LE 1 Flashcards
- Which of the following statements is characteristic of the ovary?
A) The granulosa layer of cells of a secondary follicle is highly vascularized
B) The theca externa has LH receptors and produces androstenedione
C) The theca interna secretes androstenedione in response to LH
D) The basal lamina separates the primary oocyte from the granulosa
E) The secondary follicle contains a secondary oocyte
C) The theca interna secretes androstenedione in response to LH
Rationale: The theca interna layer of the ovarian follicles contains LH receptors. Upon stimulation by LH, the theca interna cells produce androgens, primarily androstenedione, which is then used by granulosa cells to synthesize estrogen. The other options either inaccurately describe ovarian structures or their functions.
- Is a muscular layer that is regulated by ovarian hormones and oxytocin which causes increased force and rate of uterine contractions?
A) Endometrium
B) Myometrium
C) Perimetrium
B) Myometrium
Rationale: The myometrium is the muscular layer of the uterus influenced by ovarian hormones (estrogens and progesterone) and oxytocin. These influences cause changes in the contractility of the myometrium, particularly important during labor.
- Patient EF is a G1PO 14 weeks age of gestation. When is the earliest time she can expect quickening?
A) 16 weeks
B) 14 weeks
C) 20 weeks
D) 18 weeks
D) 18 weeks
- A 28-year-old primigravid, on her 24th week AOG computed from her last menstrual period, came to your clinic for her first prenatal checkup. Her fundic height (uterine measurement from symphysis pubis to funds) was noted to be 30 cm. What is the next best step in the management of this patient?
A) Reassure patient that it is a normal finding, and she could come back after 1 month for her regular check-up
B) Request for an ultrasound to determine or confirm age of gestation, or detect any abnormality
C) Advise patient to start taking protein supplements in order for the baby to catch up in size
D) Inform the patient that her correct age of gestation is 30 weeks, and not 24 weeks
B) Request for an ultrasound to determine or confirm age of gestation, or detect any abnormality
Rationale: A fundal height of 30 cm at 24 weeks suggests a measurement that is larger than expected, possibly indicating incorrect dating, a large fetus, multiple gestation, or other abnormalities. An ultrasound would provide more precise information about gestational age and assess for complications.
- Milk protein is produced by which of the following mechanisms?
A) Paracrine secretion
B) Merocrine secretion
C) Autocrine secretion
D) Apocrine secretion
D) Apocrine secretion
Rationale: Milk protein secretion in mammary glands occurs by apocrine secretion, where part of the cell cytoplasm is released with the secretory product. This is typical in the mammary gland epithelial cells.
- Each breast consists of
A) 1 mammary gland
B) 2 mammary glands
C) 5 mammary glands
D) 20 mammary glands
D) 20 mammary glands
- What is the fetal lie?
A) Cephalic
B) Breech
C) Transverse
D) Shoulder
E) Longitudinal
F) Oblique
G) Compound
C) Transverse
- Elevation of body temperature among pregnant women is secondary to:
A) Thermogenic effect of progesterone
B) Thermogenic effect of estrogen
C) Thermogenic effect of testosterone
D) Thermogenic effect of human chorionic gonadotropin
A) Thermogenic effect of progesterone
Rationale: The elevation in body temperature during pregnancy can be attributed to the thermogenic effects of progesterone, which is elevated throughout pregnancy and increases the basal metabolic rate.
- A 22-year-old female experienced her first menstrual cycle at age 14. Until recently, she had a normal regular menstrual cycle with an interval of 30 days. Six months ago, she began training for a marathon. She runs roughly 115 miles per week and as a result of her training regimen, she has lost 20 pounds. She has not menstruated for the past 3 months. Given these findings, what is the most likely endocrine explanation for her amenorrhea?
A) Absence of GRH surge
B) Prolonged elevation of follicle-stimulating hormone
C) Increase in plasma leptin
D) Absence of a surge in luteinizing hormone
E) Abnormally elevated plasma estradiol
D) Absence of a surge in luteinizing hormone
Rationale: Intense physical activity and significant weight loss can lead to hypothalamic dysfunction, which often manifests as a disruption in the normal pulsatile secretion of GnRH (gonadotropin-releasing hormone) from the hypothalamus. This disrupts the normal surge of LH necessary for ovulation, leading to amenorrhea.
- Which of the following hormones is involved in the development of the mammary glands and ducts, thus preparing the body for pregnancy?
A) Prolactin
B) Oxytocin
C) Progesterone
D) Inhibin
C) Progesterone
Rationale: Progesterone, along with estrogen, plays a crucial role in the development of the mammary glands and ducts during pregnancy. Progesterone supports glandular differentiation and growth, preparing the breasts for lactation post-delivery.
- True about the layers/coat of the wall of the uterine body:
A) The outer layer consists of peritoneum supported by a thick layer of connective tissue
B) The inner mucosal coat becomes greatly distended during pregnancy
C) The functionalis layer of the endometrium regenerates the basalis layer following each menses
D) The amount of muscle fiber in the middle coat is greater in the inner than in the outer wall
D. The amount of muscle fiber in the middle coat is greater in the inner than in the outer wall
Explanation: The middle coat of the uterine body, known as the myometrium, consists predominantly of smooth muscle bundles. These bundles are more concentrated in the inner layer than in the outer layer of the uterine body. This structural arrangement facilitates the effective contraction of the uterus during childbirth and menstruation. The statement correctly reflects the anatomical distribution of muscle fibers in the uterus, aligning with the information about the increased muscularity of the inner wall compared to the outer wall.
- Where do the uterus and the fallopian tubes arise from?
A) Wolffian ducts
B) Wartonian ducts
C) Mesonephric ducts
D) Mullerian ducts
D) Mullerian ducts
Rationale: The uterus and fallopian tubes, along with the upper part of the vagina, develop from the Müllerian ducts (paramesonephric ducts). This is the fundamental embryologic origin of most of the female reproductive tract.
- Which of the following is characteristic of the stratum basale?
A) Contains cells that are highly responsive to progesterone
B) Includes the uterine surface epithelium
C) Contains coiled arteries
D) Is the layer that undergoes shedding
E) Contains cells that replace the surface epithelium after menstruation
E) Contains cells that replace the surface epithelium after menstruation
Explanation: The stratum basale, or basal layer, of the endometrium is the layer that remains following menstruation and is responsible for regenerating the functional layer (stratum functionalis) that is shed during menstruation. This layer contains the necessary cells and structures to rebuild the surface epithelium and glandular components of the endometrium each cycle, preparing it again for potential implantation.
- A 22-year-old G1P0 at 16 weeks AOG, has ruptured tubal pregnancy and presents with hypovolemia secondary to hemorrhage. The implantation of the conceptus most likely is in the:
A) Infundibulum
B) Ampulla
C) Isthmus
D) Interstitium
B) Ampulla
Rationale: The most common site for an ectopic pregnancy is the fallopian tube, particularly the ampulla section. This area provides a common site for implantation outside the uterus due to its relative length and mobility.
- The stroma of the ovary consists of blood vessels, nerves, muscle fibers, and a type of protein called:
A) Fibrin
B) Collagen
C) Albumin
B) Collagen
Rationale: The stroma of the ovary is composed primarily of connective tissue, which includes a high concentration of collagen. Collagen provides structural integrity and support to the ovarian tissues.
- A patient at her 23rd week age of gestation came to your clinic for the first time for her prenatal check-up. Upon doing obstetric examination, you noted that the fundic height is 27 cm. Which of the following is a possible diagnosis?
A) Intrauterine growth restriction
B) Oligohydramnios
C) Polyhydramnios
D) Normal findings in pregnancy
C) Polyhydramnios
D) Normal findings in pregnancy
Rationale: Fundal height measurements in pregnancy are roughly equivalent to the week of gestation plus or minus 2 cm. At 23 weeks, a fundal height of 27 cm is within normal limits.
- After an egg is ovulated, the remaining mass is called a:
A) Theca folliculi
B) Corpus luteum
C) Vesicular folliculi
D) Corpus albicans
B) Corpus luteum
Rationale: After ovulation, the follicle transforms into the corpus luteum. This structure is crucial for producing progesterone, which supports the early stages of pregnancy until the placenta can take over.
- In the sexually mature female, ovulation is preceded by a dramatic change in luteinizing hormone. What would be the factor and the change in its release that is obligatorily linked in the change in LH before ovulation?
A) Increase in dopamine
B) Decrease in gonadotropin-releasing hormone
C) Decrease in dopamine
D) Increase in gonadotropin-releasing hormone
E) Increase in inhibin
D) Increase in gonadotropin-releasing hormone
Rationale: Ovulation is closely linked to a surge in gonadotropin-releasing hormone (GnRH), which in turn stimulates a sharp increase in luteinizing hormone (LH). This LH surge triggers ovulation.
- Which of the following is characteristic of the secretory phase of the menstrual cycle?
A) It produces ischemia and necrosis of the stratum functionalis
B) It is controlled by estrogen
C) It ends upon the arrival of ovulation
D) Endocervix is sloughed off during this phase
E) Uterine gland lumens are filled with secretions
E) Uterine gland lumens are filled with secretions
Rationale: During the secretory phase of the menstrual cycle, following ovulation and under the influence of progesterone, the uterine glands become more tortuous and their lumens fill with secretions that are important for nourishing an implanted embryo.
- The cervix is composed mainly of which of the following components?
A) Smooth muscle
B) Elastin
C) Proteoglycan
D) Collagen
D) Collagen
Rationale: The cervix is primarily composed of dense connective tissue, which includes a high content of collagen. Collagen provides structural strength and supports the cervix, especially important during pregnancy and childbirth.
- A 20-year-old primigravid, 4-5 weeks age of gestation, came to your clinic anxious because her ultrasound showed only a gestational sac, with still no fetal heart beat noted. How would you advise this patient?
A) She has evidence of an anembryonic pregnancy and needs a dilation and curettage done as soon as possible to remove the products of conception.
B) You tell the patient that she is not pregnant.
C) Reassure the patient that fetal heart beat will manifest at around 6 weeks age of gestation, and that she may opt to repeat her transvaginal ultrasound after about 2-3 weeks.
D) The ultrasound showed evidence of intrauterine fetal demise.
C) Reassure the patient that fetal heart beat will manifest at around 6 weeks age of gestation, and that she may opt to repeat her transvaginal ultrasound after about 2-3 weeks.
Rationale: At 4-5 weeks of gestation, it’s common not to detect a fetal heartbeat. It is typically visible by around 6 weeks of gestation. Reassuring the patient and suggesting a follow-up ultrasound in 1-2 weeks is appropriate to confirm normal development.
- When the myoepithelial cells contract, milk is forced from the alveoli to the nipple. Which of the following hormones causes the myoepithelial cells to contract?
A) Estrogen
B) Oxytocin
C) Progesterone
D) Inhibin
B) Oxytocin
Rationale: Oxytocin is the hormone responsible for causing the contraction of myoepithelial cells around the milk alveoli, which helps to express milk from the alveoli through the milk ducts to the nipple.
- Pap smear should be done on all asymptomatic pregnant patients during her first prenatal checkup.
A) False
B) True
A) False
Rationale: Pap smear screening is generally not recommended during the first prenatal visit unless it is due based on routine screening intervals or if there are specific indications. Pregnancy does not increase the risk of cervical cancer, and routine screening can be safely deferred until postpartum if recent results are normal.
- What is the fetal presentation?
A) Cephalic
B) Breech
C) Transverse
D) Shoulder
E) Longitudinal
F) Oblique
G) Compound
D) Shoulder
- During menstruation, a portion of the endometrial lining is shed. Which of the following layers of the endometrium is involved in the “shedding” process?
A) Stratum basalis
B) Stratum epidermalis
C) Stratum functionalis
C) Stratum functionalis
Rationale: During menstruation, the stratum functionalis layer of the endometrium is the portion that is shed. This is the functional, upper layer of the endometrium that thickens and then is sloughed off if pregnancy does not occur.
- Which of the following anteroposterior (AP) conjugate diameters of the pelvic inlet can be measured clinically?
A) Obstetric conjugate
B) Diagonal conjugate
C) True conjugate
D) Midpelvic conjugate
B) Diagonal conjugate
Rationale: The diagonal conjugate is the anteroposterior diameter of the pelvic inlet that can be clinically estimated by a pelvic exam. It helps in assessing the adequacy of the pelvic inlet for childbirth.
- Graafian follicle is characteristically found in:
A) Testes
B) Thyroid
C) Ovary
D) All of the above
C) Ovary
Rationale: The Graafian follicle, or mature ovarian follicle, is found in the ovaries. It is the stage at which the follicle is fully matured and ready to release an egg during ovulation.
- Which of the following ligaments assist in anchoring the uterus in position?
A) Round ligament
B) Broad ligament
C) Ovarian ligament
D) Suspensory ligament
A) Round ligament
- Which pelvic diameter is approximately measured by placing a closed fist against the perineum at the level of the tuberosities?
A) Transverse diameter
B) Oblique diameter
C) Intertuberous diameter
D) Interischial diameter
C) Intertuberous diameter
Rationale: The intertuberous diameter is measured between the ischial tuberosities of the pelvis and can be approximated by placing a closed fist against the perineum at the level of these tuberosities.
- Which ligament anchors the ovaries to the pelvic wall?
A) Round ligament
B) Broad ligament
C) Ovarian ligament
D) Suspensory ligament
D) Suspensory ligament
Rationale: The suspensory ligament of the ovary, also known as the infundibulopelvic ligament, extends from the ovary to the pelvic wall. It contains important structures such as the ovarian blood vessels and nerves, helping to secure the ovary in its place within the pelvic cavity.
- A 33-year-old primigravid patient came to the ER because of labor pains. You noted the following findings: LM1 breech, LM2 fetal back left, LM3 cephalic, LM4 unengaged, fetal head flexed; on internal exam, you noted that the ischial spines are prominent and the pelvic sidewalls are convergent. The bituberous diameter measures 9cm. The length of the bituberous diameter suggests that the _______ is adequate.
A) Inlet
B) Midplane
C) Outlet
C) Outlet
Rationale: The bituberous diameter, measured at 9 cm, refers to the distance between the ischial tuberosities, which is a critical measurement for assessing the adequacy of the pelvic outlet. This measurement suggests that the pelvic outlet is adequate for vaginal delivery.
- Identify the pelvic plane involved: ischial spines.
A) Inlet
B) Midplane
C) Outlet
B) Midplane
Rationale: The ischial spines are landmarks used to assess the midplane of the pelvis. They are palpated during an internal exam to help gauge the level of the fetal presenting part relative to the midpelvic plane.
- Linea Nigra.
A) Mask of pregnancy
B) Darkened Linea alba
C) Stretch marks
D) Midline separation of rectus muscles
E) Vascular stellar marks on the face
B) Darkened Linea alba
Rationale: Linea nigra is the dark vertical line that appears on the abdomen during pregnancy, representing a hyperpigmented Linea alba.
A) Mask of pregnancy (Chloasma/ Melanoma)
B) Darkened Linea alba (Linea Nigra)
C) Stretch marks (Striae gravidarum)
D) Midline separation of rectus muscles (Diastasis recti)
E) Vascular stellar marks on the face (Spider telangiectasia)
- Spider telangiectasia.
A) Mask of pregnancy
B) Darkened Linea alba
C) Stretch marks
D) Midline separation of rectus muscles
E) Vascular stellar marks on the face
E) Vascular stellar marks on the face
Rationale: Spider telangiectasia refers to small, spider-like capillary expansions visible on the skin, often found on the face, neck, and arms during pregnancy.
A) Mask of pregnancy (Chloasma/ Melanoma)
B) Darkened Linea alba (Linea Nigra)
C) Stretch marks (Striae gravidarum)
D) Midline separation of rectus muscles (Diastasis recti)
E) Vascular stellar marks on the face (Spider telangiectasia)
- Diastasis recti.
A) Mask of pregnancy
B) Darkened Linea alba
C) Stretch marks
D) Midline separation of rectus muscles
E) Vascular stellar marks on the face
D) Midline separation of rectus muscles
Rationale: Diastasis recti refers to the separation of the left and right abdominal rectus muscles, which can occur during pregnancy as the uterus expands.
A) Mask of pregnancy (Chloasma/ Melanoma)
B) Darkened Linea alba (Linea Nigra)
C) Stretch marks (Striae gravidarum)
D) Midline separation of rectus muscles (Diastasis recti)
E) Vascular stellar marks on the face (Spider telangiectasia)
- Chloasma.
A) Mask of pregnancy
B) Darkened Linea alba
C) Stretch marks
D) Midline separation of rectus muscles
E) Vascular stellar marks on the face
A) Mask of pregnancy
Rationale: Chloasma, also known as melasma or the “mask of pregnancy,” involves brownish patches of pigmentation that appear on the face, particularly on the cheeks, nose, and forehead.
A) Mask of pregnancy (Chloasma/ Melanoma)
B) Darkened Linea alba (Linea Nigra)
C) Stretch marks (Striae gravidarum)
D) Midline separation of rectus muscles (Diastasis recti)
E) Vascular stellar marks on the face (Spider telangiectasia)
- Striae gravidarum.
A) Mask of pregnancy
B) Darkened Linea alba
C) Stretch marks
D) Midline separation of rectus muscles
E) Vascular stellar marks on the face
C) Stretch marks
Rationale: Striae gravidarum are stretch marks that typically appear on the abdomen, breasts, hips, or thighs during pregnancy due to rapid stretching of the skin and hormonal changes.
A) Mask of pregnancy (Chloasma/ Melanoma)
B) Darkened Linea alba (Linea Nigra)
C) Stretch marks (Striae gravidarum)
D) Midline separation of rectus muscles (Diastasis recti)
E) Vascular stellar marks on the face (Spider telangiectasia)
- In performing what Leopold’s maneuver will you be facing the patient’s feet?
A) LM1
B) LM2
C) LM3
D) LM4
D) LM4
Rationale: In the fourth Leopold’s maneuver, the examiner faces the patient’s feet to determine the engagement of the fetal head in the maternal pelvis.
- A 33-year-old primigravid patient came to the ER because of labor pains. You noted the following findings: LM1 breech, LM2 fetal back left, LM3 cephalic, LM4 unengaged, fetal head flexed; on internal exam, you noted that the ischial spines are prominent and the pelvic sidewalls are convergent. The bituberous diameter measures 9cm. The pelvimetry findings point to WHICH inadequate plane?
A) Inlet
B) Midplane
C) Outlet
C) Outlet
Rationale: Given the findings of a bituberous diameter of 9cm and the descriptions of the pelvic anatomy (prominent ischial spines and convergent pelvic sidewalls), the inadequate plane is the pelvic outlet. This may imply difficulties during the final stages of labor, specifically during the passage of the fetus through the pelvic outlet.
A bituberous (or bi-ischial) diameter
<8 cm = Inadequate outlet
>8 cm = Adequate
- A 32-year-old primigravid, 32 weeks AOG, came to the clinic for prenatal check-up. On history taking, you noted her quickening at 19 weeks AOG. On abdominal exam, LM1 cannot be determined, LM2 ballotable firm mass felt at the maternal right, irregular, nodular doughy mass felt at the maternal left, LM3 and LM4 cannot be determined. You noted fetal movement on palpation. The doctor’s perception of fetal movement is a sign of pregnancy:
A) Presumptive
B) Probable
C) Positive
C) Positive
Rationale: The doctor’s perception of fetal movement is considered a positive sign of pregnancy because it directly involves the detection of the fetus itself, unlike presumptive or probable signs which can be caused by conditions other than pregnancy.
- Calculate the approximate measurement of the true or anatomic conjugate when given a diagonal conjugate measurement of 13 cm.
A. 10 cm
B. 11.8 cm
C. 14.2 cm
D. 12.5 cm
B) 11.8 cm
Rationale: To calculate the true or anatomical conjugate from the diagonal conjugate, subtract approximately 1.5-2 cm from the diagonal conjugate measurement. Given a diagonal conjugate of 13 cm, the true conjugate is likely around 11.5-11.8 cm.
- Vascular supply of the vagina:
A. Proximal portion: cervical branch of the uterine and vaginal artery
B. Distal vaginal walls: middle rectal artery
C. Posterior vaginal walls: internal pudendal artery
A) Proximal portion: cervical branch of the uterine and vaginal artery
Rationale: The proximal portion of the vagina is primarily supplied by the cervical branch of the uterine artery and the vaginal artery. The internal pudendal artery and middle rectal artery also contribute to the vascular supply of the vagina but are more involved with the distal and posterior aspects.
- While performing LM4, you have palpated the cephalic prominence on the same side of the fetal back. The presenting part that you will expect to palpate when you do the internal pelvic exam is the:
A. Face
B. Sinciput
C. Occiput
D. Brow
A. Face
Rationale: When the cephalic prominence (the part of the head presented by the forehead or face) is noted on the same side as the fetal back during the fourth Leopold maneuver, this suggests a face presentation for the fetus.
- Hegar’s sign is observed by the 6th to 8th week of gestation. This condition refers to the:
A. Softening of the uterine isthmus
B. Cyanosis and softening of the cervix
C. Bluish or purplish discoloration of the vaginal mucosa
D. Irregular brownish patches on the face
A. Softening of the uterine isthmus
Rationale: Hegar’s sign, typically observed between the 6th to 8th week of gestation, refers to the softening of the uterine isthmus and can be palpated as a distinct softening or compressibility between the cervix and the body of the uterus.
- The fetal presenting part is said to be engaged if the biparietal diameter has reached the level of ischial spines. This is reported as:
A. Station -3
B. Station -2
C. Station -1
D. Station 0
D. Station 0
Rationale: Engagement is defined as the descent of the fetal presenting part to the level of the ischial spines, which is described as station 0 in obstetrical terms.
- This is a probable sign of pregnancy characterized by cyanosis and softening of the cervix due to increased vascularity of the cervical tissue:
A. Hegar’s sign
B. Goodell’s sign
C. Chadwick sign
D. Spalding sign
B. Goodell’s sign
Goodell’s sign is characterized by cyanosis and softening of the cervix, which occurs due to increased vascularity and edema in the cervical tissue. This is a probable sign of pregnancy and may be observed as early as 4 weeks of gestational age.
- What is the correct progression of the fallopian tube anatomy from the proximal to the distal segment?
A. Infundibulum, ampulla, isthmus, interstitium
B. Interstitium, isthmus, ampulla, infundibulum
C. Isthmus, infundibulum, interstitium, ampulla
D. Ampulla, interstitium, infundibulum, isthmus
B. Interstitium, isthmus, ampulla, infundibulum
Rationale: The fallopian tube anatomy from proximal (uterine) to distal ends as follows: the interstitium (the part that passes through the uterine wall), isthmus (narrower section near the uterus), ampulla (wider section where fertilization commonly occurs), and the infundibulum (funnel-shaped end near the ovary).
This option correctly lists the progression of the fallopian tube anatomy from the proximal (closest to the uterus) to the distal (closest to the ovary) segments. The interstitium is the segment that passes through the uterine wall, the isthmus is the narrow part near the uterus, the ampulla is the wider, middle section where fertilization typically occurs, and the infundibulum is the funnel-shaped end near the ovary, featuring fimbriae that help capture the egg.
- You instructed your clinic nurse to determine the fetal heart rate of your pregnant patient who came to the clinic for prenatal check-up. The nurse reported the fetal heart rate to be “80 beats per minute.” How should you interpret this finding?
A. This is a normal fetal heart rate. You can proceed with your regular prenatal check-up routine.
B. Double check the nurse’s findings by quickly recounting the fetal heart rate. The nurse must have measured the maternal pulse instead.
C. Tell the nurse to wheel the patient to the operating room for an emergency cesarean section due to fetal compromise.
D. Inform the patient the baby is probably dying.
B. Double check the nurse’s findings by quickly recounting the fetal heart rate. The nurse must have measured the maternal pulse instead.
Rationale: A fetal heart rate of 80 beats per minute is abnormally low, as normal rates range from about 110 to 160 beats per minute. It’s likely that the maternal pulse was measured instead of the fetal heart rate. Verification is needed.
- A 33-year-old primigravid patient came to the ER because of labor pains. You noted the following findings: LM1 breech, LM2 fetal back left, LM3 cephalic, LM4 unengaged, fetal head flexed; on internal exam, you noted that the ischial spines are prominent and the pelvic sidewalls are convergent. The bituberous diameter measures 9cm. What is the fetal lie?
A. Longitudinal
B. Transverse
C. Cephalic
D. Breech
E. Shoulder
A. Longitudinal
Rationale: The description of the fetal position indicates a longitudinal lie, which means the long axis of the fetus is aligned with the long axis of the uterus. This can involve either a cephalic (head first) or breech (buttocks or feet first) presentation.
- Bartholin glands open into the:
A. Fallopian tubes and release a secretion which makes sperm motile
B. Uterus and release a lubricating fluid during the birth of the baby
C. Urinary bladder and assist in the release of urine
D. Vestibule and release a lubricating fluid in the vagina
D. Vestibule and release a lubricating fluid in the vagina
Rationale: The Bartholin glands are located near the vaginal opening (vestibule) and secrete fluid that helps lubricate the vagina. This fluid is essential for decreasing friction during sexual intercourse.
- A 33-year-old primigravid patient came to the ER because of labor pains. You noted the following findings: LM1 breech, LM2 fetal back left, LM3 cephalic, LM4 unengaged, fetal head flexed; on internal exam, you noted that the maternal left ischial spines are prominent and the pelvic sidewalls are convergent. The bituberous diameter measures 9cm. Which side would you put your stethoscope to determine fetal heart tones?
A. Maternal fundus
B. Maternal left
C. Maternal right
B. Maternal left
Rationale: Given that LM2 indicates the fetal back is positioned on the maternal left, and since fetal heart tones are best heard through the baby’s back, the stethoscope should be placed on the maternal left side.
- Which of the following steps executed during total abdominal hysterectomy is associated with potential ureteral injury?
A. Division of the round ligament
B. Ligation of the uterine artery
C. Ligation of the infundibulopelvic ligaments
D. Clamping of the cardinal ligaments
B. Ligation of the uterine artery
Rationale: The uterine artery is closely related anatomically to the ureter, particularly where it crosses the ureter. During ligation of the uterine artery in total abdominal hysterectomy, there is a risk of ureteral injury if not identified and avoided carefully.
- Identify the pelvic plane involved: ischial tuberosity.
A. Inlet
B. Midplane
C. Outlet
C. Outlet
Rationale: The ischial tuberosities are landmarks that help define the boundaries of the pelvic outlet.
- Identify the pelvic plane involved: diagonal conjugate.
A. Inlet
B. Midplane
C. Outlet
A. Inlet
Rationale: The diagonal conjugate measures the anteroposterior diameter of the pelvic inlet, from the lower margin of the symphysis pubis to the sacral promontory.
- This is the distance between the upper margin of symphysis pubis to the midpoint of the sacral promontory:
A. Obstetric conjugate
B. Diagonal conjugate
C. True conjugate
D. Midpelvic conjugate
C. True conjugate
- What is the best explanation for the sustained increase in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) that occurs in women after menopause?
A) Up-regulation of the number of LH receptors on granulosa cells
B) Depletion of estrogen-secreting follicles in the ovaries
C) Hyperplasia of gonadotropes of the anterior pituitary gland
D) Decreased sensitivity of GnRH-producing cells of the hypothalamus to estradiol
B) Depletion of estrogen-secreting follicles in the ovaries
Rationale: After menopause, the ovaries stop producing estrogen due to the depletion of follicles. This removal of the inhibitory effect of estrogen on the pituitary gland results in increased secretion of LH and FSH.
What is the fetal position?
A) Left mentum anterior
B) Right occiput posterior
C) Right brow posterior
D) Left face anterior
E) Cephalic
F) Transverse
G) Longitudinal
A) Left mentum anterior
- A 32-year-old primigravid, 32 weeks AOG, came to the clinic for a prenatal checkup. On history taking, you noted her quickening at 19 weeks AOG. On abdominal exam, LM1 cannot be determined, LM2 ballotable firm mass felt at the maternal right, irregular, nodular doughy mass felt at the maternal left, LM3 and LM4 cannot be determined. When did the patient feel the first fetal movement?
A) 20 weeks
B) 18 weeks
C) 19 weeks
D) 32 weeks
C) 19 weeks
Rationale: The patient’s history indicates that she first felt fetal movement at 19 weeks AOG, which is commonly referred to as quickening.
- Corpus luteum is the source of secretion of:
A) LH
B) Estradiol
C) Estrogen
D) Progesterone
E) Other:
D) Progesterone
Rationale: The corpus luteum, which forms from the remains of the follicle after ovulation, primarily secretes progesterone. This hormone is crucial for maintaining the uterine lining and supporting early pregnancy.
- In the uterine cycle, there are 2 separate negative feedbacks: Estradiol-dependent negative feedback and one positive feedback, depending on the point in the cycle. In a normal 28-day cycle, on day 21, what feedback loop is active in controlling the plasma levels of luteinizing hormone?
A) Estradiol-dependent positive feedback
B) Progesterone-dependent negative feedback
C) Progesterone-dependent positive feedback
B) Progesterone-dependent negative feedback
Rationale: On day 21 of a typical 28-day cycle, progesterone, secreted by the corpus luteum, exerts a negative feedback effect on the secretion of LH (and also FSH), stabilizing its levels to prevent further ovulatory signals.
IDENTIFY THE FETAL POSITION
A. Left occiput anterior
B. Right occiput posterior
C. Left occiput posterior
D. Right occiput anterior
E. Occiput anterior
F. Occiput posterior
A. Left occiput anterior
- Mullerian duct regression is completed by which Age of Gestation (AOG)?
A) 4-6 weeks
B) 5-7 weeks
C) 6-8 weeks
D) 9-10 weeks
D) 9-10 weeks
Explanation: Müllerian duct regression, induced by the secretion of Anti-Müllerian Hormone (AMH) from the fetal testes in male embryos, is completed by around 9 to 10 weeks of gestation. This process leads to the degeneration of the Müllerian ducts, which would otherwise develop into female reproductive structures.
- By 8 weeks, glucagon can be identified in the fetal pancreas. By which age of gestation can insulin be detected in fetal plasma?
A) 9 weeks
B) 10 weeks
C) 11 weeks
D) 12 weeks
D) 12 weeks
Explanation: Insulin, produced by the beta cells of the pancreas, can be identified in the fetal pancreas around 9 to 10 weeks of gestation. However, it becomes detectable in the fetal plasma by 12 weeks. This hormone plays a crucial role in fetal growth and metabolism.
- Which of the following immunoglobulins that can be ingested from colostrum provides mucosal protection against enteric infections?
A) IgA
B) IgG
C) IgE
D) IgM
A) IgA
Explanation: Immunoglobulin A (IgA) is the primary immunoglobulin found in colostrum and provides essential protection against pathogens at mucosal surfaces. It is critical for defending the infant against enteric infections during the early postnatal period.
- This is a presumptive sign of pregnancy, whereby vaginal mucosa becomes congested and violaceous to bluish in color
A) Goodell’s sign
B) Hegar’s sign
C) Chadwick’s sign
D) Spalding sign
C) Chadwick’s sign
Explanation: Chadwick’s sign is a presumptive sign of pregnancy that involves a change in the color of the vaginal mucosa to a deep violet or bluish hue, usually evident from about 6-8 weeks of gestation. This color change is caused by increased vascularity and blood flow in the area as part of the physiological changes during pregnancy.
- This is a probable sign of pregnancy characterized by the softening of the uterus isthmus, resulting in its compressibility on bimanual examination
A) Spalding sign
B) Goodell’s sign
C) Hegar sign
D) Chadwick sign
C) Hegar sign
Explanation: Hegar’s sign is a probable sign of pregnancy involving the softening of the lower uterine segment, or isthmus, which can be detected through bimanual examination. This sign typically appears around 6-8 weeks of gestation and is indicative of the changes the uterus undergoes to prepare for the growing fetus.
- This is a probable sign of pregnancy characterized by cyanosis and softening of the cervix due to increased vascularity of the cervical tissue
A) Hegar sign
B) Spalding sign
C) Goodell’s sign
D) Chadwick sign
C) Goodell’s sign
Explanation: Goodell’s sign is a probable sign of pregnancy that includes the softening of the cervical tip associated with increased vascularity and resultant cyanosis of the cervix. It typically occurs around the fourth to fifth week of pregnancy and is part of the body’s adaptation to accommodate a developing pregnancy.
