Prelim Test

Question 1

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

Answer 1

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

Question 2

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.

Answer 2

e. Chlamydia trachomatis

Williams, pg 1028

Question 3

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

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

Answer 3

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

Question 4

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

Answer 4

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

Question 5

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

Answer 5

a. Extracorporeal shockwave lithotripsy

Question 6

the hallmark of nephrotic syndrome is

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

Answer 6

b. Heavy proteinuria

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

Question 7

Preeclampsia or eclampsia should be particularly differentiated from

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

Answer 7

c. Nephritic syndrome

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

Question 8

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

Answer 8

d. Low sodium, low protein diet

Question 9

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

Answer 9

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)

Question 10

Most common cause (or form) of
acute glomerulonephritis

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

Answer 10

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

Question 11

Nephritic syndrome, EXCEPT:

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

Answer 11

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)

Question 12

Common pathogen in acute pyelonephritis

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

Answer 12

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)

Question 13

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

Answer 13

c.Progesterone

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

Question 14

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

Answer 14

Nothing. This is normal in pregnancy

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

Question 15

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

Answer 15

Intrinsic renal disease

Question 16

Acute kidney damage cause & associated with, EXCEPT:

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

Answer 16

a. Diabetes

Question 17

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

Answer 17

a. Pyelonephritis

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

Question 18

Nephritic syndrome, EXCEPT:

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

Answer 18

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)

Question 19

Common pathogen in acute pyelonephritis

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

Answer 19

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)

Question 20

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

Answer 20

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)

Question 21

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

Answer 21

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)

Question 22

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

Answer 22

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)

Question 23

. 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

Answer 23

c. Asymptomatic Bacteuria

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

Question 24

When is the preferred AOG to screen Aymptomatic Bacteuria

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

Answer 24

d. 24 weeks

Question 25

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

Answer 25

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

Question 26

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

Answer 26

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.

Question 27

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

Answer 27

c. Urine culture

Question 28

Common signs and symptoms of cystitis except a. Pyuria b. Dysuria c. Hematuria d. Bacteuria

Answer 28

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)

Question 29

Best treatment for Chlamydia trachomatis: a. Ampicillin b. Aminoglycosides c. Azithromycin d. Amphotercin B

Answer 29

c. Azithromycin

Question 30

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

Answer 30

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.

Question 31

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

Answer 31

b. 1 cup of salted peanuts

Question 32

Hemodialysis is associated with a. Acute Glomerulonephritis b. Acute Renal Disease c. Chronic Renal Disease d. Nephrotic Syndrome e. PCKD

Answer 32

b. Acute Renal Disease

Question 33

Abdominal Mass found in a. Acute Glomerulonephritis b. Acute Renal Disease c. Chronic Renal Disease d. Nephrotic Syndrome e. PCKD

Answer 33

e. PCKD

Question 34

Anemia from Intrinsic Renal Disease is associated with a. Acute Glomerulonephritis b. Acute Renal Disease c. Chronic Renal Disease d. Nephrotic Syndrome e. PCKD

Answer 34

c. Chronic Renal Disease

Question 35

Proteinuria= >4100 mg a. Acute Glomerulonephritis b. Acute Renal Disease c. Chronic Renal Disease d. Nephrotic Syndrome e. PCKD

Answer 35

d. Nephrotic Syndrome

Question 36

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

Answer 36

a. Acute Glomerulonephritis

Question 37

Question

Answer 37

Answer

Question 38

Implantation anywhere other than this is considered an ectopic pregnancy

Answer 38

Endometrial lining of uterine cavity

Question 39

What type of EP is the most common?

Answer 39

Tubal EP - 95%

Question 40

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

Answer 40

Ampulla - 70% Isthmus - 12% Fimbria - 11% Interstial - 2%

Question 41

What is heterotopic pregnancy?

Answer 41

Multifetal pregnancy with one normally implanted and one EP

Question 42

What confers the highest risk for EP?

Answer 42

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

Question 43

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

Answer 43

5 times

Question 44

What are the risks for EP?

Answer 44

``` . 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 ```

Question 45

What is salpingitis isthmica nodosa?

Answer 45

epithelium-lined diverticula extend into a hypertrophied muscularis layer

Question 46

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

Answer 46

Congenital fallopian tube anomaly

Question 47

What are the possible outcomes for EP?

Answer 47

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

Question 48

With EP (proximal/distal) implatations are favored.

Answer 48

Distal

Question 49

What are the possible outcomes for tubal abortion?

Answer 49

. 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

Question 50

What is tubal abortion?

Answer 50

When pregnancy passes out of the distal fallopian tube

Question 51

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.

Answer 51

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

Question 52

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

Answer 52

Acute

Question 53

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

Answer 53

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

Question 54

What are manifestations of tubal rupture of EP?

Answer 54

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

Question 55

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

Answer 55

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

Question 56

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

Answer 56

EP is no clear gestational sac or villi identified histologically

Question 57

Why are there increasing rates of EP?

Answer 57

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

Question 58

Define tubal pregnancy

Answer 58

pregnancy occuring in the fallopian tube

Question 59

Define interstial pregnancy

Answer 59

pregnancy that implants within the interstitial portion of the fallopian tube

Question 60

Differentiate and define abdominal pregnancy

Answer 60

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

Question 61

Define cervical pregnancy

Answer 61

implatation of the developing conceptus in the cervical canal

Question 62

Define Ligamentous pregnancy

Answer 62

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

Question 63

Define heterotropic pregnancy

Answer 63

condition in which ectopic and intrauterine pregnancies coexist

Question 64

Define Ovarian pregnancy

Answer 64

EP implants within the ovarian cortex

Question 65

What are the possible outcomes of tubal pregnancy?

Answer 65

``` . Tubal rupture . Tubal abortion . Pregnancy failure . Tubal abortion . Acute EP . Chronic EP ```

Question 66

Nixon sign vs Dodd's sign

Answer 66

Nixon: unilateral pulsation | Dodd's: unilateral tenderness

Question 67

What are the key components for EP diagnosis?

Answer 67

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

Question 68

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

Answer 68

.Urine: 20 - 25 mIU/mL | . Serum < or = 5 mIU/mL

Question 69

What is the important of the Discriminatory Zone?

Answer 69

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

Question 70

What are the values of the Discriminatory Zone for hCG?

Answer 70

. 1500 - 1800 mIU/mL with TVS | . 600 - 6500 mIU/mL with abdominal ultrasound

Question 71

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

Answer 71

. Failing IUP . Complete abortion . EP

Question 72

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

Answer 72

48 hours

Question 73

hCG assay are accurate for EP. True or false

Answer 73

True. hCG assays positive for 99% of EP

Question 74

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

Answer 74

No. >25 ng/mL excludes EP

Question 75

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

Answer 75

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

Question 76

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

Answer 76

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

Question 77

In normal IUP when are the following found with TVS? GS: YS: FP w/ FHR:

Answer 77

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

Question 78

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

Answer 78

``` . 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 ```

Question 79

What would be the TVS findings in an IUP?

Answer 79

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

Question 80

What are the three most common adnexal findings?

Answer 80

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

Question 81

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

Answer 81

. 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.

Question 82

What are the TVS findings in hemoperitoneum?

Answer 82

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

Question 83

What are the two ways to asess hemoperitoneum?

Answer 83

. TVS | . Culdocentesis

Question 84

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

Answer 84

. EP | . Ascites from ovarian or other cancer

Question 85

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

Answer 85

. 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.

Question 86

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

Answer 86

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

Question 87

What is the most common adnexal mass?

Answer 87

corpus luteum

Question 88

What is the importance of laproscopy in EP?

Answer 88

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

Question 89

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

Answer 89

Determine if pt is hemodynamically stable

Question 90

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

Answer 90

TVS

Question 91

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

Answer 91

Surgical management

Question 92

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

Answer 92

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

Question 93

What are the criteria for a expectant management of EP?

Answer 93

. 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

Question 94

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?

Answer 94

No. Serial b-hCG should be decreasing.

Question 95

What is the MOA of methotrexate in EP?

Answer 95

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

Question 96

What is the tubal pregnancy resolution rate for MTX?

Answer 96

. 90%

Question 97

What are the adverse effects for MTX for EP?

Answer 97

. 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

Question 98

What are the teratogenix effects of MTX?

Answer 98

. Craniofacial and skeletal abnormalities, IUGR

Question 99

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

Answer 99

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

Question 100

question

Answer 100

answer

Question 101

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

Answer 101

a. Advanced maternalage also very young and prior h.mole

Question 102

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

Answer 102

d. Trophoblast proliferation and villous stromal edema

Question 103

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.

Answer 103

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

Question 104

Partial Mole Karyotype Preliminary diagnosis uterine size

Answer 104

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

Question 105

Partial Mole theca-lutein cysts initial hCG level rate of subsequent GTN

Answer 105

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

Question 106

Complete Mole Karyotype Preliminary diagnosis uterine size

Answer 106

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

Question 107

Complete Mole theca-lutein cysts initial hCG level rate of subsequent GTN

Answer 107

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

Question 108

Partial Mole embryo-fetus amnion, fetal erythrocytes villous edema

Answer 108

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

Question 109

Partial Mole throphoblastic proliferation trophoblast atypia p57 immunostaining

Answer 109

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

Question 110

Complete Mole embryo-fetus amnion, fetal erythrocytes villous edema

Answer 110

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

Question 111

Complete Mole throphoblastic proliferation trophoblast atypia p57 immunostaining

Answer 111

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

Question 112

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

Answer 112

d. Development of a zygote that contains only paternal chromosomes

Question 113

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

Answer 113

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

Question 114

(-) p57 immunostaining a. incomplete mole b. complete mole

Answer 114

b. complete mole

Question 115

Triploid diandric monogenome A. Partial mole B. Complete mole C. Invasive mole D. Choriocarcinoma

Answer 115

A. Partial mole

Question 116

Marked trophoblast atypia A. Partial Mole B. Complete Mole C. Invasive Mole D. Choriocarcinoma

Answer 116

B. Complete Mole

Question 117

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

Answer 117

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

Question 118

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

Answer 118

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

Question 119

sonography yields a "snowstorm" appearance A. Partial Mole B. Complete Mole C. Invasive Mole D. Choriocarcinoma

Answer 119

B. Complete Mole

Question 120

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

Answer 120

A. Partial Mole

Question 121

Sonography yields multi-cystic findings A. Partial Mole B. Complete Mole C. Invasive Mole D. Choriocarcinoma

Answer 121

A. Partial Mole

Question 122

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

Answer 122

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

Question 123

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

Answer 123

normal placentas | spontaneous pregnancy losses with hydropic degerneration

Question 124

what is the preferred method of molar evacuation?

Answer 124

suction curetage

Question 125

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

Answer 125

C. Persistent high B-hcg levels

Question 126

What is the most common finding in GTN?

Answer 126

irregular bleeding associated with uterine subinvolution

Question 127

How are placental tumors clinically classified?

Answer 127

aggressive invation into the myometrium and propensity to metastasize

Question 128

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

Answer 128

b. Serum b-hCG levels

Question 129

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

Answer 129

d. Increased risk of a second molar pregnancy

Question 130

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

Answer 130

b. Suction curettage

Question 131

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

Answer 131

a. 3 1 - missed abortion 1 - b-hCG 100,000 1 - largest tumor size 4cm

Question 132

What are the parameters for WHO prognostic scoring?

Answer 132

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

Question 133

How do prognostially score age

Answer 133

0 - <40 | 1 - >40

Question 134

How do prognostially score antecedent pregnancy

Answer 134

0 - mole 1 - abortion 2 - term

Question 135

How do prognostially score interval after index pregnancy

Answer 135

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

Question 136

How do prognostially score pretreatment serum b-hCG

Answer 136

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

Question 137

How do prognostially score largest tumor size

Answer 137

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

Question 138

How do prognostially score site of metasases

Answer 138

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

Question 139

How do prognostially score number of metasases

Answer 139

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

Question 140

How do prognostially score previous failed chemotherapy drugs

Answer 140

2 - 1 | 4 - >2

Question 141

chemotherapeutic agents in the EMA-CO regimen include all EXCEPT which of the following? a. Methotrexate b. Etoposide c. Cisplatin d. Actinomycin-D

Answer 141

c. Cisplatin ``` EMA-CO Etoposide MTX actinomycin D Cyclophasphamide oncovin ```

Question 142

Factors that predispose patient to trophoblastic neoplasia

Answer 142

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

Question 143

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

Answer 143

. 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

Question 144

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

Answer 144

a. invasive mole

Question 145

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

Answer 145

a. invasive mole

Question 146

Which is locally aggressive but less prone to metastasize? a. invasive mole b. gestatinal choriocarcinoma c. placental site trophoblastic tumor d. epithelioid trophoblastic tumor

Answer 146

a. invasive mole

Question 147

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

Answer 147

b. gestatinal choriocarcinoma

Question 148

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

Answer 148

b. gestatinal choriocarcinoma

Question 149

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

Answer 149

b. gestatinal choriocarcinoma

Question 150

Metastases often develop early and are generally blood-borne. a. invasive mole b. gestatinal choriocarcinoma c. placental site trophoblastic tumor d. epithelioid trophoblastic tumor

Answer 150

b. gestatinal choriocarcinoma

Question 151

Often accompanied by ovarian theca-lutein cysts a. invasive mole b. gestatinal choriocarcinoma c. placental site trophoblastic tumor d. epithelioid trophoblastic tumor

Answer 151

b. gestatinal choriocarcinoma

Question 152

tumor arises from intermediate trophoblasts a. invasive mole b. gestatinal choriocarcinoma c. placental site trophoblastic tumor d. epithelioid trophoblastic tumor

Answer 152

c. placental site trophoblastic tumor

Question 153

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

Answer 153

c. placental site trophoblastic tumor

Question 154

Resistant to chemotherapy (2) a. invasive mole b. gestatinal choriocarcinoma c. placental site trophoblastic tumor d. epithelioid trophoblastic tumor

Answer 154

c. placental site trophoblastic tumor | d. epithelioid trophoblastic tumor

Question 155

Preferred treatment is hysterectomy (2) a. invasive mole b. gestatinal choriocarcinoma c. placental site trophoblastic tumor d. epithelioid trophoblastic tumor

Answer 155

c. placental site trophoblastic tumor | d. epithelioid trophoblastic tumor

Question 156

Develops from chorionic-type intermediate trophoblast a. invasive mole b. gestatinal choriocarcinoma c. placental site trophoblastic tumor d. epithelioid trophoblastic tumor

Answer 156

d. epithelioid trophoblastic tumor

Question 157

Questions

Answer 157

Answers

Question 158

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

Answer 158

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

Question 159

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

Answer 159

c. Cord prolapse

Question 160

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

Answer 160

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

Question 161

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

Answer 161

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

Question 162

Causes of breech, except: a. Premature b. Multiple pregnancy c. Placenta previa totalis d. Subserous fundal fibroid

Answer 162

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 ```

Question 163

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

Answer 163

b. CS

Question 164

A G5P4 (4004), term, footling breech in labor, with ruptured bag of membranes a. Vaginal delivery b. CS c. Either A or B

Answer 164

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

Question 165

G4P2 (2012), 22 weeks, franks breech, in labor a. Vaginal delivery b. CS c. Either A or B

Answer 165

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

Question 166

A G1P0, term, frank breech in labor a. Vaginal delivery b. CS c. Either A or B

Answer 166

c. Either A or B

Question 167

One knee lie below breech a. Complete breech b. Frank breech c. Incomplete breech d. A and B

Answer 167

c. Incomplete breech

Question 168

Lower extremities are flexed a. Complete breech b. Frank breech c. Incomplete breech d. A and B

Answer 168

d. A and B (Complete and Frank)

Question 169

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

Answer 169

a. Complete breech

Question 170

The lower extremities are extended at the knees a. Complete breech b. Frank breech c. Incomplete breech d. A and B

Answer 170

b. Frank breech

Question 171

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

Answer 171

c. Incomplete breech

Question 172

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

Answer 172

b. Assisted breech delivery / partial breech extraction

Question 173

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

Answer 173

a. Spontaneous breech delivery

Question 174

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

Answer 174

b. Assisted breech delivery / partial breech extraction

Question 175

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

Answer 175

c. Total breech extraction

Question 176

All are risk factors for breech presentation, EXCEPT: a. Smoking b. Hydrocephalus c. Increased maternal age d. Pelvic tumor

Answer 176

c. Increased maternal age

Question 177

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.

Answer 177

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

Question 178

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

Answer 178

c. Fetal position

Question 179

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

Answer 179

a. Fetal lie

Question 180

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

Answer 180

b. Fetal presentation

Question 181

characteristic posture assumed by the fetus in the latter months of pregnancy a. Fetal lie b. Fetal presentation c. Fetal position d. Fetal attitude

Answer 181

d. Fetal attitude

Question 182

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

Answer 182

pg 424 Breech - large, nodular mass Head - hard and round and more moveable a. Fetal lie

Question 183

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

Answer 183

pg 424 Back - hard, resistant structure Fetal extremities - small, irregular mobile parts c. Fetal position

Question 184

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

Answer 184

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

Question 185

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

Answer 185

e. Modified Prague maneuver

Question 186

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

Answer 186

a. Pinard's maneuver

Question 187

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

Answer 187

c. Loveset's maneuver

Question 188

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

Answer 188

f. Zavanelli maneuver

Question 189

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

Answer 189

b. Piper forceps

Question 190

What fetal weight is exclusionary in breech presentation?

Answer 190

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

Question 191

What BPD is exclusionary for vaginal delivery?

Answer 191

>90-100mm

Question 192

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

Answer 192

e. ≥ 10.5 cm

Question 193

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

Answer 193

f. ≥ 12 cm

Question 194

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

Answer 194

d. ≥ 10 cm

Question 195

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

Answer 195

b. ≥ 15 mm

Question 196

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

Answer 196

c. ≥25mm

Question 197

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

Answer 197

a. ≥ 0mm

Question 198

Absolute contraindication for version

Answer 198

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

Question 199

Indication for version

Answer 199

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

Question 200

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

Answer 200

``` . Multiparity . Unengaged presenting part . Nonanterior placenta . Nonobese patient . Abundant amniotic fluid ```

Question 201

Complicatioins of version

Answer 201

``` . Abruption . Preterm labor . Fetal compromise . Uterine rupture . Fetomaternal hemorrhage . Alloimmunization . Amnionic fluid embolism . Death ```

Question 202

Which tocolytics are used prior to ECV?

Answer 202

beta-mimetics terbutaline and ritodrine subcutaneous terbutaline

Question 203

Which accupressure point is used in ECV?

Answer 203

BL 67

Question 204

Question

Answer 204

Answer

Question 205

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

Answer 205

D. Cell culture failure Williams, pg 293 . Amniotic fluid leakage

Question 206

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

Answer 206

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

Question 207

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

Answer 207

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

Question 208

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

Answer 208

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.

Question 209

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

Answer 209

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.

Question 210

aneuploidy is typically associated with neural tube defects, EXCEPT: a. trisomy 21 b. trisomy 18 c. turner syndrome d. 46 XXY

Answer 210

c. turner syndrome

Question 211

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

Answer 211

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

Question 212

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

Answer 212

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

Question 213

herniation of a meningeal sac containing neural elements a. myelomeningocele b. meningocele c. anencephaly d. myeloschisis

Answer 213

a. myelomeningocele

Question 214

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

Answer 214

b. meningocele

Question 215

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

Answer 215

c. anencephaly

Question 216

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%

Answer 216

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% ```

Question 217

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

Answer 217

a. Fetal growth restriction Williams, pg 283 Table 14-6 Adverse outcomes include fetal growth restriction, preeclampsia, pre-term birth, fetal demise, and stillbirth

Question 218

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

Answer 218

A. Trisomy 21

Question 219

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

Answer 219

b. 14-16 weeks

Question 220

Trisomy 21

Answer 220

Down Syndrome

Question 221

Trisomy 18

Answer 221

Edward Syndrome

Question 222

Trisomy 13

Answer 222

Patau Syndrome

Question 223

45, X

Answer 223

Turner Syndrome

Question 224

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

Answer 224

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

Question 225

Signs of Trisomy 18

Answer 225

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

Question 226

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

Answer 226

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

Question 227

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

Answer 227

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

Question 228

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

Answer 228

Trisomy 21, Down Syndrome

Question 229

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

Answer 229

f. aota

Question 230

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

Answer 230

a. trisomy 21

Question 231

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

Answer 231

f. aota

Question 232

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

Answer 232

e. B and C

Question 233

What is the limit for nuchal translucency?

Answer 233

<3cm

Question 234

Nuchal translucency must be defferentiated from?

Answer 234

cystic hygroma

Question 235

What is cystic hygroma?

Answer 235

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

Question 236

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

Answer 236

d. A and B

Question 237

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

Answer 237

a. trisomy 21

Question 238

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

Answer 238

d. A and B

Question 239

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

Answer 239

a. trisomy 21

Question 240

What tests are performed during first trimester aneuploidy screening?

Answer 240

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

Question 241

What tests are performed during second trimester aneuploidy screening?

Answer 241

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

Question 242

What is the upper limit of MSAFP level? a. 1.0 MoM b. 1.5 MoM c. 2.0 MoM d. 2.5 MoM

Answer 242

d. 2.5 MoM

Question 243

Adverse maternal outcomes associated with elevated MSAFP

Answer 243

``` . FGR . Preeclampsia . Preterm birth . Fetal demise . Still birth ```

Question 244

Adverse maternal outcomes associated with low maternal serum estriol levels

Answer 244

. Smith-Lemli-Opitz syndrome | . Steroid sulfate deficiency

Question 245

Adverse maternal outcomes associated with steroid sulfate deficiency

Answer 245

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

Question 246

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

Answer 246

15-21 weeks

Question 247

What are the diseases looked for in carrier screening?

Answer 247

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

Question 248

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 ```

Answer 248

. Cystic fibrosis

Question 249

Mutation on gene that encodes for chloride-channel protein ``` . Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs ```

Answer 249

. Cystic fibrosis

Question 250

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 ```

Answer 250

. Cystic fibrosis

Question 251

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

Answer 251

. Spinal muscular atrophy (SMA) | . Tay-Sachs

Question 252

Results in spinal cord motor neuron degeneration ``` . Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs ```

Answer 252

. Spinal muscular atrophy (SMA)

Question 253

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 ```

Answer 253

. Spinal muscular atrophy (SMA)

Question 254

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 ```

Answer 254

. Sickle hemoglobinopathies

Question 255

Most common single-gene disorder ``` . Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs ```

Answer 255

. Thalassemias

Question 256

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

Answer 256

. A-Thalassemia

Question 257

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 ```

Answer 257

. A-Thalassemia

Question 258

Based on molecular genetic testing ``` . Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs ```

Answer 258

. A-Thalassemia

Question 259

Based on hemoglobin electrophoresis ``` . Cystic fibrosis . Spinal muscular atrophy (SMA) . Sickle hemoglobinopathies . Thalassemias . A-Thalassemia . B- Thalassemia . Tay-Sachs ```

Answer 259

. B- Thalassemia

Question 260

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

Answer 260

. Tay-Sachs

Question 261

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

Answer 261

. Tay-Sachs

Question 262

Examples of single-gene disorders found in preimplantation genetic diagnosis

Answer 262

. Cystic fibrosis . 3-thalassemia . Hemophilia

Question 263

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

Answer 263

a. polar body analysis

Question 264

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

Answer 264

b. blastomere biopsy

Question 265

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

Answer 265

c. trophectoderm biopsy

Question 266

Define dystocia

Answer 266

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

Question 267

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

Answer 267

Puerperal Complications . Pre-exclampsia . OB Hemorrhages . Puerperal infections

Question 268

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

Answer 268

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

Question 269

Define puerperal fever

Answer 269

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

Question 270

This percentage of women are febrile in the first 24 hours of peurperium after vaginal birth a. 20% b. 30% c. 50% d. 70%

Answer 270

a. 20%

Question 271

This percentage of women are febrile in the first 24 hours of peurperium after CA a. 20% b. 30% c. 50% d. 70%

Answer 271

d. 70%

Question 272

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?

Answer 272

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

Question 273

Common causes of puerperal infection

Answer 273

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

Question 274

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?

Answer 274

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

Question 275

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

Answer 275

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

Question 276

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

Answer 276

. CVA (costovertebral angle) tenderness | . Nausea and vomiting

Question 277

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

Answer 277

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

Question 278

Uterine infections have historically been known as: | What is the current accepted term?

Answer 278

. Puerperal sepsis, endometritis, endoparametritis . Metritis with pelvic cellulitis

Question 279

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

Answer 279

5. uterine infections Metritis with pelvic cellulitis

Question 280

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

Answer 280

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

Question 281

What predisposiing factors to uterine infection associated with NSVD?

Answer 281

. Intra amniotic infection | . Manual removal of placenta

Question 282

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

Answer 282

Bacteria will penetrate and can cause LGTI ``` . Group B streptococcus . C trachomatis . Mycoplasma hominis . Ureaplasma urealyticum . Gardnerella vaginalis ```

Question 283

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

Answer 283

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

Question 284

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?

Answer 284

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

Question 285

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?

Answer 285

. Escherichia coli . Klebsiella . Proteus species

Question 286

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?

Answer 286

. Gardnerella vaginalis

Question 287

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?

Answer 287

. Cocci - peptostretococcus and peptococcus species | . Other clostridium bacteriodes and fusobacterium species, mobiluncus species

Question 288

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?

Answer 288

. Mycoplasma . Chlamydia . Neisseria gonorrhea

Question 289

Inoculation of uterine incision provides aerobic/anaerobic conditions

Answer 289

anaerobic

Question 290

What are factors affect virulence of metritis?

Answer 290

. Polymicrobial . Hematomas . Devitalized tissue

Question 291

What tissue is often devitalised during delivery?

Answer 291

. Cervix . Vagina . Uterine cavity

Question 292

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

Answer 292

. Labor . Delivery . Multiple manipulations

Question 293

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

Answer 293

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

Question 294

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

Answer 294

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

Question 295

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

Answer 295

. 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

Question 296

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

Answer 296

chills due to excretion of endotoxin and bacteriolysis

Question 297

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

Answer 297

A. Oral antibiotics

Question 298

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

Answer 298

B. Parenteral antibiotics

Question 299

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

Answer 299

FALSE

Question 300

What is the choice of antimicrobials for vaginal delivery? A . Ampicillin + Gentamycin B . Clindamycin + gentamycin C . Clindamycin + Aztreonam D . Metronidazole + Ampicillin + Gentamicin

Answer 300

A . Ampicillin + Gentamycin

Question 301

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

Answer 301

B . Clindamycin + gentamycin - ampicillin with sepsis or suspected enteroccocal infection

Question 302

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

Answer 302

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

Question 303

What causes toxic shock syndrome in metritis?

Answer 303

group A and B haemolytic strep

Question 304

What surgical techniques help prevent infection?

Answer 304

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

Question 305

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

Answer 305

``` . Wound infection . Wound dehiscence . Necrotizing fascitis . Peritonitis . Adnexal infection . Parametral phlegmon ```

Question 306

What is the most common cause of antrimicrobial failure?

Answer 306

wound infection

Question 307

What are risks of wound infection?

Answer 307

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

Question 308

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

Answer 308

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

Question 309

question

Answer 309

answer

Question 310

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

Answer 310

c. No basal hypertonus . More common . Synchronous . Treatment is oxytonin

Question 311

What is the treatment for hypotonic uterine dysfunction?

Answer 311

oxytonin

Question 312

What is the treatment for hypertonic uterine dysfunction?

Answer 312

sedation

Question 313

Define adequate labor

Answer 313

> 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

Question 314

When is it arrest of second stage of labor?

Answer 314

No progress for more than 3 hrs without epidural

Question 315

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

Answer 315

b. Diminished pressure of uterine contractions

Question 316

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

Answer 316

a. < 1.2 cm/hr cervical dilational in a nullipara | 1. 5 cm/hr multipara

Question 317

if the latent phase has lasted for more than 16 hours, this is considered prolonged in: a. Nullipara b. Multipara c. Both d. neither

Answer 317

b. Multipara > 20 hours nullipara >14 hours multipara

Question 318

if the latent phase has lasted for more than 21 hours, this is considered prolonged in: a. Nullipara b. Multipara c. Both d. neither

Answer 318

c. both > 20 hours nullipara >14 hours multipara

Question 319

if the latent phase has lasted for more than 8 hours, this is considered prolonged in: a. Nullipara b. Multipara c. Both d. neither

Answer 319

d. neither > 20 hours nullipara >14 hours multipara

Question 320

Which units are the following reported in? Prolongation Disorder Protraction Disorder Arrest Disorder

Answer 320

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

Question 321

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

Answer 321

c. < 1 cm/hr descent of the presenting part in a nullipara < 2cm in multipara

Question 322

Define prolonged disorder

Answer 322

latant phase lasting > 20 hours nullipara >14 hours multipara

Question 323

What two parameters can protraction disorder be defined?

Answer 323

cervical dilation descent of presenting part

Question 324

Define protraction disorder according to cervial dilation

Answer 324

< 1.2 cm/hr nullipara | <1.5 cm/hr multipara

Question 325

Define protraction disorder according to descent of presenting part

Answer 325

< 1 cm/hr nullipara | < 2 cm/hr multipara

Question 326

what is prolonged deceleration phase in a nullipara? a. > 30 mins b. > 1hr c. > 2 hrs d. > 3 hrs

Answer 326

d. > 3 hrs

Question 327

what is prolonged deceleration phase in a multipara? a. > 30 mins b. > 1hr c. > 2 hrs d. > 3 hrs

Answer 327

b. > 1hr

Question 328

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

Answer 328

d. No progress in cervical dilation and descent

Question 329

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

Answer 329

b. Failure of descent

Question 330

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

Answer 330

d. Prolonged 2nd stage and failure of descent

Question 331

what is secondary arrest of dilation in nullipara? a. > 30 mins b. > 1hr c. > 2 hrs d. > 3 hrs

Answer 331

c. > 2 hrs

Question 332

what is secondary arrest of dilation in multipara? a. > 30 mins b. > 1hr c. > 2 hrs d. > 3 hrs

Answer 332

d. > 3 hrs

Question 333

What is arrest of descent in in nullipara? a. > 30 mins b. > 1hr c. > 2 hrs d. > 3 hrs

Answer 333

b. > 1hr

Question 334

What is arrest of descent in in multipara? a. > 30 mins b. > 1hr c. > 2 hrs d. > 3 hrs

Answer 334

b. > 1hr

Question 335

Define active phase arrest

Answer 335

No dilation for ≥ 2 hrs

Question 336

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

Answer 336

b. Failure of descent

Question 337

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

Answer 337

c. Prolonged 2nd stage and arrest of descent

Question 338

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

Answer 338

c. The DC is less than 11.5cm

Question 339

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

Answer 339

b. < 10 cm

Question 340

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

Answer 340

d. < 12 cm

Question 341

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

Answer 341

d. < 12 cm

Question 342

What is normal parietal diameter? a. 9.5 - 9.8 cm b. < 10 cm c. < 11.5 cm d. < 12 cm

Answer 342

a. 9.5 - 9.8 cm

Question 343

Define precipitous labor

Answer 343

Labor < 3 hrs

Question 344

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

Answer 344

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

Question 345

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

Answer 345

c. sacrum and sacrospinous ligament

Question 346

What three structures form the midpelvis?

Answer 346

. Lower symphysis pubis . Ischial spine . Sacrum

Question 347

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

Answer 347

d. The IS + PSM is < 13.5 cm

Question 348

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

Answer 348

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

Question 349

The average midpelvis measurement for transverse a. 5 cm b. 8 cm c. 10.5 cm d. 11.5 cm

Answer 349

c. 10.5 cm

Question 350

The average midpelvis measurement for APM a. 5 cm b. 8 cm c. 10.5 cm d. 11.5 cm

Answer 350

d. 11.5 cm

Question 351

The average midpelvis measurement for PJM a. 5 cm b. 8 cm c. 10.5 cm d. 11.5 cm

Answer 351

a. 5 cm

Question 352

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

Answer 352

b. 8 cm

Question 353

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

Answer 353

Midpelvis > Inlet > Outlet

Question 354

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

Answer 354

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

Question 355

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

Answer 355

b. interischial tuberous diameter | d. tip of the last sacral vertebra

Question 356

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

Answer 356

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

Question 357

Ways to estimate fetal head size

Answer 357

clinical - Mueller hillis maneuver sonogram - fetopelvic index

Question 358

True or False Feto pelvis dispropotion is predicted based on head size

Answer 358

FALSE - there is no satisfactory method

Question 359

What are maternal effects of dystocia

Answer 359

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

Question 360

What are the fetal effect of dystocia

Answer 360

. Caput succedaneum . Fetal head molding . Skull fracture

Question 361

What is the rate of cervical dilation in short labor?

Answer 361

Nullipara: 5cm/hr | Multipara 10cm/hr

Question 362

Short labor is associated with

Answer 362

``` abruption meconium postpartum hemorrhage cocaine abuse low apgar score ```

Question 363

question

Answer 363

answer

Question 364

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

Answer 364

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

Question 365

When do more than 80% of spontaneous abortion occur?

Answer 365

First 12 weeks

Question 366

Fetal factors of abortion and which is more likely?

Answer 366

. Anembryonic . Embryonic Both are 50%

Question 367

What is/are the anembryonic defect?

Answer 367

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

Question 368

What is/are the embryonic defect?

Answer 368

. Aneuploid | . Euploid

Question 369

Which embryonic defect has normal chromosomes?

Answer 369

Euploid | Aneuploid has chromosomal anomalies

Question 370

Which trimester is aneuploid abortion most likely?

Answer 370

First trimester - 55% | 2nd - 35%, 3rd 5%

Question 371

Which parent is most likely to contribute to aneuploid abortion?

Answer 371

Maternal gametogenesis errors 95% | Paternal - 5%

Question 372

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

Answer 372

. Autosomal trisomy - 1st mc . Monosomy X (45, X) aka Turner Syndrome - 2nd mc . Triploidy . Tetraploid aboruses . Chromosomal structural abnormalities

Question 373

Which is the most likely cause of trisomy?

Answer 373

Isolated nondisjunction

Question 374

Most common trisomy autosomes are?

Answer 374

13, 16, 18, 21, 22

Question 375

When do most aneuploid abortions occur?

Answer 375

By 8 weeks - 75%

Question 376

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

Answer 376

Euploid; peaks are 13 weeks

Question 377

Which infections increases abortion?

Answer 377

``` . Chlamydia trachomatis . Polymicrobial infection fromperiodental disease . Mycoplasma . Ureaplasma . HIV ```

Question 378

When does bacterial vaginosis cause abortion?

Answer 378

2nd trimester

Question 379

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

Answer 379

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

Question 380

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

Answer 380

Advanced AOG

Question 381

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

Answer 381

. Autoimmune; antiphospholipid antibodies directed against binding proteins in plasma . Alloimmunity; against another person

Question 382

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

Answer 382

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

Question 383

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

Answer 383

c. increasing uterine contractility by stimulating the myometrium directly

Question 384

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

Answer 384

a. acts on trophoblast and halts implantation

Question 385

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

Answer 385

high serum to level of Ab to thyroid peroxidase

Question 386

This level of caffeine consumption is associatd with increased risk of miscarriage a. 200 mg b. 300 mg c. 400 mg d. 500 mg

Answer 386

d. 500 mg 200 mg is moderate

Question 387

What environmental toxins are linked to miscarriage

Answer 387

. Bisphenol A . Phthalates . Polychlorinated byphenyls . DDT

Question 388

What serum progestorone concentrations suggest a dying pregnancy? A. <5 ng/ml b. <10 ng/ml c. >15 ng/ml d. > 20ng/ml

Answer 388

A. <5 ng/ml

Question 389

What serum progestorone concentrations suggest a healthy pregnancy? A. <5 ng/ml b. <10 ng/ml c. >15 ng/ml d. > 20ng/ml

Answer 389

d. > 20ng/ml

Question 390

What is the bhCG levels discriminatry for transvaginal sonography? A. 1500 b. 3000 c. 4500 d. 6000

Answer 390

A. 1500

Question 391

What is the bhCG levels discriminatry for transabdominal sonography? A. 1500 b. 3000 c. 4500 d. 6000

Answer 391

d. 6000

Question 392

What is yolk sac visible and diameter?

Answer 392

5.5 weeks w/ 10 mm

Question 393

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 ```

Answer 393

. Curettage . Misoprostol (oral) . Expectant management

Question 394

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 ```

Answer 394

. Observation . acetaminophen-based analgesia . bed rest

Question 395

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 ```

Answer 395

. observation

Question 396

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 ```

Answer 396

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

Question 397

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 ```

Answer 397

. Curettage

Question 398

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 ```

Answer 398

. suction curretage | . administration of broad spectrum antibiotic

Question 399

What type of medicine id misoprostol? (letters)

Answer 399

Prostaglandin E1

Question 400

What is the characteristic findings of complete abortion?

Answer 400

minimally thickened endometrium without a gestational sac

Question 401

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

Answer 401

Blood clots Decidual cast

Question 402

What is a decidual cast?

Answer 402

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

Question 403

When can fetal cardiac activity be detected?

Answer 403

6 to 6.5 weeks

Question 404

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

Answer 404

MSD (mean sac diameter) and CRL

Question 405

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

Answer 405

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

Question 406

What sonographic finding in suspected inevitable abortion?

Answer 406

oligohydramnios

Question 407

What are biological causes of septic abortion?

Answer 407

. Group a streptococcus-S pyogenes | . Clostridium perigens

Question 408

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

Answer 408

1. reciprocal translocation | 2. robertsonian translocation

Question 409

What are anatomical factors in recurrent miscarriage?

Answer 409

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

Question 410

What is the treatment for ascherman syndrome?

Answer 410

hysteroscopic adhesiolysis

Question 411

What is antiphospholipid antibody syndrome?

Answer 411

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

Question 412

Cervical clerage is offered to women whose cervical length is a. <15mm b. <20mm c. <25mm d. <30mm

Answer 412

c. < 25mm

Question 413

When is cervical cerclage often performed? A. 8 - 12 weeks b. 12 - 14 weeks c. 15 - 18 weeks d. 18 - 21 weeks

Answer 413

b. 12 - 14 weeks

Question 414

When is vagical cerclage often performed? A. 8 - 12 weeks b. 12 - 14 weeks c. 15 - 18 weeks d. 18 - 21 weeks

Answer 414

c. 15 - 18 weeks

Question 415

Which technique is more widely used for vaginal cerclage? . McDonald . Shirodkar

Answer 415

. McDonald

Question 416

In surgical abortion, what is often used for cervical ripening? A. antiprogestin mifepristone b. hygroscopic dilators c. dilapan-S d. Misoprostol

Answer 416

d. Misoprostol

Question 417

In suction curettage, what is swabbed on cervix?

Answer 417

Povidoneiodine

Question 418

For pregnancies beyond 16 weeks what instrument is used?

Answer 418

sopher forceps

Question 419

What drugs are used for medical abortion?

Answer 419

. Mifepristone + Misoprostol or . Misoprostol

Question 420

question

Answer 420

answer

Question 421

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

Answer 421

D. 15 miu/ml

Question 422

A previous salphigectomy is a sp. Risk factor for this kind of ectopic pregnancy A. Abdominal B. Interstitial C. Cervical D. Ovarian

Answer 422

B. Interstitial

Question 423

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

Answer 423

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.

Question 424

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%)

Answer 424

A. 65% (screen + 5%)

Question 425

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

Answer 425

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

Question 426

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

Answer 426

B. less than 6

Question 427

Marked trophoblast atypia A. Partial Mole B. Complete Mole C. Invasive Mole D. Choriocarcinoma

Answer 427

B. Complete Mole

Question 428

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%

Answer 428

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

Question 429

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

Answer 429

C. Measurement of midpelvis is >/= 10cm

Question 430

Parametrial phlegmon that suppurates anteriorly may involve the A. Urinary bladder B. Iliac fossa C. Vesicouterine fold D. Poupart’s ligament

Answer 430

D. Poupart’s ligament

Question 431

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

Answer 431

C. Ovarian arteries

Question 432

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

Answer 432

B. Hyaluronidase

Question 433

Most common cause of acute glomerulonephritis A. IgA nephropathy B. Acute C. PKD D. HTN GN

Answer 433

A. IgA nephropathy

Question 434

Acute kidney damage ``` A.diabetes B. Hypermesis C. Septicemia C. Hypovolemia D. Diabetes ```

Answer 434

C. Septicemia

Question 435

What is the lower limit of uterine contraction pressure required to dilate the cervix A. 45mmHg B. 35mmHg C. 25mmHg D. 15mmHg

Answer 435

D. 15mmHg

Question 436

Protraction disorder in cervical dilation

Answer 436

<1.2cm in nulli, <1.5cm in multi

Question 437

How many hours after giving protaglandin gel can you start oxytocin A. 30mins B. 1hr C. 2hrs D. 6hrs

Answer 437

D. 6hrs

Question 438

Use of oxytocin for induction of labor is contraindicated in A. Fetal demise B. Hypertonic uterine contraction C. Hypotonic uterine contraction

Answer 438

C. Hypotonic uterine contraction

Question 439

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

Answer 439

A. painless vaginal bleeding

Question 440

Which of the following directly stimulates myometrium? Mifepristone methotrexate misoprostol mithramycin

Answer 440

misoprostol

Question 441

What is the most common indication of therapeutic abortion?

Answer 441

fetal deformity

Question 442

Which is associated with first trimester abortion? A. intraamnionic hyperosmotic fluid b. menstrul aspiration, oxytocin c. vaccum aspiration, prostaglandin d. hysterotomy, laparotomy

Answer 442

c. vaccum aspiration, prostaglandin

Question 443

Management for patient with incompetent cervix? A. mcdonald at 8 weeks b. shirodkar at 12 weeks

Answer 443

b. shirodkar at 12 weeks any cerclage should be done 12-14 weeks

Question 444

What are the causes of preterm brith

Answer 444

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

Question 445

What are the 3 most common reasons for preterm birth?

Answer 445

. Spontaneous pretern labor, 40-45% | . Indicated and preterm membrane rupture

Question 446

Which causes of preterm labor often have multiple factors?

Answer 446

PPROM and spontaneous

Question 447

What genetic alteration may lead to preterm birth?

Answer 447

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

Question 448

How many preterm births are due to higher order pregnancy?

Answer 448

1 in 6

Question 449

When is group b streptococcal prophylaxis not recommended? >34 weeks 32-33 weeks 24-31 weeks <24 weeks

Answer 449

<24 weeks

Question 450

Sepsis due to this responds well to prolonged antimicrobial therapy?

Answer 450

group b streptococcus

Question 451

define PPROM

Answer 451

spontaneous rupture before 37 weeks and before labor onset

Question 452

what are major predisposing events to PPROM

Answer 452

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

Question 453

What are risk factors for PPROM?

Answer 453

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

Question 454

apoptosis in PPROM is likely regulated by

Answer 454

bacterial endotoxin, IL-ib, and TNF-a

Question 455

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

Answer 455

ability to secrete hyaluronidase

Question 456

moa of b-adrenergic receptor agonist in preterm labor

Answer 456

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

Question 457

moa of magnesium sulfate

Answer 457

calcium agonist that can alter myometrial contractility

Question 458

moa of prostagladin inhibitors

Answer 458

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

Question 459

moa of NO donors

Answer 459

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

Question 460

moa of calcium channel blockers

Answer 460

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

Question 461

substance released by streptococcus that can result in preterm birth a. hyaluronic acid b. hyaluronidase

Answer 461

b. hyaluronidase

Question 462

With an intact membrane, the chance for preterm birth is high when fetal fibronectin level is ___ a. 60 b. 28

Answer 462

a. 60

Question 463

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

Answer 463

b. betamethasone

Question 464

pregnant women who indulge in Zumba exercises are at increased risk for preterm labor a. true b. false

Answer 464

a. true

Question 465

shape of the cervix which has a higher risk for cervical dilatation a. U shape b. Y shape

Answer 465

a. U shape

Question 466

A neuroprotective agent given to pregnant women at risk for preterm birth a. Nifedipine b. MgSO4

Answer 466

b. MgSO4

Question 467

most important risk factor for preterm birth a. Maternal infection b. Prior TB

Answer 467

b. Prior TB

Question 468

Uterine stretch from multifetal pregnancy activates this substance to cause preterm labor a. Interleukin B b. CRH

Answer 468

b. CRH

Question 469

management of preterm birth due to cervical insufficiency a. McDonalds procedure b. Micronized progesterone

Answer 469

a. McDonalds procedure