1. Which of the following is correct concerning hormonal levels in menopause [1] ?

   A. Elevated FSH, Depressed LH, Depressed estrogen and progesterone
   B. Elevated FSH and LH, Elevated estrogen and progesterone
   C. Depressed FSH and LH, Depressed estrogen and progesterone
   D. Depressed FSH, Elevated LH, Depressed estrogen and progesterone
   E. Elevated FSH and LH, Depressed estrogen and progesterone

2. A 42 year old woman presents with vaginal itching, burning, and a white, thick discharge 3 days after completing a 10 day course of cefuroxime axetil (Ceftin®, second generation oral cephalosporin) for bronchitis. There is no history of a sexually transmitted disease. She is sexually active only with her husband. The most likely diagnosis is [2]:

   A. Candidal Vaginitis
   B. Atrophic Vaginitis
   C. Trichomonas infection
   D. Chlamydial infection
   E. Bacterial Vaginitis (Vaginosis)

3. The MOST important risk factor(s) for the development of cervical cancer is [3]:

   A. Diethylstilbestrol (DES) Exposure in Utero
   B. Presence of Human Papilomavirus (HPV) Serotypes 6 and/or 11
   C. Presence of Human Papilomavirus Serotypes 16 and/or 18
   D. Multiple sexual partners
   E. Early age at first intercourse

4. All of the following are risks specifically of fetal immaturity except [4]:

   A. Respiratory Distress Syndrome (RSD; Hyaline Disease of the Newborn)
   B. Necrotizing Enterocolitis (NEC)
   C. Bronchopulmonary Dysplasia (BPD)
   D. Ventricular Septal Defect (VSD)
   E. Retinopathy of Prematurity

5. Which one of the following agents has been shown to reduce the risk of spina bifida [5] ?

   A. Aspirin (low dose)
   B. Zinc
   C. Folic Acid
   D. Calcium Supplementation
   E. Vitamin A Supplementation

6. A 24 year old pregnant woman (late second trimester, 24 weeks) presents for regular examination. Her blood pressure has been running slightly high, at 130/84mm Hg in both arms. Urinalysis is completely normal, and fetal ultrasound is normal. She has been feeling well. Which ONE of the following agents has been shown to reduce the risk of hypertension AND pre-eclampsia [6] ?

   A. Aspirin (low dose)
   B. Zinc
   C. Folic Acid
   D. Calcium Supplementation
   E. Vitamin A Supplementation

7. During this examination, the patient is found to have a blood pressure of 132/93mm Hg in both arms. She is otherwise doing well. Which of the following medications is known to be safe for control of the blood pressure at this point in the pregnancy [7] ?

   A. Calcium Channel Blockers
   B. Alpha-methyldopa
   C. ACE Inhibitors
   D. Thiazide Diuretics
   E. Nitroprusside

8. A urinalysis shows 1+ protein and no blood by dipstick. A 24 hour urine collection for protein reveals 500mg/day of protein in the urine (normal <150mg/day). A complete blood count is normal except for a hematocrit of 32% (Hemoglobin 10.9). Liver function tests, renal function tests, and electrolytes are normal. The patient is sent home to bedrest (left side down) with close in house monitoring. Two days later she develops petechiae on her lower extremities with mild gum bleeding. The platelet count is 80K/µl (normal >150K/µl), Hematocrit 27%, normal white blood count, AST 300 (normal <40), ALT 350 (normal <40), LDH 1800 (normal <200), Bilirubin 2.5mg/dL (normal <1.2mg/dL) with direct component of 1.0mg/dL. The most likely diagnosis is [8]:

   A. Severe Preeclampsia (HELLP Syndrome)
   B. Hemolytic Uremic Syndrome
   C. Malignant Hypertension with Hypertensive Emergency
   D. Eclampsia
   E. Hepatitis due to fatty liver of pregnancy

9. Which of the following has been shown to substantially reduce the risk of seizure development in this patient with hypertension in pregnancy [9] ?

   A. Diazepam (Valium®)
   B. Phenobarbital
   C. Magnesium
   D. Calcium
   E. Phenytoin (Dilantin®)

10. The major concern with premature rupture of membranes (PROM) is [10]:
A. Maternal (Gestational) Diabetes
B. Prolonged Labor
C. Preterm Labor
D. Increased risk of Breech Presentation
E. Chorioamnionitis

Answers

1. E
2. A (Candida is extremely common after antibiotic therapy.)
3. C (Serotypes 6 and 11 are associated with warts and are only very rarely oncogenic.)
4. D
5. C
6. D (Aspirin reduces risk of pre-eclampsia only)
7. B (Calcium blockers are tocolytic, ACE induce fetal wastage.)
8. A (Hemorrhage, Elevated Liver enzymes, Low Platelets Syndrome of severe preeclampsia.)
9. C
10. E