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/ 2005
2-Novak’s Gynecology/ 13 th Edition/ Williams and Wilkins/ 2002
3-Clinical Gynecology Endocrinology and Infertility/ 7 th Edition / Williams &
Wilkins / 2005
4-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)
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Fetal
Monitoring
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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
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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
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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
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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
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+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
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normal fetal movement
10 movements in up to 2 hours
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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
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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
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Doppler systolic-diastolic waveform
indices of blood flow velocity
• S/D =S/D Ratio
• S-D/S= RESISTANCE INDEX
• S-D/MEAN= PULSATILTY INDEX
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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
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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
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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
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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
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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
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9- NST of a G2 / GA=37 wks/ cephalic presentation/
with a history of 2 IUFDs shows
a 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
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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
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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
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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
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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
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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
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PPV= true sick/positives
sick
true positive
False negative
healthy
False positive
True negative
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Sensitivity= true positive /sick
sick
true positive
False negative
healthy
False positive
True negative
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14-Which can not reduce fetal respiratory effort?
A-hypoxia
B-preterm labor
C- maternal feeding
D- at night (circadian effect)
Ans:C
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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26-What is the indication for Doppler velocimetry?
A- IUGR
B-postterm
C-SLE
D-APL antibody syndrome
Ans:A
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Puerperium
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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
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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
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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
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4-Which organism is the least responsible in
puerpural infection?
A- peptostreptococcus
B-enterococcus
C- chlamydia trachomatis
D-mycoplasma
Ans:D
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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
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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
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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
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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
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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
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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
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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
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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
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13-Which is wrong about parametrial phlegmon?
A-infection is unilateral and limited to broad
ligament
B-infection subsides with IV antibiotic but fever may
exist 5-7 days
C- If fever persists more than 72 hours despite
antibiotic therapy the diagnosis is ruled out
D-supracervical hysterectomy is
recommended
Ans:C
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14-What is wrong about weight loss after delivery?
A -5-6 kg weight loss after delivery is due to
uterine evacuation and blood loss
B-2-3 kg is lost because of diuresis
C-2 kg is lost because of third space volume
reduction
D-most women reach to pre pregnancy weight
by the second month after delivery
Ans: D
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15- A 26 year old woman complains of vaginal bleeding for three
months after delivery. In gynecologic exam uterine size is normal
and cervix is closed. What is the first step to be taken?
A-ultrasonography
B-beta subunit
C-Doppler sonography
D-curettage
Ans:B
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16-On average what percent of drug can be secreted in
human milk?
A-1%
B_10%
C-30%
D-50%
Ans:A
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17-Which is wrong about fever after delivery?
A-fever more than 39 c in the first 24 hours after
delivery is a sign of severe infection
B-fever in bacterial mastitis usually is late and
persistent
C-pulmonary infection usually occurs in the first 24
hours mostly after C/S
D-pyelonephritis is one of the most common reason
of infection and is most often mistaken for pelvic
infection
Ans: D
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18- A woman has gone through C/S 7 days ago . Three days after
the operation chills and fever (enigmatic fever) occured. She is
given antibiotic with no improvement in her condition. She
doesn’t look ill. What is your diagnosis?
A-pelvic abscess
B-parametrial phlegmon
C-pelvic septic thrombophlebitis
D-adenexal infection
Ans:C
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19-Who can lactate?
A- mother of a galactosemic newborn
B- mother with HBV
C- mother with active untreated TB
D-mother with breast herpetic lesions
Ans:B
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20-Which is true about C/S abscess?
A-Fever will resume one week after surgery
B-Mostly it happens after metritis
C-Fever will answer to appropriate antibiotic
therapy
D-Wound culture is negative most of the time
Ans:B
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21- How to manage breast engorgement in women who
does not choose breastfeeding her newborn?
A-oral analgesics
B-warm compress
C-broad spectrum antibiotic
D-bromocriptine
Ans:A
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22-An infection after C/S which is not responsive to
clinda+genta is because of:
A-clostridium
B-enterococcus
C-bacteroid fargilis
D-chlamydia trachomatis
Ans:B
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23- A week after NVD +episiotomy dehiscence occurs.
When the dehiscence should be repaired?
A- immediately
B-3 months later
C- 6 months later
D- 9 months later
Ans:A
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24-A 28 yr old G2 P1 woman decides on contraception during
lactation after the first week from delivery. What is the best
choice?
A- Oral progesterone 2-3 weeks after delivery
B-Depo-Provera 2 weeks after delivery
C-Implants after 4 weeks from delivery
D-oral OCP 4 weeks from delivery
Ans:A
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25-Which is true about post C/S metritis?
A- uterine culture helps to choose the best treatment
B- blood culture is negative most of the time
C- streptococcus beta hemolytic cause foul smelling
secretions
D-placental site is the site of transmission of
infection
Ans: B
Blood culture of metritis is negative most of the time.
Wound culture of C/S abscess is positive most of the
time.
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26-What is true about lactation period mastitis?
A-It occurs in the last days of the first week
B- Most of the time it is bilateral
C-nose and throat of the newborn is the source of
infection
D-it is mostly a result of coagulase-negative
staph
Ans:C
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Abnormal labor
1-What is Robin maneuver to release shoulder
dystocia?
A-rotation of post. shoulder to deliver ant. shoulder
B- abduction of shoulders
C- flex of mother’s knees and suprapubic pressure
D- rotation and extraction of ant. shoulder
Ans:B
Woods screw=A
McRoberts m.=C
Zavanelli m.= repositioning of fetal head back into the
uterus and C/S
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2-Which is wrong in PGE2 administration for labor
induction?
A-It reduces submucosal water content
B- vaginal tablet is superior to vaginal gel
C- It better affects on a cervix with Bishop score
below 4
D-It can be used instead of oxytocin for cervical
Bishop score of 5-7
Ans:A
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3-Which is wrong in breech delivery mechanism?
A-ant hip has a more rapid decent than post hip
B- ant hip is beneath the symphysis pubis and
intertrochanteric diameter rotates around a 45
degree axis
C- if post hip is beneath the symphysis pubis it has to
go through 225 degree axis rotation
D-for sacrum ant or post position, the axis of
rotation is around 45 degrees
Ans: C
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4-A woman 35 years old- P2 – GA of 38 wks -EFW of 2 kg
presents face and posterior shoulder presentation.
How do you manage her delivery?
A-induction of labor
B- internal rotation to make mentum ant position
C- observation to allow spontaneous rotation
D- C/S
Ans:C
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5-Which is wrong about persistent occiput posterior?
A-Forceps can be applied
B-manual rotation of the head can be done
C- manual rotation of the head can be done
D-there is no place for observation
Ans:D
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6-A term pregnancy- dil=3cm- eff=50%-satation=-2
soft cervix in mid position has a Bishop score of:
A-5
B-7
C-9
D-10
Ans:B
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7-In high dose oxytocin labor stimulation, what is the
maximum dose (mu/min) of oxytocin ?
A-20
B-30
C-42
D-60
Ans:C
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8- G4-L1-Ab2 / GA:38wks/full dil &eff/frank breech/
station=1 /WB=intact /FHR=100 BPM /
x-ray shows flexion of the head. What is the best
management?
A-Frank breech extraction
B-C/S
C-modified Prague maneuver
D- observation for non assisted breech delivery
Ans:A
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9-Which is wrong about face presentation?
A- This is a rare presentation above inlet
B-brow presentation most of the time changes to
face presentation
C- decent mechanism is completely different
from vertex presentation
D-delivery is possible if mentum appears
beneath the symphysis.
Ans:C
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10- Under what condition is external cephalic version
allowed in breech or transverse position,?
A- multiparity
B-placenta previa
C- presenting part engagement
D- CPD
Ans: A
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11-Which is true about pelvimetry of a breech
presentation?
A-MRI is superior to CT scan
B-MRI is faster than CT scan
C- MRI is superior to CT scan only during labor
D-MRI is not a good technique for imaging inlet
and mid pelvis
Ans:A
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12-Which is wrong about misoprostol?
A- It is a synthetic PG E1
B-It is used for peptic ulcer
C- It is used for contraception
D- Its dose is 100 mcg intra cervical for labor
induction
Ans:D
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13-Which criterion applies to low forceps?
A- the fetal head leading point should be on
station=>2
B- the fetal head leading point should be above
station=>2
C-The fetal head is on the pelvic floor
D-Sagital suture is ant-post
Ans:A
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14-Which is true about breech delivery?
A-labor duration is more lengthy than vertex
presentation
B-CP is not related to mode of delivery
C- Breech presentation happens with no definite
reason
D-pelvimetry with MRI reduces C/S rate
Ans:B
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15-Which is wrong about PGE2 gel?
A-The intracervical dose is 0.3-0.5 mg
B-The vaginal dose is 3-5 mg
C- The vaginal application releases 10 mg Q4h
D-If contractions and FHR are normal in a 2
hour observation, the patient can be discharged
Ans:C
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16- In breech presentation with a posterior shoulder ,What is the
name of the maneuver:
“The shoulder is grasped by one hand and the legs are grasped by
the other hand then the newborn is pooled toward mother’s
abdomen?”
A-Pinard
B- modified Prague
C- Bracht
D- Meuriceu
Ans:B
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17-Which is wrong in shoulder dystocia?
A-Most of shoulder dystocia cases can not be
diagnosed or predicted
B- Shoulder dystocia can be diagnosed with high
accuracy using modern imaging studies
C-ultrasound is not reliable
D- C/S is recommended in diabetic mothers with
babies more than 4500 gr and in non diabetic
mothers with babies more than 5000 gr
Ans:B
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18- A woman 34 yr G1 GA of 41wks is hospitalized. Which
regiment is more effective to improve Bishop score?
A- vaginal misoprostol 50 mcg
B- intracervical PGE2 (dinoprostone)0.5 mg
C- Oral Misoprostol 50 mcg
D-NS extra amniotic infusion
Ans:D
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Hypertensive Disorders in
Pregnancy
1-What is the accepted screening test for diagnosis of
PIH?
A-Rollover test
B-nitric oxide measurement
C-vascular endothelial growth factor
D-angiotensin test
Ans:A
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2- For a case of severe preeclampsia (BP=180/95) Mg SO4 and
C/S is ordered. An hour after C/S BP falls to 110/75. What is the
reason of BP fall?
A-Delivery removes the effect of vasospasm
B-anesthetic drugs
C-hemorrhage
D-MgSO4 effect
Ans: C
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3-Which is true about edema of preeclmpsia?
A- it has an unknown etiology
B-it is because of increased aldosterone level
C- it worsens the prognosis of preeclampsia
D- it is because of increased DOC
Ans:A
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4- A woman 48 yrs old/ G3/ BP=150/115/ has a high cholesterol
level . Her sister and brother had heart attacks in the age of 40.
Which is wrong about the management of this case?
A-Beta blocker
B- diet
C-methyl dopa
D-regular checking of lab results
Ans: A
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5- In a woman with chronic HTN Which factor has the least
effect in development of superimposed PIH?
A- PIH history
B- low dose aspirin
C- severity of HTN
D-the need for combined drug therapy
Ans:B
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6-What is the most common complication of eclampsia?
A- abruption
B-aspiration pneumonia
C-pulmonary edema
D- direct maternal mortality
Ans:A
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7-Which is true about blindness after eclampsia?
A-It has a bad prognosis
B-It lasts about 1 month
C-it is transient and lasts from 4 hours to 8 days
D-in some people it causes permanent blindness
Ans:C
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8-Which is wrong about eclampsia?
A- eclampsia can cause coma without seizure
B- All patients with eclamsia have had signs of
preeclampsia
C-After seizures respiratory rate is reduced and
cyanosis happens
D- In all cases of eclampsia severe proteinuria is
present
Ans:C
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9-Which therapy can prevent preeclampsia?
A-Low dose aspirin
B-calcium
C-fish oil
D-Antioxidants
Ans:D
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10- A 40 years old woman / G3/P2 /GA=35 wks/ BP=210/110 is
in seizure. What is the best way to control her seizure?
A-Phenytoin loading dose of 1000 mg/h IV
B- Diazepam and creatinin measurement
C- amobarbital sodium 250 mg IV
D- MgSO4 4-6 gr as loading dose
Ans:D
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11- What is the cause of platelet change in
preeclampsia?
A- increased production
B- decreased consumption
C- increased platelet aggregation
D- decreased platelet- adhering IG
Ans:A
med-ed-online
12-A woman 25 years old / G1 suffers HELLP
syndrome. What is true about her next pregnancy?
A- there is no increased risk in her next
pregnancy
B-the is increased risk of abruption and
preeclampsia
C-there is no increased risk of preterm labor or
C/S
D-there is no increased risk of IUGR
Ans:B
med-ed-online
13-Which test has a more PPV for detecting PIH?
A-urinary excretion of Kallikrein
B- roll over test
C- angiotensin II
D- hypocalciuria
Ans:A
med-ed-online
14-A pregnant woman GA=29 wks / severe headache/ blurred
vision/ BP= 200/120 has gone through routine tests and MgSO4
infusion. What other steps should be taken?
A-IV hydralazine 20 mg + IV verapamil 10 mg
B-IV hydralazine 5 mg
C- IV labetalol 80 mg
D- sublingual nifedipine 10 mg +thiazide 10 mg
Ans:B
med-ed-online
15-A case of eclampsia with seizure is given MgSO4. She is
agitated. What drug is appropriate for her agitated state?
A-2 gr MgSO4 IV
B- 250 mg amobarbital IV
C- 10 mg diazepam IM
D-no treatment is needed
Ans:B
“A” would be appropriate if a second seizure
occurs
med-ed-online
16-A woman with high blood pressure, proteinuria,
Cr>1.5 mg/dl, has an episode of seizure after 4 hours from her
delivery. What treatment do you suggest?
A-14 gr of MgSO4as the loading dose and then 2.5 gr
q4h up to 24 h after delivery
B-7 gr of MgSO4 as the loading dose and then 2.5
grq4h up to 24 h after the last seizure
C-14 gr of MgSO4 as the loading dose and then 2.5 gr
q4h up to 24h after the last seizure
D-7 gr of MgSO4 as the loading dose and then 2.5 gr
q4h up to 24h after delivery
Ans:C
med-ed-online
17-Which is not among pathophysiological changes of
preeclampsia?
A-reduction in PGE2
B-reduction in prostacyclin
C-increased thromboxane A2
D-increased resistance to angiotensin
Ans: D
med-ed-online
18-Which is wrong about proteinuria of preeclampsia?
A-Some women deliver before proteinuria
occurs
B-1+ proteinuria equals 300 mg protein in a 24
hour sample
C-NPV of a trace or negative dipstick test is
about 30 %
D-PPV of 3+/4+ proteinuria is 70%
Ans:D
med-ed-online
19-For a primigravida in 30 weeks gestation a roll-over test is
done. An increase of 35 mmHG has occurred in diastolic BP.
Which is wrong for this case?
A- She has a high probability of developing
HTN
B-She is abnormally sensitive to angiotensin II
C-increased BP is because of hyperactivity of
parasympathetic system
D-33% of these patients will develop
preeclampsia
Ans:C
med-ed-online
20-Which is wrong for visual disturbances of
preeclampsia?
A-it is because of occipital region lesions
B-if blindness does not resolve within a week , it
will remain permanently
C- It is because of retinal artery spasm that can
resolve by MgSO4
D-it is because of retinal detachment that is most
often unilateral
Ans:B
med-ed-online
21-Which is wrong about superimposed preeclampsia?
A-it occurs earlier in pregnancy and most often
is accompanied by IUGR
B- BP changes remain through life
C-some women have increased BP after 24
weeks gestation
D- above 90% of them have a history of essential
HTN
Ans:B
med-ed-online
22-A woman GA=38 wks/G2/L1/history of chronic HTN is
diagnosed as a case of severe preeclampsia. Her pregnancy is
terminated. Her BP and proteinuria and edema are improved but
she has developed orthopnea. What is your first diagnosis?
A-ATN and overload
B- hypoalbuminemia
C-peripartum cardiomyopathy
D-MS signs aggravated by fluid shift
Ans:C
med-ed-online
23-What drug has the complication of tachycardia?
A-methyl dopa
B-propranolol
C-nifedipine
D-hydralazine
Ans: D
med-ed-online
24-Which does not happen in preeclampsia?
A-reduced renal perfusion and GFR
B-increased renin-angiotensin level
C-constant electrolyte concentration
D- increased microangiopathic hemolysis
Ans:B
med-ed-online
25-A woman 32 years old/ NP /obese / 38 wks GA/
mild preeclampsia delivers her child . BP does not decrease after
several IV doses of hydralazine. Which is not a good
management?
A-Im hydralazine
B-oral labetalol
C-thiazides
D-IV MgSO4
Ans:D
med-ed-online
Hemorrhage in Obstetrics
1- A woman 35 years old /G4 L3 presents with
couvelaire uterus in C/S. When is hysterectomy
indicated?
A-presence of hematoma in the broad ligament
B-presence of hematoma in mesosalpinx
C- atony retractable to treatment
D- presence of blood in abdominal cavity
Ans:C
med-ed-online
2-Which is wrong about platelet administration?
A- Platelet can not be reserved more than 5 days
B-platelets should be administered to patients with
hemorrhage and platelet counts less than 50000/ml
C-platelet should be administered after cross-match
D- If there is no hemorrhage, platelets should be
administered to patients with platelet counts less
than 10000 /ml
Ans:D
med-ed-online
3-which is the most common reason of DIC in
Obstetrics?
A-IUFD
B-abruption
C-AF emboli
D- septic shock
Ans:B
med-ed-online
4-what is the first step in treating a G2 with late postpartum
hemorrhage (after stabilizing her condition)?
A-curettage
B-uterotonics
C-uterine artery ligation
D-hypogastric artery ligation
Ans:B
med-ed-online
5-A 16 year-old woman comes to you with heavy bleeding after a
two month delay in her periods. Pregnancy test is negative.
Ultrasound shows a thin endometrium. There is no coagulation or
anatomical problem. Which is the best treatment?
A-high dose progesterone
B-curettage
C-IV conjugate estrogen
D-diagnostic hysteroscopy
Ans:C
Conjugate estrogen 25-40 mg IV q6h or PO
2.5 mg q6h
med-ed-online
6- what is the stage of shock in a woman
70 kg / HR=130 bpm/AP=55mmHg/mod tachycardia/
urinary output=10cc in a min
A-first
B-second
C-third
D-fourth
Ans:c
med-ed-online
7-Which is true about hemorrhagic shock?
A- central venous catheter is not recommended
B-lifting the feet is not recommended
C-colloids are superior to crystalloids
D-excess NS can cause alkalosis
Ans:A
med-ed-online
8-A woman suffers intractable heavy vaginal bleeding after C/S.
Laparatomy is performed. Retrovesical hematoma is evacuated
and the site of bleeding is sutured. The bleeding does not stop.
What is the second stage in management?
A-total hysterectomy
B-bilateral uterine and ovarian arteries ligation
C-bilateral hypogastric arteries ligation
D-bilateral hypogastric and ovarian arteries ligation
Ans:D
Ovarian artery is situated in infundibulopelvic and
mesosalpinx ligament
med-ed-online
9-Which is wrong in abruption?
A-It is more likely in heroin addicts than cocaine
addicts
B-fibroma is one of the causes
C-positive past history is a risk factor
D-there is no agreement on smoking as a risk
factor
Ans:A
med-ed-online
10-A G2 with GA=14 wks is referred for spotting. Ultrasound
imaging shows twin pregnancy with one fetal demise. How the
coagulation profile may change?
A- The profile is like that of DIC
B-heavy bleeding will occur during labor
because of hypofibrinogenemia
C- repairable transient coagulopathy will occur
D-the live infant in the uterine will develop
coagulopathy
Ans:C
med-ed-online
11-Which is true about uterine inversion?
A-BP and MgSO4 can be the reason
B-it is more common in multiparas
C-it is never fatal
D-hemorrhage occurs with a delay
Ans:A
med-ed-online
12-If there is a coagulopathy disorder, which is an indication for
Heparin administration provided that circulation is intact?
A-IUFD
B-Abruption
C-septic abortion
D-HELLP syndrome
Ans:A
Heparin dose 5000 units TDS for IUFD
FFP and platelet for septic abortion
med-ed-online
13-Which is not an etiology of prepubertal females with
vaginal bleeding?
A-endocervical polyps
B-vaginitis
C-muluscum contangiosum
D-lichen sclerosis
Ans:A
med-ed-online
14-What is the drug of choice in AUB after kidney and
liver transplant?
A-desmopressin
B-GnRH agonist
C-antiprostaglandins
D-estrogens
Ans:B
med-ed-online
15-A 14 yr old girl has the chief complaint of heavy vaginal
bleeding. Her Hb is 7 gr/dl . Coagulation tests and platelets and
pelvic sonography are normal. What is your management after
treating anemia?
A-HD OCP q6h for one week
B- 25-50 mg progesterone q6h until bleeding is under
control
C- Conjugated estrogen 2.5 mg q6h PO until
bleeding is controlled followed by medroxy
progesterone
D-daily medroxy progesterone acetate 20 mg
Ans:C
med-ed-online
16-Which is wrong about stage II of hypovolemic
shock?
A-Tachycardia is a constant finding
B-blood loss is more than 1000cc
C-systolic minus diastolic BP is increased
D-BP at rest is normal
Ans:C
med-ed-online
17- A 70 kg woman has massive hemorrhage during a pelvic
surgery. Which is the best choice for blood loss compensation?
A- Packed cell +3 units of FFP+10 units of
platelet
B- Packed cell +2 units of FFP for each 6-8 units
of PC+ 2 units of platelet if platelet count is
below 100000/cc
C-whole blood
D- B and C
Ans:D
med-ed-online
Points to remember
Whole blood 500cc
Plasma 250cc
FFP 200 cc
-18°c
Cryoprecipitate
15 cc
250cc packed cell
4°c
Platelet 50cc
20-24° c
18-What is the most common coagulopathy that is
presented by AUB in adulthood?
A-Thalacemia major
B- thalacemia minor
C-von willebrand
D-ITP
Ans:D
med-ed-online
19-Which is true about int iliac artery ligation for
controlling pelvic hemorrhage?
A-Ext iliac artery should be checked before
ligation is attempted
B-ureter should not be located
C- both sides arteries should not be ligated
D-the artery should be ligated proximal to
parietal branch
Ans:A
med-ed-online
20-A woman receives 12 units of whole blood because of
hemorrhage after hysterectomy.
3 hours after operation Hb is 9 gr/dl, platelet 55000/cc
fibrinogen 100 mg/dl. What do you suggest?
A-FFP
B-platelet
C-cryoprecipitate
D-crystalloids
Ans:D
med-ed-online
21-How PG f2-alfa is administered for uterine atony?
A-20 mg IM for max 3 doses by 15-90 min
intervals
B-500 mcg IV for max 4 doses IM by 30 min
intervals
C-1000 mcg IM single dose
D-250 mcg IM for max 8 doses by 15-90 min
intervals
Ans:D
med-ed-online
22-In a 14 year old anemic girl with prolonged uterine
spotting what should be done?
A- assurance, follow up and ferrus sulfate
B- Low dose OCP q6h for 7 days
C- Low dose OCP 21 days for 3-6 cycles
D- conjugate estrogen 2.5 mg PO q6h for 7 days
Ans:c
med-ed-online
23-A 40 year old woman is hospitalized for hemorrhagic shock.
Her kidney function is normal. What is the most sensitive and
reliable clinical criteria for determining severity of volume loss?
A- tachycardia
B-tachypnea
C-oliguria
D-hypotension
Ans:C
med-ed-online
24-What is the best management of great vessels
laceration in sacral foramina?
A-Clamp and ligation of great vessels
B- clipping the vessels
C-electrocuttery
D-packing the foramen by Gel foam
Ans:D
med-ed-online
25-An extension of C/S incision causes vaginal artery laceration
and heavy bleeding. What should be done for this case?
A-uterine artery ligation
B-ovarian artery ligation
C- hypogastric artery ligation
D-hysterectomy
Ans:C
med-ed-online
26- How many ml of blood does a soaked lap pad
absorbs?
A-30 cc
B-50 cc
C-80 cc
D-100 cc
Ans:B
med-ed-online
27-What is wrong for blood loss management?
A-after an hour in a critical case only 20% of
crystalloids remains in circulation
B- the volume of crystalloids replacement is
three times the volume of blood loss
C-in all cases of blood loss a Hb of less than 8
gr/dl mandates whole blood transfusion
D-colloids increase mortality rate
Ans:C
med-ed-online
28-What is wrong about vaginal hematoma after
delivery?
A-observation if hematoma is small
B- an incision on the site if pain is severe and
hematoma enlarges
C-mattress suturing the bed of hematoma
D-pressure dressing should be applied on the
hematoma bed for 12-24 hours
Ans:D
med-ed-online
29- A repeat C/S II has hemorrhage of the incision
site. Which can best control hemorrhage?
A-ligation of placental site above and below the
incision site
B-ligation of uterine artery
C- ligation of hypogastric artery
D- embolization of uterine artery
Ans:A
med-ed-online
30-Where is the exact place of hypogastric artery
ligation?
A- immediately distal to the bifurcation
B-anterior branch distal to the bifurcation
C- anterior branch distal to post parietal branch
D- anterior and posterior branch
Ans:C
med-ed-online
31-What is the diagnosis and treatment of a tender inflamed mass
near the urethral opening in a 5 year old girl?
A-muluscum- analgesics and steroids
B-condylomata acuminata- TCA acid
C-prolaps of the urethra- topical estrogen
D- Skene gland abscess-antibiotic and
evacuation
Ans:C
med-ed-online
32-A 16 year old girl complains of heavy menstrual bleeding. She
is anemic. Her VS is stable. Your diagnosis is DUB. What should
be prescribed for her other than Iron supplements?
A-medroxy progesterone acetate 10 mg daily for
2 weeks for 3 cycles
B-monophasic OCP q6h for 7 days
C- conjugate estrogen 2.5 mg PO q6h until the
hemorrhage stops
D-LD OCP for 21 days
Ans:B
med-ed-online
33-Obturator artery is lacerated in a pelvic surgery.
Which artery should be ligated?
A-int iliac
B-lateral sacral
C-int pudendal
D-ilio lumbar
Ans:A
med-ed-online
• Paravesical space contains accessory obturator
artery from inf hypogastric
• Para rectal space contains lateral sacral and
hemorrhoidal arteries
• Obturator artery is from int iliac artery
med-ed-online
34-Which is the last choice in Von Willebrand related
AUB?
A-2.5 mg estrogen daily+ progesterone in the
last 10 days of a menstrual cycle
B-OCP
C-GnRH nasal spray
D-desmopressin infusion
Ans:D
med-ed-online
35-Which is more common in blood transfusion?
A-Hepatitis B
B-Delayed red-cell hemolytic reaction
C-Anaphylactic reaction
D-HTLV
Ans:B
med-ed-online
36- Which is wrong about fetal complications of
abruption?
A- 20-25 percent of cases demise perinatally
B-40 % are delivered prematurely
C- 12-15 % are IUFD
D-if the fetus doesn’t die in uterus, there would
be no serious neonatal complication
Ans:D
med-ed-online
37-A pregnant woman G2 GA=38 wks has the chief complaint
of vaginal spotting. There is no sign of abruption or previa by
ultrasound. What is the best management?
A- observation
B-termination of pregnancy
C-discharge
D-referring patient to another center
Ans:B
med-ed-online
38-Which is true about abruption?
A- The chance of repeated abruption is twice
B-fetal assessment techniques can predict
abruption with good precision
C-there is no means to predict abruption
D-The chance of repeated abruption is not
different
Ans:C
med-ed-online
39-Which is wrong in cases of placenta previa?
A-the safest means of diagnosing placenta previa
is transabdominal ultrasound
B-false positive results are because of full
bladder
C-low lying or total previa is best diagnosed by
trans vaginal ultrasound
D-NPV of transperineal ultrasound is 70 %
Ans: D (its NPV is 100% )
med-ed-online
40-What is the first surgical step in a case of retractable
uterine atony?
A-ligation of uterine and ovarian arteries
B-ligation of hypogastric arteries
C-subtotal hysterectomy
D- uterine artery embolization
Ans:A
med-ed-online
41-Which case does not need replacement therapy after
massive transfusion?
A- platelet of 80000 in cc
B-coagulation factor VIII of 40 %
C-fibrinogen 90 mg/dl
D- PT of 1.5 times normal level
Ans:B
med-ed-online
Preterm
and postterm
pregnancy
1-Which is wrong about the pathogenesis of preterm
labor?
A-phospholipase A2 induced by bacteria
B-PG induced by bacteria
C- macrophage induced substances
D-PAF induced by bacteria
Ans:B
med-ed-online
2-Which is wrong about FFN?
A-it is a better indicator for preterm labor than
ROM
B-FFN> 30 ng /ml is considered positive
C- amniotic fluid and maternal blood cause false
results
D-its NPV is more reliable than PPV
Ans:B
med-ed-online
3- What is your management of :
♀ 25 yrs -G1 - GA = 41 wks- cephalic presentation- FAD=normal
–favorable cervix?
A-C/S
B-stripping of the cervix
C-PG gel
D- AFI twice a week
Ans:D
med-ed-online
4-Which test is more sensitive for detecting bacteria in
AF?
A-Gram staining of AF
B-increased maternal WBC
C-increased AF IL6
D-increased maternal CPR
Ans:C
med-ed-online
5-Which is wrong about prolonged gestation?
A-placental apoptosis increases from 41-42
weeks gestation
B-umbilical cord erythropoietin increases from
41 weeks
C-Late deceleration is the most common finding
in prolonged gestational age
D-lack of vernix causes skin changes of post
maturity
Ans:C
med-ed-online
6-A 31 year old woman complains of premature labor. Dilatation
is 2 cm and eff is 50%. Water bag is intact. Which is true about
the management of this case?
A-beta agonists can cause MI and myocardial
necrosis in mother
B-terbutalin can post pone delivery for a week
C-If MgSO4 can not stop labor, nifedipine is used
D-PG inhibitors should not be used
Ans:A
med-ed-online
7-What should be done in a post trem pregnancy when
NST is normal?
A- repeat NST after 3 days
B-CST
C-AFI
D- Doppler
Ans:C
med-ed-online
8-Which is wrong in the management of a woman G1
GA=39 wks ROM Dil=2cm eff=40% HR=100 bpm T=37.5°c ?
A-Control of BP and HR q4h
B- Control of T q4h
C- antibiotic
D-induction of labor
Ans: B
T should be checked hourly
med-ed-online
9-Which is the most accurate way to detect ROM if ROM can not
be detected by speculum or ultrasonography?
A-Nitrazine test
B-Fern
C-Indigo Carmine
D-digital vaginal examination
Ans:C
med-ed-online
10-In which group of patients MgSO4 is
contraindicated?
A- Type I diabetes
B- asthma
C-hyperthyroidism
D-myasthenia gravis
Ans:D
A patient with MG should receive Amide type
anesthetics like Lidocaine and Bupivacaine
med-ed-online
11-Which combination therapy to stop labor pain is
safe?
A-MgSO4+ indomethacin
B-MgSO4+ terbutalin
C-ritodrin+ nifedipin
D-MgSO4 + nifedipin
Ans:B
med-ed-online
12-Which is not a side effect of Ritodrine?
A- pulmonary edema
B-hyper kalemia
C-hyperglycemia
D-hallucination
Ans: B
med-ed-online
13-An induction for a 41 wk gestational age pregnancy
failed. What should be done?
A- C/S
B-starting induction 6 hours later
C-Starting induction 3 days later
D- fetal well-being monitoring for one week
Ans:C
med-ed-online
IUGR
Definition
• Intrauterine growth restriction (IUGR)
occurs when the unborn baby is at or below the
10th weight percentile for his or her age (in
weeks). The fetus is affected by a pathologic
restriction in its ability to grow.

Low birth weight (LBW) means a baby
with a birth weight of less than 2500Gms,
which could be due to IUGR or Prematurity
med-ed-online
Classification
Symmetricl
the baby's head and body
are proportionately small.
may occur when the fetus
experiences a problem
during early development.
Asymmetrical
baby's brain is abnormally
large when compared to the
liver.
may occur when the fetus
experiences a problem
during later development
med-ed-online
In a normal infant, the brain
weighs about three times more
than the liver. In asymmetrical
IUGR, the brain can weigh five or
six times more than the liver.
Etiology
General- Racial / Ethnic origin,
Small maternal / paternal height / weight,
Fetal sex
Maternal causes.
Fetal causes.
Placental causes.
Idiopathic- In a majority of cases (40%) the cause is
unknown– probably due to placental insufficiency.
med-ed-online
Maternal Risk Factors
Has had a previous baby who suffered from IUGR.
Extremes of age
Is small in size (Ht & Wt).
Has poor weight gain and malnutrition during pregnancy.
Is socially deprived.
Uses substances (like tobacco, narcotics, alcohol) that can
cause abnormal development or birth defects.
Has a low total blood volume during early pregnancy.
med-ed-online
Maternal Risk Factors
Is pregnant with more than one baby.
High altitude.
Drugs like anticoagulants, anticonvulsants.
Has a cardio-vascular disease-preeclampsia, hypertension,
cyanotic heart disease, cardiac disease Gr III & IV,
diabetic vascular lesions.
Chronic kidney disease
Chronic infection- UTI, Malaria, TB, genital infections
Has an antibody problem that can make successful
pregnancy difficult (antiphospholipid antibody
syndrome, SLE).
med-ed-online
Fetal Risk Factors
Exposure to an infection-German measles (rubella),
cytomegalovirus, herpes simplex, tuberculosis, syphilis, or
toxoplasmosis, TB, Malaria, Parvo virus B19.
A birth defect (cardiovascular, renal, anencephaly, limb
defect, etc).
A chromosome defect- trisomy-18 (Edwards’
syndrome),21(Down’s syndrome), 16, 13, xo (turner’s syndrome)
A primary disorder of bone or cartilage.
A chronic lack of oxygen during development (hypoxia).
Developed outside of the uterus.
Placenta or umbilical cord defects.
med-ed-online
Placental Factors
Uteroplacental insufficiency resulting from -.
Improper / inadequate trophoblastic invasion and
placentation in the first trimester.
Lateral insertion of placenta.
Reduced maternal blood flow to the placental bed.
Fetoplacetal insufficiency due to-.
Vascular anomalies of placenta and cord.
Decreased placental functioning mass-.
Small placenta, abruptio placenta, placenta previa,
post term pregnancy.
med-ed-online
Screening:
US fetal biometry: HC- BPD- AC
Uterine Doppler studies ( Doppler Velocimetry):
bilateral notches and a mean resistance index of at least
0.55
Or
Unilateral notches and a mean resistance index of at
least 0.65 at 20 weeks.
Biochemistry: CRH level at 33 weeks
med-ed-online
Diagnosis
Neonatal Low ponderal index (Wt./Fl).
Decreased subcutaneous fat.
Presence / appearance of –
Hypoglycemia,
Hyperbilirubinemia,
Necrotizing enterocolitis,
Hyper viscosity syndrome
med-ed-online
A decrease in AFI may occur before there are
changes in the non-stress test.
med-ed-online
While the biophysical profile is an useful test,
when it becomes abnormal the fetus may
have already suffered some damage
med-ed-online
1-which test is more sensitive to fetal acidosis?
A-NST
B-BPP
C-OCT
D-Doppler velocimetry of umbilical artery
Ans:D
med-ed-online
2-What should be done for a diabetic woman 28 yrs old –G2 –
L1- AF=NL – EFW=4600 gr – GA=42 weeks
A-C/S
B-AF measurement twice a week
C-NST and OCT daily
D-PG gel to ripen cervix
Ans:A
med-ed-online
3-What is the most important reason for hypoglycemia
of a SGA fetus?
A- increased fetal consumption
B-decreased endogenous glucose production
C-hyperinsulinemia
D-reduced supply
Ans: D
med-ed-online
4-What trisomy in the form of placental mosaicism
causes IUGR?
A-13
B-16
C-18
D-21
Ans:B
med-ed-online
5-Which is wrong as an explanation for fetal growth?
A-Insulin growth factor I & II play an important
role
B-fetal pancreas can secret insulin necessary for
growth
C- leptin , a protein that is found in maternal and
fetal blood, is the product of obesity gene
D-fetal leptin secreted in the third trimester of
pregnancy is not related to fetal growth
Ans:D
med-ed-online
6-What is CMV mechanism of action in IUGR?
A- direct cytolysis
B-injury to small vessels endothelium
C-reducing cell multiplication time
D-inflammation and edema of perivascular tissue
Ans:A
med-ed-online
7-Which one is not a cause of SGA?
A- Maternal SCA
B-placenta previa
C-living at the sea level
D- positive maternal ACL antibody
Ans:C
med-ed-online
8-Which is not a finding in IUGR fetus?
A- hyper TG
B-thrombocytopenia
C-increased plasma adenosine
D-reduced placental arterial natriuretic peptide
Ans:D
med-ed-online
9-What is the chromosomal defect in a newborn with horse shoe
kidneys, prominent occiput, imperforated anus, VSD?
A- trisomy 13
B-turner
C-trisomy 18
D-trisomy 21
Ans:C
med-ed-online
Multiple
pregnancy
1- What is the best statement about ovulation induction?
A- oral and injectable ovulation induction drugs
have the same effect on inducing multiple
pregnancy
B-ovulation induction drugs increase the incidence
of dizygotic twins
C- ovulation induction drugs increase the incidence
of monozygotic twins
D-ovulation induction drugs increase the incidence
of monozygotic and dizygotic twins
Ans:D
med-ed-online
2-Which is wrong about chimeras?
A- It is the process in which two lines of cells
appear in one organism
B-A person is diagnosed as blood chimera when
he has two BGs
C-non disjunction in meiosis division is the
probable cause of chimeras
D- twins can share genetic materials via vascular
anastomosis
Ans:C
med-ed-online
3-Which is not a sign of twin to twin transfusion?
A-difference in weights more than 10%
B-hydramnios in one fetus and oligohydramnios
in the other
C- difference in Hb more than 5 gr/dl
D-monochorion with placental vascular
anastomosis
Ans:A
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4-Which age is the peak age for twin pregnancy?
A-puberty
B-26
C-37
D-35
Ans:C
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5- Which is true for prenatal care of multiple
pregnancy?
A- add 300 kcal daily
B-Daily Iron 250 mg
C-1 mg folic acid daily
D-a multiple pregnancy should have a weight
gain of 50 pounds
Ans: B
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6- What should be done for a woman 31 week gestation
with twin pregnancy and one fetus dead?
A-prophylactic heparin for DIC prevention
B- C/S
C- observation
D- tocolytics
Ans:C
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7- What is third circulation in monochorionic twins?
A- superficial artery-artery anastomosis
B- superficial vein- vein anastomosis
C- deep artery- vein anastomosis
D- deep artery-artery anastomosis
Ans: C
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8- Twins’ rate of growth resembles singleton pregnancy
up to gestational age of…
A-20 weeks
B-28-30 weeks
C-34 weeks
D- 36 weeks
Ans:B
med-ed-online
9-Which is not because of vascular anastomosis in twin
pregnancies?
A-microcephaly
B-small intestines atresia
C- Hip dislocation
D- limb amputation
Ans:C
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Amniotic membranes
1-♀ 30 yrs GA=34 w
max vertical pocket of AF=12 cm complains of
dyspnea. What do you suggest?
A- Ace inhibitors
B- daily diuretic and restricting salt consumption
C-transvaginal amniotomy
D-Indomethacin 1.5-2 mg/kg
Ans:D
med-ed-online
2-A placenta that is totally covered by chorionic villi and its
separation causes heavy bleeding that mandates hysterectomy is
called?.
A-Succenturiate
B-Fenestrated
C-Extracorial
D-membranous
Ans:D
The only placental abnormality detected by
ultrasound is membranous placenta
med-ed-online
3-What is wrong about umbilical cord?
A- Its length is determined by fetal movement
and AF volume
B- In breech presentation its length is 5 cm less
than vertex presentation
C-vellamentous insertion always contain one
umbilical artery
D-30 % of newborns with one umbilical artery
have congenital anomaly
Ans:C
med-ed-online
4-which is related to prenatal hemorrhage, prenatal
mortality, and abnormal fetus?
A- Circumvallate
B-membranous
C-Fenestrated
D-Circummarginate
Ans:A
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5-What is the least common complication of a large
placental chorioangioma?
A- polycythemia
B-heart failure
C- DIC
D- microangiopathic hemolytic anemia
Ans:A
med-ed-online
6- What is not a reason of oligohydamnios in a woman
GA=36w AFI=3cm with IUGR pregnancy?
A-reduced fetal urine
B- increased swallowing of the fetus due to
asphyxia
C-reduced fetal renal blood perfusion
D-reduced placental perfusion
Ans:B
med-ed-online
7-Which is the first stained by meconium in amniotic
fluid?
A-chorion
B-umbilical cord
C-fetal skin
D-amnion
Ans: D
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8-What is the most common lesion of placenta?
A-Infarction
B-calcification
C-fetal arteries thrombosis
D-inflammation
Ans:A
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9-Which can not increase AFI?
A-high altitude
B-maternal hydration
C-vasopressin infusion
D- maternal serum hyperosmolality
Ans:D
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10-Which is wrong about Meconium Aspiration
Syndrome?
A- It is fairly a common incidence
B-it can happen to a fetus with normal oxygenation
and normal AFI
C-Hypercarbia is a risk factor for gasping and MAS
D-It is preventable
Ans:D
The most common FHR abnormality with MAS is
severe variable deceleration
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11-How chorionic artery can be differentiated from
chorionic vein?
A- vasoactive substances are only effective on
the artery
B-the difference is in their diameter
C-artery passes over the vein
D-only by histological studies
Ans:C
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12-Which is true about the mechanism of action of
indomethacin on AF?
A-reducing fetal urine
B-increasing volume shift through fetal
membranes
C-reducing fluid production and absorption of
fluid through fetal lungs
D- increasing fetal swallowing
Ans:D
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13-Which is wrong?
A-chorionic plate of placenta is part of placenta
B-prenatal mortality is more in circumvallate
placenta
C-uterine infection is the main cause of
circumvallate placenta
D-circumvallate placenta accompanies
congenital abnormality
Ans:C
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14-Which is wrong about yellow round knots of 1-5 cm
near cord insertion into placenta?
A-these are amnion nodusum
B-these are made up of vernix, hair, sebaceous
and scaling of the fetal skin
C- These are not accompanied by fetal anomalies
D-it can be seen in cases of prolonged ROM
Ans:C
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15- A woman is hospitalized for oligohydramnios.
GA=34 w Fern=negative . What do you suggest?
A-pregnancy termination
B-observation
C-amnio infusion
D-diuretics
Ans:B
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16-Which kind of placenta can have accreta or percreta
insertion into the uterine?
A-succenturiate
B-ring shape
C-membranous
D-extracorial
Ans:C
extracorial
circumvallate
circummarginate
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17-Which is accompanied by long umbilical cord?
A-Dawn syndrome
B-limb defects
C-maternal systemic disease
D-Potter syndrome
Ans:C
Long cord >70 cm
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18- What should be done for a term pregnancy, ROM
for an hour with meconium staining?
A- amnio infusion
B-C/S
C-induction
D-observation
Ans: C
med-ed-online
Abortion
1-What is wrong about recurrent abortion?
A-HSG is the best method to R/O anatomical
etiologies
B-HSG is recommended several weeks after
operative hysteroscopy
C-vaginal ultrasonography and MRI are the best
techniques to detect anatomical defects
D-Septated uterus is the most common
anatomical cause of recurrent abortion
Ans:A
med-ed-online
2-Which is true about genetic factors in a case of
recurrent abortion?
A- Sperm and ovum of donors can be used
in couples with genetic abnormality
B-the most important genetic cause is 45X
monosomy
C- genetic causes for recurrent abortion is
R/O if karyotyping is normal
D-the genetic cause of recurrent abortion
can be cured
Ans: A
med-ed-online
3-Which is a wrong treatment for abortion?
A-200-600 mg mifepristone PO and then after
36-48 hrs 800 mg misoprostol vaginal
B-50 mg/m² MTX im and 24 hr later 800 mg
misoprostol vaginal
C- tamoxifen 20 mg daily for 4 days and then
800 mg misoprostol vaginal and if necessary
repeating after 24 hrs
D-800 mg misoprostol vaginal for 3 days for 1012 wk abortions
Ans:B
med-ed-online
4-What is a mandatory test for a 29 year old
woman with history of recurrent abortion?
A-ANA
B-ACL
C-anti paternal antibody
D-HLA profile of the parents
Ans:B
med-ed-online
Recurrent abortion tests
•
•
•
•
•
•
•
Karyotype
HSG
Luteal phase biopsy of endometrium
TSH and prolactin level
ACL ab
LAC
CBC
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5-Which is true about recurrent abortion?
A- 8- 30% is because of genetic factors among which
chromosome inversion is the most common
B- 8- 30% is because of genetic factors among which
balanced chromosomal rearrangement is the most
common
C-aneuploidy happens in old aged mothers
D-in a mother below 35 aneuploidy is because of
immunologic factors
Ans:B
med-ed-online
For cases of abortion without
fever:
Doxy 100 mg bid
or
tetracycline 250 mg qid
for 5-7 days
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6-Where is the discriminatory zone?
A-3000 IU/L HCG + abdominal US
B-1000-1500 HCG + vaginal US
C-a constant value of HCG for any type of
US
D-in multiple pregnancy it is lower than
singleton pregnancy
Ans:B
med-ed-online
7-RU486 can not attach to:
A-Progesterone receptor
B-androgen receptor
C-glucocorticosteroid receptor
D-estrogen receptor
Ans: D
med-ed-online
8-What is wrong about postabortal or “redo”
syndrome?
A- It is a complication of suction curettage
B- It is a painful cramp in the first 2 hours
after curettage
C-uterine bleeding is less than expected
D-treatment is D&C under anesthesia
Ans:D
med-ed-online
9- During a sharp curettage of an incomplete abortion
uterine is perforated. What is the first step of management?
A- curettage should be completed and
patient should remain under observation
B-laparatomy
C-curettage should be stopped and patient
should remain under observation
D- if there is no hemorrhage in the first 24
hours after operation, the patient can be
discharged
Ans:B
med-ed-online
10- The clinical findings of a woman with GA=8 wks with
the chief complaint of hemorrhage and clot passing is an
open int os Uterine size about 8 wks and no bleeding.
What should be done ?
A-No treatment is needed because abortion
is complete
B-it is a case of threatened abortion
C-it is an inevitable abortion
D-Ob sonography
Ans:D
med-ed-online
11- A woman has undergone elective abortion one week
ago. Now she comes to the clinic with the chief complaint
of hemorrhage. In PE cervix is closed, uterine is contracted
with no tenderness. Her temperature is normal . What is
the best treatment?
A-Doxy 100 mg bid for two weeks
B-clinda +genta
C-observation and check of Hb and Hct
D-hormone therapy
Ans:D
med-ed-online
12- What is the most likely cause of abortion in a 27 year
old woman with the past history of two abortions in 10 wks
and one in 15 wks with normal Karyotype conceptus?
A- endocrine
B-immunological
C-anatomic
D-infectious
Ans:B
The treatment of immunological recurrent
abortion is low dose Heparin sc 5000 units
bid+Aspirin 80 mg daily
med-ed-online
13-what is wrong about hereditary thrombophilia?
A- Factor V Laden is the most likely
cause
B-protein C resistance is because of
mutation in factor V
C-Protein C deficiency adds 3-10 % to the
risk of thrombosis formation
D- Protein S deficiency and thrombosis
risk will be eradicated after delivery
Ans:D
med-ed-online
Notes to Remember
• The most common cause of thrombophilia
syndrome is resistance to protein C.
• Antithrombin III deficiency has the most
thrombogenic property.
• Fulminant purpura is because of protein C
deficiency.
med-ed-online
14- What should be done for a woman 22 years old who
has undergone suction curettage and now suffers severe
pelvic cramps , sweating and tachycardia. Her uterus is
large and tender. She also has spotting.
A-observation and oxytocin
B-laparatomy
C-dilation and suction curettage without
anesthesia
D- CT scan
Ans:C
med-ed-online
15-What is the best way of pregnancy termination
in a bicornuate uterus with a 14 w fetal death?
A-dilatation and curettage under US
B-uterotonic drugs
C-dilatation and curettage under laparascopy
D-hysterotomy
Ans:B
Canula size in mm = GA in week minus one
med-ed-online
16- What is the management of a 32 year old woman who
has undergone failed induced abortion by MTX + PG?
A-repeat of MTX one week later
B-repeat of MTX the next day
C-repeat of PG one week later
D- repeat of PG the next day
Ans:D
med-ed-online
17- Which is not among APL mechanism of action?
A-increased platelet aggregation
B-increased prot C &S activity
C- reduced PGE2
D- direct platelet destruction
Ans:B
med-ed-online
18-What is the min size of empty gestational sac
that indicates unviable fetus in vaginal US ?
A-17 mm
B-13 mm
C-10 mm
D- 15 mm
Ans:A
>=13 mm if yolk sac can not be seen
>=17mm if embryo can not be seen
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19- Which genetic abnormality is more common in
IVF pregnancies that end with abortion?
A-trisomy
B-protein C deficiency
C-x-linked abnormalities
D-translocation
Ans:A
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20-Which is recommended in recurrent abortions
due to infectious reasons?
A- cervical culture
B-endometrium biopsy
C-chlamydia serology
D-empirical treatment of genital mycoplasma
Ans:D
med-ed-online
21- For which utertonic drug to induce abortion
placental retention is less likely?
A- oxytocin
B- PGE2
C-oxytocin+PGE2
D-PG E1( misoprostol)
Ans:D
med-ed-online
Ectopic Pregnancy
•Beta HCG below 2000+
no visible intrauterine sac+
mass in tube below 3.5 cm
______________________
control of beta HCG q 48 h
A-If a dead IP is confirmed (beta HCG increase less than
50% or below 1000mIu/mL- P below 5 ng/mL + visible
intrauterine sac) then curettage
B-If EP is confirmed (beta HCG more than 2000 and mass
>3.5 cm) then laparascopy
C-If a dead IP and EP is confirmed (beta HCG more than
2000 and mass < 3.5 cm) then MTX
FETUS SHOULD BE VISIBLE ON DAY 45 OF GESTATION
med-ed-online
1- What is your management of a 35 years old woman G1
GA=6 wks with an empty sac of 2.5 cm no heart beat and
empty uterus in Ultrasound?
A-Laparatomy and salpingectomy and follow
up
B-MTX and leukovorin
C-MTX and folic acid and iron supplement
D-laparascopy abd salpingectomy
Ans:B
med-ed-online
Indication of MTX for EP
• Hemodynamic stability
• No intra uterine pregnancy
• Max sac diameter not equal or more than
4 cm
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2-What is your management of a 36 year old woman who is
pregnant after primary infertity. She is referring to you for
spotting and hypogastric pain, beta HCG is 1500 mu/l and
ultrasound of uterus and ovaries are normal.
A-laparatomy
B-laparascopy
C-repeat of vaginal sonography several
days later
D-progesterone measurement
Ans:C
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3- A 30 year old woman has become pregnant after 5
years of infertility with ovulation induction and a history of
EP in the right tube 2 years ago.
She has undergone laparatomy for ruptured right fallopian
tube. What is the best technique for this surgery?
A-Milking
B-linear salpingectomy
C-right tube salpingectomy
D-segmantal excision and delayed
anastomosis
Ans:C
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4- In a woman 31 years old who has undergone
salpingectomy two weeks ago for EP, HCG level is
increasing. What is your management?
A-MTX
B-transvaginal sonography
C-salpingectomy
D-chest x-ray
Ans:B
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5-What is your management for a woman with :
HR=120 SBP=80 mmHg T=37.5°c uterine size=8 wks
beta HCG=2500 mIU/mL and no intrauterine pregnancy in
sonography?
A-Laparatomy
B- laparascopy
C- D&C
D-serum progesterone
Ans:A
med-ed-online
Adenexal mass< 3.5 cm MTX
adenexal mass=> 3.5 cm -> laparascopy
uncertain US + beta HCG increase less than
50% -> D&C
unstable conditions->laparatomy
med-ed-online
6-Which is wrong about EP?
A-Relaxin value in EP is less than abortion
B- there is no definite knowledge about CA 125
value in EP and abortion
C- AFP+ beta HCG+ progesterone+ estradiol
can help diagnosing of EP
D-maternal creatin kinase is less in EP versus
normal pregnancy
Ans: D
Creatin kinase and AFP are more in EP.
med-ed-online
7-Which is wrong in detecting early EP?
A-progesterone below 5-10 ng/mL contradicts
normal pregnancy
B-by vaginal sonography FHR can be detected
in day 33
C-beta HCG level increase of 75 % after 48hrs
is indicative of EP
D-vaginal sonography + Doppler are 95%
accurate in detecting EP
Ans:C
med-ed-online
8- which is a predisposing factor for ovarian EP?
A-PID
B-infertility history
C-DES exposure
D-present IUD
Ans:D
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9-Which can reduce the number of false positive
diagnosis of EP?
A-lab kits with 5 mIu/mL sensitivity
B-use of 3rd IS for HCG rather than 2nd TS
C-urine pregnancy test which can detect
beta HCG below 1000 mIu/mL
D-measuring beta HCG with serum creatin
kinase
Ans: C
med-ed-online
10-MTX single dose IM has been injected to a case of tubal
pregnancy 10 days ago . The beta HCG level falls from
2000 mIu/mL to 1600 mIu/mL.
But a severe pain persists. What is the next step?
A-beta HCG recheck
B-vaginal sonography
C-MTX reinjection
D-serial measurement of Hct
Ans:D
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11- A 17 year old woman is hospitalized for abdominal pain.
Serum progesterone is 15ng/mL.
Which is a true statement about her illness?
A-EP is R/O
B-EP risk is about 90%
C-EP and IP is R/O
D-EP and IP can not be ruled out
Ans:D
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12-All are among indications for conservative
management of EP except::
A-ovarian EP
B-reduced HCG level
C-sac of less than 3 cm
D-lack of noticeable intra abdominal
hemorrhage
Ans:A
med-ed-online
13-Which is not a risk factor for persistent EP?
A-EP>2cm
B-treatment of EP before 7 wks
C-beta subunit>1000 mIu/mL
D-EP in the proximal part of the tube
Ans:D
med-ed-online
14- In a 39 year old woman with EP, MTX is injected as a
single dose(50mg/m²) Im. Three days after the injection
beta HCG level decreased about 20%. Which is a correct
follow up?
A- another MTX is injected on day seven
B-control of HCG until it reaches 10 mIU/mL
C-laparascopy
D-MTX should be injected 1mg/kg for 5 days
Ans:B
med-ed-online
15-What is peritrophoblastic flow?
A- high resistance- low velocity
B-high velocity- low resistance
C-high resistance-high velocity
D-low velocity-low resistance
Ans:B
med-ed-online
16- What is “ring of fire” in Doppler sonography?
A-placental site
B-pelvic hyperemia
C-fetal heart
D-tubal rupture site
Ans:A
med-ed-online
17- A 23 year old woman has the chief complaint of
spotting. GA= 7 wks /beta HCG of two days ago =2500 /
last beta HCG=2700 / no evidence of IP or EP in
sonography. What is your management?
A-repeat of sonography two days later
B- MTX
C-laparascopy
D-curettage
Ans: D
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