Obstetrics - 2F Flashcards by Arianne DG

Which of the following is true regarding the role of
chest imaging in patient management during COVID10 pandemic according to consensus of Fleischner
Society?

a. Imaging is indicated in patients belonging to
Scenario 1.
b. In a resource-constrained environment where
access to CT is limited, Chest X-ray may be
preferred for patients with COVID-19 unless
features of respiratory worsening warrant the use
of CT in Scenario 1, 2, 3.
c. Imaging is indicated for patients with COVID-19
and evidence of worsening respiratory status in
Scenario 2 and 3 except Scenario 1.
d. Imaging is indicated for patients with
moderate to severe features of COVID-19
regardless of COVID-19 test results in
Scenarios 2 and 3.

d. Imaging is indicated for patients with
moderate to severe features of COVID-19
regardless of COVID-19 test results in
Scenarios 2 and 3.

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In patients diagnosed with COVID-19, crazy-paving
and consolidation of air spaces by chest CT is seen
how many days after the onset of symptoms?
a. 0-4 days
b. 5-8 days
c. 9-13 days
d. More than 14 days

b. 5-8 days

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A 26-year-old at 36 weeks AOG presented with fever.
She’s tachypneic (>30 breaths per minute), with a
SpO2 of <92%. How will you classify this patient based
on disease severity?
a. Pregnant patient with mild symptoms
b. Pregnant patient with CAP, low-risk
c. Pregnant patient with Severe Acute
Respiratory Infection (SARI)
d. Pregnant patient with acute respiratory distress
syndrome (ARDS

c. Pregnant patient with Severe Acute 
Respiratory Infection (SARI)

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A 26-year-old at 36 weeks AOG presented with fever.
She’s tachypneic (>30 breaths per minute), with a
SpO2 of <92%.

Same patient (No. 3): How will this patient be
managed?
a. Patient may be managed at home or admitted as
CAP, low-risk
b. Patient must be admitted and managed as
CAP, moderate-risk
c. Patient must be admitted and managed as CAP,
high-risk
d. Patient must be admitted and managed based on
classification of ARDS

b. Patient must be admitted and managed as

CAP, moderate-risk

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A 28-year-old primigravid at 34 weeks and 5 days
came in at the respiratory unit due to fever and cough.
She was managed as having upper respiratory tract
infection. However, after 5 days from her first
consultation, her symptoms progressed. She’s
tachypneic (RR of >30 breaths/min), febrile, O2
saturation at 89%, chest x-ray result without
progressing infiltrates. Her RT-PCR revealed a
positive result. What is your diagnosis?
a. G1P0 Pregnancy uterine, 34 weeks and 5 days,
COVID-19 positive with mild pneumonia
b. G1P0 Pregnancy uterine, 34 weeks and 5 days,
COVID-19 positive with severe acute respiratory
infection (SARI)
c. G1P0 Pregnancy uterine, 34 weeks and 5 days,
COVID-19 positive with sepsis
d. G1P0 Pregnancy uterine, 34 weeks and 5
days, COVID-19 positive with acute
respiratory distress syndrome (ARDS

d. G1P0 Pregnancy uterine, 34 weeks and 5
days, COVID-19 positive with acute
respiratory distress syndrome (ARDS)

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Regarding antithrombotic therapy during pregnancy
and lactation diagnosed with COVID-19, which of the
following has a moderate-level of recommendation
and evidences based on expert opinion?
a. Antithrombotic therapy should be continued if the
therapy is prescribed during pregnancy prior to a
diagnosis of COVID-19
b. Venous thromboembolism prophylaxis after
hospital discharge is not recommended for
pregnant patients
c. For pregnant patients hospitalized for severe
COVID-19, prophylactic dose anticoagulation
is recommended unless contraindicated
d. Anticoagulation therapy should be managed in
pregnant patients with COVID-19 in a similar way
as in pregnant patients with other conditions that
require anticoagulation in pregnancy

c. For pregnant patients hospitalized for severe
COVID-19, prophylactic dose anticoagulation
is recommended unless contraindicated

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A 30-year-old G3P2 is on prophylactic low molecular
weight heparin due to history of VTE and Factor V
Leiden Mutation. She inquires as to why she has to
switch to a medication that requires injection twice
daily at 36 weeks gestation. What will be your
response to the patient?
a. Fetal exposure to low molecular weight heparin
close to delivery increases the risk of
intraventricular hemorrhage
b. Heparin has a shorter half-life and is more
easily reversible
c. Heparin has a lower rate of heparin-induced
thrombocytopenia
d. Heparin does not cross the placenta as low
molecular weight type does.

b. Heparin has a shorter half-life and is more

easily reversible

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A 28-year-old G2P1 (0110) presents for
preconception counselling because her last
pregnancy ended in delivery at 27 weeks gestation
due to preeclampsia with severe features. Her first
pregnancy was a miscarriage at 8 weeks. She brings
documentation of lab results showing that she is
positive for anti-beta-2-glycoprotein IgM. A minimum
of how many weeks after initial labs are the
confirmatory labs done?
a. 16 weeks2
b. 12 weeks
c. 10 weeks
d. 8 weeks

b. 12 weeks

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Regarding the pharmacologic difference between
unfractionated heparin and low molecular weight
heparin, which of the following is true?
a. Unfractionated Heparin binds simultaneously to
both Factor IIa and Factor Xa.
b. Unfractionated Heparin does not significantly
bind to proteins
c. Low Molecular Weight Heparin forms complex
with antithrombin
d. Low Molecular Weight Heparin have less
inhibitory activity against Factor IIa than to
Factor Xa.

d. Low Molecular Weight Heparin have less
inhibitory activity against Factor IIa than to
Factor Xa.

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Which of the following is in the clinical criteria for
antiphospholipid syndrome?
a. At least one unexplained fetal death beyond 20
weeks gestation
b. At least one spontaneous preterm birth
c. At least one preterm birth before 34 weeks
gestation due to preeclampsia with severe
features
d. All of the choices are correct

c. At least one preterm birth before 34 weeks
gestation due to preeclampsia with severe
features

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A 25-year-old primigravid diagnosed of severe iron
deficiency at 32 weeks was managed with ferrous
sulfate 3 times a day. After 1 week, you repeated her
CBC. What would you expect to see if she is
compliant with her iron therapy?
a. An elevated reticulocyte count
b. An increased in red cell distribution width
c. An increase in the mean corpuscular volume
d. A 20% rise in hematocrit

a. An elevated reticulocyte count

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A 19-year-old primigravid at 29 weeks gestation is
noted to have anemia with hemoglobin concentration
of 8 g/dL. The peripheral blood smear showed
presence of erythrocyte hypochromia and
microcytosis. Which of the following laboratory
findings are likely to accompany this condition?
a. Elevated mean corpuscular volume
b. Decreased serum ferritin level
c. Decreased total iron binding capacity
d. Positive sickle cell screen result

b. Decreased serum ferritin level

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A 30-year-old G4P3 3003 at 38 weeks age of
gestation was brought to the ER due to profuse
vaginal bleeding. She immediately underwent
cesarean section due to placenta previa. However,
intraop, she had postpartum hemorrhage secondary
to uterine atony. Estimated blood loss was 2 liters.
She was transfused with 3 liters of fresh whole blood.
Postop day 3, she reports well and denies dizziness
nor palpitations when ambulating. She is
normotensive with a pulse rate of 92 beats/min. Her
repeat hemoglobin is stable at 8 g/dL. Which of the
following would you advise based on her clinical
status?
a. 3 months of iron supplementation at
discharge
b. Transfusion of 2 units of blood
c. Repeat a complete blood count emergently
d. All of the choices are correct

a. 3 months of iron supplementation at

discharge

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A 36-year-old G3P2 at 18 weeks gestation reports
extreme fatigue and is found to have a hemoglobin
concentration of 7.5 g/dL. The erythrocyte mean
corpuscular volume is markedly elevated and
measures 124. A peripheral blood smear is obtained
with findings of hypersegmented neutrophils with
macrocytic erythrocytes. What is the diagnosis?
a. Folic deficiency anemia
b. Iron deficiency anemia
c. Vitamin B12 deficiency anemia
d. Vitamin B6 deficiency anemia

a. Folic deficiency anemia

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A 29-year-old G1P0 at 37 weeks age of gestation
came in at the ER due to mild fever and headache.
She was noted to be febrile at 38 degrees Celsius with
a BP of 150/90 mmHg, and a heart rate of 115
beats/min. Lab exams are as follows: hematocrit at
25%, platelet count of 15, 000/μl, creatinine of 1.4
mg/dL and a peripheral blood smear which
demonstrates schistocytes. What is the most likely
underlying cause of her clinical presentation?
a. Idiopathic thrombocytopenic purpura
b. Elevated levels of large Von Willebrand factor
multimers
c. Preeclampsia with severe features
d. Endothelial damage secondary to infection

b. Elevated levels of large Von Willebrand factor

multimers

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She was noted to be febrile at 38 degrees Celsius with
a BP of 150/90 mmHg, and a heart rate of 115
beats/min. Lab exams are as follows: hematocrit at
25%, platelet count of 15, 000/μl, creatinine of 1.4
mg/dL and a peripheral blood smear which
demonstrates schistocytes.

Same patient (No. 15): What is the most appropriate
management for this patient?
a. Magnesium sulfate infusion to control convulsion
b. Induction of labor to terminate pregnancy
c. Plasmapheresis
d. All of the choices are correct

c. Plasmapheresis

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A 37-year-old G3P2 (2002) at 24 weeks age of
gestation complains of easy fatigability. She was
evaluated with a lab result of hemoglobin of 7 g/dL,
platelet count of 105, 000 and a mean corpuscular
volume of 122. Peripheral blood smear revealed
morphological changes with neutrophils that are
hypersegmented and macrocytic newly formed
erythrocytes. Peripheral nucleated erythrocytes were
also noted. Based on the findings, what additional
symptoms is she most likely to complain of?
a. Excessive perspiration
b. Dry skin
c. Hair loss
d. Anorexia

d. Anorexia

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A 30-year-old pregnant patient at 26 weeks AOG
came in due to severe bone pains. Her peripheral
smear revealed red cells with sickling and membrane
damage. Which of the following conditions do red cells
assume the shape?
a. Low oxygen tension
b. Dietary protein deficiency
c. Administration of certain antibiotics3
d. Anorexia

a. Low oxygen tension

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A 30-year-old pregnant patient at 26 weeks AOG
came in due to severe bone pains. Her peripheral
smear revealed red cells with sickling and membrane
damage.

Same patient (No. 18): Which of the following
perinatal outcomes has the highest risk in this patient?
a. Preterm birth
b. Preeclampsia
c. Growth restriction
d. Stillbirth

c. Stillbirth (SG)

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A 30-year-old pregnant patient at 26 weeks AOG
came in due to severe bone pains. Her peripheral
smear revealed red cells with sickling and membrane
damage.

Same patient : She also complains of
pleuritic chest pain and shortness of breathing. Chest
radiograph revealed ventricular hypertrophy. Which of
the following medical complications can aggravate the
cardiac dysfunction of this patient?
a. Preeclampsia
b. Serious infections
c. Chronic hypertension
d. All of the choices are correct

c. Chronic hypertension

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25-year-old female, primigravid at 33 weeks, came in
for consultation due to very itchy rashes noted on the
abdomen, 2 weeks duration. There is no past history
of atopy or psoriasis, no fever cough or difficulty of
breathing. Obstetrical examination was normal.
Weight gain was within acceptable limits. Skin
examination showed the following findings: face and
upper back with acne vulgaris, mild to moderate;
hyperpigmented skin over the armpits, areola,
inguinal areas; linea nigra prominent; striae deep
extending to the whole abdomen; erythematous
papules seen on the striae of the abdomen sparing
the umbilical region; nails with signs of brittleness and
transverse grooving; mild gingivitis setting in. Which
of the skin findings is/are not considered physiologic
in this patient?
a. Abdominal striae
b. Gingivitis
c. Linea nigra
d. Erythematous papules on the striae

d. Erythematous papules on the striae

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Same patient (No. 21): Given the nature of the skin
lesion and considering the history and physical
examination, what is the closest diagnosis for this
patient?
a. Contact dermatitis
b. Polymorphic eruption of pregnancy
c. Atopic eruption of pregnancy
d. Scabie

b. Polymorphic eruption of pregnancy

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30-year-old multigravid at 35 weeks age of gestation
(AOG), carrying twins by ultrasound, consulted to
your clinic due to presence of multiple painful and
itchy blisters on the periumbilical region that has
spread to the arms, thighs, palms, and soles in a span
of 1 month. Patient claimed that everything started as
reddish papules, plaques only on the abdomen
concentrating around the umbilical region, similar to
what she experienced during her [previous]
pregnancy. Low-grade fever was noted a week ago,
nonremitting and relieved by the intake of
paracetamol. According to the patient, the severe
itching made her feel weak. There was no history of
any medication intake prior to appearance of lesions.
What is your working diagnosis as you deal with this
patient?
a. Polymorphic eruption of pregnancy
b. Erythema multiforme
c. Dermatitis herpetiformis
d. Pemphigoid gestationi

d. Pemphigoid gestationis

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27-year-old multigravid at 36 weeks age of gestation
(AOG) complained of generalized itchy skin. Upon
examination, there are no particular prominent skin
lesion but areas of excoriation from scratching are
evident all over the skin. General lab results done
during the second trimester appeared to be all within
normal limits. Patient is afebrile and initial general
examinations are quite within normal expectations.
Results came back with elevated liver function test
and serum bile acid, low hemoglobin level, mild
pyuria, and with positive gallstones seen in
ultrasound. What is your working diagnosis?
a. Pruritus secondary to anemia
b. Pruritus secondary to UTI
c. Intrahepatic cholestasis of pregnancy
d. All of the above

c. Intrahepatic cholestasis of pregnancy

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27-year-old multigravid at 36 weeks age of gestation (AOG) complained of generalized itchy skin. Upon examination, there are no particular prominent skin lesion but areas of excoriation from scratching are evident all over the skin. General lab results done during the second trimester appeared to be all within normal limits. Patient is afebrile and initial general examinations are quite within normal expectations. Results came back with elevated liver function test and serum bile acid, low hemoglobin level, mild pyuria, and with positive gallstones seen in ultrasound. Same patient (No. 24): How will you approach management of this patient? a. Give antipruritic emollients to apply on the itchy skin areas b. Give oral antihistamine to somehow relieve the skin. c. Give oral corticosteroid to stop the itch. d. All of the above

a. Give antipruritic emollients to apply on the | itchy skin areas

27-year-old multigravid at 36 weeks age of gestation (AOG) complained of generalized itchy skin. Upon examination, there are no particular prominent skin lesion but areas of excoriation from scratching are evident all over the skin. General lab results done during the second trimester appeared to be all within normal limits. Patient is afebrile and initial general examinations are quite within normal expectations. Results came back with elevated liver function test and serum bile acid, low hemoglobin level, mild pyuria, and with positive gallstones seen in ultrasound. Same patient (No. 24): Which among the information below is true? a. Baby is safe, nothing to worry b. Mother will not have any liver or biliary disorder after giving birth c. Condition is not contagious d. Condition will only last for this pregnancy and will not recur

d. Condition will only last for this pregnancy and | will not recur

What dermatological disorder is characterized by facial pustules and coalescing draining sinuses? a. Eczema of pregnancy b. Rosacea fulminans c. Pruritic folliculitis of pregnancy d. Pruritic urticarial papules and plaques of pregnancy

b. Rosacea fulminans

What is the characteristic rash seen with erythema nodosum? a. Erythematosus papules and bullae of the abdomen b. Nontender hypopigmented plaques of flexor surfaces of the arms and legs c. Tender, red, warm nodules and plaques of extensor surfaces of the arms and legs4 d. Senile pustules of the trunk

c. Tender, red, warm nodules and plaques of | extensor surfaces of the arms and legs

A 23-year-old G2P1 (1001) came to your clinic at 32 weeks complaining of pruritic plaques and pustules on her abdomen. Which of the following lab values would you not expect to see? a. Hypercalcemia b. Hypoalbuminemia c. Leukocytosis d. Elevated erythrocyte sedimentation rate (ESR

a. Hypercalcemia

A 23-year-old G2P1 (1001) came to your clinic at 32 weeks complaining of pruritic plaques and pustules on her abdomen. ``` Same patient (No. 29): What is the best initial choice of treatment for the patient? a. Oral steroids b. Emollients c. Antibiotics d. All of the choices are correct ```

a. Oral steroids

Which of the following infections appear to occur more frequently in pregnant patients than in nonpregnant? a. Hepatitis B b. Syphilis c. Trichomonas d. Urinary Tract Infection (UTI)

d. Urinary Tract Infection (UTI)

Which of the following infections can cause severe problems for the fetus but minimal symptoms in the mother? a. Chicken pox b. Bartholin gland abscess c. Rubella d. Rubeola

c. Rubella

Two weeks after the birth of her infant, the mother brings the child in to see you. The child’s eyes is edematous with conjunctival erythema and a mucopurulent discharge. Your evaluation and treatment should include which of the following. a. Pelvic exam of the infant b. Culture maternal genital tract for GC (Gonorrhea) and Chlamydia c. Anaerobic cultures of the infant’s and the mother’s eyes d. Immunoglobulin M (IgM) titers of the infant

b. Culture maternal genital tract for GC | (Gonorrhea) and Chlamydia

38-year-old 12 weeks pregnant woman presents with painful vesicular pustular lesions with ulceration of the vulvar area. She also has painful elevated inguinal nodes. What is the most likely diagnosis? a. Lymphogranuloma venereum b. Genital herpes c. Neisseria gonorrhea d. Syphilis

a. Lymphogranuloma venereum

Patient came in at 12 weeks gestation and was found to be non-immune to rubella. Which of the following information will you give her? a. Rubella infection increases maternal mortality. b. Significant percentage of fetuses of women who develops rubella infection during pregnancy will develop congenital rubella syndrome. c. Treatment with anti-viral medication is effective. d. [Unclear audio] …rubella immunization during this pregnancy

b. Significant percentage of fetuses of women who develops rubella infection during pregnancy will develop congenital rubella syndrome

23-year-old woman in her first trimester presents with painless raised lesion in her vulva. RPR tests with elevated titer is positive along with the fluorescent treponemal antibody-absorption (FTA-ABS). Patient should be offered which of the following counseling or treatment option? a. Causative agent for syphilis, Treponema pallidum, does not cause the placenta therefore there is no risk for congenital syphilis. b. If the fetus is affected, the anatomic ultrasound will always be abnormal. c. Immediately treat her with parenteral Penicillin G. d. Penicillin-allergic women should be treated with erythromycin.

c. Immediately treat her with parenteral | Penicillin G.

A 25-year-old gravida, who have been following up throughout her pregnancy, presents at 28 weeks’ gestation and complains of fever, runny nose, conjunctivitis, tender anterolateral neck nodes generalized maculopapular rash, and arthralgia. What is the most likely cause of this patient’s condition? a. Hepatitis B b. Rubella c. Rubeola d. H. influenza (Haemophilus influenzae Infection)

b. Rubella

Patient reports having had intercourse with a new sexual partner approximately 8 days ago. She now complains of generalized malaise and fever, vulvar pain, pruritus, and vaginal discharge. Genital examination showed tender inguinal lymphadenopathy, and vesicles and ulcer on the labia majora bilaterally. What is the most likely diagnosis? a. Chlamydia trachomatis b. Neisseria c. Syphilis d. Genital herpes

d. Genital herpes

30-year-old at 34 weeks ruptures her bag of water (BOW). Three days later, she sought admission for high-grade fever. White blood cell (WBC) count was 25,000 WBCs per microliter (μL), there is fetal 5 tachycardia, and mild tenderness of her lower abdomen. Which of the following is the most likely diagnosis for this patient? a. Intraamnionic infection b. Lower genital tract infection c. Pyelonephritis d. Genital herpes

a. Intraamnionic infection

``` What causes increased renal blood flow during pregnancy? a. Increased glomerular filtration rate b. Increases peripheral resistance c. Increased plasma volume d. Ureteral dilatation ```

c. Increased plasma volume

A 34-year-old G4P3 on her 12th week of pregnancy was referred for hypertension. Her vital signs were: BP of 180/90, pulse rate of 80/min, RR of 20/min, afebrile. Her urine protein was +2. Platelet count was 250,000/ul. ALT 24 U/L, creatinine 1.6 mg/dl, LDH 126 U/L. What is the most likely diagnosis? a. Severe preeclampsia b. Urinary tract infection c. Primary renal disease d. Nephrotic syndrome

c. Primary renal disease

Same patient (No. 44): A 34-year-old G4P3 on her 12th week of pregnancy was referred for hypertension. Her vital signs were: BP of 180/90, pulse rate of 80/min, RR of 20/min, afebrile. Her urine protein was +2. Platelet count was 250,000/ul. ALT 24 U/L, creatinine 1.6 mg/dl, LDH 126 U/L. 24-hr urine collection was done which revealed creatinine clearance of 58 ml/min. Protein excretion of 750mg/24 hours. What are the risks to the mother and the baby? a. Deterioration of renal function in the mother b. Preeclampsia may occur c. IUGR and preterm labor d. All of the above

a. Deterioration of renal function in the mother b. Preeclampsia may occur c. IUGR and preterm labor d. All of the above

A 24-year-old G2P1 consulted for dysuria, frequency, and urgency for 3 days. Associated symptoms were copious mucopurulent discharge. Urinalysis showed microscopic hematuria and pyuria. There are no bacterial growth. What could be the offending organism? a. Candida b. Chlamydia c. Gonorrhea d. Trichomonas

b. Chlamydia

Routine urinalysis of a 24-year-old G2P1 on her 13th week of pregnancy was found to have significant pus cells and bacteria. Urine culture yielded more than 10,000 colony count of E. coli. She is symptomatic. What is the best management approach for this patient? a. Militant watch b. Normal prenatal check-up c. Outpatient treatment and monitoring d. Prompt hospitalization and aggressive treatment

c. Outpatient treatment and monitoring

What could prevent recurrence of pyelonephritis during pregnancy? a. Immediate treatment of the acute episode b. Antibiotic use for 3 days based on culture and sensitivity c. Daily use of prophylactic antibiotics for the remainder of the pregnancy for those who had an episode of pyelonephritis d. All of the above

c. Daily use of prophylactic antibiotics for the remainder of the pregnancy for those who had an episode of pyelonephritis

A 24-year-old G2P1 on her 37th week of gestation has admitted for labor pain. She had hypertension, proteinuria of +3 with edema. Blood pressure started rising at 28 weeks AOG and on admission the BP was 200/100 mmHg. 2 hours of good labor, she delivered spontaneously to a live baby boy. Postpartum BP went down to 150 mmHg. She developed oliguria, rising creatinine, increased plasma bicarbonate and hyperkalemia. What complication might have occurred in this patient? a. Nephrotic syndrome b. Acute glomerulonephritis c. Acute renal failure d. Acute cortical necrosis

c. Acute renal failure

Which combination are predictive of the outcome of pregnancy in patients with chronic disease? a. Hypertension and underlying renal disorder b. Hypertension and the degree of renal insufficiency c. Underlying disorder and the degree of renal insufficiency d. All of the above

b. Hypertension and the degree of renal | insufficiency

``` Which of the physiologic changes in pregnancy increases the risk of pyrosis? a. Prolonged gastric emptying time b. Increase in pressure within the veins c. Lower esophageal sphincter tone is decreased d. Lower intraesophageal pressure and increased intragastric pressure ```

c. Lower esophageal sphincter tone is | decreased

``` Hyperemesis gravidarum usually lasts until what age of gestation? a. 12 weeks b. 14 weeks c. 16 weeks d. 18 weeks ```

c. 16 weeks

``` Which of the following is NOT part of the management of hyperemesis gravidarum? a. Vitamin supplementation b. Hydration c. Anti-emetic d. Steroids ```

d. Steroids

``` This is the first line agent in the management of gastroesophageal reflux in pregnancy. a. Antacids b. H2 blockers c. Proton pump inhibitors d. Thiamine supplementation ```

a. Antacids

``` This is the antibiotic of choice for diarrhea caused by enterotoxic E. coli. a. Metronidazole b. Tinidazole c. Azithromycin d. Ciprofloxacin ```

d. Ciprofloxacin

Which of the following characteristics of acute appendicitis is typically seen in pregnancy? a. Appendix is moved upward and posteriorly behind the gravid uterus b. It may be confused with acute pyelonephritis c. Most common finding in pregnant women with acute appendicitis is leukocytosis that confirms the diagnosis d. Laparoscopy is safe for pregnant women at 30 weeks and below

b. It may be confused with acute pyelonephritis

Pregnant women may have the following outcome if they acquire viral Hepatitis A infection. a. Effects of Hepatitis A teratogens may occur b. Can be transmitted to the baby via breastmilk c. Vertical transmission is negligible d. None of the above

c. Vertical transmission is negligible

Which of the following parameters indicate the marked infectivity of patients with Hepatitis B infection? a. Hepatitis B DNA b. HBs antigen c. HBe antigen d. Anti-Hbe

c. HBe antigen

``` This parameter indicates an acute or a chronic infection with Hepatitis B virus? a. Hepatitis B DNA b. HBs antigen c. HBe antigen d. Anti-HBe ```

b. HBs antigen

The drug of choice for acetaminophen overdose is: a. Thiamine b. Acetylcysteine c. Chelating agents d. Activated charcoal

b. Acetylcysteine

A 38-year-old came into your clinic. Regularly menstruating until she became amenorrheic for 7 months. Positive pregnancy test. This is her 1st prenatal checkup and she claims to have no co morbidities. This is her third pregnancy. Previous pregnancies were all spontaneous miscarriage < 10 weeks. No D and C was done. PE= normotensive, Cardiac rate: 93, RR: 18, pre pregnancy weight: 75kg, present weight: 90kg, height: 5 ft 1”, abdomen: globular, fundic height: 32cm, good Fetal heart tone best heard on the maternal left side. Pelvic exam: soft, close, no motion tenderness, uterus enlarged Lab= Hb 110, Hct: 40, WBC: 9, neutrophils: 68, monocytes:4, lymphocytes: 23, eosinophils: 75g OGTT= FBS: 7.15mmol, 1st hour: 10.45mmol, 2nd hour: 8.4mmol. Blood type: O, HBsAg: non-reactive, RPR: non-reactive. What is your impression? a. Wrong dates b. Multiple gestation c. Gestational diabetes d. Pre gestational diabetes

d. Pre gestational diabetes

A 38-year-old came into your clinic. Regularly menstruating until she became amenorrheic for 7 months. Positive pregnancy test. This is her 1st prenatal checkup and she claims to have no co morbidities. This is her third pregnancy. Previous pregnancies were all spontaneous miscarriage < 10 weeks. No D and C was done. PE= normotensive, Cardiac rate: 93, RR: 18, pre pregnancy weight: 75kg, present weight: 90kg, height: 5 ft 1”, abdomen: globular, fundic height: 32cm, good Fetal heart tone best heard on the maternal left side. Pelvic exam: soft, close, no motion tenderness, uterus enlarged Lab= Hb 110, Hct: 40, WBC: 9, neutrophils: 68, monocytes:4, lymphocytes: 23, eosinophils: 75g OGTT= FBS: 7.15mmol, 1st hour: 10.45mmol, 2nd hour: 8.4mmol. Blood type: O, HBsAg: non-reactive, RPR: non-reactive. Same patient (No. 61): 75g OGTT= FBS: 7.15mmol, 1st hour: 10.45mmol, 2nd hour: 8.4mmol. with a diagnosis of pre gestational diabetes. How will you manage? a. Advise medical nutritional therapy at 1650 kcal per day b. Advise medical nutritional therapy at 1425 kcal per day c. Advise medical nutritional therapy at 2100 kcal d. Start insulin therapy

a. Advise medical nutritional therapy at 1650 | kcal per day

A 38-year-old came into your clinic. Regularly menstruating until she became amenorrheic for 7 months. Positive pregnancy test. This is her 1st prenatal checkup and she claims to have no co morbidities. This is her third pregnancy. Previous pregnancies were all spontaneous miscarriage < 10 weeks. No D and C was done. PE= normotensive, Cardiac rate: 93, RR: 18, pre pregnancy weight: 75kg, present weight: 90kg, height: 5 ft 1”, abdomen: globular, fundic height: 32cm, good Fetal heart tone best heard on the maternal left side. Pelvic exam: soft, close, no motion tenderness, uterus enlarged Lab= Hb 110, Hct: 40, WBC: 9, neutrophils: 68, monocytes:4, lymphocytes: 23, eosinophils: 75g OGTT= FBS: 7.15mmol, 1st hour: 10.45mmol, 2nd hour: 8.4mmol. Blood type: O, HBsAg: non-reactive, RPR: non-reactive. Same patient (No. 61): Given the total nutritional requirement for this patient, how will you advise the dietician in making the food plan? a. Carbs: 185g, protein: 82.5g, fats: 144g b. Carbs: 200, protein: 9.5, fats: 150g c. Carbs: 215g, protein: 100, fats: 115g d. Carbs: 230g, protein:150g, fats: 130g

a. Carbs: 185g, protein: 82.5g, fats: 144g

A 28-year-old G1P0 pregnancy uterine at 28 weeks is diagnosed with GDM. Her CBG pre meals were 4.05- 5.7mmol/L and her CBG 2 hour post prandial was 6.05-6.55mmol/L. On ultrasound, the fetal abdominal circumference is more than 90th percentile. Fetal biometry is at 50th percentile for AOG. Pre pregnancy weight: 65kg, present: 73kg, height: 5ft 3”. How will you manage? a. Advise medical nutritional therapy b. Start insulin therapy 34 SQ in am 17 SQ in pm c. Start insulin therapy 30 units SQ in am and 15 units SQ in pm d. Start insulin therapy 32 units SQ in am and 16 units SQ in pm

b. Start insulin therapy 34 SQ in am 17 SQ in pm

b. G1P0, pregnancy uterine, 8 weeks, GDM

A 27-year-old G1P0 pregnant for the 1st time was seen at the clinic for prenatal checkup. She is amenorrheic for 8 weeks, positive pregnancy test. 7 TVS: compatible with AOG. She complains of frequent urination and unexplained weight loss which started 6 months PTC. Urinalysis showed glucosuria. FBS: 5.2mmol/L. Same patient (No. 65): Diagnosed with GDM, how will you manage? a. Since she is still in 1st trimester, no further workups needed. Advise to follow up after 4 weeks b. Request for 75g OGTT at 24-28 weeks. If normal, repeat at 32-34 weeks c. Request for 75g OGTT now since she is high risk d. Do nutritional counseling and advise selfglucose monitoring pre and 2 hours post prandial to ensure glycemic control. Start folic acid. Follow up after 2 weeks

d. Do nutritional counseling and advise selfglucose monitoring pre and 2 hours post prandial to ensure glycemic control. Start folic acid. Follow up after 2 weeks

A healthy 23-year-old G1P0 at 36 weeks and 4 days. She had no unusual medical or family history. She had regular prenatal checkup, no obvious abnormalities. She underwent C section due to fetal distress under general anesthesia. After tracheal extubation, the patient had upward rolling of eye balls, tachycardic at >120bpm with sweating and hyperpyrexia. What is your diagnosis? a. Eclampisa b. Malignant hyperthermia c. Diabetic ketoacidosis d. Thyroid storm

d. Thyroid storm

Which of the following is included in Burch-Wartofsky Point Scale for thyrotoxicosis? a. Temp <35 degrees Celsius b. Diarrhea c. Incoherent d. Disoriented as to time place and person

b. Diarrhea

A 35-year-old woman complains of palpitation, excessive sweating and heat intolerance at 16 weeks AOG. Although she experienced these symptoms in previous pregnancies, the current symptoms are much worse. Serum free T4: 51.7 μmol/L, serum thyrotropin: 0.1 mIU/L. How will you manage? a. PTU 50 mg TID b. Methimazole 10 mg PO c. Levothyroxine 50 ug per tab BID d. No medication needed. Patient is euthyroid.

b. Methimazole 10 mg PO

A 35-year-old woman complains of palpitation, excessive sweating and heat intolerance at 16 weeks AOG. Although she experienced these symptoms in previous pregnancies, the current symptoms are much worse. Serum free T4: 51.7 μmol/L, serum thyrotropin: 0.1 mIU/L. Same patient (No. 69): After 4 weeks, patient came back. Repeat serum free T4: 30 μmol/. Serum thyrotropin: 0.15 mIU/L. How will you manage? a. PTU 100 mg TID b. Methimazole 20 mg PO c. Levothyroxine 100 ug d. No medication needed. Patient is euthyroid.

b. Methimazole 20 mg PO

``` Which of the following causes dilatation of the urinary tract during pregnancy? a. Mechanical obstructive factors b. Human chorionic gonadotropin c. Dilatation of the radial arteries d. All of the above ```

a. Mechanical obstructive factors

A 35-year-old G3P2 2002, 26 weeks AOG, sought consult for dull ache in the right periumbilical area radiating to the back. What diagnostic findings will clinch your diagnosis? a. Elevated WBC b. Elevated ESR and CRP c. Non compressible right blind-ended tuberous structure with a maximum diameter of >6mm d. Right pelvocaliectasia

c. Non compressible right blind-ended tuberous | structure with a maximum diameter of >6mm

A patient previously treated with methotrexate for rheumatoid arthritis got pregnant. She was worried that her baby was exposed to methotrexate in the pregnancy in the 1st trimester. What complications/side effect will you expect in the baby? a. Hearing loss b. Neural tube defects c. Neutropenia d. Congenital glaucoma

b. Neural tube defects

A pregnant patient on her 2nd trimester came in with a pap smear result of ASCUS, HPV +. How will you manage this patient? a. Colposcopy b. Cervical punch biopsy c. LEEP d. Cold knife conization

a. Colposcopy

A 28-year-old G1P0, 16 weeks AOG was referred for colposcopy. Colposcopic finding showed no abnormal vessels, with thin aceto-whitening and partial Lugol’s uptake. How will you manage this patient? a. Do cervical punch biopsy b. LEEP c. Cold knife conization d. Observe

d. Observe

Which is not true regarding ovarian cancer in pregnancy? a. Antenatal chemotherapy is relatively safe during 2nd and 3rd trimester b. Surgery is safe in all trimesters c. Early termination to be able to start adequate treatment improves overall survival d. Prognosis is poorer because of late initiation of proper treatmen

c. Early termination to be able to start adequate | treatment improves overall survival

A 36-year-old G5P4 4004 on her 28 weeks AOG consulted for a cervical punch biopsy which revealed squamous cell carcinoma large cell keratinizing. Pelvic exam: normal external genitalia, smooth vagina, cervix measuring 3x3cm at anterior cervical lip with a mass measuring 1.5x1.5 cm. No adnexal tenderness. Bilateral parametria was smooth. Patient wants to keep the pregnancy. How will you manage this patient? a. Start antenatal chemotherapy to reduce tumor burden during pregnancy8 b. Cervical trachelectomy to remove the tumor while preserving her pregnancy c. Delay treatment and give steroids appropriately and perform C section at 34- 36 weeks d. Give brachytherapy

c. Delay treatment and give steroids appropriately and perform C section at 34- 36 weeks

Ototoxicity secondary to antepartal administration of cisplatin is due to: a. Formation of superoxide damaging cochlea a. Alkylation of cochlear cells b. Supermethylation of organ of Corti c. Prevention of microtubule formation of the acoustic nerve cells

a. Formation of superoxide damaging cochlea

Which is true regarding the use of MRI with gadolinium contrast in pregnancy to adequately stage cancer? a. MRI with gadolinium contrast is safe during pregnancy because it is non-ionizing and may be used in any trimester b. The use of gadolinium contrast in MRI should be limited. It may be used as a contrast agent. c. MRI with gadolinium contrast should be reserved for suspected malignancy d. MRI with gadolinium contrast is not safe during the 1st trimester

The use of gadolinium contrast in MRI should | be limited. It may be used as a contrast agent.

A pregnant woman at 28 weeks AOG was diagnosed with squamous cell carcinoma after cone excision biopsy. Biopsy showed the tumor invades the stroma with a depth of 5mm. How will you manage if she wants to keep the pregnancy? a. Delay of treatment is acceptable b. Start antenatal chemotherapy and possible CS with radical hysterectomy at 34-36 weeks c. Start vaginal brachytherapy with accurate uterine shielding d. Observe progression of the tumor by doing colposcopy every 3 months and intervene with progression

a. Delay of treatment is acceptable

A 28-year-old G2P1 1001 on her 20th week AOG diagnosed with 10 cm complex mass with solid areas and papillary excrescences on TVS ultrasound. How will you manage this patient? a. Request for tumor markers to determine if the mass is benign or malignant b. Repeat TVS after 1 month to observe for rapid growing or changes in the ultrasound findings c. Immediately perform surgery to remove the adnexal mass d. Schedule the patient for elective CS at 37 weeks with removal of the ovarian mass

c. Immediately perform surgery to remove the | adnexal mass

``` . Which of the following is not contraindicated for the use of IUD? a. Suspicion of pregnancy b. Post-abortal women c. Uterine Anomaly d. AUB of unknown origin ```

b. Post-abortal women

``` Which of the condition did OCP is advised with precaution? a. Endometrial Cancer b. Uncontrolled Hypertension c. Smoker <35 yrs. old d. History of DVP ```

c. Smoker <35 yrs. old

``` Which of the following is not seen in patients with pregnancy IUD in utero? a. Congenital Anomaly b. Septic abortion c. Ectopic pregnancy d. Prematurity ```

a. Congenital Anomaly

Which statement characterizes levonorgestrel intrauterine system? a. It is inserted during 1st day of menses. b. Can be inserted anytime provided when there is no pregnancy. c. Increases the incidence of menorrhagia d. Can be kept in place for 12 years.

b. Can be inserted anytime provided when there | is no pregnancy.

Which of the following statement is true regarding the calendar system of contraception? a. Generally effective to all women. b. Can be advised to women with regular interval with past 3 cycles. c. As part of the determination of fertile period the shortest cycle is subtracted by 11 days. d. The fertile period, couple can use the barrier method

d. The fertile period, couple can use the barrier | method

It maintains the endometrium a. Estrogen effect of OCP b. Progestin effect of OCP c. Both

a. Estrogen effect of OCP

It inhibits midcycle gonadotropin? a. Estrogen effect of OCP b. Progestin effect of OCP c. Both

a. Estrogen effect of OCP

8. Peeling of endometrium a. Estrogen effect of OCP b. Progestin effect of OCP c. Both

b. Progestin effect of OCP

Irregular bleeding a. Estrogen effect of OCP b. Progestin effect of OCP c. Both

c. Both

Acne a. Estrogen effect of OCP b. Progestin effect of OCP c. Both

b. Progestin effect of OCP

Given the labor curve, at what hour did the patient entered the deceleration phase? (Deceleration phase is when patient enters 8 cm) a. 4th hour9 b. 6th hour c. 8th hour d. 10th hour

c. 8th hour

Given the labor curse, what is the abnormality? (From 8 cm, after 4 hours still full cervical dilatation) (From 5 cm to 8 cm, it took her 5 hrs.) a. Prolonged latent phase b. Protracted labor c. Arrest of cervical dilatation d. Failure of descend

b. Protracted labor

(Labor curve: From 5 cm to 8 cm, it took her 5 hrs.) How will you manage patient in above question? a. She should not wait for full cervical dilatation since there is already dysfunctional labor. b. Do forceps delivery c. do immediate CS d. Augment labor

d. Augment labor

Another labor curve given, what is the abnormality in this labor curve? (Fetal head reaches past station 0 and it is at station +1 for 3 hours) a. Protracted disorder b. Arrest of cervical dilatation c. Arrest of descent d. Failure of descent

c. Arrest of descent

Another labor curve given, what is the abnormality in this labor curve? (Fetal head reaches past station 0 and it is at station +1 for 3 hours) Same patient (No. 94): What is the complete diagnosis of labor of this patient? a. Prolonged second stage of labor secondary to arrest of descent b. Prolonged second stage of labor secondary to failure of descent c. Prolonged active phase secondary to arrest of cervical dilation d. Prolonged latent phase secondary to protracted cervical dilatation.

a. Prolonged second stage of labor secondary | to arrest of descent

``` Another labor curve, what is the abnormality? (Fetal head is at station -1 for 3 hours) a. Protracted disorder b. Arrest of cervical dilatation c. Arrest of descent d. Failure of descent ```

d. Failure of descent

``` Antibiotic prophylaxis in elective CS delivery is given within: a. 30 min before start of surgery b. An hour before the scheduled surgery c. After cord clamping d. After delivery of baby ```

a. 30 min before start of surgery

These vessels are encountered in transverse incisions such in Pfannenstiel incision: a. Ilioinguinal vessels b. Iliohypogastric vessels c. Superior and inferior epigastric vessels d. pudendal vessels

c. Superior and inferior epigastric vessels

``` Which of the following item is not indication for classical CS? a. Deeply engaged fetal head b. Myoma of lower uterine segment c. Anterior placenta previa d. Anterior placenta accreta ```

a. Deeply engaged fetal head

A patient in labor gives the history of mitral stenosis. She is asymptomatic and currently taking a beta blocker but she is not sure why her doctor recommended it. What complication is the prophylactic beta blocker trying to prevent in this patient? a. Irregular heart rhythm b. Neural thrombus formation c. Tachycardia leading to pulmonary edema d. Left ventricular hypertrophy and dilatation

c. Tachycardia leading to pulmonary edema

In a pregnant woman with a mechanical heart valve, which of the following anticoagulant regimen would be considered inadequate for prevention of thromboembolism involving the prosthesis? a. Warfarin b. Low dose unfractionated heparin c. Adjusted dose unfractionated heparin d. Adjusted dose low unfractionated heparin

b. Low dose unfractionated heparin

A 28-year-old primigravid at 28 weeks of gestation came in due to dyspnea. She is gravida cardiac? patient. On auscultation, you noted low pitched crumbling? diastolic murmur at the apex when put on a left lateral position. She also noted an occasional increase in her heart rate. To improve her heart rate, you want to reduce left atrial pressure by giving which of the following medication? a. Diuretics b. Vasodilators (Nitroglycerin) c. Beta blockers d. Digitalis

c. Beta blockers

Regarding fetal position, fetal heart sounds are best heard as short distance from the umbilicus in which of the following? a. Occipitoanterior b. Occipitoposterior c. Occipitomental d. Transverse position

a. Occipitoanterior

In cephalic presentation, if the fixed point of reference is the frontum. What will be the AP diameter presenting into the pelvis? a. Suboccipitobregmatic b. Occipitofrontal c. Occipitomental d. Trachelobregmatic

c. Occipitomental

A 28-year-old G1 presents in the clinic at 42 weeks. She states that she is tired all the time and her feet swell when she stands for too long. When her cervix was checked by the consultant, it is noted that it is posterior, close, and very firm. As discussion begins for the possibility of induction, the patient asked what can be done to improve her chances of care of having her baby delivered vaginally. What do you tell her as provider? a. CS is the best option for the baby at this point.10 b. Induction with artificial ripening agent is an option c. Transvaginal ultrasound will tell us if your cervix is ready to deliver d. Cervix must ripen on its own.

b. Induction with artificial ripening agent is an | option

This is observed when lower uterine segment contractions are stronger than the upper segment. What is this called? a. Fundal dominance of contraction b. Asynchronous uterine contraction c. Hypotonic uterine contraction d. Hypertonic uterine contraction

b. Asynchronous uterine contraction

This phenomenon results to the expulsion of fetus. a. Fundal dominance of contraction b. Asynchronous uterine contraction c. Hypotonic uterine contraction d. Hypertonic uterine contraction

a. Fundal dominance of contraction

Which of the following patients would most likely have a repeat caesarean section given that the pregnancy is a term infant, average size and cephalic in presentation? a. 32-year-old G2P1 (1001) who underwent primary CS due to arrest in cervical dilatation b. 31-year-old G3P1 (1011) who underwent CS due to breech presentation c. 38-year-old G2P1 (1001) whose first pregnancy was CS for failure of descent d. 40-year-old G4P2 (2012) whose second pregnancy was CS due to placenta previa

c. 38-year-old G2P1 (1001) whose first | pregnancy was CS for failure of descent

A 32-year-old nulligravid referred to you after a preemployment clinic noted reactive RPR. What is the next best step in the management of this patient? a. Request for VDRL b. Obtain specimen for vaginal discharge culture and tissue culture c. Request for fluorescent Treponemal antibody absorption test d. Treat immediately with penicillin

c. Request for fluorescent Treponemal antibody | absorption test

A 27-year-old comes to your clinic. Patient follows a strict vegetarian diet wants to know if her dietary choices are optimal for her baby’s development. Patient voices her willingness to change her diet if it would benefit the baby. Compared with a less stringent lacto-ovo-vegetarian diet, this patient’s diet is most likely to be deficient in which of the following? a. Vitamin A b. Vitamin B12 c. Vitamin C d. Calcium

b. Vitamin B12

A 22-year-old G2P1, 13 weeks presents for prenatal check-up. On review of her routine prenatal labs, a positive urine culture of Staphylococcus saprophyticus was noted. Urinalysis reveals (-) nitrates. Upon review of system, she denies urinary urgency, frequency or other symptoms. What is your rationale for antibiotic treatment? a. Prevent kidney stone b. Prevent preterm labor c. Decrease the risk of chorioamnionitis d. Prevent secondary trimester bleeding

b. Prevent preterm labor

A 36-year-old G5P0 at 37 weeks and 6 days present at the OB admitting complaining of decrease fetal movement. The patient denies any somatic complaints and states that she has no other health problems. Her blood pressure is 120/70 mmHg, HR of 66 bpm, fetal heart tone 130. What is the next step in the management? a. Reassure the patient that it is normal b. Schedule a 3 day recheck appointment c. Perform a biophysical profile immediately d. Schedule an ultrasound in a week

c. Perform a biophysical profile immediately

A 35-year-old G3P2 at 38 weeks AOG came in due to frank rupture of amniotic fluid. Patient was hook to a fetal monitor. CTG strips revealed rapid drop of fetal heart rate with good variability with decelerations. You will immediately check for: a. Uterine contraction b. Cervical dilatation c. Cord d. Color of amniotic fluid

c. Cord

A 35-year-old G3P2 at 38 weeks AOG came in due to frank rupture of amniotic fluid. Patient was hook to a fetal monitor. CTG strips revealed rapid drop of fetal heart rate with good variability with decelerations. What is your immediate potential intervention in the above case? a. Give tocolytics b. Initial lateral decubitus position c. Discontinue oxytocin d. Manually elevate presenting part while preparing for immediate delivery

d. Manually elevate presenting part while | preparing for immediate delivery

A 29-year-old G2P1 at 30-week gestation comes to see you with new onset gastric reflux not responsive to antacids. The patient reports that she did not experience this symptom during her first pregnancy at age 20. What physiologic changes of pregnancy explained this symptom? a. Increase gastric emptying time b. Increase large bowel motility c. Decrease water absorption in the small bowel d. Decrease gastroesophageal sphincter tone

d. Decrease gastroesophageal sphincter tone

Which of the following cases is categorized as nonmaternal death? a. Death due to congestive heart failure secondary to Rheumatic heart disease b. Death due to complications of cervical cancer associated with pregnancy c. Death from cerebrovascular accident secondary to preeclampsia severe d. Death from cardiac failure secondary to thyroid storm in pregnanc

b. Death due to complications of cervical cancer | associated with pregnancy

Which of the following is considered pregnancyassociated death?11 a. Death due to DIC secondary to severe health secondary to preeclampsia b. Death due to hypovolemic shock secondary to ruptured ectopic pregnancy c. Death due to cardiac failure secondary to mitral stenosis d. Death due to hemorrhage secondary to uterine rupture

b. Death due to hypovolemic shock secondary | to ruptured ectopic pregnancy

As a public health officer in Angeles City, your live birth is 9500, your stillbirth is 59. Your data for death of live birth born neonate before 7 days is 60. You are asked to compute for the fetal death rate. a. 5.5 b. 6.2 c. 7.3 d. 8.2

b. 6.2

c. 12.5

``` Which of the following placental steroid hormone serve as a substrate for fetal adrenal gland production of glucocorticoids and mineralocorticoids? a. Estrogen b. Progesterone c. hCG d. HPL ```

b. Progesterone

A diagnosis of syphilis was made on a pregnant woman who came in for a painless vulvar ulcer. Which of the following is true of the disease? a. Transmission to the fetus occur slowly during the secondary stage of the disease b. Treponema can survive for years in the infant and later cause disease c. Usually transmitted to the fetus as ascending infection d. CNS manifestation on the mother appears as tertiary disease

b. Treponema can survive for years in the infant and later cause disease Congenital syphilis is a chronic infectious disease caused by a spirochete (treponema pallidum) acquired by the fetus in the uterus before birth. Symptoms of this disease may not become apparent until several weeks or months after birth and, in some cases, may take years to appear. (rarediseases.org)