LE3 OB

Question 1

Which of the following characterizes type 2 diabetes?

A. Absolute insulin deficiency
B. Idiopathic basal destruction
C. Predominantly insulin resistance
D. Turner syndrome

Answer 1

C. Predominantly insulin resistance

Rationale: Type 2 diabetes is characterized by insulin resistance, where the body’s cells become less responsive to insulin, leading to decreased uptake of glucose from the bloodstream. This results in elevated blood glucose levels. Initially, the pancreas tries to compensate by producing more insulin. Over time, however, the pancreas may become less effective, leading to relative insulin deficiency. Unlike type 1 diabetes, type 2 diabetes does not involve complete or absolute insulin deficiency. Insulin resistance is often associated with obesity, physical inactivity, and genetic factors.

Question 2

What is the definition of gestational diabetes mellitus (GDM)?

A. Diabetes diagnosed in pregnancy but not type 1 or type 2
B. Diabetes diagnosed in pregnancy but controlled with insulin
C. Diabetes diagnosed in pregnancy and persisting after delivery

Answer 2

A. Diabetes diagnosed in pregnancy but not type 1 or type 2

Rationale: Gestational diabetes mellitus (GDM) is defined as diabetes diagnosed during pregnancy that is not overt type 1 or type 2 diabetes. GDM is characterized by glucose intolerance that develops or is first recognized during pregnancy. It is different from pre-existing diabetes, which occurs before conception.

Question 3

Which of the following is a high-risk factor for developing gestational diabetes mellitus?

A. Severe obesity
B. Previous preterm birth
C. History of miscarriage
D. Asthma

Answer 3

A. Severe obesity

Rationale: Severe obesity (BMI ≥30) is a major risk factor for gestational diabetes mellitus (GDM) due to its association with insulin resistance. Obesity can impair insulin sensitivity, leading to elevated blood glucose levels during pregnancy. Other high-risk factors include advanced maternal age, previous history of GDM, and a family history of diabetes.

Question 4

Which of the following fasting blood sugar levels in pregnancy indicates pre-gestational diabetes?

A. FBS > 7.5 mmol/L (135 mg/dL)
B. FBS > 6.0 mmol/L (108 mg/dL)
C. FBS > 5.5 mmol/L (100 mg/dL)
D. FBS < 4.0 mmol/L (72 mg/dL)

Answer 4

A. FBS > 7.5 mmol/L (135 mg/dL)

Rationale: A fasting blood sugar level greater than 7.5 mmol/L (135 mg/dL) during pregnancy is indicative of pre-gestational diabetes. Elevated fasting blood sugar levels suggest that the patient may have undiagnosed type 1 or type 2 diabetes before pregnancy, which requires specific management.

Question 5

Which congenital anomaly is most likely to develop in a 39-year-old G3P2 woman with a random blood sugar (RBS) of 280 mg/dL?

A. Cardiac anomaly
B. Neural tube defect
C. Facial cleft
D. Kidney malformation

Answer 5

A. Cardiac anomaly

Rationale: Maternal hyperglycemia is associated with an increased risk of congenital anomalies, particularly cardiac anomalies, in the developing fetus. Elevated blood glucose levels can lead to abnormalities during organogenesis, which occurs early in fetal development. Cardiac defects, such as ventricular septal defects (VSD), are among the most common congenital anomalies associated with maternal diabetes.

Question 6

A 33-year-old G1P0 at 36 weeks gestation has a blood glucose level of more than 140 mg/dL. Which neonatal complication is likely?

A. Macrosomia
B. Intrauterine growth restriction (IUGR)
C. Preterm birth
D. Neonatal jaundice

Answer 6

A. Macrosomia

Rationale: Elevated maternal blood glucose levels can lead to fetal hyperinsulinemia, causing increased growth and macrosomia (large birth weight). Neonates of mothers with poorly controlled blood glucose during pregnancy are at increased risk for macrosomia, which can complicate delivery and result in birth injuries such as shoulder dystocia.

Question 7

Which of the following organs is not affected by maternal hyperinsulinemia in a developing fetus?

A. Brain
B. Kidneys
C. Liver
D. Fat deposition in the trunk

Answer 7

A. Brain

Rationale: Maternal hyperinsulinemia acts as a growth factor, leading to increased fetal growth, particularly in adipose tissue, liver, and kidneys. However, the brain is less sensitive to the effects of hyperinsulinemia compared to other organs, and brain growth is generally not affected by maternal diabetes.

Question 8

What is the most likely complication during delivery for a fetus with macrosomia?

A. Shoulder dystocia
B. Umbilical cord prolapse
C. Placenta previa
D. Breech presentation

Answer 8

A. Shoulder dystocia

Rationale: Shoulder dystocia is a common complication associated with the delivery of macrosomic infants. It occurs when the fetal shoulders become impacted behind the maternal pubic bone after the delivery of the head, making delivery difficult and increasing the risk of birth injury.

Question 9

What neonatal trauma is likely to occur as a result of shoulder dystocia?

A. Brachial plexus palsy
B. Clavicle fracture
C. Skull fracture
D. Diaphragmatic paralysis

Answer 9

A. Brachial plexus palsy

Rationale: Shoulder dystocia can lead to brachial plexus palsy due to excessive lateral traction during delivery. This injury affects the nerves running through the shoulder and arm, potentially leading to weakness or paralysis of the affected limb.

Question 10

Which of the following diabetic vasculopathies is most likely to worsen in a 40-year-old G4P3 woman with a fasting blood sugar of 140 mg/dL?

A. Neuropathy
B. Nephropathy
C. Retinopathy
D. Gastropathy

Answer 10

C. Retinopathy

Rationale: Diabetic retinopathy is likely to worsen in patients with uncontrolled hyperglycemia, especially during pregnancy when metabolic demands are increased. Elevated blood sugar can damage retinal blood vessels, leading to or worsening retinopathy. Regular ophthalmologic evaluation is important for managing diabetic patients during pregnancy.

Question 11

11. A patient presents with recurrent vaginal discharge and pruritus. What is the most likely causative agent of this condition?

A. Candida albicans
B. Trichomonas vaginalis
C. Gardnerella vaginalis

Answer 11

A. Candida albicans

Rationale: Recurrent vaginal discharge with pruritus is most commonly caused by a yeast infection due to Candida albicans. This condition typically presents with a thick, white, curd-like discharge and significant itching. Trichomonas vaginalis and Gardnerella vaginalis are also causes of vaginal discharge, but they typically present with different characteristics, such as a foul smell and frothy discharge (Trichomonas) or a fishy odor (Gardnerella).

Question 12

12. A 34-year-old G3P2 woman at 32 weeks AOG presented to the ER with labor pains. Her random blood sugar was 240 mg/dL, and she was started on tocolytic therapy, including betamimetic agents, and corticosteroids for fetal lung maturity. She became obtunded. What is the most likely cause of her altered state of consciousness?

A. Diabetic ketoacidosis
B. Hypoglycemia
C. Hyperglycemic hyperosmolar state
D. Eclampsia
E. Intracranial hemorrhage

Answer 12

A. Diabetic ketoacidosis

Rationale: The patient’s high random blood sugar (240 mg/dL), combined with the stress of preterm labor and corticosteroid administration, increases her risk for diabetic ketoacidosis (DKA). DKA is a complication of diabetes characterized by hyperglycemia, ketosis, and metabolic acidosis, and it can lead to obtundation. Betamimetic agents and corticosteroids further exacerbate hyperglycemia. DKA requires urgent treatment with insulin and fluids.

Question 13

13. What is the cornerstone of management for a patient with diabetic ketoacidosis (DKA)?

A. Insulin and vigorous rehydration
B. Diuresis and furosemide
C. Epinephrine
D. Magnesium sulfate
E. Bicarbonate

Answer 13

A. Insulin and vigorous rehydration

Rationale: The management of DKA involves correcting hyperglycemia with insulin and addressing dehydration with intravenous fluids. Rehydration is critical to restore circulatory volume, while insulin is needed to lower blood glucose and suppress ketogenesis. Furosemide and epinephrine are not indicated for DKA, and bicarbonate is only used in severe acidosis (pH < 7.0).

Question 14

14. A 30-year-old G1P0 woman at 7 weeks AOG has a strong family history of diabetes. A 75 g OGTT showed the following values: FBS 90 mg/dL, 1-hour 140 mg/dL, 2-hour 120 mg/dL. What will be included in the management of this patient?

A. Diabetic diet
B. Exercise
C. Insulin treatment
D. Repeat OGTT at 24 weeks

Answer 14

D. Repeat OGTT at 24 weeks

Rationale: The patient’s current OGTT results are within the normal range for early pregnancy, but her strong family history of diabetes places her at risk for developing gestational diabetes. Therefore, repeating the OGTT at 24–28 weeks is recommended for re-evaluation, as glucose tolerance tends to worsen during the second and third trimesters.

Question 15

15. What is the contraceptive of choice after delivery for this patient with good glycemic control?

A. Low dose combined COC
B. Levonorgestrel IUD
C. Implant
D. DMPA

Answer 15

A. Low dose combined COC

Rationale: For a patient with good glycemic control postpartum, a low dose combined oral contraceptive (COC) can be considered as a contraceptive option. However, it is important to wait until at least 6 weeks postpartum if breastfeeding, as combined hormonal contraceptives can interfere with milk production. For patients with diabetes who are not breastfeeding, a low dose combined COC may be suitable if glycemic control is stable and there are no contraindications such as vascular complications. Other contraceptive options, such as a Levonorgestrel IUD or implant, are also effective and preferred in some cases due to minimal systemic hormonal effects and reduced impact on glucose metabolism. The choice should ultimately be individualized based on patient preference, medical history, and breastfeeding status.

Question 16

16. A 33-year-old G2P1 woman with a history of GDM underwent a 75 g OGTT at 7 weeks AOG with the following results: FBS 100 mg/dL (high), 1-hour 185 mg/dL (high), 2-hour 150 mg/dL (high). Which of the following shows adequate diabetic control?

A. FBS 95 mg/dL
B. 2-hour 140 mg/dL
C. 1-hour 150 mg/dL
D. HbA1c 5.2%

Answer 16

D. HbA1c 5.2%

Rationale: An HbA1c of 5.2% indicates adequate glycemic control. FBS, 1-hour, and 2-hour postprandial values need to meet specific targets in pregnancy, but HbA1c provides a broader measure of average blood glucose over time. Maintaining an HbA1c below 6% is generally considered good control during pregnancy.

Question 17

17. At what glucose level will insulin be required for the control of diabetes?

A. FBS 92 mg/dL
B. 1-hour 110 mg/dL
C. 2-hour 100 mg/dL
D. Random blood sugar 200 mg/dL

Answer 17

D. Random blood sugar 200 mg/dL

Rationale: A random blood sugar level of 200 mg/dL or higher is indicative of diabetes, particularly if accompanied by symptoms. Insulin therapy may be required when hyperglycemia cannot be controlled by diet and exercise alone, especially to prevent complications during pregnancy.

Question 18

18. Which of the following treatments for diabetes is NOT recommended for pregnant women?

A. Lispro
B. Aspart
C. Glyburide
D. Regular insulin

Answer 18

C. Glyburide

Rationale: Glyburide, an oral sulfonylurea, is generally not recommended during pregnancy due to potential risks of hypoglycemia in the neonate and transfer across the placenta. Insulin analogs such as Lispro and Aspart, as well as regular insulin, are preferred treatments as they are safe and effective in maintaining glucose control.

Question 19

19. In planning a diet for a patient with diabetes, which of the following is recommended?

A. 20-25 kcal/kg body weight
B. 40% carbohydrates
C. 20% fat
D. 40% protein

Answer 19

B. 40% carbohydrates

Rationale: A balanced diet for diabetes management typically includes about 40-50% of daily caloric intake from carbohydrates, 30-35% from fats, and 15-20% from proteins. A controlled carbohydrate intake is essential to maintain blood sugar levels, especially during pregnancy.

Question 20

20. At what gestational age is a targeted ultrasound for congenital anomalies performed?

A. 6-8 weeks
B. 11-13 weeks
C. 18-24 weeks
D. 28-34 weeks

Answer 20

C. 18-24 weeks

Rationale: A targeted ultrasound for congenital anomalies is typically performed between 18-24 weeks of gestation, which allows for detailed assessment of fetal anatomy. This timing is optimal for detecting most major congenital abnormalities, allowing appropriate counseling and planning for management if needed.

Question 21

21. At what gestational age (AOG) should antenatal surveillance with biophysical profile (BPS) be done for this patient if she remains euglycemic during pregnancy?

A. 20 weeks
B. 24 weeks
C. 28 weeks
D. 34 weeks

Answer 21

D. 34 weeks

Rationale: In women with well-controlled diabetes and no other complications, antenatal surveillance with a biophysical profile (BPS) generally begins around 34 weeks gestation. Surveillance may be started earlier if there are additional risk factors or poor glycemic control. The BPS helps assess fetal well-being, including movement, breathing, tone, and amniotic fluid levels, to ensure the pregnancy is progressing normally.

Question 22

22. When is the ideal time to terminate pregnancy for a patient with good glycemic control?

A. 37 weeks
B. 38 weeks
C. 39 weeks
D. 40 weeks

Answer 22

B. 38 weeks

Rationale: For patients with good glycemic control, delivery is typically recommended at 38 weeks gestation. Delivering at this time aims to balance the risks of stillbirth associated with diabetes and the potential complications of preterm birth. The timing ensures fetal lung maturity while minimizing the risk of adverse maternal and fetal outcomes.

Question 23

23. After delivery, this patient has normal glucose levels. Which of the following will be recommended for her?

A. 75g OGTT after 6-12 months postpartum
B. Annual 75g OGTT
C. Triannual fasting blood sugar (FBS)
D. Pre-pregnancy HbA1c

Answer 23

A. 75g OGTT after 6-12 months postpartum

Rationale: Women with gestational diabetes mellitus (GDM) should have a 75g OGTT 6-12 weeks postpartum to evaluate for persistent glucose intolerance. If glucose levels are normal, follow-up with annual screening is recommended due to the increased lifetime risk of developing type 2 diabetes.

Question 24

24. Which of the following statements is true about thyroid function in pregnancy?

A. Radioactive iodine treatment is the treatment of choice for thyrotoxicosis
B. Autoimmune thyroid disease is more common in men than in women
C. hCG stimulates thyroid-stimulating hormone (TSH) receptors
D. A high prevalence of X chromosome-positive fetal lymphocytes entering the maternal circulation

Answer 24

C. hCG stimulates thyroid-stimulating hormone (TSH) receptors

Rationale: Human chorionic gonadotropin (hCG), produced by the placenta, can stimulate TSH receptors because of its similarity to TSH, leading to increased production of thyroid hormones during early pregnancy. This can cause a mild hyperthyroid state, especially in the first trimester.

Question 25

25. A 35-year-old primigravida at 16 weeks AOG complains of palpitations. On examination, she has tachycardia, an anterior neck mass, and exophthalmos. What is the most likely diagnosis?

A. Hyperthyroidism
B. Hypothyroidism
C. Nodular non-toxic goiter
D. Thyroid carcinoma

Answer 25

A. Hyperthyroidism

Rationale: The patient’s symptoms, including palpitations, tachycardia, an anterior neck mass (goiter), and exophthalmos, are characteristic of hyperthyroidism. These symptoms are often associated with Graves’ disease, the most common cause of hyperthyroidism in pregnancy.

Question 26

26. A 35-year-old primigravida at 16 weeks AOG complains of palpitations. On examination, she has tachycardia, an anterior neck mass, and exophthalmos. Which of the following will confirm the diagnosis?

A. Thyroxine-binding globulin (TBG)
B. Thyrotropin-releasing hormone (TRH)
C. Thyroid-stimulating hormone (TSH)
D. T3 and T4

Answer 26

C. Thyroid-stimulating hormone (TSH)

Rationale: TSH is the first-line test in evaluating thyroid function. In hyperthyroidism, TSH is typically suppressed, and T3 and T4 are elevated. Measurement of free T4 may also be required to confirm the diagnosis and assess the severity of hyperthyroidism.

Question 27

27. A 35-year-old primigravida at 16 weeks AOG complains of palpitations. On examination, she has tachycardia, an anterior neck mass, and exophthalmos. What is the treatment of choice for this patient?

A. Propylthiouracil (PTU)
B. Methimazole
C. Radioactive iodine treatment
D. Subtotal thyroidectomy

Answer 27

A. Propylthiouracil (PTU)

Rationale: Propylthiouracil (PTU) is the treatment of choice for hyperthyroidism in the first trimester of pregnancy due to a lower risk of teratogenic effects compared to methimazole. Methimazole can be used after the first trimester. Radioactive iodine is contraindicated in pregnancy, and surgery is generally reserved for cases where medical management is ineffective or contraindicated.

Question 28

28. A 35-year-old primigravida at 16 weeks AOG complains of palpitations. On examination, she has tachycardia, an anterior neck mass, and exophthalmos. Which of the following is not an adverse side effect associated with PTU intake?

A. Tinnitus
B. Hepatotoxicity
C. Vasculitis
D. Allergic rash

Answer 28

A. Tinnitus

Rationale: PTU is associated with several adverse effects, including hepatotoxicity, vasculitis, and allergic rashes. Tinnitus is not commonly associated with PTU. Hepatotoxicity is a major concern, and liver function should be monitored during treatment.

Question 29

29. What embryopathy is associated with methimazole use in the first trimester for hyperthyroidism?

A. Choanal/esophageal atresia
B. Cleft lip and palate
C. Sensorineural deafness
D. Ear defects

Answer 29

A. Choanal/esophageal atresia

Rationale: Methimazole use during the first trimester of pregnancy is associated with a risk of embryopathy, including choanal atresia, esophageal atresia, and other congenital malformations. For this reason, PTU is preferred during the first trimester, and methimazole can be used afterward.

Question 30

30. Why is universal newborn screening for neonatal hypothyroidism mandated by law?

A. To promptly look for associated congenital anomalies
B. To initiate prompt treatment with iodine
C. For early and aggressive thyroxine replacement to prevent permanent mental retardation
D. All of the above

Answer 30

C. For early and aggressive thyroxine replacement to prevent permanent mental retardation

Rationale: Missing the diagnosis of congenital hypothyroidism can lead to irreversible intellectual disability. Early detection through universal newborn screening and initiation of thyroxine replacement therapy is crucial to ensure normal neurodevelopment and prevent mental retardation.

Question 31

31. What is the normal calcium requirement during pregnancy?

A. 300 mg/day
B. 1500 mg/day
C. 500 mg/day
D. 1000 mg/day

Answer 31

A. 300 mg/day

Question 32

32. A 25-year-old G1P0 presents with acute hyperemesis, dehydration, mental status changes, and incidental finding of renal calculi. Her serum calcium is greater than 144 mg/dL. She delivered the next day. What is the most likely diagnosis?

A. Hypoparathyroidism
B. Hyperparathyroidism
C. Pheochromocytoma
D. Primary hyperaldosteronism

Answer 32

B. Hyperparathyroidism

Rationale: The patient’s elevated calcium level (>144 mg/dL) along with hyperemesis, dehydration, renal calculi, and mental status changes are consistent with hyperparathyroidism. Hyperparathyroidism leads to elevated serum calcium, which may result in symptoms such as gastrointestinal disturbances, bone pain, kidney stones, and neuropsychiatric manifestations.

Question 33

33. What is the most likely neonatal complication in a pregnancy complicated by hyperparathyroidism?

A. Necrotizing enterocolitis
B. Neonatal tetany
C. Intraventricular hemorrhage
D. Respiratory distress syndrome

Answer 33

B. Neonatal tetany

Rationale: Neonatal tetany is the most likely complication in a pregnancy complicated by maternal hyperparathyroidism. The elevated calcium levels in the mother can suppress the fetal parathyroid glands, resulting in hypocalcemia and tetany in the neonate after delivery.

Question 34

34. What is the treatment of choice for hyperparathyroidism during pregnancy?

A. Surgical removal of parathyroid adenoma
B. Calcitonin
C. Oral phosphate
D. Mitramycin

Answer 34

A. Surgical removal of parathyroid adenoma

Rationale: The treatment of choice for symptomatic hyperparathyroidism during pregnancy is surgical removal of the parathyroid adenoma, ideally in the second trimester. Medical management with calcitonin or oral phosphate is less effective, and surgery is required if the condition is uncontrolled or causes significant symptoms or complications.

Question 35

35. A 29-year-old G1P0 at 20 weeks AOG presents with paroxysmal hypertensive crisis, anxiety attacks, and seizure disorder. What is the most sensitive test to diagnose her condition?

A. 24-hour urine collection for free catecholamines
B. 24-hour urine metanephrines
C. 24-hour urine vanillylmandelic acid
D. 24-hour creatinine clearance

Answer 35

A. 24-hour urine collection for free catecholamines

Rationale: The most sensitive test for diagnosing pheochromocytoma during pregnancy is a 24-hour urine collection for free catecholamines. This test measures the levels of catecholamines (epinephrine, norepinephrine) secreted by chromaffin tumors such as pheochromocytomas. Although measuring urine or plasma metanephrines can also be useful, the 24-hour urine collection for free catecholamines is a reliable test to confirm increased catecholamine secretion. Imaging studies like CT or MRI are generally avoided in pregnant women unless absolutely necessary due to radiation exposure. Early diagnosis and appropriate management are critical to reducing maternal and fetal morbidity and mortality associated with pheochromocytoma.

Question 36

36. What is the treatment of choice for a patient with pheochromocytoma during pregnancy?

A. Laparoscopic adrenalectomy
B. Antihypertensives
C. Alpha-adrenergic blockers
D. Beta-blockers

Answer 36

A. Laparoscopic adrenalectomy

Rationale: The preferred treatment for pheochromocytoma during pregnancy is laparoscopic adrenalectomy, ideally performed in the second trimester when the risk of fetal loss is lower. This surgery effectively removes the catecholamine-secreting tumor. Prior to surgery, alpha-adrenergic blockers are used to control hypertension and prevent complications. Beta-blockers may be added if needed, but only after alpha blockade is achieved to avoid unopposed alpha-adrenergic stimulation, which could worsen hypertension. Early diagnosis and proper management are critical to ensure maternal and fetal well-being.

Question 37

37. A G2P2 delivered with preeclampsia with severe features and abruptio placentae. She underwent postpartum hysterectomy due to uterine atony secondary to a Couvelaire uterus. Postpartum, she remained hypotensive with tachycardia, hypoglycemia, and lactation failure. What is the most likely diagnosis?

A. Conn’s syndrome
B. Prolactinoma
C. Sheehan syndrome
D. Cushing’s disease

Answer 37

C. Sheehan syndrome

Rationale: Sheehan syndrome is postpartum pituitary necrosis that occurs due to severe blood loss and hypotension during childbirth. The patient’s symptoms of hypotension, hypoglycemia, and lactation failure are consistent with adrenal insufficiency and pituitary dysfunction resulting from Sheehan syndrome.

Question 38

38. A 28-year-old G1P0 with chronic renal disease on corticosteroid treatment presents with moon facies, buffalo hump, and truncal obesity. She had elevated 24-hour urine cortisol levels and a positive pregnancy test. What is the diagnosis?

A. Cushing’s syndrome
B. Addison’s disease
C. Conn’s syndrome
D. Pheochromocytoma
E. Polycystic ovarian syndrome (PCOS)

Answer 38

A. Cushing’s syndrome

Rationale: The patient presents with classical features of Cushing’s syndrome, including moon facies, buffalo hump, truncal obesity, and elevated 24-hour urine cortisol levels. Cushing’s syndrome is caused by excess cortisol, either from exogenous sources like corticosteroids or endogenous overproduction by the adrenal glands or pituitary gland. Addison’s disease involves cortisol deficiency and presents with fatigue, hypotension, and hyperpigmentation, which are not seen in this patient. Conn’s syndrome is characterized by hyperaldosteronism and hypertension. Pheochromocytoma presents with episodic hypertension, sweating, and palpitations. PCOS involves hyperandrogenism, irregular periods, and polycystic ovaries but does not explain the cortisol elevation and physical symptoms presented here.

Question 39

39. A 28-year-old G1P0 with chronic renal disease on corticosteroid treatment presents with moon facies, buffalo hump, and truncal obesity. She had elevated 24-hour urine cortisol levels and a positive pregnancy test. What is the management of this patient?

A. Ketoconazole
B. Metirapone
C. Antihypertensives
D. Surgical resection of the pituitary or adrenal adenoma

Answer 39

D. Surgical resection of the pituitary or adrenal adenoma

Rationale: The management of Cushing’s syndrome in pregnancy, if due to an adrenal or pituitary adenoma, is surgical resection. Surgery is the preferred treatment when feasible, particularly in the second trimester, to avoid complications from hypercortisolism that may affect both the mother and fetus. Medications like ketoconazole and metyrapone are used if surgery is not an option, but they are generally avoided during pregnancy due to teratogenic effects.

Question 40

41. During pregnancy Residual Volume
    A. Increased
    B. Decreased

Answer 40

B. Decreased

Question 41

42. During pregnancy Inspiratory Capacity
    A. Increased
    B. Decreased

Answer 41

A. Increased

Question 42

43. Tidal volume
    A. Increased
    B. Decreased

Answer 42

A. Increased

Question 43

44. Functional Residual capacity
    A. Increased
    B. Decreased

Answer 43

B. Decreased

Question 44

45. Minute ventilation
    A. Increased
    B. Decreased

Answer 44

A. Increased

Question 45

46. Expiratory reserved volume
    A. Increased
    B. Decreased

Answer 45

B. Decreased

Question 46

47. A 34-year-old G2P1 (1001) at 30 weeks AOG presents with difficulty of breathing (DOB) for 3 days. Six days prior, she had a low-grade fever and unproductive cough, for which she self-medicated with paracetamol every 4 hours. Vitals are stable, and bilateral expiratory wheezing is noted on both upper lung fields. Fetal heart tones (FHT) are 150 bpm. No hypogastric pain, vaginal bleeding, or spotting, and good fetal movement is noted. What is the most likely impression?

A. Community-acquired pneumonia (CAP)
B. Upper respiratory tract infection (URTI)
C. Asthma in acute exacerbation
D. Chronic obstructive pulmonary disease (COPD)

Answer 46

C. Asthma in acute exacerbation

Rationale: The patient presents with symptoms of difficulty breathing, expiratory wheezing, and a history of cough, which are consistent with asthma in acute exacerbation. The presence of bilateral wheezing without significant signs of infection (such as high-grade fever) supports this diagnosis. URTI is less likely due to the presence of wheezing, and CAP would likely present with more severe symptoms, including high-grade fever and productive cough. COPD is uncommon in a young patient without a history of smoking or chronic lung disease.

Question 47

48. Which of the following is true of the hallmarks of asthma?

A. Mucus hyposecretion
B. Mucosal edema
C. Bronchial smooth muscle relaxation
D. Vascular restriction
E. None of the above

Answer 47

B. Mucosal edema

Rationale: The hallmarks of asthma include mucosal edema, mucus hypersecretion, and bronchial smooth muscle constriction, which together contribute to airway narrowing and difficulty breathing. Asthma is characterized by inflammation of the airways, leading to increased mucus production and swelling of the mucosa. Bronchial smooth muscle relaxation is not a feature of asthma; rather, bronchoconstriction occurs during an exacerbation.

Question 48

49. What is the possible precipitating factor in this patient’s asthma exacerbation?

A. Exposure to allergen
B. Intake of paracetamol
C. History of low-grade fever with non-productive cough
D. None of the above

Answer 48

C. History of low-grade fever with non-productive cough

Rationale: The patient’s initial symptoms of low-grade fever and non-productive cough suggest a viral upper respiratory tract infection, which is a common trigger for asthma exacerbations. While allergens and medications can also be triggers, in this case, the temporal relationship between the viral symptoms and the onset of asthma suggests that the preceding infection is the likely precipitating factor.

Question 49

50. In further history, the patient reports episodes of difficulty breathing occurring once a day per week, with no nocturnal awakenings and no difficulty in carrying out her usual daily activities. What is the severity classification of her asthma?

A. Intermittent
B. Mild persistent
C. Moderate persistent
D. Severe

Answer 49

A. Intermittent

Rationale: The classification of asthma severity is based on symptom frequency and impact on daily activities. Intermittent asthma is characterized by symptoms occurring less than twice per week, no nocturnal awakenings, and no interference with daily activities. Mild persistent asthma would involve symptoms more frequently, typically more than twice per week but not daily, and would have some nocturnal symptoms or limitations in activity. Given the patient’s symptoms occurring once per day per week with no nocturnal symptoms or activity limitation, her asthma is classified as intermittent.

Question 50

51. What medication should you give this patient for her asthma exacerbation?

A. Short-acting beta agonist (SABA)
B. Short-acting beta agonist + low-dose inhaled corticosteroid (ICS)
C. GABA
D. Oral corticosteroids

Answer 50

A. Short-acting beta agonist (SABA)

Rationale: A short-acting beta agonist (SABA), such as albuterol, is the first-line treatment for an acute asthma exacerbation. It works by relaxing the bronchial smooth muscle and improving airflow. Low-dose ICS may be added for maintenance therapy in persistent asthma, but it is not indicated as an initial treatment for acute exacerbations. Oral corticosteroids may be used in more severe exacerbations, but based on the current severity, a SABA is sufficient. GABA is unrelated to asthma treatment.

Question 51

52. Which of the following statements regarding complications of asthma in pregnancy are true or false?

A. Abortion
B. Congenital anomalies
C. Preeclampsia
D. Neonatal hypoxia
E. Status asthmaticus
F. Abruptio placenta

Answer 51

A. Abortion - True: Asthma in pregnancy is associated with an increased risk of miscarriage or spontaneous abortion, particularly in severe or poorly controlled cases.
B. Congenital anomalies - False: There is no direct evidence that maternal asthma increases the risk of congenital anomalies in the fetus. The primary risks are related to maternal hypoxia, which can affect fetal growth and development but not necessarily cause congenital anomalies.
C. Preeclampsia - True: Asthma has been linked to an increased risk of developing preeclampsia during pregnancy, possibly due to underlying inflammation and other related factors.
D. Neonatal hypoxia - True: Asthma exacerbations can lead to reduced oxygen supply to the fetus, increasing the risk of neonatal hypoxia, especially if asthma is not well-controlled.
E. Status asthmaticus - True: Status asthmaticus is a severe, life-threatening asthma exacerbation that can occur during pregnancy, requiring urgent medical intervention to prevent maternal and fetal complications.
F. Abruptio placenta - False: Asthma is not directly associated with an increased risk of placental abruption. Other conditions, such as hypertension and trauma, are more commonly linked to abruptio placenta.

Question 52

61. The most common cause of bacterial pneumonia is influenza.

A. True
B. False

Answer 52

B. False

Rationale: Influenza is a virus, not a bacterium, and it is not the most common cause of bacterial pneumonia. The most common cause of bacterial pneumonia is Streptococcus pneumoniae. Influenza may predispose individuals to secondary bacterial pneumonia, but it is not the direct cause.

Question 53

62. Pneumonia affects the lung parenchyma distal to the larger airways, involving the large bronchioles and alveoli.

A. True
B. False

Answer 53

A. True

Rationale: Pneumonia involves the inflammation of the lung parenchyma, which includes the large bronchioles and alveoli, leading to symptoms such as cough, fever, and difficulty breathing. It primarily affects the parts of the lung where gas exchange occurs, making it distinct from bronchitis, which affects the airways.

Question 54

63. What is the treatment regimen for pulmonary tuberculosis (PTB) in pregnant women with active disease?

A. Rifampicin, Isoniazid, and Pyrazinamide (RIP) for 2 months followed by 4 months of Rifampicin and Isoniazid
B. Rifampicin and Ethambutol for 6 months
C. Isoniazid and Pyrazinamide for 9 months
D. Rifampicin, Isoniazid, and Ethambutol for 6 months

Answer 54

A. Rifampicin, Isoniazid, and Pyrazinamide (RIP) for 2 months followed by 4 months of Rifampicin and Isoniazid

Rationale: The treatment regimen for pregnant women with active PTB includes Rifampicin, Isoniazid, and Pyrazinamide for the first 2 months (intensive phase) followed by 4 months of Rifampicin and Isoniazid (continuation phase). Pyrazinamide is generally considered safe during pregnancy, and the benefits of treatment outweigh the potential risks of untreated tuberculosis, which can have serious maternal and fetal consequences.

Question 55

64. The following are complications of asthma in pregnancy EXCEPT:

A. Abortion
B. Congenital anomalies
C. Preeclampsia
D. Neonatal hypoxia
E. Status asthmaticus

Answer 55

B. Congenital anomalies

Rationale: Asthma during pregnancy can lead to several complications, including abortion, preeclampsia, neonatal hypoxia, and status asthmaticus. However, asthma is not directly associated with an increased risk of congenital anomalies in the fetus. The primary concerns with poorly controlled asthma are related to maternal oxygenation, which can impact fetal development and increase the risk of other pregnancy complications.

Question 56

65. Which of the following is true regarding pneumonia in pregnancy?

A. PCV is recommended for healthy pregnant women
B. Gram stain of sputum is crucial for diagnosing bacterial pneumonia
C. Bacterial pneumonia can be acquired only by nasopharyngeal secretions
D. The most common cause of bacterial pneumonia is influenza

Answer 56

B. Gram stain of sputum is crucial for diagnosing bacterial pneumonia

Rationale: A Gram stain of sputum can be helpful in diagnosing bacterial pneumonia by identifying the causative organism. PCV (Pneumococcal Conjugate Vaccine) is not routinely recommended for all pregnant women, but it may be considered for those at increased risk. Bacterial pneumonia can be acquired through several routes, including inhalation of respiratory droplets, not only from nasopharyngeal secretions. The most common cause of bacterial pneumonia is Streptococcus pneumoniae, not influenza.

Question 57

66. What is the treatment regimen for pregnant women with active PTB?

A. Pyrazinamide for 2 months followed by 4 months of Rifampicin and Isoniazid
B. Ethambutol for 6 months followed by Rifampicin
C. Rifampicin, Isoniazid, and Ethambutol for 9 months
D. Isoniazid and Rifampicin for 6 months

Answer 57

A. Pyrazinamide for 2 months followed by 4 months of Rifampicin and Isoniazid

Rationale: The standard treatment regimen for active PTB in pregnancy is 2 months of intensive therapy with Pyrazinamide, Rifampicin, and Isoniazid, followed by 4 months of continuation therapy with Rifampicin and Isoniazid. Ethambutol is often added initially if there is concern for drug resistance. This regimen effectively controls TB while minimizing fetal risks.

Question 58

67. A 23-year-old G1P0 at 25 weeks, known asthmatic, was admitted with difficulty breathing even with mild exertion. ABG findings: decreased pO2, normal pH, and normal pCO2. What is the appropriate next step?

A. She is in a danger zone and should be admitted and managed
B. Mild respiratory alkalosis
C. Respiratory acidosis
D. Stable and can be discharged after 4 hours

Answer 58

A. She is in a danger zone and should be admitted and managed

Rationale: A decreased pO2 indicates hypoxemia, which is concerning in pregnancy as it may compromise oxygen delivery to both mother and fetus. The normal pH and pCO2 do not rule out the risk of significant respiratory compromise. Given her symptoms and ABG findings, she should be admitted for further management to prevent worsening of her asthma, which could lead to fetal hypoxia.

Question 59

68. A 29-year-old woman, G2P1 (1001), complains of a 3.5-week cough, low-grade fever mostly in the afternoon. What PPD findings would you consider positive for her?

A. 3 mm
B. 5 mm
C. 10 mm
D. 15 mm

Answer 59

B. 5 mm

Rationale: A PPD skin test result of ≥5 mm is considered positive in individuals with high-risk factors for tuberculosis (TB), such as pregnancy (due to relative immunosuppression) combined with clinical symptoms like a prolonged cough and low-grade fever. This aligns with the provided criteria in the chart, which includes individuals with recent TB exposure or immunosuppressive states. Since the patient has symptoms indicative of TB and is pregnant, the lower threshold of 5 mm is applicable.
• A. 3 mm: Too small to be considered positive under any condition.
• C. 10 mm: Relevant for individuals with moderate risk factors, such as IV drug use or certain medical conditions, but not directly applicable here.
• D. 15 mm: Positive only for individuals with no known risk factors.

Question 60

69. Rosey gave birth via NSD without complications. Three days later, she tested COVID antigen-positive. Is she allowed to breastfeed?

A. She can be allowed to breastfeed her infant and have skin-to-skin contact as long as infection control precautions, such as hand hygiene, are practiced.
B. She should avoid breastfeeding until she tests negative for COVID-19.
C. She can breastfeed but must wear a mask at all times.
D. Breastfeeding is contraindicated, and formula feeding should be started.

Answer 60

A. She can be allowed to breastfeed her infant and have skin-to-skin contact as long as infection control precautions, such as hand hygiene, are practiced.

Rationale: Current guidelines from the World Health Organization (WHO) and the CDC support breastfeeding even if the mother is COVID-positive, as long as proper precautions, such as mask-wearing and hand hygiene, are taken. Breast milk provides important antibodies and nutrients that benefit the infant, and the risk of transmission can be mitigated with appropriate measures.

Question 61

70. Which of the following is true about varicella pneumonia?

A. Clinical course is 3-5 days only
B. It commonly affects immunocompromised individuals
C. It has a high mortality rate in pregnant women
D. It is treated with supportive care alone

Answer 61

A. Clinical course is 3-5 days only

Rationale: Varicella pneumonia, caused by the varicella-zoster virus, usually has a clinical course lasting 3-5 days. It is characterized by symptoms such as fever, maculopapular and vesicular rash, tachypnea, cough, and dyspnea. While varicella pneumonia can be severe, particularly in pregnant women and immunocompromised individuals, the clinical course in general cases often resolves within 3-5 days with appropriate antiviral treatment and supportive care. It is important to recognize that varicella pneumonia carries a higher risk of mortality in pregnant women, but it is not limited to supportive care alone; antiviral therapy (e.g., acyclovir) is essential for management.