Obstetrics - 1F Flashcards
Subcellular substance, collagen, connective tissue which results in softening in effacement of the cervix takes place during which functional division of labor?
A. Preparatory division
G1P0, 39 weeks of gestation with mild uterine contractions every 20 to 40 minutes lasting 20 to 30 seconds for 24 hours. IE cervix 2 centimeter dilated 1.5 centimeter long cephalic presentation station minus two into a bag of water, good fetal heart tone, what is the preferred management? A. Bed rest with sedation B. Amniotomy C. Oxytocin augmentation D. CS delivery
A. bed rest with sedation
Latent phase
G1P0 40 weeks AOG admitted with 4cm dilated cervix 60% effaced left occiput anterior, station -1, intact bag of water, estimated fetal weight of 3000 gms, contraction every 4 to 6 minutes moderate intensity, fetal heart rate of 150 per minute, clinically adequate pelvis. After 3 hrs, cervix was 5 cm dilated, 60% effaced, station 0. After 3 hrs, 6 cm dilated, 70% effaced, station 0, contraction every 5 to 7 minutes, moderate good fetal heart tone. Management? A. Sedation B. Observed for another 4 hrs C. Amiotomy followed by oxytocin augmentation D. Amiotomy alone
C. Amiotomy followed by oxytocin
augmentation
(Normal cervical dilatation is 1.2cm/hr)
37 year old G4P3 3003, 40 weeks and three days AOG by amenorrhea came in due to regular uterine contractions. All her previous pregnancies were delivered vaginally without complications. The birth weights were 2.8 and 3 kilos. She was diagnosed with GDM at 26 weeks of gestation. On examination the fundic height was 35 centimeter estimated fetal weight of 3.6 to 3.8 kilograms cephalic with good fetal heart tones. On IE the cervix was 4 centimeters dilated fully effaced the head is at station minus one with intact bag of water. So what is the best management option?
A. Confirm the estimated fetal weight by ultrasound
B. Observe labor
C. Do an outright CS
D. The perform x-ray pelvimetry (not an
accurate measurement of pelvis)
B. Observe labor
25 year old G1P0 came in for labor pain she had unremarkable prenatal check up, her vital signs are normal upon PE focus on the abdomen the fundic height is was 32 centimeters estimated, fetal weight was 2.6 to 2.8 kilograms, fetal heart tones of 140 at the right lower quadrant upon IE cervix was one cm beginning effacement intact membrane station minus three. Resident observed one contractions in 30 minutes. What is the best management for this patient? A. Admit patient B. Do stress test C. Ruptured the membrane D. Send her home
D. Send her home
Which among the cardinal movement is essential for completion of labor?
A. Turning of head that the occiput is gradually moved anteriorly
B. When there is progressive downward movement of fetal head
C. Conversion of the occipitofrontal diameter to suboccipitobregmatic diameter
D. When the biparietal diameter passes
through the pelvic inlet
A. Turning of head that the occiput is gradually moved anteriorly (Internal rotation)
rationale
A. Turning of head that the occiput is gradually moved anteriorly (Internal rotation)
B. When there is progressive downward movement of fetal head (Descent)
C. Conversion of the occipitofrontal diameter to suboccipitobregmatic diameter (Flexion)
D. When the biparietal diameter passes
through the pelvic inlet (Engagement)
Which of the following cardinal movements brings the presenting part to its original position? A. Flexion B. Internal rotation C. External rotation D. Extension
C. External rotation
The resistance of the fetal head whether from the cervix, walls of the pelvis, or pelvic floor, results to which of the following cardinal movements? A. Flexion B. Internal rotation C. Extension D. External rotation
A. Flexion
Which of the following is the correct order? (Cardinal movements)
Engagement, descent, flexion, internal rotation, extension, external rotation, expulsion
A primi patient at 39 weeks came in due to bloody mucoid discharge and hypogastric pain. On a physical exam fundic height was 30 centimeter with good fetal heart tone, IE revealed the cervix at five centimeters fully efface cephalic intact bag of water station minus one. After two hours the cervix was noted to be at seven centimeters fully effaced. At what phase of labor was the patient admitted? A. Latent phase B. Early active phase C. Phase of maximum slope D. Deceleration phase
B. Early active phase (at 5 cm)
A primi patient a 39 weeks came in due to bloody mucoid discharge with fundic height of 30 centimeter, good fetal heart tone, IE cervix at five centimeters fully effaced, cephalic, intact bag of water. After 2 hours the cervix was noted to be at 7 centimeters fully effaced. What can you say about the patient’s IE after 2 hours from the time of admission?
A. Predictive of labor outcome
B. Good measure of the overall efficiency of the machine
C. Reflective of the feto-pelvic relationship
D. Heralds entry to the pelvic division
B. Good measure of the overall efficiency of the machine (phase of maximum slope)
rationale
A. Predictive of labor outcome (acceleration phase)
B. Good measure of the overall efficiency of the machine (phase of maximum slope)
C. Reflective of the feto-pelvic relationship
(deceleration phase)
D. Heralds entry to the pelvic division
(deceleration phase)
Picture of Friedman’s curve given showing ——-
phase of maximum slope
(Picture of labor curve) Primi patient, 38 weeks AOG. At what phase of labor does the abnormality occurred?
Doc Mercado: The patient is at 7 cm for 4 hours. She was admitted at 2 cm. After 2 hours, still at 2 cm. After 1 hr, 4 cm dilated. After 2 hrs, 7 cm for 4 hrs.
Phase of maximum slope.
(Picture of labor curve) G3P2 2002, 38 weeks. What is the best management?
Doc Mercado: So patient was admitted at 1 centimeter. Patient is in latent phase for 16 hours.
A. Oxytocin infusion
B. Amniotomy
C. CS
D. Therapeutic rest
D. Therapeutic Rest
Which of the ffg statements on engagement of fetal head is true?
A. In nulliparas, engagement takes place only at the onset of labor when descent occurs
B. Greatest transverse diameter of the fetal head passes thru the pelvic inlet
C. It occurs when the head is at stage -1 in the presence of 1 cm caput
D. In multiparas, engagement takes place at around 36 weeks
B. Greatest transverse diameter of the fetal head passes thru the pelvic inlet
What is the purpose of fetal head flexion in the process of labor?
A. So that suboccipitobregmatic diameter will present
B. So the fetal chin comes in contact with the fetal chest
C. So the frontooccipital diameter will present
D. This is when fetal head reaches the pelvic
floor
A. So that suboccipitobregmatic diameter will present
Most common position in which the vertex enters the pelvis with sagittal suture lying in the transverse pelvic diameter A. LOT (left occiput transverse) B. ROT (right occiput transverse) C. LOA (left occiput anterior) D. ROA (right occiput anterior)
A. LOT (left occiput transverse)
A 25 year old G1PO at 40 weeks AOG came in due to watery vaginal discharge. Fundic height is 30 cm comes with good FHT. Speculum exam reveals pooling of amniotic fluid. IE cervix was 2 cms, 50% effaced, cephalic, st -1. She has mild to moderate uterine contractions, lasting 30 seconds, interval of 10 minutes, venoclysis was done and oxytocin drip with 10 u oxytocin incorporated in 1L of DSLRS was started. You started with low dose oxytocin but still with irregular contractions. You want to achieve regular contractions. At how many drops of oxytocin will you achieve physiological dose to have regular contractions? A. 8-12 drops B. 30-32 drops C. 16-24 drops D. 2-4 drops
C. 16-24 drops
A 39 year-old multigravida presents for induction at 38 weeks gestation. The patient has a history of two prior vaginal deliveries cholestasis, pregestational diabetes, chronic hypertension requiring two medications, and a history of prior abruption in the setting of preeclampsia with severe features. You place the patient on continuous fetal monitoring. How often should the tracing berated
A. Every 15 minutes in the first stage and every 5 minutes in the second stage.
B. Every 30 minutes in the first stage and every 15 minutes in the second stage
C. Every15 minutes in the first and second stage
D. Every 15 min in the first stage and every 30
minutes in the second stage
A. Every 15 minutes in the first stage and every 5 minutes in the second stage. (remember you have a high risk patient)
Your patient is a 32 year old G3P2 at 40 weeks and 6 days AOG. Her first prenantal visit occurred after 30 weeks AOG. Examination today reveals a 1 cm dilated cervix, cephalic presentation, no ballottement of the head, and good fetal movement. What is the best next step in the management of this patient?
A. Sonographic assessment of amniotic fluid index
B. Oxytocin challenge test
C. Non stress test
D. Labor induction
A. Sonographic assessment of amniotic fluid index
After the cervix is fully dilated, what is the most important force in fetal expulsion?
A. Fetal head descending through the pelvis
B. Uterine contractions
C. Intraabdominal pressure
D. Ruptured bag of water
C. Intraabdominal pressure (doc Mercado: the mother will “push”)
In which mechanism of placental delivery does the placenta leave the body before the retroplacental hematoma? A. Chadwick mechanism B. Duncan mechanism C. Bundle mechanism D. Schultze mechanism
D. Schultze mechanism (S = shiny; no sudden
gush of blood yet)
rationale
A. Chadwick mechanism (vaginal discoloration)
B. Duncan mechanism (D = dirty; sudden gush of
blood)
C. Bundle mechanism (change of shape of uterus)
D. Schultze mechanism (S = shiny; no sudden
gush of blood yet)
In the process of vaginal delivery, as the anterior shoulder is delivered, the obstetrican palpates a loose nuchal cord. What is the best management?
A. Baby is rotated in an attempt to dislodge the cord
B. Cord is clamped and cut before proceeding with the delivery (we do this sometimes if “tight”)
C. Deliver the baby without moving the cord
D. Cord is slipped over the fetal head
D. Cord is slipped over the fetal head
The correct sequence of the 4 Core Steps of the Essential Intrapartum and Newborn Care (EINC) is as follows
A. Non separation cord clamping and cutting drying, skin-to skin contact
B. Cord clamping and cutting skin -to-skin contact non-separation, drying
C. Drying, skin to skin contact, cord clamping and cutting, non separation
D. Skin to skin contact, drying, non separation, cord clamping and cutting
C. Drying (to avoid hypothermia), skin to skin contact, (“properly timed”) cord clamping and cutting, non separation
Which of the following is a correct method of drying?
A. Dry the baby’s feet first
B. Dry the baby’s body in a random manner
C. Dry the baby’s face and head first
D. Dry the baby’s hands first
C. Dry the baby’s face and head first
Identify what part of cardinal movement is being elicited (picture)
External rotation
In EINC, how is the cord being clamped? A. Delayed cord clamping B. Immediate cord clamping C. Properly timed cord clamping D. It is not time bound
C. Properly timed cord clamping
In EINC time bound interventions, when do you
stimulate breathing and provide immediate warmth to the
neonate
A. After through drying
B. Within 90 min
C. up to 3 min
D. Within 30 sec
D. Within 30 sec
In EINC, eye care and injections are being given A. Within 90 minutes B. After through drying C. Up to 3 minutes D. Within 30 seconds
A. Within 90 minutes
In EINC, when do you place identification on the ankle of the neonate? A. Within 30 seconds B. Within 90 minutes C. After thorough drying D. Up to 3 minutes
C. After thorough drying
In EINC, when do you inspect the vagina for lacerations? A. 1-3 min B. First 30 seconds C. At the time of delivery D. 15-90 minutes
B. First 30 seconds
Of the cardinal movements of labor, internal rotation
achieves what goal?
A. Bring the occiput to an anterior position
B. Flexes the fetal neck
C. Bring the anterior fontanel through the pelvic
inlet
D. Extend the fetal head
A. Bring the occiput to an anterior position
Uninterrupted skin to skin contact is observed in which of the following? A. Within 90 minutes of age B. Within 30 seconds C. up to 3 min post delivery D. After through drying
A. Within 90 minutes of age
Which of the following is true of routine episiotomy
vaginal delivery?
A. Increase the risk of first and second degree
lacerations
B. Increases the risk of third and fourth degree
lacerations
C. Is preferred instead of individualized use of
episiotomy
D. Leads to anterior tears involving the urethra and
labia
B. Increases the risk of third and fourth degree
lacerations
The restricted use of episiotomy is associated with which of the following? A. Less anterior perineal tear B. Less posterior perineal tear C. More healing complications D. AOTA
B. Less posterior perineal tear
True of the baseline FHR?
A. Mean FHR rounded to increments of 5 bpm
during a 10-minute segment excluding period
episodic changes (accelerations/decelerations)
B. Includes periods of marked fetal heart tone
variability
C. Must be minimum of 20 minutes in any 30
minutes segment
D. Normal FHR baseline of 110-180 bpm
A. Mean FHR rounded to increments of 5 bpm
during a 10-minute segment excluding period
episodic changes
24 years old, G1P0 pregnant for 32 weeks, admitted
due to preterm labor and was given magnesium sulfate
for fetal neuroprotection and corticosteroids for fetal lung
maturity. What change in the fetal heart rate will you
expect?
A. Fetal tachycardia
B. Fetal bradycardia
C. Increased variability
D. Decrease variability
D. Decrease variability
Short term variability refers to?
A. Time interval between cardiac diastole
B. Changes during 1 minute and results in
waviness of the baseline
C. Instantaneous change in fetal heart rate from
one beat to the next
D. Normal frequency is 3 cycles per 1 minute
C. Instantaneous change in fetal heart rate from
one beat to the next
This type of fetal heart rate pattern is commonly
associated with severe fetal asphyxia, severe fetal
anemia chorioamnionitis and umbilical cord
compression.
A. Saltatory pattern
B. Sinusoidal heart pattern
C. Cardiac arrhythmia
D. Increased variability
B. Sinusoidal heart pattern
Possible etiology of fetal bradycardia? A. Maternal fever B. Abruptio placenta C. Chorioamnionitis D. Administration of betamimetic drugs
B. Abruptio placenta
Which of the following tracings has moderate
variability?
check for pictures of tracing with moderate variability
True of tachysystole?
A. 5 or fewer contractions in 10 minutes average
during a span of 30 minutes
B. Rise in the pressure above the resting pressure
baseline
C. More than 5 contractions in 10 minutes average
of 30 minutes
D. Absence of uterine contractions
C. More than 5 contractions in 10 minutes average
of 30 minutes
True of Montevideo units?
A. Uterine performance is the sum intensity in
mmHg
B. A level of 200-225 should be achieved before
consideration of CS delivery
C. During the first stage of labor with progressively
decreasing intensity
D. Maternal pushing has no effect on the uterine
activity
B. A level of 200-225 should be achieved before
consideration of CS delivery
Given the following tracing compute for the
Montevideo units (Picture of tracing was given)
A. 165
B. 175
C. 185
D. 195
A. 165
True about acceleration?
A. Visually apparent as gradual increase from the
baseline of more than 15 beats per minute
lasting for 15 seconds
B. Non-reassuring sign
C. At 32 weeks, acceleration has a peak of more
than 20 beats per minute above the baseline
D. At less than 32 weeks, a peak of more than 10
beats per minute for 10 seconds is considered
normal
D. At less than 32 weeks, a peak of more than 10
beats per minute for 10 seconds is considered
normal
Identify the deceleration type with each etiology? Umbilical compression A. Early deceleration B. Variable deceleration C. Late deceleration
B. Variable deceleration
Identify the deceleration type with each etiology? Uteroplacental insufficiency A. Early deceleration B. Variable deceleration C. Late deceleration
C. Late deceleration
Identify the deceleration type with each etiology? Fetal head compression A. Early deceleration B. Variable deceleration C. Late deceleration
A. Early deceleration
Given a tracing. Interpret using the ACOG three-tier
heart rate interpretation system?
Picture of tracing was given, according to Doc, these are
the following findings:
- Persistent late deceleration
- No variability (the tracing is almost smooth)
A. Category I – Normal
B. Category II – Indeterminate
C. Category III – Abnormal
C. Category III – Abnormal
*study fetal heart rate monitoring
Given a tracing. Interpret using the ACOG three-tier heart rate interpretation system? Picture of tracing was given, according to Doc, these are the following findings: - Minimal variability - Deceleration seen everywhere - Minimal acceleration A. Category I – Normal B. Category II – Indeterminate C. Category III – Abnormal
B. Category II – Indeterminate
*study fetal heart rate monitoring
Given a tracing. Interpret using the ACOG three-tier heart rate interpretation system? A. Category I – Normal B. Category II – Indeterminate C. Category III – Abnormal
A. Category I – Normal
*study fetal heart rate monitoring
Interpret the following (illustration)
(no decelerations, with
irregularities)
Category 1 - normal (no decelerations, with
irregularities)
*study fetal heart rate monitoring
35 year old patient came in due to severe headache.
She is on her 32nd week age of gestation. BP was noted to be 160/100 mmHg, fetal heart rate was noted to be100 bpm. IE, cervix was closed. She was hooked to a fetal monitor. Fetal heart rate pattern showed bradycardia with minimal variability, and variable decelerations with slow return to baseline without acceleration after fetal stimulation. What is your interpretation of the fetal heart rate pattern?
B. Suspicious fetal heart rate pattern
C. Abnormal fetal heart rate pattern
D. Equivocal fetal heart rate pattern
B. Suspicious fetal heart rate pattern (because
of minimal variability)
rationale
B. Suspicious fetal heart rate pattern (because
of minimal variability)
C. Abnormal fetal heart rate pattern (loss of
variability)
A primigravid patient at 40 weeks AOG in labor was
hooked to a fetal monitor. Baseline FHR is 130-140 bpm
with variability of 20 bpm. You noted on the tracing that
there is a decrease of 15 bpm, lasting for 15 secs. The
onset, nadir, and recovery of the decelerations are
coincident with the beginning, peak, and ending of the
contraction. How will you interpret this tracing?
A. There is late deceleration
B. There is an early deceleration
C. There is prolonged deceleration
B. There is an early deceleration (mirror image)
When does a fetal heart rate pattern with reduced baseline variability often encountered? A. Uteroplacental insufficiency B. Fetal movement C. Uterine contractions D. Fetal quiescent
D. Fetal quiescent
Which statement does not describe induction of
labor?
A. Stimulation of contractions before the onset of
labor in a patient with intact membranes
B. Commence with a closed cervix
C. Enhances spontaneous contractions
D. Done with an effaced cervix
C. Enhances spontaneous contractions
Which of the following is not an indication for induction of labor? A. Polyhydramnios B. Postterm pregnancy C. Oligohydramnios D. Prelabor rupture of membranes
A. Polyhydramnios
Which of the factors are maternal contraindications
for induction of labor?
A. Macrosomia
B. Malpresentation
C. Non-reassuring fetal heart rate pattern
D. Active genital herpes
D. Active genital herpes
Fetal factors to be considered if planning for
induction of labor
A. Type of previous uterine incision
B. Contracted or distorted pelvic anatomy
C. T lie presentation
D. Abnormal presentation
C. T lie presentation
Which of the following patients is suitable for
induction of labor?
A. Gravida 4, Para 2 patient with 1 spontaneous
miscarriage
B. Primigravid patient with a BMI of 31
C. Patient with closed cervix
D. Pregnant woman with estimated fetal weight of
3.8 kg
A. Gravida 4, Para 2 patient with 1 spontaneous
miscarriage (mostly likely for normal delivery
because she is already multigravid)
One of the following items is not attributed to
Prostaglandin E1.
A. Best choice for cervical ripening
B. Oxytocin should not be given after prostaglandin
administration within 6-12 hours
C. Oxytocin can only be given after removing
prostaglandin insert
D. Can be administered orally
D. Can be administered orally
Transcervical catheter insertion is a mechanical
method for cervical ripening. Which of the statements
does not describe this method?
A. Once placed in the internal cervical os, a
downward tension should be created by taping
the catheter on the thigh
B. Saline infusion can be done through the catheter
into the space between cervical os and
membranes
C. Can draw water from the cervical tissues
D. Normal saline infusion rate is at 30-40 mL/hr via
infusion pump
C. Can draw water from the cervical tissues
Vaginal dose of misoprostol is? A. 25 ug every 6 hours as needed B. 25 mg every 6 hours as needed C. 50 ug every 6 hours as needed D. 50 mg every 6 hours as needed
A. 25 ug every 6 hours as needed
Which of the following items is not considered a
contraindication for the use of Prostaglandin E2 in
cervical ripening?
A. Suspicion of fetal compromise
B. Unexplained vaginal bleeding
C. Patient with less than 3 term pregnancies
D. Women already receiving oxytocin
C. Patient with less than 3 term pregnancies
The goal of oxytocin infusion when inducing labor is
A. Adequate contractions every 30 to 60 seconds
every 3 to 5 minutes
B. Adequate contractions every 60 to 90 seconds
every 3 to 5 minutes
C. Adequate contractions every 90 to 120 seconds
every 3 to 5 minutes
B. Adequate contractions every 60 to 90 seconds
every 3 to 5 minutes
A 28-year-old G1P0 presents to the clinic at 42
weeks AOG. She states that she is tired all the time and
her feet swell when she stands for too long. When her
cervix is checked it is noted that it is posterior, closed,
uneffaced and very firm. As discussion begins regarding
the possibility of induction, the patient asks what can be
done to improve her chances of having her baby
vaginally. What do you tell her as provider?
A. CS is the best option
B. Cervix must ripen on its own
C. Induction with artificial ripening agent is an
option
D. TVS will tell if the cervix is ready to deliver
C. Induction with artificial ripening agent is an
option
30-year-old primigravida presents to your office at 39
weeks gestation. She is exhausted and ready to be
delivered but does not want to be induced. You suggest
membrane stripping and inform her that this will lead to a
rise in which of the following PG?
A. F2 alpha
B. I2
C. E2
D. H
A. F2 alpha
Which of the following complications is increased in the setting of labor induction? A. Post Partum hemorrhage B. NICU admission C. Umbilical artery pH <7.0 D. Embolism
A. Post Partum hemorrhage
A patient who underwent cervical ripening PGE2
vaginal insert is ready for labor induction. What is the
recommended period of time to wait after removing the
insert?
A. 30 mins
B. 2 hours
C. 12 hours
D. 12 hours
A. 30 mins
Oxytocin similarity to arginine vasopressin accounts
for which of the following unwanted side effects?
A. Hypertensive crisis
B. Water intoxication
C. Embolism
D. Uterine tachysystole
B. Water intoxication
26-year old will undergo emergency cesarean
section at 37 weeks AOG. After spinal anesthesia, the
patient developed dizziness, HR 102, BP 90/60. What is
the most likely cause of these signs and symptoms?
A. Compression of the aorta
B. Compression of the inferior vena cava
C. Compression of the superior vena cava
D. Compression of the aorta and IVC
D. Compression of the aorta and IVC
(26-year old will undergo emergency cesarean
section at 37 weeks AOG. After spinal anesthesia, the
patient developed dizziness, HR 102, BP 90/60. )
The initial management for the above patient is?
D. Left uterine displacement
The increase in cardiac output in a pregnant patient
is the result of?
A. Increase in SV and HR
B. Decrease in afterload, increase in HR
C. Increase in SV, decrease in systemic vascular
resistance
D. Decrease in systemic vascular resistance
A. Increase in SV and HR
During the 2nd stage of labor, the pain is transmitted via the spinal segments: A. T10-S4 B. T10-L1 C. T10-S2 D. T10-L1, S2-S4
D. T10-L1, S2-S4
Which of the following changes in the pulmonary
function best describes the rapid rate of desaturation in pregnant patients who become apneic after induction of
general anesthesia?
A. Decrease dead space ventilation
B. Decrease FRC
C. Decrease residual volume
B. Decrease FRC
A patient in labor is sitting up for her epidural. An
anesthetic dose was given. The patient’s HR and BP rise immediately after administration of the test dose. What has most likely caused for this change in vital signs?
A. Patient experienced a contraction
B. Test dose was given intravenously
C. This is a normal response to a test dose
B. Test dose was given intravenously
Which local anesthetic is associated with both
neurotoxicity and cardiotoxicity at similar serum drug
levels?
A. Bupivacaine
B. Lidocaine
C. 2-chloroprocaine
A. Bupivacaine
What are the most common precipitating events
leading to adverse outcome in obstetric anesthesia?
A. Cardiac events
B. Pharmacologic events
C. Respiratory events
D. Fetomaternal events
C. Respiratory events
Epidural anesthesia is contraindicated in which of the following? A. Patients in hypovolemia B. Patients in chronic back pain C. Patients with asthma D. Patients with AMI of >35
A. Patients in hypovolemia
What is the primary and most important reason for
administering an epidural test dose?
A. Rule out IV catheter placement
B. Ensure that anesthesia achieves a sufficient
neurologic level
C. Rule out a high spinal anesthesia
D. Give a bolus of narcotic to facilitate a rapid pain
relief
A. Rule out IV catheter placement
A 34-year old G6P6 deliver spontaneously in a
birthing home with no apparent immediate complication.
At her 8th postpartum day, she complained of profuse
vaginal bleeding. On PE, uterine fundus was 1 cm below the umbilicus. Which of the ffg will be the most likely
diagnosis?
A. Vaginal laceration
B. Uterine leiomyoma
C. Uterine subinvolution
D. Cervical trauma
C. Uterine subinvolution
In the immediate puerperium, retained placental
fragments are bound to cause which of the ffg?
A. Placental polyp
B. Postpartum hemorrhage
C. Uterine synechiae
D. Endometritis
B. Postpartum hemorrhage
As the baby suckles, afterpains usually become more intense more likely as a result of? A. Prostaglandin release B. Prolactin release C. Oxytocin release D. HCG release
C. Oxytocin release
What mostly brings about placental site involution?
A. Absorption of what remains of the placenta
B. Myometrial contraction over the placental site
C. Exfoliation and endometrial downgrowth
D. Inflammatory reaction on the site of implantation
C. Exfoliation and endometrial downgrowth
A 34-year old G6P6 was on her 14th postpartum day
when her vaginal discharge turned from scanty yellowish
brown to brisk bleeding. What is the most likely cause?
A. Unsutured cervical laceration
B. Uterine subinvolution
C. Uterine atony
D. Placental polyp
D. Placental polyp
In a 36-year-old G6P6 patient, 14 weeks postpartum
who experienced sudden profuse vaginal bleeding, an
ultrasound was done and the uterus appeared empty.
Management will be best to be:
A. Observation
B. Curettage
C. Medical
D. Hysterectomy
C. Medical
Bladder trauma is associated most closely with? A. Duration of labor B. Presentation C. Strength of uterine contraction D. Adequacy of the episiotomy
A. Duration of labor
Prolactin is essential for lactation. What directly stimulates prolactin secretion? A. Estrogen effects from pregnancy B. Oxytocin from the hypophysis C. Progesterone D. Dopamine from the hypothalamus
B. Oxytocin from the hypophysis
Provided that antibiotic therapy for mastitis is started
early before suppuration occurs, breast infection
resolves soon. What kinds of antibiotics are used
empirically for mastitis infection for breastfeeding
women?
A. Anti-anaerobic
B. Antibiotic against coliform
C. Anti-staphylococcal organism
D. Antibiotic versus gram negative organism
C. Anti-staphylococcal organism
A 26-year-old primipara on her 7th postpartum day
consulted for severe vulvar pain which started 1 day
PPC, what will be the primary consideration in this case?
A. Vulvar hematoma
B. Hemorrhoids
C. Infected episiotomy
D. Cellulitis
C. Infected episiotomy
Which of the following does not play in initiation of
breathing in a newborn?
A. Physical stimulation
B. Oxygen stimulation
C. Carbon dioxide accumulation
D. Rapid replacement of alveolar fluid with air
B. Oxygen stimulation
This factor is required to bring about the initial entry
of air into the fluid filled alveoli in the newborn.
A. High intrathoracic pressure
B. Accumulation of carbon dioxide in the alveoli
C. High negative intrathoracic pressure
D. Thoracic compression
C. High negative intrathoracic pressure
Which of the following parameter is not an immediate care for the newborn? A. Duration of labor B. Duration of rupture of membrane C. Labor complication D. Thoracic compression
D. Thoracic compression
Which statement describes primary apnea of the
newborn?
A. Follow after deep
B. Occurs when there is continued oxygen
deprivation
C. Occurs when there is continued asphyxia
D. There is transient period of rapid breathing
D. There is transient period of rapid breathing
This is an indication for giving positive pressure
ventilation with room air.
A. Heart rate at 100 bpm and above in the first 60
seconds of life
B. When the airways has not been cleared of
secretions
C. Heart rate below 100 bpm beyond 60 seconds of
life
D. Gasping respiration beyond the 30 seconds of
life
D. Gasping respiration beyond the 30 seconds of
life
Which is statement is correct in performing chest compression in a newborn? A. Goal is to deliver 130 ventilation compression every minute B. 3:1 ventilation compression ratio is recommended C. 3:1 compression ventilation ratio is recommended D. Heart rate is assessed every minute
C. 3:1 compression ventilation ratio is
recommended
Eye care for the newborn includes eye infection prophylaxis, which regimen is not used? A. 1% silver nitrate B. 0.5% erythromycin C. 1% tetracycline D. single dose ceftriaxone
D. single dose ceftriaxone
Which statement does not describe the care for the
newborn skin?
A. First bath is done after delivery to remove blood,
meconium and vernix
B. Vernix is absorbed on the newborn skin in 48
hours
C. Cord loses its moist appearance and appears
black in 24 hours
D. Umbilical stump is covered with dressing to
avoid infection
C. Cord loses its moist appearance and appears
black in 24 hours
In the first days of life meconium mostly consists of
the following except?
A. Milk ingested
B. Desquamated epithelial cells from intestine
C. Amniotic fluid
D. Lanugo
A. Milk ingested
Which statement best describe newborn stools?
A. First 2-3 days of life, stools have a consistency
of peanut butter
B. Meconium passes after the 4th day have
characteristic brownish green in color
C. Characteristic color of the stool in the first 2 days
of life are due to bile pigments
D. Bacteria colonizes the intestine after 2-3 days of
life giving the yellowish color of the stool
C. Characteristic color of the stool in the first 2 days
of life are due to bile pigments
