PATHOLOGIC OBSTETRICS

BOARD REVIEW QUESTIONS

From FEU
QUESTIONS:
1. G2P1 PU 32 weeks consulted because of
vaginal bleeding.No uterine contractions
noted.FHT-140/minute.The initial procedure that
you will perform is Dx: Placenta Previa
a.gentle speculum examination
b.internal examination
c.transvaginal ultrasound
d.transabdominal ultrasound
2.36 y/o,G3P2 PU 35 weeks complained of
vaginal bleeding and abdominal pain.BP-
150/100 mmhg.Uterine contractions were noted
every 1-2 minutes 60 secs in duration.Her last
ultrasound 2 weeks ago was normal.IE-cervix
closed uneffaced.What is the diagnosis?
a.preterm labor
b.vasa previa
c.placenta previa (painless)
d.abruptio placenta (painful)
3.36 y/o G4p3 PU 33 weeks, Previous CS 2x
has anterior placenta previa.What condition
will you have to rule out in this patient prior to a
repeat cesarean section?
a.vasa previa
b.uterine dehiscence
c.placenta accreta
d.adhesions
4.G1P1 postpartum 2 hrs was brought by the
midwife because of profuse bleeding.She
delivered at home to an 8 lbs. baby.Placenta
was spontaneously expelled after 10 minutes.On
examination ,uterus is contracted and
palpated below the navel.What is the
diagnosis?
a.uterine atony
b.retained placenta
c.lacerations
d.uterine inversion
5.32y/o G3P2 PU 30 weeks complains of
moderate vaginal bleeding.Ultrasound done
revealed a placenta totally covering the
os.What is the management for this patient?
a.Bed rest and give tocolytic
b.Bed rest,tocolytic,progesterone
c.Bed rest ,tocolytic,steroids
d. Steroids,tocolytic and deliver after 48 hrs.
6.36y/o G3P2 PU 36 weeks complained of vaginal
bleeding and abdominal pain.BP-120/80 mmhg but
she is a known hypertensive for 2 years.Uterus is
woody with no FHT heard by doppler.cervix is 3
cms dilated 1cm long , BOW intact,cephalic station -
1,with minimal bleeding.What is the BEST
management ?
a.expectant
b.amniotomy
c.induce with oxytocin
d.immediate CS
Dx: Abruptio
7. What is the MOST dreaded complication of
abruptio placenta?
a.Hypovolemia
b.Septicimia
c.Embolism
d.DIC
8.A 34y/o G3P2 postpartum 1 hr was brought by
a midwife because of vaginal bleeding and
abdominal pain.On examination,a fleshy mass
was seen protruding out of the introitus,the
fundus of the uterus cannot be palpated
abdominally.What is cause of this condition?
a.age and parity
b.strong traction of the cord
c.size of the baby
d.length of labor
9.A G1P1 complains of vaginal bleeding 2 hours
after she delivered a 3.8kg baby via NSD .Uterus
is soft and boggy palpated above the navel.What
is the initial management for this patient?
a.bimanual uterine compression
b.ice pack
c.uterine artery ligation
d.hysterectomy
10.36 y/o G3P2 PU 37 weeks previous CS 2x has
an ultrasound findings of anterior placenta
previa with absence of sonoluscent space between
the placenta and decidua.How should this patient
be managed? dx: Accreta
a.CS with manual removal of the placenta
b.CS ,leave the placenta in situ,methotrexate
c.CS,removal of placenta ,hysterectomy
d.CS with hysterectomy with
placenta in situ
11.A G3P3 postpartum 6 months ago was
selivered by NSD and complicated by atony .She
was transfused with 4 u PRBC.She has
amenorrhea,failure to lactate and loss of pubic
hairs.What is the diagnosis?
a.ashermans (adhesions)
b.sheehans
c.Simmonds (non obstetric cause of pituitary
failure)
d.PCOS
12. 36 y/0 G4P4 patient had a CS due to abruptio
placenta.The uterus was noted to be bluish with
hematoma on the anterior and posterior wall and
well contracted.What is the management?
a.expectant
b.uterine artery ligation
c.compression suture
d.hysterectomy
All are possible answers
13.G3P2 PU 38 weeks Previous CS 2x was noted
to have placenta invading the myometrium and
bladder serosa.What layer is defective in this
case? Dx: accreta
a.decidua vera
b.nitabuchs
c.myometrium
d.peritoneum
14. G1P0 PU 32 weeks has placenta partially
covering the os.What is the BEST management
for this patient?
a.wait for spontaneous labor
b.Give steroids and do CS after 48hrs
c.repeat the ultrasound at 35 weeks
d.schedule for CS at 38 weeks
If 36-37 weeks, do CS
15.A patient who delivered by CS due to abruptio
placenta was noted to have bleeding per vagina
and at the incision sites.Platelet count-
90,000,Prolonged prothrombin time and partial
thromboplastin time.What is the BEST
component therapy for her? Dx: DIC
a.whole blood
b.PRBC
c.fresh frozen plasma
d.platelet concentrate (<50,000)
QUESTIONS:
1.Which of the following will put the patient at
the highest risk for the development of Preterm
Labor?
a.multiparity
b.smoking
c.prior preterm birth
d.infection
2.G3P2(0-2-0-0) PU 32 weeks has watery vaginal
discharge.Nitrazine paper test positive(yellow to
blue).What is the management? dx: PPROM
a.tocolytic
b.steroid andtocolytic
c.expectant,steroid and ampicillin
d.steroid,tocolytic.ampicillin
3.Which of the following findings is indicative of
preterm labor?
a.uterine contractions with closed cervix
b.cervical length of 20mm
c.fibronectin -20 ng/ml
d.hypogastric pain
Cut off is < 2.5 cm
4.30 y/o G4P3 PU 30 weeks was seen.Pregnancy
test was positive at 4 weeks AOG.Fundic height -
24 cms FHT-140/min.What is the assessment of
this pregnancy ?
a.normal pregnancy
b.inaaccurate aging
c.intrauterine growth restriction
d. large for date pregnancy
5.A 35 y/o G3P2 PU 41 weeks has an ultrasound
findings of BPS-6/8 with AFI 4 cms.Cervix is
closed and 1.5 cms long cephalic station 0.What
is the best management ?
a.hydrate patient
b.CST and induce if negative
c.close fetal surveillance
d.cesarean delivery
6.What is the most common risk factor for the
development of fetal macrosomia?
a.obesity
b.diabetes
c.multiparity
d.nutrition
7.A G4P3 PU 32 weeks has a fundic height of 24
cms.Biometry revealed a BPD /femur length
compatible with 30 weeks and an abdominal
circumference compatible with 24 weeks AOG
.Which of the following is the cause of this
condition?
a.genetic (early insult)
b.chemical exposure
c.hypertension (uteroplacental
insufficiency)
d.viral infection
8.A G1P0 PU 38 weeks has a fundic height of 39
cms.Estimated fetal weight by ultrasound is 4250
grams.Her 75 gms OGTT revealed FBS -105
mg/dl and 2nd hr -160mg/dl.What is the
management?
a.wait for spontaneous labor
b.induce labor with prostaglandin
c.Wait for 39 weeks and induce with oxytocin
d.elective CS at 39 weeks (mature
lungs first)
9.G2P1 PU 34 weeks,cephalic has a fundic height
of 26 cms.Doppler velocimetry is requested every
week to monitor the fetus.Which of the following
findings will indicate severe fetal compromise?
a.increase resistance index
b.diastolic notching
c.absent end diastolic flow
d.reversed end diastolic flow (severe)
Dx: IUGR
10.G1P0 PU 42 weeks has an AFI-2cms.cervix
closed ,uneffaced but soft.Which of the following
is the best to induce labor in this patient??
a.membrane sweeping
b.oxytocin
c.prostaglandin
d.primrose oil
QUESTIONS:
1.G1P0 PU 38 weeks in labor was
admitted.Uterine contractons occurred every 2
minutes 60 secs duration.Cervix 2 cms dilated 1
cm long.After 24 hours,cervix is still 3 cms
dilated 0.5 cms long.What is the best
management? (dx: hypertonic uterine
dysfunction)
a.oxytocin
b.sedation
c.amniotomy
d.cesarean section
2.G1P0 39 weeks AOG admitted at 5 cms cervical
dilatation 0.5 cms long cephalic station -
1.Uterine contractions-200 montevideo
units.Amniotomy done revealed clear AF.cervix
dilated to 6 cms after an hour,cephalic station-
1.However after 3 hours cervix remained at 6
cms.,cephalic station -1.What is the diagnosis?
a.prolonged active phase
b.protracted active phase
c.arrest in cervical dilatation
d.failure descent
3.Failure in descent can be diagnosed if there is
no descent during which phase of labor?
a.latent
b.acceleration
c.active
d.deceleration
4.Precipitate delivery can be diagnosed in a
nulliparous patient if cervical dilatation is more
than___cms/hr (10 cm in multipara)
a.2
b.3
c.4
d.5
5.Clinical pelvimetry findings of a nulliparous
patient revealed a prominent ischial
spines,convergent sidewalls,narrow sacrosciatic
notch.Which pelvic plane is contracted?
a.inlet
b.midplane
c.outlet
6.What plane of the pelvis is tested by theMueller
Hillis Maneuver ?
a.inlet
b.midplane
c.outlet
7.G1P0 38 weeks AOG has this leopolds findings:
L1-breech L2-back on the right,small parts on
the left,L3-cephalic L4 cephalic prominence on
the right.On IE the mentum was directed at the
sacrum.What is the manner of delivery?
a.NSD
b.forceps
c.vacuum
d.cesarean
8.A multipara in labor has this IE findings.The
frontal sutures,anterior fontanel,orbital ridges
and root of the nose are palpated.What is the
presentation?
a.sincipital
b.brow
c.face
d.vertex
9.A multipara was admitted in active labor.IE
revealed a gridiron feel with back down
position.What is the best management?
a.external cephalic version
b.internal podalic version
c.low segment cesarean
d.classical cesarean
10.What forceps is used to rotate a persistent
occiput transverse to anterior position?
a.simpsons
b.kiellands
c.pipers
d.bartons
11.In shoulder dystocia ,the procedure of
hyperflexing the legs towards the abdomen is
called
a.pinards
b.rubins
c.mc roberts
d.zavanelli
12.External cephalic version to convert a breech
presentation to cephalic is recommended at what
weeks age of gestation?
a.33
b.35
c.37
d.39
13.In partial breech extraction,the procedure of
lateral deflection of the thigh,pressing on the
popliteal to flex the legs and deliver the foot is
called
a.loveset
b.hibbard
c.pinard (popliteal fossa pressure)
d.zavanelli
14.Which of the following structures is NOT
derived from the mullerian duct?
a.uterus
b.hymen (lower third urogenital)
c.upper third of the vagina
d.cervix
15.A G1P0 PU 12 weeks has a 15 cms
asymptomatic,ovarian cyst on the left
adnexa.What is the management?
a.expectant
b.immediate exploration
c.explore at 16-20 weeks
d. explore after delivery
16.Which of the following is NOT used to deliver
an entrapped head in breech presentation?
a.rubins maneuver (shoulder
dystocia)
b.mauriceau smellie veit maneuver
c.suprapubic pressure
d.durshsen incision
17.If there is no union of the mullerian duct ,the
abnormality produced is
a.unicornuate uterus
b.bicornuate
c.uterus didelphys
d.septate uterus
18.A 17 year old consulted because of primary
amenorrhea and cyclic pelvic pain.On
examination,bulging mass was noted at the
introitus with no vaginal opening.What is the
diagnosis?
a.endometrial polyp
b.prolapsed myoma
c.imperforate hymen
d.vaginal septum
19.19y/o G1P0 PU 34 weeks has painful myoma
uteri for 1 week.What is the degeneration of the
myoma ?
a.hyaline (most common)
b.carneous
c.cystic
d.sarcomatous
20.G3P2 PU 36 weeks came in fully dilated
frank breech presentation ,station + 3.The
attending physician waited for the spontaneous
expulsion of the breech up to the navel and assist
the delivery with maneuvers from navel up to the
head.What is the described type of extraction?
a.Spontaneous breech delivery
b.total breech extraction
c.complete breech extraction
d.partial breech extraction
QUESTIONS:
1.A G1P1 PU 13 weeks has an ultrasound result
twin pregnancy with single chorion and 2
amnion.When does the division of the
monozygotic twin occurred ?
a.0-4 days
b.4-8 days
c.8-12 days
d.>13 days
2.Which of the following must NOT be done in a
monoamnionic monochorionic twins?
a.Daily CTG at starting at viability
b.steroids at 26-28 weeks
c.Deliver at 38 weeks (34 weeks)
d.terminate by CS
3.Which of the following characterizes the
recipient in twin to twin transfusion//
a.anemic
b.hyperbiliribunemia
c.IUGR
d.oligohydramnios
4.Which of the following presentations in
multifetal pregnancy can be delivered vaginally
in multiparous patient?
a.twin breech-cephalic
b.twin-cephalic breech
c.twin-cephalic-transverse
d.triplets all cephalic
5.21y/o G1P0 PU 32 weeks cephalic,complaining
of headache.BP-160/100 mmhg.Urine protein
+++.What is the diagnosis?
a.gestational hypertension
b.chronic hypertension
c.transient hypertension
d.severe pre eclampsia
6.36 y/o G1P0 PU 36 weeks was admitted
because of blurring of vision.BP-150/100
mmhg,urine protein +++.Lab tests revealed low
platelets,increased LDH,SGPT and alkaline
phosphatase.What is the complete diagnosis?
a.Pre eclampsia non severe
b.Pre eclampsia,severe
c.Pre eclampsia,severe, HELLP
syndrome
d.Pre eclampsia ,severe,DIC
7.Which of the following is the most effective in
the prevention of pre eclampsia?
a.low dose aspirin
b.high dose calcium
c.fish oil
d.antioxidants
8.G2P 0 PU 35 weeks complained of epigastric
pain .BP-190/100 mmhg. Lab test revealed low
platelets and increased LDH. What is the
definitive management of this patient?
a.control hypertension with hydralazine
b.prevent convulsion with MG SO4
c.weekly surveillance testing
d.terminate pregnancy (definitive
mgt for preeclampsia, deliver)
9.Which forcep is described to have a longer
shank and a double pelvic curve?
a.bartons
b.pipers
c.simpsons
d.kiellands
10.In what diameter of the pelvis will the forcep
fits during application?
a.biparietal
b.occipitofrontal
c.occipitomental
d.suboccipitobregmatic
11.How many pop offs during vacuum extraction
before you will abandon the procedure?
a.1
b.2
c.3
d.4
12.Which of the following will qualify a patient
for a vaginal birth after a cesarean section?
a.one previous Classical CS
b.no previous uterine rupture in last 2yrs
c.can be performed in a lying in with physician
available
d.The obstetrician and
anesthesiologist must be available
13.What is the MOST frequent indication for
primary CS?
a.malpresentation
b.dystocia
c.fetal distress
d.maternal illness
14.Which of the following is a disadvantage of
pfannesteil incision?
a.weak
b.more dehiscence
c.difficult re entry
d.faulty healing
15.What is the most frequent indication for CS
hysterectomy?
a.atony
b.laceration of uterine vessels
c.accreta
d.myoma
QUESTIONS:
1.36y/o G3P2 PU 33 weeks has PPROM for 8
hours.She delivered after 24 hours of labor.On
the third postpartum day she developed vaginal
bleeding,fever and hypogastric pain.Cervix
tender on wriggling,uterus enlarged to 5 months
size and tender.What is the diagnosis?
a.cystitis
b.endometritis
c.pyelonephritis
d.thrombophlebitis
2.What is the most important factor for the
development of genital tract infection during
puerperium ?
a.number of cervical examination
b.route of delivery
c.length of labor
d.anemia
3.34y/o G3P3 post CS for 1 week due to prolonged
labor complained of vaginal bleeding,abdominal
pain and foul smelling discharge.What is the
BEST antibiotic management ?
a.ampicillin and gentamycin
b.broad spectrum cephalosporin
c.clindamycin and gentamycin
d.meropenem
4.What is the microorganism implicated in Toxic
Shock syndrome?
a.staphylococcus aureus
b.streptococcus pyogenes
c.Escherichia Coli
d.Pseudomonas
5.25y/oG1P0 PU 12 weeks with RHD is
comfortable at rest but complains of dyspnea
while washing the dishes or even when brushing
her teeth.What is the new York classification of
this patient?
a.1
b.II
c.III
d.IV
6.What is the best mode of Delivery for a 21y/o
G1P0 with RHD mitral stenosis?
a.NSD under sedation
b.assisted vaginal under pudendal
c.forceps extraction under epidural
d.cesarean section
7.A G3P3 asthmatic patient delivered to a live
baby .Which of the following should NOT be
given postpartum?
a.antibiotics
b.hydrocortisone
c.terbutaline
d.ergonovine (PGF 2a)
8.Which of the following anti TB medications is
contraindicated during pregnancy?
a.streptomycin (aminoglycoside)
b.rifampicin
c.pyrazinamide
d.ethambutol
9.23 y/o G4P1 PU 21 weeks has an asymptomatic
UTI.Urinalysis showed plenty of pus cells
however Urine culture is negative.What is the
microorganism implicated?
a.E. Coli
b.chlamydia
c.pseudomonas
d.bacterial vaginosis
10.32y/oG2P1 PU 35 weeks has recurrent UTI
and complains of fever,upper back pain,nausea
and vomiting.What is the cornerstone in the
management of this patient ? Dx: acute
pyelonephritis
a.request for creatinine
b.empiric antibiotics
c.hydration with IVF
d.antipyretic
11.What is/ are the laboratory tests needed to
evaluate a patient with thyroid disease?
a.MRI
b.thyroid ultrasound
c.TSH ,FT3FT4
d.thyroid scan
12.23y/o G1P0 PU 16 weeks has diffuse thyroid
enlargement with exopthalmos.TSH is low while
FT4 is elevated.What is the BEST treatment for
this patient?
a.propanolol
b.iodine
c.prophylthiuracil
d.thyroxine
13.When is the recommended age of gestation to
screen for gestational DM based on American
College of OB GYN?
a.first trimester
b.16-20 weeks
c.24-28 weeks
d.30-34 weeks
14.21 y/o G1P0 has a result of 145 gms/dl in the
50 gms OGCT.What is the next management for
this patient?
a.start oral hypoglycemics
b.start insulin
c.Do 100 gms OGTT
d.manage as normal pregnancy
15.Which of the following is NOT recommended
in patients with Overt DM?
a.alpha feto protein at 16-20 weeks
b.congenital scan at 18-20 weeks
c.weekly doppler velocimetry
d. regular ultrasound for growth
16.Which of the following vaccines must be given
to all pregnant patient?
a.hepatitis A
b.HPV
c.influenza (type A)
d.pneumonia
QUESTIONS:
1.28 y/o G2P1 PU 25 weeks develop low grade
fever followed development of tender, vesicular
lesions along the dermatome at the subcostal
area. What is the risk of the fetus in developing
the disease?
a. none
b. 10%
c. 20%
d. 30%
2.20y/o G1P0 PU 12 weeks has been exposed to a
relative with varicella infection 2 days ago. She
mentioned that she did not have the disease
during childhood. How will you manage this
patient?
a.reassurance
b.vaccination
c.immunoglobulin
d.vaccination and immunoglobulin
3.34y/o G3P3 delivered to a live baby with
cataracts,glaucoma and sensorineural
deafness.She mentioned that she developed high
grade fever with postauricular lympadenopathy
and generalized maculopapular rashes during
the first trimester of pregnancy.What is the
disease that she had during the first trimester?
a.Rubeola
b.Rubella
c.Varicella
d.PUPP
4.What will differentiate if the patient had a
recent rubella infection?
a.Ig M
b.Ig G
c. High avidity Ig M
d.High avidity Ig G
5.30 y/o G5P3 PU 35 weeks has uterine
contractions.She mentioned that her last baby
died of sepsis after delivery.What is the
recommended antibiotic prophylaxis ?
a.amoxicillin
b.ampicillin
c.penicillin G
d.clindamycin
6.30y/o G3P2 PU 14 weeks,complains of painless
chancre at the vulva.The chancre has red and
firm border.What is the most specific diagnostic
test for the patient?
a.RPR
b.TPHA
c.darkfield illumination
d.ELIZA
7.32 y/0 G2P1 PU 23 weeks complains of
yellowish vaginal discharge.On gram stain,gram
negative intracellular diplococci were seen.What
is the management?
a.Azithromycin plus clindamycin
b.ceftriaxone plus metronidazole
c.cetriaxone plus azithromycin
d.cefuroxime plus clindamycin
8.36y/o G3P1 PU 39 weeks was admitted in early
labor. On examination,there are multiple painful
vesicular lesions noted on the vulva. What is the
management?? (dx: HSV2)
a.insert an internal monitoring device
b.ask the nurse to prepare the forceps
c.prepare patient for cesarean
section
d.amnitomy and induce with oxytocin
9.21 y/o G1P0 PU 12 weeks complains of vulvar
itchiness.On inspection,there are multiple small
warty outgrowths noted on the labia majora and
perineum.What is the BEST management?
a.Podophylline
b.trichloracetic acid
c.laser
d.imiquimod
Dx: HPV 6, 11
10.35 y/o G3P2 PU 34 weeks complains of
premature uterine contractions.On speculum
exam,there is a moderate amount of grayish
homogenous fishy odored discharge.Grams stain
done revealed a nugent score of 8.What is the
management?
a.amoxicillin
b.clindamycin
c.metronidazole
d.cefuroxime
11.31y/o G2P1 PU 38 weeks is positive for HIV
infection with a viral load of 2000 copies/ml.What
is the BEST management?
a.Do amniotomy in early labor
b.Deliver by forceps during the second stage
c.Monitor condition of fetus by scalp sampling
d.Deliver by Cesarean section
12.32y/o G2P1 PU 36 weeks has Immune
thrombocytopenia. What is the fetal complication
anticipated if this patient will undergo vaginal
delivery?
a.vertebral fracture
b.intracranial hemorrhage
c.liver rupture
d.splenic injury
13.32y/o G1Po PU 20 weeks complains of
palpable breast mass.On examination,a 2x3 cm
solid mass was noted on the right upper
quadrant of the breast.What is the BEST
management?
a.mammogram
b.fine needle aspiration
c.breast ultrasound
d.core biopsy
14.36y/o G4P3 PU 10 weeks complained of
postcoital bleeding. An ulcerated lesion was
noted on the cervix at 3 oclock position which
bleeds to touch. Biopsy revealed squamous cell
carcinoma. The uterus is not enlarged ,movable,
both parametria are free and pliable. What is the
management ?
a.chemotherapy and wait for viability
b.cone biopsy and wait for delivery
c.chemotherapy and radiotherapy after delivery
d.radical hysterectomy with bilateral lymph
node dissection
15.Which of the following will NOT determine the
management of ovarian CA during pregnancy?
a.age of patient
b.stage of disease
c.gestational age
d.grade of the tumor