First Quarter Exam March 2021

Question 1

Which of the following statements about physiologic changes in the thyroid gland throughout pregnancy is incorrect:

Thyroxine (T4) and triiodothyroxine (T3) increases in response to the TBG

Thyrotropin releasing hormone remains unchanged and does not cross the placenta

The thyroid gland size increases moderately due to increased vascularity and hyperplasia

Thyroxine binding globulin (TBG) decreases from the 20th week throughout the pregnancy

Answer 1

Thyroxine binding globulin (TBG) decreases from the 20th week throughout the pregnancy

Question 2

A 38 y/o G2P1 (1001), 28 weeks AOG experiences low back pain. Which of following statements may explain or account for the symptom?

Serum level of relaxin is constant throughout pregnancy

Decreased joint laxity during pregnancy is mediated by progesterone, prolactin and relaxin.

Pre-pregnancy exercise programs have no effect on the incidence of musculoskeletal symptoms during pregnancy

Increase in weight during pregnancy moves the center of gravity forward on the lumbar spine and abdominal musculature.

Answer 2

Increase in weight during pregnancy moves the center of gravity forward on the lumbar spine and abdominal musculature.

Question 3

The most frequent structural malformation is:

Cardiac anomalies
Skeletal dysplasia
Genitourinary abnormalities
Neural Tube Defects

Answer 3

Cardiac anomalies

Question 4

Which of the following is true about the production of amniotic fluid during the first trimester?

Fetal urine production starts as early as 6 weeks AOG.

Transfer of water and other small molecules takes place across the skin.

Intramembranous flow across the fetal vessels on the placental surface happens in the first trimester.

Fetal urination is the primary source of amniotic fluid.

Answer 4

Transfer of water and other small molecules takes place across the skin.

Question 5

The most common chromosomal abnormality associated with first trimester miscarriages:

Triploidy
Tetraploidy
Monosomy X
Trisomy

Answer 5

Trisomy

Question 6

An 18 year old G1P0, regularly menstruating , consulted at the OBAS for vaginal bleeding. On history, she has an amenorrhea of 8 weeks . Urine pregnancy test was positive. On internal examination, the cervix is closed , corpus small, no adnexal mass/tenderness. Transvaginal ultrasound shows a single intrauterine gestational sac with mean sac diameter (MSD) of 1.5 cm. Yolk sac measures 0.3 cm. There is no fetal pole seen. What is the next BEST step?

Repeat transvaginal ultrasound after 10 days.
Repeat transvaginal ultrasound after 14 days.
Observe.
Advise for possible D and C.

Answer 6

Advise for possible D and C.

Question 7

The minimum discriminatory zone or level of B-HCG at which an intrauterine gestational sac should be visualized:

800 mIU/ml
1,200 mIU/ml
1,500 mIU/ml
500 mIU/ml

Answer 7

1,500 mIU/ml

Question 8

Which of the following statements is TRUE regarding salpingostomy for ectopic pregnancy?

The incision on the fallopian tube is left unsutured to heal by secondary intention

It involves partial resection of the affected fallopian tube

The incision on the fallopian tube is closed with delayed absorbable suture.

Serum B-HCG monitoring is not needed post-surgery.

Answer 8

The incision on the fallopian tube is left unsutured to heal by secondary intention

Question 9

As the fetal vertex descends, it encounters resistance from the bony pelvis or the soft tissues of the pelvic floor. The chin is brought into contact with the fetal thorax and the presenting diameter changes from occipitofrontal to suboccipitobregmatic for optimal passage through the pelvis. This process is:

Extension
Engagement
Descent
Flexion

Answer 9

Flexion

Question 10

With further descent and full flexion of the head, the base of the occiput comes in contact with the inferior margin of the pubic symphysis. This movement is caused by upward resistance from the pelvic floor and the downward forces from uterine contractions.

Engagement
Descent
Flexion
Extension

Answer 10

Extension

Question 11

In the sinciput presentation, the presenting part is the:

brow
diamond shaped fontanel
face
triangular-shaped fontanel

Answer 11

diamond shaped fontanel

Question 12

In the sinciput presentation, the presenting part is the:

brow
diamond shaped fontanel
face
triangular-shaped fontanel

Answer 12

diamond shaped fontanel

Question 13

A 30-year old primigravid in labor presented at 37 weeks age of gestation with the following ultrasound findings: a large for gestational age fetus in transverse presentation with an intact sizeable myelomeningocoele. These findings may lead to ineffective labor due to the following:

inadequate maternal expulsive effort
None of the above
fetopelvic disproportion
ruptured membranes without labor

Answer 13

fetopelvic disproportion

Question 14

A 30-year old primigravid in labor presented at 37 weeks age of gestation with the following ultrasound findings: a large for gestational age fetus in transverse presentation with an intact sizeable myelomeningocoele. These findings may lead to ineffective labor due to the following:

inadequate maternal expulsive effort
None of the above
fetopelvic disproportion
ruptured membranes without labor

Answer 14

fetopelvic disproportion

Question 15

Which of the following statements is true regarding the origin and propagation of contractions:

Different parts of the uterus reach their peak pressure at different times
The left pacemaker predominates over the right pacemaker and starts most of the contractile waves
Normal contractile wave of labor originates from the fundus
Depolarization wave propagates from the fundus downwards towards the cervix

Answer 15

Depolarization wave propagates from the fundus downwards towards the cervix

Question 16

Which of the following pregnancy complications is not associated with intrapartum amnioinfusion?

Cord prolapse
Chorioamnionitis
Uterine hypertonus
Seizures

Answer 16

Seizures

Question 17

This is true of nasopharyngeal suctioning of newborn

Must be done for neonates who have obvious obstruction to spontaneous breathing
Must be done routinely
Must be done for all non-vigorous neonates
Must be done if meconium is present in the amniotic fluid

Answer 17

Must be done for neonates who have obvious obstruction to spontaneous breathing

Question 18

ND, 21 year old, G1P0, came in at 8cm cervical dilatation, station 0, with regular strong contractions every 3 min lasting for 50-60 seconds. The EFW is 3.4-3.6 kg. Epidural anesthesia was immediately inserted. After 1 hour, the cervix became fully dilated, the head at station +4, hence transferred to the Delivery Room. After 4 pushes, the head of the baby was delivered, but the shoulders were trapped. The Obstetrician called for help and placed the patient in Mc Robert’s position. What would be the next best step?

Attempt to free the most accessible shoulder
Perform Gaskin maneuver
Do cesarean section
Fracture one of the clavicle

Answer 18

Attempt to free the most accessible shoulder

Question 19

This forceps is used to deliver the after coming head.

Piper
Kielland
Elliot
Simpson

Answer 19

Piper

Question 20

HP, 32 year old G4P3 (3002), seen at OPD at 37 weeks for regular prenatal check-up. Leopolds maneuver showed that the baby is in breech presentation. You offered external cephalic version. What are the things you need to be ascertained to have a safe ECV?

Must have EFW of <3000g
Must be in frank breech.
Must have intact membranes
Must not be in transverse lie

Answer 20

Must have intact membranes

Question 21

What is the most common indication for operative vaginal delivery?

Maternal exhaustion
Non-reassuring fetal status
Hypertensive disorders
Cardiac diseases

Answer 21

Hypertensive disorders

Question 22

How do we manage urinary retention and bladder dysfunction following operative vaginal deliveries?

Warm compress over the bladder
Give oxybutynin
Foley catheter drainage
Adequate pain control

Answer 22

Foley catheter drainage

Question 23

Approximately one third of all neonates develop physiological jaundice of the newborn during which period of life?

After the first week of life
Between the second and fifth day of life
Between the third and 7th day of life
Between the first and third day of life

Answer 23

Between the second and fifth day of life

Question 24

Which of the following neonatal findings are consistent with an acute peripartum or intrapartum event leading to hypoxic-ischemic encephalopathy?

Umbilical arterial acidemia with a pH < 7.30
APGAR Score <7 at 5 and 10 minutes
Umbilical arterial acidemia with a pH < 7.25
APGAR Score <5 at 5 and 10 minutes

Answer 24

APGAR Score <5 at 5 and 10 minutes

Question 25

After birth and delivery of the fetus, the duration of the puerperal period is between:

8 to 12 weeks
2 to 4 weeks
4 to 6 weeks
6 to 8 weeks

Answer 25

4 to 6 weeks

Question 26

A 20-year old G1P1 (1001) complains of severe vulvar pain during her stay at the recovery room 4 hours following an outlet forceps vaginal delivery with right mediolateral episiotomy. On examination she is awake, diaphoretic, temperature is 37.0 C, heart rate 128 beats per minute, blood pressure 90/50 mmHg, respiratory rate 26 breaths per minute. She has an 8 x 8 cm bulging mass on the right vulvar area that is tense and tender on palpation. What is the next best course of action for this case?

Urgent surgical evacuation under anesthesia
Place a vaginal pack and insert a Foley catheter
Administer intravenous pain medications and place an ice pack over the perineal area
Request for a complete blood count and observe closely

Answer 26

Urgent surgical evacuation under anesthesia

Question 27

Cruz is a 28 y/o primigravid at 32 weeks AOG with a BP range of 140-150/90-100. All blood exam results are normal and 24-hour urine collection total protein is 500 mg. Serial assessment of the following should be ordered EXCEPT:

Spot urine protein/creatinine ratio
Blood urea nitrogen
complete blood count
liver enzymes

Answer 27

Spot urine protein/creatinine ratio

Question 28

The following are more indicative of pre-eclampsia than transient blood pressure increases in chronic hypertension EXCEPT:

hypouricemia
elevated serum creatinine
elevated hematocrit
thrombocytopenia

Answer 28

hypouricemia

Question 29

Mrs. Cortez is a 37 y/o G1 at 28 weeks AOG was referred by the local health center because of a BP of 150/100 for the first time during antenatal visit. Albumin on urinalysis done in the ER is negative. Blood exam showed platelet of 200x109/L, LDH 500 IU/L AST: 42 U/L, ALT: 41 U/L serum creatinine concentration 2.1 mg/dL. What is the diagnosis?

Gestational hypertension
Pre-eclampsia without severe features
Chronic hypertension with superimposed pre-eclampsia
Pre-eclampsia with severe features

Answer 29

Pre-eclampsia with severe features

Question 30

True for postpartum hemorrhage EXCEPT

vaginal bleeding of 700 ml after 1 wk post vaginal delivery
CS blood loss of 800ml
uterine atony is the most common cause if PPH
blood loss of 1500 ml after CS-hysterectomy

Answer 30

CS blood loss of 800ml

Question 31

Factors leading to uterine inversion are EXCEPT

excessive cord traction
high parity
low-lying placenta
placenta accreta

Answer 31

low-lying placenta

Question 32

What is the incidence of preterm birth in a mother who has had 1 prior preterm birth less ≤ 34 weeks?

25%
5%
16%
41%

Answer 32

16%

Question 33

According to ACOG, the following are recommended management of preterm rupture of membranes at 24 to 31 weeks except:

Group B streptococcal prophylaxis
Tocolysis
Antimicrobials to prolong latency if with no contraindications
Single-course corticosteroids

Answer 33

Tocolysis

Question 34

The following are features of an infant with postmaturity syndrome except:

Wrinkled, peeling skin
Long, thin body
Growth restricted
Long nails

Answer 34

Growth restricted

Question 35

The fetal growth phase where the most fetal fat and glycogen are accumulated occurs at this age of gestation:

0 - 12 weeks
17 – 32 weeks
after 32 weeks
13 - 16 weeks

Answer 35

after 32 weeks