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Obstetrics 2022 > Obstetrics - 2P > Flashcards

Obstetrics - 2P Flashcards

1
Q

A 20-year-old woman at 5 weeks AOG by
amenorrhea, presents with vaginal spotting and
slight hypogastric pain. Pregnancy Test is
positive. On internal examination, cervix is
closed. So cervical and motion tenderness.
Uterus is not enlarged. No palpable adnexal
mass and tenderness. TVUS reveals thickened
endometrium with no signs of intrauterine or
extrauterine pregnancy. What is the next initial
step that you will do to this patient?

a. Request for CBC typing
b. Request for Serum B hCG
c. Request for Urinalysis
d. Request for repeat TVUS

A

b. Request for Serum B hCG

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2
Q

(A 20-year-old woman at 5 weeks AOG by
amenorrhea, presents with vaginal spotting and
slight hypogastric pain. Pregnancy Test is
positive. On internal examination, cervix is
closed. So cervical and motion tenderness.
Uterus is not enlarged. No palpable adnexal
mass and tenderness. TVUS reveals thickened
endometrium with no signs of intrauterine or
extrauterine pregnancy.)

Same patient: If serum B progesterone will be
requested with a result of 15 ng/mL, which of the
following will be your working impression?
a. Pregnancy of unknown viability
b. Pregnancy of unknown location
c. Ectopic Pregnancy
d. Missed miscarriage

A

b. Pregnancy of unknown location

RATIONALE
a. Pregnancy of unknown viability (cases
of Intrauterine pregnancy but no signs of
embryo, no fetal cardiac activity)
c. Ectopic Pregnancy (no confirmation of
any extrauterine pregnancy)
d. Missed miscarriage (no signs of
intrauterine pregnancy)

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3
Q

(A 20-year-old woman at 5 weeks AOG by
amenorrhea, presents with vaginal spotting and
slight hypogastric pain. Pregnancy Test is
positive. On internal examination, cervix is
closed. So cervical and motion tenderness.
Uterus is not enlarged. No palpable adnexal
mass and tenderness. TVUS reveals thickened
endometrium with no signs of intrauterine or
extrauterine pregnancy.)

Same patient: If B hCG is more than 3500 
mIU/mL, repeat TVUS revealed trilaminar 
endometrium, what is the nearest possible 
diagnosis of this patient?
a. Ectopic Pregnancy
b. Threatened abortion 
c. Complete abortion 
d. Missed miscarriage
A

a. Ectopic Pregnancy

RATIONALE
b. Threatened abortion (should have 
gestational sac)
c. Complete abortion (still have elevated 
BhCG)
d. Missed miscarriage (should have 
embryo without cardiac activity)
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4
Q

(A 20-year-old woman at 5 weeks AOG by
amenorrhea, presents with vaginal spotting and
slight hypogastric pain. Pregnancy Test is
positive. On internal examination, cervix is
closed. So cervical and motion tenderness.
Uterus is not enlarged. No palpable adnexal
mass and tenderness. TVUS reveals thickened
endometrium with no signs of intrauterine or
extrauterine pregnancy.)

Same patient: What do you want to check with 
your chosen next initial step?
a. Signs of anemia
b. Check for UTI
c. Check for doubling time
d. Check if there are products of 
conception
A

c. Check for doubling time

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5
Q

Patient presents for her first obstetrical visit at 8
weeks AOG by amenorrhea with complaints of
vaginal spotting. On internal exam, the cervical
os is closed without active bleeding. TVUS
revealed an intrauterine pregnancy with
gestational sac. What is your diagnosis?
a. Incomplete miscarriage
b. Missed miscarriage
c. Complete miscarriage
d. Threatened miscarriage

A

d. Threatened miscarriage

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6
Q

(Patient presents for her first obstetrical visit at 8
weeks AOG by amenorrhea with complaints of
vaginal spotting. On internal exam, the cervical
os is closed without active bleeding. TVUS
revealed an intrauterine pregnancy with
gestational sac.)

Same patient: Repeat UTZ was done after 3
weeks revealing an embryonic pole of more than
5mm without fetal cardiac activity. What is your
diagnosis?
a. Incomplete miscarriage
b. Missed miscarriage
c. Complete miscarriage
d. Threatened miscarriage

A

Missed miscarriage

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7
Q

Which of the following sonographic finding is
consistent with the American College of
Obstetrician and Gynecologist definition of early
pregnancy loss?
a. Absence of embryo with cardiac activity
more than or equal of 14 days after a
prior scan with gestational sac and with
yolk sac
b. CRL of more than 7mm and no
cardiac activity
c. Absence of embryo with cardiac activity
more than or equal to eleven days after
prior scan with gestational sac
d. All the choices are correct.

A

b. CRL of more than 7mm and no

cardiac activity

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8
Q

A woman of 8 weeks of AOG by amenorrhea
presents to the ER complaining of abdominal
pain and fever. She has a temperature of 41 C,
BP of 80/50 mmHg, no rebound or guarding but
with cervical motion tenderness and generalized
malaise. She discloses that she had induced
abortion via catheterization done by an unskilled
attendant last night. You diagnosed her as a
septic miscarriage and treat her with broad
spectrum antibiotics. Which pathogenic
organism do you suspect given the severity of
her illness?
a. Group A Strep
b. Group B Strep
c. Mycoplasma hominis
d. E. coli

A

Group A Strep (Early causes – most

pathogenic)

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9
Q

(A woman of 8 weeks of AOG by amenorrhea
presents to the ER complaining of abdominal
pain and fever. She has a temperature of 41 C,
BP of 80/50 mmHg, no rebound or guarding but
with cervical motion tenderness and generalized
malaise. She discloses that she had induced
abortion via catheterization done by an unskilled
attendant last night. You diagnosed her as a
septic miscarriage and treat her with broad
spectrum antibiotics.)

Same patient: What is your drug of choice for
this case?
a. Pen G 4 million units IV every 6 hours
b. Pen G 4 million units IV every 6 hours
+ Gentamycin 2mg/kg every 8 hours
c. Pen G 4 million units IV every 6 hours +
Gentamycin 2mg/kg every 8 hours +
Clindamycin every 8 hours
d. Imipenem

A

*Degree/severity: Moderate infection.

b. Pen G 4 million units IV every 6 hours
+ Gentamycin 2mg/kg every 8 hours

RATIONALE
a. Pen G 4 million units IV every 6 hours 
(mild pelvic infection)
c. Pen G 4 million units IV every 6 hours + 
Gentamycin 2mg/kg every 8 hours + 
Clindamycin every 8 hours (for cases of 
severe septicemia)
d. Imipenem (for cases of severe 
septicemia)
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10
Q

What is the discriminatory B hCG level above
which failure to visualize an intrauterine
pregnancy likely indicates that a pregnancy is
likely not alive or ectopically located?
a. >500
b. > or =1000
c. > or =1500

A

c. > or =1500

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11
Q

30-year-old G2P1 1001 presents at the OPD
complaining of pelvic pain and nausea. She is 6
weeks AOG by LMP. You requested for a TVUS
revealing no intrauterine pregnancy as well as
no adnexal mass and free fluid. B hCG was
done with a result of 3000 mIU/mL. What is the
best management strategy for this patient?
a. Exploratory laparotomy since she is
complaining of pelvic pain
b. No intervention. Just reassurance
c. Expectant management with 48 hours
follow-up
d. Request for blood test and start with
Methotrexate injection

A

c. Expectant management with 48 hours

follow-up

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12
Q 
What is the single best predictor of successful 
treatment with single dose methotrexate?
a. B hCG 
b. Progesterone levels
c. AOG
d. Size of the ectopic pregnancy
A

a. B hCG (used for monitoring ectopic

pregnancy

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13
Q

A 23-year-old primigravid is diagnosed with right
ectopic pregnancy unruptured. She is
hemodynamically stable and managed medically
with single dose methotrexate. Her B hCG is
3153 mIU/mL on day 1. Following methotrexate
administration and 3256 mIU/mL on day 4 and
2548 mIU/mL on day 7. What is the most
appropriate course of action based on these
values?
a. Schedule the patient for laparoscopy
b. Repeat B hCG after 1 week
c. Administer second dose of methotrexate
d. No further intervention or follow up is
required

A

b. Repeat B hCG after 1 week (magic
value: 15 % reduction between day 4
and day 7)

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14
Q

20-year-old primigravid with positive pregnancy
is diagnosed with a 2.5 cm right adnexal mass to
consider ectopic pregnancy by TVUS. Her B
hCG 1967 mIu/mL. Her hematocrit is 37% and
has small amount of free fluid in the cul de sac.
She strongly desires expectant management
rather than immediate treatment. Which aspect
of her history favors a successful resolution with
expectant management?
a. B hCG of less than 200 mIU/mL
b. Hematocrit level above 35%
c. Free fluid in the cul de sac
d. Ectopic pregnancy size < 3cm

A

d. Ectopic pregnancy size < 3cm

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15
Q

What adjunctive treatment to decrease her
complications associated with cervical ectopic
pregnancy?
a. Uterine artery embolization
b. Folly catheter cervical tamponade
c. Potation Chloride injection
d. All the choices are correct

A

a. Uterine artery embolization

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16
Q 
Most common time in gestation for pregnancy 
loss to occur is?
a. Less than 10 weeks
b. 10-14 weeks
c. 14-20 weeks
d. 20-37 weeks
A

a. Less than 10 weeks

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17
Q

Which of the following need NOT be performed
in a patient with recurrent pregnancy loss?
a. Extensive infection workup
b. Hysteroscopy
c. Lupus anticoagulant
d. Karyotyping of parents

A

a. Extensive infection workup

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18
Q

The risk of pregnancy loss is high in women

a. With 2 or more prior pregnancy loss
b. Under the age of 35
c. With prior C section
d. With prior pregnancy loss

A

a. With 2 or more prior pregnancy loss

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19
Q 
The most common cause of sporadic pregnancy 
loss in the first trimester is?
a. Infection
b. Tobacco exposure
c. Genetic abnormalities
d. DM
A

c. Genetic abnormalities

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20
Q 
The most common trisomy in spontaneous 
abortion is?
a. Trisomy 21
b. Trisomy 18
c. Trisomy 13
d. Trisomy 16
A

d. Trisomy 16

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21
Q

A female with recurrent abortion and isolated
prolonged aPTT is most likely associated with
a. Lupus anticoagulant
b. DIC
c. Von Willebrand disease
d. Hemophilia

A

a. Lupus anticoagulant

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22
Q 
All are causes of recurrent pregnancy loss 
EXCEPT:
a. APAS
b. Cervical incompetence
c. Bicornuate uterus
d. TORCH infections
A

d. TORCH infections

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23
Q 
Which of the following is false regarding 
complete miscarriage?
a. Uterus is smaller than the period of 
amenorrhea
b. Cervical os is open
c. Cervical os is closed
d. Both A and C
A

b. Cervical os is open

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24
Q 
Which of the following is not true for recurrent 
pregnancy loss?
a. Hysterosalphyngogram is the best 
method to rule out anatomical 
etiologies
b. Vaginal ultrasound may be used to 
detect anatomical defects
c. 3d vaginal ultrasound is superior to 2D 
ultrasound in detecting anatomical 
defects
d. Septate uterus is the most common 
anatomical cause of recurrent 
miscarriage
A

a. Hysterosalphyngogram is the best
method to rule out anatomical
etiologies

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25
Q

Pregnant lady of history of RPL is diagnosed to
have APAS. What would be the best treatment
for her?
a. Aspirin only
b. Aspirin + heparin
c. Aspirin + heparin + steroids
d. Aspirin + steroids

A

b. Aspirin + heparin

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26
Q 
Which of the following is not a widely accepted 
cause of RPL?
a. Progesterone deficiency
b. Uterine structural abnormalities
c. APAS Syndrome
d. Parenteral chromosomal abnormalities
A

a. Progesterone deficiency

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27
Q 
Which of the following clinical scenarios is not 
an indication for APAS testing?
a. History of severe pre-eclampsia 
requiring delivery at 38 weeks
b. History of fetal loss at 16 weeks AOG
c. History of three embryonic losses
d. History of thromboembolism
A

a. History of severe pre-eclampsia

requiring delivery at 38 weeks

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28
Q

30-year-old G4P0 0030 12-to-13-week AOG.
During prenatal check-up, OB history 3
abortions during the first and second trimester.
Vital signs: BP 110/70 mmHg, PR 78 bpm, RR
20bpm and temperature of 37C. What laboratory
should be requested?
a. B2 glycoprotein 1, Russel Viper
venom test and Anticardiolipin
antibodies
b. B2 glycoprotein 1, Russel Viper venom
test, dsDNA

A

a. B2 glycoprotein 1, Russel Viper
venom test and Anticardiolipin
antibodies

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29
Q

29-year-old primigravid 10-11 weeks AOG with
fever, body malaise and joint pain. Lab exam
shows positive ANA and anti-dsDNA. What is
the management?
a. Aspirin and heparin
b. Aspirin and prednisone
c. Aspirin, heparin and prednisone
d. Aspirin, heparin, prednisone and
azathioprine

A

b. Aspirin and prednisone

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30
Q 
What percentage of RPL is due to parental 
chromosomal abnormalities?
a. 10-12%
b. 8-9%
c. 6-8%
d. 2-4%
A

d. 2-4%

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31
Q 
The relation of the long axis of the fetus to the 
mother is called?
a. Presentation
b. Position
c. Fetal Lie
d. Attitude
A

c. Fetal Lie

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32
Q

Dysfunctional labor due to fetal factors: When
the fetal head is extended sharply, what type of
presentation results?

A

b. Face

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33
Q

35-year-old G3P2 37 weeks. In early labor with
estimated fetal weight of 2.5kg presents with
face. What will be the best management of her
delivery?

a. Induction of labor
b. Internal rotation to make mentum
anterior position
c. Caesarian section
d. Observation to allow spontaneous
rotation

A

d. Observation to allow spontaneous

rotation

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34
Q

34-year-old G2P2 38 weeks presented in the
OBAS. In early labor with baby in transverse lie.
At 4cm dilatation, the BOW spontaneously
ruptured. Which of the following is the most
distinct risk at this point?
a. Shoulder dystocia
b. Cord prolapses
c. Uterine rupture
d. Birth trauma

A

b. Cord prolapses

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35
Q 
What is McRoberts maneuver to release 
shoulder dystocia?
a. Rotation of the position shoulder to 
release the anterior shoulder
b. Abduction of shoulders 
c. Sharp flexion of maternal thighs and 
knees and suprapubic pressure 
d. Rotation and extraction of anterior 
shoulder
A

c. Sharp flexion of maternal thighs and

knees and suprapubic pressure

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36
Q 
Which of the following neonatal injuries may 
result from shoulder dystocia?
a. Femoral fracture
b. Skull fracture
c. Asphyxia
d. Intracranial hemorrhage
A

c. Asphyxia

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37
Q

Under what condition is external cephalic
version is allowed in breech and transverse
position?
a. Multiparity
b. Engaged presenting part
c. Placenta previa
d. Cephalopelvic disproportion

A

a. Multiparity

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38
Q

Fetal head after delivery retracts back and
became wedged into the perineum. This is
indicative of which of the following?
a. Contracted midplane
b. Poor maternal forces
c. Too early anesthesia
d. Shoulder dystocia

A

d. Shoulder dystocia

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39
Q

A G1P0 at term is in full cervical dilation after 6
hours of good labor with the baby’s head at
station +1. After 2 hours, the baby’s head was at
the pelvic floor with severe overlapping of the
sutures. Which of the following is a distinct risk
for the baby at this point?
a. Cord Prolapse
b. Cord compression
c. Intracranial hemorrhage
d. Sepsis

A

c. Intracranial hemorrhage

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40
Q

A 24-year-old primigravid after 6 hours of good
labor became full dilated and fully effaced. After 4
1 and a half hours, the head was at station +2.
She then complained of severe lower back ache
in spite of diminished maternal contractions.
Cervical lip was persistently present. After
another hour, the head was crowning with a
large caput. What is the most likely position of
the head?
a. Occiput anterior
b. Face
c. Occiput posterior
d. Brow

A

c. Occiput posterior

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41
Q

The challenges of the Gaskin All-4’s maneuver
for shoulder dystocia includes which of the
following
a. Time loss in patient repositioning
b. Inability of the assistant to pull hard on
the head
c. Inability of the operator to rock the fetal
shoulder from side to side
d. Inability of the fetal head to replace into
the pelvis

A

a. Time loss in patient repositioning

42
Q

A 40-year-old G4P3 3003 was admitted because
of watery vaginal discharge. Prenatal course
was uneventful. There were no comorbidities.
BMI is 25 kg/m2. Birthweight of previous babies
were in the range 2600g. IE: fully dilated, station
+3. Upon delivery of the fetal head, Turtle sign
was noted. When this occurs, the problem of
fetal size discrepancy is usually at the?
a. Pelvic inlet
b. Pelvic midplane
c. Pelvic outlet
d. Generalized contracted pelvis

A

a. Pelvic inlet

43
Q

A 26-year-old G2P1 woman at 41 weeks AOG
has been pushing for 3 hours without progress.
Throughout this time, her vaginal examination
has remained completely dilated, completely
effaced and station 0. With the head persistently
in the occiput posterior position. Which of the
following statement accurately describe the
situation?
a. Occiput posterior position is frequently
associated with a gynecoid pelvis
b. Labor progress is normal if the patient
does not have an epidural catheter for
analgesia but is abnormal if epidural
anesthesia is being used.
c. The patient is best described as
having a failure of descent
d. Bony part of the fetal head is slightly on
the body part of the pelvic inlet

A

c. The patient is best described as

having a failure of descent

44
Q

A 21-year-old G4P3 38 weeks AOG. During her
routine prenatal check-up, shows the following
findings on Leopold’s maneuver 2: A large
nodular mass on the right side and a hard round
ballotable mobile mass on the left slightly upper
portion of the abdomen. The fetal lie of the fetus
is?
a. Longitudinal
b. Oblique
c. Transverse
d. Breech

A

b. Oblique

45
Q

(A 21-year-old G4P3 38 weeks AOG. During her
routine prenatal check-up, shows the following
findings on Leopold’s maneuver 2: A large
nodular mass on the right side and a hard round
ballotable mobile mass on the left slightly upper
portion of the abdomen. )

Same patient: The presenting part of the above 
patient is most likely?
a. Breech
b. Acromion
c. Vertex
d. Mentum
A

b. Acromion

46
Q

Dysfunctional Labor (Forces and Passages). 19-
year-old G1P0at 40 weeks AOG came to the
admitting section for hypogastric pain. Vital
signs are normal with a fundic height of 31 cm.
Fetal Heart tone of 150bpm and with an IE of 2-
3 cm dilated, 50% effaced, cephalic at station -1
with intact BOW. She was hooked on the fetal
monitor which shows contractions occurring
every 8-18 minutes apart. Mild to moderate in
intensity lasting for 30 seconds. Clinical
pelvimetry seems adequate. At what stage of
labor is your patient coming to the admitting
section?
a. Latent Phase
b. Active Phase
c. Phase of maximum slope
d. Deceleration phase

A

a. Latent Phase

RATIONALE
b. Active Phase (New update: now starts
at 4cm)

47
Q

(Dysfunctional Labor (Forces and Passages). 19-
year-old G1P0at 40 weeks AOG came to the
admitting section for hypogastric pain. Vital
signs are normal with a fundic height of 31 cm.
Fetal Heart tone of 150bpm and with an IE of 2-
3 cm dilated, 50% effaced, cephalic at station -1
with intact BOW. She was hooked on the fetal
monitor which shows contractions occurring
every 8-18 minutes apart. Mild to moderate in
intensity lasting for 30 seconds. Clinical
pelvimetry seems adequate. )

Same patient: What is the acceptable limit at this 
stage of labor?
a. Less than 14 hours
b. Less than 20 hours
c. More than 14 hours
d. More than 20 hours
A

b. Less than 20 hours

48
Q

(Dysfunctional Labor (Forces and Passages). 19-
year-old G1P0at 40 weeks AOG came to the
admitting section for hypogastric pain. Vital
signs are normal with a fundic height of 31 cm.
Fetal Heart tone of 150bpm and with an IE of 2-
3 cm dilated, 50% effaced, cephalic at station -1
with intact BOW. She was hooked on the fetal
monitor which shows contractions occurring
every 8-18 minutes apart. Mild to moderate in
intensity lasting for 30 seconds. Clinical
pelvimetry seems adequate.)

Same patient: What will be the treatment of 
choice?
a. Immediate cesarian section
b. Extend monitoring for another 2 hours
c. Bedrest
d. Sedation
A

c. Bedrest

49
Q

(Dysfunctional Labor (Forces and Passages). 19-
year-old G1P0at 40 weeks AOG came to the
admitting section for hypogastric pain. Vital
signs are normal with a fundic height of 31 cm.
Fetal Heart tone of 150bpm and with an IE of 2-
3 cm dilated, 50% effaced, cephalic at station -1
with intact BOW. She was hooked on the fetal
monitor which shows contractions occurring
every 8-18 minutes apart. Mild to moderate in
intensity lasting for 30 seconds. Clinical
pelvimetry seems adequate.)

Same patient: Which of the following items
characterize the protracted active phase of
dilation?
a. If clinical pelvimetry is inadequate,
cesarian delivery is preferred
b. There is no dilation of 1cm per hour for
nulliparas
c. There is no dilation of 2cm per hour for
multiparas
d. Sedate the patient

A

a. If clinical pelvimetry is inadequate,

cesarian delivery is preferred

50
Q

(Dysfunctional Labor (Forces and Passages). 19-
year-old G1P0at 40 weeks AOG came to the
admitting section for hypogastric pain. Vital
signs are normal with a fundic height of 31 cm.
Fetal Heart tone of 150bpm and with an IE of 2-
3 cm dilated, 50% effaced, cephalic at station -1
with intact BOW. She was hooked on the fetal
monitor which shows contractions occurring
every 8-18 minutes apart. Mild to moderate in
intensity lasting for 30 seconds. Clinical
pelvimetry seems adequate.)

Same patient: Once the contraction becomes
regular with increasing intensity with shortened
interval, the patient requested for an epidural
anesthesia. What will you explain to her in terms
of the length of her labor?
a. Epidural anesthesia has no effect on the
latent phase of labor
b. It lengthens the first and second
stage of labor
c. Though epidural anesthesia may
lengthen labor, it does not slow down
the fetal descent

A

b. It lengthens the first and second

stage of labor

51
Q

A 33-year-old G3P3 patient. 40-week AOG.
came in for mild hypogastric pain. Vital signs
within normal limit. Fundic height 33 cm. Good
FHT. IE Cervix 4 cm dilated 50% effaced. Intact
bag of water. Cephalic. Station -2. What is the
acceptable rate of descent?
a. 1.2 cm/hr
b. 1 cm/hr
c. 2 cm/hr
d. 1.5 cm/hr

A

c. 2 cm/hr

52
Q

A 33-year-old G3P3 patient. 40-week AOG.
came in for mild hypogastric pain. Vital signs
within normal limit. Fundic height 33 cm. Good
FHT. IE Cervix 4 cm dilated 50% effaced. Intact
bag of water. Cephalic. Station -2. Patient
delivered in less than 3 hours after the
admission. Which is the statement being
maternal complications?
a. New born may fall to the floor
b. Brachial palsy
c. Intracranial hemorrhage
d. Postpartum hemorrhage

A

d. Postpartum hemorrhage

53
Q

A 33-year-old G3P3 patient. 40-week AOG.
came in for mild hypogastric pain. Vital signs
within normal limit. Fundic height 33 cm. Good
FHT. IE Cervix 4 cm dilated 50% effaced. Intact
bag of water. Cephalic. Station -2. Patient
delivered in less than 3 hours after the
admission. Which of the item is the fetal
complication of rapid labor?
a. Placenta abruption
b. Cervicovaginal lacerations
c. Brachial palsy
d. Uterine atony

A

c. Brachial palsy

54
Q

A 33-year-old G3P3 patient. 40-week AOG.
came in for mild hypogastric pain. Vital signs
within normal limit. Fundic height 33 cm. Good
FHT. IE Cervix 4 cm dilated 50% effaced. Intact
bag of water. Cephalic. Station -2. Patient
delivered in less than 3 hours after the
admission. Cervical dilation is facilitated by?
a. Hydrostatic action of unruptured
membrane
b. Thickening of fundal area
c. Formation of lower uterine segment
d. Resistance of the passing segment of
uterus

A

Hydrostatic action of unruptured

membrane

55
Q

A 33-year-old G3P3 patient. 40-week AOG.
came in for mild hypogastric pain. Vital signs
within normal limit. Fundic height 33 cm. Good
FHT. IE Cervix 4 cm dilated 50% effaced. Intact
bag of water. Cephalic. Station -2. Patient
delivered in less than 3 hours after the
admission. What is a fetal effect of dystocia?
a. Caput succedaneum
b. Fetal drop
c. Fistula formation
d. Abruptio placenta

A

a. Caput succedaneum

56
Q 
31-year-old G2P1 women at 40-week AOG 
progress in labor from 5 to 6 cm of cervical 
dilation over 3 hours. Which of the following best 
describe the labor?
a. Prolonged latent phase
b. Prolonged active phase
c. Failure of active phase
d. Protracted active phase
A

d. Protracted active phase

57
Q

G1P0 39-week AOG in active labor for 14 hours.
Uterine contractions 180 Montevideo units. IE
cervix 5 cm dilated 60% effaced. Left occiput
transverse. Station -1. Intact Bag of water.
Clinical pelvimetry adequate. What is the
abnormality?
a. Power
b. Passenger
c. Passage
d. Pelvis

A

a. Power

58
Q

Which of the following statement true comparing
Zhang vs Friedman’s curve?
a. Friedman curve begin to flatten at 3 to 4
cm.
b. In the zhang curve the active phase
of labor begins at 6 cm.
c. In the Friedman curve the active phase
of labor begins at 6 cm.
d. All of the above.

A

b. In the zhang curve the active phase

of labor begins at 6 cm.

59
Q

26-years-old multigravida 40-week AOG.
Presented to OB admission examination room
with labor pains. She was admitted at 6 cm
dilation. After 4 hours from time of admission IE
was the same 6 cm. What other piece of
information would you like to have to determine
your next step?
a. Estimated fetal weight
b. If her contractions are adequate
c. If her membrane is ruptured
d. If she had any analgesia

A

b. If her contractions are adequate

60
Q

Which of the following statements true regarding
contractions at mid-pelvis?
a. Causes transverse arrest of fetal
head
b. Less common than inlet contractions
c. It can be inferred when there are parallel
vaginal sidewalls
d. It is suspected if interspinous diameter
is less than 11 cm.

A

a. Causes transverse arrest of fetal

head

61
Q

Postpartum hemorrhage n old definition to
consider what would be the estimated blood loss
to have for a cesarean section?
a. < 550 ml
b. > 600 ml
c. > 1000 ml
d. < 900 ml

A

c. > 1000 ml

62
Q

32-year-old G2P1 1001 39-week AOG. Assisted
vaginal delivery via outlet forceps extraction for 6
fetal malpresentation. What is the most common
cause for postpartum hemorrhage for this
patient?
a. Uterine atony
b. Cervical laceration
c. Retained Product of conception
d. Uterine subinvolutions

A

b. Cervical laceration

63
Q 
62. Most common cause of postpartum hemorrhage 
is?
a. Retained cotyledons
b. Uterine overdistension
c. Lower genital tract lacerations
d. Uterine atony
A

d. Uterine atony

64
Q 
41-year-old G7P6 6006 37-week AOG was 
admitted for labor pains. What anticipatory plans 
should you do for known asthmatic & 
hypertensive?
a. Secure stock dose of Carboprost 
b. Secure stock dose of methergine 
c. Secure stock dose of dinoprostone
d. Secure stock dose of carbetocil.
A

d. Secure stock dose of carbetocil.

65
Q

35-year-old G2P2 2002 delivered via
spontaneous vaginal delivery in a lying in.
Referred to ER due to profuse vaginal bleeding
on examination you noticed boggy and soft
uterus. Crackles on bilateral lung fields. Patient
is hypotensive and tachycardiac. What
medication can probably give at lying in?
a. Carboprost
b. Oxytocin
c. Methergine
d. Carbetocil

A

b. Oxytocin

66
Q

Which statement is incorrect about carbetocin?
a. It is long-acting analog of oxytocin
b. It has sustained action similar to that of
methergine but without the side effect
c. Comparative studies of IV carbetocin
and IV infusion of oxytocin for the
prevention of PPH have identified
enhanced effectiveness
d. It is more effective in preventing PPH
compared to oxytocin.

A

c. Comparative studies of IV carbetocin
and IV infusion of oxytocin for the
prevention of PPH have identified
enhanced effectiveness

67
Q

32-year-old G2P2 2002 delivered via outlet
forceps extraction. 3 hours after delivery. She
referred for hypotension and tachycardia. On
examination patient is pale and incoherent. She
has soft abdomen with well contracted uterus.
There was no vaginal bleeding. What is your
diagnosis?
a. Uterine atony
b. Cervical laceration
c. Hematoma
d. Uterine rupture

A

c. Hematoma

68
Q

Patient with fundally implanted placenta
delivered vaginally. You applied vigorous cord
traction without signs of placental separation.
You noticed profuse vaginal bleeding and on
examination the inverted uterus is protruding to
the vulva. What is your diagnosis?
a. Uterine inversion stage I
b. Uterine inversion stage II
c. Uterine inversion stage III
d. Uterine inversion stage IV

A

c. Uterine inversion stage III

69
Q

Patient delivered via outlet forceps extraction.
Few hours after delivery, she complained deep
pelvic pain associated with difficulty in urinating.
On examination the patient is hypotensive,
tachycardic and pale. She has fluctuating mass
at paravaginal area. Which vessel is most likely
involved?
a. Cervical artery
b. Vestibular branch of pudendal artery
c. Descending branch of uterine artery
d. Deep circumflex vessels of paravaginal
triangle

A

c. Descending branch of uterine artery

70
Q

A patient delivered in lying in clinic 5 days ago.
She consulted ER for intermitted vaginal
bleeding. Ultrasound finding shows thickened
and heterogenous endometrium with noted fluid
within endometrial canal. What is the best
management for this patient?
a. Give uterotonic
b. Perform curettage
c. Embolization
d. Give broad spectrum antibiotics

A

d. Give broad spectrum antibiotics

71
Q

(A patient delivered in lying in clinic 5 days ago.
She consulted ER for intermitted vaginal
bleeding. Ultrasound finding shows thickened
and heterogenous endometrium with noted fluid
within endometrial canal.)

After placental delivery the uterus well
contracted but continue bleeding persistently.
So, what is the most appropriate approach to
this patient?

a. Inspect birth-canal
b. Massage uterus
c. Do a DNC
d. Give antibiotics

A

a. Inspect birth-canal

72
Q

30-year-old G6P5 5005 had profuse vaginal
bleeding after vaginal delivery. On examination
uterus noted to be boggy, what physiologic
process is responsible for the bleeding in this
patient?
a. Failure to compress spinal artery
b. Failure of decidua basalis to reepithelize
c. Increase amount of coagulation factors
d. Increase in the blood flow through
uterine vessel

A

a. Failure to compress spinal artery

73
Q

33-year-old G6P6 6006 referred to ER for
introital mass after delivery of baby at home. On
PE she is pale, hypotensive. You noted introital
mass had placenta mass with an umbilical artery
attached to it. Which of the following statement
may be carried out?
a. Use uterine relaxing agents before
manipulation
b. Immediate removal of placenta
c. Immediate oxytocin infusion once
venoclysis is available
d. Give Prostaglandin infusion prior to any
manipulation.

A

a. Use uterine relaxing agents before

manipulation

74
Q

30-year-old postpartum patient complaint of
severe hypogastric pain on PE. She was
tachycardiac. BP 80/min. There was note of
mass previously appreciated immediately after
delivery. Hematoma to consider. What artery is
most likely injured?
a. Pudendal
b. Uterine
c. Hypogastric7
d. Ovarian

A

b. Uterine

75
Q 
Which of the following suitable treatment for 
uterine inversion?
a. If recognized quickly fundal massage 
and uterotonic agents are initiated. 
b. Patient is evaluated for regional 
anesthesia. Large bore IV access is 
established. Rapid infusion is to begin 
while you wait for blood to arrive.
c. Immediate recognition and call for 
assistant improve outcome
d. All choices are correct.
A

c. Immediate recognition and call for

assistant improve outcome

76
Q 
This is fetal complication seen in placental 
abruption?
a. Postpartum hemorrhage
b. Hysterectomy
c. Non-reassuring fetal status
d. DIC
A

c. Non-reassuring fetal status

77
Q

Which statement does not describe placental
separation?
a. It can cause fetal growth restriction.
b. It can cause renal failure in mother.
c. Oligohydramnios can be seen in
traumatic abruption as a consequence
d. It can be associated with maternal
hypertension

A

c. Oligohydramnios can be seen in

traumatic abruption as a consequence

78
Q

Consumptive coagulopathy can be
characterized by which of the following items?
a. Increase in D-dimer concentration
b. Delay conversion of plasminogen to
plasmin
c. Decrease in fibrin degradation products.
d. Does not lead to thrombophilia

A

a. Increase in D-dimer concentration

79
Q

Following consideration is true in abruptio
placenta?
a. Vaginal delivery is allowed as long as
mother is stable and fetus is died.
b. Early amniotomy does not compress
spinal arteries
c. Small fetus with intact bag definitely
dilates the cervix
d. Uterotonic should not be used after
delivery of dead fetus in abruptio.

A

a. Vaginal delivery is allowed as long as

mother is stable and fetus is died.

80
Q

One of the following is true regarding placental
migration?
a. It does not occur since the villi are
anchored at internal OS
b. There is propensity to grow toward
lower uterine segment
c. Immigration is unlikely to occur if there
is previous cesarean section
d. Migration occurs at the first trimester

A

a. It does not occur since the villi are

anchored at internal OS

81
Q 
One of the demographic factors is not seen in 
placenta previa?
a. Teen Pregnancy
b. Multiparity
c. Myoma
d. Assisted Reproductive technology
A

d. Assisted Reproductive technology

82
Q

Among the following statements, which is not a
characteristics of placenta previa?
a. After placenta delivery, bleeding from
lower uterine segment is likely to occur
b. Lower segment fails to constrict the
blood vessels
c. Symptoms starts by the occurrence
of painful contractions
d. There is no bleeding until labor ensues if
the placenta implanted near at OS

A

c. Symptoms starts by the occurrence

of painful contractions

83
Q

This is frequent histologic finding in morbidly
adherent placenta?
a. Syncytia-trophoblasts invasion of
decidua basalis
b. Cyto-trophoblasts invasion of
myometrium
c. Trophoblastic giant cell infiltrating
the spinal arterioles
d. Trophoblastic infiltration of decidua
basalis

A

c. Trophoblastic giant cell infiltrating

the spinal arterioles

84
Q

Which of the following statement characterize
diagnosis of placenta previa?
a. Standard ultrasound cannot adequately
localize the placenta
b. If there is suspicious of previa digital
examination should be carried out
immediately
c. Internal examination should be done
in a setup where immediate CS
delivery can be done
d. Placenta previa is unlikely if there is
active bleeding in a patient with
ultrasound finding of placenta covering
internal OS

A

c. Internal examination should be done
in a setup where immediate CS
delivery can be done

85
Q 
Elective cesarean delivery for patient with 
morbidly adherent placenta at?
a. 32-34 week
b. 34-35 week
c. 36-37 week
d. 37-38 week
A

b. 34-35 week

86
Q 
Which of the following sonographic finding has 
highest positive and negative for placenta 
percreta?
a. Abnormal placental villous lakes
b. Thinning of retroplacental myometrium
c. Retroplacental vessel invade the 
myometrium
d. Loss of normal hypoechoic 
retroplacental zone
A

c. Retroplacental vessel invade the

myometrium

87
Q

29-year-old G2P2 24-week with two previous CS
delivery has an ultrasound findings of posterior
placenta previa with numerous placental lakes
suspicious of placental accrete. Which is the
next best step for confirmation of diagnosis?
a. Ultrasound at 28 weeks and 32 weeks
b. Doppler ultrasound of placenta
c. Do a transvaginal ultrasound
d. Do an MRI

A

d. Do an MRI

88
Q 
Which among the different causes of 
hemorrhagic pregnancy associated with 
normally implanted placenta?
a. Abruptio placenta
b. Placenta previa
c. Vasa previa
d. Placenta accreta
A

a. Abruptio placenta

89
Q

30-year-old G3P4 3003 underwent repeated CS.
Placenta was implanted anteriorly near the scar.
After delivery there was difficulty extracting
placenta. Which layer is affected?
a. Decidua capsularis
b. Decidua parietalis
c. Decidua basalis
d. All of the above

A

c. Decidua basalis

90
Q

30-year-old G2P1 36-week AOG was on her 10th
hour of delivery and still at 4 cm. Resident
decided to rupture bag of water and noticed
profuse vaginal bleeding. What is the most likely
cause?
a. Placenta previa
b. Vasa previa
c. Uterine rupture
d. Placenta abruption

A

b. Vasa previa

91
Q

For which situation submission of placenta for
pathologic examination is most informative and
cost effective?
a. Oligohydramnios complicating 3rd
trimester
b. Cholestasis complicating 3rd trimester
c. After CS delivery for arrest of descent
d. All of the choice are correct.

A

a. Oligohydramnios complicating 3rd

trimester

92
Q

Which of the following scenario an indication for
to screen for fetal maternal bleed?
a. Marginal hematoma noted during
routine pelvic ultrasound
b. Retroplacental hematoma noted
during 28-week ultrasound performed
for lagging fundal height
c. Sub-amniotic hematoma noted on visual
inspection of placenta
d. Chorioangioma noted during routine 28-
week ultrasound

A

b. Retroplacental hematoma noted
during 28-week ultrasound performed
for lagging fundal height

93
Q

Velamentous umbilical cord insertion variation
most commonly associated with higher rate of
which of the following?
a. Uterine inversion
b. Cord avulsion
c. Early separation of placenta
d. Single umbilical artery

A

b. Cord avulsion

94
Q

A single umbilical cord cyst found during first
trimester ultrasound performed for assessment
of vaginal bleeding. No other remarkable
findings noted during study. What is the most
reasonable next step?
a. Schedule follow-up ultrasound at 16-
to-18-week AOG
b. Ultrasound guided needle aspiration of
cyst
c. No alteration of routine care is indicated
d. Counselling regarding increased risk of
aneuploidy and offering chorionic villous
sampling.

A

a. Schedule follow-up ultrasound at 16-

to-18-week AOG

95
Q

28-year-old G2P1 20-week come in for fetal
anatomic survey. No pregnancy complication
noted. However, placenta was posteriorly
located and there was note of blood vessels
extending from the main placental disk crossing
in a tubular structure that are within membrane.
What do you document in ultrasound report?
a. Posterior placenta
b. Posterior placenta with accessory
lobe
c. Posterior placenta with chorioangioma
d. Posterior placenta with remote chorionic
hematoma

A

b. Posterior placenta with accessory

lobe

96
Q

28-year-old G2P1 20-week come in for fetal
anatomic survey. No pregnancy complication
noted. However, placenta was posteriorly
located and there was note of blood vessels
extending from the main placental disk crossing
in a tubular structure that are within membrane.
As a primary obstetrician of this patient which of
the following you note on patient’s report?
a. Schedule her delivery at 39-week in the
absence of prior indications
b. Closely examine placenta after
delivery to check for completeness of
placenta and do manual sweep of
uterine cavity to check for retained
products of placenta
c. Follow with serial growth ultrasound
d. All of the choice are correct

A 
b. Closely examine placenta after 
delivery to check for completeness of 
placenta and do manual sweep of 
uterine cavity to check for retained 
products of placenta
97
Q

32-year-old G2P1 at 38 weeks with prior
cesarean delivery present for growth ultrasound.
On ultrasound fetus is footling breech with
appropriate growth for gestation age. An
amniotic fluid index of 21 cm. No anomalies are
seen. What is appropriate next step in her
management?
a. Counsel the patient about the
findings and schedule her for repeat
cesarean section
b. Schedule a follow-up appointment at 1
week if undelivered
c. Counsel the patient about the findings
and do amniotomy
d. All of the choices are reasonable
option

A

a. Counsel the patient about the
findings and schedule her for repeat
cesarean section

98
Q

23-year-old multigravida presents for routine
fetal anatomic survey at 20-week AOG.
Sonographic findings show well-circumscribed
rounded predominately hypoechoic lying near
the chorionic plate and protruding into the
amniotic cavity. What modality is best use in
narrowing the differential diagnosis of placental
mass?
a. MRI
b. 3D ultrasound
c. Placental biopsy
d. Color doppler ultrasound

A

d. Color doppler ultrasound

99
Q

23-year-old multigravida presents for
routine fetal anatomic survey at 20-week AOG.
Sonographic findings show well-circumscribed
rounded predominately hypoechoic lying near
the chorionic plate and protruding into the
amniotic cavity. Which of the following will you
not recommend?
a. Submission of placental for pathologic
examination
b. Maternal serum AFP for open neural
tube defect
c. Serial Ultrasound for fetal growth and
fluids
d. Middle cerebral artery doppler of fetus

A

b. Maternal serum AFP for open neural

tube defect

100
Q 
With placenta abruption which condition 
preclude vaginal delivery?
a. Intrauterine fetal demise and prior 
classical CS hysterotomy
b. Term fetus at station 0, brisk vaginal 
bleeding and mild coagulopathy any 
station
c. Intrauterine fetal demise and HSV ulcer 
on the maternal perineum
d. All of the above.
A

a. Intrauterine fetal demise and prior

classical CS hysterotomy

Obstetrics 2022 (7 decks)

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