Hyperemesis Gravidarum HG.
Diagnosis of Pregnancy.
***) Signs and symptoms of pregnancy in the 1st trimester include all of the following, except:
A. Nausea
B. Quickening
C. Frequency of micturition
D. Soreness of breast
E. Hegar's sign
Answer: B* Quickening
***) Which of the following hormones is produced by trophoblast:
A. Luteinizing hormone
B. Follicle stimulating hormone
C. Prolactin
D. Human chorionic gonadotropin
E. Oxytocin
Answer: D* Human chorionic gonadotropin
***) Positive pregnancy test in the urine depends on the presence of:
A. Human chorionic gonadotropin
B. Progesterone
C. Estrogen
D. Calcium
E. Cortisol
Answer: A* Human chorionic gonadotropin
***) A suspicion of pregnancy at 3 wks GA may be confirmed by one of the following:
A. History of morning sickness and nausea
B. Vaginal examination
C. Abdominal examination
D. Immunological pregnancy test (hCG)
E. Breast examination
Answer: D* Immunological pregnancy test (hCG)
***) Which of the following hormones decreases after the first trimester of pregnancy:
A. Progesterone
B. Prolactin
C. Human Chorionic Gonadotropin (HCG)
D. Human Placental Lactogen (HPL)
E. Estrogen
Answer: C* Human Chorionic Gonadotropin (HCG)
2. Pregnancy & Physiological Changes.
***) All of the following statements are true, except:
A. The maximum weight increase in the uncomplicated pregnancy is 12.5 kg
B. The cardiac output has risen markedly by 40 percent during pregnancy
C. There is a slight increase of pulse rate about 15 percent
D. There is a decrease in red cell mass
E. Fibrinogen level increases during pregnancy
Answer: D* There is a decrease in red cell mass
***) Regarding cardiovascular system in normal pregnancy, the following are increased except:
A. Heart rate
B. Stroke volume
C. Plasma volume
D. Hematocrit
E. Red blood cells
Answer: D* Hematocrit
***) Blood volume is increased from the total volume during pregnancy at near term by about:
A. 10%
B. 20%
C. 25%
D. 45%
E. 100%
Answer: D*45%
***) Regarding supine hypotension one of the following is true:
A. Pressure of the gravid uterus on the aorta
B. Pressure of the gravid uterus on vena cava inferior
C. Pressure of the gravid uterus on vena cava superior
D. Constipation during pregnancy
E. Excessive heart burn
Answer: B* Pressure of the gravid uterus on vena cava inferior
***) In pregnancy concerning maternal blood the following are correct, except:
A. Plasma transcortin concentration increase
B. Free cortisol concentration increase
C. Thyroxin binding globulin concentration increase
D. Free thyroxin index increase
E. Release of TSH is not increased
Answer: D* Free thyroxin index increase
***) In the normal pregnancy all of the following increase, except:
A. Plasma volume
B. Hepatic blood flow
C. Platelet count
D. White cells count
E. Cardiac output
Answer: C* Platelet count
***) Pregnancy leads to one of the following:
A. Prolongation of stomach emptying time and increased acidity
B. Shortening of stomach emptying time and increased acidity
C. Shortening of stomach emptying time and decreased acidity
D. Prolongation of stomach emptying time and no affection of acidity
E. Prolongation of stomach emptying time and decrease acidity
Answer: E* Prolongation of stomach emptying time and decrease acidity
***) All of the following occur in alimentary tract during pregnancy, except:
A. The gums become swollen
B. Excessive salivation may occur
C. Heartburn (reflux esophagitis) is common
D. The stomach tends to empty more rapidly
E. Slow peristalsis of the bowel
Answer: D* The stomach tends to empty more rapidly
***) The cause of heartburn in pregnancy is:
A. Increased gastric motility
B. Increased vagal nerve activity
C. Gastro-esophageal reflux
D. Duodeno-gastric reflux
E. Increased gastric emptying
Answer: C* Gastro-esophageal reflux
***) Breast tissue of 2mm nodule is normal for which gestational age:
A. 28 weeks
B. 36 weeks
C. 40 weeks
D. 42 weeks
E. 44 weeks
Answer: A* 28 weeks
· Prenatal Care OB04-OB10.
Prenatal Visits.
***) All of the following are aims of antenatal care, except:
A. To monitor the well being of the fetus
B. To establish and maintain the physical health of the mother
C. The ideal time for first antenatal visit is before 14 weeks of pregnancy
D. Screening for fetal congenital abnormality
E. Screening for endometrial carcinoma
Answer: E* Screening for endometrial carcinoma
***) The embryonic life starts at:
A. The 3rd week after ovulation
B. The 5th week after ovulation
C. The 7th week after ovulation
D. The 9th week after ovulation
E. The 11th week after ovulation
Answer: C* The 7th week after ovulation
***) All of the following factors may reduce intrauterine death of the fetus, except:
A. Proper antenatal care
B. Localization of placenta in the first trimester
C. Antenatal fetal monitoring
D. Correct timing of delivery
E. Prevention of prematurity
Answer: B* Localization of placenta in the first trimester
***) In preventing anemia during pregnancy the ideal oral iron compound is:
A. 20 mg of iron
B. 100 mg of iron
C. 200 mg of iron
D. 400 mg of iron
E. 1000 mg of iron
Answer: A*20 mg of iron
***) All of the following are ideal routine blood tests carried out at first visit to an antenatal clinic, except:
A. Blood grouping and rhesus
B. Hemoglobin
C. Serological tests for syphilis
D. Rubella antibodies
E. Renal functional tests
Answer: E* Renal functional tests
***) All of the following are restriction on coitus during pregnancy, except:
A. Threatened abortion
B. History of premature labor
C. History of post partum hemorrhage
D. History of ante partum hemorrhage
E. When membranes are ruptured
Answer: C* History of post partum hemorrhage
***) Abdominal palpation in the latter half of pregnancy reveals all of the following, except:
A. The fundal height
B. The lie of the fetus
C. Cephalo-pelvic disproportion
D. The presentation of the fetal cephalic or breech
E. Whether the presenting part in engaged or not
Answer: C* Cephalo-pelvic disproportion (in the laber)
***) At 16 weeks of pregnancy, the uterine fundus is felt at:
A. Just above the pubic margin
B. At the level of umbilicus
C. Midway between umbilicus and pubic margin
D. 2 cm above the pubis
E. 2 cm above the umbilicus
Answer: C* Midway between umbilicus and pubic margin
***) At 14 weeks pregnancy a uterus may felt large for dates because of the following, except:
A. Wrong dates
B. Uterine fibroid
C. Full bladder
D. Polyhydramnios
E. Multiple pregnancy
Answer: C* Full bladder
***) A large for date uterus may be due to all of the following conditions, except:
A. Multiple pregnancy
B. Hydatidiform mole
C. Oligohydramnios
D. Uterine fibroid with pregnancy
E. Error in dates
Answer: C* Oligohydramnios
***) Causes of large for date pregnancies are the following, except:
A. Multiple pregnancy
B. Polyhydramnios
C. Hydatiform mole
D. Intrauterine fetal death
E. Diabetes with pregnancy
Answer: D* Intrauterine fetal death
***) The following factors may lead to wrong dates of delivery, except:
A. An irregular cycle
B. Regular cycles but in excess of 28 days (35-42 days)
C. Regular cycles of 28 days
D. Patient's poor memory
E. Breast feeding
Answer: C* Regular cycles of 28 days
***) To reduce the risk of recurrence of neural tube defects in a woman planning to get pregnancy, she should be advised to take:
A. Iron tablets 20 mg/day
B. Calcium tablets 1 gm/day
C. Vitamin E 200 mg/day
D. Vitamin B complex
E. Folic acid tablets 4 mg/day
Answer: E* Folic acid tablets 4 mg/day
***) Counseling of a pregnant woman during antenatal care should include advice and education on all of the following except one:
A. Smoking
B. Alcohol abuse
C. Drug abuse
D. Avoiding infection
E. Water consumption
Answer: E* Water consumption
***) The last menstrual period for a lady was June 30, the expected date of delivery is approximately:
A. March 23rd
B. April 7th
C. March 28th
D. April 23rd
E. March 7th
Answer: B* April 7th
Prenatal Screening.
***) The most sensitive prognostic test in Rh-disease of pregnancy is:
A. Antibody titer
B. Past history
C. Spectrophotometric examination of the amniotic fluid
D. Urinary bilirubin level
E. 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:
A. Following abortion
B. Following delivery of Rh-negative baby
C. At 28 weeks of gestation
D. Following ectopic pregnancy
E. Following amniocentesis
Answer: B* Following delivery of Rh-negative baby
***) All of the following are indications for anti-D-gamma-globulin administration, except:
A. Abortion caused by blighted ovum
B. Abortion secondary to cervical incompetence
C. After amniocentesis
D. After attacks of ante partum hemorrhage
E. 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:
A. All Rh-negative women should marry Rh-negative husbands
B. Anti-D to be given at 28 weeks or 32 weeks for pregnant patient with Rh-positive husband
C. Anti-D to be given within 72 hours after delivery in a patient with Rh-positive fetus
D. Anti-D to be given in Rh-negative patients with abortion (blighted ovum)
E. 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:
A. Jaundice
B. Heart failure
C. Respiratory distress syndrome
D. Congenital anomalies
E. Kernicterus
Answer: E* Kernicterus
Prenatal Diagnosis.
***) The following information may be obtained from aspiration of amniotic fluid in the 2nd and 3rd trimester of pregnancy, except:
A. Cytogenetics
B. Fetal maturity
C. Detection of neural tube defect by measurement of alpha fetoprotein
D. Polydactyly
E. Rhesus disease
Answer: D* Polydactyly
***) Amniotic fluid is used to check up all of the following, except:
A. Chromosome analysis
B. Neural tube defects
C. Lung maturity of the fetus
D. Fetal hemoglobin
E. Inborn metabolic disease
Answer: E* Inborn metabolic disease
***) Which one of the following karyotyping is not matching:
A. Normal male - 46 XY
B. Turner syndrome - 45 XO
C. Female Down syndrome - 47 XX, +21
D. Female Edwards syndrome - 47 XX, +13
E. Klinefelter syndrome - 47 XXY
Answer: D* Female Edwards syndrome - 47 XX, +13
· Medical Conditions in Pregnancy OB13-OB23.
Iron Deficiency Anemia.
***) The most common anemia during pregnancy is:
A. Iron deficiency anemia
B. Pernicious anemia
C. Sickle cell anemia
D. Thalassemia
E. 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
Eclampsiaand 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