Obstetrics - 1P Flashcards
A 26 year old woman complains of abdominal pain
and dizziness. On examination, she is found to be pale
and tachycardic. Her urine pregnancy test is positive and
her hemoglobin is 5. Bedside ultrasound reveals a left
adnexal mass and free fluid. She is taken to the
operating room for a ruptured ectopic pregnancy. While
in the operating room she arrests and unable to be
resuscitated. How would her death be classified?
a. nonmaternal death
b. direct maternal death
c. indirect maternal death
d. pregnancy-related death
d. pregnancy-related death
Which of the following is defined as the number of
maternal deaths that result from the reproductive
process per 100,00 live births?
a. maternal mortality ratio
b. direct maternal deathrate
c. maternal mortality rate
d. pregnancy related mortality rate
a. maternal mortality ratio
A patient present with severe preeclampsia at 37
weeks, labor was induced and she spontaneously
delivers at 3.2 kgs neonate. In the delivery room she
complains severe headache and suddenly collapses.
She is unable to be resuscitated. At autopsy it revealed
hemorrhage. Based on gestational age, how would her
neonate be classified?
a. early term
b. full term
c. post dates
d. post term
a. early term
Which of the following purposes would fetal
chromosomal microarray analysis be potentially
beneficial?
a. screening of a fetus with an advance age mother
b. evaluating a stillborn fetus
c. screening the fetus at 12 weeks’ gestation
whose mother personally carries a balanced
translocation
d. evaluating the fetus with trisomy 21 and a
double- outlet right ventricle
*answer in study guide is letter b (evaluating a stillborn fetus)
*ans in FB:
c. screening the fetus at 12 weeks’ gestation
whose mother personally carries a balanced
translocation
Which of the following best describe the primary role
of the ob-gyne hospitalist?
a. care for hospitalized patient who have no
primary doctor
b. care for hospitalized obstetrical patients and
help manage their emergencies
c. assists other obstetricians in procedures
d. be a back-up physicians taking calls from
home
b. care for hospitalized obstetrical patients and
help manage their emergencies
Which of the following is the single most way to
reduce maternal death according to joint WHO, UNFPA
and UNICEF?
a. skilled attendant
b. complete facility based
c. good referral system
d. transportation
a. skilled attendant
A 16-year old G1 delivers an infant with complex
congenital heart defect. The death of the newborn at 5
days of life due to the congenital heart defect. Regarding
this patient, the patient makes family planning decisions
in the post-partum period. Which of the following will
cause her to be most affected by government
interference with women’s reproductive rights?
a. ethnicity
b. pregnancy within the last year
c. age
d. prior child with congenital anomaly
c. age
G4P3 3003 at 25 weeks presents at the ER because
of severe abdominal pain, on examination the patient is
hypotensive and there were severe uterine contractions.
The patient has 3 previous caesarian section, she
underwent explore lap and upon opening up there was
complete rupture of the uterus. So fetus was delivered
with no heart beat weighing 692 grams, patient later on
develop DIC because of severe blood loss and
subsequently expired. How will you classify her death
now?
a. direct maternal death
b. perinatal death
c. indirect maternal death
d. nonmaternal death
a. direct maternal death
Which of the following cases is categorized as
nonmaternal death?
a. death from cardiac failure secondary to
thyroid storm in pregnancy
b. death due to congestive heart failure
secondary to rheumatic heart disease
c. death due to complications of breast cancer
associated with pregnancy
d. death from cerebrovascular accidents
secondary to preeclampsia severe
c. death due to complications of breast cancer
associated with pregnancy
Deficiency of which of the following nutrients will lead to miscarriage? a. folate b. iodine c. iron d. calcium
b. iodine
A primigravid who is 38 weeks was is in labor for 12
hours, on the 12th hour OB resident decided emergency
caesarian section for dysfunctional labor, during you IE
(internal examination) you noted the patient diagonal
conjugate is 11.5, the ischial spine was not palpable, the
bituberous diameter is 8 cm, the head is stationed 0, the
posterior fontanel is located posteriorly. What was the
most probable cause of dysfunctional labor?
a. inadequate inlet
b. inadequate midpelvis
c. inadequate pelvic outlet
d. posterior occiput posterior of the fetal head
d. posterior occiput posterior of the fetal head
Which pelvic type has a sacral angle of <90 degree?
a. android
b. gynecoid
c. anthropoid
d. platepelloid
a. android
A 33-year old nulligravid undergoing labor witout
anesthesia arrest at station +2, you decided to perform
outlet forcep delivery with the pudendal nerve block.
What is the landmark you use to perform the nerve
block?
a. sacrospinous ligament
b. sacrotuberous ligament
c. ischial spine
d. all of the above
c. ischial spine
Which of the following statement regarding borders
of ischiorectal fossae is incorrect:
a. posterior border: maximus gluteus muscle
and tuberous ligament
b. anterior border: inferior border of the posterior
triangle
c. lateral border: obturator internus muscle
fascia and ischial tuberosity
d. medial border: anal sphincter complex
b. anterior border: inferior border of the posterior
triangle
Which of the following does not characterize the
obstetric conjugate?
a. cannot be measured directly
b. normally measures 11 cm or more
c. shortest distance from the sacral promontory
and the symphysis pubis
d. less clinical importance of the pelvic inle
b. normally measures 11 cm or more
A 22-year old primigravid presents in active labor at
5 cm and station -2, 2 hours later she is 8 cm dilated and
the fetal head is noted at station 0, which of the following
is true?
a. fetus is too big
b. the top of the fetal head is noted at the level
of the midpelvic interspinous diameter
c. internal rotation of the fetal head to traverse
should be occurring
d. the biparietal has reached the level of the
pelvic inlet
b. the top of the fetal head is noted at the level
of the midpelvic interspinous diameter
The ability of which joint aids in the delivery of
obstructed shoulder in the case of shoulder dystocia?
a. pubic symphysis
b. sacroiliac joint
c. sacrococcygeal joint
d. all of the above
b. sacroiliac joint
The fetal head presents at station +5 in a transverse
diameter. What is the most likely pelvic shape?
d. Gynecoid (adequate pelvis)
Which of the ffg planes is bounded by the 2nd to the
3rd verterbra posteriorly, ischial bones laterally, and the
middle surface of the symphysis pubis anteriorly?
c. the plane of the greatest pelvic diameter
Which of the ffg types of pelvis has a none prominent
ischial spine, but with short and curved pubic arch, very
wide subpubic angle, and a wide bituberous diameter
c. Platypelloid pelvis
Oogonia found in the female fetuses found before birth a. they degenerate b. they become primary follicles c. they become Graafian follicles d. they multiply
a. they degenerate
*At 6 to 8 wks of intrauterine life, the ovary starts to
develop and at 20 wks, about 6 to 7 million germ cells
can be found. But from this time on, there will only be
continuous atresia until some time later, when the store
of germ cells becomes fully exhausted. The egg
depletion process of atresia starts at 15 wks so that at
birth, what remains is only 80% of that number and at
puberty the germ cell mass is only 300,000
An 18 yr-old female was diagnosed to have brain
tumor located at the neural stalk interrupting the vessels.
Which of the following will most likely result?
a. Inactivity and atrophy of the gonads
b. Hyperadrenalism
c. Hyperthyroidism
d. Decreased oxytocin production
a. Inactivity and atrophy of the gonads
*The control of the pituitary with the hypothalamus is
achieved by materials secreted in the cells of
hypothalamus and transported to the pituitary via the
portal vessel system. Experiments have been done
transplanting the pituitary to ectopic sites like under the
kidneys and it resulted to the failure of gonadal function.
On the other hand, returning the transplanted tissue to
an anatomic site under the median eminence is followed
by the generation of the portal system and normal
gonadal function is regained.
Assume that a woman could be an on-demand
ovulator like the rabbit in which copulation stimulates the
hypothalamic anterior pituitary axis and causes LH
release. An oocyte is ovulated and fertilized on day 26 of
her 28-day cycle. Which of the following is most likely to
happen?
a. Cell division of the fertilized ovum will be
delayed
b. Transit time of the fallopian tube to the ovum will
be longer
c. No implantation will occur
d. Implantation will be delayed
c. No implantation will occur
*On the 26th day of a 28-day cycle, the endometrium will
already be starting to respond with the diminishing
progesterone levels with a modest shrinking of the tissue
heights and the spiral arteriole vasomotor responses.
With shrinkage of the height and decrease in the blood
flow, venous dilatation occurs. Therefore the spiral
arterioles undergo arrhythmic vasoconstriction leading to
endometrial blanching. So even if it is not yet sloughed
off, the endometrium is not receptive anymore to a
fertilized ovum, so no implantation will occur.
If making available an ovum during ovulation is the
primary task of the ovarian cycle, what is the primary
task of the endometrial cycle?
a. Periodic sloughing of the stratum functionalis
b. Prompt individual recovery after the slough
c. Maximal secretory changes in preparation for
the (inaudible)
d. Vasoconstriction of the end arterioles
(not answered)
*c. Maximal secretory changes in preparation for
the (inaudible)?
After ovulation, a new ovarian structure emerges –
the corpus luteum. Which of the following is true?
a. Continuous administration of small amounts of
FSH is essential to maintain the viability of the
corpus luteum
b. The hallmark of the corpus luteum is its
secretion of progesterone and estradiol
c. The secretory capability of the corpus luteum
wanes during menstruation
d. Rapidly rising concentrations of the placental
lactogen rescues the corpus luteum from
degeneration (what will rescue the corpus
luteum is the early trophoblast secretion of hCG)
The hallmark of the corpus luteum is its
secretion of progesterone and estradiol
Endometrial biopsy was done on a woman on day 13
on her regular 28-day cycle. Which of the ffg will most
likely be found?
a. Presence of subnuclear vacuoles (first sign of
secretory changes)
Which of the ffg conditions will be common to
intrauterine pregnancy, viable ectopic pregnancy and
persistent corpus luteum cyst
a. Continuous increase progesterone levels
b. Continuous increase levels of estrogen
c. Apoptosis of functional layer of the endometrium
d. Decidua formation (common in intrauterine
pregnancy and viable ectopic pregnancy)
a. Continuous increase progesterone levels
The intracellular morula would now have developed
a blastocyst. Which of the ffg structure of the blastocyst
will ultimately form the physical connection b/n the
embryo and the uterus?
a. Inner cell mass (forerunner of the embryo)
b. Blastocyst cavity
c. Trophoblast (gives rise to the placenta)
d. Stromal cells of the deciduas
c. Trophoblast (gives rise to the placenta)
Which of the ffg is true regarding implantation?
a. Starts right away once a developing morula
reaches the uterine cavity
b. Precipitated by the degradation of the
extracellular matrix of the endometrium
c. Supported by the estrogen secretion of the
endometrium
d. Heralded by the intrusion of the cytotrophoblast
b/n endometrial cell layers
b. Precipitated by the degradation of the
extracellular matrix of the endometrium
Excessive invasion of the cytotrophoblast can cause
which of the ffg complications of pregnancy?
a. Preeclampsia (defective invasion of the
spiral arteries by the cytotrophoblast)
b. Preterm labor
c. IUGR
d. Placenta accreta
d. Placenta accreta
The primitive uteroplacenta circulation is formed by sipping into the? a. Chorionic plate b. Lacunar system c. Embryonic hypoblast
b. Lacunar system
With the establishment of the inter/intravillous
circulation, fetal and maternal blood come in close
contact but are always separated by which of the ffg:
a. Amniotic cavity
b. Maternal endothelial cells
c. Syncytiotrophoblast covering the villi
d. Decidua
c. Syncytiotrophoblast covering the villi
At the 3rd week of development, embryonic vessels
will start to develop at the chorionic villi which will later
connect with the forerunner of the
a. Umbilicus
b. Maternal sinusoids
c. Amniotic cavity
d. Tertiary villi
a. Umbilicus
What happens with the uteroplacental circulation
during uterine contractions
a. Diastolic blood flow velocity in the spiral arteries
are increased (must be decreased)
b. Inflow but not outflow are curtailed (both are
curtailed)
c. A somewhat larger volume of blood are
available for exchange
c. A somewhat larger volume of blood are
available for exchange
Since the BP in normal pregnancy is unchanged or
decreases slightly, which of the following mechanisms
will ensure adequate blood supply of the fetus?
Circumferential structural enlargement of the
entire uterine vasculature
Is it important that mechanisms of trophoblastic
invasion, important in which steps for normal
implantation?
Uterine artery remodeling
It is also important that the trophoblastic invasion is
controlled because unchecked invasion of the
trophoblast can result in which of the following disease
conditions?
Choriocarcinoma
