OB Finals Rationalization Sec B

Student Name

Question, Answer and Rationalization

1. Mercado, Eunice F.

1. MERCADO, EUNICE F. Which of the following is the definition of health according to WHO? a. Health is the absence of disease b. Health is the ability to perform your responsibilities without difficulties c. State of non-hospitalization for life d. State of complete physical, mental and social well-being Answer: D. Rationale: Within the framework of WHO's definition of health as a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, reproductive health addresses the reproductive processes, functions and system at all stages of life. Reference: World Health Organization 2012 (http://www.who.int/topics/reproductive_health/en/) 2. MERCADO, EUNICE F. Which of the following is/are concern/s of Reproductive Health? a. right of men and women to safe, affordable and acceptable fertility regulation b. right to appropriate health services for a safe pregnancy, delivery and a healthy baby c. right to have a responsible, satisfying and safe sex life d. all of the above Answer: D. Rationale: According to WHO, it is shaped around the five components of WHO’s Global reproductive health strategy: -improving antenatal, perinatal, postpartum and newborn care; providing high-quality services for family planning, including infertility services; -eliminating unsafe abortion; -combating sexually transmitted infections, including HIV, reproductive tract -infections, cervical cancer and other sexual and reproductive health morbidities; -promoting sexual health. Reference: World Health Organization 2012 (http://www.who.int/reproductivehealth/about_us/en/index.ht ml) 3. MERCADO, EUNICE F. What is the best program for the Reproductive Health of the

adolescent age groups? a. low-dose oral contraceptive pills b. condoms c. information, education and communication services d. religion and catechism Answer: C. Rationale: WHO carries out a range of functions to improve the health of young people, some of them include: -identifying the most effective ways of promoting good health among young people, preventing health problems and responding to them when they occur; producing the methods and tools by which evidence can be applied in countries; -raising attention of issues among the public at large and among special groups; -building a shared understanding among partners and a shared sense of purpose on what needs to be done; -supporting countries with the formulation of policies and programmes, their implementation, and monitoring and evaluation. Reference: World Health Organization 2012 (http://www.who.int/mediacentre/factsheets/fs345/en/index.ht ml) 2. Mendoza, Rigel 2. Which of the following is/are concern/s of Reproductive Faye R. Health? a. right of men and women to safe, affordable and acceptable fertility regulation b. right to appropriate health serves for a safe pregnancy, delivery and a healthy baby c. right to have a responsible, satisfying and safe sex life d. all of the above Answer: D Rationale: 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 l. Mental health aspect of reproductive health care Reference: http://www.congress.gov.ph/download/basic_15/HB04244.pdf 3.What is the best program for the Reproductive Health of the adolescent age group? a. low-dose oral contraceptive pills b. condoms c. information, education and communication services d. religion and catechism ANSWER: C Rationale: Reproductive health programs for specific groups such as adolescents, including information, education, communication and services. Reference: Sumpaico, page 2

4. The two priority areas for Reproductive Health to improve in the Western-Pacific region are: a. safe pregnancy and family planning b. safe pregnancy and breastfeeding c. family planning and anemia d. safe pregnancy and anemia Answer: A 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. http://libdoc.who.int/wpro/2001/9290611839.pdf

5. Reyes, Katrina 5. Reyes, Katrina May T. May T. According To the Millennium Development Goal, maternal mortality ratio by 2015 must decrease by: a. One-fourth b. One-half c. Three-fourths d. Two-thirds Answer: C. Three-fourths (75%) Rationale: The fifth goal is to improve maternal health, reducing maternal mortality ratio by 75%. Reference: http://www.un.org/millenniumgoals/maternal.sht ml(none discussed in Williams) 6. What is the importance of maternal and neonatal outcomes? a. It reflects the quality of health and life in a community. b. It assures the continuity of a race. c. It determines the economic needs of a country. d. It will give information on the ratio of males versus females in a population. Answer: A. It reflects the quality of health and life in a community. Rationale: Lifted from Williams Obstetrics, 23rd edition, Chapter 1: Overview of Obstetrics: Introduction—“The importance of obstetrics is attested to by the use ofmaternal and neonatal outcomes as an index of the quality of health and life in human society.” Reference: Cunningham, F. et al, Williams Obstetrics, 23rd edition, McGraw-Hills Company, Inc, 2010, Chapter 1. Overview of Obstetrics 7. Which is NOT considered to be a perinatal death? a.

a. Fetal death at 28 weeks AOG

b. c. d.

b. Fetal death during delivery at 37 weeks AOG c. Neonatal death at 3 days of life d. Neonatal death at 12 days of life

Answer: A. Fetal death at 28 weeks AOG Rationale: Perinatal period is the period after birth of an infant born after 20 weeks and ending at 28 completed days after birth. Choice A is NOT considered a perinatal death since the fetus is not yet born or delivered. Reference: Cunningham, F. et al, Williams Obstetrics, 23rd edition, McGraw-Hills Company, Inc, 2010, Chapter 1. Overview of Obstetrics under section Definitions 6. Reyes, Rachel Ann Q.

6. REYES, RACHEL ANN Q. What is the importance if maternal and neonatal outcomes? a. it reflects the quality if health and life in a community b. it assures continuity of a race c. it determines the economic needs of a country d. it will give information on the ratio of males versus female in a population Answer: A Rationale: According to the book, poor of these outcomes indicate that medical care for the entire population is lacking. Reference: Williams 22th Edition page 7 (ebook) 7. REYES, RACHEL ANN Q. Which is not considered to be a perinatal death? a. fetal death at 28 weeks AOG b. fetal death during delivery at 37 weeks AOG c. neonatal death at 3 days of life d. neonatal death at 12 days of life Answer: B Rationale: Based on the definition by NCHS and CDC, 'perinatal period is commencing at 20 weeks and ends at 28 completed days after birth' it does not tell us of death during delivery. Reference: Williams 22th Edition page 8 (ebook) 8. REYES, RACHEL ANN Q. The following must be fulfilled for a birth to happen EXCEPT? a. AOG of more than 20 weeks b. birth weight of more than 500 grams c. placenta must be separated and expelled d. crown to heel length of 25 cm Answer: C

Rationale: Birth is a complete expulsion of fetus from mother, irrespective of whether the umbilical cord has been cut or the placenta is attached. Reference: Williams 22th Edition page 8 (ebook) 7. Radina, C Philip Teomar II, A.

7. RADIN, C PHILIP TEOMAR, II, A. Which is not considered to be a perinatal death? •fetal death at 28 weeks AOG •fetal death during delivery at 37 weeks AOG •neonatal death at 3 days of life •neonatal death at 12 days of life Answer: A Rationale: Perinatal period. The period after birth of an infant born after 20 weeks and ending at 28 completed days after birth. Choice A is not considered to be a perinatal death because fetal death came before delivery. Reference: E-BOOK Williams Obstetrics 23rd Edition. Chapter 1: Overview of Obstetrics 8. RADIN, C PHILIP TEOMAR, II, A. The following arte considered for birth to happen, EXCEPT? a) AOG more than 20 weeks AOG b) birth weight of more than 500 grams c) placenta must be separated and expelled d) crown to heel length of at least 25 cm Answer: C Rationale: Live birth is the complete expulsion or extraction from the mother of a product of human conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction, breathes or shows any evidence of life, such as beating of the heart, pulsation of umbilical cord or definite movement of voluntary muscles whether or not the umbilical cord has been cut or the placenta is attached. Heart beats are to be distinguished from transient cardiac contraction; respirations are to be distinguished from fleeting respiratory efforts of gasps. Delivering of the placenta is not a prerequisite to live birth. Reference: Sumpaico W., et. al., Textbook of Obstetrics (Physiologic and Pathologic Obstetrics) 3rd edition, 2008. Page 7

9. RADIN, C PHILIP TEOMAR, II, A. A 36 y/o G4P3 (3-0-0-3), a known asthmatic is pregnant. During this pregnancy, she had more frequent asthmatic attacks. Patient went into preterm labor at 32 weeks accompanied with severe intractable asthmatic attack. The patient eventually died. This is considered to be: •direct obstetric death •indirect obstetric death •non-obstetric death •A & B are correct Answer: D Rationale: Direct maternal death. The death of the mother that results from obstetrical complications of pregnancy, labor, or the puerperium and from interventions, omissions, incorrect treatment, or a chain of events resulting from any of these factors. An example is maternal death from exsanguination after uterine rupture. Indirect maternal death. A maternal death that is not directly due to an obstetrical cause. Death results from previously existing disease or a disease developing during pregnancy, labor, or the puerperium that was aggravated by maternal physiological adaptation to pregnancy. An example is maternal death from complications of mitral valve stenosis. Nonmaternal death. 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. Choices A and B are correct because the causes of death in this case are pre term labor at 32 weeks AOG and asthma which are direct and indirect obstetric death, respectively. Reference: E-BOOK Williams Obstetrics 23d Edition. Chapter 1: Overview of Obstetrics 8. Hayes, Alpha Rana M.

08. ALPHA RANA M. HAYES The following must be fulfilled for a birth to happen, EXCEPT:

a. AOG of more than 20 weeks b. birth weight of more than 500 grams c. placenta must be separated and expelled d. crown to heel length of at least 25 cm Answer: C Rationale: All of the following choices are normal averages for a birth to happen except that placental separation and expulsion happens after the delivery of the baby. From approximately 20 weeks, the crown to heel measurement of a baby is 25 cm. The normal birth weight should be from 500 grams as shown in the graph:

References: Sumpaico, Walfrido et. al (2008) Textbook of Obstetrics: Physiologic and Pathologic Obstetrics. 3rd Edition. Chapter 43. Quezon City: Association of Writers of the Philippine Textbooks of Obstetrics and Gynecology, Inc. Website: http://www.baby2see.com/baby_birth_weight.html 09. ALPHA RANA M. HAYES A 36 y/o, G4P3 (3-0-0-3), a known asthmatic is pregnant. During this pregnancy, she had more frequent asthmatic attacks. Patient went into preterm labor at 32 weeks AOG accompanied with severe intractable asthmatic attack. The patient eventually died. This is considered to be: a. direct obstetric death

c. non-obstetric death

b. indirect obstetric death

d. A & B are correct

Answer: D Rationale: According to the World Health Organization (WHO), "A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes." Maternal deaths happen for two reasons: a direct obstetric death which is caused by complication that develops directly as a result of pregnancy, delivery or the postpartum period; an indirect obstetric death which is due to existing medical conditions that are made worse by delivery or pregnancy. There are five major medical causes of direct obstetric death: haemorrhage (28 %); complications of unsafe abortion (19%); pregnancy-induced hypertension (17%); infection (11 %); and obstructed labor (11 %). Direct obstetric deaths account for about 75 per cent of all maternal deaths in developing countries. Indirect obstetric deaths account for about 25 percent of all maternal deaths in developing countries. References: Sumpaico, Walfrido et. al (2008) Textbook of Obstetrics: Physiologic and Pathologic Obstetrics. 3rd Edition. Chapter 43. Quezon City: Association of Writers of the Philippine Textbooks of Obstetrics and Gynecology, Inc. Website: www.unicef.org 10. ALPHA RANA M. HAYES A mature oocyte is also called: a. primary oocyte b. secondary oocyte

c. tertiary oocyte d. second polar body

Answer: B Rationale: Oogenesis results in the formation of both primary oocytes before birth, and of secondary oocytes after it as part of ovulation. If fertilized, it divides into an ootid and the second polar body. A secondary oocyte will not complete meiosis II until a sperm penetrates it. However, that doesn't mean the oocyte wasn't mature already. A mature

oocyte is ejected from the Graafian follicle when it has reached a maximum level of growth. That cell is already pretty well-developed with its organelles and processes running as needed so when it is released, it is ready to undergo meiosis II.

References: Sumpaico, Walfrido et. al (2008) Textbook of Obstetrics: Physiologic and Pathologic Obstetrics. 3rd Edition. Chapter 43. Quezon City: Association of Writers of the Philippine Textbooks of Obstetrics and Gynecology, Inc. Website: http://en.wikipedia.org/wiki/Oocyte 9. Naldo, Jacob Timothy C.

9. Naldo, Jacob Timothy C. A 36 y/0, G4P3 (3-0-0-3) a known asthmatic is pregnant. During this pregnancy, she had more frequent asthmatic attacks. Patient went into preterm labor at 32 weeks AOG accompanied with severe intractable asthmatic attack. The patient eventually died. This is considered to be: a. direct obstetric death b. indirect obstetric death c. non-obstetric death d. A and B are correct Answer: B Rationale: An indirect maternal death is not directly due to an obstetrical cause, but resulting from previously existing disease, or disease that developed during pregnancy, labor, or the puerperium, but which was aggravated by maternal physiological adaptation to pregnancy. This patient was known to have a previous disease of asthma that was

aggravated by pregnancy and labor. Reference: Williams 22 Edition, PAGE # 8 10.Naldo, Jacob Timothy C. A mature oocyte is also called: a. primary oocyte b. secondary oocyte c. tertiary oocyte d. second polar body Answer: B Rationale: By the fourth month, some germ cells in the medullary region begin to enlarge. These are called primary oocytes at the beginning of the phase of growth that continues until maturity is reached. The union of egg and sperm at fertilization represents one of the most important processes in biology. Ovulation frees the secondary oocyte and the adhering cells of the cumulus oophorus from the ovary.The secondary oocyte in the period between the frist and second meiotic division that is derived from the primary oocyte shortly before ovulation. If not fertilized, degeneration occurs. Reference: Williams 22 Edition, PAGE# 21, 33 11. Naldo, Jacob Timothy C. What is a solid mass of 12 to 32 blastomeres at 3 to 4 days of fertilization? a. cleavage b. blastomere c. morula d. blastocyst Answer: C Rationale: In the two-cell zygote, the blastomeres and the 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, referred to as the morula, is produced. The morula enters the uterine cavity about 3 days after fertilization. The gradual accumulation of fluid between the cells of the morula results in the formation of the early blastocyst. Reference: Williams 22 Edition, PAGE # 34 10. Sampello, Ma. 10. SAMPELO, MA. CARMELA A.

Carmella A.

A mature oocyte is also called: a. primary oocyte b. secondary oocyte c. tertiary oocyte d. second polar body ANSWER: B RATIONALE: LH induces remodelling of the ovarian extracellular matrix to allow release of the mature oocyte with surrounding cumulus cells through the surface epithelium. Ovulation frees the secondary oocyte and adherent cells of the cumulus-oocyte complex from the ovary. *Reference: Williams 23rdedition, Chapter 3: Implantation, Embryogenesis, and Placental development 11. SAMPELO, MA. CARMELA A. What solid mass of 12 to 32 blastomeres at 3-4 days of fertilization? a. cleavage b. blastomeres c. morula d. blastocyst ANSWER: C RATIONALE: Because CLEAVAGE(A) is the process of zygote developing into blastomere. BLASTOMERES(B) will continue to divide and will develop into a solid mulberry-like ball of cells, called the MORULA(C). The morula enters the uterine cavity about 3 days after fertilization with gradual accumulation of fluid between the cells of resulting in the formation of the early BLASTOCYST(D). *Reference: Williams 23rdedition, Chapter 3: Implantation, Embryogenesis, and Placental development 12. SAMPELO, MA. CARMELA A. At what stage is the embryo implanted? a. cleavage b. blastomere c. morula d. blastocyst ANSWER: D RATIONALE: Blastocyst is stage where in the implantation of the embryo into the uterine wall takes place. It is a common feature of all mammals. *Reference: Williams 23rdedition, Chapter 3: Implantation, Embryogenesis, and Placental development

11. Ridao, Hanna 11. RIDAO, HANNA CLARE P. Clare P. What is a solid mass of 12 to 32 blastomeres at 3 to 4 days of fertilization? a. cleavage b. blastomere c. morula d. blastocyst ANSWER: C Rationale: The zygote undergoes slow cleavage for 3 days while still within the fallopian tube. As the blastomeres continue to divide, a slid mulberry-like ball of cells-- the morula-- is produced. The morula enters the uterine cavity about 3 days after fertilization. Reference: Williams, 23rd edition, page 48 12. RIDAO, HANNA CLARE P. At what stage is the embryo implanted? a. cleavage b. blastomere c. morula d. blastocyst ANSWER: D Rationale: 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 bastocyst and uterine epithelium; and 3) invasion-- penetration and invasion of syncytiotrophoblast and cytotrophoblast into the endometrium, inner third of myometrium and uteine vasculature Reference: Williams, 23rd edition, page 48 13. RIDAO, HANNA CLARE P. In gametogenesis, reduction division occurs during which meiotic division? a. first b. second c. third d. fourth ANSWER: A Rationale: It is during meiosis I, the reductional division, that the sister chromatids remain paired, attach to only one spindle, and segregate together. This centromeric cohesion is lost during the second meiotic division, which resembles

mitosis, where the replicated sisters make bipolar attachments and separate to opposite poles. Reference: Cell Division-http://www.celldiv.com/content/6/1/16 12. Villaruel, Andrea R.

12. VILLARUEL ANDREA R. At what stage is the embryo implanted? a. cleavage b. blastomere c. morula d. blastocyst Answer: D Rationale: To determine at which stage the embryo is implanted, it is advantageous to first discern the order of its development. Fertilization usually occurs in the fallopian tube. After the union of the egg and the sperm, a zygote is produced. This contains the genetic components of both the mother and the father. The said zygote undergoes cleavage intoblastomeres until continuous division produces a mulberry-like ball of cells at the 12- to 16- cell cycle called morula which then enters the uterine cavity about 3 days after fertilization. Gradual accumulation of fluid between the cells of the morula produces the early blastocyst. The blastocyst undergoes further development until an inner cell mass and trophoblasts are formed. The blastocystproduces cytokines and hormones, directly influencing endometrial receptivity, and in about 6 or 7 days, is implanted in the uterine wall by the processes of apposition, adhesion and invasion (by the function of the trophoblasts). Reference: Williams Obstetrics,23rd Edition, Chapter 3, page 48 13. VILLARUEL ANDREA R. In gametogenesis, reduction division occurs during which meiotic division? a. first b. second c. third

d. fourth Answer: A Rationale: In gametogenesis, there are only 2 cell divisions of meiosis: I and II. In meiosis I, the homologous chromosomes align themselves as pairs at the center. After which, they divide producing a haploid number ( only 23 chromosomes) gamete. Meiosis II works with an already reduced number of chromosomes producing 4 haploid cells ready for union with another haploid gamete. Reference: Langman’s Medical Embryology, 8th Edition, Chapter 1, page 6 14. VILLARUEL ANDREA R. When does differentiation in the process of oogenesis begin in the female? a. 12 weeks AOG in-utero b. 24 weeks AOG in-utero c. upon birth d. adolescence Answer: A Rationale: The oogonia begin to form when the primordial germ cells have arrived in the gonad of the developing genetically female embryo. These cells undergo a series of mitotic divisions and are arranged in clusters surrounded by flat epithelial cells by approximately the end of the 3rd month of gestation or 12 weeks AOG in-utero. So at 24 weeks AOG in-utero, majority of the oogonia have already divided by mitosis and the germ cells have already reached its maximum number. Some even have already been arrested at meiosis I, forming primary oocytes. A number of oogonia as well as primary oocytes become atretic prior to birth and continuously degenerate until only a certain number of them become viable for the resumption of meiosis by ovulation at adolescence and subsequently, fertilization. Reference: Langman’s Medical Embryology, 8th Edition, Chapter 1, page 20 13. Mendoza, Christian Julius

13) In gametogenesis, reduction division occurs during which meiotic division?

a. first b. second c. third d. fourth Answer: A. In the first stage of meiosis, called the reduction division, the members of each pair of homologous chromosomes lie side by side and crossing over occurs. Each member of the pair then moves away from the other toward opposite ends of the dividing cell, and two nuclei, each with the haploid number of double-stringed chromosomes, are formed. Source: The Columbia Electronic Encyclopedia® Copyright © 2007, Columbia University Press. Licensed from Columbia University Press. All rights reserved.www.cc.columbia.edu/cu/cup/ (http://encyclopedia2. thefreedictionary.com/reduction+division) 14) When does differentiation in the process of oogenesis begins in the female? a. 12 weeks AOG in-utero b. 24 weeks AOG in-utero c. upon birth d. adolescence Answer: A. 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. Source: Williams Obstetrics 23rd edition E-BOOK Chapter 4: Fetal Growth and Development 15) With two million oocytes at birth, how many are actually ovulated in a woman's entire life? a. 200 b. 400 c. 600 d. 800 Answer: B. The ovary contains many follicles composed of a developing egg surrounded by an outer layer of follicle cells. Each egg begins oogenesis as a primary oocyte. At birth each female carries a lifetime supply of developing oocytes, each of which is in Prophase I. A developing egg (secondary oocyte) is released each month from puberty until

menopause, a total of 400-500 eggs. Source: http://www.emc.maricopa.edu/faculty/farabee/biobk/b iobookmeiosis.html 14. Navor, Abigail 14. When does differentiation in the process of oogenesis A. begins in the female? a. 12 weeks AOG in utero b. 24 weeks AOG in utero c. Upon birth d. Adolescence Answer: A Rationale: oogenesis begins during fetal life. It begins with the onset of prophase 12 weeks AOG ( 3mos). Source: www.embryology.ch/anglais/ 15. With two million oocytes at birth, how many are actually ovulated in woman' s entire life? a. 200 b. 400 c. 600 d. 800 Answer: B Rationale: There are 2 million oocytes in human ovary at birth. About 400,000 follicles are present at the onset of puberty.1000 follicles per month until age 35 are depleted. Only 400 follicles are normally released during female reproductive life. Source: William' s 23rd, chapter 3, pages 36-37. 16. How can fertilization occur when coitus happened three days before ovulation? a. The ovum can live up to three days b. The sperm can live up to three days c. Both are correct d. Both are wrong Answer: B Rationale: Prior to ovulation, the female body begins to prepare for the introduction of sperm by maintaining a lower body temperature and producing an alkaline cervical mucus.Sperm may live between 3 and 5 days in the uterus, or between 24 and 48 hours. Source: www.mayoclinic.health 16. Tecson, Kristoffer

16. How can fertilization occur when coitus happened three days before ovulation?

•The ovum can live up to three days •The sperm can live up to three days •Both are correct •Both are wrong Answer: B Rationale: Letter A is wrong because according to Sumpaico, oocytes are fertilized in the fallopian tube usually within 12 hours after ovulation and they may not survive for more than 24 hours before disintegrating. The life span of sperm after ejaculation depends on the environmental conditions. Sperm ejaculated into a woman's vagina can live in a woman's reproductive tract for up to three days or perhaps even longer. Fertilization is possible as long as the sperm remain alive. Sperm ejaculated outside the body may survive only minutes to a few hours. Reference: http://www.mayoclinic.com/health/pregnancy/AN00281 Textbook of OBSTETRICS Sumpaico 3rd edition page 167 17. What event triggers ovulation? •Elevated estrogen level •Critical follicle size •Decrease in FSH level •LH surge Answer: D Rationale: The LH surge stimulates three major events: resumption of meiosis allowing the oocyte to undergo final maturation, luteinization of the granulosa and theca cells with increased production of progesterone, and follicle rupture with extrusion of a mature oocyte. Another important midcycle event is the conversion of the granulosa membrane from avascularized to a vascularized status Reference Textbook of OBSTETRICS Sumpaico 3rd edition page 71

18. Which process must the sperm undergo first prior to fertilization? •Ejaculation •Spermiogenesis •Capacitation •Sperm penetration Answer: C Rationale: Although spermatozoa are said to be “mature” when they leave the epididymis, their activity is held in check by multiple inhibitory factors secreted by the genital duct epithelia. Therefore, when they are first expelled in the semen, they are unable to perform their duties in fertilizing the ovum. However, on coming in contact with the fluids of the female genital tract, multiple changes occur that activate the sperm for the final processes of fertilization. These collective changes are called capacitation of the spermatozoa. This normally requires from 1 to 10 hours. Reference: Medical physiology 11th edition Guyton and Hall 17. Sigua, Roxanne C.

17. SIGUA, ROXANNE C. What event triggers ovulation? a. elevated estrogen level b. critical follicle size c. decrease in FSH level d. LH surge ANSWER: D RATIONALE: LH secretion peaks 10 to 12 hours before ovulation and stimulates the resumption of meiosis in the ovum with the release of the first polar body. Current studies suggest that in response to LH, increased progesterone and prostaglandin production by the cumulus cells, as well as GDF9 and BMP-15 by the oocyte, activates expression of genes critical to formation of a hyaluronan-rich extracellular matrix by the COC (Richards, 2007). During synthesis of this matrix, cumulus cells lose contact with one another and move outward from the oocyte along the hyaluronan polymer—this process is called expansion. This results in a 20-fold increase in the volume of the complex. Studies in mice indicate that COC expansion is critical for maintenance of fertility. In addition, LH induces remodeling of the ovarian extracellular matrix to allow release of the mature oocyte with surrounding cumulus cells through the surface epithelium. Activation of

proteases likely plays a pivotal role in weakening of the follicular basement membrane and ovulation (Curry and Smith, 2006; Ny and colleagues, 2002). Reference: Williams Obstetrics 23rd edition, Chapter 3 18. SIGUA, ROXANNE C. Which process must the sperm undergo first prior to fertilization? a. ejaculation b. spermiogenesis c. capacitation d. sperm penetration ANSWER: C RATIONALE: After the ejaculation the sperm cells go through several essential physiological changes during their time in the female genital tract before they, at the end, are able to penetrate the oocyte membrane.The first change in this cascade is capacitation. The sperm cells accomplish this during the ascension through the female genital tract (in contact with its secretions). It has to do with a physiological maturation process of the sperm cell membranes, which is seen as the precondition for the next step to follow, namely the acrosome reaction. Reference: http://www.embryology.ch/anglais/dbefruchtung/weg03.html 19. SIGUA, ROXANNE C. What is formed with completion of fertilization? a. zygote b. cleavage c. blastomere d. morula ANSWER: A 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 (Fig. 3-10). 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. Reference: Williams Obstetrics 23rd edition, Chapter 3

19. Ozaeta, 19. OZAETA, KATHLEEN JOYCE R. Kathleen Joyce R. What is formed with completion of fertilization? a. zygote b. cleavage c. blastomere d. morula ANSWER: A After fertilization in the fallopian tube, the mature ovum becomes a zygote—a diploid cell with 46 chromosomes—that then undergoes cleavage into blastomeres. Reference: Williams Obstetrics, Twenty-Third Edition p. 48 20. OZAETA, KATHLEEN JOYCE R. What is the average duration (in days) between the first day of last menstrual period and the birth of the fetus? a. 260 b. 270 c. 280 d. 290 ANSWER: C

About 280 days, or 40 weeks, elapse on average between the first day of the last menstrual period and the birth of the fetus. This corresponds to 9 and 1/3 calendar months. A quick estimate of the due date of a pregnancy based on menstrual data can be made as follows: add 7 days to the first day of the last period and subtract 3 months. Reference: Williams Obstetrics, Twenty-Third Edition p. 79 21. OZAETA, KATHLEEN JOYCE R.

What mechanism is involved in the transfer of glucose through the placental tissue? a. simple diffusion b. facilitated diffusion c. active transport d. any of the above ANSWER: B The transfer of D-glucose across cell membranes is accomplished by a carrier-mediated, stereospecific, nonconcentrating process of facilitated diffusion. At least 14 separate glucose transport proteins (GLUTs) have been discovered (Leonce and colleagues, 2006). They belong to the 12-transmembrane segment transporter superfamily and are characterized further by tissue-specific distribution. GLUT1 and GLUT-3 primarily facilitate glucose uptake by the placenta and are located in the plasma membrane of the microvilli of the syncytiotrophoblast (Korgun and colleagues, 2005). GLUT-1 expression increases as pregnancy advances and is induced by almost all growth factors (Sakata and colleagues, 1995). Reference: Williams Obstetrics, Twenty-Third Edition p. 87

20. Pacifico, Ma. Priscilla Elena

20. What is the average duration (in days) between the first day of the last menstrual period and the birth of the fetus? a. 260 c. 280 b. 270 d. 290 Answer: C Rationale: In Sumpaico, it states that: “…gestational age (also known as menstrual age and age of gestation) is calculated from the first day of the last menstrual period, in ultrasound, and in clinical practice. Pregnancy lasts for about 280 days, or 40 weeks, 9 ½ calendar months, or 10 lunar months, when calculation is made from the LMP.” Reference: Sumpaico (Textbook of Obstetrics), 3rd Edition, page 208 21. What mechanism is involved in the transfer of glucose through the placental tissue? a. Simple diffusion c. Active transport b. Facilitated diffusion d. Any of the above Answer: B Rationale: In Shnider and Levinson’s Anesthesia for Obstetrics, five mechanisms for exchange of substances

across the placenta were outlined. These are diffusion, active transport, bulk flow, pinocytosis and “breaks”. It was specifically stated that “glucose crosses the placenta via facilitated diffusion carriers inserted in both microvillous and basement membranes”, wherein its movement down the concentration gradient is depends on the blood flow, plasma concentrations and cellular energy supply. Reference: Hughes, S., Levinson, G. and Rosen, M., Shnider and Levinson’s Anesthesia for Obstetrics, pages 19-21 22. Which condition may develop due to lack of amnionic fluid during early fetal development? a. Pulmonary emphysema c. Renal agenesis b. Musculoskeletal deformities d. All of the above Answer: D Rationale: Table 21-4. Congenital Anomalies Associated with Oligohydramnios Amnionic band syndrome Cardiac: Fallot tetralogy, septal defects Central nervous system: holoprosencephaly, meningocoele, encephalocoele, microcephaly Chromosomal abnormalities: triploidy, trisomy 18, Turner syndrome Cloacal dysgenesis Cystic hygroma Diaphragmatic hernia Genitourinary: renal agenesis, renal dysplasia, urethral obstruction, bladder exstrophy, Meckel-Gruber syndrome, ureteropelvic junction obstruction, prune-belly syndrome Hypothyroidism Skeletal: sirenomelia, sacral agenesis, absent radius, facial clefting TRAP (twin reverse arterial perfusion) sequence Twin-twin transfusion VACTERL (vertebral, anal, cardiac, tracheo-esophageal, renal, limb) association Reference: Williams Textbook of Obstetrics 23rd Edition page 496 22. Magno, Warlyn Grace

22. MAGNO, WARLYN GRACE L. Which condition may develop due to lack of amniotic fluid during early fetal development?

a. pulmonary emphysema b. musculoskeletal deformities c. Renal agenesis d. All of the above Answer: D. ALL OF THE ABOVE Rationale: The volume of amnionic fluid at each week is quite variable. In general, the volume increases by 10 mL per week at 8 weeks and increases up to 60 mL per week at 21 weeks, then declines gradually back to a steady state by 33 weeks (Brace and Wolf, 1989). Amnionic fluid serves to cushion the fetus, allowing musculoskeletal development and protecting it from trauma. It also maintains temperature and has a minimal nutritive function. Epidermal growth factor (EGF) and EGF-like growth factors, such as transforming growth factor-b, are present in amnionic fluid. Ingestion of fluid into the gastrointestinal tract and inhalation into the lung may promote growth and differentiation of these tissues. Animal studies have shown that pulmonary hypoplasia can be produced by draining off amnionic fluid, by chronically draining pulmonary fluid through the trachea, and by physically preventing the prenatal chest excursions that mimic breathing (Adzick and associates, 1984; Alcorn and colleagues, 1977). Thus, the formation of intrapulmonary fluid and, at least as important, the alternating egress and retention of fluid in the lungs by breathing movements are essential to normal pulmonary development. Reference: Williams Obstetrics, 23e > Chapter 4. Fetal Growth and Development 23. MAGNO, WARLYN GRACE L. Which of the following fontanel is a small triangular area at the intersection of the sagittal and lambdoid sutures of the fetal head? a. temporal b. casserian c. greater d. posterior Answer: D. POSTERIOR FONTANEL Rationale: The head is composed of the firm skull, which is made up of two frontal, two parietal, and two temporal bones, along with the upper portion of the occipital bone and the wings of the sphenoid. These bones are separated by membranous spaces that are termed sutures. The most important sutures are the frontal, between the two

frontal bones; the sagittal, between the two parietal bones; the two coronal, between the frontal and parietal bones; and the two lambdoid, between the posterior margins of the parietal bones and upper margin of the occipital bone. Where several sutures meet, an irregular space forms, which is enclosed by a membrane and designated as a fontanel. The greater, or anterior, fontanel is a lozenge-shaped space that is situated at the junction of the sagittal and the coronal sutures. The lesser, or posterior, fontanel is represented by a small triangular area at the intersection of the sagittal and lambdoid sutures. The localization of these fontanels gives important information concerning the presentation and position of the fetus during labor. Reference: Williams Obstetrics, 23e > Chapter 4. Fetal Growth and Development 24. MAGNO, WARLYN GRACE L. In the anatomical development of fetal urinary system, what age of gestation (in weeks) is urine first produced? a. 9 b. 12 c. 15 d. 18 Answer: B. 12 WEEKS AOG Rationale: Two primitive urinary systems—the pronephros and the mesonephros—precede the development of the metanephros. The pronephros has involuted by 2 weeks, and the mesonephros is producing urine at 5 weeks and degenerates by 11 to 12 weeks. Between 9 and 12 weeks, the ureteric bud and the nephrogenic blastema interact to produce the metanephros. By week 14, the loop of Henle is functional and reabsorption occurs (Smith and associates, 1992). New nephrons continue to be formed until 36 weeks. In preterm neonates, their formation continues after birth. Fetal kidneys start producing urine at 12 weeks, and by 18 weeks, they are producing 7 to 14 mL per day. Reference: Williams Obstetrics, 23e > Chapter 4. Fetal Growth and Development 23. Parao, Angelo 23. Which of the following fontanel is a small triangular area E. at the intersection of the sagittal and lambdoid sutures of the fetal head? a. Temporal b. Caesarian

c. Greater d. Posterior Answer : D Rationale : The lesser, or posterior, fontanel is represented by a small triangular area at the intersection of the sagittal and lambdoid sutures. The localization of these fontanels gives important information concerning the presentation and position of the fetus during labor. Reference : William’s 23rd edition (online access, Accessmedicine.com) 24. In the anatomical development of fetal urinary system, what age of gestation (in weeks) is urine first produced? a. 9 b. 12 c. 15 d. 18 Answer : B Rationale: Urine usually is found in the bladder even in small fetuses. The fetal kidneys start producing urine at 12 weeks. By 18 weeks, they are producing 7 to 14 mL/day, and at term, this increases to 27 mL/hr or 650 mL/day (Wladimiroff and Campbell, 1974). Reference: William’s 23rd edition (online access, Accessmedicine.com) 24. In the fetal circulation, where does the well-oxygenated blood pass to reach the left side and eventually supply the heart and brain? a. right AV valve b. criata dividena c. foramen ovale d. ductus arteriosus Answer : C Rationale: In contrast to postnatal life, the ventricles of the fetal heart work in parallel, not in series. Well-oxygenated blood enters the left ventricle, which supplies the heart and brain, and less oxygenated blood enters the right ventricle, which supplies the rest of the body. The two separate circulations are maintained by the structure of the right atrium, which effectively directs entering blood to either the left atrium or the right ventricle, depending on its oxygen content. This separation of blood according to its oxygen content is aided by the pattern of blood flow in the inferior vena cava. The well-oxygenated blood tends to course along the medial aspect of the inferior vena cava and the less oxygenated blood stays along the lateral vessel wall. This

aids their shunting into opposite sides of the heart. Once this blood enters the right atrium, the configuration of the upper interatrial septum—the crista dividens—is such that it preferentially shunts the well-oxygenated blood from the medial side of the inferior vena cava and the ductus venosus through the foramen ovale into the left heart and then to the heart and brain (Dawes, 1962). After these tissues have extracted needed oxygen, the resulting less oxygenated blood returns to the right heart through the superior vena cava. Reference: William’s 23rd edition (online access, Accessmedicine.com) 24. Nano, Marjorie Ann J.

24. In the anatomical development of fetal urinary system, what age of gestation (in weeks) is urine first produced? a. 9 b.12 c. 15 d. 18 Answer: b. Rationale: According to the book, the fetal kidneys start producing urine at 12 weeks. By 18 weeks, they are producing 7-14 ml/ day and at term, this increases to 27 ml/hr or 650 mL/day Reference: Cunningham, G.F, et al. (2005) William Obstetrics; Fetal growth and development. 23rd edition. [chapter 4 pp 95].USA. McGraw-hill Companies, Inc. 25. In the fetal circulation, where does the well-oxygenated blood pass to reach the left side and eventually supplies the heart and brain? a. right atrioventricular valve b. crista dividenc c. foramen ovale d. ductus arteriosus Answer: C Rationale: once the blood enters the right atrium, the configuration of the upper interatrial septum (crista dividens) shunts the well oxygenated blood from the medial side of the inferior vena cava and the ductus venosus through the foramen ovale into the left heart and then to the heart and the brain. Reference: Cunningham, G.F, et al. (2005) William Obstetrics; Fetal growth and development. 23rd edition. [chapter 4 pp 89-90].USA. McGraw-hill Companies, Inc. 26. what substance/s is/are produced by type II pnemocytes

that spreads to line the alveolus to prevent alveolar collapse during expiration? a. alveolar fluid b. glucocorticoids c. surfactant d. all of the above Answer: C Rationale: there are more that 200 pulmonary cell types, but surfactant is formed specifically in type II pneumocyte that line the alveoli. Reference: Cunningham, G.F, et al. (2005) William Obstetrics; Fetal growth and development. 23rd edition. [chapter 4 pp 95-96].USA. McGraw-hill Companies, Inc. 25. Salvacion, Karl Louie G.

25. In the fetal circulation, where does the well-oxygenated blood pass to reach the left side and eventually supplies the heart and brain? •Right atrioventricular valve ovale

c. foramen

•Crista dividens arteriosus

d. ductus

Answer: C. foramen ovale Rationale: Once this blood enters the atrium, the configuration of the upper interatrial septum, called the crista dividens, is such that it preferentially shunts the welloxygenated blood from the medial side of the inferior vena cava and the ductus venosus through the foramen ovale into the left heart and then to the heart and brain (Dawes, 1962). After these tissues have extracted needed oxygen, the resulting less oxygenated blood returns to the right heart through the superior vena cava. Reference: WILLIAMS OBSTETRICS - 22nd Ed. (2005) E-BOOK 26. What substance/s is/are produced by type II pneumocytes that spreads to line the alveolus to prevent alveolar collapse during expiration? a.alveolar fluid surfactant

c.

b. glucocorticoids the above

d. all of

Answer: C. surfactant Rationale: After birth, the terminal sacs must remain expanded despite the pressure imparted by the tissue-to-air interface, and surfactant keeps them from collapsing. There are more than 40 cell types in the lung, but surfactant is formed specifically in the type II pneumonocytes that line the alveoli. These cells are characterized by multivesicular bodies that produce the lamellar bodies in which surfactant is assembled. Reference: WILLIAMS OBSTETRICS - 22nd Ed. (2005) E-BOOK

27. Circulatory disturbances of the placenta include: •Infarcts calcification

c.

•Thrombosis the above

d. all of

Answer: D. all of the above Rationale: CIRCULATORY DISTURBANCES. Placental perfusion may be impaired by disruption of uterine vessels, placental vessels, or the intervillous space. Placental Infarctions. These are the most common placental lesions, and their presence is a continuum from normal changes to extensive and pathological involvement. Placental Vessel Thrombosis. When a stem artery from the fetal circulation in the placenta is occluded, it produces a sharply demarcated area of avascularity. Necrosis of villous tissue develops from ischemia. Histopathological features include fibrinoid degeneration of the trophoblast, calcification, and ischemic infarction. If decidual artery occlusion is followed by hemorrhage, then placental abruption results. Reference: WILLIAMS OBSTETRICS - 22nd Ed. (2005) E-BOOK 26. Pamplona, Hayzelle P.

26. what substance is/are produced type II pneumocytes that spreads to line the alveolus to prevent alveolar collapse during expiration? a. alveolar fluid b. gluccocorticoids

c. surfactant d. all of the above Answer: C Rationalization: Surfactant, specifically SP A, is produced by type II pneumocyte. Reference: Williams Obstetrics, 23rd ed. Page 96. 27. Circulatory disturbances of the placenta include: a. infarcts b. thrombosis c. calcification d. all of the above Answer: D Rationalization: Placental perfusion may be impaired by disruption of uterine vessels, placental vessels, or the intervillous space. Placental infarctions the most common placental lesions, and their presence is a continuum from normal changes to extensive and pathological involvement. Placental vessel thrombosis thrombosis is when a stem artery from the fetal circulation in the placenta is occluded producing a sharply demarcated area of avascularity. This will deprive only 5 percent of the villi of their blood supply. Reference: Williams Obstetrics 22nd ed. Ebook. 28. Blood with a 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 Rationalization: Oxygen and nutrient materials required for fetal growth and maturation are delivered from the placenta by the umbilical vein. Reference: Williams Obstetrics, 23rd ed. Page 89. 27. Sanding, Elriza Mhyrel S.

27. Circulatory disturbances of the placenta include: e. infarcts f. thrombosis g. calcification h. all of the above Answer: D. all of the above Rationale: Placental perfusion disorders may be grouped into: those disrupted maternal blood flow to or within the

placenta and those that disturb fetal blood flow through the villi. A number of lesions can restrict intervillous blood flow such as maternal floor infarction, in which this condition deposits a dense fibrinoid layer on the placental basal plate, and acts as a blockade to normal maternal blood flow. These infarctions are associated with fetal growth restriction, abortion, preterm delivery and stillbirths. Furthermore, thrombi are normally found in mature placentas but may become clinically significant if a large portion of villi is lost that may restrict fetoplacental blood flow. Another one is placental calcification, in which there is deposition of Calcium salts throughout the placenta and is associated with nulliparity, higher socioeconomical status and greater maternal calcium levels. Reference: Williams 23rd edition, pages 578-580 28. Blood with a higher oxygen content returns from the placenta to the fetus through the: e. umbilical arteries f. truncal arteries g. umbilical vein h. arcuate arteries Answer: C. umbilical vein Rationale: Deoxygenated venous-like fetal blood flows to the placenta through the two umbilical arteries. Truncal arteries are perforating branches of the surface arteries that pass through the chorionic plate. Whereas, blood with significantly higher oxygen content returns from the placenta via a single umbilical vein to the fetus. Arcuate arteries supply the two layers of the endometrium. Reference: Williams 23rd edition, page 58

29. Over-the-counter pregnancy test kits test for which placental hormone? a. estogen b. progesterone c. human placental lactogen d. human chorionic gonadotropin Answer: D. human chorionic gonadotropin Rationale: The intact HCG molecule is detectable in plasma of pregnant women 7-9 days after ovulation. Maternal urine contains the same variety of HCG degradation products as maternal plasma. The principal urinary form is the terminal degradation HCG product, which is the B-core fragment. It is important to recognize that the so-called B-subunit antibody used in most pregnancy tests reacts with both intact HCG. Reference: Williams 23rd edition, page 63 28. Martinez, Xandra

28. Blood with a 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 (Umbilical Vein) Rationale: Oxygen and nutrient materials required for fetal growth and maturation are delivered from the placenta by the single umbilical vein. Reference: Williams Obstetrics, 23rd Edition. Chapter 4. Fetal Growth And Development. 29. 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: The detection of hCG in blood or urine is almost always indicative of pregnancy. Reference: Williams Obstetrics, 23rd Edition. Chapter 3. Implantation, Embryogenesis, and Placental Development. 30. In the development of the deciduas, the portion directly beneath the site of blastocyst implantation is the: A. Decidua Capsularis B. Decidua Basalis C. Decidua Parietalis D. Chorion Leave Answer: B (Decidua Basalis) Rationale: The spiral arterial system supplying the deciduas basalis directly beneath the implanting blastocyst, and ultimately the intervillous space, is altered remarkably. Reference: Williams Obstetrics, 23rd Edition. Chapter 3. Implantation, Embryogenesis, and Placental Development.

29. Vergara, Renn Miguel

29. Over-the-counter pregnancy test kits test for which placenta hormone •estrogen •progesterone •human placental lactogen •human chorionic gonadotropin Answer: D Rationale: Detection of hCG in maternal blood and urine provides the basis for endocrine tests of pregnancy; Numerous commercial immunoassays including over the counter pregnancy test kits are available for measuring serum and urine levels of hCG. Reference: Williams Obstetrics 23rd edition, page 192-193 30. In the development of the decidua, the portion directly beneath the site of blastocyst implantation is the: •decidua capsularis •decidua basalis •decidua parietalis

•chorion leave Answer: B Rationale: Decidua directly beneath blastocyst implantation is modified by trophoblast invasion and becomes the deciduas basalis. Reference: Williams Obstetrics 23rd edition, page 45 31. Which subunit of the hCG molecule is used as the tumor marker for trophoblastic disease? •alpha •beta •delta •none of the above •Answer: B Rationale: In confirmation of the diagnosis of gestational trophoblastic diseases, a system was adopted based principally on clinical findings and serial serum measurement of human chorionic gonadotropin, particularly beta-hCG. Reference: Williams Obstetrics 23rd edition, page 257

30. Panghulan, Aldee Ray

30.In the development of the deciduas, the portion directly beneath the site of blastocyst implantation is the: a. deciduas capsuralis b. deciduas basalis c. deciduas parietalis d. chorio leave ANSWER: B. decidua basalis RATIONALIZATION: In human pregnancy, the decidual reaction is completed only with blastocyst implantation. The portion of the decidua directly beneath the site of blastocyst implantation is modified by trophoblast invasion and becomes the decidua basalis; that portion overlying the enlarging blastocyst, and initially separating it from the rest of the uterine cavity, is the decidua capsularis

(Figure beside). The decidua capsularis is most prominent during the second month of pregnancy, consisting of decidual cells covered by a single layer of flattened epithelial cells without traces of glands. Internally, this portion of the decidua contacts the avascular, extraembryonic fetal membrane, the chorion laeve. The remainder of the uterus is lined by decidua parietalis, sometimes called the decidua vera when decidual capsularis and decidua parietalis are joined. SOURCE: Williams Obstetrics 21st edition e-book Chapter II page 61 of 1132 31. Which subunit of the hCG molecule is used as the tumor marker for trophoblastic disease a. alpha b. beta c. delta d. gamma ANSWER: B. beta -Beta subunit is most important because it is easily measurable by present-day technology. The rate of synthesis of the ß-subunit of hCG is believed to be limiting in the formation of the complete molecule. Trophoblasts of normal placenta and those of hydatidiform mole and choriocarcinoma tissues secrete free a- and ßsubunits as well as intact hCG. -Trophoblastic diseases are a group of pregnancy disorders including a complete hydatidiform mole, a partial mole, and choriocarcinoma. -The use of total hCG measurement in gestational trophoblastic diseases is an example of a tumor marker with 100% sensitivity and 100% specificity for trophoblast-tissue mass, with the amount of tumor tissue or mole being directly proportional to the circulating concentration of total hCG. SOURCE: Williams Obstetrics 21st edition e-book page 191 of 1132 “The Placental Hormones” 32. The most invasive cell in human physiology is: a. trophoblast b. Langhan cell c. white blood cell d. plasma cell

ANSWER: A. trophoblast Trophoblast, a very special cell; “without it, you and I would not be here”. Responsible for implantation. Its invasiveness provides for attachment of the blastocyst to the uterus. The decidua basalis contributes to the formation of the basal plate of the placenta, and differs histologically from the decidua parietalis in two important respects. First, the spongy zone of the decidua basalis consists mainly of arteries and widely dilated veins; by term, the glands have virtually disappeared. Second, the decidua basalis is invaded by trophoblastic giant cells, which appear at the time of implantation. The number and depth of endometrial penetration of the giant cells varies greatly. Although generally confined to the decidua, these cells may penetrate the myometrium. In such circumstances, their number and invasiveness may be so extensive as to be suggestive of choriocarcinoma to the inexperienced observer. SOURCE: Williams Obstetrics 21st edition e-book Chapter II page 61 of 1132 31. Magdaong, Melayne Jewel

31. MAGDAONG, MELAYNE JEWEL R. Which sub-unit of the hCG molecule is used as the tumor marker for trophoblastic disease. e. Alpha f. Beta g. Delta h. None Answer: B Rationale: trophoblast cells produce hCG in amounts that increase exponentially following implantation. hCG consists of alpha and beta subunit. Antibodies were develop with high specificity for Beta subunit. Reference: Williams 23rd edition. Pages 192-193. Chapter 8: Pre natal care 32. MAGDAONG, MELAYNE JEWEL R. The most invasive cell in human physiology is i. Trophoblast j. Langhan cell k. White blood cell l. Plasma cells Answer: A Rationale: Trophoblast the most variable structure, function development pattern of placental component; It’s invasiveness provides for implantation function as endocrine organ essential to maternal physiological adaptation and maintenance of pregnancy. Reference: Williams 23rd edition. Page 49. Chapter 3:

Implantation, embryogenesis and placental development. 33. MAGDAONG, MELAYNE JEWEL R. Which of the following is a normal characteristic of placenta? i. Weight of 500 grams j. Contains 60-70 cotyledons k. Contains an accessory lobe l. There is mixing of maternal and fetal blood within Answer; A Rationale: Average weight is 503 grams and contains 10-38 cotyledons. Reference: Williams 23rd edition. Page 54. Chapter 3: Implantation, embryogenesis and placental development.

33. Tan, Robenne 33. Which of the following is a normal characteristic of Maree A. placenta? a. Weight of 500 grams b. contains 60 to 70 cotyledons c. contains an accessory lobe d. There is mixing of maternal and fetal blood within Answer: A. Weight of 500 grams Rationale: the average placenta at term 185mm in diameter and 23mm in thickness, with the volume of 497 ml and weight of 508 g. ( 500g). Viewed from the maternal surface, the number of slightly elevated convex areas called lobes ( grossly visible lobes also been referred to as COTYLEDONS), varies from 10-38 cotyledons. Placenta dont contains any accessory lobe and there is no direct mixing of maternal and fetal blood within. 34. This placental hormone rescues and maintains the corpus a. Human placental lactogen b. estrogen c.progesterone d.Human chorionic gonadotropin Answer: D. Human chorionic gonadotropin Rationale: both subunits of Hcg are required for normal binding to the LH-Hcg receptor in the corpus luteum and the testis. LH-Hcg receptors are present in a variety of tissues, and their role is less defined. The best known biological function of Hcg is the so called rescue and maintains of function of the corpus luteum.

35. A 19 y/o, G1P0, 6 weeks pregnant, develops vaginal spotting after undergoing a unilateral salphingooopherrectomy for an ovarian mass. The spotting was most likely due to lack of which hormone: a.human placental lactogen b.human chorionic gonadotropin c.estrogen d.progesterone Answer: D. Progesterone Rationale: progesterone produced by syncytiotrophobalst facilitates and permits the maintenance of pregnancy. Formation of progesterone occurs through the uptake and use of maternal LDL cholesterol. Reference: Williams obstetrics 22nd edition. E-book.. 35. Ramos, Genie 35 Ramos, genie anne Anne Question 35. A 19 y/o G1P0, 6 weeks pregnant, develops vaginal spotting after undergoing a unilateral salpingooophorectomy for an ovarian mass. The spotting was most likely due to a lack of which hormone? a. human placental lactogen b. human chorionic gonadotroponin c. estrogen d. progesterone Answer: D Rationale: Ovulation ceases during pregnancy and the maturation of new follicles is suspended. Ordinarily only a single corpus luteum can be found in pregnant women. This functions maximally during the first 6 to 7 weeks of pregnancy - 45 weeks post-ovulstion snd thereafter contribute relativeley little to progesterone production. This observations have been confirmed by surgical removal of the corpus luteum before 7 week to 5 weeks post-ovulationwhich results in a rapid fall of maternal serum progesterone and spontaneous abortion. (Csapo and co-workers, 1973) Reference: William obstetrics,23e, chapter 5: maternal physiology 35 Ramos, Genie Anne Question 36. Dextrorotation of the uterus is due to: a. presence of the rectosigmoid on the left b. hydronephrosis of the kidney on the right c. preference of the baby to move to the right d. presence of the appendix on the right

Answer: A Rationale: By the end of 12 weeks, the uterus has become too large to remian entirely within the pelvis. As the uterus continues to enlargen it contacts the anterior abdominal wall, displaces the intestines laterally and superiorly, and continues to rise, ultimately reachinh almost to the liver. With ascent of uterus to pelvis, it usually undergoes rotation to the right. This dextrorotation likely is caused by the rectosigmoid on the left side of the pelvis. As the uterus rises, tension is exerted on the brad and round ligaments. Reference: William obstetrics,23e, chapter 5: maternal physiology 35 Ramos, Genie Anne Question 37. The elevated patches of tissue present on the ovaries that bleed easily during pregnancy are: a. endometriotic implants b. adhesions c. decidual reaction d. corpus lutem Answer: C Rationale: A decidual reaction on and beneath the surface of the ovaries is common in pregnancy and is usually observed at ceserean delivery. These elevated patches of tissue bleed easily and may on first glance resemble freshly torn adhesions. Reference: William obstetrics,23e, chapter 5: maternal physiology 36. Yu, Philip

Philip Andrew S. Yu Section B 36. Dextrorotation of the uterus is due to: a. Presence of the rectosigmoid on the left b. Hydronephrosis of the kidney on the right c. Preference of the baby to move on the right d. Presence of the appendix on the right ANSWER: A. Presence of the rectosigmoid on the left Rationalization : Because of unequal dilatation may result from a cushioning provided by the left ureter by the sigmoid colon as the consequence. 37. The elevated patches of tissues on the ovaries that bleed easily during pregnancy are:

a. Endometriotic implants Reaction

c. Decidual

b. Adhesions luteum

d. Corpus

ANSWER: C . Decidual Reaction Rationalization: A decidual reaction on and beneath the surface of the ovaries, similar to that found in the endometrial stroma, is common in pregnancy and usually observed at Caesarian Section deliveries. These elevated patches of tissue bleed easily and may on first glance resemble freshly torn adhesions. 38. The following inflammatory markers are increased in pregnancy, EXCEPT: a. Leukocyte alkaline phosphatase

c. Monocytes

b. Erythrocyte Sedimentation Rate protein

d. C-Reactive

ANSWER: C. Monocytes Rationalization: Leukocyte alkaline phosphatase, which are used to evaluate myeloproliferative disorders, are increased during early pregnancy. Erythrocyte Sedimentation Rate is increased in normal pregnancy because of elevated plasma globins and fibrinogen. C-reactive protein, an acute phase reactant rises rapidly in response to tissue trauma or inflammation. Reference: Williams Obstetrics 23rd Edition 38. Nazareno, Christine

38. NAZARENO, CHRISTINE The following inflammatory markers are increased in pregnancy except: •Leukocyte alkaline phosphatase •Erythrocyte sedimentation rate •Monocytes •C-reactive proteins Answer: Monocytes Rationalization: Beginning quite early in pregnancy, the activity of leukocyte alkaline phosphatase is increased. Such elevated activity is

not peculiar to pregnancy but occurs in a wide variety of conditions, including most inflammatory states. The concentration of C-reactive protein, an acute-phase serum reactant, rises rapidly to 1000-fold in response to tissue trauma or inflammation. Watts and colleagues (1991) measure C-reactive protein sequentially diring 81 normal pregnancies to establish normative values. Median C-reactive protein values during pregnancy were higher than values for nonpregnant women, and these values were evaluated further in labor. Another marker of inflammation, the erythrocyte sedimentation rate is increased in normal pregnancy because of elevated plasma globulins and fibrinogen. Source: William’s Obstetrics 22nd edition, pp. 131 39. NAZARENO, CHRISTINE The consequence of an elevated diaphragm in pregnancy is: •Increased diaphragmatic excursion •Decreased functional residual capacity and residual volume •Increased tidal volume •Decrease in peak expiratory flow rates Answer: Decreased functional residual capacity and residual volume Rationalization: During pregnancy, diaphragmatic excursion is actually greater than when non-pregnant. The respiratory rate changed a bit, but the tidal volume, minute ventilator volume, and minute oxygen uptake increase significantly as pregnancy advances. These events happen during normal pregnancy, but the direct consequence of an elevated diaphragm during pregnancy is the decrease in functional residual capacity and residual volume of air. Source: William’s Obstetrics 22nd edition, pp. 136 40. NAZARENO, CHRISTINE A pregnant woman who fails to excrete concentrated urine after withholding fluids for approximately 18 hours means: •The woman has renal damage •The kidneys are normal by excreting mobilized extracellular fluid of relatively low osmolality

•The kidneys are compensating for the lack of fluid intake •The contents of the urine are filtered by a diseased kidney Answer: The kidneys are normal by excreting mobilized extracellular fluid of relatively low osmolality Rationalization: In early pregnancy, the glomerular filtration rate increases as much as 50%, while the renal plasma flow is increased much greater during the beginning of the second trimester. This is may be due to the relaxin and neuronal nitric oxide synthase – which are responsible for the increased glomerular filtration and plasma flow during pregnancy. During the day, pregnant women tend to accumulate water in the form of dependent edema, and at night, while recumbent, they mobilize this fluid and excrete it via the kidneys. This reversal of the usual nonpregnant diurnal pattern of urinary flow causes nocturia and the urine is more dilute than in the non-pregnant state. Failure of a pregnant woman to excrete concentrated urine after witholding fluids for approximately 18 hours does not sfifnify renal damage. In dactm the kidney in these circumstances functions perfectly normally by excreting mobilized extracellular fluid of relatively low osmolality. Source: William’s Obstetrics 22nd edition, pp. 138

39. Pataunia, Josan

39. The consequence of an elevated diaphragm in pregnancy is? m. Increased diaphragmatic excursion n. Decreased functional residual capacity and residual volume o. Increased tidal volume p. Decreased in peak expiratory flow rates ANSWER: B RATIONALE: Increased diaphragmatic excursion is brought about by growth of the uterine mass that interferes with the range of motion of the diaphragm and with the expansion of the lungs and breathing movements. Decreased functional residual capacity and residual volume is a result of the upward pressure exerted by the abdominal contents. Increased tidal volume significantly enhances as

pregnancy advances. It, together with resting minute ventilation, is caused by several factors such as enhanced respiratory drive due to stimulatory effects of progesterone, low expiratory reserve volume, and compensated respiratory alkalosis. Peak expiratory flow rates decline progressively as gestation advances. REFERRENCE: Sumpaico, Textbook of Obstetrics, 3rd Edition, pages 234-235 Williams Obstetrics 23rd Edition, page 121. 40. A pregnant woman who fails to excrete concentrated urine after withholding fluids for approximately 18hours means: i. The woman has renal damage j. The kidneys are normal by excreting mobilized extracellular fluid of relatively low osmolality k. The kidneys are compensating for the lack of fluid intake l. The contents of the urine are filtered by a diseased kidney ANSWER: B RATIONALE: Pregnancy is associated with enhanced production of nitric oxide which, in recent studies, is implicated to be an important mediator of the renal hyperfiltration during pregnancy. REFERRENCE: Sumpaico, Textbook of Obstetrics, 3rd Edition, page 236. 41. A pregnant woman may experience an increase in the incidence of: m. Tooth decay n. Gingivitis o. Heartburn p. All of the above ANSWER: C RATIONALE: Most evidence indicates that pregnancy does not incite tooth decay. Gingivitis which is characterized by spongy swollen hyperaemic gums, is notable during pregnancy

due to increased vascularity of the gums caused by the increased in estrogen level. Heartburn (pyrosis) is common in pregnancy which is the manifestation of esophageal regurgitation or reflux of acidic secretions which is caused by a decreased lower esophageal sphincter tone contributed by progesterone secretion in pregnancy. In addition, intraesophageal pressures are lower and intragastric pressures higher in pregnant women. REFERRENCE: Sumpaico, Textbook of Obstetrics, 3rd edition, page 236237. Williams Obstetrics 23rd Edition, page 125. 40. Lameda, Randall M.

40. LAMEDA, RANDALL M. A pregnant woman who fails to excrete concentrated urine after withholding fluids for approximately 18 hours mean: a. the woman has renal damage b. the kidneys are normal by excreting mobilized extracellular fluid of relatively low osmolality c. the kidney are compensating for the lack of fluid intake d. the contents of the urine are filtered by a diseased kidney Answer: b Rationale:Normal pregnancy is associated with an appreciable increase in extracellular water, and postpartum diuresis is a physiological reversal of this process. This regularly occurs between the second and fifth days and corresponds with loss of residual pregnancy hypervolemia. In preeclampsia, both retention of fluid antepartum and diuresis postpartum may be greatly increased Reference: Williams Obstetrics, 23edition, Chapter 30: The Puerperium 41.LAMEDA, RANDALL M. A pregnant woman may experience an increase in the incidence of: a. tooth decay b. gingivitis c. heartburn d. all of the above Answer: c Rationale:

Pyrosis (heartburn) is common during pregnancy and is most likely caused by reflux of acidic secretions into the lower esophagus (see Chap. 49, Reflux Esophagitis). 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 Sundström, 1978). Reference: Williams Obstetrics, 23edition Chapter 5: Maternal Physiology 42. LAMEDA, RANDALL M. A suppressed TSH concentration in normal pregnancy may: a. fail to diagnose early hypothyroidism b. lead to a misdiagnosis of subclinical hyperthyroidism c. both of the above d. none of the above Answer: a Rationale: Beginning early in the first trimester, levels of the principal carrier protein—thyroxine-binding globulin— increases, reaches its zenith at about 20 weeks, and stabilizes at approximately double baseline values for the remainder of pregnancy. Total serum thyroxine (T4) increases sharply beginning between 6 and 9 weeks and reaches a plateau at 18 weeks. Free serum T4 levels rise slightly and peak along with hCG levels, and then they return to normal. The rise in total triiodothyronine (T3) is more pronounced up to 18 weeks, and thereafter, it plateaus. Thyroid-releasing hormone (TRH) levels are not increased during normal pregnancy, but this neurotransmitter does cross the placenta and may serve to stimulate the fetal pituitary to secrete thyrotropin (Thorpe-Beeston and associates, 1991). Normal suppression of TSH during pregnancy may lead to a misdiagnosis of subclinical hyperthyroidism. Of greater concern is the potential failure to identify women with early hypothyroidism because of suppressed TSH concentrations. To mitigate the likelihood of such misdiagnoses, Dashe and co-workers (2005) conducted a population-based study at Parkland Hospital to develop gestational-age-specific TSH nomograms for both singleton and twin pregnancies. Reference:Williams Obstetrics, 23edition Chapter 5: Maternal

Physiology 41. Macaraeg, Crisanto

MACARAEG, CRISANTO L. 41. A pregnant woman may experience an increase in the incidence of: a. tooth decay c. heartburn b. gingivitis d. all of the above Answer: C Rationale: The gravid female is prone to reflux of acid gastric contents into the lower esophagus due to displacement of the stomach by the uterus and the progesterone-mediated relaxation of the esophageal sphincter. Pregnancy does not incicte tooth decay and gingivitis. Source: William’s 23rd ed. p. 107-129 42. A suppressed TSH concentration in normal pregnancy may: a. fail to diagnosis early hypothyroidism b. lead to a misdiagnosis of subclinical hyperthyroidism c. both of the above d. none of the above Answer: C. Rationale: Thyroid glandular hyperplasia increases thyroid hormone production by 40 to 100%. However, this amount is distributed to meet maternal and fetal needs. The total volume is inversely proportional to serum thyrotropin concentrations Source: William’s 23rd ed. p. 107-129 43. The amino acid concentration is: a. higher in the maternal compartment b. higher in the fetal compartment c. equal in both maternal and fetal compartments d. distribution is dependent on maternal intake Answer: B Rationale: Compartmentalization of amino acid distribution of amino acids is regulated by the placenta (protein synthesis, oxidation and transamination of some nonessential amino acids), regardless of the maternal intake. Source: William’s 23rd ed. p. 107-129

42. Villarin, Lilia G.

42. A suppressed TSH concentration in normal pregnancy may:

•Fail to diagnosis early hypothyroidism •Lead to a misdiagnosis of subclinical hyperthyroidism •Both of the above •None of the above Answer: C Rationale: The normal suppression of TSH during pregnancy may lead to a misdiagnosis of subclinical hyperthyroidism due to the physiological changes of pregnancy that causes the thyroid gland to increase the production of thyroid hormones by 40-100% to meet both the fetal and the maternal needs. Another concern which is considerably more important is the potential failure to identify women with early hypothyroidism because of supressed TSH concentrations, which is, again, due to the thyroid related physiologic changes during pregnancy. Reference: Williams Obstetrics, 23rd edition, pages 127-128 43. The amino acid concentration is: •Higher in maternal compartment •Higher in fetal compartment •Equal in both maternal and fetal compartments •Distribution is dependent on maternal intake Answer: B Rationale: According to Cetin and co-workers in 2005 and van den Akker and associates in 2009, the amino acid concentrations are higher in the fetal than in the maternal compartment. This increased concentration is largely regulated by the placenta, which not only concentrates the amino acids into the fetal circulation, but also is involved in protein synthesis, oxidation and transamination of some nonessential amino acids. Reference: Williams Obstetrics, 23rd Edition, page 113. 44. The hormone that acts to reset the lipostat in the hypothalamus at the end of pregnancy to its previous nonpregnant level so that the added fat is lost is: •Estrogen

•Progesterone •Prolactin •Growth hormone Answer: B Rationale: According to Hytten and Thiomson in 1968, progesterone perhaps is the one that acts to reset the lipostat in the hypothalamus at the end of pregnancy, returning it to its previous non-pregnant levels. It must be recalled that the alterations in the lipostat (this causes the storage of fat) primarily occurs during midpregnancy; usually in central than in peripheral sites. This is to ensure its availability for placental transfer during the last trimester when the fetal growth rate is maximal along with essential fatty acid requirements, and to protect both the mother and the fetus during prolonged starvation or hard physical exertion. Reference: Williams Obstetrics, 23rd edition, page 113. 43. Montecalvo, Victor III

43. The amino acid concentration is: a. Higher in the maternal compartment b. Higher in the fetal compartment c. Equal in both maternal and fetal compartments d. Distribution is dependent on maternal intake Answer: B Rationale: In addition to the hydrolysis of LDL, the placenta concentrates a large number of amino acids (Lemons, 1979). Neutral amino acids from maternal plasma are taken up by trophoblasts by at least three specific processes. Presumably, amino acids are concentrated in the syncytiotrophoblasts and thence transferred to the fetal side by diffusion. Based on data from cordocentesis blood samples, the concentration of amino acids in umbilical cord plasma is greater than in maternal venous or arterial plasma (Morriss and associates, 1a994). Reference: ebook Williams obstetrics 22 edition, 44. The hormone that acts to reset the lipostat in the hypothalamus at the end of pregnancy to its previous nonpregnant level so that the added fat is lost is: a. Estrogen b. Progesterone c. Prolactin d. Growth hormone Answer: C Rationale: Pituitary prolactin secretion is regulated

by endocrine neurons in thehypothalamus, the most important ones being the neurosecretorytuberoinfundibulum (TIDA) neurons of the arcuate nucleus, which secretedopamine to act on the dopamine-2 receptors of lactotrophs, causinginhibition of prolactin secretion. Reference: ebook Williams obstetrics 22 edition, http://en.wikipedia.org/wiki/Prolactin 45. A 24 year old G1P1 came for preconceptional counseling. Her first child was born with an isolated neural tube defect. The patient inquires about folic acid supplementation. You recommend: a. No folate supplementation b. Folate supplementation achieved by taking two prenatal vitamins a day c. Folate fortified foods d. Folic acids tablets, 4.0mg/d Answer: C Rationale: Women who could become pregnant are advised to eat foods fortified with folic acid or take supplements in addition to eating folate-rich foods to reduce the risk of serious birth defects. Reference: ebook Williams obstetrics 22 edition,http://en.wikipedia.org/wiki/Folic_acid

44. Miclat, Frances Leah D.

44. MICLAT, FRANCES LEAH D. The hormone that acts to reset the lipostat in the hypothalamus at the end of pregnancy to its previous nonpregnant level so that the added fat is lost is: a. estrogen b. progesterone c. prolactin d. growth hormone Answer: B. PROGESTERONE Rationale: Hytten and Thomson (1968) cited some evidence that progesterone may act to reset a lipostat in the hypothalamus, and at the end of pregnancy the lipostat returns to its previous nonpregnant level and the added fat is lost. Reference: William’s 22nd Edition Chapter 2: Maternal Physiology 45. MICLAT, FRANCES LEAH D. A 24 year old G1P1 came for preconceptional counseling. Her

first child was born with an isolated neural tube defect. The patient inquires about folic acid supplementation. You recommend: a. no folate supplementation b. folate supplementation achieved by taking two prenatal vitamins a day c. folate fortified foods d. folic acid tablets, 4.0mg/d Answer: D. FOLIC ACID TABLETS, 4.0mg/d Rationale: A woman with a prior pregnancy complicated neural-tube defect can reduce the 3-percent recurrence risk by more than 70 percent if she supplements her daily diet with 4mg of folic acid for the month before conception and for the fist trimester of pregnancy. Reference: William’s 22nd Edition Chapter 3: Prenatal Care

46. MICLAT, FRANCES LEAH D. A woman who is a G5P1 (1-0-4-1) is a: a. multigravida b. primipara c. multipara d. A and B Answer: D. A and B Rationale: Gravida is defined as a woman who is or has been pregnant, irrespective of the pregnancy outcome. With the establishment of the first pregnancy, she becomes a primigravida, and with successive pregnancies, a multigravida. While primipara is a woman who has been delivered only once of a fetus or fetuses born alive or dead with an estimated length of gestation of 20 or more weeks. In the past, a 500 grams birthweight threshold was used to define parity. This threshold is no longer as pertinent because of the survival of infants with birthweights less than 500 grams. Reference: William’s 22nd Edition Chapter 3: Prenatal Care 47. O’Neill, Sabrina Florence

47. Iron is one mineral for which supplementation during pregnancy is recommended for the following reasons, EXCEPT: a. many women enter pregnancy with reduced iron stores b. even with normal iron stores, the markedly increased iron requirement during pregnancy generally cannot be met by average diet

c. there is physiologic decrease iron production during pregnancy causing "physiologic anemia" d. A and B Answer: A Rationalization: During pregnancy 1000 mg of iron is required with 300 mg which is actively transferred to the fetus and placenta and another 200 mg are lost trough various normal routes of excretion, primarily in the GIT. Having said this, this amount cannot be supplemented by a normal diet hence iron is required. This increased risk is called “physiologic anemia” and is a normal occurrence in pregnant women. A is excluded because whether or not the women enter pregnancy with reduced iron states, they will still be required to take iron to compensate for the “physiologic anemia” that occurs during pregnancy. Source: Williams Obstetrics 23rd Edition EBOOK, Chapter 5 Maternal Physiology 48. A pregnant patient on her first prenatal check up inquired regarding sexual activity. The history and physical examination are unremarkable. The couple has had a mutually monogamous relationship. The best advice for them regarding sexual activity is that during pregnancy: a. many pregnant women and their partners need to change sexual positions as pregnancy pregresses b. maternal orgasm should be avoided c. condoms should be used d. sexual intercourse is not safe after 6 months of gestation. Answer: A Rationalization: Coitus is generally accepted in healthy pregnant women. Unless there are certain risks of abortion or preterm labor, there is absolutely no indication against coitus. For letter D, studies have shown that intercourse in late pregnancy specifically has not been found to be harmful although there is usually a markedly decrease in couples having coitus as the pregnancy progresses. For B. there is no contraindication against maternal orgasm and is completely safe on the pregnancy and for C, unless there is an increased risk of STDs, condoms may not be used. A is usually advised because as the pregnancy progresses, certain positions become difficult and uncomfortable for the pregnant mother. Certain positions like being on top is prescribed to be able to grant comfort and safety to the pregnant mother. Source: Williams Obstetrics 23rd Edition EBOOK, Chapter 8

Prenatal care 49. At her first prenatal visit, a 23 year old gravida 1, provides a history of a daily program of exercise, which she would like to continue. You will tell her: a. she has to increase her protein intake b. non-weight bearing exercise such as stationary bicycle riding and swimming can e continued in pregnancy c. discontinue exercise after 30 weeks to prevent premature labor d. supine exercise are advisable after the first trimester of pregnancy Answer: B Rationalization: In general pregnant women do not need to limit exercise provided they do not become excessively fatigued or have a high risk to injury, in fact exercise is recommended to pregnant mothers as it significantly decreases fetal morbidities as well provides an avenue for easier labor. The best advice to give the patient is B because as mentioned, as long as they are not excessively fatigued or have a high risk to injury, exercise is allowed throughout the pregnancy. Source: Williams Obstetrics 23rd Edition EBOOK, Chapter 8 Prenatal Care 48. Rosales, Carole Zaidel M.

48. A pregnant patient on her first prenatal checkup inquired regarding sexual activity. The history and physical examination are unremarkable. The patient has had a mutually monogamous relationship. The best advice for them regarding sexual activity is that during pregnancy: a. many pregnant women and their partners need to change sexual position as pregnancy progresses b. maternal orgasms should be avoided c. Condoms should be used d. Sexual intercourse is not safe after 6 months of gestation Answer: A Rationalization: Whenever abortion or preterm labor threatens, coitus should be avoided. Otherwise, it has been generally accepted that in a healthy pregnant women, sexual intercourse is usually not harmful before the last 4 weeks or so of pregnancy. It was reported that amniotic fluid infections and perinatal mortality increased if mothers had intercourse once or more weekly in the last month leading to premature rupture of membrane. The semen of males has prostaglandin and Prostaglandins at

higher concentration may act to inhibit adenylyl cyclase or activate phospholipase C, thereby causing increased myometrial contraction. According to Dr. Crisostomo, position during sexual activity should be on the left side to prevent compression of the Aorta. Source: E-BOOK From Section 3:PREGNANCY PLANNING AND ANTEPARTUM MANAGEMENT, Chapter 10: Prenatal Care (page 154 of 1132) 49. At her first prenatal visit, a 23 year old gravida 1, provides a history of a daily program of exercise, which she should like to continue. You will tell her: a. She has to increase her protein intake b. non weight bearing exercises such as stationary bicycle riding and swimming can be continued in pregnancy c. discontinue exercise after 30 weeks to prevent premature labor d. supine exercises are advisable after the first trimester of pregnancy Answer: B Rationalization: In general it is not necessary for a pregnant woman to limit exercise, provided she does not excessively become fatigued or risk injury to herself or her fetus. Conditioned pregnant women actually improved their metabolic efficiency during exercise. The effects have been described of maternal exercise on pregnancy outcomes, the course of labor and birthweight. Well conditioned women who perform aerobics or run regularly were found to have shorter active labor and fewer caesarian deliveries, less meconium stained amniotic fluid and less fetal distress in labor. The American College of Obstetrician and Gynecologist recommends that women who are accustomed to aerobic exercise before pregnancy should be allowed to continue this during pregnancy Source: E-BOOK From Section 3:PREGNANCY PLANNING AND ANTEPARTUM MANAGEMENT, Chapter 10: Prenatal Care (page 154 of 1132) 50. Most pregnant patient will complain of excessive perspiration during pregnancy due to thermogenic effect of which hormone?

a. estrogen b.progesterone c. prolactin d. oxytocin Answer: B Rationalization Natural androgens in women may have a thermogenic effect. Indeed, differences in plasma levels in androstenedione determine energy expenditure at rest, explaining a 4% variance. This effect is independent from variations in body composition and from concentrations in thyroid hormones. From one extreme concentration of androstenedione to another, a difference in energy expenditure equal to 217 calories a day can be observed. Source: http://www.danoneinstitute.org/objective_nutrition_newsletter /on86.php; Information was retrieved on April 14, 2012. 49. Recierdo, 49. At her first prenatal visit, a 23 year old gravida 1, Francine Marie R. provides a history of a daily program of exercise, which she would like to continue. You will tell her: a. She has to increase her protein intake b. non-weight bearing exercises such as stationary bicycle riding and swimming can be continued in pregnancy c. discontinue exercise after 30 weeks to prevent premature labor d. supine exercises are advisable after the first trimester of pregnancy ANSWER: B RATIONALE: Pregnant women should follow a non weight bearing exercise such as swimming or cycling on a stationary bike which tend to have fewer injuries. A study by the American College of Obstetricians and Gynaecologists has proven that moms-to-be who follow a non weight bearing pregnancy workout are more likely to continue into the third trimester than those attempting weight bearing exercises such as lifting weights or running. REFERENCE: http://EzineArticles.com/371222 50. Most pregnant patient will complain of excessive perspiration during pregnancy due to the thermogenic effect of which hormone? a. estrogen b. progesterone

c. prolactin d. oxytocin ANSWER: B RATIONALE: Progesterone's primary functions include: acting as a precursor to estrogen and testosterone; it maintains uterine lining and aids in gestation; protects against fibrocystic breasts, endometrial and breast cancer; acts as a natural diuretic, helps use fat for energy; can be a natural antidepressant; aids thyroid hormone action; normalizes blood clotting; restores sex drive; normalizes blood sugar, zinc and copper levels; restores proper cell oxygen levels, has a thermogenic effect; builds bone and helps to protects against osteoporosis. REFERENCE: http://EzineArticles.com/12177 51. Which of the following is contraindicated during pregnancy? a. dental works and tooth extraction b. swimming c. intake of antibiotics d. none of the above ANSWER: C RATIONALE: Certain antibiotics are teratogenic to the fetus. REFERENCE: WILLIAMS 23RD EDITION. CHAPTER 14 50. Sierra, Rei Fabbie

50. SIERRA, REI FABBIE F. Most pregnant patient will complain of excessive perspiration during pregnancy due to thermogenic effect of which hormone? a. estrogen b. progesterone c. prolactin d. oxytocin ANSWER: B REASON: According to the article of published titled “Effects of Progesterone on the Autonomic Heat Production” by authors HOSONO TAKAYOSHI (Osaka Electro-communication Univ.) KANOSUE KAZUYUKI (Waseda Univ.) AKAZAWA KENZO (Osaka Univ.) UMIMOTO KOICHI (Osaka Electro-

communication Univ.) progesterone do have an effect on the thermoregulation . SOURCE: http://sciencelinks.jp/jeast/article/200615/000020061506A0526054.php 51. SIERRA, REI FABBIE F. Which of the following is contraindicated during pregnancy? a. dental works and tooth extraction b. swimming c. intakes of antibiotics d. none of the above ANSWER: C REASON: According to Gerald briggs, a pharmacist clinical specialist; not all antibiotics are safe during pregnancy “Antibiotics you should avoid altogether during pregnancy include streptomycin (used to treat tuberculosis), which can cause hearing loss in your baby, and tetracycline (including minocycline, oxytetracycline, and doxycycline), used to treat acne and respiratory infections. If you take tetracycline in the second or third trimester, it could discolor your developing baby's teeth”. SOURCE: http://www.babycenter.com/404_is-it-safe-to-takeantibiotics-during-pregnancy_1362964.bc 52. SIERRA, REI FABBIE F. The reason in performing internal examination late in pregnancy is to determine: a. consistency, effacement and dilatation of the cervix b. presenting part c. if the bag of water has already ruptured already d. A and B ANSWER: D

REASON: According to William’s Obstetric textbook (e-book) on vaginal examination late in pregnancy often provides valuable information to include: •Confirmation of the presenting part and its station •Clinical estimation of pelvic capacity and its general configuration •Consistency, effacement, and dilatation of the cervix

51. Maravilla, 51. MARAVILLA, RACHELLE DIANE B. Rachelle Diane B. Which of the following is contraindicated during pregnancy? •dental works and tooth extraction •swimming •intake of antibiotics •none of the above Answer: C Rationale: Conditioned pregnant women are allowed a varied range of activities and can continue to exercise throughout gestation provided that they do not exercise to exhaustion, that she augment heat dissipation and have adequate fluid replacement. She must also avoid supine position and activities that require good balance as pregnancy induces balance problems and joint relaxation that may predispose her to orthopedic injuries. Intake of antibiotics, on the other hand, can induce a lot of side effects like nephrotoxicity and ototoxicity (aminoglycosides), gray baby syndrome (chloramphenicol), yellow-brown discoloration of teeth (tetracyclines). Reference: Williams 23rd Edition E-book Chapter 7 and Chapter 14 *Sorry po Doc. Page numbers are not shown on the e-book. 52. MARAVILLA, RACHELLE DIANE B. The reason in performing internal examination late in pregnancy is to determine: •consistency, effacement and dilatation of the cervix •presenting part •if the bag of water has ruptured already •A and B

Answer: D Rationale: As labor progresses, the need for subsequent vaginal examinations are needed. This will monitor both the cervical changes and presenting part position. Reference: Williams 23rd Edition E-book Chapter 17 (under the heading Subsequent Vaginal Examinations) 53. MARAVILLA, RACHELLE DIANE B. Maternal condition/s that may increase heart rate and be mistaken for fetal heart tones: •maternal fever •intake of drugs (tocolytics) •thyrotoxicosis •all of the above Answer: D Rationale: •Maternal fever : the most explanation for fetal tachycardia •Intake of Drugs (tocolysis) : This is also another cause of fetal tachycardia •Thyrotoxicosis : A sublethal maternal condition that rarely induce fetal heart rate pattern changes. Reference: Williams 23rd Edition E-book Chapter 18 (under Fetal Heart Rate Patterns and Brain Damage AND Fetal Heart Rate Patterns: Tachychardia)

52. Asuncion, Jessica

52. The reason in performing internal examination late in pregnancy is to determine: a. consistency, effacement and dilatation of the cervix b. presenting part c. if the bag of water has ruptured already d. A & B Answer: B Rationale: Bimanual examination is completed by palpation, with special attention given to the consistency, length, and dilatation of the cervix; to uterine size and any adnexal masses; to the fetal presentation later in pregnancy; to the bony architecture of the pelvis; and to any anomalies of the vagina and perineum. Reference: William’s Obstetrics, 23rd Edition (EBOOK) Section

III. Antepartum: Chapter 8: “Prenatal Care.” 53. Maternal condition/s that may increase heart rate and be mistaken for fetal heart tones: a. maternal fever b. intake of drugs (tocolytics) c. thyrotoxicosis d. all of the above Answer: D Rationale: Fetal tachycardia is defined as a baseline heart rate in excess of 160 beats/min. The most common explanation for fetal tachycardia is maternal fever from chorioamnionitis, although fever from any source can increase baseline fetal heart rate. Fever is also virtually universal, and a murmur ultimately is heard in 80 to 85 percent of cases, which can seem like fetal heart tones upon examination. Magnesium sulfate, widely used in the United States for tocolysis as well as management of hypertensive women, has been arguably associated with diminished beatto-beat variability. Symptomatic thyrotoxicosis or hyperthyroidism complicates 1 in 1000 to 2000 and because normal pregnancy simulates some clinical findings similar to thyroxine (T4) excess, mild thyrotoxicosis may be difficult to diagnose. Suggestive findings include tachycardia that exceeds that usually seen with normal pregnancy, thyromegaly, exophthalmos, and failure to gain weight despite adequate food intake. Reference: William’s Obstetrics, 23rd Edition (EBOOK) Section IV. Labor and Delivery: Chapter 18: “Intrapartum Assessment;” and Section VIII. Medical and Surgical Complications: Chapter 44: “Cardiovascular Disease” and Chapter 53: “Thyroid and Other Endocrine Disorders.” 54. A 40 year old hypertensive multigravida on insulin therapy for her gestational diabetes and presently on her 30 weeks should have her next prenatal check up the latest after____ week/s: a. 1 b. 2 c. 3 d. 4 Answer: B Rationale: Subsequent prenatal visits have been traditionally

scheduled at intervals of 4 weeks until 28 weeks, and then every 2 weeks until 36 weeks, and weekly thereafter. Women with complicated pregnancies, or with what is considered a high-risk pregnancy, such as being hypertensive or having gestational diabetes, often require return visits at 1- to 2week intervals Reference: William’s Obstetrics, 23rd Edition (EBOOK) Section III. Antepartum: Chapter 8: “Prenatal Care.” 57. Salvador, Zafril Jose S. R.

57. SALVADOR, ZAFRIL JOSE S.R. Since childhood, Mrs. B has been receiving treatment for her grand mal seizures. Her medications were religiously taken until she got pregnant. What is the deformity that her baby will likely develop? a. Limb deformity b. Congenital cataract c. Leukemia d. Spina bifida Answer: D. SPINA BIFIDA Rationale: Carbamazepine has been assigned to pregnancy category D by the FDA. Carbamazepine can cause fetal harm when administered to a pregnant woman. Epidemiological data suggest that there may be an association between the use of carbamazepine during pregnancy and congenital malformations, including spina bifida. Reference 58. SALVADOR, ZAFRIL JOSE S.R. A gravid patient has been prescribed with indomethacin for her preterm labor at 28 weeks for just 3 days. What is the possible fetal complication of this treatment? a. Trachea-esophageal fistula b. Oligohydraminos c. Shortening of limbs d. Gastroschisis Answer: B. OLIGOHYDRAMINOS Rationale: Fetal hemodynamic changes, premature closure of the ductus arteriosus resulting in neonatal primary pulmonary hypertension, and neonatal oliguric renal failure, oligohydramnios, hemorrhage, and intestinal perforation have been reported as a result of this tocolytic therapy. Indomethacin is only recommended for use during pregnancy when benefit outweighs risk. Reference: retrieved fromhttp://www.drugs.com/pregnancy/indomethacin.html 59. SALVADOR, ZAFRIL JOSE S.R.

The mother of an 8 year old boy noted that his teeth are yellowish than usual compared to his playmates. She remembered she had an intake of antibiotic for minor skin infections on her face until about 2 months pregnant. What is the drug that is known for this complication? a. Chloramphenicol b. Cyclophosphamide c. Tetracyclines d. Streptomycin Answer: C. TETRACYCLINES Rationale: The use of tetracycline during tooth development [ last half of pregnancy, infancy and childhood to the age of 8 years] may cause permanent discoloration of the teeth [yellow=gray-brown]. This adverse reaction if more common during long term use of the drug but has been also observed following repeated short term courses. Reference: retrieved fromhttp://www.drugs.com/pro/tetracycline.html 58. Mendoza, Jaimee Rose G.

58. A gravid patient has been prescribed with indomethacin for her preterm labor at 28 weeks for just 3 days. What is the possible fetal complication of this treatment? a. Tracheo-esophageal fistula b. Oligohydramnios c. Shortening of limbs d. Gastroschisis Answer : B Rationale : Indomethacin in particular is reported to cause constriction of the fetal ductus arteriosus with subsequent pulmonary hypertension (Marpeau and associates, 1994; Rasanen and Jouppila, 1995). It may also decrease fetal urine output and thereby reduce amnionic fluid volume, presumably by increasing vasopressin levels and responsiveness to it (van der Heijden and colleagues, 1994; Walker and associates, 1994). Reference : William’s 23rd edition (online access, Accessmedicine.com) 59. The mother of an 8-year old boy noted that his teeth are yellowish than usual compared to his playmates. She remembered she had an intake of antibiotic for minor skin infections on her face until about 2 months pregnant. What is the drug that is known for this complication? a. Chloramphenicol b. Cyclophosphamide c. Tetracycline

d. Streptomycin Answer : C Rationale: Tetracycline may cause yellow-brown discoloration of deciduous teeth or be deposited in fetal long bones when used after 25 weeks (Kutscher and associates, 1966). Reference: William’s 23rd edition (online access, Accessmedicine.com) 60. This drug inhibits production of methionine that will cause defects in the metabolism of proteins and lipids. a. Itraconazole b. Valproic acid c. Methimazole d. Paroxetine Answer : B Rationale: Women with epilepsy have an increased risk of fetal malformations that is usually estimated to be two to three times the background rate. There has been controversy as to whether the increased risk is due to the underlying seizure disorder or the medication(s) used to treat it (Holmes and colleagues, 2001). Recent data suggest that the risks are not as great as once thought. For example, a meta-analysis by Fried and associates (2004) from the Toronto Motherisk Program showed that women with untreated epilepsy had a similar risk for major fetal malformations as did nonepileptic control women. And in the United Kingdom Epilepsy and Pregnancy Registry of 3400 women, the major fetal malformation rate was 3 percent with untreated epilepsy and 3 percent with epilepsy treated with monotherapy (Morrow and colleagues, 2006). In fact, only women who were treated with valproate had a significantly increased risk for malformations—the risk was 9 percent if valproate was part of polytherapy. Since Valproate is associated with folate and methionine, the answer is most likely valproic acid. Reference: William’s 23rd edition (online access, Accessmedicine.com) 59. Paras, Robert 59. The mother of an 8 year old boy noted that his teeth are Julius yellowish than usual compared to his playmates. She remembered she had an intake of antibiotic for minor skin infections on her face until about 2 months pregnant. What is the drug that is known for this complication? a. chloramphenicol b. cyclophosphamide c. tetracyclines d. streptomycin

Answer: C Rationale: Tetracycline may cause yellow-brown discoloration of deciduous teeth or be deposited in fetal long bones when used after 25 weeks. Reference: William’s Obstetrics, 23rd Edition (EBOOK) Section III. Antepartum: Chapter 14: “Teratology and Medications that Affect the Fetus.” 60. This drug inhibits production of methionine that will cause defect in the metabolism of proteins and lipids. a. itraconazole b. valproic acid c. methimazole d. paroxetine Answer: B Rationale: Several congenital anomalies, including neural-tube defects, cardiac defects, cleft lip and palate, and even Down syndrome, are thought to arise, at least in part, from disturbance of folic acid metabolic pathways. Folic acid is essential for the production of methionine, which is required for methylation reactions and thus production of proteins, lipids, and myelin. Hydantoin, carbamazepine, valproic acid, and phenobarbital impair folate absorption or act as antagonists. They can lead to decreased periconceptional folate levels in women with epilepsy and to fetal malformations. Reference: William’s Obstetrics, 23rd Edition (EBOOK) Section III. Antepartum: Chapter 14: “Teratology and Medications that Affect the Fetus.” 61. The mechanism of action that is responsible for the cause of defects in paternal exposures to pesticides, lead, mercury, or anesthetic gases is: •induction of gene mutation in the spermatozoon •alteration of the homeobox genes •production of oxidative intermediates •polymorphism in the genes Answer: A Rationale: In some cases, paternal exposures to drugs or environmental influences may increase the risk of adverse fetal outcome (Robaire and Hales, 1993). Several mechanisms are postulated. One is the induction of a gene

mutation or chromosomal abnormality in sperm. Because the process by which germ cells mature into functional spermatogonia takes 64 days, drug exposure at any time during the 2 months prior to conception could result in a mutation. Reference: William’s Obstetrics, 23rd Edition (EBOOK) Section III. Antepartum: Chapter 14: “Teratology and Medications that Affect the Fetus.” 60. Ramos, Iziah Rainier D.S.

60. This drug inhibits production of methionine that will cause defect in the metabolism of proteins and lipids. a. itraconazole b. valproic acid c. methimazole d. paroxetine Answer: B. Valproic acid (Anti-seizure drug) Rationalization: ITRACONAZOLE- exposed newborns had skull abnormalities , cleft- palate, humeral- radial fusion and other arm abnormalities collectively resembling Antley- Bixler syndrome. VALPROIC ACID- anti- seizure drugs impairs folate absorption therefore decreasing periconceptional folate levels. Fetuses who were exposed to this drug during embryogenesis have 23x risk of developing oral clefts, cardiac defects, and urinary tract defects. METHIMAZOLE- methimazole used in early pregnancy is associated with esophageal and choanal atresia as well as aplasia cutis. PAROXETINE- paroxetine use during pregnancy has been associated with increased risk for congenital cardiac malformation. More common anomalies are atrial and ventral septal defects. Reference: William’s Obstetrics Chapter 14 22/e (e-Book) 61. The mechanism of action that is responsible for the cause of defects in paternal exposure to pesticides, lead, mercury or anesthetic gases is: •Induction of gene mutation in the spermatozoon •Alteration of homeobox genes •Production of oxidative intermediates. •Polymorphism in the genes.

Answer: A Rationalization: The process in which germ cells mature into functional spermatogonia takes about 64 days, so exposure in this window can cause induction of gene mutation or chromosomal abnormality in the sperm. Reference: William’s Obstetrics 22/e page 196 (e-book). 62. The group of drugs that may produce renal ischemia and may lead to renal agenesis and anuria is: •Anti-convulsants •Non-steroidal anti-inflammatory •Angiotensin receptor blockers •Antimalarials. Answer: C Rationalization: ANTI- CONVULSANTS- newborns exposed to this type of drug are usually develops oral clefts, cardiac defects and urinary tract defects NSAIDs- these drugs are not considered teratogenic because they may cause reversible fetal effects is used shortly at the third trimester of pregnancy ANGIOTENSIN-RECEPTOR BLOCKERS- disruption in reninangiotensin system results in renal papillary and tubular atrophy and a significant impairment in the urinary concentrating ability ANTI-MALARIAL- Quinine and quinidine are reserved for severely ill women with chloroquine-resistant malaria. There has been no increased rate of congenital anomalies in the offspring of mothers given any of these antimalarial drugs during pregnancy. Reference: William’s Obstetrics Chapter 14 22/e (e-Book)

61. Oliveros, Mark Joseph N.

61. The mechanism of action that is responsible for the cause of defects in paternal exposures to pesticides, lead, mercury or anesthetic gases is:

•induction of gene mutation in the spermatozoon •alteration of the homeobox genes •production of oxidative intermediates •polymorphism in the genes Answer: A. Induction of gene mutation in the spermatozoon Rationale: There are some paternal exposures to drugs or environmental influences that may increase the risk of adverse fetal outcome. Several mechanisms have been postulated. One is the induction of a gene mutation or chromosomal abnormality in sperm. Because the process by which germ cells mature into functional spermatogonia takes 64 days, drug exposure at any time during the 2 months prior to conception could result in a mutation. A second possibility is that during intercourse a drug in seminal fluid could directly contact the fetus. Third, paternal germ cell exposure to drugs or environmental agents may alter gene expression. Homeobox genes encode nuclear proteins that act as transcription factors to control the expression of other developmentally important genes. The potent teratogen, retinoic acid, can activate these genes prematurely, resulting in chaotic gene expression at sensitive stages of development. Oxidative intermediates (intermediates of Hydantoin, carbamazepine, and Phenobarbital) normally are detoxified by cytoplasmic epoxide hydrolase, but because fetal epoxide hydrolase activity is weak, oxidative intermediates accumulate in fetal tissue. These free oxide radicals have carcinogenic, mutagenic, and other toxic effects. These effects are dose related and increase with multidrug therapy. Fetuses exposed to hydantoin are most likely to develop anomalies if they are homozygous for a gene mutation resulting in abnormally low levels of epoxide hydrolase (Buehler and associates, 1990). There is also a reported association between cigarette smoking and isolated cleft palate, but only in individuals with an uncommon polymorphism in the gene for transforming growth factor-1. The risk of clefts in individuals with this allele is increased two- to sevenfold. Reference: Williams Obstetrics 22nd Edition. Section III. Antepartum. Chapter 14. Teratology, Drugs, and Other Medications (Ebook)

62. The group of drugs that may produce renal ischemia and may lead to renal agenesis and anuria is: •anticonvulsants •non-steriodal anti-inflammatory •angiotensin receptor blockers •antimalarials Answer: C. Angiotensin receptor blockers Rationale: Angiotensin receptor blockers or ACE inhibitors appear to have similar effects on human fetuses. In addition, they may provoke prolonged fetal hypotension and hypoperfusion, thus initiating a sequence of events leading to renal ischemia, renal tubular dysgenesis, and then anuria. Examples of drugs are Captopril and Enalapril Anticonvulsants such as Phenytoin, Carbamazepine, Phenobarbital and Valproate cause the following effects on the fetus: Fetal hydantoin syndrome, spina bifida, neural tube defects and cardiac malformations respectively. NSAIDS such as Ibuprofen and Naproxen are used often but not considered teratogenic but they have largely reversible fetal effects when used short term in the third trimester. Indomethacin, a tocolytic agent can result in constriction of the fetal ductus arteriosus and subsequent pulmonary hypertension in the neonate. It also decreases fetal urine output and reduces amnionic fluid volume after prolonged use, presumably by increasing vasopressin levels and responsiveness to it. There has been no increased rate of congenital anomalies in the offspring of mothers given any of these antimalarial during pregnancy. Daily use of chloroquine for lupus and other connective tissue diseases has been shown to cause maternal retinopathy but no adverse fetal effects (Araiza-Casillas and colleagues, 2004; CostedoatChalumeau and co-workers, 2003). Second- or thirdtrimester use of mefloquine for asymptomatic malaria treatment has been associated with a fivefold increased risk of stillbirth (Nosten and colleagues, 1999). Reference: Williams Obstetrics 22nd Edition. Section III. Antepartum. Chapter 14. Teratology, Drugs, and Other Medications (Ebook) 63. This drug is known to develop congenital adrenal hyperplasia among female fetuses if exposure is between 712 weeks:

•antineoplastic agents •androgens •aminoglycosides •antivirals Answer: B. Androgens Rationale: An example of the fetal effects from early exposure to androgens is autosomal recessive congenital adrenal hyperplasia. Fetal adrenal glands ordinarily begin functioning by 12 weeks, but in this condition, specific enzyme deficiencies prevent the glands from hydroxylating cortisol precursors. Androgenic intermediates accumulate, masculinizing female external genitalia and producing abnormal male genital growth Antineoplastic agents such as Cyclophosphamide when taken in first trimester result to missing and hypoplastic digits on hands and feet. These anomalies are believed to be caused by necrosis of limb buds and DNA damage in surviving cells. Other defects include cleft palate, single coronary artery, imperforate anus, and fetal growth restriction with microcephaly. Maternal administration of Aminoglycosides can result in toxic fetal blood levels, but this can be avoided by using lower divided doses. Although both nephrotoxicity and ototoxicity have been reported in preterm newborns and adults treated with gentamicin or streptomycin, congenital defects resulting from prenatal exposure have not been confirmed. Antiviral Ribavirin is given by aerosol inhalation to treat respiratory syncytial virus infections in infants and young children. Pregnant women may be exposed to the drug while working in intensive care nurseries. The drug is highly teratogenic in all animal species studied and consistently produces hydrocephalus and limb abnormalities in rodent models. Although human exposures are rare, the Centers for Disease Control and Prevention and the manufacturers consider it contraindicated for use in pregnancy. Reference: Williams Obstetrics 22nd Edition. Section III. Antepartum. Chapter 14. Teratology, Drugs, and Other Medications (Ebook) 63. Reyes, Kevin

(doc,nagkamali po sya ng sinagutan..ang nasagutan nya po ay 65-67..pero ang seat #nya po ay 63. Inilagay ko na lang din po yung mga sinagutan nya just in case you consider it :))

65. in the initiation of parturition process, what is the condition that may initially cause myometrial contractility to facilitate phase 3 of parturition? a. decrease in estrogen level b. increase in maternal corticotrophin releasing hormone c. increase in fetal cortisol d. decrease in fetal DHEA-S Answer: b Rationale: corticotrophin releasing hormone may cause relaxation or contraction of myometrial cells depending on the receptor isoforms present. Reference: Williams Obstetrics 22nd edition. Chapter 6 parturition. Page 166 66. the following substances will promote uterine contraction and contribute in the initiation of labor. These substances include: a. platelet activating factors b. prostaglandin dehydrogenases c. enkaphalinases d. all of the above Answer: a Rationale: Levels of platelet activating factor in amniotic fluid is increased in labor, and PAF treatment of myometrial tissue promotes contraction. Reference: Williams Obstetrics 22nd edition. Chapter 6 parturition. Page 175

67. Which of the following is TRUE about the actin-myosin interaction during uterine contraction? a. the actin must be in globular form

b. the myosin should be in filamentous form c. calcium must bind to calmodulin d. ATP is activated Answer: c Rationale: Calcium binds to calmodulin which in turn binds to and activates myosin light chain kinase. An increase in the intracellular cytosolic concentration of calcium promote contraction. Reference: Williams Obstetrics 22nd edition. Chapter 6 parturition. Page 162

65. Saulog, Roldan

65. SAULOG, ROLDAN A. In the initiation of parturition process, what is the condition that may initially cause myometrial contractility to facilitate phase 3 a. decrease in estrogen level b. increase in maternal corticotrophin releasing hormone c. increase in fetal cotisol d. decrease in fetal DHEA-S Answer: B Rationale: During initiation of parturition the main hormones involve is the maternal corticotrophin releasing hormone or CRH. This hormone enhances fetal cortisol production at the same time production of DHEA-S in also increase that leads to increase estrogen production. Reference: Williams 23rd pages 157-158

66. SAULOG, ROLDAN A. The following substances will promote uterine contraction and contribute in the initiation of labor. these substances include: a. platelet activating factors b. prostaglandin dehydrogenases

c. enkephalinases d. all of the above Answer: A Rationale: Platelet activating Factors stimulation increases myometrial calcium levels and promotes uterine contractions. In Chorion Laeve, Prostaglandin dehydrogenase and Enkephalinases are found. These enzymes are capable of inactivating uterotonins that help regulate contrations of the uterus. During initiation of labor when the chorion disrupts this barrier is lost that leads to uninhibited uterotonins. Reference: Williams 23rd pages 161-162 67. SAULOG, ROLDAN A. Which of the following is TRUE about actin-myosin interaction during uterine contraction? a. the actin must be in globular form b. the myosin should be in filamentous form c. calcium must bind with calmodulin d. ATP is activated Answer: C Rationale: The interaction of myosin and actin is essential to muscle contraction. This interaction requires that actin be converted from a globular to filamentous form. Moreover, actin must be attached to the cytoskeleton at focal points in the cell membrane to allow development of tension (Fig. 612). Actin must partner with myosin, which is comprised of multiple light and heavy chains. The interaction of myosin and actin causes activation of adenosine triphosphatase, adenosine triphosphate hydrolysis, and force generation. This interaction is effected by enzymatic phosphorylation of the 20-kDa light chain of myosin (Stull and colleagues, 1988, 1998). This phosphorylation reaction is catalyzed by the enzyme myosin light-chain kinase, which is activated by

calcium. Calcium binds to calmodulin, a calcium-binding regulatory protein, which in turn binds to and activates myosin light-chain kinase. Reference: Williams 23rd, page 148 66. Talatala, Kith Eligin Nuestro

66. The following substances will promote uterine contraction and contribute in the initiation of labor. the substances include: a. platelet activating factors b. prostaglandin dehydrogenases c. enkephalinases d. all of the above ANSWER: A RATIONALE: Many of the uterotonins that are known to cause myometrial contractions of smooth muscles are as follows: oxytocin, prostaglandins, serotonin, histamine, platelet activating factor, angiotensin II and others. 15-hydroxy prostaglandin dehydrogenase degrades uterotonins such as prostaglandins to inactivate prostaglandins to their 15ketometabolites. REFERENCE: Page 152-154, William's Obstetrics 23rd Edition 67. Which of the following is true about the actin-myosin interaction during uterine contraction? a. the actin must be in globular form b. the myosin should be in filamentous form c. calcium must bind with calmodulin d. ATP is activated ANSWER: C RATIONALE: The interaction of myosin and actin is essential to muscle contraction. This interaction requires that actin be converted from a globular to filamentous form. Moreover, actin must be attached to the cytoskeleton at focal points in the cell membrane to allow development of tension. Actin must partner with myosin, which is comprised of multiple light and heavy chains. The interaction of myosin and actin causes activation of adenosine triphosphatase, adenosine triphosphate hydrolysis, and force generation. This interaction is effected by enzymatic phosphorylation of the 20-kDa light chain of myosin (Stull and colleagues, 1988, 1998). This phosphorylation reaction is catalyzed by the enzyme myosin light-chain kinase, which is activated by calcium. Calcium bind to calmodulin, a calcium-binding regulatory protein, which in turn binds to and activates myosin light-chain kinase. Uterine relaxation is maintained by factors that

increase myocyte cyclic adenosine monophosphate (cAMP). This activates protein kinase A (PKA) to promote phosphodiesterase activity with dephosphorylation of myosin light-chain kinase (MLCK). There are also processes that serve to maintain actin in a globular form, and thus to prevent fibril formation necessary for contractions. Uterine contractions result from reversal of these sequences. Actin now assumes a fibrillar form, and calcium enters the cell to combine with calmodulin to form complexes. These complexes activate MLCK to bring about phosphorylation of the myosin light chains. This generates ATPase activity to cause sliding of myosin over the actin fibrils, which is a uterine contractor. REFERENCE: Williams Obstetrics 23rd edition, Chapter 6 Parturition 68. The cervix is said to be most effaced if it measures ______ cm. a. 1 b. 2 c. 3 d. 4 ANSWER: A RATIONALE: The answer is letter A, though it is not directly mentioned on the book but it was said that "Cervical effacement is "obliteration" or "taking up" of the cervix. It is manifest clinically by shortening of the cervical canal from a length of about 2 cm to a mere circular orifice with almost paper-thin edges. The muscular fibers at about the level of the internal cervical os are pulled upward, or "taken up," into the lower uterine segment." , this suggests that shortening of cervical canal from 2 cm, decreasing the number, the most effaced cervix is about Chapter 22. Labor Induction > 98. Noche, Rizza Joyce C.

98. The goal of augmentation of labor is to: a) effect uterine activity sufficient to produce cervical change and fetal descent b) make the uterine contractions regular c) increase the intensity of the uterine contractions so that the mother will feel the pain and be encouraged to bear down d) make labor faster ANSWER: A RATIONALIZATION: "the goal of induction is to effect uterine activity sufficient to produce cervical change and fetal descent, while avoiding development of a non reassuring fetal status." REFERENCE: p. 506, Williams Obstetrics, 23rd edition; Intravenous Oxytocin Administration --99. If there is delay in the delivery of the rest of the body, the following maneuvers may be performed: a) hook the fingers in the baby's axillae b) apply moderate traction on the head c) apply moderate pressure on the suprapubic area d) bend the baby's neck ANSWER: B RATIONALIZATION: "Most often, the shoulders appear at the vulva just after external rotation and are born spontaneously.

If delayed, immediate extraction may appear advisable. The sides of the head are grasped with two hands, and gentle downward traction is applied until the anterior shoulder appears under the pubic arch." REFERENCE: p. 396, Williams Obstetrics, 23rd edition; Delivery of the Shoulders --100. The active management of the third stage of labor include/s: a) early cord clamping and cutting b) oxytocin before the delivery of the baby c) controlled cord traction of the umbilical cord before placental separation d) ergots given IM after the delivery of the placenta ANSWER: D RATIONALIZATION: "Oxytocin, and especially ergonovine, given before delivery of the placenta will decrease blood loss (Prendiville and associates 1988a). If they are given before delivery of the placenta, however, they may entrap an undiagnosed, undelivered second twin... If an intraveous infusion is in place, our standard practice has been to add 20 units (2 mL) of oxytocin per liter of infusate. This solution is administered after delivery of the placenta at a rate of 10 mL/min for a few minutes until the uterus remains firmly contracted and bleeding is controlled." REFERENCE: p. 398-399, Williams Obstetrics, 23rd edition; Management of the Third Stage 100. Villasenor, Marice

100. The active management of the third stage of labor include/s: a. Early cord clamping and cutting b. Oxytocin before the delivery of the baby c. Controlled cord traction of the umbilical cord before placental separation d. Ergots given IM after the delivery of the placenta Answer: C The third stage of labor refers to the period following the completed delivery of the newborn until the completed delivery of the placenta. An active management of this stage is the controlled cord traction involves traction on the umbilical cord, combined with counterpressure upwards on the uterine body by a hand placed immediately above the symphysis pubis. CCT is used on conjunction with drugs that

speed up the seperation process i.e. syntometrine Resources: Stables, Dot Physiology in Childbearing (Chapter 10) 101. The goal of immediately drying after delivery of the baby is to: a. Remove the vernix b. Keep the baby clean c. Prevent hypothermia d. Stimulate skin circulation Answer: C According to the Essential New Born Care of the DOH, wrapping the newborn with clean, dry cloth does provision of appropriate thermal care through mother and newborn maintaining a delivery room temperature of 25-28 degrees centigrade. Reference: Department of Health Philippines Unang Yakap, Essential New Born Care 102. A complication of the improper repair of a 4th degree perineal laceration is: a. Rectovaginal fistula b. Cystovaginal fistula c. Relaxed vaginal outlet d. Rectocoeale Answer: A 4TH degree perineal laceration dramatically depicts an insufficient third degree repair and subsequent rectovaginal fistula. This laceration extends from the vaginal opening through the perineal muscles and to the anus. This fistula also results from a perforation in the rectal mucosa. Reference: Journal of Obstetrics and Gynaecology (November 2003) Vol. 23, No. 6, 607–610