Obstetrics Gynecology

1.

The preferred management of a parturient whose cervix is 2 cms dilated for 24 hours without signs of maternal and fetal compromise is: a. Sedation b. Oxytocin drip c. Cesarian section d. Induction of Labor with Misoprostol

2.

A 20 y/o G1P0 was admitted at 8 cm cervical dilatation, cephalic, station –1, intact membranes, with contractions every 5 minutes,30 seconds duration, moderate intensity, adequate pelvimetry and EFW = 2,800 grams. After 1 hour of observation, the IE findings remained the same. The appropriate initial management at this point is: a. Oxytocin drip b. Amniotomy c. Sedation d. Cesarian Section

3. Inlet contraction is likely if the a. Obstetric conjugate is less than 11.5 cmA. Obstetric conjugate is less than 11.5 cmA. Obstetric conjugate is less than 11.5 cmA. Obstetric conjugate is less than 11.5 cmA. Obstetric conjugate is less than 11.5 cmA. Obstetric conjugate is less than 11.5 cm

b. Diagonal conjugate is less than 11.5 cm c. d.

Interspinous diameter is less than 10.5 cm Sidewalls are convergent

4. Prominent ischial spines, convergent sidewalls and a narrow sacrosciatic notch suggest a/an: a. Contracted pelvix inlet b. Adequate pelvic inlet c. Contracted midplane d. Adequate midplane

5. A fetus in mentum posterior or anterior position is in: a. b. c. d.

Face presentation Brow presentation Vertex presentation Breech presentation

6. If the lower extremeties of the fetus are flexed at the hips and extended at the knees so that the feet lie in close proximity to the head, the presentation is: a. b. c. d.

Complete breech Incomplete breech Footling breech Frank breech

7. A 25 y/o G3P2 was admitted at 7 cm cervical dilatation, cephalic with adequate contractions. She is expected to deliver in how many hours? a. 1 b. 2 c. 3 d. 4 8. Third stage of labor commences: a. When the cervix is fully dilated b. After episiorrhaphy c. After delivery of the fetus d. After expulsion of the placenta

a. b. c. d.

9. Which of these statements regarding episiotomies is correct: A routine episiotomy should be performed on all parturients An episiotomy is proven to be effective in preventing pelvic relaxation and incontinence With a median episiotomy, healing is fast, blood loss and pain are lesser and repair is easier compared with mediolateral episiotomy The timing of episiotomy is important and must be performed before crowning. 10. Myometrial contractions during active labor are best described by which of these statements: a. The contractions are unpredictable, lack intensity and short in duration b. The myometrium during this stage is highly responsive to tocolytic agents c. The contractions are produced by the skeletal muscles of the uterus d. The contractions cause discomfort initially on the back and radiate to the lower abdomen and groin 11. This division/phase of labor is most sensitive to analgesia and maternal sedation: a. Preparatory division

b. c. d.

Dilatational division Pelvic division Deceleration phase

12. Traumatic vaginal delivery of a large for gestational age baby most likely will tear the following perineal muscles except: a. Bulbocavernosus muscle b. Ischiocavernosus muscle c. Superficial transverse perineal muscle d. External anal sphincter 13. A 21 y/o G1P0 at 8 weeks AOG presents with vaginal spotting with a beta HCG titer of 2,000 mIU/ml. Transvaginal sonogram shows an empty uterus with a 3 cm right adnexal complex mass. The most likely diagnosis is: a. Early pregnancy with a right corpus luteum b. Incomplete abortion c. Threatened abortion d. Ectopic pregnancy 14. An 18 year old sexually active college student was rushed to the ER because of profuse vaginal bleeding and hypogastric pain of 4 hours with passage of meaty tissues. Intenal examination revealed an open cervix, a 10 week size uterus and placental tissues plugging the os. Diagnosis: a. Threatened abortion b. Inevitable abortion c. Missed abortion d. Incomplete abortion 15. Body perfusion in cases of hemorrhagic obstetric complications is best assessed by: a. Blood pressure b. Stroke volume c. Urine Output d. Pulse rate 16. The most common clinical finding in uterine rupture is: a. Shock b. Loss of station of presenting part c. Sudden, severe fetal heart rate deceleration d. Cessation of uterine contractions 17. The most consistently identified risk factor predisposing to placental abruption is: a. Smoking b. Blunt abdominal trauma c. Cocaine use d. Hypertension 18. Diagnosis of abruptio placenta is mainly based on: a. Clinical symptomatology b. Ultrasound findings c. Amount of external vaginal bleeding d. Suden fetal distress 19. In placenta accreta/increta/percreta, the placent is abnormally adherent to the myometrium due to partial or total absence of: a. Decidua capsularis b. Decidua basalis c. Decidua parietalis d. Decidua vera 20. Which of the following statements about obstetric anesthesia is not true: a. The most important single factor associated with anesthesia related maternal mortality is the experience of the anesthesiologist. b. The essentials of obstetrical pain relief are simplicity, safety and preservation of fetal homeostasis c. Without exception, all anesthetic agents that depress the maternal central nervous system cross the placenta and depress the fetal central nervous system d. Fasting for 6 hours is enough to prevent aspiration during general anesthesia

21. The pudendal nerve is blocked by local infiltration just beneath the tip of the ischial spine and advancing the needle: a. To the space between the vaginal mucosa and sacrospinous ligament

b. c. d.

Behind the sacrospinous ligament Medial to the sacrospinous ligament Lateral to the sacrospinous ligament

22. Maternal hypotension as a complication of subarachnoid block is primarily a consequence of: a. Sympathetic blockade compounded by obstructed venous return due to aortocaval compression b. Excessive dose of anesthetic c. Cerebrospinal fluid hypotension d. All of the above 23. Spinal anesthesia is contraindicated in: a. Maternal hypotension b. Severe preeclampsia c. Disorders of coagulation d. All of the above. 24. Pain during the second stage of labor results primarily from: a. Cervical dilatation b. Uterine contraction c. Distention of the pelvic floor, vagina and perineum d. All of the above 25. Which of the following statements about endometriosis is false: a. Physiologic levels of strogen and progesterone are therapeutic b. It is a benign disease with malignant characteristics. c. The classic symptom of endometriosis is pelvic pain. d. Inverse relationship between extent of endometriosis and severety of pelvic pain. 26. Endometriosis of the lungs may be explained by which theory? a. Metaplasia b. Lymphatic and Vascular Metastasis c. Immunologic Defects d. Iatrogenic Dissemination 27. One of the following is not a cardinal histologic feature of endometriosis. a. Ectopic endometrial glands b. Ectopic endometrial stroma c. Hemorrhage into adjacent tissues d. Necrobiosis 28. The most common site of endometriosis: a. Ovary b. Posterior-cul-de-sac c. Rectosigmoid d. Uterosacral ligament 29. The primary goal of hormonal treatment of endometriosis is: a. Relief of pelvic pain b. Improvement of fertility c. Regression of endometriomas d. Induction of amenorrhea 30. The greatest advantage of GnRH agonist over Danazol in the treatment of endometriosis is: a. Induction of pseudomenopause without the androgenic side effects of danazol on other steroid sensitive organs b. Effective in large endometriomas and severe adhesive disease c. Maybe given orally and parenterally d. Cheaper compared to other hormonal drugs 31. The age of menopause is: a. Related to age of menarche b. Related to body mass c. Dependent on the number of prior ovulations d. Genetically predetermined 32. The first index of declining ovarian function is: a. Significant increase in LH b. Decline in FSH level c. Decreased ovarian inhibin production d. Decline in estradiol and estrone levels

33. Endometrial CA that develops in unopposed estrogen replacement therapy in menopause is nearly always : a. Well differentiated b. Moderately differentiated c. Poorly differentiated d. Undifferentiated 34. One of the following is not a risk factor for the development of postmenopausal osteoporosis: a. White or Asian race b. High BMI c. Early spontaneous or surgical menopause d. Cigarette smoking 35. Which of the following statements regarding hormonal replacement in menopause is false? a. Estrogen therapy for postmenopausal women should be given in the lowest possible dose that relieves vasomotor symptoms b. The optimal long term dose of estrogen that should be given in asympotmatic women is 0.625 mg of conjugated equine estrogen. c. Estrogen therapy should result in pharmacologic and not physiologic circulating levels of estrogen. d. If progesterone is added to the regimen to protect the endometrium, it does not negate the beneficial effects of estrogen on vasomotor symptoms and on bone density. 36. Disregarding the cost, the most common reason why patients on HRT discontinue its use is: a. Breast tenderness b. Risk of endometrial CA c. Uterine bleeding d. Depression 37. The most common primary vulvar carcinoma is: a. Squamous cell CA b. Verrucous CA c. Basal cell CA d. Melanoma 38. One of the following statements about Paget’s disease of the vulva is false: a. Occurs generally in postmenopausal women b. Vulvar itching is a common problem c. Lesions are chronic, diffuse, erythematous and eczematoid d. It is not associated with other invasive carcinomas 39. Most vaginal malignancies are: a. Squamous cell CA b. Clear cell AdenoCA c. Sarcoma Botryoides d. Metastatic from the cervix or endometrium 40. Most squamous cell CA of the vagina appear on the: a. Upper third b. Middle third c. Lower third d. No predilection 41. Most myomas develop initially as: a. Intramural b. Submucous c. Subserous d. Intrligamentary 42. The definitive treatment for symptomatic adenomyosis is: a. GnRH agonists b. Oral contraceptives c. Danazol d. Hysterectomy

43. One of the following is not a risk factor for endometrial CA: a. Obesity b. Polycystic ovarian syndrome c. Nulliparity

d.

Combination OCP

44. A major determinant of the premalignant potential of endometrial hyperplasia is the presence of: a. Architrectural atypia b. Cytologic atypia c. Cystic dilation of the glands d. Crowding of glands 45. The major determinant of prognosis in the endometrial CA is: a. Histologic grade b. Positive peritoneal fluid cytology c. Tumor size d. Degree of myometrial invasion 46. Pattern/s of spread of endometrial CA is/are: a. Small lymphatic branch along the round ligament that runs to the inguinal femoral nodes. b. Branches from the tubal and ovarian pedicles that drain to the paraaortic nodes c. The broad ligament lymphatics that drain directly to the pelvic nodes d. All of the above

47. Staging of carcinoma of the cervix depends primarily on: a. Pelvic examination b. Intraoperative findings c. Number and location of nodal spread d. Tumor size 48. Which of the following statements is not true in intraepithelial neoplasia of the cervix: a. Atypical epithelium develops in the transformation zone during the process of squamous metaplasia. b. HPV have a major role in the genesis of premalignant lesions. c. Women with multiple sex partners have increased risk d. Age at first coitus does not affect risk of CIN 49. One of the following HPV types is not associated with cervical neoplasia a. 11 b. 16 c. 18 d. 31 50. According to the Bethesda System of pap smear interpretation, presence of koilocytes categorizes the patient under: a. Low grade squamous intraepithelial lesion (LGSIL) b. High grade squamous intraepithelial lesion (HGSIL) c. Atypical squamous cell of undetermined significance (ASCUS) d. Atypical glandular cell of undetermined significance (AGCUS) 51. Female premordial differentiation is directed by which of the following factors: a. absence of the testis b. presence of the ovary c. presence of the x-chromosome d. presence of the SRY gene 52. The labia majora are homologous to which of the following structures in males: a. median penile raphe b. scrotum c. glans penis d. corpora cavernosa 53. Lactic acid which is responsible for the acidic vaginal pH is produced from the metabolism of glycogen from the desquamated mucosal cells by: a. Gardnerella vaginalis b. Clostridium sp c. Peptostreptococci d. Lactobacilli 54. Which of the following structures is not derived from the Mullerian ducts: a. uterus b. fallopian tubes c. upper 2/3 of the vagina d. labia minora

55. The pelvic visceral organs derived their blood supply from the : a. ovarian arteries b. median sacral arteries c. internal iliac arteries d. all of the above 56. The obstetrically important antero posterior diameter of the pelvic inlet is designated as the : a. diagonal conjugate b. obstetric conjugate c. true conjugate d. none of the above 57. The pelvic diaphragm is made up of which of the following muscles; a. coccygeus m b. pubococcygeus m c. iliococcygeus m d. all of the above 58. Choose the statement that best describes the basal arteries of the endometrium: a. they are end arteries of the coiled (spiral) arteries b. they supply the superficial 3rd of the endometrium c. they are not responsive to hormonal action d. they are larger and longer than the coiled arteries 59. A diamniotic, dichorionic, monozygotic twins pregnancy results when division of the fertilized ovum occurs: a. within the 1st 72 hours after fertilization b. between the 4th and the 5th day after fertilization c. about 8 days after ferlitilization d. after the embryonic disc is formed 60. Fetal growth restriction secondary to direct cytolysis and loss of functional cells has been attributed mostly to which of the following fetal infections : a. Rubella b. Cytomegalovirus c. Hepatitis B d. Tuberculosis 61. An asymmetrically growth restricted fetus has an abnormally increased relative brain size compared with the : a. heart b. liver c. adrenals d. lungs 62. The most important of known risk factors for development of fetal macrosomia is : a. male fetus b. prolonged gestation c. smoking status of the mother d. maternal diabetes 63. The following are common complications associated with fetal macrosomia, except : a. fetopelvic disproportion b. shoulder dystocia c. brachial plexus palsy d. cord prolapse 64. Preterm labor is defined at labor occuring before 37 wks from the first day of the last normal menstrual period, accompanied by : a. progressive change in the cervix b. cervical dilatation of 2 cm or more c. cervical effacement of 80% or more d. all of the above 65. Which of the following risk factors has the least impact on the occurrence of preterm premature rupture of the membranes : a. chorioamnionitis b. abruptio placenta c. multiple fetuses d. thyrotoxicosis

66. Corticosteroids when gives during preterm labor, have been found out to prevent respiratory distress in the subsequently delivered preterm infant. The reported physiological effects of these steroids on the developing lungs include : a. increased alveolar surfactant b. decreased lung compliance c. no change in lung volume d. all of the above 67. Oligohydramnios in postterm pregnancies may result in antepartum and intrapartum fetal compromise as a consequence of : a. cord compression b. decreased uteroplacental blood flow c. fetal head compresion d. inadequate fetal nutrition 68. In persistent breech presentation an increased frequency of the following complications can be anticipated : a. prolapsed cord b. low birthweight c. operative delivery d. all of the above 69. When the lower extremities are flexed at the hips and extended at the knees, the variety of breech presentation in known at : a. complete breech b. incomplete breech c. frank breech d. footling breech 70. In a face presentation, the head is : a. hyperflexed b. hyperextended c. in occiput posterior position d. in occiput anterior position 71. Which of the following risk factors has no impact on the incidence of transverse lie : a. preterm fetus b. placenta previa c. contracted pelvis d. oligohydramnios 72. In the management of shoulder dystocia, which maneuver is performed when the parient's thighs are sharply flexed upon the abdomen : a. Mc Roberts maneuver b. Woods corkscrew maneuver c. Rubin's maneuver d. Zavanelli maneuver 73. Cells with greater on less than 46 chromosomes are known as : a. diploid b. polyploid c. aneuploid d. mosaic 74. A great majority of human malformations during the first year of life has been attributed to which of the following etiologic factors : a. genetic b. fetal infections c. maternal disease d. unknown or multifactorial 75. The most common cytogenetic finding associated with Down Syndrome is : a. trisomy 13 b. trisomy 18 c. trisomy 21 d. mosaicism 76. The chromosomal of an individual with Turner syndrome is : a. 45 X

b. c. d.

46 X 47 XXY 46 XX

77. The following events result in structural chromosomal alterations, except : a. nondisjunction b. translocation c. deletion d. inversion 78. Which of the following statements is/are true regarding the normal menstrual cycle : a. the average interval between cycles is 28 days b. it has an average blood loss of 100 ml c. the average duration of flow is 7 days d. all of the above are correct 79. Menometrorrhagia is characterized by : a. frequent but regularly timed episodes of bleeding usually occuring at intervals of 21 days or less. b. regularly timed bleeding that is decreased in amount c. excessive, prolonged bleeding that occurs at irregularly timed, frequent intervals d. bleeding that occurs between otherwise normal menstrual cycles 80. In a normally menstruating woman, the presence of subnuclear vacuoles on endometrial biopsy strongly indicates : a. ovulation b. pregnancy c. perimenopause d. an endometrial hyperplasia 81. Current researcher on follicular development during normal menstrual cycles have shown that estrogen production generally takes place in the : a. theca cells b. granulosa cells c. both A n B d. neither A nor B 82. The proliferative phase is a normal menstrual cycle is characterized by the following histologic changes; except : a. progressive mitotic growth of the zona functionalis b. evolution of the initially straight, narrow, and short endometrial glands into longer, tortuous structure c. low columnar patterns during the early proliferative phase d. profound spinal artery vascular status 83. Which of the following contraceptive methods has the highest method effectiveness : a. condom b. intrauterine device c. oral contraceptives d. spermicidal cream 84. Intrauterine devices (IUDs) may prevent pregnancy by which of the following mechanism : a. inhibiting ovulation b. inducing endometrial atrophy c. thinning of cervical mucus d. all of the above

85. A 25 year old woman and her husband use natural family planning as their contraceptive method. Her menstrual cycle length range from 26 to 32 days. She does not measure her basal body temperature. The time of her maximum (peak) fertility, with the first day of menses defined as day 1, would be between cycle days : a. hari 1 - 14 b. hari 8 - 14 c. hari 8 - 21 d. hari 14 - 21 86. This type of breech presentation where the thighs are flexed to the abdomen and the legs upon the thighs is called a. frank

b. c. d.

incomplete complete footling

87. Which of the following methods has the higher risk of contraceptive failure : a. condoms b. oral contraceptive pills c. intrauterine device d. coitus interruptus 88. Oral contraceptives may be contraindicated among women with the following disorders except : a. endometriotic cysts b. endometrial carcinoma c. undiagnosed abnormal genital bleeding d. breast carcinoma 89. The use of oral contraceptive pills reduces the risk of all of the following conditions, except : a. ectopic pregnancy b. endometrial cancer c. hepatic adenoma d. salpingitis 90. Bacterial vaginosis is diagnosed by which of the following findings : a. vaginal pH of 4.0 b. fishy -amine like odor on whiff test c. thick milk curd like secretions adherent to the vaginal wall d. presence of strawberry cervix 91. The drug of choice for vaginal trichomoniasis is : a. tetracycline b. fluconazole c. cefoxitin d. metronidazole 92. Based on the CDC guidelines for treatment of pelvic inflammatory disease, patients can be given the following drug combination an outpatient basis : a. intramuscular cefoxitin and oral doxycycline b. intramuscular cefoxitin and oral metronidazole c. intravenous cefoxitin and oral doxycycline d. intravenous clindamycin and intravenous gentamycin. 93. The most common pathogen isolated from urine of pooling women with acute cystitis is : a. chlamydia trachomatis b. escherichia coli c. staphylococcus saprophytic d. streptococusn sp 94. The type of Human Papillomavirus that are usually responsible for condylomata acuminata are : a. 6 b. 11 c. both a and b d. neither a nor b. 95. Cytomegalovirus infection may be transmitted by which of the following routes : a. droplet infections b. uteroplacental c. coitus d. all of the above 96. Which of the following approaches is recommended for immunizing the adult population against rubella especially women of childbearing age : a. vaccination of susceptible pregnant women on their prenatal check up. b. vaccination of susceptible nonpregnant women visiting family planning clinics c. vaccination of all susceptible pregnant women identified by serology d. vaccination of all unimmunized pregnant women 97. The preferred drug for treatment of all stages of syphilis is : a. ceftriaxone 250 mg IM single dose b. erythromycin 500 mg orally 4 x 1 day for 7 days c. Benzathine Penicillin G, 2.4 million units IM single dose

d.

cefoxitin 2 gms IM single dose

98. After delivering our babies by forceps extraction, vaginal laceration are usually or most commonly seen at the a. posterior middle third b. lateral middle third c. posterior upper third d. anterior upper third 99. A type of forceps that is primarily used for traction. It has an ample pelvic and cephalic curves, an English style lock and parallel shanks A. Kielland’s B. Simpson’s C. Tucker Mclane D. Elliot’s 100. An obstetrician who attempts to do forceps extraction with the knowledge that there is certain degree of disproportion at the level of the midpelvis is doing a: a. failed forceps b. elective forceps c. prophylactic forceps d. trial forceps