Obesity in obstetrics – Multiple choice questions for Vol 29, No. 3

  • 1.

    Obesity in pregnancy increases risk of which of the following in the baby?

    • a)

      An autism spectrum disorder

    • b)

      Intra-uterine growth restriction

    • c)

      Macrosomia

    • d)

      Type 1 diabetes in childhood

    • e)

      Childhood cancer

  • 2.

    Which of the following statement(s) is/are true in relation to obesity and pregnancy?

    • a)

      The risk of primary Caesarean section is higher

    • b)

      The success rate of VBAC is lower in obese women

    • c)

      The recommended carbohydrate intake is 45% – 65% of total energy in obese women in pregnancy

    • d)

      Weight reduction is recommended in obese pregnant women

    • e)

      Obesity increases the risk of Vitamin D deficiency

  • 3.

    Which statement(s) is/are true regarding medications given in pregnancy?

    • a)

      Metformin is recommended in non-diabetic obese pregnant women

    • b)

      Low dose Aspirin is recommended in all obese pregnant women

    • c)

      Low dose Aspirin is recommended in all obese pregnant women with pre-eclampsia risk factors

    • d)

      Folic acid 5 mg is recommended in obese women

    • e)

      Vitamin D is recommended in obese pregnant women

  • 4.

    With regards to obesity, which of the following statements is/are true?

    • a)

      The epidemic mainly affects developed countries

    • b)

      The worldwide incidence had trebled since the 1980s

    • c)

      There are more obese women compared to obese men

    • d)

      A BMI>40 is regarded as morbidly obese

    • e)

      Less than half of pregnant women who died in the UK (from direct or indirect causes) are obese in the 2003–05 triennial report of Confidential Enquiries into Maternal Deaths

  • 5.

    With regards to Gestation Diabetes Mellitus (GDM), which of the following is/are true?

    • a)

      It affects approximately 1 in 5 pregnancies

    • b)

      Use of insulin therapy does not influence maternal or fetal morbidity

    • c)

      Women who develop GDM have a 50% greater risk of developing diabetes during their lifetime

    • d)

      Insulin therapy is indicated once GDM has been diagnosed.

    • e)

      Losing weight for subsequent pregnancy reduces the risk of GDM

  • 6.

    With regards to the obese mother, which of the following is/are true?

    • a)

      There is no difference in terms of the risk of having a prolonged pregnancy

    • b)

      The risk of wound infection following Caesarean section is doubled in morbidly obese mothers

    • c)

      They are 4 times more likely to have a thrombo-embolic episode compared to normal weight mothers following Caesarean section

    • d)

      The need for intra-partum monitoring is no different compared to non-obese mothers

    • e)

      They are more successful in terms of breast feeding rates

  • 7.

    The following statement(s) is/are true regarding the aetiology of obesity:

    • a)

      The aetiology is multifactorial

    • b)

      Cultural and societal expectation play a significant role

    • c)

      The only significant contributing factor is genetic predisposition

    • d)

      In-utero environment may contribute to obesity in children and adults

    • e)

      Obesity is caused by higher energy intake than expenditure

  • 8.

    The following countries have a prevalence of overweight/obesity >70% according to the most recent WHO statistics:

    • a)

      United Kingdom

    • b)

      United States

    • c)

      Bolivia

    • d)

      Egypt

    • e)

      France

  • 9.

    Obesity is defined as:

    • a)

      A body mass index (BMI) of >25 kg/m 2 in adults

    • b)

      A BMI of >30 kg/m 2 in adults

    • c)

      A BMI of >35 in kg/m 2 adults

    • d)

      Over the 90 th percentile for height and weight for children

    • e)

      Over the 95 th percentile for height and weight for children

  • 10.

    The following is/are true regarding the cost of the epidemic of obesity:

    • a)

      The estimated direct costs of obesity annually in the UK in 2010 were over £9 million

    • b)

      The indirect costs to the economy are as much as £2 billion annually

    • c)

      Indirect costs of obesity include treatment for co-morbidities such as diabetes and hypertension

    • d)

      The costs are predicted to decrease over the next decade

    • e)

      Direct costs include acquisition of new medical equipment large enough to adequately cater for the needs of an obese population

  • 11.

    The following statement(s) is/are true about screening for gestational diabetes:

    • a)

      Hyperglycemia in pregnancy can only be defined as gestational diabetes in high risk groups if overt diabetes has been excluded at the first prenatal visit.

    • b)

      Both the Carpenter & Coustan criteria and the IADPSG criteria for gestational diabetes are based on perinatal outcome.

    • c)

      Findings suggest that an Hba1c measurement is not a useful alternative to an OGTT in pregnant women.

    • d)

      A glucose challenge test is acceptable to screen for GDM, but cannot replace the OGTT.

    • e)

      Only women with gestational diabetes who received insulin during pregnancy should have lifelong screening after delivery for the development of glucose intolerance.

  • 12.

    The following statement(s) is/are true about screening for gestational diabetes:

    • a)

      Cut-offs for tests used to detect diabetes in the non-pregnant population are recommended in early pregnancy

    • b)

      The Carpenter & Coustan criteria were chosen to identify women at high risk for the development of diabetes after pregnancy

    • c)

      Studies have shown that by using a HbA1c an OGTT could be avoided in approximately 40%–60% of women

    • d)

      The sensitivity of the glucose challenge test has been shown to be around 0.75

    • e)

      Women with GDM have a seven-fold increased risk of developing type 2 diabetes after pregnancy

  • 13.

    The hereditary predisposition of the tendency to develop obesity which appears to run within a family is very often contributed to by which of the following?

    • a)

      The presence of the obesity-related (FTO) gene localised on chromosome 16 transmitted through different generations.

    • b)

      Metabolic programming during intrauterine life predisposed to by the metabolic environment presented to the developing fetus causing epi-mutations and altered developmental changes in the pancreas.

    • c)

      Inappropriate nutritional and physical lifestyle attitudes prevalent in the family.

    • d)

      The socio-economic status of the family with the risk of obesity being particularly associated with high social class families in well developed countries.

    • e)

      The parenting style adopted by the parents.

  • 14.

    A School Medical Officer has been asked to review the health of a class of ten-year olds. Which of these individuals are at particular risk of developing obesity in adulthood?

    • a)

      Children whose birth weight was above the 95 th centile for their gestational age.

    • b)

      Children who were breastfed right through infancy.

    • c)

      Children whose mother is known to have two or more risk factors for the metabolic syndrome.

    • d)

      Children with an age/gender-standardized BMI approximating the 50 th centile.

    • e)

      Children with Prader-Willi Syndrome.

  • 15.

    The following genetic condition(s) is/are associated with obesity

    • a)

      Trisomy 21

    • b)

      Trisomy 18

    • c)

      Bradet-Biedl syndrome

    • d)

      Monosomy X (Turners)

    • e)

      Beckwith-Weidemann syndrome

  • 16.

    Which of the following is increased with obesity in first trimester ultrasound compared to normal weight women?

    • a)

      The incidence of fetal neural tube defects

    • b)

      The duration of time to obtain nuchal translucency

    • c)

      The completion rate of nuchal translucency measurement

    • d)

      The rate of inadequate nasal bone assessment

    • e)

      The requirement of trans-vaginal ultrasound at the time of nuchal translucency measurement

  • 17.

    Which of the following is/are true concerning second trimester ultrasound in obese women?

    • a)

      Maternal obesity alters the sensitivity of pyelectasis as a soft marker for fetal aneuploidy

    • b)

      Overweight women had lower rates of anomalous fetuses detected when compared to class I and II obese women

    • c)

      The optimal gestational age for ultrasound completion in obese women is 18–24 weeks

    • d)

      When compared to other pregnancy co-morbidities, pre-gestational diabetes decreases detection of fetal anomalies the most

    • e)

      Greater sonographer experience increases rates of adequate visualization

  • 18.

    The sensitivity of which of the following soft markers for fetal aneuploidy is decreased in obese women?

    • a)

      Short long bone length

    • b)

      Nuchal fold

    • c)

      Echogenic bowel

    • d)

      Intra-cardiac echogenic foci

    • e)

      Choroid plexus cysts

  • 19.

    Which of the following is/are true regarding third trimester ultrasound in obese women?

    • a)

      Maternal estimation of fetal weight is less accurate than ultrasound estimation

    • b)

      Existing data show that obesity does not have an effect on fetal weight estimation in the third trimester in singleton pregnancies.

    • c)

      Obesity is a risk factor for fetal macrosomia

    • d)

      Data regarding accuracy of fetal weight estimation of twin pregnancies in obese women in the third trimester show unclear results.

    • e)

      Sims technique involves placing the patient in the supine position and scanning through less dense areas of adipose on the patients flank.

  • 20.

    The following statement(s) is/are true regarding the maternal immune response to pregnancy

    • a)

      There is a Type 2 Helper T cell shift

    • b)

      There is increased susceptibility to Listeriosis

    • c)

      There is an increased susceptibility to all pathogens

    • d)

      There is potentially increased disease severity to viral haemorragic fevers such as Ebola

    • e)

      There are increased Natural Killer cells with increased cytotoxicity in the peripheral blood system

  • 21.

    Surgical site infections are known to be reduced by

    • a)

      Intraoperative prophylactic antibiotic versus pre knife to skin

    • b)

      Hyperglycaemia

    • c)

      Hypothermia

    • d)

      Staples for closure for skin

    • e)

      Vertical incision compared to transverse

  • 22.

    The effect of obesity on the immune system acts by which of the following?

    • a)

      Decrease T cell diversity

    • b)

      Increased baseline cytokines and monocytes

    • c)

      An increased of all adipokines

    • d)

      A leptin deficiency

    • e)

      An increased amount of B cells reducing the chances of repeat infections

  • 23.

    Regarding the epidemiology of obesity and thromboembolism in pregnancy:

    • a)

      The risk of VTE is increased to the same degree in pregnancy and the puerperium.

    • b)

      The mortality of pregnancy-associated VTE is higher in the USA than in the UK

    • c)

      The increased risk of VTE persists for more than 6 weeks after delivery

    • d)

      Obesity is the most important clinical risk factor for pregnancy-associated VTE.

    • e)

      Postpartum thrombosis affects the arterial system as well as the venous system.

  • 24.

    Regarding current guidelines on the prevention of VTE which of the following is/are true?

    • a)

      When obesity is present at the beginning of pregnancy, one other risk factor must also be present before thrombo-prophylaxis with low molecular weight heparin (LMWH) is considered.

    • b)

      At delivery, risk assessment for VTE distinguishes between obesity and severe obesity.

    • c)

      There is good evidence that compression stockings and intermittent compression devices are effective in obese women.

    • d)

      Morbid obesity is an indication for higher doses of prophylactic LMWH

    • e)

      Implementation of thrombo-prophylaxis guidelines has been shown to be positively related to the severity of obesity

  • 25.

    Regarding diagnosis and treatment of VTE in pregnancy, which of the following is/are true?

    • a)

      In pregnancy, unlike the non-pregnant state, DVT is equally common in the left and right legs.

    • b)

      Contrast venography is the preferred method of confirming a diagnosis of DVT in pregnancy

    • c)

      LMWH is preferred over unfractionated heparin (UFH) for the treatment of acute life-threatening pulmonary embolism

    • d)

      D-dimer testing is not recommended in pregnancy.

    • e)

      Chest X-ray and computerised tomographic pulmonary angiography are both free of risk to the pregnant woman.

  • 26.

    Compared with women of a healthy weight, maternal mortality in obese women in the UK:

    • a)

      was associated with obesity in 27% of maternal deaths in the 2006-8 triennium

    • b)

      is greatest in women with extreme obesity (BMI 50 kg/m 2 or more)

    • c)

      is due to an increased risk of amniotic fluid embolism

    • d)

      is due to an increased risk of thrombo-embolism

    • e)

      is due to an increased risk of cardiac disease

  • 27.

    The following daily supplements are recommended for all obese pregnant women:

    • a)

      Calcium

    • b)

      Vitamin D

    • c)

      Folic acid 5mg

    • d)

      Aspirin 75mg

    • e)

      Ferrous sulphate

  • 28.

    To reduce morbidity and mortality, obese women should have which of the following?

    • a)

      random blood sugar and haemoglobin A1C at 28–30 weeks to screen for gestational diabetes

    • b)

      an antenatal consultation with an obstetric anaesthetist

    • c)

      LMWH for seven days after delivery

    • d)

      prophylactic antibiotics before starting a Caesarean section

    • e)

      a uterotonic drug prior to delivery of the placenta

  • 29.

    When performing a Caesarean section in obese women which of the following aspects should be taken into account?

    • a)

      Higher doses of prophylactic antibiotics need to be considered

    • b)

      Pre-operative vaginal cleaning with an antiseptic solution is unnecessary

    • c)

      Manual removal of the placenta should be avoided

    • d)

      The subcutaneous tissue layer should be closed

    • e)

      Separate mattress sutures should be used for skin closure

  • 30.

    When managing wound complications after Caesarean section in obese women which of the following aspects need to be taken into account?

    • a)

      Small and asymptomatic seromas should be managed conservatively

    • b)

      Symptomatic and non-liquefied haematomas require surgical treatment

    • c)

      Topical treatment of wound infection associated with dehiscence should avoid the use of gauze

    • d)

      Negative pressure wound therapy of dehiscence results in faster healing times

    • e)

      Infected wounds should preferably be left to close by secondary intention

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Nov 6, 2017 | Posted by in OBSTETRICS | Comments Off on Obesity in obstetrics – Multiple choice questions for Vol 29, No. 3

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