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Question 1
Incorrect
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A 33-year -old G2Pl woman who is at 10 weeks gestation presented to the medical clinic for antenatal visit. It was revealed that she has a twin pregnancy. She was known to have had a complicated previous pregnancy with placental abruption at 34 weeks. Which of the following is considered the next step in best managing the patient in addition to routine antenatal care?
Your Answer: Hospital admission after 34 weeks
Correct Answer: Increased iron and folic acid supplementation
Explanation:Twin pregnancies are at risk for iron deficiency due to significant maternal, fetal, and placental demands. Recommendations regarding the optimal iron dose in twin pregnancies are based on clinical expert opinions, advocating doubling the dose of iron from 30 mg of elemental iron to 60 mg routinely during the second and third trimester, regardless of maternal iron stores.
If pregnant with twins, patient should take the same prenatal vitamins she would take for any pregnancy, but a recommendation of extra folic acid and iron will be made. The additional folic acid and extra iron will help ward off iron-deficiency anaemia, which is more common when patient is pregnant with multiples.
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This question is part of the following fields:
- Obstetrics
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Question 2
Incorrect
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Warfarin is contraindicated during pregnancy. Which of the following complications are possible to develop if warfarin is used in second trimester of pregnancy?
Your Answer: Maternal cerebral bleeding
Correct Answer: Fetal optic atrophy
Explanation:Administration of warfarin should be avoided throughout pregnancy and especially during the first and third trimesters as it have the ability to cross placenta. Intake of warfarin during 6-12 weeks of gestation can results in fetal warfarin syndrome which is characterized by the following features:
– A characteristic nasal hypoplasia
– Short fingers with hypoplastic nails
– Calcified epiphyses, namely chondrodysplasia punctata, which is evident on X-ray as stippling of the epiphyses.
– Intellectual disability
– Low birth weightAs these effects are usually dose dependent, recent estimates shows that the risk of fetal warfarin syndrome is around 5% in babies of women who requires warfarin throughout pregnancy.
Later exposure as after 12 weeks, is associated with symptoms like central nervous system anomalies, including microcephaly, hydrocephalus, agenesis of corpus callosum, Dandy-Walker malformation which is presented with complete absence cerebellar vermis and enlarged fourth ventricle, and mental retardation, as well as eye anomalies such as optic atrophy, microphthalmia and Peter anomaly (anterior segment dysgenesis).
Those newborns exposed to warfarin in all three trimesters there will be blindness and other complication of exposed to warfarin in neonates include perinatal intracranial and other major bleeding episodes. -
This question is part of the following fields:
- Obstetrics
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Question 3
Correct
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A 32-year-old woman at 37 weeks of gestation, who has been fine antenatally, presented with a history of sudden onset of severe abdominal pain with vaginal bleeding, and cessation of contractions after 18 hours of active pushing at home. On examination, she is conscious and pale. Her vital signs include blood pressure of 70/45 mm of Hg and a pulse rate of 115 beats per minute which is weak. Her abdomen is irregularly distended, with both shifting dullness and fluid thrill present. Fetal heart sounds are not audible. What will be the most likely diagnosis?
Your Answer: Uterine rupture
Explanation:Patient’s presentation is classic for uterine rupture, were she developed sudden abdominal pain followed by cessation of contractions, termination of urge to push and vaginal bleeding.
Abdominal examination shows no fetal cardiac activity and signs of fluid collection like fluid thrill and shifting dullness. The fluid collected will be blood, which usually enters the peritoneum after the rupture of the uterus. In such patients vaginal examination will reveal a range of cervical dilatation with evidences of cephalopelvic disproportion.
Anterior lower transverse segment is the most common site for spontaneous uterine rupture. Patient in the case presenting with tachycardia and hypotension is in shock due to blood loss and will require urgent resuscitation.Placenta previa presents with painless bleeding from the vagina and Placental abruption will present with painful vaginal bleeding with tender and tense uterine wall, however, in contrary to that of uterine rupture, uterine contractions will continue in both these cases.
Shoulder dystocia is more likely to present in a prolonged labour with a significant delay in the progress of labour. However, in this case, there is no mention of shoulder dystocia.
Disseminated intravascular coagulation (DIC) is a condition which is causes due to abnormal and excessive generation of thrombin and fibrin in the circulating blood which results in bleeding from every skin puncture sites. It results in increased platelet aggregation and consumption of coagulation factors which results in bleeding at some sites and thromboembolism at other sites. Placental abruption, or retained products of conception in the uterine cavity are the causes for DIC.
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This question is part of the following fields:
- Obstetrics
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Question 4
Incorrect
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A 37-year-old primigravid woman is admitted to labor unit at 39 weeks of gestation, due to regular uterine contractions. Her cervix is 8 cm dilated and 100% effaced, with the fetus’ vertex at +1 station. Initially the fetal heart rate was 150 bpm, as the labor progressed, it falls to 80 bpm without any changes in the mother’s general condition. Which among the following options would be the best next step in management of this case?
Your Answer: Fetal scalp blood sampling
Correct Answer: Cardiotocography
Explanation:Bradycardia of <100 bpm for more than 5 minutes or <80 for more than 3 minutes is always considered abnormal. The given case describes fetal bradycardia detected on fetal heart auscultation and the most common causes for severe bradycardia are prolonged cord compression, cord prolapse, epidural and spinal anesthesia, maternal seizures and rapid fetal descent. Immediate management including identification of any reversible causes for the abnormality and initiation of appropriate actions like maternal repositioning, correction of maternal hypotension, rehydration with intravenous fluid, cessation of oxytocin, tocolysis for excessive uterine activity, and initiation or maintenance of continuous CTG should be considered in clinical situations where abnormal fetal heart rate patterns are noticed. Consideration of further fetal evaluation and delivery if a significant abnormality persists are very important. The next step in this scenario where the baby is in 1+ station, with an abnormal fetal heart rate detected on auscultation would be to perform a confirmatory cardiotocography (CTG) and if the CTG findings confirm the condition despite initial measures obtained, prompt action should be taken. Cord compression or prolapse should come on the top of the differential diagnoses list as the the mother shows normal general conditions, but since the cervix is 8 cm dilated, 100% effaced and the fetal head is already engaged, cord prolapse would be unlikely; therefore, repeating vaginal exam is not as important as confirmatory CTG. However a vaginal exam should be done, if the scenario indicates any possibility of cord prolapse, to exclude cord compression or prolapse. NOTE– In cases of severe prolonged bradycardia, immediate delivery is recommended, if the cause cannot be identified and corrected.
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This question is part of the following fields:
- Obstetrics
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Question 5
Correct
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A 29-year-old pregnant woman in her first trimester of pregnancy presented to the medical clinic for routine antenatal care. Upon interview and history taking, it revealed that she is positive for Hepatitis C virus antibody (HCVAb). She is now concerned about transmitting the virus to her baby. Which of the following is considered correct about the patient's condition?
Your Answer: Fetal scalp blood sampling should be avoided
Explanation:Invasive procedures as fetal scalp blood sampling or internal electrode and episiotomy increase vertical transmission of HCV, especially in patients with positive HCV RNA virus load at delivery that is why it should be avoided.
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This question is part of the following fields:
- Obstetrics
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Question 6
Correct
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During early pregnancy, a pelvic examination may reveal that one adnexa is slightly enlarged. This is most likely due to:
Your Answer: Corpus luteal cyst
Explanation:Adnexa refer to the anatomical area adjacent to the uterus, and contains the fallopian tube, ovary, and associated vessels, ligaments, and connective tissue. The reported incidence of adnexal masses in pregnancy ranges from 1 in 81 to 1 in 8000 pregnancies. Most of these adnexal masses are diagnosed incidentally at the time of dating or first trimester screening ultrasound (USS). Functional cyst is the most common adnexal mass in pregnancy, similar to the nonpregnant state. A corpus luteum persisting into the second trimester accounts for 13-17% of all cystic adnexal masses. Pain due to rupture, haemorrhage into the cyst, infection, venous congestion, or torsion may be of sudden onset or of a more chronic nature.
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This question is part of the following fields:
- Obstetrics
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Question 7
Correct
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A 30-year-old woman, gravida 2 para 1, at 10 weeks of gestation comes to your office for an initial prenatal visit. Patient has had no vaginal bleeding or cramping and her first pregnancy was uncomplicated which ended with a spontaneous term vaginal delivery.She has no chronic medical conditions and has had no previous surgeries. Patient takes a daily dose of prenatal vitamin and does not use tobacco, alcohol, or any other illicit drugs. On examination her blood pressure is 122/80 mm of Hg and pulse is 70/min and BMI is 24 kg/m2. The uterine fundus is palpated above the pubic symphysis. Pelvic ultrasound shows 2 viable intrauterine gestations, a single fundal placenta, and a thin intertwin membrane that meets the placenta at a 90-degree angle. Among the below mentioned complications, this patient is at highest risk for which one to occur?
Your Answer: Twin-twin transfusion syndrome
Explanation:Twin gestations are generally at increased risk of complications and this risk is further stratified based on the chorionicity ie. number of placentas and amnionicity, the number of amniotic sacs of the gestation. In the given case patient has monochorionic diamniotic twins, which means 1 placenta and 2 amniotic sacs, based on the presence of 2 embryos, a single placenta and a thin intertwin membrane composed of 2 amniotic sacs that meets the placenta at a 90-degree angle (“T sign”). In patients who appear to have a single placenta, the base shape of the intertwin membrane distinguishes between a monochorionic (“T sign”) and fused dichorionic (“lambda sign”) gestation.
Monochorionic twins are at high risk for twin-twin transfusion syndrome (TTTS), which is a complication that can result in heart failure and fetal
eonatal mortality in both twins. In TTTS, unbalanced arteriovenous anastomoses are present between the shared placental vessels that supply the twins, because of these anastomoses, blood from the placental arteries from one twin (donor), which is of high resistance/pressure, is shunted into the placental veins of the other twin (recipient) with low resistance/pressure. This shunting of blood away from the donor twin causes anemia that leads to renal failure, oligohydramnios, low-output heart failure, and fetal growth restriction. In contrast, the shunting of blood toward the recipient twin causes polycythemia, which leads to polyhydramnios, cardiomegaly, high-output heart failure and hydrops fetalis. This in turn makes both twins at high risk for intrauterine and neonatal death.
Mild TTTS is expectantly managed with serial ultrasounds to evaluate for worsening clinical features, whereas moderate-to-severe cases are treated with laser coagulation of the placental anastomoses.In monozygotic twins, placentation type is determined by timing of the twinning. Twinning that occurs shortly after fertilization yields a dichorionic diamniotic gestation. In contrast, the incomplete division (ie, fission) that can lead to conjoined twins occurs later in development and yields a monochorionic monoamniotic gestation. As the twins are in the same sac, monochorionic monoamniotic gestations can be complicated by cord entanglement but not possible in the given case as this patient has diamniotic twins.
Risk factors for placenta accreta, implantation of the placenta directly into the myometrium, include placenta previa and prior uterine surgeries like cesarean delivery, myomectomy, etc
Twin pregnancies are at increased risk of placenta previa (placental tissue that covers the internal cervical os); however, this patient has a fundal placenta, making this complication unlikely.
Monochorionic twin gestations can be complicated by twin-twin transfusion syndrome, which is potentially a fatal condition that results from unbalanced vascular anastomoses between the vessels supplying umbilical cords of each twin.
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This question is part of the following fields:
- Obstetrics
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Question 8
Incorrect
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A 36-year-old woman is brought to the emergency department after she twisted her ankle, once initial management of her current problem is done, you realize that she is 10 weeks pregnant. On further questioning, she admits to heroin addiction and says that Doc, I sometimes need to get high on meth, but my favorite wings to fly are cocaine though, since I cannot afford it, I take a bit when I manage to crash a party. She also drinks a bottle of whisky every day. During the past few weeks, she started worrying about not being a good mother, and for this she is taking diazepam at night which she managed to get illegally. Considering everything this patient revealed, which is most likely to cause fetal malformations?
Your Answer: Heroine
Correct Answer: Alcohol
Explanation:Woman in the given case is taking a full bottle of Whisky every day. As per standards, a small glass of Whisky (1.5 Oz) is equivalent of a standard drink and a bottle definitely exceeds 12 standard drinks. This makes her fetus at significant risk for fetal alcohol syndrome (FAS) which is associated with many congenital malformations. Low-set ears, midfacial hypoplasia, elongated philtrum, upturned nose and microcephaly along with skeletal and cardiac malformations are the congenital malformations commonly associated with fetal alcohol syndrome.
Health risks of benzodiazepines during pregnancy has not been clearly established, but there are inconsistent reports of teratogenic effects associated with fetal exposure to benzodiazepines. Neonatal abstinence syndrome of delayed onset can be associated with regular use of benzodiazepine in pregnancy.
Use of Amphetamine in controlled doses during pregnancy is unlikely to pose a substantial teratogenic risk, but a range of obstetric complications such as reduced birth weight and many these outcomes which are not specific to amphetamines but influenced by use of other drug and lifestyle factors in addition to amphetamine are found commonly among women who use it during pregnancy. Exposure to amphetamines in utero may influence prenatal brain development, but the nature of this influence and its potential clinical significance are not well established.
3,4- methylenedioxymetham phetamine(MOMA), which is an amphetamine derivative and commonly known as ecstasy, have existing evidences suggesting that its use during first trimester poses a potential teratogenic risk. So it is strongly recommended to avoided the use of ecstasy during 2-8 weeks post conception or between weeks four to ten after last menstrual period as these are the considered periods of organogenesis.
Role of cocaine in congenital malformations is controversial as cases reported of malformations caused by cocaine are extremely rare. However, it may lead to fetal intracranial haemorrhage leading to a devastating outcome.
Opiate addictions carry a significant risk for several perinatal complications, but it has no proven association with congenital malformation.
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This question is part of the following fields:
- Obstetrics
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Question 9
Incorrect
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Which of the following is indicated for the treatment of chlamydial urethritis in pregnancy?
Your Answer: Metronidazole
Correct Answer: Azithromycin 1gram as single dose
Explanation:The best treatment option for chlamydial urethritis in pregnancy is Azithromycin 1g as a single dose orally. This is the preferred option as the drug is coming under category B1 in pregnancy.
Tetracycline antibiotics, including doxycycline, should never be used in pregnant or breastfeeding women.
Erythromycin Estolate is contraindicated in pregnancy due to its increased risk for hepatotoxicity. Ciprofloxacin is not commonly used for treating chlamydial urethritis and its use is not safe during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 10
Correct
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Hysterosalpingogram (HSG) is contraindicated in the following EXCEPT:
Your Answer: Congenital malformations of the uterus
Explanation:Anomalies of the cervico-uterus are widely diagnosed by HSG. The diagnostic value of HSG in the detection of anomalies varies, depending on the type of malformation.
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This question is part of the following fields:
- Obstetrics
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Question 11
Correct
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Which one of the following methods helps determine the fetal position and presentation?
Your Answer: Leopold's manoeuvre
Explanation:Fetal position and presentation is best evaluated by Leopold’s manoeuvre. It will determine which part of the foetus is in the uterine fundus.
Cullen’s sign is found in ruptured ectopic pregnancy characterised by bruising and oedema of the periumbilical region.
Mauriceau-Smelli-Veit manoeuvre is done during a breech delivery. -
This question is part of the following fields:
- Obstetrics
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Question 12
Incorrect
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A 39-year-old woman who is 8 weeks pregnant presented to the medical clinic for consultation regarding the chance of her baby having Down syndrome. She mentioned that she has read somewhere that one of the risk factors for Down syndrome is advanced maternal age. She is concerned and asks if there are ways in which she can know whether her baby will be affected. Which of the following is considered as both the safest and the most accurate diagnostic tool for the exclusion of Down syndrome?
Your Answer: Triple marker screen test
Correct Answer: Amniocentesis at 16 weeks gestation
Explanation:Amniocentesis is a prenatal procedure performed on a pregnant woman to withdraw a small amount of amniotic fluid from the sac surrounding the foetus.
The goal of amniocentesis is to examine a small amount of this fluid to obtain information about the baby, including its sex, and to detect physical abnormalities such as Down syndrome or spina bifida.
Amniocentesis is only performed on women thought to be at higher risk of delivering a child with a birth defect.Amniocentesis is performed between 16 and 20 weeks into the pregnancy. By around this time, the developing baby is suspended in about 130ml of amniotic fluid, which the baby constantly swallows and excretes. A thin needle is used to withdraw a small amount of this fluid from the sac surrounding the foetus.
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This question is part of the following fields:
- Obstetrics
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Question 13
Correct
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A 29-year-old nulliparous woman is admitted to the hospital at 37 weeks of gestation after losing about 200 mL of blood per vagina after having sexual intercourse. The bleeding has now ceased and her vitals are below: Pulse rate: 64 beats/min, Blood pressure: 120/80 mmHg, Temperature: 36.8°C. On physical exam, the uterus is enlarged and is 37 cm above the pubic symphysis. The uterus is lax and non-tender. On ultrasound, the fetal presentation is cephalic with the head freely mobile above the pelvic brim. The fetal heart rate assessed by auscultation is 155 beats/min. Which of the following is the most likely of bleeding in this patient?
Your Answer: Placenta praevia.
Explanation:In this pregnant patient with an antepartum haemorrhage at 37 weeks of gestation, her clinical presentation points to a placenta previa. Her bleeding has stopped, the uterus is of the expected size and non-tender, and the fetal head is still mobile above the pelvic brim which are all findings that would be consistent with a placenta praevia. An ultrasound examination would be done to rule-out or diagnose the condition.
An Apt test on the blood is necessary to ensure that this is not fetal blood that would come from a ruptured vasa praevia. Although this diagnosis would be unlikely since the bleeding has stopped. If there was a vasa praevia, there would be fetal tachycardia or bradycardia, where a tachycardia is often seen first but then bradycardia takes over late as fetal exsanguination occurs.
In a placental abruption with concealment of blood loss, the uterus would be larger and some uterine tenderness would be found on exam.
A cervical polyp could bleed after sexual intercourse and a speculum examination would be done to exclude it. However, it would be unlikely for a cervical polyp to cause such a large amount of blood loss. A heavy show would also rarely have as heavy as a loss of 200mL.
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This question is part of the following fields:
- Obstetrics
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Question 14
Correct
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A 28-year-old, currently at 26 weeks’ gestation of her third pregnancy, presents with irregular uterine contractions for the past 24 hours and has concerns about premature delivery. She delivered her first child at 38 weeks of gestation and her second at 39 weeks gestation. On examination, BP and urinalysis have come back normal. Her symphysis-fundal height measures 27cm, the uterus is lax and non-tender. Fetal heart rate is 148/min. She also undergoes a pelvic examination along with other investigations. Which findings would suggest that delivery is most likely going to happen before 30 weeks’ of gestation?
Your Answer: The cervix is closed, but the fetal fibronectin test on cervical secretions is positive.
Explanation:Predisposing factors of preterm delivery include a short cervix (or if it shortens earlier than in the third trimester), urinary tract or sexually transmitted infections, open cervical os, and history of a previous premature delivery. Increased uterine size can also contribute to preterm delivery and is seen with cases of polyhydramnios, macrosomia and multiple pregnancies. The shorter the cervical length, the greater the risk of a premature birth.
In this case, the risk of bacterial vaginosis and candidiasis contributing to preterm delivery would be lower than if in the context of an open cervical os. However, the risk of premature delivery is significantly increased if it is found that the fetal fibronectin test is positive, even if the os is closed. -
This question is part of the following fields:
- Obstetrics
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Question 15
Correct
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A 29 year old female presented at her 38th week of gestation to the ER with severe hypertension (210/100) and proteinuria (+++). Soon after admission, she developed generalized tonic clonic fits. What is the first line of management in this case?
Your Answer: Magnesium sulphate IV
Explanation:Magnesium Sulphate is the drug of choice in eclamptic patients. A loading dose of 4g magnesium sulphate in 100mL 0.9% saline IVI over 5min followed by maintenance IVI of 1g/h for 24h. Signs of toxicity include respiratory depression and jerky tendon reflexes. In recurrent fits additional 2g can be given. Magnesium should be stopped when the respiratory rate is <14/min, absent tendon reflexes, or urine output is <20mL/h.
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This question is part of the following fields:
- Obstetrics
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Question 16
Correct
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A 19-year-old G1 woman at 8 weeks gestation presented to the medical clinic due to complaints of nausea and vomiting over the past week and has been occurring on a daily basis. Nausea and emesis are known to be a common symptom in early pregnancy. Which of the following is considered an indicator of a more serious diagnosis of hyperemesis gravidarum?
Your Answer: Hypokalaemia
Explanation:In severe cases of hyperemesis, complications include vitamin deficiency, dehydration, and malnutrition, if not treated appropriately. Wernicke encephalopathy, caused by vitamin-B1 deficiency, can lead to death and permanent disability if left untreated. Additionally, there have been case reports of injuries secondary to forceful and frequent vomiting, including oesophageal rupture and pneumothorax.
Electrolyte abnormalities such as hypokalaemia can also cause significant morbidity and mortality. Additionally, patients with hyperemesis may have higher rates of depression and anxiety during pregnancy.
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This question is part of the following fields:
- Obstetrics
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Question 17
Correct
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A 27-year-old female reports to the emergency department due to severe right lower quadrant pain. Complaints started yesterday, as the patient noticed intermittent right lower abdominal pain associated with increased activity. She rested for remainder of the day, but the pain still continued to increase. An hour ago, the pain suddenly became constant and severe, associated with nausea and vomiting.The patient does not complaint of any radiation of pain. On examination patient's temperature is noted to be 37.2 C (99 F), blood pressure is 130/80 mm Hg, and pulse rate is 98/min.On palpation of the right lower quadrant there is tenderness without rebounding or guarding.Urine pregnancy test conducted came to be negative. Considering the following additional informations, which would be most appropriate in establishing the diagnosis of this patient?
Your Answer: History of ovarian cysts
Explanation:Common Risk factors for Ovarian torsion are presence of an ovarian mass, women who are in their reproductive age and history of infertility treatment with ovulation induction.
Common clinical presentations include sudden onset of unilateral pelvic pain along with nausea & vomiting and presence of a palpable adnexal mass. An adnexal mass with absent Doppler flow to ovary can be noted in ultrasound.
Laparoscopy with detorsion, ovarian cystectomy and oophorectomy if necrosis or malignancy is found are the common treatment options.Acute lower abdominal pain in a nonpregnant women can have various causes including pathologies of the gastrointestinal, gynecologic, or urologic systems due to the close proximity of these structures. All of these cases have classic presentations which help to characterize the disease process and thereby to differentiate the diagnosis.
In the given case, patient presents with right lower quadrant pain which is classic for ovarian torsion, occurring due to rotation of the ovary around the infundibulopelvic ligament, causing ovarian vessel occlusion. Although ovarian torsion can occur in any women in their reproductive-age, is seen more commonly in those with a history of ovarian cysts (eg, hemorrhagic cyst) or masses (eg, mature cystic teratoma) because of the greater size and density of the ovary which makes it prone to rotation and subsequent torsion. Patients will initially have intermittent pain associated with activity, as in this patient, due to partial ovarian torsion, this initial pain resolves when the adnexa spontaneously untwists and blood flow returns. When this progresses to complete ovarian torsion, patients typically develop sudden-onset, severe, nonradiating pain due to persistent ischemia, which is often associated with nausea and vomiting.
Ovarian torsion can be clinically diagnosed, but a Doppler ultrasound is performed to evaluate ovarian blood flow and also to confirm the diagnosis. Surgical detorsion to prevent ovarian necrosis and cystectomy/oophorectomy are the usual treatment options.
Any association of urinary symptoms will help to establish a urologic cause of acute right lower quadrant pain like pyelonephritis, nephrolithiasis, etc. However, patients with urologic conditions typically presents with suprapubic or flank pain which radiates to the right lower quadrant, making this diagnosis less likely in the given case.
A family history of malignancy usually does not aid in the diagnosis of acute lower abdominal pain. Although some ovarian cancers are inherited, patients with ovarian cancer typically have a chronic, indolent course with associated weight loss, early satiety, and abdominal distension.
Having multiple sexual partners is considered a risk factor for sexually transmitted infections and pelvic inflammatory disease, which can be a cause for lower abdominal pain. However, patients will typically have fever, constant and diffused pelvic pain along with rebound and guarding.
Recent sick contacts are a risk factor for gastroenteritis, which can present with nausea, vomiting and abdominal pain. However, in this case patient will typically have diffuse, cramping abdominal pain which will worsen gradually; along with persistent vomiting and diarrhea.
Ovarian torsion typically causes intermittent lower abdominal pain followed by sudden-onset of severe, nonradiating unilateral pain with associated nausea and vomiting. Ovarian torsion can occur in women in their reproductive-age, particularly those with a history of ovarian cysts.
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This question is part of the following fields:
- Obstetrics
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Question 18
Correct
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A 32-year-old woman, who is 18 weeks pregnant, is diagnosed with antiphospholipid syndrome and positive anticardiolipin antibodies. She has a history of three miscarriages, each one during the first trimester. What would be the next most appropriate step?
Your Answer: Aspirin & heparin
Explanation:The syndrome with which the woman was diagnosed is an autoimmune, hypercoagulable state which most possibly was the reason of her previous miscarriages. This is the reason why she should be on aspirin and heparin in order to prevent any future miscarriage.
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This question is part of the following fields:
- Obstetrics
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Question 19
Correct
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The risk of postpartum uterine atony is associated with:
Your Answer: Twin pregnancy
Explanation:Multiple studies have identified several risk factors for uterine atony such as polyhydramnios, fetal macrosomia, twin pregnancies, use of uterine inhibitors, history of uterine atony, multiparity, or prolonged labour.
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This question is part of the following fields:
- Obstetrics
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Question 20
Correct
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A 25 year old pregnant woman presents with constant abdominal pain, which has been present for the last few hours. Before the pain started she admits experiencing vaginal blood loss. She's a primigravida in her 30th week of gestation. Upon abdominal examination the uterus seems irritable. CTG is, however, reactive. What is the most probable diagnosis?
Your Answer: Antepartum haemorrhage
Explanation:Antepartum haemorrhage presents with bleeding, which may or may not be accompanied by pain. Uterine irritability would suggest abruptio, however contractions are present which may be confused with uterine irritability and in this case, there are no signs of pre-eclampsia present.
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This question is part of the following fields:
- Obstetrics
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