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LE4 Feeds (OB) Flashcards

1
Q
  1. The mainstay in the management of preeclampsia with severe features is:
    A. Hydralazine
    B. MgSO4
    C. Furosemide
    D. Aspirin
A

B. MgSO4
Rationale: Magnesium sulfate (MgSO4) is the drug of choice for preventing convulsions in preeclampsia with severe features. It works by stabilizing excitable membranes, reducing the risk of eclampsia, and has neuroprotective effects.

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2
Q
  1. Severe features of preeclampsia include:
    A. Intrauterine Growth Restriction (IUGR)
    B. Double increase of uric acid levels
    C. Creatinine of 1.1 mg/dL
    D. Oligohydramnios
A

C. Creatinine of 1.1 mg/dL
Rationale: Renal dysfunction indicated by elevated serum creatinine (>1.1 mg/dL) is a criterion for severe preeclampsia. Other severe features include thrombocytopenia, elevated liver enzymes, pulmonary edema, and cerebral or visual disturbances.

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3
Q
  1. If the initial BP is 210/110, what is the target BP to maintain after 4–6 hours?
    A. <120/80
    B. 140–150/90–100
    C. <140/90
    D. 130–140/80–90
A

B. 140–150/90–100
Rationale: The goal in hypertensive emergencies during pregnancy is to reduce BP gradually to prevent end-organ damage while maintaining adequate placental perfusion. Overly rapid drops in BP can lead to fetal compromise.

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4
Q
  1. A 38-year-old G1P0 at 31 weeks of gestation presents at a clinic with BP 200/120. She reports her highest BP was only 140/90, which she attributes to stress or anger. Impression at this time should be:
    A. Chronic hypertension with superimposed preeclampsia
    B. Preeclampsia with severe features
    C. HELLP syndrome
    D. Gestational hypertension
A

D. Gestational hypertension
Rationale: Gestational hypertension is defined as new-onset hypertension after 20 weeks of gestation without proteinuria or systemic findings indicative of preeclampsia. While the patient’s BP is elevated, there is no mention of proteinuria or other systemic involvement, ruling out preeclampsia or HELLP.

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5
Q
  1. Hypertension is defined as:
    A. BP of more than or equal to 140/90 on 2 consecutive occasions taken 4-6 hours apart
    B. BP of more than 150/100 in a single reading
    C. BP of more than 130/85 in 3 consecutive readings
    D. BP of more than 140/90 measured once
A

A. BP of more than or equal to 140/90 on 2 consecutive occasions taken 4-6 hours apart
Rationale: Hypertension during pregnancy is defined as a systolic BP ≥ 140 mmHg and/or a diastolic BP ≥ 90 mmHg confirmed on at least two measurements taken 4–6 hours apart.

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6
Q
  1. The most plausible etiology of preeclampsia is:
    A. Placental implantation with abnormal trophoblastic invasion
    B. Genetic predisposition
    C. Autoimmune reaction
    D. Nutritional deficiency
A

A. Placental implantation with abnormal trophoblastic invasion
Rationale: The root cause of preeclampsia is thought to be related to abnormal remodeling of the spiral arteries during placental implantation, resulting in placental hypoxia and systemic endothelial dysfunction.

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7
Q
  1. A pregnant woman with the following characteristics is more likely to develop preeclampsia:
    A. Asthmatic
    B. Nulligravid
    C. Overt diabetic
    D. 20–30 years old
A

C. Overt diabetic
Rationale: Diabetes mellitus is a well-established risk factor for preeclampsia due to its association with endothelial dysfunction and increased inflammatory markers.

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8
Q
  1. Low-dose aspirin for the prevention of preeclampsia should be started:
    A. 8 weeks–20 weeks of gestation
    B. Starting 11 weeks–36 and 6 weeks
    C. Starting 20 weeks–40 weeks
    D. After 36 weeks only
A

B. Starting 11 weeks–36 and 6 weeks
Rationale: Low-dose aspirin is recommended for women at high risk for preeclampsia starting from 11–14 weeks of gestation up to 36 weeks to reduce the risk of adverse outcomes.

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9
Q
  1. A 38-year-old with dizziness in the second month of amenorrhea and BP 90/70. How would you classify her condition?
    A. Chronic hypertension
    B. Most likely to develop preeclampsia
    C. Gestational hypertension
    D. Chronic hypertension and most likely not develop preeclampsia
A

B. Most likely to develop preeclampsia

Rationale:

This patient is in the second month of amenorrhea (early pregnancy) with a BP of 90/70 mmHg. This BP is low-normal and consistent with the expected physiologic changes in early pregnancy, such as systemic vasodilation due to hormonal effects (e.g., progesterone). However, low BP early in pregnancy does not exclude the possibility of developing preeclampsia later in pregnancy, particularly in a patient with risk factors or no prior known hypertension.

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10
Q
  1. A 35-year-old G5P4 (0404) with 3 previous CS, a history of preeclampsia, BMI 31, hypothyroidism, and BP 150/100. How many risk factors for preeclampsia does she have?
A

5
Rationale: Risk factors for preeclampsia in this case include:

History of preeclampsia
Obesity (BMI ≥ 30)
Hypothyroidism
Multiple previous pregnancies (multiparity)
Hypertension (BP ≥ 140/90)

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11
Q
  1. A 30-year-old primigravid at 27 weeks by LMP presents with BP 145/90. What is the diagnosis?
    A. Gestational hypertension
    B. Preeclampsia with severe features
    C. Preeclampsia without severe features
    D. Chronic hypertension
A

A. Gestational hypertension

Rationale:
1. Definition of Gestational Hypertension:
• Gestational hypertension is diagnosed when:
• Blood pressure (BP) is ≥140/90 mmHg on two occasions at least 4 hours apart after 20 weeks of gestation.
• There is no proteinuria or signs of end-organ dysfunction.
2. Key Findings in This Case:
• BP is elevated (145/90 mmHg), meeting the threshold for gestational hypertension.
• The patient is at 27 weeks gestation (beyond 20 weeks).
• No mention of proteinuria or other features of preeclampsia.

Why Not the Other Options?
• B. Preeclampsia with severe features:
• Severe features include severe hypertension (≥160/110 mmHg), thrombocytopenia, elevated liver enzymes, renal insufficiency, pulmonary edema, or neurologic symptoms. These are not present here.
• C. Preeclampsia without severe features:
• Preeclampsia requires proteinuria (≥300 mg/24-hour urine or protein/creatinine ratio ≥0.3) or evidence of end-organ dysfunction, which are not mentioned in this case.
• D. Chronic hypertension:
• Chronic hypertension is diagnosed when BP is elevated before 20 weeks of gestation or persists >12 weeks postpartum. In this case, the elevated BP was noted after 20 weeks of gestation.

Next Steps in Management:
1. Confirm the diagnosis:
• Repeat BP measurements at least 4 hours apart to confirm sustained

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12
Q
  1. Laboratory workup significant for the diagnosis of hypertensive disorders in pregnancies includes:
    A. Chest X-ray
    B. Uric acid
    C. Lipid profile
    D. Creatinine
A

D. Creatinine
Rationale: Hypertensive disorders in pregnancy, such as preeclampsia, are associated with renal dysfunction. Elevated serum creatinine levels (>1.1 mg/dL or doubling of baseline) are diagnostic of severe preeclampsia. Other tests like uric acid are less specific.

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13
Q
  1. Impression of HELLP syndrome at 3 weeks. Which management is acceptable?
    A. Antihypertensive therapy
    B. Expectant management
    C. Termination of pregnancy
    D. Magnesium sulfate only
A

C. Termination of pregnancy
Rationale: HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets) is a severe manifestation of preeclampsia requiring immediate delivery regardless of gestational age to prevent maternal and fetal complications.

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14
Q
  1. Which of the following is a severe feature of preeclampsia?
    A. 24-hour urine protein <0.3 g
    B. Thrombocytopenia >100,000
    C. Sudden onset of diplopia
    D. AST 12, ALT 28
A

C. Sudden onset of diplopia
Rationale: Severe features of preeclampsia include visual disturbances (e.g., diplopia), severe thrombocytopenia (<100,000), elevated liver enzymes (AST or ALT ≥70), and renal or pulmonary involvement.

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15
Q
  1. In which situation is home management of preeclampsia acceptable?
    A. Preeclampsia with severe features
    B. Preeclampsia without severe features
    C. Chronic hypertension with proteinuria
    D. Gestational hypertension with pulmonary edema
A

B. Preeclampsia without severe features
Rationale: Home management is acceptable only in cases of preeclampsia without severe features, as these patients lack signs of end-organ damage and can be closely monitored on an outpatient basis.

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16
Q
  1. A 15-year-old girl presents with upward rolling of the eyeballs and stiffening of extremities. She has a history of childhood febrile seizures. What is the diagnosis?
    A. Eclampsia
    B. Febrile seizure
    C. Seizure disorder unrelated to pregnancy
    D. Status epilepticus
A

A. Eclampsia
Rationale: In the context of pregnancy, seizures with no prior history of epilepsy and associated hypertensive features strongly suggest eclampsia, requiring urgent treatment with magnesium sulfate and delivery.

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17
Q
  1. A 15-year-old girl presents with seizures and has a history of febrile seizures. What is the next most important diagnostic investigation?
    A. EEG
    B. CT scan of the head
    C. Pelvic ultrasound
    D. Blood cultures
A

C. Pelvic ultrasound
Rationale: In a female of childbearing age presenting with seizures, pregnancy must be ruled out as it can cause eclampsia. A pelvic ultrasound can confirm pregnancy status and guide further management.

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18
Q
  1. A 39-year-old at 28 weeks of gestation presents with BP 160/100, fundic height 24 cm, and albuminuria. What is the diagnosis?
    A. Gestational hypertension
    B. Preeclampsia without severe features
    C. Preeclampsia with severe features
    D. Chronic hypertension
A

C. Preeclampsia with severe features
Rationale: Elevated BP ≥160/100, albuminuria, and a discrepancy in fundal height (suggesting fetal growth restriction) are indicators of preeclampsia with severe features.

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19
Q
  1. A 39-year-old woman presents with shortness of breath, body malaise, and epigastric pain. BP is 150/100, with fundic height 27 cm and fetal heart tone 156 bpm. What is the diagnosis?
    A. Acute fatty liver of pregnancy
    B. Gestational hypertension
    C. HELLP syndrome
    D. Severe preeclampsia
A

C. HELLP syndrome
Rationale: Epigastric pain, elevated BP, and systemic malaise are hallmark features of HELLP syndrome. It is a severe complication of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets.

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20
Q
  1. What is the most common genetic cause of abortion?
    A. Monosomy
    B. Trisomy
    C. Polyploidy
    D. Structural chromosomal abnormalities
A

B. Trisomy
Rationale: Trisomy accounts for 50–60% of genetic causes of spontaneous abortions, with common trisomies involving chromosomes 13, 16, 18, 21, and 22. These result from nondisjunction during meiosis.

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21
Q
  1. A patient had her LMP on January 1, 2023. On internal examination, the cervix is closed, there are no fetal heart tones, and the uterus is enlarged to age of gestation (AoG). What is the diagnosis?
    A. Missed abortion
    B. Inevitable abortion
    C. Complete abortion
    D. Threatened abortion
A

A. Missed abortion
Rationale: A missed abortion is characterized by fetal demise without expulsion of the products of conception. The uterus remains enlarged, and the cervix is closed, with no fetal heart tones on examination.

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22
Q
  1. A ruptured bag of water with vaginal bleeding and an open cervix indicates:
    A. Threatened abortion
    B. Complete abortion
    C. Inevitable abortion
    D. Missed abortion
A

C. Inevitable abortion
Rationale: Inevitable abortion presents with a ruptured bag of water, vaginal bleeding, and an open cervix. It implies that the pregnancy cannot continue and will inevitably result in miscarriage

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23
Q
  1. A 24-year-old G2P1 presents with bleeding and placental tissue visible on speculum examination. What is the next best step?
    A. Expectant management
    B. Admit and perform completion curettage
    C. Start misoprostol
    D. Observation only
A

B. Admit and perform completion curettage
Rationale: Visible placental tissue indicates incomplete abortion, requiring uterine evacuation via dilation and curettage to prevent infection or heavy bleeding.

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24
Q
  1. A 24-year-old G1P0 presents with bleeding. Ultrasound shows a blighted ovum. What is the management?
    A. Expectant management
    B. Dilation and curettage
    C. Spontaneous expulsion
    D. Suction curettage
A

B. Dilation and curettage
Rationale: A blighted ovum (anembryonic pregnancy) occurs when a fertilized egg implants in the uterus, but the embryo does not develop. Dilation and curettage is often performed to remove the nonviable pregnancy.

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25
Q
  1. A patient with a history of dilation and curettage presents with amenorrhea and a negative pregnancy test. What is the likely diagnosis?
    A. Sheehan’s syndrome
    B. Asherman syndrome
    C. Hypothyroidism
    D. Tuberculosis
A

B. Asherman syndrome
Rationale: Asherman syndrome occurs due to intrauterine adhesions, often after dilation and curettage, leading to menstrual irregularities, including amenorrhea.

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26
Q
  1. What is the source of progesterone during the first trimester of pregnancy?
    A. Corpus luteum
    B. Placenta
    C. Uterus
    D. Ovary
A

A. Corpus luteum
Rationale: During the first 8 weeks of pregnancy, the corpus luteum is the main source of progesterone, which supports the early pregnancy until the placenta takes over at 8–12 weeks.

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27
Q
  1. What is the medical management for threatened abortion?
    A. Progesterone
    B. Estrogen
    C. Calcium channel blockers (CCB)
    D. Misoprostol
A

A. Progesterone
Rationale: Progesterone supports the endometrium and maintains early pregnancy. It is used in threatened abortion to reduce the risk of progression to miscarriage.

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28
Q
  1. What is the usual cause of late abortion?
    A. Hypofunction of the corpus luteum
    B. Emotional or nervous factors
    C. Hypopituitarism
    D. Cervical incompetence
A

D. Cervical incompetence
Rationale: Late abortion (after 12 weeks) is often caused by cervical incompetence, where the cervix prematurely dilates, leading to pregnancy loss. Risk factors include previous trauma or surgery to the cervix.

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29
Q
  1. Which among the causes of abortion is correct?
    A. Infection: autoimmune thyroiditis
    B. Anatomic: Asherman’s syndrome
    C. Immunologic: Thrombophilias
    D. Social: 1 cup of coffee/day
A

C. Immunologic: Thrombophilias
Rationale: Immunologic factors such as antiphospholipid syndrome or thrombophilias can lead to recurrent pregnancy loss. Other correct causes include infections, anatomical abnormalities, and genetic factors.

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30
Q
  1. What is the most common site of ectopic pregnancy?
    A. Ampulla
    B. Isthmic
    C. Fimbrial
    D. Interstitial
A

A. Ampulla
Rationale: The ampulla of the fallopian tube is the most common site of ectopic pregnancies, accounting for 70% of cases. This is because fertilization often occurs here, and abnormal implantation is more likely if the zygote fails to travel to the uterus.

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31
Q
  1. Fifty percent of women with ectopic pregnancies have a history of:
    A. Tubal surgery
    B. Intrauterine device use
    C. Chronic pelvic inflammatory disease (PID)
    D. Prior ectopic pregnancy
A

C. Chronic pelvic inflammatory disease (PID)
Rationale: Chronic PID leads to scarring and damage to the fallopian tubes, increasing the risk of ectopic pregnancies. Tubal damage prevents the fertilized egg from moving into the uterus.

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32
Q
  1. Why does shoulder pain occur in ectopic pregnancy?
    A. None
    B. Diaphragmatic irritation
    C. Referred pain from the abdominal cavity
    D. Direct nerve involvement
A

B. Diaphragmatic irritation
Rationale: Shoulder pain is a referred pain due to diaphragmatic irritation caused by blood pooling under the diaphragm following tubal rupture.

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33
Q
  1. Which test can exclude hemoperitoneum in ectopic pregnancy without ultrasound?
    A. Endometrial sampling
    B. Diagnostic laparoscopy
    C. Culdocentesis
    D. Beta-hCG levels
A

C. Culdocentesis
Rationale: Culdocentesis involves inserting a needle into the posterior vaginal fornix to detect blood in the peritoneal cavity, which is often present in ruptured ectopic pregnancies.

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34
Q
  1. At what beta-hCG level should a gestational sac be visible via transvaginal ultrasound?
    A. 500–1000 mIU/mL
    B. 1000–1500 mIU/mL
    C. 1500–2000 mIU/mL
    D. 2000–2500 mIU/mL
A

C. 1500–2000 mIU/mL
Rationale: The discriminatory zone for detecting a gestational sac via transvaginal ultrasound is when beta-hCG levels are between 1500–2000 mIU/mL. If no sac is visible at these levels, ectopic pregnancy is highly suspected.

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35
Q
  1. What is the most reliable method for diagnosing ectopic pregnancy?
    A. Beta-hCG levels
    B. Endometrial sampling
    C. Ultrasound showing an extrauterine sac with remnants
    D. Laparoscopy
A

C. Ultrasound showing an extrauterine sac with remnants
Rationale: The presence of an extrauterine gestational sac with fetal parts or a yolk sac on ultrasound is diagnostic of ectopic pregnancy.

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36
Q
  1. Methotrexate can be used to treat ectopic pregnancy if:
    A. The gestational sac is <16 weeks
    B. The gestational sac is <3.5 cm and unruptured
    C. The patient has signs of rupture
    D. There is no need for follow-up beta-hCG levels
A

B. The gestational sac is <3.5 cm and unruptured
Rationale: Methotrexate is effective for treating ectopic pregnancies when the sac is small (<3.5 cm), unruptured, and the beta-hCG level is low (<5000 mIU/mL). Ruptured ectopic pregnancies require surgical intervention.

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37
Q
  1. A young female presents with 2 months of amenorrhea, severe lower abdominal pain, tachycardia, and pallor. What is the most likely diagnosis?
    A. Pelvic inflammatory disease (PID)
    B. Ruptured ovarian cyst
    C. Ectopic pregnancy
    D. Threatened abortion
A

C. Ectopic pregnancy
Rationale: The combination of amenorrhea, abdominal pain, and signs of hemodynamic instability (tachycardia, pallor) strongly suggests ectopic pregnancy, especially if the patient is of childbearing age

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38
Q
  1. The removal of a fallopian tube is referred to as:
    A. Salpingotomy
    B. Salpingostomy
    C. Salpingectomy
    D. Salpingo-oophorectomy
A

C. Salpingectomy
Rationale: Salpingectomy refers to the surgical removal of the fallopian tube, often performed when the tube is severely damaged or in cases of ruptured ectopic pregnancy.

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39
Q
  1. A 27-year-old G3P2 at 12 weeks of amenorrhea presents to the ER with hypogastric pain. Pregnancy test is positive, and transvaginal ultrasound shows a live embryo (4x5 cm) located in the fallopian tube. The uterus is empty. What is the next step?
    A. Methotrexate therapy
    B. Observation and follow-up ultrasound
    C. Diagnostic laparoscopy
    D. Exploratory laparotomy with salpingectomy
A

D. Exploratory laparotomy with salpingectomy
Rationale: A live ectopic pregnancy >4 cm in the fallopian tube requires immediate surgical intervention to prevent rupture. Salpingectomy is performed to remove the ectopic pregnancy and prevent life-threatening complications.

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40
Q
  1. Which patient is most likely to present with placenta accreta syndrome?
    A. 25-year-old with one prior cesarean section
    B. 30-year-old with a history of uterine surgery
    C. 35-year-old G4P3 with three previous cesarean sections
    D. 28-year-old with a history of preeclampsia
A

C. 35-year-old G4P3 with three previous cesarean sections
Rationale: Placenta accreta is associated with prior uterine surgeries, especially cesarean sections. The risk increases with the number of previous C-sections due to scarring and abnormal placental implantation.

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41
Q
  1. A 30-year-old primigravid at 39 weeks in labor experiences prolonged second stage of labor lasting 18 hours. She develops postpartum hemorrhage (PPH). What is the most likely cause?
    A. Uterine rupture
    B. Retained placenta
    C. Uterine muscle fatigue
    D. Coagulation disorder
A

C. Uterine muscle fatigue
Rationale: Prolonged second stage of labor can lead to uterine muscle fatigue, which impairs contraction and results in uterine atony, the most common cause of PPH.

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42
Q
  1. Which of the following cases presents with lower uterine atony?
    A. A patient with placenta previa
    B. A patient with uterine rupture
    C. A patient with a twin gestation who delivered the second baby via internal podalic version
    D. A patient with retained placental tissue
A

A. A patient with placenta previa
Rationale: Placenta previa is associated with atony of the lower uterine segment, as this region does not contract effectively post-delivery, leading to increased risk of PPH.

43
Q
  1. Which of the following findings indicates retained placenta in postpartum hemorrhage (PPH)?
    A. Uterus slightly enlarged and the cervix is open with meaty tissues plugging the os
    B. Soft, boggy uterus
    C. Firm, well-contracted uterus with closed cervix
    D. Painful contractions with no bleeding
A

A. Uterus slightly enlarged and the cervix is open with meaty tissues plugging the os
Rationale: Retained placental tissues prevent effective uterine contraction, leading to an enlarged uterus with bleeding. A soft, boggy uterus indicates uterine atony, while a firm uterus is normal postpartum.

44
Q
  1. A 26-year-old patient who underwent low forceps delivery presents with a vulvar hematoma. What is the chief complaint?
    A. Severe dysuria
    B. Profuse bleeding
    C. Excruciating pain
    D. Vulvar hematoma
A

C. Excruciating pain
Rationale: Vulvar hematomas are characterized by severe, localized pain, often described as perineal, abdominal, or buttock pain. Profuse bleeding may not always accompany hematomas as blood is trapped in the tissues.

45
Q
  1. A patient delivered via forceps and now presents with brisk vaginal bleeding. What is the likely cause?
    A. Uterine atony
    B. Retained placenta
    C. Genital tract laceration
    D. Coagulation disorder
A

C. Genital tract laceration
Rationale: Operative vaginal deliveries, such as those involving forceps, increase the risk of cervical or vaginal tears, leading to brisk bleeding despite a well-contracted uterus.

46
Q
  1. A 40-year-old G3P3 presents postpartum with a fleshy mass protruding from the introitus. She is hypotensive (80/50) with no palpable mass on the lower abdomen. What is the most likely diagnosis?
    A. Pelvic organ prolapse
    B. Acute uterine inversion
    C. Prolapsed submucous myoma
    D. Vulvar hematoma
A

B. Acute uterine inversion
Rationale: Uterine inversion presents with a fleshy mass protruding from the vagina, often accompanied by hemorrhagic shock. The absence of a palpable uterine fundus on abdominal examination is diagnostic.

47
Q
  1. Which is NOT a management option for uterine inversion?
    A. Strong traction on the umbilical cord
    B. Immediate administration of oxytocin
    C. Uterine massage through the abdomen
    D. Manual repositioning of the uterus
A

A. Strong traction on the umbilical cord
Rationale: Excessive traction on the umbilical cord is a common cause of uterine inversion and should be avoided. Treatment focuses on uterine repositioning and oxytocin to promote uterine tone.

48
Q
  1. What is an alternative management option for postpartum hemorrhage (PPH)?
    A. Manual extraction of the placenta
    B. Administration of oxytocin
    C. Balloon tamponade
    D. Suturing of vaginal tears
A

C. Balloon tamponade
Rationale: Balloon tamponade applies pressure to bleeding sites in the uterus, effectively managing severe PPH unresponsive to medications or manual procedures.

49
Q
  1. A patient presents to the emergency room with an undelivered placenta and ongoing bleeding. What is the next step?
    A. Immediate oxytocin IV
    B. Wait for natural expulsion
    C. Manual extraction of the placenta
    D. Administer misoprostol
A

C. Manual extraction of the placenta
Rationale: Retained placenta requires manual removal to control bleeding and prevent complications such as infection or uterine atony.

50
Q
  1. A 35-year-old G2P1 is scheduled for a VBAC but develops profuse bleeding 2 hours postpartum. What is the appropriate management?
    A. Repeat cesarean section
    B. Oxytocin IV
    C. Balloon tamponade
    D. Dilation and curettage
A

A. Repeat cesarean section
Rationale: Profuse bleeding in a VBAC patient suggests uterine rupture, requiring immediate surgical intervention via repeat cesarean section.

51
Q
  1. A 30-year-old G2P1 with von Willebrand disease presents with profuse postpartum bleeding. What is the next step?
    A. Administer oxytocin IV
    B. Treat the underlying disease and replace blood components
    C. Perform uterine massage
    D. Perform hysterectomy
A

B. Treat the underlying disease and replace blood components
Rationale: Patients with von Willebrand disease are prone to coagulopathy. Management includes replacement therapy with clotting factors and addressing the underlying bleeding disorder.

52
Q
  1. Which of the following is contraindicated in the drug therapy for PPH?
    A. Oxytocin IV bolus
    B. Misoprostol
    C. Tranexamic acid
    D. Ergometrine
A

A. Oxytocin IV bolus
Rationale: Oxytocin should not be given as an IV bolus due to the risk of severe hypotension and cardiac arrhythmias. It should be administered as an IV infusion instead.

53
Q
  1. What is the appropriate management of uterine inversion?
    A. Extract the placenta, then reposition the uterus
    B. Administer uterotonics before repositioning
    C. Administer tocolytics after repositioning to prevent recurrence
    D. Reposition the uterus under general anesthesia
A

D. Reposition the uterus under general anesthesia

Rationale:
Uterine inversion is a life-threatening obstetric emergency where the uterine fundus inverts and prolapses. The primary management goal is to manually reposition the uterus back to its normal anatomical position. Repositioning often requires general anesthesia or deep sedation to relax the uterine muscles, facilitating easier manipulation. This approach minimizes patient discomfort and prevents further injury.

54
Q
  1. A 19-year-old patient presents with profuse bleeding and a soft, boggy uterus. What is the appropriate management?
    A. Uterine massage
    B. Administration of uterotonics
    C. Balloon tamponade
    D. Immediate surgery
A

B. Administration of uterotonics
Rationale: Uterine atony is the leading cause of postpartum hemorrhage. Administering uterotonics like oxytocin is the first-line treatment to stimulate uterine contractions and reduce bleeding.

55
Q
  1. What is the appropriate management for symptomatic placenta previa?
    A. Immediate delivery
    B. Manage as placenta previa
    C. Perform amniotomy
    D. Administer uterotonics
A

B. Manage as placenta previa
Rationale: Placenta previa requires careful monitoring. If the patient is stable, conservative management is indicated until the pregnancy reaches a viable gestational age for delivery.

56
Q
  1. What is the cause of uterine atony?
    A. Retained placenta
    B. Uterine rupture
    C. Failure of myometrial fibers to interlace
    D. Coagulation disorder
A

C. Failure of myometrial fibers to interlace
Rationale: Uterine atony occurs when the myometrial fibers fail to contract and compress the blood vessels, resulting in postpartum hemorrhage.

57
Q
  1. What is the pathophysiology of placenta accreta?
    A. Lack of decidual basalis, with placental adherence to the myometrium
    B. Deep invasion of the myometrium
    C. Overproduction of chorionic villi
    D. Failure of placental separation at delivery
A

A. Lack of decidual basalis, with placental adherence to the myometrium
Rationale: Placenta accreta occurs due to abnormal trophoblastic invasion beyond the Nitabuch layer, leading to adherence to the myometrium.

58
Q
  1. What is the recommended treatment for uterine inversion?
    A. Controlled traction on the umbilical cord
    B. Uterine massage through the abdomen
    C. Immediate oxytocin administration
    D. Manual repositioning of the uterus
A

D. Manual repositioning of the uterus
Rationale: Uterine inversion is treated by manually repositioning the uterus into its normal anatomical position. Excessive traction on the umbilical cord should be avoided to prevent further complications.

59
Q
  1. Which statement about the medical management of postpartum hemorrhage (PPH) is true?
    A. Oxytocin is routinely given in PPH patients
    B. Uterine massage is optional
    C. Misoprostol is contraindicated
    D. Balloon tamponade is the first-line treatment
A

A. Oxytocin is routinely given in PPH patients
Rationale: Oxytocin is the first-line medication for the prevention and management of postpartum hemorrhage. It promotes uterine contractions and reduces bleeding.

60
Q
  1. A 35-year-old G2P0 at 34 weeks presents with severe abdominal pain, vaginal bleeding, and contractions every 2 minutes. FHT is 115 bpm. What is the likely diagnosis?
    A. Placenta previa
    B. Placenta accreta
    C. Abruptio placenta
    D. Uterine rupture
A

C. Abruptio placenta
Rationale: Abruptio placenta is characterized by painful vaginal bleeding, uterine tenderness, and fetal distress (e.g., bradycardia or abnormal FHT).

61
Q
  1. A 33-year-old G4P2 at 33 weeks with a history of cesarean sections is diagnosed with placenta accreta. What is the underlying pathophysiology?
    A. Loss of the Nitabuch layer
    B. Myometrial rupture
    C. Excessive decidua formation
    D. Thinning of the chorionic plate
A

A. Loss of the Nitabuch layer
Rationale: Placenta accreta results from the absence of the Nitabuch layer, leading to abnormal placental attachment to the myometrium.

62
Q
  1. What is the most sensitive modality for diagnosing placenta previa?
    A. Transvaginal ultrasonography
    B. Transabdominal ultrasonography
    C. MRI
    D. Hysteroscopy
A

A. Transvaginal ultrasonography
Rationale: Transvaginal ultrasonography is the gold standard for diagnosing placenta previa due to its high accuracy and safety.

63
Q
  1. A 31-week pregnant G4P2 presents with vaginal bleeding, no contractions, and a normal FHT of 140 bpm. What is the most likely diagnosis?
    A. Placenta previa
    B. Placenta accreta
    C. Abruptio placenta
    D. Uterine rupture
A

A. Placenta previa
Rationale: Painless vaginal bleeding in the third trimester, with no contractions or fetal distress, is characteristic of placenta previa.

64
Q
  1. Which of the following is NOT a risk factor for placenta previa?
    A. Multiple pregnancy
    B. Substance abuse
    C. History of myomectomy
    D. Long pregnancy intervals
A

D. Long pregnancy intervals
Rationale: Risk factors for placenta previa include multiple pregnancies, prior cesarean deliveries, infertility treatments, smoking, and a history of uterine surgeries like myomectomy. Long pregnancy intervals are not directly associated with placenta previa.

65
Q
  1. A 35-year-old G5P2 at 33 weeks presents with vaginal bleeding, no abdominal pain, and stable vital signs. She has had 2 prior cesarean sections for CPD and one curettage. What is her risk factor for this condition?
    A. Multiple pregnancy
    B. Previous cesarean sections
    C. Short pregnancy interval
    D. All of the above
A

D. All of the above
Rationale: Risk factors for placenta previa include prior cesarean sections, multiple pregnancies, and short interpregnancy intervals. All of these contribute to the development of placenta previa due to scarring and changes in uterine anatomy.

66
Q
  1. A 32-year-old G1P0 at 35 weeks presents with severe abdominal pain for 3 hours and vaginal bleeding. Uterus is tender, with strong uterine contractions. FHT is 150 bpm. What complications should you watch for?
    A. Hypertension
    B. Disseminated intravascular coagulation (DIC)
    C. Asherman’s syndrome
    D. Chorioamnionitis
A

B. Disseminated intravascular coagulation (DIC)
Rationale: Abruption placenta is a likely diagnosis, and DIC is a major complication due to intravascular clotting activation and consumptive coagulopathy. This is a common consequence of severe placental abruption.

67
Q
  1. Which statement is true about the gravid patient’s artery that is modified by trophoblast?
    A. Replacement of trophoblast with smooth muscle in the endothelium
    B. Replacement of smooth muscle in the endothelium with trophoblast
    C. Creation of high-resistance vessels
    D. Creation of partially low-flow zones
A

B. Replacement of smooth muscle in the endothelium with trophoblast
Rationale: During pregnancy, trophoblastic cells replace the smooth muscle in the endothelium of spiral arteries, creating a low-resistance, high-flow environment to ensure adequate placental blood supply.

68
Q
  1. What can lead to consumptive coagulopathy?
    A. Placenta previa
    B. Uterine rupture
    C. Abruptio placenta
    D. Chorioamnionitis
A

C. Abruptio placenta
Rationale: Abruptio placenta is the most common cause of consumptive coagulopathy in obstetrics, as it leads to significant activation of clotting factors and intravascular coagulation, ultimately resulting in DIC.

69
Q
  1. What is the greatest risk factor for abruptio placenta?
    A. Smoking
    B. Preeclampsia
    C. Prior abruption
    D. Low birth weight
A

C. Prior abruption
Rationale: A history of prior abruption significantly increases the risk of recurrence, making it the strongest risk factor for abruptio placenta.

70
Q
  1. What is the recommended management for pregnancies at any gestational age complicated by severe placental abruption?
    A. Immediate delivery
    B. Administer corticosteroids
    C. Wait for ultrasound confirmation
    D. Monitor maternal and fetal status
A

A. Immediate delivery
Rationale: Severe placental abruption is a medical emergency that requires immediate delivery, regardless of gestational age, to prevent further complications for both the mother and fetus.

71
Q
  1. A condition where there is invasion of the trophoblast into the myometrium is:
    A. Placenta accreta
    B. Placenta increta
    C. Placenta percreta
    D. Placental abruption
A

B. Placenta increta
Rationale: Placenta increta involves the invasion of the trophoblast into the myometrium. Placenta accreta is adhesion to the uterine wall without invasion, and placenta percreta involves penetration through the myometrium into surrounding tissues.

72
Q
  1. Which of the following is an ultrasound finding for placenta accreta?
    A. Thickening of the retroplacental zone
    B. Swiss-cheese appearance
    C. Placental edges <2 cm from the internal os
    D. Hyperechogenic areas without vascularity
A

B. Swiss-cheese appearance
Rationale: Placenta accreta is associated with multiple placental lakes seen as a “Swiss-cheese appearance” on ultrasound. These are irregular anechoic areas denoting intra-placental lacunae.

73
Q
  1. Ultrasound findings of abruptio placenta include which of the following? (TRUE/FALSE)

Pre-placental hematoma:

A

TRUE

Ultrasound findings of abruptio placenta include retroplacental and preplacental hematomas, increased placental thickness and echogenicity, and fluid collections (e.g., subchorionic or marginal).

74
Q
  1. Ultrasound findings of abruptio placenta include which of the following? (TRUE/FALSE)

Increased placental thickness and echogenicity:

A

TRUE

Ultrasound findings of abruptio placenta include retroplacental and preplacental hematomas, increased placental thickness and echogenicity, and fluid collections (e.g., subchorionic or marginal).

75
Q
  1. Ultrasound findings of abruptio placenta include which of the following? (TRUE/FALSE)

Subchorionic or marginal collection of fluid

A

TRUE

Ultrasound findings of abruptio placenta include retroplacental and preplacental hematomas, increased placental thickness and echogenicity, and fluid collections (e.g., subchorionic or marginal).

76
Q
  1. Is thinning of the uterine serosa-bladder wall complex a characteristic of abruptio placenta? (TRUE/FALSE)
A

FALSE
Rationale: Thinning of the uterine serosa and bladder wall complex is characteristic of placenta percreta, where the placenta penetrates beyond the uterine serosa.

77
Q
  1. Complications of abruptio placenta include which of the following?
    A. Hypovolemic shock
    B. Acute kidney injury
    C. Disseminated intravascular coagulation (DIC)
    D. All of the above
A

D. All of the above
Rationale: Abruptio placenta can result in hypovolemic shock due to severe blood loss, acute kidney injury from hypotension, and DIC due to consumptive coagulopathy.

78
Q
  1. A 30-year-old G2P3 at 28 weeks presents with headache, dizziness, joint pain, and BP of 180/100. Urinalysis reveals (-) albumin. What is the most likely diagnosis?
    A. HELLP
    B. Preeclampsia
    C. Eclampsia
    D. Gestational hypertension
A

A. HELLP
Rationale: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet count) is an atypical presentation of preeclampsia that may occur without hypertension or proteinuria. Joint pain suggests hemolysis, a hallmark of HELLP.

79
Q
  1. A 25-year-old pregnant female is brought to the ER with a tonic-clonic seizure. What is the most appropriate drug to give this patient?
    A. Magnesium sulfate
    B. Diazepam
    C. Phenytoin
    D. Hydralazine
A

A. Magnesium sulfate
Rationale: Eclampsia is managed with magnesium sulfate as the first-line anticonvulsant. Diazepam may be used only if magnesium sulfate fails. Hydralazine is used for blood pressure control in preeclampsia/eclampsia but does not treat seizures.

80
Q
  1. Which of the following is a severe feature of preeclampsia?
    A. Oligohydramnios
    B. Intrauterine growth restriction (IUGR)
    C. Non-dependent edema
    D. Creatinine more than 1.1
A

D. Creatinine more than 1.1
Rationale: Severe features of preeclampsia include renal dysfunction (e.g., creatinine >1.1), thrombocytopenia, liver enzyme elevation, or pulmonary edema. Oligohydramnios and IUGR are complications but not defining severe features.

81
Q
  1. At what magnesium sulfate level is respiratory depression likely to occur?
    A. 10-12 Meq/L
    B. 7-9 Meq/L
    C. 5-6 Meq/L
    D. 3-4 Meq/L
A

A. 10-12 Meq/L
Rationale: Therapeutic magnesium levels are 4-7 Meq/L. Levels above 10-12 Meq/L can cause respiratory depression, and levels >15 Meq/L may lead to cardiac arrest.

82
Q
  1. Anti-hypertensive therapy in preeclampsia aims to:
    A. Maintain adequate uteroplacental perfusion
    B. Lower BP to <120/80
    C. Completely normalize BP
    D. Prevent eclampsia
A

A. Maintain adequate uteroplacental perfusion
Rationale: The goal of antihypertensive therapy in preeclampsia is to reduce severe hypertension and prevent complications while maintaining blood flow to the placenta and fetus.

83
Q
  1. Why is magnesium sulfate continued for 24 hours postpartum?
    A. When seizures occurred antepartum or intrapartum
    B. When BP remains higher than 140/90
    C. To prevent postpartum eclampsia in pre-eclamptic patients with severe features
    D. To support breastfeeding patients
A

C. To prevent postpartum eclampsia in pre-eclamptic patients with severe features
Rationale: Postpartum eclampsia can occur up to 24-48 hours after delivery. Magnesium sulfate is continued postpartum in patients with severe features to prevent seizures.

84
Q
  1. Expectant management in preeclampsia is possible in which type of patients?
    A. Good control of BP
    B. Severity is due to new onset of proteinuria
    C. AOG is <34 weeks with good fetal status
    D. Headache can be relieved by analgesics
A

C. AOG is <34 weeks with good fetal status
Rationale: Expectant management aims to prolong pregnancy and improve fetal maturity. This is only considered in preeclampsia cases with good fetal and maternal status and an AOG of <34 weeks. Immediate delivery is required for worsening maternal or fetal condition.

85
Q
  1. Which kidney pathology is invariably present in preeclampsia?
    A. Glomerular endotheliosis
    B. Tubular necrosis
    C. Interstitial nephritis
    D. Membranous nephropathy
A

A. Glomerular endotheliosis
Rationale: Glomerular endotheliosis, characterized by endothelial cell swelling and capillary lumen obliteration, is a hallmark of preeclampsia.

86
Q
  1. What level of magnesium sulfate will produce hyporeflexia?
    A. 8-10 Meq/L
    B. 5-7 Meq/L
    C. 12-15 Meq/L
    D. >15 Meq/L
A

A. 8-10 Meq/L
Rationale: Hyporeflexia is an early sign of magnesium sulfate toxicity, occurring at levels between 8-10 Meq/L. Levels higher than 10 Meq/L may cause respiratory depression and cardiac arrest.

87
Q
  1. Why do chronic hypertensives present with normal BP at 12-16 weeks AOG?
    A. Development of spiral arterioles after the second week of trophoblastic invasion
    B. Increased maternal vascular resistance
    C. Physiological changes in cardiac output
    D. Hormonal regulation by the placenta
A

A. Development of spiral arterioles after the second week of trophoblastic invasion
Rationale: During early pregnancy, the development of spiral arterioles decreases systemic vascular resistance, leading to reduced BP in chronic hypertensive patients.

88
Q
  1. A 38-year-old primigravida at 28 weeks has BP of 150/90 mmHg and negative dipstick proteinuria. What is the diagnosis?
    A. Gestational hypertension
    B. Preeclampsia
    C. Preeclampsia with severe features
    D. Chronic hypertension
A

A. Gestational hypertension
Rationale: Gestational hypertension is defined as BP ≥140/90 mmHg after 20 weeks of gestation without proteinuria or other signs of preeclampsia.

89
Q
  1. At what gestational age should uterine artery Doppler velocimetry be done to predict preeclampsia?
    A. 11-14 weeks
    B. 16-20 weeks
    C. 20-24 weeks
    D. 24-28 weeks
A

A. 11-14 weeks
Rationale: Uterine artery Doppler velocimetry performed between 11-14 weeks is used to screen for preeclampsia and other placental insufficiency disorders.

90
Q
  1. How is uncontrolled severe hypertension defined in pregnancy?
    A. BP remains above 160/110 mmHg despite maximum doses of at least two antihypertensive drugs
    B. Persistently high BP >160/100 mmHg
    C. BP does not normalize with treatment
    D. BP with continued spikes to >200/120 mmHg
A

A. BP remains above 160/110 mmHg despite maximum doses of at least two antihypertensive drugs
Rationale: Severe hypertension is defined as BP ≥160/110 mmHg. Uncontrolled severe hypertension is resistant to treatment despite adequate medical therapy with multiple drugs.

91
Q
  1. When should patients diagnosed with HELLP syndrome be delivered?
    A. Anytime soonest after maternal stabilization
    B. At 34 weeks gestation
    C. After corticosteroid administration
    D. After 37 weeks
A

A. Anytime soonest after maternal stabilization
Rationale: HELLP syndrome is a severe obstetric emergency. Delivery is the definitive treatment and should occur as soon as maternal stabilization is achieved, regardless of gestational age.

92
Q
  1. Which statement is true about the use of diuretics in preeclampsia?
    A. Advised for uncomfortable dependent edema
    B. Since patients are hypervolemic
    C. First-line drug for pulmonary edema
    D. Not used in preeclampsia management
A

C. First-line drug for pulmonary edema
Rationale: Diuretics, such as furosemide, are generally not used in preeclampsia unless there is pulmonary edema. They are effective in reducing fluid overload in this specific scenario but are otherwise avoided due to the risk of worsening placental perfusion.

93
Q
  1. What is the outpatient drug of choice for hypertension in pregnancy?
    A. Methyldopa
    B. Labetalol
    C. Nifedipine
    D. Hydralazine
A

A. Methyldopa
Rationale: Methyldopa is the preferred antihypertensive for long-term management of chronic hypertension in pregnancy due to its safety profile for both the mother and fetus. Labetalol and nifedipine are alternatives but are more commonly used in acute settings.

94
Q
  1. A preeclamptic patient has reddish urine in the urinary catheter. What is the appropriate management?
    A. Prepare for stat cesarean section
    B. Check for CBC
    C. Assume Foley catheter trauma
    D. Hydrate the patient
A

B. Check for CBC
Rationale: Reddish urine in a preeclamptic patient may indicate hematuria or hemoglobinuria, suggesting underlying complications such as hemolysis in HELLP syndrome. A CBC should be done to check for thrombocytopenia or anemia.

95
Q
  1. A 42-year-old primigravida at 14 weeks with BP 180/100 is diagnosed with preeclampsia with severe features. What feature supports this diagnosis?
    A. Chronic hypertension
    B. Multiple gestations
    C. Oligohydramnios
    D. Proteinuria of 500 mg/dL
A

D. Proteinuria of 500 mg/dL
Rationale: The diagnostic criteria for preeclampsia include BP ≥140/90 mmHg and proteinuria ≥300 mg/dL in 24-hour urine. Proteinuria >500 mg/dL strongly suggests severe features.

96
Q
  1. A 23-year-old primigravida at 22 weeks is rushed to the hospital due to tonic-clonic movements. BP is 140/90. What is the diagnosis?
    A. Preeclampsia with severe features
    B. Preeclampsia without severe features
    C. Eclampsia
A

C. Eclampsia
Rationale: Eclampsia is defined as the occurrence of seizures in a pregnant woman with preeclampsia. This patient has BP >140/90 and tonic-clonic seizures, fulfilling the criteria for eclampsia.

97
Q
  1. Preeclampsia in a primipara could be explained by which causative agent?
    A. Genetic factors
    B. Maternal maladaptation
    C. Immunological maladaptive tolerance between maternal, paternal, and fetal tissues
    D. Placental implantation
A

C. Immunological maladaptive tolerance between maternal, paternal, and fetal tissues
Rationale: Preeclampsia is linked to an immunological maladaptive response involving paternal antigens from the fetus, maternal immune system, and placental tolerance. This distinguishes it from maternal-only factors.

98
Q
  1. What is the most effective method of predicting preeclampsia?
    A. MAP with maternal risk factors
    B. sFlt-1 with maternal characteristics
    C. Maternal risk factors alone
    D. MAP, uterine artery Doppler velocimetry, and PlGF
A

D. MAP, uterine artery Doppler velocimetry, and PlGF
Rationale: The combination of mean arterial pressure (MAP), uterine artery Doppler velocimetry, and placental growth factor (PlGF) measurement is the most effective method for early prediction of preeclampsia, offering a comprehensive assessment of vascular and placental health.

99
Q
  1. Which statement is true about the use of antihypertensives in preeclampsia?
    A. Normal BP range of 90/120-70/90
    B. Maintain a MAP of <90
    C. Starting dose should be high to prevent repeated prolonged exposure
    D. Methyldopamine would be given anytime in pregnancy
A

B. Maintain a MAP of <90
Rationale: The goal of antihypertensive therapy in preeclampsia is to maintain a mean arterial pressure (MAP) below 90 mmHg to reduce the risk of stroke and organ damage without compromising uteroplacental blood flow.

100
Q
  1. Why are antenatal corticosteroids given even beyond 34 weeks?
    A. More enhanced lung maturity
    B. Reduce cerebrovascular hemorrhage and necrosis
    C. Stabilize the capillaries
    D. Reduce inflammation
A

B. Reduce cerebrovascular hemorrhage and necrosis
Rationale: Corticosteroids are administered to reduce the risk of neonatal complications, such as cerebrovascular hemorrhage and necrosis, even in late preterm infants. They are beneficial for fetal lung and brain development.

101
Q
  1. Before subsequent doses of magnesium sulfate, what observations must be present?
    A. Respiratory rate <12
    B. Urine output >30 cc/hour
    C. Patellar reflex should not be demonstrated
    D. Cardiac rate should be at least 80 bpm
A

B. Urine output >30 cc/hour
Rationale: Magnesium sulfate toxicity is monitored by checking for urine output (to ensure excretion), preserved patellar reflexes (to detect early toxicity), and adequate respiratory function. A urine output of >30 cc/hour is essential.

102
Q
  1. What is the mode of action of magnesium sulfate?
    A. Centrally acting
    B. Competitive inhibition of neuromuscular junction
    C. Stabilization of Na channels
    D. Modulation of synaptic vessels
A

B. Competitive inhibition of neuromuscular junction
Rationale: Magnesium sulfate acts by inhibiting calcium influx at the neuromuscular junction, leading to decreased excitability of muscle cells and preventing seizures in eclampsia.

103
Q
  1. What are the most common signs and symptoms of HELLP syndrome?
    A. Jaundice
    B. Visual changes
    C. Malaise
    D. Bleeding
A

C. Malaise
Rationale: The most common symptoms of HELLP syndrome include malaise, upper right quadrant pain, and nausea. These symptoms often precede more severe manifestations like jaundice or bleeding.

104
Q
  1. A 43-year-old G1P0 at 28 weeks with BP of 220/120 presents with blurred vision and a severe headache. She was on methyldopa since 12 weeks. What is the diagnosis?
    A. Chronic hypertension with superimposed preeclampsia
    B. Severe preeclampsia
    C. Gestational hypertension
    D. Hypertensive crisis
A

A. Chronic hypertension with superimposed preeclampsia
Rationale: Chronic hypertension complicated by proteinuria or severe BP elevation (≥160/110) and symptoms such as blurred vision and headache after 20 weeks gestation is classified as superimposed preeclampsia.

0 - PCOL2 (9 decks)

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