MCQs (Part IV)

1. Studies indicate that the incidence of spina bifida and anencephaly in newborns is reduced by 50% if women take supplements of which one of the following prior to conception?

Folic acid

Vitamin E

Vitamin C

Calcium

Pantothenic Acid

2. Which of the following statements concerning placenta previa is true?

Its incidence decrease with maternal age

Its incidence is unaffected by parity

The initial hemorrhage is usually painless

Management no longer includes examination in the theatre

Vaginal examination should be done immediately

3. The most common cause of spontaneous abortion in the first 12 weeks of pregnancy is:

The presence of maternal lupus anticoagulant

Chromosomal anomalies

An incompetent cervix

Maternal tobacco abuse

Inadequate progesterone during the luteal phase

4. Following a prolonged labor and traumatic delivery, a 5015 gram male infant holds his right arm in an abducted and internally rotated position with extension at the elbow, pronation of the forearm, and flexion of the wrist. Although the grasp reflex is intact, the biceps and brachioradialis reflexes are absent. The most likely diagnosis is a

Rotator cuff tear

Clavicle fracture

Brachial plexus injury

Cerebral injury

Fractured humerus

5. It is important to obtain an adequate sample for a papnicolaou test because cervical intraepithelial neoplasia most often arises flow

Areas of cervicitis

The original squamous epithelium

The squamocolumnar junction

Cervical erosions

6. In patients with small ectopic pregnancies, medical management may include

Actinomycin D

Mefiprestone

Prostaglandin F

Methotrexate

Isotretinon

7. Which one of the following second trimester findings would most strongly suggest the possibility of a twin gestation?

Palpation of fetal parts

A discrepancy between gestational age and uterine size

Increased levels of chorionic gonadotropins in the urine

The onset of polyhydramnios

8. Which of the following best describes vaginismus?

Dyspareunia caused by a structurally small vagina

A voluntary contraction of the vaginal muscles to prevent penetration

An involuntary contraction of the vaginal and pelvic floor muscles

A condition associated with general sexual and orgasmic inhibition

9. An 18 year old girl consults you for evaluation of disabling pain with her menstrual period. This pain has been present for the last 4 years and is accompanied by nausea and headache. Physical examination was unremarkable. Your initial treatment will be:

Ergot derivatives

Antiprostaglandins

Danazole

Gonadotropin releasing hormone analogs

10. A 28 year old primigravida is found to have a hydatidiform mole on pelvic ultrasonography. The uterine contents are evacuated by suction aspiration and curettage. Subsequent management should include which one of the following?

Serial measurement of serum human chorionic gonadotropin (HCG) until it remains normal for 1 year

Therapy with methotrexate within 1 week after uterine evacuation

Encouraging the patient to conceive 3 months after the mole is removed

Monthly pelvic ultrasonography

Use of high-dose oral contraceptives (>50 mcg estrogen)

11. At what age should a female with primary amenorrhea be evaluated, regardless of normal growth and development and the presence of secondary sex characteristics?

12 years of age

14 years of age

16 years of age

18 years of age

20 years of age

12. A 30 year old gravid 5, para 4 woman, has an unplanned intrauterine pregnancy while using intrauterine contraceptive device. On examination, the string of the IUD is noted to be protruding from the cervical os. The most appropriate action is to:

Leave the IUD in place without any other treatment

Leave the IUD and continue prophylactic antibiotics throughout pregnancy

Remove the IUD immediately

Terminate the pregnancy because of the high risk of infection

Perform laparoscopy to rule out a heterotopic ectopic pregnancy

13. Which of the following drugs is an appropriate choice for treating gonococcal urethritis and cervicitis?

Erythromycin

Cefoxitin (Mefoxin)

Metronidazole (Flagyl)

Ceftriaxone (Rocephin)

Spectinomycin (Trobicin)

14. The first evidence of pubertal development in the female is usually

Onset of menarche

Appearance of breast buds

Appearance of axillary hair

Appearance of pubic hair

Onset of growth spurt

15. Women with polycystic ovary syndrome have a higher risk of which one of the following?

Sexual dysfunction

Pituitary adenoma

Adrenal hyperplasia

Impaired glucose tolerance

Ovarian malignancy

16. A 22 year old white female who works in the newborn nursery of a hospital consults you regarding her exposure yesterday to an infant with congenital rubella. Today she has a positive pregnancy test and is 8 weeks pregnant by dates and examination. Her rubella immunization status is unknown. Your immediate recommendation is:

A therapeutic abortion

Intramuscular gamma globulin

Oral amantadine (symmetrel)

A rubella antibody test

An MMR vaccination

17. Vulvovaginal trichomoniasis can be described most accurately by which of the following statements?

Caused by the overgrowth of bacteria native to some individuals

Not associated with an alteration of normal vaginal pH

Causes pelvic inflammatory disease

A sexually transmitted disease

Diagnosis can be made by obtaining a wet smear and mixing with KOH

18. Mucopurulent cervicitis characterized by the presence of visible yellow mucus on the cervix is most likely due to

Herpes simplex virus type 2

Trichomonas vaginalis

Staphylococcus aureus

Chlamydia trachomatis

Pseudomonas aeruginosa

19. Which maternal reproductive record should raise the strongest suspicion of maternal diabetes mellitus?

Loss of fetal movement and heart tones following acute abdominal pain, early in the third trimester.

First trimester loss in a primigravida

Repeated second trimester loss associated with very rapid delivery

Stillbirth early in the third trimester accompanied by bleeding

Unexplained stillbirth at term

20. Endometrial hyperplasia, a pathologic condition that is usually associated with abnormal uterine bleeding, is caused by:

The absence of both estrogen stimulation and progestational influence

The absence of estrogen stimulation and excessive progestational influence

Persistent estrogen stimulation and excessive progestational influence

Persistent estrogen stimulation in the absence of progestational influence

21. A 41 year old had a baby with Down Syndrome 10 year ago. She is anxious to know the chromosome status of her fetus in a current pregnancy. The test she can have that the fastest lab processing time for karyotype is:

Aminocentesis

Cordocentesis

Chrionic villus sampling

Coppler flow ultrasound

Cystic hygroma aspiration

22. A 27 year old woman has tried unsuccessfully for 5 months to become pregnant. At this point, the recommended evaluative procedure would be:

Semen analysis

Hysterosalpingography

Endometrial biopsy

Diagnostic laparoscopy

None of the above

23. A patient at 17 week gestation is diagnosed as having an intrauterine fetal death. She returns to the clinic 4 weeks later and has not aborted yet. This patient is at increased risk for

Septic abortion

Recurrent abortion

Consumptive coagulopathy

Future infertility

Ectopic pregnancy

24. Although rheumatic heart disease is less common than in previous decades, it still occurs during pregnancy. Deteriorating cardiac status in a pregnant woman is most likely to be associated with

Aortic regurgitation

Aortic stenosis

Mitral regurgitation

Mitral Stenosis

Tricuspid regurgitation

25. In addition to effective contraception, health benefits for women taking oral contraceptives include a decrease incidence of which of the following?

Lung cancer

Benign breast disease

Hypertension

Cervical cancer

Diabetes

26. Concerning the exogenous control of hyperglycemia in the pregnant woman who has diabetes mellitus

Oral hypoglycemic agents are useful in women who have either Class A or B diabetes mellitus

Insulin has the potential to induce hypoglycemia in the infant

Insulin dosage usually peaks at term

The primary objective in the use of insulin is to prevent ketacidosis

27. Cancer of the cervix has been found to have infiltrated the upper two thirds of a patient's vagina and parametrium but not to extend to the pelvic sidewall. The correct FIGO staging of this carcinoma is:

Stage IB

Stage IIA

Stage IIB

Stage IIIA

Stage IIIB

28. A 27 year old nondiabetic multiparous woman at 39 weeks gestation has had a previously uncomplicated pregnancy. Fundal height and estimated of fetal size have been at the upper limits of normal for several weeks. Today the fundus measures 44cm from the pubis and you estimate on palpation that the fetus is large. Clinical pelvimetry is normal. Which one of the following treatment plans is supported by objective clinical evidence?

Perform external podalic version to breech position and deliver vaginally in order to decrease the likelihood of shoulder dystocia

Place the mother on a 500 calorie/day diet in order to slow fetal weight gain

Order ultrasonography and perform a cesarean section if estimated fetal weight is 4000g

29. A 35 year old primigravida at 37 weeks gestation is diagnosed to have urinary tract infection, the antibiotic of choice should be

Cephalosporin

Tetracycline

Sulfonamide

Nitrofurantoin

Ciprofloxacin

30. A palpable ovary in a postmenopausal female should be managed by:

Following the patient with serial bimanual examinations

Referral to a gynecologist