This document contains 16 multiple choice questions related to pathologic obstetrics board review. The questions cover topics such as: diagnosing and managing placenta previa, abruptio placenta, preterm labor, intrauterine growth restriction, postpartum hemorrhage, shoulder dystocia, breech delivery, and ovarian cysts in pregnancy. The correct answers to each question are also provided.
This document contains 16 multiple choice questions related to pathologic obstetrics board review. The questions cover topics such as: diagnosing and managing placenta previa, abruptio placenta, preterm labor, intrauterine growth restriction, postpartum hemorrhage, shoulder dystocia, breech delivery, and ovarian cysts in pregnancy. The correct answers to each question are also provided.
This document contains 16 multiple choice questions related to pathologic obstetrics board review. The questions cover topics such as: diagnosing and managing placenta previa, abruptio placenta, preterm labor, intrauterine growth restriction, postpartum hemorrhage, shoulder dystocia, breech delivery, and ovarian cysts in pregnancy. The correct answers to each question are also provided.
This document contains 16 multiple choice questions related to pathologic obstetrics board review. The questions cover topics such as: diagnosing and managing placenta previa, abruptio placenta, preterm labor, intrauterine growth restriction, postpartum hemorrhage, shoulder dystocia, breech delivery, and ovarian cysts in pregnancy. The correct answers to each question are also provided.
Placenta previa, abruptio placentae, preterm labor, vasa previa are some high risk conditions discussed.
Transvaginal ultrasound should be performed as the initial procedure to confirm the diagnosis of placenta previa.
The diagnosis for this patient is abruptio placentae based on the presentation of vaginal bleeding, abdominal pain, elevated blood pressure and uterine contractions.
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
The Modified Radical Peripartum Cesarean Hysterectomy (Soleymani-Alazzam-Collins Technique) - A Systematic, Safe Procedure For The Management of Severe Placenta Accreta Spectrum