Week 8 multiple choice practice

Question 1

Pregnancies rupturing and hemorrhaging within the ___________ are a leading cause of maternal deaths in the 1st trimester.

Answer 1

fallopian tubes

Question 2

What is the optimal and most cost-effective strategy for diagnosing ectopic pregnancy?

Answer 2

TVUS followed by quantitative beta-hCG testing

Question 3

A patient presents with a tubal ectopic pregnancy that has begun to rupture; what should you Tx them with?
a) Methotrexate (PO or IM)
b) Surgical removal of pregnancy and/or tube
c) Both of the above
d) Neither of the above is the correct treatment

Answer 3

b) Surgical removal of pregnancy and/or tube

Question 4

The _______ a beta hCG is, the less likely methotrexate is to work for the ectopic pregnancy

Answer 4

higher

Question 5

After how many menstrual cycles is an abortion considered “missed” when retained?

Answer 5

More than 2

Question 6

A septic abortion is an intra_______ infection
a) Intrabdominal
b) Intrafallopian
c) Intraovarian
d) Intrauterine

Answer 6

d) Intrauterine

Question 7

When should you do a D&C? Select all that apply
a) Septic miscarriage
b) Complete abortion
c) Missed abortion
d) Partial abortion
e) Threatened abortion

Answer 7

a) Septic miscarriage
c) Missed abortion
d) Partial abortion

Question 8

In which of the following situations may the cervical os be dilated? Select all that apply
a) Septic miscarriage
b) Complete abortion
c) Missed abortion
d) Inevitable abortion
e) Incomplete abortion
f) Threatened abortion

Answer 8

d) Inevitable abortion
e) Incomplete abortion

(incomplete can be either dilated or closed)

Question 9

Which of the following is NOT typically a risk factor for first trimester pregnancy loss?
a) Genetics
b) Cervical insufficiency
c) Antiphospholipid antibodies
d) Asherman syndrome

Answer 9

b) Cervical insufficiency

Question 10

Which of the following is NOT generally a part of a spontaneous abortion workup?
a) TVUS
b) Serum estrogen level
c) Serum progesterone level
d) Serum quantitative hCG level

Answer 10

b) Serum estrogen level

Question 11

A patient’s hCG level has been rising every 48-72 hours, but not quite doubling. What is a potential cause of this?
a) Molar pregnancy
b) Incomplete miscarriage
c) Complete miscarriage
d) Ectopic pregnancy
e) Normal pregnancy

Answer 11

d) Ectopic pregnancy

Question 12

Medical abortion is appropriate up until the ______ day of pregnancy
a) 27th
b) 34th
c) 49th
d) 57th
e) 64th

Answer 12

c) 49th

Question 13

“Funneling” of the cervix may be noted on US during what?
a) Elective abortion
b) Incomplete abortion
c) Incompetent cervix
d) Ectopic pregnancy

Answer 13

c) Incompetent cervix

Question 14

Macrosomia is defined as a birth weight of _________ grams and can be predicted by abdominal circumference >______cm
a) 4000-4500 grams; >35cm
b) 3000-3500 grams; >35cm
c) 5000-5500 grams; >30cm
d) 3000-3500 grams; >30cm

Answer 14

a) 4000-4500 grams; >35cm

Question 15

Uterine atony or an undiagnosed cervical laceration were mentioned in the powerpoint to potentially occur with what?
a) Incomplete abortion
b) Complete abortion
c) Macrosomic births
d) Intrauterine Growth Restriction (IUGR)

Answer 15

c) Macrosomic births

Question 16

What is the most common cause of fetal growth restriction?
a) Hypoplastic/ infantile uterus
b) Abnormal placentation causing placental insufficiency
c) Oligohydramnios
d) Incompetent cervix

Answer 16

b) Abnormal placentation causing placental insufficiency

Question 17

With IUGR, fetal biometry measurements should be repeated every _____ week(s)
a) 1-2
b) 2-3
c) 3-4
d) 4-5
e) 5-6

Answer 17

c) 3-4

Question 18

In Tennessee, a fetal death is the death of a fetus weighing ______ or more grams.
a) 250
b) 350
c) 450
d) 550

Answer 18

b) 350

Question 19

DIC was mentioned to be a potential complication of what? Select two
a) Macrosomia
b) Intrauterine Growth Restriction (IUGR)
c) Complete abortion
d) Fetal death
e) Placenta previa
f) Placental abruption

Answer 19

d) Fetal death
f) Placental abruption

Question 20

What prevents normal development of the alveoli within the fetal lungs before 24 weeks?
a) Lack of time
b) Lack of amniotic fluid
c) Thoracic compression
d) The Congenital Diaphragmatic Hernia has not had time to close

Answer 20

b) Lack of amniotic fluid

Question 21

There is a doubled risk of PROM and PPROM in women who ____________.
a) Smoke
b) Drink
c) Consume marijuana
d) Are underweight

Answer 21

a) Smoke

Question 22

What PROM/PPROM test uses pH to distinguish amniotic fluid from urine and vaginal secretion; amniotic fluid pH >7.1 so impregnated paper turns dark blue?

Answer 22

Nitrazine test

Question 23

What PROM/PPROM test is more accurate than nitrazine but is super expensive?

Answer 23

Amnisure test

Question 24

Amniotic fluid placed on a slide and dries in room air which then resembles the leaves of a fern plant; considered to be more indicative of ruptured membranes than the nitrazine test

This describes what PROM/PPROM test?

Answer 24

Fern test

Question 25

What PROM/PPROM test can assess if there’s ample amniotic fluid around the fetus?

Answer 25

Ultrasound

Question 26

How is birth usually induced when a pt has PROM at 37 wks gestation? a) Membrane sweeping b) Amniotomy c) Digital exam d) Oxytocin (pitocin) infusion

Answer 26

d) Oxytocin (pitocin) infusion

Question 27

When should you consider corticosteroids for PROM/PPROM? Select all that apply a) Less than 24 wks b) Preterm (24-31 wks) c) Preterm (32-33 wks) d) Late preterm (34-36 wks) e) Term (>/= 37wks)

Answer 27

b) Preterm (24-31 wks) c) Preterm (32-33 wks) d) Late preterm (34-36 wks)

Question 28

Bacterial vaginosis (BV) can cause preterm birth. How should you treat BV in pregnancy? Select the two best options a) PO metronidazole (Flagyl) b) Topical metronidazole (Metrogel) c) Clindamycin d) Ceftriaxone

Answer 28

b) Topical metronidazole (Metrogel) c) Clindamycin

Question 29

E. coli and GBS are the two most common causes of what? a) Asymptomatic bacteriuria b) Acute pyelonephritis c) Chorioamnionitis d) Cervical/vaginal colonization

Answer 29

c) Chorioamnionitis

Question 30

Which of the following ARE tocolytics (uterine relaxants) used for preterm labor? Select all that apply a) Indapamide b) Indomethacin c) Nifedipine d) Magnesium sulfate e) Magnesium citrate f) Terbutaline

Answer 30

b) Indomethacin c) Nifedipine d) Magnesium sulfate f) Terbutaline

Question 31

A patient is 35 weeks pregnant and presents with a small amount of bright red and painless vaginal bleeding. What is a likely diagnosis? a) Macrosomia b) Placental abruption c) Placenta previa d) PROM

Answer 31

c) Placenta previa

Question 32

Which of the following may require hysterectomy post C-section? Select all that apply a) Placental abruption b) Placenta accreta c) Placenta previa d) Placenta increta e) Placenta percreta f) Couvelaire Uterus g) Vasa previa

Answer 32

b) Placenta accreta d) Placenta increta e) Placenta percreta f) Couvelaire Uterus

Question 33

Which type of breech position involves both feet positioned upward next to the baby’s face? a) Complete breech b) Incomplete breech c) Gerald breech d) Frank breech

Answer 33

d) Frank breech

Question 34

Many babies don’t “flip” before _____ weeks, which is why prematurity is the most likely cause of breech delivery a) 28 b) 30 c) 32 d) 34

Answer 34

c) 32

Question 35

What is the only face presentation that will allow for vaginal delivery? a) Mentum anterior b) Mentum posterior c) Mentum transverse d) None of the above

Answer 35

a) Mentum anterior

Question 36

Which position will be delivered via C-section, and cannot be converted to a position that allows vaginal delivery? a) Face b) Brow c) Shoulder d) Compound

Answer 36

c) Shoulder