- 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
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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.
- a)
- 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
- a)
- 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.
- a)
- 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.
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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.
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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.
- a)
- 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
- a)
- 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.
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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
- a)
- 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
- a)

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