OB-

gyne

Questions Answer and Rationale

1. The age of gestation wherein pregnancy is already B. 37 weeks
considered term. • A term neonate is born any time after 37 completed weeks of
A. 34 weeks gestation and up until 42 completed weeks of gestation (260 to 294
B. 37 weeks days).
C. 39 weeks
D. 42 weeks
2. Fertilization occurs in this part of the fallopian tube. C. Ampulla2
A. Isthmus
B. Cornua
C. Ampulla
D. Infundibulum
3. The symphysis pubis and the sacral promontory are B. Diagonal conjugate
the landmarks for this clinically measurable entity. • The clinically important obstetrical conjugate is the shortest distance
A. Obstetric conjugate between the sacral promontory and the symphysis pubis. Normally,
B. Diagonal conjugate this measures 10 cm or more, but unfortunately, it cannot be
C. Transverse diameter measured directly with examining fingers.
D. Bi-spinous diameter • Thus, for clinical purposes, the obstetrical conjugate is estimated
indirectly by subtracting 1.5 to 2 cm from the diagonal conjugate,
which is determined by measuring the distance from the lowest
margin of the symphysis to the sacral promontory.
4. Implantation of the fertilized ovum occurs on the: C. 6 days after fertilization
A. 2 days after fertilization • Six or 7 days after fertilization, the embryo implants the uterine wall.
B. 4 days after fertilization This process can be divided into three phases: (1) apposition—initial
C. 6 days after fertilization contact of the blastocyst to the uterine wall; (2) adhesion—increased
D. 8 days after fertilization physical contact between the blastocyst and uterine epithelium; and
(3) invasion—penetration and invasion of syncytiotrophoblast and
cytotrophoblasts into the endometrium, inner third of the myometrium,
and uterine vasculature.
5. This is the maternal side of the placenta. A. Chorion
A. Chorion
B. Amnion
C. Umbilical cord
6. The following are normal changes in pregnancy: D. All of the above
A. Linea nigra
B. Non-pitting pedal edema
C. Breast enlargement
D. All of the above
E. None of the above
7. A patient consulted due to amenorrhea for 10 weeks. A. Transabdominal ultrasound (?)
Which diagnostic modality should you use?
A. Transabdominal ultrasound
B. Transvaginal ultrasound
C. Transrectal ultrasound
D. Pelvic x-ray

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 8. LMP is: B. First day of last menstrual period
A. Last day of last menstrual period
B. First day of last menstrual period
C. Last monthly period
9. First stage of labor ends at this point. B. 10 cm cervical dilatation
A. 6 cm cervical dilatation • The clinical stages of labor may be summarized as follows:
B. 10 cm cervical dilatation o The first stage begins when spaced uterine contractions of
C. Delivery of the fetal head sufficient frequency, intensity, and duration are attained to bring
D. Delivery of the placenta about cervical thinning, or effacement. This labor stage ends
when the cervix is fully dilated—about 10 cm—to allow passage
of the term-sized fetus. The first stage of labor, therefore, is the
stage of cervical effacement and dilatation.
o The second stage begins when cervical dilatation is complete and
ends with delivery. Thus, the second stage of labor is the stage
of fetal expulsion.
o Last, the third stage begins immediately after delivery of the fetus
and ends with the delivery of the placenta. Thus, the third stage
of labor is the stage of placental separation and expulsion.
10. Fetal heart is recognizable by transvaginal ultrasound D. 10 weeks AOG
starting at: • Instruments incorporating Doppler ultrasound are often used to easily
A. 4 weeks AOG detect fetal heart action, and in the absence of maternal obesity, heart
B. 6 weeks AOG sounds are almost always detectable by 10 weeks with such
C. 8 weeks AOG instruments.
D. 10 weeks AOG • The fetal heart rate ranges from 110 to 160 beats per minute and is
typically heard as a double sound.
11. The rate of cervical dilatation for a nulligravid is: C. 1 cm per hour
A. 1 cm per 2 hours • Active phase of cervical dilatation
B. 2 cm per 1 hour o Corresponds to the dilatational division.
C. 1 cm per 1 hour o Cervical dilation of 3 to 6 cm or more, in the presence of
D. 1 cm per 30 minutes uterine contractions, can be taken to reliably represent the
threshold for active labor.
o Provide useful guidepost to labor management.
o Mean duration of active-phase labor in nullipara: 4.9 hours (max
of 11.7 hours)
▪ 1.2 cm/hour in nulliparas
▪ 1.5 cm/hour in multiparas
12. A third-degree laceration of the perineum includes: B. Partial transection of the anal sphincter
A. Coccygeus muscle • Classification of perineal lacerations
B. Partial transection of the anal sphincter o First-degree lacerations involve the fourchette, perineal skin, and
C. Complete transection of the anal sphincter vaginal mucous membrane but not the underlying fascia and
D. Tear in the rectum muscle. These included periurethral lacerations, which may bleed
profusely.
o Second-degree lacerations involve, in addition, the fascia and
muscles of the perineal body but not the anal sphincter. These
tears may be midline, but often extend upward on one or both
sides of the vagina, forming an irregular triangle.
o Third-degree lacerations extend farther to involve the external
anal sphincter.
o Fourth-degree lacerations extend completely through the rectal
mucosa to expose its lumen and thus involves disruption of both
the external and internal anal sphincters
13. Leopold’s maneuver 2 answers the question: C. Where is the fetal back?
A. Is the fetal head engaged? • The first maneuver permits identification of which fetal pole—that is,
B. What is in the fundus? cephalic or podalic—occupies the uterine fundus.
C. Where is the fetal back?
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 D. Is the fetal head flexed? • The second maneuver is accomplished as the palms are placed on
either side of the maternal abdomen, and gentle but deep pressure is
exerted. On one side, a hard, resistant structure is felt—the back. On
the other, numerous small, irregular, mobile parts are felt—the fetal
extremities.
• The third maneuver is performed by grasping with the thumb and
fingers of one hand the lower portion of the maternal abdomen just
above the symphysis pubis. If the presenting part is not engaged, a
movable mass will be felt, usually the head.
• To perform the fourth maneuver, the examiner faces the mother’s feet
and, with the tips of the first three fingers of each hand, exerts deep
pressure in the direction of the axis of the pelvic inlet. In many
instances, when the head has descended into the pelvis, the anterior
shoulder may be differentiated readily by the third maneuver.
14. The first step in doing an abdominal exam is: C. Inspect the abdomen
A. Check the fetal heart rate using a stethoscope
B. Get the fundic height
C. Inspect the abdomen
D. Do Leopold’s maneuver
15. During internal examination, the following should be F. A, B and C are correct
noted:
A. Station
B. Cervical dilatation
C. Presentation
D. Amniotic fluid
E. All of the above
F. A, B and C are correct
16. A patient presents with a painless, sudden onset of C. Placenta previa
vaginal bleeding at 26 weeks of gestation. What is • Placenta accrete syndromes arise from abnormal placental
your main consideration? implantation and adherence and are classified according to the depth
A. Placenta accreta of placental ingrowth into the uterine wall. These include placenta
B. Placenta previa accreta, increta, and percreta.
C. Abruptio placenta • Placenta previa—the internal os is covered partially or completely by
placenta. Painless bleeding is the most characteristic event with
placenta previa. Bleeding usually does not appear until near the end
of the second trimester or later, but it can begin even before
midpregnancy. And undoubtedly, some late abortions are caused by
an abnormally located placenta. Bleeding from a previa usually begins
without warning and without pain or contractions in a woman who has
had an uneventful prenatal course. This so-called sentinel bleed is
rarely so profuse as to prove fatal.
• Most women with a placental abruption have sudden-onset abdominal
pain, vaginal bleeding, and uterine tenderness.
17. In breech presentation, the aftercoming head is C. Mauriceau maneuver
delivered via: • Zavanelli maneuver
A. Zavanelli’s maneuver o Return the head and do CS. Last resort.
B. Pinnard’s maneuver o Can be used to rescue an entrapped breech fetus that cannot be
C. Mauriceau maneuver delivered vaginally.
D. McRoberts maneuver o This maneuver was described for the protruding head with
intractable shoulder dystocia.
• Pinnard’s maneuver
o Two fingers of the providers hand are placed beneath and parallel
to the femur.

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 o The thigh is then slightly abducted and pressure from the
fingertips in the popliteal fossa should induce knee flexion and
bring the foot within reach.
o The foot is then grasped to gently deliver the entire leg outside
the vagina.
• Mauriceau maneuver
o Delivery of the aftercoming head.
o Index and middle finger of one hand are applied over the maxilla,
to flex the head, while the fetal body rests on the palm of the hand
and forearm.
o The forearm is straddled by the fetal legs.
o Two fingers of the other hand then are hooked over the fetal neck,
and grasping the shoulders, downward traction is applied until the
suboccipital region appears under the symphysis.
o Gentle suprapubic pressure simultaneously applied by an
assistant helps keep the head flexed. The body then is elevated
toward the maternal abdomen, and the mouth, nose, brow, and
eventually the occiput emerges successively over the perineum.
18. The pain that is experienced during ovulation is: A. Mittelschmerz
A. Mittelschmerz • Spinnbarkeit mucus refers to the stretchy, egg white quality of cervical
B. Mittenshmerz fluids around ovulation.
C. Spinnbarkeit
D. Spinbarket
19. When the myoma is located on the muscle of the C. Intramural
uterus, it is called:
A. Subserous
B. Submucous
C. Intramural
D. Endocervical

Figure 3.1 Leiomyoma classification.

20. This is an important vitamin supplement to be take C. Folic acid
prior to pregnancy to prevent neural tube defects. • More than half of all neural-tube defects can be prevented with daily
A. Vitamin C intake of 400 μg of folic acid throughout the periconceptional period.
B. Vitamin B • Putting 140 μg of folic acid into each 100 g of grain products may
C. Folic acid increase the folic acid intake of the average American woman of
D. Ferrous sulfate childbearing age by 100 μg per day. Because nutritional sources
alone are insufficient, however, folic acid supplementation is still
recommended.
21. When you cannot return the contents of the hernia to B. Incarcerated hernia
the abdominal cavity: • Incarcerated hernia
A. Reducible hernia o The contents cannot be reduced.
B. Incarcerated hernia o May be acute, accompanied by pain, or long-standing and
C. Sliding hernia asymptomatic
• Reducible hernia
o Contents can be returned to the abdominal cavity.
• Sliding hernia
o A portion of the wall of the hernia sac is composed of an organ.

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 22. In POP Q system, the point of reference is the: B. Hymen
A. Cervix • POP–Q:
B. Hymen o Standardized terminology for the description of female pelvic
C. Vaginal fornix organ prolapses and pelvic floor dysfunction and a standard
D. Urethra measurement system for POP.
o Objective, site-specific system for describing, quantifying, and
staging pelvic support and was developed to enhance both
clinical and academic communication with respect to individual
patients and populations of patients.
o Designed to replace terms such as cystocele, rectocele, and
enterocele with anatomic landmarks rather than organs.
o Points should be expressed in centimeters above or
below the hymen.
23. These are the lesions during the most active phase of C. Red lesions
endometriosis. • Grossly, endometriosis appears in many forms, including red, brown,
A. Brown lesions black, white, yellow, pink, or clear vesicles and lesions.
B. Yellow lesions • Red, blood-filled lesions are in the most active phase of
C. Red lesions endometriosis.
D. Clear lesions
24. Which of the following is/are unstable presentation/s? D. None of the above (?)
A. Face presentation
B. Brow presentation
C. Both
D. None of the above
25. Proteinuria is defined as: A. >300mg/24 hours
A. >300mg/24 hours
Proteinuria
B. Protein: creatinine ratio ≤ 0.2
C. Protein: creatinine ration ≥ 0.2 • >300 mg/24 hours
D. <20mg/dl on dipstick • Protein: creatinine ratio ≥ 0.3
• Dipstick: 1+ persistent
26. What is the abnormal labor pattern present on the B. Secondary arrest of dilatation
partogram below?

A. Protracted descent
B. Secondary arrest of dilatation
C. Arrest of descent
D. Failure of descent
27. Respiratory paralysis and arrest happen when the D. >12 mEq/L
plasma magnesium level reaches: • Patellar reflexes disappear when the plasma magnesium level
A. >9 mEq/L reaches 10 mEq/L—about 12 mg/dL—presumably because of a
B. >10 mEq/L curariform action. This sign serves to warn of impending magnesium
C. >11 mEq/L toxicity.
D. >12 mEq/L • When plasma levels rise above 10 mEq/L, breathing becomes
weakened.
• At 12 mEq/L or higher levels, respiratory paralysis and respiratory
arrest follow.

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 28. To reverse mild to moderate respiratory depression A. Calcium gluconate
brought by magnesium sulfate administration, you • Treatment with calcium gluconate or calcium chloride, 1 g
give: intravenously, along with withholding further magnesium sulfate,
A. Calcium gluconate usually reverses mild to moderate respiratory depression.
B. Oxygen
C. Salbutamol
D. Hydralazine
29. A 24 G2P1 (1001) previously normotensive, came in A. Gestational Hypertension
at 28 weeks AOG not in labor, with a BP of 160/120
with headache and with no proteinuria. What is your
diagnosis?
A. Gestational Hypertension
B. Preeclampsia without Severe Features
C. Preeclampsia with Severe Features
D. HELLP

30. This muscle contracts to shorten the levator hiatus A. Pubococcygeus muscle
during coughing or straining.
During stressful maneuvers such as coughing or straining, the levator
A. Pubococcygeus muscle
hiatus is shortened anteriorly by contraction of the pubococcygeus
B. Puborectalis
muscles.
C. Levator ani
D. Transversalis muscle
31. Pregnancy identified by hCG testing without A. Pregnancy of Unknown Location
confirmed sonographic location.
A. Pregnancy of Unknown Location
B. Pregnancy of Unknown Viability
C. Missed Abortion
D. Threatened abortion
32. Which of the following best defines abortion? C. Spontaneous or induced termination of pregnancy less than 20
A. Spontaneous or induced termination of weeks, fetus less than 500g
pregnancy less than 12 weeks, fetus less than • A fetus or embryo removed or expelled from the uterus during the first
200g half of gestation—20 weeks or less, or in the absence of accurate
B. Spontaneous or induced termination of dating criteria, born weighing < 500 g, is called an abortus.
pregnancy less than 16 weeks, fetus less than
500g
C. Spontaneous or induced termination of
pregnancy less than 20 weeks, fetus less than
500g
D. Spontaneous or induced termination of
pregnancy less than 24 weeks, fetus less than
500g
33. MM, 36 y/o presents with vaginal bleeding and C. Threatened abortion
hypogastric pain after she went biking. She consulted • Diagnosed when a bloody vaginal discharge or bleeding appears
at the ER and on internal examination: corpus small, through a closed cervical os during first half of pregnancy (<20 wks).
cervix closed, no adnexal mass appreciated. • Bleeding usually accompanied by hypogastric pain (d/t uterine
Pregnancy test is positive. What is your diagnosis? contraction) or low back ache.
A. Missed abortion • Size of uterus is usually compatible with age of gestation.
B. Incomplete abortion • Gestational sac within the uterus: threatened abortion.
C. Threatened abortion • No gestational sac within the uterus + adnexal mass: ectopic
D. Ectopic pregnancy pregnancy.

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 34. Which of the following defines heterotopic B. One ectopic and one intrauterine pregnancy
pregnancy?
Heterotopic pregnancy – multifetal pregnancy composed of 1
A. One tubal and one abdominal pregnancy
intrauterine pregnancy coexisting with 1 implanted ectopically.
B. One ectopic and one intrauterine pregnancy
C. Two ectopic pregnancies in one fallopian tube
D. Two ectopic pregnancies, one in each fallopian
tube
35. H. Mole are differentiated histologically from other A. Villi
non-molar neoplasms by the presence of which of the
Gestational Trophoblastic Disease
following?
A. Villi • Encompass a group of tumors typified by abnormal trophoblast
B. Cytotrophoblast proliferation.
C. Syncytiotrophoblast • It is histologically divided into hydatidiform which are characterized by
D. Marked angiogenesis the presence of villi, and into nonmolar trophoblastic malignant
neoplasms, which lack villi.
36. 75-gram oral glucose tolerance test is performed at A. 24-28 weeks
what week of age of gestation?
A. 24-28 weeks
B. 18-22 weeks
C. 28-32 weeks
D. 22-26 weeks
37. Dark bluish discoloration of the vaginal mucosa B. Chadwick’s sign
secondary to congestion is called?
Hegar’s sign
A. Hegar’s sign
B. Chadwick’s sign • Isthmic softening
C. Whirlpool sign Whirlpool sign
D. None of the above • Seen when the bowel rotates around its mesentery leading to whirls
of the mesenteric vessels
38. This is a soft blowing sound produced by the passage A. Uterine souffle
of blood through dilated uterine vessels and is
synchronous with the maternal pulse: Funic souffle – whistling sound synchronous with the fetal pulse
A. Uterine souffle
B. Intestinal peristalsis
C. Fetal heart tone
D. Funic souffle
39. The total recommended weight gain range in a C. 15-25 lbs
pregnant woman with a BMI of 27 is
A. 28-40 lbs
B. 25-35 lbs
C. 15-25 lbs
D. 11-20 lbs

40. This vitamin is recommended for women at high risk D. Vitamin B6

for inadequate nutrition and in cases of nausea and
vomiting
A. Vitamin D
B. Vitamin C
C. Vitamin B12
D. Vitamin B6

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 41. This condition is characterized by an irritating curdy C. Candidiasis
whitish vaginal discharge associated with pruritic, • Pruritis – predominant symptom
tender, and edematous vulva. • The vaginal discharge is white or whitish gray, highly viscous, and
A. Bacterial vaginosis descried as granular or foccular, with no odor.
B. Trichomoniasis • Vulvar signs – erythema, edema, and excoriation
C. Candidiasis
D. Leukorrhea Trichomoniasis – primary symptom is profuse vaginal discharge (may be
white, gray, yellow, or green and frothy)
Bacterial vaginosis – unpleasant vaginal odor which is musty or fishy
42. The accuracy of crown-rump-length to predict C. 5-7 days
gestational age is
The embryofetal crown-rump length in the first trimester is accurate +5 to
A. 7-11 days
7 days. Thus, if sonographic assessment of gestational age differs by more
B. 5-7 days
than 5 days prior to 9 weeks’ gestation, or by more than 7 days later in the
C. 7-10 days
first trimester, the estimated delivery date is changed.
D. 8-10 days
43. This ventral wall defect is associated with herniation B. Omphalocele
of abdominal contents into the amnion covered by a
Gastrochisis – full-thickness abdominal wall defect located to the right of
two-layered sac of amnion and peritoneum through
the umbilical cord insertion.
the umbilical cord insertion
A. Gastroschisis Body stalk syndrome – rare, lethal anomaly characterized by abnormal
B. Omphalocele formation of the body wall.
C. Body stalk syndrome
D. None of the above
44. Which of the following is most prone to undergo C. Dermoid cyst
torsion during pregnancy?
A. Serous cystadenoma
B. Mucinous cystadenoma
C. Dermoid cyst
D. Theca lutein cyst
45. In diagnosing endometriosis, pelvic examination is A. 1st 2 days of mens
preferably done on
A. 1st 2 days of mens Carrying out a pelvic examination during the first or second day of
B. A day after mens menstrual flow may aid in the diagnosis as it is the time of maximum
C. During ovulation swelling and tenderness in the areas of endometriosis.
D. Anytime
46. It is the most popular theory of the pathogenesis of C. Retrograde menstruation
endometriosis
A. Lymphatic and vascular metastasis
B. Iatrogenic dissemination
C. Retrograde menstruation
D. Metaplasia

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 47. The most common symptom of endometriosis that C. Pelvic pain
brings a patient to consult is
A. Irregular mens
B. Infertility
C. Pelvic pain
D. Pelvic mass
48. The deadly triad of hypertensive disorders and these A. Infection and hemorrhage
2 conditions contributes greatly to maternal morbidity
and mortality The deadly triad of pregnancy – infection, hemorrhage, hypertensive
A. Infection and hemorrhage disorders.
B. Anemia and hemorrhage
C. Infection and diabetes
D. Hemorrhage and malignancies
49. Gestational hypertension is defined as A. BP > 140/90 after 20 weeks in previously normotensive woman
A. BP > 140/90 after 20 weeks in previously Classification and Diagnosis of Pregnancy-Associated Hypertension.
normotensive woman
B. BP > 140/90 after 20 weeks in previously
hypertensive woman
C. BP > 140/90 before 20 weeks in previously
normotensive woman
D. BP > 140/90 before 20 weeks in previously
hypertensive woman

50. All of the following can be a premonitory symptom of C. Vomiting

eclampsia except
Headache or visual disturbance - can precede eclampsia.
A. Headache
Epigastric or RUQ pain – frequently accompanied by elevated serum
B. Epigastric pain
hepatic transaminase levels.
C. Vomiting
Thrombocytopenia – signifies worsening preeclampsia
D. Visual disturbance
51. One of the following is a characteristic of worsening A. Thrombocytopenia
preeclampsia as it signifies platelet activation,
aggregation and microangiopathic hemolysis
A. Thrombocytopenia
B. Fetal growth restriction
C. Convulsion
D. Pulmonary edema
52. According to the diagnostic criteria for pregnancy A. Platelet <100,000/UL
associated hypertension, thrombocytopenia is
defined as Refer to no.49.
A. Platelet <100,000/UL
B. Platelet <150,000/UL
C. Platelet <200,000/UL
D. Platelet <250,000/UL
53. In a woman with preeclampsia, a convulsion that A. Eclampsia
cannot be attributed to another cause is termed: • Seizures that cannot be attributed to other causes in a woman
A. Eclampsia with preeclampsia.
B. Seizure Disorder • Compared to patients with seizure disorders or pathology in the brain
C. HELLP that causes it, eclampsia is continuous and very hard to stop.
D. Preeclampsia with severe features

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 54. According to the diagnostic criteria for pregnancy A. Creatinine >1.1 mg/dl or doubling baseline
associated hypertension, Renal Insufficiency is Table 1 Classification and Diagnosis of Pregnancy-Associated
defined as: Hypertension.
A. Creatinine >1.1 mg/dl or doubling baseline
B. Creatinine >1.2 mg/dl or doubling baseline
C. Creatinine >1.3 mg/dl or doubling baseline
D. Creatinine >1.4 mg/dl or doubling baseline

55. The only cure for preeclampaisa is: A. Termination of Pregnancy

A. Termination of Pregnancy
Goals of Management for Preeclampsia
B. Provision of Antiherpetensive Drugs
C. Provision of Magnesium Sulfate • Termination of pregnancy with the least possible trauma to mother and
D. Provision of Aspirin fetus
• Birth of an infant who subsequently thrives
• Complete restoration of health to the mother
• Termination is always the treatment of choice but terminate based
on gestational age.
o GA determines the timing of delivery.
o Try to maximize the pregnancy – both for mom and baby.
56. Eclamptic convulsions are almost always prevented D. 4-7 mEq/L
or arrested by plasma magnesium levels maintained
Monitor for magnesium toxicity:
rate
A. 1-2 mEq/L • Assess deep tendon reflexes periodically
B. 2-3 mEq/L • Some measure serum magnesium level at 4-6 hrs and adjust infusion
C. 3-4 mEq/L to maintain levels between 4 and 7 mEq/L (4.8 to 8.4 mg/dL)
D. 4-7 mEq/L • Measure serum magnesium levels if serum creatinine ≥ 1.0 mg/dL
57. Patellar reflexes disappear when the plasma D. 10 mEq/L
magnesium level reaches:
A. 7 mEq/L • Patellar reflexes disappear when the plasma magnesium level
B. 8 mEq/L reaches 10 mEq/L—about 12 mg/dL—presumably because of a
C. 9 mEq/L curariform action. This sign serves to warn of impending magnesium
D. 10 mEq/L toxicity.
• When plasma levels rise above 10 mEq/L, breathing becomes
weakened.
• At 12 mEq/L or higher levels, respiratory paralysis and respiratory
arrest follow.
Magnesium Sulfate Toxicity Levels
• 7-10 meq/L – loss of deep tendon reflex
• 10-13 meq/L – respiratory paralysis
• >15 meq/L – ECG changes
• >25 meq/L – cardiac arrest
• If over dosage: calcium gluconate 10 mL of 10% IV in over 3 mins
58. Which of the following is/are true in the delivery of
D. All of the above
gravidocardiac patients:
A. In general, vaginal delivery is preferred and labor Labor and Delivery of Gravidocardiac Patients
induction is usually safe. • In general, vaginal delivery is preferred, and labor induction is
B. Cesarean delivery is limited to obstetrical usually safe.
indications.
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 C. Epidural anesthesia is anesthesia of choice. • Cesarean delivery is usually limited to obstetrical indications, and
D. All of the above considerations are given for the specific cardiac lesion, overall
maternal condition, and availability of experienced anesthesia
personnel and hospital capabilities.
Analgesia and Anaesthesia for Gravidocardiac Patients
• For cesarean delivery, epidural analgesia is preferred by most
clinicians with caveats for its use with pulmonary arterial hypertension.
• For vaginal delivery in women with only mild cardiovascular
compromise, epidural analgesia given with intravenous
sedation often suffices
59. Which of the following supports the diagnosis of D. All of the above
Overt Diabetes Mellitus Diagnosis of Overt Diabetes Mellitus.
A. FPG >/= 126 mg/dl
B. HBA1C >/= 6.5%
C. RBS >/=200 mg/dl
D. All of the above

60. Which of the anticoagulants is/are compatible for C. Both

breastfeeding?
A. Warfarin • Warfarin, LMWH, and UFH do not accumulate in breast milk, they do
B. Heparin not induce an anticoagulant effect in the newborn.
C. Both • These anticoagulants are compatible with breastfeeding (American
D. None of these College of Obstetricians and Gynecologists, 2017).
61. Dichronicity can be diagnosed on ultrasound if there A. Twin Peak Sign
is the presence of • “Twin-peak” sign, also termed the “lambda sign,” in a 24-week
A. Twin peak sign gestation. At the top of this sonogram (left), tissue from the anterior
B. Thin membrane placenta is seen extending downward between the amnion layers. This
C. Intervening membrane < 2 mm sign confirms dichorionic twinning.
D. T sign • The “twin-peak” sign is seen at the right of the figure below. The
triangular portion of placenta insinuates between the amniochorion
layers.

Twin Peak Sign.

62. Monochronicity can be diagnosed on ultrasound if D. T Sign
there is the presence of
A. Twin peak sign • Sonographic image of the “T” sign in a monochorionic diamnionic
B. Thin membrane gestation at 30 weeks. B. Schematic diagram of the “T” sign.
C. Intervening membrane < 2 mm • Twins are separated only by a membrane created by the juxtaposed
D. T sign amnion of each twin.
• A “T” is formed at the point at which amnions meet the placenta.
• The relationship between the membranes and placenta without
apparent extension of placenta between the dividing membranes is
called the T sign.

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 T Sign.
63. The relation of the fetal long axis to that of the mother A. Fetal Lie
A. Fetal lie • Fetal lie: It is a relation of the long axis of the fetus to that of the
B. Fetal presentation mother.
C. Fetal attitude • Fetal presentation: Is that portion of the fetal body that is either
D. Fetal position foremost within the birth canal or in closest proximity to it
• Fetal attitude: Characteristic posture of the fetus in later months of
pregnancy
• Fetal position: Refers to the relationship of an arbitrarily chosen
portion of the fetal presenting part to the right or left side of the birth
canal.
64. It is how the fetus becomes folded and bent upon C. Fetal Attitude
itself in such manner that the back becomes
markedly convex Characteristic of a good fetal attitude:
A. Fetal lie • Folded upon itself to create a convex back.
B. Fetal presentation • Head sharply flexed so the chin is almost in contact with the chest
C. Fetal attitude • Thighs are flexed over the abdomen
D. Fetal position • Legs are bent at the knees.
65. Which among the following is palpated as a diamond A. Anterior Fontanelle
shape structure when you do internal examination
A. Anterior fontanelle
B. Posterior fontanelle
C. Coronal suture
D. Sagittal suture

Anterior Fontanelle.
66. The stage of labor in which cervical dilatation B. Dilatational Division
proceeds at the most rapid rate
First Stage of Labor
A. Preparatory Division
B. Dilatation Division • Preparatory division
C. Pelvic Division o The cervix dilates a little
D. B & C o Sedation and conduction analgesia are capable of arresting this
labor division
o Connective tissue changes considerably
• Dilatational division
o Dilation proceeds at its most rapid rate
o Unaffected by sedation and conduction analgesia
• Pelvic division
o Commences with deceleration phase of cervical dilatation
o Cardinal fetal movements take principally during this division
67. The expected cervical dilatation rate among D. 1.5 cm/hour
multiparas is
A. 1.2 cm/hr • Mean duration of active-phase labor in nullipara: 4.9 hours (max
B. 1.3 cm/hr of 11.7 hours)
C. 1.4 cm.hr o 1.2 cm/hour in nulliparas

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 D. 1.5 cm.hr
68. This is defined as slow rate of cervical dilatation
A. Protracted cervical dilatation
B. Failure of cervical dilatation
C. Arrest of cervical dilatation
D. Any of the above
69. Second stage of labor is defined as
A. Begins with the onset of regular contractions and
end with full cervical dilatation
B. Begins with full cervical dilatation and ends with
fetal delivery
C. Begins with fetal delivery and ends with placental
delivery
D. Begins with placental delivery and ends with one
hour post-partum
70. Which among the ff. best defines engagement?
A. The biparietal diameter in an occiput
presentation reaches ischial spines
B. The biparietal diameter in an occiput
presentation passes through the pelvic inlet
C. The biparietal diameter in an occiput
presentation is accommodated in the pelvic floor.
D. All of the above
71. This is formed when the fetal scalp immediately over
the cervical os becomes edematous
A. Subdural hematoma
B. Dural hematoma
C. Molding
D. Caput succadaneum
72. Fundal height measurement is accomplished by
measuring the distance along the abdominal wall
from
A. The top of symphisis pubis to the top of the
fundus with a full bladder
B. The top of symphisis pubis to the top of the
fundus with an emptied bladder
C. The top of urethra to the top of the fundus with
full bladder
D. The top of urethra to the top of the fundus with
an emptied bladder
73. A G3P2 PU 37 weeks came in fully dilated, frank
breech presentation, station + 3. The attending
physician waited for the spontaneous expulsion of
the breech up to the navel and assist the delivery with
the manuevers from navel up to the head. What is the
described type of extraction.
A. Spontaneous breech delivery
B. Total breech delivery
C. Complete breech delivery
D. Partial breech delivery
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o 1.5 cm/hour in multiparas
A. Protracted cervical dilatation
• Protraction of cervical dilatation– slow rate of cervical dilatation
• Arrest of cervical dilatation – 2 hours with no cervical change
B. Begins with full cervical dilatation and ends with fetal delivery
Stages of Labor
• 1st stage – uterine contractions to full cervical dilatation
• 2nd stage – full cervical dilatation to delivery of the baby
• 3rd stage – delivery of the baby to delivery of placenta
• 4th stage – first hour after delivery
B. The biparietal diameter in an occiput presentation passes through
the pelvic inlet
Engagement
• Mechanism by which the biparietal diameter – the greatest transverse
diameter in an occiput presentation – pass through the pelvic inlet.
• In nulliparous women, head engagement occurs before the onset of
labor.
• In multiparous women and in some nulliparous women, the head is
freely movable above the pelvic inlet at onset of labor.
D. Caput Succadaneum
Caput Succadaneum: In prolonged labors before complete cervical
dilatation, the portion of the fetal scalp immediately over the cervical os
becomes edematous.
Molding: The change in fetal head shape from external compressive
forces; Results to shortened suboccipitobregmatic diameter and a
lengthened mentovertical diameter; A locking mechanism of the coronal
and lambdoidal connections actually prevents such overlapping.
B. The top of symphisis pubis to the top of the fundus with an
emptied bladder
Fundal Height
• It is measured along the abdominal wall from the top of the symphysis
pubis to the top of the fundus.
• Importantly, the bladder must be emptied before fundal measurement
(Worthen, 1980).
D. Partial Breech Delivery
Spontaneous breech delivery, the fetus is expelled entirely without any
traction or manipulation other than support of the newborn.
Total breech extraction, the entire fetal body is extracted by the provider.
Partial breech extraction, the fetus is delivered spontaneously as far as
the umbilicus, but the remainder of the body is delivered by provider
traction and assisted maneuvers, with or without maternal expulsive
efforts.
Page 13 of 15
 74. Which among the following is true about engagement A. It occurs before the onset of labor among nulliparas
A. It occurs before the onset of labor among
nulliparas Engagement
B. It occurs during the onset of labor among • Mechanism by which the biparietal diameter – the greatest transverse
nulliparas diameter in an occiput presentation – pass through the pelvic inlet.
C. It occurs before the onset of labor among • In nulliparous women, head engagement occurs before the onset of
multiparas labor.
D. It occurs during the onset of labor among • In multiparous women and in some nulliparous women, the head is
multiparas freely movable above the pelvic inlet at onset of labor.
75. An arbitrary chosen portion of the fetal presenting D. Fetal Position
part to the right or left side of the birth canal
A. Fetal lie • Fetal lie: It is a relation of the long axis of the fetus to that of the mother.
B. Fetal presentation • Fetal presentation: Is that portion of the fetal body that is either
C. Fetal attitude foremost within the birth canal or in closest proximity to it
D. Fetal position • Fetal attitude: Characteristic posture of the fetus in \later months of
pregnancy
• Fetal position: Refers to the relationship of an arbitrarily chosen
portion of the fetal presenting part to the right or left side of the birth
canal.
76. Respiratory paralysis and arrest happen when the D. ≥ 12 mEq/L
plasma magnesium levels reaches
A. >/= 9 mEq/L • Patellar reflexes disappear when the plasma magnesium level
B. >/=10 mEq/L reaches 10 mEq/L—about 12 mg/dL—presumably because of a
C. >/=11 mEq/L curariform action. This sign serves to warn of impending magnesium
D. >/=12 mEq/L toxicity.
• When plasma levels rise above 10 mEq/L, breathing becomes
weakened.
• At 12 mEq/L or higher levels, respiratory paralysis and respiratory
arrest follow.
Magnesium Sulfate Toxicity Levels
• 7-10 meq/L – loss of deep tendon reflex
• 10-13 meq/L – respiratory paralysis
• >15 meq/L – ECG changes
• >25 meq/L – cardiac arrest
• If over dosage: calcium gluconate 10 mL of 10% IV in over 3 mins
77. The effective anticonvulsant that avoids producing A. Magnesium Sulfate
nervous system depression in either mother or the
infant is • Not recommended as an antihypertensive agent, but magnesium
A. Magnesium Sulfate sulfate remains the DOC for seizure prophylaxis for women with acute-
B. Diazepam onset severe hypertension during pregnancy and the postpartum
C. Labetolol period.
D. Nifedipine • Drug with neuroprotection properties.
78. The first phase in endometrial cycle A. Proliferative Phase
A. Proliferative Phase
B. Secretory Phase

Proliferative phase (red); Secretory phase (green mark)

• Proliferative phase: The endometrium thickens, and vessels develop.

• Secretory phase: Endometrium is getting ready for implantation but if
no implantation, the functionalis is shed off.
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 79. Important hormone surge during ovulation A. Luteneizing Hormone
A. LH
B. FSH

Ovulation-endometrial cycle
80. Most potent estrogen form B. Estradiol
A. Estrone
B. Estradiol • The most biologically potent naturally occurring estrogen—17β-
C. Estriol estradiol—is secreted by granulosa cells of the dominant follicle and
D. All of the above luteinized granulosa cells of the corpus luteum.

REFERENCES
1. Cunningham, F. G., Leveno, K. J., Bloom, S. L., Spong, C. Y., Dashe, J. S., Hoffman, B. L., . . . Sheffield, J. S. (2014).
Williams Obstetrics (24th edition.). New York: McGraw-Hill Education.
2. Coy, P., García-Vázquez, F. A., Visconti, P. E., & Avilés, M. (2012). Roles of the oviduct in mammalian
fertilization. Reproduction (Cambridge, England), 144(6), 649–660. https://doi.org/10.1530/REP-12-0279

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