OBGYN_Pregnancy and Extragenital Disease

Question 1

Which statements are true for the septic shock syndrome?
1) unconsciousness suggests to involvement of the central nervous system
2) total peripheral resistance decreases
3) multiorgan failure often develops
4) it is frequently caused by endotoxin of the Gram negative bacteria
5) its incidence significantly decreased due to the suppression of illegal abortions
A) answers 1, 2 and 3 are correct
B) answers 2 and 4 are correct
C) answers 3 and 4 are correct
D) all the answers are correct
E) none of the answers are correct

Answer 1

D) all the answers are correct

1) unconsciousness suggests to involvement of the central nervous system
2) total peripheral resistance decreases
3) multiorgan failure often develops
4) it is frequently caused by endotoxin of the Gram negative bacteria
5) its incidence significantly decreased due to the suppression of illegal abortions

Question 2

In which cases is inserting ureter catheter considred?
A 24-year-old primiparous woman presents at the obstetrical department. She had right-sided pain in the lower back, and lower abdominal cramps in the 27th week of gestation. She had temperature 38.4oC, pulse rate 92/min and blood pressure 110/70 mercury mm. Uterus was contractile. The uterine cervix was shortened and the uterine mouth was closed. Fetal heart rate was normal. Right-sided costo-lumbar ballotement showed sensitivity.
1) in febrile state persisting after antibiotic therapy
2) recurrent pyelonephritis
3) significant dilatation of the pyelon shown by ultrasonography
4) E. coli colony was grown in the urine sample
A) responses 1, 2 and 3 are correct
B) responses 1 and 3 are correct
C) responses 1 and 2 are correct
D) responses 2 and 4 are correct
E) there is no right response

Answer 2

B) responses 1 and 3 are correct

1) in febrile state persisting after antibiotic therapy
3) significant dilatation of the pyelon shown by ultrasonography

Question 3

Oral contraceptives can be recommended for the patients after diagnosing gestational diabetes:
A) in all cases
B) pills containing low hormone
C) only exceptionally
D) pills cannot be recommended

Answer 3

B) pills containing low hormone

Question 4

How does pregnancy affect the asthma?
A) it improves the asthma
B) it impairs the asthma
C) it does not change the symptoms
D) the above changes equally occur

Answer 4

D) the above changes equally occur

Question 5

On using prophylactic LMWH treatment in pregnancy it is mostly not necessary to monitor the anticoagulant effect because fewer hemorrhagic complication occur in such cases.
A) both are correct and there is a causal relationship between them
B) both are correct but there is no causal relationship between them
C) the first sentence in itself is correct and the second one is not correct
D) the first sentence is not correct and the second one in itself is correct
E) both are incorrect

Answer 5

C) the first sentence in itself is correct and the second one is not correct

Question 6

What is the criterion for gestational diabetes?
A) fasting blood sugar is <5.8 mmol/l
B) insulin treatment is not needed
C) it was diagnosed during pregnancy
D) all above possibilities

Answer 6

C) it was diagnosed during pregnancy

Question 7

What does the Leiden mutation result in?
A) protein S deficiency
B) activated protein C resistance
C) anti-thrombin III deficiency
D) plasminogen deficiency

Answer 7

B) activated protein C resistance

Question 8

What is characteristic for the gestational cholestasis?
1) enlargements of liver and spleen are very explicit
2) jaundice begins following the 20th weeks and developes in several weeks
3) bilirubin levels are significantly elevated in serum and urine
4) alkaline phosphatase activity in serum is very high
A) answers 1, 2 and 3 are correct
B) answers 2 and 4 are correct
C) answers 3 and 4 are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 8

B) answers 2 and 4 are correct

2) jaundice begins following the 20th weeks and developes in several weeks

4) alkaline phosphatase activity in serum is very high

Question 9

The following medicines can be successfully used during pregnancy in case of acute asthma, except:
A) sc. 250 µg terbutaline
B) iv. 10 mg methylprednisolone
C) iv. 80 mg methylprednisolone
D) iv. 2 mg/kg hydrocortisone

Answer 9

D) iv. 2 mg/kg hydrocortisone

Question 10

What treatment approach should be chosen?A 24-year-old primiparous woman presents at the obstetrical department. She had right-sided pain in the lower back, and lower abdominal cramps in the 27th week of gestation. She had temperature 38.4oC, pulse rate 92/min and blood pressure 110/70 mercury mm. Uterus was contractile. The uterine cervix was shortened and the uterine mouth was closed. Fetal heart rate was normal. Right-sided costo-lumbar ballotement showed sensitivity.
1) parenteral dose of broad spectrum antibiotic
2) left laying
3) plenty of liquid uptake
4) sedative administration
A) responses 1, 2 and 3 are correct
B) responses 1 and 3 are correct
C) responses 1 and 2 are correct
D) responses 2 and 4 are correct
E) there is no right response

Answer 10

A) responses 1, 2 and 3 are correct

1) parenteral dose of broad spectrum antibiotic
2) left laying
3) plenty of liquid uptake

Question 11

Which statement(s) is(are) true for the endotoxin?
1) glycoprotein molecule
2) lipopolysaccharide molecule
3) first of all it attacks the heart
4) it takes its origin from the membranes of Gram negative bacteria
5) cytokins do not play any role in the damage caused by it
A) answers 1, 2 and 3 are correct
B) answers 2 and 4 are correct
C) answers 3 and 4 are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 11

B) answers 2 and 4 are correct

2) lipopolysaccharide molecule
4) it takes its origin from the membranes of Gram negative bacteria

Question 12

Which disease is often associated with polycystic kidney disease?
A) mitral valve prolapse
B) asymptomatic liver cyst
C) intracranial aneurysm
D) all of the above

Answer 12

D) all of the above

Question 13

Which statement is true for the association of appendicitis and pregnancy?
A) Abdominal muscular defense is stronger during pregnancy than without pregnancy
B) The increases in white blood cell count and in red cell sedimentation can be present exclusively as signs of the acute appendicitis
C) if the probability of appendicitis can not be excluded, surgery should be performed
D) one has to strive to resolve the disease by antibiotic treatment

Answer 13

C) if the probability of appendicitis can not be excluded, surgery should be performed

Question 14

Match the following ones:

macrosomia

A) asymptomic bacteriuria
B) gestational diabetes
C) complications of IDDM
D) hemolysis
E) tuberculosis
F) cholestasis

Answer 14

B) gestational diabetes

Question 15

What is the most propbable diagnosis?A 24-year-old primiparous woman presents at the obstetrical department. She had right-sided pain in the lower back, and lower abdominal cramps in the 27th week of gestation. She had temperature 38.4oC, pulse rate 92/min and blood pressure 110/70 mercury mm. Uterus was contractile. The uterine cervix was shortened and the uterine mouth was closed. Fetal heart rate was normal. Right-sided costo-lumbar ballotement showed sensitivity.
A) placetal abruption
B) nephrolithiasis
C) pyelonephritis
D) herpes zooster

Answer 15

C) pyelonephritis

Question 16

On managing cholestasis with cholestyramine, vitamin K replacement is needed because hemorrhagic diathesis may present due to the malabsorbtion.
A) both are correct and there is a causal relationship between them
B) both are correct but there is no causal relationship between them
C) the first sentence in itself is correct and the second one is not correct
D) the first sentence is not correct and the second one in itself is correct
E) both are incorrect

Answer 16

A) both are correct and there is a causal relationship between them

Question 17

What is the most frequent cause for anemia during pregnancy?
1) iron deficiency
2) infection
3) folate deficiency
4) vitamine B12 deficiency
5) hemoglobinopathia
A) answers 1, 2 and 3 are correct
B) answers 2 and 4 are correct
C) answers 3 and 4 are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 17

A) answers 1, 2 and 3 are correct

1) iron deficiency
2) infection
3) folate deficiency

Question 18

If the normoglycemia in gestational diabetes can not be maintained by diet, insulin treatment should be started because this can prevent the macrosomia and the inherent obstetric complications.
A) both are correct and there is a causal relationship between them
B) both are correct but there is no causal relationship between them
C) the first sentence in itself is correct and the second one is not correct
D) the first sentence is not correct and the second one in itself is correct
E) both are incorrect

Answer 18

A) both are correct and there is a causal relationship between them

Question 19

Which statements are true for association of pregnancy and appendicitis?
1) the course of appendicitis is more severe during pregnancy and the inflammation is quickly spreading
2) miscarriage and preterm birth are frequently developed after formation of periappendicular abscess
3) appendix is cranially and laterally positioned when the uterus is growing during pregnancy
4) pregnancy predisposes to forming appendicitis
A) answers 1, 2 and 3 are correct
B) answers 2 and 4 are correct
C) answers 3 and 4 are correct
D) all of the answers are correct
E) none of the answers are correct

Answer 19

A) answers 1, 2 and 3 are correct

1) the course of appendicitis is more severe during pregnancy and the inflammation is quickly spreading
2) miscarriage and preterm birth are frequently developed after formation of periappendicular abscess
3) appendix is cranially and laterally positioned when the uterus is growing during pregnancy

Question 20

Incidence of infection with herpes simplex type 2 virus increases worldwide because the previous infection with herpes simplex type 1 can alter the clinical picture in case of fresh infection with herpes simlex type 2 virus.
A) both are correct and there is a causal relationship between them
B) both are correct but there is no causal relationship between them
C) the first sentence in itself is correct and the second one is not correct
D) the first sentence is not correct and the second one in itself is correct
E) both are incorrect

Answer 20

B) both are correct but there is no causal relationship between them

Question 21

Match the following ones:

elevated alkaline phosphatase

A) asymptomic bacteriuria
B) gestational diabetes
C) complications of IDDM
D) hemolysis
E) tuberculosis
F) cholestasis

Answer 21

F) cholestasis

Question 22

What is the most frequent causative agent for pyelonephritis during pregnancy?A 24-year-old primiparous woman presents at the obstetrical department. She had right-sided pain in the lower back, and lower abdominal cramps in the 27th week of gestation. She had temperature 38.4oC, pulse rate 92/min and blood pressure 110/70 mercury mm. Uterus was contractile. The uterine cervix was shortened and the uterine mouth was closed. Fetal heart rate was normal. Right-sided costo-lumbar ballotement showed sensitivity.
A) Streptococcus hemolyticus
B) Bacteriodes fragilis
C) E. coli
D) Pseudomonas

Answer 22

C) E. coli

Question 23

Match the following ones:

reduced creatinine clearance

A) asymptomic bacteriuria
B) gestational diabetes
C) complications of IDDM
D) hemolysis
E) tuberculosis
F) cholestasis

Answer 23

C) complications of IDDM

Question 24

How many per cent of maternal mortality in the developed countries are associated with thromboembolism?
A) 4 to 5%
B) 10 to 25%
C) 30%
D) 50%

Answer 24

B) 10 to 25%

Question 25

49 Incidence of thromboembolism following delivery reduced in the past decade because the early mobilization after birth and the prophylactic anticoagulation had become widespread practice. A) both are correct and there is a causal relationship between them B) both are correct but there is no causal relationship between them C) the first sentence in itself is correct and the second one is not correct D) the first sentence is not correct and the second one in itself is correct E) both are incorrect

Answer 25

A) both are correct and there is a causal relationship between them

Question 26

How often develops cystopyelitis in pregnant women with asymptomatic bacteriuria? A) 5% B) 10% C) 15% D) 20% E) 25%

Answer 26

E) 25%

Question 27

Match the following ones: elevated LDH level A) asymptomic bacteriuria B) gestational diabetes C) complications of IDDM D) hemolysis E) tuberculosis F) cholestasis

Answer 27

D) hemolysis

Question 28

Match the following ones: colony-forming units > 10^5 A) asymptomic bacteriuria B) gestational diabetes C) complications of IDDM D) hemolysis E) tuberculosis F) cholestasis

Answer 28

A) asymptomic bacteriuria

Question 29

On managing peptic ulcer, antacid medicines should be first of all applied in pregnant women since the symptoms are improving in 90% during pregnancy. A) both are correct and there is a causal relationship between them B) both are correct but there is no causal relationship between them C) the first sentence in itself is correct and the second one is not correct D) the first sentence is not correct and the second one in itself is correct E) both are incorrect

Answer 29

A) both are correct and there is a causal relationship between them

Question 30

Which disorder occurs frequently in pregnant women with normotensive chronic renal disease? 1) preeclampsia 2) anemia 3) placental abruption 4) preterm birth 5) intrauterine growth restriction A) answers 1, 2 and 3 are correct B) answers 2 and 4 are correct C) answers 3 and 4 are correct D) all of the answers are correct E) none of the answers are correct

Answer 30

D) all of the answers are correct 1) preeclampsia 2) anemia 3) placental abruption 4) preterm birth 5) intrauterine growth restriction

Question 31

What examination would help in establishing diagnosis?A 24-year-old primiparous woman presents at the obstetrical department. She had right-sided pain in the lower back, and lower abdominal cramps in the 27th week of gestation. She had temperature 38.4oC, pulse rate 92/min and blood pressure 110/70 mercury mm. Uterus was contractile. The uterine cervix was shortened and the uterine mouth was closed. Fetal heart rate was normal. Right-sided costo-lumbar ballotement showed sensitivity. 1) ultrasound 2) urinalysis 3) cardiotocography 4) total protein in seru A) responses 1, 2 and 3 are correct B) responses 1 and 3 are correct C) responses 1 and 2 are correct D) responses 2 and 4 are correct E) there is no right response

Answer 31

C) responses 1 and 2 are correct 1) ultrasound 2) urinalysis

Question 32

Which disease's incidence increases during pregnancy? A) bronchial asthma B) peptic ulcer C) iron deficiency anemia D) acute leukemia

Answer 32

C) iron deficiency anemia

Question 33

The frequency of preterm birth increases A) in case of hepatitis A B) in case of hepatitis B C) in both cases D) it does not increase in the above cases

Answer 33

C) in both cases

Question 34

1It is recommended for treating tuberculosis during pregnancy, except: A) isoniazide B) pyridoxine C) streptomycine D) rifampin E) ethambutol

Answer 34

C) streptomycine

Question 35

What may be the complication of pyelonephritis during pregnancy? 1) bacteriemia 2) unusual fluctuation in body of the temperature 3) respiratory failure 4) adult respiratory distress syndrome (ARDS) 5) hemolysis A) answers 1, 2 and 3 are correct B) answers 2 and 4 are correct C) answers 3 and 4 are correct D) all of the answers are correct E) none of the answers are correct

Answer 35

D) all of the answers are correct 1) bacteriemia 2) unusual fluctuation in body of the temperature 3) respiratory failure 4) adult respiratory distress syndrome (ARDS) 5) hemolysis

Question 36

Which is the therapeutic approach in pregnant women with thromboembolism? 1) iv. 5.000 units unfractionated heparin at every 8 hours 2) iv. 5.000 units unfractionated heparin bolus which is continued by 24.000 to 32.000 units/day heparin infusion 3) iv. 7.500 units unfractionated heparin at every 8 hours 4) iv. 5.000 units unfractionated heparin bolus that is at the same time combined with beginning therapeutic sc. low moleculer weight heparin treatment A) responses 1, 2 and 3 are right B) responses 2 and 4 are right C) responses 3 and 4 are right D) all responses are right E) there is no right response

Answer 36

B) responses 2 and 4 are right 2) iv. 5.000 units unfractionated heparin bolus which is continued by 24.000 to 32.000 units/day heparin infusion 4) iv. 5.000 units unfractionated heparin bolus that is at the same time combined with beginning therapeutic sc. low moleculer weight heparin treatment

Question 37

How often can the Leiden mutation be demonstrated in patients with thromboembolic diseases during pregnancy? A) In 20% B) in 40% C) in 60% D) in 80%

Answer 37

C) in 60%

Question 38

What are the risk factors for gestational diabetes? 1) age > 30 years 2) diabetes in medical history of the family 3) fetal macrosomia, congenital malformation and intrauterine death in the obstetrical history 4) obesity 5) hypertension 6) glycosuria A) answers 1, 2, 3 and 6 are correct B) answers 2, 3, 4 and 6 are correct C) answers 2, 3 and 6 are correct D) all of the answers are correct

Answer 38

D) all of the answers are correct 1) age > 30 years 2) diabetes in medical history of the family 3) fetal macrosomia, congenital malformation and intrauterine death in the obstetrical history 4) obesity 5) hypertension 6) glycosuria

Question 39

What distinquishes glomerulonephritis during pregnancy from the preeclampsia? A) hypertension B) hematuria C) proteinuria D) edema

Answer 39

B) hematuria

Question 40

Which cases are regarded risks for tuberculosis? 1) HIV positive people 2) residents coming from a country where tuberculosis frequently occurs 3) person who has got close contact with a person suffering from tbc 4) HIV negative alcoholic person or iv. drug user 5) homeless person and/or those living in poor social conditions A) responses 1, 2 and 3 are right B) responses 2 and 4 are right C) responses 3 and 4 are right D) all responses are right E) there is no right response

Answer 40

D) all responses are right 1) HIV positive people 2) residents coming from a country where tuberculosis frequently occurs 3) person who has got close contact with a person suffering from tbc 4) HIV negative alcoholic person or iv. drug user 5) homeless person and/or those living in poor social conditions