8–1.
Preconceptional counseling involves collection o in ormation regarding previous pregnancy outcomes, medical conditions, and amily history. What is the optimal method o collecting this in ormation?a.
Nurse visitb.
Paper intake ormc.
Online questionnaired.
Combined questionnaire plus interview8–2.
A 30-year-old woman with no known medicalconditions is noted to have 3+ glucosuria at her irst prenatal visit. A asting blood glucose level is
144 mg/dL. How should she be counseled regarding her risk or etal anomalies?
a.
Her risk is the same as other 30-year-old women.b.
Her risk is twice as high as other 30-year-old women.c.
Her risk is our old higher than other 30-year-old women.d.
Her risk is 10 times higher than other 30-year-old women.8–3.
Preconceptional evaluation o a woman with diabetes mellitus should include all EXCEPT which o the ollowing?a.
Hemoglobin A1cb.
Retinal examinationc.
Bone density testingd.
24-hour urine collection8–4.
All EXCEPT which o the ollowing can beexpected ollowing preconceptional counseling and its implementation in women with pregestational diabetes?
a.
Decreased perinatal death rateb.
Reduced congenital anomaly ratec.
Improved preconceptional olic acid used.
Decreased need or antihypertensive therapy8–5.
A 23-year-old patient tells her gynecologist that she wants to have a child in the next ew years. She is concerned as she has a seizure disorder and takesvalproic acid. It has been 1 year since her last seizure, and she has heard that seizures are dangerous or the etus. What can you tell her regarding her seizure risk during pregnancy?
a.
Because o the length o time she has been seizure- ree, it is reduced 50%.b.
I she delays pregnancy or an additional 12 months, her risk will be reduced by 50%.c.
here is an inverse relationship between the time she has been seizure- ree be ore pregnancy and her risk during pregnancy.d.
None o the above8–6.
For the patient in Question 8-5, what supplement should she begin prior to attempting conception?a.
Ironb.
Folatec.
Niacind.
Vitamin D8–7.
Which o the ollowing antiseizure medications, when taken as monotherapy, is associated with the highest rate o major congenital mal ormations?a.
Phenytoinb.
Valproic acidc.
Phenobarbitald.
Carbamazepine8–8.
Which o the ollowing is not an example o a killed bacterial or viral vaccine and there ore should not be administered during pregnancy?a.
Rabiesb.
etanusc.
Meningococcusd.
Varicella-zosterPreconceptiona l Counseling CH A P T E R 8
51
8–9.
A woman presents or a screening sonographic evaluation at 21 weeks’ gestation. A etal leg is imaged below. She and her partner ask about the requency o birth de ects in the general population. What is the correct response to their question?a.
0.1%b.
1%c.
3%d.
11%8–10.
Birth de ects are responsible or what percentage o in ant mortality?a.
2%b.
5%c.
10%d.
20%8–11.
What is the signi icance o the individual identi ied by the arrow in the ollowing image?3 2 1 II I 1 2
Reproduced with permission rom Cunningham FG, Leveno KJ, Bloom SL, et al (eds): Preconceptional counseling. In Williams Obstetrics, 24th ed. New York, McGraw-Hill, 2014, Fig. 8-2.
a.
She is one o a triplet gestation.b.
She is a ected by the condition in question.c.
She is being evaluated or a suspected condition.d.
She is the only one in her amily una ected by the condition in question.8–12.
he incidence o etal cardiac abnormalities is increased in all EXCEPT which o the ollowing maternal conditions?a.
Lead exposureb.
Phenylketonuriac.
Diabetes mellitusd.
Methylene tetrahydro olate reductase mutation carrier8–13.
What percent o etuses with the ollowing condition are born to women at low risk or the anomaly?Used with permission rom Dr. if any Woodus.
a.
10%b.
50%c.
75%d.
90%8–14.
Preconception supplementation and orti ication o some ood products with olate has had what impact on pregnancy outcomes?a.
Reduced the rate o preeclampsiab.
Reduced the incidence o childhood seizuresc.
Reduced the incidence o neural-tube de ectsPreconceptiona l a nd Prena ta l Ca re SE C T I O N 4
52
8–15.
A woman with phenylketonuria presents to her primary care physician’s o ice 1 week a ter her missed menses. A home urine pregnancy test was positive. he pregnancy was unplanned, and her blood phenylalanine level is 1012 µmol/L, which is essentially unchanged rom her baseline levels over the past several months. How should she be counseled regarding about her pregnancy outcomes?a.
Her risk or congenital anomalies is not increased.b.
here is a 50% chance or neurological impairment in her etus.c.
he risk or congenital cardiac abnormalities in her etus is 12%.d.
Her risk or a spontaneous abortion in the irst trimester is doubled.8–16.
A 23-year-old woman presents to the hospital in active labor and delivers the in ant seen below. She had received no prenatal care and upon questioning admits she has some medical problems. Which o the ollowing conditions is most likely responsible or the in ant’s condition?a.
Gaucher diseaseb.
Phenylketonuriac.
Diabetes mellitusd.
None o the above8–17.
What are the most common single-gene disorders worldwide?a.
Hemophiliasb.
halassemiasc.
Cystic ibrosis mutationsd.
Glycogen storage diseases8–18.
A 33-year-old multipara presents to Labor and Delivery complaining o decreased etal movement or 2 days at 33 weeks’ gestation. Sonographicevaluation con irms the diagnosis o etal demise. No other abnormalities are noted. What percentage o stillbirths who undergo standard karyotyping will have a chromosomal abnormality detected?
a.
0.1%b.
1%c.
13%d.
21%8–19.
What bene it does chromosomal microarray analysis have over standard karyotyping in the evaluation o stillbirth?a.
Can be per ormed on maternal bloodb.
Can be per ormed on nonviable tissuec.
Detects lower levels o tissue mosaicismd.
None o the above8–20.
All EXCEPT which o the ollowing obstetrical complications is increased in adolescent pregnancies compared with women aged 20 to 35 years?a.
Anemiab.
Preeclampsiac.
Preterm labord.
Postpartum hemorrhage8–21.
For women older than 40 years, pregnancy-related mortality rates are increase by what magnitude compared with women in their twenties?a.
wo oldb.
Five oldc.
Eight oldd.
en old8–22.
Which o the ollowing is the most common pregnancy complication in women older than 35 years?a.
Diabetesb.
Hypertensionc.
Preterm birthd.
Low birthweight MCGH319-CH08_049-055.indd 52 6/13/14 8:20 PMPreconceptiona l Counseling CH A P T E R 8
53
8–23.
In 2005, what percentage o all multi etal gestations were due to assisted reproductive technologies?a.
20%b.
30%c.
40%d.
50%8–24.
Which o the ollowing assisted reproductive technologies is associated with a higher rate o congenital abnormalities in the etus?a.
Cryopreservationb.
Ovulation inductionc.
In vitro ertilizationd.
Intracytoplasmic sperm injection8–25.
An in ant with achondroplasia is born to a 41-year- old diabetic woman and her 51-year-old husband who uses testosterone supplementation. Which o the actors in their backgrounds is most likely related to the in ant’s condition?a.
Maternal ageb.
Paternal agec.
Maternal diabetesd.
Paternal sex steroid use8–26.
Which o the ollowing obstetrical complications is not increased in obese patients?a.
Hypertensionb.
Fetal anomaliesc.
Cesarean deliveryd.
Group B streptococcal carrier requency8–27.
A 23-year-old primigravida who is seeking pregnancy presents or her annual examination, and youascertain that she smokes approximately one pack o cigarettes daily. She is considering pregnancy and is concerned about the e ect o tobacco use on pregnancy outcomes. Which o the ollowing is an accurate statement?
a.
Her risk o preterm delivery continues to all during the irst 6 months she abstains rom cigarette use.b.
Her risk or pulmonary edema complicating preeclampsia remains higher than that o the nonsmoking population.c.
he risk o etal-growth restriction should be no higher that the general population i she quits be ore she conceives.d.
None o the above8–28.
What percent o women giving birth in the United States are smokers?a.
2%b.
6%c.
14%d.
24%8–29.
Pregnant women should limit their weekly dietary intake o canned tuna to 12 ounces and shouldeliminate consumption o certain kinds o ish such as mackerel and sword ish to minimize exposure to which etal neurotoxin?
a.
Cadmiumb.
Methyl mercuryc.
Organic phosphated.
Algae-related toxin8–30.
A 19-year-old G3P2 at 28 weeks’ gestation is embarrassed to admit she has been craving and eating ice and dirt. She thinks she must be “going crazy.” What test is likely to be abnormal?a.
oxicology screenb.
Liver unction testsc.
Complete blood countPreconceptiona l a nd Prena ta l Ca re SE C T I O N 4
54
8–31.
What diagnostic test should be per ormed either prior to pregnancy or early in prenatal care to assess the risk to the etus and the pregnancy rom the disease that is typi ied by the blood smear shown in this image?Reproduced with permission rom Longo DL: Atlas o hematology and analysis o peripheral blood smears. In Longo DL, Fauci AS, Kasper DL, et al (eds): Harrison’s Principles o Internal Medicine, 18th ed. New York, McGraw-Hill, 2012, Figure e17-12.
a.
Serum erritinb.
Antiglobulin testc.
Indirect Coombs testd.
Hemoglobin electrophoresis8–32.
Ashkenazi Jewish individuals should be o eredpreconceptional screening or all EXCEPT which o the ollowing?
a.
Canavan diseaseb.
Cystic ibrosisc.
Beta thalassemiad.
ay-Sachs disease8–33.
You have recently taken the practice rom a retiring obstetrician and are meeting a patient or her irst prenatal appointment. In reviewing her old chart, you see the ollowing photo and notes that state her husband was responsible. Why are you concerned or this patient?Reproduced with permission rom Knoop KJ, Stack LB, Storrow AB, et al (eds): T e Atlas o Emergency Medicine, 3rd ed. New York, McGraw-Hill, 2010, Figure 1-3.
a.
Rate o success ul breast eeding is reduced.b.
Risk or violence against your patient is higher during pregnancy.c.
here is reduced bonding between the ather and in ant in the setting o domestic violence.d.
None o the abovePreconceptiona l Counseling CH A P T E R 8
55
CHAPTER 8 ANSw ER KEy
Q uestion
number
a nswerLetter
Pa ge cited Hea der cited
8–1
d
p. 1 5 6 Counseling Session
8–2
c
p. 1 5 7 Dia betes Mellitus
8–3
c
p. 1 6 3 Ta ble 8 -4
8–4
d
p. 1 5 7 Dia betes Mellitus
8–5
a
p. 1 5 8 Epilepsy
8–6
b
p. 1 5 8 Epilepsy
8–7
b
p. 1 5 8 Ta ble 8 -2
8–8
d
p. 1 5 8 Immuniza tions
8–9
c
p. 1 5 9 Genetic Disea se
8–10
d
p. 1 5 9 Genetic Disea ses
8–11
b
p. 1 6 0 Figure 8 -2
8–12
a
p. 1 5 9 N eura l-Tube Defects
8–13
d
p. 1 5 9 N eura l-Tube Defects
8–14
c
p. 1 5 9 N eura l-Tube Defects
8–15
a
p. 1 5 9 Ta ble 8 -3
8–16
b
p. 1 5 9 Ta ble 8 -3
8–17
b
p. 1 6 0 Tha la ssemia s
8–18
c
p. 1 6 1 Reproductive History
8–19
b
p. 1 6 1 Reproductive History
8–20
d
p. 1 6 1 Ma terna l Age
8–21
b
p. 1 6 1 Ma terna l Age
8–22
a
p. 1 6 1 Figure 8 -3
8–23
c
p. 1 6 1 Assisted Reproductive Technologies
8–24
d
p. 1 6 1 Assisted Reproductive Technologies
8–25
b
p. 1 6 2 Pa terna l Age
8–26
d
p. 1 6 2 Diet
8–27
c
p. 1 6 2 Recrea tiona l Drugs a nd Smoking
8–28
c
p. 1 6 2 Recrea tiona l Drugs a nd Smoking
8–29
b
p. 1 6 3 Ta ble 8 -4
8–30
c
p. 1 6 2 Diet
8–31
d
p. 1 6 3 Ta ble 8 -4
8–32
c
p. 1 6 1 Individua ls of Ea stern Europea n Jewish Descent
56
CHAPTER 9
In document
Novedades en auditoría, contabilidad y otras materias
(página 27-47)