Ob Evaluation 1 Final- Sec A

OB EVALUATION 1- SET A Section A Flores, Marie Felle

1. Which of the following phrases best describes Reproductive Health? a. absence of disease b. complete state of well being c. adequate coverage of contraception d. prevention of maternal death and sexually transmitted disease Answer: B. complete state of well being Rationale: Reproductive Health is defined as a state of complete physical, mental and social well-beingand NOT merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. It also includes sexual health, the purpose of which is the enhancement of life and personal relations. Complete state of well-being pretty much summarizes the whole essence of Reproductive Health that is why it is the best phrase that would best describe it. Reference:Sumpaico, 3rd Edition, page 2

Jaurigue, Jaymee

2. Which of the following statement is/are component of Reproductive Health: a. safe motherhood b. management of abortion complications c. information and services on Family Planning d. prevention and management of sexual violence e. all of the above Answer: E- all of the above Rationale: Components of Reproductive Health includes: a) information and services on Family Planning, (b) safe motherhood, (c) gynecological care including management of abortion complications, (d) prevention and treatment of sexually transmitted diseases (including HIV/AIDS), (e) prevention and management of sexual violence, (f) active discouragement of harmful traditional practices, (g) Reproductive health programmes for specific groups such as adolescents. Reference :page 4 Sumpaico, et al (2008) Textbook of Obstetrics, 3rd Edition. R

Abanto, Mara

3. Due to limitied sources, which Reproductive Health Porgrams/s in the western pacific region will be prioritized according to WHO? a. safe motherhood b. family planning c. improve child mortality d. a &b are correct Answer: D a &b are correct Rationale: The health priorities of the countries were then ranked. Highest on the list was the “high abortion rate”, with “high unmet family planning needs (“or helping couples attain desired family size”) the second priority. “Adolescent reproductive health, “safe motherhood” and the “maternal mortality rate” were the third and fourth priorities. “Infertility” was considered the fifth most important health problem. Reference: Women's Health. Western Pacific Region. WHO. p 91.

Cabalza, Mary Anne

4. For the Millennium Development Goal, Maternal Mortality by year 2015 should be decreased by how many percent? a. 25 c.75 b. 50 d.85 Answer: C. 75% Rationale: According to Millennium Development Goal 2010 Report of United Nation, There target for Maternal Mortality should reduce by three quarters or 75%, between 1990 and 2015.

References: Report on the Millennium Development Goals (June, 2010) published by United Nations Department of Economic and Social Affair.: http://www.un.org/millenniumgoals/pdf Beatriz, Roxanne Marie

5. Which branch of medicine is concerned with pregnancy, labor and puerperium and aims to promote health and well-being? a. Obstetrics c. Perinatology b. Reproductive Health d. Midwifery Answer: A Obstetrics Rationale: According to Cunningham, et. al., obstetrics is defined as a branch of medicine that deals with childbirth and maternal care and treatment before and afterbirth. It also promotes health and well-being of the pregnant woman and her baby through quality prenatal care, supervision during labor and delivery and management of the puerperium. Reference: Cunningham FG, et. al. (2010).Williams Obstetrics, 23rd edition. New York: McGraw-Hill (E-book – Chapter I. Overview of Obstetrics, paragraph 1, 2)

Cruz, Fatima

6. Which of the following is the best index of the quality of life and health in a society? (evals 1) a. population density b. fertility rate c. maternal outcome d. life expectancy Answer: C fertility rate Rationale: “The importance of obstetrics is attested to by the use of maternal and neonatal outcomes as an index of the quality of life and health in a society.” Reference: William Obstetrics 23rd edition Chapter 01 page 02.

Holgado, Anna Victoria M.

7. Which of the following is NOT a prerequisite to live birth? a) AOG more than 20 weeks b) Placenta delivered c) Pulsation of the umbilical cord d) Breathing movement Answer: (b) Placenta delivered Rationale: Live birth is a term used to record a birth whenever the newborn at or sometime after birth breathes spontaneously or shows any other sign of life such as a heartbeat or definite spontaneous movement of voluntary muscles. Heartbeats are distinguished from transient cardiac contractions, and respirations are differentiated from fleeting respiratory efforts or gasps." - Furthermore, the term "birth" refers to the complete expulsion of the fetus (after 20 weeks' gestation) from the mother - In either definitions, placental delivery has not been used as part of the criterion Reference: Cunningham, F.G. et. al (2010) "Chapter 1: Overview of Obstetrics". William's Obstetrics (23rd edition). (Retrieved from Access Medicine, McGraw-Hill)

Dimapilis, Gail Austin C.

8. Considerable weight loss of the newborn happens after delivery. Therefore the newborn must be weighed during the first ____ hour/hours of life: a. 1 b. 6 c. 12 d. 24 Answer: (a) 1 Rationale: Birthweight of neonate is determined immediately after delivery or as soon thereafter as feasible. It should be expressed to the nearest gram. Reference: Williams 23rd edition, page 3

Jualayba, Elkie

Total Births includes livebirths: a. 20 weeks AOG and above

b. and fetal deaths 20 weeks AOG and above c. 20 weeks AOG and above and fetal deaths 24 weeks AOG and above d. and fetal deaths 24 weeks AOG and above Answer: B . and fetal deaths 20 weeks AOG and above Rationale: Total Births – the total number of deliveries, live births plus fetal deaths. Reference: Walfrido Sumpaico. 3rd Ed. Page 7 Lapitan, Jaecel Reyenne

10. Birth rate is defined as number of: a. Total births per 1000 population b. Total births per 1000 total pregnancies c. Livebirths per 1000 population d. Livebirths per 1000 total pregnancies Answer: C Livebirths per 1000 population Reference: Sumpaico, W. W. (2008). Textbook of Obstetrics: Physiologic and Pathologic Obstetrics. 3rd ed. Chapter 1 page 6.

Fabian, Jeffrey Michael C.

11. Perinatal period is defined as the period from 20 weeks AOG to: A. Delivery B. 7 days of life C. 28 days of life D. 42 days of life ANSWER: C 28 days of life Rationale: Perinatal period is the period after birth of an infant born after 20 weeks and ending at 28 completed days after birth Reference: Williams, 23rd EDITION, PAGE 3

De Lemos, Diordan

12. A women delivered, prematurely in a remote area with no health facility. What is your best evidence that the new born is not an abortus? a. computed AOG based on the LMP b. time when quickening was felt c. crown to rump length of the newborn is 28 cm. d. fundic height prior to delivery is above the umbilicus ANSWER: LETTER C. crown to rump length of the newborn is 28 cm. RATIONALE: Accdg to Williams, Crown to rump length is the most accurate biometric predictor of gestational age. An abortus is defined as an embryo or fetus expelled during the 1st half of pregnancy, less than 20 weeks, less than 500 grams or less and with 16.4 cm or less in length. Since it was indicated that the crown and rump length of the newborn is 28 cm, it only means that the baby is already and approximately in his 23 to 24 weeks AOG. Knowing your AOG based on the LMP can also help you but LMP is not that accurate. Considering that there are some chances that pregnant woman might forget their own LMP unlike for the crown and rump where you can actually measure the baby’s length. Quickening cannot be used as your basis because it can occur for as early as 14th week or as late as 26th week, meaning to say, it varies for every baby. REFERENCE: 23rd Edition Williams Obstetrics by Cunninghum et al., page 352. http://www.babycenter.com/average-fetal-length-weight-chart

Cotas, Paola Ysabel D.

13. A premature infant was born at 27 to 28 weeks. The baby died on the 60 th hour of life. This is considered: a. Fresh stillbirth b. Macerated stillbirth c. Early neonatal death d. Late neonatal death Answer: C Early neonatal death Rationale: It is NOT a stillbirth because, even though the infant is premature, the baby was still delivered alive. Early neonatal death is classified as “death of a liveborn neonate during the first seven days after birth” while the late neonatal death is classified as “death after seven days but before twenty-nine days after birth.” Therefore, the answer is LETTER C, EARLY NEONATAL DEATH since the premature infant was born on the 60th hour of life or two and a half days after birth.

Reference: Page 7, Chapter 1: Overview of Maternaal Health in the Philippines, Textbook of Obstetrics (Physiologic and Pathologic Obstetrics), 3rd edition, Sumpaico et. al. Bernus, Marie Grace M.

14. A 35 y/o pregnant woman on her 34 to 35 weeks AOG delivered to a 2.5 kg live baby girl, APGAR score 9-9. Ballard’s scoring of the newborn is 36 weeks. The baby did well post-delivery. The delivery is considered as: a. preterm b. term c. postterm Answer: A Rationale: The 25 y/o pregnant woman was on her 34 to 35 weeks AOG when she delivered to the baby girl. Preterm birth is defined as delivery before 37 completed weeks AOG. (p. 804) Reference: Cunningham, F. G., Williams, J. W., Leveno, K. J., Bloom, S., Hauth, J. C., & Rouse, D. J. (2010). Williams Obstetrics. (3 ed.) (pp. 804) . New York: McGraw-Hill Professional

Crisanto, Hebe Margaret

15. A 35 years old pregnant woman on her 34 to 35 weeks AOG delivered to a 2.5 kg live baby girl, APGAR score 9-9. Ballard’s scoring of the newborn is 36 weeks, the baby did well post-delivery. The weight of this newborn is: a. low birth weight b. appropriate c. large for the gestational age Answer: b. appropriate Rationale: Weight is between the 10-90th percentile. Reference: Williams Obstetrics 23rd edition (E-book) Chapter 36, Pre-term Birth

Carlos, Jason

16. The death of the mother is due to ________ death. (Mother died from a severe asthmatic attack during post partum) a. direct obstetric b. indirect obstetric c. non-obstetric Answer: b. indirect obstetric Rationale: A direct obstetrical death is a death of a mother that results from obstetrical complications of pregnancy, labor, or the puerpurium and from interventions, omissions, incorrect treatment, or a chain of events resulting from these factors. An exaple of which is the death of a mother from exsanguination after uterine rapture. On the other hand, non-obstetric death is due to accidental or incidental causes not related to pregnancy. An example of which is a death of a mother due to a car accident. Finally, an indirect obstetric death results from previously existing disease, or a disease developing during pregnancy, labor or puerpurium that was aggravated by maternal physiological adaptation to pregnancy. An example of which is from the case given in the question above. The mother's death was due to the aggravated asthmatic attack caused by pregnancy. Reference: Williams Obstetrics, 23rd edition, chapter 1, page 3

Almaden, Vanessa

17. A 38 year old G5P4(4-0-04), was in labor when a landslide hit her baranggay. The parturient eventually died. This is considered a ________ death. a. direct obstetric b. indirect obstetric c. non-obstetric Answer:C. Non obstetric death/ Non maternal death Rationale: By definition non obstetric death is the death of the mother that results from accidental or incidental causes not related to pregnancy. An example is death from an automobile accident or concurrent malignancy. While, Direct obstetric death is defined by the death of the mother that results from obstetrical complications of pregnancy, labor or the puerpuerium and from interventions, omissions, incorrect treatment, or a chain of events resulting from any of these factors.

Indirect maternal death, on the other hand is defined by the purposeful interruption of an intrauterine pregnancy with the intention other than to produce a liveborn neonate, and which does not result in a life birth. Reference: Williams 23rd edition page 3 Jurao, Ara

18. Maternal mortality ratio is defined as the number of maternal deaths from the reproductive process over a. 10,000 population b. 10,000 livebirths c. 100,000 population d. 100,000 livebirths ANSWER: D 100,000 livebirths RATIONALE: Maternal mortality ratio is the number of maternal deaths that result from the reproductive process per 100,000 livebirths. Used more commonly, but less accurately, are the terms maternal mortality rate or maternal death rate REFERENCE: Cunningham, G., and et. al. (2010). Williams Obstetrics (23rd ed). The McGraw-Hill Companies, Inc.

Dela Cruz, Joan Vel S.

19. Majority of Filipino mothers deliver at/in a. home assisted by a doctor b. home assisted by a midwife c. lying-in clinics with a midwife d. hospital with nurses and doctors Answer: (B) home assisted by a midwife Rationale: Based on the 2003 NDHS, about 60% of deliveries take place at home, usually attended by TBA’s(Traditional Birth Attendants) or by midwives. Reference: Textbook of Obstetrics (Physiologic and Pathologic Obstetrics), 3rd ed., by Sumpaico, et al. page 5.

Delos Santos, Christian

20. Considering that the leading cause of Maternal Death is from complications of labor, delivery and puerperium, the most effective way of improving maternal mortality is to improve the training of our: a. hilot c. general practitioner b. midwives d. Obstetrician and Gynecologist Answer: A. hilot Rationalization: In our country where more births are attended by traditional birth attendants ( TBA; hilot) rather than health workers, the lowering of maternal mortality can be readily attained by directing attention to these TBA’s. Reference: Chapter 1: Overview of Philippine Obstetrics; page 7.; Textbook of Obstetrics 2nd edition.; Author: Walfrido W. Sumpaico., M.D.

Exconde, Ma. Kathrina

21. As compared to gestational age, the fertilization age is: A. Less than two weeks B. less than four weeks C. More than two weeks D. More than four weeks Answer : A Rationale: Embryologists and other reproductive biologists more often employ ovulatory age or fertilization age, both of which are typically two weeks shorter. Reference: Williams, 22nd Edition, (Chapter 8, page 208)

Co, Jeffrey James

22. The most accurate way of determining gestational age during early pregnancy is by: a. Last normal menstrual cycle c. gestational sac size b. Correlation with uterine size d. crown rump length Answer: D. crown rump length Rationale: According to Cunningham et al., the crown rump length is the most accurate way to determine gestation age during the first trimester. The Last normal menstrual cycle or LNMP is only used for patients with normal menstrual cycle. It is also erroneous because you rely on the patient’s recall of her LMP.

Reference:Williams Obstetrics, 21st edition, page 1114-1115 Constantin o, Erwin

Alcantara, Janus

23. The developing zygote enters the uterine cavity as a: a. Blastomere b. Blastocyst c. Morula d. Gastrula Answer: C Rationale: It is stated in Williams that after 3 days of slow cleaves in the fallopian tube the blastomere will develop into a morula, which is what the fetus is termed, as it enters the uterine cavity. Reference: Williams, Edition 23, Page 48 24. A woman had a positive pregnancy test done today yet she claims to have bleeding for three days just a week prior. this bleeding however was much less in amount than her usual menses. this decreased amount of bleeding can be best explained by: a. Corpus Luteum Deficiency b. Implantation Bleeding c. Pathologic or Abnormal Pregnancy d. Hormonal Imbalance ANSWER: b. Implantation Bleeding RATIONALE: this physiologic bleeding is caused by the attachment of the blastocyst into the endometrium. It is characterized by a bleeding that is less in amount compared to the usual menses REFERENCE: Williams 23rd ed. p. 221

Cabanos, Ronell

25. : Diploid number of chromosomes is maintained despite fusion of two gametes due to reduction division, which occurs during: A. First meiotic division B. Second meiotic division C. Both are correct Answer: A. First meiotic division Rationale: The first meiotic division is also called the reductional division, which resuts in the haploid number of chromosomes. The second meiotic division, also called as the equational division, preserves the haploid number of chromosomes produced during the first meiotic division. Reference : Carlson, b. M. Human Embryology and Developmental Biology. pp 5-6

Angeles, Ma. Kristina Cassandra S.

26. The process of spermatogenesis begins at: a. 12 weeks AOG b. 20 weeks AOG c. Birth d. Puberty Answer: D Puberty Rationale: Spermatogenesis the process of producing Spermatozoa from spermatogonia begins at puberty and continues until old age. Rerefence: Esteban and Gonzales Textbook of Histology pg 217

Bunyi, Maria Athena

27. The process of oogenesis begins at: a. 12 weeks AOG b. 20 weeks AOG c. birth d. puberty Answer: letter A Rationale: Following the immigration of the primordial germ cells into the gonadal ridge, oogenesis takes place in the genital primordium. Proliferation occurs and at the onset of meiosis I during the 12th week, the oogonium matures and gives rise to the primary oocytes, which become arrested in the diplotene stage of prophase I. The continuation of the development / maturation of the oocyte begins again only a few days before ovulation.

References: Sumpaico, W. et. al, Textbook of Obstetrics 3rd Edition Cunningham F. et. al. William Obstetrics 23rd Edition Andres, Rachel

28. A patient is on medication for low sperm count. Knowing the length of time for spermatogenesis to be complete, how many days post-treatment is the best time to do a seminalysis? a. 30 b. 60 c. 90 d. 120 Answer: B Rationale: Spermatogenesis is the process of producing spermatozoa from spermatogonia. It starts at puberty and continous until old age. It takes about 64 days for the spermatogonia to develop into spermatozoa. Reference: Estaban and Gonzales' Textbook of Histology 4th edition (pages 218222)

Boac, Ma. Minerva

29. Which process occurs with ovulation? a. Completion of first meiotic division b. Completion of second meiotic division c. Capacitation d. Release of two polar bodies Answer: A. Completion of first meiotic division Rationale: A. Completion of first meiotic division ovulation B. Completion of second meiotic division occurs upon fertilization. C. Capacitation is the process wherein the sperm undergoes transformation to penetrate the into the egg cell. D. During ovulation, the primary oocyte becomes a secondary oocyte and a single polar body is produced. Reference: Sumpaico. Textbook of Obstetrics (Physiologic and Pathologic Obstetrics) 3rd Edition. Page 72

De Castro, Jener N.

30. When is the maximum number of germ cells in the ovary achieved? a. 12 weeks AOG in utero b. 20 weeks AOG in utero c. At birth d. At puberty Answer: B 20 weeks AOG in utero Rationale: 12 weeks AOG in utero - 0.6 million germ cells in the ovary At birth - 2 million germ cells in the ovary At puberty - 400,000 germ cells in the ovary During 20 weeks AOG in utero (5months), there is the maximum number of germ cell in the ovary (approximately 6 million). Reference: Walfrido W. Sumpaico, Textbook of OBSTETRICS (Physiological and pathologic obstetrics) 2nd edition pages 27 and 28 (figure 3.5)

Balandan, Patricia Joy C.

31. At what age in years does atresia of follicles start to accelerate? a. 25 b. 30 c. 35 d. 40 Answer: C. 35 Rationale: In human ovary, 2 million oocytes are found at birth and about 400,000 follicles are present at the onset of puberty. The remaining follicles are depleted at a rate of approximately 1000 follicles per month until 35 years of age, when this rate accelerates. Therefore, more than 99.9 percent of follicles undergo degenerative process known as atresia. Reference: Williams 22nd Edition, page 40

Atienza,

32. Exposure to teratogens will cause major congenital anomalies between 4 to 8

Kriska

weeks AOG because this is the period of: a. rapid differentiation b. maximal growth

c. Increased cellular division d. Optimal change in shape

Answer: A. Rapid differentiation Rationale: Increased cellular division of the embryo begins after fertilization, it involves multiplication of cells via mitosis, in the fallopian tube, the mature ovum becomes a zygote—a diploid cell with 46 chromosomes—that then undergoes cleavage into blastomeres. The zygote undergoes cleavage for 3 days. As the blastomoeres continue to divide, the morula is produced. The morula enters the uterine cavity about 3 days after fertilization.Optimal change in shape occurs at week 3, the embryo will have three distinct layers with a defined top and bottom, front and back, left and right. At no other time in its development will the embryo undergo such a radical transformation. Beyond week 8 maximal growth occurs, the unborn baby is now called a fetus. The embryonic period is from the second through the eighth week. It encompasses organogenesis and is thus the most crucial with regard to structural malformationsat this stage rapid differentiation of the embryo occurs. Refrence: Wililam’s Obstetrics 23rd Edition pages 48, 313 www.baby2see.com/development Delos Santos, Sharmen S.

33. What must happen for the completion of the second meiotic division in the oogenesis? a. LH surge b. Follicle size 20 mm c. Ovulation d. Fertilization Answer: d Fertilization Rationale: During gametogenesis, the oogonium becomes primary oocyte in the process of meiosis and arrested in prophase I during birth until puberty. When puberty occurs, primary oocyte undergoes meiosis I to produce secondary oocyte with first polar body. Secondary oocyte is arrested in metaphase II. Meiosis II is completed only if sperm penetration occurs. Reference: Chapter 3: Implantation, Embryogenesis and Placental Development. Section 2 P 47. William’sObstetrics 23rd Edition.

Hernadez, Kristeen Khae B.

34. Fertilization is complete within how many hours from ovulation? a. 12 c. 36 b. 24 d. 48 Answer: B Rationale: The union of egg and sperm at fertilization represents one of the most important and fascinating processes in biology. Ovulation frees the secondary oocyte and adherent cells of the cumulus-oocyte complex from the ovary. Although technically this mass of cells is released into the peritoneal cavity, the oocyte is quickly engulfed by the infundibulum of the fallopian tube. Further transport through the oviduct is accomplished by directional movement of cilia and tubal peristalsis. Fertilization normally occurs in the oviduct, and it is generally agreed that it must take place within a few hours, and no more than a day after ovulation. Reference: Electronic book Williams Obstetrics, Twenty-Third Edition. Chapter 3 “Implantation, Embryogenesis, and Placental Development”

De Los Santos, Kathrine Aira N.

35. What is the function of Human Chorionic Gonadotropin (hCG) during early embryonic period? a. source of hematopoiesis b. maintains endometrium in secretory phase c. prevents regression of the corpus luteum d. nourishes the developing embryo Answer: c. prevents regression of the corpus luteum Rationale: The best known biological function of human chorionic gonadotropin is the "rescue" and maintenance of function of the corpus luteum which is by means of continued progesterone production. Reference: Ebook(2010). Cunningham, F.G, K.J. Leveno, S.L. Bloom, J.C. Hauthe,

D.J. Rose& C.Y. Spring. Chapter 3: Implantation, Embryogeness and Plcenta. Williams Obstetrics. 23rded. USA: McGraw-Hill Companies, Inc. Bonita, Marriane

36. Part of the endometrium where implantation takes place: a. decidua parietalis c. deciduas capsularis b. decidua vera d. deciduas basalis ANSWER: D RATIONALE: Decidua directly beneath blastocyst implantation is modified by trophoblast invasion and becomes the decidua basalis. The decidua capsularis overlies the enlarging blastocysts, and initially separates it from the rest of the uterine cavity... The remainder of the uterus is lined by decidua parietalis sometimes called decidua vera when decidua capsularis and parietalis are joined.

Gozun, Jacel Shayne P.

REFERENCE: Cunningham, F. Gary, Kenneth Leveno, Steven Bloom, John Hauth, Dwight Rouse and Catherine Spong. 23rd Edition.William’s Obstetrics. Pg.64. McGraw Hill: New York. 2010. 37. Which structure facilitates implantation by invading the adjacent endometrium and its blood vessels? a. cytotrophoblast b. syncytiotrophoblast c. extraembryonic coelom d. inner cell mass ANSWER: b. syncytiotrophoblast RATIONALE: a. Cytotrophoblasts elaborate selected proteinases that degrade the decidual extracellular matrix. b. Syncytiotrophoblast facilitates the penetration and invasion of the endometrium, inner third of the myometrium, and uterine vasculature. At about 12 days after conception, the syncytiotrophoblast is permeated by a system of intercommunicating channels called trophoblastic lacunae. As the embryo enlarges, more maternal decidua basalis is invaded by basal syncytiotrophoblast. After invasion of superficial decidual capillary walls, lacunae become filled with maternal blood. c. Extraembryonic coelom is a result of the union of large cavities within the extraembryonic mesoderm which splits it into two layers namely the extraembryonic somatic mesoderm, lining the trophoblast and amnion, and the extraembryonic splanchnic mesoderms, covering the yolk sac. d. Inner cell mass forms the embryo itself. References: Cunningham, G. et al (2010).Williams Obstetrics, Twenty-Third Edition. United States of America: McGraw Hill. Chrobnolab AG Vision Group. (2009). Atlas of Human Embryology. Retrieved from http://www.embryo.chronolab.com/formation.htm.

Fernandez, Quennie

38. What significant event occurs during gastrula stage? a) neural tube formation b) GIT formation c) bone mineralization d) differentiation of three germ layers Answer: d) differentiation of three germ layers Rationale: The most characteristic event occurring the 3rd week of gestation is gastrulation, the process that establishes all three germ layerds(ectoderm, mesoderm, and endoderm) in the embryo.

Neural tube formation happens after the 3rd week of gestation when neural fold approach each other on the midline and fuse beginning in the future neck(fifth somite) and proceeds cephalad and caudad. GIT formation happens upon the division of the gut tube or primitive gut during the 4th week of gestation. Bone formation happens through membranous ossification as for flat bones and endochondral ossification for long bones which starts at the end of the 4th week of gestation. Reference: Sadler, T.W. Ph. D. (2000). Langman’s Medical Embryology. (8th ed. ) Chapel Hill, North Carolina Genovana, Raymond

39. The epithelial linings of the respiratory passage, gi tract and glands and glandular cells of the liver and pancreas arise from the embryonicA) Ectoderm B) Mesoderm C) Endoderm Answer: C) ENDODERM Rationale: • The gastrointestinal tract is the main organ system derived from the endodermal germ layer (page 82) • The endodermal germ layer initially forms the epithelial lining of the primitive gut, the epithelial lining of the respiratory tract, the parenchyma of the liver and pancreas (Figure 6.19 p.83; page 83-84) Reference: LANGMAN’S MEDICAL EMBRYOLOGY 11th edition (di ko mkita sa Williams)

Barron, Emmanuel John V.

40. In what portion of the endometrial cavity does implantation usually occur? a. antero-fundal c. antero mid-portion b. postero-fundal d. postero mid-portion Answer: d. postero-fundal Rationalization: At the time of its interaction with the endometrium, the blastocyst is composed of 100 to 250 cells. The blastocyst usually adheres to the endometrial epithelium by apposition. This most commonly occurs on the upper posterior uterine wall. Reference: Williams Obstetrics, 23rd edition, page 49

Castro, Sylvester

41. What is the reliable basis of using menstrual age for determining the age of pregnancy? a. most women have a regular cycle. b. It is more accurate than the ovulatory period. c. It is used in Naegele’s rule d. The last menstrual period is easy to recall. Answer: d. The last menstrual period is easy to recall Rationale: The timing of events in early human development is described as days or weeks postfertilization, that is, postconceptional. By contrast, in most chapters of this book, clinical pregnancy dating is calculated from the start of the last menstrual period. As discussed earlier, the length of the follicular phase of the cycle is subject to more variability than the luteal phase. Thus, 1 week postfertilization corresponds to approximately 3 weeks from the last menstrual period in women with regular 28day cycles. That is why it is easy to recall. Reference: Williams Obstetrics 23 editions Fertilization and Implantation pages 1436

Alaba, Aileen Abigail

42. Which of the following is correct about the duration of pregnancy? a. Average duration is 40 weeks b. Corresponds to 9 2/3 calendar months c. Corresponds to 9 lunar months d. All of the above Answer: A Average duration is 40 weeks Rationale: The mean duration of pregnancy is calculated from the first day of the

last normal menstrual period is very close to 280 days or 40 weeks. Reference: Willams Edition # 23, Page number 195 Fabia, Mary Joyce S.

Garin, Christine Abigail R.

43. If the LMP was last December 13,2011, when is the 280th day of pregnancy using Naegele’s rule? A. August 20, 2012 B. September 20, 2012 C. August 21, 2012 D. September 6, 2012 Answer: B. September 20, 2012 Rationale: Formula: Add 7 days to the first day of Last menstrual period and subtract 3 months. Solution: December 13 + 7 = December 20 December 20 – 3 months = September 20 Therefore, the answer is September 20, 2012 Reference: Chapter 4. Fetal growth and development. Section 2 page 78, William’s Obstetrics 23rd Edition. Which of the following is the correct order of developmental phase within 2 weeks after ovulation? a. formation of free blastocyst - implantation of blastocyst - fertilization b. fertilization – formation of free blastocyst – implantation of blastocyst c. implantation of blastocyst – formation of free blastocyst – fertilization d. any of the above Answer: b. fertilization – formation of free blastocyst – implantation of blastocyst Rationale: After fertilization in the fallopian tube, the mature ovum becomes a zygote— a diploid cell with 46 chromosomes—that then undergoes cleavage into blastomeres. In the two-cell zygote, the blastomeres and polar body are free in the perivitelline fluid and are surrounded by a thick zona pellucida. The zygote undergoes slow cleavage for 3 days while still within the fallopian tube. As the blastomeres continue to divide, a solid mulberry-like ball of cells—the morula—is produced. The morula enters the uterine cavity about 3 days after fertilization. Gradual accumulation of fluid between the cells of the morula results in the formation of the early blastocyst. After which comes implantation. Implantation of the embryo into the uterine wall is a common feature of all mammals. In women, it takes place 6 or 7 days after fertilization. This process can be divided into three phases: (1) apposition—initial adhesion of the blastocyst to the uterine wall; (2) adhesion—increased physical contact between the blastocyst and uterine epithelium; and (3) invasion—penetration and invasion of syncytiotrophoblast and cytotrophoblast into the endometrium, inner third of the myometrium, and uterine vasculature. Reference: Williams Obstetrics, Twenty-Third Edition (ebook), chapter 3

Jalea, Jelly Ann

45. At what earliest menstrual age (weeks) is fetal genitalia distinguishable as male or female? a. 10 d. 16 b. 14 e. 20 Answer: b. 14 Rationale: Gender can be determined by inspection of the external genitalia by 14th week of menstrual age (12th week by fertilization age). Reference: Cunningham, et. al., Williams Obstetrics 23rd edition (2010). Section II: Anatomy and Physiology, Chapter 3: Implantation, Embryogenesis, and Placental Development

Gatdula, Joanne Karla C.

46. In a normal development of a fetus, at what menstrual age (weeks) is the crown-rump length measure approximately 25 cm and weight is about 1100 grams? a. 28 c. 36 b. 32 d. 40 Answer: A. 28

Rationale: The crown-rump length is approximately 25 cm, and the fetus weighs about 1100 g. The thin skin is red and covered with vernix caseosa. The pupillary membrane has just disappeared from the eyes. The otherwise normal neonate born at this age has a 90-percent chance of survival without physical or neurological impairment. Reference: Williams Obstetrics, 23rd Edition pg 80 De Guzman, Geelvie

Gabriel, Gretchen

47. Which of the following fontanel is situated at the junction of the sagittal and lambdoid sutures of the fetal head? a. casserian b. greater c. posterior d. temporal Answer: c. posterior Rationale: The lesser, or posterior fontanel is represented by a small triangular area at the intersection of the sagittal and lambdoid sutures (Williams). Letters a is incorrect since casserian or Casser’s fontanel refers to the mastoid fontanel (Ecyclo Online Encyclopedia). It is the membranous interval on either side between the mastoid angle of the parietal bone, the petrous portion of the temporal bone, and the occipital bone. Letter b is incorrect since the greater fontanel is also known as the anterior fontanel. Letter d refers to the temporal suture located at the lateral side of the fetal head. Reference: : Cunningham, F. Gary. et. al. Williams Obstetrics 23rd edition. Published 2010 (Chapter 4, page 81) Encyclo Online Encyclopedia. http://www.encyclo.co.uk/define/Casser's%20fontanel 48. Which of the structures is transversed by substances from maternal blood to fetal blood for transfer of oxygen and nutrients? a. syncytiotrophoblast b. stroma of the intravillous space c. fetal capillary wall d. all of the above Answer: D Rationale: Substances that pass from maternal blood to fetal blood must traverse first the SYNCYTIOTROPHOBLAST, then STROMA OF THE INTRAVILLOUS SPACE, and finally the FETAL CAPILLARY WALL. Although this histological barrier separates the blood in the maternal and fetal circulations, it does not function like a simple physical barrier. In fact, throughout pregnancy, syncytiotrophoblast actively or passively permits, facilitates and adjusts the amount and rate of transfer of a wide range of substances to the fetus. Reference: Williams Obstetrics 23rd ed

Jezreel Joy B. Javier

49. What mechanism is involved in the transfer of oxygen, carbon dioxide, and anesthetic gases through the syncytiotrophoblast? a. Simple diffusion c. Active transport b. Selective and facilitated diffusion d. All of the above Answer: A Simple diffusion Rationale: Oxygen, carbon dioxide, water and anesthetic gases are low molecular weight compounds transported through simple diffusion. According to Williams (22nd Edition), Most substances with a molecular mass less than 500 d diffuse readily through placental tissue. Molecular weight is clearly important in determining the rate of transfer by diffusion. Simple diffusion, however, is by no means the only mechanism of transfer of low-molecular-weight compounds. Simple diffusion appears to be the mechanism involved in the transfer of oxygen, carbon dioxide, water, and most (but not all) electrolytes. Anesthetic gases also pass through the placenta rapidly by simple diffusion. Example of Selective and facilitated diffusion is Ascorbic Acid, because it’s concentration is two to four times higher in fetal plasma than in maternal plasma (Morriss and associates, 1994), that is why it can’t traverse the placenta Reference: Williams Obstetrics, 22nd edition (e-book) p. 58

Dizon, Ron

50. Which glucose transport proteins (GLUT) primarily facilitate glucose uptake by the placenta?

a. b. c. d.

GLUT 1 and 3 GLUT 2 and 4 GLUT 5 and 6 GLUT 12 and 14

Answer: A (GLUT 1 and 3) Rationale: GLUT 1 and 3 primarily facilitate glucose uptake by the placenta and are located in the plasma membrane of the microvilli of the syncytiotrophoblast Source: p 87, Williams Obstetrics 23rd edition Daniel Christophe r J. Carreon

51. What is the main composition of amniotic fluid after 20 weeks gestation age? a. Ultrafiltrate of maternal plasma b. Extracellular fluid that reflects the composition of fetal plasma c. Fetal urine d. Mixture of the three above Answer: c. Fetal urine Rationalization: “By the beginning of the second trimester, it consists largely of extracellular fluid that diffuses through the fetal skin and thus reflects the composition of fetal plasma (Gilbert and Brace, 1993). After 20 weeks, the cornification of fetal skin prevents this diffusion, and amnionic fluid is composed largely of fetal urine.” Reference: Williams Obstetrics, 23rd edition, page 88, Amnionic Fluid

Lapitan, Jemelyn R.

52. Which of the following fetal vessels convey the highest oxygen and nutrients? a. Ductusvenosus b. Superior vena cava c. Aorta d. Pulmonary artery Answer: A. Ductusvenosus Rationale: Blood with significantly higher oxygen content returns from the placenta via a single umbilical vein to the fetus. Among the four choices above, the ductusvenosus is the most proximal vessel to the placenta and umbilical vein. The ductusvenosus will therefore convey blood with the highest concentrations of oxygen and nutrients. Reference: p. 56, Chapter 3, Section 2, Williams Obstetrics, 23rd edition

Luna, Juan Carlos

53. After birth, what is the remnant of umbilical vein after it constricts or collapses? a. Umbilical ligaments b. Ligamentumvenosum c. Ligamentumteres d. Ductusligamentus Answer: C. Ligamentumteres Rationale: The fate of the following vessels are as follows: Umbilical arteries  Umbilical ligaments Ductursvenosusligamentumvenosum Ductusarteriosusductusligamentus Umbilical vein ligamentumteres Reference: Chapter 4. Fetal Growth and Development page 89-90. William’s Obstetrics

Jonathan B. 54. Which is the main immunoglobulin in the fetus that is being transferred across Ancheta the placenta by receptor mediated process in syncytiotrophoblast? a. IgM b. IgA c. IgG d. IgD e. Answer: c. IgG Rationale: Insulin, steroid hormones, and thyroid hormones cross the placenta, but at very slow rates. The hormones synthesized in situ in the trophoblasts enter both the maternal and fetal circulations, but not equally. Examples are concentrations of

chorionic gonadotropin and placental lactogen, which are much lower in fetal plasma than in maternal plasma. Substances of high molecular weight usually do not traverse the placenta, but there are important exceptions, such as immunoglobulin G—molecular weight 160,000 Da—which is transferred by way of a specific trophoblast receptor–mediated mechanism. Reference: Williams Obstetrics 23rd edition, Chapter 4: Fetal Growth and Development, Mechanism of Transfer Han Joo Yeon

55. ----

Agoncillo, Andre Luis R.

56. A parturient on her 39th week of pregnancy is in active labor for 2 days. How would you explain the dark-greenish-black appearance of Amniotic fluid after the rupture of membrane? a.This normally happens in a mature fetus. b. Arginine vasopressin release from the fetal pituitary stimulates the colon to contract. c. It is reassuring sign of fetal status. d. There is a high chance of small intestinal bowel obstruction. ANSWER: B Arginine vasopressin release from the fetal pituitary stimulates the colon to contract. Rationale: AVP stimulates the smooth muscle of the colon to contract, resulting in intra-amnionic defecation (DeVane and co-workers, 1982; Rosenfeld and Porter, 1985). References: Williams Edition 23rd page 94

Ferrer, JanMichael A.

57. In the anatomical development of fetal urinary system, what structure gives rise to bladder and urethra? a. urogenital sinus b. intermediate mesoderm c. mesonephros d. allantois Answer: a. urogenital sinus Rationale: Letter a is correct. During the 4th to 7th week of development, the cloaca divides into the urogenital sinus anteriorly and the anal canal posteriorly. Three (3) portions of the urogenital sinus can be distinguished: the upper & largest part will be the urinary bladder, the narrow pelvic part which in male gives rise to the prostatic and membranous parts of the urethra and lastly, the phallic part. Letter b is incorrect since derivatives of the intermediate mesoderm include the nephrogenic cord and the ureteric bud, which give rise to the kidneys and ureters, respectively. Letter c is incorrect since the mesonephros gives rise to the efferent ductules of the testis, the epididymis, vas deferens, seminal vesicle, and vestigial structures such as the appendix testis, appendix epididymis, and paradidymis. Letter d is incorrect since the allantois develops into a fibrous cord, the urachus, which runs from the fetal bladder to the umbilicus. Reference: • Sadler, T.W., Langman’s Medical Embryology 11th edition (Chapter 15, page 243) • http://en.wikipedia.org/wiki/Mesonephros. Obtained from the World Wide Web on February 23, 2012 • http://wiki.medpedia.com/Development_of_Urinary_System. Obtained from the World Wide Web on February 23, 2012 • http://www.medscape.com/viewarticle/465897_5. Obtained from the World Wide Web on February 23, 2012

Aguila, Julie Ann Dianne M.

58. A fetus with an amniotic membrane rupture before 20 weeks of gestation will have an Imamture lung development. Which stage is likely affected? a. pseudoglandular b. canalicular c. terminal sac d. A and B

ANSWER: B. Canalicular stage RATIONALE: Lung development occurs in three stages: pseudoglandular, canalicular, and terminal sac. For every stage, a particular part of the bronchial stage develops. At age of gestation week 5 to 17, the pseudoglandular stage occurs which allows the growth of the fetus' intersegmental bronchial tree. At the 16th to 25th week of gestation, the canalicular stage occurs and the previosly formed terminal bronchiole becomes respiratory bronchioles, and eventually divide to become multiple saccular ducts. And as the case implies in the question above, an amnionic membrane rupture before the 20th week of gestation an immature lung development is to be expected since at that time, the canalicular stage has not yet completed. However, normal bronchial branching and cartilage development may be expected as a result of a completed pseudoglandular stage. REFERENCE: Williams, 22nd edition. page 66 (ebook) Joyce Ann R. Garcia

59. When is the genetic gender established as XY or XX? a. ovulation b. fertilization c.implantation d. expression of SRY gene Answer: B. Rationale: Genetic gender – XX or XY- is established at the time of FERTILIZATION, but for the first 6 weeks, development of male and female embryos is morphologically indistinguishable. Reference: Williams Obstetrics, 23rd edition. p. 99

Atienza, Emmanuel

60. Which of the following conditions leads to a female sexual differentiation? a. absence of male gonad b. presence of SRYgene c. production of Mullerian-inhibiting substance d. presence of fetal ovary ANSWER A RATIONALE: Testes development is directed by a gene called the SRYgene or TDF gene. Mullerian-inhibiting substance prevents the development of the uterus, fallopian tube, and upper vagina. Presence of fetal ovary is also seen in pseudohrmaphroditism. Absence of the testes leads to female sexual differentiation Reference: Williams 22nd edition page 113-116

Lao, Charles

61. Circulatory disturbances of the placenta include a. Infarction b. Thrombose formation c. Calcification d. All of the above Answer: D Rationale: Circulatory Disturbance Fetal thrombotic vasculopathy Hematoma

Placental calcification

• Villi may thrombose w/ obstruction distally • Common in mature placenta o May be pathological if large portion villi lost • Associated w/ miscarrianges, abruption, fetal growth restriction, preterm delivery, adherent placenta • Retroplacental o Between placenta + decidua • Marginal o Between chorion + decidue o Subchorionic hemorrhage • Subchorial o A.k.a. Breus mole o Along intervillous space • Subamnionic o Between placenta + amnion o Fetal vessel origin • Most common on maternal surface of basal

Villous infarction

Perivillousfibrinoid deposition

Maternal floor infarction

plate • Associated w/ nulliparity, higher socioeconomic status, high maternal Ca levels • Degree of calcifications on US does NOT correlate well with neonatal outcome • Caused by uteroplacental disease • Common in mature placenta o BUT if numerous, can get placental insufficiency • May be associated w/ PET or SLE • Yellow-white nodules w/in placenta • Normal part of placental aging o Slow maternal blood flow currents around individuals villus • Blood statis + fibrin deposition • Diminishes oxygentation to villus • Deposition of dense, fibrinoid layer on placental basal plate o May be associated w/ maternal thrombophilia • Block maternal blood flow • Associated w/ fetal growth restriction, abortion, preterm delivery, stillbirths

Reference: Williams, OBSTETRICS Espinoza, Faith Kristine R.

62. Human chorionic gonadotropin starts to be detected in the blood and urine of pregnant women at the time of: a. blastocyst formation b. blastocyst implantation c. calcification d. all of the above Answer: B Rationale: The human chorionic gonadotropin (hCG) molecule can be detected in the plasma of a pregnant woman about 7 to 9 days after the midcycle surge of the luteinizing hormone (LH) that precedes ovulation, so it is most likely that hCG enters the maternal blood at the time of blastocyst implantation. Maternal urine contains the same variety of hCG degradation products as maternal plasma. Thus, hCG levels in the urine can be detected at the time of blastocyst implantation as well. Reference: Williams, 23rd Edition, Page 63-64.

Angeles, Patricia Khaye Danao

63. Blood with higher oxygen content returns from the placenta to the fetus through the: A. Umbilical Arteries B. Truncal Arteries C. Umbilical Vein D. Arcuate Arteries ANSWER: C RATIONALE: According to Sumpaico (2008), the fetal circulation is described as different from the adult circulation due to the fact that oxygenated blood from the placenta passes through the single umbilical vein. All nutrients for fetal growth and development are delivered to the fetal heart by the umbilical vein in the umbilical cord. Also, Cunningham (2010) supported this fact by stating that the oxygenated blood from the mother passes in the placenta through the umbilical vein. Saying that the oxygenated blood is carried by the umbilical vein, therefore this vessel is the one that carries a higher oxygen content in the fetal circulation. RESOURCES: W. Sumpaico (2008). Texbook of Obstetrics: Physiologic and Pathologic Obstetrics 3rd edition, page 181 and 216. OVT-Graphic Inc: Philiipines. F. Cunningham (2010). Williams Obstetrics

Galang, Kim

64. The Following changes are seen in “placental aging”, except: a. Increased thickness of the syncytium b. Formation of syncytial knots c. Thickening of the capillary basement membranes d. Obliteration of fetal vessels Answer: A. Increased Thickness of the syncytium Rationale: The answer is letter A since in placental aging or maturation, decreased syncytiotrophoblastic thickness happens to meet the fetal metabolic requirements

by increasing the efficiency of transport and exchange between the mother and fetus. Reference: Pages 54-55, Chapter 3, Section II of Williams Obstetrics 23rd edition Billiones, Kim Irving D.

65. Over-the-counter pregnancy test kits test for which placental hormone? a. estrogen b. progesterone c. human placental lactogen d. human chorionic gonadotropin ANSWER: D human chorionic gonadotropin RATIONALE: Human chorionic gonadotropin (HCG) is produced almost exclusively in the placenta. It is detectable in maternal plasma, and its metabolism products, such as the β-core fragment may be detectable in the urine. Most pregnancy tests contain the β-subunit antibody which reacts with both the intact HCG molecule and the β-core fragment, the latter being the major form present in the urine. Reference: William’s Obstetrics. 22nd edition, Chapter 3: Implantation, Embryogenesis, and Placental Development

Bayting, Ormalyn B.

66. The umbilical cord as term normally has: A. Two veins and one artery B. Two arteries and one vein C. Two arteries and two veins D. Two arteries and valves of Hoboken Answer: B. Two arteries and one vein Rationale: In the umbilical cord, or funis, three umbilical vessels may be seen. One umbilical vein wherein the blood coming from the mother flows and two arteries wherein blood coming from the fetus exits. Reference: Williams Obstetrics 23rd edition. Page 62

Basul, Charine

67. In the development of the decidua, the portion directly beneath the site of blastocyst implantation is the: A. decidua capsularis B. decidua basalis C. decidua parietalis D. decidua laeve Answer: B. decidua basalis Rationale: The decidua of pregnancy is composed of three parts based on its anatomical location. The portion of the decidua directly beneath the site of blastocyst implantation is modified by trophoblast invasion and becomes the decidua basalis. The portion overlying the enlarging blastocyst and initially separating it from the rest of uterine cavity is the decidua capsularis; the chorion leave is the avascular extraembryonic fetal membrane in contact with decidua capsularis and the decidua parietalis is the lining of the remainder of the uterus. Reference: Sumpaico 3rd edition, Page 158

Garcia , Paul Mitchell L.

68. Which of these statements regarding human chorionic gonadotropin is incorrect? a. It is the “pregnancy hormone” b. It has biological activity similar to luteinizing hormone c. It is structurally related to lutenizing hormone, follicle stimulating hormone, and thyroid stimulating hormone d. It is secreted by cytotrophoblasts Answer: none of the above Rationale: Human chorionic gonadotropin : • So-called pregnancy hormone • Similar activity to lutenizing hormone (LH) • Glycoprotein ( structurally related to LH, FSH and TSH) • Mostly synthesized in the placenta, (cytotrophoblast and syncytiotrophoblast) Reference: Cunningham, Gary F, et al. Williams Obstetrics. 23rd ed. USA: McGraw-

Hill, 2010. P 63 Ereno, Ephraim Adrian

69. Which part of the HCG molecule is useful as a tumor marker for trophoblastic disease a. nicked hCG molecule b. alpha subunit c. beta subunit d. core-fragment of hCG Answer: A Rationale: The nicked forms of hCG predominate in hydatidiform mole or choriocarcinoma. Reference: Sumpaico, Textbook of Obstetrics, 3rd ed., page 194

Lim, Gerriane R.

70. This statement is not true of human placentation: a. Decidua and maternal blood are juxtaposed to fetal blood. b. It is hemochorioendothelial c. Maternal blood in the intervillous space directly bathes the trophoblasts. d. Substances transferring from the mother to the fetus must transverse the intervillous space. ANSWER: A. Decidua and maternal blood are juxtaposed to fetal blood. Rationalization: The term hemochorial is used to describe human placentation. It derives from hemo referring to maternal blood, which directly bathes the syncytiotrophoblast, and chorio for chorion (placenta). The older term hemochorioendothelial takes into consideration that chorionic tissue is separated from fetal blood by the endothelial wall of the fetal capillaries that traverse the villous core. At all sites of direct cell-to-cell contact, maternal tissues (both decidua and blood) are justaposed to EXTRAEMBRYONIC CELLS (trophoblasts) and not the embryonic cells or fetal blood. The placenta links mother and fetus by indirect interaction with maternal blood that spurts into the intervillous space from uteroplacental vessels. Maternal blood bathes the outer syncytiotrophoblast to allow exchange of gases and nutrients with fetal capillary blood within connective tissue at the villous core. Fetal and maternal blood are not normally mixed in this hemochorial placenta. There is also a paracrine system that links mother and fetus through the anatomical and biochemical juxtaposition of extraembryonic chorion laeve of fetal origin and maternal decidua parietalis. Maternal blood in the intervillous space directly bathes the trophoblasts. Transfer of substances, i.e oxygen and nutrients, from mother to fetus is accomplished first by transfer of intervillous space into the synctiotrophoblast. There is no direct transfer from maternal to fetal blood. RESOURCE: Williams 23rd edition, Chapter 3 (Implantation, Embryogenesis, and Placental Development: Introduction) page 51

Balboa, Barbara Kate P.

71. The following is NOT a function of the trophoblast a. Endocrine b. Secretion of the hormone that maintains pregnancy c. Nutrition of the conceptus d. Implantation Answer: B Secretion of the hormone that maintains pregnancy Rationale: A, C, and D are the only functions of the trophoblast. *The hormone that maintains pregnancy is ESTROGEN, which is primarily secreted by the Ovaries. Reference: 23rd Ed. Of Williams, Page no.49

Abejuela, Yoti Gonzales, Daniel Abraham

72.LOA 73. An abnormal placenta has: a. a weight of 500 grams b. 10-38 cotyledons c. an accessory lobe d. intact fetal circulation Answer: C Rationale: At term, the average placenta has a weight of 508 grams (which may

increase to 650 grams at 40 weeks AoG), with 10-38 cotyledons and intact circulation. Accessory lobes may be retained in the uterus and may cause hemorrhaging if untreated. Reference: Williams Obstetrics (E-book), Chapter 3, Chapter 27 Anacay, Denise B.

74. Which of the following is not a function of the amnion? a. Provides most of the tensile strength of the fetal membranes b. Lipolysis for fetal nutrition c. Maintenance of amniotic fluid homeostasis d. Secretion of cytokines and vasopeptides Answer: B. Lipolysis for fetal nutrition Rationale: The amnion provides almost all tensile strength of the fetal membranes. It is metabolically active, is involved in solute and water transport for amnionic fluid homeostasis, and produces an impressive array of bioactive compounds. Reference: William’s Obstetrics 23rd Edition Chapters 3 pages 59-61

Alcazaren, Ramon Michael Christophe r S.

75. The placental hormone rescues and maintains the corpus luteum: a. Human placental lactogen b. Estrogen c. Progesterone d. HCG Answer: D, Human chorionic Gonadotropin Rationale: The best-known biological function of HCG is the so-called rescue and maintenance of function of the corpus luteum – that is, continued progesterone production. Reference: Williams Obstetrics 23rdedition , Implantation, Embryogenesis and Placental Development page 64.

Ebdani, Alea D.

76. This placental hormone promotes the growth of the endometrium. a) human placental lactogen b) estrogen c) progesterone d) HCG Answer: b) estrogen Rationale: During pregnancy, the extreme quantities of estrogens cause enlargement of the mother’s uterus or endometrium. HPL acts on maternal lipolysis with increased levels of circulating free fatty acids. This provides a source of energy for maternal metabolism and fetal nutrition. Also it has an anti-insulin or "diabetogenic" action. Progesterone facilitates the maintenance of pregnancy. . HCG is for the rescue and maintenance of function of corpus luteum-that is, continued production of progesterone and secretion of relaxin References: Williams Obstetrics, 23rd ed. Chapter 3. Implantation, Embryogenesis, and Placental Development Guyton and Hall, Textbook of medical physiology 11th ed. Chapter 81.Female Physiology before the Pregnancy and Female Hormones

Genoroso, Veronica H.

77. Intraamnionic infection (chorioamnionitis) is best managed by: a) Immediate Caesarean section b) High forceps extraction c) Antibiotics and expedient delivery d) Steroids and assisted vaginal delivery Answer: C. Antibiotics and expedient delivery Rationale: Chorioamnionitis can complicate term pregnancy and preterm delivery and cause Prelabor Rupture of Membranes (PROM). Management of PROM may be different depending on how far along is the pregnancy. However, the constant management for PROM is a course of antibiotics be it 34 weeks along the pregnancy. The preferred route of delivery is vaginal and the use of steroids is shown to be beneficial but is only used when the fetus may be delivered preterm (24-34weeks) but the lung is immature. Reference: Williams Obstetrics by Cunningham et al, 23rd Ed (E-book); Textbook of

Obstetrics by Sumpaico et al, 3rdEd. Chapter 44. Basnet, Archana

78. A placenta with an accessory lobe will most likely lead to which complication during third stage of labor? A. Infection B. Neurologic Shock C. Hemorrhage D. Amniotic Fluid Embolism Answer: C. HEMORRHAGE Rationalize: The accessory lobe may sometimes be retained in the uterus after delivery and may cause serious hemorrhage in some cases, accompanying vasa previa may cause dangerous fetal hemorrhage at delivery. References: chapter 27, abnormalities of the placenta, umbilical cord, and membrane. Williams obstetrics edition 23rd

De Leon, Jana Pamela Y.

79. Which placental hormone is used to monitor response to treatment of choriocarcinoma? a. a. Human placental lactogen b. b. Estrogen c. c. Progesterone d. d. Human chorionic gonadotropin ANSWER: D Rationale: The amniotic fluid concentration of hCG early in pregnancy is similar to maternal plasma. Urine concentration of hCG follows the pattern of maternal plasma. Significantly, higher plasma levels are found in pregnancy with hydatidiform mole or choriocarcinoma. Reference: Sumpaico, Textbook of Obstetrics, 3rd ed., page 194.

Lopez, Edison

80. The concentration of human chorionic gonadotropin in serum is the same as its concentration in the urine. Choices: True or False Answer: False Rationale: Both Serum and Urine hcg tests are done to measure the amount of hcg in the mother to determine pregnancy. Though there are a lot of studies pertaining to urine hcg as inaccurate compared to serum hcg tests it is still without a doubt a trusted test to perform. But there is a wide range of values for hcg which differs in both serum and urine. Thus it is best to use both tests for pregnancy test. References: http://www.babymed.com/hcg-level http://www.babyhopes.com/articles/bloodtestmoreaccurate.html

David Layug

81. Uterine Hypertrophy in the second half of pregnancy is due to: A. Estrogen B. Progesterone C. Pressure exerted by the expanding products of conception D. All of the above Answer: C. Pressure exerted by the expanding products of conception Rationale: Estrogen and Progesterone cause the hypertrophy of the uterus during the 1st 12 weeks of pregnancy. 12 weeks and up, the hypertrophy is predominated by the pressure exerted by the expanding products of conception. Reference: Williams Obstetrics 23rd Edition (Maternal Physiology) Pages 107-108

Fernandez, Edna Joyce M.

82. The delivery of most substances essential for growth and metabolism of the fetus and placenta, as well as removal of most metabolic wastes, is dependent on: a. adequate perfusion of the placental intervillous space b. total uterine blood flow c. normal placenta d. presence of 2 arteries and 1 vein in the umbilical cord Answer: a. adequate perfusion of the placental intervillous space Rationale:

-

The delivery of most substances essential for growth and metabolism of the fetus and placenta, as well as removal of most metabolic wastes, is dependent on adequate perfusion of the placental intervillous space. - The placenta is the organ of transfer between mother and fetus - At the maternal-fetal interface, there is transfer of oxygen and nutrients from the mother to the fetus and carbon dioxide and metabolic wastes from fetus to mother. - There are no direct communications between fetal blood, which is contained in the fetal capillaries of the chorionic villi, and the maternal blood, which remains in the intervillous space - Bidirectional transfer depends on the process that permits or aids the transport through the syncytiotrophoblast of the intact chorionic villi. - Maternal blood in the extravascular compartment, that is, the intervillous space, is the primary biologic unit of maternal-fetal transfer. - In determining the effectiveness of the human placenta as an organ of transfer, atleast 10 variables are important: o The concentration of the substace in maternal plasma, and the extent to which it is bound to another compound, such as carrier protein. o The rate of maternal blood flow through the intervillous space o The area available for exchange across the villous trophoblast epithelium o If the substance is transferred by simple diffusion, the physical properties of the trophoblastic tissue o For any substance actively transported, the capacity of the biochemical machinery of the placenta for effecting active transfer o The amount of the substance metabolized by the placenta during transfer o The area for exchange across the fetal intervillous capillaries o The concentration of the substance in the fetal blood o Specific binding or carrier proteins in the fetal or maternal circulation. o The rate of the fetal blood flow through the villous capillaries. Reference: p. 108, Ch. 5 Maternal Physiology pp. 83 - 85, Ch. 4 Fetal Growth and Development 23rd ed. Williams Obstetrics Feliciano, Christian Mico G.

83. . What is the basis for the physiologic anemia in pregnancy? A. More plasma than erythrocytes is added to the maternal circulation B. More erythrocyte than plasma is added to the maternal circulation C. Moderate erythroid hyperplasia is present in the bone marrow D. More water intake of pregnant women due to increase water requirement Answer: A Rationale: Anemia of pregnancy is a condition of pregnancy characterized by a reduction in the concentration of hemoglobin in the blood. It may be physiologic or pathologic. In physiologic anemia of pregnancy, the reduction in concentration results from dilution because the plasma volume expands more than the erythrocyte volume. The hematocrit in pregnancy normally drops several points below its pregnancy level. References: anemia of pregnancy. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved February 23 2012 from http://medicaldictionary.thefreedictionary.com/anemia+of+pregnancy Rationale: Plasma volume begins to increase during the sixth week of pregnancy. There is no significant increase in erythrocyte production during the first trimester. Dilutional anemia is first apparent by seventh to eighth week. Increase in erythrocyte production is apparent during the second trimester. Lowest hemoglobin explainable by dilutional effect (the physiologic anemia of pregnancy) is 11 g/dl in first trimester and 10g/dl in second and third trimesters. Physiologic anemia of pregnancy is normochromic, is normocytic, does not worsen during the third trimester, and does not require additional evaluation or specific treatment. References: Greer, J. P., & Wintrobe, M. M. (2008). Wintrobe's clinical hematology. (12, illustrated ed., p. 1240). Lippincott Williams & Wilkins, 2008. Retrieved February 23 2012 from http://books.google.com/books? id=68enzUD7BVgC&pg=PA1240&lpg=PA1240&dq=physiologic+anemia+in+pre

gnancy&source=bl&ots=fEFNgBShTt&sig=YfhAQuWc0sX_DYh4LScrDn99KU&hl=en&sa=X&ei=UFpGT7GwDYViAeKv8ChDg&ved=0CG0Q6AEwCQ Bejasa, Cana

84. by: a. b. c. d.

Remission of some autoimmune disorders during pregnancy may be explained suppressed Th1 response suppressed Tc1 response upregulation of Th2 all of the above

Answer: (d) All of the above Rationale: Pregnancy has been assumed to be associated with suppression of a variety of humoral and cell-mediated immunological functions in order to accommodate the "foreign" semiallogeneic fetal graft. One important mechanism appears to involve the suppression of T-helper (Th) 1 and T-cytotoxic (Tc) 1 cells, which decreases secretion of interleukin (IL)-2, interferon-γ, and tumor necrosis factor-β. However, not all aspects of immunological function are depressed. For example, there is upregulation of Th2 cells to increase secretion of IL-4, IL-6, and IL-13. Reference: Williams Obstetrics, 23rd Edition. Page 116 Galicia, Jose Maria F.

85. The increase in cardiac silhouette on chest radiograph of pregnant patients is due to the following EXCEPT: a. the heart is displaced to the left and upward b. the heart is rotated somewhat on its long axis c. the base is moved somewhat laterally from its usual position d. some degree of pericardial effusion Answer: C Rationale: It’s the apex that is moved somewhat laterally from its usual position and not the base. Reference: Williams Obstetrics 23rd Edition, Chapter 5 (E-Book)

Lugtu, Ryan Christophe r B.

86. The pulmonary function that is affected by pregnancy is: a. respiratory rate c. inspiratory reserve volume b. tidal volume d. vital capacity ANSWER: B RATIONALE: Because during pregnancy the respiratory rate is essentially unchanged, but tidal volume and resting minute ventilation increase significantly as pregnancy advances. Reported significantly increased mean tidal volume—0.66 to 0.8 L/min compared with non pregnant women. REFERENCE: William’s Obstetrics 23rd edition e-book,Chapter 5

Caraveo, Julien Nicole C.

87. The physiology dyspnea in pregnancy: a. results from increased tidal volume that lowers the blood PCO2 b. induced in large part by estrogen and to a lesser degree by progesterone c. estrogen lowers the threshold centrally d. caused by the increased sensitivity of the chemoreflex response to CO2 ANSWER: A RATIONALE:because the answer in letter B is false, it is not induced largely by estrogen but progesterone. Same as the answer in letter C, progesterone is the one which lowers the threshold centrally. Letter D answer is the result of progesterone action. REFERENCE: Williams 23rd Edition, p. 122

Eufracio, Ma. Christine Angela D.

88. The clinical relevance of any increased glomerular filtration rate in pregnancy is/ are: a. increased in rurinary frequency in 90% of pregnant women b. renal disease may not be diagnosed earlier because serum creatinine is decreased during normal pregnancy c. urinary infection are more virulent d. protein, amino acid and glucose excretion decreased

Answer: B. renal disease may not be diagnosed earlier because serum creatinine is decreased during normal pregnancy Rationale: Serum Creatinine and urea nitrogen values decreases during normal gestation; >0.8 mg/dl (>72 umol/L) creatinine already suspect; protein, amino acid and glucose secretion all increase. Reference: Williams Obstetrics, 22nd Edition p.137 Collante, Maria Lourdes M.

89. Which of the following urinalysis results in a pregnant woman indicates an abnormal finding? a. glucosuria b. proteinuria c. hematuria d. pyuria Answer: D. pyuria Rationale: Result of urinalysis during pregnancy is essentially unchanged, except for occasional glucosuria. There is also an increased excretion of proteins, but it usually not that large enough to be detected by usual screening methods. Hematuria may be due to trauma to the lower urinary tract during labor and delivery. On the other hand, pyuria may be due to infection to the urinary tract that causes the presence of pus in the urine. Infections may be attributed with physiologic hydroureter of pregnancy, vesico-ureteral reflex, or hormonal (estrogenic) influences. “Glucosuria during pregnancy is not necessarily abnormal. The appreciable increase in glomerular filtration, together with impaired tubular reabsorption capacity for filtered glucose, accounts in most cases for the glucosuria (Davison and Hytten, 1975). Even though glucosuria is common during pregnancy, the possibility of diabetes mellitus should not be ignored when glucosuria is recurrent. Protenuria is normally not evident during pregnany except occasionally in slight amounts during or soon after vigorous labor. Hematuria, if not the result of contamination during collection, is compatible with a diagnosis of urinary tract disease. Difficult labor and delivery, of course, can cause hematuria because of trauma to the lower urinary tract. Little information exists on the frequency of hematuria or its proper evaluation if it is persistent in the antepartum period. Frequency, urgency, dysuria, and pyuria accompanied by a urine culture with no growth may be the consequence of urethritis caused by Chlamydia trachomatis, a common pathogen of the genitourinary tract. Mucopurulent cervicitis usually coexists, and erythromycin therapy is effective.” Reference: BIBLIOGRAPHY \l 13321 Cunningham, M. F., Leveno, M. K., Bloom, M. S., Hauth, M. J., Gilstrap III, M. L., & Wenstrom, M. K. (2007). Williams Obstetrics (E-book). The McGraw-Hill Companies. Chapter 48. Cunningham, M. F., MacDonald, M. P., Gant, M. N., Leveno, M. K., Gilstrap III, M. L., Hankins, M. G., et al. (1997). Williams Obstetrics (20th edition ed.). Stamford, Connecticut: Appleton & Lange. Page 212.

Lagamayo, Dian

90. Pyrosis in pregnancy is due to: A. reflux of acidic secretions into the upper esophagus and altered position of the stomach B. decreased lower esophageal sphincter tone C. higher intraesophageal pressure and lower intragastric pressures in pregnant women D. Esophageal peristalsis that has higher wave speed and higher amplitude. Answer: B Rationale: Pyrosis (heartburn) is most likely caused by reflux of acidic secretions into the lower esophagus. Although the altered position of the stomach probably contributes to its frequent occurrence, lower esophageal sphincter tone also is decreased. In addition, intraesophageal pressures are lower and intragastric pressures higher in pregnant women. At the same time, esophageal peristalsis has lower wave speed and lower amplitude (Ulmsten and Sundstrom, 1978). (Lifted

directly from Williams) A. Is incorrect because reflux of acidic secretions should be into the LOWER esophagus not from the upper. C. Is incorrect because the intraesophageal pressures should be LOWER not higher and the intragastric pressures in pregnant women should be HIGHER not lower. D. Is incorrect because esophageal peristalsis has LOWER wave speed and amplitude not higher. Reference: Williams Obstetrics, 22nd edition (eBook) chapter 5: Maternal Physiology, page 84 Barzaga, Gillian T.

91. The increased prevalence of cholesterol gallstones in normal multiparous women is caused by: A. Decreased residual volume due to increased contractility of the gallbladder B. Estrogen impairing gallbladder contraction by inhibiting cholecystokinin-mediated smooth muscle stimulation C. Stasis due to impaired emptying leading to increased bile cholesterol saturation D. Increase dietary intake of cholesterol-laden food. Answer: C. Stasis due to impaired emptying leading to increased bile cholesterol Rationale: During normal pregnancy, the contractility of the gallbladder is reduced, leading to an increased residual volume (Braverman and co-workers, 1980). This may be because progesterone impairs gallbladder contraction by inhibiting cholecystokinin-mediated smooth muscle stimulation, which is the primary regulator of gallbladder contraction. Impaired emptying leads to stasis, which associated with increased bile cholesterol saturation of pregnancy, contributes to the increased prevalence of cholesterol gallstones in multiparous women. (Lifted directly from Williams Obstetrics) A. is incorrect because the residual volume is INCREASED and the contractility of the gallbladder is DECREASED. B. Is incorrect because it is PROGESTERONE, and not estrogen, that impairs gallbladder contraction by inhibiting the cholecystokinin-mediated smooth muscle stimulation. D. is not valid because not all women have the same diet. Reference: Williams Obstetrics, 23e (e-book) > Chapter 5.Maternal Physiology

Angue, Kendy Q.

92. The thyroid gland undergoes moderate enlargement during pregnancy because of the following, EXCEPT: a. glandular hyperplasia b. increased vascularity c. increased thyrotropin concentration d. none of the above Answer: C Rationale: Increased thyrotropin concentration does not contribute to the moderate enlargement of the thyroid gland during pregnancy because anatomically, the thyroid gland undergoes moderate enlargement during pregnancy caused by glandular hyperplasia and increased vascularity. Mean thyroid volume increased from 12 mL in the first trimester to 15 mL at delivery. Total volume was inversely proportional to serum thyrotropin concentration. Reference: Williams 23rd edition, page 127

Garcia, Ray Wilson M.

93. Which among the following is the least contributor to increase in weight gain by 40 weeks of pregnancy • a. Fetus • b. Placenta • c. Amniotic fluid • d. Uterus ANSWER: B. PLACENTA Rationale: By 40 weeks of pregnancy, the contributors in decreasing order in the weight gain are the following: fetus(3400g), maternal stores(3345g), extravascular fluid(1480g), blood(1450g), uterus(970g), Amnionic fluid(800g), placenta(650g),

breasts(405g). Among the choices, placenta is the least contributor to the weight gain. Reference: Williams Obstetrics 23rd Edition page 112 table 5-1 Aguinaldo, Mary Angeli M.

94. Pitting edema of the ankles and legs late in pregnancy is because of: a. incrased venous pressure below the level of the uterus b. partial aortic occlusion c. increase in interstitial colloid osmotic pressure d. increase salt intake due to the increase requirement for sodium and potassium Answer: A increased venous pressure below the level of the uterus Rationale: During normal pregnancy, an average woman retains about 6.5 L of extra water. Particularly at the end of a day, a significant percentage of pregnant women exhibit fluid accumulation leading to pitting edema of the ankles and legs. The edema is brought about by an increase in venous pressure below the level of the uterus. This increase in pressure is in turn, due to the partial occlusion of the vena cava. Reference: Williams Obstetrics 21st edition p. 174

Amer, Muhamma d Rajhi

95. The distribution of proteins in pregnancy are the following, EXCEPT A. Fetus and placenta. C. Stroma and ducts of the breast B. Uterine contractile protein. D. Hemoglobin in the maternal blood ANSWER: C RATIONALE: The products of conception, the uterus, and maternal blood are relatively rich in protein rather than fat and carbohydrates. At term, the fetus and placenta together weigh about 4kg and contain approximately 500g of protein, or about half of the total pregnancy increase. The remaining 500g is added to the uterus as contractile protein, to the breast primarily the glands, and to the maternal blood as hemoglobin and plasma protein. Therefore, the proteins of pregnant women are distributed at the glands of the breast not in the stroma or ducts of the breast. REFERENCE: 23rd Williams Obstetrics by Cunningham, et.al. Page 113

Chua, Hedley Ghizel L.

96. Hyperinsulinemia in pregnancy can be explained by: a. decreased metabolism of insulin b. pregnancy-induced state of peripheral insulin resistance c. suppression of glucagons d. decrease lipolysis Answer: B Rationale: Gravid women show hyperglycemia and hyperinsulinemia after an oral glucose meal. This is consistent with pregnancy-induced state of peripheral resistance. In late normal pregnancy, insulin sensitivity is 45 to 70 percent lower. When there is an increase in glucose level, the pancreatic beta-cells would secrete insulin, but since there is an insulin resistance, the normal response of the pancreas is to further increase the level of insulin secreted. References: Williams Obstetrics 23rd ed. Page 113

Abad, Mary Raina Angeli Z.

97. The concentration of fat in pregnancy is increased with: a. Storage of fat occurring in the first trimester of pregnancy b. Deposition of fat at the peripheral rather than central sites c. The fat becoming available for transfer in the second trimester d. Progesterone setting the lipostat in the hypothalamus Answer: D Rationale: A is not correct because storage of fat occurs in mid-pregnancy. B is not correct because deposition of fat is at the central sites rather than peripheral sites. C is not correct because fat becomes available for transfer in the last trimester. Reference: Williams, page 113

Dizon, Melissa N.

98. The demand of the developing fetus for calcium is met normally by the following EXCEPT: a. Doubling of maternal intestinal calcium absorption b. Dietary intake of sufficient calcium

c. Mobilization of calcium from maternal bones d. None of the above Answer: d. None of the above Rationale: the pregnant woman retains approximately 30g of calcium (dietary intake). This amount of calcium represents only approximately 2.5% of total maternal calcium, most of which is in bone, and which can readily be mobilized for fetal growth (mobilization of calcium from maternal bones). Heaney and Skillman demonstrated increased calcium absorption by the intestine and and progressive retention through pregnancy (doubling of maternal intestinal calcium absorption). References: Williams obstetrics, p.204 Coronel, Marie France

99. Maternal anemia is characterized by a) hemoglobin is less than 12 g/dl b) serrum ferritin levels less than 20 ng/dl c) decrease serum transferrin d) a cause of fetal anemia Answer: a) hemoglobin is less than 12 g/dl Rationale: According to Sumpaico et al, anemia in pregnancy is defined according to trimester but is generally described as hemoglobin below 11 g/dl Reference: Textbook of Obstetrics 3rd Edition by Walfrido W. Sumpaico, page 982

Andres, Raphael

100. Serum concentrations of sodium and potassium are decreased slightly despite the increased total accumulations of sodium and potassium due to: a. expanded plasma volume c. Increased glomerular filtration rate b. enhanced tubular resorption d. Increased renal blood flow ANSWER: a. expanded plasma volume RATIONALE: During normal pregnancy, nearly 1000 mEq of sodium and 300 mEq of potassium are retained. Although the glomerular filtration of sodium and potassium is increased, the excretion of these electrolytes is unchanged during pregnancy as a result of enhanced tubular resorption. And although there are increased total accumulations of sodium and potassium, their serum concentrations are decreased slightly because of expanded plasma volume. REFERENCE: Williams OBSTETRICS 23rd Edition (page 114)

Dela Cruz, Doris Joan

101. Give the provisions of the Reproductive Health Bill pending in Congress. Answer: House Bill No. 4244 The Responsible Parenthood, Reproductive Health and Population and Development Act of 2011. An act providing a comprehensive policy on responsible parenthood, reproductive health, and population and development and for other purposes Provisions: Reproductive Health Care refers to the access to a full range of methods facilities, services and supplies that contribute to reproductive health and well-being by preventing and solving health related problems. Elements include the following: a. Family planning information and services b. Maternal, infant child health and nutrition including breastfeeding c. Proscription of abortion and management of abortion complications d. Adolescent and youth reproductive health e. Prevention and management of reproductive infections, HIV, AIDs and other STIs f. Elimination of violence against women g. Education and counseling on sexuality and reproductive health h. Treatment of breast and reproductive tract cancers and other gynecological conditions and disorders i. Male responsibility and participation in reproductive health j. Prevention and treatment of infertility and sexual dysfunction k. Reproductive health education for the adolescents and l. Mental health aspect of reproductive health care Rationale: According to Honorable Edcel Lagman, one of the authors of the above bill,

although the reproductive health care is one of the basic human rights, it remains elusive and illusory for millions of Filipinos especially the poorest of the poor. This proposed bill will promote maternal health and decreased maternal morbidity, with proper spacing of children it will promote women employment, also it will decrease infant and child mortality, promoting socioeconomic factors and access to health service for all. Reference: http://www.congress.gov.ph/audience/index.php?d=billstext#bills http://www.congress.gov.ph/download/basic_15/HB04244.pdf Co, Lizette Ann Jennifer

102. Give the components of the Millennium Development Goal referring to Maternal and Child Care. Answer: The MDG is composed of eight goals, with Goal # 4 aiming to reduce child mortality (reduce children under-five mortality rate by two-thirds by 2015) and Goal # 5 to improve maternal health (reduce by three quarters, between 1990 and 2015 the maternal mortality ratio). Sources: Philippines Midterm Progress Report on the Millennium Development Goals (http://www.wpro.who.int/phl/files/unangyakap/mdg.pdf); Maternal , Newborn and Child (http://www.wpro.who.int/philippines/sites/maternal/campaign.htm)

Kalalo, Gerard Michael C.

103. Discuss solutions on how Maternal Mortality Ratio can be decreased. The prenatal care developed and designed during the 1900s has been proven to be effective in decreasing the Maternal Mortality Ratio from 690 per 100,000 births in 1920 to 50 per 100,000 by 1955. At present, the utilization of the Prenatal Care has decreased the Maternal Mortality Ratio significantly to 8 per 100,000. It has been proven in a study conducted in North Carolina that the risk of pregnancy-related maternal death was decreased fivefold among recipients of prenatal care. Reference: William’s Obstetrics, 23rd ed. Page 190

Banzon, Tracy

104. Give the components of WHO Reproductive Health 1. Improving antenatal, perinatal, postpartum and newborn care; 2. Providing high-quality services for family planning, including infertility services; 3. Eliminating unsafe abortion; 4. Combating sexually transmitted infections, including HIV, reproductive tract infections, cervical cancer and other sexual and reproductive health morbidities; 5. Promoting sexual health. Reference: Biennial Report of HRP 2008-2009: UNDP/UNFPA/WHO/World Bank Special programme of research, development and research training in human reproduction (HRP). World Health Organization. 2010: Page 1 .

Buenafe, Jonas Joaquin R.

105. The LNMP was on September 2, 2011. What is the age of gestation today (December 5, 2011)? Answer: To compute for the gestational age we must know the number days that have elapsed from her LNMP until today: Number of days from September 2, 2011 upto December 5, 2011: 94 days In terms of weeks, the age of gestation is (94days*(1week/7days)) 13 weeks and 3 days.* *it is important than the AOG be reported in exact numbers if applicable; remainders should also be indicated if there’s any References: Cunningham, G. et al (2010). Williams obstetrics (23rd ed.) (p. 195). McGraw-Hill Companies Inc.

Afaga, Desiree

106. (Based on the given on #105: LNMP was on September 2, 2011. What is her AOG today (December 5, 2011)?A patient has 35 days cycle. Which day of her cycle will she most likely ovulate? Explain why. Answer: November 21, 2011 Rationale: The day of ovulation corresponds to 14 days prior to the age of gestation (AOG). Since the computed AOG is 95 days or 13 weeks and 4 days, we subtract 14 days. Thus, the day of ovulation has most likely occurred 81 days prior to AOG, which corresponds to November 21, 2011. Reference: Williams Obstetrics 23rd Edition (E-book), Chapter 3 Implantation, Embryogenesis and Placental Development

Cruz, Spica E.

107. Explain why the AOG is more than two weeks from the fertilization age. Answer & Rationale Age of Gestation is the time elapsed since the first day of the last menstrual period, which precedes the conception. In a normal menstrual cycle, the first date of menstruation (Gestational Age) reliably occurs about 14 days after ovulation. This acounts for the two weeks' difference in gestational age and fertilization age. Reference: Williams Obstetrics 23rd Chapter 3. Implantation, Embryogenesis, and Placental Development & Chapter 4. Fetal Growth and Development ebook

Bustos, Nikki Elinor G.

108. A 31 year old primigravida has an LMP of May 31, 2011. Using Naegele’s rule: a. What is the age of gestation today? (December 13, 2011) b. Give the appropriate fetal length in mm. Answer: a. AOG = 196 days or 28 weeks b. Fetal Length = 1000 grams Computation: May June July Aug Sept Oct Nov Dec -

0 30 days 31 days 31 days 30 days 31 days 30 days + 13 days 196 days/ 7 days/ 1 week = 28 weeks

Reference: Cunningham et al., Williams Obstetrics, 23rd Edition, Section II Chapter 4 “Fetal Growth and Development”. McGraw- Hill N.Y. 2010 Camarinta, Karla Mae I.

109. A 31 year old primigravida has an LMP of May 31, 2011 Using Naegele’s rule: a. What is the age of gestation today? (December 13, 2011) b. Give the appropriate fetal length in mm. Answer: b.

a. AOG = 196 days or 28 weeks Fetal Length = 250mm (25cm)

Rationale: May - 0 June - 30 days July - 31 days Aug - 31 days Sept - 30 days Oct - 31 days Nov - 30 days Dec - 13 days 196 days 7days 28 weeks Reference: Williams 23rd Edition, Chapter 4: Fetal Growth and Development, page

80 Fresnido, Kyle Thomas

Kamantigu e, Janine E.

110. A 31 year oldprimigravida has an LMP of May 31, 2011 UsingNaegele’s rule a. give the age of gestation today (December 13, 2011) 12 13 2011 05 31 2011 196 days or 28 weeks b. give the external characteristics of the fetus at this age of gestation weight: 1100 gms skin is red covered with vernixcaseosa papillary membrane has just disappeared from the eyes length: 25 cm 111. A 31-year-old primigravida has an LMP of June 28, 2011 Using Naegele’s rule, compute the following: a. Give the age of gestation today. (December 13, 2011) b. Give the approximate fetal weight. Answer: a. 24 weeks AOG b. 630 g Rationale: According to Williams Obstetrics, obstetricians customarily calculate gestational age as menstrual age of a given pregnancy. A quick estimate of the due date of a pregnancy based on menstrual cycle can be made as follows: add 7 days to the first day of the last menstrual period and subtract 3 months (Naegele’s Rule). So in calculating the age of gestation of the fetus, it follows that the first day of the last menstrual period must be used as basis for the calculation. Calculation: June 28, 2011  2 July  31 August  30 September  31 October  30 November  31 December  13 168 168/7 = 24 weeks AOG And also, according to Williams Obstetrics, by the end of the 24th week, the fetus weighs about 630 g. Reference: Cunningham, F. G., et al. (1997). Williams Obstetrics(20th Edition), pp. 151, 154 and 229. Appleton & Lange.

Fernando, Emily Anne T.

112. A 31 yr old primigravida has an LMP of June 28, 2011. Using the Naegeles rule compute the following: A. give the age of gestation today (dec. 13 2011) B. Give the approximate fetal length in m C. Answer: A. AOG: 5months and 15 days B. Fetal length: approximately 160mm Naegele’s rule : first day of last normal menstrual period, add 7 days and minus 3 months (estimated date of delivery) Reference: Williams Obstetrics (22nd ed) page 94; 208

ARCAIRA, JOSHUA A.

113. A 31 year old primigravida has an LMP of June 28, 2011. Using Naegele’s rule, compute the following: a. Give the age of gestation today? (December 13, 2011)

b. Give the external physical characteristics of the fetus at this AOG. Answers: a. The AOG is 28 weeks and 1 day. b. The thin skin of the fetus is red and is covered with vernix caseosa. The papillary membrane has also just disappeared from the eyes. Rationale: a. Naegele’s rule is an estimation of the EDD (estimated date of delivery) and is computed by adding 7 days to the LMP and counting 3 months backwards. The solution is as follows: LMP: June 28, 2011 → 28 + 7 = July 5, 2011 → July, June, May, April EDD = April 5, 2012 To get the age of gestation you can either: (a) count backwards from the EDD, or (b) count from the LMP to the present date. Since we wish to utilize Naegele’s rule, we use option (a). EDD = April 5, 2012 → 5 days March → 31 February → 29 January → 31 December → 18 (not counting December 13) TOTAL 83 days → 83/7 = 11 weeks and 6 days. We assume that on the EDD, the baby is 40 weeks in (or in other words completed pregnancy to term) or 280 days. We then subtract the number above from 280 days then convert into weekly nomenclature: 280 – 83 = 197 days or 28 weeks and 1 day. b. During the embryonic period, the embryo has formed the optic cups, lens, and eyelids. By 12 weeks AOG, the skin and nails have started to develop. At 20 weeks AOG, the skin becomes less transparent and lanugo covers the entire body. At 28 weeks AOG, the skin is red and is covered by vernix caseosa and the pupillary membrane has disappeared from the developing fetal eyes. REFERENCE: Williams 23rd Edition, pages 78-80 Licudan, Lester D.

114. What type of trophoblast is responsible for the secretion of hormones during pregnancy? Answer: Syncytiotrophoblast Rationale: hCG, HPL and most of the steroids produced during pregnancy are all synthesized and secreted in the syncytiotrophoblast. References: Cunningham, F., et.al.(2010). Implantation, Embryogenesis and Placental Development.Williams

Francesca Debbie L. Liu

115. What is the precursor for estrogen biosynthesis in the human placenta? Answer: Plasma C19-Steroids as estrogen precursors in human placenta. Rationale: The pathways of estrogen synthesis in the placenta differ from those in the ovary of nonpregnant women. Estrogen production in the ovary takes place during the follicular and luteal phase through the interaction of theca and granulosa cells. Specifically, androstenedione is synthesized in ovarian theca and then transferred to adjacent granulosa cells for estradiol synthesis. Estradiol production within the corpus luteum of nonpregnant women as well as in early pregnancy continues to require interaction between the luteinized theca and granulosa cells. In human trophoblast, neither cholesterol nor progesterone can serve as precursor for estrogen biosynthesis. A crucial enzyme necessary for sex steroid synthesis— steroid 17 -hydroxylase/17,20-lyase (CYP17)—is not expressed in the human placenta. Consequently, the conversion of C21-steroids to C19-steroids—the latter being the immediate and obligatory precursors of estrogens—is not possible Although C19-steroids—dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S)— often are called adrenal androgens, these steroids can also serve as estrogen

precursors (Fig. 3-29). Ryan (1959a) found that there was an exceptionally high capacity of placenta to convert appropriate C19-steroids to estrone and estradiol. The conversion of DHEA-S to estradiol requires placental expression of four key enzymes that are located principally in syncytiotrophoblast (Bonenfant and colleagues, 2000; Salido and co-workers, 1990). First, the placenta expresses high levels of steroid sulfatase (STS), which converts the conjugated DHEA-S to DHEA. DHEA is then acted upon by 3 -hydroxysteroid dehydrogenase type 1 (3 HSD) to produce androstenedione. Cytochrome P450 aromatase (CYP19) then converts androstenedione to estrone, which is then converted to estradiol by 17 hydroxysteroid dehydrogenase type 1 (17 HSD1 Frandsen and Stakemann (1961) found that levels of urinary estrogens in women pregnant with an anencephalic fetus were only about 10 percent found in normal pregnancy. The adrenal glands of anencephalic fetuses are atrophic because of absent hypothalamic-pituitary function, which precludes ACTH stimulation. Thus, it seemed reasonable that fetal adrenal glands might provide substance(s) used for placental estrogen formation. In subsequent studies, DHEA-S was found to be a major precursor of estrogens in pregnancy (Baulieu and Dray, 1963; Siiteri and MacDonald, 1963). The large amounts of DHEA-S in plasma and its much longer half-life uniquely qualify it as the principal precursor for placental estradiol synthesis. There is a 10- to 20-fold increase in the metabolic clearance rate of plasma DHEA-S in women at term compared with that in men and nonpregnant women (Gant and co-workers, 1971). This rapid use results in a progressive decrease in plasma DHEA-S concentration as pregnancy progresses (Milewich and co-workers, 1978). However, maternal adrenal glands do not produce sufficient amounts of DHEA-S to account for more than a fraction of total placental estrogen biosynthesis. The fetal adrenal glands are quantitatively the most important source of placental estrogen precursors in human pregnancy. A schematic representation of the pathways of estrogen formation in the placenta is presented in Figure 3-29. As shown, the estrogen products released from the placenta are dependent on the substrate available. Thus, estrogen production during pregnancy reflects the unique interactions between fetal adrenal glands, fetal liver, placenta, and maternal adrenal glands Reference: Williams Obstetrics 23rd edition Chapter 3 Beredo, Charleen Joy A.

116. What is the precursor for the biosynthesis of progesterone by the placenta? Answer: Maternal plasma cholesterolwas the principal precursor—as much as 90 percent—of progesterone biosynthesis. Reference: F. Gary Cunningham, M.D. & Kenneth J. Leveno,M.D. et al (2010). 23rd edition of Williams Obstetrics. In M. F. Gary Cunningham, M. Kenneth J. Leveno, M. Steven L. Bloom, M. John C. Hauth, M. Dwight J. Rouse, & M. Catherine Y. Spong, 23rd edition of Williams Obstetrics (p. Chapter 3). United States of America.: The McGraw-Hill Companies, Inc.

Anacan, Keight Arren R.

117. What are the gastrointestinal tract changes in normal pregnancy and their clinical significance. Answer: • • • •

•

Gastrointestinal tract changes seen in normal pregnancy includes: Displacement of stomach and intestines due to enlarging uterus, as a result physical findings in some diseases are also altered Appendix are usually displaced upward and laterally also due to enlargement of uterus Although gastric emptying time appears to be unchanged during the each trimester of pregnancy, during labor it may be prolonged especially if analgesic agents were administered. There is decrease in the lower esophageal tone, intraesophageal pressures and increase in intragastric pressures which may cause pyrosis. Alteration in the position of the stomach and lower amplitude and wave speed of esophageal peristalsis also contributes to pyrosis or heartburn. Epulis or highly vascular swelling of gums develops occassionaly but

• • •

•

•

typically regress. Hemorrhoids are also common, they are caused in large measure by constipation and elevated pressure in veins below the level of the enlarged uterus. There is no remarkable increase in liver size during normal pregnancy however there diameter of portal vein and its blood flow increases. Total alkaline phosphatase activity in serum doubles during pregnancy but much of this is attributed to heat stable placental alkalibe phosphatase isozymes. Serum aspartate transaminase, alanine transaminase, glutamyl transferase and bilirubin levels are slightly lower compared to non pregnant normal values The concentration of serum albumin decreases during pregnancy but total albumin is increased because of a greater volume of distribution. The reduction in albumin concentration, combined with a normal slight increase in serum globulin levels, results in a decrease in the albuminto-globulin ratio similar to that seen in certain hepatic diseases. The contractility of the gallbladder is reduced, leading to an increased residual volume. Reduction in gallbladder contractility is due to progesterone that impairs gallbladder contraction by inhibiting cholecystokinin-mediated smooth muscle stimulation, Impaired gallbladder contraction leads to stasis, and this, associated with the increased cholesterol saturation of pregnancy.

Reference: F. Cunningham et al., Williams Obstetrics 22nd edition. Chapter 5. Maternal Physiology. Gnilo, Darlene

118. Give the important functions of pregnancy- induced hypervolemia. Answer: Important functions of pregnancy-induced hypervolemia include: 1. To meet the metabolic demands of the enlarged uterus 2. To provide an abundance of nutrients and elements 3. To protect the mother and the fetus 4. To safeguard the mother against the adverse effects of blood loss Rationale: 1. It is important to meet the metabolic demands of the enlarged uterus because during pregnancy, the vascular system is greatly hypertrophied. 2. An abundance of nutrients & elements is important to support both the rapidly growing placenta and fetus. 3. Hypervolemia can provide protection to the mother & the fetus against deleterious effects of impaired venous return in the supine and erect positions. 4. It is also important to protect the mother from adverse effects of blood loss associated during partuition. Reference Cunningham, Leveno, Bloom, Hauth, Gilstrap III, Wenstrom: Williams Obstetrics 23nd edition. Ebook. Section II , Chapter 5

Boussati, Jamela

119. Give the renal anatomic changes in normal pregnancy and their clinical significance. Answer: • Kidney size increases slightly. Size returns to normal postpartum. • Kidney is 1.5 cm longer during the early puerperium compared with 6 months later. (Baily and Rolleston, 1971) Because: Glomerular Filtration Rate (GFR) and Renal Plasma Flow increase in early pregnancy. o GFR increase as much as 25% by second week after conception. o 50% by the beginning of the second trimester. That’s why there in Urinary frequency during pregnancy. o Renal Plasma flow increases. (Davison and Noble, 1981) • Dilation, which can be confused with obstructive uropathy; retained urine leads to collection errors; renal infections are more virulent; may be responsible for “Distention Syndrome”

• Increase urinary Reference: Williams Obstetrics 23rd Edition P. 56 Cruz, Arcturus

120. Give the important functions of pregnancy-induced hypervolemia. Answer important functions: 1. To meet the metabolic demands of the enlarged uterus with its greatly hypertrophied vascular system. 2. To provide an abundance of nutrients and elements to support the rapidly growing placenta and fetus. 3. To protect the mother and in turn the fetus, against the deleterious effects of impaired venous return in the supine and erect positions. 4. To safeguard the mother against the adverse effects of blood loss associated with parturition. Rationale Without the Pregnancy induced hypervolemia, the pregnant mother’s body will have a difficult time adapting to changes happening during pregnancy specially with regards to the growing demand of the Fetus and its reaction to the Mothers body like decrease in venous return in supine and erect position and also Blood loss during parturition and also give nutrients to growing fetus by increasing the blood elements. Reference: (Williams EBOOK) (23rd edition) (chapter1)