SBA Pharmacology 10 Single Best Answer (SBA)
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1. A 28-year-old woman planning her first pregnancy asks how to reduce the risk of neural tube defects in her baby. What is the most appropriate advice?
Answer: Start folic acid 400 mcg daily at least 3 months before conception
Folic acid supplementation (400 mcg daily) for at least 3 months pre-conception and through early pregnancy is standard to reduce neural tube defect risk.
2. A 30-year-old woman in her first trimester presents with nausea and vomiting affecting her daily life but is able to tolerate some fluids. What is the most appropriate first-line treatment?
Answer: Promethazine
First-line therapy for mild to moderate nausea/vomiting in pregnancy includes antihistamines such as promethazine. Pyridoxine is an adjunct; ondansetron is second-line.
3. A 32-year-old woman at 34 weeks gestation presents with severe pruritus, particularly on her palms and soles. Liver function tests show elevated ALT and bile acids. What is the most appropriate management?
Answer: Ursodeoxycholic acid and weekly monitoring of bile acids
Obstetric cholestasis is managed with ursodeoxycholic acid to reduce bile acid levels and relieve symptoms, plus close monitoring of LFTs and fetal well-being.
4. A 35-year-old woman at 10 weeks gestation presents with vaginal bleeding and cramping. Ultrasound shows a gestational sac without fetal pole. What is the most appropriate management?
Answer: Prescribe misoprostol and arrange follow-up
For a missed miscarriage, medical management with misoprostol helps expel the retained products. Follow-up ensures completion.
5. A 28-year-old woman presents with lower abdominal pain and light vaginal bleeding. She has a positive urine pregnancy test, and transvaginal ultrasound shows no intrauterine pregnancy. Serum beta-hCG is 1,000 IU/L. What is the most appropriate next step?
Answer: Repeat beta-hCG in 48 hours
If ultrasound does not show an intrauterine pregnancy and beta-hCG is borderline, serial beta-hCG measurements help differentiate normal early pregnancy from ectopic or failing pregnancy.
6. A 32-year-old woman at 28 weeks gestation undergoes an oral glucose tolerance test. Fasting glucose is 5.5 mmol/L, and 2-hour glucose is 9.2 mmol/L. What is the most appropriate diagnosis?
Answer: Gestational diabetes mellitus (GDM)
Fasting ≥5.1 mmol/L and/or 2-hour OGTT ≥8.5 mmol/L generally confirm gestational diabetes in pregnancy guidelines.
7. A 35-year-old woman at 36 weeks gestation presents with severe headache, blood pressure of 180/110 mmHg, and proteinuria (+++). What is the most appropriate next step?
Answer: Admit for blood pressure control and consider early delivery
Severe pre-eclampsia requires hospital admission, intravenous antihypertensives if needed, and evaluation for prompt delivery (especially after 34-37 weeks).
8. Why is pregnancy a hypercoagulable state?
Answer: Increased levels of procoagulant factors and reduced fibrinolysis
Pregnancy induces a hypercoagulable state by boosting clotting factors and diminishing fibrinolysis, protecting against haemorrhage but heightening VTE risk.
9. A 38-year-old woman at 34 weeks gestation presents with painless vaginal bleeding. Ultrasound confirms a placenta previa. What is the most appropriate next step?
Answer: Admit for observation and plan delivery at 37 weeks
With placenta previa and no active bleeding, expectant management in hospital until near term is standard to minimise haemorrhage risk.
10. A 29-year-old woman requests medical management for her miscarriage but later changes her mind after the process begins. She is distressed and regrets her decision. How should the healthcare team proceed?
Answer: Continue the treatment plan and provide emotional support
Once medical management has begun, it is generally irreversible. Compassionate support and counselling should be offered to the patient.
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