By Śeherīārajī Dādābhāī Bharūcā; Parsee Punchayet Funds and Proeperties
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B) Sclerosing cholangitis should be part of the differential diagnosis for obstetric cholestasis. (c) Raised alkaline phosphatase supports the diagnosis of sclerosing cholangitis. (d) Antimitochondrial antibodies might be positive in patients with sclerosing cholangitis in pregnancy. (e) Ursodeoxycholic acid (UDCA) is a potential treatment for sclerosing cholangitis. Answers (a) (b) (c) (d) (e) F T F F T 1. MULTIPLE CHOICE QUESTIONS 33 Explanation (a) Primary sclerosing cholangitis is a chronic liver disease characterized by fibrosis and inflammation in the intrahepatic and extrahepatic bile ducts.
A Heaf test, consisting of a six-point, disposable puncture apparatus that is activated through a small amount of purified protein derivative of Mycobacterium tuberculosis (PPD), placed on the flexor surface of the left forearm can be used safely in pregnancy: a negative result of discrete induration at the puncture sites is classified as grade 0 or 1 (maximum, grade 4) and implies that further investigation is not required. HIV-positive patients might have a delayed response, and false negatives are more common in this population.
Answers (a) (b) (c) (d) (e) F F T F T Explanation (a) Women with rheumatoid arthritis might experience some improvement in their symptoms during pregnancy, although up to one-quarter will continue to have severe symptoms. Unlike other autoimmune conditions, there is no evidence that disease activity influences pregnancy outcome, which is generally good unless there is hypertension, secondary antiphospholipid syndrome (APS) (uncommon), or significant joint problems that limit hip abduction (for vaginal delivery) or neck extension (for general anaesthetic).