Obstetrics - COMPRE 2020 Flashcards
Which of the following patient will most likely have a C-section even if the pregnancy is term and cephalic in presentation?
38 year old G2P1 (1001) her first pregnancy was a C-section for failure of descent secondary to contracted inlet
A 35 year old G1P0 came in for labor pain, her vital signs were normal upon PE fundic height was 32cm, estimated fetal weight 2.6 – 2.8Kg, FHT 14o/min RLQ, upon IE 1cm dilated, beginning effacement, intact membrane, st -3, 1 contraction per 30 minutes, what is the best management for this patient?
Send her home
There was a labor curve given. The following questions are based on that. A G1P0 38 weeks AOG, identify the abnormality.
Arrest of cervical dilation
G1P0 38 weeks AOG, at what stage of labor does the
abnormality occurs?
Phase of maximum slope (The curve was in dilatation)
G3P2 (2002), 38 weeks AOG, at what phase of labour you recognize labor abnormality?
Deceleration phase (the curve shows 9cm dilatation)
Identify the labor abnormality?
Failure of decent (St -2 for 3 hours)
G3P2 (2002) 38 weeks AOG, what is your diagnosis?
Prolonged latent phase (1cm for 17 hours)
G3P2 (2002) 38 weeks AOG, what is the best management?
Therapeutic rest (1cm for 17 hours)
Multigravida patient is admitted on her 4th hour of labor, with regular contractions, cervix 2cm dilated, 50% effaced, st-2, LOP position, after 4 hours the cervix is 4cm dilated, fully effaced, st2, LOP, amniotomy was done. After 2 hours the cervix is 6cm
dilated, st 0, LOP, after 1 hour: 7cm dilated, st 0, 5 minutes to 3 hours, IE was done same finding, now with 2cm caput. Uterine contractions are strong, every 2-3 minutes, what is the best management?
C-section
A 24 year old primigravid patient consulted at the OB-ER. On the 10th hour of labor, she complains of watery vaginal discharge for an hour and irregular contractions. IE: 3-4cm dilated, ruptured bag, clear fluid gushing, head at station -1. 2 hour after
admission, the resident referred the patient to you with strong contractions every 1-2 minutes lasting to 40-60 seconds. Repeat IE was the same.
Sedate the patient and hook to tocometer
Which of the following statement, the engagement of the fetal head is true?
The greatest diameter, the transverse diameter passes through the pelvic inlet
In a vaginal delivery, the anterior shoulder is delivered, the OB palpates a nuchal cord, what is the best management?
Cord is slipped over the fetal head
What is the importance of fetal head flexion in the course of labor?
The occipitobregmatic diameter will present
Most common position in which the vertex enters the pelvis with the sagittal suture lying in the transverse pelvic diameter?
Left occiput transverse
A 31 year old G1P0, 34 weeks AOG, complaining of absence of fetal movement for 10 hours, vital signs are normal, fundic height 30cm, FHT 140??? RLQ. What is the best management?
Do a non- stress test immediately
A 33 year old G3P2, 40 weeks and 6 days, 1cm dilated, cephalic, no ballottement of the head, good fetal movement. What is the best management?
Do an amniotic fluid index
Correct sequence of new born care
Immediate drying, skin to skin contact, cord clamping and nonseparation
Which of the following is the correct method of drying?
Dry the baby’s face and head first
A 28 year old G1P0, at 38 weeks AOG, came in due to
hypogastria pain, patient had irregular prenatal check-up, upon PE: FH 27cm, with Leopold’s maneuverer revealed both transverse lei. Identify the position?
Right acromiodorsoanterior position
What is presenting diameter of the picture given below?
Occipitomental diameter
25 year old G2P1 (1001), at 39 weeks AOG, 1st pregnancy was normal delivery, prenatal check-up was unremarkable, PE: FH 32cm, Leopold’s maneuverer 2 FHT at left maternal side, LP 3 is unengaged. Not audible occiput was higher than sinciput. IE: cervix 3cm, 80% effaced, +BOW, st -2, what is the presenting diameter?
Occipitomental
A 25 year old, 38 weeks G1P0 came in due to labor pain, with FH 32cm, with good fetal heart tone, IE: 4-5cm, fully effaced, +BOW St 0, after 3 hours IE: fully dilated, fully effaced, -BOW, St +1, however fetal ear was palpated. What is your impression?
Posterior asynclitism
A 35 year old, 38 weeks AOG, G1P0 in labor, FH 33cm, with good fetal heart tone, 4cm???, fully effaced, +BOW, St 0, cephalic. After 3 hours fully dilated, fully effaced, st +!, however you palpated the fetal ear. After 2 hours still fully dilated, fully effaced, st +3. You noted that the mother was exhausted, she cannot bare down adequately. What will be your next step?
Forceps delivery
A 28 year old G1P0, in a 2nd stage of labor for 1 hour, the head is at St +2, in LOT position, after satisfying all the requirements for using forceps, which among the following forceps will you use?
Keilland forceps
A 30 year old G1P0 in 2nd stage of labor for 2 hours, satisfying all the requirements for using the forceps delivery, you will apply this type of forceps?
Simpson’s forceps
A G1P0 in 2nd stage of labor for 2 hours, the head has now developed a caput, now shows sagittal suture in anteroposterior diameter, what conditions has now lead to the use of forceps delivery?
Low forceps
23 year old G1P0, 38 weeks AOG, UTZ single intrauterine pregnancy, cephalic, BPS 10/10, amniotic fluid 14cm, posterior grade 3 placenta, estimated fetal weight 4kg, 75 grams OGTT at 28 weeks AOG normal, physical examination: vital signs normal, FH 37cm, no uterine contractions, IE: cervix soft, closed, midposition and adequate pelvis. What is the management for this patient?
Not audible. sadt (di masarap kabonding)
Most common cause of mid transverse arrest of fetal head during labor?
Contracted mid pelvis
In a young primigravid, in labor at term, what cardinal
movement will be affected if there is convergence of pelvic side walls and narrowed interspinous diameter
Internal rotation
32 year old G4P3(3003),37-38 weeks AOG, comes in labor, Fundic height = 30, good fetal heart tone, IE cervix fully dilated, st +3, left sacrum anterior. What is the most appropriate delivery method for the after coming head
Mauriceau maneuver
What is the best indicator of pelvic adequacy for vaginal breech delivery?
Steady cervical dilation and progressive descent with
contractions
23 year old, primigravid delivered 30 minutes ago with profuse vaginal bleeding, BP 90/60, PR 94 bpm, IE cervix 5 cm dilated, uterus contracted at level of umbilicus, what is the management of this patient?
Check for cervical and vaginal laceration
A 21 year old is birthed via forceps assisted vaginal delivery to a 2000 grams baby girl. In the process of the delivery, she sustains a second degree perineal laceration. During inspection prior to repair a non-enlarging solid swelling of clotted blood 1cm in
diameter is noted adjacent to the tear within the sub mucosa. After repairing the laceration, what is the next step in the management of this patient?
Manage expectantly with frequent evaluation
A 38 year old G5P5 delivered a 4100 grams baby after a 15 hour labor including a 2 and a half second stage. During the repair of midline episiotomy there is a marked increase in the amount of vaginal bleeding. Which of the following is an immediate cause of post-partum hemorrhage?
Uterine atony
32 year old, G3P2 (2002), delivered spontaneously to a live term baby boy in a tertiary hospital. She gave a previous history of low segment caesarean section in 2014 for placenta previa. In this case the attending resident failed to check the placenta because he was in a hurry to transfer her to the ward. The delivery room was overcrowded. After 30 minutes the patient
passed out and the nurse on duty noted her bed sheets to be fully blood soaked. What is the gross mistake made?
Placenta was not inspected for completeness
A 35 year old, G4P3, who delivered at 39 weeks via normal vaginal delivery, the placenta was implanted fundally, delivery of the placenta was complicated by an inverted uterus with subsequent haemorrhage leading to 1500 ml of blood loss. How will you manage the above patient?
Call for help, secure blood products, adequate anaesthesia, and manual reduction
A 29 year old, G2P1, 30 weeks AOG, comes to see you with new onset gastric reflux not responsive to antacids. The patient reported that she did not experience this during her previous pregnancy at the age of 20. What physiologic changes of
pregnancy explained this symptom?
Decreased gastroesophagel sphincter tone
A 28 year old, G2P1 (1001), of 5 weeks AOG came in for prenatal check-up. You requested for transvaginal ultrasound, findings showed, intrauterine gestation of 5 weeks and 4 days by gestational sac diameter, there was an ovarian cyst measuring 7cm of the widest diameter at the left side. The description of ring of fire was also noted. What is the possible adnexal cyst?
Corpus luteum
This change in the cervix makes identification of atypical glandular cells in Pap smear difficult.
Hyperplasia and hyper secretory appearance of endocervical glands
Which of the following soluble receptor
attenuates vascular endothelial and placental growth factor in vivo?
SFLT-1
The fetus gains the most amount of weight during which period of AOG?
10-20 weeks
Which of the following statements is true regarding the glucose and insulin levels in pregnant and non-pregnant women?
Glucose levels increases after meals in pregnancy
A 28 year old, G1P0, 42 weeks AOG presents to the clinic with complaints that she is always tired all the time and her feet swell if she stands for too long. Her cervix is posterior, closed, uneffaced and very firm. As discussion begins regarding the possibility of induction, the patient asks what her chances of having her baby vaginally are.
Induction with artificial ripening agent is an option
. A 25 year old, G1P0 at 39 weeks came in due to watery vaginal
discharge, FH 30 cm, with Good fetal heart tone, cervical exam
includes pooling amniotic fluid, IE 1cm, 50% effaced, cephalic, st
-1, she has mild to moderate uterine contractions lasting 30
seconds interval of 10 minutes, venoclysis was done, oxytocin
drip with 10 units oxytocin incorporated in 1 liter of D5LRS was
started. How many drops of oxytocin will achieve regular
contractions
16-24 drops
What is the fetal position when the fetal head after engagement
goes into posterior asynclitism at the pelvic brim?
Left occiput transverse
A 27 year old, G1P0, was seen at the clinic for prenatal care for
her amenorrhoea for 8 weeks and PT is positive. TVS done
compatible with AOG. She complains of frequent urination and
unexplained weight loss which started 6 months prior to the
pregnancy. You requested urinalysis which revealed glycosuria.
FBS 130mg/dl. What is the diagnosis
G1P0, pregnancy uterine, 8 weeks AOG, Overt diabetes mellitus
For patients with average risk for GDM. When should testing be
done?
Perform 75g OGTT at 24-28 weeks, then repeat at 32 weeks
AOG
A 38 year old, G2P1, consulted at 10 weeks AOG, her 1st baby was 4.1 kg at birth and was delivered via CS. Her BMI in-between pregnancies was 32. Her mother died of diabetic complications.
Her blood chemistry 6 weeks post-partum was within normal
limits. Which of the following should be done.
Diabetes screening as soon as feasible
Fetal growth monitoring is essential in the management of
diabetes in pregnancy because diabetic pregnant patients are
prone to develop fetal macrosomia with poor glycemic control.
Which of the following is true?
Fetal macrosomia is associated with difficult delivery and birth trauma
Polyhydramnios is one of the fetal complications of diabetes in pregnancy. Which of the following is true?
Polyhydramnios is caused by fetal hyperglycemia which leads to polyuria
Glycemic targets in overt or gestational diabetes
2 hours post-prandial blood glucose of less than or equal to —-
120mg/dl
When should the patient with diabetes treated with insulin be delivered
38 weeks
ACOG, recommends to repeat the 75g 2 hour OGTT for the diagnosis of overt DM post-partum
6 weeks
From within outward which of the following are tissues of the
pelvic floor
Peritoneum, sub peritoneal connective tissue, internal pelvic
fascia, levator ani muscles and coccygeus, external pelvic fascia,
superficial muscles and fascia, subcutaneous and the skin
In median episiotomy which of the following will be in the
restoration of the perineal body for long support?
Closure of fascia and incised muscles
21 year old 31-32 weeks with the chief complaint of watery
vaginal discharge VS: BP 110/70, T 38.2 C pulse rate of 102,
abdominal exam- no uterine contraction, FHT 132/min ,
speculum exam with pooling of amniotic fluid, IE cervix 2cm 80%
effaced cephalic, station 0.What is the best management for
her?
Induction of labor ( because patient shows signs of
chorioamnionitis)
21 year old 31-32 weeks with the chief complaint of watery
vaginal discharge, abdominal exam- no uterine contraction,
good FHT, speculum exam with pooling of amniotic fluid, IE
cervix soft and closed. Which of the following is not part of the
management?
Nifedipine
Which of the following is true regarding family planning?
IUD is best suited for older porous women
Gian 22 y/o, G2P2 (2002) commercial sex worker came in for
desirous for contraception. What is the best method you would
advise?
Condom
Lea 26 y/o G1P1 (1001) came in for consult for contraception.
PMH unremarkable. She is on 3rd day of her menstruation.
Positive for acne. BMI is normal. IE unremarkable. What is the
best method suited for her?
Combined oral contraceptive
What is the mechanism of action of combined oral contraceptive
pills?
Estrogenic agent suppress the FSH; Progestational agent suppress the LH
Which of the following breast diseases are the cause of
spontaneous non milky nipple discharge?
Fibrocystic change and intraductal papilloma
BRCA 1 and BRCA 2 are the genes found in the breast and the
ovarian tissue. Which of the following are their main role?
Encode for DNA repair
56 y/o sought consult for second opinion for her previous
consecutive annual breast mammography showing BIRADS
category 1 and 2. It should be explained to her that this category
is?
Non malignant
52 y/o nulligravid with stage 2 breast cancer having a preoperative multi-disciplinary counselling asks about her survival
after surgery and post op chemo radiation. Which of the
following statement is true about survival after breast cancer
surgery?
Survival depends on presence and no of axillary node
metastasis
24 y/o nulligravid complains of painful small lumps in both of her
breasts. She is on day 25 of her regular menstrual cycle. Family
history (-) breast Cancer On palpation found nodularities on
upper inner quadrant of both breast. What is the next step in
the evaluation?
Repeat breast exam after menstruation
What is the suggested management of asymptomatic
leiomyoma?
Observation and annual pelvic exam
Select the best statement that characterizes the leiomyoma?
Sufficiently large uterus due to myoma can cause urinary
frequency
Which medical management address the symptoms of
dysmenorrhea, menorrhagia, pelvic pressure and infertility?
GnRH agonist
According to FIGO Iatrogenic cause of abnormal uterine
bleeding is?
Warfarin
Endometriosis may have this characteristic?
Spread by adherent lymphatic
Primary method to diagnose endometriosis is to?
Laparoscopy
Which of the following symptoms is least seen in patient with
endometriosis?
Non cyclic Pelvic pain
A perimenopausal women with mild cyclic pain with
endometriosis can be managed with?
Expectant management
GnRH agonist are used in the treatment of endometriosis.
Which of the following statement is true regarding its effect on
endometriosis?
Estrogen can be added as an adjunct therapy
The hypo estrogenic state….. necessary in the treatment of
endometriosis can be created medically with contraceptive
inducing?
Pseudo pregnancy state
In cases of primary amenorrhea in pubertal patient having
discordance between genotype and phenotype with
psychological female gender identity management includes?
Hormonal replacement therapy and pre expected (?)
menopause
Which of the following causes of secondary amenorrhea will
come up with a positive result in a progesterone challenge test?
Polycystic ovarian syndrome
Which of the following patients with genetic disorders
presenting with amenorrhea, which one would have a uterus?
Swyer syndrome the pure gonadal deficiency
Which of the functional cyst will appear in ovarian hyper
stimulation using assisted ovarian technology?
The theca lutein cyst
Which of the statement best describes a mature cystic
teratoma?
May contain a dermal process
What is the best indicator of ovarian reserve?
Anti-mullerian hormone
Best diagnostic tool to determine tubal patency?
Hysterosalphingogram
Part of workup of infertile women presenting with
oligomenorrhea?
Prolactin
Correct statement of perimenopause?
Menstrual irregularities defines and establishes peri menopausal transition
. 29 year old G2P2 present with a 2cm lesion at the cervix which
appears only at a small portion of a adjacent vaginal. What Is the
next step to be taken?
Punch biopsy of the lesion
For cervical cancer what is the most significant prognostic
factor?
Stage of the disease
Stage of the disease
The histological changes associated with intraepithelial
neoplasia in the vulva or cervix is basically?
Loss of normal maturation of the squamous epithelium
A 60 y/o complains of vulvar irritation on the pelvic exam she
has 2x2 cm thick whitish elevated lesion at the labia majora
what is the diagnostic procedure of choice in this patient?
Excision biopsy
Regarding vulvar intraepithelial neoplasia, which of the following
statement is correct?
The risk of progression to cancer is higher in older women
50 y/o women is found to have asymmetric 1x1 cm….edges
which according to the patient used to be black but is now
reddish black. What is the best management approach?
Do excision biopsy
What is the best treatment function of the paeget disease of the
vulva?
Wide Local excision
A 40 y/o G3P3 consulted at OPD with an atypical cellular
hyperplasia in the pap smear .The next step in the management
of her case is?
Colposcopy
A 45 y/o G5 presents with abnormal uterine bleeding. Speculum
exam reveals smooth closed cervix with malodorous discharge
and corpus enlarged. What is the next course of action in the
management of this patient?
Biopsy
48 y/o healthy post-menopausal woman has a pap smear which
reveal s atypical glandular cells. She doesn’t have history of
abnormal Pap smear. Which of the following is the next best
step?
Colposcopy, endocervical curettage and endometrial sampling48 y/o healthy post-menopausal woman has a pap smear which
reveal s atypical glandular cells. She doesn’t have history of
abnormal Pap smear. Which of the following is the next best
step?
Colposcopy, endocervical curettage and endometrial sampling
What is the most important prognostic factor of the vulvar
cancer?
Lymph node involvement
Primary vaginal cancer is rare. Most cancer vagina are extension
from which organ?
Cervix
Adenocarcinoma is more likely to have the squamous cell to
spread to which organ or tissue?
Lungs
A 62 y/o post-menopausal woman complains of on and off
profuse vaginal bleeding. Pertinent PE shows normal external
genitalia, smooth vaginal walls, smooth small cervix and
enlarged uterus. What is the diagnostic procedure of choice in
this patient?
Endometrial biopsy
When is staging accomplished in endometrial CA?
When the results of histopath are in
