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In the Name of God

In the Name of God. Obstetrics study guide 5 Mitra Ahmad Soltani 2008. Med-ed-online.org. References. Braunwald Eugene, et al. Harrison's Principles of Internal Medicine. 16th edition. McGrawHill ; 2005 Iranian Council for Graduate Medical Education. Exam questions.1998-2007

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In the Name of God

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  1. In the Name of God Obstetrics study guide 5 Mitra Ahmad Soltani 2008 Med-ed-online.org

  2. References • Braunwald Eugene, et al. Harrison's Principles of Internal Medicine. 16th edition. McGrawHill; 2005 • Iranian Council for Graduate Medical Education. Exam questions.1998-2007 • Iranian Council for graduate Medical Education. Board and pre-board Exam questions for OBS and Gyn.2001-2006 • Pritchard JA, MacDonald PC, Gant NF. Williams Obstetrics. 22nd ed. New York, NY: McGraw-Hill; 2005

  3. What is the most common kidney stones during pregnancy? A-calcium phosphate B-uric acid C-calcium oxalate D-struvite Ans:c Treatment of stones in pregnancy: double J stent

  4. Which type of stone is more common in these disorders? 1- hyperparathyroidism 2-intestines disorders 3-bladder 4-prostate 5-proteus infection Ans: 1/phosphate 2/oxalate 3/uric acid-calcium oxalate 4/calcium phosphate 5/struvite

  5. What should be done in a 14 wk pregnant woman suffering from flank pain, frequency, and bacteriuria of 30000/mL? A-treatment B-repeat of U/A, U/C C-IVP D-No action is needed Ans:A

  6. A 22 wk pregnant woman has repeated episodes of bacteriuria in pregnancy. Which prophylaxis is recommended? A-Amoxicillin 3 grs single dose B-Nitrofurantoin 100 mg qd till the pregnancy is terminated C-Sulfonamide 500 mg qid for three days D-Nitrofurantoin 100 mg qid for 21 days Ans:B

  7. Which is not a consequence of acute pyelonephritis? A-Reduced GFR and Cr clearance B-ARDS C-Hemolysis D-Reduced erythropoietin production Ans:D

  8. A pregnant woman suffering from pyelonephritis is hospitalized but her fever and pain persists despite antibiotic therapy. Ultrasound shows no pathology. What do you recommend? A-kidney CT B-repeat of U/C C-cystoscopy D-IVP Ans:D

  9. Which is true in a pregnant woman with asymptomatic bacteriurea? A-If not treated 50% of cases proceed to acute Infection. B-If not responsive to initial antibiotic, nitrofurantoin for 21 days should be given. C-Recurrent rate is less than 10 percent. D-Single dose therapy has high failure rate. Ans:B

  10. In a kidney transplanted woman, Which is a contraindication for pregnancy? A-presence of severe HTN one year after kidney transplant. B-When there is no sign of transplant rejection. C- in presence of intermittent proteinurea. D- When drug therapeutic level is reached. Ans:A

  11. Which is not happening in an acute pyelonephritis ? A- thermo-regulatory instability B-reduced glomerular filtration rate C-hemolysis D-increased erythropoeitin production Ans:D

  12. Which is wrong about dialysis in pregnancy? A-Type of dialysis-hemodialysis versus peritoneal-does not significantly influence pregnancy outcome. B-Longer duration of dialysis can have better results. C-Abortion and preterm labor are common. D-Neonatal survival is better when dialysis starts before conception. Ans:D

  13. Which is true about ureteral stones in pregnancy? A-They are common in pregnancy. B-Flank pain is the most common symptom. C-More than 80% have hematuria. D-Laser is contraindicated in pregnancy. Ans:B

  14. Which statement is wrong? A-Protein filtration rate increases during pregnancy. B-Protein excretion is constant throughout pregnancy. C- Cr more than 0.9 mg/l per day shows kidney lesion. D-kidney biopsy is better to be done after pregnancy. Ans:C

  15. Which is a wrong statement? A- Low protein diet is advised for CRF in pregnancy. B- Higher rate of preeclampsia is the only risk of CRF in pregnancy C-50% of CRF pregnant women will develop HTN. Ans:A

  16. Which is a true statement? A-Renal calculi are more common in pregnancy but because of ureteral dilation they are less symptomatic. B-Hematuria is the most common sign of renal calculi in pregnancy. C-Lithotripsy can be used for early pregnancy . D- Ultrasound is the preferred method for diagnosis of renal calculi Ans:D

  17. Which is not an appropriate follow up for a G2/hix of infertility/10wks GA pregnant woman? A-Frequent prenatal visit for BP monitoring B-Serial serum Cr and urine protein measurements C-serial U/C D-Low protein diet and 180 mg supplemental iron Ans:D

  18. A pregnant woman has acute pyelonephritis. Despite outpatient therapy she develops oliguria, hypoxia, acidosis, and encephalopathy. BP and CXR are normal. What is the diagnosis? A- SIRS B-severe sepsis C-ARDS D-Septic shock Ans:B

  19. Points to remember Cr in Urine: • 20-25 mg/kg male • 15-20 mg/kg female In a 24 hr urine: • 40-150 mg prot • 600-1800 mg Cr • 600-2500 cc =volume

  20. IMP: Pyelonephritis • General: condition/position/diet • Lab: CBC diff, BG, Rh, U/A,U/C, k, Na, BUN/Cr, WW, MP,B/CX2 (Repeat of U/C after initiation of antibiotics if positive then kidney sono) • reserve of 2 units of PC • IV : 1000cc DW5% free • AMP keflin 2 gr stat then 1 gr q6h • Amp gentamicin 80 mg im stat then 60 mg tds • OTHER: Control of vital sign q4hrs, control of FHR,FAD chart , check of I/O with measure, sono OB

  21. Which is the most common cause of intestinal obstruction in pregnancy? A-vulvolus B-adhesions C-hernia D-appendicitis Ans:B

  22. Which is wrong about cirrhosis in pregnancy? A-Pregnancy is very rare . B-Alcohol consumption is the leading cause C-Esophageal sclerotherapy is a good management in pregnancy D-Porto-systemic shunts can reduce mortality rate Ans:B Post necrotic cirrhosis due to hepatitis(B,C) is more common in pregnant cases.

  23. Which is not a complication of hyperalimentation? A-hemothorax B-cholesthasis C-tamponade D-preterm delivery Ans:D

  24. Which is wrong about appendicitis in pregnancy? A- High fever is a constant finding. B-WBC can be more than16000 in mL(with PMN>80%). C- Rebound tenderness is present in 50% of cases. D-Concomitant UTI can make the diagnosis difficult. Ans:A

  25. A 28 year old 38 wk pregnant woman complains of periumbilical pain with rebound, emesis and vomiting. FHR is regular. There is no labor pain. WBC=12000/ ultrasound normal/T=37.6 C. What is the diagnosis? A-pyelonephritis, TX=antibiotic B-appendicitis, TX=antibiotic,laparatomy C-false labor,TX=observation D-degenerated myoma, TX=observation Ans:B

  26. Which is a wrong statement? A-Hepatitis B is not transmitted from mother to the fetus. B-Only HBs Ag, and Hbe Ag positive mothers can transmit it to their fetus. C-Hepatitis B IG +vaccine should be given to the newborns of HBs Ag positive mothers. D-High risk pregnant women can take one dose of hepatitis vaccine in pregnancy. Ans:A

  27. Which is a wrong statement? A- Acetaminophen intoxication signs are vomiting, sweating, pallor and weakness. B-Liver failure occurs after 24-48 hrs from ingestion. C-Treatment should be started after 4hrs according to a plasma level >120 mcg/ml. D-Tx is N-acetylcysteine 30 mg/kg stat and then 70 mg/kg q4h for 17 doses (72 hours) Ans:D

  28. A mother with Hbe Ag positive chronic hepatitis B is giving birth to a contaminated newborn. What is not a possible route of transmission? A-Digestion B-milk C-saliva D-placenta Ans:D

  29. A 36wk pregnant woman is icterus and has generalized pruritus. ALT and AST are normal. But Bil is highly elevated and AlP is slightly increased . Liver ultrasound is normal. What is the most probable diagnosis? A-intrahepatic cholesthasis B-gall stones C-PUPPP D-hepatitis Ans:A

  30. A 29 year old 28 wk pregnant woman with BMI=30 complains of vomiting, RUQ pain and fever. WBC=13800/ml and ultrasound shows small gall stones. What is the best management? A-ursodeoxycholic acid PO B-lithotripsy C-hospitalization and observation D-cholecystectomy Ans:D

  31. Which case of needlestick without previous vaccination should receive hepatitis B IG? A -HBV test result of the patient=neg/ physician=pos B- Tests results of the patient=pos/ physician=neg C-No action is needed if both of them are HCV negative. D-Both of them should receive IG immediately. Ans:B

  32. Which is a good diagnostic test for fatty liver of pregnancy? A- ultrasound B-MRI C-CT scan D-lab or clinical findings Ans:D

  33. In a pregnant woman with hyperemesis gravidarum, weight loss, normal brain MRI and serum electrolytes, Which vitamin deficiency can result in convulsions and coma? A-B1 B-K C- B2 D- B6 Ans:A

  34. Obese pregnant women have higher risks of: A-thrombophelebitis B-HTN C-C/S D-placenta previa Ans:D

  35. Which is wrong in a pregnant woman who complains of abdominal colicky pain, distension, constipation and bilious vomiting? A- During pain bowel sounds are enhanced. B-Reduced bowel sounds shows ischemia. C-Increased WBC and fever occur in the early course of obstruction. D-Bowel gas in AXR rules out ileus. Ans:C

  36. Which is false? A- Peptic ulcer in young women is mostly in deodenum. B-There is no exacerbation in achalasia course C- Asymptomatic diaphragmatic hernia should not be operated D-Peptic ulcer symptoms subside in pregnancy Ans:C

  37. Which is a wrong statement about intrahepatic cholestasis? A-Oral antihistamines are useful B-Cholestyramine can cause vit K deficiency C-Ursodexy cholic relieves prupritus and lowers liver enzymes D-Cholestasis has no adverse effect on pregnancy Ans:D

  38. Which is ture about IBS in pregnancy? A- It is exacerbated in pregnancy. B-It can have adverse effect on pregnancy. C-Steroid is contraindicated in pregnancy. D-Surgery is contraindicated in pregnancy. Ans:B

  39. A 12 wk pregnant woman HBS Ab=neg comes for advice because she finds out her husband is HBS Ag+. What do you suggest ? A-IG +vaccine with booster dose one month and then six month later B-IG during pregnancy and a vaccine for the newborn C-vaccine D-IG during pregnancy and vaccine after the delivery Ans:A

  40. A pregnant woman complains of heart burn in the last wks of her pregnancy. Antacid and H2 antagonist do not help. What is your next step? A- liver enzyme test and ultrasound B-metoclopramide C- GI ultrasound D-endoscopy Ans:D

  41. What is true about a newborn of an HBS Ag+/NBeAg-/HBeAb+ mother? A- Hepatitis is transmitted through placenta. B-There is an 80% risk of contamination during delivery. C- Breast feeding can be a route of transmission. D- Usually the newborn is not affected. Ans:D

  42. Which is true about hepatitis in pregnancy? A- It has poor prognosis. B-It can cause preterm labor. C-It is transmitted via placenta. D-Vaccination is more preventive during pregnancy than non pregnancy. Ans:B

  43. Which is not true about a case of hyperemesis gravidarum? A-It is more common in male sex fetus pregnancies. B-Hunger causes acidosis and vomiting causes alkalosis. C-It can cause vit B1and K deficiency. D-It can happen because of cholecystitis. Ans:A

  44. What is the first step in the management of peptic ulcer in pregnancy? A-antacid B-H2 blockers C-PPI D-sucralfate Ans:A

  45. A 35 year old G3/ P2 /20 wk GA/ complains of severe pain in RUQ with vomiting and fever. You find no abdominal distension. What is the diagnosis? A-severe preeclampsia B-gallbladder stone C- cholecystitis D-pancreatitis Ans: C

  46. Which is true about scleroderma? A-3/4 of cases will have exacerbations in pregnancy. B-Increased collagen production is the main reason for scleroderma. C-More than 50% of patients die of kidney or pulmonary involvement. D-Pregnancy have relieving effect on dysphagia and reflux . Ans:B

  47. Which is wrong about a new born with Lupus and heart block? A- Steroid given to the mother before 16 wks of GA can prevent new born heart block. B- It has poor prognosis for the new born. C-All mothers are Ab SS-A and SS-B positive. D- Heart block is transient in the new born. Ans:D

  48. Which drug can not cause drug-induced SLE? A- quinidine B-phenobarbital C-hydralazine D-OCP Ans:D

  49. Which is wrong about SLE in pregnancy? A- Lupus nephropathy is very similar to severe preeclampsia. B-It can have convulsions like preeclampsia. C-It can cause thrombocytopenia. D-New born heart block can be cured by treatment. Ans:D

  50. A 30 year old G3 /10 wk GA/with 2 previous fetal demise complains of knee arthritis and rashes on the face. She has IgG antiphospholipids of 50 units and her Sm Ab is positive. What is the best treatment for her? A- Therapeutic dose aspirin till 24 wks and then low dose aspirin up to delivery +hydroxychloroquine B-Heparin 5000 units bd sc+ aspirin 80 mg C-Heparin7500 units sc bd +aspirin60 mg daily+ prednisone 1- mg per day D- Azathioprine 3 mg /kg po +prednisone 1 gr daily for 3 days and then 1-2 mg/kg daily till delivery Ans:C

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