J FEU NRMF INSTITUTE OF MEDICINE Department of Obstetrics and Gynecology FINAL EXAMINATIONS ~ THIRD YEAR PHYSIOLOGY OBSTETRICS SUBJECT CODE: 342 November 5, 2015 (Thursday; 8:00am - 11:00am) nw INSTRUCTIONS: PLEASE FOLLOW ALL INSTRUCTIONS VERY CAREFULLY. SHADE THE LETTER OF YOUR FINAL ANSWER. CHOOSE ONE FINAL ANSWER ONLY. MORE THAN ONE ANSWER IS CONSIDERED WRONG. STRICTLY NO ERASURES AND ALTERATIONS OF YOUR FINAL ANSWER B 1. A parturient is more than 5 cis dilated and feels pain at (Fgibteaumbical prea 8/10 in severity. What is ‘ST Management? ~ A, Paracervical block B. Give epidural block C. Give spinal block D. Pudendal block C. 2 Aparturient who is fully dilated wif head & station +4 feels 9/10 pain at the vaginal area. NO qualified anesthetist S paseo. What is the BEST thing to do? ‘A Observe B. Give spinal block 127 Administer pudendal block D. Give saddle block ssthesia induction Antacids: Antibiotics ©. Analgesic D. Antipyretics 4. Aparturient is given combined spinal and epidural anesthesia. Seconds later A she had seizures. What is the most likely reason for this? ‘A. Spinal anesthesia B, Epidural anesthesia Both .. None of the above A 3, To mitigate risk in case(6f aspiration, Which should be given shortly before 5. Which of the following if TRUE of intravenous sedatives? cause protongation jf B. safer than regional analgesia C. equally efficacious with regional analgesia in providing pain relief D. readily cross the placenta 6. Non-pharmacological method of pain contro! that helps increase sta endorphins 8 See Lamaze 8, Clic! hypoois D. Deep breathing Note: | THERE MANGE CORRECTIONS ._ + decrease md from obstetri Which of the following should be dong to decrease >picity. rie D - anesine fasting for at least 8 hours B. giving of antiemetic. C, pre-anesthetic fluid hydration ©. Allof the above aoe ? 8 What anatomical structure separates the true pelvis from the false pelvis’ A Linea terminalis “B. Interischial diameter C. Intertuberous diameter D. Greater transverse diameter of the inlet C8 Te steropostenor dame of he pei inlet BEST indicated by this mea agonal conjugate B, True conjugate Z& Obstetric conjugate D. Shape of the pelvic inlet 10. A primigravida, in sarly labor for a full-term fetus, in cephalic presentation had a A reasurement of LL cpa-trom the midposition of the symphysis pubis to the Promontory of thé Sacrum, Is her pelvic inlet clinically adequate? Yes B. No Andra 11. primigravida in her second stage of labor had an ocgiput trans\ 3 hours) On examination, she has prominent ischial’ --r Straight sacrum. Where is the cephajopeluc — \/~ B. Pelvic midplane q PF Pelvic outlet 'D. No cephalo-pelvic disproportion 12.On clinical pelvimetry, the distance between t cm and the posterior sagittal of the outlet was' adequate? A. Yes & No 13. What represents the shortest diameter of the pelvic cavity? (a ‘A. Obstetric conjugate True conjugate Fiinter spinous diameter \ D. Intertuberous diameter i B 14. What type of pelvis is gral enterongstariny, has increased anterior and posterior ‘segments, straight or divergent sidewalls, long and curved pubic arch = slightly ‘arrow sub pubic angie? B. Anthropoid c idee Ai Papaloid CD ischial tuberosities wal? Is the pelvic outietRP an EASTE clinical pelvimetry ata patient in labor revealed that the sacr; ont A not be reached 11.5 om sidewalls straight ischial spines not promeay o (Oaenum well Curved, sacrosciatic notch wide and shaliow and sub pu 9 th si DUDIC 85%,,What is your assessment of the pelvis? — F Clinically adequate 8. Contracted D 16 Internal examination of a nulliparous woman in active labor revealed the most dependent portion of the head to be at station 0. What does this mean? A. The head is engaged B. The inlet is adequate C. The midplane is contracted Do AandB CC. 17-Which ofthe following petvic dia SNORMAD) A Greatest transverse enster otf anis12 om B. Anteroposterior diameter of the midans11 cm 7 C. Interspinous diameter 10 cmc = P Posterior sagittal diameter of the outlet 4.5 cm Identify the phase of parturition in the following A. Stimulation B. Quiescence C. Involution D. Activation Bus 22 ylo G2P1 (1001) consulting at the outpatient department at {6 weeks gestation for congenital anomaly scan by ultrasound. nNS’" A 19.A 27 ylo G1P0 37 weeks gestation mentions during her prenatal visit that she felt ‘the baby “dropped” and descended, causing pressure in her inguinal area DR 20.A 39 ylo GaP3 (3003) 38 WEEKS gestation is Currently fully dilated cervix and is "7 actively pushing with each contraction Identify the stage/phase of labor of the following A. First stage, latent phase @ B. First stage, active phase “ C. First stage, deceleration phase D. Second stage / E. Third stage E; 21.A 32 ylo G3P2 (2002) who has delivered a live term infant, and is currently showing signs of placental separation Bg, 28-422 vio G3P2(2002) 37 weeks, corvx 6 om diated, 9% effaced, cephalic, '% station (-1), ruptured bag of water, uterine contractions every 5-6 minuies. moderateIdentify the stage/phase of labor in the Friedman's curve First stage, latent phase First stage, acceleration phase First stage, deceleration phase First stage, maximum slope of dilatation Second stage A B c D. E LO 0 2 4 6 8 10 12 “4 16 Cc 24. Which of the following is/are TRUE of Braxton Hicks Contractions 7 A. Earliest sign of labor B. Pathologic if seen in phase 1 of parturition Benign myometrial contractions D. All of the above E. Aand B only 25.Mrs Chloe came back her ultrasound result as follows: Singje live, 5 ROG, appropriate for gesiatoratgae Good somate Seti ea 7 fic activity. fluid. No adnexal mass. Cervixt Tom ory Which of the following is EST aise lather” (fe Her pregnancy is ok. Comie back for next check up after 4 weeks — B. She is at risk in preterm labor. C. She is in preterm labor. D. She has an incompetent cervix. — 26. What is ao A. Retroplacental hematoma forms atBUshes the center 3 Brood collects between the membranes and the uterine wall anc escapes from the vagi Glistening amnion, covering the placental surface, presents at the vulva D. retroplacental hematoma follows the placentaaver vay Dy 28 How is postpartum hemorrhag Crtase 29 tum 198 prevented in th A. Maintain myometrium iiré s ST oe pee yt min a state of rigid and Persistent contraction and Br Promote closure of the cervical opening to © Manual extraction ofthe placenta nt Pend loss — D. All of the above E. A and C only 29. Phase 4 Parturitiagasts for ‘A. an hour after delivery of the baby B. an hour after the delivery of the placenta C. 2 weeks after labor and delivery PD. 4-6 weeks after labor and celivery 30. Which group of agents is theorized to initiate phasé 3 ot parturition? A. Uterotonics ~~ * B. Sex steroids C,,Betamimetics Calcium channel blockers «<- 31. Which of the following is a primary regulator & oxytoci teoeptar expression? A, Calcium rnane Progesterone ‘C. Prostaglandin dehydrogenase D. Corticotropin-releasing hormone 32. On ultrasound, the baby was noted to have 4p absent fogtal calvacium. ‘Which of the following abnormalities of parturition has gece mT finding? A. Preterm labor ———— B. Prolonged gestation C, Uterine tachysystole ZB Allof the above 33.A G1P0 at term complains of hy astric pain and bloody show. The cervix is 5 c ‘Which of the following are plausible causes of the complaint of the patient? #- Myometrial hypoxia B. Uterine peritoneum stretching / C. Compressed vein ganglia in the cervix ‘ D. Aand B only FF Bend C only CC. 34.Which ofthe following is/are true about the Regia es ‘A. Itis present in about 50 percent of labor®-at term B. It is unstable and can convert to transverse or oblique lie. ‘The jong axis of the fetus lies parallel to that of the mother” . All of the above 35.A 20 year-old primigravida on’ in labor, with a 7.cm dilated, almost fully effaced cervix, ruptured bag of waters, cephalic, with th2 anterior fontanellowermost in the canal. What is this type of presentation? ‘A. face a B, sinciput brow vertexa 76 Tre nclude the followingEXCEPT _ A 36 Predisposing factors to-+rai /e, lipary placenta previa C. hydramnios D. uterine anomalies euver performed? hands. are placed on each side of the lower ure Is exerted ion of 8 37. How is the third Leopold's man hand the lower porti A. the tips of the fingers ‘of both maternal abdomen and deep press B. by grasping with thumb and fingers of one the maternal abdomen C. with the tips ofthe first three fingers of each hand, deep pressure S made in the direction of the axis of the pelvic inlet J Allof the above » what fetal head diameter navigates the planes of the pelvis? Bo yr tose, B. suboccipitobregmatic C. mentooccipital D. biparietal 39 A 26 year old primigravida in labor was admitted with a § cm dilated, 80 % Gtaced cervix, BOW(+), cephalic, station (-) 1. After S hours the oSfvae became 10 om dilated and the bag of swaters{BOW) ruptured sponta with the head now at stalion-Gathree hours later, the head was stil a station 0. Which part of labor here was prolonged? A. the latent phase B, the phase of maximum slope £. the deceleration phase 'D. the second stage of labor C 40.Which of the cardinal movements of labor is responsible for the smaller presenti fer of the fetal head? / B. Descent “Flexion . Internal rotation A a ‘agement has occurred, which of the following has been accomplished? i plane has passed the inlet B. The most dependent portion of the fetal head is at the level of the inlet C. The fetal head is just entering the true pelvis D. The cephalic prominence cannot be determined on Leopold's 43¢ maneuver ion, what is the next step \o deliver the anterior shoulder? C 42 After external rotat A Pal y up B. Pull the baby sideways _Se Pull the baby down D. Pull the baby up diagonally 43 Lane Sagi suturé ts closer to the symphysis pubis, what is the Condition? ynchtism : Posterior asynciitism C. No asynelitismEASTERN TT A “4 This type af episiotom s with higher rates of anal sphincter and f pisiotomy is a ith higher rates of Tris type o episiciony fed with higher rates of anal sphincter and y A. Median — BF Mediolatera i C. Both 45. One h A oe ae ae ie posterior perineum over the fetal chin to extend the fetal head n over the occiput with pr ee taned pressure downward to flex the head is: B. Vacuum extraction C. Modified Crede's D. Brandt Andrews C, Risautatin of the FHT is done _a une contraction: A at of ipseretia eer B. During the peak of &. After 47. When the fetal head is encircied by the vulvar ring, this is called A. Ritgen's —— B. Crowning C. Engagement . 48. The earliest sign of placental separation is. ‘A. Lengthening of the cord B, Gush of blood from the vagina SL, Calkin's sign 2% Uterus rises in the abdomen C. 42,Prolonged second stage of labor in nulliparas occurs when the ‘A, Itexceeds 3 hours with epidural anesthesia B. Hitis more than 2 hours without anesthes' Both D. Neither >} D 50,Lacerations extending to tH rpotalmucosa ‘A. First degree B. Second degree C, Third degree Y’ Fourth degree ** g 51 After delivery of fetus, the umbilical cord is clamped and ext The next step to do while holding the clamped cords: eparom canreigorous ‘traction of the cord to pull the placenta x B. Preseure is applied to the body of the uterus cephalad Uterus is pushed downward with the abdominal hand 52, Upon inspection ofthe perineum after delivery of the nfent ta, a laceration was noted frofTr the skit | mucosa and perineal muscis with iFvolvement of the gral sphincter This is what type of laceration? A. First degree laceration 2 Second degree laceration ‘C. Third degree laceration D. Fourth degree lacerationD 53.432 year old G2P4 (1001) term, cephalic is admitted at the delivery room at 4 om, 60% effaced, station -2, with intact bag of waters. The following is/are components of active managem fatient A. Pelvic examination is done every 2 Rours — 8. Amniotomy is performed if cervical dilatation is not progressing 1 cnvhour C. Oxytocin infusion is given if there is inadequate uterine contractions D&Allof the above ~ A 54 This refers to the time following delivery during which maternal changes return to Nonpregnant state’ & Puerperium B. Postpartum C. Peripartum D. Fifth stage of labor C 55. The uterus retums to pregravid size by ‘A, weeks after delivery — (5 weeks after delivery C. 8 weeks after delivery D. 10 weeks after delivery A 56.A primipara delivered 2 weeks-ago is complaining of intermittent crampy hypogastric pain. What ig NOT considered in the imnfediate management? Ac Initiate empiric antimicrobial therapy for endometritis 8. Reassure the patient that the uterus tends to remain tonically contracted following delivery but usually becomes mild by the third day (7%. Offer analgesic therapy 57..A puerpara on her 2° weak pastpartiim is complaining of white-yellaw vaginal Cc discharge. What is your impression? ‘A. Lochia rubra ©, st" B, Lochia serosa “ Lochia alba —~, A 58. Which of the following becomes th source of new endometriyim during the puerperium? OR Deteua basalis B. Decidua functionalis C. Decidua spongiosa D. Decidua compacta B 82.4 woman on her 3¢ bleeding of minimal ar int. On bimanual examitta 1 fale boon re unos mphysis iresa con ‘A__Chlamydial infection Retained placental fragments Incompletely remodeled uteroplacental arteries racologisis, aINg'S NourS% 12 hours after delivery 7 8: bleeding 24 hours to 12 weeks after delivery - C. develops 14 weeks after the delivery D. develops 16 weeks after the deliveryRN unr 61 Awoman delivered(10 day8,ago «: cK oderate vaginal 1yS,ago came back complaining of moderate va D bleeding. On PE: stabtevital signs; IE cervix firm closed, corpus stghtly crlargedo aonoval mgss pox ieceress ([tasoue ree @ndometrium. What is the BEST nis pa - management in this patient? Give antibiotics ae B. Perform suction curettage c C. Perform curettage & Uterotonics: methylergonovine Cc 62.A woman delivered 2 weeks ago consulted complaining of moderate vaginal bleeding. On PE: stable vital signs; IE cervix is Tem open, corpus arlawedTo 2 months size, no adnexal mass nor tederness_UNffasound ravealed thickened endometrium probably retained piacental tissties. What is the BES management in this patient? A Give antibiotics 2 Perform suction curettage C. Perform curettage D. Uterotonies: oxytocin 63, What are the obstetrical factors that can cause urinary incontinence? do A. length of 2 stage of labor— _——— B. infant head circumference“ C. birthweight ~ DTA of the above 0 64, Which of the following hematological changes in the pi verperiuny is abnormal? ) A. WBC count someti Teaches 30,000/uL B. relative lymphopenia 7 ©. absolute eosinophenia /B. Thrombocytopenia 65, TRUE about weight loss in the puerperium. A loss of 2 to 3 kg due to uterine evacuation and blood loss * loss of 5 to 6 kg due to uterine evacuation and blood loss + C. loss of about 4 to 5 kg through diuresis D. loss of about 5 to 6 kg through diuresis A & Marked separation of rectus abdominis is called: (AC diastasis recti B. Linea nigra C. striae gravidarum C. 67.Compared with mature milk, colosttumis richer with thisithese components, which protects the newbom against enteric pathogens A. Minerals and amino acids~~ B. Essential fatty acids ate C__ Immunoglobulin BZA of the abovet 68.A 25 yio G1P1, on her 2"! postpartum day, is very anxious because she's still not lactating She complained that her breasts are engorged and tender Her last attempt to nurse her baby is right after delivery. What is the BEST advice to give her? ‘A. Encourage her to regularly breastfeed and/or pump breasts B. Reassure her that some women may not lactate immediately C. Prescribe her with formula or infant milk D. Allof the above & AandB only 69. Women wn do poubasise’ may expect their menstruation __ efter delivery: ( KK 6-8 weeks B. 10-12 weeks C. 6-8 months D. 10-12 months A\ 70.4 63P2 delivered 2 montns ago consulted for ‘amily planning. She has been ‘exclusively breastfeeding for 2 months. What contraception can be given to her at this time? A. Progestin-only contraceptives / B. Combined oral contraceptive pills C. Calendar method PD 71. Postpartum blues is likely the result of several factor/s ‘A. Emotional letdown following excitement and fears during pregnancy 7 B. Fatigue from loss of sleep during labor and postpartum C. Anxiety over ability to provide appropriate care for new baby PO Allof the above E72. Advantages @f EARLY gmbulation includels A. Less bladder ions” B. Improved bowel function “ C. Increased thromboembolic events D._Alll of the above Aand B only D 73..AG1P1, who recently underwent Gasareen section, is on Ks" Dramacanie post-op day. According to the Amerrea College of Obstetncrans and Gyriseblogrste, when is the (GEST TIME discharge her from the hospital? A. 12 hours = B,, 24 hours ZL. 48 hours D. 96 hours A 74. Which of the following vascular supply of tpe SodometnD is responsive to hormonal influence? BE Spiral B. Arcuate A se i homologous o ; ig Roui jament B. Uterosacral ligaments C. Mackenrodt ligaments: D. Broad ligaments 10& — C 76 Of the 2 million oocytes in the human ovary present at birth, approximately how many are present-al puberty?) aa RK 200,000 2S B. 300, 000 & 400, 000 D. 500, 000 S 77 Which of the following is the endometrial layer thats shedwith every menstrual oe et —oa«“e A. Basalis 2 Decidual C. Funetionalis layer D. Luteinized layer 78. The recommended dose of folic acid is per day, taken preconceptionally to prevent or decrease the incidenoeroT neural tube defects> A. 400.ug B. 300ug YS, 20009 100 ug D 79 the respiratory trac€Ghangels in pregnancy 's/are A. the Graphragm rises about 4 cm B. thoracic circumference increases by 6 cm/ C. subcostal angle becomes narrow AandB E. Band C C 80. Which of the following is/are seen in pregnancy? ‘gallbladder contractility is increased B. increase in the liver size , the appendix is displaced upward and lateral B& Shortened gastric emptying time gr ergec! read: 8 81.In anormal term pregnancy, if the weight of the baby is,3000 gm, what is the ‘weight of the placenta in grams? < ye Vee B 22. when oxygen is needed by the fetus, where will it will pass? A, Umbilical arteries 5S. Umbilical vein C. Spiral veins D. Uterine vein Reo. 83. Human chorionic gonadotrophin takes over progesterone secr corpus luteum by the AC & day after ovulation B. 6" day postovulation C. 5 day after ovulation D. 4* day postovulation from the nzed in 84, Human chorionic gonadotrophin & Mainly synth LS... Natmmeaenianll Renae B&F Syneitiotrophoblast C. Decidual cells D. Amniotic epithelium Cc 85. This finding, seen(by 4 to 5 wodks of gestation, is ing irsdsonographic evidence of pregnancy A Cardiac activity - B. intradecidual sign C. gestational sac D. crown rump length © 86 Awo its for check up on October 30, 2015. Her last menstrual period \ woman presents @ July 10, 2015) What is the expected date of delivery? wary 17, 2016 _B. March 17, 2016 Me C. April 17, 2016 D. May 17, 2016 Ve botnet a 87 What is the complete obstetrical score if a wornan's obstetrical history includes 1. child borryalis 5 ‘set of iwins bom prematurely with ope ‘Of them stillbgrn, nancies? = No miscarriages nor ectopic pregnanci A_G2P271203) B. G2P3 (1203) Z. G2P2 (1202) D. G2P2 (1203) g 88. Yellowish-brown discoloration of deciduous teeth is associated with intake of this Chloramphenicol & Tetracyciine C. Sulfonamides: D. Metronidazole 89. Grey baby syndrome is caused by ine 90.A woman with severe cystic acna lesions has been taki ‘She and her husband want to have children already. the couple? Fe discontinue isotretinoin and plan pregnancy 1-2 months after B. She can get pregnant anytime..>< a C. Isotretinoin is not associated with high pregnancy loss. >< D. Switch to a topical preparation and plan pregnancy ><aunivr & 9 ew the followigg immunoglobuling can pass t B IgA © Igd D. IgE E. IgM through the placenta? A 92. Organogenesis takes place A_from fertilization to the first 8 weeks of life Z B from 9" to 12" week of life C. from 13 to 24 weeks D_ beyond 24 weeks AX 98 The surface tension reducing component of lung surfactant is A. Phosphatidyl glycerol 3 Dipaimitoyl phosphatidyl choline (DPPC) C. Phosphatidyl ethanolamine D. Phosphatidyl choline D 94 Ina contraction stress test (CST), contractions are induced with A. Dilute oxytocin IV infusion — B. Nipple stimulation C. rubbing uterus Rand B E AandC 95.A Gravida 3 Para 2 (2002) at Ai.wooKs AOS)vas admitted for induction of labor On TE cervix was soft, closed intact bag of waters, cephalic floafing Contraction stress test was done which revedied the tracing below. Interpret the (osullB 96. On ultrasound of a patient with by the 4 quadrant technique will likely be Normal —""~ & Decreased C. Increased D. Unchanged C7. Type of fetal heart rate deceleration of above tracing Early © B Variable Late ~ D. Prolonged A 98.The MOST common cause of etal tachycardids A. Matemal fever *, Fetal compromise C. Cardiac arrhythmias D. Sympathetic medications C 9.Doppier velocimetry has proven to be of benefit in which of the following ‘conditions? KR Fetal hypoxia B. Fetal distress C. Growth restriction D. Pre-eclampsia D 100. Which of the following NOT? component of standard ulltascund exemnintion in the third times Fetal number B. Presentation C. Cardiac acitivity D. Measurement of nuchal transiucency $ 101. Which of the following is a complication of amniocentesis? A. fetal growth restriction — B. infection C_ oligohydramnios 2 pulmonary hypoplasia 4 enesig, the amniotic fiuid volume eetg 10: E 103 examination in the third trimester? A 8 Cc. O. D 104 v 1085. screening? kK screening? Diabetes mellitus Which of the following condition WiICMOST Fpquire alpha-fetoprotein B History of neural tube defect in the family ©. History of Trisomy 27 in The family D. Multiple pregnancy Which ofthe following © NOT aJcomponent of standard ultrasound — | Fetal number Presentation Cardiac acitivity Measurement of nuchal translucency ¢ Which of the following is a complication of amniocentesis? as ad fetal growth restriction infection oligohydramnios pulmonary hypoplasia oOm> Which of the following condition will MOST require alpha-fetoprotein A. Diabetes mellitus B. History of neural tube defect in the family C. History of Trisomy 21 in the family _ D. Multiple pregnancy X sped END OF EXAM guests —