Obstetrics and Gynecology Board Review Practice Questions
Book 2 - 2004
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QUESTION

71. Your patient has a microcytic anemia on her first set of prenatal labs.

All of the following statements are correct EXCEPT:

A) The most commonly encountered anemia in pregnancy is Iron Deficiency Anemia which has the following characteristics: microcytic, hypochromic, MCV < 80 f/L, Serum Fe < 50 mcg/dL, MCHC < 30%, Serum ?Ferritin, ?TIBC
B) Combined Fe / folate deficiency is never normocytic, normochromic anemia
C) Folate deficiency is a risk for Neural Tube Defect.
D) Most common megaloblastic anemia is folate deficiency.
E) Vitamin B12 deficiency is associated with malabsorption diseases.

ANSWER

71.     B     Combined Fe/folate deficiency is never normocytic, normochromic anemia

The maternal blood volume rises by about one-third to provide for the increase in uteroplacental vasculature and pregnancy related venous dilatation. The plasma volume rises about 45%, but the red cell volume only rises by about 25%. This causes hemodilution producing the physiological anemia of pregnancy. Hemoglobin level may fall, but mean corpuscular volume [MCV] and mean corpuscular hemoglobin [MCH] both remain unchanged.

The result of combined iron and folic acid deficiency may be a normocytic, normochromic anemia. Anemia in pregnancy can increase the chances of fetal hypoxia, intra uterine growth restriction, premature labor, and puerperal sepsis. Folic acid deficiency is associated with a higher incidence of abruption. Post partum hemorrhage is not more common, but if moderate hemorrhage occurs, it may have profound results. When anemia is found late in pregnancy the patient may have iron deficiency, folic acid deficiency, hemoglobinopathy, exaggerated physiological anemia, occult blood loss, and/or primary hypoplasia of the bone marrow, and further evaluation should be entertained.

1. Beischer NA, Mackay EV, Colditz PB. Obstetrics and the Newborn, 3rd edition, London: WB Saunders, 1997, chapter 36.

2. P. Zieve & L. Waterbury, “Abn. Red Cell and Hemoglobin Production” in A. M. Harvey, R. J. Johns, et al., The Principles and Practice of Medicine, 20th edition, chapter 47, NY: Appleton-Century-Crofts, 1980:499 - 503.

3. The Merck Manual, 17th ed., Whitehouse Station, NJ: Merck Research Laboratories, 1999, p 2049-2050.

 

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QUESTION

103. The following statements are correct regarding Varicella-Zoster during pregnancy EXCEPT:

A) Varicella-Zoster immune globulin [V-ZIG] should be administered to the newborn if the mother developed chickenpox within 5 days prior to or 2 days following delivery
B) Maternal administration of V-ZIG reduces the occurrence of congenital varicella syndrome
C) V-ZIG can be considered to treat the pregnant women herself to prevent the complications of chickenpox
D) All of the above
E) None of the above

ANSWER

103.     B     Maternal administration of V-ZIG reduces the occurrence of congenital
varicella syndrome

Maternal treatment with acyclovir has not been demonstrated to reduce or prevent fetal effects of congenital varicella syndrome. IV administration of this drug is recommended for neonates who develop varicella within the first 2 weeks postpartum. Oral acyclovir given within 24 hours of the rash will reduce new lesion formation and improve constitutional symptoms in children, adolescents, and adults. Oral acyclovir appears safe for pregnant women; however, varicella pneumonia is treated with IV acyclovir to reduce maternal mortality.

V-ZIG is expensive and sometimes hard to come by in a hurry in the quantity needed to administer to an adult. Consider doing some lab work to evaluate mom’s immune status. Many people are seemingly immune even though they were never vaccinated and do not remember having the disease. Many commercial labs can turn a stat specimen around in 24-36 hours.

1. ACOG Practice Bulletin # 20, “Perinatal Viral and Parasitic Infections,” Sept. 2000.

OBGYN BOARD REVIEW, Ob-Gyn Board Review Practice Questions, Obstetrics Practice Questions, Obstetrics Board Review, Obstetrics and Gynecology Board Review, Ob/Gyn Written Board Exam Practice Questions and Study Materials (Obstetrics and Gynecology)

QUESTION

229. A 47-year-old woman presents to your office complaining of post coital spotting for the past three months. Her last pap smear was ten years ago. Pelvic exam reveals a fungating cervical mass, which extends one-third of the way down the vagina. The uterus is normal size and shape. Bimanual and rectovaginal exam reveal smooth parametria and pelvic sidewalls. Cervical biopsy returns poorly differentiated squamous cell carcinoma. IVP reveals right-sided hydronephrosis.

Her FIGO state is:

A) IIA
B) IIB
C) IIIA
D) IIIB
E) IVA

ANSWER

229.     D     IIIB

Cervical cancer is one of the most common malignancies in women in the developing world. For this reason the FIGO staging for cervical cancer performed clinically, not surgically. The only adjunctive tests, which can be used to stage cervical cancer, are intravenous pyelogram, chest x-ray, barium enema, and cytoscopy and proctoscopy.

The following is the staging for cervical cancer:

Stage 1 - Cancer in the cervix only

  • IA - Invasion of the cervical tissues can only be seen with a microscope. (Further classified into 1A1 and 1A2, depending upon depth)
  • IB - Lesions wider than 7 mm or deeper than 5 mm, or that can be seen without a microscope (Further classified for tumors larger or smaller than 4 cm)

Stage 2 - Cancer extends beyond the cervix, but not as far as the pelvic wall

  • 2A - Extends to upper part of the vagina, but not to parametria
  • 2B - Extends to the parametrial tissues (but not to the pelvic wall).

Stage 3 - The cancer has extended beyond Stage 2, but not beyond the pelvic area. Note: although this system does not include lymph node sampling, in other systems a positive lymph node would put the cancer in Stage 3.

  • 3A - The cancer has spread to the lower third of the vagina, but nowhere else.
  • 3B - The cancer has spread to the pelvic wall, or has blocked a ureter

Stage 4 - Cancer has spread to the bladder, rectum, or outside the pelvis.

  • 4A - Spread to the rectum or bladder.
  • 4B - Spread (metastasis) to distant organs such as the lungs or liver.

The presence of hydronephrosis or pelvic sidewall involvement classifies this patient as a FIGO Stage IIIB cervical carcinoma.

1. Morrow CP, Curtin JP, (eds.). Gynecologic Cancer Surgery. 1st edition. Livingston NY. Churchill. 1996:469

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