Obstetrics
and Gynecology Written Board Exam Sample Questions
Book 3 - 2004
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QUESTION
61.
All of the following statements regarding severe preeclampsia
are true EXCEPT:
A)
Overt thrombocytopenia (<100,000 platelets/uL) is an
ominous sign and delivery is usually indicated
B) Women with severe preeclampsia-eclampsia who develop
pulmonary edema most often do so post-partum
C) Persistent proteinuria of 2+ or more, or 24-hour urinary
excretion of 4 grams or more constitutes severe preeclampsia
D) Epigastric or right upper quadrant pain likely results
from hepatocellular necrosis and edema that stretches Glisson’s
capsule
E) Severe preeclampsia warrants consideration of prompt
delivery, except for cases of extreme fetal prematurity
ANSWER
61. E
Severe preeclampsia warrants consideration
of prompt delivery, except for cases of extreme fetal prematurity
The
incidence of pregnancy-induced hypertension is commonly reported
to be approximately 5 percent of all deliveries. Severe preeclampsia
is marked by the presence of one or more of the following
aberrations:
•
Diastolic blood pressure >110 mmHg or higher
• Proteinuria 2+ or greater, or >4 g in 24-hour excretion
• Oliguria
• Pulmonary edema
• Convulsions
• Thrombocytopenia <100,000 platelets /uL
• Hyperbilirubinemia
• Liver enzyme elevation
• Headache
• Visual disturbance
• Upper abdominal pain
• Fetal growth restriction
Hematological
abnormalities may develop in some women with pregnancy-induced
hypertension. Overt thrombocytopenia (< 100,000 platelets/uL)
may become severe and pose life-threatening complications.
Such circumstances are ominous and delivery is usually indicated.
Plasma oncotic pressure decreases in normal term pregnancies
and falls even more appreciably in preeclampsia, secondary
to increased vascular permeability and proteinuria. Inattentive
fluid management in the parturient with pregnancy induced
hypertension often leads to postpartum pulmonary edema.
Liver
involvement in preeclampsia is most serious and is frequently
accompanied by evidence of multiple organ dysfunction. With
severe preeclampsia, alterations in tests of hepatic function
are notable. Hepatocellular necrosis and edema may stretch
Glisson’s capsule and manifest as epigastric or right
upper quadrant pain. Subcapsular hematomas and hepatic rupture
may rarely occur, and contribute to a mortality rate in excess
of 30 percent.
In
all cases of severe preeclampsia, particularly those marked
by pulmonary edema, oliguria, or hepatic dysfunction, delivery
is mandatory irrespective of fetal age.
1.
Cunningham FG, MacDonald PC, Gant NF, eds. Williams Obstetrics.
21st ed. Connecticut: Appleton & Lange, 2001:569.
QUESTION
145.
All of the following are RNA viruses EXCEPT:
A)
Hepatitis A
B) Hepatitis B
C) Hepatitis C
D) Hepatitis D
E) Hepatitis E
ANSWER
145.
B Hepatitis
B
Hepatitis
B virus (HBV) is a double-stranded DNA virus with worldwide
distribution, transmitted by parenteral and sexual contact.
Risk factors include multiple sexual partners, intravenous
drug abuse, and receipt of blood products. Its incubation
period is 40 to 100 days, and it can be recovered from all
body fluids, most importantly, blood, breast milk, and amniotic
fluid. HBV surface antigen (HBsAg) and anti-HBc IgM antibody
are seen in the early clinical phase of infection, before
icteric changes or elevations in liver function tests. They
indicate infectivity. The presence of HBe antigen (HBeAg)
denotes active viral replication. Although HBeAg usually indicates
acute infection, its persistence correlates both with the
chronic carrier state and with the ultimate development of
hepatocellular
carcinoma. The risk of maternal–fetal transmission increases
dramatically to 90% when acute infection occurs in the third
trimester or in the presence of both HBsAg and HBeAg positivity,
and is a consequence of intrapartum exposure to blood and
genital secretions. If the mother develops HBV infection remote
from delivery and has developed anti-HB antibodies, the risk
of fetal or neonatal infection is considerably less.
1.
Gabbe SG, Niebyl JR, Simpson JL, (eds.). Obstetrics Normal
and Problem Pregnancies. 3rd Edition. Livingston NY. Churchill.
1996:1217
QUESTION
248.
A fetus whose mother has Marfan’s syndrome and whose
father is normal has what chance of inheriting the disease?
A)
2%
B) 5%
C) 10%
D) 25%
E) 50%
ANSWER
248.
E 50%
Because
of the autosomal dominant inheritance of Marfan syndrome,
the risk of having an affected offspring is 50% if one of
the parents has the disease. Although there appears to be
a high degree of penetrance, there is a wide variability in
expression of the disease. The majority of cases are familial,
with 80% of patients having a positive family history. In
the remaining 20% no family history is present and the disease
is assumed to be the result of a new sporadic mutation. Although
the prenatal detection of Marfan syndrome may not be possible
for all patients, a definitive diagnosis may be made in some
families with marker alleles for the mutant gene. The diagnosis
has been made by both genetic linkage analysis and fetoechocardiography.
Marfan syndrome has been linked to mutations in the fibrillin
gene, which is located on the long arm of chromosome 15. Using
genetic linkage analysis with fibrillin-specific markers,
prenatal diagnosis by chorionic villus sampling or amniocentesis
is possible in informative families.
1.
Creasy RK, Resnik R, editors, Iams JD, associate editor, Maternal-Fetal
Medicine, Principles and Practice, 5th ed. Philadelphia (PA):
Saunders, 2003:838.
2.
Pyeritz RE. Marfan Syndrome. In Cecil Textbook of Medicine,
21st edition, WB Saunders Co, Philadelphia, 2003:1118.
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