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Patho OB > Prelim Test > Flashcards

Prelim Test Flashcards

1
Q

which of the following is diagnostic of asymptomatic
bacteriuria

a. A more than 100,000 organisms/ml in a clean voided urine
b. Proteinuria of more than 300 mg/ml
c. Pus cells on urinalysis > 0-2/ ml
d. Positive kidney punch test

A

a. A more than 100,000 organisms/ml in a clean voided urine

Williams, pg 1027
A clean-voided specimen containing more than 100,000 organisms/mL is diagnostic

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2
Q

lower tract symptoms with pyuria accompanied by sterile
urine culture is highly indicative of which etiologic organism

e. Chlamydia trachomatis
a. E. coli
b. Chlamydia trachomatis
c. Klebsiella pneumoniae
d. Proteus sp.

A

e. Chlamydia trachomatis

Williams, pg 1028

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3
Q

differential diagnosis for acute pyelonephritis in a
pregnant woman include the following, EXCEPT:

A. Chorioamnionitis
B. Appendicitis
C. Gastroenteritis
D. Preterm labor

A

C. Gastroenteritis

Wiliams, pg 1028
The differential diagnosis (of acute pyelonephritis) includes: labor, chroioamnionitis, adnexal torsion, appendicitis, placental abruption, or infarcted leiomyoma. Also signs of sepsis syndrome

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4
Q

which of the following statements is CORRECT in the
management of a pregnant woman with acute
pyelonephritis

a. Establish a urine output of > 5 ml/hr with intravenous crystalloid solution
b. Repeat urine culture after 1-2 days of antimicrobial treatment
c. Repeat hematology and chemistry studies after 1 week afebrile
d. Discharge patient when 24 hrs afebrile and continue oral antibiotics to complete for 7-10 days

A

d. Discharge patient when 24 hrs afebrile and continue oral antibiotics to complete for 7-10 days

Williams, pg 1029
. Establish a urine output of > 50 ml/hr with intravenous crystalloid solution
. Repeat urine culture after 1-2 weeks of antimicrobial treatment
. Repeat hematology and chemistry studies after 48 hours afebrile

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5
Q

which of the following is contraindicated in the
management of nephrolithiasis in pregnancy

a. Extracorporeal shockwave lithotripsy
b. Ureteral stenting
c. YAG laser lithotripsy
d. Percutaneous nephrostomy

A

a. Extracorporeal shockwave lithotripsy

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6
Q

the hallmark of nephrotic syndrome is

a. Hypoalbuminemia
b. Heavy proteinuria
c. Hypercholesterolemia
d. edema

A

b. Heavy proteinuria

Williams, pg 1033
In addition to heavy urine protein excretion, the syndrome is characterized by hypoalbuminemia, hypercholesterolemia, and edema

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7
Q

Preeclampsia or eclampsia should be particularly differentiated from

a. Acute pyelonephritis
b. Nephrotic syndrome
c. Nephritic syndrome
d. Polycystic kidney disease

A

c. Nephritic syndrome

Acute nephritic syndromes during
pregnancy can be diicult to diferentiate
from severe preeclampsia or eclampsia (all conditions have hypertension)
(page 1032)

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8
Q

To prevent renal stone formation, which of the following is recommended

a. Ketogenic diet
b. Carbohydrate-free diet
c. Low calcium diet
d. Low sodium, low protein diet

A

d. Low sodium, low protein diet

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9
Q

Causes of acute kidney injury are the
following, EXCEPT:

a. Preeclampsia
b. Gestational diabetes
c. Hypovolemia in placenta previa
d. massive hemorrhage in abruptio
placenta

A

b. Gestational diabetes

acute renal ischemia is still often associated with severe
preeclampsia and hemorrhage . Particularly contributory are HELLP (hemolysis, elevated liver enzymes, low
platelet levels) syndrome and placental abruption . Septicemia is another frequent comorbidity. AKI is also common in women with acute fatty liver of pregnancy. Some degree of renal insuiciency was found in some . Another developed AKI from dehydration caused by severe hyperemesis gravidarum at 15 weeks. Other causes include thrombotic micro angiopathies (page 1036)

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10
Q

Most common cause (or form) of
acute glomerulonephritis

a. IgA nephropathy
b. poststreptococcal
c. SLE
d. HTN GN

A

a. IgA nephropathy

IgA nephropathy, also known as Berger
disease, is the most common form of acute
glomerulonephritis worldwide.

Acute Nephritic Syndromes:
poststreptococcal, infective endocarditis, SLE, antiglomerular basement membrane disease, IgA nephropathy (Berger disease), ANCA vasculitis, Henoch-Schonlein purpura, cryoglobulinemia, membranoproliferative and mesangioproliferative glomerulonephritis (1032

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11
Q

Nephritic syndrome, EXCEPT:

a. Lipids
b. Albumin
c. Pyuria
d. RBC

A

a. Lipids

The clinical presentation usually includes hypertension, hematuria, red-cell casts, pyuria, and proteinuria. Varying degrees of renal insuiciency and salt and water retention
result in edema, hypertension, and circulatory congestion (page 1032)

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12
Q

Common pathogen in acute pyelonephritis

a. Klebsiella granulomatis
b. Pseudomonas aeruginosa
c. Chlamydia trachomatis
d. Group B streptococcus

A

d. Group B streptococcus (E. coli is most common)

Bacteremia is demonstrated in 1 5 to 20 percent of these women. E coli is isolated from urine or blood in 70 to 80 percent of infections, Klebsiela pneumoniae in 3 to 5 percent, Enterobacter or Proteus species in 3 to 5 percent, and gram-positive organisms, including group B Streptococcus and Staphylococcus aureus in up to 10 percent of cases (page 1028)

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13
Q

Structural dilatation of the renal calyxes and ureter on the first trimester of pregnancy is likely due to the effect of this particular hormone

a. hCg
b. Estrogen
c. Progesterone
d. Human Placental Lactogen

A

c.Progesterone

Some dilatation develops before 1 4 eeks and likely stems from progesterone-induced relaxation of the muscularis. (page 1025-1026)

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14
Q

Pt has serum creatinine level of 0.7 mg/dL. What is the next step?

A

Nothing. This is normal in pregnancy

pg 1026
Vasodilation due to pregesterone induced relaxation of muscularis leads to increased filtration

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15
Q

Pt has had serial serum creatinine levels of 1.0, 1.2, 1.0 mg/dL. What is the first things suspected?

A

Intrinsic renal disease

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16
Q

Acute kidney damage cause & associated with, EXCEPT:

a. Diabetes
b. Hypermesis
c. Septicemia
d. Hypovolemia

A

a. Diabetes

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17
Q

24 y/o G1P0 12 weeks, history N/V (3 days) weakness, skin & mucosa are dry. High risk for

a. Pyelonephritis
b. CRD
c. Acute kidney infection
d. Nephrolithiasis

A

a. Pyelonephritis

2nd trimester, nulliparity, young age, unilateral and right-sided, fever and shaking chills, aching pain, dehydration

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18
Q

Nephritic syndrome, EXCEPT:

a. Lipids
b. Albumin
c. Pyuria
d. RBC

A

a. Lipids

The clinical presentation usually includes hypertension, hematuria, red-cell casts, pyuria, and proteinuria. Varying degrees of renal insuiciency and salt and water retention
result in edema, hypertension, and circulatory congestion (page 1032)

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19
Q

Common pathogen in acute pyelonephritis

a. Klebsiella granulomatis
b. Pseudomonas aeruginosa
c. Chlamydia trachomatis
d. Group B streptococcus

A

d. Group B streptococcus

If this infection is suspected, a urine sample obtained by catheterization may be preferred to avoid obscuring contamination from the lower genital tract. The urinary sediment contains many leukocytes, frequently in clumps, and numerous bacteria. Bacteremia is demonstrated in 1 5 to 20 percent of these women. E coli is isolated from urine or blood in 70 to 80 percent of infections, Klebsiela pneumoniae in 3 to 5 percent, Enterobacter or Proteus species in 3 to 5 percent, and gram-positive organisms, including group B Streptococcus and Staphylococcus aureus in up to 10 percent of cases (page 1028)

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20
Q

The good standard for the diagnosis of Asymptomatic bacteuria is Urine Culture.In the absence of urine culture this can be an alternative laboratory test for screening asympromatic bacteuria in pregnancy

a. urine dipstick leukocyte esterase
b. urine dipstick for nitrite test
c. Urine gram staining uncentrifuged sample
d. Urine dipstick for protein determination

A

a. urine dipstick leukocyte esterase

. Less expensive screening tests
such as the leukocyte esterase/nitrite dipstick are cost efective when the prevalence is <2 percent. Also, a dipstick culture technique has excellent
positive- and negative-predictive values (page 1027)

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21
Q

Medical condition during or preceding pregnancy considered to be highly susceptible to the formation of asymptomatic infection or Bacteruria

a. Iron deficiency anemia
b. Hypertension
c. Diabetes mellitus
d. Collagen Vascular Disease

A

c. Diabetes mellitus

But even if pregnancy itself does not enhance these virulence factors, urinary stasis, vesicoureteral reflux, and diabetes predispose to symptomatic upper urinary infections (page 1026)

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22
Q

In a study perform by Schieve et. Al. UTI when untreated is highly associated to the development of

a. Low birth weight infants
b. Pregnancy associated hypertension
c. Anemia
d. A and C only
e. A, B , and C

A

e. A, B, and C

reported urinary tract infection to be associated with greater risks for low-birthweight infants, preterm delivery, pregnancy-associated hypertension,
and anemia. (page 1027)

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23
Q

. LBD, 16y/o,G1P0 on her 20 weeks AOG had her routine prenatal check up. Patient doesn�t complain of anything, there was no vaginal discharge on pelvic examination V/S BP: 100/60 mmHg, RR: 20, T:37.2C, PE: unremarkable for gravid woman, Urinalysis; WBC: 10-15hpf, RBC:0-2 hpf,urine nitrates negative, leukocytes esterase: negative, Urine culture:150,000cfu,CBC within normal limit 5. Based on the ff. data presented, what is the probable diagnosis?

a. Acute Uncomplicated Cystitis or Urethritis
b Acute Uncomplicated Pyelonephritis
c. Asymptomatic Bacteuria
d. Acute Glomeruonephritis

A

c. Asymptomatic Bacteuria

This refers to persistent, actively multiplying bacteria within the urinary tract in asymptomatic
women.

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24
Q

When is the preferred AOG to screen Aymptomatic Bacteuria

a. 5-6 weeks
b. 8 weeks
c. 16 weeks
d. 24 weeks

A

d. 24 weeks

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25
Q

Pyelonephritis is the leading cause of Septic Shock during pregnancy. In preterm and infant deliveries urosepsis may be associated with increased incidence of

a. Cerebral Palsy
b. Respiratory distress syndrome
c. Bronchopulmonary Leukomalacia
d. Necrotizing Enterocolitis

A

a. Cerebral Palsy

Urosepsis may be related t o a n increased incidence of cerebral palsy in preterm infants (page 1028)

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26
Q

Acute Glomerulonepthitis has profound effect on pregnancy outcome, the worst perinatal outcome are seen in pregnant women with

a. Impaired renal function
b. Early onset-with severe features of Preeclampsia
c. Nephrotic-range proteinuria
d. A, C only
e. A, B, and C

A

e. A, B, and C

Although most of these women had normal renal function, half developed hypertension, a fourth
were delivered preterm. The worst perinatal outcomes were in women with impaired renal function, early or severe hypertension, and nephrotic-range proteinuria. Similar outcomes have been reported for pregnancies in
women with IgA nephropathy.

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27
Q

What is the optimal screening test for Asymptomatic bacteuria in pregnancy?

a. Routine Analyisis
b. Urine nitrite determination
c. Urine culture
d. Urine leukocyte esterease

A

c. Urine culture

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28
Q

Common signs and symptoms of cystitis except

a. Pyuria
b. Dysuria
c. Hematuria
d. Bacteuria

A

c. Hematuria

Cystitis produces dysuria, urgency, and frequency, but with few associated systemic indings. Pyuria and bacteriuria are usually found. Microscopic hematuria is common, and occasionally there is gross hematuria from hemorrhagic cystitis (page 1028)

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29
Q

Best treatment for Chlamydia trachomatis:

a. Ampicillin
b. Aminoglycosides
c. Azithromycin
d. Amphotercin B

A

c. Azithromycin

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30
Q

Clinical findings of acute pyelonephritis

a. Sudden onset of fever and chills
b. Left kidney is mostly affected
c. RUQ tenderness
d. N/V with bilious material

A

a. Sudden onset of fever and chills

Pyelonephritis i s unilateral and right-sided in more than half of cases, and it is bilateral in a fourth. Fever and shaking chills usually develop rather abruptly, and patients have aching pain in one or both lumbar regions. Anorexia, nausea, and vomiting may worsen dehydration. Tenderness usually can be elicited by percussion in one or both costovertebral angles.

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31
Q

Which of the following regimen in pregnancy will promote nephrolithiasis

a. 1 cup of milk
b. 1 cup of salted peanuts
c. 1 cup of yogurt
d. _ cup of nonfat milk and 1 tab calcium carbonate 500mg

A

b. 1 cup of salted peanuts

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32
Q

Hemodialysis is associated with

a. Acute Glomerulonephritis
b. Acute Renal Disease
c. Chronic Renal Disease
d. Nephrotic Syndrome
e. PCKD

A

b. Acute Renal Disease

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33
Q

Abdominal Mass found in

a. Acute Glomerulonephritis
b. Acute Renal Disease
c. Chronic Renal Disease
d. Nephrotic Syndrome
e. PCKD

A

e. PCKD

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34
Q

Anemia from Intrinsic Renal Disease is associated with

a. Acute Glomerulonephritis
b. Acute Renal Disease
c. Chronic Renal Disease
d. Nephrotic Syndrome
e. PCKD

A

c. Chronic Renal Disease

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35
Q

Proteinuria= >4100 mg

a. Acute Glomerulonephritis
b. Acute Renal Disease
c. Chronic Renal Disease
d. Nephrotic Syndrome
e. PCKD

A

d. Nephrotic Syndrome

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36
Q

Acute post-strep

a. Acute Glomerulonephritis
b. Acute Renal Disease
c. Chronic Renal Disease
d. Nephrotic Syndrome
e. PCKD

A

a. Acute Glomerulonephritis

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37
Q

Question

A

Answer

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38
Q

Implantation anywhere other than this is considered an ectopic pregnancy

A

Endometrial lining of uterine cavity

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39
Q

What type of EP is the most common?

A

Tubal EP - 95%

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40
Q

What type of tubal EP is the most common? What is 2nd most common?

A

Ampulla - 70%
Isthmus - 12%

Fimbria - 11%
Interstial - 2%

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41
Q

What is heterotopic pregnancy?

A

Multifetal pregnancy with one normally implanted and one EP

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42
Q

What confers the highest risk for EP?

A

surgeries for prior tubal pregnancy, for fertility restoration, or sterilization

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43
Q

What is the risk of having an EP when there was a previous EP?

A

5 times

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44
Q

What are the risks for EP?

A 
. Surgery
. Prior STD
. Tubal infection
. Peritubal adhesions secondary to salpingitis, appendicitis, or endometriosis
. Salpingitis ithmica nodosa
. Congenital fallopian tube anomalies
. Infertility/ART
. Smoking 
. IUD
. Progesterone only contraceptives
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45
Q

What is salpingitis isthmica nodosa?

A

epithelium-lined diverticula extend into a hypertrophied muscularis layer

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46
Q

A female fetus is exposed to diethylstilbesterol in utero. What is a possible consequence for the fetus?

A

Congenital fallopian tube anomaly

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47
Q

What are the possible outcomes for EP?

A

. Tubal rupture
. Tubal abortion
. Pregnancy failure w/ resolution

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48
Q

With EP (proximal/distal) implatations are favored.

A

Distal

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49
Q

What are the possible outcomes for tubal abortion?

A

. Hemorrhage may cease and symptoms eventually dissapear
. Bleeding persists as products remain in tube
. Blood pools in rectouterine cul-de-sac (Pouch of Douglas)
. If fimbruated extremity is occluded, hematosalpinx
. Reabsorption
. Reimplantation for become abdominal pregnancy

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50
Q

What is tubal abortion?

A

When pregnancy passes out of the distal fallopian tube

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51
Q

A pt has a history of EP. Previous test results show that serum B-hCG levels were low at the time. What type of EP did the pt have? Support diagnosis.

A

Chronic EP; abnormal trophoblast dies early and thus negative or low static serum B-hCG levels are found

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52
Q

Which has a high serum B-hCG level? Acute or chronic

A

Acute

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53
Q

A pt has delayed menstruation, abdominal pain, and vaginal bleeding. LMP was 8 weeks ago. What is most likely diagnosis?

A

Ectopic pregnancy

The classic triad is delayed menstruation, abdominal pain, and vaginal bleeding or spotting.

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54
Q

What are manifestations of tubal rupture of EP?

A 
. Lower abdominal and pelvic pain
. Bulging posterior vaginal fornix due to collection of blood
. Tender, boggy mass beside uterus
. Enlarged uterus
. Diaphragmatic irritation
. (+) culdocentesis
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55
Q

After a suspected acute hemorrhage, hemoglobin or hematocrit readings are taken. Which is more valuable? Initial reading or serial readings?

A

Serial readings; Hemoglobin or hematocrit may only initiall show a slight reduction

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56
Q

A pt has passed a decidual cast. Did pt have an ectopic pregnancy or abortion? How do you differentiate?

A

EP is no clear gestational sac or villi identified histologically

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57
Q

Why are there increasing rates of EP?

A 
. STD
. early diagnosis for hCG and TVUS
. Certain contraception
. Unsuccessful tubal sterilization
. ART (assisted reproductive technique)
. Induced abortion
. Increased tubal surgery
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58
Q

Define tubal pregnancy

A

pregnancy occuring in the fallopian tube

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59
Q

Define interstial pregnancy

A

pregnancy that implants within the interstitial portion of the fallopian tube

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60
Q

Differentiate and define abdominal pregnancy

A

Primary - the 1st and only implatation occurs on a peritonieal surface

Secondary - implatation originally in the tubal ostia, subsequently aborted and then reimplanted intothe peritoneal surface

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61
Q

Define cervical pregnancy

A

implatation of the developing conceptus in the cervical canal

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62
Q

Define Ligamentous pregnancy

A

a secondary form of EP in which a primary tubal pregnancy erods intot he mesosalpinx and is located between the leaves of the broad ligament

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63
Q

Define heterotropic pregnancy

A

condition in which ectopic and intrauterine pregnancies coexist

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64
Q

Define Ovarian pregnancy

A

EP implants within the ovarian cortex

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65
Q

What are the possible outcomes of tubal pregnancy?

A 
. Tubal rupture
. Tubal abortion
. Pregnancy failure
. Tubal abortion
. Acute EP
. Chronic EP
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66
Q

Nixon sign vs Dodd’s sign

A

Nixon: unilateral pulsation

Dodd’s: unilateral tenderness

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67
Q

What are the key components for EP diagnosis?

A

. Physical finding
. Transvaginal sonography (TVS)
. Serum B-hCG (initial and serial)
. Diagnostic surgery

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68
Q

What are the lower limits for ELISA used as pregnancy test?

A

.Urine: 20 - 25 mIU/mL

. Serum < or = 5 mIU/mL

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69
Q

What is the important of the Discriminatory Zone?

A

B-hCG levels above which failure to visualize a uterine pregnancy indicates that the pregnancy either is not alive or is ectopic

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70
Q

What are the values of the Discriminatory Zone for hCG?

A

. 1500 - 1800 mIU/mL with TVS

. 600 - 6500 mIU/mL with abdominal ultrasound

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71
Q

A pt has a serum B-hCG concentration of 1700 mIU/mL and TVS showed an empty uterus. What are the likey differentials?

A

. Failing IUP
. Complete abortion
. EP

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72
Q

What is the mean doubling time for serum b-hCG level?

A

48 hours

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73
Q

hCG assay are accurate for EP. True or false

A

True. hCG assays positive for 99% of EP

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74
Q

A pt has serum progesterone level of 28 ng/mL. Can this be an ectopic pregnancy?

A

No. >25 ng/mL excludes EP

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75
Q

A pt has serum progesterone level of 23 ng/mL. Can this be an ectopic pregnancy?

A

Inconclusive. Most ectopic pregnancies have values between 10 and 25 ng/mL.

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76
Q

A pt has serum progesterone level of 3 ng/mL. Can this be an ectopic pregnancy?

A

Possibly. <5ng/mL suggests a dead fetus or EP

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77
Q

In normal IUP when are the following found with TVS?

GS:
YS:
FP w/ FHR:

A

Gestational Sac: 4.5 to 5 wks
Yolk Sac: 5 to 6 wks
Fetal with fetal heart rate: 5.5 to 6 wks

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78
Q

What would be the TVS findings in an EP? What is considered diagnostic?

A 
. Trilaminar endometrial pattern (diagnostic)
. Anechoic fluid collection (pseudogestational sac and decidual cyst)
. Ovoid
. Central
. Poorly defined margins
. Absent decidual reaction
. Single decidual layer
. No double decidual sac sign
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79
Q

What would be the TVS findings in an IUP?

A 
. Round
. Eccentric
. Well defined margins
. Intradecidual sign
. Double decidual sac sign
. Growth rate: 0.8 mm/day
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80
Q

What are the three most common adnexal findings?

A

. Inhomogenous mass adjacent to the oary - 60%
. Hyperechoic ring - 20%
. Gestational sac with fetal pole - 13%

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81
Q

“Ring of fire” was the radiologic finding. What modality was used? Define “ring of fire”. Is this diagnostic?

A

. Used Doppler color imaging
. increased vascularity resulting in plaental blood flow within the periphery of the complex adnexal mass
. Not diagnostic. Can be EP or corpus luteym cyst.

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82
Q

What are the TVS findings in hemoperitoneum?

A

. anechoic or hypoechoic fluid in the dependent retrouterine cul-de-sac >50ml
. Blood in the Morison pouch near liver (400-700 mL)

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83
Q

What are the two ways to asess hemoperitoneum?

A

. TVS

. Culdocentesis

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84
Q

Pt was found to have peritoneal fluid + adnexal mass. What is the likely dx? What are some ddx?

A

. EP

. Ascites from ovarian or other cancer

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85
Q

How is a culdocentesis performed? What do positive and negative findings mean? What is the significance of clots and clotting? Is it diagnostic?

A

. Cervis is pulled outward and upward toward the symphysis with a tenaculum, and a long 18-gauge needle is inserted through the posterior vaginal fornix into the retrouterine cul-de-sac.

. (+) fluid containg fragments of old clots or bloody fluid; non-clotting bloody fluid
. (-) unsat entry into the cul-de-sac

. Old clots or non-clotting bloody fluid does not suggest hemoperitoneum; blood samples that clot can be from an adjacent blood vessel or form a brisk ectopic pregnancy.

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86
Q

What is the importance of endometrial sampling? What are the most common findings?

A

. Lack coexisting trophoblast
. 42% decidual reaction
. 22% secretory reaction
. 12% proliferative endometrium

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87
Q

What is the most common adnexal mass?

A

corpus luteum

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88
Q

What is the importance of laproscopy in EP?

A

Reliable diagnosis due to direct visualization of the fallopian tube and pelvis AND ready transition to operative therapy if needed

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89
Q

In evaluation of EP what is the first consideration after presentation of classic traid of symptoms?

A

Determine if pt is hemodynamically stable

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90
Q

If pt with classic triad of EP is hemodynamically stable what is the next course of action?

A

TVS

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91
Q

If pt with classic triad of EP is NOT hemodynamically stable what is the next course of action?

A

Surgical management

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92
Q

If pt with classic triad of EP has a non-diagnostic TVS, what is the next step in evaluation? What are most common findings?

A

. serum b-hCG
. >1500 discriminatory level is ectopic pregnancy
. <1500 discriminatory level = repeat in 48 hours

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93
Q

What are the criteria for a expectant management of EP?

A

. Asymptomatic, hemodynamically stable
. Tubal EP
. Decreasing serial b-hCG (esp if initial was =/<1500)
. Small ectopic mass
. No TVS evidence of intra-abdominal bleeding or rupture
. <100 ml fluid in pouch of Douglas

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94
Q

A pt has been diagnosed with tubal EP. She is asymptomatic and hemodynamically stable. Her serial b-hCG shows an increase. Can we use expectant management?

A

No. Serial b-hCG should be decreasing.

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95
Q

What is the MOA of methotrexate in EP?

A

. Folic acid antagonist
. Blocks reduction of dihyrofolate to tetrahydrofolate (active form)
. Purine and pyrimidine synthesis is halted
. Arrest of DNA, RNA, and protein synthesis

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96
Q

What is the tubal pregnancy resolution rate for MTX?

A

. 90%

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97
Q

What are the adverse effects for MTX for EP?

A

. Harm to bone marrow, GI mucossa, respiratory epithelium
. Toxic to hepatocytes and renally excreted
. Teratogen
.excreted in breast milk and may accumulate in neonatal tissue

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98
Q

What are the teratogenix effects of MTX?

A

. Craniofacial and skeletal abnormalities, IUGR

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99
Q

For single dose MTX, what days do you test B- hCG? What trend are you looking for? What is the management?

A

. Days 4 and 7
. 15% difference
. =/>15% difference, repeat test weekly until undetectable
. <15% difference, repeat MTX and begin new day 1

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100
Q

question

A

answer

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101
Q

a predominant maternal risk factor for molar pregnancy includes which of the following?

a. Advanced maternalage
b. Prior cesarean delivery
c. Type 2 diabetes mellitus
d. African American ethnicity

A

a. Advanced maternalage

also very young and prior h.mole

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102
Q

which of the following histological changes, as shown here, are characteristic of hydatidiform mole?

a. Chronic villitis and inclusion bodies
b. Cytotrophoblast and syncysiotrophoblast
c. Villous lymphocytic infiltrates and syncytial knots
d. Trophoblast proliferation and villous stromal edema

A

d. Trophoblast proliferation and villous stromal edema

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103
Q

hydatidiform moles are characterized by the lack of/presence of villi and nonmolar trophoblastic malignant neoplasm are characterized by the lack of/presence of villi.

A

hydatidiform moles are characterized by the presence of villi and nonmolar trophoblastic malignant neoplasm are characterized by the lack of villi.

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104
Q

Partial Mole

Karyotype
Preliminary diagnosis
uterine size

A

Karyotype - 69XXX or 69XXY
Preliminary diagnosis - missed abortion
uterine size - small for dates

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105
Q

Partial Mole

theca-lutein cysts
initial hCG level
rate of subsequent GTN

A

theca-lutein cysts - rare
initial hCG level - <100,000
rate of subsequent GTN - 1-5%

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106
Q

Complete Mole

Karyotype
Preliminary diagnosis
uterine size

A

Karyotype - 46XX
Preliminary diagnosis - molar gestation
uterine size - large for dates

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107
Q

Complete Mole

theca-lutein cysts
initial hCG level
rate of subsequent GTN

A

theca-lutein cysts - 25-30%
initial hCG level - >100,000
rate of subsequent GTN 15-20%

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108
Q

Partial Mole

embryo-fetus
amnion, fetal erythrocytes
villous edema

A

embryo-fetus - often present
amnion, fetal erythrocytes - often present
villous edema - focal

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109
Q

Partial Mole

throphoblastic proliferation
trophoblast atypia
p57 immunostaining

A

throphoblastic proliferation - focal, slight to moderate
trophoblast atypia - mild
p57 immunostaining - positive

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110
Q

Complete Mole

embryo-fetus
amnion, fetal erythrocytes
villous edema

A

embryo-fetus - absent
amnion, fetal erythrocytes - absent
villous edema - widespread

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111
Q

Complete Mole

throphoblastic proliferation
trophoblast atypia
p57 immunostaining

A

throphoblastic proliferation - slight to severe
trophoblast atypia - marked
p57 immunostaining - negative

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112
Q

With regard to molar pregnancies, what does the
term “androgenesis” refer to?

a. Increased placental androgen production
that promotes villous edema
b. Development of a zygote that contains
only maternal chromosomes
c. Increased placental androgen production
the leads to maternal virilization
d. Development of a zygote that contains only paternal chromosomes

A

d. Development of a zygote that contains only paternal chromosomes

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113
Q

Increased serum free thyroxine levels in women with hydatidiform moles stem from increases in which of the following:

A. Maternal estrogen levels
B. Fetal thyroxine production
C. Maternal progesterone levels
D. Maternal B-HCG levels

A

D. Maternal B-HCG levels

thyrotropin-like effects of hCG frequently cause serum free thyroxine (fT4) level to be levated and TSH levels to be decreased

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114
Q

(-) p57 immunostaining

a. incomplete mole
b. complete mole

A

b. complete mole

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115
Q

Triploid diandric monogenome

A. Partial mole
B. Complete mole
C. Invasive mole
D. Choriocarcinoma

A

A. Partial mole

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116
Q

Marked trophoblast atypia

A. Partial Mole
B. Complete Mole
C. Invasive Mole
D. Choriocarcinoma

A

B. Complete Mole

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117
Q

As gestation advances, symptoms tend to be more/less pronounced with complete complete mole compared to partial mole

A

As gestation advances, symptoms tend to be MORE pronounced with complete complete mole compared to partial mole

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118
Q

What is the phenomenon called when high serum hCG levels cause a false negative? Why?

A

Hook effect; excessive hCG level oversaturate the assay’s targeting antibody and create a falsely low reading

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119
Q

sonography yields a “snowstorm” appearance

A. Partial Mole
B. Complete Mole
C. Invasive Mole
D. Choriocarcinoma

A

B. Complete Mole

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120
Q

sonography yields a thickened, multicystic placenta along with a fetus or at least fetal tissue

A. Partial Mole
B. Complete Mole
C. Invasive Mole
D. Choriocarcinoma

A

A. Partial Mole

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121
Q

Sonography yields multi-cystic findings

A. Partial Mole
B. Complete Mole
C. Invasive Mole
D. Choriocarcinoma

A

A. Partial Mole

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122
Q

p57 is a nuclear protein whose gene is maternally/paternally imprinted and maternally/paternally expressed

A

p57 is a nuclear protein whose gene is paternally imprinted and maternally expressed

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123
Q

In addition to partial moles, what are the two conditions in which p57 is strongly expressed?

A

normal placentas

spontaneous pregnancy losses with hydropic degerneration

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124
Q

what is the preferred method of molar evacuation?

A

suction curetage

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125
Q

Criteria for diagnosis of gestational trophoblastic neoplasia, which of the ff is included?

A. Rising B-hcg levels
B. Plateued B-hcg levels
C. Persistent high B-hcg levels
D. Aota

A

C. Persistent high B-hcg levels

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126
Q

What is the most common finding in GTN?

A

irregular bleeding associated with uterine subinvolution

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127
Q

How are placental tumors clinically classified?

A

aggressive invation into the myometrium and propensity to metastasize

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128
Q

the diagnosis of gestational trophoblastic neoplasia
typically is determined by which of the following?

a. Histologic tissue evaluation
b. Serum b-hCG levels
c. Physical examination findings
d. CT imaging

A

b. Serum b-hCG levels

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129
Q

true evidence-based risks for future pregnancy following treatment of gestational trophoblastic disease include which of the following?

a. Decreased fertility
b. Increased risk of preterm labor
c. Increased risk of placenta accreta
d. Increased risk of a second molar pregnancy

A

d. Increased risk of a second molar pregnancy

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130
Q

35-year-old, G2P1 (0010), pregnancy uterine 10 weeks AOG, sought consult at a local hospital. Transvaginal ultrasound showed slightly enlarged uterus with thickened multi-cystic placenta with fetus, endometrial strip 4 cm. serum beta hCG was 10,000. Her previous pregnancy was last april 2018, missed abortion terminated with D & C.

how will you manage this case?

a. Hysterectomy
b. Suction curettage
c. Hysterotomy
d. expectant

A

b. Suction curettage

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131
Q

35-year-old, G2P1 (0010), pregnancy uterine 10 weeks AOG, sought consult at a local hospital. Transvaginal ultrasound showed slightly enlarged uterus with thickened multi-cystic placenta with fetus, endometrial strip 4 cm. serum beta hCG was 10,000. Her previous pregnancy was last april 2018, missed abortion terminated with D & C.

according to the WHO modified prognostic scoring
system that was adapted by the international federation of Gynecology and Obstetrics
(FIGO), what is the score of this patient?

a. 3
b. 4
c. 5
d. 6

A

a. 3

1 - missed abortion
1 - b-hCG 100,000
1 - largest tumor size 4cm

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132
Q

What are the parameters for WHO prognostic scoring?

A 
age
antedecent pregnancy
interval after index pregnancy
pretreatment serum b-hCG
largest tumor size
site of metastases
number of metastases
previous failed chemotherapy drugs
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133
Q

How do prognostially score age

A

0 - <40

1 - >40

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134
Q

How do prognostially score antecedent pregnancy

A

0 - mole
1 - abortion
2 - term

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135
Q

How do prognostially score interval after index pregnancy

A

0 - <4 mo
1 - 4-6 mo
2 - 7-12 mo
4 - >12

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136
Q

How do prognostially score pretreatment serum b-hCG

A

0 - < 10.3
1 - 10.3 - 10.4
2 - 10.4 - 10.5
4 - > 10.5

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137
Q

How do prognostially score largest tumor size

A

0 - <3 cm
1- 3-4 cm
2 - >5cm

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138
Q

How do prognostially score site of metasases

A

1 - spleen, kidney
2 - GI
4 - liver, brain

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139
Q

How do prognostially score number of metasases

A

1 - 1-4
2 - 5-8
4 - >8

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140
Q

How do prognostially score previous failed chemotherapy drugs

A

2 - 1

4 - >2

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141
Q

chemotherapeutic agents in the EMA-CO regimen include all EXCEPT which of the following?

a. Methotrexate
b. Etoposide
c. Cisplatin
d. Actinomycin-D

A

c. Cisplatin

EMA-CO
Etoposide
MTX
actinomycin D
Cyclophasphamide
oncovin
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142
Q

Factors that predispose patient to trophoblastic neoplasia

A 
. Complete moles
. Older maternal age
. Uterine size large for gestational age
. Theca-lutein cysts >6cm
. Slow decline in b-hCG levels
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143
Q

Criteria for diagnosis of gestational trophoblastic neoplasia

A. Rising B-hcg levels
B. Plateued B-hcg levels
C. Persistent high B-hcg levels
D. Aota

A

. Rising B-hcg levels: >10% for 3 weekly consecutive measurements
. Plateued B-hcg levels: ±10% for 4 measurements during a period of 3 weeks or longer
. Persistent high B-hcg levels for 6 months
. Histological criteria for chiriocarcinoma

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144
Q

Which is common to follow h. moles and ininvasive moles?

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

a. invasive mole

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145
Q

Characterised by extensivei tissue invasion by trophoblas and whole villi, penetration deep into the myometrium, and sometimes peritonum, parametrium or vaginal vault

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

a. invasive mole

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146
Q

Which is locally aggressive but less prone to metastasize?

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

a. invasive mole

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147
Q

Most common type of trophoblastic neoplasm to follow a term pergnancy or miscarriage?

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

b. gestatinal choriocarcinoma

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148
Q

Composed of cells reminiscent of early cytrophoblast and syncytiotrophoblast, and contains no villi

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

b. gestatinal choriocarcinoma

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149
Q

Rapidly growing tumor invades both myometrium and blood vessels to create hemorrhage and necrosis. Tumor spread outward and become visible on the uterine serface as dark, irregular nodules

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

b. gestatinal choriocarcinoma

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150
Q

Metastases often develop early and are generally blood-borne.

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

b. gestatinal choriocarcinoma

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151
Q

Often accompanied by ovarian theca-lutein cysts

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

b. gestatinal choriocarcinoma

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152
Q

tumor arises from intermediate trophoblasts

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

c. placental site trophoblastic tumor

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153
Q

Serum b-hCG level may be ony modestly elevated and have high proportion of free b.hCG as a diagnosis

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

c. placental site trophoblastic tumor

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154
Q

Resistant to chemotherapy (2)

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

c. placental site trophoblastic tumor

d. epithelioid trophoblastic tumor

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155
Q

Preferred treatment is hysterectomy (2)

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

c. placental site trophoblastic tumor

d. epithelioid trophoblastic tumor

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156
Q

Develops from chorionic-type intermediate trophoblast

a. invasive mole
b. gestatinal choriocarcinoma
c. placental site trophoblastic tumor
d. epithelioid trophoblastic tumor

A

d. epithelioid trophoblastic tumor

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157
Q

Questions

A

Answers

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158
Q

A 32 y/o (2002) requested for an external cephalic version at 34-36 wks aog after it was diagnosed with utz as complete breech she is afraid that most severe frequent complication of vaginal breech delivery might happen to her baby which is

a. Head entrapment
b. Cord prolapse
c. Spinal cord injury
d. Abruptio placenta

A

b. Cord prolapse

pg 542
Compared with cephalic presentation, umbilical cord prolapse is more frequent with breech fetuses

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159
Q

Based on nursery statistics received, the most major neonatal morbidity and mortality with breech presentation is:

a. Birth trauma
b. IUGR
c. Cord prolapse
d. Cerebral palsy

A

c. Cord prolapse

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160
Q

29 y/o G5P4 (4004) is in latent phase of labor. Absolute contraindication for vaginal breech delivery:

a. Prolong missed abortion
b. Footling breech
c. Hyperflexion of fetal head
d. Prolonged latent phase of labor

A

b. Footling breech

Table 28-1. Factors favoring Cesarean Delivery of the Breech Fetus
. Lack of operator experience
. Patient request for cesarean delivery
. Large fetus >3800 to 4000g
. Apparently healthy and viable preterm fetus either with active labor or with indicated delivery
. Severe fetal-growth restriction
. Fetal anomaly incompatible with birth trauma
. Incomplete or footling breech presentation
. Hyperextended head
. Pelvic contraction or unfavorable pelvic shape determined clinically or with pelvimetry
. Prior cesarean delivery

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161
Q

A 22 y/o G1P0, 37 weeks AOG, in breech position and is advised External Cephalic Version. She should be told that:

a. She should be offered General anesthesia
b. The procedure can be done with oligohydramnios
c. Tocolysis will improve the result of external version
d. Engagement of the presenting part is not considered a contraindication to version

A

d. Engagement of the presenting part is not considered a contraindication to version

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162
Q

Causes of breech, except:

a. Premature
b. Multiple pregnancy
c. Placenta previa totalis
d. Subserous fundal fibroid

A

d. Subserous fundal fibroid

pg 540
Risks include
. Early gestational age
. Extremes of amniotic fluid volume
. Multifetal gestation
. Hydrocephaly
. Anencephaly
. Structural uterine abnormalities
. Placenta previa
. Pelvic tumors
. Prior breech delivery
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163
Q

G3P2 (2002), term, frank breech in labor, intrauterine fetal death, G1 delivered vaginally, G2 delivered by caesarean section due to fetal distress, mgt?

a. Vaginal delivery
b. CS
c. Either A or B

A

b. CS

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164
Q

A G5P4 (4004), term, footling breech in labor, with ruptured bag of membranes

a. Vaginal delivery
b. CS
c. Either A or B

A

b. CS

Table 28-1. Factors favoring Cesarean Delivery of the Breech Fetus
. Lack of operator experience
. Patient request for cesarean delivery
. Large fetus >3800 to 4000g
. Apparently healthy and viable preterm fetus either with active labor or with indicated delivery
. Severe fetal-growth restriction
. Fetal anomaly incompatible with birth trauma
. Incomplete or footling breech presentation
. Hyperextended head
. Pelvic contraction or unfavorable pelvic shape determined clinically or with pelvimetry
. Prior cesarean delivery

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165
Q

G4P2 (2012), 22 weeks, franks breech, in labor

a. Vaginal delivery
b. CS
c. Either A or B

A

a. Vaginal delivery

541
periviable fetuses, 20-<26 weeks, do no support routine cesarean delivery to improve mortality

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166
Q

A G1P0, term, frank breech in labor

a. Vaginal delivery
b. CS
c. Either A or B

A

c. Either A or B

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167
Q

One knee lie below breech

a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B

A

c. Incomplete breech

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168
Q

Lower extremities are flexed

a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B

A

d. A and B (Complete and Frank)

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169
Q

Both hips are flexed and one or both knees are also flexed

a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B

A

a. Complete breech

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170
Q

The lower extremities are extended at the knees

a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B

A

b. Frank breech

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171
Q

Double footling breech

a. Complete breech
b. Frank breech
c. Incomplete breech
d. A and B

A

c. Incomplete breech

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172
Q

What do you call the type of vaginal breech where an infant was delivered without assurance as far as the umbilicus, and the reminder of the body is manually assisted by the obstetrician?

a. Spontaneous breech delivery
b. Assisted breech delivery / partial breech extraction
c. Total breech extraction
d. A and B only

A

b. Assisted breech delivery / partial breech extraction

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173
Q

fetus is expelled entirely spontaneously without any traction or manipulation other than support of the newborn

a. Spontaneous breech delivery
b. Assisted breech delivery / partial breech extraction
c. Total breech extraction

A

a. Spontaneous breech delivery

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174
Q

the fetus is delivered spontaneously as far as the umbilicus, but the remainder of the body is extracted or delivered with operator with operator traction and assisted maneuvers, with or without maternal expulsive efforts

a. Spontaneous breech delivery
b. Assisted breech delivery / partial breech extraction
c. Total breech extraction

A

b. Assisted breech delivery / partial breech extraction

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175
Q

the entire body of the fetus is extracted by the obstetrician.

a. Spontaneous breech delivery
b. Assisted breech delivery / partial breech extraction
c. Total breech extraction

A

c. Total breech extraction

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176
Q

All are risk factors for breech presentation, EXCEPT:

a. Smoking
b. Hydrocephalus
c. Increased maternal age
d. Pelvic tumor

A

c. Increased maternal age

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177
Q

Which of the statements is INCORRECT?

a. Breech presentation is more common in babies.
b. All women with a breech presentation should be offered external cephalic version at 37-38 weeks.
c. Breech presentation is associated with a higher perinatal mortality regardless of the mode of delivery.
d. CS should be offered to all women with twins where the presentation is cephalic in the first twin and breech in the second twin.

A

c. Breech presentation is associated with a higher perinatal mortality regardless of the mode of delivery.

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178
Q

Refers to the relationship of an arbitrarily chosen portion of the presenting part to the right or left side of the birth canal.

a. Fetal lie
b. Fetal presentation
c. Fetal position
d. Fetal attitude

A

c. Fetal position

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179
Q

the relation of the fetal long axis to that of the mother and is either longitudinal or transverse

a. Fetal lie
b. Fetal presentation
c. Fetal position
d. Fetal attitude

A

a. Fetal lie

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180
Q

the presenting part is that portion of the fetal body that is either foremost within the birth canal or in closest proximity to it

a. Fetal lie
b. Fetal presentation
c. Fetal position
d. Fetal attitude

A

b. Fetal presentation

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181
Q

characteristic posture assumed by the fetus in the latter months of pregnancy

a. Fetal lie
b. Fetal presentation
c. Fetal position
d. Fetal attitude

A

d. Fetal attitude

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182
Q

What are the two options that can be felt with Leopold’s Maneuver 1? What do they describe? What can be told from the following?

a. Fetal lie
b. Fetal presentation
c. Fetal position
d. Fetal attitude

A

pg 424

Breech - large, nodular mass
Head - hard and round and more moveable

a. Fetal lie

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183
Q

What are the two options that can be felt with Leopold’s Maneuver 2? What do they describe? What can be told from the following?

a. Fetal lie
b. Fetal presentation
c. Fetal position
d. Fetal attitude

A

pg 424

Back - hard, resistant structure
Fetal extremities - small, irregular mobile parts

c. Fetal position

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184
Q

Which maneuver is normally used during breech delivery to deliver head?

a. Pinard’s maneuver
b. Mauriceau maneuver
c. Loveset’s maneuver
d. Leopold’s maneuver
e. Modified Prague maneuver
f. Zavanelli maneuver

A

b. Mauriceau maneuver

pg 546
Index and middle finger of one hand are applied over the maxilla, to flex the head, while the fetal body rests on the palm of the same hand and forearm

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185
Q

What maneuver is used when the breech is born with back posterior?

a. Pinard’s maneuver
b. Mauriceau maneuver
c. Loveset’s maneuver
d. Leopold’s maneuver
e. Modified Prague maneuver
f. Zavanelli maneuver

A

e. Modified Prague maneuver

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186
Q

What maneuver is used in frank breech?

a. Pinard’s maneuver
b. Mauriceau maneuver
c. Loveset’s maneuver
d. Leopold’s maneuver
e. Modified Prague maneuver
f. Zavanelli maneuver

A

a. Pinard’s maneuver

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187
Q

What maneuver is used for nuchal arm?

a. Pinard’s maneuver
b. Mauriceau maneuver
c. Loveset’s maneuver
d. Leopold’s maneuver
e. Modified Prague maneuver
f. Zavanelli maneuver

A

c. Loveset’s maneuver

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188
Q

What maneuver is used for head entrapment?

a. Pinard’s maneuver
b. Mauriceau maneuver
c. Loveset’s maneuver
d. Leopold’s maneuver
e. Modified Prague maneuver
f. Zavanelli maneuver

A

f. Zavanelli maneuver

189
Q

The forceps specifically designed for the delivery of the aftercoming head in the breech birth.

a. Simpson forceps
b. Piper forceps
c. Ovum forceps
d. Uterine forceps

A

b. Piper forceps

190
Q

What fetal weight is exclusionary in breech presentation?

A

> 2500g and <3800-4000g or evidence of growth restriction

191
Q

What BPD is exclusionary for vaginal delivery?

A

> 90-100mm

192
Q

What measurement will permit planned vaginal delivery for inlet anteroposterior diameter?

a. ≥ 0mm
b. ≥ 15 mm
c. ≥25mm
d. ≥ 10 cm
e. ≥ 10.5 cm
f. ≥ 12 cm

A

e. ≥ 10.5 cm

193
Q

What measurement will permit planned vaginal delivery for inlet transverse diameter?

a. ≥ 0mm
b. ≥ 15 mm
c. ≥25mm
d. ≥ 10 cm
e. ≥ 10.5 cm
f. ≥ 12 cm

A

f. ≥ 12 cm

194
Q

What measurement will permit planned vaginal delivery for midpelvic interspinous distance?

a. ≥ 0mm
b. ≥ 15 mm
c. ≥25mm
d. ≥ 10 cm
e. ≥ 10.5 cm
f. ≥ 12 cm

A

d. ≥ 10 cm

195
Q

What is the recommend fetal biometry of the sum of the inlet obstetrical conjugate minus the fetal BPD?

a. ≥ 0mm
b. ≥ 15 mm
c. ≥25mm
d. ≥ 10 cm
e. ≥ 10.5 cm
f. ≥ 12 cm

A

b. ≥ 15 mm

196
Q

What is the recommended fetal biometry of the inlet transverse diameter minus the BPD?

a. ≥ 0mm
b. ≥ 15 mm
c. ≥25mm
d. ≥ 10 cm
e. ≥ 10.5 cm
f. ≥ 12 cm

A

c. ≥25mm

197
Q

What is the recommended fetal biometry of the midpelvis interspinous distance minus the BPD?

a. ≥ 0mm
b. ≥ 15 mm
c. ≥25mm
d. ≥ 10 cm
e. ≥ 10.5 cm
f. ≥ 12 cm

A

a. ≥ 0mm

198
Q

Absolute contraindication for version

A 
. Placenta previa
. Multifetal gestation
. Early labor
. Oligohydramnios or rupture of membrane
. Known nuchal cord
. Structural uterine abnormalities
. Fetal-growth restriction
. Prior abruption
199
Q

Indication for version

A

breech presentation is recognized prior to labor in a woman who has reached 37 weeks’ gestation

200
Q

Factors that can improve the chances of a successful attempts at version

A 
. Multiparity
. Unengaged presenting part
. Nonanterior placenta
. Nonobese patient
. Abundant amniotic fluid
201
Q

Complicatioins of version

A 
. Abruption
. Preterm labor
. Fetal compromise
. Uterine rupture
. Fetomaternal hemorrhage
. Alloimmunization
. Amnionic fluid embolism
. Death
202
Q

Which tocolytics are used prior to ECV?

A

beta-mimetics terbutaline and ritodrine subcutaneous terbutaline

203
Q

Which accupressure point is used in ECV?

A

BL 67

204
Q

Question

A

Answer

205
Q

A 42-year-old in your office who is now 5 weeks pregnant
with her fifth baby. She is very concerned regarding the risk of down syndrome because of her advance maternal age.
After extensive genetic counseling, she has decided to
undergo a second-trimester amniocentesis to determine
the karyotype of her fetus. Prior to performing the procedure, you inform the patient that all of the following are possible complications of the amniocentesis. EXCEPT:

a. Amniotic fluid leakage
b. Chorioamnionitis
c. Limb reduction defects
d. Cell culture failure

A

D. Cell culture failure

Williams, pg 293
. Amniotic fluid leakage

206
Q

The risk of having a baby with down syndrome for a 30 yo woman increase

a. if the father of the baby is 40 yo
b. if her pregnancy has achieved by induction of
ovulation by menotropins (follistin, gonadal F)
c. if she has had a previous baby with triploidy
d. if she has had three first trimester spontaneous abortion

A

c. if she has had a previous baby with triploidy

Williams, pg 278
Other important fetal aneuploidy risk factors (other than age) include numerical chromosomal abnormality or structural chromosomal rearrangement in the woman or her partner or a prior pregnancy with autosomal trisomy or triploidy

207
Q

a 24 yo white woman has a maternal serum a-fetoprotein (MAFP) at 17 weeks gestation of 6.0 mutliples of the median (MOM). The next step should be

a. A second MSAFP test
b. Ultrasound examination
c. Amniocentesis
d. Amniography

A

b. Ultrasound examination

Williams, pg 283
Most centers now use targeted sonography as the primary method to evaluate elevated MSAFP levels and as the prenatal diagnostic test of choice for neural-tube defects.

MSAFP level of 2.5 MoM as the upper limit of normal

208
Q

Advantages of ultrasound nuchal translucency over
biochemical screening for down syndrome include

a. Uses transvaginal approach
b. More consistent measurements than lab
tests
c. Better in multiple gestation
d. Wide gestational age range
e. More convenient for patients

A

c. better in multiple gestation

Williams, pg 286
Sonography can augmesnt screening by providing acurate gestational age assessment by detecting multifetal gestations and by identifying major sturctural abnormalities and minor sonographic markers.

209
Q

the embryonic neural tube is formed via neuralation, which involves shaping, folding, and midline fusion of the neural plate and is complete after how many days from conception?

a. 14 days
b. 21 days
c. 25 days
d. 35 days

A

d. 35 days

Williams, pg 192
NTDs result from incomplete closure of the neaural tube by the embryonic age of 26 to 28 days.

Presomite- 19 days
-differentiation of body stalk and en embryonic sac is formed

7 somites- 21 days
-neural groove begins forming

17 somites- 22 days
PERIODS:

  • IMPLANTATION: 1-2 Weeks
  • EMBRYONIC PERIOD/ ORGANOGENESIS: In here neural tube develops in the 3rd -4th week.
210
Q

aneuploidy is typically associated with neural tube defects, EXCEPT:

a. trisomy 21
b. trisomy 18
c. turner syndrome
d. 46 XXY

A

c. turner syndrome

211
Q

true regarding antenatal monitoring of neural tube
defects, EXCEPT:

a. fetal echocardiogram is requested for cardiac function and structure
b. amniocentesis should be considered for fetal karyotyping
c. antepartal serial ultrasound of femoral length alone to monitor fetal growth
d. determination of alpha feto protein is an integral part during antepartum

A

c. antepartal serial ultrasound of femoral length ALONE to monitor fetal growth

212
Q

this form of neural tube defect appears as a wide
splaying of the vertebral arch with no visible covering

a. myelomeningocele
b. meningocele
c. anencephaly
d. myeloschisis

A

d. myeloschisis

pg 192

Myelomeningocele - herniation of a meningeal sac containing neural elements

Meningocele – is a birth defect where there is a sac protruding from the spinal column. The sac includes spinal fluid, but does not contain neural tissue. It may be covered with skin or with meninges

Anencephaly - is the absence of a major portion of the brain, skull, and scalp that occurs during embryonic development.

Myeloschisis - a developmental defect characterized by a cleft spinal cord that results from the failure of the neural plate to fuse and form a complete neural tube

213
Q

herniation of a meningeal sac containing neural elements

a. myelomeningocele
b. meningocele
c. anencephaly
d. myeloschisis

A

a. myelomeningocele

214
Q

birth defect where there is a sac protruding from the spinal column. The sac includes spinal fluid, but does not contain neural tissue. It may be covered with skin or with meninges

a. myelomeningocele
b. meningocele
c. anencephaly
d. myeloschisis

A

b. meningocele

215
Q

the absence of a major portion of the brain, skull, and scalp that occurs during embryonic development.

a. myelomeningocele
b. meningocele
c. anencephaly
d. myeloschisis

A

c. anencephaly

216
Q

combining both free beta hCG and pregnancy associated plasma protein –A alone can identify trisomy 21 in
how many percent?

a. 40-45%
b. 55-60%
c. 60-65%
d. 65-70%

A

d. 65-70% (should be 80-84%)

pg 280
Table 14-4
1st trim screen
NT, hCG, PAPP-A = 80-84%
1st trim NT alone = 64-70%
217
Q

the possible consequences of higher AFP or unexplained
elevation in AFP level in structurally normal pregnancy is
associated with development of

a. fetal growth restriction
b. polyhydramnios
c. placenta previa
d. abortion or 1st trimester loss

A

a. Fetal growth restriction

Williams, pg 283
Table 14-6

Adverse outcomes include fetal growth restriction, preeclampsia, pre-term birth, fetal demise, and stillbirth

218
Q

Aneuploidy is typically associated with neural tube defect and is present in 10% of cases of

A. Trisomy 21
B. Trisomy 18
C. Turner Syndrome
D. 46XX

A

A. Trisomy 21

219
Q

MSAFP is best measured during this time:

A. 12-14 weeks
B. 14-16 weeks

A

b. 14-16 weeks

220
Q

Trisomy 21

A

Down Syndrome

221
Q

Trisomy 18

A

Edward Syndrome

222
Q

Trisomy 13

A

Patau Syndrome

223
Q

45, X

A

Turner Syndrome

224
Q

In addition to neural tube defects, elevated AFP and + acetylcholisterase are also present in other fetal obnormalities such as

A 
. Ventral wall defects
. Esophageal atresia
. Fetal tetratoma
. Cloacal extrophy
. Skin abnormalities such as epidermolysis bullosa
225
Q

Signs of Trisomy 18

A

Edward Syndrome

. Unusally small head
. Back of head is prominent
. Ears are malformed and low-set
. Mouth and jaw are small (may also have cleft palate)
. Hands are clenched into fists, and the index finger overlaps the other fingers
. Clubfeet (or rocker bottom feet) and toes may be webbed or fused

226
Q

In addition to maternal age, other risk factors for down syndrom and other aneuploidy are

A

. Numerical chromosomal abnormality or structural chromosomal rearrangements in the woman or her parterner
. Prior pregnancy with autosomal trisomy or triploidy

227
Q

What 4 structures do you look for in first trimester scan in sagittal section of the fetus?

A

. Nuchal translucency (most important)
. Nasal bone
. Skin - hyperechoic line
. Intracranial

228
Q

What is suspected if there is tricuspid valve regurgitation as found by doppler?

A

Trisomy 21, Down Syndrome

229
Q

Performed 11-14 weeks aneuploidy screening

a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota

A

f. aota

230
Q

First trimester Serum b-hCG level is higher

a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota

A

a. trisomy 21

231
Q

First trimester Serum PAPP-A is lower

a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota

A

f. aota

232
Q

First trimester Both b-hCG level and PAPP-A is lower

a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota

A

e. B and C

233
Q

What is the limit for nuchal translucency?

A

<3cm

234
Q

Nuchal translucency must be defferentiated from?

A

cystic hygroma

235
Q

What is cystic hygroma?

A

a venolymphatic malformation that appears as a septated hypoechoic space behind the neck, extending along the length of the back

236
Q

In second trimester, maternal serum SFP is lower

a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota

A

d. A and B

237
Q

In second trimester, higher b-hCG

a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota

A

a. trisomy 21

238
Q

In second trimester, lower unconjugated estriol

a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota

A

d. A and B

239
Q

In second semester, higher dimeric inhibin

a. trisomy 21
b. trisomy 18
c. trisomy 13
d. A and B
e. B and C
f. aota

A

a. trisomy 21

240
Q

What tests are performed during first trimester aneuploidy screening?

A

. B-hCG
. Pregnancy-associated plasma protein A (PAPP-A)
. Sonographic measurement of Nuchal Translucency (NT)

241
Q

What tests are performed during second trimester aneuploidy screening?

A

. Maternal serum SFP
. B-hCG
. Unconjugated estriol
. Dimeric inhibin

242
Q

What is the upper limit of MSAFP level?

a. 1.0 MoM
b. 1.5 MoM
c. 2.0 MoM
d. 2.5 MoM

A

d. 2.5 MoM

243
Q

Adverse maternal outcomes associated with elevated MSAFP

A 
. FGR
. Preeclampsia
. Preterm birth
. Fetal demise
. Still birth
244
Q

Adverse maternal outcomes associated with low maternal serum estriol levels

A

. Smith-Lemli-Opitz syndrome

. Steroid sulfate deficiency

245
Q

Adverse maternal outcomes associated with steroid sulfate deficiency

A

. X-linked ichthyosis
. Kallman syndrome
. Chondrodysplasia punctata
. Mental retardation

246
Q

When is the latest that a patient should have aneuploidy screening?

A

15-21 weeks

247
Q

What are the diseases looked for in carrier screening?

A 
. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
248
Q

Mutation in the CFTR gene on the long arm of chromosome 7

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Cystic fibrosis

249
Q

Mutation on gene that encodes for chloride-channel protein

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Cystic fibrosis

250
Q

One mutation must be present in each copy of the gener but they need not be the same mutation

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Cystic fibrosis

251
Q

Autosomal recessive disorder

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Spinal muscular atrophy (SMA)

. Tay-Sachs

252
Q

Results in spinal cord motor neuron degeneration

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Spinal muscular atrophy (SMA)

253
Q

Caused by mutations in the SMN1 gene, located on long arm of chromosome 5

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Spinal muscular atrophy (SMA)

254
Q

Prenatal diagnosis can be performed witheither chorionic villus sampling or amniocentesis

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Sickle hemoglobinopathies

255
Q

Most common single-gene disorder

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Thalassemias

256
Q

Hb Barts disease

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. A-Thalassemia

257
Q

Cis deletion for both parents leads to hydrops and fetal loss

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. A-Thalassemia

258
Q

Based on molecular genetic testing

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. A-Thalassemia

259
Q

Based on hemoglobin electrophoresis

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. B- Thalassemia

260
Q

Spot in macula

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Tay-Sachs

261
Q

Hex A storage deficiency

. Cystic fibrosis
. Spinal muscular atrophy (SMA)
. Sickle hemoglobinopathies
. Thalassemias
. A-Thalassemia
. B- Thalassemia
. Tay-Sachs
A

. Tay-Sachs

262
Q

Examples of single-gene disorders found in preimplantation genetic diagnosis

A

. Cystic fibrosis
. 3-thalassemia
. Hemophilia

263
Q

This technique is used to infer whether a developing oocyte is afected by a maternally inherited genetic disorder

a. polar body analysis
b. blastomere biopsy
c. trophectoderm biopsy

A

a. polar body analysis

264
Q

This technique is done at the 6t to 8-cell (cleavage) stage when an embryo is 3 days old. This allows both maternal and paternal genomes to be evaluated. Cell removed from zona pellucid.

a. polar body analysis
b. blastomere biopsy
c. trophectoderm biopsy

A

b. blastomere biopsy

265
Q

This technique involved removal of 5-7 cells froma 5 to 6 day blastocyst. No cells are removed from developing embryo.

a. polar body analysis
b. blastomere biopsy
c. trophectoderm biopsy

A

c. trophectoderm biopsy

266
Q

Define dystocia

A

includes any discorder that may be encountered during pregnancy which may cause complication

267
Q

What are the top 3 causes of maternter dealth before the 20th century?

A

Puerperal Complications

. Pre-exclampsia
. OB Hemorrhages
. Puerperal infections

268
Q

What are the major complication that account for nearly 75% of all maternal deaths?

A 
. Infections (post-partum)
. Severe bleeding (post-partum)
. High blood pressure
. Complications from delivery
. Unsafe abortion
269
Q

Define puerperal fever

A

Any temperature elevation of 38C or highter which occur on any 2 of the first 10 days postpartum

270
Q

This percentage of women are febrile in the first 24 hours of peurperium after vaginal birth

a. 20%
b. 30%
c. 50%
d. 70%

A

a. 20%

271
Q

This percentage of women are febrile in the first 24 hours of peurperium after CA

a. 20%
b. 30%
c. 50%
d. 70%

A

d. 70%

272
Q

Febrile patient with 40C fever responds to medicine and returns. She delivered vaginally 8 hours ago. What do you suspect is the cause of fever?

A

High spiking fever, 39C or higher, developing within the first 24 hours after birth may be associated with a very virulent pelvic infection caused by either group A or group B streptococcus

273
Q

Common causes of puerperal infection

A
  1. genital tract infections
  2. breast engorgement
  3. uti
  4. atelectasis (respiratory distorder)
  5. uterine infections
  6. acute pyelonephritis
274
Q

Febrile pt with 38C presents with red, stretch, shiny skin over breasts. When will you tell the patient the fever will abate? What is the treatment?

A

. Temp <39C
. Fever abates w/n 24 hours
. Treat by expressing milk

275
Q

Puerperal fever due to urinary tract infection is common/not common. Why?

A

Not common due to normal diuresis during post partum (reaction to increased plasma volume during pregnancy)

276
Q

You suspect the pt has puerperal fever due to acute pyelonephritis. What other clinical signs do you look for?

A

. CVA (costovertebral angle) tenderness

. Nausea and vomiting

277
Q

Febrile pt underwent CS with general anesthesia. What puerpral complication are we concerned with and how is it treated?

A

Atelectasis usually follow an abdominal delivery. The mucus plug is higher in the alveoli and may be related to hypoventilation

Treat by: immediate ambulation, coughing, and deep breathing

278
Q

Uterine infections have historically been known as:

What is the current accepted term?

A

. Puerperal sepsis, endometritis, endoparametritis

. Metritis with pelvic cellulitis

279
Q

What is the most common cause of infection after childbirth?

  1. genital tract infections
  2. breast engorgement
  3. uti
  4. atelectasis (respiratory distorder)
  5. uterine infections
  6. acute pyelonephritis
A
  1. uterine infections

Metritis with pelvic cellulitis

280
Q

What are common factors of uterine infection regardlesss of route of delivery?

A

. Membrane rupture
. Prolong labor
. Multiple cervical examination
. Internal fetal monitoring

281
Q

What predisposiing factors to uterine infection associated with NSVD?

A

. Intra amniotic infection

. Manual removal of placenta

282
Q

Why do we perform IE only as needed? What is the underlying cause?

A

Bacteria will penetrate and can cause LGTI

. Group B streptococcus
. C trachomatis
. Mycoplasma hominis
. Ureaplasma urealyticum
. Gardnerella vaginalis
283
Q

Other than route of dlivery, what are other risk factors for uterine infections?

A 
. Socioeconimic status
. Poor nutrition
. LGTI
. General anesthesia
. Multifetal gestation
. Young maternal age
. Nulliparity
. Obesity
. Meconium stained AF
284
Q

Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is positive for gram-positive species. What are the possible bacterial infections?

A

. Group a, b, c, d streptococci
. Enterococcus
. Staphylococcus aureus
. Staphylococcus epidermis

285
Q

Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is positive for gram-negative species. What are the possible bacterial infections?

A

. Escherichia coli
. Klebsiella
. Proteus species

286
Q

Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is inconclusive for gram positive and negartive species. What are the possible bacterial infections?

A

. Gardnerella vaginalis

287
Q

Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is anaerobic. What are the possible bacterial infections?

A

. Cocci - peptostretococcus and peptococcus species

. Other clostridium bacteriodes and fusobacterium species, mobiluncus species

288
Q

Pt presents with fever 8 hours after giving birth. All other causes of infection have been excluded except for LGTI. You culture her urine. It is neither aerobic or anearobic. What are the possible bacterial infections?

A

. Mycoplasma
. Chlamydia
. Neisseria gonorrhea

289
Q

Inoculation of uterine incision provides aerobic/anaerobic conditions

A

anaerobic

290
Q

What are factors affect virulence of metritis?

A

. Polymicrobial
. Hematomas
. Devitalized tissue

291
Q

What tissue is often devitalised during delivery?

A

. Cervix
. Vagina
. Uterine cavity

292
Q

The uterine cavity is normally sterile. By what route does it become contaminated?

A

. Labor
. Delivery
. Multiple manipulations

293
Q

What are the usual sites involved in metritis following normal delivery?

A

. Placental implantation site
. Decidua
. Adjacent myometrium
. Cervicovaginal lacerations

294
Q

What are the usual sites involved in metritis following cesarian section?

A

. Placental implantation site
. Decidua
. Adjacent myometrium
. Uterine incision site

295
Q

What is the clinical course of metritis? Which is the least clinically significant?

A

. Fever >38
. Chills
. Pulse rate follows the temperature curve
. Parametrial tenderness
. (possible) foul lochia
. Leucocytosis - least clinically significant as there is leucocytosis in normal pregnancy

296
Q

A pt with metritis experiences chills. What is the cause?

A

chills due to excretion of endotoxin and bacteriolysis

297
Q

A febrile pt with metritis presents with no spiking fever that responds well to medicine. What treatment would you prescribe?

A. Oral antibiotics
B. Parenteral antibiotics

A

A. Oral antibiotics

298
Q

A febrile pt with metritis presents with cellulitis and parametrial involvement. What treatment would you prescribe?

A. Oral antibiotics
B. Parenteral antibiotics

A

B. Parenteral antibiotics

299
Q

Choice of antibiotics is the same for vaginal delivery and CS.

T/F

A

FALSE

300
Q

What is the choice of antimicrobials for vaginal delivery?

A . Ampicillin + Gentamycin
B . Clindamycin + gentamycin
C . Clindamycin + Aztreonam
D . Metronidazole + Ampicillin + Gentamicin

A

A . Ampicillin + Gentamycin

301
Q

What is the choice of antimicrobials for CS? Under what circumstance would you add a 3rd anti-microbial?

A . Ampicillin + Gentamycin
B . Clindamycin + gentamycin
C . Clindamycin + Aztreonam
D . Metronidazole + Ampicillin + Gentamicin

A

B . Clindamycin + gentamycin

  • ampicillin with sepsis or suspected enteroccocal infection
302
Q

(Perioperative/postoperative) antimicrobial prophylaxis decreases the incidence and severity of post CS delivery infections

A

Perioperative antimicrobial prophylaxis decreases the incidence and severity of post CS delivery infections

303
Q

What causes toxic shock syndrome in metritis?

A

group A and B haemolytic strep

304
Q

What surgical techniques help prevent infection?

A

. Preoperative vaginal cleasing
. Allowing the placenta to separate spontaneously
. Exteriorizing the uterus
. Close subcutaneous tissue in obese women

305
Q

What are the complications of abdominal incisional infection? (6)

A 
. Wound infection
. Wound dehiscence
. Necrotizing fascitis
. Peritonitis
. Adnexal infection
. Parametral phlegmon
306
Q

What is the most common cause of antrimicrobial failure?

A

wound infection

307
Q

What are risks of wound infection?

A 
(factors inhibiting wound healing)
. Obesity
. Uncontrolled diabetes
. Corticoid therapy
. Immunosuppressions
. Anemia
. Poor hemostasis
308
Q

What is the treatment for wound infection of abdominal incisional infection?

A

. Antimicrobials
. Surgical drainage
. Careful inspection of the abdominal fascia

309
Q

question

A

answer

310
Q

which of the following characterizes hypnotic uterine dysfunction?

a. Highest pressure gradient is over the midzone
b. Treatment is sedation
c. No basal hypertonus
d. Asynchronous uterine pressure gradient

A

c. No basal hypertonus

. More common
. Synchronous
. Treatment is oxytonin

311
Q

What is the treatment for hypotonic uterine dysfunction?

A

oxytonin

312
Q

What is the treatment for hypertonic uterine dysfunction?

A

sedation

313
Q

Define adequate labor

A

> 6cm of dilation with membrane rupture and 4 or more hours of adequate contractions

or

no progress for more than 4 hours in nulliparous with epidural and 3 without

314
Q

When is it arrest of second stage of labor?

A

No progress for more than 3 hrs without epidural

315
Q

what is one possible reason for prolongation of the second stage of labor in women under epidural analgesia?

a. Failure of head flexion
b. Diminished pressure of uterine contractions
c. Failure of internal rotation
d. Failure to bear down because of fear of pain

A

b. Diminished pressure of uterine contractions

316
Q

what is protraction disorder?

a. < 1.2 cm/hr cervical dilational in a nullipara
b. < 2 cm/hr cervical dilatation in a multipara
c. < 3 cm/hr descent of the presenting part in a nullipara
d. No progress in cervical dilataion and descent

A

a. < 1.2 cm/hr cervical dilational in a nullipara

1. 5 cm/hr multipara

317
Q

if the latent phase has lasted for more than 16 hours, this is considered prolonged in:

a. Nullipara
b. Multipara
c. Both
d. neither

A

b. Multipara

> 20 hours nullipara
14 hours multipara

318
Q

if the latent phase has lasted for more than 21 hours, this is considered prolonged in:

a. Nullipara
b. Multipara
c. Both
d. neither

A

c. both

> 20 hours nullipara
14 hours multipara

319
Q

if the latent phase has lasted for more than 8 hours, this is considered prolonged in:

a. Nullipara
b. Multipara
c. Both
d. neither

A

d. neither

> 20 hours nullipara
14 hours multipara

320
Q

Which units are the following reported in?

Prolongation Disorder
Protraction Disorder
Arrest Disorder

A

Prolongation Disorder - HRs
Protraction Disorder - CMs
Arrest Disorder - HRs

321
Q

what is protraction disorder?

a. < 1.5 cm/hr cervical dilational in a nullipara
b. < 2 cm/hr cervical dilatation in a multipara
c. < 1 cm/hr descent of the presenting part in a nullipara
d. No progress in cervical dilataion and descent

A

c. < 1 cm/hr descent of the presenting part in a nullipara

< 2cm in multipara

322
Q

Define prolonged disorder

A

latant phase lasting

> 20 hours nullipara
14 hours multipara

323
Q

What two parameters can protraction disorder be defined?

A

cervical dilation

descent of presenting part

324
Q

Define protraction disorder according to cervial dilation

A

< 1.2 cm/hr nullipara

<1.5 cm/hr multipara

325
Q

Define protraction disorder according to descent of presenting part

A

< 1 cm/hr nullipara

< 2 cm/hr multipara

326
Q

what is prolonged deceleration phase in a nullipara?

a. > 30 mins
b. > 1hr
c. > 2 hrs
d. > 3 hrs

A

d. > 3 hrs

327
Q

what is prolonged deceleration phase in a multipara?

a. > 30 mins
b. > 1hr
c. > 2 hrs
d. > 3 hrs

A

b. > 1hr

328
Q

What is failure of descent?

a. < 1.5 cm/hr cervical dilational in a nullipara
b. < 2 cm/hr cervical dilatation in a multipara
c. < 1 cm/hr descent of the presenting part in a nullipara
d. No progress in cervical dilation and descent

A

d. No progress in cervical dilation and descent

329
Q

what is the diagnosis if the head has remained at station 0 in a nullipara with epidural after 2 hours in the second stage?

a. Arrest of descent
b. Failure of descent
c. Prolonged 2nd stage and arrest of descent
d. Prolonged 2nd stage and failure of descent

A

b. Failure of descent

330
Q

what is the diagnosis if the head has remained at station 0 in a nullipara without epidural after 2 hours in the second stage?

a. Arrest of descent
b. Failure of descent
c. Prolonged 2nd stage and arrest of descent
d. Prolonged 2nd stage and failure of descent

A

d. Prolonged 2nd stage and failure of descent

331
Q

what is secondary arrest of dilation in nullipara?

a. > 30 mins
b. > 1hr
c. > 2 hrs
d. > 3 hrs

A

c. > 2 hrs

332
Q

what is secondary arrest of dilation in multipara?

a. > 30 mins
b. > 1hr
c. > 2 hrs
d. > 3 hrs

A

d. > 3 hrs

333
Q

What is arrest of descent in in nullipara?

a. > 30 mins
b. > 1hr
c. > 2 hrs
d. > 3 hrs

A

b. > 1hr

334
Q

What is arrest of descent in in multipara?

a. > 30 mins
b. > 1hr
c. > 2 hrs
d. > 3 hrs

A

b. > 1hr

335
Q

Define active phase arrest

A

No dilation for ≥ 2 hrs

336
Q

what is the diagnosis if the head has remained at station 0 in a multipara with epidural after 1 hours in the second stage?

a. Arrest of descent
b. Failure of descent
c. Prolonged 2nd stage and arrest of descent
d. Prolonged 2nd stage and failure of descent

A

b. Failure of descent

337
Q

what is the diagnosis if the head has remained at station 0 in a multipara without epidural after 1 hours in the second stage?

a. Arrest of descent
b. Failure of descent
c. Prolonged 2nd stage and arrest of descent
d. Prolonged 2nd stage and failure of descent

A

c. Prolonged 2nd stage and arrest of descent

338
Q

in which of the following is the pelvic inlet contracted?

a. The OC is less than 11 cm
b. The GTD is less than 13.5 cm
c. The DC is less than 11.5cm
d. The true conjugate is less than 12 cm

A

c. The DC is less than 11.5cm

339
Q

In a conctracted pelvic inlet what is the measurement of anteroposterior diameter?

a. 9.5 - 9.8 cm
b. < 10 cm
c. < 11.5 cm
d. < 12 cm

A

b. < 10 cm

340
Q

In a conctracted pelvic inlet what is the measurement of greatest transverse diameter?

a. 9.5 - 9.8 cm
b. < 10 cm
c. < 11.5 cm
d. < 12 cm

A

d. < 12 cm

341
Q

In a conctracted pelvic inlet what is the measurement of diagonal conjugate?

a. 9.5 - 9.8 cm
b. < 10 cm
c. < 11.5 cm
d. < 12 cm

A

d. < 12 cm

342
Q

What is normal parietal diameter?

a. 9.5 - 9.8 cm
b. < 10 cm
c. < 11.5 cm
d. < 12 cm

A

a. 9.5 - 9.8 cm

343
Q

Define precipitous labor

A

Labor < 3 hrs

344
Q

The anterior midpelvis is bounded by:

a. upper border of the symphysis pubis and the ischiopubic rami
b. lower border of the symphysis pubis and the ischiopubic rami
c. sacrum and sacrospinous ligament
d. sacrum and sacrotuberous ligament

A

b. lower border of the symphysis pubis and the ischiopubic rami

345
Q

The posterior midpelvis is bounded by:

a. upper border of the symphysis pubis and the ischiopubic rami
b. lower border of the symphysis pubis and the ischiopubic rami
c. sacrum and sacrospinous ligament
d. sacrum and sacrotuberous ligament

A

c. sacrum and sacrospinous ligament

346
Q

What three structures form the midpelvis?

A

. Lower symphysis pubis
. Ischial spine
. Sacrum

347
Q

the pelvic midplane is considered contracted in which of the following?

a. The IS is < 11 cm
b. The APM is 12 cm
c. The PSM is 5 cm
d. The IS + PSM is < 13.5 cm

A

d. The IS + PSM is < 13.5 cm

348
Q

the pelvic midplane is considered contracted in which of the following?

a. The IS is < 8 cm
b. The APM is 12 cm
c. The PSM is 5 cm
d. The IS + PSM is < 14.5 cm

A

a. The IS is < 8 cm
b. The APM is 12 cm
c. The PSM is 5 cm
d. The IS + PSM is < 14.5 cm

349
Q

The average midpelvis measurement for transverse

a. 5 cm
b. 8 cm
c. 10.5 cm
d. 11.5 cm

A

c. 10.5 cm

350
Q

The average midpelvis measurement for APM

a. 5 cm
b. 8 cm
c. 10.5 cm
d. 11.5 cm

A

d. 11.5 cm

351
Q

The average midpelvis measurement for PJM

a. 5 cm
b. 8 cm
c. 10.5 cm
d. 11.5 cm

A

a. 5 cm

352
Q

A pelvic outlet is contracted when the interischial tuberous diameter is less than

a. 5 cm
b. 8 cm
c. 10.5 cm
d. 11.5 cm

A

b. 8 cm

353
Q

Rank the following from most common to least common cause of pelvic contraction

Inlet
Midpelvis
Outlet

A

Midpelvis > Inlet > Outlet

354
Q

Anterior outlet triangle is bound by

a. inferior posterior surface of the symphysis pubis
b. interischial tuberous diameter
c. pubic rami
d. tip of the last sacral vertebra
e. tip of coccyx

A

a. inferior posterior surface of the symphysis pubis
b. interischial tuberous diameter
c. pubic rami

355
Q

Posterior outlet triangle is bound by

a. inferior posterior surface of the symphysis pubis
b. interischial tuberous diameter
c. pubic rami
d. tip of the last sacral vertebra
e. tip of coccyx

A

b. interischial tuberous diameter

d. tip of the last sacral vertebra

356
Q

which of the following id true about the pelvic outlet?

a. The IT is the common base between the 2
triangles
b. The apex of the posterior triangle is the tip of the
coccyx
c. The IT is contracted if it is < 10 cm
d. Pure outlet contraction is common

A

a. The IT is the common base between the 2
triangles

Ratio: The apex of the posterior triangle is the tip of the last sacral vertebra
The IT is contracted if it is < 8 cm
Pure outlet contraction is RARE

357
Q

Ways to estimate fetal head size

A

clinical - Mueller hillis maneuver

sonogram - fetopelvic index

358
Q

True or False

Feto pelvis dispropotion is predicted based on head size

A

FALSE - there is no satisfactory method

359
Q

What are maternal effects of dystocia

A

. Intrapartum infection
. Uterine rupture
. Pathological retraction - Ring of Bandl
. Fistula formation
. Pelvic floor injury
. Postpartum lower extrimity nerve injury

360
Q

What are the fetal effect of dystocia

A

. Caput succedaneum
. Fetal head molding
. Skull fracture

361
Q

What is the rate of cervical dilation in short labor?

A

Nullipara: 5cm/hr

Multipara 10cm/hr

362
Q

Short labor is associated with

A 
abruption
meconium
postpartum hemorrhage
cocaine abuse
low apgar score
363
Q

question

A

answer

364
Q

Define abortion

a. less than 15 weeks
b. less than 20 weeks
c. less than 500g
d. less than 250g

A

b. or c.

Loss of a fetus less than 20 weeks age of gestation or a birthweight less than 500g

365
Q

When do more than 80% of spontaneous abortion occur?

A

First 12 weeks

366
Q

Fetal factors of abortion and which is more likely?

A

. Anembryonic
. Embryonic

Both are 50%

367
Q

What is/are the anembryonic defect?

A

Blighted ovum; fertilized egg attaches to the uterine wall but does not develop

368
Q

What is/are the embryonic defect?

A

. Aneuploid

. Euploid

369
Q

Which embryonic defect has normal chromosomes?

A

Euploid

Aneuploid has chromosomal anomalies

370
Q

Which trimester is aneuploid abortion most likely?

A

First trimester - 55%

2nd - 35%, 3rd 5%

371
Q

Which parent is most likely to contribute to aneuploid abortion?

A

Maternal gametogenesis errors 95%

Paternal - 5%

372
Q

What are the 5 types of aneuploid abortion? Which are the first most common and second most common?

A

. Autosomal trisomy - 1st mc
. Monosomy X (45, X) aka Turner Syndrome - 2nd mc

. Triploidy
. Tetraploid aboruses
. Chromosomal structural abnormalities

373
Q

Which is the most likely cause of trisomy?

A

Isolated nondisjunction

374
Q

Most common trisomy autosomes are?

A

13, 16, 18, 21, 22

375
Q

When do most aneuploid abortions occur?

A

By 8 weeks - 75%

376
Q

Which of the following is aborted later and when does it peak?

. Aneuploid
. Euploid

A

Euploid; peaks are 13 weeks

377
Q

Which infections increases abortion?

A 
. Chlamydia trachomatis
. Polymicrobial infection fromperiodental disease
. Mycoplasma
. Ureaplasma
. HIV
378
Q

When does bacterial vaginosis cause abortion?

A

2nd trimester

379
Q

When is the best time for operation for benign ovarian cyst? Why?

A

2nd trimester (14-16 weeks); placenta is already established

380
Q

When is abdominal trauma most likely to cause miscariage? Earlier or later gestation

A

Advanced AOG

381
Q

What are the the pathophysiological models of the immunoligical factors of abortion? Which is most potent?

A

. Autoimmune; antiphospholipid antibodies directed against binding proteins in plasma

. Alloimmunity; against another person

382
Q

MOA of Mifepristone

a. acts on trophoblast and halts implantation
b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction
c. increasing uterine contractility by stimulating the myometrium directly

A

b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction

383
Q

MOA of Misoprostol

a. acts on trophoblast and halts implantation
b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction
c. increasing uterine contractility by stimulating the myometrium directly

A

c. increasing uterine contractility by stimulating the myometrium directly

384
Q

MOA of Methotrexate

a. acts on trophoblast and halts implantation
b. increases uterine contractility by reversing the progesterone-induced inhibition of contraction
c. increasing uterine contractility by stimulating the myometrium directly

A

a. acts on trophoblast and halts implantation

385
Q

What thyroid related lab result is a marker for increase of miscarriage?

A

high serum to level of Ab to thyroid peroxidase

386
Q

This level of caffeine consumption is associatd with increased risk of miscarriage

a. 200 mg
b. 300 mg
c. 400 mg
d. 500 mg

A

d. 500 mg

200 mg is moderate

387
Q

What environmental toxins are linked to miscarriage

A

. Bisphenol A
. Phthalates
. Polychlorinated byphenyls
. DDT

388
Q

What serum progestorone concentrations suggest a dying pregnancy?

A. <5 ng/ml

b. <10 ng/ml
c. >15 ng/ml
d. > 20ng/ml

A

A. <5 ng/ml

389
Q

What serum progestorone concentrations suggest a healthy pregnancy?

A. <5 ng/ml

b. <10 ng/ml
c. >15 ng/ml
d. > 20ng/ml

A

d. > 20ng/ml

390
Q

What is the bhCG levels discriminatry for transvaginal sonography?

A. 1500

b. 3000
c. 4500
d. 6000

A

A. 1500

391
Q

What is the bhCG levels discriminatry for transabdominal sonography?

A. 1500

b. 3000
c. 4500
d. 6000

A

d. 6000

392
Q

What is yolk sac visible and diameter?

A

5.5 weeks w/ 10 mm

393
Q

What is the management for incomplete abortion?

. acetaminophen-based analgesia
. administration of broad spectrum
. antibiotics
. bed rest
. curettage
. expectant management
. medical evacuation
. misoprostol
. observation
. suction curretage
. surgical or medical evactuation
A

. Curettage
. Misoprostol (oral)
. Expectant management

394
Q

What is the management for threatened abortion?

. acetaminophen-based analgesia
. administration of broad spectrum
. antibiotics
. bed rest
. curettage
. expectant management
. medical evacuation
. misoprostol
. observation
. suction curretage
. surgical or medical evactuation
A

. Observation
. acetaminophen-based analgesia
. bed rest

395
Q

What is the management for complete abortion?

. acetaminophen-based analgesia
. administration of broad spectrum
. antibiotics
. bed rest
. curettage
. expectant management
. medical evacuation
. misoprostol
. observation
. suction curretage
. surgical or medical evactuation
A

. observation

396
Q

What is the management for missed abortion?

. acetaminophen-based analgesia
. administration of broad spectrum
. antibiotics
. bed rest
. curettage
. expectant management
. medical evacuation
. misoprostol
. observation
. suction curretage
. surgical or medical evactuation
A

. surgical or medical evactuation
. Misoprostol (vaginal)
. Observation

397
Q

What is the management for inevitable abortion?

. acetaminophen-based analgesia
. administration of broad spectrum
. antibiotics
. bed rest
. curettage
. expectant management
. medical evacuation
. misoprostol
. observation
. suction curretage
. surgical or medical evactuation
A

. Curettage

398
Q

What is the management for septic abortion?

. acetaminophen-based analgesia
. administration of broad spectrum
. antibiotics
. bed rest
. curettage
. expectant management
. medical evacuation
. misoprostol
. observation
. suction curretage
. surgical or medical evactuation
A

. suction curretage

. administration of broad spectrum antibiotic

399
Q

What type of medicine id misoprostol? (letters)

A

Prostaglandin E1

400
Q

What is the characteristic findings of complete abortion?

A

minimally thickened endometrium without a gestational sac

401
Q

Complete gestation in complete abortion should be discerned from what 2?

A

Blood clots

Decidual cast

402
Q

What is a decidual cast?

A

a layer of endometrium in the shape of the uterine cavity can appear as collapsed sac

403
Q

When can fetal cardiac activity be detected?

A

6 to 6.5 weeks

404
Q

What value difference of <5mm raises concern in missed abortion?

A

MSD (mean sac diameter) and CRL

405
Q

In cases of suspected inevitable abortion what is the laboratory finding?

A

amnionic fluid will fern on a microscope slide or will have a pH of >7

406
Q

What sonographic finding in suspected inevitable abortion?

A

oligohydramnios

407
Q

What are biological causes of septic abortion?

A

. Group a streptococcus-S pyogenes

. Clostridium perigens

408
Q

In recurrent miscarriagees are what the two most common chromosomal abnormalities?

A
  1. reciprocal translocation

2. robertsonian translocation

409
Q

What are anatomical factors in recurrent miscarriage?

A

. Ascherman syndrom - uterine synechiae
. Uterine leiomyomas
. Congenital genital tract anamolies

410
Q

What is the treatment for ascherman syndrome?

A

hysteroscopic adhesiolysis

411
Q

What is antiphospholipid antibody syndrome?

A

defined by antiphospholipid antibodies in combination with barious forms of reprodutive loss and increased risks for venous thromboembolism

412
Q

Cervical clerage is offered to women whose cervical length is

a. <15mm
b. <20mm
c. <25mm
d. <30mm

A

c. < 25mm

413
Q

When is cervical cerclage often performed?

A. 8 - 12 weeks

b. 12 - 14 weeks
c. 15 - 18 weeks
d. 18 - 21 weeks

A

b. 12 - 14 weeks

414
Q

When is vagical cerclage often performed?

A. 8 - 12 weeks

b. 12 - 14 weeks
c. 15 - 18 weeks
d. 18 - 21 weeks

A

c. 15 - 18 weeks

415
Q

Which technique is more widely used for vaginal cerclage?

. McDonald
. Shirodkar

A

. McDonald

416
Q

In surgical abortion, what is often used for cervical ripening?

A. antiprogestin mifepristone

b. hygroscopic dilators
c. dilapan-S
d. Misoprostol

A

d. Misoprostol

417
Q

In suction curettage, what is swabbed on cervix?

A

Povidoneiodine

418
Q

For pregnancies beyond 16 weeks what instrument is used?

A

sopher forceps

419
Q

What drugs are used for medical abortion?

A

. Mifepristone + Misoprostol

or

. Misoprostol

420
Q

question

A

answer

421
Q

For single dose methotrexate therapy, resolution time is defined as serum b-hcg of

A. <100 miu/ml
B. <50 miu/ml
C. 20 miu/ml
D. 15 miu/ml

A

D. 15 miu/ml

422
Q

A previous salphigectomy is a sp. Risk factor for this kind of ectopic pregnancy

A. Abdominal
B. Interstitial
C. Cervical
D. Ovarian

A

B. Interstitial

423
Q

This type of congenital abnormality seen on sagittal view of an ultrasound showing a defect on dorsal aspect of cranio-axial view

A. Sacrococcygeal Teratoma
B. Lipoma
C. Open Neural Tube Defect

A

C. Open Neural Tube Defect

Sacrococcygeal Teratoma - sonographically
appears as a solid and/or cystic mass that arises
from the anterior sacrum and usually extends
inferiorly and externally as it grow
Neural Tube Defects include anencephaly,
myelomeningocele (also called spina bifida),
cephalocele, and other rare spinal fusion (or
schisis) abnormalities. They result from
incomplete closure of the neural tube by the
embryonic age of 26 to 28 days.
Women currently have the option of neural-tube
defect screening with MSAFP, sonography, or
both. Targeted sonography is the preferred
diagnostic test, and in addition to characterizing
the neural-tube defect, it may identify other
abnormalities or conditions that also result in
MSAFP elevation.

424
Q

What is the detection rate in quadruple testing (MSAFP, Estriol, HCG and dimeric inhibin) in younger than 35 y.o patient

A. 65% (screen + 5%)
B. 75 % (screen + 5%)
C.85 % (screen + 5%)
D. 80% (screen + 5%)

A

A. 65% (screen + 5%)

425
Q

MSAFP is best measured during this time:
A. 12-14 weeks
B. 14-16 weeks

A

B. 14-16 weeks

MSAFP

  • Routinely measured as a screening test for NTDs from 15-20 wks
  • After 12th wk- maternal serum level of AFP will now begin to rise
426
Q

Based in FIGO what is the low risk for gestational tropho neoplasia

A. less than 4
B. less than 6
C. Less than 8
D. Less than 10

A

B. less than 6

427
Q

Marked trophoblast atypia

A. Partial Mole
B. Complete Mole
C. Invasive Mole
D. Choriocarcinoma

A

B. Complete Mole

428
Q

35y/o G3P2 (2002), 30 wks AOG. First pregnancy was delivered vaginally and second pregnancy by cesarian section because of footling breech presentation. She wants to know if she can undergo VBAC (vaginal birth after CS) and she asks her chance of having breech presentation again.

A. 1%
B. 5%
C. 10%
D. 28%

A

C. 10%

the recurrence rate for a second breech presentation was 10 percent, and for a subsequent third breech it was 28 percent

429
Q

Vaginal delivery a breech baby, requesting ultrasound findings should associate w/ the ff. EXCEPT:

A. Fetal size
B. Degree of neck extension
C. Measurement of midpelvis is >/= 10cm
D. Type of breech

A

C. Measurement of midpelvis is >/= 10cm

430
Q

Parametrial phlegmon that suppurates anteriorly may involve the

A. Urinary bladder
B. Iliac fossa
C. Vesicouterine fold
D. Poupart’s ligament

A

D. Poupart’s ligament

431
Q

Septic thromboplebitis

A. Spiral arteries
B. Radial artery
C. Ovarian arteries

A

C. Ovarian arteries

432
Q

This enzyme secreted by GBS degrades the cervical epithilium barrier favoring ascending infection to cause ptb

A. Glycosaminidase
B. Hyaluronidase
C. Neuraminidase
D. Glycan dessolvent

A

B. Hyaluronidase

433
Q

Most common cause of acute glomerulonephritis

A. IgA nephropathy
B. Acute
C. PKD
D. HTN GN

A

A. IgA nephropathy

434
Q

Acute kidney damage

A.diabetes
B. Hypermesis
C. Septicemia
C. Hypovolemia
D. Diabetes
A

C. Septicemia

435
Q

What is the lower limit of uterine contraction pressure required to dilate the cervix

A. 45mmHg
B. 35mmHg
C. 25mmHg
D. 15mmHg

A

D. 15mmHg

436
Q

Protraction disorder in cervical dilation

A

<1.2cm in nulli, <1.5cm in multi

437
Q

How many hours after giving protaglandin gel can you start oxytocin

A. 30mins
B. 1hr
C. 2hrs
D. 6hrs

A

D. 6hrs

438
Q

Use of oxytocin for induction of labor is contraindicated in

A. Fetal demise
B. Hypertonic uterine contraction
C. Hypotonic uterine contraction

A

C. Hypotonic uterine contraction

439
Q

Which of the following would lead to a diagnosis of an incompetent cervix?

A. painless vaginal bleeding

b. cramping abdominal painc
c. dysuria, fever, and vaginal bleeding
d. watery vaginal discharge

A

A. painless vaginal bleeding

440
Q

Which of the following directly stimulates myometrium?

Mifepristone
methotrexate
misoprostol
mithramycin

A

misoprostol

441
Q

What is the most common indication of therapeutic abortion?

A

fetal deformity

442
Q

Which is associated with first trimester abortion?

A. intraamnionic hyperosmotic fluid

b. menstrul aspiration, oxytocin
c. vaccum aspiration, prostaglandin
d. hysterotomy, laparotomy

A

c. vaccum aspiration, prostaglandin

443
Q

Management for patient with incompetent cervix?

A. mcdonald at 8 weeks
b. shirodkar at 12 weeks

A

b. shirodkar at 12 weeks

any cerclage should be done 12-14 weeks

444
Q

What are the causes of preterm brith

A

. Spontaneous preterm labor with intact membranes
. Idiopathic preterm premature rupture of membranes
. Delivery for maternal or fetal indications
. Twins and higher-order multifetal births

445
Q

What are the 3 most common reasons for preterm birth?

A

. Spontaneous pretern labor, 40-45%

. Indicated and preterm membrane rupture

446
Q

Which causes of preterm labor often have multiple factors?

A

PPROM and spontaneous

447
Q

What genetic alteration may lead to preterm birth?

A

inherited mutations in genes regulating collagen assembly may lead to cervical insufficiency or PPROM

448
Q

How many preterm births are due to higher order pregnancy?

A

1 in 6

449
Q

When is group b streptococcal prophylaxis not recommended?

> 34 weeks
32-33 weeks
24-31 weeks
<24 weeks

A

<24 weeks

450
Q

Sepsis due to this responds well to prolonged antimicrobial therapy?

A

group b streptococcus

451
Q

define PPROM

A

spontaneous rupture before 37 weeks and before labor onset

452
Q

what are major predisposing events to PPROM

A

infection, oxidative stress-induced DNA damage, premature cellular senescence

453
Q

What are risk factors for PPROM?

A

socioeconomic status, BMI <19.8, nutritional deficiency, smoking, and prior PPROM

454
Q

apoptosis in PPROM is likely regulated by

A

bacterial endotoxin, IL-ib, and TNF-a

455
Q

what is the likely reason why gbs predisposes to preterm birth?

A

ability to secrete hyaluronidase

456
Q

moa of b-adrenergic receptor agonist in preterm labor

A

reducee intracellular ionized calcium level and prevent activation of myometrial contractile proteins

457
Q

moa of magnesium sulfate

A

calcium agonist that can alter myometrial contractility

458
Q

moa of prostagladin inhibitors

A

act by inhibiting prostagladin synthesis or by blocking their action on target organs; prostagladin synthase is responsible for the conversation of free arachidonic acid to prostagladin

aetylsalicylate and indomethacin

459
Q

moa of NO donors

A

potent smooth muscle relaxants affect the vasculature, gut, and uterus;

460
Q

moa of calcium channel blockers

A

myometrial activity is directly related to cytoplasmic free calcium and reduced calcium concentrations inhibit contractions; inhbit calcium entry through cell membrane channels

461
Q

substance released by streptococcus that can result in preterm birth

a. hyaluronic acid
b. hyaluronidase

A

b. hyaluronidase

462
Q

With an intact membrane, the chance for preterm birth is high when fetal fibronectin level is ___

a. 60
b. 28

A

a. 60

463
Q

at 31 weeks, Mrs. X was given 2 doses of 12 mg corticosteroid therapy for fetal lung maturity every 24 hours. What type of steroid did she receive?

a. Dexamethasone
b. betamethasone

A

b. betamethasone

464
Q

pregnant women who indulge in Zumba exercises are at increased risk for preterm labor

a. true
b. false

A

a. true

465
Q

shape of the cervix which has a higher risk for cervical dilatation

a. U shape
b. Y shape

A

a. U shape

466
Q

A neuroprotective agent given to pregnant women at risk for preterm birth

a. Nifedipine
b. MgSO4

A

b. MgSO4

467
Q

most important risk factor for preterm birth

a. Maternal infection
b. Prior TB

A

b. Prior TB

468
Q

Uterine stretch from multifetal pregnancy activates
this substance to cause preterm labor

a. Interleukin B
b. CRH

A

b. CRH

469
Q

management of preterm birth due to cervical insufficiency

a. McDonalds procedure
b. Micronized progesterone

A

a. McDonalds procedure

Patho OB (12 decks)

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