Professional Documents
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a
b
c
d
e
severe headache
nystagmus
epigastric pain
liver tenderness
abnormal liver enzymes.
b
Nystagmus is not a presenting feature of pre-eclampsia.
One of the following is false... The following are associated with cord
prolapse:
a preterm labour
b fetal abnormality
c occipito-transverse position
d internal podalic version
e artificial rupture of the membranes.
c
There is no association between cord prolapse and occipito-transverse
position.
b
There is increasing experience in the use of spinal anaesthesia for delivery
by Caesarean section in women with placenta praevia.
One of the following is true... When categorising fetal rate pattern features
into reassuring, non-reassuring and abnormal:
a a baseline rate of 105 is reassuring
b a single prolonged deceleration lasting up to three minutes is abnormal
c early decelerations are abnormal
d variable decelerations are non-reassuring
e baseline variability of less than fi ve for 30 minutes is nonreassuring.
d
http://www.mediafire.com/?gkz3n1vgzfwcav7
b.
c.
d.
e.
Group B streptococcus
Rubella virus
Treponemal pallidum
Varicella zoster
c. Herpes simplex
d. Parvovirus
e. Rubeola
12. A 20-year-old woman who works as a kindergarten teacher presents for her
routine visit at 32 weeks. Her fundal height measures 40 cm. An ultrasound
reveals polyhydramnios, an appropriately grown fetus with ascites and scalp
edema. The patient denies any recent illnesses, but some of the children at
her school have been sick recently. What is the most likely cause of the fetal
findings?
a. Cytomegalovirus
b. Hepatitis B
c. Influenza A
d. Parvovirus
e. Toxoplasmosis gondii
13. A 25-year-old female in her first pregnancy delivers a 6-lb male infant at
38 weeks. The infant develops fever, vesicular rash, poor feeding, and
listlessness at 1 week of age. What is the most likely cause of the infants
signs and symptoms?
a. Cytomegalovirus
b. Group B streptococcus
c. Hepatitis B
d. Herpes simplex
e. Listeria monocytogenes
14. A 22-year-old woman delivers a 7-lb male infant at 40 weeks without any
complications. On day 3 of life, the infant develops respiratory distress,
hypotension, tachycardia, listlessness, and oliguria. What is the most likely
cause of the infants illness?
a. Cytomegalovirus
b. Group B streptococcus
c. Hepatitis B
d. Herpes simplex
e. L. monocytogenes
1. The answer is d.
* A mild group B coxsackievirus infection of the mother during the antepartum
period may give rise to a virulent infection in the newborn, sometimes
resulting in a fatal encephalomyocarditis.
*A maternal rubella infection may cause neonatal HSM, petechial rash, and
jaundice; in addition, viral shedding may last for months or years.
* Herpes zoster, the causative agent of varicella (chicken pox), is an
especially dangerous organism for the newborn. Varicella is rare in pregnancy,
but if it occurs shortly before delivery, the viremia may spread to the fetus
before protective maternal antibodies have had a chance to form. Congenital
varicella can be fatal to the newborn; the increasing availability of zoster
immunoglobulin, however, may allow clinicians to attack the infection before
significant fetal viremia has developed.
*Shingles, which is a reactivation of varicella, would not likely have fetal
effects because of already existing maternal IgG from the initial exposure.
* Herpes virus can be acquired by the fetus as it passes down the genital
tract and can cause a severe, often fatal herpes infection in the newborn.
2. The answer is b.
Rubella is one of the most teratogenic agents known. Risk of congenital
rubella infection in the fetus is 80% when the mother has a rubella infection
in the first trimester.
This risk decreases to 25% by the end of the second trimester.
3. The answer is c.
Spectinomycin is the treatment of choice for pregnant women who have
asymptomatic N. gonorrhoeae infections and who are allergic to penicillin.
Erythromycin is another drug that is effective in treating asymptomatic
gonorrhea. Although tetracycline is an effective alternative to penicillin,
its use is generally contraindicated in pregnancy.
Administration of chloramphenicol is not recommended to treat women, pregnant
or not, who have cervical gonorrhea
the use of ampicillin or penicillin analogues is contraindicated for
penicillin-allergic patients.
4. The answer is a.
Toxoplasmosis, a protozoal infection caused by T. gondii, can result from
ingestion of raw or undercooked meat infected by the organism or from contact
with infected cat feces.
The French, because their diet includes raw meat, have a high incidence.
5. The answer is e.
The incidence of major malformations in women with diabetes is 5% to 10%.
It is believed that they are a consequence of poorly controlled diabetes in
the preconception and early pregnancy period.
Glycosylated hemoglobin (Hgb A1c) level greater than 10.6 has a 25% risk of
fetal malformations.
The most common single organ system anomalies are cardiac (38%),
musculoskeletal (15%), and central nervous system (10%).
Sacral agenesis is a rare malformation seen commonly in severely diabetic
women
6. The answer is e.
Maternal infection with viruses and bacteria during pregnancy can cause an
array of fetal effects from none to congenital malformations and death.
Maternal infection with varicella-zoster during the first half of pregnancy
can cause malformations such as cutaneous and bony defects, chorioretinitis,
cerebral cortical atrophy, and hydronephrosis.
Adults with varicella infection fare much worse than children; about 10% will
develop a pneumonitis, and some of these will require ventilatory support.
7. The answer is b.
Rubella is one of the most teratogenic agents known.
Fetal manifestations of infection correlate with time of maternal infection
and fetal organ development.
If infection occurs in the first 12 weeks, 80% of fetuses manifest congenital
rubella syndrome, while only 25% if occurs at the end of the second trimester.
Congenital rubella syndrome includes one or more of the following:
eye lesions, cardiac disease, sensorineural deafness, CNS defects, growth
restriction, thrombocytopenia, anemia, liver dysfunction, interstitial
pneumonitis, and osseous changes.
Rubeola (measles) virus does not appear to have any teratogenic effect on the
fetus
8. The answer is a
Cytomegalovirus in the mother is usually asymptomatic, but 15% of adults will
have a mononucleosis-like syndrome.
Maternal immunity does not prevent recurrence or congenital infection.
Congenital infection includes low birth weight, microcephaly, intracranial
calcifications, chorioretinitis, mental and motor retardation, sensorineural
deficits, hepatosplenomegaly, jaundice, anemia, and thrombocytopenic purpura.
The virus is shed in the secretions of affected individuals.
9. The answer is e.
T. gondii is transmitted by eating infected raw or undercooked meat and
contact with infected cat feces.
Maternal immunity appears to protect against fetal infection
Acute infection in the mother is often subclinical, but symptoms can include
fatigue, lymphadenopathy, and myalgias.
Fetal infection is more common when disease is acquired later in pregnancy
(60% in third trimester vs 10% in first trimester).
Congenital disease consists of low birth weight, hepatosplenomegaly, jaundice,
anemia, neurological disease with seizures, intracranial calcifications, and
mental retardation.
Influenza does not cause any fetal effects.
and asymptomatic.
A 50% risk of neonatal infection occurs with primary maternal infection, but
only 4% to 5% risk with recurrent outbreaks.
Postnatal infectionoccur through contact with oral and skin lesions.
Neonatal infection presentation is nonspecific, with signs and symptoms such
as irritability, lethargy, fever, and poor feeding.
Less than 50% of infants do not have skin lesions.
You should question the patient if she has abused which of the following
substances during her pregnancy?
a. Alcohol
b. Benzodiazepines
c. Heroin
d. Methadone
4. Your 25-year-old patient is pregnant at 36 weeks gestation. She has an
acute urinary tract infection (UTI). Which of the following medications is
contraindicated in the treatment of the UTI in this patient?
a. Ampicillin
b. Nitrofurantoin
c. Trimethoprim/
sulfamethoxazole
d. Cephalexin
e. Amoxicillin/clavulanate
5. You diagnose a 21-year-old woman at 12 weeks gestation with gonorrhea
cervicitis. Which of the following is the most appropriate treatment for her
infection?
a. Doxycycline
b. Chloramphenicol
c. Tetracycline
d. Minocycline
e. Ceftriaxone
6. During a routine return OB visit, an 18-year-old G1P0 patient at 23 weeks
gestational age undergoes a urinalysis. The dipstick done by the nurse
indicates the presence of trace glucosuria. All other parameters of the urine
test are normal. Which of the following is the most likely etiology of the
increased sugar detected in the urine?
a. The patient has diabetes.
b. The patient has a urine infection.
c. The patients urinalysis is consistent with normal pregnancy.
d. The patients urine sample is contaminated.
e. The patient has kidney disease.
7.Which of the following is the most common form of contraception used by
reproductive-age women in the United States?
a. Pills
b. Condom
c. Diaphragm
d. Intrauterine device (IUD)
e. Permanent sterilization
8.which of the following neoplasms has been associated with the use of oral
contraceptives?
a. Breast cancer
b. Ovarian cancer
c. Endometrial cancer
d. Hepatic cancer
e. Hepatic adenoma
9.Which of the following is the best explanation for the mechanism of the
action of the intrauterine device (IUD)?
1. The answer is e.
In the case of hepatitis A and B, rabies, tetanus, and varicella, patients may
be treated with immunoglobulin .
Inactivated bacterial vaccines can be used for cholera, plague, and typhoid,
as appropriate.
Vaccines for measles and mumps are generally considered to be contraindicated,
as these are live viruses
2. The answer is d.
Inactivated or formalin-killed vaccines such as those for influenza, typhoid
fever, tetanus, pertussis, diphtheria toxoid, rabies, poliomyelitis, cholera,
plague, and Rocky Mountain spotted fever are probably not hazardous for either
the mother or the fetus.
Among the live viral vaccines, such as those for measles, mumps, and
poliomyelitis, only the rubella vaccine theoretically may retain its
teratogenic properties. There is a 5% to 10% risk of fetal infection when the
vaccine is administered during the first trimester. However, no cases of
congenital rubella syndrome have been reported in this group of patients.
Of the commonly administered attenuated live viral vaccines, only the polio
virus has the ability to spread from a vaccine to susceptible persons in the
immediate environment. Therefore, the risk of infection for the pregnant
mother who has been exposed to children who have recently been vaccinated for
measles, mumps, and rubella is probably minimal.
3. The answer is a.
Chronic alcohol abuse, which can cause liver disease, folate deficiency, and
many other disorders in a pregnant woman, also can lead to the development of
congenital abnormalities in the child.
Ethyl alcohol is one of the most potent teratogens known.
The chief abnormalities associated with the fetal alcohol syndrome are cardiac
anomalies and joint defects.
Chronic abuse of alcohol may also be associated with an increased incidence of
mental retardation in the children of affected women.
Heroin, benzodiazepines, and methadone are not major teratogens.
6. The answer is c.
The finding of glucosuria is common during pregnancy and usually is not
indicative of any pathology.
During pregnancy, there is an increase in the glomerular filtration rate and a
decrease in tubular reabsorption of filtered glucose. In fact, one of six
women will spill glucose in the urine during pregnancy.
If the patient has risk factors for diabetes, such as obesity, previous
macrosomic
baby, advanced maternal age, or family history of diabetes, the physician
may want to screen for diabetes with a glucose tolerance test.
If the patient has a urinary tract infection, the dipstick will also show an
increase in
WBCs and blood.
A contaminated urine sample would not be a cause of isolated glucosuria.
7. The answer is e.
contraceptive methods used by reproductive-age women in the United States,
34.1% used permanent sterilization (tubal ligation by any method for
themselves or vasectomy for their partners).
Oral contraception was used by 28%, and barrier methods of contraception were
used by 17.5% of women surveyed.
8. The answer is e.
the progestational component of combination pills (or progestin-only
minipills) may confer a protective effect against carcinoma of the breast and
endometrium, and avoiding ovulation may decrease the risk of developing
ovarian carcinoma. A slightly
higher risk of cervical carcinoma was observed in some studies of users of
oral
contraceptives.
Although the risk of developing benign liver adenomas is increasedsomewhat in
users of oral contraceptives, the risk of hepatic carcinoma is not increased.
9. The answer is d.
It is currently believed that alteration in the cellular and biochemical
components of the endometrium occurs with the IUD, culminating in the
development of a sterile inflammatory reaction.
Polymorphonuclear leukocytes, giant cells, plasma cells, and macrophages are
seen in the endometrium after placement.
No effects on the fallopian tubes or systemic hormone levels have been
identified, nor is a bacterial endometritis produced.
LARA CROFT
Labour
Abruption of placenta
Rupture ( ectopic & uterus)
Abortion
Cholestasis
Rectus sheath heamatoma
Ovarian tumour
Fibroid
Torsion of uterus