2. Prenatal Screening.

***) The most sensitive prognostic test in Rh-disease of pregnancy is:

1. Antibody titer

2. Past history

3. Spectrophotometric examination of the amniotic fluid

4. Urinary bilirubin level

5. Fetal movements

Answer: C* Spectrophotometric examination of the amniotic fluid

***) Indication of anti-D administration to Rh-negative mothers married to Rh-positive husbands includes all the following except:

1. Following abortion

2. Following delivery of Rh-negative baby

3. At 28 weeks of gestation

4. Following ectopic pregnancy

5. Following amniocentesis

Answer: B* Following delivery of Rh-negative baby

***) All of the following are indications for anti-D-gamma-globulin administration, except:

1. Abortion caused by blighted ovum

2. Abortion secondary to cervical incompetence

3. After amniocentesis

4. After attacks of ante partum hemorrhage

5. To Rh-negative unsensitized mother giving birth to Rh-positive fetus

Answer: A* Abortion caused by blighted ovum

***) Regarding the prevention of Rh-isoimmunization, all the following are true except:

1. All Rh-negative women should marry Rh-negative husbands

2. Anti-D to be given at 28 weeks or 32 weeks for pregnant patient with Rh-positive husband

3. Anti-D to be given within 72 hours after delivery in a patient with Rh-positive fetus

4. Anti-D to be given in Rh-negative patients with abortion (blighted ovum)

5. Anti-D immunoglobulin causes severe neonatal jaundice

Answer: D* Anti-D to be given in Rh-negative patients with abortion (blighted ovum)

***) The most common cause of fetal death in uterus in Rh-isoimmunization is:

1. Jaundice

2. Heart failure

3. Respiratory distress syndrome

4. Congenital anomalies

5. Kernicterus

Answer: E* Kernicterus

Prenatal Diagnosis.

***) The following information may be obtained from aspiration of amniotic fluid in the 2^nd and 3^rd trimester of pregnancy, except:

1. Cytogenetics

2. Fetal maturity

3. Detection of neural tube defect by measurement of alpha fetoprotein

4. Polydactyly

5. Rhesus disease

Answer: D* Polydactyly

***) Amniotic fluid is used to check up all of the following, except:

1. Chromosome analysis

2. Neural tube defects

3. Lung maturity of the fetus

4. Fetal hemoglobin

5. Inborn metabolic disease

Answer: E* Inborn metabolic disease

***) Which one of the following karyotyping is not matching:

1. Normal male - 46 XY

2. Turner syndrome - 45 XO

3. Female Down syndrome - 47 XX, +21

4. Female Edwards syndrome - 47 XX, +13

5. Klinefelter syndrome - 47 XXY

Answer: D* Female Edwards syndrome - 47 XX, +13

• Medical Conditions in Pregnancy ob13-ob23.

1. Iron Deficiency Anemia.

***) The most common anemia during pregnancy is:

1. Iron deficiency anemia

2. Pernicious anemia

3. Sickle cell anemia

4. Thalassemia

5. Hemolytic anemia

Answer: A* Iron deficiency anemia

***) Regarding iron deficiency anemia in pregnancy, all the following are true except:

Is related to social class

Is very common in multiple pregnancy

Is prevented with adequate diet only

Can usually be treated with oral iron

Is more common in multi parous women

Answer: C*Is prevented with adequate diet only

***) Factors causing iron deficiency anemia in pregnancy are all of the following, except:

Sickle cell disease

Lack of iron supplements

Poor diet

Bleeding

Mal absorption

Answer: A* Sickle cell disease

***) All of the following are causes of iron deficiency anemia during pregnancy, except:

Inadequate iron in the diet

Excessive blood loss

Infrequent pregnancies

Abnormal demand as in multiple pregnancy

Mal absorption

Answer: C* Infrequent pregnancies

***) Effects of iron deficiency anemia in pregnancy include all of the following, except:

Increased plasma volume

Increased cardiac output

Decreased peripheral resistance

Oxygen dissociation curve shifted to the left

Heart failure may occur in severe cases

Answer: D* Oxygen dissociation curve shifted to the left

Folate Deficiency Anemia.

***) Folic acid deficiency during pregnancy may occur from the following, except:

Multiple pregnancies

Low HCl acid in the stomach

Grand multi-parous women

Poor diet

Anticonvulsant therapy in epileptic pregnant women

Answer: B* Low HCl acid in the stomach

***) In folic acid deficiency during pregnancy the earliest changes are:

Erythrocyte macrocytosis

Megaloblastic anemia

Low concentration of serum folate

Increased urinary formiminoglutamic acid (FIGLA)

Hypersegmentation of neutrophils

Answer: C* Low concentration of serum folate

***) Megaloblastic anemia in pregnancy is mainly due to:

Iron deficiency

Vitamin B₁₂ deficiency

Folic acid deficiency

Vitamin B₁ excess

Hypoxia

Answer: C* Folic acid deficiency

Diabetes Mellitus DM.

***) In a pregnant patient with diabetes mellitus, all the following are true except:

Glucosuria is unreliable sign of control

Insulin requirement usually increases

Blood sugar should be maintained at approximately 160 mg/dl

Persistent hyperglycemia is worse than occasional hypoglycemia

Glycosylated Hb gives indication of previous long-term blood sugar levels

Answer: C* Blood sugar should be maintained at approximately 160 mg/dl

***) In diabetes mellitus associated with pregnancy all of the following statements are true, except:

There is higher risk of congenital abnormality

There is higher risk of fetal death during the last weeks of pregnancy

Usually insulin requirement is increased

Delivery is always by caesarian section

Stabilization of diabetes should be done as early as possible during pregnancy

Answer: D* Delivery is always by caesarian section

***) All of the following are adverse effect of diabetes on pregnancy, except:

Increased risk of microsomia

Increased risk of placenta previa

Increased risk of abortion

Increased risk of congenital abnormalities

Increased risk of candidialvulvovaginitis

Answer: B* Increased risk of placenta previa

***) All of the following are effects of diabetes on pregnancy, except:

Pre-eclampsia

Intrauterine fetal death

Increased incidence of fetal congenital abnormalities

Oligohydramnios

Shoulder dystocia

Answer: D* Oligohydramnios

***) All of the following are associated with complications in pregnant patient with diabetes mellitus, except:

Maternal ketoacidosis

Intrauterine fetal death

Trichomonas infection

Polyhydramnios

Pre-eclamptic toxemia

Answer: C* Trichomonas infection

***) Indications of glucose tolerance test during pregnancy include all following, except:

Family history of diabetes

Renal glucosuria

Unexplained stillbirth

Polyhydramnios

Delivery of 4.5 kg baby

Answer: B* Renal glucosuria

***) In a pregnant patient with history of diabetes in both parents, the probability of abnormal glucose metabolism is:

10%

25%

50%

75%

100%

Answer: C*50%

***) Which one of the following contributes to good control of diabetes in pregnancy:

300 mg carbohydrate per day diet

Good control of protein intake

Oral hypoglycemic drugs in mild cases

Twice daily mixture of short and medium acting insulin

Bed rest in the last 3 months of pregnancy

Answer: D* Twice daily mixture of short and medium acting insulin

***) In diabetes with pregnancy, there is an increased incidence of:

Traumatic delivery

Maternal death

Maternal head trauma

Normoglycemia

Delivery at home

Answer: A* Traumatic delivery

Hypertension.

***) Pre-existing raised blood pressure before pregnancy or in early pregnancy may be due to the following, except:

Pre-eclampsia

Essential hypertension

Renal artery stenosis

Pheochromocytoma

Coarctation of aorta

Answer: A* Pre-eclampsia

***) Concerning pregnancy induced hypertension, all the following are true except:

Common in women with diabetes mellitus

Treatment includes furosemide (Lasix)

Albuminuria is due to this condition

Delivery usually cure this condition

Will recur in 30% of cases in subsequent pregnancies

Answer: B* Treatment includes furosemide (Lasix)

***) Concerning gestational hypertension, all the following are true except:

The blood pressure rises all through pregnancy

The blood pressure decreases few days after delivery

The hypertension is not necessarily to be associated with proteinuria

The pregnancy should not exceed more than 40 weeks

The blood pressure rises in the third trimester

Answer: A* The blood pressure rises all through pregnancy

***) One of the following statements regarding pregnancy induced hypertension is true:

Can be relieved by use of diuretics

Post partum pregnancy induced hypertension is the most dangerous

Relief of pregnancy induced hypertension is achieved by anti-tetanus toxoid

Death of the fetus is usually followed by complete improvement

Fetus is usually large for date

Answer: B* Post partum pregnancy induced hypertension is the most dangerous

Eclampsia and Pre-eclampsia.

***) All of the following conditions are more likely to be associated with pre-eclampsia, except:

Multiparity

Multiple pregnancy

Chronic kidney disease

Diabetes mellitus

Vesicular mole

Answer: A* Multiparity

***) The following conditions are associated with high frequency of pre-eclampsia, except:

Diabetes

Multiple pregnancy

Polyhydramnios

Hydatiform mole

Placenta previa

Answer: C* Polyhydramnios

***) The following statements regarding ante partum pre-eclampsia toxemia are true, except:

Treatment with diuretics is of great value

Primary treatment with diazoxide is contraindicated

Plasma uric acid level is elevated

Materno-placental blood flow falls to less than 50%

There is increased incidence of PET in future pregnancies

Answer: A* Treatment with diuretics is of great value

***) The following about a patient developing proteinuric hypertension (pre-eclampsia) in pregnancy are true, except:

Serum uric acid concentration increases

The plasma volume decreases

Placental function tests values decrease

Hb concentration increases

Creatinine clearance increases

Answer: E* Creatinine clearance increases

***) One of the following is a grave sign of severe pre-eclampsia:

A PCV (Packed cell volume) of 55%

BP 160/100 mm HG

Proteinuria of 2 g/24h

Deep tendon reflex with 3+/4+

Edema of lower limbs up to the knees

Answer: D* Deep tendon reflex with 3+/4+

***) All the following are symptoms or signs of impending eclampsia, except:

Severe headache

Polyuria

Epigastric pain

Exaggerated reflexes

Visual disturbances

Answer: B* Polyuria

***) Signs and symptoms of impending eclampsia include all of following, except:

Headache

Sacral edema

Epigastric pain

Hyperreflexia

Blurring of vision

Answer: B* Sacral edema

***) Signs of fulminating pre-eclampsia include the following, except:

Hyperreflexia

Epigastric tenderness

Poor urine output

Maternal weight loss

Proteinuria

Answer: D* Maternal weight loss

***) The usual manner of death in case of eclampsia is:

Cerebral hemorrhage

Congestive heart failure

Cardiac arrest during convulsions

Uremia

Hemorrhagic pneumonia

Answer: A* Cerebral hemorrhage

***) The complications of pre-eclampsia include all of the following, except:

Abruption placenta

Polyhydramnios

Intrauterine growth retardation

Decreased renal blood flow

Abnormal liver enzymes

Answer: B* Polyhydramnios

***) In a case of pre-eclamptic toxemia at 40 weeks, the best management is:

Induction of labor

Cesarean section

Give methyldopa only

Give diuretics (Lasix) only

Give hydralazine only

Answer: A* Induction of labor

***) The most worrisome sign or symptom of serious pathology in late pregnancy is:

Swollen ankles

Constipation

Visual changes

Nocturia

Heartburn

Answer: C* Visual changes

Heart and Pregnancy.

***) Regarding changes in the heart during pregnancy, all the following are true except:

Third sound

Diastolic murmur

Soft systolic murmur

Increased pulse rate

Slight displacement of the apex

Answer: B* Diastolic murmur

***) Which of the following signs is diagnostic of heart disease in pregnancy:

Diastolic heart murmur

Soft systolic heart murmur

Tachycardia

Arrhythmia

Accentuated first heart sound

Answer: A* Diastolic heart murmur

***) Which of the following physical signs is least likely to indicate organic heart disease in pregnant woman:

Systolic murmur

Diastolic murmur

Atrial fibrillation

Cardiac enlargement

Palpation of a thrill

Answer: A* Systolic murmur

***) The following are factors which may lead to heart failure in patient with heart disease in pregnancy, except:

Tachycardia

Emotional upset

Physical exercise

A systolic murmur

Lower limbs edema

Answer: D* A systolic murmur

***) In a pregnant patient with mitral stenosis, all the following are true except:

To have labor induced at 38 weeks

Sit upright in labor

Could be considered for mitral valvotomy during pregnancy

Should not be given ergometrine (oxytocin) in the third stage of labor

Should have elective forceps delivery unless spontaneous delivery is very rapid

Answer: A* To have labor induced at 38 weeks

***) Pregnancy is contraindicated in all of the following conditions except:

Uncorrected atrial septal defect

Marfan's syndrome

Uncompensated cardiac failure

Eisenmenger's syndrome

Severe mitral stenosis

Answer: A* Uncorrected atrial septal defect

Hyperemesis Gravidarum HG.

***) Concerning hyperemesis gravidarum, all the following are true except:

Usually occurs in the first trimester

Is associated with hydatiform mole

Is associated with multiple pregnancy

Occurs most commonly in multigravida

May require admission to the hospital

Answer: D* Occurs most commonly in multigravida

Jaundice in Pregnancy.

***) The following may cause jaundice during pregnancy, except:

Acute fatty atrophy of the liver

Viral hepatitis

Severe pre-eclampsia

Chlorpromazine

Erythromycin

Answer: D* Chlorpromazine

Urinary Tract Complications.

***) The likely organism to cause urinary tract infection in pregnancy is:

Group B streptococcus

Klebsiella pneumonia

Chlamydia trachomatis

Proteus species

Escherichia coli

Answer: E* Escherichia coli

***) Asymptomatic bacteriuria means one of the following:

Urine contains more than 1,000 organisms per milliliter

Urine contains more than 2,000 organisms per milliliter

Urine contains more than 5,000 organisms per milliliter

Urine contains more than 10,000 organisms per milliliter

Urine contains more than 100,000 organisms per milliliter

Answer: E* Urine contains more than 100,000 organisms per milliliter

***) Regarding acute pyelonephritis with pregnancy, all the following are true except:

Right kidney is more affected than the left

Temperature is usually over 39°C

Antibiotic should be started before bacteriological results are available

The incidence of pre-term labor is increased

Intravenous pyelography IVP should be done promptly

Answer: E* Intravenous pyelography IVP should be done promptly

***) In acute pyelonephritis during pregnancy the most common causative organism is:

Pseudomonas

Klebsiella

E.Coli

Proteus

Shigella

Answer: C* E.Coli

***) The following encourage pyelitis in pregnancy, except:

Urinary stasis

Abnormalities of the renal tract

Constipation

Dehydration

Diabetes mellitus

Answer: D* Dehydration

***) Management of acute pyelonephritis during pregnancy includes all of the following, except:

Admission to the hospital

IV fluids

Antibiotics

Intravenous pyelogram (IVP) following delivery

Induction of labor

Answer: E* Induction of labor

***) Pregnant patients with chronic renal disease have an increased of all of the following, except:

Pre-eclampsia

Abortion

Stillbirth

Intrauterine growth retardation

Postmaturity

Answer: E* Postmaturity

***) All of the following may cause proteinuria during pregnancy, except:

A result of contamination

Urinary tract infection

Pre-eclampsia

Cardiac disease in pregnancy

Varicose veins in pregnancy

Answer: E* Varicose veins in pregnancy

***) All of the following complications of urinary tract may occur during pregnancy, except:

Asymptomatic bacteriuria

Ureteric colic

Lower urinary tract infection is uncommon

Hematuria due to varicose veins in the bladder (hemangioma)

Acute urine retention

Answer: C* Lower urinary tract infection is uncommon

***) Urinary estriol during pregnancy is mainly derived from:

Fetal kidneys

Maternal kidneys

Fetal adrenals

Maternal adrenals

Maternal liver

Answer: C* Fetal adrenals

***) An appropriate choice of antibiotics therapy for urinary tract infection in 15 weeks pregnant is:

Doxycycline

Tetracycline

Ciprofloxacin

Nitrofurantoin

Metronidazole

Answer: D* Nitrofurantoin