Obstetrics and Gynecology Mock Review

OBSTETRICS AND GYNECOLOGY INSTRUCTION: Select the correct answer for each of the following questions. Mark only one answer for each item by shading the box corresponding to the letter of your choice on the answer sheet provided. STRICTLY NO ERASURES ALLOWED. Use pencil no. 2 only. 1. In the immediate puerperium in a setting of excessive vaginal bleeding, the guide to instituting blood transfusion therapy is: A. The amount of blood lost B. The pulse rate C. The diastolic blood pressure D. The sytolic blood pressure 2. The greatest amount of blood would normally be lost in which of the following procedure? A. An uncomplicated cesarean section of a single fetus at term B. An uncomplicated vaginal delivery of twins at term C. An uncomplicated cesarean section of twins at term D. A vaginal delivery of normal term infant 3. All of the following structures are involved in the supportive role that the pelvic floor plays except the: A. Lovator ani muscles B. Uterus C. Parametria D. Bulbo-cavernous muscles 4. You have performed a D & C on your patient for what you had diagnosed as an incomplete abortion. The pathology report returns describing generalized trophoblastic proliferations and hydropic villi without blood vessels. Which of the following is the most likely? A. Incomplete abortion B. Choriocarcinoma C. Hydatidiform mole D. Complete abortion 5. The hormone for maintenance of pregnancy is: A. Human chorionic gontropin B. Progesterone C. Prolactin D. Estriol 6. Which of the following statements is not true regarding chlamydia trachomatis? A. It can be effectively treated with cephalosporins B. It is 3 – 5 times more common than gonorrhea C. It causes lymphogranuloma venereum D. It causes neonatal pnemonia 7. What is/are the techniques that are useful in reducing the patient’s anxiety and increasing rapport during an examination include: A. Taking the initial history before the patient has changed into an examination gown. B. Discussing psychosocial as well as biological aspects of the partner’s presenting complaint C. Avoiding frequent interruptions during the taking of history D. All of these techniques

8. The first Leopold’s maneuver in LScA will reveal the fundus to be: A. Not occupied by the fetal part B. Occupied by the fetal head C. Occupied by the breech D. Occupied by the ballotable mass 9. The transverse diameter of the pelvic inlet in the female measures: A. 13-14 cm B. 14-15 cm C. 10-11 cm D. 11-12 cm E. 12-13 cm 10. Which is the narrowest diameter of the true pelvis: A. The anterior – posterior diameter of the inlet B. The anterior – posterior diameter of the mid-pelvis C. The transverse diameter of the mid – pelvis D. The transverse diameter of the inlet 11. The relation of the fetal parts to one another determines the: A. Attitude of the fetus B. Presentation of the fetus C. Lie of the fetus D. Position of the fetus 12. In the active phase of the first stage of labor, the cervix of a parous patient should dilate at least: A. 1.5 cm per hour B. 1.0 cm per hour C. 0.5 cm per hour D. 2.0 cm per hour E. 2.5 cm per hour 13. Which is not an oxytocic used in the third or fourth stage of labor: A. Oxytocin B. Ergonovine maleate C. Epinephrine D. Ergonovine maleate E. Methylergonovine maleate 14. What marks the beginning of the active phase of the first stage of labor: A. 100% effacement B. 4 – cm dilatation C. 3 – cm dilatation D. 2 – cm dilatation E. Change in slope of the dilatation curve

15. Which of the following is not a sign of placental separation: A. A significant decrease in uterine pain occurs B. The umbilical cord protrudes farther out of the vaginal opening C. A sudden gush of blood occurs in many cases D. The uterus rises in the abdomen E. The uterus becomes globular and usually firmer 16. All of the following are reported signs or symptoms of adenomyosis of the uterus except: A. Normal size uterus B. Increased menstrual flow C. Uterine tenderness D. Elevation of serum CA 125 above 35 17. A syndrome of amenorrhea – glactorrhea developing postpartum is: A. Ahumada del Castillo B. Budd – Chiari C. Sheehans D. Chiari – Brommel 18. The shape of a pelvic inlet is oval, and the transverse diameter is significantly greater than the anterior diameter. The pelvis would be classified as: A. Glynecoid B. Anthropoid C. Android D. Platypelloid 19. The substance responsible for release of milk, i.e. the let – down reflex is: A. Progesterone B. Prostaglandin C. Estrogen D. Oxytocin 20. Choose the correct statement about the diagnosis of placental abruption: A. An abnormal fetal lie is characteristic B. Hypotension and anemia is present C. Fetal dealth is more common than fetal distress D. External hemorrhage is more frequent than concealed hemorrhage 21. A term infant is delivered as a double – footling breech. It is noted to have an Apgar of 3 at one minute and later to be irritable and restless. The muscles are rigid and the anterior fontanel bulges. The patient develops progressive bradycardia. The most likely diagnosis is: A. Intracranial hemorrhage B. Brain stem injury C. Infection D. Congenital abnormality 22. All of the following are common is early pelvic inflammary disease (PID), except: A. Temperature of 1020F or greater B. Cul – de – sac fullness and mass C. Bilateral pelvic tenderness, i.e. parametrial tenderness D. Marked tenderness and pain on movement of cervix

23. Maternal morbidity is defined as: A. High rectal temperature in the first ten days postpartum B. An oral temperature of 380C C. All oral temperature of 380C or more on any two of the first ten days postpartum D. Postpartum hemorrhage 24. The initial treatment of choice in hypothalamic amenorrhea when ovulation is desired is: A. Daily dose of FSH followed after 2 weeks by HCG B. Clomiphene C. Prequent coitus D. Cyclic progesterone 25. A woman dies from complication of mitral stenosis during the course of her pregnancy. This would be defined as: A. A direct maternal death B. Accidental death C. A non – maternal death D. An indirect maternal death 26. Of the following ovarian tumors the most radiosensitive is: A. Embryonal carcinoma B. Dysgerminoma C. Endodermal sinus tumor D. Choriocarcinoma 27. A pelvic inlet is felt to be contracted if: A. The transverse diameter is only 10 cm B. Configuration is platypelloid C. The anteroposterior (AP) diameter is only 12 cm D. The mother is short 28. Which of the following racial groups has the highest incidence of Rh negative individuals? A. Oriental B. White C. Black D. Indian 29. Prophylactic forceps is: A. Delivery by appointment B. Elective low forceps C. Elective low – mid forcep D. Mid forceps 30. A 30 year old woman at term goes into labor a midnight. At that afternoon she has been dilated to 5 cm for six hours. Standard measures for obstetric care would dictate evaluation of all of the following except: A. Abnormalities of fetal size/position B. Abnormalities of uterine contractions C. Abnormalities of the architecture of the maternal D. Nutritional status – patient may just need something to eat to provide the energy for labor

31. A diagnosis of pelvic contraction may be made if the following measurement is present: A. Transverse diameter of the outlet is 11cm B. Transverse diameter of the midplane is 8.5cm C. AP diameter of the inlet is 12.0 cm D. Obstetrical conjugate is 10.8 cm 32. Crowning is best defined as: A. When the fetal head is first visible through the vulva B. When the greatest diameter of the fetal head comes through the vulva C. When the presenting part reaches the pelvic floor D. When the perineum bulges in front of the fetal head 33. A growth retarded infant may be the result of: A. Teenage pregnancy B. Gestational diabetes C. Heavy smoking D. All three options 34. A 30 – year old G1 P0 is found to have an 8 – week size, irregular uterus. She does not complain of pain or excess bleeding. The Pap smear is negative. Which of the following constitutes adequate therapy? A. D and C B. Hysterectomy C. Close observation D. Cervical conization 35. Adenomyosis is likely to be associated with: A. All of the given choices B. Symmetrical uterine enlargement C. Infertility D. Abnormal uterine bleeding 36. Fetal cardiac activity can be identified with ultrasound as early as: A. 9 – 10 weeks B. 3 – 4 weeks C. 7 – 8 weeks D. 5 - 6 weeks 37. The standard drug for Chlamydia infection in the genital tract as: A. Aminoglycoside B. Cephalosporin C. Tetracycline D. Amoxycillin 38. A factor that appears to affect the age of menopause is: A. Use of oral contraceptives B. Number of term pregnancies C. Weight D. Smoking

39. The frequency of breech presentation at term is: A. 7 to 8 percent B. 3 to 4 percent C. 1 to 2 percent D. 5 to 6 percent 40. A 58 year old woman complains of vaginal burning and dyspareunia. Characteristic of the vagina would be expected to include all of the following except: A. An alkaline Ph B. A thinned epithelium C. Superficial colls D. Decreased glycogen 41. The available evidence implicates agent transmitted during coitus in the etiology of this cancer. A. CA of the cervix B. CA of the vagina C. CA of the endometrium D. CA of the ovary 42. Normal fetal blood volume is approximately: A. 15 ml /kg B. 50 ml / kg C. 80 ml / kg D. 100 ml / kg 43. The major infant risk of gestional diabetes is: A. Macrosomia B. Respiratory distress C. Hypoglycemia D. Anomalies 44. During pregnancy, most myoma A. Enlarge and undergoes degeneration B. Remain the same size and do not undergo degeneration C. Shrink and undergo degeneration D. Grow 45. Late bleeding in the postpartum period is most often caused by: A. Retained placental frugments B. Uterine rupture C. Uterine atony D. Coagulopathies 46. Which of the following histories might lead you to suspect the existence of a prediabetic state in a patient pregnant for the third time? A. Abruptic placenta occured in the second pregnancy B. Both preceding infants were premature C. Jaundice appeared in the last trimester of the second pregnancy but not in the first D. Previous unexplained intrauterine death occured at 38 weeks gestation

47. The sympto-thermal of NFP includes: A. Cervical mucus, BBT and calendar method B. Calendar and cervical mucus method C. BBT and calendar method D. Cervical mucus, BBT and mittelechmerz 48. Select the list which arranges the methods of contraception in the proper descending order by their method effectiveness A. Sterilization, IUD, condom, oral contraceptives B. Sterilization, oral contraceptives, IUD, condom C. Sterilization, IUD, oral contraceptives, condom D. Oral contraceptives, sterilization, IUD, spermicidal foams and jelly 49. Colpotomy is: A. Visualization of the pelvic organs through a laparoscopy B. An incision in the cul-de-sac C. Visualization through a lens system inserted into the cul-de-sac D. Needle aspiration of the contents of the pouch of Douglas 50. Which of the following statements about estimating the degree of obstetrical hemorrhage is correct? A. Visual estimates of blood loss are usually low B. The rate of urine flow reflects renal perfusion during the use of potent diuretics C. A normal blood pressure precludes the possibility of dangerous hypovolemia D. The “tilt test” is most useful in patients who are hypotensive when recumbent 51. A patient with a pituitary insufficiency and amenorrhea may best have ovulation induced by: A. Clomiphene B. Cyclic progesterone C. Daily dose of FSH followed by human chorionic gonadotropin (HCG) D. Low level estrogen therapy 52. Prior to performing a cesarean for prolapse of the umbilical cord, fetal viability is best confirmed by: A. Ultrasound visualization of the fetal heart B. Palpation of the umbilical cord C. Assessment of fetal heart tones by auscultation D. Assessment of fetal heart tones by Doppler 53. What is the procedure of choice in G2 P1 patient in LSCA, in labor for 3 hours? A. Forceps rotation B. Version and extraction C. Cesarean section D. Await spontaneous vaginal delivery 54. Birth control pills have a positive effect on cancer prevention in which of the following Organs? A. Fallopian tubes B. Cervix C. Endometrium D. Vagina

55. If titanic uterine contractions or tumulatous labor occurs while a patients is receiving a dilute intravenous solution of oxytocin, the immediate treatment of choice is: A. Discontinue the oxytocin infusion B. Other anesthesia C. Immediate cesarean section D. Morphine sulfate, 10 mg IV 56. Which of the following blood groups is responsible for the greatest incidence of erytroblastosis fetalis? A. E B. ABO C. Kell D. C 57. Which of the following patterns noted on continuous monitoring of fetal heart rate is most indicative of fetal distress? A. Increasing baseline variability (saltatory pattern) B. Variable deceleration with baseline variability C. Late deceleration without baseline variability D. Early deceleration pattern 58. Of the following statements, which is false? A. The pelvis brim is the boundary between the abdomen and the false pelvis B. The coccyx is triangular in shape and composed of three to five segments C. The sacrum is composed of five fused vertebrae D. The ischial spine is located superior to the ischial tuberosity 59. The principal active metabolite of meperidine is: A. Normeperidine B. Succinic acid C. Benzyl ergonine D. Phosgene 60. An overwhelming percentage of ovarian cancer belongs to: A. Epithelial tumors B. Soft tissue tumors C. Sex cord stroma tumor D. Germ cell tumors 61. After having an ectopic pregnancy in one tube, a patient has approximately what risk of an ectopic in the other tube? A. 1% B. 30% C. 10% D. 50% 62. Enlargement of chorionic villi is not associated with: A. Diabetes B. Fetal congestive heart failure C. Erythroblastosis (hydropic type) D. Rheumatic fever

63. Which of the following statements about the risks and benefits of postmenopausal hormonal replacement therapy is true? A. Most studies have shown a beneficial effect on mortality from coronary heart disease. B. The increased risk of endometrial cancer is specially high among women using combination preparations (estrogen and progestion) C. Most studies have shown a reduced risk of breast cancer among women using estrogen only preparations D. There is a slightly increased risk of pulmonary embolism 64. A G2P1 is in labor at 37 weeks gestation with the infant in RSP. Which of the following sets of pelvic measurements is an indication for cesarean delivery: A-P inlet (cm) Transverse inlet (cm) Interspinous (cm) A. 12.5 12.0 10.5 B. 11.0 12.0 9.5 C. 12.0 12.0 10.0 D. 11.0 12.0 9.0 65. A benign lesion of genital origin that may be found in surgical scars, the rectum, the lung, and lymph nodes is: A. Adenomyosis B. Endometriosis C. Mesonephromas D. Teratoma 66. The lining of cervical ectropions is: A. Squamous epithelium B. Transitional epithelium C. Columnar epithelium D. Squamous epithelium with keratinization 67. Which of the following would be the best method of describing an ovarian mass? A. Hen’s egg – shaped B. Firm, mobile, 6 cm C. The size of a peanut D. Teratomas 68. A G2P1 has been on the labor floor for 3 hours having regular contractions. The contractions are very painful and occur every 4 minutes. Pelvic examination reveals a 3 cm dilated cervix with no change in cervical dilation over the 3 hours. Which of the following is appropriate therapy? A. Demerol B. Epidural anesthesia C. Oxytocin D. Prostaglandin gel 69. The most common site of gynecologic malignancy in the Philippines is: A. Vulva B. Cervix C. Endometrium D. Ovary

70. The most frequent indication of primary cesarean section: A. Malpresentation B. Severe pre-eclampsia C. Total placenta previa D. Contracted pelvis 71. Which of the following changes occurs in the oviduct during pregnancy? A. Decidual cells may develop in the stroma of the endosalpinx B. The epithelium proliferates significantly C. A continuous decidual membrane is formed D. The musculature undergoes marked hypertrophy 72. High dose of progesterone for threatened abortion may A. Save the fetus B. Cause retention of a dead fetus C. Keep the placenta alive D. Keep the corpus luteum functioning 73. What is the most common presentation in a twin gestation? A. Cephalic – transverse B. Breech – breech C. Cephalic – breech D. Cephalic – cephalic 74. During the labor of a face presentation the presenting part is at the level of the ischial spines. The fetal biparietal diameter is probably A. Above the inlet B. Engaged C. At the level of the ischial spines D. Below the inlet 75. The present appropriate use(s) for obstetric forceps are: A. To overcome cephalopelvic disproportion (CPD) B. To save time at delivery C. Traction and rotation D. To bring the fetal head into an engaged position 76. Approximately, how many milliroentgens do the fetal gonads receive from an anteroposterior (AP), lateral and pelvic inlet series of pelvimetry films? A. 1,000 B. 3,000 C. 500 D. 100 77. Metabolic rate of the newborn infant is determinedn chiefly by: A. Analgesics and anesthetics given to mother before birth B. Muscular activity as expressed in limb movements C. Thermal gradient between skin and surrounding air D. Deep colonic termperature

78. Which statement about the menstrual cycle is true: A. The secretory phase is characterized by a thin endometrium of less than 2 mm thickness B. Menstrual flow lasts 4-6 days with an average blood loss of 25 – 60 ml C. Standard cycle length for human females is 34 days D. The last day of bleeding defines the first day of the menstrual cycle 79. The renal lesion most associated with eclampsia is: A. Pyclonephritis B. Glomerular endothelial swelling C. Cortical necrosis D. Acute tubular necrosis 80. Hysterosalpingography is useful in the diagnasis of all of the following, except: A. A submucous myoma B. Acute endometrium C. An incompetent cervix D. Peritubal adhesions 81. A 48 – year old asymptomatic patient is found to have an 8 week size irregular myomatous uterus. Appropriate management should be: A. Fractional dilatation and curettage B. Myomectomy C. Re – evaluation in 6 -12 months D. Hysterectomy 82. A 25 year old mentally retarded woman is brought to you by her parents who are worried that she may become pregnant. Which of the following methods of birth control would be most appropriate? A. Medroxyprogesterone acetate injections B. IUD C. Diaphragm D. Combination pills 83. Surface tension – reducing substances produced by the fetal lung are: A. Polypeptides B. Derivatives of arachidonic acid C. Phospholipids D. Polysaccharides 84. Which of these diseases cannot cause pelvic inflammatory disease? A. Crohn’s disease B. Syphilis C. Appendicitis D. Schistosomiasis 85. Amniocentesis in the management of postdatism is used to determine: A. Meconium staining B. Human chorionic somatomammotropin (hCS) levels C. Estriol levels D. Maturity

86. The term small for gestational age refers to an infant who weighs loss than the: A. 5th percentile for gestational age B. 50th percentile for gestational age C. 10th percentile for gestational age D. 25th percentile for gestational age 87. The disadvantage of median episiotomy as compared to mediolateral episiotomy is: A. More difficult to repair B. Blood loss greater C. Extention through anal sphincter and rectum D. Anatomical and results more or less faulty in 10% of cases 88. A high – risk is being followed by electronic fetal heart rate monitoring. Which of the following would be least ominous? A. Accelerations of the heart rate B. Heart rate below 80/ minute C. Decreased beat – to – beat variability in heart rate D. Decerlerations of heart rate 89. Which is not true of appendicitis in pregnancy? A. The incidence is unchanged by pregnancy B. Diagnosis is difficult C. The maternal death rate increases as gestational age increases D. Surgical treatment should be delayed until the diagnosis is firmly established 90. Women with endometrial carcinoma most frequently present with which of the following symptoms? A. Vaginal discharge B. Postmenopausal bleeding C. Bloating D. Weight loss 91. The most common cause of anesthetic death from general anesthesia is: A. Pneumonitis B. Renal failure C. Hepatitis D. Cerebrovascular accident 92. At the 5th lunar month the uterus in a normal pregnancy is: A. Not palpable abdominally B. Palpable midway between the umbilicus and the sternum C. Palpable at the level of the umbilicus D. Palpable just over the symphysis 93. The most frequent pathogen currently implicated in infectious causes of early abortion is: A. Listeria monocytogenes B. Toxoplasma gondii C. Mycoplasma hominis D. Brucella abortus

94. The pudencial nerve can be easily blocked by local anesthetics. It is: A. Sensory to the uterus B. Motor to levator ani muscle C. Motor to the bladder D. Sensory to the perineum 95. “Eggs” found in the ovary within the primordial follicles are A. Primary occytes B. Seconday occytes C. Oogonia D. First polar body 96. The normal basal uterine tone in labor is: A. 30 – 35 mmHg B. 20 – 25 mmHg C. 10 – 15 mmHg D. 30 – 45 mmHg 97. Adequacy of the pelvic inlet may be estimated on pelvic examination by measuring the: A. Obstetrical conjugate B. Diagonal conjugate C. Posterior sagittal midpelvis D. Iliac spine 98. An endometrial biopsy is useful in the diagnosis of the following, except: A. Pelvic tuberculosis B. Abnormal uterine bleeding C. Luteal phase defect D. Adenomyosis 99. A straight sacrum will: A. Invariably cause inlet dystocia B. Reduce the antero-posterior diameter of the inlet C. Reduce the antero-posterior diameter of the midplane D. Invariably cause midpelvic dystocia 100. Patients with uterine leiomyomata accompanied by excessive uterine bleeding should initially be treated and / or evaluated by: A. Irradiation B. Myomectomy C. Hysterectomy D. D & C

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