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LE1 - OB2 Flashcards

1
Q

What is the recommended antepartum surveillance test for term pregnancies to assess fetal well-being?
A. Contraction stress test

A

A. Contraction stress test

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2
Q

A pregnant patient with polyhydramnios is most likely to experience which of the following complications?
A. Abruptio placenta

A

A. Abruptio placenta

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3
Q

A 41-week AOG patient presents for a prenatal check-up with complaints of reduced fetal movement. As a medical attendant, what is the best course of action?
A. Subject the patient to a contraction stress test

A

A. Subject the patient to a contraction stress test

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4
Q

Pregnant patients with a BMI of 38 are most likely to develop which of the following conditions?
A. Cardio renal disease

A

A. Cardio renal disease

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5
Q

Placenta previa is most commonly observed in which type of pregnant patient?
A. Multiparous

A

A. Multiparous

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6
Q

What is the most common outcome in patients with an incompetent cervix?
A. Immature delivery

A

A. Immature delivery

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7
Q

In a biophysical profile (BPP), which parameter is the last to disappear in cases of fetal hypoxia?
A. Fetal tone

A

A. Fetal tone

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8
Q

A 28-year-old woman with regular menstruation presents for prenatal care. What is the estimated age of gestation (AOG)?
A. 10 weeks and 3 days

A

A. 10 weeks and 3 days

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9
Q

Thick meconium staining is noted during labor. What is the appropriate next step?
A. Closely monitor for abnormalities in fetal tracing

A

A. Closely monitor for abnormalities in fetal tracing

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10
Q

What does a reactive non-stress test indicate?
A. <2 accelerations in a 20-minute window with noted fetal movements

A

A. <2 accelerations in a 20-minute window with noted fetal movements

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11
Q

A 33-year-old primigravida at 38 weeks AOG presents with a biophysical profile score of 8/10. As the attending physician, what should be your next step?
A. Do a backup test like the Contraction Stress Test

A

A. Do a backup test like the Contraction Stress Test

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12
Q

Which vessel is most commonly assessed using Doppler velocimetry to evaluate the sufficiency of the uteroplacental unit?
A. Umbilical artery

A

A. Umbilical artery

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13
Q

When is variable fetal descent most likely to be observed?
A. Premature rupture of membranes (PROM)

A

A. Premature rupture of membranes (PROM)

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14
Q

What biophysical profile finding would result in a score of zero?
A. 2 gross movements of fetal count

A

A. 2 gross movements of fetal count

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15
Q

In a fetus with repetitive decelerations, what is the most important type of deceleration to consider?
A. Late deceleration

A

A. Late deceleration

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16
Q

What does the “Count to 10” fetal movement method involve?
A. Counting the number of minutes it takes for the baby to complete 10 movements

A

A. Counting the number of minutes it takes for the baby to complete 10 movements

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17
Q

Which statement is true regarding fetal scalp stimulation?
A. It has very limited use in cases of fetal tachycardia

A

A. It has very limited use in cases of fetal tachycardia

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18
Q

Uterine contractions occurring every 5-10 minutes are indicative of what condition?
A. Tachysystole

A

A. Tachysystole

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19
Q

Which antenatal test is used to perform a physical examination of the fetus?
A. Biophysical profile (BPS)

A

A. Biophysical profile (BPS)

Fetal Breathing Movements: At least one episode of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes is considered normal.

Gross Fetal Movements: At least three discrete body or limb movements within 30 minutes are required.

Fetal Tone: At least one episode of active extension and return to flexion of the fetal limb(s) or trunk, including opening and closing of the hand, within 30 minutes is necessary.

Amniotic Fluid Volume: A single vertical pocket of amniotic fluid measuring at least 2 cm in depth is required, or an amniotic fluid index (AFI) of 5 cm or more.

Nonstress Test (NST): Reactive NST, which includes two or more fetal heart rate accelerations of 15 bpm or more above baseline lasting for at least 15 seconds, is considered normal.

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20
Q

A 25-year-old at 32 weeks pregnant with intrauterine growth restriction (IUGR) presents with abnormal Doppler waveform. What is the appropriate management?
A. Expectant management with complete bed rest

A

A. Expectant management with complete bed rest

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21
Q

What criteria must be met for auscultation using a stethoscope or Doppler to be comparable to velocimetry monitoring?
A. Fetal heart rate is assessed for a whole minute

A

A. Fetal heart rate is assessed for a whole minute

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22
Q

Which antepartum test assesses fetal breathing and heart rate reactivity?
A. Non-Stress Test (NST)

A

A. Non-Stress Test (NST)

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23
Q

A 39-year-old at 41 weeks AOG presents for a labor check-up. What valid concerns should be considered?
A. Meconium aspiration

A

A. Meconium aspiration

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24
Q

What is the appropriate management for a pregnant patient with Doppler velocimetry revealing notching?
A. Admit the patient for steroid administration

A

A. Admit the patient for steroid administration

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25
Q

Which Doppler velocimetry region is investigated to assess brain-sparing movement in the fetus?
A. Middle cerebral artery

A

A. Middle cerebral artery

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26
Q
  1. Which of the following features are characteristic of a Category I fetal heart rate (FHR) tracing?
    A. Baseline rate of 110-160 bpm, moderate variability, absent late or variable decelerations, and early decelerations present or absent
    B. Baseline rate of 100-110 bpm, absent variability, late decelerations present, and early decelerations absent
    C. Baseline rate of 120-170 bpm, moderate variability, variable decelerations present, and accelerations absent
    D. Baseline rate of 130-140 bpm, absent variability, early decelerations present, and accelerations present
A

A. Baseline rate of 110-160 bpm, moderate variability, absent late or variable decelerations, and early decelerations present or absent

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27
Q

Which biophysical profile (BPP) variable is most predictive in the context of a positive infection?
A. Breathing

A

A. Breathing

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28
Q

Which biophysical profile (BPP) variable is the only chronic marker?
A. Amniotic fluid volume

A

A. Amniotic fluid volume

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29
Q

Which antepartum test is known to correlate with labor?
A. Contraction Stress Test (CST)

A

A. Contraction Stress Test (CST)

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30
Q

When is the best time to perform a congenital anomaly scan?
A. 24-38 weeks

A

A. 24-38 weeks

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31
Q

A 26-year-old primigravida with an unknown last menstrual period (LMP) presents with feelings of bloatedness and abdominal enlargement. She reports feeling fetal movement (quickening) since the second week of July. When did the patient likely feel the movement?
A. 27-29 weeks

A

A. 27-29 weeks

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32
Q

Which antepartum test does not require a dilated cervix or ruptured membranes?
A. Indirect Electronic Fetal Monitoring (CTG)

A

A. Indirect Electronic Fetal Monitoring (CTG)

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33
Q

Which statement is true regarding fetal scalp pH?
A. When pH is <7.2, immediate abdominal termination (cesarean delivery) is warranted

A

A. When pH is <7.2, immediate abdominal termination (cesarean delivery) is warranted

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34
Q

A 35-year-old parturient is 70% effaced with cervical dilatation. What is indicated?
A. Adequate uterine contraction

A

A. Adequate uterine contraction

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35
Q

What is the baseline fetal heart rate marker?
A. 140-150 bpm

A

A. 140-150 bpm
B. 110-160 bpm

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36
Q

In fetal tracing, what is considered the most important feature?
A. Presence of acceleration

A

A. Presence of acceleration

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37
Q

Which of the following is included in fetal resuscitation methods?
A. Discontinuation of uterine stimulants

A

A. Discontinuation of uterine stimulants

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38
Q

What is the purpose of optimizing ultrasound resolution?
A. Provide for better view of ultrasound resolution

A

A. Provide for better view of ultrasound resolution

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39
Q

What potential problem is common among all tall pregnant patients?
A. Macrosomic deliveries

A

A. Macrosomic deliveries

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40
Q

Which of the following is true regarding post-term pregnancy?
A. Previous post-term pregnancy is a risk factor

A

A. Previous post-term pregnancy is a risk factor

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41
Q

At what gestational age does amniotic fluid peak?
A. 38 weeks

A

A. 38 weeks

POLY = GIT/ TORCHES
OLIGO = URINARY TRACT/LUNGS

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42
Q

A modified biophysical profile (BPS) with a perfect score of 8 is considered acceptable provided that which of the following conditions is met?
A. Amniotic fluid volume is 2-7.9 cm

A

A. Amniotic fluid volume is 2-7.9 cm

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43
Q

Which of the following is not a component of the Bishop Score?
A. Position
B. Contraction
C. Dilation

A

B. Contraction

CERVICAL DILATION/EFFACEMENT/CONSISTENCY/POSITION
FETAL STATION

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44
Q

A 42-week pregnant patient presents with an internal examination (IE) showing normal external genitalia, closed cervix, and a firm cervix. What is the Bishop score, and what is the best next step?
A. Give cervical ripening agent
B. Give oxytocin

A

A. Give cervical ripening agent

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45
Q

Which complication is most likely to occur in a post-term pregnancy?
A. Oligohydramnios
B. Polyhydramnios
C. Respiratory Distress Syndrome (RDS)

A

A. Oligohydramnios

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46
Q

Which of the following does not describe a post-mature baby?
A. Wrinkled skin
B. Open eyes; alert baby
C. Long nails
D. Long wide

A

D. Long wide

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47
Q

What causes skin changes in a post-mature baby?
A. Loss of protective vernix

A

A. Loss of protective vernix

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48
Q

Which patient is most likely to experience a post-term pregnancy?
A. A patient with prolonged stage of labor
B. A patient with a history of preterm birth
C. A patient with a growth-restricted infant
D. A patient with a congenital anomaly

A

A. A patient with prolonged stage of labor

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49
Q

Which of the following occurs when placental function is maintained but normal amniotic fluid is present?
A. Healthy and large fetus

A

A. Healthy and large fetus

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50
Q

Which of the following is true regarding dysmaturity syndrome?
A. Oligohydramnios

A

A. Oligohydramnios

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51
Q

A patient is at term by size but is unsure of her menstrual dates. Which of the following would be most beneficial in determining the age of gestation (AOG)?
A. Fundic height
B. Force her to remember
C. Quickening
D. Estimated Fetal Weight

A

A. Fundic height

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52
Q

What is the most reliable indicator of age of gestation in the second trimester?
A. Biophysical Profile (BPP)

A

A. Biophysical Profile (BPP)

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53
Q

Cervical ripening can be achieved through which of the following methods?
A. Prostaglandin administration and membrane stripping

A

A. Prostaglandin administration and membrane stripping

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54
Q

A post-term baby is at increased risk for which of the following?
A. Meconium aspiration

A

A. Meconium aspiration

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55
Q

At what gestational age does the fundal height reach the level of the umbilicus?
A. 20th week

A

A. 20th week

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56
Q

Babies with neural tube defects are more likely to be:
A. Post-term

A

A. Post-term

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57
Q

According to Martin, what percentage of pregnancies are considered post-term?
A. 0.4%
B. 0.10%
C. 4%
D. 10%

A

D. 10%

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58
Q

Which maternal complications should be anticipated in a post-term pregnancy?
A. Stillbirth
B. Meconium aspiration
C. Preeclampsia
D. AOTA

A

D. AOTA

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59
Q

Which is true about placental dysfunction?

A. Associated with decreased levels of kisspeptin
B. Results in increased placental weight
C. Leads to polyhydramnios
D. Commonly occurs in preterm pregnancies

A

A. Associated with decreased levels of kisspeptin

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60
Q

Which complication is brought about by oligohydramnios?

A. Fetal growth restriction
B. Respiratory distress syndrome
C. Cord compression
D. Preterm labor

A

C. Cord compression

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61
Q

Which of the following statements is not true regarding pre-term labor, except:
A. It is associated with cervical change

A

A. It is associated with cervical change

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62
Q

Which of the following statements is true regarding preterm infants, except:
A. Those delivered after 37 weeks

A

A. Those delivered after 37 weeks

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63
Q

Which of the following statements is not true regarding uterine distension as a cause of spontaneous preterm labor?
A. Absence of regular uterine contraction

A

A. Absence of regular uterine contraction

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64
Q

What is the most common route of infection that may cause spontaneous preterm labor?
A. Transplacental transfer of systemic infection
B. Retrograde flow of infection
C. Ascending infection
D. Respiratory droplets

A

C. Ascending infection

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65
Q

What is the condition associated with loss due to painless cervical dilatation?
A. Cervical deficiency
B. Cervical ineffectiveness
C. Cervical inability
D. Cervical incompetence

A

D. Cervical incompetence

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66
Q

Which of the following is a possible indicator of clinical chorioamnionitis in women with preterm ruptured membranes?
A. Fetal tachycardia
B. Positive vaginal culture
C. Leukocytosis
D. Fever

A

D. Fever.

Explanation: Fever is a key clinical indicator of chorioamnionitis, particularly in women with preterm ruptured membranes. Chorioamnionitis is an infection of the amniotic fluid, membranes, placenta, and/or the uterus, and it often presents with maternal fever as one of the primary signs.

While fetal tachycardia, leukocytosis, and positive vaginal culture might also be associated with chorioamnionitis, they are not as specific or definitive as fever in the clinical diagnosis of this condition. Fever, particularly when it is accompanied by other symptoms such as uterine tenderness, foul-smelling amniotic fluid, or maternal tachycardia, strongly suggests the presence of chorioamnionitis.

67
Q

What are possible indications for performing a cerclage?
A. Recurrent mid-trimester losses
B. Short cervix identified during sonography
C. Threatened preterm labor with cervical dilatation
D. All of the above (AOTA)

A

D. All of the above (AOTA)

68
Q

A 35-year-old G4P3 (3003) at 36 weeks gestation presents with a history of three previous cesarean sections. She has no history of bleeding, reports good fetal movement, and is not in labor. What test should be requested?
A. Fetal age determination by fetal biometry
B. Ultrasound for placental status
C. Non-stress test
D. Doppler velocimetry

A

B. Ultrasound for placental status

69
Q

A 28-year-old G4P3 (0300) presents to the clinic for a prenatal checkup with a 10-week missed period and a positive pregnancy test. She is not bleeding. What management would most likely benefit her?
A. Complete bed rest for the entire pregnancy
B. Administration of tocolytics throughout the pregnancy
C. Placement of a cerclage in 2-6 weeks
D. Prohibition of sexual contact until the second trimester

A

C. Placement of a cerclage in 2-6 weeks

70
Q

For a patient with a poor obstetric history and categorized as high risk for neonatal death, when should antepartum surveillance testing commence?
A. At the time of labor
B. 28-32 weeks AOG
C. Two weeks before the AOG of past neonatal death
D. At the time of diagnosis of the condition

A

C. Two weeks before the AOG of past neonatal death

71
Q

A 33-year-old G2P1 (1001) with a history of previous cesarean section for arrest of descent with a 4 kg baby presents for her first prenatal checkup after missing her menses for 2 months. What is the most important initial laboratory test to include?
A. Congenital scan
B. Pap smear
C. Hepatitis B antigen
D. OGTT

A

C. Hepatitis B antigen

72
Q

Which congenital anomaly is most frequently present in fetuses of patients with polyhydramnios?
A. Renal agenesis - oligohydramnios
B. Duodenal atresia
C. Posterior urethral valve obstruction
D. Imperforate anus

A

B. Duodenal atresia

73
Q

Which of the following is a high-risk factor for postpartum hemorrhage?
A. Placenta percreta
B. Twin pregnancy
C. Prominent dermoid cyst

A

A. Placenta percreta

74
Q

The presence of two late decelerations with at least three uterine contractions is termed:
A. Negative CST
B. Positive CST
C. Non-reactive CST
D. Reactive CST

A

B. Positive CST

75
Q

The presence of at least two incidences of a 15 bpm rise from the baseline fetal heart rate lasting for 15 seconds, coincident with fetal movement, suggests:
A. Stillbirth is unlikely in 99.8% of cases
B. The fetus is still preterm
C. There is cord compression
D. Non-reactive NST

A

A. Stillbirth is unlikely in 99.8% of cases

76
Q

Which is the last biophysical variable to disappear in case of fetal hypoxia?
A. Non-stress test
B. Fetal tone
C. Fetal movement
D. Fetal breathing

A

B. Fetal tone

77
Q

Reverse end-diastolic flow in umbilical artery Doppler velocimetry suggests what percentage of placental blood flow insufficiency?
A. 50-55%
B. 40-45%
C. 70-75%
D. 95-100%

A

C. 70-75%

78
Q

Brain-sparing phenomenon in the fetus is associated with abnormalities in which fetal vessel?
A. Umbilical artery
B. Middle cerebral artery
C. Uterine artery
D. Ductus venosus

A

B. Middle cerebral artery

79
Q

Which of the following statements is true regarding fetal movement counting?
A. Fetal movement is expected at its peak 1 hour post meal
B. Fetal movement is consistently felt by the mother
C. Fetal movement decreases as AOG advances
D. Fetal movement is at its maximum number at night

A

A. Fetal movement is expected at its peak 1 hour post meal

80
Q

The following tracing can be interpreted as: good baseline fetal heart rate with 5 accelerations.
A. Category I
B. Category II
C. Category III

A

A. Category I

81
Q

Cesarean sections for recurrent variable decelerations due to meconium can be reduced by which of the following treatment methods?
A. Administration of steroids
B. Amnioinfusion
C. Forceps extraction
D. Antibiotic treatment

A

B. Amnioinfusion

82
Q

Which intrapartum test investigates fetal oxygenation and ensures that the patient has reactivity?
A. NST
B. Fetal oximetry
C. Fetal stimulation
D. Fetal scalp pH

A

C. Fetal stimulation

Fetal stimulation tests, such as vibroacoustic stimulation or scalp stimulation, are used intrapartum to assess fetal oxygenation and ensure fetal reactivity. This is in contrast to the NST (Nonstress Test), which is typically used antepartum.

83
Q

Which condition may manifest as fetal bradycardia but is not necessarily associated with hypoxia?
A. Maternal intake of beta-blockers
B. Maternal bradycardia
C. Fetal intraventricular septal defect
D. Hydrocephalus

A

A. Maternal intake of beta-blockers

84
Q

Fetal non-reassuring conditions may be assessed using a fetal Doppler or stethoscope. Which of the following is true?
A. Baseline HR 110-160 (normal)
B. Variability of less than 5 (normal)
C. Fetal HR <100 bpm 30 seconds after contraction
D. Fetal tachycardia lasting 5-10 minutes

A

C. Fetal HR <100 bpm 30 seconds after contraction could be indicative of a late deceleration, which is a sign of fetal distress and may require further evaluation. Late decelerations occur when the fetal heart rate decreases after the peak of a contraction and slowly returns to baseline, potentially indicating compromised fetal oxygenation.

85
Q

What is the expected fetal tracing in a patient with severe oligohydramnios due to ruptured membranes?
A. Variable decelerations
B. Late decelerations
C. Sinusoidal pattern
D. Tachycardia

A

A. Variable decelerations

86
Q

Which invasive antepartum test is used for fetal exchange transfusion?
A. Cordocentesis
B. Amniocentesis
C. Chorionic villus sampling
D. Fetoscopy

A

A. Cordocentesis

87
Q

When are late decelerations usually seen?
A. Preeclampsia
B. Variable decelerations
C. Oligohydramnios
D. Diabetes

A

A. Preeclampsia

88
Q

What does a favorable cervix mean?
A. Cervix 3 cm, medium consistency, anterior position, station -1, 70% effacement

A

A. Cervix 3 cm, medium consistency, anterior position, station -1, 70% effacement
Cervix 3 cm: This indicates some dilation.
Medium consistency: This is somewhat favorable (more favorable than firm).
Anterior position: This is favorable (an anterior cervix is more aligned with the birth canal).
Station -1: The fetal head is 1 cm above the ischial spines, which is acceptable but not the most favorable.
70% effacement: Indicates significant thinning of the cervix, which is favorable.

89
Q

A patient with cervical dilatation of 8-9 cm, fully effaced cervix, cephalic presentation, ruptured bag of waters, and station +2 presents with decelerations on fetal tracing. What is the most likely type of deceleration?
A. Early deceleration

A

A. Early deceleration

90
Q

What type of deceleration is indicated in this tracing? (no picture provided)
A. Early deceleration

A

A. Early deceleration

91
Q

A biophysical profile (BPS) done on a 34-week pregnant woman with diabetes revealed a score of 6/8. What is the next best step?
A. Back up the test with a Non-Stress Test (NST)
B. Expedite delivery of the patient
C. Administer steroids
D. Repeat testing after 1-2 weeks

A

A. Back up the test with a Non-Stress Test (NST)

92
Q

What is the only chronic marker of asphyxia in the biophysical profile?
A. Fetal tone
B. Fetal breathing
C. Fetal movement
D. Amniotic fluid volume

A

D. Amniotic fluid volume

93
Q

Notchings in the uterine arteries of a 35-week primigravid woman suggest which of the following?
A. Pre-eclampsia may ensue sooner or later
B. Cesarean section must be considered as the mode of delivery
C. Intrauterine growth restriction is severe already
D. A medical condition like diabetes mellitus is present

A

A. Pre-eclampsia may ensue sooner or later

94
Q

Which antepartum test evaluates basal oxygenation of the placenta by assessing blood flow?
A. NST
B. CST
C. Doppler velocimetry
D. BPS

A

C. Doppler velocimetry

95
Q

Which antepartum test assesses the fetal heart rate response to fetal activity?
A. NST
B. CST
C. Doppler velocimetry
D. BPS

A

A. NST

96
Q

If fetal movements were first noted in the second week of August and the consultation was on September 23, what is the AOG?
A. 21-23 weeks

A

A. 21-23 weeks

97
Q

A 31-year-old primigravid patient is in her 15th hour of labor with variable decelerations on the tracing. What does this indicate?
A. Variable deceleration

A

A. Variable deceleration

98
Q

A 23-year-old G2P1 (1001) at 41 weeks with 4 cm dilation and 80% effacement shows this tracing. What does it suggest?
A. Insufficiency of the uteroplacental unit

A

Answer: A. Insufficiency of the uteroplacental unit

99
Q

Which of the following statements is true regarding thick meconium staining during labor?
A. Indication for cesarean section
B. Resolves with amnioinfusion
C. Meconium staining is an environmental hazard that should be considered worrisome only when concomitant with abnormal CTG tracing

A

B. Resolves with amnioinfusion

100
Q

Which of the following is an adequate MVU result?
A. 20
B. 110
C. 210
D. 310

A

C. 210

101
Q

A variable deceleration not resulting in fetal hypoxia can be due to which of the following?
A. Administration of Magnesium Sulfate
B. Oxytocin
C. Prostaglandin
D. All of the above

A

D. All of the above

102
Q

A 28-year-old woman with an unknown LMP comes in for a consultation complaining of bloating and an enlarging abdomen. She reports feeling fetal movements below her umbilicus since the 3rd week of July 2022. What is her estimated age of gestation?
A. 26-27 weeks

A

A. 26-27 weeks

103
Q

A modified biophysical profile (BPS) with a perfect score of 8 is acceptable provided that:
A. Amniotic fluid volume is 2-7.9 cm
B. Age of gestation is 32 weeks and above
C. NST is non-reactive
D. CST is positive

A

A. Amniotic fluid volume is 2-7.9 cm

104
Q

Which of the following intrapartum tests requires a ruptured amniotic sac for proper assessment?
A. Fetal scalp pH
B. Labor admission test
C. External cardiotocography
D. Fetal acoustic stimulation

A

A. Fetal scalp pH

105
Q

Which statement is true regarding the presence of thick meconium staining in the amniotic fluid?
A. Newborns, if vigorous, should no longer routinely receive intrapartum suctioning
B. Presence of thick meconium-stained amniotic fluid is an indication for cesarean section
C. It is a high-risk obstetric hazard in all pregnancies
D. It highly suggests asphyxia in the fetus

A

A. Newborns, if vigorous, should no longer routinely receive intrapartum suctioning

106
Q

In a biophysical profile, which of the following observations will get a score of 2?
A. Amniotic volume of 1.2 cm
B. 3 gross movements of the fetal trunk
C. 1 episode of fetal breathing
D. 1 fetal heart rate acceleration in a 30-minute window

A

B. 3 gross movements of the fetal trunk

107
Q

A 38-year-old primigravid woman with preeclampsia with severe features is at 28 weeks of gestation with a fundal height of 23 cm, FHT of 145 bpm, and BP maintained at 140/90 mmHg on methyldopa 250 mg once a day. What is the appropriate antepartum surveillance test?
A. BPS
B. Doppler velocimetry
C. Fetal movement counting
D. Contraction stress testing

A

B. Doppler velocimetry

108
Q

What is the most pertinent question to ask a 40-year-old primigravid woman with a triplet pregnancy at 10 weeks gestation?

A. Did you undergo any infertility treatments or assisted reproductive techniques?

A

A. Did you undergo any infertility treatments or assisted reproductive techniques?

109
Q

A patient at 39-40 weeks AOG presents at her prenatal check-up complaining of subjectively reduced fetal movement. As her medical attendant, you will:
A. Assure her that fetal movement normally declines at term
B. Check for regularity of fetal heart tones by Doppler
C. Admit for induction of labor
D. Request for BPS

A

B. Check for regularity of fetal heart tones by Doppler

110
Q

A 32-year-old multigravid woman in the second stage of labor with a cephalic presentation, ruptured bag of water, station +3, and decelerations on the CTG. The next best thing to do is:
A. Fetal scalp pH
B. Book the patient for a stat cesarean section
C. Fetal scalp stimulation

A

A. Fetal scalp pH

111
Q

A congenital anomaly scan is best done at what age of gestation?
A. 16-22 weeks
B. 22-24 weeks
C. 24-28 weeks
D. 28-32 weeks

A

A. 16-22 weeks

112
Q

A 22-year-old primigravid woman came to the ER due to regular uterine contractions. She cannot remember her LMP but was told she is due for delivery on November 30. What is her estimated AOG?
A. 31-32 weeks

A

A. 31-32 weeks

113
Q

A patient at 40 weeks AOG came into the ER because of an absence of fetal movement for 1 day. Two days ago, a BPS revealed 8/8. Intrauterine fetal demise was noted on repeat ultrasound due to the absence of fetal movement. How do we explain this?
A. Most likely the fetus had a cord accident

A

A. Most likely the fetus had a cord accident

114
Q

A 32-year-old primigravid woman at 41 weeks AOG is in labor. Which antepartum test should be conducted?
A. Contraction stress test (CST)

A

A. Contraction stress test (CST)

115
Q

A patient at 32 weeks gestation had a BPS score of 6/8 (-2 for fetal breathing). What should be the next step?
A. Do fetal movement counting
B. Complete BPS with an additional NST
C. Perform a contraction stress test
D. Perform Doppler velocimetry

A

B. Complete BPS with an additional NST

116
Q

Which of the following statements is true regarding preterm labor, except?
A. Regular uterine contractions
B. Occurs before 37 weeks
C. Not associated with cervical change
D. May occur after 24 completed weeks

A

C. Not associated with cervical change

117
Q

Which of the following statements is true regarding a preterm infant, except?
A. Birth weight less than 2.5 kilograms
B. Associated with Respiratory Distress Syndrome
C. Those delivered after 37 completed weeks
D. Prematurity represents incomplete development

A

C. Those delivered after 37 completed weeks

118
Q

The term “appropriate for gestational age” describes newborns with weights in which percentile range?
A. 10th to 90th percentile

A

A. 10th to 90th percentile

119
Q

Which of the following lifestyle factors associated with cigarette smoking is not linked to spontaneous preterm labor?
A. Poverty
B. Inadequate maternal weight gain
C. Obesity

A

C. Obesity

120
Q

Which of the following statements is not true regarding uterine distention as a cause of spontaneous preterm labor?
A. Absence of regular uterine contractions

A

A. Absence of regular uterine contractions

121
Q

What is the most common route of infection that may cause spontaneous preterm labor?
A. Transplacental transfer of systemic infection
B. Retrograde flow of infection
C. Ascending infection
D. Respiratory droplets

A

C. Ascending infection

122
Q

What term describes the loss associated with painless cervical dilatation?
A. Cervical deficiency
B. Cervical ineffectiveness
C. Cervical inability
D. Cervical incompetence

A

D. Cervical incompetence

123
Q

Possible indications for performing cerclage include:
A. Recurrent mid-trimester losses
B. Short cervix identified during sonography
C. Threatened preterm labor with cervical dilatation
D. All of the above (AOTA)

A

D. All of the above (AOTA)

124
Q

What is a reliable indicator of clinical chorioamnionitis in women with preterm ruptured membranes?
A. Fetal tachycardia + vaginal culture
B. Leukocytosis
C. Fever

A

C. Fever

125
Q

What is the most appropriate management of preterm premature rupture of membranes (PPROM) at or beyond 34 weeks gestation?
A. Expedited delivery

A

A. Expedited delivery

126
Q

What is the risk of recurrence for women who have had one prior spontaneous preterm delivery at or before 34 weeks?
A. 16%

A

A. 16%

127
Q

Preterm birth prevention includes all of the following except:
A. Cervical cerclage
B. Progestin compounds
C. Public health care programs
D. Cesarean section

A

D. Cesarean section

128
Q

Which of the following statements is true regarding corticosteroid administration in preterm labor?
A. Accelerates fetal lung maturity

A

A. Accelerates fetal lung maturity

129
Q

Beta-adrenergic receptor agonists as tocolytic agents have all of the following effects except:
A. Reduce intracellular calcium levels
B. Prevent myometrial contractile proteins
C. Cause pulmonary edema
D. Treat infections

A

C. Cause pulmonary edema

130
Q

Adverse neonatal outcomes in preterm delivery include all of the following except:
A. Respiratory distress syndrome
B. Necrotizing enterocolitis
C. Intracranial hemorrhage
D. Periodontal disease

A

D. Periodontal disease

131
Q

A 28-year-old G1P0 at 31 4/7 weeks gestation complains of fluid leakage from the vagina. Which of the following tests will not aid in the diagnosis of PROM?
A. pH determination of vaginal fluid
B. Nitrazine test
C. Fern test
D. Gram stain

A

D. Gram stain

132
Q

A 22-year-old G2P1 (0101) at 35 6/7 weeks gestation complains of regular uterine contractions associated with watery vaginal discharge. What is your plan of management?
A. Give tocolytics
B. Administer corticosteroids
C. Bed rest
D. Induction of labor

A

D. Induction of labor

133
Q

A 30-year-old G3P1 (1011) at 30 weeks and 4 days gestation complains of regular uterine contractions, FHT 135 bpm, and 2 cm cervical dilatation. What is your management?
A. Give tocolytic agents and corticosteroids
B. Bed rest
C. Induction of labor

A

A. Give tocolytic agents and corticosteroids

134
Q

Which of the following statements is NOT true regarding Magnesium sulfate?
A. Calcium antagonist which may inhibit labor
B. Administered IV- loading dose 4g then continuous infusion 2g/hr
C. Adverse effect: fetal bone thinning and fractures when exposed for more than 5-7 days
D. Accelerates fetal lung maturity

A

D. Accelerates fetal lung maturity

135
Q

Nifedipine is not currently used with magnesium sulfate due to which of the following adverse effects?
A. Nifedipine can cause fetal bone thinning and fractures
B. Nifedipine acts to inhibit calcium entry through cell membrane channels to arrest preterm labor
C. Nifedipine is safe and more effective than beta agonists
D. Nifedipine enhances neuromuscular blocking effects of magnesium that can interfere with pulmonary and cardiac functions

A

D. Nifedipine enhances neuromuscular blocking effects of magnesium that can interfere with pulmonary and cardiac functions

136
Q

A 36-year-old patient at 25w5d diagnosed with cervical insufficiency was noted to have a short cervix during sonographic examination. What is your plan of management?
A. Corticosteroids
B. Tocolytics
C. Cervical cerclage
D. Antimicrobial therapy

A

C. Cervical cerclage

137
Q

A 25-year-old G2P0 (0010) at 29w5d complains of regular uterine contractions and is 1 cm dilated. What is your plan?
A. Give Betamethasone: two 12-mg doses administered intramuscularly 24 hours apart
B. Give Dexamethasone: two 6-mg doses administered intramuscularly every 24 hours
C. Both A and B
D. Neither A nor B

A

A. Give Betamethasone: two 12-mg doses administered intramuscularly 24 hours apart

138
Q

A 22-year-old G1P0 at 32 weeks gestation complains of watery vaginal discharge for 48 hours associated with uterine contractions. The patient was febrile (Temp 38°C) with fetal tachycardia, uterine tenderness, and malodorous vaginal discharge. What is your impression?
A. Cervical incompetence
B. Chorioamnionitis
C. Placenta previa
D. Abruptio placenta

A

B. Chorioamnionitis

139
Q

A 30-year-old G4P2 (0302) at 12 weeks AOG consults for prenatal care. She is a nonsmoker and non-alcoholic. Her pre-pregnancy weight was 120 lbs, and her current weight is 125 lbs. Which of the following factors puts her at risk for preterm birth?
A. Obstetric history
B. Weight gain
C. Age
D. Lifestyle

A

A. Obstetric history

140
Q

Which of the following is true regarding postterm pregnancy?
A. It is equivalent to EDC
B. The risk is greater in Blacks than in Whites
C. Previous postterm pregnancy is a risk factor
D. AOTA (All of the above)

A

C. Previous postterm pregnancy is a risk factor

141
Q

With an LMP of December 11, 2021, what is the current gestational age category?
A. Early term
B. Term
C. Late term
D. Post term

A

B. Term

142
Q

At what gestational age does amniotic fluid peak?
A. 37 weeks
B. 38 weeks
C. 39 weeks
D. 40 weeks

A

B. 38 weeks

Amniotic fluid volume typically peaks around 36 to 38 weeks of gestation, after which it gradually decreases as the pregnancy approaches full term.

143
Q

What are the components of the modified biophysical profile?
A. Amniotic fluid index, non-stress test
B. Amniotic fluid index, contraction stress test
C. Fetal tone, fetal movement, respiration, amniotic fluid index, contraction stress test

A

A. Amniotic fluid index, non-stress test

144
Q

Which of the following is NOT a component of the Bishop score?
A. Status of amniotic fluid
B. Position of the fetal head
C. Contraction
D. Lie

A

C. Contraction

145
Q

Internal examination shows normal external genitalia, nulliparous vagina, cervix closed, firm and posterior, beginning effacement in a G1P0 at 42 weeks AOG. What is the most appropriate management?
A. Give cervical ripening
B. Give oxytocin
C. Perform cesarean section
D. Advise the patient to walk around

A

A. Give cervical ripening

146
Q

Which complication will you anticipate in a postterm pregnancy?
A. Oligohydramnios
B. Polyhydramnios
C. Respiratory Distress Syndrome (RDS)
D. Retinopathy of prematurity

A

A. Oligohydramnios

147
Q

Which does not describe a postterm mature baby?
A. Wrinkled, patchy skin
B. Long nails
C. Open eyes, alert baby
D. Long, wide body

A

D. Long, wide body

148
Q

Skin changes of postmaturity are caused by:
A. Prolonged stay in the uterus and amniotic fluid
B. Loss of protective effect of vernix caseosa
C. Effects of labor
D. Lack of nutrients

A

B. Loss of protective effect of vernix caseosa

149
Q

Which among the following patients is most likely to have a postterm pregnancy?
A. Caucasian with 2 previous preterm births
B. Growth-restricted infant
C. Patient with uterine didelphys
D. Patient with a congenital anomaly scan showing hydrocephalus

A

D. Patient with a congenital anomaly scan showing hydrocephalus

150
Q

When placental function is maintained and accompanied by normal amniotic fluid at 42 weeks, we should expect:
A. Healthy but large fetus

A

A. Healthy but large fetus

151
Q

Which is true for postmaturity syndrome?
A. Placental function is maintained
B. There is oligohydramnios
C. There is a higher risk of shoulder dystocia
D. All of the above (AOTA)

A

D. All of the above (AOTA)

152
Q

A patient past her due date (September 23, 2022) goes to the ER to be examined if she is in labor. Her cervix is closed and uneffaced. What is the best course of action?
A. Admit the patient and induce vaginal delivery
B. Admit the patient and perform a stat cesarean section
C. Reassure the patient and wait for spontaneous labor
D. Admit the patient for close monitoring

A

C. Reassure the patient and wait for spontaneous labor

153
Q

If the patient is unsure of her LMP, which of the following clinical information is the most beneficial in determining the age of gestation (AOG)?
A. Fundic height
B. Force her to remember LMP
C. Estimated fetal weight
D. Quickening

A

A. Fundic height

154
Q

What is the most appropriate management of preterm rupture of membranes at or beyond 34 weeks gestation?
A. Expectant management
B. Expectant management unless fetal lung maturity is confirmed
C. Expedited delivery
D. A course of corticosteroids followed by delivery

A

C. Expedited delivery

155
Q

Which is the most infrequently encountered presentation at the time of delivery?
A. Breech
B. Face
C. Face and brow
D. Shoulder

A

D. Shoulder

156
Q

What is a reliable indicator for determining age of gestation (AOG) in the 2nd trimester?
A. Crown-rump length
B. Biparietal diameter
C. Femoral length
D. Non-metric parameters

A

B. Biparietal diameter

157
Q

A Bishop score of 2 corresponds to which cervical characteristics?
A. Cervix 1 cm dilated, beginning effacement, station -1, firm and posterior

A

A. Cervix 1 cm dilated, beginning effacement, station -1, firm and posterior

158
Q

Your patient’s internal examination shows cervix at 3 cm, 80% effaced, station 0, soft and anterior. What is the next best step?
A. Admit for cesarean section
B. Reassure the patient
C. Admit and proceed with delivery
D. Do cervical ripening

A

C. Admit and proceed with delivery

159
Q

A 28-year-old woman comes to your office for the first time for an antenatal check-up. Ultrasound performed shows 16 weeks consistent with her LMP. If she now presents at 42 weeks AOG with fundal height consistent with the date, what should be done next?
A. Perform twice-weekly NSTs

A

A. Perform twice-weekly NSTs

160
Q

Cervical ripening can be achieved through which accepted methods?
A. Prostaglandins and membrane stripping

A

A. Prostaglandins and membrane stripping

161
Q

At 20 weeks, you expect the fundal height to be at:
A. The level of the umbilicus

A

A. The level of the umbilicus

162
Q

Postterm babies are at risk for:
A. Meconium aspiration

A

A. Meconium aspiration

163
Q

Quickening was felt by a multipara on September 19, 2022. What is the estimated LMP?
A. May 30, 2022

A

A. May 30, 2022

PRIMA 16-18 WKS
MULTI 18-20

0 - OB2 (4 decks)

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