Obgyn - Pregnancy and extragenital diseases

Question 1

OBG - 9.1
Oral contraceptives can be recommended for the patients after diagnosing gestational diabetes:
A) in all cases
B) pills containing low hormone
C) only exceptionally
D) pills cannot be recommended

Answer 1

ANSWER
B) pills containing low hormone
EXPLANATION
The gonadotrophic and growth hormones are mostly responsible for the diabetic action of pregnancy, however, the rise in estrogen level also contributes to it, therefore it should be striven for prescribing contraceptive pills with lower estrogen content.

Question 2

OBG - 9.2
What is the criterion for gestational diabetes?
A) fasting blood sugar is <5.8 mmol/l
B) insulin treatment is not needed
C) it was diagnosed during pregnancy
D) all above possibilities

Answer 2

ANSWER
C) it was diagnosed during pregnancy
EXPLANATION
Criterion for gestational diabetes is that it has been recognized during pregnancy. The gestational diabetes can be latent or manifest, and it can or cannot need insulin treatment.

Question 3

OBG - 9.4
The frequency of preterm birth increases
A) in case of hepatitis A
B) in case of hepatitis B
C) in both cases
D) it does not increase in the above cases

Answer 3

ANSWER
C) in both cases
EXPLANATION
Frequency of preterm birth increases due to hepatitis A and B acquired in pregnancy.

Question 4

OBG - 9.6
What distinquishes glomerulonephritis during pregnancy from the preeclampsia?
A) hypertension
B) hematuria
C) proteinuria
D) edema

Answer 4

ANSWER
B) hematuria
EXPLANATION
The hypertension, proteinuria and edema occur in both diseases, hematuria is however seen only in glomerulonephritis. It should be realized that superimposed preeclampsia often develops due to previous glomerulonephritis.

Question 5

OBG - 9.14
How does pregnancy affect the asthma?
A) it improves the asthma
B) it impairs the asthma
C) it does not change the symptoms
D) the above changes equally occur

Answer 5

ANSWER
D) the above changes equally occur
EXPLANATION
Effect of pregnancy on the asthma is difficult to be calculated. Its symptoms improve in one half of the cases and impair in their other half.

Question 6

OBG - 9.15
The following medicines can be successfully used during pregnancy in case of acute asthma, except:
A) sc. 250 µg terbutaline
B) iv. 10 mg methylprednisolone
C) iv. 80 mg methylprednisolone
D) iv. 2 mg/kg hydrocortisone

Answer 6

ANSWER
B) iv. 10 mg methylprednisolone
EXPLANATION
10 mg methylprednisolone means under-dosing so results cannot be expected by this treatment.

Question 7

OBG - 9.16
Which disease’s incidence increases during pregnancy?
A) bronchial asthma
B) peptic ulcer
C) iron deficiency anemia
D) acute leukemia

Answer 7

ANSWER
C) iron deficiency anemia
EXPLANATION
Pregnancy does not significantly influence the incidence of asthma, peptic ulcer and leukemia. In contrast, the iron deficient anemia is more frequent during pregnancy due to the fetal consumption than without pregnancy.

Question 8

OBG - 9.17
Which statement is true for the association of appendicitis and pregnancy?
A) Abdominal muscular defense is stronger during pregnancy than without pregnancy
B) The increases in white blood cell count and in red cell sedimentation can be present exclusively as signs of the acute appendicitis
C) if the probability of appendicitis can not be excluded, surgery should be performed
D) one has to strive to resolve the disease by antibiotic treatment

Answer 8

ANSWER
C) if the probability of appendicitis can not be excluded, surgery should be performed
EXPLANATION
There is no difference in the muscular defense, and the higher white cell count and erythrocyte sedimentaion can occur in pregnancy because of other causes as well. Acute appendicitis should be resolved by surgery, because development of the periappendicular abscess or peritonitis in pregnancy endangers the fetus as well as the mother,s life.

Question 9

OBG - 9.18
How often can the Leiden mutation be demonstrated in patients with thromboembolic diseases during pregnancy?
A) In 20%
B) in 40%
C) in 60%
D) in 80%

Answer 9

ANSWER
C) in 60%
EXPLANATION
The Leiden mutation can be shown in two thirds of the thromboembolic diseases associated with pregnancy.

Question 9

OBG - 9.19
What does the Leiden mutation result in?
A) protein S deficiency
B) activated protein C resistance
C) anti-thrombin III deficiency
D) plasminogen deficiency

Answer 9

ANSWER
B) activated protein C resistance
EXPLANATION
Activated protein C resistance can be shown in case of Leiden mutation

Question 10

OBG - 9.20
How many per cent of maternal mortality in the developed countries are associated with thromboembolism?
A) 4 to 5%
B) 10 to 25%
C) 30%
D) 50%

Answer 10

ANSWER
B) 10 to 25%
EXPLANATION
Maternal mortality associated with thromboembolism is 10 to 25 per cent in the developed countries.

Question 11

OBG - 9.21
It is recommended for treating tuberculosis during pregnancy, except:
A) isoniazide
B) pyridoxine
C) streptomycine
D) rifampin
E) ethambutol

Answer 11

ANSWER
C) streptomycine
EXPLANATION
Streptomycine treatment used for tuberculosis is contraindicated during pregnancy because of damaging the fetal auditory organs.

Question 12

OBG - 9.23
How often develops cystopyelitis in pregnant women with asymptomatic bacteriuria?
A) 5%
B) 10%
C) 15%
D) 20%
E) 25%

Answer 12

ANSWER
E) 25%
EXPLANATION
If the asymptomatic bacteriuria is not diagnosed and treated during pregnancy, cystopyelitis presents in every 4th cases

Question 13

OBG - 9.24
Which disease is often associated with polycystic kidney disease?
A) mitral valve prolapse
B) asymptomatic liver cyst
C) intracranial aneurysm
D) all of the above

Answer 13

ANSWER
D) all of the above
EXPLANATION
All 3 diseases occur more frequently than the average in women with polycystic kidneys

Question 14

OBG - 9.25
Which statements are true for the septic shock syndrome?
1) unconsciousness suggests to involvement of the central nervous system
2) total peripheral resistance decreases
3) multiorgan failure often develops
4) it is frequently caused by endotoxin of the Gram negative bacteria
5) its incidence significantly decreased due to the suppression of illegal abortions

A) answers 1, 2 and 3 are correct
B) answers 2 and 4 are correct
C) answers 3 and 4 are correct
D) all the answers are correct
E) none of the answers are correct

Answer 14

ANSWER
D) all the answers are correct
EXPLANATION
All listed statements are right.

Question 15

OBG - 9.26
Which statement(s) is(are) true for the endotoxin?
1) glycoprotein molecule
2) lipopolysaccharide molecule
3) first of all it attacks the heart
4) it takes its origin from the membranes of Gram negative bacteria
5) cytokins do not play any role in the damage caused by it

A) answers 1, 2 and 3 are correct
B) answers 2 and 4 are correct
C) answers 3 and 4 are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 15

ANSWER
B) answers 2 and 4 are correct
EXPLANATION
Endotoxin is a lipopolysaccharide molecule which takes its origin from membranes of Gram-negative bacteria.

Question 16

OBG - 9.28
Which disorder occurs freqently in pregnant women with normotensive chronic renal disease?
1) preeclampsia
2) anemia
3) placental abruption
4) preterm birth
5) intrauterine growth restriction

A) answers 1, 2 and 3 are correct
B) answers 2 and 4 are correct
C) answers 3 and 4 are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 16

ANSWER
D) all of the answers are correct
EXPLANATION
All complications listed occur more frequently during pregnancy of the women with chronic renal disease.

Question 17

OBG - 9.29
What is the most frequent cause for anemia during pregnancy?
1) iron deficiency
2) infection
3) folate deficiency
4) vitamine B12 deficiency
5) hemoglobinopathia

A) answers 1, 2 and 3 are correct
B) answers 2 and 4 are correct
C) answers 3 and 4 are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 17

ANSWER
A) answers 1, 2 and 3 are correct
EXPLANATION
Most frequent causes of the anemia presenting during pregnancy are iron deficiency, folate deficiency and infection. Deficiency in vitamin B12 and hemoglobinopathia are only the rare causes of anemia in pregnancy

Question 18

OBG - 9.30
What may be the complication of pyelonephritis during pregnancy?
1) bacteriemia
2) unusual fluctuation in body of the temperature
3) respiratory failure
4) adult respiratory distress syndrome (ARDS)
5) hemolysis

A) answers 1, 2 and 3 are correct
B) answers 2 and 4 are correct
C) answers 3 and 4 are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 18

ANSWER
D) all of the answers are correct
EXPLANATION
All complications and/or symptoms can develop during pregnancy of women with pyelonephritis not treated.

Question 19

OBG - 9.31
Which cases are regarded risks for tuberculosis?
1) HIV positive people
2) residents coming from a country where tuberculosis frequently occurs
3) person who has got close contact with a person suffering from tbc
4) HIV negative alcoholic person or iv. drug user
5) homeless person and/or those living in poor social conditions

A) responses 1, 2 and 3 are right
B) responses 2 and 4 are right
C) responses 3 and 4 are right
D) all responses are right
E) there is no right response

Answer 19

ANSWER
D) all responses are right
EXPLANATION
Risk for tuberculosis is high in every cases listed.

Question 20

OBG - 9.33
Which is the therapeutic approach in pregnant women with thromboembolism?
1) iv. 5.000 units unfractionated heparin at every 8 hours
2) iv. 5.000 units unfractionated heparin bolus which is continued by 24.000 to 32.000 units/day heparin infusion
3) iv. 7.500 units unfractionated heparin at every 8 hours
4) iv. 5.000 units unfractionated heparin bolus that is at the same time combined with beginning therapeutic sc. low moleculer weight heparin treatment

A) responses 1, 2 and 3 are right
B) responses 2 and 4 are right
C) responses 3 and 4 are right
D) all responses are right
E) there is no right response

Answer 20

ANSWER
B) responses 2 and 4 are right
EXPLANATION
By using iv. unfractionated heparin the anticoagulation can be quickly achieved, i.e. the expansion of thrombus formation can be abruptly inhibited while the action of sc. low molecular weight heparin begins only 3 to 4 hours following giving.

Question 21

OBG - 9.34
What is characteristic for the gestational cholestasis?
1) enlargements of liver and spleen are very explicit
2) jaundice begins following the 20th weeks and developes in several weeks
3) bilirubin levels are significantly elevated in serum and urine
4) alkaline phosphatase activity in serum is very high

A) answers 1, 2 and 3 are correct
B) answers 2 and 4 are correct
C) answers 3 and 4 are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 21

ANSWER
B) answers 2 and 4 are correct
EXPLANATION
Enlargement of liver is moderate and the spleen is not larger. Bilirubin level increased merely little

Question 22

OBG - 9.35
Which statements are true for association of pregnancy and appendicitis?
1) the course of appendicitis is more severe during pregnancy and the inflammation is quickly spreading
2) miscarriage and preterm birth are frequently developed after formation of periappendicular abscess
3) appendix is cranially and laterally positioned when the uterus is growing during pregnancy
4) pregnancy predisposes to forming appendicitis

A) answers 1, 2 and 3 are correct
B) answers 2 and 4 are correct
C) answers 3 and 4 are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 22

A) answers 1, 2 and 3 are correct
EXPLANATION
Pregnancy does not predispose to appendicitis. Fortunately, pregnancy is rarely associated with appendicitis, once it occurs its course is more severe probably due to the better blood flow

Question 23

OBG - 9.36
What are the risk factors for gestational diabetes?
1) age > 30 years
2) diabetes in medical history of the family
3) fetal macrosomia, congenital malformation and intrauterine death in the obstetrical history
4) obesity
5) hypertension
6) glycosuria

A) answers 1, 2, 3 and 6 are correct
B) answers 2, 3, 4 and 6 are correct
C) answers 2, 3 and 6 are correct
D) all of the answers are correct

Answer 23

ANSWER
D) all of the answers are correct
EXPLANATION
All factors listed are the risks for gestational diabetes so if they exist the fasting blood sugar measurement should be supplemented with glucose load test.

Question 24

OBG-9.37-9.42
Match the following ones:
A) asymptomic bacteriuria
B) gestational diabetes
C) complications of IDDM
D) hemolysis
E) tuberculosis
F) cholestasis

OBG - 9.37 - elevated LDH level
OBG - 9.38 - elevated alkaline phosphatase
OBG - 9.39 - reduced creatinine clearance
OBG - 9.40 - colony-forming units > 105
OBG - 9.42 - macrosomia

Answer 24

ANSWER
OBG - 9.37 - elevated LDH level - D)
OBG - 9.38 - elevated alkaline phosphatase - F)
OBG - 9.39 - reduced creatinine clearance - C)
OBG - 9.40 - colony-forming units > 105 - A)
OBG - 9.42 - macrosomia - B

Question 25

OBG - 9.44
On managing peptic ulcer, antacid medicines should be first of all applied in pregnant women since the symptoms are improving in 90% during pregnancy.
A) both are correct and there is a causal relationship between them
B) both are correct but there is no causal relationship between them
C) the first sentence in itself is correct and the second one is not correct
D) the first sentence is not correct and the second one in itself is correct
E) both are incorrect

Answer 25

ANSWER
A) both are correct and there is a causal relationship between them
EXPLANATION
It is known from experience that symptoms of peptic ulcers significantly decrease or disappear during pregnancy, therefore its first line therapy is giving antacids

Question 26

OBG - 9.45
On managing cholestasis with cholestyramine, vitamin K replacement is needed because hemorrhagic diathesis may present due to the malabsorbtion.
A) both are correct and there is a causal relationship between them
B) both are correct but there is no causal relationship between them
C) the first sentence in itself is correct and the second one is not correct
D) the first sentence is not correct and the second one in itself is correct
E) both are incorrect

Answer 26

ANSWER
A) both are correct and there is a causal relationship between them
EXPLANATION
Cholestyramine is among others also inhibitory for absorbing vitamin K, therefore vitamin K is recommended parenterally giving in case of long-lasting cholestyramine therapy.

Question 27

OBG - 9.47
If the normoglycemia in gestational diabetes can not be maintained by diet, insulin treatment should be started because this can prevent the macrosomia and the inherent obstetric complications.
A) both are correct and there is a causal relationship between them
B) both are correct but there is no causal relationship between them
C) the first sentence in itself is correct and the second one is not correct
D) the first sentence is not correct and the second one in itself is correct
E) both are incorrect

Answer 27

ANSWER
A) both are correct and there is a causal relationship between them
EXPLANATION
Hyperglycemia is responsible for approximately 80 per cent of the fetal macrosomia („fuel” theory) therefore the normoglycemia achieved by insulin treatment properly managed decreases the frequency of macrosomia.

Question 28

OBG - 9.49
Incidence of thromboembolism following delivery reduced in the past decade because the early mobilization after birth and the prophylactic anticoagulation had become widespread practice.
A) both are correct and there is a causal relationship between them
B) both are correct but there is no causal relationship between them
C) the first sentence in itself is correct and the second one is not correct
D) the first sentence is not correct and the second one in itself is correct
E) both are incorrect

Answer 28

ANSWER
A) both are correct and there is a causal relationship between them
EXPLANATION
Both statements are true and there is a causal relationship between them.

Question 29

OBG - 9.52
Incidence of infection with herpes simplex type 2 virus increases worldwide because the previous infection with herpes simplex type 1 can alter the clinical picture in case of fresh infection with herpes simlex type 2 virus.
A) both are correct and there is a causal relationship between them
B) both are correct but there is no causal relationship between them
C) the first sentence in itself is correct and the second one is not correct
D) the first sentence is not correct and the second one in itself is correct
E) both are incorrect

Answer 29

ANSWER
B) both are correct but there is no causal relationship between them
EXPLANATION
Both statements are true but there is no causal relationship between them.

Question 30

OBG - 9.55
On using prophylactic LMWH treatment in pregnancy it is mostly not necessary to monitor the anticoagulant effect because fewer hemorrhagic complication occur in such cases.
A) both are correct and there is a causal relationship between them
B) both are correct but there is no causal relationship between them
C) the first sentence in itself is correct and the second one is not correct
D) the first sentence is not correct and the second one in itself is correct
E) both are incorrect

Answer 30

ANSWER
C) the first sentence in itself is correct and the second one is not correct
EXPLANATION
On using LMWH treatment with prophylactic dose, laboratory monitoring of the anticoagulant effect is generally not necessary. Incidence of hemorrhagic complications does not change in such cases.

Question 31

OBG - 9.56
What is the most propbable diagnosis?
A 24-year-old primiparous woman presents at the obstetrical department. She had right-sided pain in the lower back, and lower abdominal cramps in the 27th week of gestation. She had temperature 38.4oC, pulse rate 92/min and blood pressure 110/70 mercury mm. Uterus was contractile. The uterine cervix was shortened and the uterine mouth was closed. Fetal heart rate was normal. Right-sided costo-lumbar ballotement showed sensitivity.
A) placetal abruption
B) nephrolithiasis
C) pyelonephritis
D) herpes zooster

Answer 31

ANSWER
C) pyelonephritis
EXPLANATION
Tenderness of the costo-lumbar region suggests renal disease. The fever marks inflammatory process, so the most probable diagnosis is pyelonephritis.

Question 32

OBG - 9.57
What is the most frequent causative agent for pyelonephritis during pregnancy?
A 24-year-old primiparous woman presents at the obstetrical department. She had right-sided pain in the lower back, and lower abdominal cramps in the 27th week of gestation. She had temperature 38.4oC, pulse rate 92/min and blood pressure 110/70 mercury mm. Uterus was contractile. The uterine cervix was shortened and the uterine mouth was closed. Fetal heart rate was normal. Right-sided costo-lumbar ballotement showed sensitivity.
A) Streptococcus hemolyticus
B) Bacteriodes fragilis
C) E. coli
D) Pseudomonas

Answer 32

ANSWER
C) E. coli
EXPLANATION
E. coli can be identified as causative agent > 90 per cent of patients with pyelitis or pyelonephritis during pregnancy.

Question 33

OBG - 9.58
What examination would help in establishing diagnosis?
A 24-year-old primiparous woman presents at the obstetrical department. She had right-sided pain in the lower back, and lower abdominal cramps in the 27th week of gestation. She had temperature 38.4oC, pulse rate 92/min and blood pressure 110/70 mercury mm. Uterus was contractile. The uterine cervix was shortened and the uterine mouth was closed. Fetal heart rate was normal. Right-sided costo-lumbar ballotement showed sensitivity.
1) ultrasound
2) urinalysis
3) cardiotocography
4) total protein in seru

A) responses 1, 2 and 3 are correct
B) responses 1 and 3 are correct
C) responses 1 and 2 are correct
D) responses 2 and 4 are correct
E) there is no right response

Answer 33

ANSWER
C) responses 1 and 2 are correct
EXPLANATION
Urinalysis shows many leukocytes and bacteria, ultrasound exam can confirm pyelectasy on one side and urinary stasis, resp.

Question 34

OBG - 9.59
What treatment approach should be chosen?
A 24-year-old primiparous woman presents at the obstetrical department. She had right-sided pain in the lower back, and lower abdominal cramps in the 27th week of gestation. She had temperature 38.4oC, pulse rate 92/min and blood pressure 110/70 mercury mm. Uterus was contractile. The uterine cervix was shortened and the uterine mouth was closed. Fetal heart rate was normal. Right-sided costo-lumbar ballotement showed sensitivity.
1) parenteral dose of broad spectrum antibiotic
2) left laying
3) plenty of liquid uptake
4) sedative administration

A) responses 1, 2 and 3 are correct
B) responses 1 and 3 are correct
C) responses 1 and 2 are correct
D) responses 2 and 4 are correct
E) there is no right response

Answer 34

ANSWER
A) responses 1, 2 and 3 are correct
EXPLANATION
Starting broad spectrum antibiotic treatment is recommended in pregnant patients with feverish pyelitis and to send at the same time urine sample to bacterial culture. The urine drainage is promoted by that the patient is laid on the side opposite to the inflammation. (Pyelitis presents on the right side in 70 per cent). Plenty of fluid intake increases the diuresis and so decreases urinary stasis in the pyelon.

Question 35

OBG - 9.60
In which cases is inserting ureter catheter considred?
A 24-year-old primiparous woman presents at the obstetrical department. She had right-sided pain in the lower back, and lower abdominal cramps in the 27th week of gestation. She had temperature 38.4oC, pulse rate 92/min and blood pressure 110/70 mercury mm. Uterus was contractile. The uterine cervix was shortened and the uterine mouth was closed. Fetal heart rate was normal. Right-sided costo-lumbar ballotement showed sensitivity.
1) in febrile state persisting after antibiotic therapy
2) recurrent pyelonephritis
3) significant dilatation of the pyelon shown by ultrasonography
4) E. coli colony was grown in the urine sample

A) responses 1, 2 and 3 are correct
B) responses 1 and 3 are correct
C) responses 1 and 2 are correct
D) responses 2 and 4 are correct
E) there is no right response

Answer 35

ANSWER
B) responses 1 and 3 are correct
EXPLANATION
Aim of inserting ureter catheter is to stop the stasis in pyelon. Reduction of pressure in pyelon promotes the renal filtration i.e. „washing through the kidney”. This can improve the efficacy of antibiotic treatment so far unsuccessful. In addition, the change of antibiotic treatment should be considered. Recurrent pyelonephritis in itself is no indication for inserting ureter catheter but it needs treating with targeted and long-lasting antibiotics