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In the Name of God
Obstetrics study guide 5
Mitra Ahmad Soltani
2008
References
• Braunwald Eugene, et al. Harrison's Principles of Internal
Medicine. 16th edition. McGrawHill; 2005
• Iranian Council for Graduate Medical Education. Exam
questions.1998-2007
• Iranian Council for graduate Medical Education. Board and
pre-board Exam questions for OBS and Gyn.2001-2006
• Pritchard JA, MacDonald PC, Gant NF. Williams
Obstetrics. 22nd ed. New York, NY: McGraw-Hill; 2005
What is the most common kidney stones during
pregnancy?
A-calcium phosphate
B-uric acid
C-calcium oxalate
D-struvite
Ans:c
Treatment of stones in pregnancy: double J stent
Which type of stone is more common in these
disorders?
1- hyperparathyroidism
2-intestines disorders
3-bladder
4-prostate
5-proteus infection
Ans:
1/phosphate
2/oxalate
3/uric acid-calcium oxalate
4/calcium phosphate
5/struvite
What should be done in a 14 wk pregnant woman
suffering from flank pain, frequency, and bacteriuria of
30000/mL?
A-treatment
B-repeat of U/A, U/C
C-IVP
D-No action is needed
Ans:A
A 22 wk pregnant woman has repeated episodes of
bacteriuria in pregnancy. Which prophylaxis is
recommended?
A-Amoxicillin 3 grs single dose
B-Nitrofurantoin 100 mg qd till the pregnancy is
terminated
C-Sulfonamide 500 mg qid for three days
D-Nitrofurantoin 100 mg qid for 21 days
Ans:B
Which is not a consequence of acute pyelonephritis?
A-Reduced GFR and Cr clearance
B-ARDS
C-Hemolysis
D-Reduced erythropoietin production
Ans:D
A pregnant woman suffering from pyelonephritis is
hospitalized but her fever and pain persists despite
antibiotic therapy. Ultrasound shows no pathology.
What do you recommend?
A-kidney CT
B-repeat of U/C
C-cystoscopy
D-IVP
Ans:D
Which is true in a pregnant woman with asymptomatic
bacteriurea?
A-If not treated 50% of cases proceed to acute
Infection.
B-If not responsive to initial antibiotic,
nitrofurantoin for 21 days should be given.
C-Recurrent rate is less than 10 percent.
D-Single dose therapy has high failure rate.
Ans:B
In a kidney transplanted woman, Which is a
contraindication for pregnancy?
A-presence of severe HTN one year after kidney
transplant.
B-When there is no sign of transplant rejection.
C- in presence of intermittent proteinurea.
D- When drug therapeutic level is reached.
Ans:A
Which is not happening in an acute pyelonephritis ?
A- thermo-regulatory instability
B-reduced glomerular filtration rate
C-hemolysis
D-increased erythropoeitin production
Ans:D
Which is wrong about dialysis in pregnancy?
A-Type of dialysis-hemodialysis versus
peritoneal-does not significantly influence
pregnancy outcome.
B-Longer duration of dialysis can have better
results.
C-Abortion and preterm labor are common.
D-Neonatal survival is better when dialysis
starts before conception.
Ans:D
Which is true about ureteral stones in pregnancy?
A-They are common in pregnancy.
B-Flank pain is the most common symptom.
C-More than 80% have hematuria.
D-Laser is contraindicated in pregnancy.
Ans:B
Which statement is wrong?
A-Protein filtration rate increases during
pregnancy.
B-Protein excretion is constant throughout
pregnancy.
C- Cr more than 0.9 mg/l per day shows kidney
lesion.
D-kidney biopsy is better to be done after
pregnancy.
Ans:C
Which is a wrong statement?
A- Low protein diet is advised for CRF in
pregnancy.
B- Higher rate of preeclampsia is the only risk of
CRF in pregnancy
C-50% of CRF pregnant women will develop
HTN.
Ans:A
Which is a true statement?
A-Renal calculi are more common in pregnancy
but because of ureteral dilation they are less
symptomatic.
B-Hematuria is the most common sign of renal
calculi in pregnancy.
C-Lithotripsy can be used for early pregnancy .
D- Ultrasound is the preferred method for
diagnosis of renal calculi
Ans:D
Which is not an appropriate follow up for a G2/hix of
infertility/10wks GA pregnant woman?
A-Frequent prenatal visit for BP monitoring
B-Serial serum Cr and urine protein
measurements
C-serial U/C
D-Low protein diet and 180 mg supplemental
iron
Ans:D
A pregnant woman has acute pyelonephritis. Despite
outpatient therapy she develops oliguria, hypoxia,
acidosis, and encephalopathy. BP and CXR are normal.
What is the diagnosis?
A- SIRS
B-severe sepsis
C-ARDS
D-Septic shock
Ans:B
Points to remember
Cr in Urine:
• 20-25 mg/kg male
• 15-20 mg/kg female
In a 24 hr urine:
• 40-150 mg prot
• 600-1800 mg Cr
• 600-2500 cc =volume
IMP: Pyelonephritis
• General: condition/position/diet
• Lab: CBC diff, BG, Rh, U/A,U/C, k, Na, BUN/Cr, WW, MP,B/CX2
(Repeat of U/C after initiation of antibiotics if positive then
kidney sono)
• reserve of 2 units of PC
• IV : 1000cc DW5% free
• AMP keflin 2 gr stat then 1 gr q6h
• Amp gentamicin 80 mg im stat then 60 mg tds
• OTHER: Control of vital sign q4hrs, control of FHR,FAD chart ,
check of I/O with measure, sono OB
Which is the most common cause of intestinal
obstruction in pregnancy?
A-vulvolus
B-adhesions
C-hernia
D-appendicitis
Ans:B
Which is wrong about cirrhosis in pregnancy?
A-Pregnancy is very rare .
B-Alcohol consumption is the leading cause
C-Esophageal sclerotherapy is a good
management in pregnancy
D-Porto-systemic shunts can reduce mortality
rate
Ans:B
Post necrotic cirrhosis due to hepatitis(B,C) is
more common in pregnant cases.
Which is not a complication of hyperalimentation?
A-hemothorax
B-cholesthasis
C-tamponade
D-preterm delivery
Ans:D
Which is wrong about appendicitis in pregnancy?
A- High fever is a constant finding.
B-WBC can be more than16000 in mL(with
PMN>80%).
C- Rebound tenderness is present in 50% of
cases.
D-Concomitant UTI can make the diagnosis
difficult.
Ans:A
A 28 year old 38 wk pregnant woman complains of
periumbilical pain with rebound, emesis and vomiting.
FHR is regular. There is no labor pain. WBC=12000/
ultrasound normal/T=37.6 C. What is the diagnosis?
A-pyelonephritis, TX=antibiotic
B-appendicitis, TX=antibiotic,laparatomy
C-false labor,TX=observation
D-degenerated myoma, TX=observation
Ans:B
Which is a wrong statement?
A-Hepatitis B is not transmitted from mother to
the fetus.
B-Only HBs Ag, and Hbe Ag positive mothers can
transmit it to their fetus.
C-Hepatitis B IG +vaccine should be given to
the newborns of HBs Ag positive mothers.
D-High risk pregnant women can take one dose
of hepatitis vaccine in pregnancy.
Ans:A
Which is a wrong statement?
A- Acetaminophen intoxication signs are
vomiting, sweating, pallor and weakness.
B-Liver failure occurs after 24-48 hrs from
ingestion.
C-Treatment should be started after 4hrs
according to a plasma level >120 mcg/ml.
D-Tx is N-acetylcysteine 30 mg/kg stat and then
70 mg/kg q4h for 17 doses (72 hours)
Ans:D
A mother with Hbe Ag positive chronic hepatitis B is
giving birth to a contaminated newborn. What is not a
possible route of transmission?
A-Digestion
B-milk
C-saliva
D-placenta
Ans:D
A 36wk pregnant woman is icterus and has generalized
pruritus. ALT and AST are normal. But Bil is highly
elevated and AlP is slightly increased . Liver ultrasound
is normal. What is the most probable diagnosis?
A-intrahepatic cholesthasis
B-gall stones
C-PUPPP
D-hepatitis
Ans:A
A 29 year old 28 wk pregnant woman with BMI=30
complains of vomiting, RUQ pain and fever.
WBC=13800/ml and ultrasound shows small gall
stones. What is the best management?
A-ursodeoxycholic acid PO
B-lithotripsy
C-hospitalization and observation
D-cholecystectomy
Ans:D
Which case of needlestick without previous vaccination
should receive hepatitis B IG?
A -HBV test result of the patient=neg/
physician=pos
B- Tests results of the patient=pos/
physician=neg
C-No action is needed if both of them are HCV
negative.
D-Both of them should receive IG immediately.
Ans:B
Which is a good diagnostic test for fatty liver of
pregnancy?
A- ultrasound
B-MRI
C-CT scan
D-lab or clinical findings
Ans:D
In a pregnant woman with hyperemesis gravidarum,
weight loss, normal brain MRI and serum electrolytes,
Which vitamin deficiency can result in convulsions and
coma?
A-B1
B-K
C- B2
D- B6
Ans:A
Obese pregnant women have higher risks of:
A-thrombophelebitis
B-HTN
C-C/S
D-placenta previa
Ans:D
Which is wrong in a pregnant woman who complains of
abdominal colicky pain, distension, constipation and
bilious vomiting?
A- During pain bowel sounds are enhanced.
B-Reduced bowel sounds shows ischemia.
C-Increased WBC and fever occur in the early
course of obstruction.
D-Bowel gas in AXR rules out ileus.
Ans:C
Which is false?
A- Peptic ulcer in young women is mostly in
deodenum.
B-There is no exacerbation in achalasia course
C- Asymptomatic diaphragmatic hernia should
not be operated
D-Peptic ulcer symptoms subside in pregnancy
Ans:C
Which is a wrong statement about intrahepatic
cholestasis?
A-Oral antihistamines are useful
B-Cholestyramine can cause vit K deficiency
C-Ursodexy cholic relieves prupritus and lowers
liver enzymes
D-Cholestasis has no adverse effect on
pregnancy
Ans:D
Which is ture about IBS in pregnancy?
A- It is exacerbated in pregnancy.
B-It can have adverse effect on pregnancy.
C-Steroid is contraindicated in pregnancy.
D-Surgery is contraindicated in pregnancy.
Ans:B
A 12 wk pregnant woman HBS Ab=neg comes for
advice because she finds out her husband is HBS Ag+.
What do you suggest ?
A-IG +vaccine with booster dose one month and
then six month later
B-IG during pregnancy and a vaccine for the
newborn
C-vaccine
D-IG during pregnancy and vaccine after the
delivery
Ans:A
A pregnant woman complains of heart burn in the last
wks of her pregnancy. Antacid and H2 antagonist do
not help. What is your next step?
A- liver enzyme test and ultrasound
B-metoclopramide
C- GI ultrasound
D-endoscopy
Ans:D
What is true about a newborn of an HBS Ag+/NBeAg/HBeAb+ mother?
A- Hepatitis is transmitted through placenta.
B-There is an 80% risk of contamination during
delivery.
C- Breast feeding can be a route of transmission.
D- Usually the newborn is not affected.
Ans:D
Which is true about hepatitis in pregnancy?
A- It has poor prognosis.
B-It can cause preterm labor.
C-It is transmitted via placenta.
D-Vaccination is more preventive during
pregnancy than non pregnancy.
Ans:B
Which is not true about a case of hyperemesis
gravidarum?
A-It is more common in male sex fetus
pregnancies.
B-Hunger causes acidosis and vomiting causes
alkalosis.
C-It can cause vit B1and K deficiency.
D-It can happen because of cholecystitis.
Ans:A
What is the first step in the management of peptic
ulcer in pregnancy?
A-antacid
B-H2 blockers
C-PPI
D-sucralfate
Ans:A
A 35 year old G3/ P2 /20 wk GA/ complains of severe
pain in RUQ with vomiting and fever. You find no
abdominal distension. What is the diagnosis?
A-severe preeclampsia
B-gallbladder stone
C- cholecystitis
D-pancreatitis
Ans: C
Which is true about scleroderma?
A-3/4 of cases will have exacerbations in
pregnancy.
B-Increased collagen production is the main
reason for scleroderma.
C-More than 50% of patients die of kidney or
pulmonary involvement.
D-Pregnancy have relieving effect on dysphagia
and reflux .
Ans:B
Which is wrong about a new born with Lupus and heart
block?
A- Steroid given to the mother before 16 wks of
GA can prevent new born heart block.
B- It has poor prognosis for the new born.
C-All mothers are Ab SS-A and SS-B positive.
D- Heart block is transient in the new born.
Ans:D
Which drug can not cause drug-induced SLE?
A- quinidine
B-phenobarbital
C-hydralazine
D-OCP
Ans:D
Which is wrong about SLE in pregnancy?
A- Lupus nephropathy is very similar to severe
preeclampsia.
B-It can have convulsions like preeclampsia.
C-It can cause thrombocytopenia.
D-New born heart block can be cured by
treatment.
Ans:D
A 30 year old G3 /10 wk GA/with 2 previous fetal demise
complains of knee arthritis and rashes on the face. She has IgG
antiphospholipids of 50 units and her Sm Ab is positive. What is
the best treatment for her?
A- Therapeutic dose aspirin till 24 wks and then low
dose aspirin up to delivery +hydroxychloroquine
B-Heparin 5000 units bd sc+ aspirin 80 mg
C-Heparin7500 units sc bd +aspirin60 mg daily+
prednisone 1- mg per day
D- Azathioprine 3 mg /kg po +prednisone 1 gr daily for
3 days and then 1-2 mg/kg daily till delivery
Ans:C
Which is true about RA?
A- It is exacerbated in pregnancy.
B- There is no change in the course of disease in
pregnancy.
C- Flares happen after delivery.
D- OCPs are not recommended.
Ans:c
Which antibody is more specific for the diagnosis of
SLE?
A- Anti nuclear
B-anti Sm
C- anti phospholipid
D- anti histon
Ans:B
Which antibody is more common in a patient whose
new born suffers heart block?
A- anti SS
B-Anti phospholipid
C-anti nuclear
D-anti DNA
Ans:A
Which is true about RA in pregnancy?
A- There is an increased risk of preterm delivery.
B-MTX is not contraindicated in pregnancy.
C- Symptoms subside after delivery.
D-IUD is not recommended.
Ans:D
Which is a better treatment for a 28 year old woman
/G3/8wks GA/IgG anti phospholipid 45 units/history of
2 IUFD?
A-Enoxaparin 40 mg daily sc
B-Aspirin 80 mg daily + prednisone 15 mg daily
C-Prednisone 1mg/kg+ IG 0.4 gr/kg daily
D-Enoxaparin 40 mg daily+ aspirin 80 mg daily
Ans:D
A 25 yrs old woman /w=43 kg/ 26 wks GA/ Hb=8
complains of anorexia. What is your management?
A- 100 mg Iron
B- 200 mg Iron+ multivitamin and folic acid
C- 100 mg Iron+ multivitamin and folic acid
D- 60 mg Iron+ folic acid
Ans:B
Which is true about hemophilia A and pregnancy?
A- It is because of factor 8(Christmas) deficiency.
B- 50% of male children will have the disease.
C- By CVS we can diagnose it prenatally.
D- Labor and delivery can cause hemorrhage in
the fetus or new born.
Ans:C
Which is a wrong statement?
A- Anemia in the second trimester is a risk factor
for preterm delivery.
B-IDA can cause LBW in the new born.
C-Hb>13.2 in the second trimester can reduce
neonatal mortality rate.
D-30% of maternal mortality rate in third world
countries is because of anemia.
Ans:C
Which is true about ITP ?
A- Maternal and fetal platelet count are closely
correlated.
B- It is mandatory to take scalp blood sample for
platelet count.
C- There is no evidence that pregnancy increases
the risk of ITP exacerbation.
D- Fetus has more risk of having low platelet
count.
Ans:C
Which is wrong?
A- The outcome of pregnancy is related to the
etiology of anemia.
B- Hb>13 has adverse effects on pregnancy
outcome.
C-Hb>13.2 in the second trimester can reduce
neonatal mortality rate.
d-Anemia can cause maternal complications
and hospitalization.
Ans:D
Which is wrong about ITP?
A- Pregnancy is not responsible for ITP
recurrence.
B-If platelets are below 50000, steroids should
be initiated.
C- Cases of ITP that do not respond to steroids
should receive IVIG.
D- There is close relationship between maternal
and fetal platelet count.
Ans:D
A 36 wk pregnant woman with sickle cell anemia has
severe pain in her legs. Which is more effective?
A-heparin
B-dextran
C-hydration+ morphine
D-RBC transfusion
Ans:C
Which is wrong about aplastic anemia in pregnancy?
A-1/3 of cases need termination of pregnancy.
B- 50% die perinatally.
C- Androgen steroids are effective.
D- Granulocyte transfusion is used to prevent
infection.
Ans:D
Which is true about sickle-cell anemia in pregnancy?
A- 60% have non-reactive NST.
B- Systolic-diastolic ratio in uterine artery is
reduced.
C- Attacks cause reduction of fetal perfusion.
D-C/S is the choice.
Ans:A
Which is true about megaloblastic anemia in
pregnancy?
A- It is always because of folic acid deficiency.
B-It is seen in vegetarians.
C- It is seen more in women who consume meat.
D- Megaloblastic anemia causes bulimia.
Ans:A
Which is wrong about the effect of sickle-cell anemia
on cardiac function?
A-Heart disease is rarely a cause of death.
B- In most cases ventricular dysfunction will be
corrected by reduction in preload, increase in
afterload, and reduction in ejection fraction.
C- Output and blood volume is increased in pregnancy.
D- Severe preeclampsia with sickle-cell disease can
cause ventricular dysfunction .
Ans:B
Which is true for cases of pregnancy-induced hemolytic
anemia?
A-Steroids are useful.
B-It happens in the third trimester.
C- It subsides by pregnancy termination.
D- There is no immunological etiology involved.
Ans:A
Which is true about Von willebrand’s Disease?
A-It has AD inheritance.
B-It is rarely acquired.
C- Hemorrhage after delivery is rare.
D- Pregnancy outcome differs from normal
pregnancies.
Ans:A
What will happen if Iron requirement of a pregnant
woman can not be met in the second trimester?
A- It has no effect on her serum iron level.
B-It has no effect on maternal Hb or Hct.
C- It has no effect on fetal Hb.
D- It has no effect on her serum ferritin.
Ans:C
In which group of ITP, splenectomy is not
recommended?
A- Those who need high dose of treatment for
remission.
B-Those with recurrent episodes.
C-Those who respond to steroids within 2 wks
of treatment.
D-Those who are not responsive to high dose
gamma globulin.
Ans:C
Which is true about antithrombin deficiency in
pregnancy?
A- It is the most common thrombophilias in
pregnancy.
B- It occurs 2-5 in 1000 population.
C- New born will have purpura fulminans.
D- It has an AR inheritance pattern.
Ans:A
Which is wrong?
A-Hyperpigmentation occurs in the last 4- 5
months of pregnancy.
B-Nevi enlarge and become hyperpigmented.
C-Hyperpigmentation is exacerbated by UV light.
D-Hyperpigmention is more pronounced in
white people.
Ans:A
What is true about PUPPP?
A- They occur in the second trimester of
pregnancy and can cause maternal sepsis.
B-They happen early in the course of pregnancy
and can cause abortion.
C-They happen in the first trimester of
pregnancy and can cause preterm labor.
D- They disappear by the third wk after delivery.
Ans:D
Which is accompanied by high MMR?
A- psoriasis
B- pemphigus
C-herpes gestationis
D-Neurofibromatosis
Ans:B
Which is wrong about melanoma in pregnancy?
A- 90% it is on a previous nevi.
B- Therapeutic abortion would increase 5 year
survival.
C- It is fatal.
D- It is recommended that pregnancy be
avoided 3-5 years from treatment .
Ans:B
Which is wrong about pemphigoid?
A-It is urticarial papules on the abdomen and
limbs.
B- By delivery they disappear.
C- It recurs in the next pregnancies.
D- It is related TO HLA-DRJ andHLA-DR4
Ans:B
Which disorder subsides by pregnancy?
A neurofibromatosis
B- psoriasis
C- pemphigus
D-Hansen’s disease
Ans:B
Which is accompanied by C3 deposition in basal
membrane?
A- pruritus gravidarum
B- PUPPP
C-herpes gestationis
D-prurigo of pregnancy
Ans:C
feature
pruritus
urticaria
Papules and
dermatitis
vesicles
With systemic
symptoms
Disease
Cholestasis of pregnancy: the most
common dermatological disorder
associated with pregnancy – it
doesn’t need steroid
PUPPP: no adverse effect on the
perinatal outcome
Prurigo of pregnancy: does not recur
in subsequent pregnancy
Herpes gestationis:C3 deposition in
the basement membrane
Impetigo herpetiformis:
microabscesses spongiform pustules
of Kogoj
Which is not necessary prior to syphilis treatment?
A-Allergy testing for penicillin
B-HIV antibody testing
C- serological testing
D-Lumbar puncture
Ans:D
Which is wrong about HIV + patients?
A-They have to be vaccinated against hepatitis,
pneumococcal infection, influenza.
B-CIN is more common in HIV + with HPV.
C-CD4 count is the best indicator of response to
treatment.
D-ZDV is not necessary for patients with CD4
count of less than 300 cells /mL.
Ans:D
Which is true about the newborn of a syphilitic
mother?
A- It won’t be infected if pregnancy happens in
the “late latent” stage of syphilis.
B- It won’t be infected if mother has taken
benzathine penicillin G during pregnancy.
C-If mother was treated by erythromycin,
newborn needs Lumbar Puncture.
D-If the newborn is seropositive with a normal
CSF, no treatment is needed.
Ans:D
A 12 wk pregnant woman has close contact with a child
with mumps. What is your suggestion?
A- No action is needed.
B-Amantadine till delivery.
C-IG
D-acyclovir IV
Ans:A
Which is wrong about ZDV in pregnancy?
A-It is not recommended in the first trimester of
pregnancy.
B-It is given for prevention after close contact.
C-It is administered throughout pregnancy for
prevention of transmission to the fetus.
D-It is not contraindicated during pregnancy.
Ans:A
Which is a risk factor for future diabetes in the fetus?
A-enterovirus
B-hantavirus
C-adenovirus
D-herpesvirus
Ans:A
Which is a good treatment for chlamydia infection in
pregnancy?
A-Erythro Estolate 500 mg qid for 7 days
B-Erythro ethylsuccinate 400 mg qid fro 7 days
C-amoxicillin 500 mg tds for 7 days
D- erythromycin base 250 mg qid for 7 days
Ans:C
Erythro estolate and tetracyclin are
contraindicated in pregnancy
Chlamydia treatment in pregnancy- red ink is the first
choice:
amoxicillin 500 mg tds for 7 days
erythromycin base 500 mg qid for 7 days or 250
mg qid for 14 days
Erythromycin Estolate 500 mg qid for 7 days
Erythromycin ethylsuccinate 800 mg qid for 7
days Or 400 mg qid for 14 days
Azithromycin 1 g as a single dose
What is postexposure prophylaxis of an HIV +
needlestick injury?
A-ZVD 200 tds+ lamivudine 100 mg BD for 4 wks
B- follow up with antibody testing
C- Indinavir 800 mg tds for 4 wks
D- indinavir 800 mg tds for six months
Ans:A
If the source patient has advanced AIDS , a high load
of HIV or has been treated with nucleoside
analogues, indinavir 800 mg tds is added
Which is wrong about influenze in pregnancy?
A- Amantadine 200 mg/d in the first 48 hrs
reduces symptoms.
B- Infection in the first or second trimester can
cause fetal malformation
C- All women should be vaccinated against
influenza after the first trimester.
D- Amantadine effect in pregnancy is not proven
yet.
Ans:B
What is the best prophylaxis for a 20 wk pregnant
woman who wants to travel to a country where malaria
is prevalent?
A- chloroquine
B-mefloquine
C-quinine
D-quinidine
Ans:A
What is the treatment of GBS in a 36 wk pregnant
woman who complains of vaginal discharge?
A- ampicillin till delivery
B-penicillin injection for the new born
C-penicillin and gentamicin for one week
D-ampicillin IV for the mother and penicillin G
for the new born after delivery
Ans:D
Which is not true for an HIV positive pregnant woman
in her prenatal care?
A-vaccination against hepatitis B and influenza
B-if CD4 count is below 200/mcl, prophylaxis
against P.carini.
C- determination of CD4+ count till delivery
D- Avoiding mouth suction devices for clearing
the airway
Ans:C
What is the gold standard diagnostic test for a 32 wk
pregnant woman with herpetic genital lesions?
A- papanicolao staining(Tzanck)
B- PCR
C- culture
D-HSV-2 antibody
Ans:C
Which is true about gonorrhea?
A- There is no correlation between G. infection
and spontaneous abortion.
B- PROM is more prevalent.
C- G. infection only affects the fetus in the third
trimester.
D-The drug of choice is ceftriaxone if the mother
is allergic to penicillin.
Ans:B
Which is the best test for diagnosis of fetal
contamination with Toxoplasmosis?
A-PCR
B- IgG
C- IgM
D-ultrasound for malformations
Ans:D
Which is true about CMV?
A- Antibody measurement is not recommended.
B- In suspected cases IG is injected.
C- GU secretion culture is recommended.
D- If antibody is present, acyclovir should be
given.
Ans:A
What should be done in a pregnant woman in labor
who complains of varicella zoster infection for three
days?
A-ZIG for the new born
B-Varivax for the new born
C- no action is needed
D- VZIG for the mother
Ans:A
Varicella zoster
• The least probable contamination period is
during 13-20 weeks of GA.
• VZIG during the first 96 hrs from close contact
is preventive to the mother.
• VZIG dose is:125 units/10 kg IM
• VZIG for the newborn is needed when the
mother shows the symptoms within 5 days
before to 2 days after delivery.
Pneumonia treatment in pregnancy
• Uncomlicated (pneumococci, mycoplasma,
chlamydiae): erythromycin 500-1000 mg every 6
hours
• Haemophilus:cefotaxime,ceftizoxime,
Cefuroxime
• Penicilline resistance: levofloxacin
• Influanza: amantadine 200 mg daily if begun within
48 hours of symptoms
• Varicella:acyclovir iv 10 mg/kg every 8 hours
• VZIG:within 96 hrs of exposure 125u/10kg im
What should be done for a 6 wk pregnant woman who
had close contact with a patient suffering from
Rubella?
A- If IgG is negative, IG is given.
B- No action is needed if IgG and IgM are
positive.
C- No action is needed if IgG is positive and IgM
is negative.
D- Pregnancy should be terminated if IgG and
IgM are positive.
Ans:C
What is wrong about gonoccocal eye infection
prophylaxis in a new born?
A- Ceftriaxone 25-50 mg/kg IM or IV to the new
born
B- Erythromycin eye ointment
C- C/S
Ans: C
Which is wrong?
A-The best screening test of congenital syphilis is
umbilical blood test.
B- VDRL and PRP are often positive in primary
syphilis.
C-VDRL and RPR are always positive in
secondary syphilis.
D-PCR of amniotic fluid is 100% specific.
Ans:A
Which is true about toxoplasmosis in pregnancy?
A- Most cases present with acute infection
symptoms.
B- Fetal contamination risk reduces as
pregnancy advances.
C- Maternal contamination prior to pregnancy
has no effect on the fetus.
D- 50% of new born have retinal involvement.
Ans: C
A G2 38 wk pregnant woman on acyclovir ( for history of herpes)
has no herpetic lesion in perineum, vagina and cervix now. Fetus
has normal heart tone. What should be done?
A-doubling acyclovir dosage+ Induction of labor
B- induction of labor
C- doubling acyclovir dosage+ C/S.
D-C/S after 12 hrs
Ans:B
How can you prevent vertical contamination from an
HIV-AIDS mother?
A-ZVD during pregnancy + C/S+ forbidding
breast feeding
B-ZDV during labor till one month after delivery
C-ZVD after delivery for one wk to both mother
and the newborn
D-C/S in case of ROM +ZVD as long as the new
born is breastfed
Ans: A
Which is wrong about a mother who develops rubella
symptoms?
A- There is a 50% chance that the fetus is
contaminated after 26 GA.
B- Malformations occur in all fetuses with
contamination prior to 11 wks .
C-Pan encephalitis and diabetes type I happen in
the second and third decade of life.
Ans:A
What is the treatment of Condylomata Acuminata in a
33 wk pregnant woman?
A- Podophylline resin
B- interferon
C- 5-flurouracil cream
D- trichloroacetic acid
Ans:D
What should be prescribed for a newborn with
chlamydia ophthalmic lesions?
A-Erythromycin 50 mg/kg /d PO 10-14 days
B-Amoxicillin Po 50mg/kg/d for 7-10 days
C- azithromycin single dose
D-AgNO3 drops single dose
Ans:A
What should be prescribed to prevent chlamydia
ophthalmic lesions in a newborn?
A-Erythromycin PO 10-14 days
B-Amoxicillin Po 7-10 days
C- AgNO3 drops single dose
D- These drugs are not effective for prevention.
Ans:D
In a 15 wk pregnant woman with possible CMV
infection, IgM and IgG tests are not conclusive. What
should be doen?
A- US and amniocentesis
B- No further work/up is needed.
C- treatment with ganciclovir
D-repeat of serologic tests
Ans:A
GBS prophylaxis in needed in:
1-preterm labor before 37 wks
2-pre term rupture of the membranes
3-ROM more than 18 hours
4-GBS infection in a previous newborn
5-T>=38 c during labor
6- history of GBS bacteriurea
C/S is needed in cases of herpes:
• If primary or recurrent lesions are visualized
near the time of labor or when the
membranes are ruptured.
• Disregard the duration of rupture.
A 21 yr old 30 wk pregnant woman on methimazole for
thyrotoxicosis complains of fever, sore throat and
tachycardia. What is your management?
A-d/c methimazole
B- thyroidectomy
C-adding thyroxine
D-termination of pregnancy
Ans:A
PTU 300-450 mg/d is preferred in pregnancy.
A 28 yr old /G2/P1/ 31 wk GA/ complains of headache ,
galactorrhea and visual disturbances. What is your
management of this case of pituitary macroadenoma?
A- surgery
B-bromocriptine
C-pregnancy termination
D- radiation
Ans:B
Which is wrong?
A-Methimazole and PTU cross placenta.
B-They are similar in terms of side effects.
C-PTU is preferred in lactating mothers.
D-Repeated CBC check is recommended to R/O
agranulococytosis.
Ans:D
Which is wrong about postpartum thyroiditis?
A-Goiter is usually large.
B- Thyrotoxicosis happen in the early phase.
C- Goiter is painless.
D- Fatigue and palpitations are two common
symptoms.
Ans:A
Thyroiditis(reduced RAIU)
cause
feature
Amiodarone
Reduced T4  increased T4, reduced T3, increased
TSH, increased rT3
Acute
TFT normal-pain-fever-Increased ESR- increased WBC
Riedel
TFT normal-Pressure on adjacent organs- firm goiter
deQuervain’s
Or subacute viral
Or granulomatos
TFT change in three stages:
0-6w(hyper)
6-12w(hypo)
>12w(normal)
Silent
Or painless
Or subacute lymphocytic
Or postpartum
HyperthyroidismTreatment is beta blockers
Chronic lymphocytic
Or Hashimoto
Hurthle cell ,prone to lymphoma type B-the most
common cause of hypothyroidism in areas with iodine
A pregnant woman G2/P1/25 wk GA/is hospitalized for
confusion. She developed fatigue, emesis, and vomiting
and psychiatric problems since three days ago. The lab
results show hypercalcemia. What is your
management?
A-daily phosphate
B- termination of pregnancy
C-NS+ furosemide
D-steroids
Ans:C
What is recommended for a pregnant case of Addison
disease?
A-increasing her glucocorticoid dose
B-adding mineraocorticoids
C-Hydrochortisone 100 mg q8hrs during labor
and delivery
D-increasing her glucocorticoid dose in lactation
Ans:C
A pregnant woman suffers cardiac failure after a thyroid
storm. She is in ICU now. What is the best treatment?
A- PTU PO 1 gr loading dose and then 200 mg q6
hrs.
B-5 drops of supersaturated solution potassium
iodine (SSKI)q8hrs
C- 10 drops Lugol solution q 8 hrs
D- lithium carbonate 300 mg q6hrs
Ans:A
Thyroid Enlargement
• 1- unilateral:
• TSH=Nl,FNA=benign---->T4
• Hot in scan, follicular in pathology----> RAI
• Cold in Scan, follicular in pathology------->thyroidectomy
• 2-bilateral:
• Symmetric:
• T4 increased------>Graves------>methimazole,PTU
• T4 =nl----->goiter------>T4
• Nonsymmetric:
• Toxic MNG------> methimazole then RAI
• 3- reduced T4-------> levothyroxine (control by TSH)
• 4- reduced RAIU> deQuervain’s thyroiditis >Aspirin+
Glucocorticoids
Which is wrong about Cerebral Venous Thrombosis?
A- The risk is reduced in pregnancy.
B- Head ache is the most common symptom.
10% of patients will have convulsions.
C- Treatment is anticonvulsants and antibiotics.
D-Heparin anticoagulation is controversial.
Ans:A
Which is wrong about Multiple Sclerosis?
A-Pregnancy has no adverse effect on MS.
B-C/S is performed only for obstetrical
indications.
C-Spinal anesthesia is safe in MS.
D-Breast feeding does not cause exacerbations.
Ans:C
Which is the best treatment of depression in the first
trimester of pregnancy?
A- Imipramine
B-fluoxetine
C-amitriptyline
D-nortriptyline
Ans:B
Which is true about carpal tunnel syndrome in
pregnancy?
A- Ulnar nerve is involved.
B- Delivery relieves the symptoms.
C- It is unilateral in 80% of cases.
D- Surgery and steroid injections are the
treatment.
Ans:B
Which is wrong about epilepsy in pregnancy?
A-Epilepsy increases the risk of fetal malformations.
B- Pregnancy causes 35% increase in episodes.
C- The epileptic drug dose should be increased in
pregnancy because drug intestinal absorption is
reduced .
D- The epileptic drug dose should be increased in
pregnancy because drug metabolism is reduced .
Ans:D
What is your advice to a pregnant woman who takes
carbamazepine for epileptic seizures?
A-weekly NST from the 32 wk of pregnancy
B-measuring serum drug level in case of a
seizure
C-D/c of drug because of malformation risk
D-Vit K injection in the third trimester of
pregnancy
Ans:B
A 34 yr old 34 wk pregnant woman who developed
fever and severe head ache after delivery is in seizures
now. Her BP is 110/80 mmHg. She had no history of
convulsions or preeclampsia. What is your diagnosis?
A-Cerebral venous thrombosis
B- cerebral emboli
C-SAH
D-hemorrhagic stroke
Ans:A
Which is true about MS in pregnancy?
A- Steroids can reduce permanent disabilities.
B- The risk of relapse is more after delivery.
C-IFN B1a is teratogenic.
D- C/S is the best mode of delivery.
Ans:C