Final exam Saudi Board 2009

1. Fibroid, treatment

According to a recent Cochrane Database System Review in regard to

Interventions to reduce haemorrhage during myomectomy for fibroids.
Which of the following Is true?
a. There was a significant reductions in blood loss with misoprostol
b. There was no evidence of effect on blood loss with vasopressin and
analogues
c. There was no evidence of effect on blood loss with bupivacaine plus
epinephrine tranexamic acid
d. There was no evidence of effect on blood loss with peri-cervical
tourniquet.
e. There was a significant reductions in blood loss with myoma enucleation
by morcellation or oxytocin.

Answer A

2. Fibroid, treatment

Which of the following treatment modalities is a non invasive promising

alternative to myomectomy
a. Uterine fibroid embolization.
b. focused high-energy MRI-guided ultrasound.
c. MRI-guided laser myolysis.
d. Laparoscopic uterine artery occlusion.
e. Laparoscopic myolysis.

Answer B

3. Fibroid, treatment
 Which of the following is true in regard to uterine artery embolization (UFE)?
a. Premature ovarian failure occurs in 5-10 % of patients .
b. The risk of post partum haemorrhage is 10 times of that which occurs
after myomectomy.
c. One of the advantages of UFE is the substantial reduced risk of adhesion
formation.
d. The risk of preterm labour after UFE is similar to that which occurs after
myomectomy.
e. Uterine-artery embolization(UFE) should be the first line of treatment for
women with symptomatic uterine fibroids who wish to conceive

Answer B

4. Fibroid, treatment

A 36 years old infertile lady was diagnosed to have an intramural fibroid of 3

centimeters in its largest dimensions and is distorting the endometrial cavity
at a salinesonohystrogram. Post- myomectomy the patient ;
a. Is less likely to have a pregnancy without assisted reproduction.
b. Is less likely to have a miscarriage.
c. Has no change in pregnancy rate prior to myomectomy.
d. Is more likely to have a miscarriage.
e. Has a significant increase in conception rate.

Answer E

5. Infertility, diagnosis

In regard to the postcoital test. Which of the following is true?

a. A normal test is said when there is at least 5 motile sperms per high
power field and the cervical mucus should show ferning and
>5 cm spinnbarkeit.
b. The pregnancy rate at 24 months is higher in couples who
had the routine postcoital test versus those who did not.
c. A normal test is said when there is at least 10 motile sperms per high
power field and the cervical mucus should show ferning and
>5 cm spinnbarkeit.
d. A normal test is said when there is at least 5 motile sperms per high
power field and the cervical mucus should show ferning and
3 cm spinnbarkeit.
e. A normal test is said when there is at least 10 sperms per high power field
and the cervical mucus should show ferning and 5 cm
spinnbarkeit.
 Answer A

6. Infertility , treatment

A 30 years old infertile lady who has a proximal tubal blockage seeks a
pregnancy. Which of the following is the most appropriate treatment?

a. Ovulation induction plus timed intercourse.

b. Ovulation induction plus intrauterine insemination.
c. Tubocornual anastomosis by laparotomy.
d. In Vitro fertilization.
e. selective salpingography with tubal catheterization.

Answer E

7. infertility, diagnosis

In regard to endometrial biopsy for evaluation of ovulation.

Which of the following is true?
a. An endometrial biopsy is considered to be normal if the
assigned date from the histologic examination is within two
days of the actual date calculated from the previous LH
surge as day 14.
b. The results of the endometrial biopsy should be interpreted with reference
to the next menstrual period rather than to onset of ovulation ART surgery.
c. Compared to fertile women, infertile women has a higher prevalence of
out-of-phase biopsies.
d. Luteinizing hormone is responsible for major changes in the endometrium.
e. Endometrial biopsy is indicated for patients who are infertile with
oliogomenorrhoea.

Answer A
8. Infertility, diagnosis

In regard to At home- semen analysis (Fertell). Which of the following is

true?
a. It provides an estimate of the total motile sperm using a
"swim-up" technique and an estimate of morphology.
b. It provides an estimate of the total motile sperm using a
"swim-up" technique and an estimate of pH.
c. It provides an estimate of the total motile sperm using a
"swim-up" technique followed by reaction with a
monoclonal antibody against a sperm surface antigen.
d. It provides an estimate of the total motile sperm using a
"swim-up" technique and an estimate of grade A motility.
e. It provides a visual estimate of the concentration of
progressively motile sperm in a semen sample using a test
that is completed within approximately 3 hours of
production of the sample.
Answer C

9. Reproductive endocrinology, treatment

According to Cochrane Database System Review in regard to Laparoscopic

"drilling" by diathermy or laser for ovulation induction in anovulatory
polycystic ovary syndrome. Which of the following is true when laparoscopic
surgery was compared to gonadotropin therapy?
a. After twelve months of follow-up, gonadotropin therapy resulted in a
higher rates of ovulation.
b. No significant differences were seen in ongoing pregnancy rates between
the two treatments.
c. ovarian hyperstimulation were reported to be higher in gonadotropin
therapy.
d. The cost per pregnancy appeared to be lower with gonadotropin.
e. less in miscarriage rates were seen in laparoscopic surgery.

Answer B
10. Infertility , treatment

A 29 years old lady with secondary infertility for five years received
gonadotropin therapy for several cycles with three cycles of intrauterine
insemination. Her hysterosalpingogram showed patent tubes with evidence of
peritubal adhesions. What is the next most appropriate treatment?
a. In Vitro fertilization.
b. Laparoscopy adhesiolysis.
c. Repeat hysterosalpingogram (HSG).
d. Chlamydia prophylaxis and repeat Insemination.
e. Offer another two cycles of ovulation induction and intrauterine
insemination.

Answer B

11. Infertility , treatment

Compared to Clomiphene citrate; which of the following is an advantage of

Letrozole use for ovulation induction?
a. Pregnancies conceived after letrozole treatment had less miscarriage and
ectopic pregnancy rates.
b. Letrozole yield a higher pregnancy rates in stimulated cycles.
c. Letrozole is more cheaper.
d. Letrozole does not deplete estrogen receptors at target organs.
e. Both drugs have similar fetal effects.
Answer D

12. Infertility , treatment

In regard to Couples with unexplained infertility; Which of the

following is true?
a. couples with unexplained infertility do not have subtle
functional abnormalities in oocyte and/or sperm function.
b. couples with unexplained infertility are preferably treated with
advanced assisted technologies.
c. Sperm function test are must in these conditions.
d. effective fertility treatment for unexplained infertility
demonstrates an increase in the pregnancy rate above
baseline fecundability.
 e. 10 to 20 percent of couples with unexplained infertility
followed prospectively without active treatment become
pregnant each month.

Answer D

13. Infertility , epidemiology

In regard to the effect of smoking on fertility. Which of the following is true?

a. Women exposed to cigarette smoke in-utero are found to
have similar fecundability to those who did not.
b. Adult male offspring of mothers who smoked greater than
5 cigarettes/day during pregnancy had lower sperm counts
than the sons of nonsmokers.
c. Odds of pregnancy per number of in vitro fertilization
cycles is similar in smokers compared to nonsmokers.
d. Fecundability is decreased if the female partner smokes
greater than 20 cigarettes per day.
e. The subfertility associated with smoking can be reversed
within a year of cessation.

14. Infertility, epidemiology

Selective tubal catheterization;

a. is successful in obtaining tubal patency in 20 to 30 percent of patients.

b. is successful in obtaining tubal patency in 40 to 50 percent of patients
c. is successful in obtaining tubal patency in 60 to 80 percent of patients
d. is successful in obtaining tubal patency in 85 to 90 percent of patients
e. is successful in obtaining tubal patency in 10 to 20 percent of patients

Answer C

15. Infertility , epidemiology

Tubal anastomosis;
a. Is a better option than In Vitro fertilization in women younger than 37
years who have 4 cm of residual tube.
b. Previously used sterilization technique has no impact on the anastomosis
success.
c. Laparoscopic tubal anastomosis leads to a better success rate than
conventional microsurgical anastomosis.
 d. Ectopic pregnancy rates are higher after conventional microsurgical
anastomosis.
e. Hysterosalpingogram should be performed six weeks after the procedure
to confirm tubal patency.

Answer A

16. Infertility , diagnosis

In regard to hysterosalpingogram. Which of the following is true?
a. Painful procedure is frequently with the use of oil contrast media rather
than water soluble media.
b. Post HSG pelvic inflammatory disease rate is around 10%.
c. Oil contrast media has a better safety profile and produces
higher quality visualization of tubal mucosa.
d. Spasm may be alleviated by rest followed by slower
injection or intravenous injection of glucagon.
e. Post procedure pregnancy rate are higher after the use of water soluble
media.
Answer D

17. Infertility , epidemiology

Hydrosalpinx

a. Decreases the pregnancy rate after In Vitro fertilization (IVF) by 70%.

b. Increases the risk of miscarriage by three folds after In Vitro fertilization
(IVF) pregnancies.
c. The relative increase in the pregnancy rate after
salpnigectomy is greatest in women with hydrosalpinx
visible on ultrasound.
d. Proximal tubal blockage is as effective as salpnigectomy in improving
pregnancy rates after In Vitro fertilization (IVF).
e. Drainage of the hydrosalpinx at the time of oocyte
collection is as salpnigectomy in improving pregnancy rates after In Vitro
fertilization (IVF) and less invasive.
Answer C

18. Surgical capabilities, postoperative management, pathology

Richter's hernia;
 a. occurs usually at 5mm lateral ports sites after laparoscopy.
b. a hernia involving only omentum.
c. can result in bowel strangulation leading to perforation.
d. can be minimized by withdrawing the cannula with its valve closed.
e. commonly occurs if the pneumoperitoneum pressure used is at 10 mm Hg.

Answer C

19. Surgical capabilities, preoperative management, diagnosis

In regard to gynecologic laparoscopic complications. Which of

the following is true;
a. The diagnosis of an enterotomy is usually delayed in more
than 70 percent of cases.
b. The open technique is associated with fewer complications
than the closed technique.
c. The commonest cause of death in these procedures were
due to gas embolism.
d. Over 50 percent of these complications occurred at entry.
e. Inserting the laparoscopic trocars directly into the
peritoneal cavity before insufflating is associated with more
entry complications.

Answer D

20. Surgical capabilities, preoperative management, diagnosis

Which following interventions effectively reduced pain after

laparoscopy?
a. Increasing intra-abdominal pressure.
b. Increasing the insufflation rate.
c. Keeping drains postoperatively.
d. Using insufflation gases, such as nitrous oxide, helium, or
argon.
e. Cooling and humidifying the insufflation gas.
Answer D
21. Surgical capabilities, preoperative management, tratment

In regard to hysteroscopy. Which of the following is true?

a. The best distension media for contact hysteroscopy is carbon dioxide.
b. Bipolar electrocautery is best used with normal saline or Ringer's
lactate as distension media.
c. Mannitol differs from all other electrolyte-poor fluids
because it is hyperosmolar.
d. the risks of fluid absorption are associated mainly with
electrolyte fluids.
e. A deficit of 1200 ml of glycine is generally safe.
Answer B

22. Surgical capabilities, preoperative management, treatment

Which of the following is proved to reduce Fluid overload and

electrolyte imbalance during hysteroscopy?
a. Maintain intrauterine pressure at 120 mmHg.
b. Intracervical injections of a dilute vasopressin solution.
c. Treatment with a gonadotropin-releasing hormone analog.
d. Limit the procedure time to 2 hours.
e. add an easily measurable tracer to distending media e.g
ethanol.
Answer B

23. Surgical capabilities, postoperative management, pathology

Which of the following procedures carries the highest risk of uterine

perforation?
a. endometrial resection.
b. Curettage of a postpartum uterus.
c. Dilatation and curettage for gynecological conditions.
d. Dilatation and curettage in the postmenopausal patients.
e. Induced first and second trimester abortions.
Answer B

24. Amenorrhea, Epidemiology

 Suzan is a 30 years old lady who is para 1 +1, presented complaining of
oliogomenorrhoea after her last pregnancy which was a missed abortion
evacuated surgically. A hysteroscopy was performed and revealed intrauterine
adhesions. Which of the following is true in regard to her condition?
a. Amenorrhea is the most common reason for patients who
present for evaluation.
b. The frequency of adhesions with significant postcesarean
delivery endometritis does not differ from those without
postcesarean infection.
c. 40 percent of cases of severe intrauterine adhesive disease
are related to curettage for pregnancy complications.
d. The extent of adhesions seen on hysteroscopy correlates
well with degree of menstrual irregularity.
e. Sonohysterography is a better diagnostic tool than
hysterosalpingogram in diagnosing intrauterine adhesions.
Answer B

25. Amenorrhea, treatment

Which of the following is best to prevent reformation of intrauterine
adhesions after hysteroscopic adhesion resection?
a. Placement of Intrauterine device postoperatively.
b. Placement of intrauterine Foley's catheter balloon postoperatively.
c. Use of conjugated estrogen one week after the procedure.
d. Use of conjugated estrogen in the period immediately after the
procedure.
e. Use of conjugated estrogen four weeks prior to the procedure.
Answer B

26. Endometriosis, treatment

Lila is a 16 years old girl who was diagnosed as sever endometriosis. She was
put on GnRH agonist with add-back therapy for sex months which relived her
agony, after stopping this treatment all other treatments failed to control the
pain. Which of the following is an appropriate?
a. Ask for a baseline bone density evaluation and restart the regimen, and if
normal follow up in 2 years.
b. Repeat laparoscopic procedure and all visible lesions of endometriosis
should be cauterized, laser ablated, or resected.
c. Re-start combined oral contraceptive pills.
d. Start Danazole.
e. Restart GnRH agonist.
Answer A
 27. Literature and research and epdimiology

Which of the following describes the relative risk?

a. provide an understanding of the magnitude of risk

compared with a standard.
b. The relative risk equals the incidence in exposed
individuals divided by the incidence in unexposed
individuals.
c. The relative risk equals the odds that an individual with a
specific condition has been exposed to a risk factor divided
by the odds that a control has been exposed.
d. It reflects the additional incidence of disease related to an
exposure taking into account the background rate of the
disease.
e. refers to the extent to which repeated measurements of a
relatively stable phenomenon fall closely to each other.
Answer B

prenatal diagnosis, diagnosis .28

Which of the following fetal findings is LEAST often associated with other congenital
?anomalies

a) omphalocele

b) gastroschisis

c) diaphragmatic hernia

d) duodenal atresia

e) posturethral valve
 Answer is E

gynecological Malignancy , cervix, treatment .29

An 8 weeks pregnant lady is found to have stage III carcinoma of the cervix. The most
:appropriate treatment option would be

a) delivery by cesarean section at 34 weeks and irradiate

b) deliver vaginally at term and irradiate

c) perform hysterotomy now and irradiate

d) perform radical hysterectomy and pelvic lymphadenectomy now

e) irradiate now

Answer is E

Labor and delivery, pathology .30

?Which of the following situations has the greatest risk for the mother and infant

a) rupture of an intact uterus

 b) rupture of a previous uterine scar

c) pathologic contraction ring

d) dehiscence of a uterine scar

e) cervical laceration

Answer is A

Breast, treatment .31

A pregnant patient is diagnosed to have carcinoma of the breast. The most

appropriate management is

a) abortion and irradiation

b) abortion and breast surgery

c) abortion , surgery , and irradiation

d) mastectomy and node evaluation and irradiation following delivery

e) start tamoxifen therapy followed by surgery after delivery

Answer is D

Late pregnancy disorders, treatment .32

A 34 year old woman , gravida 3, para 2, presents at 38 weeks of gestation in

early labor. Cervical examination reveals dilation of 3 cm, and a firm ridge in the
membranes is noted with palpation. Ultrasonography reveals vertex presenting
fetus with what appears to be a placenta previa at the level of the internal cervical
?os. Which of the following should be the next step in management
 a) continuo expectant management

b) Sterile speculum examination

c) Amniocentesis

d) Color flow Doppler ultrasonography

e) Amniotomy

Answer is D

Puerperium morbidity, pathology .33

A 33 year old woman with hypertension had a repeat cesarean delivery at 36

weeks of gestation for a placenta previa. The surgery was difficult, with adhesions
and excessive blood loss. Both intraoperatively and postoperatively the patient was
severely hypotensive. Following six units of blood replacement , her blood pressure is
110/60 mm Hg, pulse rate is 96 beats per minute, urine output is 10 mL/h , and renal
epithelial tubulare cells and red cells casts are present in the urine. Her urine sodium
is 70 mg/L and urine to plasma urea ratio is less than 3:1. Your diagnosis is

a) prerenal failure

b) ligated ureter

c) acute tubular necrosis

d) acute cortical necrosis

e) water itexocation

Answer is C
 prenatal care, routine care, diagnosis .34

A woman at 24 weeks of gestation has a fundal height of 27 cm. You perform a

complete basic ultrasound examination in your office. The examination is technically
satisfactory, and all components of the examination are normal . Biometry is
consistent with her gestational age . On the basis of this findings, the only condition
that you have ruld out is

a) Down syndrome ( trisomy 21 )

b) tetralogy of Fallot ( ventricular septal defect, pulmonic stenosis, right

ventricular hypertrophy, overriding of the aorta )

c) tracheoesophageal fistula ( TEF )

d) cleft lip

e) Potter syndrome ( bilateral renal agnesis )

Answer is E

medical disorders in pregnancy, cardiopulmonary disease, pathology .35

A 30 year old nulligravid woman presents to your office for preconceptional

counseling. Her medical history is notable for a ventricular septal defect ( VSD ). Her
last echocardiogram revealed bidirectional shunting across the VSD and pulmonary
hypertension. Which of the following changes occurring in the peripartum period will
?place her at the greatest risk

a) Decrease in blood pressure

 b) Increase in heart rate

c) Increase in cardiac output

d) Increase in cardiac stroke volume

e) Increase in blood coagulability

Answer is A

medical disorders in pregnancy, cardiopulmonary disease, pathology .36

A 32 year old nulliparous woman has been referred to you by her cardiologist for
a prepregnancy consultation. An echocardiogram performed by the cardiologist
demonstrated isolated severe aortic stenosis. Cardiac catheterization demonstrated a
peak systolic pressure gradient of 120 mm Hg across the aortic valve. She has had
dyspnea on climbing one flight of stairs and walking half a block. She greatly desires
to conceive. Her most serious risk for cardiovascular compromise during the third
trimester and the intrapartum and postpartum periods of pregnancy, should she
conceive is

a) an increase in heart rate

b) a decrease in pulmonary vascular resistance

==c) a decrease in intravascular volume

d) an increase in strok volume

e) a decrease in periferal vascular resistance

Answer is C
 medical disorders in pregnancy, hematology and autoimmune disease, .37
diagnosis

A 26 year old primigravid woman with a history of systemic lupus erythematosus

( SLE ) is being seen for a routine prenatal visit at 26 weeks of gestation. She has
noticed mild pleuritic chest pains as well as joint and muscle aches for the past 7
days. Her blood pressure is 142 / 90 mm Hg and protein is detected in her urine ( 3+
on semiquantitive analysis ). Which of the following will best confirm the diagnosis of
?lupus nephritis and distinguish it from preeclampsia in this patient

a) Low platelet count

==b) Low serum concentration of C3

c) Elevated ratio of CH50 to barium

d) Elevated serum uric acid level

e) Elevated liver enzymes

Answer is B

medical disorders in pregnancy, infectious disease, treatment .38

A 24 year old woman, gravida 2, para 1, presents for her first obstetric visit at 14
weeks of gestation. She states that her mother, who lives with her, is currently being
treated for tuberculosis. The patients purified protein derivative ( PPD ) test shows 5
mm of induration, and her chest X- ray is negative. You recommend

a) no therapy

b) isoniazid ( INH ) 300 mg daily for 6 months, beginning immediately

c) INH, 300 mg, and rifampin, 600 mg, daily for 4 months beginning
immediately
 d) INH, 300 mg daily for 6 months, beginning after delivery

e) INH, 300 mg daily for 12 months, beginning after delivery

Answer is B

fetal monitoring, diagnosis .39

Follow up of nonreactive nonstress ( NSTs ) by the contraction stress test ( CST ) or

biophysical profile at your hospital is cumbersome and time consuming. In evaluating
the possible use of vibroacoustic stimulation (VAS ) to decrease the number of
nonreactive NSTs, which of the following has the greatest influence on the likelihood
?of a reactive NST following VAS

a) Gestational age ( 26 versus 36 weeks )

b) Duration of stimulus ( 3 seconds versus 5 seconds )

c) Number of stimuli ( one versus two )

d) Time since last meal ( 1 hour versus 8 hours )

e) patient position (left lateral versus right lateral)

Answer is A

prenatal diagnosis, epidemiology .40

A 25 year old woman, gravida 1, para 0, is currently at 18 weeks of gestation. Her

first prenatal visit was at 6 weeks of gestation. Fetal heart tones were heard by
Doppler at 10 weeks. She had a normal triple screen (maternal serum alpha
fetoprotein, human chorionic gonadotropin, estriol ) at 16 weeks. She has no medical
 problems. In discussing the pros and cons of screening ultrasonography at 18 20
weeks, you can correctly tell her there is a consensus in the literature that the
examination will

a) decrease perinatal morbidity

b) decrease neonatal mortality

c) decrease maternal morbidity

d) increase detection of fetal anomalies

e) be not cost effective

Answer is D

medical disorders in pregnancy, endocrine disease, epidemiology .41

A 25 year old primigravid woman presents for her second prenatal visit at 22
weeks of gestation. She has had type 1 diabetes mellitus for 15 years and has known
nephropathy. The results of her initial evaluation in the first trimester included
creatinine clearance, 120 mL/min: serum creatinine, 0.8 mg/dL : 24-hour proteinuria,
1.7 g: and blood pressure, 120/80 mm Hg. At this visit her uterine size is appropriate
for her dates, and fetal heart tones are present. Regarding her prognosis for this
:pregnancy, you counsel her that

a) She already has preeclampsia

b) Her fetus will probably develop intrauterine growth restriction ( IUGR )

c) Her probability of perinatal mortality is less than 10%

d) Her probability of a term delivery ( 37 weeks ) is greater than 90%

e) Her probability of renal failure by the end of the pregnancy is greater than
20%

Answer is C
 medical disorders in pregnancy, cardiopulmonary disease, epidemiology .42

A 35 year old woman, gravida 4, para 2, with a twin gestation presents at 35

weeks in congestive heart failure. Workup leads to a diagnosis of preipartum
cardiomyopathy. The patient is stabilized and labor is induced. Delivery of both twins
is uncomplicated. The patients postpartum course is protracted, with findings of
persistent cardiomegaly and congestive heart failure. Six weeks postpartum. She
improved, and an echocardiogram reveals normal cardiac size but a left ventricular
ejection fraction of 35%. What specific counseling is appropriate for this patient
?regarding future pregnancy

a) Further studies are indicated

b) Pregnancy is not contraindicated if she is maintained on inotropic

.medications

c) Pregnancy is not contraindicated if she is maintained on prophylactic

.antibiotics

.d) She should not become pregnant again

e) Pregnancy is contraindicated only if pulmonary hypertension is insured

Answer is D

labor and delivery , traetment .43

A 35 year old woman at term has a total placenta previa. After a cesarean
delivery, the obstetrician is having difficulty removing the placenta. The patient is
bleeding profusely, and the anesthesiologist informs the clinician that she is not able
to maintain the patients blood pressure. The most appropriate surgical management
is
 a) curettage

b) ligation of the posterior branch of the hypogastric arteries

c) embolization of uterine arteries under radiologic guidance

d) cesarean hysterectomy

e) cesarean hysterectomy and bilateral salpingo-oophorectomy

Answer is D

medical disorders in pregnancy, hematology and autoimmune disease, .44

treatment

A 28 year old primigravid woman at 25 weeks of gestation has had mild

rheumatoid arthritis for the past 2 years. Because of recent skeletal muscle
weakness, she was tested and found to have myasthenia gravis (MG). In addition to
an anticholinesterase drug, the first line of treatment includes

a) azathioprine ( Imuran )

b) corticotropin

c) prednisone

d) plasmapheresis

e) thymectomy

Answer is C
 medical disorders in pregnancy, hypertension , treatment .45

A 35 year old woman, gravida 4, para 3, at 32 weeks of gestation requires a

cesarean delivery under general anesthetic. On examination her blood pressure is
180/120 mm Hg, her pulse rate is 90 beats per minute, and she has 4+ proteinuria.
The patient has not received any treatment. Medical options to lower her blood
:pressure before intubation include all of the following EXEPT

a) Oral nifedipine capsules

b) Intravenous ( IV ) nitroglycerin ( Nitro-Bid )

c) Intravenous acetazolamide sodium ( Diamox )

d) Intravenous hydralzine hydrochloride

e) Intravenous labetalol hydrochloride ( Normdyne, Trandate )

Answer is C

medical disorders in pregnancy, endocrine disease, epidemiology .46

:The following statements are true about insulin-dependent diabetes and pregnancy

a) Unexplained intrauterine death remains a leading cause of perinatal

mortality

b) The deterioration in diabetic nephropathy that occurs in pregnancy persists

postpartum

c) Cesarean section rate is usually about 30-50 % in most series

d) The risk of intrauterine growth restriction ( IUGR ) correlates to the

glycosylated haemoglobin (HbA1C) level

e) The commonest structural abnormality in offspring of diabetics is caudal

regression syndrome
 Answer is C

Rh Isoimmunization, treatment .47

The following are true concerning amniocentesis in the management of fetal

:isoimmune erythroblastosis

a) It is of no value before 27 weeks gestation

b) It can be used to manage pregnancies complicated by anti- Kell antibodies

c) When the amniotic fluid delta optical density ( OD ) is falling and the
maternal antibodies are stable, the fetus is definitely rhesus negative and no
further checks are necessary

d) It is indicated when maternal anti- D concentration exceeds 4 folds

e) Rising delta OD indicates the need for immediate delivery

Answer D
 Analgesia and anesthesia, pathology .48

:Postdural puncture headache

a) always presents within a few hours of inadvertent dural tap

b) is worse early in the morning

c) is relieved by paracetamol

d) is relieved by abdominal pressure

e) can be avoided by preventing straining in the second stage of labour

Answer D

Analgesia and anesthesia, pathology .49

:Epidural anesthesia is contraindicated in the following neurological diseases

a) spina bifida

b) multiple sclerosis

c) raised intracranial pressure

d) myasthenia gravis

e) epilepsy

Answer C
 prenatal diagnosis, diagnosis .50

Which of the following types of ultrasound scans is most likely to be associated with
?trisomy 21

a) Lemon sign

b) Banan sign

==c) Double bubble sign

d) Cloverleaf sign

e) Spolding sign

Answer C

medical disorders in pregnancy, endocrine disease, epidemiology .51

A 37- year- old woman, gravid 3, para 2, with gestational diabetes presents for her 26
weeks prenatal check- up. Fasting glucose levels have been 110- 120 mg/ dL, and 1
hour postprandial glucose levels have been 150- 160 mg/ dL . The fetus is at greatest
risk of developing

a) anemia

b) macrosomia

c) hyperclacemia

d) intrapartum fetal distress

e) reduced amniotic fluid index

 Answer B

early pregnancy complications, treatment .52

Which of the following is the most likely adverse side effect of prostaglandin E2
?( Prostin, Prepidil ) abortifacient vaginal suppositories

a) Hypertension

b) Hyperthermia

c) Bronchospasm

d) Cardiac arrhythmia

e) Atrial fibrilation

Answer B

fetal growth, treatment .53

An 38 year old woman, gravid 1, para 0, is at 34 weeks of gestation with a growth

restricted singleton fetus. Follow up ultrasound examination demonstrates a fetus
in cephalic presentation with an amniotic fluid index of 8 cm, an estimated fetal
weight below the 10th percentile for gestational age, and absent end diastolic
velocity in the umbilical artery. Which of the following is appropriate management
?for this pregnancy

a) Labor induction

b) Low dose aspirin

c) Cesarean delivery
 d) Daily nonstress test

e) Maternal hyperoxygenation

Answer A

medical disorders in pregnancy, infectious disease, treatment .54

A 25 year old woman, gravid 1, para 0, is at 26 weeks of gestation, presented to the

emergency room complaining of fever. The patient was suspected to have pandemic
?H1N1 influenza. Which of the following statements is true

a. Patient should receive antiviral therapy with Zanamivir.

b. Treatment should be initiated with Oseltamivir phosphate
c. Treatment should be started after confirming the result with diagnostic
testing.
d. Acetaminophen is not helpful when fever is present in this case.
e. The benefits of antiviral therapy are expected to be greatest when initiated
within the first 96 hours following symptom onset.

Answer B
 preterm labor, treatment .55

A 33 year old woman, gravid 3 para 2. Had 2 premature deliveries at 35 & 32 weeks
of gestation. She was complaining of premature contractions intermittently in this
pregnancy. She was given a course of steroids at 25 weeks of gestation. Currently,
she is 31 weeks of gestation and started to have more frequent crumbs and lower
:abdominal pin. Your plan of management could include

a. 17-alpha-hydroxyprogesterone 1000 mg intramuscular weekly.

b. Oral Ritodrine 10 mg q8 hours.
c. Ampicillin 1000 mg intravenously Q6 hours for 48 hours then oral Amoxil 500
mg Q 8 hours for 5 days.
d. Cervical cerclage.
e. A second course of antenatal glucocorticoids.

Answer E

prenatal diagnosis, diagnosis .56

A pregnant woman is concerned about the possibility of

giving birth to a second child with amaurotic familial idiocy
(Tay-Sachs disease ). A study that will show whether the
fetus is affected is:

a) Measurement of alpha-fetoprotein in maternal serum

b) Measurement of glucose 6-phosphate dehydrogenase in
amniotic cell
c) Preparation of a karyotype from cultured amniotic cells
d) Measurement of hexosaminidase A in cultured amniotic
cells
e) measument of middle cerebral artery doppler

answer D

medical disorders in pregnancy, infection in pregnancy, diagnosis .57


An ultrasound scan reveals a hydropic fetus with a
large placenta and microcephaly is present. During
treatment the woman develops a Jarisch-Herxheimer
reaction. What is the dignosis?

a) Cytomegalovirus
b) Hepatitis B
c) Parvovirus
d) Rubella
e) Treponema pallidum

Answer E

prenatal diagnosis, diagnosis .58

A pregnant woman tells you that her husbands brother

died of Duchenne muscular dystrophy. Proper management
of this patient should include:

a) Amniocentesis for determination of fetal sex

b) Fetoscopy to obtain fetal blood for measurement of
creatine kinase concentration
c) Counseling the couple that the risk of a male being affected
is 1 in 2
d) Fetoscopy to obtain a specimen of fetal muscle for biopsy
e) Amniocentesis for karyotyping and gene mapping

Answer E

.late pregnancy disorders, Epidemiology .59


Placenta praevia:

a) Nulliparity is a risk factor

b) Complicates approximately 1 in 400 pregnancies
c) Is associated with intra-uterine growth restriction
d) Is commonly diagnosed MRI
e) Four Caesarean section scars increases the risk by more
than 50%

Answer C

prenatal care, pregnancy counseling, pathology .60

which of the following injectable vaccines is

contraindicated during pregnancy?

a) Tetanus
b) Poliomyelitis
c) Mumps
d) Influenza
e) Rabies

Answer C

.medical disorderse in pregnancy, cardiopulmonary disease, treatment .61

The following drugs would be appropriate and safe to

treat a maternal supraventricular tachycardia (SVT) at 27
weeks gestation EXCEPT:

a) Verapamil
b) Digoxin
c) Adenosine
d) Amiodarone
e) Flecanide

Answer D

.prenatal diagnosis, Diagnosis .62

 Amniotic fluid acetylcholinesterase concentration is a
useful predictor of:

a) Obstructive uropathy
b) Fetomaternal bleeding
c) Muscular dystrophy
d) Congenital heart disease
e) Open neural tube defects

Answer E

early pregnancy disorders, epidemiology .63

The most frequent maternal factor causing recurrent

:pregnancy loss is

a)genetic

b)uterine

c)luteal phase defect

d)antiphospholipid syndrome

e)unexplained

Answer E

early pregnancy disorders, diagnosis .64

The most controversial test for the routine evaluation

of the cause of recurrent miscarriage is

a)HSG

b)endometrial biopsy
 c)parental karyotyping

d)evaluation of anticardiolipin

e)blocking antibodies

Answer E

reproductive tracts anomalies, epidemiology .65

The first trimester spontaneous abortion rate is highest

?for patients with which type of uterine anomaly

a)unicornuate

b)arcuate

c)septate

d)bicornuate

e)didelphys

Answer C

reproductive tracts anomalies, epidemiology .66

What percentage of women with a unicornuate uterus have

?an associated rudimentary horn

a)5%

b)10%
 c)33%

d)48%

e)65%

Answer E

prenatal care, routine care, diagnosis .67

If a pregnancy is normal cardiac activity will be seen

sonographically by the time the embryo length is

a) 2mm

b) 5mm

c) 8mm

d)10mm

e)12mm

Answer B

early pregnancy disorders, epidemiology .68

-The single most common chromosome abnormality in sponta

:neous abortuses is

a) monosomyX (Turner's syndrome)

b)trisomy16

c)trisomy 21
 d)triploidy

e)tetraploidy

Answer A

prenatal diagnosis, epidemiology .69

What percentage of Down's (trisomy 21) fetuses survive

?to term

a) 10%

b) 33%

c) 50%

d) 75%

e) 90%

Answer B

medical disorders in pregnancy, infectious disease, epidemiology .70

With maternal viremia, the rate of placental transmission

:of virus is highest with

a)HIV

b)CMV

c)herpes simplex
 d)rubella

e)varicella-zoster

Answer D

medical disorders in pregnancy, infectious disease, epidemiology .71

: The most common viral infection in the fetus is

a)rubella

b)CMV

c)herpes simplex

d)HIV

e)varicella-zoster

Answer B

medical disorders in pregnancy, infectious disease, diagnosis .72

Which of the following fetal abnormalities is found in

-the congenital varicella syndrome but not in the con

?genital rubella syndrome

a)Skin cicatrix formation

b)Microcephaly

c)Growth retardation

d)Chorioretinitis
 e)cataracts

Answer A

gestational trophoplastic disease, epidemiology .73

After remission of hCG titers following evacuation of

a hydatiform mole,theca-lutein cysts should regress

: within

a)1 week

b)2 weeks

c)3-4 weeks

d)6-8 weeks

e)12 weeks

Answer D

gestational trophoplastic disease, epidemiology .74

The risk of hydatiform mole is highest in which maternal

?age group

a)20

b)20-30

c)30-40

d)40-50

e)no difference
 Answer D

Preterm labor, epidemiology .75

The strongest correlation with preterm birth is found

:with

a)DES exposure

b)low socioeconomic status

c)uterine anomaly

d)young age

e)prior preterm birth

Answer E

Late pregnancy disorders, treatment .76

Oral hydration of women with oligohydramnios has been

shown to

a)increase the AFI (amniotic fluid index) markedly

b)increase the AFI minimally

c)not influence the AFI

d)produce inconsistent effects on the AFI

e) produce negative effects on the AFI

Answer B
medical disorders in pregnancy, heamatological and autoimmune disease, .77
epidemiology

-Which of the following dermatologic disorders of preg

:nancy has been associated with maternal mortality

a)papular dermatitis

b)impetigo herpetiformis

c)prurigo gestationis

d)herpes gestationis

e)acne vulgaris

Answer B

newborn , pathology .78

The postpartum increase in thyrotropin secretion in the

neonate is caused by

a)breathing air

b)suckling

c)ambient diurnal variation (day / night)

d)body cooling

e)intrapartum maternal thryrotropin transfer to the

fetus

Answer D