Obstetrics Flashcards
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
EXPLANATIONHemodynamic 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.
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
Vena cava inferior syndrome features:A) headache
B) maternal blood pressure dicreases
C) phosphene
D) Vena cava inferior thrombosis and increased maternal blood pressure
ANSWER
B) maternal blood pressure dicreases
EXPLANATIONIn 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.
The carbonhydrate 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 resistanceEXPLANATIONThe carbohydrate metabolism of the pregnant woman is characterized by increased insulin resistance.
Required daily calcium intake in pregnancy:A) 800 mg B) 500-1000 mg C) 1200 mg D) 2000 mg E) 3 g
ANSWERC) 1200 mg
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
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
B) all of the answers are correct
Choose the direction in which each laboratory parameter changes in normal pregnancy: A) increases B) decreases C) unchanged OBG - 7.25 - hemoglobin level OBG - 7.26 - white blood cell count OBG - 7.27 - erythrocyte sedimentation rate OBG - 7.28 - serum iron levels OBG - 7.29 - clotting time
ANSWEROBG -
7.25 - hemoglobin level - B)
OBG - 7.26 - white blood cell count - A)
OBG - 7.27 - erythrocyte sedimentation rate - A)
OBG - 7.28 - serum iron levels - B)
OBG - 7.29 - clotting time - C)
Maternal blood pressure increases in the first half of pregnancy because the cardiac output is increased by nearly 20% at the end of the first trimester related to the pre-pregnancy value.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
D) the statement is false, but the explanation itself is true
EXPLANATIONIn the first half of pregnancy blood pressure decreases, but the cardiac output is nearly 20% higher than pregestational values at the end of the first trimester.
The circadian rhythm of blood pressure often changes in pregnancy because when the pregnant woman lays back the uterus compresses the vena cava inferior and prevent the flow in the pelvic veins.
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
D) the statement is false, but the explanation itself is true
EXPLANATIONThe circadian rhythm of blood pressure does not change in pregnancy (except in preeclampsia). Laying back, the uterus may compress the vena cava inferior and thus inhibit the vena cava inferior flow (vena cava inferior syndrome).
The risk of thrombosis is increased in pregnancy because the coagulation time is elongated.
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
C) the statement is true, but the explanation is false;
EXPLANATIONThe risk of thrombosis is increased in pregnancy due to the slow venous flow in the lower limbs and not because of the decreased coagulation time.
Pyelectasia of the right kidney is common in pregnancy because the uterus leans to the right and compresses the ureter.
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
A) both the statement and the explanation are true and a causal relationship exists between them;
EXPLANATIONPyelectasia is more common on the right side because the uterus slightly leans to the right.
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
C) IV magnesium sulfate+ IV hydralazine ( Nepresol)
EXPLANATIONHydralazine 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.
First-line therapy in seizure during pregnancy: A) phenobarbital B) carbamazepine C) phenytoin D) intravenous diazepam
ANSWER
D) intravenous diazepam
EXPLANATIONFirst-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.
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
C) >= 7,8 mmol/l
EXPLANATIONIf 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.
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
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 %.
Which are the symptoms of threatened eclampsia?
1) visual disturbances, constant or severe headache
2) severe hypertension
3) hyperreflexivity
4) vomiting, epigastric painA) 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
E) all of the answers are correct
EXPLANATIONCriteria for eclampsia are severe hypertension, epigastric or right upper quadrant pain, cerebral or visual disturbances, vomiting and hyperreflexion can occur.
Pair the pathogens with the adequate clinical condition:
A) fetal ophthalmia, opthalmoblenorrhoea
B) fetal chorioretinitis
C) neonatal pneumonia
D) chronic hepatitisOBG - 8.33 - Hepatitis B virus
OBG - 8.34 - Toxoplasma gondii
OBG - 8.35 - Neisseria gonorrhoeae
OBG - 8.36 - Chlamydia trachomatis
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)
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
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)
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
A) both the statement and the explanation are true and a causal relationship exists between them;
EXPLANATIONAsymotomatic rubella infection in the 1st trimester carries 80% risk of development congenital complex anomalies, with cardiac, eyes and central nervous system involvement
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
A) both the statement and the explanation are true and a causal relationship exists between them;
EXPLANATIONBoth of the two statements are true and the procedure related risks are an approximetly 1%.
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.
ANSWER
C) the statement is true, but the explanation is false;
EXPLANATIONFirst 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.
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
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.
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
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.
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
C) placental abruption
EXPLANATION
Symptoms of pain, hypotension, tachycardy prove the abruption. Previous ultrasound examination proved the normal location of the placenta.
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
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.
Which examination should be given first?
Primiparous patient in 32th weeks of pregnancy with 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
C) transabdominal ultrasound
EXPLANATIONPlacenta 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.
The most important complication is: Primiparous patient in 32th weeks of pregnancy with heavy bleeding from vagina without any uterine contraction. A) premature rupture of membranes B) preeclampsia C) haemorrhagic shock D) prolapse of umbilical cord
C) haemorrhagic shock
EXPLANATION
Severe bleeding may be lead to haemorrhagic shock which can be life –threatening.
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
D) admit to Dept of ObGyn
EXPLANATIONBecause of the symptoms of HELLP syndrome the patient need to admit to Dept of ObGyn
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
B) pills containing low hormone
EXPLANATIONThe 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.
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
C) in both cases
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
D) the above changes equally occur
EXPLANATIONEffect 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.
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
B) iv. 10 mg methylprednisolone
EXPLANATION
10 mg methylprednisolone means under-dosing so results cannot be expected by this treatment.
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
C) if the probability of appendicitis can not be excluded, surgery should be performed
EXPLANATIONThere 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.
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
C) in 60%
EXPLANATIONThe Leiden mutation can be shown in two thirds of the thromboembolic diseases associated with pregnancy.
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%
B) 10 to 25%
EXPLANATIONMaternal mortality associated with thromboembolism is 10 to 25 per cent in the developed countries.
How often developes cystopyelitis in pregnant women with asymptomatic bacteriuria? A) 5% B) 10% C) 15% D) 20% E) 25%
ANSWER
E) 25%
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) 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
D) all responses are right
