Student Name Question, Answer and Rationalization 1. Mercado,
Eunice F. 1. MERCADO, EUNICE F.Which of the following is the definition of health according to WHO?
a. Health is the absence of disease
b. Health is the ability to perform your responsibilities without difficulties
c. State of non-hospitalization for life
d. State of complete physical, mental and social well-being Answer: D.
Rationale: Within the framework of WHO's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health addresses the reproductive processes, functions and system at all stages of life.
Reference: World Health Organization 2012
(http://www.who.int/topics/reproductive_health/en/)
2. MERCADO, EUNICE F.
Which of the following is/are concern/s of Reproductive Health?
a. right of men and women to safe, affordable and acceptable fertility regulation
b. right to appropriate health services for a safe pregnancy, delivery and a healthy baby
c. right to have a responsible, satisfying and safe sex life d. all of the above
Answer: D.
Rationale: According to WHO, it is shaped around the five components of WHO’s Global reproductive health strategy: -improving antenatal, perinatal, postpartum and newborn care;
providing high-quality services for family planning, including infertility services;
-eliminating unsafe abortion;
-combating sexually transmitted infections, including HIV, reproductive tract -infections, cervical cancer and other sexual and reproductive health morbidities;
-promoting sexual health.
Reference: World Health Organization 2012
(http://www.who.int/reproductivehealth/about_us/en/index.ht ml)
3. MERCADO, EUNICE F.
adolescent age groups?
a. low-dose oral contraceptive pills b. condoms
c. information, education and communication services d. religion and catechism
Answer: C.
Rationale: WHO carries out a range of functions to improve the health of young people, some of them include:
-identifying the most effective ways of promoting good health among young people, preventing health problems and
responding to them when they occur;
producing the methods and tools by which evidence can be applied in countries;
-raising attention of issues among the public at large and among special groups;
-building a shared understanding among partners and a shared sense of purpose on what needs to be done;
-supporting countries with the formulation of policies and programmes, their implementation, and monitoring and evaluation.
Reference: World Health Organization 2012
(http://www.who.int/mediacentre/factsheets/fs345/en/index.ht ml)
2. Mendoza, Rigel
Faye R. 2. Which of the following is/are concern/s of Reproductive Health? a. right of men and women to safe, affordable and acceptable fertility regulation
b. right to appropriate health serves for a safe pregnancy, delivery and a healthy baby
c. right to have a responsible, satisfying and safe sex life d. all of the above
Answer: D
Rationale: House Bill No. 4244 The Responsible Parenthood, Reproductive Health and Population and Development Act of 2011.
An act providing a comprehensive policy on responsible parenthood, reproductive health, and population and development and for other purposes Provisions:
Reproductive Health Care refers to the access to a full range of methods facilities, services and supplies that contribute to reproductive health and well-being by preventing and solving health related problems. Elements include the following: a. Family planning information and services
b. Maternal, infant child health and nutrition including breastfeeding
c. Proscription of abortion and management of abortion complications
d. Adolescent and youth reproductive health
e. Prevention and management of reproductive infections, HIV, AIDs and other STIs
f. Elimination of violence against women
g. Education and counseling on sexuality and reproductive health
h. Treatment of breast and reproductive tract cancers and other gynecological conditions and disorders
i. Male responsibility and participation in reproductive health j. Prevention and treatment of infertility and sexual
dysfunction
k. Reproductive health education for the adolescents l. Mental health aspect of reproductive health care Reference:
http://www.congress.gov.ph/download/basic_15/HB04244.pdf 3.What is the best program for the Reproductive Health of the adolescent age group?
a. low-dose oral contraceptive pills b. condoms
c. information, education and communication services d. religion and catechism
ANSWER: C
Rationale: Reproductive health programs for specific groups such as adolescents, including information, education,
communication and services. Reference: Sumpaico, page 2
4. The two priority areas for Reproductive Health to improve in the Western-Pacific region are:
a. safe pregnancy and family planning b. safe pregnancy and breastfeeding c. family planning and anemia
d. safe pregnancy and anemia Answer: A
Rationale:
The health priorities of the countries were then ranked. Highest on the list was the “high abortion rate”, with “high unmet family planning needs (“or helping couples attain
desired family size”) the second priority. “Adolescent
reproductive health, “safe motherhood” and the “maternal mortality rate” were the third and fourth priorities.
“Infertility” was considered the fifth most important health problem.
Reference: Women's Health. Western Pacific Region. WHO. http://libdoc.who.int/wpro/2001/9290611839.pdf
5. Reyes, Katrina
May T. 5. Reyes, Katrina May T.According To the Millennium Development Goal, maternal mortality ratio by 2015 must decrease by:
a. One-fourth b. One-half c. Three-fourths d. Two-thirds
Answer: C. Three-fourths (75%)
Rationale: The fifth goal is to improve maternal health, reducing maternal mortality ratio by 75%.
Reference: http://www.un.org/millenniumgoals/maternal.sht ml(none discussed in Williams)
6. What is the importance of maternal and neonatal outcomes?
a. It reflects the quality of health and life in a community. b. It assures the continuity of a race.
c. It determines the economic needs of a country. d. It will give information on the ratio of males versus females in a population.
Answer: A. It reflects the quality of health and life in a community.
Rationale: Lifted from Williams Obstetrics, 23rd edition, Chapter 1: Overview of Obstetrics: Introduction—“The
importance of obstetrics is attested to by the use ofmaternal and neonatal outcomes as an index of the quality of health and life in human society.”
Reference: Cunningham, F. et al, Williams Obstetrics, 23rd edition, McGraw-Hills Company, Inc, 2010, Chapter 1.
Overview of Obstetrics
7. Which is NOT considered to be a perinatal death? a. a. Fetal death at 28 weeks AOG
b. b. Fetal death during delivery at 37 weeks AOG c. c. Neonatal death at 3 days of life
d. d. Neonatal death at 12 days of life Answer: A. Fetal death at 28 weeks AOG
Rationale: Perinatal period is the period after birth of an infant born after 20 weeks and ending at 28 completed days after birth. Choice A is NOT considered a perinatal death since the fetus is not yet born or delivered.
Reference: Cunningham, F. et al, Williams Obstetrics, 23rd edition, McGraw-Hills Company, Inc, 2010, Chapter 1.
Overview of Obstetrics under section Definitions
6. Reyes, Rachel
Ann Q. 6. REYES, RACHEL ANN Q.What is the importance if maternal and neonatal outcomes? a. it reflects the quality if health and life in a community b. it assures continuity of a race
c. it determines the economic needs of a country
d. it will give information on the ratio of males versus female in a population
Answer: A
Rationale: According to the book, poor of these outcomes indicate that medical care for the entire population is lacking. Reference: Williams 22th Edition page 7 (ebook)
7. REYES, RACHEL ANN Q.
Which is not considered to be a perinatal death? a. fetal death at 28 weeks AOG
b. fetal death during delivery at 37 weeks AOG c. neonatal death at 3 days of life
d. neonatal death at 12 days of life Answer: B
Rationale: Based on the definition by NCHS and CDC,
'perinatal period is commencing at 20 weeks and ends at 28 completed days after birth'
it does not tell us of death during delivery.
Reference: Williams 22th Edition page 8 (ebook) 8. REYES, RACHEL ANN Q.
The following must be fulfilled for a birth to happen EXCEPT? a. AOG of more than 20 weeks
b. birth weight of more than 500 grams c. placenta must be separated and expelled d. crown to heel length of 25 cm
Rationale: Birth is a complete expulsion of fetus from mother, irrespective of whether the umbilical cord has been cut or the placenta is attached.
Reference: Williams 22th Edition page 8 (ebook) 7. Radina, C
Philip Teomar II, A.
7. RADIN, C PHILIP TEOMAR, II, A.
Which is not considered to be a perinatal death? •fetal death at 28 weeks AOG
•fetal death during delivery at 37 weeks AOG •neonatal death at 3 days of life
•neonatal death at 12 days of life Answer: A
Rationale: Perinatal period. The period after birth of an infant born after 20 weeks and ending at 28 completed days after birth. Choice A is not considered to be a perinatal death because fetal death came before delivery.
Reference: E-BOOK Williams Obstetrics 23rd Edition. Chapter 1: Overview of Obstetrics
8. RADIN, C PHILIP TEOMAR, II, A.
The following arte considered for birth to happen, EXCEPT? a ) A O G m o r e t h a n 2 0 w e e k s A O G b ) b i r t h w e i g h t o f m o r e t h a n 5 0 0 g r a m s c ) p l a c e n t a m u s t b e s e p a r a t e d a n d e x p e l l e d d ) c r o w n t o h e e l l e n g t h o f a t l e a s t 2 5 c m Answer: C
Rationale: Live birth is the complete expulsion or extraction from the mother of a product of human conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction, breathes or shows any
evidence of life, such as beating of the heart, pulsation of umbilical cord or definite movement of voluntary muscles whether or not the umbilical cord has been cut or the placenta is attached.
Heart beats are to be distinguished from transient cardiac contraction; respirations are to be distinguished from fleeting respiratory efforts of gasps. Delivering of the placenta is not a prerequisite to live birth.
Reference: Sumpaico W., et. al., Textbook of Obstetrics
9. RADIN, C PHILIP TEOMAR, II, A.
A 36 y/o G4P3 (3-0-0-3), a known asthmatic is pregnant. During this pregnancy, she had more frequent asthmatic attacks. Patient went into preterm labor at 32 weeks
accompanied with severe intractable asthmatic attack. The patient eventually died. This is considered to be:
•direct obstetric death •indirect obstetric death •non-obstetric death •A & B are correct Answer: D
Rationale: Direct maternal death. The death of the mother that results from obstetrical complications of pregnancy, labor, or the puerperium and from interventions, omissions, incorrect treatment, or a chain of events resulting from any of these factors. An example is maternal death from
exsanguination after uterine rupture.
Indirect maternal death. A maternal death that is not directly due to an obstetrical cause. Death results from previously existing disease or a disease developing during pregnancy, labor, or the puerperium that was aggravated by maternal physiological adaptation to pregnancy. An example is maternal death from complications of mitral valve stenosis.
Nonmaternal death. Death of the mother that results from accidental or incidental causes not related to pregnancy. An example is death from an automobile accident or concurrent malignancy.
Choices A and B are correct because the causes of death in this case are pre term labor at 32 weeks AOG and asthma which are direct and indirect obstetric death,
respectively.
Reference: E-BOOK Williams Obstetrics 23d Edition. Chapter 1: Overview of Obstetrics
8. Hayes, Alpha
Rana M. 08. ALPHA RANA M. HAYES
a. AOG of more than 20 weeks
b. birth weight of more than 500 grams c. placenta must be separated and expelled d. crown to heel length of at least 25 cm Answer: C
Rationale: All of the following choices are normal averages for a birth to happen except that placental separation and expulsion happens after the delivery of the baby.
From approximately 20 weeks, the crown to heel measurement of a baby is 25 cm. The normal birth weight should be from 500 grams as shown in the graph:
References:
Sumpaico, Walfrido et. al (2008) Textbook of Obstetrics: Physiologic and Pathologic Obstetrics. 3rd Edition. Chapter 43. Quezon City: Association of Writers of the Philippine Textbooks of Obstetrics and Gynecology, Inc.
Website: http://www.baby2see.com/baby_birth_weight.html 09. ALPHA RANA M. HAYES
A 36 y/o, G4P3 (3-0-0-3), a known asthmatic is pregnant. During this pregnancy, she had more frequent asthmatic attacks. Patient went into preterm labor at 32 weeks AOG accompanied with severe intractable asthmatic attack. The patient eventually died. This is considered to be:
b. indirect obstetric death d. A & B are correct Answer: D
Rationale: According to the World Health
Organization (WHO), "A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or
aggravated by the pregnancy or its management but not from accidental or incidental causes."
Maternal deaths happen for two reasons: a direct obstetric death which is caused by complication that develops directly as a result of pregnancy, delivery or the postpartum period; an indirect obstetric death which is due to existing medical conditions that are made worse by delivery or pregnancy. There are five major medical causes of direct obstetric death: haemorrhage (28 %); complications of unsafe abortion (19%); pregnancy-induced hypertension (17%);
infection (11 %); and obstructed labor (11 %). Direct obstetric deaths account for about 75 per cent of all maternal deaths in developing countries. Indirect obstetric deaths account for about 25 percent of all maternal deaths in developing countries.
References:
Sumpaico, Walfrido et. al (2008) Textbook of Obstetrics: Physiologic and Pathologic Obstetrics. 3rd Edition. Chapter 43. Quezon City: Association of Writers of the Philippine Textbooks of Obstetrics and Gynecology, Inc.
Website: www.unicef.org 10. ALPHA RANA M. HAYES A mature oocyte is also called:
a. primary oocyte c. tertiary oocyte
b. secondary oocyte d. second polar body Answer: B
Rationale: Oogenesis results in the formation of
both primary oocytes before birth, and of secondary oocytes after it as part of ovulation. If fertilized, it divides into an ootid and the second polar body. A secondary oocyte will not complete meiosis II until a sperm penetrates it. However, that doesn't mean the oocyte wasn't mature already. A mature
oocyte is ejected from the Graafian follicle when it has reached a maximum level of growth. That cell is already pretty well-developed with its organelles and processes running as needed so when it is released, it is ready to undergo meiosis II.
References:
Sumpaico, Walfrido et. al (2008) Textbook of Obstetrics: Physiologic and Pathologic Obstetrics. 3rd Edition. Chapter 43. Quezon City: Association of Writers of the Philippine Textbooks of Obstetrics and Gynecology, Inc.
Website: http://en.wikipedia.org/wiki/Oocyte
9. Naldo, Jacob
Timothy C. 9. Naldo, Jacob Timothy C.A 36 y/0, G4P3 (3-0-0-3) a known asthmatic is pregnant. During this pregnancy, she had more frequent asthmatic attacks. Patient went into preterm labor at 32 weeks AOG accompanied with severe intractable asthmatic attack. The patient eventually died. This is considered to be:
a. direct obstetric death b. indirect obstetric death c. non-obstetric death d. A and B are correct Answer: B
Rationale: An indirect maternal death is not directly due to an obstetrical cause, but resulting from previously existing disease, or disease that developed during pregnancy, labor, or the puerperium, but which was aggravated by maternal physiological adaptation to pregnancy. This patient was known to have a previous disease of asthma that was
aggravated by pregnancy and labor.
Reference: Williams 22 Edition, PAGE # 8 10.Naldo, Jacob Timothy C.
A mature oocyte is also called: a. primary oocyte
b. secondary oocyte c. tertiary oocyte d. second polar body Answer: B
Rationale: By the fourth month, some germ cells in the medullary region begin to enlarge. These are called primary oocytes at the beginning of the phase of growth that
continues until maturity is reached. The union of egg and sperm at fertilization represents one of the most important processes in biology. Ovulation frees the secondary oocyte and the adhering cells of the cumulus oophorus from the ovary.The secondary oocyte in the period between the frist and second meiotic division that is derived from the primary oocyte shortly before ovulation. If not fertilized, degeneration occurs.
Reference: Williams 22 Edition, PAGE# 21, 33 11. Naldo, Jacob Timothy C.
What is a solid mass of 12 to 32 blastomeres at 3 to 4 days of fertilization? a. cleavage b. blastomere c. morula d. blastocyst Answer: C
Rationale: In the two-cell zygote, the blastomeres and the polar body are free in the perivitelline fluid and are
surrounded by a thick zona pellucida. The zygote undergoes slow cleavage for 3 days while still within the fallopian tube. As the blastomeres continue to divide, a solid mulberry-like ball of cells, referred to as the morula, is produced. The morula enters the uterine cavity about 3 days after
fertilization. The gradual accumulation of fluid between the cells of the morula results in the formation of the early blastocyst.
Reference: Williams 22 Edition, PAGE # 34
Carmella A. A mature oocyte is also called: a. primary oocyte b. secondary oocyte c. tertiary oocyte d. second polar body ANSWER: B
RATIONALE: LH induces remodelling of the ovarian extracellular matrix to allow release of the mature oocyte with surrounding cumulus cells through the surface
epithelium. Ovulation frees the secondary oocyte and
adherent cells of the cumulus-oocyte complex from the ovary. *Reference: Williams 23rdedition, Chapter 3: Implantation, Embryogenesis, and Placental development
11. SAMPELO, MA. CARMELA A.
What solid mass of 12 to 32 blastomeres at 3-4 days of fertilization? a. cleavage b. blastomeres c. morula d. blastocyst ANSWER: C
RATIONALE: Because CLEAVAGE(A) is the process of zygote developing into blastomere. BLASTOMERES(B) will continue to divide and will develop into a solid mulberry-like ball of cells, called the MORULA(C). The morula enters the uterine cavity about 3 days after fertilization with gradual accumulation of fluid between the cells of resulting in the formation of the early BLASTOCYST(D).
*Reference: Williams 23rdedition, Chapter 3: Implantation, Embryogenesis, and Placental development
12. SAMPELO, MA. CARMELA A.
At what stage is the embryo implanted? a. cleavage
b. blastomere c. morula d. blastocyst ANSWER: D
RATIONALE: Blastocyst is stage where in the implantation of the embryo into the uterine wall takes place. It is a common feature of all mammals.
*Reference: Williams 23rdedition, Chapter 3: Implantation, Embryogenesis, and Placental development
11. Ridao, Hanna
Clare P. 11. RIDAO, HANNA CLARE P.What is a solid mass of 12 to 32 blastomeres at 3 to 4 days of fertilization? a. cleavage b. blastomere c. morula d. blastocyst ANSWER: C
Rationale: The zygote undergoes slow cleavage for 3 days while still within the fallopian tube. As the blastomeres continue to divide, a slid mulberry-like ball of cells-- the morula-- is produced. The morula enters the uterine cavity about 3 days after fertilization.
Reference: Williams, 23rd edition, page 48 12. RIDAO, HANNA CLARE P.
At what stage is the embryo implanted? a. cleavage
b. blastomere c. morula d. blastocyst ANSWER: D
Rationale: Implantation of the embryo into the uterine wall is a common feature of all mammals. In women, it takes place 6 or 7 days after fertilization. This process can be divided into three phases: 1) apposition--initial adhesion of the blastocyst to the uterine wall; 2) adhesion--increased physical contact between the bastocyst and uterine epithelium; and 3) invasion-- penetration and invasion of syncytiotrophoblast and cytotrophoblast into the endometrium, inner third of myometrium and uteine vasculature
Reference: Williams, 23rd edition, page 48 13. RIDAO, HANNA CLARE P.
In gametogenesis, reduction division occurs during which meiotic division? a. first b. second c. third d. fourth ANSWER: A
Rationale: It is during meiosis I, the reductional division, that the sister chromatids remain paired, attach to only one
spindle, and segregate together. This centromeric cohesion is lost during the second meiotic division, which resembles
mitosis, where the replicated sisters make bipolar attachments and separate to opposite poles. Reference: Cell
Division--http://www.celldiv.com/content/6/1/16 12. Villaruel,
Andrea R. 12. VILLARUEL ANDREA R.
At what stage is the embryo implanted? a. cleavage
b. blastomere c. morula d. blastocyst Answer: D
Rationale: To determine at which stage the embryo is implanted, it is advantageous to first discern the order of its development. Fertilization usually occurs in the fallopian tube. After the union of the egg and the sperm, a zygote is
produced. This contains the genetic components of both the mother and the father. The said zygote
undergoes cleavage intoblastomeres until continuous division produces a mulberry-like ball of cells at the 12- to 16- cell cycle called morula which then enters the uterine cavity about 3 days after fertilization. Gradual accumulation of fluid between the cells of the morula produces the early
blastocyst. The blastocyst undergoes further development until an inner cell mass and trophoblasts are formed. The blastocystproduces cytokines and hormones, directly influencing endometrial receptivity, and in about 6 or 7 days, is implanted in the uterine wall by the processes of
apposition, adhesion and invasion (by the function of the trophoblasts).
Reference: Williams Obstetrics,23rd Edition, Chapter 3, page 48
13. VILLARUEL ANDREA R.
In gametogenesis, reduction division occurs during which meiotic division?
a. first b. second c. third
d. fourth Answer: A
Rationale: In gametogenesis, there are only 2 cell divisions of meiosis: I and II. In meiosis I, the homologous
chromosomes align themselves as pairs at the center. After which, they divide producing a haploid number ( only 23 chromosomes) gamete. Meiosis II works with an already reduced number of chromosomes producing 4 haploid cells ready for union with another haploid gamete.
Reference: Langman’s Medical Embryology, 8th Edition, Chapter 1, page 6
14. VILLARUEL ANDREA R.
When does differentiation in the process of oogenesis begin in the female?
a. 12 weeks AOG in-utero b. 24 weeks AOG in-utero c. upon birth
d. adolescence Answer: A
Rationale: The oogonia begin to form when the primordial germ cells have arrived in the gonad of the developing genetically female embryo. These cells undergo a series of mitotic divisions and are arranged in clusters surrounded by flat epithelial cells by approximately the end of the 3rd month of gestation or 12 weeks AOG in-utero. So at 24 weeks AOG in-utero, majority of the oogonia have already divided by mitosis and the germ cells have already reached its
maximum number. Some even have already been arrested at meiosis I, forming primary oocytes. A number of oogonia as well as primary oocytes become atretic prior to birth and continuously degenerate until only a certain number of them become viable for the resumption of meiosis by ovulation at adolescence and subsequently, fertilization.
Reference: Langman’s Medical Embryology, 8th Edition, Chapter 1, page 20
13. Mendoza,
a. first b. second c. third d. fourth
Answer: A. In the first stage of meiosis, called the reduction division, the members of each pair of homologous
chromosomes lie side by side and crossing over occurs. Each member of the pair then moves away from the other toward opposite ends of the dividing cell, and two nuclei, each with the haploid number of double-stringed chromosomes, are formed.
Source: The Columbia Electronic Encyclopedia® Copyright © 2007, Columbia University Press. Licensed from Columbia University Press. All rights
reserved.www.cc.columbia.edu/cu/cup/ (http://encyclopedia2. thefreedictionary.com/reduction+division)
14) When does differentiation in the process of oogenesis begins in the female?
a. 12 weeks AOG in-utero b. 24 weeks AOG in-utero c. upon birth
d. adolescence
Answer: A. Oogenesis takes place in the genital primordium. Proliferation occurs and at the onset of meiosis I during the 12th week. The oogonium matures and gives rise to the primary oocytes, which become arrested in the diplotene stage of prophase I.
Source: Williams Obstetrics 23rd edition E-BOOK Chapter 4: Fetal Growth and Development
15) With two million oocytes at birth, how many are actually ovulated in a woman's entire life?
a. 200 b. 400 c. 600 d. 800
Answer: B. The ovary contains many follicles composed of a developing egg surrounded by an outer layer of follicle cells. Each egg begins oogenesis as a primary oocyte. At birth each female carries a lifetime supply of developing oocytes, each of which is in Prophase I. A developing egg (secondary oocyte) is released each month from puberty until
menopause, a total of 400-500 eggs.
Source: http://www.emc.maricopa.edu/faculty/farabee/biobk/b iobookmeiosis.html
14. Navor, Abigail
A. 14. When does differentiation in the process of oogenesis begins in the female? a. 12 weeks AOG in utero
b. 24 weeks AOG in utero c. Upon birth
d. Adolescence Answer: A
Rationale: oogenesis begins during fetal life. It begins with the onset of prophase 12 weeks AOG ( 3mos).
Source: www.embryology.ch/anglais/
15. With two million oocytes at birth, how many are actually ovulated in woman' s entire life?
a. 200 b. 400 c. 600 d. 800 Answer: B
Rationale: There are 2 million oocytes in human ovary at birth. About 400,000 follicles are present at the onset of puberty.1000 follicles per month until age 35 are depleted. Only 400 follicles are normally released during female reproductive life.
Source: William' s 23rd, chapter 3, pages 36-37.
16. How can fertilization occur when coitus happened three days before ovulation?
a. The ovum can live up to three days b. The sperm can live up to three days c. Both are correct
d. Both are wrong Answer: B
Rationale: Prior to ovulation, the female body begins to prepare for the introduction of sperm by maintaining a lower body temperature and producing an alkaline cervical
mucus.Sperm may live between 3 and 5 days in the uterus, or between 24 and 48 hours.
Source: www.mayoclinic.health 16. Tecson,
•The ovum can live up to three days •The sperm can live up to three days •Both are correct
•Both are wrong Answer: B
Rationale: Letter A is wrong because according to
Sumpaico, oocytes are fertilized in the fallopian tube usually within 12 hours after ovulation and they may not survive for more than 24 hours before disintegrating.
The life span of sperm after ejaculation depends on the environmental conditions. Sperm ejaculated into a woman's vagina can live in a woman's reproductive tract for up to three days or perhaps even longer. Fertilization is possible as long as the sperm remain alive. Sperm ejaculated outside the body may survive only minutes to a few hours.
Reference:
http://www.mayoclinic.com/health/pregnancy/AN00281 Textbook of OBSTETRICS Sumpaico 3rd edition page 167 17. What event triggers ovulation?
•Elevated estrogen level •Critical follicle size •Decrease in FSH level •LH surge
Answer: D
Rationale: The LH surge stimulates three major events: resumption of meiosis allowing the oocyte to undergo final maturation, luteinization of the granulosa and theca cells with increased production of progesterone, and follicle rupture with extrusion of a mature oocyte. Another important
midcycle event is the conversion of the granulosa membrane from avascularized to a vascularized status
Reference Textbook of OBSTETRICS Sumpaico 3rd edition page 71
18. Which process must the sperm undergo first prior to fertilization? •Ejaculation •Spermiogenesis •Capacitation •Sperm penetration Answer: C
Rationale: Although spermatozoa are said to be “mature” when they leave the epididymis, their activity is held in check by multiple inhibitory factors secreted by the genital duct epithelia. Therefore, when they are first expelled in the semen, they are unable to perform their duties in fertilizing the ovum. However, on coming in contact with the fluids of the female genital tract, multiple changes occur that activate the sperm for the final processes of fertilization. These
collective changes are called capacitation of the
spermatozoa. This normally requires from 1 to 10 hours. Reference: Medical physiology 11th edition Guyton and Hall 17. Sigua,
Roxanne C. 17. SIGUA, ROXANNE C.What event triggers ovulation? a. elevated estrogen level b. critical follicle size c. decrease in FSH level d. LH surge
ANSWER: D
RATIONALE: LH secretion peaks 10 to 12 hours before ovulation and stimulates the resumption of meiosis in the ovum with the release of the first polar body. Current studies suggest that in response to LH, increased progesterone and prostaglandin production by the cumulus cells, as well as GDF9 and BMP-15 by the oocyte, activates expression of genes critical to formation of a hyaluronan-rich extracellular matrix by the COC (Richards, 2007). During synthesis of this matrix, cumulus cells lose contact with one another and move outward from the oocyte along the hyaluronan polymer—this process is called expansion. This results in a 20-fold increase in the volume of the complex. Studies in mice indicate that COC expansion is critical for maintenance of fertility. In addition, LH induces remodeling of the ovarian extracellular matrix to allow release of the mature oocyte with surrounding cumulus cells through the surface epithelium. Activation of
proteases likely plays a pivotal role in weakening of the follicular basement membrane and ovulation (Curry and Smith, 2006; Ny and colleagues, 2002).
Reference: Williams Obstetrics 23rd edition, Chapter 3 18. SIGUA, ROXANNE C.
Which process must the sperm undergo first prior to fertilization? a. ejaculation b. spermiogenesis c. capacitation d. sperm penetration ANSWER: C
RATIONALE: After the ejaculation the sperm cells go through several essential physiological changes during their time in the female genital tract before they, at the end, are able to penetrate the oocyte membrane.The first change in this cascade is capacitation. The sperm cells accomplish this during the ascension through the female genital tract (in contact with its secretions). It has to do with a physiological maturation process of the sperm cell membranes, which is seen as the precondition for the next step to follow, namely the acrosome reaction.
Reference:
http://www.embryology.ch/anglais/dbefruchtung/weg03.html 19. SIGUA, ROXANNE C.
What is formed with completion of fertilization? a. zygote
b. cleavage c. blastomere d. morula ANSWER: A
RATIONALE: After fertilization in the fallopian tube, the mature ovum becomes a zygote—a diploid cell with 46 chromosomes—that then undergoes cleavage into blastomeres (Fig. 3-10). In the two-cell zygote, the
blastomeres and polar body are free in the perivitelline fluid and are surrounded by a thick zona pellucida. The zygote undergoes slow cleavage for 3 days while still within the fallopian tube. As the blastomeres continue to divide, a solid mulberry-like ball of cells—the morula—is produced. The morula enters the uterine cavity about 3 days after
fertilization. Gradual accumulation of fluid between the cells of the morula results in the formation of the early blastocyst. Reference: Williams Obstetrics 23rd edition, Chapter 3
19. Ozaeta,
Kathleen Joyce R. 19. OZAETA, KATHLEEN JOYCE R. What is formed with completion of fertilization? a. zygote
b. cleavage c. blastomere d. morula ANSWER: A
After fertilization in the fallopian tube, the mature ovum becomes a zygote—a diploid cell with 46 chromosomes—that then undergoes cleavage into blastomeres.
Reference: Williams Obstetrics, Twenty-Third Edition p. 48 20. OZAETA, KATHLEEN JOYCE R.
What is the average duration (in days) between the first day of last menstrual period and the birth of the fetus?
a. 260 b. 270 c. 280 d. 290 ANSWER: C
About 280 days, or 40 weeks, elapse on average between the first day of the last menstrual period and the birth of the fetus. This corresponds to 9 and 1/3 calendar months. A quick estimate of the due date of a pregnancy based on menstrual data can be made as follows: add 7 days to the first day of the last period and subtract 3 months.
Reference: Williams Obstetrics, Twenty-Third Edition p. 79 21. OZAETA, KATHLEEN JOYCE R.
What mechanism is involved in the transfer of glucose through the placental tissue?
a. simple diffusion b. facilitated diffusion c. active transport d. any of the above ANSWER: B
The transfer of D-glucose across cell membranes is accomplished by a carrier-mediated, stereospecific,
nonconcentrating process of facilitated diffusion. At least 14 separate glucose transport proteins (GLUTs) have been discovered (Leonce and colleagues, 2006). They belong to the 12-transmembrane segment transporter superfamily and are characterized further by tissue-specific distribution. GLUT-1 and GLUT-3 primarily facilitate glucose uptake by the
placenta and are located in the plasma membrane of the microvilli of the syncytiotrophoblast (Korgun and colleagues, 2005). GLUT-1 expression increases as pregnancy advances and is induced by almost all growth factors (Sakata and colleagues, 1995).
Reference: Williams Obstetrics, Twenty-Third Edition p. 87
20. Pacifico, Ma.
Priscilla Elena 20. What is the average duration (in days) between the first day of the last menstrual period and the birth of the fetus?
a. 260 c. 280
b. 270 d. 290
Answer: C
Rationale: In Sumpaico, it states that:
“…gestational age (also known as menstrual age and age of gestation) is calculated from the first day of the last menstrual period, in ultrasound, and in clinical practice. Pregnancy lasts for about 280 days, or 40 weeks, 9 ½ calendar months, or 10 lunar months, when calculation is made from the LMP.”
Reference: Sumpaico (Textbook of Obstetrics), 3rd Edition, page 208
21. What mechanism is involved in the transfer of glucose through the placental tissue?
a. Simple diffusion c. Active transport b. Facilitated diffusion d. Any of the above Answer: B
Rationale: In Shnider and Levinson’s Anesthesia for Obstetrics, five mechanisms for exchange of substances
across the placenta were outlined. These are diffusion, active transport, bulk flow, pinocytosis and “breaks”. It was
specifically stated that “glucose crosses the placenta via facilitated diffusion carriers inserted in both microvillous and basement membranes”, wherein its movement down the concentration gradient is depends on the blood flow, plasma concentrations and cellular energy supply.
Reference: Hughes, S., Levinson, G. and Rosen, M., Shnider and Levinson’s Anesthesia for Obstetrics, pages 19-21
22. Which condition may develop due to lack of amnionic fluid during early fetal development?
a. Pulmonary emphysema c. Renal agenesis
b. Musculoskeletal deformities d. All of the above
Answer: D Rationale:
Table 21-4. Congenital Anomalies Associated with Oligohydramnios
Amnionic band syndrome
Cardiac: Fallot tetralogy, septal defects
Central nervous system: holoprosencephaly, meningocoele, encephalocoele, microcephaly
Chromosomal abnormalities: triploidy, trisomy 18, Turner syndrome Cloacal dysgenesis
Cystic hygroma
Diaphragmatic hernia
Genitourinary: renal agenesis, renal dysplasia, urethral obstruction, bladder exstrophy, Meckel-Gruber syndrome, ureteropelvic junction obstruction, prune-belly syndrome
Hypothyroidism
Skeletal: sirenomelia, sacral agenesis, absent radius, facial clefting TRAP (twin reverse arterial perfusion) sequence
Twin-twin transfusion
VACTERL (vertebral, anal, cardiac, tracheo-esophageal, renal, limb) association
Reference: Williams Textbook of Obstetrics 23rd Edition page 496
22. Magno,
Warlyn Grace 22. MAGNO, WARLYN GRACE L.Which condition may develop due to lack of amniotic fluid during early fetal development?
a. pulmonary emphysema b. musculoskeletal deformities
c. Renal agenesis d. All of the above
Answer: D. ALL OF THE ABOVE
Rationale: The volume of amnionic fluid at each week is quite variable. In general, the volume increases by 10 mL per week at 8 weeks and increases up to 60 mL per week at 21 weeks, then declines gradually back to a steady state by 33 weeks (Brace and Wolf, 1989).
Amnionic fluid serves to cushion the fetus, allowing
musculoskeletal development and protecting it from trauma. It also maintains temperature and has a minimal nutritive function. Epidermal growth factor (EGF) and EGF-like growth factors, such as transforming growth factor-b, are present in amnionic fluid. Ingestion of fluid into the gastrointestinal tract and inhalation into the lung may promote growth and
differentiation of these tissues. Animal studies have shown that pulmonary hypoplasia can be produced by draining off amnionic fluid, by chronically draining pulmonary fluid through the trachea, and by physically preventing the prenatal chest excursions that mimic breathing (Adzick and associates, 1984; Alcorn and colleagues, 1977). Thus, the formation of intrapulmonary fluid and, at least as important, the alternating egress and retention of fluid in the lungs by breathing movements are essential to normal pulmonary development.
Reference: Williams Obstetrics, 23e > Chapter 4. Fetal Growth and Development
23. MAGNO, WARLYN GRACE L.
Which of the following fontanel is a small triangular area at the intersection of the sagittal and lambdoid sutures of the fetal head?
a. temporal b. casserian c. greater d. posterior
Answer: D. POSTERIOR FONTANEL
Rationale: The head is composed of the firm skull, which is made up of two frontal, two parietal, and two temporal bones, along with the upper portion of the occipital bone and the wings of the sphenoid. These bones are separated by membranous spaces that are termed sutures.
frontal bones; the sagittal, between the two parietal bones; the two coronal, between the frontal and parietal bones; and the two lambdoid, between the posterior margins of the parietal bones and upper margin of the occipital bone. Where several sutures meet, an irregular space forms, which is enclosed by a membrane and designated as a fontanel. The greater, or anterior, fontanel is a lozenge-shaped space that is situated at the junction of the sagittal and the coronal sutures. The lesser, or posterior, fontanel is represented by a small triangular area at the intersection of the sagittal and lambdoid sutures. The localization of these fontanels gives important information concerning the presentation and position of the fetus during labor.
Reference: Williams Obstetrics, 23e > Chapter 4. Fetal Growth and Development
24. MAGNO, WARLYN GRACE L.
In the anatomical development of fetal urinary system, what age of gestation (in weeks) is urine first produced?
a. 9 b. 12 c. 15 d. 18
Answer: B. 12 WEEKS AOG
Rationale: Two primitive urinary systems—the pronephros and the mesonephros—precede the development of the metanephros. The pronephros has involuted by 2 weeks, and the mesonephros is producing urine at 5 weeks and
degenerates by 11 to 12 weeks. Between 9 and 12 weeks, the ureteric bud and the nephrogenic blastema interact to produce the metanephros. By week 14, the loop of Henle is functional and reabsorption occurs (Smith and associates, 1992). New nephrons continue to be formed until 36 weeks. In preterm neonates, their formation continues after birth. Fetal kidneys start producing urine at 12 weeks, and by 18 weeks, they are producing 7 to 14 mL per day.
Reference: Williams Obstetrics, 23e > Chapter 4. Fetal Growth and Development
23. Parao, Angelo
E. 23. Which of the following fontanel is a small triangular area at the intersection of the sagittal and lambdoid sutures of the fetal head?
a. Temporal b. Caesarian
c. Greater d. Posterior Answer : D
Rationale : The lesser, or posterior, fontanel is represented by a small triangular area at the intersection of the sagittal and lambdoid sutures. The localization of these fontanels gives important information concerning the presentation and position of the fetus during labor.
Reference : William’s 23rd edition (online access, Accessmedicine.com)
24. In the anatomical development of fetal urinary system, what age of gestation (in weeks) is urine first produced? a. 9
b. 12 c. 15 d. 18
Answer : B
Rationale: Urine usually is found in the bladder even in small fetuses. The fetal kidneys start producing urine at 12 weeks. By 18 weeks, they are producing 7 to 14 mL/day, and at term, this increases to 27 mL/hr or 650 mL/day (Wladimiroff and Campbell, 1974).
Reference: William’s 23rd edition (online access, Accessmedicine.com)
24. In the fetal circulation, where does the well-oxygenated blood pass to reach the left side and eventually supply the heart and brain?
a. right AV valve b. criata dividena c. foramen ovale d. ductus arteriosus Answer : C
Rationale: In contrast to postnatal life, the ventricles of the fetal heart work in parallel, not in series. Well-oxygenated blood enters the left ventricle, which supplies the heart and brain, and less oxygenated blood enters the right ventricle, which supplies the rest of the body. The two separate
circulations are maintained by the structure of the right atrium, which effectively directs entering blood to either the left atrium or the right ventricle, depending on its oxygen content. This separation of blood according to its oxygen content is aided by the pattern of blood flow in the inferior vena cava. The well-oxygenated blood tends to course along the medial aspect of the inferior vena cava and the less oxygenated blood stays along the lateral vessel wall. This
aids their shunting into opposite sides of the heart. Once this blood enters the right atrium, the configuration of the upper interatrial septum—the crista dividens—is such that it
preferentially shunts the well-oxygenated blood from the medial side of the inferior vena cava and the ductus venosus through the foramen ovale into the left heart and then to the heart and brain (Dawes, 1962). After these tissues have extracted needed oxygen, the resulting less oxygenated blood returns to the right heart through the superior vena cava.
Reference: William’s 23rd edition (online access, Accessmedicine.com)
24. Nano,
Marjorie Ann J. 24. In the anatomical development of fetal urinary system, what age of gestation (in weeks) is urine first produced? a. 9
b.12 c. 15 d. 18
Answer: b.
Rationale: According to the book, the fetal kidneys start producing urine at 12 weeks. By 18 weeks, they are
producing 7-14 ml/ day and at term, this increases to 27 ml/hr or 650 mL/day
Reference: Cunningham, G.F, et al. (2005) William Obstetrics; Fetal growth and development. 23rd edition. [chapter 4 pp 95].USA. McGraw-hill Companies, Inc.
25. In the fetal circulation, where does the well-oxygenated blood pass to reach the left side and eventually supplies the heart and brain?
a. right atrioventricular valve b. crista dividenc
c. foramen ovale d. ductus arteriosus Answer: C
Rationale: once the blood enters the right atrium, the
configuration of the upper interatrial septum (crista dividens) shunts the well oxygenated blood from the medial side of the inferior vena cava and the ductus venosus through the
foramen ovale into the left heart and then to the heart and the brain.
Reference: Cunningham, G.F, et al. (2005) William Obstetrics; Fetal growth and development. 23rd edition. [chapter 4 pp 89-90].USA. McGraw-hill Companies, Inc.
that spreads to line the alveolus to prevent alveolar collapse during expiration?
a. alveolar fluid b. glucocorticoids c. surfactant d. all of the above Answer: C
Rationale: there are more that 200 pulmonary cell types, but surfactant is formed specifically in type II pneumocyte that line the alveoli.
Reference: Cunningham, G.F, et al. (2005) William Obstetrics; Fetal growth and development. 23rd edition. [chapter 4 pp 95-96].USA. McGraw-hill Companies, Inc.
25. Salvacion,
Karl Louie G. 25. In the fetal circulation, where does the well-oxygenated blood pass to reach the left side and eventually supplies the heart and brain?
•Right atrioventricular valve c. foramen ovale
•Crista dividens d. ductus
arteriosus
Answer: C. foramen ovale
Rationale: Once this blood enters the atrium, the
configuration of the upper interatrial septum, called the crista dividens, is such that it preferentially shunts the
well-oxygenated blood from the medial side of the inferior vena cava and the ductus venosus through the foramen ovale into the left heart and then to the heart and brain (Dawes, 1962). After these tissues have extracted needed oxygen, the
resulting less oxygenated blood returns to the right heart through the superior vena cava.
Reference: WILLIAMS OBSTETRICS - 22nd Ed. (2005) E-BOOK 26. What substance/s is/are produced by type II pneumocytes that spreads to line the alveolus to prevent alveolar collapse during expiration?
a.alveolar fluid c.
surfactant
b. glucocorticoids d. all of
Answer: C. surfactant
Rationale: After birth, the terminal sacs must remain
expanded despite the pressure imparted by the tissue-to-air interface, and surfactant keeps them from collapsing. There are more than 40 cell types in the lung, but surfactant is formed specifically in the type II pneumonocytes that line the alveoli. These cells are characterized by multivesicular bodies that produce the lamellar bodies in which surfactant is
assembled.
Reference: WILLIAMS OBSTETRICS - 22nd Ed. (2005) E-BOOK
27. Circulatory disturbances of the placenta include:
•Infarcts c.
calcification
•Thrombosis d. all of
the above
Answer: D. all of the above
Rationale: CIRCULATORY DISTURBANCES. Placental
perfusion may be impaired by disruption of uterine vessels, placental vessels, or the intervillous space. Placental
Infarctions. These are the most common placental lesions, and their presence is a continuum from normal
changes to extensive and pathological involvement. Placental Vessel Thrombosis. When a stem artery from the fetal
circulation in the placenta is occluded, it produces a sharply demarcated area of avascularity. Necrosis of villous tissue develops from ischemia. Histopathological features include fibrinoid degeneration of the trophoblast, calcification, and ischemic infarction. If decidual artery occlusion is followed by hemorrhage, then placental abruption results.
Reference: WILLIAMS OBSTETRICS - 22nd Ed. (2005) E-BOOK 26. Pamplona,
Hayzelle P. 26. what substance is/are produced type II pneumocytes that spreads to line the alveolus to prevent alveolar collapse during expiration?
a. alveolar fluid b. gluccocorticoids
c. surfactant d. all of the above Answer: C
Rationalization: Surfactant, specifically SP A, is produced by type II pneumocyte.
Reference: Williams Obstetrics, 23rd ed. Page 96. 27. Circulatory disturbances of the placenta include: a. infarcts
b. thrombosis c. calcification d. all of the above Answer: D
Rationalization: Placental perfusion may be impaired by disruption of uterine vessels, placental vessels, or the intervillous space. Placental infarctions the most common placental lesions, and their presence is a continuum from normal changes to extensive and pathological involvement. Placental vessel thrombosis thrombosis is when a stem artery from the fetal circulation in the placenta is occluded
producing a sharply demarcated area of avascularity. This will deprive only 5 percent of the villi of their blood supply.
Reference: Williams Obstetrics 22nd ed. Ebook.
28. Blood with a higher oxygen content returns from the placenta to the fetus through the :
a. umbilical arteries b. truncal arteries c. umbilical vein
d. arcuate arteries Answer: C
Rationalization: Oxygen and nutrient materials required for fetal growth and maturation are delivered from the placenta by the umbilical vein.
Reference: Williams Obstetrics, 23rd ed. Page 89. 27. Sanding,
Elriza Mhyrel S. 27. Circulatory disturbances of the placenta include:e. infarcts f. thrombosis
g. calcification h. all of the above
Answer: D. all of the above
Rationale: Placental perfusion disorders may be grouped into: those disrupted maternal blood flow to or within the
placenta and those that disturb fetal blood flow through the villi. A number of lesions can restrict intervillous blood flow such as maternal floor infarction, in which this condition deposits a dense fibrinoid layer on the placental basal plate, and acts as a blockade to normal maternal blood flow. These infarctions are associated with fetal growth restriction,
abortion, preterm delivery and stillbirths. Furthermore, thrombi are normally found in mature placentas but may become clinically significant if a large portion of villi is lost that may restrict fetoplacental blood flow. Another one is placental calcification, in which there is deposition of Calcium salts throughout the placenta and is associated with
nulliparity, higher socioeconomical status and greater maternal calcium levels.
Reference: Williams 23rd edition, pages 578-580
28. Blood with a higher oxygen content returns from the placenta to the fetus through the:
e. umbilical arteries f. truncal arteries g. umbilical vein h. arcuate arteries
Answer: C. umbilical vein
Rationale: Deoxygenated venous-like fetal blood flows to the placenta through the two umbilical arteries. Truncal arteries are perforating branches of the surface arteries that pass through the chorionic plate. Whereas, blood with significantly higher oxygen content returns from the placenta via a single umbilical vein to the fetus. Arcuate arteries supply the two layers of the endometrium.
29. Over-the-counter pregnancy test kits test for which placental hormone?
a. estogen b. progesterone
c. human placental lactogen d. human chorionic gonadotropin
Answer: D. human chorionic gonadotropin
Rationale: The intact HCG molecule is detectable in plasma of pregnant women 7-9 days after ovulation. Maternal urine contains the same variety of HCG degradation products as maternal plasma. The principal urinary form is the terminal degradation HCG product, which is the B-core fragment. It is important to recognize that the so-called B-subunit antibody used in most pregnancy tests reacts with both intact HCG. Reference: Williams 23rd edition, page 63
28. Martinez,
Xandra 28. Blood with a higher oxygen content returns from the placenta to the fetus through the: A. Umbilical Arteries
B. Truncal Arteries C. Umbilical Vein D. Arcuate Arteries Answer: C (Umbilical Vein) Rationale:
Oxygen and nutrient materials required for fetal growth and maturation are delivered from the placenta by the single umbilical vein.
Reference: Williams Obstetrics, 23rd Edition. Chapter 4. Fetal Growth And Development.
29. Over-the-counter pregnancy test kits test for which placental hormone?
A. Estrogen B. Progesterone
C. Human placental lactogen D. Human chorionic gonadotropin
Rationale:
The detection of hCG in blood or urine is almost always indicative of pregnancy.
Reference: Williams Obstetrics, 23rd Edition. Chapter 3. Implantation, Embryogenesis, and Placental Development.
30. In the development of the deciduas, the portion directly beneath the site of blastocyst implantation is the:
A. Decidua Capsularis B. Decidua Basalis C. Decidua Parietalis D. Chorion Leave
Answer: B (Decidua Basalis)
Rationale: The spiral arterial system supplying the deciduas basalis directly beneath the implanting blastocyst, and
ultimately the intervillous space, is altered remarkably.
Reference: Williams Obstetrics, 23rd Edition. Chapter 3. Implantation, Embryogenesis, and Placental Development.
29. Vergara,
Renn Miguel 29. Over-the-counter pregnancy test kits test for which placenta hormone •estrogen
•progesterone
•human placental lactogen •human chorionic gonadotropin Answer: D
Rationale: Detection of hCG in maternal blood and urine provides the basis for endocrine tests of pregnancy; Numerous commercial immunoassays including over the counter pregnancy test kits are available for measuring serum and urine levels of hCG.
Reference: Williams Obstetrics 23 rd edition, page 192-193 30. In the development of the decidua, the portion directly beneath the site of blastocyst implantation is the:
•decidua capsularis •decidua basalis •decidua parietalis
•chorion leave Answer: B
Rationale: Decidua directly beneath blastocyst implantation is modified by trophoblast invasion and becomes the
deciduas basalis.
Reference: Williams Obstetrics 23 rd edition, page 45
31. Which subunit of the hCG molecule is used as the tumor marker for trophoblastic disease?
•alpha •beta •delta
•none of the above •Answer: B
Rationale: In confirmation of the diagnosis of gestational trophoblastic diseases, a system was adopted based
principally on clinical findings and serial serum measurement of human chorionic gonadotropin, particularly beta-hCG. Reference: Williams Obstetrics 23 rd edition, page 257
30. Panghulan,
Aldee Ray 30.In the development of the deciduas, the portion directly beneath the site of blastocyst implantation is the: a. deciduas capsuralis b. deciduas basalis c. deciduas parietalis d. chorio leave ANSWER: B. decidua basalis RATIONALIZATION: In human pregnancy, the decidual reaction is completed only with
blastocyst implantation. The portion of the decidua
directly beneath the site of blastocyst implantation is modified by trophoblast invasion and becomes the decidua basalis; that portion
overlying the enlarging blastocyst, and initially separating it from the rest of the uterine cavity, is the decidua capsularis
(Figure beside). The decidua capsularis is most prominent during the second month of pregnancy, consisting of decidual cells covered by a single layer of flattened epithelial cells without traces of glands. Internally, this portion of the decidua contacts the avascular, extraembryonic fetal
membrane, the chorion laeve. The remainder of the uterus is lined by decidua parietalis, sometimes called the decidua vera when decidual capsularis and decidua parietalis are joined.
SOURCE: Williams Obstetrics 21st edition e-book Chapter II page 61 of 1132
31. Which subunit of the hCG molecule is used as the tumor marker for trophoblastic disease
a. alpha b. beta c. delta d. gamma
ANSWER: B. beta
-Beta subunit is most important because it is easily measurable by present-day technology.
The rate of synthesis of the ß-subunit of hCG is believed to be limiting in the formation of the complete molecule.
Trophoblasts of normal placenta and those of hydatidiform mole and choriocarcinoma tissues secrete free a- and ß-subunits as well as intact hCG.
-Trophoblastic diseases are a group of pregnancy disorders including a complete hydatidiform mole, a partial mole, and choriocarcinoma.
-The use of total hCG measurement in gestational
trophoblastic diseases is an example of a tumor marker with 100% sensitivity and 100% specificity for trophoblast-tissue mass, with the amount of tumor tissue or mole being directly proportional to the circulating concentration of total hCG. SOURCE: Williams Obstetrics 21st edition e-book page 191 of 1132 “The Placental Hormones”
32. The most invasive cell in human physiology is: a. trophoblast
b. Langhan cell c. white blood cell d. plasma cell
ANSWER: A. trophoblast
Trophoblast, a very special cell; “without it, you and I would not be here”. Responsible for implantation. Its invasiveness provides for attachment of the blastocyst to the uterus.
The decidua basalis contributes to the formation of the basal plate of the placenta, and differs histologically from the
decidua parietalis in two important respects. First, the spongy zone of the decidua basalis consists mainly of arteries and widely dilated veins; by term, the glands have virtually disappeared. Second, the decidua basalis is invaded by trophoblastic giant cells, which appear at the time of implantation. The number and depth of endometrial penetration of the giant cells varies greatly. Although
generally confined to the decidua, these cells may penetrate the myometrium. In such circumstances, their number and invasiveness may be so extensive as to be suggestive of choriocarcinoma to the inexperienced observer.
SOURCE: Williams Obstetrics 21st edition e-book Chapter II page 61 of 1132
31. Magdaong,
Melayne Jewel 31. MAGDAONG, MELAYNE JEWEL R.Which sub-unit of the hCG molecule is used as the tumor marker for trophoblastic disease.
e. Alpha f. Beta g. Delta h. None Answer: B
Rationale: trophoblast cells produce hCG in amounts that increase exponentially following implantation. hCG consists of alpha and beta subunit. Antibodies were develop with high specificity for Beta subunit.
Reference: Williams 23rd edition. Pages 192-193. Chapter 8: Pre natal care
32. MAGDAONG, MELAYNE JEWEL R.
The most invasive cell in human physiology is i. Trophoblast
j. Langhan cell k. White blood cell l. Plasma cells Answer: A
Rationale: Trophoblast the most variable structure, function development pattern of placental component; It’s
invasiveness provides for implantation function as endocrine organ essential to maternal physiological adaptation and maintenance of pregnancy.
Implantation, embryogenesis and placental development. 33. MAGDAONG, MELAYNE JEWEL R.
Which of the following is a normal characteristic of placenta? i. Weight of 500 grams
j. Contains 60-70 cotyledons k. Contains an accessory lobe
l. There is mixing of maternal and fetal blood within Answer; A
Rationale: Average weight is 503 grams and contains 10-38 cotyledons.
Reference: Williams 23rd edition. Page 54. Chapter 3: Implantation, embryogenesis and placental development.
33. Tan, Robenne
Maree A. 33. Which of the following is a normal characteristic of placenta? a. Weight of 500 grams
b. contains 60 to 70 cotyledons c. contains an accessory lobe
d. There is mixing of maternal and fetal blood within Answer: A. Weight of 500 grams
Rationale: the average placenta at term 185mm in diameter and 23mm in thickness, with the volume of 497 ml and weight of 508 g. ( 500g). Viewed from the maternal surface, the number of slightly elevated convex areas called lobes ( grossly visible lobes also been referred to as COTYLEDONS), varies from 10-38 cotyledons. Placenta dont contains any accessory lobe and there is no direct mixing of maternal and fetal blood within.
34. This placental hormone rescues and maintains the corpus a. Human placental lactogen
b. estrogen c.progesterone
d.Human chorionic gonadotropin
Answer: D. Human chorionic gonadotropin
Rationale: both subunits of Hcg are required for normal binding to the LH-Hcg receptor in the corpus luteum and the testis. LH-Hcg receptors are present in a variety of tissues, and their role is less defined. The best known biological function of Hcg is the so called rescue and maintains of function of the corpus luteum.
35. A 19 y/o, G1P0, 6 weeks pregnant, develops vaginal spotting after undergoing a unilateral
salphingo-oopherrectomy for an ovarian mass. The spotting was most likely due to lack of which hormone:
a.human placental lactogen b.human chorionic gonadotropin c.estrogen
d.progesterone
Answer: D. Progesterone
Rationale: progesterone produced by syncytiotrophobalst facilitates and permits the maintenance of pregnancy.
Formation of progesterone occurs through the uptake and use of maternal LDL cholesterol.
Reference: Williams obstetrics 22nd edition. E-book..
35. Ramos, Genie
Anne 35 Ramos, genie anneQuestion 35. A 19 y/o G1P0, 6 weeks pregnant, develops vaginal spotting after undergoing a unilateral salpingo-oophorectomy for an ovarian mass. The spotting was most likely due to a lack of which hormone?
a. human placental lactogen
b. human chorionic gonadotroponin c. estrogen
d. progesterone Answer: D
Rationale: Ovulation ceases during pregnancy and the maturation of new follicles is suspended. Ordinarily only a single corpus luteum can be found in pregnant women. This functions maximally during the first 6 to 7 weeks of
pregnancy - 45 weeks post-ovulstion snd thereafter
contribute relativeley little to progesterone production. This observations have been confirmed by surgical removal of the corpus luteum before 7 week to 5 weeks post-ovulation- which results in a rapid fall of maternal serum progesterone and spontaneous abortion. (Csapo and co-workers, 1973) Reference: William obstetrics,23e, chapter 5: maternal physiology
35 Ramos, Genie Anne
Question 36. Dextrorotation of the uterus is due to: a. presence of the rectosigmoid on the left
b. hydronephrosis of the kidney on the right c. preference of the baby to move to the right d. presence of the appendix on the right
Answer: A
Rationale: By the end of 12 weeks, the uterus has become too large to remian entirely within the pelvis. As the uterus continues to enlargen it contacts the anterior abdominal wall, displaces the intestines laterally and superiorly, and
continues to rise, ultimately reachinh almost to the liver. With ascent of uterus to pelvis, it usually undergoes rotation to the right. This dextrorotation likely is caused by the rectosigmoid on the left side of the pelvis. As the uterus rises, tension is exerted on the brad and round ligaments.
Reference: William obstetrics,23e, chapter 5: maternal physiology
35 Ramos, Genie Anne
Question 37. The elevated patches of tissue present on the ovaries that bleed easily during pregnancy are:
a. endometriotic implants b. adhesions
c. decidual reaction d. corpus lutem Answer: C
Rationale: A decidual reaction on and beneath the surface of the ovaries is common in pregnancy and is usually observed at ceserean delivery. These elevated patches of tissue bleed easily and may on first glance resemble freshly torn
adhesions.
Reference: William obstetrics,23e, chapter 5: maternal physiology
36. Yu, Philip Philip Andrew S. Yu Section B
36. Dextrorotation of the uterus is due to:
a. Presence of the rectosigmoid on the left b. Hydronephrosis of the kidney on the right c. Preference of the baby to move on the right d. Presence of the appendix on the right
ANSWER: A. Presence of the rectosigmoid on the left Rationalization : Because of unequal dilatation may result from a cushioning provided by the left ureter by the sigmoid colon as the consequence.
37. The elevated patches of tissues on the ovaries that bleed easily during pregnancy are:
a. Endometriotic implants c. Decidual Reaction
b. Adhesions d. Corpus
luteum
ANSWER: C . Decidual Reaction
Rationalization: A decidual reaction on and beneath the surface of the ovaries, similar to that found in the
endometrial stroma, is common in pregnancy and usually observed at Caesarian Section deliveries. These elevated patches of tissue bleed easily and may on first glance resemble freshly torn adhesions.
38. The following inflammatory markers are increased in pregnancy, EXCEPT:
a. Leukocyte alkaline phosphatase c. Monocytes b. Erythrocyte Sedimentation Rate d. C-Reactive protein
ANSWER: C. Monocytes
Rationalization: Leukocyte alkaline phosphatase, which are used to evaluate myeloproliferative disorders, are increased during early pregnancy. Erythrocyte Sedimentation Rate is increased in normal pregnancy because of elevated plasma globins and fibrinogen. C-reactive protein, an acute phase reactant rises rapidly in response to tissue trauma or inflammation.
Reference: Williams Obstetrics 23rd Edition
38. Nazareno,
Christine 38. NAZARENO, CHRISTINEThe following inflammatory markers are increased in pregnancy except:
•Leukocyte alkaline phosphatase •Erythrocyte sedimentation rate •Monocytes
•C-reactive proteins Answer: Monocytes Rationalization:
Beginning quite early in pregnancy, the activity of leukocyte alkaline phosphatase is increased. Such elevated activity is
not peculiar to pregnancy but occurs in a wide variety of conditions, including most inflammatory states.
The concentration of C-reactive protein, an acute-phase serum reactant, rises rapidly to 1000-fold in response to tissue trauma or inflammation. Watts and colleagues (1991) measure C-reactive protein sequentially diring 81 normal pregnancies to establish normative values. Median C-reactive protein values during pregnancy were higher than values for nonpregnant women, and these values were evaluated further in labor.
Another marker of inflammation, the erythrocyte
sedimentation rate is increased in normal pregnancy because of elevated plasma globulins and fibrinogen.
Source: William’s Obstetrics 22nd edition, pp. 131 39. NAZARENO, CHRISTINE
The consequence of an elevated diaphragm in pregnancy is: •Increased diaphragmatic excursion
•Decreased functional residual capacity and residual volume
•Increased tidal volume
•Decrease in peak expiratory flow rates
Answer: Decreased functional residual capacity and residual volume
Rationalization:
During pregnancy, diaphragmatic excursion is actually greater than when non-pregnant. The respiratory rate changed a bit, but the tidal volume, minute ventilator
volume, and minute oxygen uptake increase significantly as pregnancy advances. These events happen during normal pregnancy, but the direct consequence of an elevated diaphragm during pregnancy is the decrease in functional residual capacity and residual volume of air.
Source: William’s Obstetrics 22nd edition, pp. 136 40. NAZARENO, CHRISTINE
A pregnant woman who fails to excrete concentrated urine after withholding fluids for approximately 18 hours means:
•The woman has renal damage
•The kidneys are normal by excreting mobilized extracellular fluid of relatively low osmolality