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True statements regarding the midpelvis except:

A. Clinical estimation of its capacity by any form of direct measurement is not possible
B. It is the plane of least pelvic dimensions
C. It is measured at the level of the ischial spines
D. It is important following internal rotation of the fetal head during obstructed labor



True about the following statements regarding the pelvic inlet except:

A. The transverse diameter is constructed at right angles to the obstetrical conjugate
B. The obstetrical conjugate can be measured directly by the examining fingers
C. Its posterior boundaries are the promontory and the alae of the sacrum
D. It is bounded laterally by the linea terminalis



The shortest AP diameter the fetus must pass thru in the pelvic inlet is the

A. Bituberous
B. Bispinous
C. Obstetric conjugate
D. Diagonal conjugate



Prominent ischial spines, convergent sidewalls, and shallow sacrum were noted on clinical pelvimetry. Which pelvic plane is contracted?

A. Inlet
B. Midplane
C. Inlet and midplane
D. Midplane and outlet



How can you evaluate the transverse diameter of the pelvic inlet

A. Clinical or manual measurement
B. Imaging
C. Subtract 1.5-2cm from the diagonal conjugate
D. Caput formation in the baby



True statements about the increase in width of the symphisis pubis:

A. Occurs more in primigravidas than multiparas
B. Returns to normal soon after delivery
C. Permanent change in multiparas
D. Permanent change in primigravidas



Modifications of the cervix during phase 1 of parturition except

A. Collagen breakdown and rearrangement of fibers
B. Increase in dermatan sulfate
C. Increase in hyaluronic acid
D. Increase in amount of cytokines



Type of pelvis with round inlet

A. Anthropoid
B. Android
C. Gynecoid
D. Platypeloid



The head of the average term fetus enters the pelvis inlet with the sagittal suture in the ________ position in the anthropoid pelvis.

A. Transverse
B. Anteroposterior
C. Oblique
D. Posterior



Which phase of parturition is characterized by myometrial contraction and retraction to prevent excessive bleeding after delivery of infant

A. Phaso 0
B. Phase 1
C. Phase 2
D. Phase 3



Increased myometrial contractility due to mechanical stretching of cervix

a. Ferguson's reflex
b. Lightening reflex
c. Bandl's ring
d. Braxton-hicks



TRUE of oxytocin during parturition EXCEPT:
A. increased oxytocin receptors

B. stimulates decidua to increase progesterone release
C. increased maternal levels at the second stage of labor
D. increased maternal levels at early post partum period



Possible causes of pain during labor EXCEPT:

a) hypoxia of the contracted myometrium
b) nerve ganglia compression in the cervix
c) stretching of the LUS during dilation
d) stretch of the peritoneum overlying the fundus



True statements about cervical effacement except:

A. Muscles at internal os are pulled upward
B. Shortening of cervical canal
C. Causes expulsion ofmucus plug
D. Obliteration takes place from below then upward



True statement about lightening except

a. occurs with the development of the lower uterine segment
b. observed in phase 0 of parturition
c. fetal head descends through the pelvic inlet
d. mother complains that it seems the baby dropped



Brief, unpredictable, and very low intensity myometrial contractions occuring near the end of pregnancy:

A. Ferguson reflex
B. Lightening reflex
C. Bandl's ring
D. Braxton-Hicks contractions



During normal labor as a result of lower segment thinning and upper segment thickening, a boundary btw the two is marked by a ridge on the inner uterine surface is referred to as

A. Ferguson's reflex
B. Physiological retraction ring
C.Bandl's ring
D. Braxton hicks



When the cervix is fully dilated, what is the most important force in the expulsion of the fetus?

a. maternal intra-abdominal pressure
b. Ferguson's reflex
c. pressure from amniotic fluid
d. fundal pressure exerted by attendant



Mrs. Ferrer is a 25 yo G2P1 (1001) at 39 weeks AOG, consulted at the ER for passage of blood-tinged mucts from the vagina associated with the onset of regular uterine contraction. On IE, cervix is 1cm dilated, 50% effaced midline in position with intact bag of water. Stage of labor:

A. Stage 0.
B. Stage 1
C. Stage 2.
D. Stage 3.



Which of the following is the correct sequence of the cardinal movements of labor?

A. engagement, flexion, extension, int rotation, ext rotation, descent, expulsion
B. descent, engagement, int rotation, flexion, ext rotation, extension, expulsion
C. engagement, descent, flexion, int rotation, extension, ext rotation, expulsion
D. flexion, int rotation, engagement, extension, ext rotation, descent, expulsion



Which phase is predictive of the outcome of labor?

A. Acceleration
B. Max. Slope
C. Deceleration



Which suture approaches sacral promontory in anterior synclitism

A. Coronal
B. Lambdoid
C. Sagittal suture



If the cephalic prominence palpated is at the side of fetal back

A. Engaged
B. Not engaged
C. Extension
D. Flexion



What is the diameter of the fetal head when it is flexed?

A. Biparietal
B. Suboccipitobregmatic
C. Occipito-frontal
D. Mento-occipital



What is the cardinal movement of labor wherein the bisacromial diameter of the fetus has rotated into the AP diameter of the pelvis?

A. Internal rotation
B. Extension
C. External rotation
D. Expulsion



25 year old G2P1 (1001, admitted with PU, 39 AOG, cephalic presentation, in labor. In IE, cervix fully dilated with fetal head at station +1.What stage in labor?

A. 0
B. 1
C. 2
D. 3



25 year old G2P1 (1001, admitted with PU, 39 AOG, cephalic presentation, in labor. In IE, cervix fully dilated with fetal head at station +1. Fetal heart tones should be monitored every:

A. 5 mins
B. 10 mins
C. 15 mins
D. 20 mins



On IE in the delivery room, the fetal head was noted to be at station +2. The ff. must be done except:

A. Monitor fetal heart tone
B. Monitor fetal heart contraction
C. Perform an episiotomy
D. Check vital signs



Laceration: anal sphincter

A. 1st degree
B. 2nd degree
C. 3rd degree
D. 4th degree



Occurs in the placental delivery except:

A. Uterus globular and firmer
B. Sudden gush of amniotic fluid
C. Uterus rises
D. Umbilical cord protrudes of vagina



During the 3rd stage of labor, bleeding and maternal side 1st

A. Duncan
B. Schultze
C. Ritgen
D. Brandt-Andrews



What endogenous hormone is responsible for uterine contraction postpartum?

A. Progesterone
B. Prolactin
C. Oxytocin
D. Estrogen



Happens to cervix

A. Closes immediately
B. Still opens 2-3 days
C. Effacement
D. External os returns to pregravida



Changes in the urinary tract during the postpartum period EXCEPT:

A. Puerperal bladder has decreased capacity and sensitivity to intravesical pressure
B. Edema and hyperemia of bladder wall
C. Overdistention, incomplete emptying and excessive residual urine are common
D. Postpartum patients are more prone to develop urinary tract infection



After 15 hours of labor under epidural anesthesia, Mrs. Alonzo was not able to void freely. She recalled that heavy fundal pressure was exerted by the residents to facilitate her delivery. Upon insertion of a foley catheter, 2000 ml of urine was drained. How can this condition be prevented?

A. Instruct the patient to void often during labor
B. Give prophylactic antibiotics
C. Apply pressure on the hypogastrium of the patient
D. DO uterine massage immediately postpartum



Mrs. Cruz delivered vaginally a 4 kg baby an hour ago. While monitoring her at the recovery room, you observed profuse vaginal bleeding and the uterus was not contracted on examination. What is your diagnosis?

A. vaginal laceration
B. disseminated intravascular coagulation
C. uterine atony
D. normal postpartum finding



Return of menstruation after delivery if the patient is not breastfeeding:

A. 3 to 4 weeks
B. 6 to 8 weeks
C. 10 to 12 weeks
D. 10 to 12 weeks



Mrs. Matin had an unremarkable vaginal delivery2 weeks ago. She complains of a persistent whitish vaginal discharge which is not foul smelling and is not accompanied by vaginal pruritis.

What is the vaginal discharge called?

A. lochia alba
B. lochia rubra
C. lochia serosa
D. vaginal candidiasis



Mrs. Matin had an unremarkable vaginal delivery2 weeks ago. She complains of a persistent whitish vaginal discharge which is not foul smelling and is not accompanied by vaginal pruritis.

What is the expected corpus size on internal examination?

A. 10 weeks
B. 16 weeks
C. 18 weeks
D. 20 weeks



Mrs. Matin had an unremarkable vaginal delivery2 weeks ago. She complains of a persistent whitish vaginal discharge which is not foul smelling and is not accompanied by vaginal pruritis.

She is complaining that her old clothes before she got pregnant still did not fit her. You will reassure her that she will return to her prepregnancy weight _____ months.

A. 4
B. 6
C. 8
D. 10



Mrs. Matin had an unremarkable vaginal delivery2 weeks ago. She complains of a persistent whitish vaginal discharge which is not foul smelling and is not accompanied by vaginal pruritis.

She is asking when could she start sexual contact. What will you advise her?

A. coitus can be resumed based on her desire and comfort
B. she could wait for at least 1 month postpartum
C. she could wait for at least 2 months postpartum
D. she should wait until the vaginal recharge resolves



. What causes vaginal atrophy and dryness resulting to decreased vaginal lubrication for breastfeeding women?
A. increased oxytocin release
B. suppressed estrogen production
C. increased prolactin release
D. suppressed progesterone production



True statements about breast milk EXCEPT
A. Lipid fraction of human milk provides essential acids and fat-soluble vitamins
B. Phospholipids & cholesterol compose 0.5-0.8% of breast milk
C. High quality of protein in breast milk compensates for its lower quantity
D. Protein in breast milk is not sufficient for the energy needs of a preterm infant



Mrs. Trinidad consulted for breast tenderness. She has been breastfeeding her newborn since one month postpartum. On examination, her breasts are symmetrically enlarged with cracked areolar skin in the nipples. She has no fever and no palpable mass on examination. What will you recommend?
A. discontinue breastfeeding until breast tenderness is resolved
B. supplement with milk formula to lessen breast tenderness
C. gram stain of discharge from the nipple
D. breastfeed first in the least affected area



Mrs. Reyes is breastfeeding her 4 months old baby. She is asking about her need for contraception since today is her first day of menses. What will you recommend?

A. start injectable contraception at 6 months postpartum
B. start combined oral contraceptives at 6 months postpartum
C. start progestin only pills now
D. no need for additional contraception if still fully breastfeeding



Mechanism of action of oral contraceptive pills EXCEPT

A. impairs sperm viability
B. inhibits ovulation
C. inhibits sperm migration by thickening of cervical mucus
D. creates an endometrium unfavourable for implantation



A 37 year old G4P4 patient who smokes 10 cigarettes a day would like to use a temporary hormonal contraception. What will you recommend?

A. monthly injectable
B. multiphasic oral contraceptive
C. monophasic oral contraceptive
D. depot medroxyprogesterone acetate (DMPA)



Mrs. Lacson started using althea oral contraceptive pills (a combined OCP consisting of cyproterone acetate and ethinyl estradiol) consisting of 21 pills on March 1 which is her first day of menses. After consuming the first pack, she had her menses March 25-28. When will you instruct her to start her next pack of OCP?

A. March 22
B. March 25
C. March 28
D. March 29



Combined OCP is best recommended for which case?

A. 41 y/o G4P3 (3003) with hypertension and migraine headache
B. 39 y/o G3P3 (3003) who smokes 1 pack of cigarette per day
C. 38 y/o G5P5 (5005) with completed family size with no vices
D. 20 y/o G2P1 (1001) with deep vein thrombosis



Mrs. Cruz was given depot medroxyprogesterone acetate intramuscularly today (March 1, 2010). When will you recommend her to follow up for the next dose?

A. April 1, 2010
B. May 1, 2010
C. June 1, 2010
D. July 1, 2010



Mrs. Cortez has been using depot medroxyprogesterone acetate (DMPA) intramuscular injection for 3 years with good compliance. She consulted at the clinic for her injection which is due today. Her last normal menstrual period is December 20,2009. What is your next step?

A. Administer the DMPA
B. Check pregnancy test
C. Administer the DMPA but use back up contraception
D. Use combined OCP



True statements about depot medroxyprogesterone acetate EXCEPT

A. Can be used by breastfeeding women, 35 years and older and smoker
B. Contraindicated in patients with ischemic heart disease
C. Prevents cervical cancer
D. Delayed return of fertility



Lea is a 22 year old G0 medical student who is sexually active with irregular menses and acne. What contraceptive method will you best recommend?

A. Depot medroxyprogesterone acetate
B. Progestin only pills
C. Condom
D. Combined OCP



Main mechanism of action of copper intrauterine device (IUD)

A. Inflammatory actions in the uterus which is spermicidal
B. Inhibits ovulation
C. Inhibits sperm migration by thickening of cervical mucus
D. Interference with successful implantation of the fertilized ovum



True statements about IUD EXCEPT

A. Dysmenorrheal and increase in menstrual flow may be observed
B. Contraindicated in women with a history of pelvic infection
C. Delay in return of fertility after removal
D. Contraindicated in women with rheumatic disease



Disadvantage of IUD EXCEPT:

A. Uterine cramping or pain
B. Perforation most likely to occur at the time of insertion
C. Ectopic pregnancy with a device in place
D. Increased rate of fetal malformations



Mirena (levonorgestrel releasing) IUD was inserted today (March 1, 2010). When will you recommend this to be replaced?

A. 2015
B. 2018
C. 2020
D. 2023



Mrs. Reyes consulted at the clinic for amenorrhea (LMP: December 17,2009) with a positive pregnancy test. She had an IUD inserted a year ago. What will you recommend?

A. Remove the IUD immediately if the string is visible
B. Remove the IUD postpartum if the patient is asymptomatic
C. Remove the IUD when the fetus is viable
D. Administer intravenous antibiotics



True statements about male condoms EXCEPT

A. Safe and has no systemic side effects
B. No medical contraindications (except latex allergy)
C. Absolute protection against sexually transmitted diseases
D. Lower pregnancy rate than female condoms



True statements about diaphragms EXCEPT

A. Should be used with spermicide cream
B. May be inserted before intercourse
C. Remove immediately after intercourse to avoid toxic shock syndrome
D, Variable in size and may not remain in place if too small



True statements about the calendar or rhythm method

A. Requires recording of the duration of the 10 previous menstrual cycles
B. Shortest cycle minus 11 equals the first day of fertile period
C. Longest cycle minus 11 equals the last day of the fertile period
D. Shortest cycle minus 18 equals the last day of the fertile period



The last normal menstrual period of Ana is February 14 to 17, 2010. She is using the Basal Body Temperature (BBT) method of family planning. When will you tell her to abstain from sexual intercourse?

A. February 14 through the 3rd day after the increase in temperature
B. February 17 through the 5th day after the increase in temperature
C. On the 3rd day after the increase in temperature
D. On the 5th day after the increase in temperature



True statements about female sterilization EXCEPT

A. Increased risk of ectopic pregnancy
B. Highly effective (0.5 pregnancies per 100 women during first year of use)
C. Effective immediately
D. Decreased complication rate compared to vasectomy



Bilateral tubal ligation is best recommended for which cause?

A. 39 y/o G4P1 (0121) with history of hypertension during the last pregnancy
B. 38 y/o G3P3 (3003) with first pregnancy with her 2nd husband
C. 40 y/o G5P5 (5005) with completed family size
D. 20 y/o G2P1 (1001) with heart disease



Pregnancy after a vasectomy can be due to the following EXCEPT

A. Unprotected intercourse soon after ligation
B. Incomplete occlusion of the seminal vesicles
C. Recanalization
D. Sexual contact after 10 ejaculations



The pain in the first stage of labor is subserved by the ff. spinal segments

a. T4-T9
b. T10-L1
c. L2-S1
d. S2-S4



The pain in the second stage of labor is subserved by the ff. spinal segments:

a. T4-T9
b. T10-L1
c. L2-S1
d. S2-S4



A 30 year old G2P1-1001 patient comes in 6 cm dilated with strong and painful uterine contractions every 2-3 minutes. Which of the ff. will provide her with the best pain relief during the first stage of labor?

a. spinal
b. epidural
c. paracervical
d. pudendal



What is the most common complication of spinal anesthesia

a. spinal headache
b. aspiration
c.maternal hypertension
d. nausea and vomiting



Anesthesia related mortality occurs most often during

a. epidural anesthesia for patients with heart disease
b. local anesthesia for patients with hypertension
c. spinal anesthesia for patients with hypertension
d. general anesthesia for caesarian section



True statements about regional anesthesia during pregnancy EXCEPT

a. allow the patient to participate in the birth process
b. decreases likelihood of fetal depression
c. increases maternal aspiration pneumonia
d. allow rapid birth and early breastfeeding



A 21 year old G1P1-1001 married, college graduate consulted the clinic with her husband for advice on whether she can have an IUD placed because she has no desire to get pregnant for the next couple of years. After doing a complete medical history and physical/gynaecologic examination, what is the next best thing that you should do?

a. prescribe an IUD and schedule her for insertion
b. explain to her the disadvantages of having an IUD
c. layout all applicable contraceptive optins and their benefits and risks
d. refer her to another physician because you do not practice artificial family planning



A 16 year old G1P1(1001) college student, who recently delivered, went to the clinic with her 17 year old partner for post-partum consultation. What is the next best thing to do?

a. notify the parents and secure consent
b. refer the patient to a consultation
c. advise on available methods of family planning
d. advise on sexual abnormalities

A or C


A 44 year old G5P5-5005, married, arrived alone in the ER in active labor. On examination, the fetal elbow and arm is palpable through a 4 cm dilated cervix and advised the patient that she will undergo an emergency cesarean section for transverse lie. The patient told you that she is desirable of bilateral tubal ligation. What will you do?

a. secure consent for cesarean section and bilateral tubal ligation as the patient requested and do the procedure
b. wait for the husband and secure his consent for bilateral tubal ligation
c. schedule for bilateral tubal ligation 6 weeks postpartum
d. advise the patient other options of artificial family planning methods



A young married couple consulted for prescriptions of combined oral contraceptive pills for the first time. On further history and PE, you found out that the patient has deep vein thrombosis which is a contraindication for this type of contraception. What will you do?

a. promote a low dose estrogen combined oral contraceptive pills
b. advise other forms of contraception
c. refer her to an internist for thrombolytic and prescribe the COCs
d. refer to another OB-GYN



19 year old nulligravid single consult with mother for contraceptions. after complete thorough exam, mother asks the doctor for complete information on her daughter's condition. What must the physician do?

a. give all info
b. ask daughter to disclose the finding
c. refer to other doctor



Reproductive health is defined as a state of complete ____, ____ and ____ well-being, not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes.

a. physical, social, spiritual
b. physical, mental, social
c. physical, psychological, spiritual
d. physical, mental, spiritual