II.

Primary method of action is to elicit a sterile

inflammatory response, resulting in sperm being
engulfed, immobilized, and destroyed by
inflammatory cells.
III. Reduce tubal motility that in turn inhibits sperm
and blastocyst transport
IV. IUDs do not affect ovulation, nor do they act as
abortifacients.
Day 4 Week 2 A. I, II, III, IV
Obstetrics and Gynecology B. I, II, III
1. Spermicides: C. I, II
I. Nonoxynol 9 D. III, IV
II. Octoxynol 9 Answer: A
III. Menfegol and Benzalkonium chloride
IV. Levonorgestrel
A. I, II, III, IV
B. I, II, III
C. I, II
D. III, IV
Answer: B

4. POP failure rates

A. 5%
B. 6%
C. 7%
D. 8%
Answer: D

5. EC are contraindicated with women with a history of

I. DVT
2. Absolute contraindications for IUD use
II. PE
I. Prior ectopic pregnancy
III. MI
II. History of STI in pas 3 months
IV. Stroke
III. Acute cervical, uterine, or salpingeal infection
A. I, II, III, IV
IV. Copper allergy
B. I, II, III
A. I, II, III, IV
C. I, II
B. I, II, III
D. III, IV
C. I, II
Answer: A
D. III, IV
Answer: D

6. Surgical sterilization
I. Tubal ligation has a failure rate of 0.3 %
3. Mechanism of action of IUD II. Vasectomy has a failure rate of 0.15%
I. Are known to act mainly by killing sperm III. Pregnancy rates after vasectomy reversal range
(spermicidal) and preventing fertilization. from 18% to 60%.
 IV. In vasectomy The success rate of vasal
re-anastomosis is 60% to 70%.
A. I, II, III, IV
B. I, II, III
C. I, II
D. III, IV
Answer: A
7. Placenta previa
I. Occurs in approximately 3.5 to 5 per 1,000 births
II. Accounts for nearly 20% of all antepartum
hemorrhage
III. Placenta previa can also be complicated by an
associated placenta accreta (placenta previa
accreta) in approximately 5% of cases.
IV. The risk of placenta previa is increased in patients
with prior uterine surgeries such as myomectomy
or uterine septum resection.
A. I, II, III, IV
B. I, II, III
C. I, II
D. III, IV
Answer: A
Placenta previa
● Occurs in approximately 3.5 to 5 per 1,000 births
and accounts for nearly 20% of all antepartum
hemorrhage.
● Previa occurs in as many as 1% to 5% of women
with a prior cesarean section.
● Because a bleeding previa often results in delivery,
which may occur preterm, it is a common
indication for preterm delivery. Placenta previa
can also be complicated by an associated
placenta accreta (placenta previa accreta) in
approximately 5% of cases. The risk of placenta
accreta is increased in women with placenta
previa in the setting of prior cesarean delivery.
● The risk of placenta previa is increased in patients
with prior uterine surgeries such as
○ myomectomy
○ uterine septum resection.
● Other risk factors include:
○ uterine anomalies
○ multiple gestations
○ Multiparity
○ advanced maternal age
○ Smoking
○ previous placenta previa.
● The likelihood of placenta previa increases
significantly with each additional cesarean
delivery, putting those women with repeat
cesarean section at significant risk with each
additional pregnancy.
8. A 32-year-old G1P0 Caucasian woman presents for her
anatomy ultrasound at 18 weeks by IVF dating. On
ultrasound, the fetus is noted to have an anterior placenta
with a posterior succenturiate lobe. She has no concerns.
Her pregnancy is otherwise uncomplicated at this time.
What does finding an anterior placenta with a posterior
succenturiate lobe on ultrasound put this patient at risk for?
A. Placenta previa
B. Placental abruption
C. Cervical Incompetence
D. Vasa previa
Answer: D
Vasa Previa
● There is an increased incidence of vasa previa
when there is a succenturiate lobe, particularly
when this lobe is noted to be some distance from
the rest of the placenta.
● A succenturiate lobe is an accessory placental
lobe.
● In this case, the bulk of the placenta is implanted
in one portion of the uterine wall, but a small lobe
of the placenta is implanted in another
location.
● The vessels that connect these two portions of
the placenta are unprotected and may course
over the cervix and present as a vasa previa.
● When a vasa previa is present in the case of a
succenturiate lobe, these unprotected vessels
may cross over the internal cervical os, making
them vulnerable to compression by the
presenting fetal part or to being torn when the
membranes are ruptured.
● In this case, the bulk of the placenta is anterior
and the succenturiate lobe is posterior so it is
possible that the vessels connecting the two
lobes could course over the internal os of the
cervix resulting in a vasa previa.
● There is no significant increase in the
incidence of placenta previa, placental
abruption, cervical incompetence, or preterm
labor as a result of a succenturiate posterior
lobe of the placenta.
● On transvaginal ultrasound, color Doppler
demonstrates that there are vessels from the
anterior placental lobe coursing over the
internal os to connect to the posterior
succenturiate placenta lobe.
● The fetus is noted to be in the vertex
presentation. Otherwise, the pregnancy
continues to be uncomplicated.
9. What is the preferred mode of delivery in patients with this
finding?
A. Emergent cesarean delivery
B. Scheduled cesarean delivery
C. Induction Of Labor,including artificial rupture of
membranes
D. Spontaneous vaginal delivery, including
spontaneous rupture of membranes
Answer: B
● In patients with a known vasa previa diagnosed on
ultrasound, generally a cesarean delivery is the
preferred mode of delivery so as to decrease
the risk of rupture of the fetal vessels.
● There is a significantly higher neonatal survival
rate in those infants who have a vasa previa
diagnosed prenatally, most likely because when
it is not diagnosed prenatally, the diagnosis is
 usually made at the time of fetal vessel compression during uterine
rupture, which in turn leads to significant fetal contractions.
anemia and often death. ● Head compression during labor is usually
● Ideally, cesarean delivery should be scheduled associated with early decelerations that start
before the patient goes into labor and/or before a contraction and recover by the end of the
spontaneously ruptures in order to prevent fetal contraction.
vessel rupture at the time of the rupture of ● A true sinusoidal tracing is never normal and
membranes. is indicative of nonreassuring fetal status.
● This is commonly done at 36 weeks’ gestation,
though some clinicians have even recommended
earlier.
● Although not preferable, if the patient does
desire to have a vaginal delivery and there is
evidence of fetal anemia on continuous fetal
monitoring, emergent cesarean delivery would
then be necessary.
● Also, if the patient does choose to undergo a
vaginal delivery (induction or spontaneous),
artificial rupture of membranes is contraindicated,
as the risk of fetal vessel rupture is higher than
with spontaneous rupture of membranes.

10. What does the sinusoidal pattern on the fetal monitoring

strip suggest?
A. Fetal anemia
B. Uteroplacental insufficiency
C. Cord Compression
D. Head compression
Answer: A
● A sinusoidal pattern on continuous FHR
monitoring indicates fetal anemia.
● Although this can sometimes be confused with
pseudosinusoidal pattern, when there is a true
sinusoidal pattern, it is considered to be
nonreassuring because it indicates fetal
anemia.
● Given the small fetal blood volume, a
sinusoidal pattern should prompt an emergent
delivery (as fast as possible) by the
obstetrician.
● Fetal anemia in this case was most likely
caused by rupture of the fetal vessels (vasa
previa) upon rupture of the membranes.
● Uteroplacental insufficiency is not associated
with a sinusoidal FHR tracing.
● Late decelerations are the typical fetal tracing
finding when uteroplacental insufficiency
occurs.
○ These can be subtle or overt but if they
are recurrent with every contraction for
more than three contractions, the
obstetrician should undertake immediate
intervention.
● Cord compression causes variable
decelerations, rather than a sinusoidal pattern.
○ This can usually be resolved with an
intraamniotic infusion using an
intrauterine pressure catheter.
○ By instilling the uterus with fluid, the
cord has more protection from
Pediatrics and Nutrition I. Nutrition and growth during 3-6 years of life predict
1. The child who helps to undress; puts 3 words adult stature and some health outcomes
together (subject, verb, object); and handles spoon II. Major risk period for growth stunting is between 4
well, his/her MOST appropriate age is around and 24 months of age
A. 15 mo III. Estimated average requirement (EAR) is the
B. 18 mo average daily nutrient intake level estimated to
C. 24 mo meet the requirements for 50% of the population
D. 30 mo IV. Recommended dietary allowance (RDA) is an
Answer: C estimate of the daily average nutrient intake to
meet the nutritional needs of >97% of the
2. Of those babies who have prolonged crying episodes in individuals in a population
the first 2 mo of life, the percentage that will remain having A. I, II, III, IV
similar episodes is about 11 B. I, II, III
A. 1% C. I
B. 5% D. III, IV
C. 10% Answer: C
D. 30% ● First 3 years of life
Answer: B
6. In consideration of preventing infections in the stabilization
3. The first permanent tooth to erupt is phase of malnutrition in unimmunized 10-month-old boys. Of
A. central incisor at 6 yr 13 the following, the vaccine that is recommended to be given is
B. molar at 6 yr A. oral polio vaccine
C. premolar at 6-7 yr B. acellular pertussis vaccine
D. Lower canine at 6-7 yr C. measles vaccine
E. upper canine at 6-7 yr D. pneumococcal vaccine
Answer: B Answer: C
● The first permanent molars usually erupt between ● Measles vaccine is given to unimmunized children
ages 6 and 7 years. For that reason, they often are age >6 mo.
called the “six-year molars.”
● They are among the “extra” permanent teeth in 7. Allergic shiners represent
that they don’t replace an existing primary tooth. A. an upward rubbing of the nose with an open palm
● These important teeth sometimes are mistaken for B. continuous open- mouth breathing
primary teeth. C. Dark circles under the eyes
● The six-year molars also help determine the shape D. transverse crease of the nose
of the lower face and affect the position and health Answer: C
of other permanent teeth. ● Allergic shiners - Dark circles under the eyes.
● The first deciduous teeth to fall are central ● Allergic salute - an upward rubbing of the nose
incisors. with an open palm
● Allergic gape - continuous open- mouth breathing
4. The following medications are truly matched to their major
pharmacological groups EXCEPT 8. A 7-year-old boy developed small hypopigmented
I. methylphenidate …… stimulant depressed scars after fingernail scratches; he has been
II. atomoxetine …………. serotonin-norepinephrine treated with nonsteroidal antiinflammatory drugs (NSAIDs)
reuptake inhibitor for a rheumatic disease 6 weeks ago. Of the following, the
III. escitalopram ……… selective serotonin reuptake NSAID that is MOST likely to cause such a unique skin
inhibitors reaction is
IV. fluoxetine………………. tricyclic antidepressants A. celecoxib
A. I, II, III, IV B. meloxicam
B. I, II, III C. indomethacin
C. I, II D. Naproxen
D. III, IV Answer: D
Answer: B Naproxen
● These are the common medications used in ● More likely than other NSAIDs to cause
Pediatric psychiatric disorders which pediatrician pseudoporphyria.
should be familiar with. ● Pseudoporphyria is more likely to occur in
● Fluoxetine is common antidepressant and it is fair-skinned individuals and on sun-exposed areas.
another selective serotonin reuptake inhibitors ● If pseudoporphyria develops; the inciting NSAID
should be discontinued because scars can persist
5. Regarding nutritional requirement during childhood, all the for years or be permanent.
following are true EXCEPT
9. Rotavirus vaccine should not be initiated for infants older
than
A. 11 wk
B. 13 wk
C. 15 wk
D. 17 wk
Answer: C

10. The final dose of rotavirus vaccine must be administered

no later than
A. 6 mo of age
B. 8 mo of age
C. 10 mo of age
D. 12 mo of age
E. 18 mo of age
Answer: B
● Two rotavirus vaccines are available, RotaTeq
(RV5) and Rotarix (RV1).
● With both vaccines, the 1st dose can be
administered as early as 6 wk of age and must
be administered by 14 wk 6 days.
● The final dose in the series must be
administered no later than 8 mo of age.
● The RV5 vaccine is administered in 3 doses at
least 4 wk apart.
● The RV1 vaccine is administered in 2 doses at
least 4 wk apart.
● Immunization should not be initiated for infants 15
wk of age and older as stated in the immunization
schedule.
 3. Following is true regarding Causation
Preventive Medicine and Public Health I. Agent originally referred to an infectious
1. Assessing community’s health microorganism or pathogen: a virus, bacterium,
I. Public health officials responsible for parasite, or other microbe.
policy development, implementation, II. Host refers to the human who can get the disease.
and evaluation use epidemiologic III. Environment refers to extrinsic factors that affect
information as a the agent and the opportunity for exposure.
factual framework for decision making. IV. Component and casual pies
II. To assess the health of a population or A. I, II, III, IV
community, relevant sources of data B. I, II, III
must be identified and analyzed by C. I, II
person, place, and time. D. III, IV
III. More detailed data may need to be Answer: B
collected and analyzed to determine
whether health services are available, 4. Which of the following is statements is true?
accessible, effective, and efficient. I. infectivity refers to the proportion of exposed
IV. For example, public health officials persons who become infected.
used epidemiologic data and methods to II. Pathogenicity refers to the proportion of infected
identify baselines, to set health goals for individuals who develop clinically apparent
the nation in 2000 and 2010, and to disease.
monitor progress toward these goals. III. Virulence refers to the proportion of clinically
A. I, II, III, IV apparent cases that are severe or fatal.
B. I, II, III IV. Carriers Such persons who are infectious but have
C. I, II subclinical disease are called carriers.
D. III, IV A. I, II, III, IV
Answer: A B. I, II, III
C. I, II
2. Is probably the single most important “person” attribute, D. III, IV
because almost every health-related event varies with this Answer: A
attribute
A. Place of birth 5. The hallmark feature of an analytic epidemiologic study is:
B. Comorbids A. Use of an appropriate comparison group
C. Age B. Laboratory confirmation of the diagnosis
D. Gender C. Publication in a peer-reviewed journal
Answer: C D. Statistical analysis using logistic regression
● Age is probably the single most important “person” Answer: A
attribute,because almost every health-related
event varies with age. 6. Accepting Parent offspring separation, it includes:
● A number of factors that also vary with age I. Differentiation of self in relation to family origin
include: II. Development of intimate peer relationship
○ susceptibility III. Establishment of self in work
○ opportunity for exposure IV. Taking on the parenting role
○ Latency A. I, II, III, IV
○ incubation period of the disease B. I, II, III
○ physiologic response (which affects, C. I, II
among other things, disease D. III, IV
development) Answer: A
● When analyzing data by age, epidemiologists try
to use age groups that are narrow enough to 7. The physician deal with multiple variables, works in the
detect any age-related patterns that may be harmony of the wishes of the patient and family, and
present in the data. coordinates all aspects of the therapy which involve
● For some diseases, particularly chronic diseases, specialist and others:
10-year age groups may be adequate. A. Stage I
B. Stage II
C. Stage III
D. Stage V
Answer: C
8. It is important that the physician elicits explanatory model
of diagnosis to patient if disease is not life threatening and
patient is liable to be duly alarmed
A. Stage I
B. Stage II
C. Stage III
D. Stage V
Answer: B

9. Points to the family adjustment on crisis

A. Stage I
B. Stage II
C. Stage III
D. Stage V
Answer: D

10. Most challenging and rewarding part of medical practice

A. Stage I
B. Stage II
C. Stage III
D. Stage V
Answer: C