Obgyn - The physiology of pregnancy (25) Flashcards
OBG - 7.1
The following hemodynamic changes are characteristic in pregnancy, except:
A) increase in cardiac output
B) decrease in blood pressure in the first half of pregnancy
C) increase in heart rate
D) increase in venous pressure in the lower limbs
E) increase in central venous pressure
ANSWER
E) increase in central venous pressure
EXPLANATION
Hemodynamic changes in pregnancy include increased cardiac output, decreased blood pressure in the first half of pregnancy, increased heart rate and increased venous pressure in the lower limbs. Pregnancy is not characterized by an increase in central venous pressure.
OBG - 7.2
CTG alteration in vena cava inferior syndrome:
A) persistent tachycardia
B) acceleration
C) the fetal heart rate is unchanged
D) the fetal heart rate decelerates
E) reduced oscillation
ANSWER
D) the fetal heart rate decelerates
EXPLANATION
In vena cava inferior syndrome the placental circulation is decreased, therefore the fetal heart rate decelerates, bradycardia can be seen on CTG.
OBG - 7.3
Physiological changes in pregnancy, except:
A) the pH and composition of the saliva changes
B) stomach and intestinal motility increase
C) pyelectasia, especially on the right side
D) serum levels of T3, T4 increase but TSH level is unchanged
E) the ligaments are loosened
ANSWER
B) stomach and intestinal motility increase
EXPLANATION
In pregnancy the composition and the pH of the saliva changes due to hormonal effects. The enlarged uterus compresses the ureters and as it leans towards the right side the compression and enlargment of the ureter is more expressed on the right. The retrograde urine stasis may cause pyelectasia. The pregnant uterus pushes the intestines upwards, and the motility of the intestinal tract decreases. In pregnancy, the levels of serum T3, T4 increase, TSH remains unchanged. The joints are loosened.
OBG - 7.4
Vena cava inferior syndrome features:
A) headache
B) maternal blood pressure decreases
C) phosphene
D) vena cava inferior thrombosis and increased maternal blood pressure
ANSWER
B) maternal blood pressure decreases
EXPLANATION
In vena cava inferior syndrome when the pregnant woman lays back the uterus overlies and compresses the vena cava inferior. Due to the decline in venous backflow, a fast maternal blood pressure drop occurs, dizzyness, sweating and tachycardia may lead to collapse. The decrease in the placental circulation causes fetal bradycardia. Vena cava inferior syndrome is not characterized by headache, visual symptoms, vena cava inferior thrombosis or elevated blood pressure.
OBG - 7.5
The following changes are characteristic in pregnancy, except:
A) acromegaloid symptoms
B) hyperpigmentation
C) increased lumbar lordosis
D) general vessel dilation
E) decrease in cardiac output
ANSWER
E) decrease in cardiac output
EXPLANATION
As a consequence of hormonal changes in pregnancy, acromegaloid symptoms, hyperpigmentation, increased lumbar lordosis and vesseldilation occur frequently. Cardiac output increases in healthy pregnancy.
OBG - 7.6
The carbohydrate metabolism in pregnancy is characterized by:
A) higher fasting blood sugar levels
B) increased insulin resistance
C) lower fasting blood glucose levels
D) reduced insulin resistance
E) increased glucose absorption
ANSWER
B) increased insulin resistance
EXPLANATION
The carbohydrate metabolism of the pregnant woman is characterized by increased insulin resistance.
OBG - 7.8
Required daily calcium intake in pregnancy:
A) 800 mg
B) 500-1000 mg
C) 1200 mg
D) 2000 mg
E) 3 g
ANSWER
C) 1200 mg
EXPLANATION
Daily calcium requirement in pregnancy is 1200 mg
OBG - 7.10
Daily iron requirements in pregnancy (based on RDA recommendations):
A) 30 mg
B) 100 mg
C) 5-10 mg
D) 300 mg
E) 500 mg
ANSWER
A) 30 mg
EXPLANATION
The daily iron requirement in pregnancy is 30 mg.
OBG - 7.11
Which skin condition is characteristic for pregnancy?
A) depigmentation
B) erythema nodosum
C) lichenificatio
D) increased pigmentation
ANSWER
D) increased pigmentation
EXPLANATION
Characteristic skin change in pregnancy is the increased pigmentation. Especially in those areas that are predominantly pigmented: the vulva, skin under the navel and the nipples. The pigment spot around the eye and the cheekbones is chloasma gravidarum. The cause of pigmentation is the increased production of melatonin. Increased pigmentation will regress after birth.
OBG - 7.12
Protein content of urine collected in 24 hours in normal pregnancy:
A) is abnormal only if it exceeds 500 mg / l
B) is acceptable only if less than 300 mg / l
C) not abnormal up to 1000 mg / l
D) is acceptable only under 150 mg / l
ANSWER
B) is acceptable only if less than 300 mg / l
EXPLANATION
In normal pregnancies, protein content of urine collected within 24 hours is below 300 mg.
OBG - 7.13
Causes of physiological glucosuria in pregnancy:
1) increased mobilization of carbonhydrate storages
2) increased GFR
3) reduced insulin resistance
4) filtered glucose can not be reabsorbed in tubules
5) glucose excretion increases in tubules
A) 1st, 2 and 3rd answers are correct
B) 1st, 3rd and 4th answers are correct
C) 1st, 4th and 5th answers are correct
D) 1st, 3rd and 5th answers are correct
E) 2nd and 4th answers are correct
F) 2nd, 3rd and 4th answers are correct
ANSWER
E) 2nd and 4th answers are correct
EXPLANATION
In pregnancy, the cause of physiological glucosuria is that glucose excreted via increased glomerular filtration cannot be reabsorbed in the tubules.
OBG - 7.14
During pregnancy, the following characteristic physiological changes occur in the kidneys and the urinary tract:
1) the ureter tone decreases
2) the peristalsis of the ureter increases
3) pyelectasia
4) the GFR increases
5) the kidney’s ability to dilute the urine is significantly reduced
A) 1st, 2nd, 4th and 5th answers are correct
B) all of the answers are correct
C) 2nd and 4th answers are correct
D) 1st, 3rd and 4th answers are correct
E) 2nd, 4th and 5th answers are correct
ANSWER
D) 1st, 3rd and 4th answers are correct
EXPLANATION
In pregnancy the tone of the ureters decreases, pyelectasia develops and the GFR grows.
OBG - 7.15
Cardiovascular changes in pregnancy:
1) increased heart rate
2) increased systolic volume
3) increase in blood pressure in the second half of pregnancy
4) increased cardiac output
5) increased venous pressure in the lower limbs
A) 1st, 2nd, 4th and 5th answers are correct
B) all of the answers are correct
C) 2nd, 3rd and 4th answers are correct
D) 3rd, 4th and 5th answers are correct
E) 4th and 5th answers are correct
ANSWER
B) all of the answers are correct
EXPLANATION
In pregnancy the heart rate increases, the systolic output increases, blood pressure is elevated in the second half of pregnancy, the cardiac output increases and the venous pressure increases in the lower limbs.
OBG - 7.18
Characteristic for vena cava inferior syndrome:
1) decrease in maternal blood pressure
2) acceleration of fetal heart rate
3) faintness of the pregnant woman
4) occurs when the pregnant lays on the back
5) increased maternal blood pressure
A) 1st, 2nd and 3rd answers are correct
B) 1st, 3rd and 4th answers are correct
C) 2nd, 3rd and 4th answers are correct
D) 2nd, 4th and 5th answers are correct
E) 3rd, 4th and 5th answers are correct
ANSWER
B) 1st, 3rd and 4th answers are correct
EXPLANATION
See 7.4. question.
OBG-7.19-7.24
Select the direction in which physiological parameters change during pregnancy:
A) increases
B) decreases
C) unchanged
D) increases in the first half of pregnancy
E) decreases in the first half and increases in the second half of pregnancy
OBG - 7.19 - heart rate
OBG - 7.20 - systolic blood pressure
OBG - 7.21 - insulin resistance
OBG - 7.22 - diastolic blood pressure
OBG - 7.23 - GFR
OBG - 7.24 - risk of thrombosis
ANSWER
OBG - 7.19 - heart rate - A)
OBG - 7.20 - systolic blood pressure - E)
OBG - 7.21 - insulin resistance - A)
OBG - 7.22 - diastolic blood pressure - E)
OBG - 7.23 - GFR - A)
OBG - 7.24 - risk of thrombosis - A)
