FEU NRMF INSTITUTE OF MEDICINE of Obstetrics and FINAL EXAMINATION — PHYSIOLOGIC OBSTETRICS SUBJECT CODE: 342 March 21, 2013 (Thursday; 08:00am — 11:00am) INSTRUCTIONS: PLEASE FOLLOW ALL INSTRUCTIONS VERY CAREFULLY. SHADE LEGIBLY YOUR FINAL ANSWER IN THE ANSWER SHEET. CHOOSE ONE FINAL ANSWER ONLY. MORE THAN ONE ANSWER IS CONSIDERED WRONG. STRICTLY NO ERASURES AND ALTERATIONS OF YOUR FINAL ANSWER. 41__Who among the following is(OD considered high risk for anesthesia? a ©" A 14 year old, primigravid B. 30 year old with short neck and height of 5'5” C. Multigravid with previous spinal surgery B. 34 years old, muitigravid with dentures ie oo of the following is the most commonly used opioid for pain related to labor? A. Nalbuphine B. Fentanyl &. Meperidine 5. Promethazine 2 ‘ '3“The following statements are (RUD of the non-oharmacological approach of pain cont A. Education and counseling play an important role in improving pain control during labor B. Lamaze delivery follows the psychoprophylactic method which is a potent analgesic &. The rate of cesarean delivery-was not affected when a strong support group is present as compared to its absence. _D. Emotional tension can potentiate pain 4 This drug has its advantage over other narcotics as it has lesser reported cases of neonatal respiratory depression. . & Butorphenol felaghant (ot? ony cos of evel Jor poner 8. Meperidine one ee ae C. Promethazine D. Fentanyl x 5. This narcotic is associated with sinusoidal fetal heart rate pattern: f A. Butorphenol B. Meperidine C. Promethazine B. Fentanylsia, which of the following 6 To hypotension following regional anesthe= pike ® practice/s is/are being done? zehion . aa re ‘A. giving of vasopressors before induct fon * 4 daw 8. pli a 500 to 1000mI of fluid before induction CC. premedication before induction Sevenps D. placing the patient on the supine position when hypotension de E, all of the above ical bIOcK? 7. Which of the following statements is/are((RUP regarding paracery cal Fthe cervi A. Itisdone by 14.9 clock Poste ection ci > _B. Bupivacaine is superior to lidocaine as it provide lesser adverse C. Disadvantage of which is that itis short-acting, hence have fo De NET. repestedly/ ‘i, > lena pie + ia Be PES D. Aandc > lamer . + Bape > pans) Somme Aa a a ey mg 3 The inden TSE can ve dion Wich nal? ‘Ac Use of a small-gauge spinal needle i: Rab nn ts, SE ix e B. Minimal number of puncture is advocated” hee C. Preloading with @I)of IV fluid? oie B AendB eins Hak pl E. ABC Eien ofthe following is a (@reoti antagonist that is capable of reversing respiratory depression from opioid narcotic? ‘A. Butorphanol 6 BENaloxone C. Halothane D. Promethazine 40. Which of the following is an €6solu¥8 contraindication to regional anesthesia? . Matemal use of once-daily dose of iow-molecular weight heparin wahin 3) hours 2 B. Matemal blood pressure of 140/90 mmHg ~« 4 me : Mother on first'dose antibiotic based on a positive blood culture and sensitivity: Tp tba eden //( fi, D. CNS mass with normal intracranial pressure CG 41. Mrs. Ortiz, 35 year-old, Gravida 3 Para 2 (2002) came in@em, with head at station@3* Her 2 previous pregnancies were delivered via normal snantaneous delivery under Epidurg anesthesia. The BEST choice of anesthesia for her is: ‘A. -Pudendal block ln tek op « @linand) vols) B. Epidural anesthesia -pxlmy rex! hte. ee a ee fk ets ro C. General endotracheal anesihexia eo foouraen Say D. Paracervical ee Dak far dain siden, ‘aay Hy a doy tabs 2°" calc — apn ein] opine99'S given for resolution of 2 ee Sulfate HY of regional anesthesar® 1OliM® —+ paid rat dt oy me sot festations of Orne tollowir are si 5 A Tetrasane Stating cal anesthetics, EDD . B Bupivacaine Ropivacaine P. Lidocaine -piats, v upon Z oe Complete analgesia for the these dermatomes: & T10t0 ss B. Ti2t0s4 ioe ©. Tiosa D. T7toTs Pain of labor and vaginal delivery requires a block of 1 1S:Pain on tha lower genital tract is basically transmitted by the nerve A. sciatic AB. obturator pes 1D ee aarts ot C. femoral D. inguinal pudendal 16-Elaine, a 32 year-old GaP2 (2002), previous LSCS 1! due to placenta previa and now on her 37" week of gestation, comes to the ‘emergency room complaining of prafuse vaginal bleeding. Upon ultrasound examination, the flacentDis seen to be totally Cavating the intemal os of the cervix with placenta percreta. You have decided to do ' @ Stat repeat caesarean section. The anesthetic technique of choice should be: A. epidural Repl B. subarachnoid block C. general anesthesia intravenously &. general anesthesia by endotracheal intubation No. 17-21. Matching type: match the evenis with the specfc phase of parturton ae A. Phase 1-p Ds on hi, @ RDN: atts | fof Pm B. Phase 2- Baw, C. Phase 3-um * rik D. Phase 4 ~ mp a ek mp fe Flap ling an! pa 517 Formation of physiologic retraétion ring -2 818. ip! ripening aR et ween stretching of the myometrium does not lead to uterine contraction | 0 ling of the episiorhapyo -4 ¢ 24-Regular uterine Gontractions with cervix 4.cms dilated. ~® me [a al =e = iRPORS + lee sath mals "Magra fs mnccen mae tector, ‘ant rt ae dnp 7 I ptt wl opr as Ml rg iho Median fein der sate, sein’ fw ee i stat Cans { pagnng ‘toad ded She oo iors] prin { fess jet Pe jhe ae ep apr ite, det Sd . ie Sei ben, Bb jr, sens Thy fed ove tyr pon wh BNNo. 22 — 28, Matching type: match the molecules/events with its, action on gont ‘A. Stimulate uterine contractions B. Promote uterine relaxation C. No effect on uterine contraction Ee jocint® ~ Heat & | 2BProstaglandine - retajree. sans fear Tow TAat® Acs Noe | | 24 Progesterone ~ 4c, tr & omies Hw Gaicium channel blockers > - 4 ca" jux 25Eluose — ane No. 27 - 100. Multiple choice: choose the letter corresponding to the best answer Which of the following substances serve as myometrial gap junctions? A. Collagens peopel dr fad r Fly ovina pli fe fr Sarda B. Gonnexins: ———+] mc sna J pan ae pf C. Globular actins BE pf dlocd icy matin omy oy D, fibronectins ese twa phase of parturition is mifepristone effective? A. Phase 1 -s ippoline= nugtt- fwd onropk Oded 4 plas Jus B. Phase 2-m - a fi ther, bh in © Hn apr ©. Phase 3-H Beis ocd Sioa pat D_ AT of the above ea : 23.SSuring the delivery of the placenta, a glistening structure to which an umbilical co was attached, presented at the vulva Eventually the placenta was expelled. the mechanism of placental separation? A. Duncan ‘ Aa, ~ Citing aoe Bane Sol Ge foie — Bok D. Ritgen wire resident reports that the cervix of the parturient is Gull) dilated and effages Based on the knowledge of the forces that is the most important factor at this siage of labor, what should be the next appropriate step that should be done? ‘A. Do enema to stimulate uterine contractions JB. Ask the mother to push and bear down C. Give oxytocin D. Give prostaglandin 31. Which of the foliowing hypotheses best explains the initiation of phase 3 of. ee "A. Functional cortisol withdrawal resulting in an increase in prostaglandins B. Progesterone withdrawal as an effect of hyalorinidase inhibition C. Activation of fetal hypothalamic pituitary adrenal placental axis D> Increases in number and sensitivity of oxytocin receptors lay of for Ban papptat tack pert Heyorn Sf c52.Compared to skeletal muscles, which of the following characteristics of smooth muscles offers a more advantageous contraction? ‘A Generation of forces along one axis B. More structured alignment of muscle fibers C. Greater muscle fiber shortening D. Allofthe abovey 33-Which of the follows res isan inerease yee einaasaures is in fel during the 1% stage of labor? B. intrabdom mer 2e8ur® 88 @ result of uterine contractign/ es sare Pressure as a result of matemal valsafa maneuver D ht Pressure as result of enzymatic degradation of the collagen _ Pressure as a result of doing the riigens maneuver +@BHow can a A Cause initiation of preterm labor? There is increase in- B esetaioe leading to an increase in proteases that rupture of membranes Cc neat oa leads to myometrial contraction placent that stimulates uterine cor ne WF all of the above Se aa ae > ns i the alaionsbip ofthe ong ads ofthe fetus tothe long axis ofthe motner? &. tie C. Position 33 Presentation 38What is the presenting part in vertex presentation? ‘A. Anterior fontanal + lin qf Dy tain stn oath oH popped pes of B. Brow posed ature Toth nad te pray Fg piel C. Chin i ae — 10 | tap ponies ae fou ys oe oe Bah ry et 37 Where is the flexion of a frank breach presentation? A. Ankle =F plan {105 wi B. Back &. Hips ‘D. Knee 3eWhen the posterior fontanel is exactly under the symphysis pubis, what is the position? (Direct occiput anterior (DOA) ‘8. Direct occiput posterior (DOP) ©. Left occiput anterior (LOA) BD. Right occiput anterior (ROA) In which of the following condition is shoulder presentation seen? A. Vertex presentati B. Complete breechXpresentation r. Oblique lie D. Transverse lie @where is the location of the head in Right Acromiodorso posterior (RADP)? 5 & Fundus B. Right of the mother C. Left of the mother D. Lower uterine segment 41. When the cephalic prominence is at the same side as the small parts, what is thesnd follows after extemal rotation is i a Descent © Delivery of the anterior shoulder C. Flexion Internal rotation 43/What is engagement? This is when the- AX. biparietal plane has passed the pelvic inlet B. most dependent portion has just passed the pelvic inlet C. biparietal plane is at the level of the ischial spines D. most dependent portion is above the ischial spines ‘Which of the following terms is defined as the lateral deflection of the head of the fetus to anterior or posterior of the pelvis? & Asynclitism + lio! flit, Seema /pih pies p B. Engagement C. Flexion D. Descent What is caput succedanum ? X. Edema of the scalp at the area immediately over the cervical os due to prolonged labor B. Hematoma on tite scalp at the area not prolonged labor ‘on the cervical os due to trauma of C. Elongation of the fetal heaa due to prolonged labor Enlargement of the head due to inflammation from sucopsive contraction ich of the following occurs even without labor especially in a nullipara? &. Engagement arts fo pope th B. Extension C. [ntemal rotation ‘A. Pressure of amniotic fluid B. Direct pressure of the fundus upon the breech with contractions raligoa- ppt tb as a ol fa Eagly fils ean, 10 ft whe f pond Fo estitution nding By to | pe 47Anich of the following is most important in the Second sper Jabor in the desi tus? nt Jou 3) pore of mile p wert (ct dat psn fr {. Bearing down efforts of maternal abdominal muscles ‘ fe rot Extension and straightening of the fetal body oe i A is the presenting diameter of the fetal head when in flexion? { fist by ~~A. Bitemporal > ih spanish st é damn ws B. Fronto-occipital abtted poe don yup prt dont . Mento-occipital 3 bocripito bregmatic pregnant came at the €B)claiming to have watery vaginal discharge but on inspection, there was very minimal discharge I in the vagina that looks just normaily seen in a vagina. What will determine rupture of the bag of waters? A. Doan Amniotic fluid index using ultrasound B. Observe the vaginé until fluid comes out Zs Test the pH-of the vagina D. Look for ee in the vaginal fluid50. Two ht ic contraetions teen with an admitting finding of beginning cervical dilatation, oooh ate Sa 4— § minutes, mild to moderate, lasting for 30, ‘Obseri§ the most appropriated next stop? : Br Sb8er8 for further of labor » DO an internal examination & Give oxytocin Prepare for vaginal delivery at the delivery room 51.1n a parturient with in baby crowning, what is the next step? Co A Delivery of the anterior shoulder B. Delivery of the head SAA fil noes, C, Doan episiotomy Deve] Mh fad dud Th tdi P! Do a Modified Ritgen’s maneuver ae 2am rss qo he : San (OME TY oe daca ff & ne the delivery of the baby, what is next appropriate step?” ™ Wait for placental separation 8. Pull the umbilical cord to separate the placenta Cc. Massage the uterus to have ‘sustained contraction D. Push the uterus towards the fundus * 53. Puerperium encompasses the first _ week/s after delivey Do oA 8 1-2 £28 4-6 his is the scarred tissue of the hymen after delivery: A. Rugae 5 Myrtiform caruncles C. Vaginal inclusion cyst D. Episiotomy scar The following parts of the genital tract do not resume its pre-pregnant state even after the puerperium, EXCEPT the- * A. cervixe B. vagina Ae uterus JB. labia 96. Which of the following statements is True of afterpains? They are- A. experienced by primigravidsX & more pronounced as parity increases / C. as painful as labor pains.x D. stimulated only by infant suckling x §7. Which of the following statements is TRUE of Lochia? It- 0 XX persists up to day 10 post-partum” B. may persist up to 4-8 weeks after deliveryx C. consists of sloughing of decidual tissue and bacteria D. Bandc 58. Characteristic of Endometrial regeneration: = _ A Starts from the supe}icial layer of the decidua B. rapid except at the placental implantation site C. will be only complete at the end of the Puerperal period DB Bandc E, ABC59, Urinary bladder trauma as a cause of urinary retention is most closely related with (Which of the following condition/procedure? J use of regional analgesia B. episiotomy C. length of the 2nd stage of labor D. birth weight of the infant (©yGrinary tract changels during the puerperium include: A. diuresis B. bladder over distention C. dilated renal pelves and ureters *D. AandB . ABC lich of the following statements is/are TRUE of colostrum? A. Itis produced after day 5 posiparturA. &%. ‘ts protein is more of globulin. C. It contains less sugar and more fat and minerals. we It is converted to mature milk after 2 weeks. The i he immunoglobulin predominant in human breast milk is: K \oh B. IgG C. IgM D. IgE 63. Which of the following is/are benefits of breastfeeding? It- A. decreases the incidence of diarrhea in the neonate D B. decreases the incidence of postpartum weight retention in the mother C. enhances cognitive development D, Aandc ABC wa following may be done to relieve breast engorgement postpartum, EXCEPT &. giving Bromocriptine B. wearing of wellfitting brassiere C. application of ice packs giving of oral analgesics is condition is 2uafelare' contraindication to breastfeeding AK. HIV infection 'B. Hepatitis B infection # Pre ongoing treatment Herpetic lesions on the lower trunk 66. This is the most common cause of Mastitis: A: lowmatemal immune response B, ‘infant's mouth &. personal hygiene D. breastiy, a 2, = ae 3 ylO primigrayi discharge, isto ered by NSD on M, larch 19, 2013. internal admits Sf y ISclean dy nernce ternal examination on fundus pape ioe 880; Corvix is soft, 1 em iptated Parous introitus, vagina rs dilatog, ut \ 6 Noted arid pantie Below ha umbtcshsea uterus is well contracted and iol examination on this patient B. should be eieaene tim® of discharyo r at the time of di won 96. Stil on the a OPD rene Patient: This patient followed up 2 weeko after delivery at the admits tip of finger 100 consuming 4 fully soaked pads por day. IE: corvix is sot ger, uterine fundus palpable midway between umbilicus anc SYIPhysis pub. Th oy nau Papable midway between umbilicus and at this point iséxpectédto be: lochia rubra ee Bot lane ray B. lochia serosa RISO i ci lochia alba oy }oua } too 69/A 26 ylo G2P2 (2002) Postpartum 10 days followed up at the OPD because of Profuse vaginal bleeding. P.E,: stable vital signs; abdomen uterine fundus palpable midway between umbilicus and symphysis pubis; IE cervix is 1 cm dilated, uterus is Soft enlarged to 3-4 months size. The most common reason for late postpartum hemorrhage is: J placental site subinvolution B. retained placental fragment C. metritis cervical lacerations 32.wo primipara, day 10 Post-CS secondary to prolon, 2") labor consulted because of fever, chills and dysuria and consistency. Pertinent P E. stable vital signs, Temperature of 68.6abdomen flabby, soft, no tendemess, IE cervix is soft, closed, uterus well contracted and enlarged to 2 months size. This/ these is/are reason/s for the condition of the patient: A. Dilated ureters 108 dts B. Presence of lochia “pg og {le Of i po bein, C, Prolonged labor Which part of the uterus becomes the lower uterine segment during pregnancy? A. cervix . isthmus C. cornua D. corpus 72. What is the relationship between the uterine artery and the ureter at the area 2 cm lateral to the cervix? & they are parallel to each other B, the ureter crosses over the uterine artery C. they are far from each other D. the uterine artery crosses over the ureter 73. The production of what hormone isthe most important factor in endometrial recovery following menstruation? A. Estradiol B. Progesterone C. hCG BAH74 & 76 % 78 0 i The Secretion of which hormone peaks 10 — 12 hours before ovulation and Stimulates the resumption of meiosis in the ovum? A FSH BH C. Estradiol JF. progesterone 5 What is the implantation stage of 2 -« the fertilized ovum’ Which part of the placenta is responsible for the initiation of jabor? A. Fetal fibronectin ‘system — - Hemochoricendethelial system C. Integrin system ge Paracrine system Nhat is the nature of a Hofbauer cell? & Fetal macrophage 8. Matemal leukocyte C. Glandular cell D. Specialized myometrial cell Which of the following structurels is/are absent in the amnion? A. Blood vessels ot 8. Smooth muscles & Newes D. ABC ‘What is the primary function of the human placental lactogen? A. Inhibit gluconeogenesis & Increases maternal lipolysis . Prevents angiogenesis 80/JA the absence of hCG, what clinical condition may happen to the fetus? 82. u A. Failure of the uterus to develop ¢ : B. Non closure of the ductus arteriosus during delivery C. Congenital hypothyroidism Abortion \ich of the following pulmonary function tests is INCREASED during pregnancy? A. Functional residual capacity Be Tidai volume C. Residual volume D. Total pulmonary resistance ‘Which of the following findings is considered in a pregnant woman? A, Slight left axis deviation on ECG B& Exaggerated split first heart sound __ C. Grade 3 diastolic murmurSS. At what gestational age in weeks will fetal heart sounds be audible witha fetal 5 omar in 100% of live pregnancies? » 16 aS Cc. 20 D. 22 Most antibiot tics Such as penicillin, macrolides and cephalosporins fall under this category of the Food and Drug Administration for Drugs and Medications: AA BB £.c DD 57. This NSAID when used as a tocolytic agent can result in constriction of the fetal Guctus arteriosus and cause pulmonary hypertension in the neonate: A. ibuprofen 88. Which of the following corresponds to the greatest transverse diameter of the fetal » head? A. biparietal B. bitemporal &. cccipitobregmatic D. suboccipitobregmatic 83When is the earliest age of gestation in weeks by which a sonologist can determine the fetal sex? A 12 B14 C. 16 D1 $0. f hydramnios is : Suspected, the measurement of the ical just pe a 1 largest vertical pocket mi Ba ‘ C10 B12ate fetal biometric parameter is best correlated to 10 weeks age of gesiation? Gestational sac Crown-rump length Biparietal diameter _D. Femur length om> gxnnicn Of the following is considered as malformation? JC Spina bifida *! B. Limb reduction secondary to Amniotic band «fF C. Contracture secondary to oligchydramnios D. Trisomy 24 ~spden $2What is the classification in terms of birth defect etiology of oligohydramnios causing pulmonary hypoplasia, limb contracture and facial deformities ? A. Deformity B. Malformation C. Syndrome Sequence 94. The behavioral state which coincides with@c neonate < Bb XX State 1F B. State 2F C. State 3F State 4F fnich of the following is a requirement for a valid CST? With recording of contraction with FHT B. At least 2 contractions in 10 mins C. Contractions should be 20 secs long X D. Contractions must be induced only x sleep)or rapid eye movement of the 96. In a contraction stress test (CST), heralds uteroplacental insufficiency (Impaired gas exchange ® B. Late decelerations C. Variable decelerations D. Fetal compromise lal is the lower limit of the fetal heart rate to be considered normal at term? ‘A, 90 bpm 110 bom C. 140 bpm D. 160 bpm 98. The single most reliable sign of fetal compromise is fA. decreased fetal hear rate variability B. prolonged deceleration C, bradycardia @& persistent late deceleration 99. This represents the shortest diameter of the pelvic cavity A A, interspinous diameter 4. obstetric conjugate C. intertuberous diameter D. true conjugate"This diameter of t measured A, Obstetric conjugate & Diagonal conjugate C. True conjugate D. Anatomic conjugate he pelvic inlet is the only conjugate that can be clinically *eherneattacenanananetottE ND) OF EXAMINATION*tttetttnetnsnennen