LE 1

Question 1

1. Which of the following statements is characteristic of the ovary?
   A) The granulosa layer of cells of a secondary follicle is highly vascularized
   B) The theca externa has LH receptors and produces androstenedione
   C) The theca interna secretes androstenedione in response to LH
   D) The basal lamina separates the primary oocyte from the granulosa
   E) The secondary follicle contains a secondary oocyte

Answer 1

C) The theca interna secretes androstenedione in response to LH
Rationale: The theca interna layer of the ovarian follicles contains LH receptors. Upon stimulation by LH, the theca interna cells produce androgens, primarily androstenedione, which is then used by granulosa cells to synthesize estrogen. The other options either inaccurately describe ovarian structures or their functions.

Question 2

3. Is a muscular layer that is regulated by ovarian hormones and oxytocin which causes increased force and rate of uterine contractions?
   A) Endometrium
   B) Myometrium
   C) Perimetrium

Answer 2

B) Myometrium
Rationale: The myometrium is the muscular layer of the uterus influenced by ovarian hormones (estrogens and progesterone) and oxytocin. These influences cause changes in the contractility of the myometrium, particularly important during labor.

Question 3

2. Patient EF is a G1PO 14 weeks age of gestation. When is the earliest time she can expect quickening?
   A) 16 weeks
   B) 14 weeks
   C) 20 weeks
   D) 18 weeks

Answer 3

D) 18 weeks

Question 4

4. A 28-year-old primigravid, on her 24th week AOG computed from her last menstrual period, came to your clinic for her first prenatal checkup. Her fundic height (uterine measurement from symphysis pubis to funds) was noted to be 30 cm. What is the next best step in the management of this patient?
   A) Reassure patient that it is a normal finding, and she could come back after 1 month for her regular check-up
   B) Request for an ultrasound to determine or confirm age of gestation, or detect any abnormality
   C) Advise patient to start taking protein supplements in order for the baby to catch up in size
   D) Inform the patient that her correct age of gestation is 30 weeks, and not 24 weeks

Answer 4

B) Request for an ultrasound to determine or confirm age of gestation, or detect any abnormality
Rationale: A fundal height of 30 cm at 24 weeks suggests a measurement that is larger than expected, possibly indicating incorrect dating, a large fetus, multiple gestation, or other abnormalities. An ultrasound would provide more precise information about gestational age and assess for complications.

Question 5

5. Milk protein is produced by which of the following mechanisms?
   A) Paracrine secretion
   B) Merocrine secretion
   C) Autocrine secretion
   D) Apocrine secretion

Answer 5

D) Apocrine secretion
Rationale: Milk protein secretion in mammary glands occurs by apocrine secretion, where part of the cell cytoplasm is released with the secretory product. This is typical in the mammary gland epithelial cells.

Question 6

6. Each breast consists of
   A) 1 mammary gland
   B) 2 mammary glands
   C) 5 mammary glands
   D) 20 mammary glands

Answer 6

D) 20 mammary glands

Question 7

8. What is the fetal lie?
   A) Cephalic
   B) Breech
   C) Transverse
   D) Shoulder
   E) Longitudinal
   F) Oblique
   G) Compound

Answer 7

C) Transverse

Question 8

10. Elevation of body temperature among pregnant women is secondary to:
    A) Thermogenic effect of progesterone
    B) Thermogenic effect of estrogen
    C) Thermogenic effect of testosterone
    D) Thermogenic effect of human chorionic gonadotropin

Answer 8

A) Thermogenic effect of progesterone
Rationale: The elevation in body temperature during pregnancy can be attributed to the thermogenic effects of progesterone, which is elevated throughout pregnancy and increases the basal metabolic rate.

Question 9

11. A 22-year-old female experienced her first menstrual cycle at age 14. Until recently, she had a normal regular menstrual cycle with an interval of 30 days. Six months ago, she began training for a marathon. She runs roughly 115 miles per week and as a result of her training regimen, she has lost 20 pounds. She has not menstruated for the past 3 months. Given these findings, what is the most likely endocrine explanation for her amenorrhea?
    A) Absence of GRH surge
    B) Prolonged elevation of follicle-stimulating hormone
    C) Increase in plasma leptin
    D) Absence of a surge in luteinizing hormone
    E) Abnormally elevated plasma estradiol

Answer 9

D) Absence of a surge in luteinizing hormone
Rationale: Intense physical activity and significant weight loss can lead to hypothalamic dysfunction, which often manifests as a disruption in the normal pulsatile secretion of GnRH (gonadotropin-releasing hormone) from the hypothalamus. This disrupts the normal surge of LH necessary for ovulation, leading to amenorrhea.

Question 10

13. Which of the following hormones is involved in the development of the mammary glands and ducts, thus preparing the body for pregnancy?
    A) Prolactin
    B) Oxytocin
    C) Progesterone
    D) Inhibin

Answer 10

C) Progesterone
Rationale: Progesterone, along with estrogen, plays a crucial role in the development of the mammary glands and ducts during pregnancy. Progesterone supports glandular differentiation and growth, preparing the breasts for lactation post-delivery.

Question 11

14. True about the layers/coat of the wall of the uterine body:
    A) The outer layer consists of peritoneum supported by a thick layer of connective tissue
    B) The inner mucosal coat becomes greatly distended during pregnancy
    C) The functionalis layer of the endometrium regenerates the basalis layer following each menses
    D) The amount of muscle fiber in the middle coat is greater in the inner than in the outer wall

Answer 11

D. The amount of muscle fiber in the middle coat is greater in the inner than in the outer wall
Explanation: The middle coat of the uterine body, known as the myometrium, consists predominantly of smooth muscle bundles. These bundles are more concentrated in the inner layer than in the outer layer of the uterine body. This structural arrangement facilitates the effective contraction of the uterus during childbirth and menstruation. The statement correctly reflects the anatomical distribution of muscle fibers in the uterus, aligning with the information about the increased muscularity of the inner wall compared to the outer wall.

Question 12

15. Where do the uterus and the fallopian tubes arise from?
    A) Wolffian ducts
    B) Wartonian ducts
    C) Mesonephric ducts
    D) Mullerian ducts

Answer 12

D) Mullerian ducts
Rationale: The uterus and fallopian tubes, along with the upper part of the vagina, develop from the Müllerian ducts (paramesonephric ducts). This is the fundamental embryologic origin of most of the female reproductive tract.

Question 13

16. Which of the following is characteristic of the stratum basale?
    A) Contains cells that are highly responsive to progesterone
    B) Includes the uterine surface epithelium
    C) Contains coiled arteries
    D) Is the layer that undergoes shedding
    E) Contains cells that replace the surface epithelium after menstruation

Answer 13

E) Contains cells that replace the surface epithelium after menstruation
Explanation: The stratum basale, or basal layer, of the endometrium is the layer that remains following menstruation and is responsible for regenerating the functional layer (stratum functionalis) that is shed during menstruation. This layer contains the necessary cells and structures to rebuild the surface epithelium and glandular components of the endometrium each cycle, preparing it again for potential implantation.

Question 14

17. A 22-year-old G1P0 at 16 weeks AOG, has ruptured tubal pregnancy and presents with hypovolemia secondary to hemorrhage. The implantation of the conceptus most likely is in the:
    A) Infundibulum
    B) Ampulla
    C) Isthmus
    D) Interstitium

Answer 14

B) Ampulla
Rationale: The most common site for an ectopic pregnancy is the fallopian tube, particularly the ampulla section. This area provides a common site for implantation outside the uterus due to its relative length and mobility.

Question 15

18. The stroma of the ovary consists of blood vessels, nerves, muscle fibers, and a type of protein called:
    A) Fibrin
    B) Collagen
    C) Albumin

Answer 15

B) Collagen
Rationale: The stroma of the ovary is composed primarily of connective tissue, which includes a high concentration of collagen. Collagen provides structural integrity and support to the ovarian tissues.

Question 16

19. A patient at her 23rd week age of gestation came to your clinic for the first time for her prenatal check-up. Upon doing obstetric examination, you noted that the fundic height is 27 cm. Which of the following is a possible diagnosis?
    A) Intrauterine growth restriction
    B) Oligohydramnios
    C) Polyhydramnios
    D) Normal findings in pregnancy

Answer 16

C) Polyhydramnios

D) Normal findings in pregnancy
Rationale: Fundal height measurements in pregnancy are roughly equivalent to the week of gestation plus or minus 2 cm. At 23 weeks, a fundal height of 27 cm is within normal limits.

Question 17

20. After an egg is ovulated, the remaining mass is called a:
    A) Theca folliculi
    B) Corpus luteum
    C) Vesicular folliculi
    D) Corpus albicans

Answer 17

B) Corpus luteum
Rationale: After ovulation, the follicle transforms into the corpus luteum. This structure is crucial for producing progesterone, which supports the early stages of pregnancy until the placenta can take over.

Question 18

22. In the sexually mature female, ovulation is preceded by a dramatic change in luteinizing hormone. What would be the factor and the change in its release that is obligatorily linked in the change in LH before ovulation?
    A) Increase in dopamine
    B) Decrease in gonadotropin-releasing hormone
    C) Decrease in dopamine
    D) Increase in gonadotropin-releasing hormone
    E) Increase in inhibin

Answer 18

D) Increase in gonadotropin-releasing hormone
Rationale: Ovulation is closely linked to a surge in gonadotropin-releasing hormone (GnRH), which in turn stimulates a sharp increase in luteinizing hormone (LH). This LH surge triggers ovulation.

Question 19

23. Which of the following is characteristic of the secretory phase of the menstrual cycle?
    A) It produces ischemia and necrosis of the stratum functionalis
    B) It is controlled by estrogen
    C) It ends upon the arrival of ovulation
    D) Endocervix is sloughed off during this phase
    E) Uterine gland lumens are filled with secretions

Answer 19

E) Uterine gland lumens are filled with secretions
Rationale: During the secretory phase of the menstrual cycle, following ovulation and under the influence of progesterone, the uterine glands become more tortuous and their lumens fill with secretions that are important for nourishing an implanted embryo.

Question 20

24. The cervix is composed mainly of which of the following components?
    A) Smooth muscle
    B) Elastin
    C) Proteoglycan
    D) Collagen

Answer 20

D) Collagen
Rationale: The cervix is primarily composed of dense connective tissue, which includes a high content of collagen. Collagen provides structural strength and supports the cervix, especially important during pregnancy and childbirth.

Question 21

25. A 20-year-old primigravid, 4-5 weeks age of gestation, came to your clinic anxious because her ultrasound showed only a gestational sac, with still no fetal heart beat noted. How would you advise this patient?
    A) She has evidence of an anembryonic pregnancy and needs a dilation and curettage done as soon as possible to remove the products of conception.
    B) You tell the patient that she is not pregnant.
    C) Reassure the patient that fetal heart beat will manifest at around 6 weeks age of gestation, and that she may opt to repeat her transvaginal ultrasound after about 2-3 weeks.
    D) The ultrasound showed evidence of intrauterine fetal demise.

Answer 21

C) Reassure the patient that fetal heart beat will manifest at around 6 weeks age of gestation, and that she may opt to repeat her transvaginal ultrasound after about 2-3 weeks.
Rationale: At 4-5 weeks of gestation, it’s common not to detect a fetal heartbeat. It is typically visible by around 6 weeks of gestation. Reassuring the patient and suggesting a follow-up ultrasound in 1-2 weeks is appropriate to confirm normal development.

Question 22

26. When the myoepithelial cells contract, milk is forced from the alveoli to the nipple. Which of the following hormones causes the myoepithelial cells to contract?
    A) Estrogen
    B) Oxytocin
    C) Progesterone
    D) Inhibin

Answer 22

B) Oxytocin
Rationale: Oxytocin is the hormone responsible for causing the contraction of myoepithelial cells around the milk alveoli, which helps to express milk from the alveoli through the milk ducts to the nipple.

Question 23

27. Pap smear should be done on all asymptomatic pregnant patients during her first prenatal checkup.
    A) False
    B) True

Answer 23

A) False
Rationale: Pap smear screening is generally not recommended during the first prenatal visit unless it is due based on routine screening intervals or if there are specific indications. Pregnancy does not increase the risk of cervical cancer, and routine screening can be safely deferred until postpartum if recent results are normal.

Question 24

28. What is the fetal presentation?
    A) Cephalic
    B) Breech
    C) Transverse
    D) Shoulder
    E) Longitudinal
    F) Oblique
    G) Compound

Answer 24

D) Shoulder

Question 25

29. During menstruation, a portion of the endometrial lining is shed. Which of the following layers of the endometrium is involved in the "shedding" process? A) Stratum basalis B) Stratum epidermalis C) Stratum functionalis

Answer 25

C) Stratum functionalis Rationale: During menstruation, the stratum functionalis layer of the endometrium is the portion that is shed. This is the functional, upper layer of the endometrium that thickens and then is sloughed off if pregnancy does not occur.

Question 26

30. Which of the following anteroposterior (AP) conjugate diameters of the pelvic inlet can be measured clinically? A) Obstetric conjugate B) Diagonal conjugate C) True conjugate D) Midpelvic conjugate

Answer 26

B) Diagonal conjugate Rationale: The diagonal conjugate is the anteroposterior diameter of the pelvic inlet that can be clinically estimated by a pelvic exam. It helps in assessing the adequacy of the pelvic inlet for childbirth.

Question 27

31. Graafian follicle is characteristically found in: A) Testes B) Thyroid C) Ovary D) All of the above

Answer 27

C) Ovary Rationale: The Graafian follicle, or mature ovarian follicle, is found in the ovaries. It is the stage at which the follicle is fully matured and ready to release an egg during ovulation.

Question 28

32. Which of the following ligaments assist in anchoring the uterus in position? A) Round ligament B) Broad ligament C) Ovarian ligament D) Suspensory ligament

Answer 28

A) Round ligament

Question 29

33. Which pelvic diameter is approximately measured by placing a closed fist against the perineum at the level of the tuberosities? A) Transverse diameter B) Oblique diameter C) Intertuberous diameter D) Interischial diameter

Answer 29

C) Intertuberous diameter Rationale: The intertuberous diameter is measured between the ischial tuberosities of the pelvis and can be approximated by placing a closed fist against the perineum at the level of these tuberosities.

Question 30

35. Which ligament anchors the ovaries to the pelvic wall? A) Round ligament B) Broad ligament C) Ovarian ligament D) Suspensory ligament

Answer 30

D) Suspensory ligament Rationale: The suspensory ligament of the ovary, also known as the infundibulopelvic ligament, extends from the ovary to the pelvic wall. It contains important structures such as the ovarian blood vessels and nerves, helping to secure the ovary in its place within the pelvic cavity.

Question 31

36. A 33-year-old primigravid patient came to the ER because of labor pains. You noted the following findings: LM1 breech, LM2 fetal back left, LM3 cephalic, LM4 unengaged, fetal head flexed; on internal exam, you noted that the ischial spines are prominent and the pelvic sidewalls are convergent. The bituberous diameter measures 9cm. The length of the bituberous diameter suggests that the _______ is adequate. A) Inlet B) Midplane C) Outlet

Answer 31

C) Outlet Rationale: The bituberous diameter, measured at 9 cm, refers to the distance between the ischial tuberosities, which is a critical measurement for assessing the adequacy of the pelvic outlet. This measurement suggests that the pelvic outlet is adequate for vaginal delivery.

Question 32

37. Identify the pelvic plane involved: ischial spines. A) Inlet B) Midplane C) Outlet

Answer 32

B) Midplane Rationale: The ischial spines are landmarks used to assess the midplane of the pelvis. They are palpated during an internal exam to help gauge the level of the fetal presenting part relative to the midpelvic plane.

Question 33

39. Linea Nigra. A) Mask of pregnancy B) Darkened Linea alba C) Stretch marks D) Midline separation of rectus muscles E) Vascular stellar marks on the face

Answer 33

B) Darkened Linea alba Rationale: Linea nigra is the dark vertical line that appears on the abdomen during pregnancy, representing a hyperpigmented Linea alba. A) Mask of pregnancy (Chloasma/ Melanoma) B) Darkened Linea alba (Linea Nigra) C) Stretch marks (Striae gravidarum) D) Midline separation of rectus muscles (Diastasis recti) E) Vascular stellar marks on the face (Spider telangiectasia)

Question 34

40. Spider telangiectasia. A) Mask of pregnancy B) Darkened Linea alba C) Stretch marks D) Midline separation of rectus muscles E) Vascular stellar marks on the face

Answer 34

E) Vascular stellar marks on the face Rationale: Spider telangiectasia refers to small, spider-like capillary expansions visible on the skin, often found on the face, neck, and arms during pregnancy. A) Mask of pregnancy (Chloasma/ Melanoma) B) Darkened Linea alba (Linea Nigra) C) Stretch marks (Striae gravidarum) D) Midline separation of rectus muscles (Diastasis recti) E) Vascular stellar marks on the face (Spider telangiectasia)

Question 35

41. Diastasis recti. A) Mask of pregnancy B) Darkened Linea alba C) Stretch marks D) Midline separation of rectus muscles E) Vascular stellar marks on the face

Answer 35

D) Midline separation of rectus muscles Rationale: Diastasis recti refers to the separation of the left and right abdominal rectus muscles, which can occur during pregnancy as the uterus expands. A) Mask of pregnancy (Chloasma/ Melanoma) B) Darkened Linea alba (Linea Nigra) C) Stretch marks (Striae gravidarum) D) Midline separation of rectus muscles (Diastasis recti) E) Vascular stellar marks on the face (Spider telangiectasia)

Question 36

42. Chloasma. A) Mask of pregnancy B) Darkened Linea alba C) Stretch marks D) Midline separation of rectus muscles E) Vascular stellar marks on the face

Answer 36

A) Mask of pregnancy Rationale: Chloasma, also known as melasma or the "mask of pregnancy," involves brownish patches of pigmentation that appear on the face, particularly on the cheeks, nose, and forehead. A) Mask of pregnancy (Chloasma/ Melanoma) B) Darkened Linea alba (Linea Nigra) C) Stretch marks (Striae gravidarum) D) Midline separation of rectus muscles (Diastasis recti) E) Vascular stellar marks on the face (Spider telangiectasia)

Question 37

43. Striae gravidarum. A) Mask of pregnancy B) Darkened Linea alba C) Stretch marks D) Midline separation of rectus muscles E) Vascular stellar marks on the face

Answer 37

C) Stretch marks Rationale: Striae gravidarum are stretch marks that typically appear on the abdomen, breasts, hips, or thighs during pregnancy due to rapid stretching of the skin and hormonal changes. A) Mask of pregnancy (Chloasma/ Melanoma) B) Darkened Linea alba (Linea Nigra) C) Stretch marks (Striae gravidarum) D) Midline separation of rectus muscles (Diastasis recti) E) Vascular stellar marks on the face (Spider telangiectasia)

Question 38

44. In performing what Leopold's maneuver will you be facing the patient's feet? A) LM1 B) LM2 C) LM3 D) LM4

Answer 38

D) LM4 Rationale: In the fourth Leopold's maneuver, the examiner faces the patient’s feet to determine the engagement of the fetal head in the maternal pelvis.

Question 39

45. A 33-year-old primigravid patient came to the ER because of labor pains. You noted the following findings: LM1 breech, LM2 fetal back left, LM3 cephalic, LM4 unengaged, fetal head flexed; on internal exam, you noted that the ischial spines are prominent and the pelvic sidewalls are convergent. The bituberous diameter measures 9cm. The pelvimetry findings point to WHICH inadequate plane? A) Inlet B) Midplane C) Outlet

Answer 39

C) Outlet Rationale: Given the findings of a bituberous diameter of 9cm and the descriptions of the pelvic anatomy (prominent ischial spines and convergent pelvic sidewalls), the inadequate plane is the pelvic outlet. This may imply difficulties during the final stages of labor, specifically during the passage of the fetus through the pelvic outlet. A bituberous (or bi-ischial) diameter <8 cm = Inadequate outlet >8 cm = Adequate

Question 40

46. A 32-year-old primigravid, 32 weeks AOG, came to the clinic for prenatal check-up. On history taking, you noted her quickening at 19 weeks AOG. On abdominal exam, LM1 cannot be determined, LM2 ballotable firm mass felt at the maternal right, irregular, nodular doughy mass felt at the maternal left, LM3 and LM4 cannot be determined. You noted fetal movement on palpation. The doctor's perception of fetal movement is a sign of pregnancy: A) Presumptive B) Probable C) Positive

Answer 40

C) Positive Rationale: The doctor's perception of fetal movement is considered a positive sign of pregnancy because it directly involves the detection of the fetus itself, unlike presumptive or probable signs which can be caused by conditions other than pregnancy.

Question 41

47. Calculate the approximate measurement of the true or anatomic conjugate when given a diagonal conjugate measurement of 13 cm. A. 10 cm B. 11.8 cm C. 14.2 cm D. 12.5 cm

Answer 41

B) 11.8 cm Rationale: To calculate the true or anatomical conjugate from the diagonal conjugate, subtract approximately 1.5-2 cm from the diagonal conjugate measurement. Given a diagonal conjugate of 13 cm, the true conjugate is likely around 11.5-11.8 cm.

Question 42

48. Vascular supply of the vagina: A. Proximal portion: cervical branch of the uterine and vaginal artery B. Distal vaginal walls: middle rectal artery C. Posterior vaginal walls: internal pudendal artery

Answer 42

A) Proximal portion: cervical branch of the uterine and vaginal artery Rationale: The proximal portion of the vagina is primarily supplied by the cervical branch of the uterine artery and the vaginal artery. The internal pudendal artery and middle rectal artery also contribute to the vascular supply of the vagina but are more involved with the distal and posterior aspects.

Question 43

49. While performing LM4, you have palpated the cephalic prominence on the same side of the fetal back. The presenting part that you will expect to palpate when you do the internal pelvic exam is the: A. Face B. Sinciput C. Occiput D. Brow

Answer 43

A. Face Rationale: When the cephalic prominence (the part of the head presented by the forehead or face) is noted on the same side as the fetal back during the fourth Leopold maneuver, this suggests a face presentation for the fetus.

Question 44

50. Hegar's sign is observed by the 6th to 8th week of gestation. This condition refers to the: A. Softening of the uterine isthmus B. Cyanosis and softening of the cervix C. Bluish or purplish discoloration of the vaginal mucosa D. Irregular brownish patches on the face

Answer 44

A. Softening of the uterine isthmus Rationale: Hegar's sign, typically observed between the 6th to 8th week of gestation, refers to the softening of the uterine isthmus and can be palpated as a distinct softening or compressibility between the cervix and the body of the uterus.

Question 45

51. The fetal presenting part is said to be engaged if the biparietal diameter has reached the level of ischial spines. This is reported as: A. Station -3 B. Station -2 C. Station -1 D. Station 0

Answer 45

D. Station 0 Rationale: Engagement is defined as the descent of the fetal presenting part to the level of the ischial spines, which is described as station 0 in obstetrical terms.

Question 46

52. This is a probable sign of pregnancy characterized by cyanosis and softening of the cervix due to increased vascularity of the cervical tissue: A. Hegar's sign B. Goodell's sign C. Chadwick sign D. Spalding sign

Answer 46

B. Goodell's sign Goodell's sign is characterized by cyanosis and softening of the cervix, which occurs due to increased vascularity and edema in the cervical tissue. This is a probable sign of pregnancy and may be observed as early as 4 weeks of gestational age.

Question 47

53. What is the correct progression of the fallopian tube anatomy from the proximal to the distal segment? A. Infundibulum, ampulla, isthmus, interstitium B. Interstitium, isthmus, ampulla, infundibulum C. Isthmus, infundibulum, interstitium, ampulla D. Ampulla, interstitium, infundibulum, isthmus

Answer 47

B. Interstitium, isthmus, ampulla, infundibulum Rationale: The fallopian tube anatomy from proximal (uterine) to distal ends as follows: the interstitium (the part that passes through the uterine wall), isthmus (narrower section near the uterus), ampulla (wider section where fertilization commonly occurs), and the infundibulum (funnel-shaped end near the ovary). This option correctly lists the progression of the fallopian tube anatomy from the proximal (closest to the uterus) to the distal (closest to the ovary) segments. The interstitium is the segment that passes through the uterine wall, the isthmus is the narrow part near the uterus, the ampulla is the wider, middle section where fertilization typically occurs, and the infundibulum is the funnel-shaped end near the ovary, featuring fimbriae that help capture the egg.

Question 48

55. You instructed your clinic nurse to determine the fetal heart rate of your pregnant patient who came to the clinic for prenatal check-up. The nurse reported the fetal heart rate to be "80 beats per minute." How should you interpret this finding? A. This is a normal fetal heart rate. You can proceed with your regular prenatal check-up routine. B. Double check the nurse's findings by quickly recounting the fetal heart rate. The nurse must have measured the maternal pulse instead. C. Tell the nurse to wheel the patient to the operating room for an emergency cesarean section due to fetal compromise. D. Inform the patient the baby is probably dying.

Answer 48

B. Double check the nurse's findings by quickly recounting the fetal heart rate. The nurse must have measured the maternal pulse instead. Rationale: A fetal heart rate of 80 beats per minute is abnormally low, as normal rates range from about 110 to 160 beats per minute. It's likely that the maternal pulse was measured instead of the fetal heart rate. Verification is needed.

Question 49

56. A 33-year-old primigravid patient came to the ER because of labor pains. You noted the following findings: LM1 breech, LM2 fetal back left, LM3 cephalic, LM4 unengaged, fetal head flexed; on internal exam, you noted that the ischial spines are prominent and the pelvic sidewalls are convergent. The bituberous diameter measures 9cm. What is the fetal lie? A. Longitudinal B. Transverse C. Cephalic D. Breech E. Shoulder

Answer 49

A. Longitudinal Rationale: The description of the fetal position indicates a longitudinal lie, which means the long axis of the fetus is aligned with the long axis of the uterus. This can involve either a cephalic (head first) or breech (buttocks or feet first) presentation.

Question 50

57. Bartholin glands open into the: A. Fallopian tubes and release a secretion which makes sperm motile B. Uterus and release a lubricating fluid during the birth of the baby C. Urinary bladder and assist in the release of urine D. Vestibule and release a lubricating fluid in the vagina

Answer 50

D. Vestibule and release a lubricating fluid in the vagina Rationale: The Bartholin glands are located near the vaginal opening (vestibule) and secrete fluid that helps lubricate the vagina. This fluid is essential for decreasing friction during sexual intercourse.

Question 51

58. A 33-year-old primigravid patient came to the ER because of labor pains. You noted the following findings: LM1 breech, LM2 fetal back left, LM3 cephalic, LM4 unengaged, fetal head flexed; on internal exam, you noted that the maternal left ischial spines are prominent and the pelvic sidewalls are convergent. The bituberous diameter measures 9cm. Which side would you put your stethoscope to determine fetal heart tones? A. Maternal fundus B. Maternal left C. Maternal right

Answer 51

B. Maternal left Rationale: Given that LM2 indicates the fetal back is positioned on the maternal left, and since fetal heart tones are best heard through the baby’s back, the stethoscope should be placed on the maternal left side.

Question 52

60. Which of the following steps executed during total abdominal hysterectomy is associated with potential ureteral injury? A. Division of the round ligament B. Ligation of the uterine artery C. Ligation of the infundibulopelvic ligaments D. Clamping of the cardinal ligaments

Answer 52

B. Ligation of the uterine artery Rationale: The uterine artery is closely related anatomically to the ureter, particularly where it crosses the ureter. During ligation of the uterine artery in total abdominal hysterectomy, there is a risk of ureteral injury if not identified and avoided carefully.

Question 53

61. Identify the pelvic plane involved: ischial tuberosity. A. Inlet B. Midplane C. Outlet

Answer 53

C. Outlet Rationale: The ischial tuberosities are landmarks that help define the boundaries of the pelvic outlet.

Question 54

62. Identify the pelvic plane involved: diagonal conjugate. A. Inlet B. Midplane C. Outlet

Answer 54

A. Inlet Rationale: The diagonal conjugate measures the anteroposterior diameter of the pelvic inlet, from the lower margin of the symphysis pubis to the sacral promontory.

Question 55

63. This is the distance between the upper margin of symphysis pubis to the midpoint of the sacral promontory: A. Obstetric conjugate B. Diagonal conjugate C. True conjugate D. Midpelvic conjugate

Answer 55

C. True conjugate

Question 56

74. What is the best explanation for the sustained increase in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) that occurs in women after menopause? A) Up-regulation of the number of LH receptors on granulosa cells B) Depletion of estrogen-secreting follicles in the ovaries C) Hyperplasia of gonadotropes of the anterior pituitary gland D) Decreased sensitivity of GnRH-producing cells of the hypothalamus to estradiol

Answer 56

B) Depletion of estrogen-secreting follicles in the ovaries Rationale: After menopause, the ovaries stop producing estrogen due to the depletion of follicles. This removal of the inhibitory effect of estrogen on the pituitary gland results in increased secretion of LH and FSH.

Question 57

What is the fetal position? A) Left mentum anterior B) Right occiput posterior C) Right brow posterior D) Left face anterior E) Cephalic F) Transverse G) Longitudinal

Answer 57

A) Left mentum anterior

Question 58

77. A 32-year-old primigravid, 32 weeks AOG, came to the clinic for a prenatal checkup. On history taking, you noted her quickening at 19 weeks AOG. On abdominal exam, LM1 cannot be determined, LM2 ballotable firm mass felt at the maternal right, irregular, nodular doughy mass felt at the maternal left, LM3 and LM4 cannot be determined. When did the patient feel the first fetal movement? A) 20 weeks B) 18 weeks C) 19 weeks D) 32 weeks

Answer 58

C) 19 weeks Rationale: The patient's history indicates that she first felt fetal movement at 19 weeks AOG, which is commonly referred to as quickening.

Question 59

78. Corpus luteum is the source of secretion of: A) LH B) Estradiol C) Estrogen D) Progesterone E) Other:

Answer 59

D) Progesterone Rationale: The corpus luteum, which forms from the remains of the follicle after ovulation, primarily secretes progesterone. This hormone is crucial for maintaining the uterine lining and supporting early pregnancy.

Question 60

79. In the uterine cycle, there are 2 separate negative feedbacks: Estradiol-dependent negative feedback and one positive feedback, depending on the point in the cycle. In a normal 28-day cycle, on day 21, what feedback loop is active in controlling the plasma levels of luteinizing hormone? A) Estradiol-dependent positive feedback B) Progesterone-dependent negative feedback C) Progesterone-dependent positive feedback

Answer 60

B) Progesterone-dependent negative feedback Rationale: On day 21 of a typical 28-day cycle, progesterone, secreted by the corpus luteum, exerts a negative feedback effect on the secretion of LH (and also FSH), stabilizing its levels to prevent further ovulatory signals.

Question 61

80. The membrane investing the ovum just outside the membrane granulosa is: A) Theca interna B) Discus proligerus C) Zona pellucida

Answer 61

C) Zona pellucida Rationale: The zona pellucida is a glycoprotein layer surrounding the plasma membrane of mammalian oocytes. It is located outside the oocyte itself but immediately surrounds it, acting as a vital barrier and mediator of sperm-oocyte interactions during fertilization.

Question 62

- 64. Appendectomy last 2000 - 65. Treated for Pelvic Inflammatory Disease last month - 67. Asthmatic since childhood Components of History Taking: a. Medical History b. Personal/Social History c. Obstetric History d. Gynecologic History e.Chief Complaint f. Menstrual History

Answer 62

a. Medical History Definition: This includes any past medical conditions, treatments, surgeries, and hospitalizations unrelated directly to reproductive health. It encompasses the overall health background of the patient, chronic conditions, and significant past medical interventions. Examples: Appendectomy, treatment for Pelvic Inflammatory Disease, asthma.

Question 63

- 68. Married for 3 years - 72. High school undergraduate Components of History Taking: a. Medical History b. Personal/Social History c. Obstetric History d. Gynecologic History e.Chief Complaint f. Menstrual History

Answer 63

b. Personal/Social History Definition: This section details the patient's personal circumstances and lifestyle factors that may impact health. It includes marital status, education, occupation, habits such as smoking or alcohol use, and social support systems. Examples: Married for 3 years, high school undergraduate.

Question 64

- 66. Baby intubated for Respiratory Distress Syndrome - 69. Decreased fetal movement - 70. Underwent curettage for her 2nd miscarriage Components of History Taking: a. Medical History b. Personal/Social History c. Obstetric History d. Gynecologic History e.Chief Complaint f. Menstrual History

Answer 64

c. Obstetric History Definition: This includes details related to past and current pregnancies, outcomes, complications, and any interventions during childbirth. It helps to understand the patient's reproductive success and challenges. Examples: Baby intubated for Respiratory Distress Syndrome, decreased fetal movement, underwent curettage for a miscarriage.

Question 65

- 65. Treated for Pelvic Inflammatory Disease last month - 70. Underwent curettage for her 2nd miscarriage - 73. Watery vaginal discharge 1h prior to consult Components of History Taking: a. Medical History b. Personal/Social History c. Obstetric History d. Gynecologic History e.Chief Complaint f. Menstrual History

Answer 65

d. Gynecologic History Definition: This pertains to the health of the female reproductive system outside of pregnancy. It includes menstrual history, sexually transmitted infections, previous gynecologic surgeries, and any reproductive health complaints. Examples: Treatment for Pelvic Inflammatory Disease, curettage for miscarriage, dysmenorrhea, watery vaginal discharge.

Question 66

- 69. Decreased fetal movement - 73. Watery vaginal discharge 1h prior to consult Components of History Taking: a. Medical History b. Personal/Social History c. Obstetric History d. Gynecologic History e.Chief Complaint f. Menstrual History

Answer 66

e. Chief Complaint Definition: This is the primary reason the patient seeks medical attention, stated in the patient's own words. It includes current symptoms or problems that prompted the consultation. Examples: Decreased fetal movement, watery vaginal discharge.

Question 67

- 71. (+) dysmenorrhea on D1 of cycle Components of History Taking: a. Medical History b. Personal/Social History c. Obstetric History d. Gynecologic History e.Chief Complaint f. Menstrual History

Answer 67

f. Menstrual History Definition: This covers the details of the patient's menstrual cycles, including the age of menarche, regularity, frequency, duration of periods, and any associated symptoms such as pain or abnormal bleeding. It helps in diagnosing reproductive and hormonal disorders. Examples: Dysmenorrhea on the first day of the cycle.

Question 68

81. What is the fetus' approximate age of gestation when you palpate the uterine fundus midway between the umbilicus and the symphysis pubis? A) 20 weeks AOG B) 12 weeks AOG C) 16 weeks AOG D) 30 weeks AOG

Answer 68

C) 16 weeks AOG Rationale: At 16 weeks AOG, the fundus of the uterus is typically palpated midway between the umbilicus and the symphysis pubis. 12 weeks after LMP – Above pubic symphysis 16 weeks – Halfway between pubic symphysis and umbilicus 20 weeks – At the level of umbilicus 36 weeks – Fundus is just below ensiform cartilage

Question 69

82. It is a mucosal layer that contains endocrine gland that produces nutritive secretions. Regulated by ovarian hormones and varies in thickness during menstruation. A) Endometrium B) Myometrium C) Perimetrium

Answer 69

A) Endometrium Rationale: The endometrium is the mucosal layer of the uterus that is regulated by ovarian hormones and varies in thickness throughout the menstrual cycle. It also contains glands that produce secretions which are nutritive, especially important for early pregnancy.

Question 70

83. If after ovulation, pregnancy does not take place, then the: A) Produces a lot of relaxin and oxytocin B) Degenerates in a short time C) Is maintained in the presence of progesterone D) Becomes active and secretes a lot of LH and FSH

Answer 70

B) Degenerates in a short time Rationale: If pregnancy does not occur after ovulation, the corpus luteum degenerates within about 14 days, leading to a decrease in progesterone and estrogen levels, which in turn triggers menstruation.

Question 71

IDENTIFY THE FETAL POSITION A. Left occiput anterior B. Right occiput posterior C. Left occiput posterior D. Right occiput anterior E. Occiput anterior F. Occiput posterior

Answer 71

A. Left occiput anterior

Question 72

86. Layer of cells immediately surrounding the ovum but outside the zona pellucida is called as: A) Germinal epithelium B) Corona radiata C) Theca interna D) Membrana granulosa

Answer 72

B) Corona radiata Rationale: The corona radiata is the layer of cells that immediately surrounds the ovum but outside the zona pellucida. These cells are derived from the granulosa cells that remain attached to the oocyte after ovulation.

Question 73

87. Your friend, Ana, a 28-year-old primigravid, on her 10th week age of gestation, is worried about her severe gastrointestinal symptoms like nausea and vomiting and asked you if her symptoms will ever stop. How would you counsel your friend? A) Advise her that the GI symptoms will abate after the first trimester, correlating with the levels of beta HCG in her blood. B) Advise her that symptoms will definitely worsen as the pregnancy progresses. C) Inform the patient that nausea and vomiting are not normal during the 10th week of pregnancy, and should normally manifest around the second month of pregnancy. D) Inform the patient that her symptoms will not stop, and that she has to take anti-emetics for the whole duration of her pregnancy.

Answer 73

A) Advise her that the GI symptoms will abate after the first trimester, correlating with the levels of beta HCG in her blood. Rationale: Nausea and vomiting during pregnancy, often referred to as morning sickness, typically peak in the first trimester and tend to decrease as levels of beta-HCG stabilize or decline after the first trimester.

Question 74

88. A 28-year-old G2P1 (1001) came to your clinic due to missed menses. Pregnancy test is positive. She could not recall her last menstrual period because she has been experiencing irregular cycles since her last pregnancy. You did a pelvic exam and noted that the uterus was enlarged, with the fundus reaching the level of the umbilicus. What is the approximate age of gestation for this patient's pregnancy? A) 12 weeks AOG B) 16 weeks AOG C) 32 weeks AOG D) 20 weeks AOG

Answer 74

D) 20 weeks AOG Rationale: When the fundus of the uterus reaches the level of the umbilicus, it typically indicates an approximate gestational age of 20 weeks. 12 weeks after LMP – Above pubic symphysis 16 weeks – Halfway between pubic symphysis and umbilicus 20 weeks – At the level of umbilicus 36 weeks – Fundus is just below ensiform cartilage

Question 75

89. You are to perform an internal pelvic examination on patient GH who is on her 37th week of pregnancy. Your findings will include the following except: A) 3cm dilated B) 80% effaced C) Intact bag of water D) Floating station E) Adequate pelvis F) All of these findings are included G) None of the above findings

Answer 75

F) All of these findings are included

Question 76

90. What is the fetal presentation if the sacrum is the fetal part palpated on internal exam? A) Shoulder presentation B) Breech C) Sinciput presentation D) Face presentation

Answer 76

B) Breech Rationale: If the sacrum is palpated during an internal exam, it indicates a breech presentation, where the buttocks or feet of the fetus are positioned to enter the birth canal first.

Question 77

91. Patient CD is currently on her 16th week of pregnancy. During abdominal examination, you expect to palpate the fundus: A) Midway between the symphysis pubis & umbilicus B) Below the symphysis pubis C) At the level of the symphysis pubis D) At the level of the umbilicus

Answer 77

A) Midway between the symphysis pubis & umbilicus Rationale: At 16 weeks AOG, the fundus is typically palpated midway between the symphysis pubis and the umbilicus. 12 weeks after LMP – Above pubic symphysis 16 weeks – Halfway between pubic symphysis and umbilicus 20 weeks – At the level of umbilicus 36 weeks – Fundus is just below ensiform cartilage

Question 78

93. A 28-year-old G2P1 (1001) came to your clinic due to missed menses. Pregnancy test is positive. She could not recall her last menstrual period because she has been experiencing irregular cycles since her last pregnancy. You did a pelvic exam and noted that the uterus was enlarged, with the fundus reaching the level of the umbilicus. What is the approximate fundic height for this patient? A) 30 cms B) 15 cms C) 20 cms D) 28 cms

Answer 78

C) 20 cms Rationale: The fundal height, when the uterus reaches the level of the umbilicus, typically corresponds to approximately 20 centimeters, which is indicative of around 20 weeks of gestation.

Question 79

94. A 33-year-old primigravid patient came to the ER because of labor pains. You noted the following findings: LM1 breech, LM2 fetal back left, LM3 cephalic, LM4 unengaged, fetal head flexed; on internal exam, you noted that the ischial spines prominent and the pelvic sidewalls are convergent. The bituberous diameter measures 9cm. What is the fetal presentation? A) Longitudinal B) Transverse C) Cephalic D) Breech E) Shoulder

Answer 79

C) Cephalic LM1: Breech identified at the fundus. LM2: Fetal back located on the left. LM3: Cephalic part found low in the pelvis. LM4: Head is unengaged, yet flexed. LM 1 & 3 = Mom's Head LM 2 & 4 = Mom's Feet

Question 80

95. A 32-year-old primigravid, 32 weeks AOG, came to the clinic for prenatal check-up. On history taking, you noted her quickening at 18 weeks AOG. On abdominal exam, LM1 cannot be determined, LM2 ballotable firm mass felt at the maternal right, irregular, nodular doughy mass felt at the maternal left, LM3 and LM4 cannot be determined. What is the fetal lie? A) Cephalic B) Breech C) Transverse D) Oblique E) Longitudinal

Answer 80

C) Transverse LM1 (Leopold’s First Maneuver): cannot be determined, suggesting difficulty in identifying the fundal content, possibly due to the position or the presentation of the fetus. LM2 (Leopold’s Second Maneuver): a ballotable firm mass is felt at the maternal right, which likely indicates the fetal back or a part that is hard and rounded, such as a head or buttocks. Irregular, nodular doughy mass felt at the maternal left: This likely represents the fetal limbs or other smaller, irregularly shaped parts of the fetus. LM3 and LM4 (Leopold’s Third and Fourth Maneuver): cannot be determined, adding to the difficulty in identifying the lower part of the uterus and the presenting part at the pelvic inlet.

Question 81

96. The perineal body is the site of convergence and interlacing of fibers of the following muscles which include/s: A) Bulbospongiosus B) External anal sphincter C) Superficial and deep perineal muscles D) All of the above

Answer 81

D) All of the above Rationale: The perineal body is a structure in the perineum where the fibers of the bulbospongiosus, external anal sphincter, and superficial and deep perineal muscles interlace and converge, providing structural support to the pelvic floor.

Question 82

97. During the proliferative phase of the menstrual cycle, the functional layer of the endometrium undergoes which of the following changes? A) Blood vessels become ischemic B) The epithelium is renewed C) The stroma swells because of edema D) Glands become coiled E) The stratum basale breaks down

Answer 82

B) The epithelium is renewed Rationale: During the proliferative phase of the menstrual cycle, the functional layer of the endometrium undergoes regeneration and thickening, primarily through the renewal of the surface epithelium and proliferation of the glands and stromal cells.

Question 83

98. True about the pudendal nerve: A) It enters the Alcock canal at the lesser sciatic notch, superior to the ischial spine B) Pudendal nerve block can provide adequate analgesia even in cases of extensive obstetrical manipulation during delivery C) Its branches include: inferior rectal nerve, nerve to the clitoris and perineal nerve D) All of the above

Answer 83

D) All of the above Rationale: The pudendal nerve does enter the Alcock canal at the lesser sciatic notch above the ischial spine. It provides sensory and motor innervation to the perineum, and its block can offer sufficient analgesia during obstetrical procedures. Its branches include the inferior rectal nerve, the nerve to the clitoris, and the perineal nerve.

Question 84

99. What Leopold's maneuver will aid you in locating the fetal heartbeat? A) Fundal grip B) Pelvic grip C) Pawlik's grip D) Umbilical grip

Answer 84

D) Umbilical grip Rationale: The umbilical grip (the third Leopold maneuver) helps in locating the fetal back and, subsequently, the fetal heartbeat. This maneuver involves palpating the uterus at the level of the umbilicus to feel for the back or limbs of the fetus, which aids in placing the stethoscope correctly.

Question 85

100. What is the normal position of the uterus? A) Anteversion and anteflexion B) Retroversion and retroflexion C) Anteversion only D) Retroversion only

Answer 85

A) Anteversion and anteflexion Rationale: The normal position of the uterus is typically described as anteverted and anteflexed. Anteversion refers to the forward tilt of the uterus towards the bladder, and anteflexion describes the forward bending of the uterus at the cervix.

Question 86

101. Which of the following gonadotropins is correctly associated with the structures in the ovary? A) FSH stimulates the primordial follicles to develop B) LH stimulates proliferation of the granulosa layer of cells in the multilaminar primary follicle C) LH inhibits the production of estrogen in the corpus luteum D) FSH stimulates proliferation of the follicular cells in the granulosa layer of the secondary follicle

Answer 86

D) FSH stimulates proliferation of the follicular cells in the granulosa layer of the secondary follicle Rationale: FSH (Follicle-stimulating hormone) primarily stimulates the growth and development of the ovarian follicles. In the secondary follicle, FSH promotes the proliferation of follicular cells in the granulosa layer, leading to estrogen production and follicle maturation.

Question 87

36. The transition from the embryonic period to the fetal period begins at: A) 8 weeks after the 1st day of the last menstrual period B) 8 weeks after fertilization C) 10 weeks after fertilization D) 12 weeks after the 1st day of the last menstrual period

Answer 87

A) 8 weeks after the 1st day of the last menstrual period Rationale: The transition from the embryonic period to the fetal period typically occurs at 8 weeks from the first day of the last menstrual period (LMP), which is approximately 6 weeks after fertilization. This marks the completion of major organ development and the beginning of the fetal stage.

Question 88

37. Limb buds are present A) 4th week after ovulation B) 6th week after ovulation C) 8th week after ovulation D) 10th week after ovulation

Answer 88

A) 4th week after ovulation Rationale: According to the description provided, arm and leg buds appear around the 4th week after ovulation, marking an early stage of limb development.

Question 89

38. Heart is completely formed A) 4th week after ovulation B) 6th week after ovulation C) 8th week after ovulation D) 10th week after ovulation

Answer 89

B) 6th week after ovulation Rationale: By the 6th week after ovulation, the heart is fully formed. This stage is crucial as it is when the heartbeat can first be detected by ultrasound, usually around the 6th gestational week.

Question 90

39. The canalicular period of lung development, during which bronchi and bronchioles enlarge and alveolar ducts develop, is nearly completed. A) 20 weeks B) 24 weeks C) 28 weeks D) 32 weeks

Answer 90

B) 24 weeks Rationale: By 24 weeks, the canalicular phase of lung development is nearly completed, making it a critical period for lung maturation that supports the viability of the fetus outside the womb.

Question 91

40. This fetus has a 90% chance of survival without physical or neurological impairment. A) 20 weeks B) 24 weeks C) 28 weeks D) 32 weeks

Answer 91

C) 28 weeks Rationale: By 28 weeks, significant developments in fetal maturation, including lung development, increase the likelihood of survival without major impairments to 90%.

Question 92

41. In the fetal skull, what is the greatest transverse diameter which is significant clinically during labor monitoring? A) Occipitofrontal diameter B) Biparietal diameter C) Bitemporal diameter D) Suboccipitobregmatic diameter

Answer 92

B) Biparietal diameter Rationale: The biparietal diameter is clinically significant as it is the largest transverse diameter of the fetal skull and a critical measurement for assessing whether the fetal head can pass through the mother's pelvis during labor. 1. **Bitemporal (8.0 cm)** – the greatest distance between the two temporal sutures. 2. **Biparietal (9.5 cm)** – the greatest transverse diameter of the head, which extends from one parietal boss to the other. 3. **Suboccipitobregmatic (9.5 cm)** – from the middle of the large fontanel to the undersurface of the occipital bone. 4. **Occipitofrontal (11.5 cm)** – root of the nose to the most prominent portion of the occipital bone. 5. **Occipitomental (12.5 cm)** – from the chin to the most prominent portion of the occiput.

Question 93

42. Fetal blood is first produced in the yolk sac. Eventually moves to the liver then to the bone marrow. What type of hemoglobin is produced in the bone marrow? A) Gower 1 B) Gower 2 C) Hgb A D) Hgb F

Answer 93

C) Hgb A

Question 94

43. Amniotic formation starts at 12 weeks and peaks at what age of gestation? A) 24 weeks B) 28 weeks C) 30 weeks D) 34 weeks

Answer 94

C) 30 weeks Rationale: While the document doesn't explicitly mention the peak, the description indicates that amniotic fluid continues to increase throughout the second trimester, making it reasonable to infer that the peak occurs around 30 weeks before it begins to decline towards term.

Question 95

44. Which among the immunoglobulins crosses the placenta? A) IgA B) IgE C) IgG D) IgM

Answer 95

C) IgG Rationale: Immunoglobulin G (IgG) is the only class of immunoglobulin that can cross the placenta. This transfer provides the newborn with passive immunity to infections that the mother has antibodies against.

Question 96

45. At what age of gestation does swallowing begin? A) 8-10 weeks B) 10-12 weeks C) 12-14 weeks D) 14-16 weeks

Answer 96

B) 10-12 weeks Rationale: Swallowing begins at 10 to 12 weeks of gestation. This early gastrointestinal activity plays a role in the regulation of amniotic fluid volume and is crucial for fetal development.

Question 97

46. In cases of Gestational Diabetes or Diabetes Mellitus in pregnancy, what leads to the development of Fetal Macrosomia? A) Fetal hyperinsulinemia B) Maternal hyperinsulinemia C) Fetal hypoglycemia D) Maternal hypoglycemia

Answer 97

A) Fetal hyperinsulinemia Rationale: In gestational diabetes or diabetes mellitus during pregnancy, high maternal blood glucose levels lead to increased glucose transfer to the fetus, stimulating the fetal pancreas to produce more insulin (fetal hyperinsulinemia). This results in accelerated fetal growth and may lead to macrosomia (a larger than normal baby).

Question 98

47. What is the greatest circumference of the head, which is too large to fit into the pelvis without flexion? A) Occipitofrontal diameter B) Suboccipitobregmatic diameter C) Occipitomental diameter D) Bitemporal diameter

Answer 98

C) Occipitomental diameter Explanation: The occipitomental diameter is the largest diameter of the fetal head, measuring from the back of the occiput to the chin (mentum). This diameter typically ranges around 13.5 cm and requires significant flexion of the fetal head to navigate through the maternal pelvis during childbirth. If the head were in an occipitomental position (face presenting), this would usually necessitate a cesarean delivery due to the difficulty in fitting this diameter through the pelvis naturally.

Question 99

48. True or False: There is a direct communication between fetal and maternal blood? A) True B) False

Answer 99

B) False Explanation: There is no direct communication between fetal and maternal blood. Instead, their blood supplies are separated by the placental barrier, which allows the exchange of nutrients, gases, and waste products via diffusion and active transport mechanisms but prevents direct blood mixing.

Question 100

49. True or False? Intervillous space is the secondary unit of maternal-fetal transfer A) True B) False

Answer 100

B) False Explanation: The intervillous space is not a "secondary" unit but a primary site of maternal-fetal exchange. It is filled with maternal blood, which bathes the chorionic villi containing the fetal capillaries, facilitating the transfer of oxygen, nutrients, and waste between the mother and the fetus.

Question 101

50. True or False: Placenta is the organ of transfer between mother and fetus A) True B) False

Answer 101

A) True Explanation: The placenta is indeed the organ responsible for the transfer of nutrients, gases, and waste between the maternal and fetal circulations. It also plays crucial roles in hormone production that support pregnancy.

Question 102

51. True or False. Bidirectional transfer happens through the syncytiotrophoblast A) True B) False

Answer 102

A) True Explanation: The syncytiotrophoblast, a layer of the placenta, facilitates the bidirectional transfer of nutrients and gases between the maternal and fetal blood. It acts as a selective barrier, allowing certain substances to pass while blocking others, and is involved in both the uptake of maternal nutrients and the release of fetal waste products.

Question 103

52. True or False: Nutrition from the mother to the fetus enters the intervillous space A) True B) False

Answer 103

A) True Explanation: Nutrition from the mother is delivered to the fetus through the maternal blood that enters the intervillous space of the placenta. Here, the nutrients are transferred from the maternal blood into the fetal blood via the chorionic villi, which contain the fetal capillaries.

Question 104

53. The first hemopoiesis is first demonstrated in the yolk sac and finally by? A) gestational sac B) liver C) bone marrow D) None of the above

Answer 104

C) bone marrow Explanation: Hemopoiesis (the formation of blood cellular components) initially occurs in the yolk sac, then progresses to the liver and spleen during fetal development, and is finally taken over by the bone marrow. This transition to bone marrow occurs late in fetal development and continues throughout life.

Question 105

54. When erythropoiesis moves into the liver, these hemoglobins are formed: A) Hgb Gower 1 B) Hgb Gower 2 C) Hgb Portland D) Hgb F

Answer 105

D) Hgb F Explanation: When erythropoiesis (the production of red blood cells) moves into the liver, Hemoglobin F (fetal hemoglobin) is predominantly formed. Hemoglobin F has a higher affinity for oxygen than the adult form (Hemoglobin A), which is crucial for efficient oxygen transfer from the mother to the fetus.

Question 105

55. This hormone stimulates the colonic smooth muscle to contract, which results in intramnionic defecation: A) HCG B) Vasopressin C) Estrogen D) Progesterone

Answer 105

B) Vasopressin Explanation: Vasopressin, also known as antidiuretic hormone (ADH), can stimulate smooth muscle contraction, including in the gastrointestinal tract. While its primary role is in water reabsorption in the kidneys, it can affect other smooth muscles. However, the term "intramnionic defecation" seems incorrect or misstated, as fetuses do not defecate in utero under normal conditions; they release meconium into the amniotic fluid typically near or during birth, which is not influenced directly by vasopressin. This description might be a misinterpretation or typo in the context provided.

Question 106

56. Fetal kidneys start urine production A) 10-12 weeks B) 18 weeks C) 32-34 weeks D) 37-40 weeks

Answer 106

A) 10-12 weeks Explanation: Fetal kidneys begin producing urine at around 12 weeks of gestation. This urine production is crucial for the formation and maintenance of amniotic fluid, which plays a key role in fetal development.

Question 107

57. Increase in urine production by 7-14 ml/day A) 10-12 weeks B) 18 weeks C) 32-34 weeks D) 37-40 weeks

Answer 107

B) 18 weeks Explanation: By 18 weeks of gestation, the fetal kidneys are producing 7 to 14 mL per day. This significant increase is part of the normal development and function of the fetal renal system.

Question 108

58. Peak of urine production A) 10-12 weeks B) 18 weeks C) 32-34 weeks D) 37-40 weeks

Answer 108

C) 32-34 weeks Explanation: The peak of fetal urine production occurs around 32-34 weeks. At this stage, urine production reaches its maximum, contributing significantly to the volume of amniotic fluid. Following this peak, there is a gradual decline, returning to a steady state by around 33 weeks, and then it starts to decline by 36 weeks.

Question 109

59. Alveolar stage of development A) 10-12 weeks B) 18 weeks C) 32-34 weeks D) 37-40 weeks

Answer 109

C) 32-34 weeks The alveolar stage of lung development in a fetus begins around 32-34 weeks of gestation. During this stage, the alveoli, which are the tiny air sacs responsible for gas exchange in the lungs, start to form. This stage is crucial for the development of a functional respiratory system and continues to develop into childhood, significantly increasing the number of alveoli.

Question 110

60. Canalicular stage of lung development A) 10-12 weeks B) 18 weeks C) 32-34 weeks D) 37-40 weeks

Answer 110

B) 18 weeks Explanation: The canalicular stage occurs roughly between the 16th and 25th weeks of gestation. This stage is critical for the development of the lung structure necessary for gas exchange, with significant growth in the bronchial architecture and the beginning of surfactant production by type II pneumocytes. The midpoint of this range, around 18 weeks, represents a significant period during this stage.

Question 111

61. Lifespan of fetal erythrocytes lengthens to 90 days A) 10-12 weeks B) 18 weeks C) 32-34 weeks D) 37-40 weeks

Answer 111

D) 37-40 weeks Explanation: The lifespan of fetal erythrocytes increases to approximately 90 days by term. Initially, fetal red blood cells have a shorter lifespan, but as the fetus approaches term, the lifespan extends, coinciding with changes in hemoglobin type and overall maturity of the hematopoietic system.

Question 112

62. Fetal thyroid can concentrate iodide: A) 10-12 weeks B) 18 weeks C) 32-34 weeks D) 37-40 weeks

Answer 112

A) 10-12 weeks Explanation: The fetal thyroid gland starts to concentrate iodide and synthesize thyroid hormones such as thyroxine by 10-12 weeks of gestation. This early functionality is part of the development of the pituitary-thyroid system, which is functional by the end of the first trimester. The capacity to concentrate iodide more avidly than the maternal thyroid by 12 weeks demonstrates the early functional independence of the fetal thyroid gland in terms of iodide handling and hormone production.

Question 113

63. Without prophylactic treatment of Vitamin K to the newborn, this coagulation factor will decrease: A) Factor I B) Factor VII C) Factor VIII D) Factor XII

Answer 113

B) Factor VII Explanation: Vitamin K is essential for the carboxylation and activation of several clotting factors, including Factor II (prothrombin), VII, IX, and X. Factor VII has one of the shortest half-lives among these and is typically the first to become deficient in Vitamin K deficiency, leading to an increased risk of bleeding in newborns who do not receive prophylactic Vitamin K.

Question 114

64. Which of the following is true about the placenta? A) Placenta serves as fetal lung B) Fetal blood has more affinity for CO2 than maternal blood C) Placenta is non-permeable to CO2 D) Transfer of O2 across the placenta is not limited by blood flow

Answer 114

A) Placenta serves as fetal lung Explanation: The placenta functions similarly to the lungs for the fetus, as it is responsible for the exchange of gases (oxygen and carbon dioxide) between the maternal and fetal bloodstreams. It also plays roles akin to other organs, such as the kidney and gastrointestinal system, by facilitating the transfer of nutrients and the excretion of waste products.

Question 115

65. Mullerian duct regression is completed by which Age of Gestation (AOG)? A) 4-6 weeks B) 5-7 weeks C) 6-8 weeks D) 9-10 weeks

Answer 115

D) 9-10 weeks Explanation: Müllerian duct regression, induced by the secretion of Anti-Müllerian Hormone (AMH) from the fetal testes in male embryos, is completed by around 9 to 10 weeks of gestation. This process leads to the degeneration of the Müllerian ducts, which would otherwise develop into female reproductive structures.

Question 116

66. By 8 weeks, glucagon can be identified in the fetal pancreas. By which age of gestation can insulin be detected in fetal plasma? A) 9 weeks B) 10 weeks C) 11 weeks D) 12 weeks

Answer 116

D) 12 weeks Explanation: Insulin, produced by the beta cells of the pancreas, can be identified in the fetal pancreas around 9 to 10 weeks of gestation. However, it becomes detectable in the fetal plasma by 12 weeks. This hormone plays a crucial role in fetal growth and metabolism.

Question 117

67. Which of the following immunoglobulins that can be ingested from colostrum provides mucosal protection against enteric infections? A) IgA B) IgG C) IgE D) IgM

Answer 117

A) IgA Explanation: Immunoglobulin A (IgA) is the primary immunoglobulin found in colostrum and provides essential protection against pathogens at mucosal surfaces. It is critical for defending the infant against enteric infections during the early postnatal period.

Question 118

68. A 21 y/o patient came in at the clinic with a chief complaint of no menstrual cycle or menarche. On examination, the patient has a blind pouch as a vagina, no pubic hair, and no axillary hair. On further investigation, the karyotype showed 46 XY; ultrasound revealed the absence of uterus, cervix, and fallopian tubes. This patient most likely has: A) True hermaphroditism B) Androgen insensitivity syndrome C) Congenital adrenal hyperplasia D) Klinefelter syndrome

Answer 118

B) Androgen Insensitivity Syndrome Explanation: Androgen insensitivity syndrome (AIS) is characterized by the presence of a 46 XY karyotype in individuals who have external female genitalia but are genetically male. These individuals typically present with primary amenorrhea, normal breast development, and absent or sparse pubic and axillary hair due to the body's inability to respond to androgens. The absence of internal female reproductive organs such as the uterus and fallopian tubes is also indicative of AIS.

Question 119

69. AB, a 28 y/o G1P0 who cannot remember her LMP, came for prenatal consultation. She brought with her a transvaginal ultrasound done November 17, 2021, which revealed an intrauterine pregnancy 10 weeks AOG. A plausible expectation in this case is: A) Patient should have felt quickening a month ago B) Age of gestation of this patient is 15 weeks C) EDD is on September 24, 2022 D) Fundic height could be 25 cm

Answer 119

C) EDD is on September 24, 2022 Explanation: Calculating from the ultrasound date (November 17, 2021) when the pregnancy was measured at 10 weeks, you can estimate the due date by adding 30 weeks to this date, which indeed points around September 24, 2022. This assumes a typical gestation period of 40 weeks from the last menstrual period.

Question 120

70. CD, 39 y/o primigravid at her 14 weeks amenorrhea, came for prenatal today. She is anxious that her baby may be abnormal. The most appropriate action to ease her anxiety is: A) Refer for abortion B) Do a quad screen at 3rd trimester C) Offer a congenital anomaly scan at 18-22 weeks D) Prepare her emotionally

Answer 120

C) Offer a congenital anomaly scan at 18-22 weeks Explanation: A congenital anomaly scan, typically performed between 18 and 22 weeks of gestation, is designed to check for structural abnormalities in the fetus. This would be an appropriate and direct way to address her concerns about fetal abnormalities, as it provides concrete information about the baby’s health.

Question 121

71. In order to decrease fetal neural tube defects in a nulligravid planning to start a family, folic acid must be taken during: A) 3-4 months before conception B) 3rd trimester C) 2nd trimester D) 1st trimester

Answer 121

A) 3-4 months before conception Explanation: Folic acid is crucial for reducing the risk of neural tube defects in the developing fetus. It is recommended to start taking folic acid at least 3 to 4 months before conception and continue through the first trimester to ensure adequate folate levels during the critical early stages of neural development.

Question 122

72. When oligohydramnios is present, the most common condition causing it is: A) Renal agenesis B) Fetal CNS abnormality C) Rupture of membranes D) Postmaturity

Answer 122

A) Renal agenesis Explanation: Oligohydramnios, or low amniotic fluid, can be caused by several conditions, but renal agenesis (the absence of one or both kidneys at birth) is a significant cause. Without functioning kidneys, the fetus produces little to no urine, leading to reduced amniotic fluid volume since fetal urine is a major component of amniotic fluid during pregnancy.

Question 123

73. Initial prenatal visit should elicit most importantly the following: A) uterine abnormality B) baseline blood pressure C) assignment of age of gestation D) placental localization

Answer 123

C) assignment of age of gestation Explanation: Determining the accurate age of gestation during the initial prenatal visit is crucial for establishing an expected due date (EDD), which guides the timing of future prenatal tests, screens for gestational age-related risks, and plans for delivery. While assessing baseline health markers like blood pressure is also important, accurate dating of the pregnancy is fundamental for effective prenatal care.

Question 124

74. Initial testing or laboratory requests to unmask asymptomatic disease include: A) Rubella IgG titers B) Urine C&S C) AntiHepatitis B Surface Antigen D) Pelvic ultrasound

Answer 124

B) Urine C&S A) Rubella IgG titers Explanation: Initial prenatal testing often includes screening for Rubella immunity (through IgG titers) to determine a woman's susceptibility to rubella, which can severely affect fetal development if contracted during pregnancy. Testing for asymptomatic urinary infections and hepatitis B are also common, but establishing rubella immunity is critical for preventive health measures during pregnancy.

Question 125

75. FG, a 21-year-old G1P0 at her 34 weeks of age of gestation, came for a prenatal check-up. She complained of nausea and vomiting, especially after eating. Advice should include: A) Take ginger and candies with meals B) Assume an upright position for at least 40 minutes after meals C) Stop hematinics, milk, and vitamin B D) Intake more fluids

Answer 125

A) Take ginger and candies with meals

Question 126

76. Internal examination should be done on: A) Every prenatal check-up B) 2nd Trimester in patients with complaints of hypogastric pain C) 3rd Trimester patients with chief complaints of vaginal bleeding D) On the first prenatal check-up

Answer 126

B) 2nd Trimester in patients with complaints of hypogastric pain C) 3rd Trimester patients with chief complaints of vaginal bleeding Explanation: An internal examination is warranted in the third trimester if there are specific indications such as vaginal bleeding, which could signify placental issues or other complications that need urgent evaluation. Routine internal exams at every prenatal visit are not recommended as they can increase the risk of introducing infections and are generally unnecessary unless indicated by specific symptoms or concerns.

Question 127

77. HI, a 42-year-old G1P0, presented for prenatal care for the first time. Most importantly, a first-trimester ultrasound is warranted to assess: A) Fetal congenital anomalies B) Fetal aging by Crown-Rump Length (CRL) C) Placental position D) Amniotic fluid volume

Answer 127

B) Fetal aging by Crown-Rump Length (CRL) Explanation: In the first trimester, the most critical use of an ultrasound is to establish accurate gestational dating by measuring the crown-rump length (CRL) of the fetus. This measurement is the most reliable in the first trimester and provides essential information for calculating the due date, especially important in older mothers who may have increased risks associated with pregnancy.

Question 128

78. Tdap is given to all pregnant women: A) 3 times during the entire pregnancy B) Between 28-37 weeks C) Only when delivery is expected to be in a lying-in clinic D) Anytime

Answer 128

B) 28-37W Rationale: The Tdap vaccine (tetanus, diphtheria, and acellular pertussis) is recommended for all pregnant women to protect both the mother and the newborn from pertussis (whooping cough), as well as tetanus and diphtheria. The optimal time for administration is between 27 and 36 weeks of gestation. This timing ensures that the mother has enough time to develop antibodies to the pertussis bacterium and pass them to the fetus, which provides the newborn with passive immunity during the first few months of life when the baby is most vulnerable. The guideline specifically mentions giving one dose of Tdap during each pregnancy within this timeframe, aligning best with option B (28-37 weeks).

Question 129

79. Vaccines contraindicated during pregnancy include: A) Hepatitis B B) MMR C) Hepatitis C D) Inactivated Influenza

Answer 129

B) MMR Explanation: The MMR vaccine, which protects against measles, mumps, and rubella, is contraindicated during pregnancy because it contains live, attenuated viruses which pose a theoretical risk to the fetus. Pregnant women should wait to receive the vaccine until after they have given birth.

Question 130

80. The most important determinant of appropriate care in pregnancy is the: A) Maternal Health B) Fetal Health C) Gestational Age D) Estimated Fetal Weight

Answer 130

C) Gestational Age Explanation: Gestational age is crucial as it guides the management and monitoring of the pregnancy, determining the timing of prenatal tests, interventions, and the expected date of delivery. It helps in assessing the growth and development of the fetus at appropriate pregnancy stages.

Question 131

81. If we are confined to a single ultrasound to be done in a pregnancy, it is best done on: A) 18-22 weeks B) 10-14 weeks C) 39-41 weeks D) 37 weeks

Answer 131

A) 18-22 weeks Explanation: An ultrasound performed between 18-22 weeks, often called the "anatomy scan," is crucial for assessing fetal anatomy for abnormalities, verifying gestational age, evaluating the placenta, and confirming the number of fetuses. This period provides optimal visualization of fetal structures for assessment of normal development and detection of potential anomalies.

Question 132

82. JK, a 24-year-old primigravid, consulted at the OPD due to missed menses. Pregnancy test is positive. She could not recall her last menstrual period because she has been experiencing irregular cycles since her teenage years. You did a pelvic exam and noted that the cervix was soft, and uterus was enlarged, reaching halfway between the symphysis pubis and the umbilicus. What is the approximate age of gestation in weeks for this patient's pregnancy? A) 20 B) 16 C) 32 D) 12

Answer 132

B) 16 Explanation: The description of the uterus size, reaching halfway between the pubis and the umbilicus, typically corresponds to about 16 weeks of gestation. This is a common clinical sign used to estimate gestational age, especially when the menstrual history is unclear or unreliable.

Question 133

83. What structure constricts or collapses after birth? A) Umbilical vessels B) Ductus venosus C) Foramen ovale D) All of the above

Answer 133

D) All of the above Explanation: After birth, several fetal circulatory structures undergo functional closure: Umbilical vessels constrict to stop blood flow from the placenta. Ductus venosus closes, which shunted blood from the umbilical vein directly to the inferior vena cava during fetal life. Foramen ovale closes as the blood pressure in the left atrium exceeds that in the right, promoting normal adult circulation. These changes are crucial for the transition from fetal to neonatal circulation.

Question 134

84. This is a presumptive sign of pregnancy, whereby vaginal mucosa becomes congested and violaceous to bluish in color A) Goodell's sign B) Hegar's sign C) Chadwick's sign D) Spalding sign

Answer 134

C) Chadwick's sign Explanation: Chadwick's sign is a presumptive sign of pregnancy that involves a change in the color of the vaginal mucosa to a deep violet or bluish hue, usually evident from about 6-8 weeks of gestation. This color change is caused by increased vascularity and blood flow in the area as part of the physiological changes during pregnancy.

Question 135

85. This is a probable sign of pregnancy characterized by the softening of the uterus isthmus, resulting in its compressibility on bimanual examination A) Spalding sign B) Goodell's sign C) Hegar sign D) Chadwick sign

Answer 135

C) Hegar sign Explanation: Hegar's sign is a probable sign of pregnancy involving the softening of the lower uterine segment, or isthmus, which can be detected through bimanual examination. This sign typically appears around 6-8 weeks of gestation and is indicative of the changes the uterus undergoes to prepare for the growing fetus.

Question 136

86. This is a probable sign of pregnancy characterized by cyanosis and softening of the cervix due to increased vascularity of the cervical tissue A) Hegar sign B) Spalding sign C) Goodell's sign D) Chadwick sign

Answer 136

C) Goodell's sign Explanation: Goodell's sign is a probable sign of pregnancy that includes the softening of the cervical tip associated with increased vascularity and resultant cyanosis of the cervix. It typically occurs around the fourth to fifth week of pregnancy and is part of the body's adaptation to accommodate a developing pregnancy.

Question 137

87. OP, a 32-year-old G3P2 (2002), on her 30th week of gestation computed her last menstrual period, came to your clinic for her first prenatal checkup. Her fundic height was noted to be 25 cm. What is the next best step in management of this patient? A) Request for an ultrasound to determine or confirm age of gestation, or detect any fetal compromise B) Inform the patient that her correct age of gestation is 25 weeks and not 30 weeks C) Reassure patient that it is a normal finding, and she could come back after 1 month for her regular prenatal checkup D) Advise the patient to start taking protein supplements in order for the baby to catch up in size

Answer 137

A) Request for an ultrasound to determine or confirm age of gestation, or detect any fetal compromise Explanation: The discrepancy between the gestational age based on the last menstrual period (30 weeks) and the fundic height (25 cm) suggests the need for an ultrasound to confirm gestational age, assess fetal growth, and rule out any issues such as fetal growth restriction or oligohydramnios.

Question 138

88. QR, a 17-year-old female student, accompanied by her mother, came to the ER complaining of nausea and vomiting. On history, you found that her last normal menstrual period was 7 weeks ago. She refuses internal exam. What would you do first? A) Do a pregnancy test B) Give the patient antibiotics for her gastroenteritis C) Give the patient progesterone to induce menses D) Give the patient anti-emetics, then send her home

Answer 138

A) Do a pregnancy test Explanation: Given the recent history of a missed period and symptoms of nausea and vomiting, the first step would be to conduct a pregnancy test to confirm or rule out pregnancy as the cause of her symptoms. This is a non-invasive and straightforward approach to begin her evaluation.

Question 139

89. TS, a 24-year-old primigravid, on her 10th week age of gestation, is worried about her severe GI symptoms like nausea and vomiting and asked you if her symptoms will ever stop. How would you counsel your patient? A) Advise her that symptoms will definitely worsen as the pregnancy progresses since this is her first pregnancy B) Advise her that the GI symptoms will abate after the first trimester, correlating with the levels of beta HCG in her blood C) Inform the patient that nausea and vomiting are not normal during the 12th week of pregnancy and should normally manifest around the second month of pregnancy D) Inform the patient that her symptoms will not stop, and that she has to take antiemetics for the whole duration of pregnancy

Answer 139

B) Advise her that the GI symptoms will abate after the first trimester, correlating with the levels of beta HCG in her blood Explanation: Nausea and vomiting in pregnancy, commonly known as morning sickness, typically peak during the first trimester and often improve significantly or resolve by the end of the first trimester as beta HCG levels begin to stabilize or decrease.

Question 140

90. UV, a 28-year-old primigravid, came to the OPD, 10-11 weeks age of gestation, and very anxious about her baby's well-being. She worries why she hasn't felt any fetal movements so far. She has no vaginal bleeding nor abdominal pain. How could you counsel this patient? A) Inform the patient this is abnormal, and that the baby might probably be dead B) Advise this patient to undergo ultrasound as soon as possible to confirm fetal status C) Use your stethoscope to detect any fetal heartbeat and to confirm fetal status D) Reassure the patient and advise her that quickening does not happen until at least 4-5 months age of gestation

Answer 140

D) Reassure the patient and advise her that quickening does not happen until at least 4-5 months age of gestation Explanation: Fetal movements, or "quickening," are typically felt by first-time mothers between 18-22 weeks of gestation (about 4-5 months). Reassuring the patient that not feeling movements at 10-11 weeks is completely normal and expected can help alleviate her anxiety.

Question 141

91. Came to the clinic complaining of irregular contractions, she is on her 30th weeks age of gestation. She notes that her contractions usually increase in frequency when her uterus is massaged or stimulated and abate when she rests. Internal exam revealed a closed, uneffaced cervix. How would you counsel the patient? A) Admit the patient and start intravenous tocolytics because she is definitely in preterm labor B) Reassure the patient that she might just be experiencing Braxton-Hicks contractions, which are normally felt starting at 28 weeks age of gestation C) Give oral tocolytics for 1 month D) Put the patient on complete bed rest until she delivers

Answer 141

B) Reassure the patient that she might just be experiencing Braxton-Hicks contractions, which are normally felt starting at 28 weeks age of gestation Explanation: Braxton-Hicks contractions are common in the third trimester. They are typically irregular, non-painful, and often stop with rest or changes in activity. Since the internal examination shows a closed, uneffaced cervix, this further supports that these are likely Braxton-Hicks contractions and not true labor.

Question 142

92. The beaded cellular pattern of the cervical mucus of a pregnant patient is due to which hormone? A) Progesterone B) Estrogen C) bHCG D) Luteinizing hormone

Answer 142

A) Progesterone Explanation: Progesterone is known to influence the consistency and character of cervical mucus during pregnancy. It thickens the mucus, which can lead to a beaded appearance under microscopic examination. This hormone helps in maintaining pregnancy and changes the characteristics of cervical mucus to prevent the entry of pathogens and additional sperm.

Question 143

93. This is a probable evidence of pregnancy described as the sensation of something hard "bouncing" against the palm of the examiner's hands when the uterus is moved from side to side. A) Outlining of Uterus B) Spalding sign C) Quickening D) Ballotment

Answer 143

D) Ballotment Explanation: Ballottement is a technique used in prenatal examinations where a sharp tap on the cervix during a pelvic exam causes the fetus to rise in the amniotic fluid and then rebound to its original position. It's considered a probable sign of pregnancy, detectable from the second trimester.

Question 144

94. This is the term used for imaginary pregnancy/spurious pregnancy which may happen among women strongly desirous of pregnancy, and where the patient may feel signs and symptoms of pregnancy. A) Pseudocyesis B) PICA C) Heterotypic D) Pseudocyst

Answer 144

A) Pseudocyesis Explanation: Pseudocyesis refers to a false or imagined pregnancy where a woman believes she is pregnant and may even exhibit many of the symptoms and physical changes. This condition can occur in women who intensely desire to be pregnant or fear becoming pregnant.

Question 145

95. A condition where a pregnant woman suffers from an extreme case of nausea and vomiting associated with hyperplacentosis, like multiple pregnancies or molar pregnancy: A) Striae gravidarum B) Hyperemesis gravidarum C) Pseudocyesis D) Braxton Hicks

Answer 145

B) Hyperemesis gravidarum Explanation: Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy that can lead to weight loss, dehydration, and electrolyte imbalances. It is more likely to occur in conditions of high hCG levels, such as with molar pregnancies or multiple gestations, where there is excessive placental tissue or development.

Question 146

96. You instructed your OPD nurse to determine the fetal heart rate of your pregnant patient who came to the OPD for a prenatal check-up. The nurse reported the fetal heart rate to be "80 per minute." How should you interpret this finding? A. Tell the nurse to wheel the patient to the operating room for an emergency cesarean section due to fetal bradycardia. B. This is a normal heart rate. You can proceed with your regular check-up routine. C. Inform the patient that the baby is probably dying. D. Double-check the nurse’s findings by quickly recounting the fetal heart rate. The nurse must have measured the maternal pulse instead.

Answer 146

D. Double-check the nurse’s findings by quickly recounting the fetal heart rate. The nurse must have measured the maternal pulse instead. Explanation: A fetal heart rate of 80 beats per minute is abnormally low, as normal fetal heart rates range from 120 to 160 beats per minute. It's possible that the nurse may have inadvertently measured the maternal pulse rate instead. Verifying the fetal heart rate is crucial to ensure accurate assessment and management.

Question 147

97. What is the function of human chorionic gonadotropin (hCG)? A. Supports fetal implantation. B. Produces estrogen that is important in producing skin changes in pregnancy. C. Supports early pregnancy by preventing involution of the corpus luteum. D. Produces progesterone to support uterine quiescence.

Answer 147

C. Supports early pregnancy by preventing involution of the corpus luteum. Explanation: Human chorionic gonadotropin (hCG) is essential for maintaining early pregnancy by preventing the degeneration of the corpus luteum, thereby ensuring the continued production of progesterone which is vital for sustaining the uterine lining.

Question 148

98. AZ, a 25-year-old primigravid, comes for prenatal care. She does not remember her last normal menstrual period since she has very irregular menstrual cycles. On abdominal exam, the uterus is at the level of the umbilicus. What is the estimated age of gestation in weeks? A. 12 B. 20 C. 30 D. 16

Answer 148

B. 20 Explanation: The uterus typically reaches the level of the umbilicus around 20 weeks of gestation, which serves as a general physical marker for estimating the age of gestation, especially when menstrual history is unclear. 12 weeks after LMP – Above pubic symphysis 16 weeks – Halfway between pubic symphysis and umbilicus 20 weeks – At the level of umbilicus 36 weeks – Fundus is just below ensiform cartilage

Question 149

99. A woman who has delivered only once a fetus or fetuses born alive or dead with an estimated length of gestation of 20 or more weeks. A. Primipara B. Nulligravida C. Multipara D. Nullipara

Answer 149

A. Primipara Explanation: A primipara is a woman who has given birth once with a fetus or fetuses who were born alive or dead at 20 weeks of gestation or later.

Question 150

100. DH, a primigravid 18 weeks AOG, consulted at the OPD for her 2nd prenatal check-up. All laboratory results were unremarkable. The patient was asymptomatic. When will you advise her to follow up? A. At 22 weeks AOG B. At 24 weeks AOG C. At 20 weeks AOG D. At 32 weeks AOG

Answer 150

B. At 24 weeks AOG Explanation: The typical schedule for prenatal visits is monthly until 28 weeks for an uncomplicated pregnancy. Since DH is currently 18 weeks along, scheduling her next appointment in 6 weeks, which would be at 24 weeks AOG, fits within the standard care protocol of monthly visits for this stage of pregnancy. This schedule allows adequate monitoring without unnecessary frequency, as more frequent visits (every two weeks) do not start until 28 weeks. FREQUENCY OF PRENATAL VISIT * Trimester: Divide pregnancy into 3 equal trimesters approximately 3 months or 14 weeks * Frequency of Prenatal Visits: o Monthly = <28 weeks o Every 2 Weeks = 28 to 36 weeks o Weekly = >37 weeks * With complicated pregnancies: Often requires return visits at 1 to 2-week intervals