LE 6 OB Flashcards
- Preterm pregnancy complicated by oligohydramnios should be investigated with regards to:
a. Maternal intake of fluids, especially cold water
b. Presence of congenital anomalies
c. Intake of tocolytics
d. Disease like severe anemia
b. Presence of congenital anomalies
Rationale: Oligohydramnios in preterm pregnancies is commonly associated with congenital anomalies, particularly those affecting the renal system (e.g., renal agenesis, posterior urethral valves). It may also be linked to uteroplacental insufficiency.
- A 40-week primigravid came to the clinic for a prenatal check-up. The fundic height is 28 cm, FHT 150 bpm, estimated fetal weight (EFW) 1.8 kg. IE reveals cervix 1-2 cm, beginning of effacement, intact bag of waters, cephalic, station -3. What is the next best step?
a. Induction of labor
b. Do contraction stress test (CST)
c. Immediate cesarean section
d. Perform amnioinfusion
b. Do contraction stress test (CST)
Rationale: A significant discrepancy between gestational age and fetal growth suggests intrauterine growth restriction (IUGR). A CST helps evaluate fetal well-being by assessing its response to uterine contractions.
- Fetal growth is dependent upon which of the following?
a. Occupation of the patient
b. Adequacy of uteroplacental blood flow
c. Amount of amniotic fluid
d. Usual position of the patient when lying down
b. Adequacy of uteroplacental blood flow
Rationale: Uteroplacental blood flow directly affects fetal oxygen and nutrient supply, which are critical for normal fetal growth. Compromised blood flow can lead to IUGR.
- IUGR is present when:
a. The fundic height at 30 weeks is 20 cm
b. There is plateauing of fetal growth estimates on two consecutive observations
c. Maternal weight gain is less than 1 pound per week
d. Oligohydramnios is evident
b. There is plateauing of fetal growth estimates on two consecutive observations
Rationale: Serial ultrasound assessments showing no increase in fetal weight or biometric parameters indicate IUGR, which results from placental insufficiency, infections, or maternal conditions.
- The brain-sparing phenomenon:
a. Results in constitutionally small IUGR
b. Produces bigger abdominal circumferences compared to head circumferences
c. May explain increased amniotic fluid amongst IUGRs
d. Explains asymmetrical growth restriction
d. Explains asymmetrical growth restriction
Rationale: The brain-sparing effect occurs when fetal blood flow is preferentially directed to vital organs (brain, heart, adrenals) at the expense of peripheral tissues, leading to asymmetrical IUGR.
- Which condition dictates termination of pregnancy with IUGR remote from term?
a. Presence of brain maturity
b. Reversed end-diastolic flow in umbilical artery on Doppler velocimetry
c. Biophysical profile (BPS) of 8/10 with a non-reactive non-stress test (NST)
d. Presence of early deceleration on contraction stress test
b. Reversed end-diastolic flow in umbilical artery on Doppler velocimetry
Rationale: Reversed end-diastolic flow is a sign of severe placental insufficiency and fetal compromise, necessitating immediate delivery regardless of gestational age.
- A 28-year-old regular menstruator at 36 weeks AOG by transvaginal ultrasound has a fundic height of 25 cm and FHT of 128 bpm. The most likely diagnosis is:
a. Fetal growth restriction
b. Gestational hypertension
c. Polyhydramnios
d. Placental abruption
a. Fetal growth restriction
Rationale: A fundic height measurement significantly lower than expected for gestational age suggests IUGR, requiring further evaluation with ultrasound fetal weight estimation and Doppler studies.
- Mechanism by which cytomegalovirus (CMV) produces IUGR:
a. Placental ischemia
b. Decreased uteroplacental perfusion
c. Cytolysis and loss of functioning cells
d. Increased maternal cytokine release
c. Cytolysis and loss of functioning cells
Rationale: CMV causes IUGR by direct viral damage to fetal cells, leading to cytolysis and impaired fetal organ development, particularly in the brain and liver.
- Absence of diastolic flow in the umbilical artery suggests:
a. There is at least 30% loss of uteroplacental function
b. Severe metabolic acidosis in the fetus at this time
c. Outright cesarean section for delivery of the fetus
d. Presence of recurrent variable decelerations
a. There is at least 30% loss of uteroplacental function
Rationale: The absence of diastolic flow indicates progressive placental insufficiency. While not an immediate indication for delivery like reversed flow, it suggests fetal distress and requires close monitoring.
- Monitoring of fetal growth is best done at what interval?
a. Daily
b. Weekly
c. Every 3-4 weeks
d. Every 6-8 weeks
c. Every 3-4 weeks
Rationale: Serial growth scans every 3-4 weeks allow for adequate assessment of fetal growth trends while minimizing unnecessary exposure to ultrasound. More frequent monitoring is reserved for high-risk cases.
- A G1 at 16 weeks AOG presents with on-and-off right upper quadrant pain, nausea, and vomiting, which she has experienced even before pregnancy. What is the best diagnostic test to assess her symptoms?
a. Abdominal Ultrasound
b. Liver Function Tests
c. CT Scan
d. MRI
d. MRI
Rationale: MRI is the preferred imaging modality in pregnancy when evaluating conditions such as cholecystitis that require detailed soft tissue assessment while avoiding ionizing radiation.
- A 26-year-old G1 at 18 weeks AOG presents with chronic vague abdominal pain, diarrhea, and hematochezia. Which of the following would be the least ideal preparation for a scheduled colonoscopy?
a. Clear liquid diet
b. NPO for 6-8 hours before procedure
c. Bowel prep with polyethylene glycol
d. No liquid diet
d. No liquid diet
Rationale: A clear liquid diet is essential before colonoscopy to ensure proper bowel cleansing. Avoiding liquids entirely would prevent effective preparation and could lead to poor visualization during the procedure.
- A 24-year-old G1 at 9 weeks AOG presents with nausea and vomiting for 3 weeks, without fever or diarrhea. She has lost 8 pounds, has sunken eyeballs, dry lips, dry mouth, confusion, and difficulty walking and speaking. What is the most likely diagnosis?
a. Hyperthyroidism
b. Wernicke’s encephalopathy
c. Hypoglycemia
d. Preeclampsia
b. Wernicke’s encephalopathy
Rationale: Wernicke’s encephalopathy is a complication of hyperemesis gravidarum due to thiamine (Vitamin B1) deficiency. Classic triad: ataxia, ophthalmoplegia, and confusion.
- A 24-year-old G1 at 9 weeks AOG presents with nausea and vomiting for 3 weeks, weight loss of 8 pounds, confusion, sunken eyeballs, dry lips, dry mouth, and difficulty walking and speaking. What is NOT included in her immediate treatment?
a. IV thiamine
b. IV fluids with dextrose
c. Enteral nutrition
d. Electrolyte replacement
c. Enteral nutrition
Rationale: Patients with Wernicke’s encephalopathy due to hyperemesis gravidarum require bowel rest. Total parenteral nutrition (TPN) is preferred over enteral nutrition in the acute phase.
- A 24-year-old G1 at 9 weeks AOG presents with severe nausea and vomiting for 3 weeks, significant weight loss, confusion, sunken eyeballs, dry lips, dry mouth, and difficulty walking and speaking. Which is NOT a possible contributing factor to this condition?
a. Hyperthyroidism
b. Psychological factors
c. Restrictive diet
d. Obesity
d. Obesity
Rationale: Obesity is not a contributing factor in hyperemesis gravidarum, as affected patients typically experience significant weight loss. Hyperthyroidism, psychological factors, and restrictive diets can exacerbate symptoms.
- A 35-year-old with a history of prolonged NSAID use for a shoulder injury presents with severe epigastric pain. What is the most likely diagnosis?
a. Cholecystitis
b. Peptic ulcer disease
c. Acute pancreatitis
d. GERD
b. Peptic ulcer disease
Rationale: Chronic NSAID use is a significant risk factor for peptic ulcer disease due to its inhibition of prostaglandins, leading to decreased gastric mucosal protection and increased acid injury.
- A 35-year-old G2P1 at 16 weeks AOG presents with nausea and severe epigastric pain. What is the first diagnostic tool?
a. Abdominal ultrasound
b. Abdominal MRI
c. Urea breath test
d. Upper GI endoscopy
a. Abdominal ultrasound
Rationale: Abdominal ultrasound is the first-line imaging modality in pregnancy to assess epigastric pain, ruling out gallbladder pathology and other non-intrusive diagnoses before considering endoscopy.
- A 35-year-old G2P1 at 16 weeks AOG presents with nausea and severe epigastric pain. Which of the following is NOT included in the treatment?
a. Clarithromycin
b. Tetracycline
c. Amoxicillin
d. Metronidazole
b. Tetracycline
Rationale: Tetracycline is contraindicated in pregnancy due to its effects on fetal bone and teeth development. Clarithromycin, amoxicillin, and metronidazole are safer alternatives for treating H. pylori infection.
- A 38-year-old smoker presents with a retrosternal burning sensation. What is the most likely diagnosis?
a. Peptic ulcer disease
b. GERD
c. Esophageal spasm
d. Angina
b. GERD
Rationale: GERD presents with retrosternal burning (heartburn), often aggravated by smoking. It results from gastric acid reflux due to lower esophageal sphincter dysfunction.
- A 38-year-old smoker at 20 weeks AOG presents with retrosternal burning sensation. Which of the following is NOT included in the treatment?
a. Antacids
b. H2 blockers
c. Misoprostol
d. Lifestyle modifications
c. Misoprostol
Rationale: Misoprostol is contraindicated in pregnancy due to its abortifacient properties. GERD in pregnancy is managed with antacids, H2 blockers, and lifestyle modifications.
- A 20-year-old G2P1 at 24 weeks after the Christmas holidays presents with low-grade fever, hypogastric pain, and 3-4 episodes of watery stool. No pathogenic agent was found on testing. What should NOT be included in the management?
a. Oral rehydration therapy
b. Probiotics
c. Ciprofloxacin
d. Dietary modifications
c. Ciprofloxacin
Rationale: Ciprofloxacin is a quinolone, contraindicated in pregnancy due to its risk of cartilage damage in the fetus. Supportive care, hydration, and probiotics are the preferred treatment.
- A 35-year-old at 22 weeks AOG recently traveled from Singapore and presents with severe abdominal pain and mucoid bloody stool. What is the most likely pathogenic agent?
a. Salmonella
b. Shigella
c. Entamoeba histolytica
d. Rotavirus
c. Entamoeba histolytica
Rationale: Amoebiasis (amoebic dysentery) caused by Entamoeba histolytica is common in travelers from endemic areas. It presents with dysentery, cramping, and weight loss.
- Which of the following is a cytotoxin-producing causative agent of acute diarrhea syndrome in pregnancy?
a. Clostridium difficile
b. Escherichia coli
c. Vibrio cholerae
d. Rotavirus
a. Clostridium difficile
Rationale: C. difficile produces toxins A and B, leading to pseudomembranous colitis. It is a significant cause of antibiotic-associated diarrhea.
- A 34-year-old Jewish woman with a history of RLQ colicky pain and diarrhea presents at 36 weeks AOG with severe abdominal pain, high-grade fever, and failure to gain weight. Endoscopy reveals segmental colitis and perianal fistulas. What is the most likely diagnosis?
a. Ulcerative colitis
b. Crohn’s disease
c. Celiac disease
d. Diverticulitis
b. Crohn’s disease
Rationale: Crohn’s disease involves transmural inflammation and can affect any part of the GI tract. It often presents with perianal disease, segmental colitis, and RLQ pain.
- A 34-year-old Jewish woman at 36 weeks AOG with Crohn’s disease presents with severe abdominal pain and perianal fistulas. Which of the following is NOT included in her management?
a. Corticosteroids
b. Methotrexate
c. Biologic therapy
d. Nutritional support
b. Methotrexate
Rationale: Methotrexate is contraindicated in pregnancy due to its teratogenic effects. Corticosteroids and biologic therapy can be used to manage Crohn’s disease flares.
- A 34-year-old Jewish woman at 36 weeks AOG with Crohn’s disease presents with severe abdominal pain and perianal fistulas. Which of the following is NOT a fetal complication of this disease?
a. Fetal growth restriction
b. Preterm birth
c. Congenital anal atresia
d. Miscarriage
c. Congenital anal atresia
Rationale: Crohn’s disease is associated with fetal growth restriction, preterm birth, and miscarriage. Congenital anal atresia is not a known complication.
- A 34-year-old Jewish woman at 36 weeks AOG with Crohn’s disease presents with severe abdominal pain and perianal fistulas. What is the recommended mode of delivery?
a. Vaginal delivery at the onset of labor
b. Immediate induction
c. Cesarean section
d. Cesarean section after glucocorticoids
a. Vaginal delivery at the onset of labor
Rationale: Cesarean section is not routinely indicated in Crohn’s disease unless there is severe perianal disease or obstetric indications.
- A 25-year-old G2P1 at 35 weeks AOG presents with generalized pruritus, particularly on the palms and soles, with mild jaundice. Liver function tests reveal elevated bilirubin and transaminases. What is the most likely diagnosis?
a. Acute fatty liver of pregnancy
b. Intrahepatic cholestasis of pregnancy
c. Viral hepatitis
d. HELLP syndrome
b. Intrahepatic cholestasis of pregnancy
Rationale: Intrahepatic cholestasis of pregnancy (ICP) presents with pruritus and elevated bile acids. It is associated with an increased risk of fetal complications.
- A 25-year-old G2P1 at 35 weeks AOG with intrahepatic cholestasis of pregnancy presents with pruritus and mild jaundice. Which of the following is NOT included in management?
a. Antihistamines
b. Cholestyramine
c. Ursodeoxycholic acid
d. Liver transplant
d. Liver transplant
Rationale: Liver transplant is reserved for severe liver failure, which is rare in ICP. Ursodeoxycholic acid is the treatment of choice.
- A 25-year-old G2P1 at 35 weeks AOG with intrahepatic cholestasis of pregnancy is at risk for fetal complications. What should be the mode of delivery?
a. Immediate induction of labor
b. Immediate cesarean section
c. Cesarean section at 39 weeks AOG
d. Induction of labor at 37 weeks AOG
d. Induction of labor at 37 weeks AOG
Rationale: Induction at 37 weeks is recommended to reduce the risk of stillbirth associated with intrahepatic cholestasis of pregnancy.
- Which of the following statements about acute fatty liver of pregnancy (AFLP) is TRUE?
a. AFLP always occurs in the first trimester
b. AFLP commonly recurs in subsequent pregnancies
c. AFLP is a form of severe eclampsia without HELLP syndrome
d. AFLP causes hepatic function to return to normal postpartum
d. AFLP causes hepatic function to return to normal postpartum
Rationale: AFLP is a severe but reversible condition. Liver function usually normalizes postpartum, but immediate delivery is required to prevent maternal and fetal complications.
- Which of the following statements about viral hepatitis in pregnancy is TRUE?
a. Clinical and biochemical findings differ significantly from non-pregnant individuals
b. Pregnant women have a higher risk of fulminant hepatitis, particularly with hepatitis E
c. Hepatitis B infection in pregnancy does not require special precautions
d. Hepatitis C is commonly transmitted through breast milk
b. Pregnant women have a higher risk of fulminant hepatitis, particularly with hepatitis E
Rationale: Hepatitis E infection in pregnancy has a high risk of fulminant hepatic failure, particularly in the third trimester.
- Which of the following best indicates the risk of developing hepatocellular carcinoma?
a. HBsAg
b. HBeAg
c. HBV DNA
d. Anti-HBs
a. HBsAg
Rationale: The presence of HBsAg indicates ongoing infection (acute or chronic). Chronic hepatitis B infection, particularly with persistent HBsAg and high viral loads, increases the risk of hepatocellular carcinoma (HCC). HBeAg indicates high infectivity, while Anti-HBs suggests immunity.
- A symptomatic 30-year-old G1 at 8 weeks AOG tests positive for HBsAg on routine prenatal screening. What must be included in the management of her neonate?
a. Hepatitis B immunoglobulin (HBIG) immediately after birth
b. Hepatitis B recombinant vaccine immediately after birth
c. Full formula feeding
d. A and B only
d. A and B only
Rationale: Infants born to mothers with hepatitis B should receive both Hepatitis B immunoglobulin (HBIG) and the Hepatitis B vaccine within the first 24 hours of life to prevent vertical transmission. Breastfeeding is not contraindicated as long as the neonate is immunized.
- The husband of a 25-year-old unvaccinated primigravida at 36 weeks AOG is diagnosed with hepatitis A. What should be included in the management of the patient?
a. Isolation from the husband
b. Breastfeeding is contraindicated
c. First dose of hepatitis A vaccine in the same arm
d. Passive immunization with hepatitis A immunoglobulin (HAV Ig)
d. Passive immunization with hepatitis A immunoglobulin (HAV Ig)
Rationale: Pregnant women exposed to hepatitis A, especially those unvaccinated, should receive HAV Ig for immediate passive immunity. The hepatitis A vaccine can also be given but does not provide immediate protection. Breastfeeding is not contraindicated.
- A gravid patient presents with 1-2 days of flu-like symptoms, followed by vesicular lesions that crust over in seven days. What is the most likely diagnosis?
a. Measles
b. Varicella
c. Rubella
d. Erythema infectiosum
b. Varicella
Rationale: Varicella (chickenpox) in pregnancy presents with flu-like symptoms followed by vesicular lesions that crust over in a week.
- What is the leading cause of mortality in varicella infection during pregnancy?
a. Encephalitis
b. Pneumonia
c. Disseminated varicella
d. Meningitis
b. Pneumonia
Rationale: Varicella pneumonia is a severe complication in adults, particularly in pregnant women, leading to significant morbidity and mortality.
- When is a person with varicella considered contagious?
a. From the time of exposure until resolution of the rash
b. One day before the onset of the rash until the lesions crust over
c. Only during the vesicular stage
d. From the appearance of the rash until resolution
b. One day before the onset of the rash until the lesions crust over
Rationale: Varicella is highly contagious from one day before rash onset until all lesions are crusted.
- An asymptomatic primigravida is found to have >100,000 organisms/mL on urine culture during routine prenatal screening. What is the diagnosis?
a. Cystitis
b. Asymptomatic bacteriuria
c. Pyelonephritis
d. Urethritis
b. Asymptomatic bacteriuria
Rationale: Asymptomatic bacteriuria is defined as significant bacteriuria (>100,000 CFU/mL) without symptoms. It requires treatment in pregnancy to prevent pyelonephritis.
- A 28-year-old G2P1 presents with dysuria, frequency, and fever. What is the best method to confirm the diagnosis?
a. Urinalysis
b. Urine Culture
c. CBC
d. AOTA (All of the Above)
d. AOTA (All of the Above)
Rationale: Urinalysis detects leukocytes and nitrites, urine culture confirms the causative organism, and CBC assesses systemic infection.
- At what gestational age is the risk highest for developing congenital varicella syndrome?
a. Before 12 weeks AOG
b. Between 13 and 20 weeks AOG
c. After 20 weeks AOG
d. During labor and delivery
b. Between 13 and 20 weeks AOG
Rationale: The highest risk for congenital varicella syndrome occurs between 13-20 weeks AOG, leading to limb hypoplasia, skin scarring, and neurologic defects.
- What is the causative agent of mumps?
a. RNA paramyxovirus
b. DNA herpesvirus
c. Orthomyxovirus
d. Retrovirus
a. RNA paramyxovirus
Rationale: Mumps is caused by an RNA paramyxovirus, which primarily affects the parotid glands and may lead to complications like orchitis.
- Colonic pseudo-obstruction is characterized by massive abdominal distension and hemicolon dilation. What is the underlying mechanism?
a. Adynamic colon
b. Constipation
c. Low fiber diet
d. Poor water intake
a. Adynamic colon
Rationale: Colonic pseudo-obstruction (Ogilvie syndrome) results from an adynamic colon, often following surgery or trauma, leading to functional bowel obstruction.
- What is the most common cause of gastroduodenal ulcers in non-pregnant patients?
a. Intermittent fasting
b. Excessive caffeine intake
c. GERD
d. Helicobacter pylori infection
d. H. pylori infection
Rationale: H. pylori is the most common cause of gastroduodenal ulcers. It is associated with peptic ulcer disease and can impact pregnancy outcomes.
- Which of the following statements about the MMR vaccine is FALSE?
a. It is contraindicated in pregnancy
b. It contains live attenuated viruses
c. It is safe to administer during pregnancy
d. It provides lifelong immunity
c. It is safe to administer during pregnancy
Rationale: Live vaccines like MMR are contraindicated in pregnancy due to the risk of fetal infection.
- A patient presents with fever, cough, coryza, and conjunctivitis. What is the most likely diagnosis?
a. Varicella
b. Rubella
c. Rubeola (Measles)
d. Scarlet fever
c. Rubeola (Measles)
Rationale: Measles presents with the classic 3 Cs (cough, coryza, conjunctivitis) and fever, followed by a maculopapular rash.
- What is considered the most complete teratogen?
a. Varicella
b. Toxoplasmosis
c. Cytomegalovirus
d. Rubella
d. Rubella
Rationale: Rubella is highly teratogenic, particularly in the first trimester, causing congenital rubella syndrome with deafness, heart defects, and cataracts.
- At what gestational age does rubella have a 90% chance of causing congenital infection?
a. < 12 weeks
b. 13-14 weeks
c. End of second trimester
d. Third trimester
a. < 12 weeks
Rationale: The risk of fetal rubella infection is highest in the first trimester, especially before 12 weeks, leading to severe congenital abnormalities.
- Which exotoxin is associated with multi-organ involvement in toxic shock syndrome?
a. Staphylococcus aureus
b. Streptococcus pyogenes
c. Group B streptococcus
d. Candida albicans
a. Staphylococcus aureus
Rationale: S. aureus produces TSST-1, leading to toxic shock syndrome, characterized by fever, hypotension, and multi-organ failure.
- What is the most common causative agent of neonatal sepsis?
a. Staphylococcus aureus
b. Streptococcus pyogenes
c. Group A streptococcus
d. Streptococcus agalactiae
d. Streptococcus agalactiae
Rationale: Group B streptococcus (GBS) is the leading cause of early-onset neonatal sepsis, typically transmitted during birth.
- At what gestational age is rectovaginal culture screening for Group B streptococcus (GBS) typically performed?
a. 28-30 weeks
b. 30-32 weeks
c. 35-37 weeks
d. 38-40 weeks
c. 35-37 weeks
Rationale: GBS screening is done at 35-37 weeks AOG to identify carriers and determine the need for intrapartum antibiotic prophylaxis to prevent neonatal sepsis.
- During pregnancy, cardiac output increases by:
a. 10-20%
b. 20-30%
c. 30-50%
d. 50-70%
c. 30-50%
Rationale: Cardiac output increases by 30-50% due to an increase in stroke volume and heart rate. This supports the increased metabolic demands of pregnancy.
- Systemic vascular resistance during pregnancy decreases due to:
a. Increase in catecholamines
b. Increase in estrogen and progesterone
c. Decrease in renin-angiotensin-aldosterone system (RAAS)
d. Increase in erythropoiesis
b. Increase in estrogen and progesterone
Rationale: Estrogen and progesterone act as vasodilators, reducing systemic vascular resistance and leading to a decrease in mean arterial pressure, reaching its lowest point in the second trimester.
- A 24-year-old primigravida experiences the greatest decrease in systemic vascular resistance during which trimester?
a. First trimester
b. Second trimester
c. Third trimester
d. Any trimester
b. Second trimester
Rationale: Systemic vascular resistance decreases due to vasodilation from progesterone, estrogen, and nitric oxide, reaching its lowest point in the second trimester.
- A 21-year-old G1 at 30 weeks AOG experiences an increase in afterload and a decrease in cardiac return due to:
a. Increased fetal metabolic demand
b. Increased blood viscosity
c. Compression of the aorta & vena cava
d. Placental insufficiency
c. Compression of the aorta & vena cava
Rationale: The gravid uterus compresses the aorta and inferior vena cava in the supine position, reducing venous return and cardiac output, which can cause supine hypotensive syndrome.
- What is the best position to study the hemodynamic capacity of a pregnant woman?
a. Supine
b. Right lateral decubitus
c. Left lateral decubitus
d. Sitting upright
c. Left lateral decubitus
Rationale: The left lateral decubitus position relieves aortocaval compression, improving venous return and cardiac output.
- Successful maternal-fetal circulation is accomplished by:
a. Increased fetal cardiac output
b. Structural modification of the trophoblast on the maternal artery
c. Increased placental thickness
d. Increased maternal erythropoiesis
b. Structural modification of the trophoblast on the maternal artery
Rationale: The trophoblast invades and remodels maternal spiral arteries, reducing resistance and facilitating increased placental blood flow.
- During pregnancy, functional residual capacity (FRC) usually:
a. Increases
b. Decreases
c. Remains unchanged
b. Decreases
Rationale: FRC decreases by 10-25% due to the enlarged uterus elevating the diaphragm, reducing lung volumes.
- During pregnancy, glomerular filtration rate (GFR) increases by:
a. 30%
b. 50%
c. 40%
d. 60%
c. 40%
Rationale: GFR increases by 40% to accommodate fetal metabolic waste removal and maintain maternal fluid balance.
- A 32-year-old G1 at 34 weeks who frequently eats chocolate experiences GERD symptoms when she lies down. The primary cause is:
a. Increased intra-abdominal pressure
b. Hormonal changes, particularly progesterone
c. Reduced lower esophageal sphincter pressure
d. Delayed gastric emptying
b. Hormonal changes, particularly progesterone
Rationale: Progesterone relaxes the lower esophageal sphincter, increasing reflux and contributing to GERD symptoms.
- The most common indication for abdominal exploration in pregnancy is:
a. Ectopic pregnancy
b. Appendicitis
c. Cholecystitis
d. All of the above
d. All of the above
Rationale: Surgical emergencies such as ectopic pregnancy, appendicitis, and cholecystitis are common indications for abdominal exploration in pregnancy.
- In a patient at 32 weeks AOG, Murphy’s sign is best elicited in which location?
a. Right upper quadrant
b. Epigastric region
c. Right subchondral area
d. Left lower quadrant
a. Right upper quadrant
- A pregnant patient at 32 weeks presents with acute abdominal pain. What is the least likely diagnosis?
a. Appendicitis
b. Cholecystitis
c. Ovarian torsion
d. Placental abruption
b. Cholecystitis
Rationale: While cholecystitis is common in pregnancy, appendicitis is the most likely diagnosis for right lower quadrant pain.
- What is the most likely diagnosis for a pregnant patient at 32 weeks with right lower quadrant pain?
a. Appendicitis
b. Cholecystitis
c. Pyelonephritis
d. Ureteral stones
a. Appendicitis
Rationale: Appendicitis is the most common non-obstetric surgical emergency in pregnancy, often presenting with atypical pain due to uterine displacement.
- What is the recommended treatment for appendicitis in pregnancy?
a. IV antibiotics only
b. Surgery
c. Conservative management
d. Observation
b. Surgery
Rationale: Surgical intervention (appendectomy) is the standard treatment to prevent perforation and sepsis.
- What is the best diagnostic test for appendicitis in pregnancy?
a. CT Scan
b. MRI
c. Ultrasound
d. A & B
c. Ultrasound
- If a pregnant patient develops generalized peritonitis, the prognosis will be:
a. Good
b. Poor
b. Poor
Rationale: Appendicitis increases the likelihood of abortion or preterm labor, especially if peritonitis develops. Without peritonitis, the prognosis is excellent.
- The likelihood of abortion is increased when appendicitis is complicated by:
a. Uterine rupture
b. Peritonitis
c. Pyelonephritis
d. Placenta previa
b. Peritonitis
Rationale: Appendicitis is a common indication for abdominal surgery in pregnancy. Peritonitis significantly increases the risk of abortion or preterm labor.
- A 40-year-old G5P4 at 32 weeks presents with RUQ and epigastric pain, direct and rebound tenderness, nausea, and vomiting. The most likely diagnosis is:
a. Acute pancreatitis
b. Acute appendicitis
c. Acute cholecystitis
d. Pyelonephritis
c. Acute cholecystitis
Rationale: Acute cholecystitis commonly presents with RUQ pain, nausea, and vomiting. Pregnancy-related hormonal changes increase the risk of gallstone formation.
- What is the most common cause of acute cholecystitis in pregnancy?
a. Infection
b. Fecalith
c. Fat/Cholesterol
d. Estrogen excess
c. Fat/Cholesterol
Rationale: Gallbladder stasis and increased cholesterol secretion in pregnancy contribute to gallstone formation, the leading cause of acute cholecystitis.
- In some cases, acute cholecystitis can be managed by:
a. Antibiotics
b. Analgesics
c. Surgery
d. All of the above
d. All of the above
Rationale: Initial management of acute cholecystitis includes antibiotics and analgesics. If symptoms persist or complications arise, surgery (cholecystectomy) is indicated.
- A 40-year-old G5P4 at 32 weeks presents with acute cholecystitis. Which is NOT a risk factor for her condition?
a. Advanced maternal age
b. Multiparity
c. High-fat diet
d. None of the above (AOTA)
d. None of the above (AOTA)
Rationale: All listed factors, including age, multiparity, and dietary habits, increase the risk of gallstone formation and acute cholecystitis in pregnancy.
- A 23-year-old G2P1 at 34 weeks is involved in a car accident. She has a contusion on the peri-umbilical area and presents with tetanic uterine contractions. What is the most likely diagnosis?
a. Preterm labor
b. Uterine rupture
c. Placenta abruptio
d. Uterine atony
c. Placenta abruptio
Rationale: The presence of tetanic uterine contractions suggests placental abruption, a life-threatening complication often triggered by trauma.
- What is the most common maternal injury in motor vehicle accidents?
a. Cerebral contusion
b. Uterine rupture
c. Placental abruption
d. Long bone fracture
c. Placental abruption
Explanation:
Placental abruption is the most common maternal injury in motor vehicle accidents (MVAs), occurring in 1–5% of minor crashes and 20–50% of major crashes. The sudden deceleration forces in an MVA can shear the placenta away from the uterine wall, leading to bleeding, fetal distress, or even fetal loss.
- What is the correct way to use an automobile seatbelt during pregnancy?
a. Upper belt above, lower belt below the uterus
b. Both belts above the uterus
c. Lower belt across the abdomen
d. Upper belt over the uterus
a. Upper belt above, lower belt below the uterus
Rationale: Proper seatbelt positioning minimizes uterine compression and protects both the mother and fetus in case of an accident.
- When performing CPR on a pregnant woman, what is the correct positioning?
a. Supine position
b. Left lateral decubitus, ~30° angle
c. Trendelenburg position
d. Right lateral decubitus
b. Left lateral decubitus, ~30° angle
Rationale: Placing the patient at a 30° left lateral tilt reduces aortocaval compression and improves maternal circulation during CPR.
- Which of the following is NOT a physiological change in pregnancy?
a. Increased cardiac output
b. Increased renal plasma flow
c. Increased serum creatinine
d. Decreased systemic vascular resistance
c. Increased serum creatinine
Rationale: Serum creatinine usually decreases due to increased renal clearance and hemodilution in pregnancy.
- Which renal adaptation in pregnancy is TRUE?
a. Renal plasma flow increases by 40%
b. GFR increases by 50%
c. Normal non-pregnant values remain unchanged in pregnancy
d. Estrogen causes vasoconstriction
a. Renal plasma flow increases by 40%
Rationale: Renal plasma flow increases by 40% to accommodate fetal waste removal and maintain maternal fluid balance.
- Which of the following physiologic changes of pregnancy is TRUE?
a. Kidneys decrease in size
b. Increased ureteral reflux
c. Pelvocalyceal constriction
d. Intrarenal vasoconstriction
b. Increased ureteral reflux
Rationale: Ureteral reflux increases due to progesterone-induced smooth muscle relaxation, leading to urinary stasis and increased UTI risk.
- A 21-year-old pregnant woman undergoing a routine prenatal check-up has a urine culture showing 30,000 CFU/mL. She has no medical illnesses and is asymptomatic. What is the most probable diagnosis?
a. Cystitis
b. Pyelonephritis
c. Asymptomatic bacteriuria
d. Ureterolithiasis
c. Asymptomatic bacteriuria
Rationale: Asymptomatic bacteriuria (ASB) is defined as ≥10,000–100,000 CFU/mL of a single bacterial species in a clean-catch urine sample without symptoms of UTI.
- What is the most likely risk factor for asymptomatic bacteriuria in this patient?
a. Diabetes
b. Sexual activity
c. Pregnancy itself
d. Poor hygiene
c. Pregnancy itself
Rationale: Pregnancy increases the risk of ASB due to hormonal and anatomical changes, leading to urinary stasis and vesicoureteral reflux.
- If a pregnant patient has a urine culture of >30,000 CFU/mL, should she be treated?
a. Yes
b. No
a. Yes
Rationale: ASB in pregnancy should always be treated to prevent progression to pyelonephritis, which can lead to maternal and fetal complications.
- What is the drug of choice for treating UTI in pregnancy?
a. Nitrofurantoin
b. Cephalexin
c. Ciprofloxacin
d. Doxycycline
b. Cephalexin
Rationale: Cephalexin is a first-line antibiotic for UTIs in pregnancy due to its safety profile and effectiveness against E. coli. Nitrofurantoin is also used but is avoided near term.
- What is the estimated recurrence rate of UTI in pregnancy?
a. 10%
b. 20%
c. 30%
d. 50%
c. 30%
Rationale: Pregnant women with ASB have a 30% risk of developing recurrent UTIs or pyelonephritis if left untreated.
- When should a test for cure be performed after antibiotic treatment for UTI in pregnancy?
a. 48-72 hours
b. One week
c. Two weeks
d. Four weeks
c. Two weeks
Rationale: A test for cure (repeat urine culture) is recommended two weeks after completing antibiotics to ensure eradication of bacteria and prevent recurrence.
- A 28-year-old multigravida at 27 weeks presents with hematuria, fever, and costovertebral angle tenderness. What is the most probable diagnosis?
a. Acute pyelonephritis
b. Cystitis
c. Ureterolithiasis
d. Urethritis
a. Acute pyelonephritis
Rationale: Acute pyelonephritis in pregnancy presents with fever, flank pain, nausea, vomiting, and costovertebral angle tenderness. It is more common on the right side.
- What is the appropriate treatment for acute pyelonephritis in pregnancy?
a. IV fluids
b. IV antibiotics
c. Pain control
d. All of the above
d. All of the above
Rationale: Acute pyelonephritis in pregnancy requires IV antibiotics (e.g., cephalosporins), IV fluids for hydration, and pain control. Severe cases may require hospitalization.
- A 28-year-old multigravida at 27 weeks presents to the ER with hematuria, fever, and costovertebral angle tenderness. What is the first step in management?
a. Send for urine culture
b. Start oral antibiotics
c. Admit the patient
d. Order a renal ultrasound
c. Admit the patient
Rationale: Pyelonephritis in pregnancy can rapidly progress to sepsis, requiring hospital admission for IV antibiotics, fluids, and close monitoring.
- What is the cornerstone of treatment for acute pyelonephritis in pregnancy?
a. Hydration
b. Diuretics
c. Pain management
d. Foley catheter insertion
a. Hydration
Rationale: IV fluid hydration is crucial to maintain renal perfusion, prevent preterm labor, and promote bacterial clearance.
- In pregnant women treated for pyelonephritis, 99% become afebrile within how many days?
a. 1 day
b. 2 days
c. 3 days
d. 5 days
c. 3 days
Rationale: Most pregnant women with pyelonephritis become afebrile within 72 hours of IV antibiotic therapy. Persistent fever suggests an abscess or resistant infection.
- What is the preferred treatment for pregnant women with recurrent pyelonephritis?
a. Cephalexin
b. Nitrofurantoin
c. Ciprofloxacin
d. Trimethoprim-sulfamethoxazole
b. Nitrofurantoin
Rationale: Nitrofurantoin is used for prophylaxis in pregnant women with recurrent pyelonephritis. It is given as a daily suppressive therapy until delivery.
- What is the best diagnostic tool for intrauterine growth restriction (IUGR)?
a. Fundal height measurement
b. Doppler velocimetry
c. Serial ultrasound
d. Amniotic fluid index
c. Serial ultrasound
Rationale: Serial ultrasound biometry is the gold standard for diagnosing IUGR, tracking fetal growth and estimating fetal weight.
- Which placental abnormality is associated with IUGR?
a. Circumvallate placenta
b. Placenta previa
c. Velamentous cord insertion
d. Succenturiate placenta
a. Circumvallate placenta
Rationale: Circumvallate placenta is linked to placental insufficiency, which can lead to IUGR due to restricted nutrient and oxygen exchange.
- What is a common maternal cause of IUGR?
a. Hypertension
b. Polyhydramnios
c. Gestational diabetes
d. Previous macrosomic pregnancy
a. Hypertension
Rationale: Hypertension (chronic or gestational) leads to placental insufficiency, restricting fetal growth.
- What is a common fetal cause of IUGR?
a. Maternal obesity
b. Multiple pregnancy
c. Polyhydramnios
d. Macrosomia
b. Multiple pregnancy
Rationale: Twin-to-twin transfusion syndrome (TTTS) and unequal placental sharing in multiple pregnancies can cause growth restriction in one or more fetuses.
- What is the role of umbilical artery Doppler in IUGR?
a. Measures amniotic fluid volume
b. Assesses adequate uteroplacental perfusion
c. Estimates fetal heart rate variability
d. Detects fetal lung maturity
b. Assesses adequate uteroplacental perfusion
Rationale: Umbilical artery Doppler velocimetry evaluates blood flow resistance. Absent or reversed end-diastolic flow suggests severe placental insufficiency.
- What does middle cerebral artery (MCA) Doppler assess in IUGR?
a. Fetal renal perfusion
b. Brain-sparing phenomenon
c. Amniotic fluid index
d. Liver size
b. Brain-sparing phenomenon
Rationale: MCA Doppler detects brain-sparing, a compensatory response where blood is preferentially shunted to the fetal brain due to placental insufficiency.
- What is a fetal factor that influences growth?
a. Gender
b. Maternal height
c. Uterine position
d. Placental weight
a. Gender
Rationale: Male fetuses tend to be larger than female fetuses due to genetic and hormonal differences.
- What is a common sign of oligohydramnios in pregnancy?
a. Polyuria
b. Maternal dehydration
c. Watery vaginal discharge
d. Fetal tachycardia
c. Watery vaginal discharge
Rationale: Oligohydramnios may result from rupture of membranes, causing watery vaginal discharge due to amniotic fluid leakage.
- What is the best test to assess a term IUGR fetus?
a. Contraction stress test (CST)
b. Non-stress test (NST)
c. Amniotic fluid index (AFI)
d. Doppler velocimetry
a. Contraction stress test (CST)
Rationale: CST evaluates fetal well-being by assessing fetal heart rate response to uterine contractions in suspected IUGR at term.
- How is IUGR best diagnosed?
a. Fundal height measurement
b. Serial ultrasound
c. Doppler velocimetry
d. Maternal weight gain assessment
b. Serial ultrasound
Rationale: Serial ultrasound biometry is the most accurate method for diagnosing and monitoring IUGR.
- IUGR is definitively diagnosed when:
a. Fundal height lags behind gestational age
b. Fetal ultrasound growth estimates plateau
c. Doppler shows decreased umbilical artery flow
d. Oligohydramnios is present
b. Fetal ultrasound growth estimates plateau
Rationale: Failure of fetal growth progression on serial ultrasounds is a defining feature of IUGR.
- In which pregnancy is IUGR most likely to occur?
a. Singleton pregnancy
b. Twin pregnancy
c. Triplet pregnancy
d. Quadruplet pregnancy
d. Quadruplet pregnancy
Rationale: Higher-order multiple pre
- Fetuses with congenital anomalies usually present with:
a. Early onset of growth restriction
b. Polyhydramnios
c. Hyperactive movements
d. Increased amniotic fluid index
a. Early onset of growth restriction
Rationale: Congenital anomalies often cause early-onset IUGR due to structural or metabolic defects affecting fetal growth.
- The brain-sparing phenomenon results in:
a. Increased abdominal circumference
b. Fetal growth restriction
c. Improved lung maturity
d. Increased amniotic fluid index
b. Fetal growth restriction
Rationale: Brain-sparing redistributes blood flow to the brain at the expense of other organs, leading to asymmetric IUGR with a smaller abdominal circumference.
- What is the best predictor of the brain-sparing phenomenon in IUGR?
a. Head circumference
b. Abdominal circumference
c. Amniotic fluid index
d. Femur length
b. Abdominal circumference
Rationale: Abdominal circumference is the most sensitive parameter for detecting brain-sparing because it reflects reduced liver perfusion and fetal malnutrition.
- What is the mechanism by which cytomegalovirus (CMV) infection causes intrauterine growth restriction (IUGR)?
a. Placental infarction
b. Cytolysis and loss of functioning cells
c. Reduced placental perfusion
d. Decreased fetal movement
b. Cytolysis and loss of functioning cells
Rationale: CMV is a lytic virus that causes cytopathic effects, leading to cellular destruction and dysfunction, which contributes to IUGR.
- Which of the following is true about asymmetrical IUGR?
a. It is most commonly seen among preeclamptic patients with severe features
b. It is associated with fetal chromosomal abnormalities
c. It usually presents in the first trimester
d. It has a better prognosis than symmetrical IUGR
a. It is most commonly seen among preeclamptic patients with severe features
Rationale: Preeclampsia causes placental insufficiency, leading to asymmetrical IUGR, where the brain is spared but the abdomen and liver are disproportionately small.
- What is the recommended intervention to prevent meconium aspiration syndrome (MAS) in a newborn with thick meconium staining?
a. Immediate suctioning before delivery
b. Do direct laryngeal suctioning on resuscitation
c. Perform early amnioinfusion
d. Delay delivery until spontaneous clearance
b. Do direct laryngeal suctioning on resuscitation
Rationale: Direct laryngeal suctioning during resuscitation removes thick meconium from the airway, preventing meconium aspiration syndrome (MAS).
- What is the precise definition of macrosomia?
a. Birth weight > 4,500 g
b. Birth weight > 4,000 g
c. Non-existent and thus controversial
d. Birth weight > 90th percentile
a. Birth weight > 4,500 g
⸻
Explanation:
Macrosomia is precisely defined as a birth weight greater than 4,500 grams (4.5 kg) regardless of gestational age. This is the most widely accepted clinical definition, especially in the context of increased risk for delivery complications (e.g., shoulder dystocia, birth trauma, cesarean delivery).
- A 38-year-old G3P2 at 39 weeks presents after 10 hours of labor with contractions every 15 minutes, 8 cm dilated, fully effaced. What should be monitored?
a. Arrest of dilation
b. Arrest of descent
c. Uterine rupture
d. Cord prolapse
b. Arrest of descent
Rationale: Failure of fetal descent in active labor can indicate cephalopelvic disproportion (CPD) or inadequate uterine contractions, requiring further evaluation.
- A 28-year-old G1P0 at 30 weeks presents to the ER with decreased fetal movements. Ultrasound at 37 weeks shows a 3.4 kg fetus. What is the most likely diagnosis?
a. Fetal macrosomia secondary to gestational diabetes mellitus (GDM)
b. IUGR due to placental insufficiency
c. Polyhydramnios
d. Oligohydramnios
a. Fetal macrosomia secondary to gestational diabetes mellitus (GDM)
Rationale: A fetus weighing 3.4 kg at 37 weeks is large for gestational age (LGA), commonly associated with GDM-induced fetal overgrowth.
- What is an antepartum sign suggestive of a macrosomic fetus?
a. Polyhydramnios
b. Maternal weight gain
c. Reduced fetal movement
d. Low amniotic fluid index
b. Maternal weight gain
Rationale: Excessive maternal weight gain increases the risk of fetal macrosomia, particularly in pregnancies complicated by GDM or obesity.
- What is a potential maternal complication associated with fetal macrosomia?
a. Postpartum hemorrhage
b. Shoulder dystocia
c. Umbilical cord prolapse
d. Preterm labor
a. Postpartum hemorrhage
Rationale: Macrosomia increases the risk of uterine atony, postpartum hemorrhage, and birth canal trauma due to the large fetal size.
- Macrosomic fetuses are at special risk for which neonatal complication?
a. Hypoplastic left heart syndrome
b. Brachial plexus palsy
c. Neonatal hypoglycemia
d. Tetralogy of Fallot
b. Brachial plexus palsy
Rationale: Shoulder dystocia in macrosomic fetuses increases the risk of brachial plexus injury, particularly Erb’s palsy due to excessive traction on the shoulder during delivery.
- During pregnancy, cardiac output will increase by:
a. 10-20%
b. 20-30%
c. 30-50%
d. 50-70%
c. 30-50%
Rationale: Cardiac output increases by 30-50% due to increased blood volume and stroke volume, ensuring adequate perfusion to the placenta and fetus.
- Systemic vascular resistance decreases during pregnancy due to which factor?
a. Increased catecholamines
b. Increased progesterone and estrogen
c. Increased cardiac contractility
d. Increased plasma osmolarity
b. Increased progesterone and estrogen
Rationale: Estrogen and progesterone induce vasodilation, reducing systemic vascular resistance and lowering blood pressure in early pregnancy.
- A 21-year-old G1 at 30 weeks AOG has increased afterload and decreased cardiac return due to:
a. Increased maternal metabolic demand
b. Uteroplacental shunting
c. Compression of the aorta & the vena cava
d. Increased catecholamine levels
c. Compression of the aorta & the vena cava
Rationale: The gravid uterus compresses the inferior vena cava and aorta, reducing venous return and leading to supine hypotensive syndrome.
- Successful maternal-fetal circulation is accomplished by:
a. Increased maternal erythropoiesis
b. Placental enlargement
c. Structural modification of the trophoblast on maternal arteries
d. Increased uterine contractility
c. Structural modification of the trophoblast on maternal arteries
Rationale: The trophoblast remodels spiral arteries, reducing vascular resistance and increasing blood flow to the placenta.
- To assess the hemodynamic capacity of a pregnant woman, what is the best position?
a. Supine
b. Right lateral decubitus
c. Left lateral decubitus
d. Semi-Fowler’s
c. Left lateral decubitus
Rationale: The left lateral decubitus position relieves aortocaval compression, improving venous return and cardiac output.
- During pregnancy, functional residual capacity (FRC) usually:
a. Increases
b. Decreases
c. Remains unchanged
b. Decreases
Rationale: FRC decreases by 10-25% due to diaphragmatic elevation from the expanding uterus, leading to reduced lung volume.
- By how much does the glomerular filtration rate (GFR) increase during pregnancy?
a. 30%
b. 40%
c. 50%
d. 60%
b. 40%
Rationale: GFR increases by 40% due to renal hyperfiltration required for fetal metabolic waste clearance and maternal fluid balance.
- A 32-year-old G1P0 at 34 weeks AOG, who enjoys eating chocolates, frequently experiences GERD when lying down. What is the most likely cause?
a. Increased intra-abdominal pressure
b. Delayed gastric emptying
c. Increased hormonal progesterone
d. Uterine displacement of the stomach
c. Increased hormonal progesterone
Rationale: Progesterone relaxes the lower esophageal sphincter, increasing the risk of acid reflux (GERD), especially in the supine position.
- What is the most common indication for abdominal exploration in pregnancy?
a. Ectopic pregnancy
b. Appendicitis
c. Cholecystitis
d. Missed abortion
e. All of the above
e. All of the above
Rationale: Ectopic pregnancy, appendicitis, and cholecystitis are leading causes of surgical intervention during pregnancy.
- A 32-year-old G2P1 at 32 weeks AOG presents with nausea, vomiting, and fever. Murphy’s sign is best elicited in which location?
a. Right upper quadrant
b. Epigastric region
c. Right subchondral area
d. Left lower quadrant
c. Right subchondral area
Rationale: In pregnancy, the gallbladder is displaced upward by the uterus, making Murphy’s sign palpable in the right subchondral area.
- During pregnancy, functional residual capacity (FRC) usually:
a. Increases
b. Decreases
c. Remains unchanged
b. Decreases
Rationale: FRC declines due to the upward displacement of the diaphragm, reducing lung volumes and increasing the risk of dyspnea.
- What is the primary cause of respiratory alkalosis during pregnancy?
a. Increased progesterone
b. Increased cortisol
c. Increased estrogen
d. Increased tidal volume
a. Increased progesterone
Rationale: Progesterone stimulates the respiratory center, increasing tidal volume and minute ventilation, leading to mild respiratory alkalosis.
- A 24-year-old G1P1 presents with nausea, vomiting, loss of appetite, stable vital signs, and RLQ rebound tenderness. What is the least likely diagnosis?
a. Acute appendicitis
b. Ectopic pregnancy
c. Ovarian torsion
d. Acute cholecystitis
d. Acute cholecystitis
Rationale: Acute cholecystitis typically presents with RUQ pain, fever, and nausea, whereas RLQ pain is more suggestive of appendicitis, ectopic pregnancy, or ovarian pathology.
- What is the most likely diagnosis in this patient with RLQ pain, nausea, and rebound tenderness?
a. Acute appendicitis
b. Ectopic pregnancy
c. Ovarian torsion
d. Ureterolithiasis
a. Acute appendicitis
Rationale: Appendicitis is the most common non-obstetric surgical emergency in pregnancy. Classic presentation includes RLQ pain, nausea, and rebound tenderness.
- What is the appropriate management for acute appendicitis in pregnancy?
a. IV antibiotics only
b. Surgical exploration
c. Observation
d. High-fiber diet
b. Surgical exploration
Rationale: Appendectomy is the definitive treatment to prevent perforation, sepsis, and fetal complications.
- What is the best diagnostic imaging modality for appendicitis in pregnancy?
a. Ultrasound
b. CT Scan
c. MRI
d. A and B
d. A and B (CT Scan and MRI)
Rationale: MRI is preferred over CT to avoid radiation exposure, but CT is more sensitive when ultrasound is inconclusive.
- If the patient develops generalized peritonitis, the prognosis is:
a. Good
b. Poor
c. Unchanged
d. Improved with antibiotics alone
b. Poor
Rationale: Generalized peritonitis significantly increases the risk of sepsis, preterm labor, and maternal morbidity. Immediate surgical intervention is required.
- What is the likelihood of abortion in a pregnant patient with generalized peritonitis?
a. Increased
b. Decreased
c. Unchanged
d. No effect
a. Increased
Rationale: Peritonitis increases uterine irritability and inflammatory cytokines, which can trigger preterm labor or spontaneous abortion.
- A 45-year-old G5P4 at 32 weeks AOG presents with RUQ pain and nausea. What is the most likely diagnosis?
a. Acute appendicitis
b. Acute cholecystitis
c. Preeclampsia
d. HELLP syndrome
b. Acute cholecystitis
Rationale: Acute cholecystitis is common in pregnancy, especially in multiparous women and those >40 years old, due to hormonal effects on gallbladder motility.
- What is the most likely cause of acute cholecystitis in this patient?
a. Bacterial infection
b. Cholesterol stones
c. Hemolysis
d. Viral hepatitis
b. Cholesterol stones
Rationale: Pregnancy increases gallbladder stasis and cholesterol saturation, leading to cholesterol gallstone formation, the primary cause of acute cholecystitis.
- How can some cases of acute cholecystitis be managed conservatively?
a. Antibiotics
b. Analgesics
c. Surgery
d. All of the above
d. All of the above
Rationale: Mild cases may be managed with IV antibiotics and analgesics, but surgery (cholecystectomy) is required if symptoms persist or complications develop.
- A 45-year-old G5P4 (4004) at 32 weeks AOG presents with severe abdominal pain, RUQ rebound tenderness, nausea, and vomiting. What is the risk factor for her condition, EXCEPT?
a. Age
b. Gender
c. Parity
d. AOTA
NOTA (None of the Above)
Rationale: Advanced maternal age, female gender, and multiparity are all risk factors for gallbladder disease in pregnancy due to hormonal effects on gallbladder motility and bile composition.
- A 23-year-old G2P1 presents with sudden severe abdominal pain and fetal distress. The patient is most likely experiencing:
a. Uterine rupture
b. Placenta previa
c. Placenta abruptio
d. B and C
d. B and C
Rationale: Placental abruption presents with sudden-onset abdominal pain, uterine tenderness, and fetal distress. Placenta previa should also be considered in cases of painless vaginal bleeding.
- What is the most common maternal injury in motor vehicle accidents during pregnancy?
a. Placental abruption
b. Pulmonary contusion and uterine rupture
c. Lower limb fractures
d. Traumatic brain injury
a. Placental abruption
- What is the correct way to use an automobile seatbelt during pregnancy?
a. Upper belt is placed over the uterus, and the lower belt is across the abdomen
b. Upper belt is above the uterus, and the lower belt fits snugly across the upper thighs and well below the uterus
c. Both belts should be placed below the uterus to prevent compression
d. Seatbelts should be avoided in pregnancy
b. Upper belt is above the uterus, and the lower belt fits snugly across the upper thighs and well below the uterus
Rationale: Proper seatbelt use prevents direct uterine trauma and reduces the risk of placental abruption and fetal injury in a crash.
- What medication is recommended for administration during adult cardiac arrest?
a. 1 mg epinephrine IV/IO every 3 to 5 minutes
b. 10 mg epinephrine IV/IO every 3 to 5 minutes
c. 10 mg epinephrine IV/IO every 5 to 10 minutes
d. None of the above
a. 1 mg epinephrine IV/IO every 3 to 5 minutes
Rationale: According to Advanced Cardiac Life Support (ACLS) guidelines, 1 mg epinephrine IV/IO is administered every 3 to 5 minutes during cardiac arrest to enhance myocardial perfusion and increase chances of return of spontaneous circulation (ROSC).
- TRUE or FALSE: Medication doses do not require alteration to accommodate the physiological changes of pregnancy.
a. TRUE
b. FALSE
b. FALSE
Rationale: Pregnancy alters drug pharmacokinetics due to increased plasma volume, renal clearance, and hepatic metabolism. Some drugs require dose adjustments to maintain therapeutic levels while avoiding fetal risks.
- TRUE or FALSE: Cardiac output in pregnancy increases by 30% to 50%.
a. TRUE
b. FALSE
a. TRUE
Rationale: Cardiac output increases by 30-50% during pregnancy due to increased stroke volume and heart rate, ensuring adequate perfusion to the placenta and fetus.
- A significant increase in ejection fraction (8%) and stroke volume (27%) in the left lateral position occurs at what gestational age?
a. 20 weeks
b. 32 weeks
c. 36 weeks
d. 25 weeks
b. 32 weeks
Rationale: At 32 weeks AOG, cardiac output is near its peak, and the left lateral position optimizes venous return by reducing aortocaval compression by the gravid uterus.
- A pregnant patient at 16 weeks and 3 days undergoes ultrasound to determine the fetal gender. The scan reveals a single intrauterine pregnancy in breech presentation with a single deepest pocket (SDP) of 1.3 cm, but the gender was not determined. What is the appropriate interpretation of the ultrasound result?
a. Everything is going well with her pregnancy. The AOG is just too early for gender determination.
b. Suspicion of IUGR is in order.
c. Additional tests such as BPS and Doppler velocimetry must be requested.
d. Suspicion of fetal congenital anomaly should be raised.
b. Suspicion of IUGR is in order.
Rationale: An SDP of 1.3 cm suggests oligohydramnios, which is associated with intrauterine growth restriction (IUGR). Further evaluation with Doppler velocimetry and biophysical profile (BPS) is warranted.
- What is the most common cause of oligohydramnios?
a. Congenital anomaly such as esophageal atresia
b. IUGR
c. Hypertensive disorders in pregnancy
d. Ruptured membranes
d. Ruptured membranes
Rationale: Premature rupture of membranes (PROM) is the most common cause of oligohydramnios, leading to decreased amniotic fluid levels and increased risk of fetal complications.
- Which of the following is a placental cause of IUGR?
a. Megaplacenta
b. Circumvallate placenta
c. Placenta previa
d. Complete hydatidiform mole
b. Circumvallate placenta
Rationale: Circumvallate placenta is associated with placental insufficiency, which can restrict fetal growth and lead to IUGR.
- What is the most appropriate surveillance test for a term IUGR fetus?
a. Doppler velocimetry
b. Contraction stress test
c. Non-stress test
d. Biophysical profile
b. Contraction stress test (CST)
Rationale: CST assesses fetal well-being by monitoring fetal heart rate (FHR) response to contractions, helping determine fetal reserve and placental function in term IUGR cases.
- What is a recognized maternal morbidity associated with macrosomia?
a. Brachial plexus injury
b. Metabolic acidosis
c. Increased cesarean section (CS) rates
d. Clavicular fractures
c. Increased cesarean section (CS) rates
Rationale: Macrosomia increases the likelihood of labor complications, including cephalopelvic disproportion (CPD), prolonged labor, and increased need for cesarean delivery.
- During labor, which of the following is a sign that fetal macrosomia may be present?
a. Arrest of descent of the presenting part
b. Meconium staining of amniotic fluid
c. Non-reassuring fetal status
d. Uncontrolled maternal diabetes mellitus
a. Arrest of descent of the presenting part
Rationale: Macrosomia increases the risk of cephalopelvic disproportion (CPD), leading to prolonged labor and arrest of descent.
- A 41-year-old G6P5 (5-0-0-5) at 40 weeks presents in labor. She has a history of forceps delivery due to exhaustion and is currently on insulin therapy for gestational diabetes. Fundal height is 41 cm, estimated fetal weight (EFW) is 4 kg, cervix is 1-2 cm dilated, and there is thick meconium-stained amniotic fluid. What is the most appropriate next step?
a. Request an ultrasound for fetal weight estimation
b. Hook the patient to a fetal monitor
c. Allow the patient to go for a trial of labor
d. Perform a lower transverse cesarean section (LTCS) and offer bilateral tubal ligation (BTL)
d. Perform a lower transverse cesarean section (LTCS) and offer bilateral tubal ligation (BTL)
Rationale: The combination of macrosomia (EFW 4 kg), insulin-dependent diabetes, and thick meconium-stained fluid increases the risk of shoulder dystocia and birth complications, warranting an elective cesarean delivery.
- What is the most helpful maneuver to prevent or manage shoulder dystocia?
a. Application of fundal pressure during contractions
b. Strong suprapubic pressure by an assistant
c. Assisting the baby to accomplish external rotation
d. Forceful downward traction of the fetal head toward the rectum
b. Strong suprapubic pressure by an assistant
Rationale: Suprapubic pressure helps dislodge the anterior shoulder from the pubic symphysis, reducing the risk of brachial plexus injury. Fundal pressure should be avoided as it worsens impaction.
- What is an antepartum clue suggesting the presence of fetal macrosomia?
a. Prolonged second stage of labor
b. Elderly primigravida
c. Diabetes mellitus
d. Need for operative delivery
c. Diabetes mellitus
Rationale: Gestational diabetes and poorly controlled diabetes mellitus (DM) are strong risk factors for fetal macrosomia, leading to complications such as shoulder dystocia and birth trauma.
