Tiêu đề [OBGYN] Compre 2023.pdf ✅

🙏 OBSTETRICS AND GYNECOLOGY COMPREX2 OBGYN 22 May 2023 | Answers are STUDENT-GENERATED, please use with caution. V.01 1. Which of the following immunoglobulins is exclusively produced by the fetus? A. IgM B. IgA C. IgG D. IgG and IgM A A. Among the choices IgM is the only one that is exclusively produced by the fetus B. Can be produced by both fetus and adults C. Can be produced by both fetus and adults D. Can be produced by both fetus and adults [https://www.ncbi.nlm.nih.gov/books/NBK27162/] 2. A 30-year-old G1P0 at 23 weeks AOG was diagnosed to have preterm premature rupture of membranes (PPROM). If there will be continuous passage of water per vagina, which of the following conditions is expected to complicate the fetus? A. Duodenal Atresia B. Pulmonary Hypoplasia C. Respiratory Distress Syndrome D. Spina Bifida B A. Unrelated to PPROM B. PPROM can result in oligohydramnios which may result in pulmonary hypoplasia of the FETUS if left untreated. C. Can be considered but this usually occurs in INFANTS as compared to pulmonary hypoplasia. D. Part of neural tube defects caused by inadequate maternal folic acid intake [trans / textbook / link reference] 3. Which of the following conditions in pregnancy is the leading cause of maternal morbidity and mortality? A. Obesity B. Hypertension C. Bronchial Asthma D. Diabetes B A. Not included in the top causes of maternal morbidity and mortality. B. According to WHO 2014, the top causes of maternal death are hemorrhage, hypertension and sepsis. C. Not included in the top causes of maternal morbidity and mortality. D. Not included in the top causes of maternal morbidity and mortality. [OBS - 1.01 Overview of Obstetrics] 4. Who among these pregnant women has the HIGHEST risk to develop preeclampsia? A. 25 y/o G3P2 (2002) B. 29 y/o G1P0 C. 18 y/o G2P1 (1001) D. 17 y/o G1P0 D A. Not suggestive of risk for preeclampsia. B. Patient is nulliparous, however choice D would be more at risk for preeclampsia. C. Patient is young, however she is not nulliparous, which confers less risk compared to choice D. D. Patient possesses 2 risk factors for preeclampsia: young age and nulliparity. [trans / textbook / link reference] 5. Who among these pregnant women has the HIGHEST risk to develop diabetes? A. 29 y/o G1P0, American descent B. 36 y/o G2P1(1001), previous baby with birth weight of 2.1kg C. 40 y/o G3P2 (2002), previous CS D. 35 y/o G2P1(1001), previous baby with cleft lip C Common risk factors for GDM: 1. Advanced maternal age: Women who are 35 years or older may have an increased risk. 2. Previous history of gestational diabetes: If a woman has had gestational diabetes in a previous pregnancy, her risk may be higher in subsequent pregnancies. 3. Previous birth with macrosomia: A previous baby with a high birth weight (macrosomia), typically defined as over 4 kg (8.8 lbs), may indicate an increased risk. OBGYN OBGYN COMPREHENSIVE EXAMINATION 2 Page 1 of 19
4. Previous history of cesarean section (CS): While not a direct risk factor, a previous CS may be associated with other risk factors, such as advanced maternal age or a history of gestational diabetes. 5. Family history of diabetes: Having a first-degree relative (parent, sibling) with diabetes increases the risk. 6. Ethnicity: Some ethnic groups, such as Hispanic, African American, Native American, South Asian, and Pacific Islander, have a higher risk of gestational diabetes. [OBS - 3.02 Diabetes Mellitus and Thyroid Disorders , p.2] 6. A 27 year old primigravid on her 26 weeks gestation complains of heartburn described as retrosternal burning sensation. What is the first line therapy? A. Proton pump inhibitors B. Common oral antacids C. H2 receptor antagonists D. Prostaglandin E1 Ana B A. Safe in pregnancy but not first line. Food and Drug Administration has classified omeprazole as a category C drug in pregnancy (indicating that studies in animals have shown a risk to the fetus but that adequate data in humans are not available) because of toxic effects on animal embryos and fetuses when the drug is given at high doses. All other PPIs are classified as category B drugs (indicating that studies in animals have not shown a risk to the fetus but that adequate data in humans are not available. B. Antacids containing aluminum, calcium, and magnesium were not found to be teratogenic in animal studies and are recommended as first-line treatment of heartburn and acid reflux during pregnancy. C. Considered safe to take during pregnancy but not first line D. Safe in pregnancy but not indicated for heartburn as it may cause cervical ripening and induction of labor [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821234/#:~:text=acid%2Dreducin g%20agents-,Antacids,and%20acid%20reflux%20during%20pregnancy.] 7. Some pregnant women have worrisome upper gastrointestinal bleeding that may be secondary to small linear mucosal tears near the esophageal junction. Which of the following describes this condition? A. Boerhaave’s Syndrome B. Mallory-Weiss Syndrome C. Crohn’s disease D. Barrett’s esophagus B A. With sustained retching, the less common, but more serious, esophageal rupture - Boerhaave syndrome - may develop from greatly increased esophageal pressure. B. Mallory-Weiss tears are described to be small linear mucosal tears near the gastroesophageal junction caused by persistent vomiting. C. Crohn’s disease involves not only the bowel mucosa but the deep layers (may be transmural) D. Barrett esophagus is a premalignant condition characterized by conversion of the normal esophageal squamous epithelium into metaplastic columnar epithelium. [Williams Obstetrics 25th Edition, p.1047; OBS - 3.05 Gastrointestinal and Neurological Disorders (Bautista-Zamora) , p.5] 8. Who among these pregnant women has the HIGHEST risk to develop B? A. See Rationale B OBGYN OBGYN COMPREHENSIVE EXAMINATION 2 Page 2 of 19
pre-eclampsia? A. 25 y/o G3P2 (2002) B. 29 y/o G1P0 C. 18 y/o G2P1 (1001) D. 17 y/o G1P0 B. RISK FACTORS FOR PRE-ECLAMPSIA a. Immunologic Related i. Nulliparous ii. Previous Pre-eclampsia iii. Multiple Gestation iv. Abnormal placentation b. Disease-related i. Chronic HTN ii. Chronic renal disease iii. Collagen Vascular Disease iv. Progestational DM c. Maternal Related i. African American ii. Obesity iii. 35 < Age < 20 iv. New paternity v. Cohabilitation < 1 year d. Family History i. Relatives ii. Mother-in-law e. Short inter-pregnancy interval f. Hydrops Fetalis g. Molar Pregnancy h. Excessive Weight Gain i. Nutrition C. See rationale B D. See rationale B [2023 OB Trans 2.02 - High Risk Pregnancy] 9. A 39-year-old G5P4 (4004) known diabetic on irregular insulin use was referred due to consideration of a big term baby with EFW of 5kg. Spontaneous rupture of the membranes revealed excessive amount of amniotic fluid. What neonatal condition should be anticipated? A. Rapid drop in plasma glucose concentration B. Early onset hypercalcemia as metabolic derangement C. Gradual decrease in hematocrit concentration D. Pathological ventricular remodeling progression A A. One of the most common fetal effects of maternal diabetes is fetal hypoglycemia. B. See rationale A C. See rationale A D. See rationale A [Reference] 10. A 28-year-old recently diagnosed with GDM delivered via cesarean section for dysfunctional labor and delivered a live term baby girl weighing 4,300 grams. What diagnostic test is recommended postpartum to evaluate glucose metabolism? A. 75g, 2-hr oral glucose tolerance test at 4-12 weeks postpartum B. Fasting blood glucose determination daily for 3 days postpartum C. 100g, 2-hr oral glucose tolerance test at 6-12 weeks postpartum D. Glycosylated hemoglobin determination before discharge A A. 5th International Workshop-Conference on GDM: recommended 75g OGTT at 6 to 12 weeks postpartum ACOG: at 4 to 12 weeks postpartum For total counseling of patients, screening with 75g OGTT between 4-12 weeks is done, others 6-12 weeks B. Fasting or random plasma glucose 1-3 days post-delivery is done to detect persistent, overt DM. C. 75g 2h OGTT is used D. Glycosylated hemoglobin is not part of the postpartum evaluation [OBS 203 Diabetes Mellitus & Thyroid Disorders] 11. A 30-year-old, G1P0 with a previous myomectomy complained of sudden severe abdominal pain and vaginal bleeding 2 hours after the onset of labor pains. She was pale and hypotensive with no fetal heart tones. What is the most likely diagnosis? A. Placenta accreta B. Placenta previa C. Uterine rupture D. Abruptio placenta C A. Placenta accreta is a condition where the placenta attaches too deeply into the uterine wall but does not typically present with sudden severe pain and hypotension. B. Placenta previa is a condition where the placenta partially or completely covers the cervix, leading to painless vaginal bleeding. It does not usually cause sudden severe pain or hypotension. OBGYN OBGYN COMPREHENSIVE EXAMINATION 2 Page 3 of 19