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OB- Finals Flashcards

1
Q
  1. When is the proper timing to do controlled cord traction?
    A. Only when you start to notice the 4 signs of placental separation
    B. Immediately after fetal delivery
    C. Just wait for the sudden gush of blood and traction may be immediately applied
    D. Right after the delivery of the placenta
A

A. Only when you start to notice the 4 signs of placental separation.
Rationale: Controlled cord traction is part of the active management of the third stage of labor. It should be performed only after signs of placental separation are observed, such as a gush of blood, apparent lengthening of the umbilical cord, and the uterus rising in the abdomen and becoming firm. Performing it too early can increase the risk of complications such as placental retention or uterine inversion.

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2
Q
  1. The layer of the endometrium that is in the border of the uterine lumen?
    A. Stratum functionale
    B. Stratum basale
    C. Stratum arteriosa
    D. All of the above
A

A. Stratum functionale
Rationale: The endometrium has two layers: the stratum functionale, which lines the uterine cavity and is shed during menstruation, and the stratum basale, which is the permanent layer that regenerates the functionale after each menstrual cycle.

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3
Q
  1. Fertilization occurs in what part of the fallopian tube?
    A. Fimbria
    B. Ampulla
    C. Isthmus
    D. Uterotubal junction
A

B. Ampulla
Rationale: Fertilization most commonly occurs in the ampulla, the widest section of the fallopian tube. This area provides an optimal environment for the sperm and egg to meet.

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4
Q
  1. Which of the following statements about gametogenesis is TRUE?
    A. It occurs exclusively in utero.
    B. Both processes (oogenesis and spermatogenesis) require the presence of gonadotrophins
    C. Males and females are born with a finite number of gametes.
    D. Both gametes originate from a common primordial germ cell.
A

D. Both gametes originate from a common primordial germ cell.

Explanation:
Both male and female gametes (sperm and eggs, respectively) originate from primordial germ cells. These cells are the common precursors to both spermatogonia and oogonia, which are the cells that eventually develop into sperm and eggs through the processes of spermatogenesis and oogenesis, respectively.

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5
Q
  1. Which of the following structures contribute to both the pelvic inlet and outlet?
    A. Pubic symphysis
    B. Iliopectineal line
    C. Ischipubic ramus
    D. Sacral promontory
A

A. Pubic symphysis

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6
Q
  1. Choose the best answer from the choices below: A 36 y.o. G5P5 (5005) underwent partial breech extraction under general anesthesia. Postpartum, the nurse on duty noted that due to vaginal bleeding, her diaper was already changed 4x. IE showed a soft and boggy uterus.
    A. Puerperal sepsis
    B. Uterine atony
    C. Postpartum bladder atony
    D. Septic pelvic thrombophlebitis
A

B. Uterine atony
Rationale: Uterine atony, the failure of the uterus to contract effectively after delivery, is a common cause of postpartum hemorrhage. The description of a soft and boggy uterus is a classic sign of this condition.

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7
Q
  1. What do you expect of the umbilical cord during placental separation?
    A. The umbilical cord should shorten
    B. The umbilical cord should lengthen
    C. The umbilical cord should be of the same length
    D. All are possible
A

B. The umbilical cord should lengthen
Rationale: As the placenta separates from the uterine wall and descends into the lower segment or the vagina, the umbilical cord appears to lengthen outside the vagina. This observation is a clinical sign of placental separation.

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8
Q
  1. When erythropoiesis moves to the liver, these Hemoglobin is produced?
    A. Hgb Gower 1
    B. Hgb Gower 2
    C. Hgb F
    D. Hgb Portland
A

C. Hgb F
Rationale: During fetal development, erythropoiesis occurs in the liver and produces Hemoglobin F (fetal hemoglobin), which has a higher affinity for oxygen than adult hemoglobin. This facilitates the transfer of oxygen from the mother to the fetus.

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9
Q
  1. What is the one-cell stage of the fertilized ovum after pronuclear membrane breakdown but before first cleavage occurs?
    A. Zygote
    B. Morula
    C. Conceptus
    D. Embryo
A

A. Zygote
Explanation: A zygote is the initial cell formed when a sperm and an egg combine their DNA material, which occurs right after the breakdown of the pronuclear membranes and before the cell begins to divide.

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10
Q
  1. Please refer to the picture. What is the fetal presentation?
    A. Breech
    B. Cephalic
    C. Transverse
    D. Longitudinal
    E. Oblique
A

A. Breech

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11
Q
  1. Which hormone brings about “nurturing instincts” in a new mother?
    A. Estrogen
    B. Prostaglandin
    C. Oxytocin
    D. Relaxin
A

C. Oxytocin
Explanation: Oxytocin, often referred to as the “love hormone,” plays a crucial role in bonding and maternal behaviors, and is also involved in labor and breastfeeding.

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12
Q
  1. In what phase of parturition is a G2P1 patient with a 7-cm. dilated cervix?
    A. Quiescence
    B. Activation
    C. Stimulation
    D. Involution
A

C. Stimulation
Explanation: The stimulation phase refers to the active phase of labor, which involves significant cervical dilation progressing from 6 cm to complete dilation.

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13
Q
  1. At the time of ovulation, in which stage of oogenesis would the oocyte be?
    A. Prophase I
    B. Prophase II
    C. Metaphase I
    D. Metaphase II
A

D. Metaphase II
Explanation: At ovulation, the oocyte is arrested in metaphase II of meiosis and will only complete meiosis if fertilization occurs.

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14
Q
  1. Bechay is a 30-year-old G1P0 at 39 4/7 weeks AOG, who came in with a chief complaint of labor pains. Uterine contractions were every 4 to 5 minutes, moderate to strong intensity, lasting for 50 seconds. lE was 5 to 6 cm dilated, 80% effaced, soft consistency, mid-position, intact bag of waters, station -1. What is the Bishop score?
    A. 6
    B. 11
    C. 3
    D. 15
A

B. 11

Cervical Dilation (5-6 cm): 3
Cervical Effacement (80%): 3
Cervical Consistency (Soft): 2
Cervical Position (Mid-position): 1
Fetal Station (-1): 2

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15
Q
  1. A 37-year-old G1P1 (1001) delivered spontaneously at the local lying-in after 18 hrs of labor. She complained that the midwife on-duty repeatedly did lE on her, a total of 10x in the span of 18 hrs. Upon discharge, she had 3 episodes of fever, temp. of 38.5°C and above.
    A. Puerperal sepsis
    B. Uterine atony
    C. Postpartum bladder atony
    D. Septic pelvic thrombophlebitis
A

A. Puerperal sepsis
Explanation: Puerperal sepsis, an infection of the genital tract occurring within 28 days after childbirth, can result from multiple internal examinations, presenting with symptoms such as fever.

Puerperal Sepsis: Focuses on infection of the uterine or genital tract postpartum, presenting with systemic symptoms like fever and tachycardia, primarily treated with antibiotics.
Septic Pelvic Thrombophlebitis: Involves a thrombotic and infectious process in the pelvic veins, requiring both anticoagulation and antibiotic treatment, with a focus on managing both the clot and infection.

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16
Q
  1. A 30-year-old G1P1 (1001) underwent normal spontaneous delivery under epidural anesthesia after 16 hrs of labor. She reported that she urinated twice in the whole duration of labor. Postpartum, she could not urinate and had to be catheterized.
    A. Puerperal sepsis
    B. Uterine atony
    C. Postpartum bladder atony
    D. Septic pelvic thrombophlebitis
A

C. Postpartum bladder atony
Explanation: Postpartum bladder atony refers to a temporary inability to urinate due to the effects of prolonged labor, anesthesia, and other factors affecting bladder function.

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17
Q
  1. What is the type of female pelvic shape (according to the Caldwell Moloy classification) that has a short AP diameter, compared to a wide transverse diameter?
    A. Gynecoid
    B. Android
    C. Platypelloid
    D. Anthropoid
A

C. Platypelloid
Explanation: A platypelloid pelvis is characterized by a wide transverse diameter relative to a shorter anteroposterior diameter, resembling a flat shape.

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18
Q
  1. A patient with the vulva distended by the breech at the height of pushing is in the:
    A. Quiescence
    B. Activation
    C. Stimulation
    D. Involution
A

C. Stimulation
Explanation: The stimulation phase of labor involves active contractions and significant progression in cervical dilation and effacement, leading to the descent of the fetus through the birth canal.

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19
Q
  1. Which process occurs in the Phase of Involution?
    A. Large vessels are compressed.
    B. Placental site diminishes in size.
    C. Abdominal muscles contract persistently.
    D. Upper and lower uterine segments are enhanced.
A

B. Placental site diminishes in size.
Explanation: The involution phase is characterized by the uterus shrinking back to its non-pregnant size, including the reduction in size of the placental site and the healing process following placental detachment.

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20
Q
  1. Cathy is a 35-year-old G3P2(2002), 39 6/7 weeks AOG who came in for her regular prenatal check-up. FHT 140s. There was one uterine contraction in 20 minutes, lasting 30 seconds, mild intensity. On IE, the cervix is 1 cm dilated, 50% effaced. What is the status of Cathy and your advice to her?
    A. She is not in active labor and send her home. Advise to watch out for signs of labor
    B. She is in labor. Advise to ambulate at home
    C. A repeat IE should be done after 4 hours to determine if she is in labor
    D. A repeat IE should be done after 2 hours to determine if she is in labor
A

A. She is not in active labor and send her home. Advise to watch out for signs of labor
Explanation: Cathy’s contraction pattern and cervical dilation indicate that she is not yet in active labor. It is common practice to advise watching for more regular and intense contractions or other signs of labor progression before admitting.

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21
Q

Age of Development:

  1. Fetal swallowing starts at:
    A. 10-12 weeks
    B. 18 weeks
    C. 32-34 weeks
    D. 37 weeks
A

A. 10-12 weeks

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22
Q

Age of Development:

  1. Urine production starts at:
    A. 10-12 weeks
    B. 18 weeks
    C. 32-34 weeks
    D. 37 weeks
A

A. 10-12 weeks

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23
Q

Age of Development:

  1. Thyroid gland synthesizes hormones at:
    A. 10-12 weeks
    B. 18 weeks
    C. 32-34 weeks
    D. 37 weeks
A

A. 10-12 weeks

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24
Q

Age of Development:

  1. Fetal erythrocytes have a life of until 90 days at:
    A. 10-12 weeks
    B. 18 weeks
    C. 32-34 weeks
    D. 37 weeks
A

D. 37 weeks

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25
Q

Age of Development:

  1. The canalicular stage of the lungs occurs at:
    A. 10-12 weeks
    B. 18 weeks
    C. 32-34 weeks
    D. 37 weeks
A

B. 18 weeks

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26
Q
  1. Which of the following statements about the process of gametogenesis is correct?
    A. The primordial germ cells are derived from the ectoderm in the yolk sac.
    B. Both primary oocytes and primary spermatocytes are arrested in prophase 1 at birth.
    C. Two meiotic divisions are necessary to produce haploid gametes.
    D. At the completion of meiosis II, mature gametes are formed.
A

C. Two meiotic divisions are necessary to produce haploid gametes.
Explanation: Gametogenesis involves two meiotic divisions to reduce the chromosome number by half, producing haploid gametes (sperm and eggs).

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27
Q
  1. Area of the breast which must be attached to the baby’s open mouth to stimulate milk let-down:
    A. Lactiferous ducts
    B. Nipple
    C. Areola
    D. Acinus
A

C. Areola.
When a baby latches onto the breast for feeding, it is important that the baby’s mouth covers not just the nipple but also part of the surrounding areola. This proper latch helps stimulate milk let-down.

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28
Q
  1. What is an accurate description of the active phase of labor?
    A. There is increased production of hyaluronan
    B. Cervical dilatation and descent are maximal
    C. Feto-pelvic relationships come into play
    D. It begins with maternal expulsive efforts
A

B. Cervical dilatation and descent are maximal
Explanation: The active phase of labor is characterized by significant cervical dilation from about 6 cm to complete dilation, and descent of the fetus, indicating maximal changes necessary for delivery.

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29
Q

Enumerate the 5 findings (complete and correct sequence) during an internal pelvic examination of a pregnant patient in labor.

A

Inspection > Speculum > Bimanual > Internal Exam

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30
Q
  1. Marie is a 29-year-old G1P0 at 40 1/7 weeks AOG. On examination, contractions were every 2 minutes, strong in intensity, lasting for 40 secs. IE revealed a cervix at 5 cm, 80% effaced, medium consistency, mid position, intact bag of waters, station -1. What is the appropriate management?
    A. She is still in the latent phase. Send her home and reassure her.
    B. She is in the active phase. Admit her and monitor progress of labor.
    C. Ask her to ambulate and come back after 12 hours for repeat IE.
    D. Disproportionate cesarean labor because you suspect that she has cephalopelvic disproportion.
A

B. She is in the active phase. Admit her and monitor progress of labor.
Explanation: Given the frequency and intensity of contractions, along with 5 cm dilation, Marie is in the active phase of labor. Admission for close monitoring and management is appropriate to ensure safe delivery.

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31
Q
  1. A multiparous patient with lochia rubra is in the ___ Phase of Parturition.
    A. Quiescence
    B. Activation
    C. Stimulation
    D. Involution
A

D. Involution
Explanation: Lochia rubra, which is the red, bloody discharge following birth, occurs during the involution phase when the uterus is contracting back to its pre-pregnancy size and healing after placental detachment.

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32
Q
  1. Please refer to the picture. What is the fetal position?
    A. Left occiput anterior
    B. Left occiput posterior
    C. Right occiput anterior
    D. Right occiput posterior
    E. Occiput anterior
    F. Occiput posterior
    G. Left occiput transverse
    H. Right occiput transverse
A

A. Left occiput anterior

33
Q
  1. The intertuberous diameter refers to which plane of the pelvis?
    A. Inlet
    B. Midplane
    C. Outlet
    D. AP diameter
A

C. Outlet
Explanation: The intertuberous diameter is a measure of the distance between the ischial tuberosities and refers to the outlet plane of the pelvis, important in the assessment of pelvic adequacy for vaginal delivery.

34
Q
  1. Choose the best answer from the choices below: A 18 y.o. postpartum patient complained of fever of 39°C noted on day 2 postpartum. She also noted a disparity in the size of her lower extremities with the right leg being “swollen.”
    A. Puerperal sepsis
    B. Uterine atony
    C. Postpartum bladder atony
    D. Septic pelvic thrombophlebitis
A

D. Septic pelvic thrombophlebitis
Explanation: The presence of fever and unilateral leg swelling in a postpartum patient suggests septic pelvic thrombophlebitis, a condition involving inflammation and clot formation in pelvic veins.

35
Q
  1. Milk production starts at this structure.
    A. Lactiferous ducts
    B. Nipple
    C. Areola
    D. Acinus
A

D. Acinus
Explanation: Milk production occurs in the alveoli or acini, which are glandular structures in the breast. These produce milk that is then transported to the nipple via the lactiferous ducts.

36
Q
  1. What structure constricts or collapses after birth?
    A. Umbilical vessels
    B. Ductus venosus
    C. Foramen ovale
    D. All of the above
    E. None of the above
A

D. All of the above
Explanation: After birth, several fetal circulatory structures close:
Umbilical vessels constrict to stop blood flow between the fetus and the placenta.
Ductus venosus closes, redirecting blood flow from the umbilical vein to the liver.
Foramen ovale closes to ensure blood is directed through the lungs for oxygenation.

37
Q
  1. Annie is a 25-year-old G1P0, 39 1/7 weeks AOG. On IE, the cervix was 4 cms dilated, 60% effaced, soft consistency, mid position, intact bag of waters, station -3. Is the fetus engaged at this point?
    A. Yes
    B. No
    C. Not sure, repeat IE after 1 hour
A

B. No
Explanation: Fetal engagement is typically indicated by the presenting part of the fetus reaching the ischial spines of the pelvis, or station 0. At station -3, the fetus is not yet engaged.

38
Q
  1. Which of the following is a remnant of the umbilical vein?
    A. Umbilical ligament
    B. Ligamentum teres
    C. Ligamentum venosum
    D. Hypogastric arteries
A

B. Ligamentum teres
Explanation: The ligamentum teres, also known as the round ligament of the liver, is a remnant of the umbilical vein that carried oxygenated blood from the placenta to the fetus during pregnancy.

39
Q
  1. In the fetal skull, what is the greatest transverse diameter which is significant during labor monitoring?
    A. Occipitofrontal diameter
    B. Bitemporal diameter
    C. Biparietal diameter
    D. Suboocipitobregmatic diameter
A

C. Biparietal diameter
Explanation: The biparietal diameter, the distance between the two parietal bones of the skull, is the most significant transverse diameter in assessing fetal head size during labor monitoring.

40
Q
  1. What is the transformation of round spermatids arising from the final division of meiosis into spermatozoa?
    A. Gametogenesis
    B. Spermatogenesis
    C. Spermiogenesis
    D. Spermiation
A

C. Spermiogenesis
Explanation: Spermiogenesis is the process in which spermatids transform into mature spermatozoa, involving the development of flagella, reduction of cytoplasm, and condensation of the nucleus.

41
Q
  1. Oogonia and Spermatogonia are specialized primordial germ cells which share the following developmental milestones except:
    A. Both undergo mitosis in utero.
    B. Both undergo 2 meiotic divisions to produce 2N gametes.
    C. Both discard excess genetic material in the form of polar bodies.
    D. Both complete the diploid number of chromosomes at the time of fertilization.
A

B. Both undergo 2 meiotic divisions to produce 2N gametes.

Incorrect: This statement has a miswording that leads to inaccuracy. Both oogonia and spermatogonia do undergo two meiotic divisions, but they result in 1N (haploid) gametes, not 2N (diploid). The purpose of meiosis in gametogenesis is to reduce the chromosome number by half, making gametes haploid so that upon fertilization, the diploid state (2N) is restored.

42
Q
  1. The interspinous diameter refers to which plane of the pelvis?
    A. Inlet
    B. Midplane
    C. Outlet
    D. AP diameter
A

B. Midplane
Explanation: The interspinous diameter refers specifically to the transverse diameter measured between the two ischial spines, which is part of the midplane (or midpelvis) of the pelvis. This dimension is critical for evaluating the potential for obstructed labor and making decisions regarding the mode of delivery, particularly assessing the risk for midpelvic contractions and the necessity for cesarean section in cases where the pelvic dimensions are inadequate.

43
Q
  1. What is the correct sequence of the cardinal movements of labor?
    A. Descent, engagement, flexion, internal rotation, extension, external rotation, expulsion
    B. Engagement, flexion, descent, internal rotation, extension, external rotation, expulsion
    C. Engagement, flexion, descent, extension, internal rotation, external rotation, expulsion
    D. Descent, engagement, flexion, external rotation, extension, internal rotation, expulsion
A

B. Engagement, flexion, descent, internal rotation, extension, external rotation, expulsion
Explanation: The cardinal movements of labor describe the sequence of movements that the fetal head undergoes to navigate through the birth canal during delivery.

44
Q
  1. What is the PLANE of least pelvis dimension?
    A. Inlet
    B. Midplane
    C. Outlet
    D. AP diameter
A

B. Midplane
Explanation: The midplane, also known as the midpelvis or plane of least pelvic dimensions, is critical during labor because it includes the level of the ischial spines, marking the zero station of the fetal head’s descent. This area often presents the greatest challenge for the descending fetal head, particularly if the pelvic dimensions are tight or malformed, making it the narrowest bony passageway through which the fetus must pass during birth. The dimensions at this level can be a deciding factor in the progression of labor and the potential need for operative delivery.

45
Q
  1. What is the only diameter that can clinically measure the pelvic inlet?
    A. Obstetric conjugate
    B. Interischial diameter
    C. Bituberous diameter
    D. Diagonal conjugate
    E. True conjugate
A

D. Diagonal conjugate
Explanation: The diagonal conjugate is the clinical measurement that estimates the smallest front-to-back distance of the pelvic inlet. It can be assessed through a pelvic exam and helps estimate the obstetric conjugate.

46
Q
  1. It has microscopic pores where milk is extruded.
    A. Lactiferous ducts
    B. Nipple
    C. Areola
    D. Acinus
A

B. Nipple
Explanation: The nipple contains microscopic pores where the milk produced in the mammary glands is extruded, facilitated by the lactiferous ducts that transport the milk to the nipple.

47
Q
  1. The first hemopoiesis is first demonstrated in the?
    A. Liver
    B. Bone marrow
    C. Yolk sac
    D. All of the above
A

C. Yolk sac
Explanation: The first site of hematopoiesis (blood cell formation) in the developing embryo is the yolk sac, occurring early in pregnancy before the liver and bone marrow take over these functions.

48
Q
  1. Please refer to the picture. What is the fetal position?
    A. Left occiput anterior
    B. Left occiput posterior
    C. Right occiput anterior
    D. Right occiput posterior
    E. Occiput anterior
    F. Occiput posterior
    G. Left occiput transverse
    H. Right occiput transverse
A

A. Left occiput anterior

49
Q
  1. Choose the best answer from the choices below: A 28-year-old G1P1 (1001) delivered spontaneously after 20 hours of labor, in the local lying-in. Postpartum day 1, she noted passage of foul-smelling vaginal bleeding and temperature of 40°C.
    A. Puerperal sepsis
    B. Uterine atony
    C. Postpartum bladder atony
    D. Septic pelvic thrombophlebitis
A

A. Puerperal sepsis
Explanation: Foul-smelling vaginal discharge and a high fever postpartum are indicative of puerperal sepsis, an infection of the genital tract after childbirth.

50
Q
  1. You admitted a 31-year-old primigravida at 40 weeks AOG. During prenatal check-up, she was diagnosed to have Pre-eclampsia. Now that she is in labor, how often should the fetal heart rate be monitored during the second stage of labor?
    A. Every hour
    B. Every 30 minutes
    C. Every 15 minutes
    D. Every 5 minutes
A

D. Every 5 minutes
Explanation: In cases of pre-eclampsia and during the second stage of labor, close monitoring of the fetal heart rate is crucial, typically every 5 minutes, to ensure fetal well-being due to the increased risks associated with hypertensive disorders.

51
Q
  1. A 17-year-old, G0P0, on day 2 of her menstruation belongs to what Phase of Parturition?
    A. Quiescence
    B. Activation
    C. Stimulation
    D. Involution
A

A. Quiescence
Explanation: Menstruation is not part of the parturition phases, which pertain to childbirth. However, in the context of the menstrual cycle outside of pregnancy, it aligns most closely with the quiescent phase, where there is the least activity in terms of uterine muscle contraction.

52
Q
  1. Sheila is a 38-year-old G2P1(1001) at 38 5/7 weeks AOG came to the ER for watery vaginal discharge. On examination, contractions were every 10 minutes, moderate, lasting for 40 secs,. IE was cervix at 2 cms dilated, 60% effaced, firm in consistency, posterior position, station -3. What is the bishop score?
    A. 2
    B. 3
    C. 4
    D. 5
A

B. 3

Cervical Dilation (2 cm): 1
Cervical Effacement (60%): 2
Cervical Consistency (Firm): 0
Cervical Position (Posterior): 0
Fetal Station (-3): 0

53
Q
  1. In the phase of Activation, the lower uterine segment corresponds to the ___ in the non-pregnant state.
    A. Ectocervix
    B. Internal os
    C. External os
    D. Endocervix
A

B. Internal os

Explanation:

In the phase of Activation during pregnancy, changes occur in the lower uterine segment, which corresponds to the area around the internal os in the non-pregnant state. The internal os is the internal opening of the cervical canal into the uterus. During pregnancy, the lower uterine segment undergoes remodeling and becomes part of the pathway through which the fetus will pass during delivery.

54
Q
  1. A 27-year-old, G1P0, comes in for a consult at her 8th week of pregnancy. Which of the following statements will hold true at this stage of pregnancy?
    A. This coincides with the expected day that menstruation is expected to come.
    B. This coincides with the time that HCG is detectable only by a blood exam.
    C. This is the time that organogenesis commences.
    D. This is the time that organogenesis is complete.
A

C. This is the time that organogenesis commences.
Rationale: At the 8th week of pregnancy, organogenesis, which is the formation of organs in the embryo, is actively occurring. This stage is crucial for the proper development of the fetus.

55
Q
  1. A G2P1 patient comes in for a consult on her 20th week of pregnancy. What should the conceptus be called at this time?
    A. Fetus
    B. Embryo
    C. Blastocyst
    D. Zygote
A

A. Fetus
Rationale: From the 10th week of gestation onwards, the conceptus is referred to as a fetus, indicating it has developed from the embryonic stage into the fetal stage, where it grows and matures until birth.

56
Q
  1. These structures, when full, enlarge the breast and make the breast texture very firm to hard.
    A. Lactiferous ducts
    B. Nipple
    C. Areola
    D. Acinus
A

A. Lactiferous ducts

57
Q
  1. It is a fallacy that when this structure is inverted, the mother can not breastfeed anymore.
    A. Lactiferous ducts
    B. Nipple
    C. Areola
    D. Acinus
A

B. Nipple
Rationale: It’s a common misconception that women with inverted nipples cannot breastfeed. Many women with inverted nipples can still breastfeed effectively, although they may require some additional techniques or tools.

58
Q
  1. Pls refer to the picture. What is the fetal lie?
    A. Breech
    B. Cephalic
    C. Transverse
    D. Longitudinal
    E. Oblique
A

D. Longitudinal

59
Q
  1. A primigravid with occasional hypogastric pains and a soft closed cervix on IE is in the ___ Phase of Parturition.
    A. Quiescence
    B. Activation
    C. Stimulation
    D. Involution
A

A. Quiescence
Rationale: The quiescence phase is characterized by a lack of significant uterine activity, which aligns with occasional hypogastric pains and a soft closed cervix, indicating the uterus is in a resting state.

60
Q
  1. Pls refer to the picture. What is the presentation?
    A. Face (cephalic)
    B. Brow (cephalic)
    C. Occiput (cephalic)
    D. Longitudinal
    E. Shoulder (transverse)
    F. Breech
A

C. Occiput (cephalic)

61
Q
  1. What is the type of female pelvic shape (according to the Caldwell-Moloy classification) that is the MOST ideal for childbearing?
    A. Gynecoid
    B. Android
    C. Platypelloid
    D. Anthropoid
A

A. Gynecoid
Rationale: The gynecoid pelvis is considered the most favorable for childbirth due to its rounded shape, which allows for the easiest passage of the fetus during delivery.

62
Q
  1. Which patient is in Stage 2 of labor?
    A. A primigravid asleep in the delivery room
    B. A G3P1 patient with fetal head at Station +2
    C. A patient whose placenta was expelled with a missing cotyledon
    D. A G2P2 patient given family planning advice upon discharge from the hospital
A

B. A G3P1 patient with fetal head at Station +2
Rationale: Stage 2 of labor involves the period from full cervical dilation to the delivery of the baby. A fetal head at Station +2 indicates the baby is descending through the birth canal, consistent with this stage.

63
Q
  1. Begins at the level of the ischial spine and completed when presenting part meets the lower pelvis
    A. Flexion
    B. Descent
    C. Engagement
    D. Internal rotation
    E. External rotation
    F. Extension
    G. Expulsion
A

B. Descent

Descent: This includes several components:
* Begins at the level of the ischial spine and is completed when the presenting part meets the lower pelvis.
* Dependent on the pressure of the amniotic fluid and fundal contractions.
* Accelerates in the active phase when the cervix is about 5 to 7 cms dilated.

Overview of Descent
- Significance:
- Descent is the primary movement necessary for a vaginal birth, involving the downward movement of the fetus into and through the birth canal.

Descent in Different Parity
- Nulliparas (first-time mothers):
- Engagement, where the fetal head locks into the pelvis, may occur before the onset of labor.
- Further descent often does not proceed until the second stage of labor.
- Multiparas (mothers with previous deliveries):
- Descent typically begins concurrently with engagement, often happening earlier and more smoothly compared to nulliparas.

Forces Driving Descent
1. Pressure of Amniotic Fluid:
- Acts as a hydrostatic force exerted by the amniotic fluid enclosed by the chorion and amnion against the cervix, contributing to cervical effacement and dilation.
- Illustrated in Figure 35 which demonstrates how this pressure influences the cervix and surrounding tissues.

  1. Direct Pressure of the Fundus on the Breech:
    • The downward pressure exerted by the uterine fundus on the fetal breech aids in pushing the fetus downward.
  2. Contraction of Abdominal Muscles:
    • Maternal abdominal muscles contract and exert additional force, aiding in pushing the fetus towards the birth canal during labor.
  3. Extension and Straightening of the Fetal Body:
    • As the fetus descends, it tends to extend and straighten, which aligns its body to better fit through the dimensions of the maternal pelvis.
64
Q
  1. The descending head meets resistance and tucks the head into its chest
    A. Flexion
    B. Descent
    C. Engagement
    D. Internal rotation
    E. External rotation
    F. Extension
    G. Expulsion
A

A. Flexion

C. Flexion

Overview
- Purpose of Flexion:
- Flexion occurs as the fetal head meets resistance from the cervix, pelvic floor, or pelvic walls during its descent through the birth canal.

Mechanism of Flexion
- Response to Resistance:
- As the fetal head encounters resistance, it naturally flexes, causing the chin to draw closer to the fetal thorax.
- Substitution of Diameters:
- The flexion of the head substitutes the shorter suboccipito-bregmatic (S-O-B) diameter for the longer occipitofrontal (O-F) diameter.
- Illustration: Demonstrated in Figure 36, this adjustment is crucial as it allows the smallest possible head diameter to present and progress through the birth canal.

Significance
- Essential for Descent:
- Flexion is a critical movement in the sequence of cardinal movements of labor, as it facilitates the descent of the fetus by aligning the head in an optimal position to navigate the spatial constraints of the pelvis.

65
Q
  1. Brief rotation at 45 degrees to align head with back and shoulders
    A. Flexion
    B. Descent
    C. Engagement
    D. Internal rotation
    E. External rotation
    F. Extension
    G. Expulsion
A

D. Internal rotation

Internal Rotation
* consists of a turning of the head in such a manner that the occiput gradually moves toward the symphysis pubis anteriorly from its original position
* essential for the completion of labor, except when the fetus is unusually small.

D. Internal Rotation
Process of Internal Rotation
* Initial Position:
* The occiput starts from either a transverse or slightly off-center position in the pelvis.
* Movement:
* The occiput gradually moves anteriorly toward the symphysis pubis or, less commonly, posteriorly toward the hollow of the sacrum.
Timing and Necessity
* Completion of Rotation:
* Internal rotation is not accomplished until the head reaches the level of the ischial spines.
* Importance:
* This movement is crucial for the completion of labor, enabling the head to align with the pelvic outlet for delivery, except in cases where the fetus is unusually small.

66
Q
  1. The head reaches the perineum, the occiput, then face then the chin passes
    A. Flexion
    B. Descent
    C. Engagement
    D. Internal rotation
    E. External rotation
    F. Extension
    G. Expulsion
A

F. Extension

E. Extension
Mechanics of Extension
* Process Following Internal Rotation:
* After the head completes internal rotation, and as it reaches the vulva, it undergoes extension.
* Necessity of Extension:
* Extension is necessary because the vulvar outlet is oriented upward and forward; thus, the head must extend to pass through it.
Potential Complications Without Extension
* Impact on Perineum:
* If the head remains sharply flexed upon reaching the pelvic floor and is driven further downward without extending, it could impinge on the posterior portion of the perineum and risk tearing through the perineal tissues.
Forces Influencing Extension
* Dual Forces:
* When the head presses on the pelvic floor, it encounters two key forces:
* First Force: Exerted by the uterus, acting more posteriorly.
* Second Force: Provided by the resistant pelvic floor and the symphysis, acting more anteriorly.
* Resultant Vector:
* The interplay of these forces creates a resultant vector directed toward the vulvar opening, facilitating the extension of the head.
* Contact at Symphysis Pubis:
* As extension progresses, the base of the occiput comes into direct contact with the inferior margin of the symphysis pubis, aiding in the final movement to deliver the head.

67
Q
  1. Head and shoulders lifted to mother’s pubic bone, flexing laterally in the direction of the symphysis pubis
    A. Flexion
    B. Descent
    C. Engagement
    D. Internal rotation
    E. External rotation
    F. Extension
    G. Expulsion
A

G. Expulsion

Initial Stage of Expulsion
* Anterior Shoulder Delivery:
* The anterior shoulder first appears under the symphysis pubis, leading to distension of the perineum by the posterior shoulder.
* If the anterior shoulder cannot easily pass or is wedged behind the symphysis, this may lead to shoulder dystocia, a critical situation requiring immediate management.
Completion of Delivery
* Delivery of Shoulders:
* Anterior Shoulder: Visualized first as it navigates under the symphysis pubis (as shown in Figure
38).
* Posterior Shoulder: Follows the anterior shoulder and becomes visible as it moves over the perineal area (as shown in Figure 39).
* Final Fetal Delivery:
* Following the delivery of the shoulders, the rest of the body usually follows without significant resistance, completing the process of childbirth.

68
Q
  1. Biparietal diameter of fetal head passes the pelvic inlet
    A. Flexion
    B. Descent
    C. Engagement
    D. Internal rotation
    E. External rotation
    F. Extension
    G. Expulsion
A

C. Engagement

A. Engagement
* Definition:
* Engagement occurs when the greatest transverse diameter of the fetal head in occiput presentation passes through the pelvic inlet.
* Timing:
* Nulliparas (first-time mothers): Typically happens in the last few weeks of pregnancy.
* Multiparas (mothers with previous deliveries): Engagement may not occur until labor begins.
* Positioning:
* Synclitism: The sagittal suture is equidistant from the symphysis pubis and sacral promontory, indicating that the fetal head is aligned with the maternal pelvis.
* Floating: In many multiparas and some nulliparas, the fetal head remains freely movable above the pelvic inlet at the onset of labor.
* Common Fetal Position: The Left Occiput Transverse (LO) position is slightly more common than the Right Occiput Transverse (RO) position.

B. Asynclitism
* Definition:
* Asynclitism refers to a situation where the fetal head’s sagittal suture is not aligned midway between the symphysis pubis and the sacral promontory.
* Types of Asynclitism:
1. Anterior Asynclitism (Naegele’s Obliquity):
* The sagittal suture is deflected towards the sacral promontory.
* More of the anterior parietal bone presents itself to the examining fingers.
2. Posterior Asynclitism (Litzmann’s Obliquity):
* The sagittal suture is deflected towards the symphysis pubis.
* More of the posterior parietal bone presents.
* Sometimes noted by the presentation of the ear.

69
Q
  1. Dependent on the pressure of the amniotic fluid and fundal contractions
    A. Flexion
    B. Descent
    C. Engagement
    D. Internal rotation
    E. External rotation
    F. Extension
    G. Expulsion
A

B. Descent

Overview of Descent
* Significance:
* Descent is the primary movement necessary for a vaginal birth, involving the downward movement of the fetus into and through the birth canal.
Descent in Different Parity
* Nulliparas (first-time mothers):
* Engagement, where the fetal head locks into the pelvis, may occur before the onset of labor.
* Further descent often does not proceed until the second stage of labor.
* Multiparas (mothers with previous deliveries):
* Descent typically begins concurrently with engagement, often happening earlier and more smoothly compared to nulliparas.
Forces Driving Descent
1. Pressure of Amniotic Fluid:
* Acts as a hydrostatic force exerted by the amniotic fluid enclosed by the chorion and amnion against the cervix, contributing to cervical effacement and dilation.
* Illustrated in Figure 35 which demonstrates how this pressure influences the cervix and surrounding tissues.
2. Direct Pressure of the Fundus on the Breech:
* The downward pressure exerted by the uterine fundus on the fetal breech aids in pushing the fetus downward.
3. Contraction of Abdominal Muscles:
* Maternal abdominal muscles contract and exert additional force, aiding in pushing the fetus towards the birth canal during labor.
4. Extension and Straightening of the Fetal Body:
* As the fetus descends, it tends to extend and straighten, which aligns its body to better fit through the dimensions of the maternal pelvis.

70
Q
  1. Accelerates in the active phase when the cervix is about 5 to 7 cms dilated
    A. Flexion
    B. Descent
    C. Engagement
    D. Internal rotation
    E. External rotation
    F. Extension
    G. Expulsion
A

B. Descent

Overview of Descent
* Significance:
* Descent is the primary movement necessary for a vaginal birth, involving the downward movement of the fetus into and through the birth canal.
Descent in Different Parity
* Nulliparas (first-time mothers):
* Engagement, where the fetal head locks into the pelvis, may occur before the onset of labor.
* Further descent often does not proceed until the second stage of labor.
* Multiparas (mothers with previous deliveries):
* Descent typically begins concurrently with engagement, often happening earlier and more smoothly compared to nulliparas.
Forces Driving Descent
1. Pressure of Amniotic Fluid:
* Acts as a hydrostatic force exerted by the amniotic fluid enclosed by the chorion and amnion against the cervix, contributing to cervical effacement and dilation.
* Illustrated in Figure 35 which demonstrates how this pressure influences the cervix and surrounding tissues.
2. Direct Pressure of the Fundus on the Breech:
* The downward pressure exerted by the uterine fundus on the fetal breech aids in pushing the fetus downward.
3. Contraction of Abdominal Muscles:
* Maternal abdominal muscles contract and exert additional force, aiding in pushing the fetus towards the birth canal during labor.
4. Extension and Straightening of the Fetal Body:
* As the fetus descends, it tends to extend and straighten, which aligns its body to better fit through the dimensions of the maternal pelvis.

71
Q
  1. After vaginal delivery of your patient, you palpated the abdomen and you noticed that the uterus rose up into the abdomen. How will you interpret this finding?
    A. This is a normal finding
    B. Alert the whole team, because you might be expecting profuse bleeding
    C. Bring the patient immediately to the operating room and prepare her for an exploratory laparotomy
    D. All the statements are false
A

B. Alert the whole team, because you might be expecting profuse bleeding
Explanation: The uterus rising up into the abdomen immediately postpartum can be a sign of uterine inversion, a serious and potentially life-threatening complication where the uterus turns inside out. This condition requires immediate medical attention to prevent severe hemorrhage.

72
Q
  1. True Hermaphroditism
    A. Category I
    B. Category II
    C. Category III
    D. Category IV
A

B. Alert the whole team, because you might be expecting profuse bleeding
Explanation: The uterus rising up into the abdomen immediately postpartum can be a sign of uterine inversion, a serious and potentially life-threatening complication where the uterus turns inside out. This condition requires immediate medical attention to prevent severe hemorrhage.

73
Q
  1. Androgen Insensitivity Syndrome
    A. Category I
    B. Category II
    C. Category III
    D. Category IV
A

B. Category II

74
Q
  1. Turner Syndrome
    A. Category I
    B. Category II
    C. Category III
    D. Category IV
A

C. Category III

75
Q
  1. What is the process wherein germ cells undergo a complex series of divisions to give rise to oocytes?
    A. Gametogenesis
    B. Oogenesis
    C. Ovulation
    D. Fertilization
A

B. Oogenesis
Explanation: Oogenesis is the specific term for the development of the ova or eggs in females, where germ cells (oogonia) undergo several divisions and developmental changes to become mature oocytes. This process starts before birth and completes at ovulation, during the reproductive years of a female. Gametogenesis is a broader term that includes both spermatogenesis and oogenesis, the processes by which male and female gametes (sperm and ova, respectively) are produced.

76
Q

Leopold Maneuvers

*Examiner stands on either side of the patient, facing the patient’s head.
A. LM 1
B. LM 2
C. LM 3
D. LM 4

A

A. LM 1

77
Q

Leopold Maneuvers

  • A hard, resistant, convex structure on the right maternal side
  • Detects and counts the FHT (Fetal Heart Tone)
    A. LM 1
    B. LM 2
    C. LM 3
    D. LM 4
A

B. LM 2

78
Q

Leopold Maneuvers

  • Using the thumb and fingers of one hand, grasps the lower portion of the maternal abdomen just above the symphysis pubis
  • Suprapubic palpation using thumb and fingers just above the symphysis pubis
    A. LM 1
    B. LM 2
    C. LM 3
    D. LM 4
A

C. LM 3

79
Q

Leopold Maneuver

  • Palpation of the bilateral lower quadrants to determine engagement of the fetal presenting part
  • Fetal head is not engaged: examiner’s hands converge
  • Determines the fetal attitude
    A. LM 1
    B. LM 2
    C. LM 3
    D. LM 4
A

D. LM 4

OB1 (5 decks)

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