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Patho OB 2 > OB Final > Flashcards

OB Final Flashcards

1
Q

question

A

answer

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2
Q

24 weeks pregnant woman with multifetal pregnancy manifested for signs of preterm labor. What is the treatment for the case?

A) Corticosteroids
B) Bed rest
C) Tocolytics
D) Pessary

A

C) Tocolytics

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3
Q

Effects on pregnant patient of infection

A) Serologic
B) Gestational Age
C) Mode of Acquisition
D) Immunologic

A

B) Gestational Age

AOTA?

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4
Q

Intrauterine fetal transfusion is management option for infection caused by:

A) Parvovirus
B) CMV
C) Influenza
D) Mumps

A

A) Parvovirus

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5
Q

Most common anomaly in congenital rubella syndrome seen in 60-75%

A

Sensorineural deafness

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6
Q

The most common anomaly associated with congenital hyperplasia in 60-75%?

A) Malformation
B) Cardiac Anomaly
C) Mental retardation

A

B) Cardiac Anomaly

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7
Q

In contrast to congenital varicella, varicella-zoster immune globulin should be administered in neonatal varicella

A) 2 days before and a week after delivery
B) 7 days before and 7 days after delivery
C) 5 days before and 5 days after delivery
D) 5 days before and 2 days after delivery

A

D) 5 days before and 2 days after delivery

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8
Q

Diagnosis of toxoplasmosis in the mother is best confirmed by serology. Serologic test suggestive of an acute infection includes the identification of

A) IgM antibody
B) Extensive high IgG Ab titer
C) IgG seroconversion from negative to positive
D) A and B
E) A, B, C
A

E) A, B, C

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9
Q

The most valuable test for congenital toxoplasmosis is by detection through PCR. What specimen is obtained?

A) Maternal blood
B) Maternal tissue
C) Amniotic fluid
D) Fetal tissue

A

C) Amniotic fluid

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10
Q

Confirmatory test for VZV

A) Antibody VZV IgM
B) Antibody VZV IgG
C) VZV IgM
D) VZV IgG

A

C) VZV IgM

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11
Q

As opposed to congenital rubella, neonatal rubella happens when?

A

Congenital rubella – happens during pregnancy

Neonatal rubella – acquired after birth

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12
Q

True about influenza vaccine?

A) All health worker should be vaccinated yearly
B) 70-90% efficacy and decrease the severity
C) All women planning to be pregnant should be vaccinated in flu season
D) A and C
E) All of the above

A

E) All of the above

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13
Q

True on Influenza immunization

A) Getting pregnant at flu season
B) 70-90% efficacy and reduced severity
C) Healthworkers require immunization
D) All of the above

A

D) All of the above

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14
Q

) In congenital toxoplasmosis infection, 40% neonates born to mothers with evidence of disease, most likely to occur when maternal infection develops during

A) 1st trimester
B) 2nd trimester
C) 3rd trimester
D) After delivery

A

C) 3rd trimester

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15
Q

40% of neonates affected with toxoplasmosis infection given that the mother during pregnancy has the said disease

A) Maternal blood
B) Fetal blood
C) Amniotic fluid

A

A) Maternal blood

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16
Q

Rubella crosses the placenta thru hematogenous dissemination, rate decreases with increasing gestational age. However, 50-80% develop infection as early as this gestation

A) 12 weeks
B) 14 weeks
C) 18 weeks
D) 20 weeks

A

B) 14 weeks

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17
Q

The initial immune response of the fetus after delivery came from?

A) Cell-mediated immunity
B) Humoral
C) Both
D) Neither

A

C) Both

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18
Q

What is the proper way of collection for screening of group B streptococcus?

A) From distal vagina and anorectal
B) Use speculum for proper visualization of vagina and rectum
C) Proximal vagina and anorectal
D) A and B
E) A and C
A

D) A and B

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19
Q

Not true about Antileukotrienes effective in the management of acute asthma

A

Effective in the management of acute asthma

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20
Q

Prophylacyive antibiotic

A) Group A streptococcus
B) Group B streptococcus
C) Streptococcus agalactiae (GBS)
D) All of the above

A

D) All of the above

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21
Q

Classic sign of Sick Neonate, Except:

A) Poor suck
B) Vomiting
C) Lethargy
D) Hyperthermia

A

D) Hyperthermia

response to sepsis may be hypothermia

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22
Q

Most common cause of Neonatal sepsis

A) Group A streptoccocus
B) Listeria monocytogenes
C) Streptococcus agalactiae
D) Mycobacterium leprae

A

C) Streptococcus agalactiae

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23
Q

Acquired neonatal infection

A) 24 hours
B) 48 hours
C) 72 hours
D) 96 hours

A

C) 72 hours

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24
Q

Sulfadoxine-pyrethamine is given to:

A) Toxoplasmosis
B) Malaria
C) Hansen’s Disease
D) Listeriosis

A

A) Toxoplasmosis

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25
Q

In pregnancy, the predominant CD4 T-cell is/are?

A) Th1
B) Th2
C) Th3
D) Th4

A

B) Th2

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26
Q

The primary fetal response in case of exposure to infectious agents is?

A) IgG
B) IgA
C) IgM
D) IgE

A

C) IgM

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27
Q

Entry of vertical transmission during pregnancy includes?

A) Placenta
B) Labor and Delivery
C) Breast Feeding
D) All of the Above

A

D) All of the Above

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28
Q

Not associate with fetal effects?

A) Mumps
B) Varicella Zoster
C) Measles
D)German measles

A

A) Mumps

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29
Q

After being given a mumps vaccine, it is recommended that women should not get pregnant for the next?

A) 2 weeks
B) 4 weeks
C) 6 weeks
D) 8 weeks

A

B) 4 weeks

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30
Q

Associated with placental trophoblast invasion?

A) Group A streptococcus
B) Group B streptococcus
C) Salmonellosis
D) Listeria Monocytogenes

A

D) Listeria Monocytogenes

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31
Q

Development of CMI and humoral immune response occurs by?

a. 5-10 weeks
b. 8-15 weeks
c. 15-20 weeks
d. 21-25 weeks

A

b. 8-15 weeks

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32
Q

question

A

answer

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33
Q

Best measures for assessment of asthma include the following:

A. Subjective assessment
B. FEV and PEFR
C. Arterial blood gas analysis
D. Clinical assessment
E. Aota
A

B. FEV and PEFR

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34
Q

Guidelines to management of labor and delivery in asthmatic

mother/woman includes the ff except:

A

ANS: PFA 2 AND ERGONOVINE for uterine atony.

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35
Q

Which of the following is the Most common cause of Pneumonia?

A. Mycoplasma pneumonia
B. Legionella Pneumonia
C. Influenza A
D. CA MRSA

A

C. Influenza A

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36
Q

The ff. describes the diagnostic procedures used for Pneumonia:

A. Chest xray accurately predicts the etiology
B. Chest radiography is essential for the diagnosis
C. Sputum cultures is primarily indicated in all cases of pneumonia
D. All of the above

A

B. Chest radiography is essential for the diagnosis

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37
Q

A 30 year old G3P2 on her 30 week AOG with history of mild upper respiratory tract infection, present with cough, dyspnea
and fever. What is the effective initial monotherapy recommended:

A. Levofloxacin
B. Vancomycin
C. Erythromycin
D. Linezolid

A

C. Erythromycin

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38
Q

Exceptions to delay INH tx to pregnant tuberculin positive women.

A. Known skin test converter
B. Positive PPD exposed to active dse.
C. HIV women
D. A and C
E. AOTA
A

E. AOTA

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39
Q

Beta-agonist given to asthmatics in order to

A

abate bronchospasm

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40
Q

Severe asthma type not responding to 30-60 minutes intensive therapy

A

Status Asthmaticus

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41
Q

Positive for Tuberculin Skin Test (TST)/Purified Protein Derivative (PPD)

A

greater > 5mm wheal formation/induration after 48-72 hours

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42
Q

Continued treatment for TB

a. Isoniazid and Rifampicin
b. Ethambutol and Rifampicin
c. Ethambutol and Pyrazinamide

A

a. Isoniazid and Rifampicin

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43
Q

Carbon monoxide, later in pregnancy

a. Structural anomalies
b. Growth restriction
c. Anoxic encephalopathy
d. No fetal effects

A

c. Anoxic encephalopathy

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44
Q

With no known risk factors for TB, aninduration or wheal of this size is indicative of a need for Anti-TB treatment:

a. > 3mm
b. > 5mm
c. > 10mm
d. > 15mm

A

d. > 15mm

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45
Q

Breastfeeding is NOT a contraindication during Anti-TB treatment

a. True
b. False

A

a. True

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46
Q

question

A

answer

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47
Q

Cardiac output increases by approximately what percent?

A

Cardiac output increases approximately 40%

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48
Q

Increase in CO is due to

A

Stroke Volume

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49
Q

When is CO maximal?

A

28 weeks AOG

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50
Q

Normal (left/right) ventricular function is maintained during pregnancy

A

Normal left ventricular function is maintained during pregnancy

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51
Q

5 Symptoms of heart disease during pregnancy

A 
. Progressive dyspnea or orthopnea
. Nocturnal cough
. Hemoptysis
. Syncope
. Chest pain
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52
Q

diagnostic studies for heart disease

A

electrocardiography, cxr, echocardiography

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53
Q

15° left axis deviation in ecg due to

A

due to an elevated diaphragm in

pregnancy

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54
Q

what are findings in heart disease in pregnancy

A 
. 15° left axis deviation – due to an elevated diaphragm in
pregnancy
. Mild ST changes
. Reduced PR interval
. Inverted or flattened T waves
. 1 wave in lead D1
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55
Q

Which permits accurate diagnosis of most heart diseases during
pregnancy?

electrocardiography, cxr, echocardiography

A

echocardiography

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56
Q

slight limitation of physical activity

Class I
Class II
Class III
Class IV

A

Class II

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57
Q

comfortable at rest

Class I
Class II
Class III
Class IV

A

Class I, II, and III

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58
Q

ordinary physical activity is undertaken, discomfort in the form of excessive fatigue, palpitation,dyspnea, or anginal pain results

Class I
Class II
Class III
Class IV

A

Class II

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59
Q

marked limitation of physical activity

Class I
Class II
Class III
Class IV

A

Class III

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60
Q

less than ordinary activity causes excessive fatigue, palpitation, dyspnea, or anginal pain

Class I
Class II
Class III
Class IV

A

Class III

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61
Q

Which NYHA class is a predictor of cardiac complications?

A

Class III and IV

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62
Q

What singular clinical finding is a predictor of cardiac complication?

A

cyanosis

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63
Q

(Left/Right) sided heart obstruction is a predictor of cardiac complication

A

Left sided heart obstruction

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64
Q

Define left sided heart obstruction

. Mitral valve area of
. Aortic valve are
. peak left ventricular outflow tract gradient
. Ejection fraction

A

. Mitral valve area of <2 cm2
. Aortic valve are below 1.5 cm2
. peak left ventricular outflow tract gradient >30mmHg by 2D Echo
. Ejection fraction <40%

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65
Q

risk of congenital heart disease in offspring is?

A

risk of congenital heart disease in offspring is 3-4%

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66
Q

What cardiovascular changes in pregnancy occur that affect general management?

A

. Blood volume
. CO
. decline in systemic vascular resistance
. hypercoagulability

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67
Q

Basilar rales, Dyspnea on exertion, Excessive coughing, Hemoptysis, Progressive edema, Tachycardia

Are clinical symptoms of which NYHA Class?

A

Class I and II

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68
Q

What is the specific danger in illicit drug use on cardiac pathology?

A

raises the risk of infective endocarditis

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69
Q

Which anesthetic is preferred with CVD?

A

epidural

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70
Q

in CVD what is the preferred position during labor?

A

Semirecumbent position with lateral tilt

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71
Q

Findings suggestive of impending ventricular failure during labor

Heart rate
RR
Associated with

A

Heart rate of > 100 beats/min
RR >24/min
Associated with dyspnea

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72
Q

Manifestation of Intrapartum Heart Failure (2)

A

Pulmonary edema with hypoxia, Hypotension

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73
Q

Pros and cons of porcine tissue valves

A

Pro: Safer for pregnancy, Anticoagulant not required

Con: Needs another replacement in 10 to 15 years

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74
Q

What is management when there is mechanical valve replacement?

A

. Full coagulation throughout pregnancy
. Use unfractionated heparin between 6-12 weeks and at 36 weeks
. Starting at 35,000 U SQ, BID
. Warfarin is used for the rest of the pregnancy
. If delivery occurs before effect of anticoagulant fades, may give Protamine sulfate thru IV

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75
Q

Which type of contraception is contraindicated?

A

combination OCP

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76
Q

most common cause of mitral stenosis lesions

A

Rheumatic endocarditis

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77
Q

management of mitral stenosis

A 
Physical activity limited
Reduce salt intake
Diuretic started
B-blockers
IV verapamil/electrocardioversion
Digoxin
Heparin
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78
Q

Mitral insufficiency is (well/poorly) tolerated during pregnancy. Prophylaxis against what is indicated?

A

Well tolerated during pregnancy

Prophylaxis against bacterial endocarditis indicated

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79
Q

What Implies myxomatous degeneration?

A

mitral valve prolapse

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80
Q

mitral valve prolapse involves

A

Valve leaflets, Annulus, Chordae tendinae

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81
Q

Normal aortic valve area vs Severe stenosis.

What is the pressure gradient in aortic stenosis?

A

Normal aortic valve area: 3-4 cm2
Severe stenosis: <1 cm2
Pressure gradient: <5mmHg

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82
Q

Management of aortic stenosis?

A

Limitation of activity
Treat for infection
Valve replacement
Valvotomy

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83
Q

Aortic insufficiency is (well/poorly) tolerated during pregnancy.

A

Well tolerated during pregnancy

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84
Q

Pt has Systolic ejection murmur, pulmonary area louder during
inspiration. What is Dx?

A

pulmonic stenosis

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85
Q

2nd most common congenital heart lesion in adults

A

atrical septal defect

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86
Q

When is ventricular septal defects well tolerated?

A

well tolerated for small to moderate, left to right shunts

heart failure and pulmonary hypertension does not develop if defect is <1.25 cm2

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87
Q

This unrepaired defect may lead to Pulmonary hypertension

A

Pulmonary hypertension may occur in unrepaired Patent ductus arteriousus

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88
Q

What are characteristics of cyanotic heart disease?

A

Tetralogy of Fallot: Large Ventricular Septal Defect, Pulmonary Stenosis, RVH, Overriding aorta

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89
Q

What is Eisenmenget syndrome? What conditions is it common in? (3)

A

Pulmonary vascular resistance > systemic vascular resistance

Common in: ASD, VSD, PDA

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90
Q

Normal resting Pulmonary

Pressure vs Pulmonary Hypertension

A

Normal resting Pulmonary
Pressure: 12- 16 mmHg

Pulmonary Hypertension: > 25mmHg

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91
Q

Pulmonary Hypertension is what NYHA class? Pregnancy is (well/poorly) tolerated.

A

GROUP II: most commonly encountered in pregnancy

Pregnancy is CONTRAINDICATED

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92
Q

Treatment of Pulmonary Hypertension

A

Limitation of movement, Avoid supine position, O2, Vasodilators

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93
Q

Analgesia for pulmonary htn

A

subarachnoid, Avoid epidural analgesia

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94
Q

diagnositc criteria for peripartum cardiomyopathy

A
  1. Cardiac Failure in the last month or within 5 months of pregnancy
  2. No cause for the failure
  3. No heart disease before pregnancy
  4. Left ventricular systolic dysfunction
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95
Q

hallmark finding in idiopathic cardiomyopathy and treatment

A

Hallmark finding: cardiomegaly

TREATMENT

  • NaCl is restricted
  • Diuretics
  • Hydralazine
  • Digoxin
  • Heparin
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96
Q

Diagnosis of peripartum heart failure

A

Chronic hypertension with superimposed Preeclampsia

. Basilar rales w/ nocturnal cough
. Sudden decline in activity
. Increase dyspnea on exertion
. Hemoptysis

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97
Q

management of peripartum heart failure

A

diuretics, antihypertensive, anticoagulant

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98
Q

What is the Duke criteria used for and what are the points?

A

diagnosis of infective endocarditis; positive blood cultures for typical organisms and evidence of
endocardial involvement

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99
Q

What are the maneuvers to raise vagal tone ablock the AV node?

A 
vagal maneuvers - raise vagal tone ablock the
atrioventricular node
-­‐ Valsalva maneuver
-­‐ carotid sinus massage
-­‐ bearing down
-­‐ immersion of the face in ice water
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100
Q

pre-excitation of the ventricles of the heart due to an accessory pathway known as the bundle of kent

A. Wolf-Parkinson-white syndrome
B. Supraventricular Tachyarrythmia
C. Ventricular Tachycardia
D. Inc. QT interval

A

A. Wolf-Parkinson-white syndrome

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101
Q

Manged with Vagal maneuvers, Intravenous adenosine, Electrical cardioversion

A. Wolf-Parkinson-white syndrome
B. Supraventricular Tachyarrythmia
C. Ventricular Tachycardia
D. Inc. QT interval

A

B. Supraventricular Tachyarrythmia

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102
Q

Associated with fatal ventricular arrhythmias and w/ intake of: Azithromycin, Erythromycin, Clarithromycin

A. Wolf-Parkinson-white syndrome
B. Supraventricular Tachyarrythmia
C. Ventricular Tachycardia
D. Inc. QT interval

A

D. Inc. QT interval

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103
Q

When is CS recommned in marfan syndrom?

A

aortic root measures 4 to 5 cm or greater

104
Q

A 23 year old primigravid. Diagnosed case of mitral valve prolapse. Complain of fatigue, palpitations, and dyspnea on ordinary activities. What is the patient’s classification?

A. Class I
B. Class II
C. Class III
D. Class IV

A

B. Class II

105
Q

2.22 y/o G1P0 pregnancy uterine 10 weeks came in for prenatal check-up. She had valve replacement during childhood. What anticoagulant therapy is she most likely using now?

A. Warfarin
B. Coumarin
C. Heparin
D. She is not using any

A

C. Heparin

106
Q

22 y/o G1P0 pregnancy uterine 10 weeks came in for prenatal check-up. She had valve replacement during childhood. If she undergoes vaginal delivery at term, and if she will need anticoagulant?

A. Right after delivery
B.6 hours after delivery
C.24 hours after delivery
D. 28 hours after delivery

A

B.6 hours after delivery

107
Q

Prominent sign of ventricle failure

A. Fever
B. Dyspnea
C. Chest pain
D. Syncope

A

B. Dyspnea

108
Q

A 21 y/o primigravid patient was diagnosed with aortic stenosis. What could have caused her condition?

A. Most likely due to an infective process during her childhood days
B. Most likely congenital in nature
C. Most likely a connective tissue disease
D. Most likely because of hypervolemia she is experiencing during pregnancy

A

B. Most likely congenital in nature

109
Q

35 y/o G3P3 (3003), postpartum day 7, came in due to difficulty of breathing. Normal PE, chest x-ray, ECG: peripartum cardiomyopathy. Most likely condition:

A. Valvular myocarditis
B. Autoimmune response to pregnancy
C. Chronic hypertension with superimposed preeclampsia
D. Unknown

A

D. Unknown

110
Q

A 28 y/o, multigravida complains of palpitation. ECG shows supraventricular tachycardia. The management consist of the following, EXCEPT:

A. Carotid massage
B. Immersion of the face in lukewarm water
C. Valsalva maneuver
D. Beta blocker

A

B. Immersion of the face in lukewarm water

111
Q

Pregnant Woman was diagnosed with Aortic Stenosis. Asks how she could have had it.

A. Infectious disease from childhood
B. Congenital
C. Connective tissue disease
D. Acquired

A

B. Congenital

112
Q

Cardio changes are evident in?

A. Earl Pregnancy
B. Mid pregnancy
C. Late Pregnancy
D. Not related

A

B. Mid pregnancy

113
Q

Tubal ligation may only be done on a gravido-cardiac patient that is

A. Afebrile
B. Not anemic
C. Not in respiratory distress
D. All of the above

A

D. All of the above

114
Q

The first warning sign that at would make the physician suspect that the pregnant woman is developing heart failure is

A. Dyspnea on exertion
B. Hemoptysis
C. Tachycardia
D. Basilar rales

A

D. Basilar rales

115
Q

Best Prognosis for pregnancy outcome

A. Aortic Stenosis
B. Mitral Stenosis
C. Eisenmenger syndrome
D. Aortic Regurgitation

A

D. Aortic Regurgitation

116
Q

Heart Disease not commonly seen in pregnant woman?

A .Aortic Stenosis
B .Mitral Stenosis
C .Mitral Insufficiency
D. Aortic Insufficiency

A

A .Aortic Stenosis

117
Q

Obstetrical complication that is attributed to the development of peripartum heart failure?

A. GDM 
B. Gestational hypertension 
C. Pre-Eclampsia 
D. Chronic Hypertension 
E. Chronic hypertension with superimposed pre eclampsia
A

E. Chronic hypertension with superimposed pre eclampsia

118
Q

Most common arryhtmia in reproductive age

A. Wolf-Parkinson-white syndrome
B. Supraventricular Tachyarrythmia
C. Ventricular Tachycardia
D. Inc. QT interval

A

B. Supraventricular Tachyarrythmia

119
Q

What is the recommended anesthesia for gravido-cardiac patient?

A.Pudendal Block
B. General Anesthesia
C.Subarachnoid block
D.Epidural Block

A

D.Epidural Block

120
Q

Cardiac output is higher in the ______
position:

A. standing
B. sitting
C. left lateral decubitus
D. supine

A

C. left lateral decubitus

121
Q

____ out of 10 women with heart disease died during puerperium:

A. 2
B. 4
C. 6
D. 8

A

D. 8

122
Q

Because of hypervolemia and increased
cardiac output, one can expect ___________ on physical examination:

A. systolic murmur
B. diastolic murmur
C. orthopnea
D. edema

A

A. systolic murmur

123
Q 
During normal pregnancy, there is an
expected \_\_\_\_\_ degrees left axis deviation on
ECG:
A. 5
B. 10
C. 15
D. 20
A

C. 15

124
Q

50% of the increase in cardiac output for pregnant women occurs as early as 10 weeks AOG.

A. True
B. False

A

B. False; 28 weeks

125
Q

The increase in stroke volume is due to the increase in the maternal blood volume during pregnancy.

A. True
B. False

A

A. True

126
Q

The following are normal changes in the cardiovascular system of pregnant women:

A. 20 degrees left axis deviation
B. mild ST wave changes in the inferior leads
C. increase in the cardio-thoracic ratio
D. AOTA

A

B. mild ST wave changes in the inferior leads

127
Q

Risk of congenital heart disease among
children of mothers with such heart disease:

A. 1-2%
B. 2-3%
C. 3-4%
D. 4-5%

A

C. 3-4%

128
Q

Factors that may affect the management of
heart disease during pregnancy:

A. blood volume changes
B. fluctuation of blood volume after delivery
C. increase in peripheral vascular resistance
after delivery
D. hypercoagulability of blood

A

D. hypercoagulability of blood

129
Q

The best contraceptive for gravidocardiac patients would be:

A. OCPs
B. progestin only pills
C. IUD
D. tubal sterilization
E. vasectomy of the husband
A

D. tubal sterilization

130
Q

A gravidocardiac woman is at risk of cardiac
failure if her ejection fraction is less than:
A. 10%
B. 20%
C. 40%
D. 60%

A

C. 40%

131
Q

question

A

answer

132
Q

General categories of predisposing factors for ob hemorrhage

A

abnormal implantation, injuries to the birth canal, ob factors, vulnerable pt, uterine atony, coagulation defects

133
Q

Expected blood loss after delivery

A

(blood loss of more than 500 cc after NSD and more than 1000 cc after CS delivery.)

134
Q

According to the ACOG, postpartum hemorrhage is defined as

A

According to the ACOG, postpartum hemorrhage is defined as cumulative blood loss >1000 mL accompanied by signs and symptoms of hypovolemia

135
Q

Normal Pregnancy Induced Hypervolemia

A

30-60% of the blood volume, 1500-2000 ml

136
Q

blood loss can be estimated as the sum of the calculated pregnancy-added volume PLUS

A

PLUS 500 mL for each 3 volume percent decline of the hematocrit

137
Q

Most important for activating hemostasis

A

contraction and retraction

138
Q

hemostasis is achieved first by myometrial contraction

A

myometrial contraction

139
Q

describe a Well Contracted Uterus

A

should be in the hypogastric area, slightly below the umbilicus, has to be stone hard, uterus has to be tetanically contracted or else the patient will suffer from hemorrhage

140
Q

how does retained placental fragments cause postpartum hemorrhage

A

Adherent pieces of placenta or large blood clots prevent effective contraction and retraction of the myometrium, impairs hemostasis at the implantation site

141
Q

signs of uterine atony

A

. Enlarged, boggy uterus: pathognomonic sign
. above the umbilicus
. not soft (just like water balloons)

142
Q

risk factors of uterine atony

A

. Overdistended uterus
. Macrosomia
. High parity (more than 4)

143
Q

central separation

Duncan mechanism
Shultze mechanism

A

Shultze mechanism

144
Q

blood remains concealed behind the placenta and membranes until the placenta is delivered

Duncan mechanism
Shultze mechanism

A

Shultze mechanism

145
Q

peripheral separation

Duncan mechanism
Shultze mechanism

A

Duncan mechanism

146
Q

blood from the implantation site may escape into the vagina immediately

Duncan mechanism
Shultze mechanism

A

Duncan mechanism

147
Q

Manual removal of placenta

A

One hand grasps the fundus. The other hand is inserted into the uterine cavity, and the fingers are swept from side to side as they are advanced

When the placenta has become detached, it is grasped and removed.

148
Q

2nd most common cause of post partum hemorrhage

A

retained placental fragments

149
Q

Units of blood for

Placenta Previa
Placenta Accreta
Placenta Percreta

A

Placenta Previa- 2 units of blood
Placenta Accreta- 4 units of blood
Placenta Percreta- 8 units of blood

150
Q

management of percreta

A

Prompt hysterectomy

151
Q

Mechanism of Placental Separation

A
  1. Uterus becomes round and globular
  2. Sudden gush of blood
  3. Uterus goes back to the pelvic cavity
  4. Lengthening of the cor
152
Q

How long do you wait for placenta to separate?

A

Average is 5 mins. but as long as the patient is stable, wait for 5-15 mins.

153
Q

What are the two surgical interventions for inverted uterus?

A

Huntington procedure - application of atraumatic clamps to each round ligament and upward traction or placing a deep traction suture in the inverted fundus or grasping it with tissue forceps.

Haultain incision - sagittal surgical cut made posteriorly through the muscular ring to release constriction ring that prohibits repositioning.

154
Q

application of atraumatic clamps to each round ligament and upward traction or placing a deep traction suture in the inverted fundus or grasping it with tissue forceps

Haultain incision
Huntington procedure

A

Huntington procedure

155
Q

sagittal surgical cut made posteriorly through the muscular ring to release constriction ring that prohibits repositioning

Haultain incision
Huntington procedure

A

Haultain incision

156
Q

Injury to the lower portion of the vagina and the perineal body

Perineal Lacerations
Vaginal lacerations
Injuries to the cervix

A

Perineal Lacerations

157
Q

Suturing

Perineal Lacerations
Vaginal lacerations
Injuries to the cervix

A

Perineal Lacerations

158
Q

Laceration involving the middle or upper third of the vagina

Perineal Lacerations
Vaginal lacerations
Injuries to the cervix

A

Vaginal lacerations

159
Q

Extensive repair of the laceration

Perineal Lacerations
Vaginal lacerations
Injuries to the cervix

A

Vaginal lacerations

160
Q

Difficult forceps rotation or
deliveries performed incompletely

Perineal Lacerations
Vaginal lacerations
Injuries to the cervix

A

Injuries to the cervix

161
Q

Laparotomy; Intrauterine exploration; Surgical repair

Perineal Lacerations
Vaginal lacerations
Injuries to the cervix

A

Injuries to the cervix

162
Q

What is Colporrhexis?

A

Colporrhexis - cervix entirely or partially avulsed from the vagina in the anterior, posterior, or lateral fornices

163
Q

Risk factors of puerperal hematomas

A

Risk factors: Nulliparity, episiotomy and forceps delivery

164
Q

often involve branches of the pudendal artery, including posterior rectal, transverse perineal, or posterior labial artery

vulvar hematoma
vulvovaginal hematoma
paravaginal hematoma
retroperitoneal hematoma

A

vulvar hematoma

165
Q

involve the descending branch of the uterine artery

vulvar hematoma
vulvovaginal hematoma
paravaginal hematoma
retroperitoneal hematoma

A

paravaginal hematoma

166
Q

Most common symptom of puerperal hematoma

A

Most common symptom: Severe Perineal Pain

167
Q

Complete vs incomplete uterine rupture

A

Incomplete Uterine Rupture (Uterine dehiscence) - uterine muscle separated but visceral peritoneum is intact

168
Q

Diagnosis of Uterine Rupture

A

Hemoperitoneum from a ruptured uterus may result in irritation of the diaphragm with pain referred to the chest

169
Q

First sign of uterine rupture is? Followed by?

A

First sign of uterine rupture is Abnormal fetal heart rate pattern

then followed by pain, maternal hypovolemia – blood loss is strictly concealed

170
Q

A case of a 38 yo, G5P3(3013) 37 weeks AOG, ongoing repeat CS for the fourth time with intraoperative findings: gravid uterus, uterine serosa infiltrated with placenta villi; term, cephalic live baby.

What is the most likely diagnosis?

A. Placental abruption
B. Placenta accreta
C. Placenta increta
D. Placenta percreta

A

C. Placenta increta

171
Q

A case of a 38 yo, G5P3(3013) 37 weeks AOG, ongoing repeat CS for the fourth time with intraoperative findings: gravid uterus, uterine serosa infiltrated with placenta villi; term, cephalic live baby.

How must the case be managed?
A. Hysterectomy with bilateral salpingooophorectomy
B. Hysterectomy with bilateral salpingectomy
C. Hysterectomy with bilateral salpingooophorectomy w/ methotrexate
D. Repeat LTCS with bilateral tubal

A

C. Hysterectomy with bilateral salpingooophorectomy w/ methotrexate

172
Q

40 year old G5P4 delivered a term 3.8 kg, immediately after delivering the placenta. BP was 70/50, PR 110 bpm. What step is not done to the patient?

A. Immediate curettage for retained placenta.
B. Uterine massage for atony.
C. Check for vulvar laceration.
D. Insert double line and hydrate.

A

A. Immediate curettage for retained placenta.

173
Q

36 year old G5P5 delivered a baby weighing 2500g referred to ER due to hypotension and profuse vaginal bleeding. Upon inspection, (+) bleeding fleshy mass outside vagina with umbilical cord dangling from it. Placenta carefully detached. IE: Fundus palpable inside vagina. Palpation: intended fundus. Diagnosis?

A. Uterine atony
B. Uterine inversion
C. Placenta previa
D. Vulvar hematoma

A

B. Uterine inversion

174
Q

A 21 year old G1P1 known diabetic, delivered a term live baby with birth weight of 4.2 kg uterus delivered completely. Uterus notes to be enlarged and boggy.

A. Uterine atony
B. Vulvar hematoma
C. Uterine inversion
D. Placenta previa

A

A. Uterine atony

175
Q

2500g. referred to ER due to hypotension and profuse vaginal bleeding. Upon inspection, (+) bleeding fleshy mass outside vagina with umbilical cord dangling from it. Placenta carefully detached. IE: fundus palpable inside vagina. Palpation: indented fundus. Diagnosis:

a. Uterine atony
b. Uterine inversion
c. Placenta previa
d. Vulvar hematoma

A

b. Uterine inversion

176
Q

question

A

answer

177
Q

JNC 8 guidelines includes,
except:

A. Recommends selection
among: ACE-l,ARB, CCB, diuretics
B. Diabetes: lowers pressure <140/90
C. HTN: defined as >140/90
D. CKD lowers pressure <140/90; adds ACE-l and ARB to improve outcomes
A

CKD lowers pressure <140/90; adds ACE-l and ARB to improve outcomes

178
Q

Ideal time to counsel
women with chronic
hypertension and
desirous in pregnancy

A. Preconception
B. 1st Trimester…
C. 2nd Trimester…
D. 3rd Trimester…

A

A. Preconception

179
Q

Lifestyle modification for
hypertensive patients Except:

A. Moderation of alcohol
B. Decrease Sodium intake not more than 2400mg per day; desirable is 1500 per day
C. Increase intake of vegetables, poultry, fish, red meat and sweets
D. Moderate to vigorous intensity of physical activity 3-4/week lasting an average of 40 mins per session

A

C. Increase intake of vegetables, poultry, fish, red meat and sweets

180
Q

Which of the ff. Is an adverse effect of chronic hypertension in pregnancy?

A. Post term
B. Stillbirth
C. Fetal macrosomia
D. Placenta Previa

A

B. Stillbirth

181
Q

How will you classify chronic hypertension in pregnancy?

A. >140/90 prior to pregnancy or <20 wks AOG with new onset of proteinuria
B. >190/140 prior to pregnancy or <20 wks AOG, persist 12 weeks after
delivery
C. >140/90 prior to pregnancy or <20 wks AOG, persist 12 weeks after delivery
D. >160/200 prior to pregnancy or <20 wks AOG, with new onset of proteinuria

A

C. >140/90 prior to pregnancy or <20 wks AOG, persist 12 weeks after delivery

182
Q

Which is NOT a component of HELLP
Syndrome?

A. Increased LDH
B. Proteinuria 2+ on Urine dipstick
C. Increased SGPT
D. Platelet less than <100,000/μg

A

B. Proteinuria 2+ on Urine dipstick

183
Q

36 weeks. Blurring of vision and headache. BP: 180/100 mmHg. Cervix long, firm, uneffaced. What is the management?

A. MgSO4, Antihypertensive drugs, immediately do CS
B. MgSO4, Antihypertensive drugs, Betamethasone, induce labor
C. Observe, wait for 37 weeks for lung maturity

A

A. MgSO4, Antihypertensive drugs, immediately do CS

184
Q

24 y/o, 30 weeks AOG, BP: 180/110, came in for her prenatal checkup. She complains of labor pains every hour, (+) bag of waters, albumin 3+,
CBC and platelets, and SGPT within normal levels.

A. Admit patient, give MgSO4, antihypertensive medication plus
betamethasone and induction of
labor
B. Discharge patient and follow-up after 2 weeks
C. Give MgSO4 plus hypertensive medication, then do CS
D. Give MgSO4 plus antihypertensive agent then deliver

A

A. Admit patient, give MgSO4, antihypertensive medication plus
betamethasone and induction of
labor

185
Q

What anti-hypertensive drug/s is/are proven to be safe and effective in
pregnancy?

A. Diuretics (Furosemide)
B. Centrally-acting β-adrenergic
antagonists (Methyldopa)
C. ACE inhibitors (Captopril)
D. All of the Above
A

B. Centrally-acting β-adrenergic

antagonists (Methyldopa)

186
Q

G2P1 30 weeks AOG, obese, admitted due to her BP: 180/110. Patient is asymptomatic. What treatment should be given?

A. Clonidine
B. Methyldopa

A

B. Methyldopa

187
Q

In women with chronic hypertension and superimposed preeclampsia with severe features, what is the drug of choice for neuroprophylaxis?

A. Diazepam
B. Sodium Valproate
C. Carbamazepine
D. Magnesium Sulfate

A

D. Magnesium Sulfate

188
Q

A 21 y/o G1P0 with chronic hypertension and superimposed preeclampsia. What will be the plan for management?

A. BPS and NST
B. Double dose of vitamins
C. Frequent sonography
D. None of the Above

A

C. Frequent sonography

189
Q

Management of chronic mild to moderate hypertension:

A. Treatment of persistent BP of <160/105mmHg
B. Treatment of neuro, cardio, renal C. Treatment of healthy patients with persistent >150/100mmHg
D. (+) end organ damage, treat DBP >90mmHg to avoid end organ failure

A

C. Treatment of healthy patients with persistent >150/100mmHg

190
Q

37 y/o, G2P1, 27 weeks AOG, pre-gestational: 140/90, ER due to headache BP of 160/110, (-) proteinuria

A. Gestational hypertension
B. Chronic hypertension
C. Chronic hypertension with superimposed preeclampsia
D. Preeclampsia with severe features

A

D. Preeclampsia with severe features

191
Q

30 y/o G2P1 (1001) with chronic HTN, which of the ff. is included in the “preemptive” management for the patient?

A. High dose aspirin
B. High dose antioxidant (vitamin C) C. Low dose aspirin
D. Low dose calcium

A

C. Low dose aspirin

192
Q

Adverse effects of Chronic Hypertension

A. Fetal Death
B. Stroke
C. Neonatal Death
D. AOTA

A

D. AOTA

193
Q

Treatment for Chronic Hypertension in pregnant women except?

A. Diuretics
B. ACEi
C. Beta
D. CCB

A

B. ACEi

194
Q

Adverse pregnancy outcome is increased in patients with

A. Poorly controlled Hypertension
B. Taking 2 anti-hypertensive drugs C. Both
D. Neither

A

C. Both

195
Q

Uncontrolled Chronic Hypertension in Pregnancy increases risk for?

A. Placenta abruption
B. CVA
C. Heart Failure
D. AOTA

A

D. AOTA

196
Q

In chronic hypertension, the most affected organ is?

A. CNS
B. Heart
C. Placenta
D. Kidneys

A

D. Kidneys

197
Q

Absolute contraindication of pregnancy with chronic hypertension

A. CVA
B. Pre-eclampsia
C. Kidney disease
D. AOTA

A

A. CVA

198
Q

Chronic Hypertension in a 39 year old Primigravid patient is diagnosed as early as

A. 10 weeks AOG
B. 15 weeks AOG
C. 20 weeks AOG
D. 25 weeks AOG

A

C. 20 weeks AOG

199
Q

Evidence of proteinuria in Preeclampsia

A. 400mg/24 hour urine collection
B. 0.3 protein:creatinine ratio
C. Both

A

C. Both

200
Q

Prevents cerebral hemorrhage

A. Nifedipine
B. Hydralazine
C. Labetalol

A

B. Hydralazine

201
Q

28 y/o, primi, 28 wks, 150/100, bipedal edema

. gestational hypertension
. chronic hypertension
. chronic hypertension superimposed with preeclampsia
. Preeclampsia
. Eclampsia
A

gestational hypertension

new onset after 20 week AOG; no proteinuria

202
Q

30 y/o, primi, 14-15 wks, 160/100, 2+ proteinuria

. gestational hypertension
. chronic hypertension
. chronic hypertension superimposed with preeclampsia
. Preeclampsia
. Eclampsia
A

. chronic hypertension superimposed with preeclampsia

before 20 AOG

203
Q

32 y/o, primi, 28 wks, 140/90, 3 g proteinuria

. gestational hypertension
. chronic hypertension
. chronic hypertension superimposed with preeclampsia
. Preeclampsia
. Eclampsia
A

. Preeclampsia

proteinuria:
. > 300mg/24 hr urine or
. Protein/creatinine ratio > 0.3 or
. Dipstick reading of 1+

204
Q 
. gestational hypertension
. chronic hypertension
. chronic hypertension superimposed with preeclampsia
. Preeclampsia
. Eclampsia
A

. Eclampsia

205
Q

29 y/o G1P0 at 34 weeks AOG, diagnosed with preeclampsia with severe features. What is in her maternal history that will make her at risk for PIH?

a. Primipara
b. Nullipara
c. AOG
d. Age

A

b. Nullipara

206
Q

What is PIH classification of a sudden rise in mean arterial pressure, but still in normal range, may also signify preeclampsia? BP < 140/90

a. Chronic hypertension
b. Gestational hypertension
c. Preeclampsia – non-severe
d. Delta Hypertension

A

d. Delta Hypertension

207
Q

25 y/o G1P0, 28 weeks AOG, BP 140/90 (pre), pregnant BP unknown, lab result – all normal, hypertensive – worried if transient or not.

a. Preeclampsia will lead to chronic
hypertension
b. Wait for 12 weeks, and if BP >
140/90 – chronic hypertension
c. Wait for 6 hours. If BP >140/90 –
CHRONIC HYPERTENSION
d. Delta hypertension, therefore, only
transient.
A

b. Wait for 12 weeks, and if BP >

140/90 – chronic hypertension

208
Q

question

A

answer

209
Q

forceps for round multiparous infant

Kielland
Pipers
Tucker-Mclane
Simpson

A

Tucker-Mclane

210
Q

forceps used for the breech delivery

Kielland
Pipers
Tucker-Mclane
Simpson

A

Pipers

211
Q

used for deep transverse arrest

Kielland
Pipers
Tucker-Mclane
Simpson

A

Kielland

212
Q

molded head in nulliparous

Kielland
Pipers
Tucker-Mclane
Simpson

A

Simpson

213
Q

which of the ff. is not part of the criteria for outlet forceps delivery?

a. sagittal suture is in the antero-posterior diameter
b. fetal head is at the perineum
c. scalp is visible at the introitus w/o separating the labia
d. leading part of the fetal skull is at the station equal to or greater than +2

A

d.leading part of the fetal skull is at the station equal to or greater than +2

214
Q

w/c of the ff. factors is associated with operative delivery failure?

a. birth weight of 3500g
b. direct occiput anterior position of fetal head
c. absence of regional or general anesthesia
d. right occiput position of fetal head

A

c. absence of regional or general anesthesia

215
Q

the flexion point is the most important determinant of success in vaccum extraction. flexion point is along the sagittal suture

a. 3cm from the anterior fontanel
b. failure of extraction
c. failure of forceps delivery

A

a.3cm from the anterior fontanel

216
Q

anesthesia for outlet forceps extraction:

a. Regional
b. General
c. IV sedation
d. Pudendal

A

d. Pudendal

217
Q

Blade solid shank is narrow

Kielland
Pipers
Tucker-Mclane
Simpson

A

Tucker-Mclane

218
Q

MC forceps with Cephalic and Pelvic curves

Kielland
Pipers
Tucker-Mclane
Simpson

A

Simpson

219
Q

Parallel Shanks

Kielland
Pipers
Tucker-Mclane
Simpson

A

Simpson

220
Q

Fenestrated blade

Kielland
Pipers
Tucker-Mclane
Simpson

A

Simpson

Pipers

221
Q

English Lock

Kielland
Pipers
Tucker-Mclane
Simpson

A

Tucker-Mclane

Simpson

222
Q

sliding lock

Kielland
Pipers
Tucker-Mclane
Simpson

A

Kielland

223
Q

Minimal pelvic curvature, light weight

Kielland
Pipers
Tucker-Mclane
Simpson

A

Kielland

224
Q

long shank

Kielland
Pipers
Tucker-Mclane
Simpson

A

Pipers

225
Q

double pelvic curve

Kielland
Pipers
Tucker-Mclane
Simpson

A

Pipers

226
Q

In vacuum extraction, the flexion point is the most important determinant of its success. This is located along the sagittal suture

A. 3 cm behind the posterior fontanel
B. 3 cm in front of the posterior fontanel
C. 3 cm behind the anterior fontanel
D. 3 cm in front of the anterior fontanel

A

B. 3 cm in front of the posterior fontanel

227
Q

In vacuum delivery additional prerequisite is/are :

A. Fetus should be atleast 34 wks AOG
B. Fetal scalp blood sampling should not have recently done
C. None of the above
D. A and B

A

D. A and B

228
Q

To prevent perineal laceration in operative vaginal delivery the following may be used

A. Liberal median episiotomy 
B. Mediolateral episiotomy 
C. Rotate from POP to OA 
D. B&C
E. A&C
A

B. Mediolateral episiotomy

229
Q

Which of the following fetal injury in operative vaginal delivery is the function of the angle of traction applied?

a. Shoulder dystocia from brachial plexus
b. Facial nerve paralysis
c. Scalp laceration
d. Intracranial hemorrhage

A

Shoulder dystocia from brachial plexus

230
Q

Which of the following fetal injury in operative vaginal delivery is the function of compression of the nerve against the facial bones?

a. Shoulder dystocia from brachial plexus
b. Facial nerve paralysis
c. Scalp laceration
d. Intracranial hemorrhage

A

b. Facial nerve paralysis

231
Q

Flexion point except

A. 3 cm from anterior
B. Maximum traction
C. Along the sagittal suture

A

A. 3 cm from anterior (ans 6cm)

232
Q

Fetal head is engaged and at station >/= +2

A. Outlet forceps
B. Low forceps
C. Mid forceps
D. High forceps

A

B. Low forceps

233
Q

Fetal skull has reached the pelvic floor

A. Outlet forceps
B. Low forceps
C. Mid forceps
D. High forceps

A

A. Outlet forceps

234
Q

Landing point of the fetal skull is at station above +2cm but engaged

A. Outlet forceps
B. Low forceps
C. Mid forceps
D. High forceps

A

C. Mid forceps

235
Q

Fetal head is unengaged

A. Outlet forceps
B. Low forceps
C. Mid forceps
D. High forceps

A

D. High forceps

236
Q

The most important function of both forceps and vacuum is for traction

T or F

A

correct

237
Q

For operative vaginal delivery, the 2 most important discriminator of risk for both mother and infant are traction and application

t or f

A

incorrect

station and rotation

238
Q

Prerequisite for operative vaginal delivery

a. Station – 1
b. Bispinous diameter 8.5 cm
c. Ruptured bag of water

A

c. Ruptured bag of water

239
Q

Causes of operative delivery failure

A

. Persistent occiput posterior
. Absence of regional or general anesthesia
. Birthweight >4000 grams

240
Q

In forceps application, the fetal head is
perfectly grasped when the long axis
corresponds to the,

a. Subfrontal diameter
b. Occipotomento diameter
c. SOB diameter
d. NOTA

A

b. Occipotomento diameter

241
Q

question

A

answer

242
Q

Sarah, 26 y/o G1P0 at 16 weeks AOG,complains of frequent palpitations, nauseaand vomiting. On PE, she has thyromegalyand mild exophthalmos.What is yourworking diagnosis, based on herpresentation?

a. Hyperthyroidism
b. Hypothyroidism
c. Gestational Trophoblastoid
d. Hyperemesis gravidarum

A

a. Hyperthyroidism

243
Q

Sarah, 26 y/o G1P0 at 16 weeks AOG,complains of frequent palpitations, nauseaand vomiting. On PE, she has thyromegalyand mild exophthalmos.

What are the expected laboratory findingsfor your initial impression on Sarah?

a. Decrease TSH, elevated T4
b. Increase TSH, low free T4
c. Decrease TSH, normal free T4
d. Increase TSH, normal free T4

A

a. Decrease TSH, elevated T4

244
Q

Sarah, 26 y/o G1P0 at 16 weeks AOG,complains of frequent palpitations, nauseaand vomiting. On PE, she has thyromegalyand mild exophthalmos. What is the treatment?

A

Propylthiouracil (PTU) and or Methimazole

245
Q

Choanal/esophageal atresia, atypia cutis,embryopathies. Associated drug?

a. Methimazole
b. Iodine
c. Propylthiouracil

A

a. Methimazole

PTU has maternal effects

246
Q

Fetus become thyrotoxic:

a. Withdraw all medications
b. Adjust maternal thionamides
c. Shift to radioactive iodine therapy
d. No therapy yet. Just start after delivery

A

b. Adjust maternal thionamides

247
Q

(Hypothyroidism) What laboratory test will you request to confirm the diagnosis?

a. TSH, T3, T4
b. TSH and TBG
c. TSH, fT3, and fT4

A

c. TSH, fT3, and fT4

248
Q

Drug of Choice for Hashimoto’s thyroiditis

a. PTU
b. Methimazole
c. Levothyroxine
d. Iodine

A

c. Levothyroxine

249
Q

Patient was unable to breastfeed. Duringdelivery, patient had uterine atony, lost alot of blood. She was infused with 2 units of whole blood. What’s the probable diagnosis?

a. Cushing’s syndrome
b. Addisonian crisis
c. Pheochromocytoma
d. Sheehan’s syndrome

A

d. Sheehan’s syndrome

250
Q

Hormone assay normally seen in a primigravid on her 10thweek of pregnancy

A. Increase HCG and increase TSH; decrease TBG and T4
B. Increase T4 and TBG; decrease TSH and HCG
C. Increase T3 and T4; decrease TBG
D. Increase TBG and T4; decrease TSH

A

D. Increase TBG and T4; decrease TSH

251
Q

G1P0 7wks AOG, palpitation, easy fatiguability. Thyroid studies reveal Thyroid peroxidase Ab. Treatment prevent this complication

A. Preterm birth
B. Hyperparathyroid
C. Tetanic seizure
D. Placenta previa

A

A. Preterm birth

252
Q

S/Sx: Nausea, vomiting, weakness, high serum calcium

A. Hyperthyroidism
B. Hypothyroidism
C. Hyperparathyroidism
D. Hypoparathyroidism

A

C. Hyperparathyroidism

253
Q

Tetany and seizure with neonatal fractures

A. Hypothyroidism
B. Hyperthyroidism
C. Hypoparathyroidism
D. Hyperparathyroidism

A

C. Hypoparathyroidism

254
Q

10% tumor

A. Congenital Adrenal Hyperplasia
B. Pheochromocytoma
C. Cushing Syndrome

A

B. Pheochromocytoma

255
Q

Idiopathic adrenal hyperplasia

A. Addison’s Disease
B. Cushing Syndrome
C. Primary Aldosteronism

A

C. Primary Aldosteronism

256
Q

Treatment for ASB

A. Amoxicillin
B. Nitrofurantoin
C. Ampicillin
D. Aminoglycoside

A

B. Nitrofurantoin

Patho OB 2 (10 decks)

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