In the Name of God

1
In the Name of God

• OBS GYN EXAM QUESTIONS, CASES AND NOTES
• BY
• Mitra Ahmad Soltani
• References
• 1-Williams Obstetrics / 22nd Edition/ MC.
  Graw Hill/ 20052-Novaks Gynecology/ 13 th
  Edition/ Williams and Wilkins/ 20023-Clinical
  Gynecology Endocrinology and Infertility/ 7 th
  Edition / Williams Wilkins / 20054-TE Lindes
  (Operative Gynecology) 9 th Edition / Williams
  and Wilkins / 2003
• 5-Iranian Council for Graduate Medical.
  Education. Promotion and board Exam
  questions.(2000-2007)

2
Fetal Monitoring
3
1- For a patient who has labor pain, an abnormal
NST mandates an int monitoring of FHR.
Supraventricular arrhythmia is detected. The
fetus looks healthy by ultrasonography. AF is
clear. What step should be taken?

• A- fetal echocardiography
• B- C/S
• C- Conservative management
• D-amiodarone
• Ansc

4
2-In the second stage of labor ,you notice a
persistent fetal heart rate bradycardia of 110
bpm. What is your management?

• A- left lateral position, nasal oxygen, 1000 cc
  serum, fetal monitoring
• B- detecting fetal blood PH
• C-after 40 min intervention is needed
• D- It is a normal event in this stage . No
  further step is needed.
• AnsD

5
3-BPP of a 34-week pregnancy is 4. What step
should be taken?

• A-L/S should be determined . If it is below 2,
  the BPP should be repeated
• B-immediate pregnancy termination
• C-BPP should be repeated if it is below 6 ,
  pregnancy termination
• D- BPP should be repeated 48 hours later and
  management is designed according to that score
• AnsC

6
Points to remember

• NST
• Favorable Increase15 bpm for 15 seconds within
  20 min of beginning the test (before 32 wks of GA
  we consider 10bpm lasting 10 seconds)
• BPP
• Pregnancy termination for
• reduced AF
• Gestational age over 36 weeks
• Score of 2
• Repeating the BPP test for
• Score below 6 less than 36 weeks gestation/ low
  Bishop/ L/Sgt2

7
OCT late decelerations following 50 or more of
contractions

• 3 or more contractions
• Lasting at least 40 seconds
• In a 10-min period
• By either spontaneous contractions or
• 0.5 mU/min oxytocin
• Doubled every 20 minutes
• Hyperstimulation frequency more than every 2 min
  or lasting longer than 90 seconds

8
normal fetal movement

• 10 movements in up to 2 hours

9
4- What is the fetal heart rate pattern in a
fetus with placental insufficiency?

• A-late deceleration and loss of variability
  occurring concomitantly
• B-first late deceleration and then loss of
  variability
• C- first loss of variability and then late
  deceleration
• D-first accentuated variability and then late
  deceleration
• AnsB

10
5- Which statement is wrong about MCA Doppler?

• A- compared to FHR monitoring , MCA Doppler is
  more sensitive to fetal hypoxia
• B- in an IUGR case, hypoxia causes reduction in
  Pulsatility Index (PI)
• C- in an anemic fetus because of Rh
  incompatibility velocity is reduced in MCA
• D- with pregnancy advancing there will be a
  normal increase in MCA velocity
• Ansc

11
Doppler systolic-diastolic waveform indices of
blood flow velocity

• S/D S/D Ratio
• S-D/S RESISTANCE INDEX
• S-D/MEAN PULSATILTY INDEX

12
6- After epidural procedure for a pregnant
woman the fetal heart rate shows 12-14 waves of
sinusoidal waves with acceleration. With regard
to the following data, what is your
management?age26 yrs/ GA36 wks/ dil3 cm/
eff50

• A-pregnancy termination for hypoxia
• B-this is pseudo sinusoidal pattern normal after
  epidural procedure. No step is needed.
• C-change of position and oxygen to relieve
  pressure on the umbilical cord
• D-pregnancy termination for fetal hemorrhage
• AnsB

13
7- Amnioinfusion has been proposed to cure
variable deceleration due to oligohydramnios.
What has the least probability to occur during
amnio infusion?

• A-abruption
• B-uterine rupture
• C-uterine hypertonia
• D-cord prolaps
• AnsA

14
8- Silent oscillatory pattern refers to

• A- baseline variability of FHR of less than 5 bpm
  
• B- two or more acceleration of 15 bpm
• C-one acceleration of 15 bpm
• D-baseline FHR variability of more than 5 bpm
• AnsA

15
9-Which is wrong about late deceleration

• A-it occurs after the peak and nadir of uterine
  contraction
• B-lag phase represents fetal PO2 level not fetal
  blood PH
• C-the less the fetal PO2 before uterine
  contraction, the more is the lag phase before
  deceleration
• D-reduced fetal PO2 level below critical level
  activates chemoreceptors and decelerations
• AnsC

16
Points to remember

• Positive OCT 50 or more of uterine contractions
  accompany FHR decelerations
• Variable deceleration occurs gt three times in a
  20 min interval with FHR drop to 70 bpm
• Persistent deceleration more than 30 bpm
  reduction in a 2-10 min interval
• Bradycardia more than 30 bpm reduction of FHR in
  more than 10 min

17
9- NST of a G2 / GA37 wks/ cephalic
presentation/ with a history of 2 IUFDs showsa
2-min deceleration. What is the best management?

• A- daily BPP and observation
• B- C/S
• C- repeat of NST 24 hours later
• D-vaginal exam with continuous fetal monitoring
• Ans B

18
10-What is equivocal-suspicious result in OCT?

• A-no late or significant variable deceleration
• B-late decelerations following 50 or more of
  contractions (even if the contraction frequency
  is fewer than three in 10 minutes)
• C- intermittent late decelerations or significant
  variable decelerations
• D-decelerations that occurs with contractions
  frequent than every 2 min or lasting 90 sec
• E- fewer than three contractions in 10 min or an
  uninterpretable tracing
• AnsC

19
11- Which is wrong about fetal heart rate
deceleration?

• A- maternal HTN can cause chronic placental
  dysfunction and late deceleration
• B- early deceleration of 20 bpm of baseline shows
  fetal hypoxia and acidemia
• C- increased afterload can activate
  chemoreceptors and cause late deceleration
• AnsB

20
12- A pregnant womans BPP shows a non-reactive
NST, one inspiration in 3 min of 30 sec duration,
2 body movements, one Flex and Ext of limbs, AF
of one vertical packet of 3 cm. What is your
management?

• A- pregnancy asphyxia and pregnancy termination
• B- repeating the test one week later w/o the
  possibility of fetal asphyxia
• C- repeating the test with the possibility of
  fetal asphyxia
• D- the possibility of asphyxia, repeat of the
  test on the spot and if abnormal, termination of
  pregnancy
• AnsC

21
Points to rememberscore two, otherwise zero

• 1-Tone 1
• 2-Respiration 1 of 30 sec
• 3-AF 1pocket more than 2 cm
• 4-NST 2 of 15 bpm of 15 sec in a 20 min strip
• 5-Movement 3 in 30 min

22
13- Which one is acceptable in fetal health
assessment?

• A- negative predictive value for most tests is
  about 99.8
• B- positive predictive value for abnormal tests
  is more than 80
• C- management should be done based on true
  positive tests
• D- tests are based on many clinical trials
• AnsA

23
PPV true sick/positives
24
Sensitivity true positive /sick
25
14-Which can not reduce fetal respiratory effort?

• A-hypoxia
• B-preterm labor
• C- maternal feeding
• D- at night (circadian effect)
• AnsC

26
15- Female 23 yrs G1 GA36wks has gone through
BPP for lupus. The fetus shows 3 movements/ one
respiratory effort of 30 sec/one
flex/non-reactive NST/AF of one pocket of 3 cm.
What is your management?

• A-pregnancy termination
• B-repeating the test one week later
• C-repeating the test immediately
• D-repeating the test 24 hours later
• AnsB

27
16-Which is wrong about S/D ratio?(max sys flow
velocity/min end-diastolic flow velocity)

• A-S/D ratio increases gradually in the second
  half of pregnancy
• B-S/D ratio increases in lupus and HTN
• C- reversed diastolic flow can be seen in
  placental dysfunction
• D- Absent diastolic flow can be seen in cases of
  aneuploidy
• AnsA

28
17-G2 P1 28 yrs female comes to the clinic with
the chief complaint of reduced fetal movement.
Her gestational age is uncertain. In ultrasound
AF is normal and the fetus is reported as term.
What should be done for her?

• A-Doppler velocimetry
• B-labor induction
• C- immediate C/S
• D- US twice weekly
• AnsB
• Normal FAD at least 10 movement sensation in 2
  hours

29
18-Which is not an ominous sign in NST?

• A- No increase in FHR in 90 min
• B- non repeating variable deceleration of less
  than 30 sec
• C- deceleration that lasts more than one min
• D- variable deceleration less than 3 times in a
  20-min interval
• AnsB

30
19- Fetal heart rate auscultation reveals FHR of
220 (PSVT). What is your management?

• A-Digoxin
• B-echocardiography and fetal karyotyping
• C- This is an ominous sign of future hydrops and
  heart block of lupus pregnancy
• D-This is transitional. No treatment is needed
• AnsA

31
20- In a diabetic woman of 37 wks, BPP shows no
fetal movement -one respiratory effort of 30 sec
-2 accelerations of 15 sec and one AF pocket of 2
cm. What is your management?

• A- pregnancy termination
• B- repeating test on the same day
• C-repeating test in the third day
• D- amniocentesis
• AnsB

32
21- In a 20 yr old woman of a PIH case, more than
50 of uterine contractions are accompanied with
decelerations. What does this mean?

• A- Recurrent deceleration
• B-significant variable deceleration
• C-prolonged deceleration
• D-long-term variability
• AnsC

33
22-The BPP of a 36 wk pregnant woman shows 1
respiratory effort, 2 movements with no
acceleration, one flex and Ext of the limbs, and
AFI of 10 cm. The repeat of the test after 24
hours later shows the same results. What is your
management?

• A- Pregnancy termination
• B- Pregnancy termination if bishop score is
  favorable
• C- twice a week BPP
• D-once a week BPP
• AnsA

34
23- Which pattern is a sign of fetal distress in
a 43 wk pregnant woman ?

• A- prolonged deceleration
• B-saltatory pattern
• C-variable deceleration
• D- late deceleration
• Ans A

35
24-What drug does not reduce beat to beat
variability ?

• A- narcotics
• B-barbiturates
• C-phenothiazine
• D- in the first hour after MgSO4 administration
• AnsD
• Acidemia causes btb variability reduction
• Hypoxia causes btb variability increase

36
25-What is the BPP score of 3 movements in 30
min / one acceleration of more than 15 sec/3
movements/ one tonic activity/ AF pocket of more
than 2 cm?

• A- 8/10
• B-8/12
• C-10/12
• D-6/10
• AnsD

37
26-What is the indication for Doppler velocimetry?

• A- IUGR
• B-postterm
• C-SLE
• D-APL antibody syndrome
• AnsA

38

• Puerperium

39
1-What is the change in the milk of ovulating
women versus non-ovulating lactating women?

• A- No difference
• B-lactose is more in ovulating women milk
• C-K and glucose is more
• D-Na and Cl is more
• AnsD

40
2-Which change can be seen in puerperium?

• A-maternal heart beat is increased 2 days after
  delivery
• B- endometrium repair is resumed three weeks
  after delivery
• C- Ureters will return to non pregnant state
  after 8 weeks
• D- Vaginal rugae appear after 3 months from
  delivery
• AnsC

41
3-Which is true about puerpural changes?

• A- total number of uterine muscular cells is not
  reduced
• B-vaginal rugae occur in the third month from
  delivery
• C-uterine connective tissue wont change
• D-uterine is re-epithelialized totally in the
  first week of pregnancy
• AnsA

42
4-Which organism is the least responsible in
puerpural infection?

• A- peptostreptococcus
• B-enterococcus
• C- chlamydia trachomatis
• D-mycoplasma
• AnsD

43
5-What is your management in a lactating mother
who is a candidate for radioactive iodine
administration?

• A- lactation after two weeks from iodine exposure
  is safe
• B- lactating during iodine administration is safe
  because iodine is not secreted in the milk
• C-lactation during the first 15 hours is
  contraindicated
• D- lactation is contraindicated
• AnsA

44
6- A patient comes to the clinic because of fever
4 days after C/S which persists 72 hours from
antibiotic administration. What is the most
likely reason of antibiotic failure?

• A- wound infection
• B- pelvic thrombophlebitis
• C- pyelonephritis
• D- adenexal infection
• AnsA

45
7-What is wrong about puerpural immunization?

• A- tetanus and diphtheria vaccine before
  discharge from hospital is advocated
• B-a woman already injected measles vaccine does
  not need a booster dose
• C- Rh negative women with an Rh positive newborn
  should take RhoGam
• D- women who have never taken rubella vaccine
  should be vaccinated
• AnsB

46
8-Which is not a contraindication to lactation?

• A- alcoholics and drug abusers
• B- HSV and HBV patients whose infants have taken
  IG against these viruses
• C- AIDS and active TB
• D- women under breast cancer treatment
• AnsB

47
9-Which is wrong about OCP use in lactation
period?

• A- Oral progesterone can be used after 2-3 weeks
  from delivery
• B- Implants can be used immediately after
  delivery
• C- Depot medroxy Progesterone acetate can be used
  6 weeks from delivery
• D- Combined OCP is used 6 weeks from delivery
• AnsB

48
10-What is wrong about antibiotic therapy of
pelvic infection after C/S?

• A- imipenemcilastatin should be used in
  intractable cases
• B- clindagenta is the standard treatment
• C- Genta pennicilin G are the first line therapy
  
• D- ampicillin is added when enterococcus is
  suspected
• AnsC

49
11-Which is wrong about infection after C/S?

• A- there is no definite relationship between
  anemia and infection
• B-sexual practices definitely play a role in
  infection
• C- young age and pimigravidity is a risk factor
• D- three or more doses of betamethasone in
  preterm labor is a risk factor
• AnsB

50
12-Which is wrong about human lactation?

• A- a normal milk secretion is more than 60 cc per
  day
• B-Milk is isotonic to plasma and more than 50 of
  its osmotic pressure is due to its lactose
• C-milk lactose can leak to blood and urine and
  this may be mistaken as glucosuria
• D- Iron reserve affects milk iron content
• AnsD

51
13-Which is wrong about parametrial phlegmon?

• A-infection is unilateral and limited to broad
  ligament
• B-infection subsides with IV antibiotic but fever
  may exist 5-7 days
• C- If fever persists more than 72 hours despite
  antibiotic therapy the diagnosis is ruled out
• D-supracervical hysterectomy is
• recommended
• AnsC

52
14-What is wrong about weight loss after delivery?

• A -5-6 kg weight loss after delivery is due to
• uterine evacuation and blood loss
• B-2-3 kg is lost because of diuresis
• C-2 kg is lost because of third space volume
  reduction
• D-most women reach to pre pregnancy weight by the
  second month after delivery
• Ans D

53
15- A 26 year old woman complains of vaginal
bleeding for three months after delivery. In
gynecologic exam uterine size is normal and
cervix is closed. What is the first step to be
taken?

• A-ultrasonography
• B-beta subunit
• C-Doppler sonography
• D-curettage
• AnsB

54
16-On average what percent of drug can be
secreted in human milk?

• A-1
• B_10
• C-30
• D-50
• AnsA

55
17-Which is wrong about fever after delivery?

• A-fever more than 39 c in the first 24 hours
  after delivery is a sign of severe infection
• B-fever in bacterial mastitis usually is late
  and persistent
• C-pulmonary infection usually occurs in the first
  24 hours mostly after C/S
• D-pyelonephritis is one of the most common reason
  of infection and is most often mistaken for
  pelvic infection
• Ans D

56
18- A woman has gone through C/S 7 days ago .
Three days after the operation chills and fever
(enigmatic fever) occured. She is given
antibiotic with no improvement in her condition.
She doesnt look ill. What is your diagnosis?

• A-pelvic abscess
• B-parametrial phlegmon
• C-pelvic septic thrombophlebitis
• D-adenexal infection
• AnsC

57
19-Who can lactate?

• A- mother of a galactosemic newborn
• B- mother with HBV
• C- mother with active untreated TB
• D-mother with breast herpetic lesions
• AnsB

58
20-Which is true about C/S abscess?

• A-Fever will resume one week after surgery
• B-Mostly it happens after metritis
• C-Fever will answer to appropriate antibiotic
  therapy
• D-Wound culture is negative most of the time
• AnsB

59
21- How to manage breast engorgement in women who
does not choose breastfeeding her newborn?

• A-oral analgesics
• B-warm compress
• C-broad spectrum antibiotic
• D-bromocriptine
• AnsA

60
22-An infection after C/S which is not
responsive to clindagenta is because of

• A-clostridium
• B-enterococcus
• C-bacteroid fargilis
• D-chlamydia trachomatis
• AnsB

61
23- A week after NVD episiotomy dehiscence
occurs. When the dehiscence should be repaired?

• A- immediately
• B-3 months later
• C- 6 months later
• D- 9 months later
• AnsA

62
24-A 28 yr old G2 P1 woman decides on
contraception during lactation after the first
week from delivery. What is the best choice?

• A- Oral progesterone 2-3 weeks after delivery
• B-Depo-Provera 2 weeks after delivery
• C-Implants after 4 weeks from delivery
• D-oral OCP 4 weeks from delivery
• AnsA

63
25-Which is true about post C/S metritis?

• A- uterine culture helps to choose the best
  treatment
• B- blood culture is negative most of the time
• C- streptococcus beta hemolytic cause foul
  smelling secretions
• D-placental site is the site of transmission of
  infection
• Ans B
• Blood culture of metritis is negative most of the
  time.
• Wound culture of C/S abscess is positive most of
  the time.

64
26-What is true about lactation period mastitis?

• A-It occurs in the last days of the first week
• B- Most of the time it is bilateral
• C-nose and throat of the newborn is the source of
  infection
• D-it is mostly a result of coagulase-negative
  staph
• AnsC

65
Abnormal labor
66
1-What is Robin maneuver to release shoulder
dystocia?

• A-rotation of post. shoulder to deliver ant.
  shoulder
• B- abduction of shoulders
• C- flex of mothers knees and suprapubic pressure
• D- rotation and extraction of ant. shoulder
• AnsB
• Woods screwA
• McRoberts m.C
• Zavanelli m. repositioning of fetal head back
  into the uterus and C/S

67
2-Which is wrong in PGE2 administration for labor
induction?

• A-It reduces submucosal water content
• B- vaginal tablet is superior to vaginal gel
• C- It better affects on a cervix with Bishop
  score below 4
• D-It can be used instead of oxytocin for cervical
  Bishop score of 5-7
• AnsA

68
3-Which is wrong in breech delivery mechanism?

• A-ant hip has a more rapid decent than post hip
• B- ant hip is beneath the symphysis pubis and
  intertrochanteric diameter rotates around a 45
  degree axis
• C- if post hip is beneath the symphysis pubis it
  has to go through 225 degree axis rotation
• D-for sacrum ant or post position, the axis of
  rotation is around 45 degrees
• Ans C

69
4-A woman 35 years old- P2 GA of 38 wks -EFW of
2 kg presents face and posterior shoulder
presentation.How do you manage her delivery?

• A-induction of labor
• B- internal rotation to make mentum ant position
• C- observation to allow spontaneous rotation
• D- C/S
• AnsC

70
5-Which is wrong about persistent occiput
posterior?

• A-Forceps can be applied
• B-manual rotation of the head can be done
• C- manual rotation of the head can be done
• D-there is no place for observation
• AnsD

71
6-A term pregnancy- dil3cm- eff50-satation-2s
oft cervix in mid position has a Bishop score of

• A-5
• B-7
• C-9
• D-10
• AnsB

72
7-In high dose oxytocin labor stimulation, what
is the maximum dose (mu/min) of oxytocin ?

• A-20
• B-30
• C-42
• D-60
• AnsC

73
8- G4-L1-Ab2 / GA38wks/full dil eff/frank
breech/ station1 /WBintact /FHR100 BPM /
x-ray shows flexion of the head. What is the
best management?

• A-Frank breech extraction
• B-C/S
• C-modified Prague maneuver
• D- observation for non assisted breech delivery
• AnsA

74
9-Which is wrong about face presentation?

• A- This is a rare presentation above inlet
• B-brow presentation most of the time changes to
  face presentation
• C- decent mechanism is completely different from
  vertex presentation
• D-delivery is possible if mentum appears beneath
  the symphysis.
• AnsC

75
10- Under what condition is external cephalic
version allowed in breech or transverse
position,?

• A- multiparity
• B-placenta previa
• C- presenting part engagement
• D- CPD
• Ans A

76
11-Which is true about pelvimetry of a breech
presentation?

• A-MRI is superior to CT scan
• B-MRI is faster than CT scan
• C- MRI is superior to CT scan only during labor
• D-MRI is not a good technique for imaging inlet
  and mid pelvis
• AnsA

77
12-Which is wrong about misoprostol?

• A- It is a synthetic PG E1
• B-It is used for peptic ulcer
• C- It is used for contraception
• D- Its dose is 100 mcg intra cervical for labor
  induction
• AnsD

78
13-Which criterion applies to low forceps?

• A- the fetal head leading point should be on
  stationgt2
• B- the fetal head leading point should be above
  stationgt2
• C-The fetal head is on the pelvic floor
• D-Sagital suture is ant-post
• AnsA

79
14-Which is true about breech delivery?

• A-labor duration is more lengthy than vertex
  presentation
• B-CP is not related to mode of delivery
• C- Breech presentation happens with no definite
  reason
• D-pelvimetry with MRI reduces C/S rate
• AnsB

80
15-Which is wrong about PGE2 gel?

• A-The intracervical dose is 0.3-0.5 mg
• B-The vaginal dose is 3-5 mg
• C- The vaginal application releases 10 mg Q4h
• D-If contractions and FHR are normal in a 2 hour
  observation, the patient can be discharged
• AnsC

81
16- In breech presentation with a posterior
shoulder ,What is the name of the maneuverThe
shoulder is grasped by one hand and the legs are
grasped by the other hand then the newborn is
pooled toward mothers abdomen?

• A-Pinard
• B- modified Prague
• C- Bracht
• D- Meuriceu
• AnsB

82
17-Which is wrong in shoulder dystocia?

• A-Most of shoulder dystocia cases can not be
  diagnosed or predicted
• B- Shoulder dystocia can be diagnosed with high
  accuracy using modern imaging studies
• C-ultrasound is not reliable
• D- C/S is recommended in diabetic mothers with
  babies more than 4500 gr and in non diabetic
  mothers with babies more than 5000 gr
• AnsB

83
18- A woman 34 yr G1 GA of 41wks is
hospitalized. Which regiment is more effective to
improve Bishop score?

• A- vaginal misoprostol 50 mcg
• B- intracervical PGE2 (dinoprostone)0.5 mg
• C- Oral Misoprostol 50 mcg
• D-NS extra amniotic infusion
• AnsD

84
Hypertensive Disorders in Pregnancy
85
1-What is the accepted screening test for
diagnosis of PIH?

• A-Rollover test
• B-nitric oxide measurement
• C-vascular endothelial growth factor
• D-angiotensin test
• AnsA

86
2- For a case of severe preeclampsia (BP180/95)
Mg SO4 and C/S is ordered. An hour after C/S BP
falls to 110/75. What is the reason of BP fall?

• A-Delivery removes the effect of vasospasm
• B-anesthetic drugs
• C-hemorrhage
• D-MgSO4 effect
• Ans C

87
3-Which is true about edema of preeclmpsia?

• A- it has an unknown etiology
• B-it is because of increased aldosterone level
• C- it worsens the prognosis of preeclampsia
• D- it is because of increased DOC
• AnsA

88
4- A woman 48 yrs old/ G3/ BP150/115/ has a high
cholesterol level . Her sister and brother had
heart attacks in the age of 40. Which is wrong
about the management of this case?

• A-Beta blocker
• B- diet
• C-methyl dopa
• D-regular checking of lab results
• Ans A

89
5- In a woman with chronic HTN Which factor has
the least effect in development of superimposed
PIH?

• A- PIH history
• B- low dose aspirin
• C- severity of HTN
• D-the need for combined drug therapy
• AnsB

90
6-What is the most common complication of
eclampsia?

• A- abruption
• B-aspiration pneumonia
• C-pulmonary edema
• D- direct maternal mortality
• AnsA

91
7-Which is true about blindness after eclampsia?

• A-It has a bad prognosis
• B-It lasts about 1 month
• C-it is transient and lasts from 4 hours to 8
  days
• D-in some people it causes permanent blindness
• AnsC

92
8-Which is wrong about eclampsia?

• A- eclampsia can cause coma without seizure
• B- All patients with eclamsia have had signs of
  preeclampsia
• C-After seizures respiratory rate is reduced and
  cyanosis happens
• D- In all cases of eclampsia severe proteinuria
  is present
• AnsC

93
9-Which therapy can prevent preeclampsia?

• A-Low dose aspirin
• B-calcium
• C-fish oil
• D-Antioxidants
• AnsD

94
10- A 40 years old woman / G3/P2 /GA35 wks/
BP210/110 is in seizure. What is the best way to
control her seizure?

• A-Phenytoin loading dose of 1000 mg/h IV
• B- Diazepam and creatinin measurement
• C- amobarbital sodium 250 mg IV
• D- MgSO4 4-6 gr as loading dose
• AnsD

95
11- What is the cause of platelet change in
preeclampsia?

• A- increased production
• B- decreased consumption
• C- increased platelet aggregation
• D- decreased platelet- adhering IG
• AnsA

96
12-A woman 25 years old / G1 suffers HELLP
syndrome. What is true about her next pregnancy?

• A- there is no increased risk in her next
  pregnancy
• B-the is increased risk of abruption and
  preeclampsia
• C-there is no increased risk of preterm labor or
  C/S
• D-there is no increased risk of IUGR
• AnsB

97
13-Which test has a more PPV for detecting PIH?

• A-urinary excretion of Kallikrein
• B- roll over test
• C- angiotensin II
• D- hypocalciuria
• AnsA

98
14-A pregnant woman GA29 wks / severe headache/
blurred vision/ BP 200/120 has gone through
routine tests and MgSO4 infusion. What other
steps should be taken?

• A-IV hydralazine 20 mg IV verapamil 10 mg
• B-IV hydralazine 5 mg
• C- IV labetalol 80 mg
• D- sublingual nifedipine 10 mg thiazide 10 mg
• AnsB

99
15-A case of eclampsia with seizure is given
MgSO4. She is agitated. What drug is appropriate
for her agitated state?

• A-2 gr MgSO4 IV
• B- 250 mg amobarbital IV
• C- 10 mg diazepam IM
• D-no treatment is needed
• AnsB
• A would be appropriate if a second seizure
  occurs

100
16-A woman with high blood pressure, proteinuria,
Crgt1.5 mg/dl, has an episode of seizure after 4
hours from her delivery. What treatment do you
suggest?

• A-14 gr of MgSO4as the loading dose and then 2.5
  gr q4h up to 24 h after delivery
• B-7 gr of MgSO4 as the loading dose and then 2.5
  grq4h up to 24 h after the last seizure
• C-14 gr of MgSO4 as the loading dose and then 2.5
  gr q4h up to 24h after the last seizure
• D-7 gr of MgSO4 as the loading dose and then 2.5
  gr q4h up to 24h after delivery
• AnsC

101
17-Which is not among pathophysiological changes
of preeclampsia?

• A-reduction in PGE2
• B-reduction in prostacyclin
• C-increased thromboxane A2
• D-increased resistance to angiotensin
• Ans D

102
18-Which is wrong about proteinuria of
preeclampsia?

• A-Some women deliver before proteinuria occurs
• B-1 proteinuria equals 300 mg protein in a 24
  hour sample
• C-NPV of a trace or negative dipstick test is
  about 30
• D-PPV of 3/4 proteinuria is 70
• AnsD

103
19-For a primigravida in 30 weeks gestation a
roll-over test is done. An increase of 35 mmHG
has occurred in diastolic BP. Which is wrong for
this case?

• A- She has a high probability of developing HTN
• B-She is abnormally sensitive to angiotensin II
• C-increased BP is because of hyperactivity of
  parasympathetic system
• D-33 of these patients will develop preeclampsia
• AnsC

104
20-Which is wrong for visual disturbances of
preeclampsia?

• A-it is because of occipital region lesions
• B-if blindness does not resolve within a week ,
  it will remain permanently
• C- It is because of retinal artery spasm that can
  resolve by MgSO4
• D-it is because of retinal detachment that is
  most often unilateral
• AnsB

105
21-Which is wrong about superimposed preeclampsia?

• A-it occurs earlier in pregnancy and most often
  is accompanied by IUGR
• B- BP changes remain through life
• C-some women have increased BP after 24 weeks
  gestation
• D- above 90 of them have a history of essential
  HTN
• AnsB

106
22-A woman GA38 wks/G2/L1/history of chronic
HTN is diagnosed as a case of severe
preeclampsia. Her pregnancy is terminated. Her BP
and proteinuria and edema are improved but she
has developed orthopnea. What is your first
diagnosis?

• A-ATN and overload
• B- hypoalbuminemia
• C-peripartum cardiomyopathy
• D-MS signs aggravated by fluid shift
• AnsC

107
23-What drug has the complication of tachycardia?

• A-methyl dopa
• B-propranolol
• C-nifedipine
• D-hydralazine
• Ans D

108
24-Which does not happen in preeclampsia?

• A-reduced renal perfusion and GFR
• B-increased renin-angiotensin level
• C-constant electrolyte concentration
• D- increased microangiopathic hemolysis
• AnsB

109
25-A woman 32 years old/ NP /obese / 38 wks GA/
mild preeclampsia delivers her child . BP does
not decrease after several IV doses of
hydralazine. Which is not a good management?

• A-Im hydralazine
• B-oral labetalol
• C-thiazides
• D-IV MgSO4
• AnsD

110
Hemorrhage in Obstetrics
111
1- A woman 35 years old /G4 L3 presents with
couvelaire uterus in C/S. When is hysterectomy
indicated?

• A-presence of hematoma in the broad ligament
• B-presence of hematoma in mesosalpinx
• C- atony retractable to treatment
• D- presence of blood in abdominal cavity
• AnsC

112
2-Which is wrong about platelet administration?

• A- Platelet can not be reserved more than 5 days
• B-platelets should be administered to patients
  with hemorrhage and platelet counts less than
  50000/ml
• C-platelet should be administered after
  cross-match
• D- If there is no hemorrhage, platelets should be
  administered to patients with platelet counts
  less than 10000 /ml
• AnsD

113
3-which is the most common reason of DIC in
Obstetrics?

• A-IUFD
• B-abruption
• C-AF emboli
• D- septic shock
• AnsB

114
4-what is the first step in treating a G2 with
late postpartum hemorrhage (after stabilizing her
condition)?

• A-curettage
• B-uterotonics
• C-uterine artery ligation
• D-hypogastric artery ligation
• AnsB

115
5-A 16 year-old woman comes to you with heavy
bleeding after a two month delay in her periods.
Pregnancy test is negative. Ultrasound shows a
thin endometrium. There is no coagulation or
anatomical problem. Which is the best treatment?

• A-high dose progesterone
• B-curettage
• C-IV conjugate estrogen
• D-diagnostic hysteroscopy
• AnsC
• Conjugate estrogen 25-40 mg IV q6h or PO
• 2.5 mg q6h

116
6- what is the stage of shock in a woman 70 kg
/ HR130 bpm/AP55mmHg/mod tachycardia/urinary
output10cc in a min

• A-first
• B-second
• C-third
• D-fourth
• Ansc

117
7-Which is true about hemorrhagic shock?

• A- central venous catheter is not recommended
• B-lifting the feet is not recommended
• C-colloids are superior to crystalloids
• D-excess NS can cause alkalosis
• AnsA

118
8-A woman suffers intractable heavy vaginal
bleeding after C/S. Laparatomy is performed.
Retrovesical hematoma is evacuated and the site
of bleeding is sutured. The bleeding does not
stop. What is the second stage in management?

• A-total hysterectomy
• B-bilateral uterine and ovarian arteries ligation
• C-bilateral hypogastric arteries ligation
• D-bilateral hypogastric and ovarian arteries
  ligation
• AnsD
• Ovarian artery is situated in infundibulopelvic
  and mesosalpinx ligament

119
9-Which is wrong in abruption?

• A-It is more likely in heroin addicts than
  cocaine addicts
• B-fibroma is one of the causes
• C-positive past history is a risk factor
• D-there is no agreement on smoking as a risk
  factor
• AnsA

120
10-A G2 with GA14 wks is referred for spotting.
Ultrasound imaging shows twin pregnancy with one
fetal demise. How the coagulation profile may
change?

• A- The profile is like that of DIC
• B-heavy bleeding will occur during labor because
  of hypofibrinogenemia
• C- repairable transient coagulopathy will occur
• D-the live infant in the uterine will develop
  coagulopathy
• AnsC

121
11-Which is true about uterine inversion?

• A-BP and MgSO4 can be the reason
• B-it is more common in multiparas
• C-it is never fatal
• D-hemorrhage occurs with a delay
• AnsA

122
12-If there is a coagulopathy disorder, which is
an indication for Heparin administration provided
that circulation is intact?

• A-IUFD
• B-Abruption
• C-septic abortion
• D-HELLP syndrome
• AnsA
• Heparin dose 5000 units TDS for IUFD
• FFP and platelet for septic abortion

123
13-Which is not an etiology of prepubertal
females with vaginal bleeding?

• A-endocervical polyps
• B-vaginitis
• C-muluscum contangiosum
• D-lichen sclerosis
• AnsA

124
14-What is the drug of choice in AUB after kidney
and liver transplant?

• A-desmopressin
• B-GnRH agonist
• C-antiprostaglandins
• D-estrogens
• AnsB

125
15-A 14 yr old girl has the chief complaint of
heavy vaginal bleeding. Her Hb is 7 gr/dl .
Coagulation tests and platelets and pelvic
sonography are normal. What is your management
after treating anemia?

• A-HD OCP q6h for one week
• B- 25-50 mg progesterone q6h until bleeding is
  under control
• C- Conjugated estrogen 2.5 mg q6h PO until
  bleeding is controlled followed by medroxy
  progesterone
• D-daily medroxy progesterone acetate 20 mg
• AnsC

126
16-Which is wrong about stage II of hypovolemic
shock?

• A-Tachycardia is a constant finding
• B-blood loss is more than 1000cc
• C-systolic minus diastolic BP is increased
• D-BP at rest is normal
• AnsC

127
17- A 70 kg woman has massive hemorrhage during a
pelvic surgery. Which is the best choice for
blood loss compensation?

• A- Packed cell 3 units of FFP10 units of
  platelet
• B- Packed cell 2 units of FFP for each 6-8 units
  of PC 2 units of platelet if platelet count is
  below 100000/cc
• C-whole blood
• D- B and C
• AnsD

128
Points to remember
129
18-What is the most common coagulopathy that is
presented by AUB in adulthood?

• A-Thalacemia major
• B- thalacemia minor
• C-von willebrand
• D-ITP
• AnsD

130
19-Which is true about int iliac artery ligation
for controlling pelvic hemorrhage?

• A-Ext iliac artery should be checked before
  ligation is attempted
• B-ureter should not be located
• C- both sides arteries should not be ligated
• D-the artery should be ligated proximal to
  parietal branch
• AnsA

131
20-A woman receives 12 units of whole blood
because of hemorrhage after hysterectomy.3 hours
after operation Hb is 9 gr/dl, platelet
55000/ccfibrinogen 100 mg/dl. What do you
suggest?

• A-FFP
• B-platelet
• C-cryoprecipitate
• D-crystalloids
• AnsD

132
21-How PG f2-alfa is administered for uterine
atony?

• A-20 mg IM for max 3 doses by 15-90 min intervals
• B-500 mcg IV for max 4 doses IM by 30 min
  intervals
• C-1000 mcg IM single dose
• D-250 mcg IM for max 8 doses by 15-90 min
  intervals
• AnsD

133
22-In a 14 year old anemic girl with prolonged
uterine spotting what should be done?

• A- assurance, follow up and ferrus sulfate
• B- Low dose OCP q6h for 7 days
• C- Low dose OCP 21 days for 3-6 cycles
• D- conjugate estrogen 2.5 mg PO q6h for 7 days
• Ansc

134
23-A 40 year old woman is hospitalized for
hemorrhagic shock. Her kidney function is normal.
What is the most sensitive and reliable clinical
criteria for determining severity of volume loss?

• A- tachycardia
• B-tachypnea
• C-oliguria
• D-hypotension
• AnsC

135
24-What is the best management of great vessels
laceration in sacral foramina?

• A-Clamp and ligation of great vessels
• B- clipping the vessels
• C-electrocuttery
• D-packing the foramen by Gel foam
• AnsD

136
25-An extension of C/S incision causes vaginal
artery laceration and heavy bleeding. What should
be done for this case?

• A-uterine artery ligation
• B-ovarian artery ligation
• C- hypogastric artery ligation
• D-hysterectomy
• AnsC

137
26- How many ml of blood does a soaked lap pad
absorbs?

• A-30 cc
• B-50 cc
• C-80 cc
• D-100 cc
• AnsB

138
27-What is wrong for blood loss management?

• A-after an hour in a critical case only 20 of
  crystalloids remains in circulation
• B- the volume of crystalloids replacement is
  three times the volume of blood loss
• C-in all cases of blood loss a Hb of less than 8
  gr/dl mandates whole blood transfusion
• D-colloids increase mortality rate
• AnsC

139
28-What is wrong about vaginal hematoma after
delivery?

• A-observation if hematoma is small
• B- an incision on the site if pain is severe and
  hematoma enlarges
• C-mattress suturing the bed of hematoma
• D-pressure dressing should be applied on the
  hematoma bed for 12-24 hours
• AnsD

140
29- A repeat C/S II has hemorrhage of the
incisionsite. Which can best control hemorrhage?

• A-ligation of placental site above and below the
  incision site
• B-ligation of uterine artery
• C- ligation of hypogastric artery
• D- embolization of uterine artery
• AnsA

141
30-Where is the exact place of hypogastric artery
ligation?

• A- immediately distal to the bifurcation
• B-anterior branch distal to the bifurcation
• C- anterior branch distal to post parietal branch
• D- anterior and posterior branch
• AnsC

142
31-What is the diagnosis and treatment of a
tender inflamed mass near the urethral opening in
a 5 year old girl?

• A-muluscum- analgesics and steroids
• B-condylomata acuminata- TCA acid
• C-prolaps of the urethra- topical estrogen
• D- Skene gland abscess-antibiotic and evacuation
• AnsC

143
32-A 16 year old girl complains of heavy
menstrual bleeding. She is anemic. Her VS is
stable. Your diagnosis is DUB. What should be
prescribed for her other than Iron supplements?

• A-medroxy progesterone acetate 10 mg daily for 2
  weeks for 3 cycles
• B-monophasic OCP q6h for 7 days
• C- conjugate estrogen 2.5 mg PO q6h until the
  hemorrhage stops
• D-LD OCP for 21 days
• AnsB

144
33-Obturator artery is lacerated in a pelvic
surgery. Which artery should be ligated?

• A-int iliac
• B-lateral sacral
• C-int pudendal
• D-ilio lumbar
• AnsA

145

• Paravesical space contains accessory obturator
  artery from inf hypogastric
• Para rectal space contains lateral sacral and
  hemorrhoidal arteries
• Obturator artery is from int iliac artery

146
34-Which is the last choice in Von Willebrand
related AUB?

• A-2.5 mg estrogen daily progesterone in the last
  10 days of a menstrual cycle
• B-OCP
• C-GnRH nasal spray
• D-desmopressin infusion
• AnsD

147
35-Which is more common in blood transfusion?

• A-Hepatitis B
• B-Delayed red-cell hemolytic reaction
• C-Anaphylactic reaction
• D-HTLV
• AnsB

148
36- Which is wrong about fetal complications of
abruption?

• A- 20-25 percent of cases demise perinatally
• B-40 are delivered prematurely
• C- 12-15 are IUFD
• D-if the fetus doesnt die in uterus, there would
  be no serious neonatal complication
• AnsD

149
37-A pregnant woman G2 GA38 wks has the chief
complaint of vaginal spotting. There is no sign
of abruption or previa by ultrasound. What is the
best management?

• A- observation
• B-termination of pregnancy
• C-discharge
• D-referring patient to another center
• AnsB

150
38-Which is true about abruption?

• A- The chance of repeated abruption is twice
• B-fetal assessment techniques can predict
  abruption with good precision
• C-there is no means to predict abruption
• D-The chance of repeated abruption is not
  different
• AnsC

151
39-Which is wrong in cases of placenta previa?

• A-the safest means of diagnosing placenta previa
  is transabdominal ultrasound
• B-false positive results are because of full
  bladder
• C-low lying or total previa is best diagnosed by
  trans vaginal ultrasound
• D-NPV of transperineal ultrasound is 70
• Ans D (its NPV is 100 )

152
40-What is the first surgical step in a case of
retractable uterine atony?

• A-ligation of uterine and ovarian arteries
• B-ligation of hypogastric arteries
• C-subtotal hysterectomy
• D- uterine artery embolization
• AnsA

153
41-Which case does not need replacement therapy
after massive transfusion?

• A- platelet of 80000 in cc
• B-coagulation factor VIII of 40
• C-fibrinogen 90 mg/dl
• D- PT of 1.5 times normal level
• AnsB

154
Preterm and postterm pregnancy
155
1-Which is wrong about the pathogenesis of
preterm labor?

• A-phospholipase A2 induced by bacteria
• B-PG induced by bacteria
• C- macrophage induced substances
• D-PAF induced by bacteria
• AnsB

156
2-Which is wrong about FFN?

• A-it is a better indicator for preterm labor than
  ROM
• B-FFNgt 30 ng /ml is considered positive
• C- amniotic fluid and maternal blood cause false
  results
• D-its NPV is more reliable than PPV
• AnsB

157
3- What is your management of ? 25 yrs -G1 - GA
41 wks- cephalic presentation- FADnormal
favorable cervix?

• A-C/S
• B-stripping of the cervix
• C-PG gel
• D- AFI twice a week
• AnsD

158
4-Which test is more sensitive for detecting
bacteria in AF?

• A-Gram staining of AF
• B-increased maternal WBC
• C-increased AF IL6
• D-increased maternal CPR
• AnsC

159
5-Which is wrong about prolonged gestation?

• A-placental apoptosis increases from 41-42
• weeks gestation
• B-umbilical cord erythropoietin increases from 41
  weeks
• C-Late deceleration is the most common finding in
  prolonged gestational age
• D-lack of vernix causes skin changes of post
  maturity
• AnsC

160
6-A 31 year old woman complains of premature
labor. Dilatation is 2 cm and eff is 50. Water
bag is intact. Which is true about the management
of this case?

• A-beta agonists can cause MI and myocardial
  necrosis in mother
• B-terbutalin can post pone delivery for a week
• C-If MgSO4 can not stop labor, nifedipine is used
• D-PG inhibitors should not be used
• AnsA

161
7-What should be done in a post trem pregnancy
when NST is normal?

• A- repeat NST after 3 days
• B-CST
• C-AFI
• D- Doppler
• AnsC

162
8-Which is wrong in the management of a woman G1
GA39 wks ROM Dil2cm eff40 HR100 bpm
T37.5c ?

• A-Control of BP and HR q4h
• B- Control of T q4h
• C- antibiotic
• D-induction of labor
• Ans B
• T should be checked hourly

163
9-Which is the most accurate way to detect ROM if
ROM can not be detected by speculum or
ultrasonography?

• A-Nitrazine test
• B-Fern
• C-Indigo Carmine
• D-digital vaginal examination
• AnsC

164
10-In which group of patients MgSO4 is
contraindicated?

• A- Type I diabetes
• B- asthma
• C-hyperthyroidism
• D-myasthenia gravis
• AnsD
• A patient with MG should receive Amide type
  anesthetics like Lidocaine and Bupivacaine

165
11-Which combination therapy to stop labor pain
is safe?

• A-MgSO4 indomethacin
• B-MgSO4 terbutalin
• C-ritodrin nifedipin
• D-MgSO4 nifedipin
• AnsB

166
12-Which is not a side effect of Ritodrine?

• A- pulmonary edema
• B-hyper kalemia
• C-hyperglycemia
• D-hallucination
• Ans B

167
13-An induction for a 41 wk gestational age
pregnancy failed. What should be done?

• A- C/S
• B-starting induction 6 hours later
• C-Starting induction 3 days later
• D- fetal well-being monitoring for one week
• AnsC

168
IUGR
169
Definition

• Intrauterine growth restriction (IUGR) occurs
  when the unborn baby is at or below the 10th
  weight percentile for his or her age (in weeks).
  The fetus is affected by a pathologic restriction
  in its ability to grow.

• Low birth weight (LBW) means a baby with a birth
  weight of less than 2500Gms, which could be due
  to IUGR or Prematurity

170
Classification
Symmetricl
Asymmetrical
baby's brain is abnormally large when compared to
the liver. may occur when the fetus experiences a
problem during later development
the baby's head and body are proportionately
small. may occur when the fetus experiences a
problem during early development.
171
In a normal infant, the brain weighs about three
times more than the liver. In asymmetrical IUGR,
the brain can weigh five or six times more than
the liver.
172
Etiology

• General- Racial / Ethnic origin,
• Small maternal / paternal height / weight,
• Fetal sex
• Maternal causes.
• Fetal causes.
• Placental causes.
• Idiopathic- In a majority of cases (40) the
  cause is unknown probably due to placental
  insufficiency.

173
Maternal Risk Factors

• Has had a previous baby who suffered from IUGR.
• Extremes of age
• Is small in size (Ht Wt).
• Has poor weight gain and malnutrition during
  pregnancy.
• Is socially deprived.
• Uses substances (like tobacco, narcotics,
  alcohol) that can cause abnormal development or
  birth defects.
• Has a low total blood volume during early
  pregnancy.

174
Maternal Risk Factors

• Is pregnant with more than one baby.
• High altitude.
• Drugs like anticoagulants, anticonvulsants.
• Has a cardio-vascular disease-preeclampsia,
  hypertension, cyanotic heart disease, cardiac
  disease Gr III IV, diabetic vascular lesions.
• Chronic kidney disease
• Chronic infection- UTI, Malaria, TB, genital
  infections
• Has an antibody problem that can make successful
  pregnancy difficult (antiphospholipid antibody
  syndrome, SLE).

175
Fetal Risk Factors

• Exposure to an infection-German measles
  (rubella), cytomegalovirus, herpes simplex,
  tuberculosis, syphilis, or toxoplasmosis, TB,
  Malaria, Parvo virus B19.
• A birth defect (cardiovascular, renal,
  anencephaly, limb defect, etc).
• A chromosome defect- trisomy-18 (Edwards
  syndrome),21(Downs syndrome), 16, 13, xo
  (turners syndrome)
• A primary disorder of bone or cartilage.
• A chronic lack of oxygen during development
  (hypoxia).
• Developed outside of the uterus.
• Placenta or umbilical cord defects.

176
Placental Factors

• Uteroplacental insufficiency resulting from -.
• Improper / inadequate trophoblastic invasion and
  placentation in the first trimester.
• Lateral insertion of placenta.
• Reduced maternal blood flow to the placental bed.
• Fetoplacetal insufficiency due to-.
• Vascular anomalies of placenta and cord.
• Decreased placental functioning mass-.
• Small placenta, abruptio placenta, placenta
  previa, post term pregnancy.

177
Screening

• US fetal biometry HC- BPD- AC
• Uterine Doppler studies ( Doppler Velocimetry)
• bilateral notches and a mean resistance index of
  at least 0.55
• Or
• Unilateral notches and a mean resistance index of
  at least 0.65 at 20 weeks.
• Biochemistry CRH level at 33 weeks

178
Diagnosis
Neonatal -

• Low ponderal index (Wt./Fl).
• Decreased subcutaneous fat.
• Presence / appearance of
• Hypoglycemia,
• Hyperbilirubinemia,
• Necrotizing enterocolitis,
• Hyper viscosity syndrome

179
A decrease in AFI may occur before there are
changes in the non-stress test.
180
While the biophysical profile is an useful test,
when it becomes abnormal the fetus may have
already suffered some damage
181
1-which test is more sensitive to fetal acidosis?

• A-NST
• B-BPP
• C-OCT
• D-Doppler velocimetry of umbilical artery
• AnsD

182
2-What should be done for a diabetic woman 28 yrs
old G2 L1- AFNL EFW4600 gr GA42 weeks

• A-C/S
• B-AF measurement twice a week
• C-NST and OCT daily
• D-PG gel to ripen cervix
• AnsA

183
3-What is the most important reason for
hypoglycemia of a SGA fetus?

• A- increased fetal consumption
• B-decreased endogenous glucose production
• C-hyperinsulinemia
• D-reduced supply
• Ans D

184
4-What trisomy in the form of placental mosaicism
causes IUGR?

• A-13
• B-16
• C-18
• D-21
• AnsB

185
5-Which is wrong as an explanation for fetal
growth?

• A-Insulin growth factor I II play an important
  role
• B-fetal pancreas can secret insulin necessary for
  growth
• C- leptin , a protein that is found in maternal
  and fetal blood, is the product of obesity gene
• D-fetal leptin secreted in the third trimester of
  pregnancy is not related to fetal growth
• AnsD

186
6-What is CMV mechanism of action in IUGR?

• A- direct cytolysis
• B-injury to small vessels endothelium
• C-reducing cell multiplication time
• D-inflammation and edema of perivascular tissue
• AnsA

187
7-Which one is not a cause of SGA?

• A- Maternal SCA
• B-placenta previa
• C-living at the sea level
• D- positive maternal ACL antibody
• AnsC

188
8-Which is not a finding in IUGR fetus?

• A- hyper TG
• B-thrombocytopenia
• C-increased plasma adenosine
• D-reduced placental arterial natriuretic peptide
• AnsD

189
9-What is the chromosomal defect in a newborn
with horse shoe kidneys, prominent occiput,
imperforated anus, VSD?

• A- trisomy 13
• B-turner
• C-trisomy 18
• D-trisomy 21
• AnsC

190
Multiple pregnancy
191
1- What is the best statement about ovulation
induction?

• A- oral and injectable ovulation induction drugs
  have the same effect on inducing multiple
  pregnancy
• B-ovulation induction drugs increase the
  incidence of dizygotic twins
• C- ovulation induction drugs increase the
  incidence of monozygotic twins
• D-ovulation induction drugs increase the
  incidence of monozygotic and dizygotic twins
• AnsD

192
2-Which is wrong about chimeras?

• A- It is the process in which two lines of cells
  appear in one organism
• B-A person is diagnosed as blood chimera when he
  has two BGs
• C-non disjunction in meiosis division is the
  probable cause of chimeras
• D- twins can share genetic materials via vascular
  anastomosis
• AnsC

193
3-Which is not a sign of twin to twin
transfusion?

• A-difference in weights more than 10
• B-hydramnios in one fetus and oligohydramnios in
  the other
• C- difference in Hb more than 5 gr/dl
• D-monochorion with placental vascular anastomosis
• AnsA

194
4-Which age is the peak age for twin pregnancy?

• A-puberty
• B-26
• C-37
• D-35
• AnsC

195
5- Which is true for prenatal care of multiple
pregnancy?

• A- add 300 kcal daily
• B-Daily Iron 250 mg
• C-1 mg folic acid daily
• D-a multiple pregnancy should have a weight gain
  of 50 pounds
• Ans B

196
6- What should be done for a woman 31 week
gestation with twin pregnancy and one fetus dead?

• A-prophylactic heparin for DIC prevention
• B- C/S
• C- observation
• D- tocolytics
• AnsC

197
7- What is third circulation in monochorionic
twins?

• A- superficial artery-artery anastomosis
• B- superficial vein- vein anastomosis
• C- deep artery- vein anastomosis
• D- deep artery-artery anastomosis
• Ans C

198
8- Twins rate of growth resembles singleton
pregnancy up to gestational age of

• A-20 weeks
• B-28-30 weeks
• C-34 weeks
• D- 36 weeks
• AnsB

199
9-Which is not because of vascular anastomosis in
twin pregnancies?

• A-microcephaly
• B-small intestines atresia
• C- Hip dislocation
• D- limb amputation
• AnsC

200
Amniotic membranes
201
1-? 30 yrs GA34 w max vertical pocket of
AF12 cm complains of dyspnea. What do you
suggest?

• A- Ace inhibitors
• B- daily diuretic and restricting salt
  consumption
• C-transvaginal amniotomy
• D-Indomethacin 1.5-2 mg/kg
• AnsD

202
2-A placenta that is totally covered by chorionic
villi and its separation causes heavy bleeding
that mandates hysterectomy is called?.

• A-Succentu