) does IADPSG (WHO 2013) use for diagnosing GDM on a 75 g OGTT?
48. A pregnant woman at 30 weeks with known rheumatic mitral stenosis (valve area 1.0 cm²) develops progressive dyspnea, orthopnea, and atrial fibrillation. Echocardiography confirms moderate-to-severe MS. She is on betablockers and anticoagulation. Next best management step?
49. In iron deficiency anemia in pregnancy, when should parenteral iron be preferred over oral supplementation?
50. A 28-year-old woman at 26 weeks gestation has a 75g OGTT: fasting glucose 88 mg/dL, 1-hour 192 mg/dL, 2-hour 154 mg/dL. Using IADPSG 2010 criteria, which of the following is the CORRECT interpretation?
51. A pregnant woman with known rheumatic mitral stenosis (valve area 0.9 cm², mean gradient 15 mmHg) becomes symptomatic with pulmonary edema at 24 weeks. She is in NYHA Class III. According to modified WHO (mWHO) risk classification for pregnancy, her cardiac risk class is:
52. A primigravida at 32 weeks with sickle cell disease (HbSS) presents with acute chest syndrome: fever 38.8°C, chest pain, new pulmonary infiltrate on CXR, and SaO2 falling to 91%. Which intervention has BEST evidence for improving outcomes specifically in pregnancy-associated acute chest syndrome?
53. A 28-year-old primigravida at 28 weeks gestation undergoes a 75 g oral glucose tolerance test (OGTT). Her fasting blood glucose is 96 mg/dL, 1-hour glucose is 188 mg/dL, and 2-hour glucose is 155 mg/dL. How many abnormal values are there and what is the diagnosis?
54. A pregnant woman at 36 weeks with known mitral stenosis (valve area 0.9 cm², moderate-severe) develops progressive breathlessness (NYHA Class III). Her heart rate is 110/min. The most appropriate initial medical management is:
55. A pregnant woman at 20 weeks has haemoglobin 7.8 g/dL. Peripheral smear shows microcytic hypochromic anaemia with target cells. Serum ferritin is 62 ng/mL (normal). Haemoglobin electrophoresis shows HbA2 5.8% and HbF 3.2%. The most likely diagnosis is:
56. A 28-year-old primigravida at 24 weeks has a fasting plasma glucose of 92 mg/dL and a 2-hour post-75g OGTT value of 155 mg/dL. Applying IADPSG criteria, she is diagnosed with:
57. A pregnant woman with known mitral stenosis (valve area 1.0 cm²) at 28 weeks develops worsening dyspnoea and an episode of paroxysmal nocturnal dyspnoea. Echocardiography confirms severe MS with mean gradient 12 mmHg and pulmonary artery systolic pressure 55 mmHg. She is in sinus rhythm. NYHA class III. Optimal management is:
58. Regarding iron supplementation in pregnancy: a woman at 20 weeks has Hb 9.2 g/dL, MCV 68 fL, serum ferritin 8 ng/mL. She is on oral iron 200 mg/day elemental iron but compliance is poor due to GI side effects. The MOST appropriate alternative IV iron preparation with the best safety profile and ability to give as a single total-dose infusion is:
59. A pregnant woman at 26 weeks underwent a 75 g OGTT (WHO 2013/IADPSG criteria). Her fasting glucose was 5.0 mmol/L (90 mg/dL), 1-hour glucose was 10.8 mmol/L (195 mg/dL), and 2-hour glucose was 8.3 mmol/L (150 mg/dL). Which criterion(a) meet the threshold for gestational diabetes mellitus?
60. A woman with rheumatic mitral stenosis (valve area 0.9 cm²) and WHO Class III cardiac risk becomes pregnant. What is the PREFERRED mode of delivery management?
61. Iron-deficiency anaemia in pregnancy is most commonly evaluated by which investigation that is considered the 'gold standard' for assessing iron stores?
62. A 26-year-old primigravida at 28 weeks undergoes a 75 g OGTT. Results: fasting plasma glucose 88 mg/dL, 1-hour 188 mg/dL, 2-hour 152 mg/dL. According to IADPSG criteria (adopted by WHO 2013 and most Indian guidelines), this result is:
63. A pregnant woman at 20 weeks is found to have a mitral stenosis with valve area of 1.0 cm² on echocardiography. She is symptomatic despite beta-blocker and diuretic therapy. The best intervention to manage her mitral stenosis during pregnancy is:
64. A 32-year-old G2P1 at 36 weeks has iron-deficiency anaemia with Hb 7.2 g/dL, serum ferritin 6 ng/mL. She had a previous upper GI bleed and cannot tolerate oral iron. Intravenous ferric carboxymaltose is planned. The advantage of ferric carboxymaltose over iron sucrose in this clinical setting is:
65. A pregnant woman at 24 weeks undergoes a 75 g 2-hour OGTT. Fasting plasma glucose is 88 mg/dL, 1-hour value is 175 mg/dL, and 2-hour value is 160 mg/dL. Using IADPSG/WHO 2013 criteria, what is the diagnosis?
66. A pregnant woman with known rheumatic mitral stenosis at 20 weeks develops progressive dyspnoea. Echocardiography shows severe MS with mitral valve area 0.9 cm². Heart rate is 100 bpm and AF has developed. The most appropriate immediate management is:
67. A 32-year-old primigravida at 24 weeks undergoes a 75-g OGTT. Fasting glucose is 88 mg/dL; 1-hour glucose is 162 mg/dL; 2-hour glucose is 143 mg/dL. According to IADPSG/WHO 2013 criteria, which statement correctly describes the result?
68. A 28-year-old primigravida at 24 weeks undergoes a 75-g OGTT. Fasting glucose is 95 mg/dL; 1-hour glucose is 185 mg/dL; 2-hour glucose is 155 mg/dL. According to IADPSG criteria, how many values meet the GDM threshold?
69. A pregnant woman with rheumatic heart disease has mitral stenosis with a valve area of 1.2 cm² and NYHA Class II symptoms. She is at 30 weeks. The haemodynamically preferred mode of delivery is:
70. The Confidential Enquiry into Maternal Deaths (MBRRACE-UK) consistently identifies cardiac disease as the leading indirect cause of maternal mortality. Among cardiac causes, the MOST common specific cardiac lesion causing maternal death in the UK is:
71. A 29-year-old woman at 26 weeks gestation undergoes a 75 g OGTT. Results: fasting 97 mg/dL, 1-hour 188 mg/dL, 2-hour 156 mg/dL. Using IADPSG/WHO 2013 criteria (thresholds: fasting 92, 1-hour 180, 2-hour 153 mg/dL — any one value meeting or exceeding threshold diagnoses GDM), how many criteria does she meet?
72. A 35-year-old woman with known rheumatic mitral stenosis (MVA 0.9 cm²) presents at 28 weeks with worsening dyspnoea (NYHA Class III). She is in sinus rhythm. Which statement best reflects current management?
73. A 26-year-old with Eisenmenger syndrome (VSD with reversed shunt) at 8 weeks gestation presents for counselling. What is the most critical piece of information regarding her prognosis?
74. The WHO defines anaemia in pregnancy in the second trimester as haemoglobin below:
75. A 28-year-old G2P1 at 28 weeks gestation undergoes a 100-g oral glucose tolerance test (OGTT). Results: Fasting 92 mg/dL, 1-hour 187 mg/dL, 2-hour 158 mg/dL, 3-hour 136 mg/dL. Using Carpenter-Coustan criteria (thresholds: fasting 95, 1-hr 180, 2-hr 155, 3-hr 140), how many values are abnormal and what is the diagnosis?
76. A pregnant woman with rheumatic heart disease (mitral stenosis, MVA 1.0 cm²) is in NYHA Class III at 30 weeks gestation. Which statement regarding management is MOST accurate?
77. A pregnant woman at 28 weeks with rheumatic heart disease (severe mitral stenosis, MVA 0.8 cm²) develops progressive dyspnoea with resting O₂ saturation 91%. She is in sinus rhythm. What is the MOST appropriate intervention?
78. A 31-year-old pregnant woman at 24+0 weeks undergoes a 75 g oral glucose tolerance test (OGTT). Results: fasting glucose 90 mg/dL, 1-hour glucose 195 mg/dL, 2-hour glucose 148 mg/dL. Using IADPSG/WHO 2013 criteria, what is the diagnosis?
79. In a pregnant woman with WHO Class IV cardiac disease (Eisenmenger syndrome), pregnancy is associated with approximately what maternal mortality rate?
80. In a pregnant woman, gestational diabetes is diagnosed on a 75 g OGTT at 24–28 weeks when the 2-hour plasma glucose value meets which threshold (WHO 2013 criteria)?
81. A 28-year-old primigravida with rheumatic mitral stenosis (valve area 1.2 cm²) is at 28 weeks with New York Heart Association Class II symptoms. Her heart rate is 102 bpm. Which drug is MOST appropriate to improve maternal haemodynamics in this scenario?
82. A 30-year-old pregnant woman is found to have haemoglobin of 8.2 g/dL at 28 weeks with a peripheral smear showing microcytic hypochromic cells and target cells, serum ferritin 85 µg/L. The MOST likely diagnosis is:
83. A pregnant woman at 28 weeks with pre-gestational Type 1 diabetes has HbA1c of 8.5%. She is concerned about fetal risk. Which congenital malformation has the strongest association with poor periconceptional glycemic control in diabetes?
84. A pregnant woman at 30 weeks is found to have hemoglobin of 7.2 g/dL with a peripheral smear showing microcytosis, hypochromia, and target cells. Serum ferritin is 6 ng/mL. She is at high altitude. The most appropriate treatment is:
85. A woman with rheumatic mitral stenosis (MVA 1.0 cm²) becomes pregnant. She is in NYHA class II. She develops increasing dyspnea at 22 weeks despite beta-blocker therapy. The most appropriate intervention is:
86. A 28-year-old woman has gestational diabetes diagnosed at 26 weeks. Her fasting glucose is 7.2 mmol/L on repeat testing. She was initially managed with dietary changes. What is the NEXT appropriate step?
87. The HAPO study established which primary relationship in gestational diabetes?
88. A pregnant woman with known mitral stenosis (MVA 1.2 cm²) is 28 weeks gestation. She develops progressive dyspnea and orthopnea with NYHA Class III symptoms. Heart rate is 115 bpm. Which management is MOST appropriate?
89. The HAPO (Hyperglycemia and Adverse Pregnancy Outcomes) Study established new diagnostic thresholds for gestational diabetes. Based on HAPO, the IADPSG (2010) criterion for GDM diagnosis at the 75 g OGTT is fasting glucose ≥92 mg/dL, 1-hour ≥180 mg/dL, or 2-hour ≥153 mg/dL. This is based on finding that adverse pregnancy outcomes increased significantly above which odds ratio threshold?
90. Peripartum cardiomyopathy (PPCM) is defined as heart failure developing in the last month of pregnancy or within how many months postpartum, with no identifiable cause, and LV ejection fraction typically below what threshold?
91. A pregnant woman at 10 weeks has a mechanical prosthetic mitral valve. Which anticoagulation regimen carries the highest risk to the fetus but is most effective for maternal thromboprophylaxis?
92. A pregnant woman at 28 weeks is found to have a fasting plasma glucose of 95 mg/dL and a 2-hour post-75 g OGTT value of 160 mg/dL. By IADPSG/WHO 2013 criteria, she is diagnosed with:
93. A 28-year-old primigravida with rheumatic mitral stenosis (valve area 1.0 cm²) develops exertional dyspnoea at 22 weeks. She is in NYHA Class III. The most appropriate management at this stage, before resorting to delivery, is:
94. Which peripartum cardiomyopathy trial (BOARD trial / IPAC study) identified bromocriptine as a potential treatment by targeting prolactin-mediated 16-kDa cardiotoxic cleavage?
95. A pregnant woman at 28 weeks undergoes a 75 g oral glucose tolerance test (OGTT). Her fasting plasma glucose is 94 mg/dL, 1-hour value is 188 mg/dL, and 2-hour value is 150 mg/dL. Using the IADPSG/WHO 2013 criteria, the diagnosis is:
96. A 26-year-old woman with rheumatic heart disease (mitral stenosis, mitral valve area 1.2 cm²) presents at 28 weeks gestation with dyspnoea on mild exertion, palpitations, and bilateral basal rales. She is in NYHA Class III. The safest drug for controlling her ventricular rate (atrial fibrillation with fast ventricular response) in pregnancy is:
97. A woman with pre-existing type 1 diabetes mellitus plans pregnancy. The HbA1c before conception that is associated with the lowest risk of congenital malformations and safest target for pre-conception counseling is:
98. A 28-year-old woman with rheumatic mitral stenosis (MVA 1.0 cm²) becomes pregnant. She develops dyspnea at rest at 28 weeks. Medications include beta-blocker. The MOST appropriate intervention at this stage is:
99. In a pregnant woman with sickle cell disease, which of the following is the MOST common obstetric complication?
100. In a pregnant woman with hyperthyroidism due to Graves' disease, which of the following is the MOST important concern regarding propylthiouracil (PTU) use in the first trimester?
101. A woman at 32 weeks gestation has iron deficiency anemia with Hb 7.2 g/dL and ferritin 6 µg/L. She is intolerant to oral iron due to severe GI side effects. The PREFERRED management is:
102. A 30-week pregnant woman undergoes a 75g OGTT. Fasting glucose: 88 mg/dL; 1-hour: 182 mg/dL; 2-hour: 148 mg/dL. According to IADPSG/WHO 2013 criteria, what is the diagnosis?
103. A pregnant woman with rheumatic mitral stenosis (valve area 1.0 cm²) becomes breathless at 28 weeks despite diuretics and beta-blockers. Heart rate is 110 bpm in sinus rhythm. What is the most appropriate intervention?
104. A primigravida at 36 weeks is found to have haemoglobin of 8.2 g/dL with MCV 66 fL, serum ferritin 6 µg/L. She has been on oral iron for 8 weeks with poor compliance. What is the preferred treatment at this gestation?
105. A pregnant woman at 28 weeks with pre-existing type 1 diabetes has HbA1c 7.8%. She develops sudden symptomatic hypoglycaemia (BG 42 mg/dL). Which insulin adjustment is LEAST appropriate in the immediate management?
106. The HAPO study established which correlation that changed gestational diabetes diagnostic thresholds worldwide?
107. A pregnant woman with rheumatic mitral stenosis (valve area 1.0 cm², symptomatic at 24 weeks, NYHA III) is on beta-blockers. Despite optimal medical therapy her symptoms worsen at 28 weeks. The MOST appropriate intervention is:
108. A 26-year-old woman with sickle cell disease (HbSS) at 28 weeks gestation has haemoglobin 7.2 g/dL. She has no acute complication. What is the recommended transfusion approach in this asymptomatic anaemia?
109. In gestational diabetes mellitus, which pharmacological agent is preferred when glycaemic targets are not achieved by diet and lifestyle modification in a patient with eGFR 85 mL/min/1.73m², no cardiac history, at 26 weeks gestation?
110. A pregnant woman at 36 weeks has HbA1c 7.8% and is on insulin. Her fetal biometry shows EFW at the 90th percentile with normal amniotic fluid index. According to ACOG, at what gestation should delivery be planned in a woman with pregestational diabetes and LGA fetus, assuming no other complications?
111. Iron deficiency anemia in pregnancy is treated with which oral iron preparation that has the best absorption and what is the recommended elemental iron dose per day in severe deficiency?
112. The HAPO (Hyperglycemia and Adverse Pregnancy Outcomes) study demonstrated a continuous relationship between maternal glucose and adverse perinatal outcomes. Which primary outcome showed the STRONGEST continuous association with maternal fasting plasma glucose?
113. A 28-year-old with Type 1 diabetes mellitus (pre-gestational) presents at 8 weeks gestation. HbA1c is 9.2%. She is on insulin. What is the MOST important counselling point regarding the risk to the fetus specifically related to this HbA1c level?