Miscellaneous

Question 1

All women are screened during the first prenatal visit for asymptomatic bacteriuria due to risk of […], preterm birth, and low birth weight.

Answer 1

All women are screened during the first prenatal visit for asymptomatic bacteriuria due to risk of pyelonephritis, preterm birth, and low birth weight.

defined as an asymptomatic patient that grows > 100,000 colony-forming units/mL of a single organism on urinalysis (typically E. coli

Question 2

Can a pregnant woman with capacity refuse cesarean section if vaginal delivery would put the unborn child at risk?

Answer 2

Yes

a pregnant woman with capacity has the right to refuse treatment, regardless of risk to the unborn child

Question 3

Can women with chronic hepatitis C infection breastfeed?

Answer 3

Yes

as long as there is no active bleeding from the nipple

Question 4

Does levothyroxine significantly increase the risk for neonatal thyrotoxicosis?

Answer 4

No (doesn’t cross placenta to a significant degree)

Question 5

False pregnancy, or […], is the belief that one is pregnant when they aren’t really.

Answer 5

False pregnancy, or pseudocyesis, is the belief that one is pregnant when they aren’t really.

may present with clinical signs of pregnancy (e.g. morning sickness, amenorrhea, abdominal distention) with a negative pregnancy test

Question 6

First-line treatment options for asymptomatic bacteriuria during pregnancy include […], amoxicillin-clavulanate, and nitrofurantoin.

Answer 6

First-line treatment options for asymptomatic bacteriuria during pregnancy include cephalexin, amoxicillin-clavulanate, and nitrofurantoin.

all women are screened during the first prenatal visit due to risk of pyelonephritis, preterm birth, and low birth weight associated with ASB

Question 7

First-line treatment options for asymptomatic bacteriuria during pregnancy include cephalexin, […], and nitrofurantoin.

Answer 7

First-line treatment options for asymptomatic bacteriuria during pregnancy include cephalexin, amoxicillin-clavulanate, and nitrofurantoin.

all women are screened during the first prenatal visit due to risk of pyelonephritis, preterm birth, and low birth weight associated with ASB

Question 8

First-line treatment options for asymptomatic bacteriuria during pregnancy include cephalexin, amoxicillin-clavulanate, and […].

Answer 8

First-line treatment options for asymptomatic bacteriuria during pregnancy include cephalexin, amoxicillin-clavulanate, and nitrofurantoin.

all women are screened during the first prenatal visit due to risk of pyelonephritis, preterm birth, and low birth weight associated with ASB

Question 9

How do the following laboratory values change during pregnancy?

Total T3/T4: […]

Free T3/T4: […]

TSH: […]

Answer 9

Total T3/T4: Increased

Free T3/T4: Unchanged

TSH: Decreased

Question 10

In patients with osteoporosis, the risk for fragility fracture is highest in those with a history of […].

Answer 10

In patients with osteoporosis, the risk for fragility fracture is highest in those with a history of prior fragility fracture.

Question 11

Newborns with ABO incompatibility are typically asymptomatic at birth or have […].

Answer 11

Newborns with ABO incompatibility are typically asymptomatic at birth or have mild anemia.

maternal IgG antibodies against blood groups A and B develop from exposure to antigens in food, bacteria, viruses, etc. and can cause mild disease in a newborn

Question 12

Nonclassic congenital adrenal hyperplasia is caused by a […] of 21-hydroxylase.

Answer 12

Nonclassic congenital adrenal hyperplasia is caused by a partial deficiency of 21-hydroxylase.

manifests as symptoms of hyperandrogenism in adolescents or young adults

Question 13

One way in which thyroid hormone production is increased during pregnancy is through direct stimulation of TSH receptors by […].

Answer 13

One way in which thyroid hormone production is increased during pregnancy is through direct stimulation of TSH receptors by hCG.

Question 14

One way in which thyroid hormone production is increased during pregnancy is through increased estrogen-induced synthesis of […].

Answer 14

One way in which thyroid hormone production is increased during pregnancy is through increased estrogen-induced synthesis of thyroxine-binding globulin (TBG).

patients with normal thyroid reserve subsequently increase thyroid hormone production to maintain free hormone levels

Question 15

Peripartum cardiomyopathy typically causes rapid-onset systolic heart failure at > […] weeks gestation or in the early postpartum period.

Answer 15

Peripartum cardiomyopathy typically causes rapid-onset systolic heart failure at > 36 weeks gestation or in the early postpartum period.

e.g. fatigue, dyspnea, cough, pedal edema

Question 16

Postpartum thyroiditis is associated with […] antibodies.

Answer 16

Postpartum thyroiditis is associated with anti-thyroid peroxidase antibodies.

considered a variant of Hashimoto thyroidits

Question 17

Postpartum thyroiditis is often characterized by an initial brief […]-thyroid phase followed by a […]-thyroid phase.

Answer 17

Postpartum thyroiditis is often characterized by an initial brief hyper-thyroid phase followed by a hypo-thyroid phase.

e.g. anxiety, palpitations followed by fatigue, weight gain, constipation, hypercholesterolemia, etc.

Question 18

Postpartum thyroiditis is similar to painless thyroiditis, but is diagnosed if symptoms occur within […] of childbirth.

Answer 18

Postpartum thyroiditis is similar to painless thyroiditis, but is diagnosed if symptoms occur within one year of childbirth.

Question 19

Pregnant women with a history of genital HSV infection should receive prophylactic acyclovir or valacyclovir beginning at […] weeks of pregnancy.

Answer 19

Pregnant women with a history of genital HSV infection should receive prophylactic acyclovir or valacyclovir beginning at 36 weeks of pregnancy.

reduces risk of an outbreak around the time of delivery, thus decreasing the risk of cesarean delivery

Question 20

Secondary amenorrhea is defined as the absence of menses for > 3 cycles or > […] months in women who menstruated previously.

Answer 20

Secondary amenorrhea is defined as the absence of menses for > 3 cycles or > 6 months in women who menstruated previously.

Question 21

The first-line agents for management of essential hypertension during pregnancy are […] and […].

Answer 21

The first-line agents for management of essential hypertension during pregnancy are labetalol and methyldopa.

acceptable alternatives include hydralazine and nifedipine

Question 22

The […] test may be used to determine if a higher dose of anti-D immune globulin is needed after a procedure or delivery.

Answer 22

The Kleihauer-Betke test may be used to determine if a higher dose of anti-D immune globulin is needed after a procedure or delivery.

the standard dose (300 mg) is enough to neutralize 30 mL of fetal blood; this test is typically used when there is an increased risk of fetal blood cells entering the maternal circulation (e.g. placental abruption, amniocentesis)

Question 23

What is the likely diagnosis in a newborn born to a mother with Grave’s disease that presents with irritability, tachycardia, and low birth weight?

Answer 23

Neonatal thyrotoxicosis

due to passage of maternal TSH receptor antibodies across the placenta

Question 24

What is the likely diagnosis in a newborn with hirsutism, phalanx/nail hypoplasia, and a cleft palate?

Answer 24

Fetal hydantoin syndrome

classically seen with phenytoin or carbamazepine use

Question 25

What is the likely diagnosis in a patient with an adducted and internally rotated shoulder following an eclamptic seizure?

Answer 25

posterior shoulder dislocation

typically occurs with violent muscle contractions (e.g. seizure, electrocution)

Question 26

What is the likely diagnosis in a pregnant woman that presents with intense generalized pruritus, especially at night, and elevated aminotransferases?

Answer 26

Intrahepatic cholestasis of pregnancy

diagnosis of exclusion; typically resolves within weeks following delivery

Question 27

What is the most appropriate first step for a patient that tests positive for HIV but does not want to tell his/her partner?

Answer 27

encourage the patient to tell the partner(s) & notify the local health department

public health laws require reporting HIV to the local public health department

Question 28

What is the next step in diagnosis for a patient with secondary amenorrhea and a negative pregnancy test?

Answer 28

Measure serum prolactin, TSH, and FSH

assesses for the most common causes of secondary amenorrhea (hyperprolactinemia, thyroid dysfunction, premature ovarian failure)

Question 29

What is the preferred imaging modality for diagnosis of acute appendicitis during pregnancy?

Answer 29

Ultrasound (graded compression technique)

if ultrasound is non-diagnostic, MRI can be performed for further assessment

Question 30

What is the preferred imaging modality for diagnosis of nephrolithiasis during pregnancy?

Answer 30

Pelvic and renal ultrasound

low-dose CT urography can be considered in the 2nd or 3rd trimester if ultrasound is not helpful

Question 31

What is the probability of a child having hemophilia A if born to a carrier mother and unaffected father?

Answer 31

25%

50% chance that the child is a son; 50% of sons will inherit the mutated X chromosome

Question 32

What is the recommended antepartum treatment for a pregnant woman with HIV?

Answer 32

Combined anti-retroviral therapy (ART)

e.g. two NRTIs and an NNRTI or protease inhibitor

Question 33

What is the recommended intrapartum treatment for a pregnant woman with an HIV viral load

Answer 33

ART + vaginal delivery

Question 34

What is the recommended intrapartum treatment for a pregnant woman with an HIV viral load > 1000 copies/mL?

Answer 34

ART + zidovudine + cesarean delivery

Question 35

What is the recommended management for a pregnant patient with chronic hepatitis C infection and no immunity to hepatitis A/B?

Answer 35

Administer hepatitis A and B vaccines

can be safely administered during pregnancy; ribavirin is contraindicated due to teratogenic effects

Question 36

What is the recommended management for a pregnant woman with an active genital HSV infection that presents in labor?

Answer 36

Cesarean delivery

recommended for women in labor with active genital HSV infection or prodromal symptoms

Question 37

What is the recommended management for a woman with medically-managed hypothyroidism that desires to get pregnant in the near future?

Answer 37

Increase levothyroxine dose at the time pregnancy is detected

women with pre-existing hypothyroidism are unable to increase thyroxine production enough to maintain free T3/T4 levels with a rising thyroxine-binding globulin

Question 38

What is the recommended treatment for a newborn with neonatal thyrotoxicosis?

Answer 38

Methimazole + beta-blocker until condition self-resolves

typically self-resolves over the first few weeks to months of life (as maternal antibodies disappear from circulation)

Question 39

What is the recommended treatment for an infant born to a mother with an HIV viral load

Answer 39

Zidovudine for > 6 weeks

Question 40

What is the recommended treatment for an infant born to a mother with an HIV viral load > 1000 copies/mL?

Answer 40

Multi-drug ART for > 6 weeks

Question 41

What is the typical outcome of postpartum thyroiditis?

Answer 41

Return to euthyroid over several months

self-limited disease