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In the Name of God Obstetrics study guide 5 Mitra Ahmad Soltani 2008.

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1 In the Name of God Obstetrics study guide 5 Mitra Ahmad Soltani 2008

2 References Braunwald Eugene, et al. Harrison's Principles of Internal Medicine. 16th edition. McGrawHill; 2005 Iranian Council for Graduate Medical Education. Exam questions.1998-2007 Iranian Council for graduate Medical Education. Board and pre-board Exam questions for OBS and Gyn.2001-2006 Pritchard JA, MacDonald PC, Gant NF. Williams Obstetrics. 22 nd ed. New York, NY: McGraw-Hill; 2005

3 What is the most common kidney stones during pregnancy? A-calcium phosphate B-uric acid C-calcium oxalate D-struvite Ans:c Treatment of stones in pregnancy: double J stent

4 Which type of stone is more common in these disorders? 1- hyperparathyroidism 2-intestines disorders 3-bladder 4-prostate 5-proteus infection Ans: 1/phosphate 2/oxalate 3/uric acid-calcium oxalate 4/calcium phosphate 5/struvite

5 What should be done in a 14 wk pregnant woman suffering from flank pain, frequency, and bacteriuria of 30000/mL? A-treatment B-repeat of U/A, U/C C-IVP D-No action is needed Ans:A

6 A 22 wk pregnant woman has repeated episodes of bacteriuria in pregnancy. Which prophylaxis is recommended? A-Amoxicillin 3 grs single dose B-Nitrofurantoin 100 mg qd till the pregnancy is terminated C-Sulfonamide 500 mg qid for three days D-Nitrofurantoin 100 mg qid for 21 days Ans:B

7 Which is not a consequence of acute pyelonephritis? A-Reduced GFR and Cr clearance B-ARDS C-Hemolysis D-Reduced erythropoietin production Ans:D

8 A pregnant woman suffering from pyelonephritis is hospitalized but her fever and pain persists despite antibiotic therapy. Ultrasound shows no pathology. What do you recommend? A-kidney CT B-repeat of U/C C-cystoscopy D-IVP Ans:D

9 Which is true in a pregnant woman with asymptomatic bacteriurea? A-If not treated 50% of cases proceed to acute Infection. B-If not responsive to initial antibiotic, nitrofurantoin for 21 days should be given. C-Recurrent rate is less than 10 percent. D-Single dose therapy has high failure rate. Ans:B

10 In a kidney transplanted woman, Which is a contraindication for pregnancy? A-presence of severe HTN one year after kidney transplant. B-When there is no sign of transplant rejection. C- in presence of intermittent proteinurea. D- When drug therapeutic level is reached. Ans:A

11 Which is not happening in an acute pyelonephritis ? A- thermo-regulatory instability B-reduced glomerular filtration rate C-hemolysis D-increased erythropoeitin production Ans:D

12 Which is wrong about dialysis in pregnancy? A-Type of dialysis-hemodialysis versus peritoneal-does not significantly influence pregnancy outcome. B-Longer duration of dialysis can have better results. C-Abortion and preterm labor are common. D-Neonatal survival is better when dialysis starts before conception. Ans:D

13 Which is true about ureteral stones in pregnancy? A-They are common in pregnancy. B-Flank pain is the most common symptom. C-More than 80% have hematuria. D-Laser is contraindicated in pregnancy. Ans:B

14 Which statement is wrong? A-Protein filtration rate increases during pregnancy. B-Protein excretion is constant throughout pregnancy. C- Cr more than 0.9 mg/l per day shows kidney lesion. D-kidney biopsy is better to be done after pregnancy. Ans:C

15 Which is a wrong statement? A- Low protein diet is advised for CRF in pregnancy. B- Higher rate of preeclampsia is the only risk of CRF in pregnancy C-50% of CRF pregnant women will develop HTN. Ans:A

16 Which is a true statement? A-Renal calculi are more common in pregnancy but because of ureteral dilation they are less symptomatic. B-Hematuria is the most common sign of renal calculi in pregnancy. C-Lithotripsy can be used for early pregnancy. D- Ultrasound is the preferred method for diagnosis of renal calculi Ans:D

17 Which is not an appropriate follow up for a G2/hix of infertility/10wks GA pregnant woman? A-Frequent prenatal visit for BP monitoring B-Serial serum Cr and urine protein measurements C-serial U/C D-Low protein diet and 180 mg supplemental iron Ans:D

18 A pregnant woman has acute pyelonephritis. Despite outpatient therapy she develops oliguria, hypoxia, acidosis, and encephalopathy. BP and CXR are normal. What is the diagnosis? A- SIRS B-severe sepsis C-ARDS D-Septic shock Ans:B

19 Points to remember Cr in Urine: 20-25 mg/kg male 15-20 mg/kg female In a 24 hr urine: 40-150 mg prot 600-1800 mg Cr 600-2500 cc =volume

20 IMP: Pyelonephritis General: condition/position/diet Lab: CBC diff, BG, Rh, U/A,U/C, k, Na, BUN/Cr, WW, MP,B/CX2 (Repeat of U/C after initiation of antibiotics if positive then kidney sono) reserve of 2 units of PC IV : 1000cc DW5% free AMP keflin 2 gr stat then 1 gr q6h Amp gentamicin 80 mg im stat then 60 mg tds OTHER: Control of vital sign q4hrs, control of FHR,FAD chart, check of I/O with measure, sono OB

21 Which is the most common cause of intestinal obstruction in pregnancy? A-vulvolus B-adhesions C-hernia D-appendicitis Ans:B

22 Which is wrong about cirrhosis in pregnancy? A-Pregnancy is very rare. B-Alcohol consumption is the leading cause C-Esophageal sclerotherapy is a good management in pregnancy D-Porto-systemic shunts can reduce mortality rate Ans:B Post necrotic cirrhosis due to hepatitis(B,C) is more common in pregnant cases.

23 Which is not a complication of hyperalimentation? A-hemothorax B-cholesthasis C-tamponade D-preterm delivery Ans:D

24 Which is wrong about appendicitis in pregnancy? A- High fever is a constant finding. B-WBC can be more than16000 in mL(with PMN>80%). C- Rebound tenderness is present in 50% of cases. D-Concomitant UTI can make the diagnosis difficult. Ans:A

25 A 28 year old 38 wk pregnant woman complains of periumbilical pain with rebound, emesis and vomiting. FHR is regular. There is no labor pain. WBC=12000/ ultrasound normal/T=37.6 C. What is the diagnosis? A-pyelonephritis, TX=antibiotic B-appendicitis, TX=antibiotic,laparatomy C-false labor,TX=observation D-degenerated myoma, TX=observation Ans:B

26 Which is a wrong statement? A-Hepatitis B is not transmitted from mother to the fetus. B-Only HBs Ag, and Hbe Ag positive mothers can transmit it to their fetus. C-Hepatitis B IG +vaccine should be given to the newborns of HBs Ag positive mothers. D-High risk pregnant women can take one dose of hepatitis vaccine in pregnancy. Ans:A

27 Which is a wrong statement? A- Acetaminophen intoxication signs are vomiting, sweating, pallor and weakness. B-Liver failure occurs after 24-48 hrs from ingestion. C-Treatment should be started after 4hrs according to a plasma level >120 mcg/ml. D-Tx is N-acetylcysteine 30 mg/kg stat and then 70 mg/kg q4h for 17 doses (72 hours) Ans:D

28 A mother with Hbe Ag positive chronic hepatitis B is giving birth to a contaminated newborn. What is not a possible route of transmission? A-Digestion B-milk C-saliva D-placenta Ans:D

29 A 36wk pregnant woman is icterus and has generalized pruritus. ALT and AST are normal. But Bil is highly elevated and AlP is slightly increased. Liver ultrasound is normal. What is the most probable diagnosis? A-intrahepatic cholesthasis B-gall stones C-PUPPP D-hepatitis Ans:A

30 A 29 year old 28 wk pregnant woman with BMI=30 complains of vomiting, RUQ pain and fever. WBC=13800/ml and ultrasound shows small gall stones. What is the best management? A-ursodeoxycholic acid PO B-lithotripsy C-hospitalization and observation D-cholecystectomy Ans:D

31 Which case of needlestick without previous vaccination should receive hepatitis B IG? A -HBV test result of the patient=neg/ physician=pos B- Tests results of the patient=pos/ physician=neg C-No action is needed if both of them are HCV negative. D-Both of them should receive IG immediately. Ans:B

32 Which is a good diagnostic test for fatty liver of pregnancy? A- ultrasound B-MRI C-CT scan D-lab or clinical findings Ans:D

33 In a pregnant woman with hyperemesis gravidarum, weight loss, normal brain MRI and serum electrolytes, Which vitamin deficiency can result in convulsions and coma? A-B1 B-K C- B2 D- B6 Ans:A

34 Obese pregnant women have higher risks of: A-thrombophelebitis B-HTN C-C/S D-placenta previa Ans:D

35 Which is wrong in a pregnant woman who complains of abdominal colicky pain, distension, constipation and bilious vomiting? A- During pain bowel sounds are enhanced. B-Reduced bowel sounds shows ischemia. C-Increased WBC and fever occur in the early course of obstruction. D-Bowel gas in AXR rules out ileus. Ans:C

36 Which is false? A- Peptic ulcer in young women is mostly in deodenum. B-There is no exacerbation in achalasia course C- Asymptomatic diaphragmatic hernia should not be operated D-Peptic ulcer symptoms subside in pregnancy Ans:C

37 Which is a wrong statement about intrahepatic cholestasis? A-Oral antihistamines are useful B-Cholestyramine can cause vit K deficiency C-Ursodexy cholic relieves prupritus and lowers liver enzymes D-Cholestasis has no adverse effect on pregnancy Ans:D

38 Which is ture about IBS in pregnancy? A- It is exacerbated in pregnancy. B-It can have adverse effect on pregnancy. C-Steroid is contraindicated in pregnancy. D-Surgery is contraindicated in pregnancy. Ans:B

39 A 12 wk pregnant woman HBS Ab=neg comes for advice because she finds out her husband is HBS Ag+. What do you suggest ? A-IG +vaccine with booster dose one month and then six month later B-IG during pregnancy and a vaccine for the newborn C-vaccine D-IG during pregnancy and vaccine after the delivery Ans:A

40 A pregnant woman complains of heart burn in the last wks of her pregnancy. Antacid and H2 antagonist do not help. What is your next step? A- liver enzyme test and ultrasound B-metoclopramide C- GI ultrasound D-endoscopy Ans:D

41 What is true about a newborn of an HBS Ag+/NBeAg- /HBeAb+ mother? A- Hepatitis is transmitted through placenta. B-There is an 80% risk of contamination during delivery. C- Breast feeding can be a route of transmission. D- Usually the newborn is not affected. Ans:D

42 Which is true about hepatitis in pregnancy? A- It has poor prognosis. B-It can cause preterm labor. C-It is transmitted via placenta. D-Vaccination is more preventive during pregnancy than non pregnancy. Ans:B

43 Which is not true about a case of hyperemesis gravidarum? A-It is more common in male sex fetus pregnancies. B-Hunger causes acidosis and vomiting causes alkalosis. C-It can cause vit B1and K deficiency. D-It can happen because of cholecystitis. Ans:A

44 What is the first step in the management of peptic ulcer in pregnancy? A-antacid B-H2 blockers C-PPI D-sucralfate Ans:A

45 A 35 year old G3/ P2 /20 wk GA/ complains of severe pain in RUQ with vomiting and fever. You find no abdominal distension. What is the diagnosis? A-severe preeclampsia B-gallbladder stone C- cholecystitis D-pancreatitis Ans: C

46 Which is true about scleroderma? A-3/4 of cases will have exacerbations in pregnancy. B-Increased collagen production is the main reason for scleroderma. C-More than 50% of patients die of kidney or pulmonary involvement. D-Pregnancy have relieving effect on dysphagia and reflux. Ans:B

47 Which is wrong about a new born with Lupus and heart block? A- Steroid given to the mother before 16 wks of GA can prevent new born heart block. B- It has poor prognosis for the new born. C-All mothers are Ab SS-A and SS-B positive. D- Heart block is transient in the new born. Ans:D

48 Which drug can not cause drug-induced SLE? A- quinidine B-phenobarbital C-hydralazine D-OCP Ans:D

49 Which is wrong about SLE in pregnancy? A- Lupus nephropathy is very similar to severe preeclampsia. B-It can have convulsions like preeclampsia. C-It can cause thrombocytopenia. D-New born heart block can be cured by treatment. Ans:D

50 A 30 year old G3 /10 wk GA/with 2 previous fetal demise complains of knee arthritis and rashes on the face. She has IgG antiphospholipids of 50 units and her Sm Ab is positive. What is the best treatment for her? A- Therapeutic dose aspirin till 24 wks and then low dose aspirin up to delivery +hydroxychloroquine B-Heparin 5000 units bd sc+ aspirin 80 mg C-Heparin7500 units sc bd +aspirin60 mg daily+ prednisone 1- mg per day D- Azathioprine 3 mg /kg po +prednisone 1 gr daily for 3 days and then 1-2 mg/kg daily till delivery Ans:C

51 Which is true about RA? A- It is exacerbated in pregnancy. B- There is no change in the course of disease in pregnancy. C- Flares happen after delivery. D- OCPs are not recommended. Ans:c

52 Which antibody is more specific for the diagnosis of SLE? A- Anti nuclear B-anti Sm C- anti phospholipid D- anti histon Ans:B

53 Which antibody is more common in a patient whose new born suffers heart block? A- anti SS B-Anti phospholipid C-anti nuclear D-anti DNA Ans:A

54 Which is true about RA in pregnancy? A- There is an increased risk of preterm delivery. B-MTX is not contraindicated in pregnancy. C- Symptoms subside after delivery. D-IUD is not recommended. Ans:D

55 Which is a better treatment for a 28 year old woman /G3/8wks GA/IgG anti phospholipid 45 units/history of 2 IUFD? A-Enoxaparin 40 mg daily sc B-Aspirin 80 mg daily + prednisone 15 mg daily C-Prednisone 1mg/kg+ IG 0.4 gr/kg daily D-Enoxaparin 40 mg daily+ aspirin 80 mg daily Ans:D

56 A 25 yrs old woman /w=43 kg/ 26 wks GA/ Hb=8 complains of anorexia. What is your management? A- 100 mg Iron B- 200 mg Iron+ multivitamin and folic acid C- 100 mg Iron+ multivitamin and folic acid D- 60 mg Iron+ folic acid Ans:B

57 Which is true about hemophilia A and pregnancy? A- It is because of factor 8(Christmas) deficiency. B- 50% of male children will have the disease. C- By CVS we can diagnose it prenatally. D- Labor and delivery can cause hemorrhage in the fetus or new born. Ans:C

58 Which is a wrong statement? A- Anemia in the second trimester is a risk factor for preterm delivery. B-IDA can cause LBW in the new born. C-Hb>13.2 in the second trimester can reduce neonatal mortality rate. D-30% of maternal mortality rate in third world countries is because of anemia. Ans:C

59 Which is true about ITP ? A- Maternal and fetal platelet count are closely correlated. B- It is mandatory to take scalp blood sample for platelet count. C- There is no evidence that pregnancy increases the risk of ITP exacerbation. D- Fetus has more risk of having low platelet count. Ans:C

60 Which is wrong? A- The outcome of pregnancy is related to the etiology of anemia. B- Hb>13 has adverse effects on pregnancy outcome. C-Hb>13.2 in the second trimester can reduce neonatal mortality rate. d-Anemia can cause maternal complications and hospitalization. Ans:D

61 Which is wrong about ITP? A- Pregnancy is not responsible for ITP recurrence. B-If platelets are below 50000, steroids should be initiated. C- Cases of ITP that do not respond to steroids should receive IVIG. D- There is close relationship between maternal and fetal platelet count. Ans:D

62 A 36 wk pregnant woman with sickle cell anemia has severe pain in her legs. Which is more effective? A-heparin B-dextran C-hydration+ morphine D-RBC transfusion Ans:C

63 Which is wrong about aplastic anemia in pregnancy? A-1/3 of cases need termination of pregnancy. B- 50% die perinatally. C- Androgen steroids are effective. D- Granulocyte transfusion is used to prevent infection. Ans:D

64 Which is true about sickle-cell anemia in pregnancy? A- 60% have non-reactive NST. B- Systolic-diastolic ratio in uterine artery is reduced. C- Attacks cause reduction of fetal perfusion. D-C/S is the choice. Ans:A

65 Which is true about megaloblastic anemia in pregnancy? A- It is always because of folic acid deficiency. B-It is seen in vegetarians. C- It is seen more in women who consume meat. D- Megaloblastic anemia causes bulimia. Ans:A

66 Which is wrong about the effect of sickle-cell anemia on cardiac function? A-Heart disease is rarely a cause of death. B- In most cases ventricular dysfunction will be corrected by reduction in preload, increase in afterload, and reduction in ejection fraction. C- Output and blood volume is increased in pregnancy. D- Severe preeclampsia with sickle-cell disease can cause ventricular dysfunction. Ans:B

67 Which is true for cases of pregnancy-induced hemolytic anemia? A-Steroids are useful. B-It happens in the third trimester. C- It subsides by pregnancy termination. D- There is no immunological etiology involved. Ans:A

68 Which is true about Von willebrand’s Disease? A-It has AD inheritance. B-It is rarely acquired. C- Hemorrhage after delivery is rare. D- Pregnancy outcome differs from normal pregnancies. Ans:A

69 What will happen if Iron requirement of a pregnant woman can not be met in the second trimester? A- It has no effect on her serum iron level. B-It has no effect on maternal Hb or Hct. C- It has no effect on fetal Hb. D- It has no effect on her serum ferritin. Ans:C

70 In which group of ITP, splenectomy is not recommended? A- Those who need high dose of treatment for remission. B-Those with recurrent episodes. C-Those who respond to steroids within 2 wks of treatment. D-Those who are not responsive to high dose gamma globulin. Ans:C

71 Which is true about antithrombin deficiency in pregnancy? A- It is the most common thrombophilias in pregnancy. B- It occurs 2-5 in 1000 population. C- New born will have purpura fulminans. D- It has an AR inheritance pattern. Ans:A

72 Which is wrong? A-Hyperpigmentation occurs in the last 4- 5 months of pregnancy. B-Nevi enlarge and become hyperpigmented. C-Hyperpigmentation is exacerbated by UV light. D-Hyperpigmention is more pronounced in white people. Ans:A

73 What is true about PUPPP? A- They occur in the second trimester of pregnancy and can cause maternal sepsis. B-They happen early in the course of pregnancy and can cause abortion. C-They happen in the first trimester of pregnancy and can cause preterm labor. D- They disappear by the third wk after delivery. Ans:D

74 Which is accompanied by high MMR? A- psoriasis B- pemphigus C-herpes gestationis D-Neurofibromatosis Ans:B

75 Which is wrong about melanoma in pregnancy? A- 90% it is on a previous nevi. B- Therapeutic abortion would increase 5 year survival. C- It is fatal. D- It is recommended that pregnancy be avoided 3-5 years from treatment. Ans:B

76 Which is wrong about pemphigoid? A-It is urticarial papules on the abdomen and limbs. B- By delivery they disappear. C- It recurs in the next pregnancies. D- It is related TO HLA-DRJ andHLA-DR4 Ans:B

77 Which disorder subsides by pregnancy? A neurofibromatosis B- psoriasis C- pemphigus D-Hansen’s disease Ans:B

78 Which is accompanied by C3 deposition in basal membrane? A- pruritus gravidarum B- PUPPP C-herpes gestationis D-prurigo of pregnancy Ans:C

79 featureDisease pruritusCholestasis of pregnancy: the most common dermatological disorder associated with pregnancy – it doesn’t need steroid urticariaPUPPP: no adverse effect on the perinatal outcome Papules and dermatitis Prurigo of pregnancy: does not recur in subsequent pregnancy vesiclesHerpes gestationis:C3 deposition in the basement membrane With systemic symptoms Impetigo herpetiformis: microabscesses spongiform pustules of Kogoj

80 Which is not necessary prior to syphilis treatment? A-Allergy testing for penicillin B-HIV antibody testing C- serological testing D-Lumbar puncture Ans:D

81 Which is wrong about HIV + patients? A-They have to be vaccinated against hepatitis, pneumococcal infection, influenza. B-CIN is more common in HIV + with HPV. C-CD4 count is the best indicator of response to treatment. D-ZDV is not necessary for patients with CD4 count of less than 300 cells /mL. Ans:D

82 Which is true about the newborn of a syphilitic mother? A- It won’t be infected if pregnancy happens in the “late latent” stage of syphilis. B- It won’t be infected if mother has taken benzathine penicillin G during pregnancy. C-If mother was treated by erythromycin, newborn needs Lumbar Puncture. D-If the newborn is seropositive with a normal CSF, no treatment is needed. Ans:D

83 A 12 wk pregnant woman has close contact with a child with mumps. What is your suggestion? A- No action is needed. B-Amantadine till delivery. C-IG D-acyclovir IV Ans:A

84 Which is wrong about ZDV in pregnancy? A-It is not recommended in the first trimester of pregnancy. B-It is given for prevention after close contact. C-It is administered throughout pregnancy for prevention of transmission to the fetus. D-It is not contraindicated during pregnancy. Ans:A

85 Which is a risk factor for future diabetes in the fetus? A-enterovirus B-hantavirus C-adenovirus D-herpesvirus Ans:A

86 Which is a good treatment for chlamydia infection in pregnancy? A-Erythro Estolate 500 mg qid for 7 days B-Erythro ethylsuccinate 400 mg qid fro 7 days C-amoxicillin 500 mg tds for 7 days D- erythromycin base 250 mg qid for 7 days Ans:C Erythro estolate and tetracyclin are contraindicated in pregnancy

87 Chlamydia treatment in pregnancy- red ink is the first choice: amoxicillin 500 mg tds for 7 days erythromycin base 500 mg qid for 7 days or 250 mg qid for 14 days Erythromycin Estolate 500 mg qid for 7 days Erythromycin ethylsuccinate 800 mg qid for 7 days Or 400 mg qid for 14 days Azithromycin 1 g as a single dose

88 What is postexposure prophylaxis of an HIV + needlestick injury? A-ZVD 200 tds+ lamivudine 100 mg BD for 4 wks B- follow up with antibody testing C- Indinavir 800 mg tds for 4 wks D- indinavir 800 mg tds for six months Ans:A If the source patient has advanced AIDS, a high load of HIV or has been treated with nucleoside analogues, indinavir 800 mg tds is added

89 Which is wrong about influenze in pregnancy? A- Amantadine 200 mg/d in the first 48 hrs reduces symptoms. B- Infection in the first or second trimester can cause fetal malformation C- All women should be vaccinated against influenza after the first trimester. D- Amantadine effect in pregnancy is not proven yet. Ans:B

90 What is the best prophylaxis for a 20 wk pregnant woman who wants to travel to a country where malaria is prevalent? A- chloroquine B-mefloquine C-quinine D-quinidine Ans:A

91 What is the treatment of GBS in a 36 wk pregnant woman who complains of vaginal discharge? A- ampicillin till delivery B-penicillin injection for the new born C-penicillin and gentamicin for one week D-ampicillin IV for the mother and penicillin G for the new born after delivery Ans:D

92 Which is not true for an HIV positive pregnant woman in her prenatal care? A-vaccination against hepatitis B and influenza B-if CD4 count is below 200/mcl, prophylaxis against P.carini. C- determination of CD4+ count till delivery D- Avoiding mouth suction devices for clearing the airway Ans:C

93 What is the gold standard diagnostic test for a 32 wk pregnant woman with herpetic genital lesions? A- papanicolao staining(Tzanck) B- PCR C- culture D-HSV-2 antibody Ans:C

94 Which is true about gonorrhea? A- There is no correlation between G. infection and spontaneous abortion. B- PROM is more prevalent. C- G. infection only affects the fetus in the third trimester. D-The drug of choice is ceftriaxone if the mother is allergic to penicillin. Ans:B

95 Which is the best test for diagnosis of fetal contamination with Toxoplasmosis? A-PCR B- IgG C- IgM D-ultrasound for malformations Ans:D

96 Which is true about CMV? A- Antibody measurement is not recommended. B- In suspected cases IG is injected. C- GU secretion culture is recommended. D- If antibody is present, acyclovir should be given. Ans:A

97 What should be done in a pregnant woman in labor who complains of varicella zoster infection for three days? A-ZIG for the new born B-Varivax for the new born C- no action is needed D- VZIG for the mother Ans:A

98 Varicella zoster The least probable contamination period is during 13-20 weeks of GA. VZIG during the first 96 hrs from close contact is preventive to the mother. VZIG dose is:125 units/10 kg IM VZIG for the newborn is needed when the mother shows the symptoms within 5 days before to 2 days after delivery.

99 Pneumonia treatment in pregnancy Uncomlicated (pneumococci, mycoplasma, chlamydiae): erythromycin 500-1000 mg every 6 hours Haemophilus:cefotaxime,ceftizoxime, Cefuroxime Penicilline resistance: levofloxacin Influanza: amantadine 200 mg daily if begun within 48 hours of symptoms Varicella:acyclovir iv 10 mg/kg every 8 hours VZIG:within 96 hrs of exposure 125u/10kg im

100 What should be done for a 6 wk pregnant woman who had close contact with a patient suffering from Rubella? A- If IgG is negative, IG is given. B- No action is needed if IgG and IgM are positive. C- No action is needed if IgG is positive and IgM is negative. D- Pregnancy should be terminated if IgG and IgM are positive. Ans:C

101 What is wrong about gonoccocal eye infection prophylaxis in a new born? A- Ceftriaxone 25-50 mg/kg IM or IV to the new born B- Erythromycin eye ointment C- C/S Ans: C

102 Which is wrong? A-The best screening test of congenital syphilis is umbilical blood test. B- VDRL and PRP are often positive in primary syphilis. C-VDRL and RPR are always positive in secondary syphilis. D-PCR of amniotic fluid is 100% specific. Ans:A

103 Which is true about toxoplasmosis in pregnancy? A- Most cases present with acute infection symptoms. B- Fetal contamination risk reduces as pregnancy advances. C- Maternal contamination prior to pregnancy has no effect on the fetus. D- 50% of new born have retinal involvement. Ans: C

104 A G2 38 wk pregnant woman on acyclovir ( for history of herpes) has no herpetic lesion in perineum, vagina and cervix now. Fetus has normal heart tone. What should be done? A-doubling acyclovir dosage+ Induction of labor B- induction of labor C- doubling acyclovir dosage+ C/S. D-C/S after 12 hrs Ans:B

105 How can you prevent vertical contamination from an HIV-AIDS mother? A-ZVD during pregnancy + C/S+ forbidding breast feeding B-ZDV during labor till one month after delivery C-ZVD after delivery for one wk to both mother and the newborn D-C/S in case of ROM +ZVD as long as the new born is breastfed Ans: A

106 Which is wrong about a mother who develops rubella symptoms? A- There is a 50% chance that the fetus is contaminated after 26 GA. B- Malformations occur in all fetuses with contamination prior to 11 wks. C-Pan encephalitis and diabetes type I happen in the second and third decade of life. Ans:A

107 What is the treatment of Condylomata Acuminata in a 33 wk pregnant woman? A- Podophylline resin B- interferon C- 5-flurouracil cream D- trichloroacetic acid Ans:D

108 What should be prescribed for a newborn with chlamydia ophthalmic lesions? A-Erythromycin 50 mg/kg /d PO 10-14 days B-Amoxicillin Po 50mg/kg/d for 7-10 days C- azithromycin single dose D-AgNO3 drops single dose Ans:A

109 What should be prescribed to prevent chlamydia ophthalmic lesions in a newborn? A-Erythromycin PO 10-14 days B-Amoxicillin Po 7-10 days C- AgNO3 drops single dose D- These drugs are not effective for prevention. Ans:D

110 In a 15 wk pregnant woman with possible CMV infection, IgM and IgG tests are not conclusive. What should be doen? A- US and amniocentesis B- No further work/up is needed. C- treatment with ganciclovir D-repeat of serologic tests Ans:A

111 GBS prophylaxis in needed in: 1-preterm labor before 37 wks 2-pre term rupture of the membranes 3-ROM more than 18 hours 4-GBS infection in a previous newborn 5-T>=38 c during labor 6- history of GBS bacteriurea

112 C/S is needed in cases of herpes: If primary or recurrent lesions are visualized near the time of labor or when the membranes are ruptured. Disregard the duration of rupture.

113 A 21 yr old 30 wk pregnant woman on methimazole for thyrotoxicosis complains of fever, sore throat and tachycardia. What is your management? A-d/c methimazole B- thyroidectomy C-adding thyroxine D-termination of pregnancy Ans:A PTU 300-450 mg/d is preferred in pregnancy.

114 A 28 yr old /G2/P1/ 31 wk GA/ complains of headache, galactorrhea and visual disturbances. What is your management of this case of pituitary macroadenoma? A- surgery B-bromocriptine C-pregnancy termination D- radiation Ans:B

115 Which is wrong? A-Methimazole and PTU cross placenta. B-They are similar in terms of side effects. C-PTU is preferred in lactating mothers. D-Repeated CBC check is recommended to R/O agranulococytosis. Ans:D

116 Which is wrong about postpartum thyroiditis? A-Goiter is usually large. B- Thyrotoxicosis happen in the early phase. C- Goiter is painless. D- Fatigue and palpitations are two common symptoms. Ans:A

117 Thyroiditis(reduced RAIU) causefeature AmiodaroneReduced T4  increased T4, reduced T3, increased TSH, increased rT3 AcuteTFT normal-pain-fever-Increased ESR- increased WBC RiedelTFT normal-Pressure on adjacent organs- firm goiter deQuervain’s Or subacute viral Or granulomatos TFT change in three stages: 0-6w(hyper) 6-12w(hypo) >12w(normal) Silent Or painless Or subacute lymphocytic Or postpartum Hyperthyroidism- Treatment is beta blockers Chronic lymphocytic Or Hashimoto Hurthle cell,prone to lymphoma type B-the most common cause of hypothyroidism in areas with iodine

118 A pregnant woman G2/P1/25 wk GA/is hospitalized for confusion. She developed fatigue, emesis, and vomiting and psychiatric problems since three days ago. The lab results show hypercalcemia. What is your management? A-daily phosphate B- termination of pregnancy C-NS+ furosemide D-steroids Ans:C

119 What is recommended for a pregnant case of Addison disease? A-increasing her glucocorticoid dose B-adding mineraocorticoids C-Hydrochortisone 100 mg q8hrs during labor and delivery D-increasing her glucocorticoid dose in lactation Ans:C

120 A pregnant woman suffers cardiac failure after a thyroid storm. She is in ICU now. What is the best treatment? A- PTU PO 1 gr loading dose and then 200 mg q6 hrs. B-5 drops of supersaturated solution potassium iodine (SSKI)q8hrs C- 10 drops Lugol solution q 8 hrs D- lithium carbonate 300 mg q6hrs Ans:A

121 Thyroid Enlargement 1- unilateral: TSH=Nl,FNA=benign---->T4 Hot in scan, follicular in pathology----> RAI Cold in Scan, follicular in pathology------->thyroidectomy 2-bilateral: Symmetric: T4 increased------>Graves------>methimazole,PTU T4 =nl----->goiter------>T4 Nonsymmetric: Toxic MNG------> methimazole then RAI 3- reduced T4-------> levothyroxine (control by TSH) 4- reduced RAIU> deQuervain’s thyroiditis >Aspirin+ Glucocorticoids

122 Which is wrong about Cerebral Venous Thrombosis? A- The risk is reduced in pregnancy. B- Head ache is the most common symptom. 10% of patients will have convulsions. C- Treatment is anticonvulsants and antibiotics. D-Heparin anticoagulation is controversial. Ans:A

123 Which is wrong about Multiple Sclerosis? A-Pregnancy has no adverse effect on MS. B-C/S is performed only for obstetrical indications. C-Spinal anesthesia is safe in MS. D-Breast feeding does not cause exacerbations. Ans:C

124 Which is the best treatment of depression in the first trimester of pregnancy? A- Imipramine B-fluoxetine C-amitriptyline D-nortriptyline Ans:B

125 Which is true about carpal tunnel syndrome in pregnancy? A- Ulnar nerve is involved. B- Delivery relieves the symptoms. C- It is unilateral in 80% of cases. D- Surgery and steroid injections are the treatment. Ans:B

126 Which is wrong about epilepsy in pregnancy? A-Epilepsy increases the risk of fetal malformations. B- Pregnancy causes 35% increase in episodes. C- The epileptic drug dose should be increased in pregnancy because drug intestinal absorption is reduced. D- The epileptic drug dose should be increased in pregnancy because drug metabolism is reduced. Ans:D

127 What is your advice to a pregnant woman who takes carbamazepine for epileptic seizures? A-weekly NST from the 32 wk of pregnancy B-measuring serum drug level in case of a seizure C-D/c of drug because of malformation risk D-Vit K injection in the third trimester of pregnancy Ans:B

128 A 34 yr old 34 wk pregnant woman who developed fever and severe head ache after delivery is in seizures now. Her BP is 110/80 mmHg. She had no history of convulsions or preeclampsia. What is your diagnosis? A-Cerebral venous thrombosis B- cerebral emboli C-SAH D-hemorrhagic stroke Ans:A

129 Which is true about MS in pregnancy? A- Steroids can reduce permanent disabilities. B- The risk of relapse is more after delivery. C-IFN B1a is teratogenic. D- C/S is the best mode of delivery. Ans:C

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