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Residency Exams > 2nd Long Exam 2021 > Flashcards

2nd Long Exam 2021 Flashcards

1
Q

The following is not a maternal complication of Dystocia: a. Uterine rupture

b. Fistula formation
c. Cephalohematoma and caput succedaneum

d. Pelvic Floor injury

A

Cephalohematoma and caput succedaneum

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2
Q

Based on the diagnostic criteria for abnormal labor patterns, what pattern is represented by the solid line below:

a. Secondary arrest of dilatation
b. Protracted descent
c. Prolonged latent phase
d. Protracted active phase dilatation

A

c. Prolonged latent phase

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3
Q

Based on the diagnostic criteria for abnormal labor patterns, what pattern is represented by Line D below: (Note: Broken lines illustrate normal dilation and descent patterns)

a. Failure of descent
b. Protracted descent
c. None of the above
d. Arrest of descent

A

d. Arrest of descent

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4
Q

The labor room intern plotted the following partograph for a 35 year old primigravid with Gestational Diabetes Mellitus (Height: 142 cm; Weight: 68 kg) at 39 weeks age of gestation:

a. Protracted descent
b. Arrest of descent
c. Prolonged latent phase
d. Failure of descent

A

b. Arrest of descent

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5
Q

What is the clinical significance of a “stargazing fetus”?

a. Deliver by PBE.
b. Deliver by Cesarean section.
c. Deliver the after coming head using forceps.
d. Deliver by CBE.

A

Deliver by Cesarean section.

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6
Q

What is the clinical significance of a “stargazing fetus”? a. Deliver by PBE. b. Deliver by Cesarean section. c. Deliver the after coming head using forceps. d. Deliver by CBE.

A

Deliver by Cesarean section.

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7
Q

Management of head entrapment during a vaginal breech delivery:

a. Mauriceau maneuver
b. IV sedation and tocolytic
c. Duhrssen incision
d. Piper forceps delivery

A

d. Duhrssen incision

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8
Q

A 20 y/o G1P0, 38 weeks AOG was admitted fully dilated, cephalic, ruptured BOW, face presentation, mentum posterior position, station +1. After 1 hour of observation, internal exam findings did not change. Estimated fetal weight is 3kg. Pelvimetry is adequate. What is the best management?

a. Internal podalic version and extraction
b. Forceps delivery.
c. Cesarean section
d. Oxytocin augmentation

A

c. Cesarean section

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9
Q

Dinoprostone 0.5 mg gel was given for cervical ripening in a postdated primigravid at 8 in the morning. What time should the next dose be given if still warranted?

a. 4 om
b. 8 pm
c. 12nn
d. 2 pm

A

d. 2 pm

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10
Q

Dinoprostone vaginal insert was placed for cervical ripening in a postdated primigravid at 8 am. What time should it be removed if labor did not ensue?

a. 12 nn
b. 8 pm
c. 4 pm
d. 2 pm

A

b. 8 pm

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11
Q

Risk factors for pre-term birth EXCEPT:

a. BMI <19 kg/m2 or pre pre-pregnancy weight <50kg
b. Psychological issues (eg, stress, depression)
c. Prior cervical surgery
d. Married marital status

A

d. Married marital status

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12
Q

Preterm refers to a fetus or a pregnancy of a neonate that is less than 37 weeks AOG but more than 20 weeks. The sub-category wherein the age of gestation is between 28 to 32 weeks AOG is called:

a. Moderate to late preterm
b. Very preterm
c. Extremely preterm
d. Mildly preterm

A

b. Very preterm

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13
Q

A 26 G2P1 (0101) 35 weeks 4 days AOG consulted for regular uterine contractions. She has stable vital signs, good fetal heart tones, in cephalic presentation. On internal examination, the cervix is 4 cm, fully effaced with intact bag of waters. You may request for the following EXCEPT:

a. Rectovaginal group B streptococcal culture
b. CBC
c. Urine CS
d. Fetal fibronectin

A

d. Fetal fibronectin

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14
Q

Preterm babies may be given MgSO4 for neuroprotection to prevent:

a. Autism
b. Cerebral Palsy
c. Subgaleal hematoma
d. Intraventricular hemorrhage

A

b. Cerebral Palsy

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15
Q

A 28 G2P1 (0101), 21 weeks AOG consulted for her regular pre-natal follow up. She is asymptomatic and has been on vaginal progesterone since 16 weeks AOG. Her cervical length is 2.2 cm. You may offer the following to prevent another pre-term birth.

a. Cerclage
b. No additional intervention
c. Additional intramuscular progesterone
d. Increased dose of vaginal progesterone

A

a. Cerclage

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16
Q

Which of the following factors is the greatest determinant of twin-specific complications?

a. Fetal sex
b. Chorionicity
c. Zygosity
d. Amnionicity

A

b. Chorionicity

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17
Q

Before 8 weeks of gestation, which of the following features is most helpful in determining amnionicity in a twin gestation?

a. Number of placental masses
b. Number of yolk sacs
c. Number of embryos
d. Presence of intervening membrane

A

b. Number of yolk sacs

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18
Q

A 24 year old G3P2(2002) came to the labor room at 38 weeks age of gestation for imminent delivery and delivered a term live baby girl, 3000 g, with good AGPAR score. She however, showed a first trimester ultrasound that showed a monochorionic-diamnionic pregnancy with both fetuses having good cardiac activity. Which of the following is the most probable explanation for this singleton delivery?

a. Misdiagnosis by sonographer
b. Acardiac twinning
c. Early intrauterine demise of one twin with resorption
d. Parasitic twinning

A

c. Early intrauterine demise of one twin with resorption

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19
Q

During routine scan at 32 weeks in a monochorionic-diamnionic twin pregnancy, the following were noted: Twin A – oligohydramnios, urinary bladder not visualized, SGA; Twin B – polyhydramnios, urinary bladder seen, absent cardiac activity. What is the Twin-to-twin Transfusion stage according to the Quintero system?

a. IV
b. III
c. II
d. V

A

d. V

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20
Q

A 33 year old G2P1 (1001) with a dichorionic twin pregnancy came in at 37 weeks AOG for regular uterine contractions. Internal examination shows cervix 4 cm, fully effaced, presenting part station -1. Sonography showed twin A in cephalic presentation with EFW of 2700 g and twin B in breech presentation with EFW of 2300 g. Which of the following is appropriate management?

a. Vaginal delivery of both twins
b. Vaginal delivery of 1st of twin, external cephalic version of 2nd of twin
c. Vaginal delivery of 1st of twin, cesarean delivery of 2nd of twin
d. Vaginal delivery of 1st of twin, internal podalic version of 2nd of twin

A

a. Vaginal delivery of both twins

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21
Q

An 18-year old primigravid came for prenatal consult. She is on her 20th week of gestation. She disclosed presence of congenital heart (unrepaired septal defect). Presently she reports shortness of breath and chest pain when taking 1 flight of stairs, but is comfortable at rest. Based on the NYHA, what is her functional capacity?

a. IV
b. II
c. III
d. I

A

b. II

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22
Q

An 18-year old primigravid came for prenatal consult. She is on her 20th week of gestation. She disclosed presence of congenital heart (unrepaired septal defect). Presently she reports shortness of breath and chest pain when taking 1 flight of stairs, but is comfortable at rest. Based on the NYHA, what is her functional capacity?

a. IV
b. II
c. III
d. I

A

b. II

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23
Q

Which of the following can be used for treating asthma acutely?

a. Terbutaline
b. Zileuton
c. Cromolyn
d. Montelukast

A

a. Terbutaline

24
Q

The following are fetal responses to maternal hypoxemia, except:

a. decreased cardiac output
b. decreased umbilical blood flow
c. increased systemic vascular resistance
d. decreased pulmonary vascular resistance

A

d. decreased pulmonary vascular resistance

25
Q

A 30 yo G1P0, 28 weeks AOG, came in due to dysphagia, chest pain and regurgitation. The following are management options for this case, except?

a. If dilatation of the esophagus and medical therapy does not provide relief, myotomy is considered
b. Do barium swallow radiography to demonstrate bird beak or ace of spades narrowing at the distal esophagus
c. Give high-fat diet and anticholinergic drugs
d. Endoscopy is performed to exclude gastric carcinoma

A

c. Give high-fat diet and anticholinergic drugs

26
Q

Which of the following is true regarding the management of acute pyelonephritis?

a. Hospitalized patients may be discharged when afebrile for 12 hours, consider antimicrobial therapy for 7 to 10 days. b. Antibiotics should be started only when culture studies are available. c. Intravenous hydration to ensure adequate urinary output is the cornerstone of treatment. d. Outpatient management should be done 1st before considering hospitalization.

A

c. Intravenous hydration to ensure adequate urinary output is the cornerstone of treatment.

27
Q

A 30-year-old G2P1 (1001) came in at 30 weeks age of gestation with the following 75-gram OGTT result: FBS: 105 mg/dl 1st hour: 259 mg/dl 2nd hour: 210 mg/dl What is the diagnosis? a. Type II DM b. Overt diabetes mellitus c. Type I DM d. Gestational diabetes mellitus

A

b. Overt diabetes mellitus

28
Q

A primigravida on her 38th week of gestation, diagnosed with gestational diabetes mellitus, insulin-requiring, was being monitored at the clinic. Her latest CBG monitoring showed pre-prandial values of 105-110 mg/dl and 1st hour values of 180-200 mf/dl. On ultrasound, the estimated fetal weight is 4800 grams. How will you deliver the patient? a. Induce labor now. Monitor progress of labor and watch out for shoulder dystocia b. Induction of labor at 39 weeks and assisted vaginal delivery under epidural anesthesia. Watch out for shoulder dystocia. c. Elective CS now at 38 weeks d. Continue CBG monitoring. Schedule for elective CS at 39 weeks age of gestation.

A

c. Elective CS now at 38 weeks

29
Q

A 25 year old woman G2P1 (1001) was diagnosed in childhood to have Hemophilia A. She is currently 38 weeks and 4 days AOG by LMP, in cephalic presentation in early labor. On initial internal exam, cervix is 5 cm. dilated, fully effaced. Intact amniotic sac. Cephalic, station -1. Baseline intrapartal trace showed a category one trace. a. Operative vaginal delivery is the best option b. Outright cesarean section is indicated. c. Maintain a well-contracted postpartum uterus. d. A liberal right mediolateral episiotomy must be done

A

c. Maintain a well-contracted postpartum uterus.

30
Q

A G1P0 diagnosed to have brain aneurysm underwent endovascular coil insertion under fluoroscopic guidance at 28 weeks AOG. The patient was counselled. She was lost to follow-up until 38 weeks AOG when she consulted for labor pains. IE 2 cm., 30% effaced. What would be your management? a. Assisted vaginal delivery with permanent family planning methods b. Allow assisted vaginal delivery c. Outright cesarean delivery d. Cesarean section with bilateral tubal ligation

A

b. Allow assisted vaginal delivery

31
Q

A 34 y.o. G3P2 women at 35 weeks AOG presents in the active phase of labor 6cm. cervical dilatation. A history of postpartum psychosis in her previous pregnancy was elicited. Which statement is FALSE? a. Close monitoring is imperative up to the 7th day postpartum b. Postpartum psychosis has a 50 % recurrence risk during the next pregnancy c. Lithium therapy may be initiated immediately after delivery of the current fetus. d. Women with psychosis must be put on suicide watch

A

a. Close monitoring is imperative up to the 7th day postpartum

32
Q

Which common pregnancy associated dermatosis is associated with adverse fetal outcome and usually has no primary skin lesion. Laboratory findings include elevation of serum bile acid levels and mildly increased hepatic aminotransferase levels. a. Atopic eruption of pregnancy b. Pruritic urticarial papules and plaques of pregnancy (PUPPP) c. Intrahepatic cholestasis of pregnancy d. Pemphigoid gestationis (PG)

A

c. Intrahepatic cholestasis of pregnancy

33
Q

Which pregnancy associated dermatoses responds to treatment with cholestyramine and ursodeoxycholic acid? a. Intrahepatic cholestasis of pregnancy b. Pruritic urticarial papules and plaques of pregnancy (PUPPP) c. Atopic eruption of pregnancy d. Pemphigoid gestationis (PG)

A

a. Intrahepatic cholestasis of pregnancy

34
Q

Treatment regimen for IAI, includes: a. All of the above b. Ampicillin 2g IV q6h + Gentamicin 5mg/kg IV q24 c. Cefazolin 2g IV q8h + Gentamicin 2mg/kg IV load then 1.5mg/kg q8 d. Clindamycin 900mg IV q8 + Gentamicin 2mg/kg IV load then 1.5mg/kg q8

A

a. All of the above

35
Q

AF, a 35 y/o G2P1 (1001) has diffuse macular rash on the palms of the hand and soles of the feet with a positive FTA ABS test. Treatment regimen for this case: a. Benzathine Penicillin G 2.4 million units IM weekly x 3 doses b. Aqueous Penicillin G 3 million units IV every 4 hours c. Benzathine Penicillin G 2.4 million units IM single dose d. Benzathine Penicillin G 7.2 million units IM single dose

A

c. Benzathine Penicillin G 2.4 million units IM single dose

36
Q

The following can be given as Intrapartum antibiotic prophylaxis EXCEPT a. Clindamycin 900mg/IVT every 8 hours until delivery b. Ampicillin 6 grams/IVT as loading dose then 1 gram every 4 hours until delivery c. Penicillin G, 5M units/IV as loading dose, then 2.5-3M units/IVT every 4 hours until delivery d. Vancomycin 25mg/kg/IVT every 8 hours until delivery

A

d. Vancomycin 25mg/kg/IVT every 8 hours until delivery

37
Q

A 44 year old G4P3 (3013) consulted for recurrent dysuria. She reported 3 episodes occurring over the past year and each time she was given unrecalled oral antibiotics which offered mild relief. What common symptoms will you elicit in the patient to support your initial diagnosis? a. hematuria, dysuria, frequency b. frequency, urgency, dysuria c. dysuria, post-void dribbling, urgency d. dyspareunia, dysuria, hematuria

A

b. frequency, urgency, dysuria

38
Q

The most common location of vaginal injury following normal coitus is: a. Left vaginal fornix b. Anterior fornix c. Right vaginal fornix d. Posterior fornix

A

d. Posterior fornix

39
Q

A 24 year old nulligravid consulted for severe vulvar pain associated with undocumented fever that started three days ago. On pelvic examination, there was note of a 4 x 3 cm fluctuant, cystic, tender mass at the left labia majora. What is the best treatment option for the patient? a.Incision and drainage b. Drain placement c. Excision d. Marsupialization

A

d. Marsupialization

40
Q

What procedure may be done to establish presence of allodynia? a. Culture for atypical Candida and bacteria b. Vulvar scraping c. Cotton swab test d. Vulvar biopsy

A

c. Cotton swab test

41
Q

Which of the following statements on adenomyosis is true? a. Prominent hemorrhagic changes are seen microscopically within the glandular lakes b. Infiltrating glands and stroma undergo cyclical changes concurrent with that of the endometrium c. Standard criteria for diagnosis requires presence of glands and stroma 2.5 mm from the basalis layer d. There is abundance of inflammatory cells surrounding the adenomyotic foci

A

c. Standard criteria for diagnosis requires presence of glands and stroma 2.5 mm from the basalis layer

42
Q

Routine transvaginal scan in a 52 yo postmenopausal asymptomatic woman revealed a 4.5 cm unilocular anechoic cyst with absence of flow on color Doppler. CA-125 was 10 U/ml. What should be done next? a. perform laparoscopic cystectomy b. repeat ultrasound and CA 125 after 6 months c. total hysterectomy with bilateral salpingooophorectomy d. nothing else should be done

A

b. repeat ultrasound and CA 125 after 6 months

43
Q

The treatment of endometriosis include all the following EXCEPT: a. oral progesterone b. Combined oral contraceptive pills c. Estrogen d. GnRH agonist

A

c. Estrogen

44
Q

In order to minimize the recurrence of the disease while ensuring the least amount of destruction of normal ovarian stroma, this technique should be employed in laparoscopic oophorocystectomy for an endometriotic cyst: a. Cyst aspiration b. Wedge resection of ovary c. Coagulation of cyst wall d. Removal of cyst wall

A

d. Removal of cyst wall

45
Q

A 44yo G3P3 (3003) with a history of 2 previous laparoscopic procedures for severe endometriosis desires long-term relief of symptoms. The most appropriate next surgical procedure is: a. Total hysterectomy with bilateral salpingooophorectomy b. Hysterectomy c. Bilateral salpingoophorectomy d. Laparoscopic presacral neurectomy

A

a. Total hysterectomy with bilateral salpingooophorectomy

46
Q

Which of the following is the most common nonsquamous cell malignancy of the vulva? a. Melanoma b. Sarcoma c. Basal cell carcinoma d. Bartholin’s gland carcinoma

A

a. Melanoma

47
Q

A 30 year-old G2P1 came to the clinic for prenatal check-up. She’s 24 weeks AOG. Baseline tests included a Pap smear which later showed HSIL. What is the preferred thing to do? a. do HPV testing b. do colposcopy c. repeat Pap smear after 2 months d. defer colposcopy until 6 weeks postpartum

A

b. do colposcopy

48
Q

A 55-year old G4P4 consulted for vulvar irritation. On examination, the vulvar skin was thin, with diffuse white discoloration. On biopsy, it showed thinned out epithelium, with loss or blunting of the rete ridges. What is the most likely diagnosis of this patient? a. Paget’s disease b. VIN c. Lichen sclerosus d. Squamous hyperplasia

A

c. Lichen sclerosus

49
Q

A 60-year old woman came in for vulvar itching. On examination, there is a crinkled whitish shiny skin in the periclitoral area. What important diagnostic test should be performed on this patient? a. Cytologic evaluation b. Keyes punch biopsy c. Colposcopy d. Toluidine blue test

A

b. Keyes punch biopsy

50
Q

20years old G1 underwent completion curettage for incomplete abortion at 8 weeks AOG . The pathologist gave a diagnosis of hydropic abortion but suggested further examination to determine exact diagnosis. A p57kip2 was done which turned out to be positive. What will your conclusion be? a. Result cannot differentiate between hydropic abortion and partial mole b. Result is compatible with Complete mole c. Diagnosis of hydropic abortion is definitely correct d. Result cannot differentiate between hydropic abortion and complete mole

A

b. Result is compatible with Complete mole

51
Q

Which is TRUE regarding salpingostomy: a. After evacuation of the products, a suture is placed around the incision site to ligate bleeders. b. The product of conception is extracted piecemeal to ensure complete evacuation. c. This procedure is done for pregnancy more than 3 cm located at the distal third of the fallopian tube. d. A linear incision is created on the antimesenteric border of the tube.

A

d. A linear incision is created on the antimesenteric border of the tube.

52
Q

The most frequently cited risk factor for pelvic organ prolapse is a. Age b. Obesity c. Childbirth d. Menopause

A

c. Childbirth

53
Q

True of risk factors for pelvic organ prolapse: a. All statements are true. b. Gynecoid pelvis are less likely to predispose to pelvic organ prolapse than android pelvis. c. Elective cesarean section can prevent pelvic floor dysfunction d. Elective episiotomy is not advocated because of greater risk for maternal harm and lack of evidence of benefit.

A

d. Elective episiotomy is not advocated because of greater risk for maternal harm and lack of evidence of benefit.

54
Q

One of the 6 defined points in POP-Q is described as: a. Point Bp is a point at the midline of the posterior vagina 3cms proximal to the hymen b. Point Aa is a point along the anterior vagina to the posterior fornix c. Point C refers to cul de sac d. Point D refers to the point of descent of the vaginal stump

A

a. Point Bp is a point at the midline of the posterior vagina 3cms proximal to the hymen

55
Q

Which of the following points in the POP-Q is measured at rest and the prolapse is reduced: a. From the posterior fourchette to the mid-anal opening b. From the hymen to the posterior vaginal fornix c. From the middle of the external urethral meatus to the posterior fourchette d. All of the above

A

b. From the hymen to the posterior vaginal fornix

56
Q

JL, a 22 y/o G1P0 on her 10th week of pregnancy tested negative for Rubella IgG. When is the best time to vaccinate her with MMR? a. immediately postpartum prior to hospital discharge b. 6 weeks postpartum c. at 28 weeks AOG d. at 14 weeks AOG

A

a. immediately postpartum prior to hospital discharge

57
Q

What adverse event should be anticipated within 15 minutes after HPV vaccination: a. Pruritus at injection site b. High grade fever c. Pain at injection site d. Syncope

A

d. Syncope

Residency Exams (1 decks)

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