Obgyn - The pathology of pregnancy(34)

Question 1

OBG - 8.1
Recommended first-line antibiotic for the treatment of primary toxoplasmosis infection during pregnancy:
A) metronidazole
B) spiramycin
C) ampicillin
D) doxycycline

Answer 1

ANSWER
B) spiramycin
EXPLANATION
Spiramycin is an effective treatment in toxoplasmosis It reduces the prevalence of the fetal infection but the effect to reduce the severity of fetal damage is controversial.

Question 2

OBG - 8.2
Predominant organism in pyelonephritis during pregnancy:
A) Candida albicans
B) Escherichia coli
C) Streptococcus agalactiae
D) Ureaplasma urealyticum

Answer 2

ANSWER
B) Escherichia coli
EXPLANATION
Candida albicans usually cause vulvovaginitis, streptococcus agalactice is a major cause of severe neonatal infection, ureaplasma urealyticm cause cervicitis. E.coli is the most frequently isolated organism in urinary tract infections.

Question 3

OBG - 8.3
Emergency therapy for hypertensive crisis in preeclampsia:
A) IV hydralazine ( Nepresol) + IV calcium
B) oral magnesium sulfate + oral beta-blocker
C) IV magnesium sulfate+ IV hydralazine ( Nepresol)
D) IV calcium + oral beta-blocker

Answer 3

ANSWER
C) IV magnesium sulfate+ IV hydralazine ( Nepresol)
EXPLANATION
Hydralazine is the most efficacious drug for the acute control of hypertensive crisis. Magnesium sulfate reinforces the effect of hydralazine and is the first-line treatment for prevention of eclamptic seizures.

Question 4

OBG - 8.4
Characteristic for hypertensive disorders during pregnancy, except:
A) proteinuria
B) liver enzymes elevation
C) pulmonary edema
D) serum creatinine decrease

Answer 4

ANSWER
D) serum creatinine decrease
EXPLANATION
Proteinuria, liver enzymes elevation or in severe form pulmonary edema are important signs of hypertensive disorders during pregnancy. Other factors such as elevated serum creatinine level are evidence for severe form of the disease.

Question 5

OBG - 8.6
First-line therapy in seizure during pregnancy:
A) phenobarbital
B) carbamazepine
C) phenytoin
D) intravenous diazepam

Answer 5

ANSWER
D) intravenous diazepam
EXPLANATION
First-line therapy for epileptic seizure irrespective pregnancy is the administration of diazepam. Administration of barbiturate can cause folic acid deficiency, carbamazepine or phenitoin can cause embriopathy.

Question 6

OBG - 8.7
What is AFI (Amniotic fluid index)?
A) Quotient of the largest amniotic fluid pockets and the sagital diameter of the uterus
B) Quotient of the amniotic water volume and the fetal body weight
C) It represents the total of the linear measurements of the largest amniotic fluid pockets noted of each of the four quadrants of the gestational sac. (in centimeters)
D) Quotient of the amniotic fluid and the surface which was taken by the fetal body on the sagital ultrasound view

Answer 6

ANSWER
C) It represents the total of the linear measurements of the largest amniotic fluid pockets noted of each of the four quadrants of the gestational sac. (in centimeters)
EXPLANATION
AFI is used for the assessement to determine the amniotic fluid volume abnormalities (particular for polyhydramnion) (Phelan, J. P. et al.: Amniotic fluid volume assessment with the four-quadrant technic at 36—42 weeks’ gestation. J. reprod. Med. 32:540, 1987.)

Question 7

OBG - 8.8
Glucose tolerance test in the screening for gestational diabetes is abnormal if the 2-hour plasma glucose level:
A) >= 11,1 mmol/l
B) >= 7.0 mmol/l
C) >= 7,8 mmol/l
D) >= 8,7 mmol/l

Answer 7

ANSWER
C) >= 7,8 mmol/l
EXPLANATION
If the 2- hour glucose tolerance test result exceeds the level of 7.8 mmol/l ,gestational diabetes is present. However the two another abnormally high level requires treatment.

Question 8

OBG - 8.9
Predisposing factors associated with abruptio placentae, except:
A) maternal hypertension
B) smoking
C) external trauma during pregnancy
D) anaemia
E) multiple birth

Answer 8

ANSWER
D) anaemia
EXPLANATION
All of them are predisponic factors for abruptio placentae except anaemia. The common possible cause in the listed cases is the damages /lesions of vessels.

Question 9

OBG - 8.10
Which is false about hydatidiform mole?
A) proliferation of throphoblast cells
B) genetic composition is triploid
C) in 20% of cases can lead to choriocarcinoma
D) plasma hCG level is elevated

Answer 9

ANSWER
C) in 20% of cases can lead to choriocarcinoma
EXPLANATION
The incidence of the gestational throphoblast diseases is about 20%, but choriocarcinoma represents a smaller amount of that . The incidence of hydatiform mole transformation to choriocarcinoma is about 2 %.

Question 10

OBG - 8.12
After resolving extrauterine pregnancy an Rh-negative pregnant requires:
A) evaluation of the administration of Rh immune globulin is individual
B) administration of Rh immune globulin is not necessary
C) Rh immune globulin should be given
D) maternal Rh-antibody titer should be considered in the next pregnancy

Answer 10

ANSWER
C) Rh immune globulin should be given
EXPLANATION
To avoid the Rh-isoimmunisation , Rh immune globuline should be given within 72 hours to an Rh-negative woman with an ectopic pregnancy.

Question 11

OBG - 8.13
Which one is the correct method in multiple pregnancy if one twin’s detected fetal anomaly is incompatible with life?
A) to continue the pregnancy
B) interruption of the multiple pregnancy is required
C) selective reduction of the affected twin is recommended
D) CTG surveillance is required regularly

Answer 11

ANSWER
C) selective reduction of the affected twin is recommended
EXPLANATION
In cases of twin pregnancy where one of the fetuses is affected by severe congenital anomaly or and the other fetus is healthy, selective abortion has been accepted as the method of choice to save the healthy sibling and to improve its life expectations.

Question 12

OBG - 8.15
Etiology of ectopic pregnancy:
1) anomaly of the Fallopian tubes development
2) previous inflammation in the lumen of the tubes
3) Chlamydia trachomatis infection
4) scars, adhesions in the tube’s wall

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 12

ANSWER
E) all of the answers are correct
EXPLANATION
All of abnormalities that has an effect on a fallopian tube’s normal function can be a cause of ectopic pregnancy. Such as congenital tubes anomalies, inflammations, scars in the wall of fallopian tubes.

Question 13

OBG - 8.16
What drug/drugs is/are a good management in the treatment of hypertensive disorders in pregnancy?
1) alpha-methyldopa
2) calcium antagonist
3) beta -blockers
4) thiazid diuretics

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 13

ANSWER
A) 1st, 2nd and 3rd answers are correct
EXPLANATION
Diuretic can not be used in pregnancy expecially in preeclampsia, because of the reduction of plasma volume and the potential for decreasing placental perfusion

Question 14

OBG - 8.17
Which can cause polyhydramnion?
1) fetal haemolytic anaemia
2) premature rupture of the membranes
3) diabetes mellitus
4) praeeclampsia

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 14

ANSWER
B) 1st and 3rd answers are correct
EXPLANATION
Praeeclampsia due to placental insufficiency can cause oligohydramnion. Premature rupture of membranes cause oligohydramnion. Severe maternal diabetes or fetal haemolytic anaemia can cause polyhydramnion

Question 15

OBG - 8.18
Which are the symptoms of threatened eclampsia?
1) visual disturbances, constant or severe headache
2) severe hypertension
3) hyperreflexivity
4) vomiting, epigastric pain

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 15

ANSWER
E) all of the answers are correct
EXPLANATION
Criteria for eclampsia are severe hypertension, epigastric or right upper quadrant pain, cerebral or visual disturbances, vomiting and hyperreflexion can occur

Question 16

OBG - 8.19
Complications associated with polyhydramnios:
1) prolapse of umbilical cord
2) uterine dysfunction
3) preterm birth
4) placental abruption
5) abnormal fetal presentations

A) 1st, 2nd, 4th and 5th answers are correct
B) 1st, 3rd and 4th answers are correct
C) 1st, 3rd and 5th answers are correct
D) all of the answers are correct

Answer 16

ANSWER
D) all of the answers are correct
EXPLANATION
In cases of polyhydramnion spontaneous rupture of membranes can lead to acute uterine decompression with the risk of cord prolapse or placental abruption. Due to over-expansion of the uterus contraction can be occur and may lead to premature birth. Uterine dysfunction and postpartum haemorrhage resut form uterine atony consequent to overdistension. Abnormal fetal presentation are also more common.

Question 17

OBG-8.21-8.24
Pair the correct characteristics with the disorders:
A) Explained by placental insufficiency
B) Often associated with multiple pregnancy
C) Usually occurs in the first 12 weeks
D) tubal rupture is possible

OBG - 8.21 - Intrauterine growth restriction
OBG - 8.22 - ectopic pregnancy
OBG - 8.23 - spontaneous abortion
OBG - 8.24 - breech presentation

Answer 17

ANSWER
OBG - 8.21 - Intrauterine growth restriction - A)
OBG - 8.22 - ectopic pregnancy - D)
OBG - 8.23 - spontaneous abortion - C)
OBG - 8.24 - breech presentation - B)

Question 18

OBG-8.25-8.28
Pair the disorders with the laboratory parameters :
A) Rhesus isoimmunization
B) Hypertensive disorders of pregnany
C) Recurrent abortion
D) Hydatidiform moles

OBG - 8.25 - Proteinuria (24hr-urine collection)
OBG - 8.26 - Maternal anti-D antibody titer
OBG - 8.27 - Beta-hCG
OBG - 8.28 - Evaluation of paternal and maternal chromosomes

Answer 18

ANSWER
OBG - 8.25 - Proteinuria (24hr-urine collection) - B)
OBG - 8.26 - Maternal anti-D antibody titer - A)
OBG - 8.27 - Beta-hCG - D)
OBG - 8.28 - Evaluation of paternal and maternal chromosomes - C)

Question 19

OBG-8.29-8.32
Pair the pathogens with the adequate therapeutic possibilities.
A) spiramycin
B) acyclovir
C) azithromycin macrolid
D) third generation cephalosporins

OBG - 8.29 - Toxoplasma gondii
OBG - 8.30 - Chlamydia trachomatis
OBG - 8.31 - Herpes simplex (HSV-2, HSV-1)
OBG - 8.32 - Neisseria gonorrhoeae

Answer 19

ANSWER
OBG - 8.29 - Toxoplasma gondii - A)
OBG - 8.30 - Chlamydia trachomatis - C)
OBG - 8.31 - Herpes simplex (HSV-2, HSV-1) - B)
OBG - 8.32 - Neisseria gonorrhoeae - D)

Question 20

OBG-8.33-8.36
Pair the pathogens with the adequate clinical condition:
A) fetal ophthalmia, opthalmoblenorrhoea
B) fetal chorioretinitis
C) neonatal pneumonia
D) chronic hepatitis
OBG - 8.33 - Hepatitis B virus
OBG - 8.34 - Toxoplasma gondii
OBG - 8.35 - Neisseria gonorrhoeae
OBG - 8.36 - Chlamydia trachomatis

Answer 20

ANSWER
OBG - 8.33 - Hepatitis B virus - D)
OBG - 8.34 - Toxoplasma gondii - B)
OBG - 8.35 - Neisseria gonorrhoeae - A)
OBG - 8.36 - Chlamydia trachomatis - C)

Question 21

OBG-8.37-8.44
Pair the diagnosis with the correct answer:
A) placenta praevia
B) abruptio placenta
C) both of them
D) none of them

OBG - 8.37 - bright red or brownish bleeding occurs, pain localised only to the uterus

OBG - 8.38 - hard, boardline uterus

OBG - 8.39 - it usually occurs in the second or third trimester of pregnancy

OBG - 8.40 - no need of hospitalization
OBG - 8.41 - blood coagulation disorders can occur
OBG - 8.42 - fetal heart frequency stays physiological
OBG - 8.43 - preeclampsia can preceed
OBG - 8.44 - In severe form can cause fetal death

Answer 21

ANSWER
OBG - 8.37 - bright red or brownish bleeding occurs, pain localised only to the uterus - B)

OBG - 8.38 - hard, boardline uterus - B)

OBG - 8.39 - it usually occurs in the second or third trimester of pregnancy - A)

OBG - 8.40 - no need of hospitalization - D)

OBG - 8.41 - blood coagulation disorders can occur - B)

OBG - 8.42 - fetal heart frequency stays physiological - A)

OBG - 8.43 - preeclampsia can preceed - B)

OBG - 8.44 - In severe form can cause fetal death - C

Question 22

OBG - 8.45
Detection of acute rubella infection in first trimester requires pregnancy termination, because if acute rubella infection does occur in first trimester, the risk of severe congenital malformations following infection is 80%.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 22

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them;
EXPLANATION
Asymotomatic rubella infection in the 1st trimester carries 80% risk of development congenital complex anomalies, with cardiac, eyes and central nervous system involvement (Miller, F. et al.: Consequences of confirmed maternal rubella at successive stages of pregnancy. Lancet 2:781, 1982.)

Question 23

OBG - 8.46
Cause of bleeding during pregnancy is always due to abnormal placental implantation because the placenta also synthetises intrauterin steroids.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 23

ANSWER
D) the statement is false, but the explanation itself is true
EXPLANATION
There are multiple reasons for haemorrhage during pregnancy (not only placental abnormalities) . The placenta plays an important role in steroid biosynthesis.

Question 24

OBG - 8.47
Chromosomal abnormalities are true indication of amniocentesis in cases when the risk of the abnormalities is more than 1 % because the fetal loss rate is about 1% per procedure.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 24

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them;
EXPLANATION
Both of the two statements are true and the procedure related risks are an approximetly 1%.

Question 25

OBG - 8.48
Hypoglicaemia occurs often in macrosomia caused by maternal diabetes that is the reason why normoglycaemia needs to maintain with oral antidiabetic drugs escpecially during organogenesis.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 25

ANSWER
C) the statement is true, but the explanation is false;
EXPLANATION
First statement is true, but oral hypoglycamic agents that cross the placenta are not recommended for pregnant women because of the risk of teratogenesis exspeccialy during organogenesis.

Question 26

OBG - 8.52
What is the most probable diagnosis?
A 31-year-old primipara in 8th week of pregnancy has more frequently vomiting and inability to retain food, and requires hospitalization.
A) ectopic pregnancy
B) threatened miscarriage
C) hydatidiform mola
D) choriocarcinoma
E) hyperemesis gravidarum

Answer 26

ANSWER
E) hyperemesis gravidarum
EXPLANATION
both types of molar pregnancies and choriocarcinoma have the signs of nausea and vomiting but may be less frequent than in hyperemesis gravidarum.

Question 27

OBG - 8.53
Which examination should be given first?
A 31-year-old primipara in 8th week of pregnancy has more frequently vomiting and inability to retain food, and requires hospitalization.
A) chest X-Ray
B) pelvic ultrasound
C) blood test for electrolyte and acetone
D) ECG
E) CT

Answer 27

ANSWER
C) blood test for electrolyte and acetone
EXPLANATION
Blood test for electrolyte and acetone are the less complicated and should choose first than can be followed by ultrasound and other examinations.

Question 28

OBG - 8.54
What is the first-line treatment?
A 31-year-old primipara in 8th week of pregnancy has more frequently vomiting and inability to retain food, and requires hospitalization.
A) administration of antibiotic
B) administration of iv. fluid
C) administration diuretics
D) sedation
E) only observation

Answer 28

ANSWER
B) administration of iv. fluid
EXPLANATION
Rehydration, intravenous fluids should be provided to replenish the lost intravascular volume.

Question 29

OBG - 8.55
What is the most likely diagnosis?
A 32-year-old multiple pregnant in 37th weeks of pregnancy is delivered by paramedics to the hospital with vaginal bleeding and severe abdominal pain. Stabbing pain high in the uterine fundus. Blood pressure: 80/60 Hgmm, Pulse: 100/min. Obstetrical examination: cervix dilatated, rupture of membrane, amniotic fluid is bloody. Fetal bradycardia. Anamnesis: Ultrasound during the 28th week detected fundal location of the placenta.
A) placenta previa
B) placenta accreta
C) placental abruption
D) velamentous umbilical cord

Answer 29

ANSWER
C) placental abruption
EXPLANATION
Symptoms of pain, hypotension, tachycardy prove the abruption. Previous ultrasound examination proved the normal location of the placenta.

Question 30

OBG - 8.56
Which is the good management?
A 32-year-old multiple pregnant in 37th weeks of pregnancy is delivered by paramedics to the hospital with vaginal bleeding and severe abdominal pain. Stabbing pain high in the uterine fundus. Blood pressure: 80/60 Hgmm, Pulse: 100/min. Obstetrical examination: cervix dilatated, rupture of membrane, amniotic fluid is bloody. Fetal bradycardia. Anamnesis: Ultrasound during the 28th week detected fundal location of the placenta.
A) C/S after managing the shock
B) administration of oxytocin with careful observation
C) acute tocolysis and careful observation
D) immediately C/S, iv. fluid, transfusion

Answer 30

ANSWER
D) immediately C/S, iv. fluid, transfusion
EXPLANATION
Treatment should primarily focus on surgery AND correct the hypovolaemia in same time to avoid the presence of DIC and intrauterine fetal demise.

Question 31

OBG - 8.58
Which examination should be given first?
Primiparous patient in 32th weeks of pregnancy notices heavy bleeding from vagina without any uterine contraction.
A) blood test for complete blood count and measure of clotting potential
B) bimanual examination
C) transabdominal ultrasound
D) abdominal MRI
E) temperature measurement

Answer 31

ANSWER
C) transabdominal ultrasound
EXPLANATION
Placenta previa is almost exclusively diagnosed by ultrasonography. Theoretically transvaginal examination /ultrasound could precipitate bleeding so it should be avoided. Later lab test can be performed if it is necessary. No need of temperature measurement.

Question 32

OBG - 8.60
The most important complication is:
Primiparous patient in 32th weeks of pregnancy notices heavy bleeding from vagina without any uterine contraction.
A) premature rupture of membranes
B) preeclampsia
C) haemorrhagic shock
D) prolapse of umbilical cord

Answer 32

ANSWER
C) haemorrhagic shock
EXPLANATION
Severe bleeding may be lead to haemorrhagic shock which can be life –threatening.

Question 33

OBG - 8.61
Which is the good management?Multiparous pregnant in 37th weeks of pregnancy goes to see her GP with symptoms of dizziness, epigastric and right upper quadrant pain for two days. Blood pressure: 145/90 Hgmm, pulse 82/min. Urine dipstick test: elevated levels of protein
A) antacids and diet
B) spasmolytic and digestive drugs, diet
C) admit to Dept of Internal Medicine
D) admit to Dept of ObGyn
E) admit to Dept of infectious diseases

Answer 33

ANSWER
D) admit to Dept of ObGyn
EXPLANATION
Because of the symptoms of HELLP syndrome the patient need to admit to Dept of ObGyn