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OBS &GYN EXAM QUESTIONS, CASES AND NOTES

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1 OBS &GYN EXAM QUESTIONS, CASES AND NOTES
In the Name of God OBS &GYN EXAM QUESTIONS, CASES AND NOTES BY: Mitra Ahmad Soltani References: 1-Williams Obstetrics / 22nd Edition/ MC. Graw Hill/ Novak’s Gynecology/ 13 th Edition/ Williams and Wilkins/ Clinical Gynecology Endocrinology and Infertility/ 7 th Edition / Williams & Wilkins / TE Linde’s (Operative Gynecology) 9 th Edition / Williams and Wilkins / 2003 5-Iranian Council for Graduate Medical. Education. Promotion and board Exam questions.( ) med-ed-online

2 Fetal Monitoring med-ed-online

3 A- fetal echocardiography B- C/S C- Conservative management
1- For a patient who has labor pain, an abnormal NST mandates an int monitoring of FHR. Supraventricular arrhythmia is detected. The fetus looks healthy by ultrasonography. AF is clear. What step should be taken? A- fetal echocardiography B- C/S C- Conservative management D-amiodarone Ans:c med-ed-online

4 B- detecting fetal blood PH C-after 40 min intervention is needed
2-In the second stage of labor ,you notice a persistent fetal heart rate bradycardia of 110 bpm. What is your management? A- left lateral position, nasal oxygen, 1000 cc serum, fetal monitoring B- detecting fetal blood PH C-after 40 min intervention is needed D- It is a normal event in this stage . No further step is needed. Ans:D med-ed-online

5 3-BPP of a 34-week pregnancy is 4. What step should be taken?
A-L/S should be determined . If it is below 2, the BPP should be repeated B-immediate pregnancy termination C-BPP should be repeated if it is below 6 , pregnancy termination D- BPP should be repeated 48 hours later and management is designed according to that score Ans:C med-ed-online

6 Points to remember NST:
Favorable: Increase15 bpm for 15 seconds within 20 min of beginning the test (before 32 wks of GA we consider 10bpm lasting 10 seconds) BPP: Pregnancy termination for: reduced AF Gestational age over 36 weeks Score of 2 Repeating the BPP test for: Score below 6 + less than 36 weeks gestation/ low Bishop/ L/S>2 med-ed-online

7 +OCT: late decelerations following 50% or more of contractions
3 or more contractions Lasting at least 40 seconds In a 10-min period By either spontaneous contractions or: 0.5 mU/min oxytocin Doubled every 20 minutes Hyperstimulation: frequency more than every 2 min or lasting longer than 90 seconds med-ed-online

8 10 movements in up to 2 hours
normal fetal movement 10 movements in up to 2 hours med-ed-online

9 A-late deceleration and loss of variability occurring concomitantly
4- What is the fetal heart rate pattern in a fetus with placental insufficiency? A-late deceleration and loss of variability occurring concomitantly B-first late deceleration and then loss of variability C- first loss of variability and then late deceleration D-first accentuated variability and then late deceleration Ans:B med-ed-online

10 5- Which statement is wrong about MCA Doppler?
A- compared to FHR monitoring , MCA Doppler is more sensitive to fetal hypoxia B- in an IUGR case, hypoxia causes reduction in Pulsatility Index (PI) C- in an anemic fetus because of Rh incompatibility velocity is reduced in MCA D- with pregnancy advancing there will be a normal increase in MCA velocity Ans:c med-ed-online

11 Doppler systolic-diastolic waveform indices of blood flow velocity
S/D =S/D Ratio S-D/S= RESISTANCE INDEX S-D/MEAN= PULSATILTY INDEX med-ed-online

12 A-pregnancy termination for hypoxia
6- After epidural procedure for a pregnant woman the fetal heart rate shows waves of sinusoidal waves with acceleration. With regard to the following data, what is your management?: age:26 yrs/ GA:36 wks/ dil:3 cm/ eff=50% A-pregnancy termination for hypoxia B-this is pseudo sinusoidal pattern normal after epidural procedure. No step is needed. C-change of position and oxygen to relieve pressure on the umbilical cord D-pregnancy termination for fetal hemorrhage Ans:B med-ed-online

13 A-abruption B-uterine rupture C-uterine hypertonia D-cord prolaps
7- Amnioinfusion has been proposed to cure variable deceleration due to oligohydramnios. What has the least probability to occur during amnio infusion? A-abruption B-uterine rupture C-uterine hypertonia D-cord prolaps Ans:A med-ed-online

14 8- Silent oscillatory pattern refers to:
A- baseline variability of FHR of less than 5 bpm B- two or more acceleration of 15 bpm C-one acceleration of 15 bpm D-baseline FHR variability of more than 5 bpm Ans:A med-ed-online

15 9-Which is wrong about late deceleration:
A-it occurs after the peak and nadir of uterine contraction B-lag phase represents fetal PO2 level not fetal blood PH C-the less the fetal PO2 before uterine contraction, the more is the lag phase before deceleration D-reduced fetal PO2 level below critical level activates chemoreceptors and decelerations Ans:C med-ed-online

16 Points to remember Positive OCT: 50% or more of uterine contractions accompany FHR decelerations Variable deceleration: occurs >= three times in a 20 min interval with FHR drop to 70 bpm Persistent deceleration: more than 30 bpm reduction in a 2-10 min interval Bradycardia: more than 30 bpm reduction of FHR in more than 10 min med-ed-online

17 A- daily BPP and observation B- C/S C- repeat of NST 24 hours later
9- NST of a G2 / GA=37 wks/ cephalic presentation/ with a history of 2 IUFDs shows a 2-min deceleration. What is the best management? A- daily BPP and observation B- C/S C- repeat of NST 24 hours later D-vaginal exam with continuous fetal monitoring Ans: B med-ed-online

18 10-What is equivocal-suspicious result in OCT?
A-no late or significant variable deceleration B-late decelerations following 50% or more of contractions (even if the contraction frequency is fewer than three in 10 minutes) C- intermittent late decelerations or significant variable decelerations D-decelerations that occurs with contractions frequent than every 2 min or lasting 90 sec E- fewer than three contractions in 10 min or an uninterpretable tracing Ans:C med-ed-online

19 11- Which is wrong about fetal heart rate deceleration?
A- maternal HTN can cause chronic placental dysfunction and late deceleration B- early deceleration of 20 bpm of baseline shows fetal hypoxia and acidemia C- increased afterload can activate chemoreceptors and cause late deceleration Ans:B med-ed-online

20 A- pregnancy asphyxia and pregnancy termination
12- A pregnant woman’s BPP shows a non-reactive NST, one inspiration in 3 min of 30 sec duration, 2 body movements, one Flex and Ext of limbs, AF of one vertical packet of 3 cm. What is your management? A- pregnancy asphyxia and pregnancy termination B- repeating the test one week later w/o the possibility of fetal asphyxia C- repeating the test with the possibility of fetal asphyxia D- the possibility of asphyxia, repeat of the test on the spot and if abnormal, termination of pregnancy Ans:C med-ed-online

21 Points to remember: score two, otherwise zero
1-Tone: 1 2-Respiration: 1 of 30 sec 3-AF: 1pocket more than 2 cm 4-NST: 2 of 15 bpm of 15 sec in a 20 min strip 5-Movement: 3 in 30 min med-ed-online

22 13- Which one is acceptable in fetal health assessment?
A- negative predictive value for most tests is about 99.8% B- positive predictive value for abnormal tests is more than 80% C- management should be done based on true positive tests D- tests are based on many clinical trials Ans:A med-ed-online

23 PPV= true sick/positives
true positive False negative healthy False positive True negative med-ed-online

24 Sensitivity= true positive /sick
False negative healthy False positive True negative med-ed-online

25 14-Which can not reduce fetal respiratory effort?
A-hypoxia B-preterm labor C- maternal feeding D- at night (circadian effect) Ans:C med-ed-online

26 A-pregnancy termination B-repeating the test one week later
15- Female 23 yrs G1 GA=36wks has gone through BPP for lupus. The fetus shows 3 movements/ one respiratory effort of 30 sec/one flex/non-reactive NST/AF of one pocket of 3 cm. What is your management? A-pregnancy termination B-repeating the test one week later C-repeating the test immediately D-repeating the test 24 hours later Ans:B med-ed-online

27 A-S/D ratio increases gradually in the second half of pregnancy
16-Which is wrong about S/D ratio? (max sys flow velocity/min end-diastolic flow velocity) A-S/D ratio increases gradually in the second half of pregnancy B-S/D ratio increases in lupus and HTN C- reversed diastolic flow can be seen in placental dysfunction D- Absent diastolic flow can be seen in cases of aneuploidy Ans:A med-ed-online

28 A-Doppler velocimetry B-labor induction C- immediate C/S
17-G2 P1 28 yrs female comes to the clinic with the chief complaint of reduced fetal movement. Her gestational age is uncertain. In ultrasound AF is normal and the fetus is reported as term. What should be done for her? A-Doppler velocimetry B-labor induction C- immediate C/S D- US twice weekly Ans:B *Normal FAD: at least 10 movement sensation in 2 hours med-ed-online

29 18-Which is not an ominous sign in NST?
A- No increase in FHR in 90 min B- non repeating variable deceleration of less than 30 sec C- deceleration that lasts more than one min D- variable deceleration less than 3 times in a 20-min interval Ans:B med-ed-online

30 B-echocardiography and fetal karyotyping
19- Fetal heart rate auscultation reveals FHR of 220 (PSVT). What is your management? A-Digoxin B-echocardiography and fetal karyotyping C- This is an ominous sign of future hydrops and heart block of lupus pregnancy D-This is transitional. No treatment is needed Ans:A med-ed-online

31 A- pregnancy termination B- repeating test on the same day
20- In a diabetic woman of 37 wks, BPP shows no fetal movement -one respiratory effort of 30 sec -2 accelerations of 15 sec and one AF pocket of 2 cm. What is your management? A- pregnancy termination B- repeating test on the same day C-repeating test in the third day D- amniocentesis Ans:B med-ed-online

32 A- Recurrent deceleration B-significant variable deceleration
21- In a 20 yr old woman of a PIH case, more than 50 % of uterine contractions are accompanied with decelerations. What does this mean? A- Recurrent deceleration B-significant variable deceleration C-prolonged deceleration D-long-term variability Ans:C med-ed-online

33 A- Pregnancy termination
22-The BPP of a 36 wk pregnant woman shows 1 respiratory effort, 2 movements with no acceleration, one flex and Ext of the limbs, and AFI of 10 cm. The repeat of the test after 24 hours later shows the same results. What is your management? A- Pregnancy termination B- Pregnancy termination if bishop score is favorable C- twice a week BPP D-once a week BPP Ans:A med-ed-online

34 A- prolonged deceleration B-saltatory pattern C-variable deceleration
23- Which pattern is a sign of fetal distress in a 43 wk pregnant woman ? A- prolonged deceleration B-saltatory pattern C-variable deceleration D- late deceleration Ans: A med-ed-online

35 24-What drug does not reduce beat to beat variability ?
A- narcotics B-barbiturates C-phenothiazine D- in the first hour after MgSO4 administration Ans:D Acidemia causes btb variability reduction Hypoxia causes btb variability increase med-ed-online

36 25-What is the BPP score of : 3 movements in 30 min / one acceleration of more than 15 sec/3 movements/ one tonic activity/ AF pocket of more than 2 cm? A- 8/10 B-8/12 C-10/12 D-6/10 Ans:D med-ed-online

37 26-What is the indication for Doppler velocimetry?
A- IUGR B-postterm C-SLE D-APL antibody syndrome Ans:A med-ed-online

38 Puerperium med-ed-online

39 B-lactose is more in ovulating women milk C-K and glucose is more
1-What is the change in the milk of ovulating women versus non-ovulating lactating women? A- No difference B-lactose is more in ovulating women milk C-K and glucose is more D-Na and Cl is more Ans:D med-ed-online

40 2-Which change can be seen in puerperium?
A-maternal heart beat is increased 2 days after delivery B- endometrium repair is resumed three weeks after delivery C- Ureters will return to non pregnant state after 8 weeks D- Vaginal rugae appear after 3 months from delivery Ans:C med-ed-online

41 3-Which is true about puerpural changes?
A- total number of uterine muscular cells is not reduced B-vaginal rugae occur in the third month from delivery C-uterine connective tissue won’t change D-uterine is re-epithelialized totally in the first week of pregnancy Ans:A med-ed-online

42 4-Which organism is the least responsible in puerpural infection?
A- peptostreptococcus B-enterococcus C- chlamydia trachomatis D-mycoplasma Ans:D med-ed-online

43 A- lactation after two weeks from iodine exposure is safe
5-What is your management in a lactating mother who is a candidate for radioactive iodine administration? A- lactation after two weeks from iodine exposure is safe B- lactating during iodine administration is safe because iodine is not secreted in the milk C-lactation during the first 15 hours is contraindicated D- lactation is contraindicated Ans:A med-ed-online

44 B- pelvic thrombophlebitis C- pyelonephritis D- adenexal infection
6- A patient comes to the clinic because of fever 4 days after C/S which persists 72 hours from antibiotic administration. What is the most likely reason of antibiotic failure? A- wound infection B- pelvic thrombophlebitis C- pyelonephritis D- adenexal infection Ans:A med-ed-online

45 7-What is wrong about puerpural immunization?
A- tetanus and diphtheria vaccine before discharge from hospital is advocated B-a woman already injected measles vaccine does not need a booster dose C- Rh negative women with an Rh positive newborn should take RhoGam D- women who have never taken rubella vaccine should be vaccinated Ans:B med-ed-online

46 8-Which is not a contraindication to lactation?
A- alcoholics and drug abusers B- HSV and HBV patients whose infants have taken IG against these viruses C- AIDS and active TB D- women under breast cancer treatment Ans:B med-ed-online

47 9-Which is wrong about OCP use in lactation period?
A- Oral progesterone can be used after 2-3 weeks from delivery B- Implants can be used immediately after delivery C- Depot medroxy Progesterone acetate can be used 6 weeks from delivery D- Combined OCP is used 6 weeks from delivery Ans:B med-ed-online

48 A- imipenem+cilastatin should be used in intractable cases
10-What is wrong about antibiotic therapy of pelvic infection after C/S? A- imipenem+cilastatin should be used in intractable cases B- clinda+genta is the standard treatment C- Genta+ pennicilin G are the first line therapy D- ampicillin is added when enterococcus is suspected Ans:C med-ed-online

49 11-Which is wrong about infection after C/S?
A- there is no definite relationship between anemia and infection B-sexual practices definitely play a role in infection C- young age and pimigravidity is a risk factor D- three or more doses of betamethasone in preterm labor is a risk factor Ans:B med-ed-online

50 12-Which is wrong about human lactation?
A- a normal milk secretion is more than 60 cc per day B-Milk is isotonic to plasma and more than 50% of its osmotic pressure is due to its lactose C-milk lactose can leak to blood and urine and this may be mistaken as glucosuria D- Iron reserve affects milk iron content Ans:D med-ed-online

51 13-Which is wrong about parametrial phlegmon?
A-infection is unilateral and limited to broad ligament B-infection subsides with IV antibiotic but fever may exist 5-7 days C- If fever persists more than 72 hours despite antibiotic therapy the diagnosis is ruled out D-supracervical hysterectomy is recommended Ans:C med-ed-online

52 14-What is wrong about weight loss after delivery?
A -5-6 kg weight loss after delivery is due to uterine evacuation and blood loss B-2-3 kg is lost because of diuresis C-2 kg is lost because of third space volume reduction D-most women reach to pre pregnancy weight by the second month after delivery Ans: D med-ed-online

53 A-ultrasonography B-beta subunit C-Doppler sonography D-curettage
15- A 26 year old woman complains of vaginal bleeding for three months after delivery. In gynecologic exam uterine size is normal and cervix is closed. What is the first step to be taken? A-ultrasonography B-beta subunit C-Doppler sonography D-curettage Ans:B med-ed-online

54 16-On average what percent of drug can be secreted in human milk?
Ans:A med-ed-online

55 17-Which is wrong about fever after delivery?
A-fever more than 39 c in the first 24 hours after delivery is a sign of severe infection B-fever in bacterial mastitis usually is late and persistent C-pulmonary infection usually occurs in the first 24 hours mostly after C/S D-pyelonephritis is one of the most common reason of infection and is most often mistaken for pelvic infection Ans: D med-ed-online

56 B-parametrial phlegmon C-pelvic septic thrombophlebitis
18- A woman has gone through C/S 7 days ago . Three days after the operation chills and fever (enigmatic fever) occured. She is given antibiotic with no improvement in her condition. She doesn’t look ill. What is your diagnosis? A-pelvic abscess B-parametrial phlegmon C-pelvic septic thrombophlebitis D-adenexal infection Ans:C med-ed-online

57 A- mother of a galactosemic newborn B- mother with HBV
19-Who can lactate? A- mother of a galactosemic newborn B- mother with HBV C- mother with active untreated TB D-mother with breast herpetic lesions Ans:B med-ed-online

58 20-Which is true about C/S abscess?
A-Fever will resume one week after surgery B-Mostly it happens after metritis C-Fever will answer to appropriate antibiotic therapy D-Wound culture is negative most of the time Ans:B med-ed-online

59 C-broad spectrum antibiotic D-bromocriptine Ans:A
21- How to manage breast engorgement in women who does not choose breastfeeding her newborn? A-oral analgesics B-warm compress C-broad spectrum antibiotic D-bromocriptine Ans:A med-ed-online

60 D-chlamydia trachomatis
22-An infection after C/S which is not responsive to clinda+genta is because of: A-clostridium B-enterococcus C-bacteroid fargilis D-chlamydia trachomatis Ans:B med-ed-online

61 A- immediately B-3 months later C- 6 months later D- 9 months later
23- A week after NVD +episiotomy dehiscence occurs. When the dehiscence should be repaired? A- immediately B-3 months later C- 6 months later D- 9 months later Ans:A med-ed-online

62 A- Oral progesterone 2-3 weeks after delivery
24-A 28 yr old G2 P1 woman decides on contraception during lactation after the first week from delivery. What is the best choice? A- Oral progesterone 2-3 weeks after delivery B-Depo-Provera 2 weeks after delivery C-Implants after 4 weeks from delivery D-oral OCP 4 weeks from delivery Ans:A med-ed-online

63 25-Which is true about post C/S metritis?
A- uterine culture helps to choose the best treatment B- blood culture is negative most of the time C- streptococcus beta hemolytic cause foul smelling secretions D-placental site is the site of transmission of infection Ans: B Blood culture of metritis is negative most of the time. Wound culture of C/S abscess is positive most of the time. med-ed-online

64 26-What is true about lactation period mastitis?
A-It occurs in the last days of the first week B- Most of the time it is bilateral C-nose and throat of the newborn is the source of infection D-it is mostly a result of coagulase-negative staph Ans:C med-ed-online

65 Abnormal labor

66 1-What is Robin maneuver to release shoulder dystocia?
A-rotation of post. shoulder to deliver ant. shoulder B- abduction of shoulders C- flex of mother’s knees and suprapubic pressure D- rotation and extraction of ant. shoulder Ans:B Woods screw=A McRoberts m.=C Zavanelli m.= repositioning of fetal head back into the uterus and C/S med-ed-online

67 2-Which is wrong in PGE2 administration for labor induction?
A-It reduces submucosal water content B- vaginal tablet is superior to vaginal gel C- It better affects on a cervix with Bishop score below 4 D-It can be used instead of oxytocin for cervical Bishop score of 5-7 Ans:A med-ed-online

68 3-Which is wrong in breech delivery mechanism?
A-ant hip has a more rapid decent than post hip B- ant hip is beneath the symphysis pubis and intertrochanteric diameter rotates around a 45 degree axis C- if post hip is beneath the symphysis pubis it has to go through 225 degree axis rotation D-for sacrum ant or post position, the axis of rotation is around 45 degrees Ans: C med-ed-online

69 B- internal rotation to make mentum ant position
4-A woman 35 years old- P2 – GA of 38 wks -EFW of 2 kg presents face and posterior shoulder presentation. How do you manage her delivery? A-induction of labor B- internal rotation to make mentum ant position C- observation to allow spontaneous rotation D- C/S Ans:C med-ed-online

70 5-Which is wrong about persistent occiput posterior?
A-Forceps can be applied B-manual rotation of the head can be done C- manual rotation of the head can be done D-there is no place for observation Ans:D med-ed-online

71 6-A term pregnancy- dil=3cm- eff=50%-satation=-2 soft cervix in mid position has a Bishop score of:
Ans:B med-ed-online

72 7-In high dose oxytocin labor stimulation, what is the maximum dose (mu/min) of oxytocin ?
Ans:C med-ed-online

73 A-Frank breech extraction B-C/S C-modified Prague maneuver
8- G4-L1-Ab2 / GA:38wks/full dil &eff/frank breech/ station=1 /WB=intact /FHR=100 BPM / x-ray shows flexion of the head. What is the best management? A-Frank breech extraction B-C/S C-modified Prague maneuver D- observation for non assisted breech delivery Ans:A med-ed-online

74 9-Which is wrong about face presentation?
A- This is a rare presentation above inlet B-brow presentation most of the time changes to face presentation C- decent mechanism is completely different from vertex presentation D-delivery is possible if mentum appears beneath the symphysis. Ans:C med-ed-online

75 C- presenting part engagement D- CPD Ans: A
10- Under what condition is external cephalic version allowed in breech or transverse position,? A- multiparity B-placenta previa C- presenting part engagement D- CPD Ans: A med-ed-online

76 11-Which is true about pelvimetry of a breech presentation?
A-MRI is superior to CT scan B-MRI is faster than CT scan C- MRI is superior to CT scan only during labor D-MRI is not a good technique for imaging inlet and mid pelvis Ans:A med-ed-online

77 12-Which is wrong about misoprostol?
A- It is a synthetic PG E1 B-It is used for peptic ulcer C- It is used for contraception D- Its dose is 100 mcg intra cervical for labor induction Ans:D med-ed-online

78 13-Which criterion applies to low forceps?
A- the fetal head leading point should be on station=>2 B- the fetal head leading point should be above station=>2 C-The fetal head is on the pelvic floor D-Sagital suture is ant-post Ans:A med-ed-online

79 14-Which is true about breech delivery?
A-labor duration is more lengthy than vertex presentation B-CP is not related to mode of delivery C- Breech presentation happens with no definite reason D-pelvimetry with MRI reduces C/S rate Ans:B med-ed-online

80 15-Which is wrong about PGE2 gel?
A-The intracervical dose is mg B-The vaginal dose is 3-5 mg C- The vaginal application releases 10 mg Q4h D-If contractions and FHR are normal in a 2 hour observation, the patient can be discharged Ans:C med-ed-online

81 A-Pinard B- modified Prague C- Bracht D- Meuriceu Ans:B
16- In breech presentation with a posterior shoulder ,What is the name of the maneuver: “The shoulder is grasped by one hand and the legs are grasped by the other hand then the newborn is pooled toward mother’s abdomen?” A-Pinard B- modified Prague C- Bracht D- Meuriceu Ans:B med-ed-online

82 17-Which is wrong in shoulder dystocia?
A-Most of shoulder dystocia cases can not be diagnosed or predicted B- Shoulder dystocia can be diagnosed with high accuracy using modern imaging studies C-ultrasound is not reliable D- C/S is recommended in diabetic mothers with babies more than 4500 gr and in non diabetic mothers with babies more than 5000 gr Ans:B med-ed-online

83 A- vaginal misoprostol 50 mcg
18- A woman 34 yr G1 GA of 41wks is hospitalized. Which regiment is more effective to improve Bishop score? A- vaginal misoprostol 50 mcg B- intracervical PGE2 (dinoprostone)0.5 mg C- Oral Misoprostol 50 mcg D-NS extra amniotic infusion Ans:D med-ed-online

84 Hypertensive Disorders in Pregnancy

85 1-What is the accepted screening test for diagnosis of PIH?
A-Rollover test B-nitric oxide measurement C-vascular endothelial growth factor D-angiotensin test Ans:A med-ed-online

86 A-Delivery removes the effect of vasospasm B-anesthetic drugs
2- For a case of severe preeclampsia (BP=180/95) Mg SO4 and C/S is ordered. An hour after C/S BP falls to 110/75. What is the reason of BP fall? A-Delivery removes the effect of vasospasm B-anesthetic drugs C-hemorrhage D-MgSO4 effect Ans: C med-ed-online

87 3-Which is true about edema of preeclmpsia?
A- it has an unknown etiology B-it is because of increased aldosterone level C- it worsens the prognosis of preeclampsia D- it is because of increased DOC Ans:A med-ed-online

88 D-regular checking of lab results Ans: A
4- A woman 48 yrs old/ G3/ BP=150/115/ has a high cholesterol level . Her sister and brother had heart attacks in the age of 40. Which is wrong about the management of this case? A-Beta blocker B- diet C-methyl dopa D-regular checking of lab results Ans: A med-ed-online

89 D-the need for combined drug therapy Ans:B
5- In a woman with chronic HTN Which factor has the least effect in development of superimposed PIH? A- PIH history B- low dose aspirin C- severity of HTN D-the need for combined drug therapy Ans:B med-ed-online

90 6-What is the most common complication of eclampsia?
A- abruption B-aspiration pneumonia C-pulmonary edema D- direct maternal mortality Ans:A med-ed-online

91 7-Which is true about blindness after eclampsia?
A-It has a bad prognosis B-It lasts about 1 month C-it is transient and lasts from 4 hours to 8 days D-in some people it causes permanent blindness Ans:C med-ed-online

92 8-Which is wrong about eclampsia?
A- eclampsia can cause coma without seizure B- All patients with eclamsia have had signs of preeclampsia C-After seizures respiratory rate is reduced and cyanosis happens D- In all cases of eclampsia severe proteinuria is present Ans:C med-ed-online

93 9-Which therapy can prevent preeclampsia?
A-Low dose aspirin B-calcium C-fish oil D-Antioxidants Ans:D med-ed-online

94 A-Phenytoin loading dose of 1000 mg/h IV
10- A 40 years old woman / G3/P2 /GA=35 wks/ BP=210/110 is in seizure. What is the best way to control her seizure? A-Phenytoin loading dose of 1000 mg/h IV B- Diazepam and creatinin measurement C- amobarbital sodium 250 mg IV D- MgSO gr as loading dose Ans:D med-ed-online

95 11- What is the cause of platelet change in preeclampsia?
A- increased production B- decreased consumption C- increased platelet aggregation D- decreased platelet- adhering IG Ans:A med-ed-online

96 A- there is no increased risk in her next pregnancy
12-A woman 25 years old / G1 suffers HELLP syndrome. What is true about her next pregnancy? A- there is no increased risk in her next pregnancy B-the is increased risk of abruption and preeclampsia C-there is no increased risk of preterm labor or C/S D-there is no increased risk of IUGR Ans:B med-ed-online

97 13-Which test has a more PPV for detecting PIH?
A-urinary excretion of Kallikrein B- roll over test C- angiotensin II D- hypocalciuria Ans:A med-ed-online

98 A-IV hydralazine 20 mg + IV verapamil 10 mg B-IV hydralazine 5 mg
14-A pregnant woman GA=29 wks / severe headache/ blurred vision/ BP= 200/120 has gone through routine tests and MgSO4 infusion. What other steps should be taken? A-IV hydralazine 20 mg + IV verapamil 10 mg B-IV hydralazine 5 mg C- IV labetalol 80 mg D- sublingual nifedipine 10 mg +thiazide 10 mg Ans:B med-ed-online

99 D-no treatment is needed Ans:B
15-A case of eclampsia with seizure is given MgSO4. She is agitated. What drug is appropriate for her agitated state? A-2 gr MgSO4 IV B- 250 mg amobarbital IV C- 10 mg diazepam IM D-no treatment is needed Ans:B “A” would be appropriate if a second seizure occurs med-ed-online

100 16-A woman with high blood pressure, proteinuria, Cr>1
16-A woman with high blood pressure, proteinuria, Cr>1.5 mg/dl, has an episode of seizure after 4 hours from her delivery. What treatment do you suggest? A-14 gr of MgSO4as the loading dose and then 2.5 gr q4h up to 24 h after delivery B-7 gr of MgSO4 as the loading dose and then 2.5 grq4h up to 24 h after the last seizure C-14 gr of MgSO4 as the loading dose and then 2.5 gr q4h up to 24h after the last seizure D-7 gr of MgSO4 as the loading dose and then 2.5 gr q4h up to 24h after delivery Ans:C med-ed-online

101 17-Which is not among pathophysiological changes of preeclampsia?
A-reduction in PGE2 B-reduction in prostacyclin C-increased thromboxane A2 D-increased resistance to angiotensin Ans: D med-ed-online

102 18-Which is wrong about proteinuria of preeclampsia?
A-Some women deliver before proteinuria occurs B-1+ proteinuria equals 300 mg protein in a 24 hour sample C-NPV of a trace or negative dipstick test is about 30 % D-PPV of 3+/4+ proteinuria is 70% Ans:D med-ed-online

103 A- She has a high probability of developing HTN
19-For a primigravida in 30 weeks gestation a roll-over test is done. An increase of 35 mmHG has occurred in diastolic BP. Which is wrong for this case? A- She has a high probability of developing HTN B-She is abnormally sensitive to angiotensin II C-increased BP is because of hyperactivity of parasympathetic system D-33% of these patients will develop preeclampsia Ans:C med-ed-online

104 20-Which is wrong for visual disturbances of preeclampsia?
A-it is because of occipital region lesions B-if blindness does not resolve within a week , it will remain permanently C- It is because of retinal artery spasm that can resolve by MgSO4 D-it is because of retinal detachment that is most often unilateral Ans:B med-ed-online

105 21-Which is wrong about superimposed preeclampsia?
A-it occurs earlier in pregnancy and most often is accompanied by IUGR B- BP changes remain through life C-some women have increased BP after 24 weeks gestation D- above 90% of them have a history of essential HTN Ans:B med-ed-online

106 C-peripartum cardiomyopathy D-MS signs aggravated by fluid shift Ans:C
22-A woman GA=38 wks/G2/L1/history of chronic HTN is diagnosed as a case of severe preeclampsia. Her pregnancy is terminated. Her BP and proteinuria and edema are improved but she has developed orthopnea. What is your first diagnosis? A-ATN and overload B- hypoalbuminemia C-peripartum cardiomyopathy D-MS signs aggravated by fluid shift Ans:C med-ed-online

107 23-What drug has the complication of tachycardia?
A-methyl dopa B-propranolol C-nifedipine D-hydralazine Ans: D med-ed-online

108 24-Which does not happen in preeclampsia?
A-reduced renal perfusion and GFR B-increased renin-angiotensin level C-constant electrolyte concentration D- increased microangiopathic hemolysis Ans:B med-ed-online

109 A-Im hydralazine B-oral labetalol C-thiazides D-IV MgSO4 Ans:D
25-A woman 32 years old/ NP /obese / 38 wks GA/ mild preeclampsia delivers her child . BP does not decrease after several IV doses of hydralazine. Which is not a good management? A-Im hydralazine B-oral labetalol C-thiazides D-IV MgSO4 Ans:D med-ed-online

110 Hemorrhage in Obstetrics

111 A-presence of hematoma in the broad ligament
1- A woman 35 years old /G4 L3 presents with couvelaire uterus in C/S. When is hysterectomy indicated? A-presence of hematoma in the broad ligament B-presence of hematoma in mesosalpinx C- atony retractable to treatment D- presence of blood in abdominal cavity Ans:C med-ed-online

112 2-Which is wrong about platelet administration?
A- Platelet can not be reserved more than 5 days B-platelets should be administered to patients with hemorrhage and platelet counts less than 50000/ml C-platelet should be administered after cross-match D- If there is no hemorrhage, platelets should be administered to patients with platelet counts less than /ml Ans:D med-ed-online

113 3-which is the most common reason of DIC in Obstetrics?
A-IUFD B-abruption C-AF emboli D- septic shock Ans:B med-ed-online

114 C-uterine artery ligation D-hypogastric artery ligation Ans:B
4-what is the first step in treating a G2 with late postpartum hemorrhage (after stabilizing her condition)? A-curettage B-uterotonics C-uterine artery ligation D-hypogastric artery ligation Ans:B med-ed-online

115 A-high dose progesterone B-curettage C-IV conjugate estrogen
5-A 16 year-old woman comes to you with heavy bleeding after a two month delay in her periods. Pregnancy test is negative. Ultrasound shows a thin endometrium. There is no coagulation or anatomical problem. Which is the best treatment? A-high dose progesterone B-curettage C-IV conjugate estrogen D-diagnostic hysteroscopy Ans:C Conjugate estrogen mg IV q6h or PO 2.5 mg q6h med-ed-online

116 A-first B-second C-third D-fourth Ans:c
6- what is the stage of shock in a woman 70 kg / HR=130 bpm/AP=55mmHg/mod tachycardia/ urinary output=10cc in a min A-first B-second C-third D-fourth Ans:c med-ed-online

117 7-Which is true about hemorrhagic shock?
A- central venous catheter is not recommended B-lifting the feet is not recommended C-colloids are superior to crystalloids D-excess NS can cause alkalosis Ans:A med-ed-online

118 B-bilateral uterine and ovarian arteries ligation
8-A woman suffers intractable heavy vaginal bleeding after C/S. Laparatomy is performed. Retrovesical hematoma is evacuated and the site of bleeding is sutured. The bleeding does not stop. What is the second stage in management? A-total hysterectomy B-bilateral uterine and ovarian arteries ligation C-bilateral hypogastric arteries ligation D-bilateral hypogastric and ovarian arteries ligation Ans:D Ovarian artery is situated in infundibulopelvic and mesosalpinx ligament med-ed-online

119 9-Which is wrong in abruption?
A-It is more likely in heroin addicts than cocaine addicts B-fibroma is one of the causes C-positive past history is a risk factor D-there is no agreement on smoking as a risk factor Ans:A med-ed-online

120 A- The profile is like that of DIC
10-A G2 with GA=14 wks is referred for spotting. Ultrasound imaging shows twin pregnancy with one fetal demise. How the coagulation profile may change? A- The profile is like that of DIC B-heavy bleeding will occur during labor because of hypofibrinogenemia C- repairable transient coagulopathy will occur D-the live infant in the uterine will develop coagulopathy Ans:C med-ed-online

121 11-Which is true about uterine inversion?
A-BP and MgSO4 can be the reason B-it is more common in multiparas C-it is never fatal D-hemorrhage occurs with a delay Ans:A med-ed-online

122 Heparin dose 5000 units TDS for IUFD
12-If there is a coagulopathy disorder, which is an indication for Heparin administration provided that circulation is intact? A-IUFD B-Abruption C-septic abortion D-HELLP syndrome Ans:A Heparin dose 5000 units TDS for IUFD FFP and platelet for septic abortion med-ed-online

123 A-endocervical polyps B-vaginitis C-muluscum contangiosum
13-Which is not an etiology of prepubertal females with vaginal bleeding? A-endocervical polyps B-vaginitis C-muluscum contangiosum D-lichen sclerosis Ans:A med-ed-online

124 C-antiprostaglandins D-estrogens Ans:B
14-What is the drug of choice in AUB after kidney and liver transplant? A-desmopressin B-GnRH agonist C-antiprostaglandins D-estrogens Ans:B med-ed-online

125 B- 25-50 mg progesterone q6h until bleeding is under control
15-A 14 yr old girl has the chief complaint of heavy vaginal bleeding. Her Hb is 7 gr/dl . Coagulation tests and platelets and pelvic sonography are normal. What is your management after treating anemia? A-HD OCP q6h for one week B mg progesterone q6h until bleeding is under control C- Conjugated estrogen 2.5 mg q6h PO until bleeding is controlled followed by medroxy progesterone D-daily medroxy progesterone acetate 20 mg Ans:C med-ed-online

126 16-Which is wrong about stage II of hypovolemic shock?
A-Tachycardia is a constant finding B-blood loss is more than 1000cc C-systolic minus diastolic BP is increased D-BP at rest is normal Ans:C med-ed-online

127 A- Packed cell +3 units of FFP+10 units of platelet
17- A 70 kg woman has massive hemorrhage during a pelvic surgery. Which is the best choice for blood loss compensation? A- Packed cell +3 units of FFP+10 units of platelet B- Packed cell +2 units of FFP for each 6-8 units of PC+ 2 units of platelet if platelet count is below /cc C-whole blood D- B and C Ans:D med-ed-online

128 Points to remember

129 A-Thalacemia major B- thalacemia minor C-von willebrand D-ITP Ans:D
18-What is the most common coagulopathy that is presented by AUB in adulthood? A-Thalacemia major B- thalacemia minor C-von willebrand D-ITP Ans:D med-ed-online

130 A-Ext iliac artery should be checked before ligation is attempted
19-Which is true about int iliac artery ligation for controlling pelvic hemorrhage? A-Ext iliac artery should be checked before ligation is attempted B-ureter should not be located C- both sides arteries should not be ligated D-the artery should be ligated proximal to parietal branch Ans:A med-ed-online

131 A-FFP B-platelet C-cryoprecipitate D-crystalloids Ans:D
20-A woman receives 12 units of whole blood because of hemorrhage after hysterectomy. 3 hours after operation Hb is 9 gr/dl, platelet 55000/cc fibrinogen 100 mg/dl. What do you suggest? A-FFP B-platelet C-cryoprecipitate D-crystalloids Ans:D med-ed-online

132 21-How PG f2-alfa is administered for uterine atony?
A-20 mg IM for max 3 doses by min intervals B-500 mcg IV for max 4 doses IM by 30 min intervals C-1000 mcg IM single dose D-250 mcg IM for max 8 doses by min intervals Ans:D med-ed-online

133 A- assurance, follow up and ferrus sulfate
22-In a 14 year old anemic girl with prolonged uterine spotting what should be done? A- assurance, follow up and ferrus sulfate B- Low dose OCP q6h for 7 days C- Low dose OCP 21 days for 3-6 cycles D- conjugate estrogen 2.5 mg PO q6h for 7 days Ans:c med-ed-online

134 A- tachycardia B-tachypnea C-oliguria D-hypotension Ans:C
23-A 40 year old woman is hospitalized for hemorrhagic shock. Her kidney function is normal. What is the most sensitive and reliable clinical criteria for determining severity of volume loss? A- tachycardia B-tachypnea C-oliguria D-hypotension Ans:C med-ed-online

135 A-Clamp and ligation of great vessels B- clipping the vessels
24-What is the best management of great vessels laceration in sacral foramina? A-Clamp and ligation of great vessels B- clipping the vessels C-electrocuttery D-packing the foramen by Gel foam Ans:D med-ed-online

136 A-uterine artery ligation B-ovarian artery ligation
25-An extension of C/S incision causes vaginal artery laceration and heavy bleeding. What should be done for this case? A-uterine artery ligation B-ovarian artery ligation C- hypogastric artery ligation D-hysterectomy Ans:C med-ed-online

137 26- How many ml of blood does a soaked lap pad absorbs?
A-30 cc B-50 cc C-80 cc D-100 cc Ans:B med-ed-online

138 27-What is wrong for blood loss management?
A-after an hour in a critical case only 20% of crystalloids remains in circulation B- the volume of crystalloids replacement is three times the volume of blood loss C-in all cases of blood loss a Hb of less than 8 gr/dl mandates whole blood transfusion D-colloids increase mortality rate Ans:C med-ed-online

139 28-What is wrong about vaginal hematoma after delivery?
A-observation if hematoma is small B- an incision on the site if pain is severe and hematoma enlarges C-mattress suturing the bed of hematoma D-pressure dressing should be applied on the hematoma bed for hours Ans:D med-ed-online

140 A-ligation of placental site above and below the incision site
29- A repeat C/S II has hemorrhage of the incision site. Which can best control hemorrhage? A-ligation of placental site above and below the incision site B-ligation of uterine artery C- ligation of hypogastric artery D- embolization of uterine artery Ans:A med-ed-online

141 30-Where is the exact place of hypogastric artery ligation?
A- immediately distal to the bifurcation B-anterior branch distal to the bifurcation C- anterior branch distal to post parietal branch D- anterior and posterior branch Ans:C med-ed-online

142 A-muluscum- analgesics and steroids B-condylomata acuminata- TCA acid
31-What is the diagnosis and treatment of a tender inflamed mass near the urethral opening in a 5 year old girl? A-muluscum- analgesics and steroids B-condylomata acuminata- TCA acid C-prolaps of the urethra- topical estrogen D- Skene gland abscess-antibiotic and evacuation Ans:C med-ed-online

143 A-medroxy progesterone acetate 10 mg daily for 2 weeks for 3 cycles
32-A 16 year old girl complains of heavy menstrual bleeding. She is anemic. Her VS is stable. Your diagnosis is DUB. What should be prescribed for her other than Iron supplements? A-medroxy progesterone acetate 10 mg daily for 2 weeks for 3 cycles B-monophasic OCP q6h for 7 days C- conjugate estrogen 2.5 mg PO q6h until the hemorrhage stops D-LD OCP for 21 days Ans:B med-ed-online

144 A-int iliac B-lateral sacral C-int pudendal D-ilio lumbar Ans:A
33-Obturator artery is lacerated in a pelvic surgery. Which artery should be ligated? A-int iliac B-lateral sacral C-int pudendal D-ilio lumbar Ans:A med-ed-online

145 Para rectal space contains lateral sacral and hemorrhoidal arteries
Paravesical space contains accessory obturator artery from inf hypogastric Para rectal space contains lateral sacral and hemorrhoidal arteries Obturator artery is from int iliac artery med-ed-online

146 34-Which is the last choice in Von Willebrand related AUB?
A-2.5 mg estrogen daily+ progesterone in the last 10 days of a menstrual cycle B-OCP C-GnRH nasal spray D-desmopressin infusion Ans:D med-ed-online

147 35-Which is more common in blood transfusion?
A-Hepatitis B B-Delayed red-cell hemolytic reaction C-Anaphylactic reaction D-HTLV Ans:B med-ed-online

148 36- Which is wrong about fetal complications of abruption?
A percent of cases demise perinatally B-40 % are delivered prematurely C % are IUFD D-if the fetus doesn’t die in uterus, there would be no serious neonatal complication Ans:D med-ed-online

149 B-termination of pregnancy C-discharge
37-A pregnant woman G2 GA=38 wks has the chief complaint of vaginal spotting. There is no sign of abruption or previa by ultrasound. What is the best management? A- observation B-termination of pregnancy C-discharge D-referring patient to another center Ans:B med-ed-online

150 38-Which is true about abruption?
A- The chance of repeated abruption is twice B-fetal assessment techniques can predict abruption with good precision C-there is no means to predict abruption D-The chance of repeated abruption is not different Ans:C med-ed-online

151 39-Which is wrong in cases of placenta previa?
A-the safest means of diagnosing placenta previa is transabdominal ultrasound B-false positive results are because of full bladder C-low lying or total previa is best diagnosed by trans vaginal ultrasound D-NPV of transperineal ultrasound is 70 % Ans: D (its NPV is 100% ) med-ed-online

152 A-ligation of uterine and ovarian arteries
40-What is the first surgical step in a case of retractable uterine atony? A-ligation of uterine and ovarian arteries B-ligation of hypogastric arteries C-subtotal hysterectomy D- uterine artery embolization Ans:A med-ed-online

153 B-coagulation factor VIII of 40 % C-fibrinogen 90 mg/dl
41-Which case does not need replacement therapy after massive transfusion? A- platelet of in cc B-coagulation factor VIII of 40 % C-fibrinogen 90 mg/dl D- PT of 1.5 times normal level Ans:B med-ed-online

154 Preterm and postterm pregnancy

155 1-Which is wrong about the pathogenesis of preterm labor?
A-phospholipase A2 induced by bacteria B-PG induced by bacteria C- macrophage induced substances D-PAF induced by bacteria Ans:B med-ed-online

156 2-Which is wrong about FFN?
A-it is a better indicator for preterm labor than ROM B-FFN> 30 ng /ml is considered positive C- amniotic fluid and maternal blood cause false results D-its NPV is more reliable than PPV Ans:B med-ed-online

157 B-stripping of the cervix C-PG gel D- AFI twice a week Ans:D
3- What is your management of : ♀ 25 yrs -G1 - GA = 41 wks- cephalic presentation- FAD=normal –favorable cervix? A-C/S B-stripping of the cervix C-PG gel D- AFI twice a week Ans:D med-ed-online

158 4-Which test is more sensitive for detecting bacteria in AF?
A-Gram staining of AF B-increased maternal WBC C-increased AF IL6 D-increased maternal CPR Ans:C med-ed-online

159 5-Which is wrong about prolonged gestation?
A-placental apoptosis increases from 41-42 weeks gestation B-umbilical cord erythropoietin increases from 41 weeks C-Late deceleration is the most common finding in prolonged gestational age D-lack of vernix causes skin changes of post maturity Ans:C med-ed-online

160 A-beta agonists can cause MI and myocardial necrosis in mother
6-A 31 year old woman complains of premature labor. Dilatation is 2 cm and eff is 50%. Water bag is intact. Which is true about the management of this case? A-beta agonists can cause MI and myocardial necrosis in mother B-terbutalin can post pone delivery for a week C-If MgSO4 can not stop labor, nifedipine is used D-PG inhibitors should not be used Ans:A med-ed-online

161 7-What should be done in a post trem pregnancy when NST is normal?
A- repeat NST after 3 days B-CST C-AFI D- Doppler Ans:C med-ed-online

162 A-Control of BP and HR q4h B- Control of T q4h C- antibiotic
8-Which is wrong in the management of a woman G1 GA=39 wks ROM Dil=2cm eff=40% HR=100 bpm T=37.5°c ? A-Control of BP and HR q4h B- Control of T q4h C- antibiotic D-induction of labor Ans: B T should be checked hourly med-ed-online

163 D-digital vaginal examination Ans:C
9-Which is the most accurate way to detect ROM if ROM can not be detected by speculum or ultrasonography? A-Nitrazine test B-Fern C-Indigo Carmine D-digital vaginal examination Ans:C med-ed-online

164 10-In which group of patients MgSO4 is contraindicated?
A- Type I diabetes B- asthma C-hyperthyroidism D-myasthenia gravis Ans:D A patient with MG should receive Amide type anesthetics like Lidocaine and Bupivacaine med-ed-online

165 11-Which combination therapy to stop labor pain is safe?
A-MgSO4+ indomethacin B-MgSO4+ terbutalin C-ritodrin+ nifedipin D-MgSO4 + nifedipin Ans:B med-ed-online

166 12-Which is not a side effect of Ritodrine?
A- pulmonary edema B-hyper kalemia C-hyperglycemia D-hallucination Ans: B med-ed-online

167 B-starting induction 6 hours later C-Starting induction 3 days later
13-An induction for a 41 wk gestational age pregnancy failed. What should be done? A- C/S B-starting induction 6 hours later C-Starting induction 3 days later D- fetal well-being monitoring for one week Ans:C med-ed-online

168 IUGR

169 Definition Intrauterine growth restriction (IUGR) occurs when the unborn baby is at or below the 10th weight percentile for his or her age (in weeks). The fetus is affected by a pathologic restriction in its ability to grow. Low birth weight (LBW) means a baby with a birth weight of less than 2500Gms, which could be due to IUGR or Prematurity Description There are standards or averages in weight for unborn babies according to their age in weeks. When the baby's weight is at or below the 10th percentile for his or her age, it is called intrauterine growth retardation or fetal growth restriction. These babies are smaller than they should be for their age. How much a baby weighs at birth depends not only on how many weeks old it is, but the rate at which it has grown. This growth process is complex and delicate. There are three phases associated with the development of the baby. During the first phase, cells multiply in the baby's organs. This occurs from the beginning of development through the early part of the fourth month. During the second phase, cells continue to multiply and the organs grow. In the third phase (after 32 weeks of development), growth occurs quickly and the baby may gain as much as 7 ounces per week. If the delicate process of development and weight gain is disturbed or interrupted, the baby can suffer from restricted growth. med-ed-online

170 Classification Symmetricl Asymmetrical
the baby's head and body are proportionately small. may occur when the fetus experiences a problem during early development. baby's brain is abnormally large when compared to the liver. may occur when the fetus experiences a problem during later development Application of the international foetal growth reference curve will vary according to its specific clinical and public health uses or purposes. Criteria for diagnosis of foetal growth restriction (e.g., SGA) should be related to evidence of increased risk for perinatal mortality and/or other indices of adverse outcomes. The new reference should provide percentiles [(e.g., 3rd, 5th, 10th, 15th, 25th, 50th (median), 75th, 85th, 90th, 95th, and 97th)] as well as z-scores [(e.g., -3, -2, -1, 0 (mean), 1, 2, and 3 SD)], so that health planners and practitioners can use the most appropriate cut off based on local circumstances. Proportionality at birth may be related to adverse outcomes. Thus there is a need to develop reference data for birth length and head circumference in relation to GA, and for birth weight in relation to birth length. Because the concepts of 'wasting' and 'stunting' have proven useful for categorizing undernourished infants and older children, an attempt should be made to quantify the mortality and morbidity risks associated with 'wasted' and 'stunted' newborns and to develop indicators for their classification. med-ed-online

171 In a normal infant, the brain weighs about three times more than the liver. In asymmetrical IUGR, the brain can weigh five or six times more than the liver.

172 Etiology General- Racial / Ethnic origin, Maternal causes.
Small maternal / paternal height / weight, Fetal sex Maternal causes. Fetal causes. Placental causes. Idiopathic- In a majority of cases (40%) the cause is unknown– probably due to placental insufficiency. In developed countries, cigarette smoking is far and away the most important etiologic determinant, but low gestational weight gain and low pre-pregnancy BMI are also determinants. The etiologic roles of pre-eclampsia, short stature, genetic factors, and alcohol and drug use during pregnancy are well-established but quantitatively less important. Socioeconomic disparities in IUGR risk within developed countries are largely attributable to socioeconomic gradients in smoking, weight gain and maternal stature. In poor urban areas where cocaine abuse is highly prevalent, this may also be important. The etiologic role of micronutrients in IUGR remains to be clarified. The best evidence concerning their importance derives from randomized trials and from systematic overviews of those trials contained in the Cochrane Collaboration Pregnancy and Childbirth database. Unfortunately, there are few supplementation or fortification trials in developing country settings where deficiencies in these micronutrients are prevalent. Trials are required to define the possible etiologic roles of iron, calcium, vitamin D, and vitamin A, especially in developing countries. The evidence concerning folate, magnesium, and zinc also looks sufficiently promising to justify further investigation. med-ed-online

173 Maternal Risk Factors Has had a previous baby who suffered from IUGR.
Extremes of age Is small in size (Ht & Wt). Has poor weight gain and malnutrition during pregnancy. Is socially deprived. Uses substances (like tobacco, narcotics, alcohol) that can cause abnormal development or birth defects. Has a low total blood volume during early pregnancy. The physiologic and molecular mechanisms by which nutritional or other determinants affect fetal growth are incompletely understood. Growth is determined not only by substrate availability but also by the integrity of physiologic processes necessary to ensure transfer of nutrients and oxygen to the developing fetus. Expansion of maternal plasma volume, maintenance of uterine blood flow, and development of adequate placentation are key physiologic mechanisms required for optimal fetal growth. All substances used by the fetus are transported by the placenta: some (like oxygen and most other gases) by passive diffusion, others by facilitated transport proteins (e.g., Glut 1 for glucose), and still others (e.g., amino acids) by active energy-dependent transport processes. Insulin-like growth factors (IGFs) are important mediators of substrate incorporation into fetal tissue. IGF1 appears to induce cell differentiation, including (perhaps) oligodendrocyte development in the brain, whereas IGF2 may function to stimulate mitosis. It remains uncertain whether these physiologic and molecular mechanisms are merely the final common pathways for genetic or environmental determinants of IUGR, or whether they themselves vary (favorably or pathologically) independently of those determinants. med-ed-online

174 Maternal Risk Factors Is pregnant with more than one baby.
High altitude. Drugs like anticoagulants, anticonvulsants. Has a cardio-vascular disease-preeclampsia, hypertension, cyanotic heart disease, cardiac disease Gr III & IV, diabetic vascular lesions. Chronic kidney disease Chronic infection- UTI, Malaria, TB, genital infections Has an antibody problem that can make successful pregnancy difficult (antiphospholipid antibody syndrome, SLE). Most of the evidence on etiologic determinants is based on observational studies and systematic overviews or meta-analyses of such studies. In developing countries, the major determinants of IUGR are nutritional: low gestational weight gain (primarily due to inadequate energy intake), low pre-pregnancy BMI (reflecting chronic maternal undernutrition), and short maternal stature (principally due to undernutrition and infection during childhood). Gastroenteritis, intestinal parasitosis, and respiratory infections are prevalent in developing countries and may also have an important impact. Malaria is a major determinant in countries where that disease is endemic. Cigarette smoking is an increasingly important factor in some settings. In developed countries, cigarette smoking is far and away the most important etiologic determinant, but low gestational weight gain and low pre-pregnancy BMI are also determinants. The etiologic roles of pre-eclampsia, short stature, genetic factors, and alcohol and drug use during pregnancy are well-established but quantitatively less important. Socioeconomic disparities in IUGR risk within developed countries are largely attributable to socioeconomic gradients in smoking, weight gain and maternal stature. In poor urban areas where cocaine abuse is highly prevalent, this may also be important. med-ed-online

175 Fetal Risk Factors Exposure to an infection-German measles (rubella), cytomegalovirus, herpes simplex, tuberculosis, syphilis, or toxoplasmosis, TB, Malaria, Parvo virus B19. A birth defect (cardiovascular, renal, anencephaly, limb defect, etc). A chromosome defect- trisomy-18 (Edwards’ syndrome),21(Down’s syndrome), 16, 13, xo (turner’s syndrome) A primary disorder of bone or cartilage. A chronic lack of oxygen during development (hypoxia). Developed outside of the uterus. Placenta or umbilical cord defects. The etiologic role of micronutrients in IUGR remains to be clarified. The best evidence concerning their importance derives from randomized trials and from systematic overviews of those trials contained in the Cochrane Collaboration Pregnancy and Childbirth database. Unfortunately, there are few supplementation or fortification trials in developing country settings where deficiencies in these micronutrients are prevalent. Trials are required to define the possible etiologic roles of iron, calcium, vitamin D, and vitamin A, especially in developing countries. The evidence concerning folate, magnesium, and zinc also looks sufficiently promising to justify further investigation. The physiologic and molecular mechanisms by which nutritional or other determinants affect fetal growth are incompletely understood. Growth is determined not only by substrate availability but also by the integrity of physiologic processes necessary to ensure transfer of nutrients and oxygen to the developing fetus. Expansion of maternal plasma volume, maintenance of uterine blood flow, and development of adequate placentation are key physiologic mechanisms required for optimal fetal growth. All substances used by the fetus are transported by the placenta: some (like oxygen and most other gases) by passive diffusion, others by facilitated transport proteins (e.g., Glut 1 for glucose), and still others (e.g., amino acids) by active energy-dependent transport processes. Insulin-like growth factors (IGFs) are important mediators of substrate incorporation into fetal tissue. IGF1 appears to induce cell differentiation, including (perhaps) oligodendrocyte development in the brain, whereas IGF2 may function to stimulate mitosis. It remains uncertain whether these physiologic and molecular mechanisms are merely the final common pathways for genetic or environmental determinants of IUGR, or whether they themselves vary (favorably or pathologically) independently of those determinants. med-ed-online

176 Placental Factors Uteroplacental insufficiency resulting from -.
Improper / inadequate trophoblastic invasion and placentation in the first trimester. Lateral insertion of placenta. Reduced maternal blood flow to the placental bed. Fetoplacetal insufficiency due to-. Vascular anomalies of placenta and cord. Decreased placental functioning mass-. Small placenta, abruptio placenta, placenta previa, post term pregnancy. The etiologic role of micronutrients in IUGR remains to be clarified. The best evidence concerning their importance derives from randomized trials and from systematic overviews of those trials contained in the Cochrane Collaboration Pregnancy and Childbirth database. Unfortunately, there are few supplementation or fortification trials in developing country settings where deficiencies in these micronutrients are prevalent. Trials are required to define the possible etiologic roles of iron, calcium, vitamin D, and vitamin A, especially in developing countries. The evidence concerning folate, magnesium, and zinc also looks sufficiently promising to justify further investigation. The physiologic and molecular mechanisms by which nutritional or other determinants affect fetal growth are incompletely understood. Growth is determined not only by substrate availability but also by the integrity of physiologic processes necessary to ensure transfer of nutrients and oxygen to the developing fetus. Expansion of maternal plasma volume, maintenance of uterine blood flow, and development of adequate placentation are key physiologic mechanisms required for optimal fetal growth. All substances used by the fetus are transported by the placenta: some (like oxygen and most other gases) by passive diffusion, others by facilitated transport proteins (e.g., Glut 1 for glucose), and still others (e.g., amino acids) by active energy-dependent transport processes. Insulin-like growth factors (IGFs) are important mediators of substrate incorporation into fetal tissue. IGF1 appears to induce cell differentiation, including (perhaps) oligodendrocyte development in the brain, whereas IGF2 may function to stimulate mitosis. It remains uncertain whether these physiologic and molecular mechanisms are merely the final common pathways for genetic or environmental determinants of IUGR, or whether they themselves vary (favorably or pathologically) independently of those determinants. med-ed-online

177 Screening: US fetal biometry: HC- BPD- AC
Uterine Doppler studies ( Doppler Velocimetry): bilateral notches and a mean resistance index of at least 0.55 Or Unilateral notches and a mean resistance index of at least 0.65 at 20 weeks. Biochemistry: CRH level at 33 weeks IUGR can be difficult to diagnose and in many cases doctors are not able to make an exact diagnosis until the baby is born. A mother who has had a growth restricted baby is at risk of having another during a later pregnancy. Such mothers are closely monitored during pregnancy. The length in weeks of the pregnancy must be carefully determined so that the doctor will know if development and weight gain are appropriate. Checking the mother's weight and abdomen measurements can help diagnose cases when there are no other risk factors present. Measuring the girth of the abdomen is often used as a tool for diagnosing IUGR. During pregnancy, the healthcare provider will use a tape measure to record the height of the upper portion of the uterus (the uterine fundal height). As the pregnancy continues and the baby grows, the uterus stretches upward in the direction of the mother's head. Between 18 and 30 weeks of gestation, the uterine fundal height (in cm.) equals the weeks of gestation. If the uterine fundal height is more than 2-3 cm below normal, then IUGR is suspected. Ultrasound is used to evaluate the growth of the baby. Usually, IUGR is diagnosed after week 32 of pregnancy. This is during the phase of rapid growth when the baby should be gaining more weight. IUGR caused by genetic factors or infection may sometimes be detected earlier. med-ed-online

178 Diagnosis Neonatal - Low ponderal index (Wt./Fl).
Decreased subcutaneous fat. Presence / appearance of – Hypoglycemia, Hyperbilirubinemia, Necrotizing enterocolitis, Hyper viscosity syndrome IUGR can be difficult to diagnose and in many cases doctors are not able to make an exact diagnosis until the baby is born. A mother who has had a growth restricted baby is at risk of having another during a later pregnancy. Such mothers are closely monitored during pregnancy. The length in weeks of the pregnancy must be carefully determined so that the doctor will know if development and weight gain are appropriate. Checking the mother's weight and abdomen measurements can help diagnose cases when there are no other risk factors present. Measuring the girth of the abdomen is often used as a tool for diagnosing IUGR. During pregnancy, the healthcare provider will use a tape measure to record the height of the upper portion of the uterus (the uterine fundal height). As the pregnancy continues and the baby grows, the uterus stretches upward in the direction of the mother's head. Between 18 and 30 weeks of gestation, the uterine fundal height (in cm.) equals the weeks of gestation. If the uterine fundal height is more than 2-3 cm below normal, then IUGR is suspected. Ultrasound is used to evaluate the growth of the baby. Usually, IUGR is diagnosed after week 32 of pregnancy. This is during the phase of rapid growth when the baby should be gaining more weight. IUGR caused by genetic factors or infection may sometimes be detected earlier. med-ed-online

179 A decrease in AFI may occur before there are changes in the non-stress test.
RCTs aimed at other putative causes of IUGR have been disappointing. For example, efforts to prevent and treat hypertensive disorders have not significantly reduced IUGR. Trials using antiplatelet agents in high-risk women have yielded only modest benefits, while trials of betablockers have suggested a potential for harm. Prenatal care and nutritional education interventions have not heretofore been shown to impact significantly on IUGR, but better approaches are required (e.g., community-wide interventions to promote optimal weight gain and discourage 'eating down'). Future research in the prevention and treatment of IUGR should be based on sound epidemiologic and other scientific evidence. Rigorous randomization procedures (including concealment of treatment allocation) and efforts to minimize losses to follow-up fare required to ensure high methodological quality. Without randomization there is a high risk of bias due to confounding. Sample sizes should be planned with sufficient power to detect significant impacts on IUGR and other fetal/infant outcomes. Study designs should also include practical measures to assess gestational age, as well as potential obstetric complications or other adverse outcomes. Lastly, while systematic reviews of RCTs represent the most objective way to evaluate the effectiveness of health care interventions, the available data are limited. Moreover, there are problems related to the size of the trials, their heterogeneity, settings, and methodologic quality. Findings from observational studies should not be totally discounted, but rather tested in RCTs whenever possible. med-ed-online

180 While the biophysical profile is an useful test, when it becomes abnormal the fetus may have already suffered some damage med-ed-online

181 1-which test is more sensitive to fetal acidosis?
A-NST B-BPP C-OCT D-Doppler velocimetry of umbilical artery Ans:D med-ed-online

182 B-AF measurement twice a week C-NST and OCT daily
2-What should be done for a diabetic woman 28 yrs old –G2 – L1- AF=NL – EFW=4600 gr – GA=42 weeks A-C/S B-AF measurement twice a week C-NST and OCT daily D-PG gel to ripen cervix Ans:A med-ed-online

183 3-What is the most important reason for hypoglycemia of a SGA fetus?
A- increased fetal consumption B-decreased endogenous glucose production C-hyperinsulinemia D-reduced supply Ans: D med-ed-online

184 4-What trisomy in the form of placental mosaicism causes IUGR?
B-16 C-18 D-21 Ans:B med-ed-online

185 5-Which is wrong as an explanation for fetal growth?
A-Insulin growth factor I & II play an important role B-fetal pancreas can secret insulin necessary for growth C- leptin , a protein that is found in maternal and fetal blood, is the product of obesity gene D-fetal leptin secreted in the third trimester of pregnancy is not related to fetal growth Ans:D med-ed-online

186 6-What is CMV mechanism of action in IUGR?
A- direct cytolysis B-injury to small vessels endothelium C-reducing cell multiplication time D-inflammation and edema of perivascular tissue Ans:A med-ed-online

187 7-Which one is not a cause of SGA?
A- Maternal SCA B-placenta previa C-living at the sea level D- positive maternal ACL antibody Ans:C med-ed-online

188 8-Which is not a finding in IUGR fetus?
A- hyper TG B-thrombocytopenia C-increased plasma adenosine D-reduced placental arterial natriuretic peptide Ans:D med-ed-online

189 A- trisomy 13 B-turner C-trisomy 18 D-trisomy 21 Ans:C
9-What is the chromosomal defect in a newborn with horse shoe kidneys, prominent occiput, imperforated anus, VSD? A- trisomy 13 B-turner C-trisomy 18 D-trisomy 21 Ans:C med-ed-online

190 Multiple pregnancy

191 1- What is the best statement about ovulation induction?
A- oral and injectable ovulation induction drugs have the same effect on inducing multiple pregnancy B-ovulation induction drugs increase the incidence of dizygotic twins C- ovulation induction drugs increase the incidence of monozygotic twins D-ovulation induction drugs increase the incidence of monozygotic and dizygotic twins Ans:D med-ed-online

192 2-Which is wrong about chimeras?
A- It is the process in which two lines of cells appear in one organism B-A person is diagnosed as blood chimera when he has two BGs C-non disjunction in meiosis division is the probable cause of chimeras D- twins can share genetic materials via vascular anastomosis Ans:C med-ed-online

193 3-Which is not a sign of twin to twin transfusion?
A-difference in weights more than 10% B-hydramnios in one fetus and oligohydramnios in the other C- difference in Hb more than 5 gr/dl D-monochorion with placental vascular anastomosis Ans:A med-ed-online

194 4-Which age is the peak age for twin pregnancy?
A-puberty B-26 C-37 D-35 Ans:C med-ed-online

195 5- Which is true for prenatal care of multiple pregnancy?
A- add 300 kcal daily B-Daily Iron 250 mg C-1 mg folic acid daily D-a multiple pregnancy should have a weight gain of 50 pounds Ans: B med-ed-online

196 A-prophylactic heparin for DIC prevention B- C/S C- observation
6- What should be done for a woman 31 week gestation with twin pregnancy and one fetus dead? A-prophylactic heparin for DIC prevention B- C/S C- observation D- tocolytics Ans:C med-ed-online

197 7- What is third circulation in monochorionic twins?
A- superficial artery-artery anastomosis B- superficial vein- vein anastomosis C- deep artery- vein anastomosis D- deep artery-artery anastomosis Ans: C med-ed-online

198 A-20 weeks B-28-30 weeks C-34 weeks D- 36 weeks Ans:B
8- Twins’ rate of growth resembles singleton pregnancy up to gestational age of… A-20 weeks B weeks C-34 weeks D- 36 weeks Ans:B med-ed-online

199 9-Which is not because of vascular anastomosis in twin pregnancies?
A-microcephaly B-small intestines atresia C- Hip dislocation D- limb amputation Ans:C med-ed-online

200 Amniotic membranes

201 B- daily diuretic and restricting salt consumption
1-♀ 30 yrs GA=34 w max vertical pocket of AF=12 cm complains of dyspnea. What do you suggest? A- Ace inhibitors B- daily diuretic and restricting salt consumption C-transvaginal amniotomy D-Indomethacin mg/kg Ans:D med-ed-online

202 A-Succenturiate B-Fenestrated C-Extracorial D-membranous Ans:D
2-A placenta that is totally covered by chorionic villi and its separation causes heavy bleeding that mandates hysterectomy is called?. A-Succenturiate B-Fenestrated C-Extracorial D-membranous Ans:D The only placental abnormality detected by ultrasound is membranous placenta med-ed-online

203 3-What is wrong about umbilical cord?
A- Its length is determined by fetal movement and AF volume B- In breech presentation its length is 5 cm less than vertex presentation C-vellamentous insertion always contain one umbilical artery D-30 % of newborns with one umbilical artery have congenital anomaly Ans:C med-ed-online

204 A- Circumvallate B-membranous C-Fenestrated D-Circummarginate Ans:A
4-which is related to prenatal hemorrhage, prenatal mortality, and abnormal fetus? A- Circumvallate B-membranous C-Fenestrated D-Circummarginate Ans:A med-ed-online

205 D- microangiopathic hemolytic anemia Ans:A
5-What is the least common complication of a large placental chorioangioma? A- polycythemia B-heart failure C- DIC D- microangiopathic hemolytic anemia Ans:A med-ed-online

206 B- increased swallowing of the fetus due to asphyxia
6- What is not a reason of oligohydamnios in a woman GA=36w AFI=3cm with IUGR pregnancy? A-reduced fetal urine B- increased swallowing of the fetus due to asphyxia C-reduced fetal renal blood perfusion D-reduced placental perfusion Ans:B med-ed-online

207 7-Which is the first stained by meconium in amniotic fluid?
A-chorion B-umbilical cord C-fetal skin D-amnion Ans: D med-ed-online

208 8-What is the most common lesion of placenta?
A-Infarction B-calcification C-fetal arteries thrombosis D-inflammation Ans:A med-ed-online

209 9-Which can not increase AFI?
A-high altitude B-maternal hydration C-vasopressin infusion D- maternal serum hyperosmolality Ans:D med-ed-online

210 10-Which is wrong about Meconium Aspiration Syndrome?
A- It is fairly a common incidence B-it can happen to a fetus with normal oxygenation and normal AFI C-Hypercarbia is a risk factor for gasping and MAS D-It is preventable Ans:D The most common FHR abnormality with MAS is severe variable deceleration med-ed-online

211 11-How chorionic artery can be differentiated from chorionic vein?
A- vasoactive substances are only effective on the artery B-the difference is in their diameter C-artery passes over the vein D-only by histological studies Ans:C med-ed-online

212 12-Which is true about the mechanism of action of indomethacin on AF?
A-reducing fetal urine B-increasing volume shift through fetal membranes C-reducing fluid production and absorption of fluid through fetal lungs D- increasing fetal swallowing Ans:D med-ed-online

213 A-chorionic plate of placenta is part of placenta
13-Which is wrong? A-chorionic plate of placenta is part of placenta B-prenatal mortality is more in circumvallate placenta C-uterine infection is the main cause of circumvallate placenta D-circumvallate placenta accompanies congenital abnormality Ans:C med-ed-online

214 A-these are amnion nodusum
14-Which is wrong about yellow round knots of 1-5 cm near cord insertion into placenta? A-these are amnion nodusum B-these are made up of vernix, hair, sebaceous and scaling of the fetal skin C- These are not accompanied by fetal anomalies D-it can be seen in cases of prolonged ROM Ans:C med-ed-online

215 A-pregnancy termination B-observation C-amnio infusion D-diuretics
15- A woman is hospitalized for oligohydramnios. GA=34 w Fern=negative . What do you suggest? A-pregnancy termination B-observation C-amnio infusion D-diuretics Ans:B med-ed-online

216 16-Which kind of placenta can have accreta or percreta insertion into the uterine?
A-succenturiate B-ring shape C-membranous D-extracorial Ans:C med-ed-online

217 17-Which is accompanied by long umbilical cord?
A-Dawn syndrome B-limb defects C-maternal systemic disease D-Potter syndrome Ans:C Long cord >70 cm med-ed-online

218 A- amnio infusion B-C/S C-induction D-observation Ans: C
18- What should be done for a term pregnancy, ROM for an hour with meconium staining? A- amnio infusion B-C/S C-induction D-observation Ans: C med-ed-online

219 Abortion

220 1-What is wrong about recurrent abortion?
A-HSG is the best method to R/O anatomical etiologies B-HSG is recommended several weeks after operative hysteroscopy C-vaginal ultrasonography and MRI are the best techniques to detect anatomical defects D-Septated uterus is the most common anatomical cause of recurrent abortion Ans:A med-ed-online

221 2-Which is true about genetic factors in a case of recurrent abortion?
A- Sperm and ovum of donors can be used in couples with genetic abnormality B-the most important genetic cause is 45X monosomy C- genetic causes for recurrent abortion is R/O if karyotyping is normal D-the genetic cause of recurrent abortion can be cured Ans: A med-ed-online

222 3-Which is a wrong treatment for abortion?
A mg mifepristone PO and then after hrs 800 mg misoprostol vaginal B-50 mg/m² MTX im and 24 hr later 800 mg misoprostol vaginal C- tamoxifen 20 mg daily for 4 days and then 800 mg misoprostol vaginal and if necessary repeating after 24 hrs D-800 mg misoprostol vaginal for 3 days for wk abortions Ans:B med-ed-online

223 C-anti paternal antibody D-HLA profile of the parents Ans:B
4-What is a mandatory test for a 29 year old woman with history of recurrent abortion? A-ANA B-ACL C-anti paternal antibody D-HLA profile of the parents Ans:B med-ed-online

224 Recurrent abortion tests
Karyotype HSG Luteal phase biopsy of endometrium TSH and prolactin level ACL ab LAC CBC med-ed-online

225 5-Which is true about recurrent abortion?
A % is because of genetic factors among which chromosome inversion is the most common B % is because of genetic factors among which balanced chromosomal rearrangement is the most common C-aneuploidy happens in old aged mothers D-in a mother below 35 aneuploidy is because of immunologic factors Ans:B med-ed-online

226 For cases of abortion without fever: Doxy 100 mg bid or tetracycline 250 mg qid for 5-7 days
med-ed-online

227 6-Where is the discriminatory zone?
A-3000 IU/L HCG + abdominal US B HCG + vaginal US C-a constant value of HCG for any type of US D-in multiple pregnancy it is lower than singleton pregnancy Ans:B med-ed-online

228 A-Progesterone receptor B-androgen receptor
7-RU486 can not attach to: A-Progesterone receptor B-androgen receptor C-glucocorticosteroid receptor D-estrogen receptor Ans: D med-ed-online

229 8-What is wrong about postabortal or “redo” syndrome?
A- It is a complication of suction curettage B- It is a painful cramp in the first 2 hours after curettage C-uterine bleeding is less than expected D-treatment is D&C under anesthesia Ans:D med-ed-online

230 9- During a sharp curettage of an incomplete abortion uterine is perforated. What is the first step of management? A- curettage should be completed and patient should remain under observation B-laparatomy C-curettage should be stopped and patient should remain under observation D- if there is no hemorrhage in the first 24 hours after operation, the patient can be discharged Ans:B med-ed-online

231 A-No treatment is needed because abortion is complete
10- The clinical findings of a woman with GA=8 wks with the chief complaint of hemorrhage and clot passing is an open int os Uterine size about 8 wks and no bleeding. What should be done ? A-No treatment is needed because abortion is complete B-it is a case of threatened abortion C-it is an inevitable abortion D-Ob sonography Ans:D med-ed-online

232 A-Doxy 100 mg bid for two weeks B-clinda +genta
11- A woman has undergone elective abortion one week ago. Now she comes to the clinic with the chief complaint of hemorrhage. In PE cervix is closed, uterine is contracted with no tenderness. Her temperature is normal . What is the best treatment? A-Doxy 100 mg bid for two weeks B-clinda +genta C-observation and check of Hb and Hct D-hormone therapy Ans:D med-ed-online

233 A- endocrine B-immunological C-anatomic D-infectious Ans:B
12- What is the most likely cause of abortion in a 27 year old woman with the past history of two abortions in 10 wks and one in 15 wks with normal Karyotype conceptus? A- endocrine B-immunological C-anatomic D-infectious Ans:B The treatment of immunological recurrent abortion is low dose Heparin sc 5000 units bid+Aspirin 80 mg daily med-ed-online

234 13-what is wrong about hereditary thrombophilia?
A- Factor V Laden is the most likely cause B-protein C resistance is because of mutation in factor V C-Protein C deficiency adds 3-10 % to the risk of thrombosis formation D- Protein S deficiency and thrombosis risk will be eradicated after delivery Ans:D med-ed-online

235 Notes to Remember The most common cause of thrombophilia syndrome is resistance to protein C. Antithrombin III deficiency has the most thrombogenic property. Fulminant purpura is because of protein C deficiency. med-ed-online

236 A-observation and oxytocin B-laparatomy
14- What should be done for a woman 22 years old who has undergone suction curettage and now suffers severe pelvic cramps , sweating and tachycardia. Her uterus is large and tender. She also has spotting. A-observation and oxytocin B-laparatomy C-dilation and suction curettage without anesthesia D- CT scan Ans:C med-ed-online

237 A-dilatation and curettage under US B-uterotonic drugs
15-What is the best way of pregnancy termination in a bicornuate uterus with a 14 w fetal death? A-dilatation and curettage under US B-uterotonic drugs C-dilatation and curettage under laparascopy D-hysterotomy Ans:B Canula size in mm = GA in week minus one med-ed-online

238 A-repeat of MTX one week later B-repeat of MTX the next day
16- What is the management of a 32 year old woman who has undergone failed induced abortion by MTX + PG? A-repeat of MTX one week later B-repeat of MTX the next day C-repeat of PG one week later D- repeat of PG the next day Ans:D med-ed-online

239 17- Which is not among APL mechanism of action?
A-increased platelet aggregation B-increased prot C &S activity C- reduced PGE2 D- direct platelet destruction Ans:B med-ed-online

240 >=13 mm if yolk sac can not be seen
18-What is the min size of empty gestational sac that indicates unviable fetus in vaginal US ? A-17 mm B-13 mm C-10 mm D- 15 mm Ans:A >=13 mm if yolk sac can not be seen >=17mm if embryo can not be seen med-ed-online

241 B-protein C deficiency C-x-linked abnormalities D-translocation Ans:A
19- Which genetic abnormality is more common in IVF pregnancies that end with abortion? A-trisomy B-protein C deficiency C-x-linked abnormalities D-translocation Ans:A med-ed-online

242 D-empirical treatment of genital mycoplasma Ans:D
20-Which is recommended in recurrent abortions due to infectious reasons? A- cervical culture B-endometrium biopsy C-chlamydia serology D-empirical treatment of genital mycoplasma Ans:D med-ed-online

243 A- oxytocin B- PGE2 C-oxytocin+PGE2 D-PG E1( misoprostol) Ans:D
21- For which utertonic drug to induce abortion placental retention is less likely? A- oxytocin B- PGE2 C-oxytocin+PGE2 D-PG E1( misoprostol) Ans:D med-ed-online

244 Ectopic Pregnancy

245 Beta HCG below 2000+ no visible intrauterine sac+ mass in tube below 3
Beta HCG below no visible intrauterine sac+ mass in tube below 3.5 cm ______________________ control of beta HCG q 48 h A-If a dead IP is confirmed (beta HCG increase less than 50% or below 1000mIu/mL- P below 5 ng/mL + visible intrauterine sac) then curettage B-If EP is confirmed (beta HCG more than 2000 and mass >3.5 cm) then laparascopy C-If a dead IP and EP is confirmed (beta HCG more than 2000 and mass < 3.5 cm) then MTX FETUS SHOULD BE VISIBLE ON DAY 45 OF GESTATION med-ed-online

246 A-Laparatomy and salpingectomy and follow up B-MTX and leukovorin
1- What is your management of a 35 years old woman G1 GA=6 wks with an empty sac of 2.5 cm no heart beat and empty uterus in Ultrasound? A-Laparatomy and salpingectomy and follow up B-MTX and leukovorin C-MTX and folic acid and iron supplement D-laparascopy abd salpingectomy Ans:B med-ed-online

247 Indication of MTX for EP
Hemodynamic stability No intra uterine pregnancy Max sac diameter not equal or more than 4 cm med-ed-online

248 C-repeat of vaginal sonography several days later
2-What is your management of a 36 year old woman who is pregnant after primary infertity. She is referring to you for spotting and hypogastric pain, beta HCG is 1500 mu/l and ultrasound of uterus and ovaries are normal. A-laparatomy B-laparascopy C-repeat of vaginal sonography several days later D-progesterone measurement Ans:C med-ed-online

249 B-linear salpingectomy C-right tube salpingectomy
3- A 30 year old woman has become pregnant after 5 years of infertility with ovulation induction and a history of EP in the right tube 2 years ago. She has undergone laparatomy for ruptured right fallopian tube. What is the best technique for this surgery? A-Milking B-linear salpingectomy C-right tube salpingectomy D-segmantal excision and delayed anastomosis Ans:C med-ed-online

250 B-transvaginal sonography C-salpingectomy D-chest x-ray Ans:B
4- In a woman 31 years old who has undergone salpingectomy two weeks ago for EP, HCG level is increasing. What is your management? A-MTX B-transvaginal sonography C-salpingectomy D-chest x-ray Ans:B med-ed-online

251 A-Laparatomy B- laparascopy C- D&C D-serum progesterone Ans:A
5-What is your management for a woman with : HR=120 SBP=80 mmHg T=37.5°c uterine size=8 wks beta HCG=2500 mIU/mL and no intrauterine pregnancy in sonography? A-Laparatomy B- laparascopy C- D&C D-serum progesterone Ans:A med-ed-online

252 Adenexal mass< 3. 5 cm MTX adenexal mass=> 3
Adenexal mass< 3.5 cm MTX adenexal mass=> 3.5 cm -> laparascopy uncertain US + beta HCG increase less than 50% -> D&C unstable conditions->laparatomy med-ed-online

253 6-Which is wrong about EP?
A-Relaxin value in EP is less than abortion B- there is no definite knowledge about CA 125 value in EP and abortion C- AFP+ beta HCG+ progesterone+ estradiol can help diagnosing of EP D-maternal creatin kinase is less in EP versus normal pregnancy Ans: D Creatin kinase and AFP are more in EP. med-ed-online

254 7-Which is wrong in detecting early EP?
A-progesterone below 5-10 ng/mL contradicts normal pregnancy B-by vaginal sonography FHR can be detected in day 33 C-beta HCG level increase of 75 % after 48hrs is indicative of EP D-vaginal sonography + Doppler are 95% accurate in detecting EP Ans:C med-ed-online

255 8- which is a predisposing factor for ovarian EP?
A-PID B-infertility history C-DES exposure D-present IUD Ans:D med-ed-online

256 9-Which can reduce the number of false positive diagnosis of EP?
A-lab kits with 5 mIu/mL sensitivity B-use of 3rd IS for HCG rather than 2nd TS C-urine pregnancy test which can detect beta HCG below 1000 mIu/mL D-measuring beta HCG with serum creatin kinase Ans: C med-ed-online

257 D-serial measurement of Hct Ans:D
10-MTX single dose IM has been injected to a case of tubal pregnancy 10 days ago . The beta HCG level falls from 2000 mIu/mL to 1600 mIu/mL. But a severe pain persists. What is the next step? A-beta HCG recheck B-vaginal sonography C-MTX reinjection D-serial measurement of Hct Ans:D med-ed-online

258 D-EP and IP can not be ruled out Ans:D
11- A 17 year old woman is hospitalized for abdominal pain. Serum progesterone is 15ng/mL. Which is a true statement about her illness? A-EP is R/O B-EP risk is about 90% C-EP and IP is R/O D-EP and IP can not be ruled out Ans:D med-ed-online

259 D-lack of noticeable intra abdominal hemorrhage
12-All are among indications for conservative management of EP except:: A-ovarian EP B-reduced HCG level C-sac of less than 3 cm D-lack of noticeable intra abdominal hemorrhage Ans:A med-ed-online

260 13-Which is not a risk factor for persistent EP?
A-EP>2cm B-treatment of EP before 7 wks C-beta subunit>1000 mIu/mL D-EP in the proximal part of the tube Ans:D med-ed-online

261 A- another MTX is injected on day seven
14- In a 39 year old woman with EP, MTX is injected as a single dose(50mg/m²) Im. Three days after the injection beta HCG level decreased about 20%. Which is a correct follow up? A- another MTX is injected on day seven B-control of HCG until it reaches 10 mIU/mL C-laparascopy D-MTX should be injected 1mg/kg for 5 days Ans:B med-ed-online

262 15-What is peritrophoblastic flow?
A- high resistance- low velocity B-high velocity- low resistance C-high resistance-high velocity D-low velocity-low resistance Ans:B med-ed-online

263 16- What is “ring of fire” in Doppler sonography?
A-placental site B-pelvic hyperemia C-fetal heart D-tubal rupture site Ans:A med-ed-online

264 A-repeat of sonography two days later B- MTX C-laparascopy D-curettage
17- A 23 year old woman has the chief complaint of spotting. GA= 7 wks /beta HCG of two days ago =2500 / last beta HCG=2700 / no evidence of IP or EP in sonography. What is your management? A-repeat of sonography two days later B- MTX C-laparascopy D-curettage Ans: D med-ed-online

265 med-ed-online


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