Obstetrics

PATHOLOGIC OBSTETRICS BOARD REVIEW QUESTIONS From FEU

QUESTIONS:

1. G2P1 PU 32 weeks consulted because of vaginal bleeding.No uterine contractions noted.FHT-140/minute.The initial procedure that you will perform is Dx: Placenta Previa

a.gentle speculum examination b.internal examination c.transvaginal ultrasound d.transabdominal ultrasound

2.36 y/o,G3P2 PU 35 weeks complained of vaginal bleeding and abdominal pain.BP150/100 mmhg.Uterine contractions were noted every 1-2 minutes 60 secs in duration.Her last ultrasound 2 weeks ago was normal.IE-cervix closed uneffaced.What is the diagnosis? a.preterm labor b.vasa previa c.placenta previa (painless)

d.abruptio placenta (painful)

3.36 y/o G4p3 PU 33 weeks, Previous CS 2x has anterior placenta previa.What condition will you have to rule out in this patient prior to a repeat cesarean section? a.vasa previa b.uterine dehiscence

c.placenta accreta d.adhesions

4.G1P1 postpartum 2 hrs was brought by the midwife because of profuse bleeding.She delivered at home to an 8 lbs. baby.Placenta was spontaneously expelled after 10 minutes.On examination ,uterus is contracted and palpated below the navel.What is the diagnosis? a.uterine atony b.retained placenta

c.lacerations d.uterine inversion

5.32y/o G3P2 PU 30 weeks complains of moderate vaginal bleeding.Ultrasound done revealed a placenta totally covering the os.What is the management for this patient? a.Bed rest and give tocolytic b.Bed rest,tocolytic,progesterone

c.Bed rest ,tocolytic,steroids d. Steroids,tocolytic and deliver after 48 hrs.

6.36y/o G3P2 PU 36 weeks complained of vaginal bleeding and abdominal pain.BP-120/80 mmhg but she is a known hypertensive for 2 years.Uterus is woody with no FHT heard by doppler.cervix is 3 cms dilated 1cm long , BOW intact,cephalic station 1,with minimal bleeding.What is the BEST management ? a.expectant

b.amniotomy c.induce with oxytocin d.immediate CS Dx: Abruptio

7. What is the MOST dreaded complication of abruptio placenta? a.Hypovolemia b.Septicimia c.Embolism

d.DIC

8.A 34y/o G3P2 postpartum 1 hr was brought by a midwife because of vaginal bleeding and abdominal pain.On examination,a fleshy mass was seen protruding out of the introitus,the fundus of the uterus cannot be palpated abdominally.What is cause of this condition? a.age and parity

b.strong traction of the cord c.size of the baby d.length of labor

9.A G1P1 complains of vaginal bleeding 2 hours after she delivered a 3.8kg baby via NSD .Uterus is soft and boggy palpated above the navel.What is the initial management for this patient?

a.bimanual uterine compression b.ice pack c.uterine artery ligation d.hysterectomy

10.36 y/o G3P2 PU 37 weeks previous CS 2x has an ultrasound findings of anterior placenta previa with absence of sonoluscent space between the placenta and decidua.How should this patient be managed? dx: Accreta a.CS with manual removal of the placenta b.CS ,leave the placenta in situ,methotrexate c.CS,removal of placenta ,hysterectomy

d.CS with hysterectomy with placenta in situ

11.A G3P3 postpartum 6 months ago was selivered by NSD and complicated by atony .She was transfused with 4 u PRBC.She has amenorrhea,failure to lactate and loss of pubic hairs.What is the diagnosis? a.ashermans (adhesions)

b.sheehans

c.Simmonds (non obstetric cause of pituitary failure) d.PCOS

12. 36 y/0 G4P4 patient had a CS due to abruptio placenta.The uterus was noted to be bluish with hematoma on the anterior and posterior wall and well contracted.What is the management? a.expectant

b.uterine artery ligation c.compression suture d.hysterectomy All are possible answers

13.G3P2 PU 38 weeks Previous CS 2x was noted to have placenta invading the myometrium and bladder serosa.What layer is defective in this case? Dx: accreta a.decidua vera

b.nitabuchs c.myometrium d.peritoneum

14. G1P0 PU 32 weeks has placenta partially covering the os.What is the BEST management for this patient? a.wait for spontaneous labor b.Give steroids and do CS after 48hrs c.repeat the ultrasound at 35 weeks d.schedule for CS at 38 weeks If 36-37 weeks, do CS

15.A patient who delivered by CS due to abruptio placenta was noted to have bleeding per vagina and at the incision sites.Platelet count90,000,Prolonged prothrombin time and partial thromboplastin time.What is the BEST component therapy for her? Dx: DIC a.whole blood b.PRBC

c.fresh frozen plasma d.platelet concentrate (13 days

2.Which of the following must NOT be done in a monoamnionic monochorionic twins? a.Daily CTG at starting at viability b.steroids at 26-28 weeks

c.Deliver at 38 weeks (34 weeks) d.terminate by CS

3.Which of the following characterizes the recipient in twin to twin transfusion// a.anemic

b.hyperbiliribunemia c.IUGR d.oligohydramnios

4.Which of the following presentations in multifetal pregnancy can be delivered vaginally in multiparous patient? a.twin breech-cephalic

b.twin-cephalic breech c.twin-cephalic-transverse d.triplets all cephalic

5.21y/o G1P0 PU 32 weeks cephalic,complaining of headache.BP-160/100 mmhg.Urine protein +++.What is the diagnosis? a.gestational hypertension b.chronic hypertension c.transient hypertension

d.severe pre eclampsia

6.36 y/o G1P0 PU 36 weeks was admitted because of blurring of vision.BP-150/100 mmhg,urine protein +++.Lab tests revealed low platelets,increased LDH,SGPT and alkaline phosphatase.What is the complete diagnosis? a.Pre eclampsia non severe b.Pre eclampsia,severe

c.Pre eclampsia,severe, HELLP syndrome d.Pre eclampsia ,severe,DIC

7.Which of the following is the most effective in the prevention of pre eclampsia?

a.low dose aspirin b.high dose calcium c.fish oil d.antioxidants

8.G2P 0 PU 35 weeks complained of epigastric pain .BP-190/100 mmhg. Lab test revealed low platelets and increased LDH. What is the definitive management of this patient? a.control hypertension with hydralazine b.prevent convulsion with MG SO4 c.weekly surveillance testing

d.terminate pregnancy (definitive mgt for preeclampsia, deliver)

9.Which forcep is described to have a longer shank and a double pelvic curve? a.bartons

b.pipers c.simpsons d.kiellands

10.In what diameter of the pelvis will the forcep fits during application? a.biparietal b.occipitofrontal

c.occipitomental d.suboccipitobregmatic

11.How many pop offs during vacuum extraction before you will abandon the procedure? a.1 b.2

c.3 d.4

12.Which of the following will qualify a patient for a vaginal birth after a cesarean section? a.one previous Classical CS b.no previous uterine rupture in last 2yrs c.can be performed in a lying in with physician available

d.The obstetrician and anesthesiologist must be available

13.What is the MOST frequent indication for primary CS? a.malpresentation

b.dystocia c.fetal distress d.maternal illness

14.Which of the following is a disadvantage of pfannesteil incision? a.weak b.more dehiscence

c.difficult re entry d.faulty healing

15.What is the most frequent indication for CS hysterectomy?

a.atony b.laceration of uterine vessels c.accreta d.myoma

QUESTIONS:

1.36y/o G3P2 PU 33 weeks has PPROM for 8 hours.She delivered after 24 hours of labor.On the third postpartum day she developed vaginal bleeding,fever and hypogastric pain.Cervix tender on wriggling,uterus enlarged to 5 months size and tender.What is the diagnosis? a.cystitis

b.endometritis c.pyelonephritis d.thrombophlebitis

2.What is the most important factor for the development of genital tract infection during puerperium ? a.number of cervical examination

b.route of delivery c.length of labor d.anemia

3.34y/o G3P3 post CS for 1 week due to prolonged labor complained of vaginal bleeding,abdominal pain and foul smelling discharge.What is the BEST antibiotic management ? a.ampicillin and gentamycin b.broad spectrum cephalosporin

c.clindamycin and gentamycin d.meropenem

4.What is the microorganism implicated in Toxic Shock syndrome?

a.staphylococcus aureus b.streptococcus pyogenes c.Escherichia Coli d.Pseudomonas

5.25y/oG1P0 PU 12 weeks with RHD is comfortable at rest but complains of dyspnea while washing the dishes or even when brushing her teeth.What is the new York classification of this patient? a.1 b.II

c.III d.IV

6.What is the best mode of Delivery for a 21y/o G1P0 with RHD mitral stenosis? a.NSD under sedation b.assisted vaginal under pudendal

c.forceps extraction under epidural d.cesarean section

7.A G3P3 asthmatic patient delivered to a live baby .Which of the following should NOT be given postpartum? a.antibiotics b.hydrocortisone c.terbutaline

d.ergonovine (PGF 2a)

8.Which of the following anti TB medications is contraindicated during pregnancy?

a.streptomycin (aminoglycoside) b.rifampicin c.pyrazinamide d.ethambutol

9.23 y/o G4P1 PU 21 weeks has an asymptomatic UTI.Urinalysis showed plenty of pus cells however Urine culture is negative.What is the microorganism implicated? a.E. Coli

b.chlamydia c.pseudomonas d.bacterial vaginosis

10.32y/oG2P1 PU 35 weeks has recurrent UTI and complains of fever,upper back pain,nausea and vomiting.What is the cornerstone in the management of this patient ? Dx: acute pyelonephritis a.request for creatinine b.empiric antibiotics

c.hydration with IVF d.antipyretic

11.What is/ are the laboratory tests needed to evaluate a patient with thyroid disease? a.MRI b.thyroid ultrasound c.TSH ,FT3FT4 d.thyroid scan

12.23y/o G1P0 PU 16 weeks has diffuse thyroid enlargement with exopthalmos.TSH is low while FT4 is elevated.What is the BEST treatment for this patient? a.propanolol b.iodine

c.prophylthiuracil d.thyroxine

13.When is the recommended age of gestation to screen for gestational DM based on American College of OB –GYN? a.first trimester b.16-20 weeks

c.24-28 weeks d.30-34 weeks

14.21 y/o G1P0 has a result of 145 gms/dl in the 50 gms OGCT.What is the next management for this patient? a.start oral hypoglycemics b.start insulin

c.Do 100 gms OGTT d.manage as normal pregnancy

15.Which of the following is NOT recommended in patients with Overt DM? a.alpha feto protein at 16-20 weeks b.congenital scan at 18-20 weeks

c.weekly doppler velocimetry d. regular ultrasound for growth

16.Which of the following vaccines must be given to all pregnant patient? a.hepatitis A b.HPV

c.influenza (type A) d.pneumonia

QUESTIONS:

1.28 y/o G2P1 PU 25 weeks develop low grade fever followed development of tender, vesicular lesions along the dermatome at the subcostal area. What is the risk of the fetus in developing the disease?

a. none b. 10% c. 20% d. 30%

2.20y/o G1P0 PU 12 weeks has been exposed to a relative with varicella infection 2 days ago. She mentioned that she did not have the disease during childhood. How will you manage this patient? a.reassurance b.vaccination c.immunoglobulin d.vaccination and immunoglobulin

3.34y/o G3P3 delivered to a live baby with cataracts,glaucoma and sensorineural deafness.She mentioned that she developed high grade fever with postauricular lympadenopathy and generalized maculopapular rashes during the first trimester of pregnancy.What is the disease that she had during the first trimester? a.Rubeola

b.Rubella c.Varicella d.PUPP

4.What will differentiate if the patient had a recent rubella infection? a.Ig M b.Ig G c. High avidity Ig M d.High avidity Ig G

5.30 y/o G5P3 PU 35 weeks has uterine contractions.She mentioned that her last baby died of sepsis after delivery.What is the recommended antibiotic prophylaxis ? a.amoxicillin b.ampicillin

c.penicillin G d.clindamycin

6.30y/o G3P2 PU 14 weeks,complains of painless chancre at the vulva.The chancre has red and firm border.What is the most specific diagnostic test for the patient? a.RPR b.TPHA c.darkfield illumination d.ELIZA

7.32 y/0 G2P1 PU 23 weeks complains of yellowish vaginal discharge.On gram stain,gram negative intracellular diplococci were seen.What is the management? a.Azithromycin plus clindamycin b.ceftriaxone plus metronidazole c.cetriaxone plus azithromycin d.cefuroxime plus clindamycin

8.36y/o G3P1 PU 39 weeks was admitted in early labor. On examination,there are multiple painful vesicular lesions noted on the vulva. What is the management?? (dx: HSV2) a.insert an internal monitoring device b.ask the nurse to prepare the forceps

c.prepare patient for cesarean section d.amnitomy and induce with oxytocin

9.21 y/o G1P0 PU 12 weeks complains of vulvar itchiness.On inspection,there are multiple small warty outgrowths noted on the labia majora and perineum.What is the BEST management? a.Podophylline

b.trichloracetic acid c.laser d.imiquimod Dx: HPV 6, 11

10.35 y/o G3P2 PU 34 weeks complains of premature uterine contractions.On speculum exam,there is a moderate amount of grayish homogenous fishy odored discharge.Grams stain done revealed a nugent score of 8.What is the management? a.amoxicillin b.clindamycin c.metronidazole d.cefuroxime

11.31y/o G2P1 PU 38 weeks is positive for HIV infection with a viral load of 2000 copies/ml.What is the BEST management? a.Do amniotomy in early labor b.Deliver by forceps during the second stage c.Monitor condition of fetus by scalp sampling

d.Deliver by Cesarean section

12.32y/o G2P1 PU 36 weeks has Immune thrombocytopenia. What is the fetal complication anticipated if this patient will undergo vaginal delivery? a.vertebral fracture

b.intracranial hemorrhage c.liver rupture d.splenic injury

13.32y/o G1Po PU 20 weeks complains of palpable breast mass.On examination,a 2x3 cm solid mass was noted on the right upper quadrant of the breast.What is the BEST management? a.mammogram b.fine needle aspiration c.breast ultrasound

d.core biopsy

14.36y/o G4P3 PU 10 weeks complained of postcoital bleeding. An ulcerated lesion was noted on the cervix at 3 o’clock position which bleeds to touch. Biopsy revealed squamous cell carcinoma. The uterus is not enlarged ,movable, both parametria are free and pliable. What is the management ? a.chemotherapy and wait for viability b.cone biopsy and wait for delivery c.chemotherapy and radiotherapy after delivery d.radical hysterectomy with bilateral lymph node dissection

15.Which of the following will NOT determine the management of ovarian CA during pregnancy?

a.age of patient b.stage of disease c.gestational age d.grade of the tumor