VAGINAL BLEEDING IN PREGNANCY

1. Placentas that lie within close proximity of the internal cervical os but do not reach it are termed low lying. What is the
boundary threshold that defines a low-lying placenta?
a. 1.0 cm
b. 2.0 cm
c. 3.0 cm
d. 4.0 cm

2. The incidence of placenta previa increases with which of the following factors?
a. Increasing parity
b. Increasing maternal age
c. Increasing number of cesarean deliveries
d. All of the above

3. Which of the following has the highest associated relaEve risk for placental abrupEon?
a. Thrombophilia
b. Prior abrup8on
c. ChorioamnioniEs
d. Preterm ruptured membranes

4. All EXCEPT which of the following are associated with primary uterine rupture?
a. Hydramnios
b. Forceps delivery
c. Breech extracEon
d. Prior cesarean delivery

5. Ms. Jones, a 32-year-old G3P2 gravida with chronic hypertension, had a normal labor that arrested during the second stage
at + 1 staEon. She complained of mild dyspnea and faEgue. The fetus had a leT occiput anterior presentaEon and was
delivered by forceps. CompleEon of the third stage followed quickly, and the fundus was noted to be firm. Brisk vaginal
bleeding was then noted. What is the most likely cause of bleeding?
a. Uterine atony
b. Uterine rupture
c. Retained placenta
d. Genital tract lacera8on

6. The genital tract of the paEent from QuesEon 5 was carefully examined, and no laceraEons were noted. ProphylacEc
oxytocin at 200 mU/min was being administered. The examiner then noted that although the fundus felt firm, the lower
uterine segment was boggy. Which of the following is suitable treatment in this situaEon?
a. Hemabate, 250 μg intramuscularly
b. Methergine, 0.2 mg intramuscularly
c. A 20-unit oxytocin intravenous bolus
d. All are suitable

7. For Ms. Jones, the paEent from QuesEon 5, one dose of a uterotonic agent is given and the fundus is massaged. Despite
this, she conEnues to bleed. Which of the following is suitable treatment in this situaEon?
a. Administer Methergine, 0.2 mg intramuscularly
b. Perform laparotomy to prepare for postpartum hysterectomy
c. Mobilize a team that includes obstetricians, nurses, and anesthesiologists.
d. All of the above

8. For Ms. Jones, the paEent from QuesEon 5, you have provided general anesthesia, evaluated the genital tract again, and
administered three doses of Hemabate. Despite this, she conEnues to bleed, and you have iniEated whole blood
transfusion. Which of the following is suitable treatment in this situaEon?
a. Consider laparotomy and uterine compression suture placement
b. ConEnue to administer Hemabate intramuscularly every 20 minutes
c. Insert a Bakri postpartum balloon or large Foley catheter balloon into the uterine cavity and inflate the balloon
d. All of the above
 9. For the paEent in QuesEon 5, despite Bakri balloon placement, heavy uterine bleeding conEnues.
You perform a laparotomy and find an atonic uterus. Which of the following is suitable treatment in this
situaEon?
a. Internal iliac artery ligaEon
b. Uterine compression suture placement
c. Bilateral uterine artery and uteroovarian pedicle ligaEon
d. All of the above

10. For the paEent in QuesEon 5, despite these measures, Ms. Jones conEnues to bleed now from all surgical edges, and the
uterus remains atonic. Which of the following is suitable treatment in this situaEon?
a. IniEate hysterectomy
b. Administer 20-unit oxytocin intravenous bolus
c. Evaluate for dilu8onal coagulopathy and con8nue uterine compression
d. All of the above

INFECTIONS IN PREGNANCY

1. 25/F, nonpregnant woman who complains of vaginal discharge and postcoital spoang. Gram stain as done on her purulent
vaginal discharge and revealed intracellular gram negaEve diplococci. What is the MOST likely diagnosis of the paEent's symptoms?

A. Bacterial vaginosis
B. Trichomonas cerviciEs
C. Chlamydia cerviciEs
D. Gonococcal cervici=s

2. What is one of the basis for considering hypertension during pregnancy as transient?

A. If repeat serum uric acid does not increase

B. If urine protein increase to plus 1
C. If blood pressure remains 130/90 mmHg or higher
D. If blood pressure returns to normal by 12 weeks postpartum

3. In what stage of labor is the cervix fully effaced and dilated to 6 cm?
A. DeceleraEon phase
B. Ac=ve phase
C. Prelatent phase
D. Latent phase

4. A 26 year-old primigravid at 12-weeks AOG came in for her first prenatal visit. The following
should be performed EXCEPT:
A. Chlamydia culture
B. RPR
C. Gonorrhea culture
D. GBS culture

5. What is the most common indicaEon for primary cesarean delivery?

A. Failure to progress in labor
B. Abnormal placentaEon
C. Prior classical hysterotomy
D. Prior cesarean delivery
6. A 28 year-old G1P0 at 36 weeks AOG comes to the ER due to sudden fluid discharge from
her vagina 16 hours ago. Tocometry shows no contracEons and the fluid demonstrates a ferning
pahern. What is the diagnosis?
A. Preterm rupture of membranes
B. Premature rupture of membranes
C. Preterm premature rupture of membranes
D. Prolonged rupture of membranes

7. What is the treatment of choice for lymphogranuloma venereum?

A. Penicillin G
B. Doxycycline
C. CeTriaxone
D. Clindamycin

8. What is the Bishop score of a paEent with the following internal examinaEon findings: cervix
dilated to 2 cm, cervix at mid-posiEon with medium consistency, effaced to 40-50%, and fetal
staEon at -2?
A.2
B.3
C.4
D.5

9. A primigravid who is receiving magnesium sulfate for eclampsia presents with absent deep
tendon reflexes bilaterally. Which of the following should be given?
A. IV calcium gluconate
B. 10mL, 10% calcium gluconate
C. IV hydralazine
D. Low-dose aspirin

10. In quesEon 42, the paEent’s presentaEon corresponds to what serum magnesium sulfate
concentraEon in mg/mL?
A. 8
B. 10
C. 15
D. 17