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In the Name of God

In the Name of God. OBS &GYN EXAM QUESTIONS, CASES AND NOTES BY: Mitra Ahmad Soltani References:

jeremy-mcclain
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In the Name of God

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  1. In the Name of God OBS &GYN EXAM QUESTIONS, CASES AND NOTES BY: Mitra Ahmad Soltani References: 1-Williams Obstetrics / 22nd Edition/ MC. Graw Hill/ 20052-Novak’s Gynecology/ 13 th Edition/ Williams and Wilkins/ 20023-Clinical Gynecology Endocrinology and Infertility/ 7 th Edition / Williams & Wilkins / 20054-TE Linde’s (Operative Gynecology) 9 th Edition / Williams and Wilkins / 2003 5-Iranian Council for Graduate Medical. Education. Promotion and board Exam questions.(2000-2007) med-ed-online

  2. Fetal Monitoring med-ed-online

  3. 1- For a patient who has labor pain, an abnormal NST mandates an int monitoring of FHR. Supraventricular arrhythmia is detected. The fetus looks healthy by ultrasonography. AF is clear. What step should be taken? A- fetal echocardiography B- C/S C- Conservative management D-amiodarone Ans:c med-ed-online

  4. 2-In the second stage of labor ,you notice a persistent fetal heart rate bradycardia of 110 bpm. What is your management? A- left lateral position, nasal oxygen, 1000 cc serum, fetal monitoring B- detecting fetal blood PH C-after 40 min intervention is needed D- It is a normal event in this stage . No further step is needed. Ans:D med-ed-online

  5. 3-BPP of a 34-week pregnancy is 4. What step should be taken? A-L/S should be determined . If it is below 2, the BPP should be repeated B-immediate pregnancy termination C-BPP should be repeated if it is below 6 , pregnancy termination D- BPP should be repeated 48 hours later and management is designed according to that score Ans:C med-ed-online

  6. Points to remember • NST: Favorable: Increase15 bpm for 15 seconds within 20 min of beginning the test (before 32 wks of GA we consider 10bpm lasting 10 seconds) • BPP: Pregnancy termination for: • reduced AF • Gestational age over 36 weeks • Score of 2 Repeating the BPP test for: • Score below 6 + less than 36 weeks gestation/ low Bishop/ L/S>2 med-ed-online

  7. +OCT: late decelerations following 50% or more of contractions • 3 or more contractions • Lasting at least 40 seconds • In a 10-min period • By either spontaneous contractions or: • 0.5 mU/min oxytocin • Doubled every 20 minutes Hyperstimulation: frequency more than every 2 min or lasting longer than 90 seconds med-ed-online

  8. normal fetal movement 10 movements in up to 2 hours med-ed-online

  9. 4- What is the fetal heart rate pattern in a fetus with placental insufficiency? A-late deceleration and loss of variability occurring concomitantly B-first late deceleration and then loss of variability C- first loss of variability and then late deceleration D-first accentuated variability and then late deceleration Ans:B med-ed-online

  10. 5- Which statement is wrong about MCA Doppler? A- compared to FHR monitoring , MCA Doppler is more sensitive to fetal hypoxia B- in an IUGR case, hypoxia causes reduction in Pulsatility Index (PI) C- in an anemic fetus because of Rh incompatibility velocity is reduced in MCA D- with pregnancy advancing there will be a normal increase in MCA velocity Ans:c med-ed-online

  11. Doppler systolic-diastolic waveform indices of blood flow velocity • S/D =S/D Ratio • S-D/S= RESISTANCE INDEX • S-D/MEAN= PULSATILTY INDEX med-ed-online

  12. 6- After epidural procedure for a pregnant woman the fetal heart rate shows 12-14 waves of sinusoidal waves with acceleration. With regard to the following data, what is your management?:age:26 yrs/ GA:36 wks/ dil:3 cm/ eff=50% A-pregnancy termination for hypoxia B-this is pseudo sinusoidal pattern normal after epidural procedure. No step is needed. C-change of position and oxygen to relieve pressure on the umbilical cord D-pregnancy termination for fetal hemorrhage Ans:B med-ed-online

  13. 7- Amnioinfusion has been proposed to cure variable deceleration due to oligohydramnios. What has the least probability to occur during amnio infusion? A-abruption B-uterine rupture C-uterine hypertonia D-cord prolaps Ans:A med-ed-online

  14. 8- Silent oscillatory pattern refers to: A- baseline variability of FHR of less than 5 bpm B- two or more acceleration of 15 bpm C-one acceleration of 15 bpm D-baseline FHR variability of more than 5 bpm Ans:A med-ed-online

  15. 9-Which is wrong about late deceleration: A-it occurs after the peak and nadir of uterine contraction B-lag phase represents fetal PO2 level not fetal blood PH C-the less the fetal PO2 before uterine contraction, the more is the lag phase before deceleration D-reduced fetal PO2 level below critical level activates chemoreceptors and decelerations Ans:C med-ed-online

  16. Points to remember • Positive OCT: 50% or more of uterine contractions accompany FHR decelerations • Variable deceleration: occurs >= three times in a 20 min interval with FHR drop to 70 bpm • Persistent deceleration: more than 30 bpm reduction in a 2-10 min interval • Bradycardia: more than 30 bpm reduction of FHR in more than 10 min med-ed-online

  17. 9- NST of a G2 / GA=37 wks/ cephalic presentation/ with a history of 2 IUFDs showsa 2-min deceleration. What is the best management? A- daily BPP and observation B- C/S C- repeat of NST 24 hours later D-vaginal exam with continuous fetal monitoring Ans: B med-ed-online

  18. 10-What is equivocal-suspicious result in OCT? A-no late or significant variable deceleration B-late decelerations following 50% or more of contractions (even if the contraction frequency is fewer than three in 10 minutes) C- intermittent late decelerations or significant variable decelerations D-decelerations that occurs with contractions frequent than every 2 min or lasting 90 sec E- fewer than three contractions in 10 min or an uninterpretable tracing Ans:C med-ed-online

  19. 11- Which is wrong about fetal heart rate deceleration? A- maternal HTN can cause chronic placental dysfunction and late deceleration B- early deceleration of 20 bpm of baseline shows fetal hypoxia and acidemia C- increased afterload can activate chemoreceptors and cause late deceleration Ans:B med-ed-online

  20. 12- A pregnant woman’s BPP shows a non-reactive NST, one inspiration in 3 min of 30 sec duration, 2 body movements, one Flex and Ext of limbs, AF of one vertical packet of 3 cm. What is your management? A- pregnancy asphyxia and pregnancy termination B- repeating the test one week later w/o the possibility of fetal asphyxia C- repeating the test with the possibility of fetal asphyxia D- the possibility of asphyxia, repeat of the test on the spot and if abnormal, termination of pregnancy Ans:C med-ed-online

  21. Points to remember:score two, otherwise zero 1-Tone: 1 2-Respiration: 1 of 30 sec 3-AF: 1pocket more than 2 cm 4-NST: 2 of 15 bpm of 15 sec in a 20 min strip 5-Movement: 3 in 30 min med-ed-online

  22. 13- Which one is acceptable in fetal health assessment? A- negative predictive value for most tests is about 99.8% B- positive predictive value for abnormal tests is more than 80% C- management should be done based on true positive tests D- tests are based on many clinical trials Ans:A med-ed-online

  23. PPV= true sick/positives med-ed-online

  24. Sensitivity= true positive /sick med-ed-online

  25. 14-Which can not reduce fetal respiratory effort? A-hypoxia B-preterm labor C- maternal feeding D- at night (circadian effect) Ans:C med-ed-online

  26. 15- Female 23 yrs G1 GA=36wks has gone through BPP for lupus. The fetus shows 3 movements/ one respiratory effort of 30 sec/one flex/non-reactive NST/AF of one pocket of 3 cm. What is your management? A-pregnancy termination B-repeating the test one week later C-repeating the test immediately D-repeating the test 24 hours later Ans:B med-ed-online

  27. 16-Which is wrong about S/D ratio?(max sys flow velocity/min end-diastolic flow velocity) A-S/D ratio increases gradually in the second half of pregnancy B-S/D ratio increases in lupus and HTN C- reversed diastolic flow can be seen in placental dysfunction D- Absent diastolic flow can be seen in cases of aneuploidy Ans:A med-ed-online

  28. 17-G2 P1 28 yrs female comes to the clinic with the chief complaint of reduced fetal movement. Her gestational age is uncertain. In ultrasound AF is normal and the fetus is reported as term. What should be done for her? A-Doppler velocimetry B-labor induction C- immediate C/S D- US twice weekly Ans:B *Normal FAD: at least 10 movement sensation in 2 hours med-ed-online

  29. 18-Which is not an ominous sign in NST? A- No increase in FHR in 90 min B- non repeating variable deceleration of less than 30 sec C- deceleration that lasts more than one min D- variable deceleration less than 3 times in a 20-min interval Ans:B med-ed-online

  30. 19- Fetal heart rate auscultation reveals FHR of 220 (PSVT). What is your management? A-Digoxin B-echocardiography and fetal karyotyping C- This is an ominous sign of future hydrops and heart block of lupus pregnancy D-This is transitional. No treatment is needed Ans:A med-ed-online

  31. 20- In a diabetic woman of 37 wks, BPP shows no fetal movement -one respiratory effort of 30 sec -2 accelerations of 15 sec and one AF pocket of 2 cm. What is your management? A- pregnancy termination B- repeating test on the same day C-repeating test in the third day D- amniocentesis Ans:B med-ed-online

  32. 21- In a 20 yr old woman of a PIH case, more than 50 % of uterine contractions are accompanied with decelerations. What does this mean? A- Recurrent deceleration B-significant variable deceleration C-prolonged deceleration D-long-term variability Ans:C med-ed-online

  33. 22-The BPP of a 36 wk pregnant woman shows 1 respiratory effort, 2 movements with no acceleration, one flex and Ext of the limbs, and AFI of 10 cm. The repeat of the test after 24 hours later shows the same results. What is your management? A- Pregnancy termination B- Pregnancy termination if bishop score is favorable C- twice a week BPP D-once a week BPP Ans:A med-ed-online

  34. 23- Which pattern is a sign of fetal distress in a 43 wk pregnant woman ? A- prolonged deceleration B-saltatory pattern C-variable deceleration D- late deceleration Ans: A med-ed-online

  35. 24-What drug does not reduce beat to beat variability ? A- narcotics B-barbiturates C-phenothiazine D- in the first hour after MgSO4 administration Ans:D Acidemia causes btb variability reduction Hypoxia causes btb variability increase med-ed-online

  36. 25-What is the BPP score of :3 movements in 30 min / one acceleration of more than 15 sec/3 movements/ one tonic activity/ AF pocket of more than 2 cm? A- 8/10 B-8/12 C-10/12 D-6/10 Ans:D med-ed-online

  37. 26-What is the indication for Doppler velocimetry? A- IUGR B-postterm C-SLE D-APL antibody syndrome Ans:A med-ed-online

  38. Puerperium med-ed-online

  39. 1-What is the change in the milk of ovulating women versus non-ovulating lactating women? A- No difference B-lactose is more in ovulating women milk C-K and glucose is more D-Na and Cl is more Ans:D med-ed-online

  40. 2-Which change can be seen in puerperium? A-maternal heart beat is increased 2 days after delivery B- endometrium repair is resumed three weeks after delivery C- Ureters will return to non pregnant state after 8 weeks D- Vaginal rugae appear after 3 months from delivery Ans:C med-ed-online

  41. 3-Which is true about puerpural changes? A- total number of uterine muscular cells is not reduced B-vaginal rugae occur in the third month from delivery C-uterine connective tissue won’t change D-uterine is re-epithelialized totally in the first week of pregnancy Ans:A med-ed-online

  42. 4-Which organism is the least responsible in puerpural infection? A- peptostreptococcus B-enterococcus C- chlamydia trachomatis D-mycoplasma Ans:D med-ed-online

  43. 5-What is your management in a lactating mother who is a candidate for radioactive iodine administration? A- lactation after two weeks from iodine exposure is safe B- lactating during iodine administration is safe because iodine is not secreted in the milk C-lactation during the first 15 hours is contraindicated D- lactation is contraindicated Ans:A med-ed-online

  44. 6- A patient comes to the clinic because of fever 4 days after C/S which persists 72 hours from antibiotic administration. What is the most likely reason of antibiotic failure? A- wound infection B- pelvic thrombophlebitis C- pyelonephritis D- adenexal infection Ans:A med-ed-online

  45. 7-What is wrong about puerpural immunization? A- tetanus and diphtheria vaccine before discharge from hospital is advocated B-a woman already injected measles vaccine does not need a booster dose C- Rh negative women with an Rh positive newborn should take RhoGam D- women who have never taken rubella vaccine should be vaccinated Ans:B med-ed-online

  46. 8-Which is not a contraindication to lactation? A- alcoholics and drug abusers B- HSV and HBV patients whose infants have taken IG against these viruses C- AIDS and active TB D- women under breast cancer treatment Ans:B med-ed-online

  47. 9-Which is wrong about OCP use in lactation period? A- Oral progesterone can be used after 2-3 weeks from delivery B- Implants can be used immediately after delivery C- Depot medroxy Progesterone acetate can be used 6 weeks from delivery D- Combined OCP is used 6 weeks from delivery Ans:B med-ed-online

  48. 10-What is wrong about antibiotic therapy of pelvic infection after C/S? A- imipenem+cilastatin should be used in intractable cases B- clinda+genta is the standard treatment C- Genta+ pennicilin G are the first line therapy D- ampicillin is added when enterococcus is suspected Ans:C med-ed-online

  49. 11-Which is wrong about infection after C/S? A- there is no definite relationship between anemia and infection B-sexual practices definitely play a role in infection C- young age and pimigravidity is a risk factor D- three or more doses of betamethasone in preterm labor is a risk factor Ans:B med-ed-online

  50. 12-Which is wrong about human lactation? A- a normal milk secretion is more than 60 cc per day B-Milk is isotonic to plasma and more than 50% of its osmotic pressure is due to its lactose C-milk lactose can leak to blood and urine and this may be mistaken as glucosuria D- Iron reserve affects milk iron content Ans:D med-ed-online

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