Obstetrics Test Blue Print

DAVAO MEDICAL SCHOOL FOUNDATION Davao City COLLEGE OF MEDICINE DEPARTMENT OF OB-GYN OB TEST QUESTIONS FOR PRC Source: William Obstetrics 21st Edition ____ 1. Pain during the first stage of labor is mediated through: A. 7th and 8th thoracic nerves B. 9th and 10th thoracic nerves C. 10th , 11th, 12th thoracic nerves & 1st lumbar nerve D. 1st, 2nd, and 3rd lumbar nerves Chapter 15, page 368 Ms. Paraso, 18 year-old, G1P0, 39-40 weeks AOG, was brought to the Delivery Suite because of labor pains. On admission, BP=110/80; FH=34cm; FHT= 145 bpm. Internal examination: Cervix 3cm, 60% effaced; intact BOW, station -2; cephalic presentation. Uterine contractions were occurring at every 5-6 minutes interval, 30 seconds duration; mild to moderate contractions. ____ 2. The patient in this case is already in what phase of labor? A. latent case B. acceleration phase C. phase of maximum slope D. deceleration test Chapter 18, page 428 ____3. The following pelvimetry suggest midpelvic contraction, except: A. spines are prominent B. pelvic sidewalls converge C. sacral promontory can be reached at 8.0 cm D. sacrosciatic notch is narrow Chapter 18, page 437 ___ 4. Which of the following statements is not a characteristic of cephalhematoma? A. This is usually caused by injury to the periosteum of the skull during labor and delivery B. Hemorrhage can occur over one or both parietal bones C. The periosteal limitations with definite palpable edges will not differentiate the cephalhematoma from caput succedaneum D. Cephalhematoma may not appear for hours after delivery, often growing larger and disappearing only after several weeks Chapter 39, page 1079 ____ 5. Fetal Heart Rate Patterns suggesting true fetal distress is/are: A. Zero beat-to-beat variability B. Severe decelerations C. Persistent baseline rate changes D. All of the above Chapter 14, page 349 ____ 6. Which of the following statements regarding drug use in pregnancy is true: A. Drugs cross the placenta in varying degrees depending on lipid solubility, molecular size, maternal metabolism, protein binding and storage. B. Drugs associated with cardiac malformations will exert their effect when ingested after the eighth week from fertilization. C. The fetus is safe from drug and substance effects during the fetal period. D. As a general rule, drugs are safe until proven otherwise. Chapter 38, page 1007

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____ 7. A fetus in transverse lie becomes a fetus in oblique lie when the long axis forms a/an: A. Right angle B. Obtuse angle C. Acute angle D. All of the above Chapter 12, page 293 ____ 8. Choose the correct statement regarding the female reproductive organs: A. The cardinal ligament of the uterus connects the cervix to the posterior surface of the pubis B. The uterine artery crosses over the ureter in its course C. The ovarian veins (right and left) drain into the inferior vena cava. D. Lymphatic drainage of the uterus and the upper ¾ of the vagina is directed towards the pelvic nodes only that from the lower ¼ of the vagina is directed into the superficial inguinal nodes. Chapter 3, page 43 ____9. The shortest distance between the promontory of the sacrum and the symphysis pubis: A. Obstetric conjugate B. Diagonal conjugate C. True conjugate D. None of the above Chapter 3, page 58 ____ 10. If the thighs are flexed on the abdomen and the legs upon the thighs, this is a: A. Incomplete Breech Presentation B. Complete Breech Presentation C. Frank Breech Presentation D. Footling Breech Presentation Chapter 12, page 293 ____ 11. A conclusive diagnosis of rupture membranes is made: A. By testing the pH of the vaginal fluid B. When amnionic fluid is seen pooling in the posterior fornix C. By using the indicator nitrazine test D. Detection of alpha-fetoprotein in the vaginal vault Chapter 13, page 312 ____ 12. Lacerations that include the skin and mucous membrane, the fascia and the muscles of the perineal body are classified as: A. Third-degree laceration B. Second-degree laceration C. First-degree laceration D. Fourth-degree laceration Chapter 13, page 325 ____ 13. A 25-year-old G3P2 (2002) was referred to the hospital for prolonged second stage of labor. What condition will not favor outlet forceps extraction? A. The cervix is fully dilated B. There is no cephalopelvic disproportion C. The most dependent portion is at the level of the ischial spines D. the sagittal suture of the fetal head is in the AP diameter Chapter 21, page 487

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____ 14. A 29-year-old primigravid was admitted for labor pains. The cervix remained 9 cms. dilated for 3 hours and the fetal head was at station O in right occiput posterior position. The correct management is: A. Forceps extraction B. Low segment cesarean section C. Internal podalic version D. Cesarean hysterectomy Chapter 18, page 431 ____ 15. Of the hematologic changes associated with preeclampsia, the following is the most common: A. hemolysis B. thrombocytopenia C. decreased plasma clotting factors D. increase plasma clotting factors Chapter 24, page 575 ____ 16. The most important information that the obstetrician has for a successful management of pregnancy complicated by hypertension is: A. knowledge of the gestational age of the fetus B. knowledge of the weight of the fetus C. knowledge of the fetal biophysical score D. knowledge of the maternal-fetal Doppler blood flow studies Chapter 24, page 591 ____17. During puerperium the uterus descends into the cavity of the true pelvis within: A. one (1) week C. two (2) weeks B. ten (10) days D. four (4) weeks Chapter 17, page 404 ____ 18. If a woman does not nurse, her menses usually return within: A. 4-6 weeks C. 8-10 weeks B. 6-8 weeks D. 3 months Chapter 17, page 419 ____ 19. Antimicrobial regimens for pelvic infection following cesarean delivery proven to have the greatest efficacy which is widely studied: A. Ampicillin-Gentamicin B. extended spectrum PCN C. extended spectrum Aps D. Quipenem and cilatasis Chapter 26, page 677 ____ 20. An acute febrile illness with severe multi-system derangement characterized by fever, headache, mental confusion, macular erythematous rash, subcut, edema, nausea, vomiting and watery diarrhea and marked hemoconcentration: A. toxic shock syndrome B. Group AB-hemolytic strep infection C. Pelvic abscess D. Septic pelvis thrombophlebitis Chapter 26, page 685 ____ 21. The best method of diagnosing uterine atony is by: A. observation of vaginal bleeding B. cervical and vaginal inspection C. palpation of the uterus D. careful BP and RR observations Chapter 25, page 638

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____ 22. In the immediate puerperium, in a setting of excessive of 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 systolic blood pressure Chapter 25, page 653 ____ 23. Inversion of the uterus is almost always subsequent upon: A. difficult forceps delivery B. abruptio placenta C. multiple pregnancy D. traction of the umbilical cord before the separation Chapter 25, page 642 ____ 24. Fetal growth is divided into the following 3 consecutive cell growth phases: A. Hyperplasia, Hypertrophy, Hyperplasia and Hypertrophy B. Hypertrophy, Hyperplasia and Hypertrophy, Hyperplasia C. Hyperplasia, Hypertrophy and Hyperplasia, Hypertrophy D. None of the above Chapter 29, page 744 ____ 25. The following screening and identification of fetal growth restriction should be done: A. Uterine fundal height B. Ultrasonic measurements C. Doppler Velocimetry D. All of the above Chapter 29, page 753 ____ 26. This placental disorder is associated with certain maternal diseases such as hypertension wherein there is reduction in functioning placenta, which may lead to enarteritic thickening and obliteration termed hemorrhagic endovasculitis (HEV): A. placenta accreta B. abruptio placenta C. vasa previa D. placental infarction Chapter 32, page 829 ____ 27. Amniotomy in abruptio: A. hasten delivery B. reduce entry of thromboplastin into maternal circulation C. character of the fluid increases the suspicion of abruptio D. all of the above choices Chapter 25, page 629 ____ 28. Which of the following is NOT associated with an increased abortion rate? A. advanced paternal age B. Class A1 Diabetes Mellitus C. Advanced maternal age D. Pregnancy within 3 months of a live birth Chapter 33, page 857 ____ 29. Which of the following uterine abnormalities has the greatest likelihood of spontaneous abortions? A. Asherman's syndrome B. Bicarnuate uterus C. Leimyomata D. Uterine septa Chapter 33, page 862

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____ 30. Which of the following signs/symptoms most strongly implies a ruptured ectopic pregnancy with sizable intraperitoneal hemorrhage? A. shoulder pain on inspiration B. Heavy vaginal bleeding C. nausea and vomiting D. abdominal mass, unilateral Chapter 34, page 890 ____ 31. This is characteristic of complete H-mole: A. usually triploid 69XXY, XYY B. composed of a mixture of N-sized chorionic villi mixed with large hydropic ones C. is 46XX or YY coming from father 90% of the time D. fetus is usually present Chapter 32, page 836 ____ 32. Patient is considered at high risk of developing persistent gestational trophoblastic disease when the following risk factor/s is/are present: A. theca luteum cyst of 5 cm. B. age less than 40 C. hCG level> 100,000 D. uterine enlargement of 3 months AOG Chapter 32, page 839 ____ 33. Pre-operative evaluation of cervical incompetence is best done: A. before 14 weeks B. after 14 weeks and not later than 20 weeks C. after 20 weeks D. after the 2nd trimester Chapter 33, page 863 ___ 34. The effect of myoma on pregnancy includes: A. Abruptio is common on placentas implanted over or in contact with a myoma B. Growth of myomas increases with gestational age C. It is an absolute indication for CS delivery D. Fetal malposition and preterm labor are not commonly seen Chapter 35, page 929 ____ 35. In Ovarian masses, complicating pregnancy: A. The most common ovarian tumors are cystic B. Solid ovarian masses are most likely benign C. Cysts of less than 5 cm should be removed D. Cyst rupture is the most frequent and serious complication Chapter 35, page 931 ____ 36. Uterine rupture in trauma: A. Rupture of the uterus is common with blunt trauma B. Clinical findings may be identical to placental abruption C. Usually associated with indirect impact to the uterus D. All of the above Chapter 43, page 1173 ____ 37. The most common skin symptom during pregnancy: A. burning sensation B. pruritus C. pain D. cold sensation Chapter 54, page 1430

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____ 38. Major risk for maternal mortality during pregnancy: A. atrial septal defect B. ventricular septal defect C. patent ductus arteriosus D. pulmonary hypertension Chapter 44, page 1194 ____ 39. The most accurate and safest method to diagnose heart disease in pregnancy is: A. electrocardiogram B. chest x-ray C. two-dimensional echocardiogram D. coronary angiogram Chapter 44, page 1184 Mrs. Williams delivered to a live term baby boy, with no complications noted. On the boy's second year of life, he was noted that he does not answer when his name is called, and does not react if other children are shouting in front of him. Maternal history revealed maternal fever and a three-day generalized maculopapular rash. ____40. The most common cause(s) of the deafness in children is/are: A. Maternal influenza B. Maternal Rubella C. Maternal cytomegalovirus D. B and C are correct Chapter 56, page 1468 Bella, a 23 year-old commercial sex worker, went to the Social Hygiene clinic for her regular check-up. On examination, she was noted to have variable rash on the palms and soles of both feet. ____ 41. The following are characteristics of primary chancre of syphilis: A. characterized by a painless firm ulcer with raised edges and a granulation base B. persists for 2 to 6 weeks and heals spontaneously C. often accompanied by nontender, enlarged inguinal lymph nodes D. all the above are correct Chapter 57, page 1487 Gloria, a 27-year-old G1P0, on her 20 th week gestation, was known to be HIV positive one year prior to this pregnancy. ____ 42. following: A. B. C. D.

Prevention of vertical (mother to infant) transmission of HIV infection is/are the Cesarean delivery Antiretroviral therapy and vaginal delivery Antiretroviral therapy and cesarean section Antiretroviral therapy Chapter 37, page 1503

A 29 years old female, married, G1P0 AOG 16 weeks, complained of vague abdominal wall pain for 3 days, with slight fever and urgency. She took Paracetamol 500 mg and there was temporary relieved of symptoms. A few minutes prior to consultation, she noticed blood tinged urine. Husband is an overseas worker (Seaman). ____43. What is the probable clinical impression on consultation? A. acute pyelonephritis uncomplicated B. acute urethritis syndrome C. acute cystitis, hemorrhagic D. acute pyelonephritis complicated Chapter 47, page 1255

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____ 44. The following is true about cholestasis of pregnancy: A. Occurs in the third trimester but can occur earlier B. The initial and most characteristic symptom is pruritus which is most severe during the day C. Jaundice develops in a majority of patients D. Amelioration of symptoms is not achieved with delivery Chapter 48, page 1284 ____ 45. Which of the following maternal metabolic adaptations does not occur in normal pregnancy? A. Decreased insulin secretion B. Increased resistance to insulin action C. Relative fasting hypoglycemia D. Increased plasma lipids Chapter 51, page 1360 ____ 46. Which of the following laboratory tests will help the clinician diagnose hyperthyroidism in pregnancy? A. TSH B. Free T4 C. Free T3 D. All of the above Chapter 50, page 1341 ____ 47. Which among these measures of pulmonary function is expected to increase during pregnancy? A. Residual volume B. Expiratory reserve volume C. Functional residual capacity D. Minute ventilation Chapter 46, page 1225 ____ 48. True statement as regards asthma and pregnancy: A. With mild asthma, carbon dioxide retention in the blood is expected. B. Asthma has predictable worsening during pregnancy C. Monitoring of efficacy of treatment is by symptoms alone. D. Maternal alkalosis may cause fetal hypoxemia even before maternal oxygenation is compromised Chapter 46, page 1231 ____ 49. Anemia in pregnant woman is defined as hemoglobin value: A. less than 12 g/L B. less than 14 g/L C. less than 10 g/L D. less than 8 g/L Chapter 49, page 1309 ____ 50. The total iron in normal pregnancy is about: A. 200 mg B. 300 mg C. 800 mg D. 1000 mg Chapter 49, page 1309

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