OB EVALUATION 1- SET A Section A
Flores,
Marie Felle 1. Which of the following phrases best describes Reproductive Health?a. absence of disease b. complete state of well being
c. adequate coverage of contraception
d. prevention of maternal death and sexually transmitted disease Answer: B. complete state of well being
Rationale: Reproductive Health is defined as a state of complete physical, mental and social well-beingand NOT merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. It also includes sexual health, the purpose of which is the enhancement of life and personal relations.
Complete state of well-being pretty much summarizes the whole essence of Reproductive Health that is why it is the best phrase that would best describe it. Reference:Sumpaico, 3rd Edition, page 2
Jaurigue, Jaymee
2. Which of the following statement is/are component of Reproductive Health: a. safe motherhood
b. management of abortion complications c. information and services on Family Planning d. prevention and management of sexual violence e. all of the above
Answer: E- all of the above
Rationale: Components of Reproductive Health includes: a) information and services on Family Planning, (b) safe motherhood, (c) gynecological care including management of abortion complications, (d) prevention and treatment of sexually transmitted diseases (including HIV/AIDS), (e) prevention and management of sexual violence, (f) active discouragement of harmful traditional practices, (g) Reproductive health programmes for specific groups such as adolescents. Reference :
R page 4 Sumpaico, et al (2008) Textbook of Obstetrics, 3rd Edition. Abanto,
Mara
3. Due to limitied sources, which Reproductive Health Porgrams/s in the western pacific region will be prioritized according to WHO? a. safe motherhood
b. family planning
c. improve child mortality d. a &b are correct
Answer: D a &b are correct
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. p 91. Cabalza,
Mary Anne 4. For the Millennium Development Goal, Maternal Mortality by year 2015 should be decreased by how many percent?
a. 25 c.75
b. 50 d.85
Answer: C. 75%
Rationale: According to Millennium Development Goal 2010 Report of United Nation, There target for Maternal Mortality should reduce by three quarters or 75%, between 1990 and 2015.
References: Report on the Millennium Development Goals (June, 2010) published by United Nations
Department of Economic and Social Affair.: http://www.un.org/millenniumgoals/pdf
Beatriz, Roxanne Marie
5. Which branch of medicine is concerned with pregnancy, labor and puerperium and aims to promote health and well-being?
a. Obstetrics c. Perinatology b. Reproductive Health d. Midwifery Answer: A Obstetrics
Rationale: According to Cunningham, et. al., obstetrics is defined as a branch of medicine that deals with childbirth and maternal care and treatment before and afterbirth. It also promotes health and well-being of the pregnant woman and her baby through quality prenatal care, supervision during labor and delivery and management of the puerperium.
Reference: Cunningham FG, et. al. (2010).Williams Obstetrics, 23rd edition. New York: McGraw-Hill
(E-book – Chapter I. Overview of Obstetrics, paragraph 1, 2) Cruz,
Fatima 6. Which of the following is the best index of the quality of life and health in a society? (evals 1) a. population density
b. fertility rate
c. maternal outcome d. life expectancy
Answer: C fertility rate
Rationale: “The importance of obstetrics is attested to by the use of maternal and neonatal outcomes as an index of the quality of life and health in a society.”
Reference: William Obstetrics 23rd edition Chapter 01 page 02. Holgado,
Anna Victoria M.
7. Which of the following is NOT a prerequisite to live birth? a) AOG more than 20 weeks
b) Placenta delivered
c) Pulsation of the umbilical cord d) Breathing movement
Answer: (b) Placenta delivered
Rationale: Live birth is a term used to record a birth whenever the newborn at or sometime after birth breathes spontaneously or shows any other sign of life such as a heartbeat or definite spontaneous movement of voluntary muscles. Heartbeats are distinguished from transient cardiac contractions, and respirations are
differentiated from fleeting respiratory efforts or gasps."
- Furthermore, the term "birth" refers to the complete expulsion of the fetus (after 20 weeks' gestation) from the mother
- In either definitions, placental delivery has not been used as part of the criterion Reference: Cunningham, F.G. et. al (2010) "Chapter 1: Overview of
Obstetrics". William's Obstetrics (23rd edition). (Retrieved from Access Medicine, McGraw-Hill)
Dimapilis, Gail Austin C.
8. Considerable weight loss of the newborn happens after delivery. Therefore the newborn must be weighed during the first ____ hour/hours of life:
a. 1 b. 6 c. 12 d. 24
Answer: (a) 1
Rationale: Birthweight of neonate is determined immediately after delivery or as soon thereafter as feasible. It should be expressed to the nearest gram.
Reference: Williams 23rd edition, page 3 Jualayba,
b. and fetal deaths 20 weeks AOG and above
c. 20 weeks AOG and above and fetal deaths 24 weeks AOG and above d. and fetal deaths 24 weeks AOG and above
Answer: B . and fetal deaths 20 weeks AOG and above
Rationale: Total Births – the total number of deliveries, live births plus fetal deaths. Reference: Walfrido Sumpaico. 3rd Ed. Page 7
Lapitan, Jaecel Reyenne
10. Birth rate is defined as number of: a. Total births per 1000 population
b. Total births per 1000 total pregnancies c. Livebirths per 1000 population
d. Livebirths per 1000 total pregnancies Answer: C Livebirths per 1000 population
Reference: Sumpaico, W. W. (2008). Textbook of Obstetrics: Physiologic and
Pathologic Obstetrics. 3rd ed. Chapter 1 page 6. Fabian,
Jeffrey Michael C.
11. Perinatal period is defined as the period from 20 weeks AOG to: A. Delivery
B. 7 days of life C. 28 days of life D. 42 days of life
ANSWER: C 28 days of life
Rationale: Perinatal period is the period after birth of an infant born after 20 weeks and ending at 28 completed days after birth
Reference: Williams, 23rd EDITION, PAGE 3 De Lemos,
Diordan 12. A women delivered, prematurely in a remote area with no health facility. What is your best evidence that the new born is not an abortus? a. computed AOG based on the LMP
b. time when quickening was felt
c. crown to rump length of the newborn is 28 cm. d. fundic height prior to delivery is above the umbilicus
ANSWER: LETTER C. crown to rump length of the newborn is 28 cm.
RATIONALE: Accdg to Williams, Crown to rump length is the most accurate biometric predictor of gestational age. An abortus is defined as an embryo or fetus expelled during the 1st half of pregnancy, less than 20 weeks, less than 500 grams or less and with 16.4 cm or less in length. Since it was indicated that the crown and rump length of the newborn is 28 cm, it only means that the baby is already and approximately in his 23to 24 weeks AOG.
Knowing your AOG based on the LMP can also help you but LMP is not that accurate. Considering that there are some chances that pregnant woman might forget their own LMP unlike for the crown and rump where you can actually measure the baby’s length. Quickening cannot be used as your basis because it can occur for as early as 14th week or as late as 26th week, meaning to say, it varies for every baby.
REFERENCE: 23rd Edition Williams Obstetrics by Cunninghum et al., page 352. http://www.babycenter.com/average-fetal-length-weight-chart
Cotas, Paola Ysabel D.
13. A premature infant was born at 27 to 28 weeks. The baby died on the 60th hour of life. This is considered:
a. Fresh stillbirth b. Macerated stillbirth c. Early neonatal death d. Late neonatal death Answer: C Early neonatal death
Rationale: It is NOT a stillbirth because, even though the infant is premature, the baby was still delivered alive. Early neonatal death is classified as “death of a live-born neonate during the first seven days after birth” while the late neonatal death is classified as “death after seven days but before twenty-nine days after birth.” Therefore, the answer is LETTER C, EARLY NEONATAL DEATH since the premature infant was born on the 60th hour of life or two and a half days after birth.
Reference: Page 7, Chapter 1: Overview of Maternaal Health in the Philippines, Textbook of Obstetrics (Physiologic and Pathologic Obstetrics), 3rd edition, Sumpaico et. al.
Bernus, Marie Grace M.
14. A 35 y/o pregnant woman on her 34 to 35 weeks AOG delivered to a 2.5 kg live baby girl, APGAR score 9-9. Ballard’s scoring of the newborn is 36 weeks. The baby did well post-delivery.
The delivery is considered as: a. preterm
b. term c. postterm Answer: A
Rationale: The 25 y/o pregnant woman was on her 34 to 35 weeks AOG when she delivered to the baby girl. Preterm birth is defined as delivery before 37 completed
weeks AOG. (p. 804)
Reference: Cunningham, F. G., Williams, J. W., Leveno, K. J., Bloom, S., Hauth, J. C., & Rouse, D. J. (2010). Williams Obstetrics. (3 ed.) (pp. 804) . New York: McGraw-Hill Professional
Crisanto, Hebe Margaret
15. A 35 years old pregnant woman on her 34 to 35 weeks AOG delivered to a 2.5
kg live baby girl, APGAR score 9-9. Ballard’s scoring of the newborn is 36 weeks, the baby did well post-delivery.
The weight of this newborn is: a. low birth weight
b. appropriate
c. large for the gestational age Answer: b. appropriate
Rationale: Weight is between the 10-90th percentile.
Reference: Williams Obstetrics 23rd edition (E-book) Chapter 36, Pre-term Birth Carlos,
Jason 16. The death of the mother is due to ________ death. (Mother died from a severe asthmatic attack during post partum) a. direct obstetric
b. indirect obstetric c. non-obstetric
Answer: b. indirect obstetric
Rationale: A direct obstetrical death is a death of a mother that results from obstetrical complications of pregnancy, labor, or the puerpurium and from
interventions, omissions, incorrect treatment, or a chain of events resulting from these factors. An exaple of which is the death of a mother from exsanguination after uterine rapture. On the other hand, non-obstetric death is due to accidental or incidental causes not related to pregnancy. An example of which is a death of a mother due to a car accident. Finally, an indirect obstetric death results from previously existing disease, or a disease developing during pregnancy, labor or puerpurium that was aggravated by maternal physiological adaptation to
pregnancy. An example of which is from the case given in the question above. The mother's death was due to the aggravated asthmatic attack caused by pregnancy. Reference: Williams Obstetrics, 23rd edition, chapter 1, page 3
Almaden,
Vanessa 17. A 38 year old G5P4(4-0-04), was in labor when a landslide hit her baranggay. The parturient eventually died. This is considered a ________ death. a. direct obstetric
b. indirect obstetric c. non-obstetric
Answer:C. Non obstetric death/ Non maternal death
Rationale: By definition non obstetric death is the 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.
While, Direct obstetric death is defined by the death of the mother that results from obstetrical complications of pregnancy, labor or the puerpuerium and from
interventions, omissions, incorrect treatment, or a chain of events resulting from any of these factors.
Indirect maternal death, on the other hand is defined by the purposeful interruption of an intrauterine pregnancy with the intention other than to produce a liveborn neonate, and which does not result in a life birth.
Reference: Williams 23rd edition page 3
Jurao, Ara 18. Maternal mortality ratio is defined as the number of maternal deaths from the reproductive process over
a. 10,000 population b. 10,000 livebirths c. 100,000 population d. 100,000 livebirths
ANSWER: D 100,000 livebirths
RATIONALE: Maternal mortality ratio is the number of maternal deaths that result from the reproductive process per 100,000 livebirths. Used more commonly, but less accurately, are the terms maternal mortality rate or maternal death rate
REFERENCE: Cunningham, G., and et. al. (2010). Williams Obstetrics (23rd ed). The McGraw-Hill Companies, Inc.
Dela Cruz,
Joan Vel S. 19. Majority of Filipino mothers deliver at/in a. home assisted by a doctor b. home assisted by a midwife
c. lying-in clinics with a midwife d. hospital with nurses and doctors
Answer: (B) home assisted by a midwife
Rationale: Based on the 2003 NDHS, about 60% of deliveries take place at home, usually attended by TBA’s(Traditional Birth Attendants) or by midwives.
Reference: Textbook of Obstetrics (Physiologic and Pathologic Obstetrics), 3rd ed., by Sumpaico, et al. page 5.
Delos Santos, Christian
20. Considering that the leading cause of Maternal Death is from complications of labor, delivery and puerperium, the most effective way of improving maternal mortality is to improve the training of our:
a. hilot c. general practitioner
b. midwives d. Obstetrician and Gynecologist Answer: A. hilot
Rationalization: In our country where more births are attended by traditional birth attendants ( TBA; hilot) rather than health workers, the lowering of maternal
mortality can be readily attained by directing attention to these TBA’s.
Reference: Chapter 1: Overview of Philippine Obstetrics; page 7.; Textbook of Obstetrics 2nd edition.; Author: Walfrido W. Sumpaico., M.D.
Exconde, Ma. Kathrina
21. As compared to gestational age, the fertilization age is: A. Less than two weeks
B. less than four weeks C. More than two weeks D. More than four weeks Answer : A
Rationale: Embryologists and other reproductive biologists more often employ
ovulatory age or fertilization age, both of which are typically two weeks shorter.
Reference: Williams, 22nd Edition, (Chapter 8, page 208) Co, Jeffrey
James
22. The most accurate way of determining gestational age during early pregnancy is by:
a. Last normal menstrual cycle c. gestational sac size b. Correlation with uterine size d. crown rump length Answer: D. crown rump length
Rationale: According to Cunningham et al., the crown rump length is the most accurate way to determine gestation age during the first trimester. The Last normal menstrual cycle or LNMP is only used for patients with normal menstrual cycle. It is also erroneous because you rely on the patient’s recall of her LMP.
Reference:Williams Obstetrics, 21st edition, page 1114-1115 Constantin
o, Erwin 23. The developing zygote enters the uterine cavity as a:a. Blastomere b. Blastocyst
c. Morula d. Gastrula Answer: C
Rationale: It is stated in Williams that after 3 days of slow cleaves in the fallopian tube the blastomere will develop into a morula, which is what the fetus is termed, as it enters the uterine cavity.
Reference: Williams, Edition 23, Page 48 Alcantara,
Janus 24. A woman had a positive pregnancy test done today yet she claims to have bleeding for three days just a week prior. this bleeding however was much less in amount than her usual menses. this decreased amount of bleeding can be best explained by:
a. Corpus Luteum Deficiency b. Implantation Bleeding
c. Pathologic or Abnormal Pregnancy d. Hormonal Imbalance
ANSWER: b. Implantation Bleeding
RATIONALE: this physiologic bleeding is caused by the attachment of the blastocyst into the endometrium. It is characterized by a bleeding that is less in amount compared to the usual menses
REFERENCE: Williams 23rd ed. p. 221 Cabanos,
Ronell
25. : Diploid number of chromosomes is maintained despite fusion of two gametes due to reduction division, which occurs during:
A. First meiotic division B. Second meiotic division C. Both are correct
Answer: A. First meiotic division
Rationale: The first meiotic division is also called the reductional division, which resuts in the haploid number of chromosomes.
The second meiotic division, also called as the equational division, preserves the haploid number of chromosomes produced during the first meiotic division.
Reference : Carlson, b. M. Human Embryology and Developmental Biology. pp 5-6 Angeles,
Ma. Kristina Cassandra S.
26. The process of spermatogenesis begins at: a. 12 weeks AOG
b. 20 weeks AOG c. Birth
d. Puberty Answer: D Puberty
Rationale: Spermatogenesis the process of producing Spermatozoa from spermatogonia begins at puberty and continues until old age.
Rerefence: Esteban and Gonzales Textbook of Histology pg 217 Bunyi,
Maria Athena
27. The process of oogenesis begins at: a. 12 weeks AOG
b. 20 weeks AOG c. birth
d. puberty Answer: letter A
Rationale: Following the immigration of the primordial germ cells into the gonadal ridge, 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. The continuation of the development / maturation of the oocyte begins again only a few days before ovulation.
References: Sumpaico, W. et. al, Textbook of Obstetrics 3rd Edition Cunningham F. et. al. William Obstetrics 23rd Edition
Andres,
Rachel 28. A patient is on medication for low sperm count. Knowing the length of time for spermatogenesis to be complete, how many days post-treatment is the best time to do a seminalysis? a. 30 b. 60 c. 90 d. 120 Answer: B
Rationale: Spermatogenesis is the process of producing spermatozoa from spermatogonia. It starts at puberty and continous until old age. It takes about 64 days for the spermatogonia to develop into spermatozoa.
Reference: Estaban and Gonzales' Textbook of Histology 4th edition (pages 218-222)
Boac, Ma.
Minerva 29. Which process occurs with ovulation? a. Completion of first meiotic division b. Completion of second meiotic division c. Capacitation
d. Release of two polar bodies
Answer: A. Completion of first meiotic division Rationale:
A. Completion of first meiotic division ovulation
B. Completion of second meiotic division occurs upon fertilization.
C. Capacitation is the process wherein the sperm undergoes transformation to penetrate the into the egg cell.
D. During ovulation, the primary oocyte becomes a secondary oocyte and a single polar body is produced.
Reference: Sumpaico. Textbook of Obstetrics (Physiologic and Pathologic Obstetrics) 3rd Edition. Page 72
De Castro,
Jener N. 30. When is the maximum number of germ cells in the ovary achieved?a. 12 weeks AOG in utero b. 20 weeks AOG in utero
c. At birth d. At puberty
Answer: B 20 weeks AOG in utero
Rationale: 12 weeks AOG in utero - 0.6 million germ cells in the ovary At birth - 2 million germ cells in the ovary
At puberty - 400,000 germ cells in the ovary
During 20 weeks AOG in utero (5months), there is the maximum number of germ cell in the
ovary (approximately 6 million).
Reference: Walfrido W. Sumpaico, Textbook of OBSTETRICS (Physiological and pathologic obstetrics) 2nd edition pages 27 and 28 (figure 3.5)
Balandan, Patricia Joy C.
31. At what age in years does atresia of follicles start to accelerate? a. 25
b. 30 c. 35 d. 40 Answer: C. 35
Rationale: In human ovary, 2 million oocytes are found at birth and about 400,000 follicles are present at the onset of puberty. The remaining follicles are depleted at a rate of approximately 1000 follicles per month until 35 years of age, when this
rate accelerates. Therefore, more than 99.9 percent of follicles undergo
degenerative process known as atresia. Reference: Williams 22nd Edition, page 40
Kriska weeks AOG because this is the period of:
a. rapid differentiation c. Increased cellular division
b. maximal growth d. Optimal change in shape
Answer: A. Rapid differentiation
Rationale: Increased cellular division of the embryo begins after fertilization, it involves multiplication of cells via mitosis, in the fallopian tube, the mature ovum becomes a zygote—a diploid cell with 46 chromosomes—that then undergoes cleavage into blastomeres. The zygote undergoes cleavage for 3 days. As the blastomoeres continue to divide, the morula is produced. The morula enters the uterine cavity about 3 days after fertilization.Optimal change in shape occurs at week 3, the embryo will have three distinct layers with a defined top and bottom, front and back, left and right. At no other time in its development will the embryo undergo such a radical transformation. Beyond week 8 maximal growth occurs, the unborn baby is now called a fetus. The embryonic period is from the second through the eighth week. It encompasses organogenesis and is thus the most crucial with regard to structural malformationsat this stage rapid differentiation of the embryo occurs.
Refrence: Wililam’s Obstetrics 23rd Edition pages 48, 313 www.baby2see.com/development
Delos Santos, Sharmen S.
33. What must happen for the completion of the second meiotic division in the oogenesis? a. LH surge b. Follicle size 20 mm c. Ovulation d. Fertilization Answer: d Fertilization
Rationale: During gametogenesis, the oogonium becomes primary oocyte in the process of meiosis and arrested in prophase I during birth until puberty. When puberty occurs, primary oocyte undergoes meiosis I to produce secondary oocyte with first polar body. Secondary oocyte is arrested in metaphase II. Meiosis II is completed only if sperm penetration occurs.
Reference: Chapter 3: Implantation, Embryogenesis and Placental Development. Section 2 P 47. William’sObstetrics 23rd Edition.
Hernadez, Kristeen Khae B.
34. Fertilization is complete within how many hours from ovulation?
a. 12 c. 36
b. 24 d. 48
Answer: B
Rationale: The union of egg and sperm at fertilization represents one of the most important and fascinating processes in biology. Ovulation frees the secondary oocyte and adherent cells of the cumulus-oocyte complex from the ovary. Although technically this mass of cells is released into the peritoneal cavity, the oocyte is quickly engulfed by the infundibulum of the fallopian tube. Further transport through the oviduct is accomplished by directional movement of cilia and tubal peristalsis. Fertilization normally occurs in the oviduct, and it is generally agreed that it must take place within a few hours, and no more than a day after ovulation. Reference: Electronic book Williams Obstetrics, Twenty-Third Edition. Chapter 3 “Implantation, Embryogenesis, and Placental Development” De Los
Santos, Kathrine Aira N.
35. What is the function of Human Chorionic Gonadotropin (hCG) during early embryonic period?
a. source of hematopoiesis
b. maintains endometrium in secretory phase c. prevents regression of the corpus luteum d. nourishes the developing embryo
Answer: c. prevents regression of the corpus luteum
Rationale: The best known biological function of human chorionic gonadotropin is the "rescue" and maintenance of function of the corpus luteum which is by means of continued progesterone production.
D.J. Rose& C.Y. Spring. Chapter 3: Implantation, Embryogeness and Plcenta. Williams Obstetrics. 23rded. USA: McGraw-Hill Companies, Inc.
Bonita,
Marriane 36. Part of the endometrium where implantation takes place:a. decidua parietalis c. deciduas capsularis b. decidua vera d. deciduas basalis
ANSWER: D
RATIONALE: Decidua directly beneath blastocyst implantation is modified by trophoblast invasion and becomes the decidua basalis. The decidua capsularis overlies the enlarging blastocysts, and initially separates it from the rest of the uterine cavity... The remainder of the uterus is lined by decidua parietalis
sometimes called decidua vera when decidua capsularis and parietalis are joined.
REFERENCE: Cunningham, F. Gary, Kenneth Leveno, Steven Bloom, John Hauth, Dwight Rouse and Catherine Spong. 23rd Edition.William’s Obstetrics. Pg.64. McGraw Hill: New York. 2010.
Gozun, Jacel Shayne P.
37. Which structure facilitates implantation by invading the adjacent endometrium and its blood vessels?
a. cytotrophoblast b. syncytiotrophoblast c. extraembryonic coelom d. inner cell mass
ANSWER: b. syncytiotrophoblast RATIONALE:
a. Cytotrophoblasts elaborate selected proteinases that degrade the decidual extracellular matrix.
b. Syncytiotrophoblast facilitates the penetration and invasion of the endometrium, inner third of the myometrium, and uterine vasculature. At about 12 days after conception, the syncytiotrophoblast is permeated by a system of intercommunicating channels called trophoblastic lacunae. As the embryo enlarges, more maternal decidua basalis is invaded by basal syncytiotrophoblast. After invasion of superficial decidual capillary walls, lacunae become filled with maternal blood.
c. Extraembryonic coelom is a result of the union of large cavities within the extraembryonic mesoderm which splits it into two layers namely the extraembryonic somatic mesoderm, lining the trophoblast and amnion, and the extraembryonic splanchnic mesoderms, covering the yolk sac.
d. Inner cell mass forms the embryo itself. References:
Cunningham, G. et al (2010).Williams Obstetrics, Twenty-Third Edition. United States of America: McGraw Hill.
Chrobnolab AG Vision Group. (2009). Atlas of Human Embryology. Retrieved from http://www.embryo.chronolab.com/formation.htm.
Fernandez, Quennie
38. What significant event occurs during gastrula stage? a) neural tube formation
b) GIT formation c) bone mineralization
d) differentiation of three germ layers
Answer: d) differentiation of three germ layers
Rationale: The most characteristic event occurring the 3rd week of gestation is gastrulation, the process that establishes all three germ layerds(ectoderm, mesoderm, and endoderm) in the embryo.
Neural tube formation happens after the 3rd week of gestation when neural fold approach each other on the midline and fuse beginning in the future neck(fifth somite) and proceeds cephalad and caudad.
GIT formation happens upon the division of the gut tube or primitive gut during the 4th week of gestation.
Bone formation happens through membranous ossification as for flat bones and endochondral ossification for long bones which starts at the end of the 4th week of gestation.
Reference: Sadler, T.W. Ph. D. (2000). Langman’s Medical Embryology. (8th ed. ) Chapel Hill, North Carolina
Genovana, Raymond
39. The epithelial linings of the respiratory passage, gi tract and glands and glandular cells of the liver and pancreas arise from the
embryonic-A) Ectoderm B) Mesoderm C) Endoderm
Answer: C) ENDODERM Rationale:
• The gastrointestinal tract is the main organ system derived from the endodermal germ layer (page 82)
• The endodermal germ layer initially forms the epithelial lining of the primitive gut, the epithelial lining of the respiratory tract, the parenchyma of the liver and pancreas (Figure 6.19 p.83; page 83-84)
Reference: LANGMAN’S MEDICAL EMBRYOLOGY 11th edition (di ko mkita sa Williams)
Barron, Emmanuel John V.
40. In what portion of the endometrial cavity does implantation usually occur? a. antero-fundal c. antero mid-portion
b. postero-fundal d. postero mid-portion Answer: d. postero-fundal
Rationalization: At the time of its interaction with the endometrium, the
blastocyst is composed of 100 to 250 cells. The blastocyst usually adheres to the endometrial epithelium by apposition. This most commonly occurs on the upper
posterior uterine wall.
Reference: Williams Obstetrics, 23rd edition, page 49 Castro,
Sylvester
41. What is the reliable basis of using menstrual age for determining the age of pregnancy?
a. most women have a regular cycle.
b. It is more accurate than the ovulatory period. c. It is used in Naegele’s rule
d. The last menstrual period is easy to recall. Answer: d. The last menstrual period is easy to recall
Rationale: The timing of events in early human development is described as days or weeks postfertilization, that is, postconceptional. By contrast, in most chapters of this book, clinical pregnancy dating is calculated from the start of the last menstrual period. As discussed earlier, the length of the follicular phase of the cycle is subject to more variability than the luteal phase. Thus, 1 week postfertilization corresponds to approximately 3 weeks from the last menstrual period in women with regular 28-day cycles. That is why it is easy to recall.
Reference: Williams Obstetrics 23 editions Fertilization and Implantation pages 14-36
Alaba, Aileen Abigail
42. Which of the following is correct about the duration of pregnancy? a. Average duration is 40 weeks
b. Corresponds to 9 2/3 calendar months c. Corresponds to 9 lunar months
d. All of the above
Answer: A Average duration is 40 weeks
last normal menstrual period is very close to 280 days or 40 weeks. Reference: Willams Edition # 23, Page number 195
Fabia, Mary Joyce S.
43. If the LMP was last December 13,2011, when is the 280th day of pregnancy using Naegele’s rule?
A. August 20, 2012 B. September 20, 2012 C. August 21, 2012 D. September 6, 2012 Answer: B. September 20, 2012 Rationale:
Formula: Add 7 days to the first day of Last menstrual period and subtract 3 months.
Solution:
December 13 + 7 = December 20
December 20 – 3 months = September 20 Therefore, the answer is September 20, 2012
Reference: Chapter 4. Fetal growth and development. Section 2 page 78, William’s Obstetrics 23rd Edition.
Garin, Christine Abigail R.
Which of the following is the correct order of developmental phase within 2 weeks after ovulation?
a. formation of free blastocyst - implantation of blastocyst - fertilization b. fertilization – formation of free blastocyst – implantation of blastocyst c. implantation of blastocyst – formation of free blastocyst – fertilization d. any of the above
Answer: b. fertilization – formation of free blastocyst – implantation of blastocyst
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. 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. After which comes implantation.
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 blastocyst and uterine epithelium; and (3) invasion—penetration and invasion of
syncytiotrophoblast and cytotrophoblast into the endometrium, inner third of the myometrium, and uterine vasculature.
Reference: Williams Obstetrics, Twenty-Third Edition (ebook), chapter 3 Jalea, Jelly
Ann
45. At what earliest menstrual age (weeks) is fetal genitalia distinguishable as male or female?
a. 10 d. 16
b. 14 e. 20
Answer: b. 14
Rationale: Gender can be determined by inspection of the external genitalia by 14th week of menstrual age (12th week by fertilization age).
Reference: Cunningham, et. al., Williams Obstetrics 23rd edition (2010). Section II: Anatomy and Physiology, Chapter 3: Implantation, Embryogenesis, and Placental Development
Gatdula, Joanne Karla C.
46. In a normal development of a fetus, at what menstrual age (weeks) is the crown-rump length measure approximately 25 cm and weight is about 1100 grams?
a. 28 c. 36
b. 32 d. 40
Rationale: The crown-rump length is approximately 25 cm, and the fetus weighs about 1100 g. The thin skin is red and covered with vernix caseosa. The pupillary membrane has just disappeared from the eyes. The otherwise normal neonate born at this age has a 90-percent chance of survival without physical or neurological impairment.
Reference: Williams Obstetrics, 23rd Edition pg 80 De
Guzman, Geelvie
47. Which of the following fontanel is situated at the junction of the sagittal and lambdoid sutures of the fetal head?
a. casserian b. greater c. posterior d. temporal
Answer: c. posterior
Rationale: The lesser, or posterior fontanel is represented by a small triangular
area at the intersection of the sagittal and lambdoid sutures (Williams). Letters a is
incorrect since casserian or Casser’s fontanel refers to the mastoid fontanel (Ecyclo Online Encyclopedia). It is the membranous interval on either side between the mastoid angle of the parietal bone, the petrous portion of the temporal bone, and the occipital bone. Letter b is incorrect since the greater fontanel is also known as the anterior fontanel. Letter d refers to the temporal suture located at the lateral side of the fetal head.
Reference: :
Cunningham, F. Gary. et. al. Williams Obstetrics 23rd edition. Published 2010 (Chapter 4, page 81)
Encyclo Online Encyclopedia. http://www.encyclo.co.uk/define/Casser's%20fontanel Gabriel,
Gretchen
48. Which of the structures is transversed by substances from maternal blood to fetal blood for transfer of oxygen and nutrients?
a. syncytiotrophoblast
b. stroma of the intravillous space c. fetal capillary wall
d. all of the above Answer: D
Rationale: Substances that pass from maternal blood to fetal blood must traverse first the SYNCYTIOTROPHOBLAST, then STROMA OF THE INTRAVILLOUS SPACE, and finally the FETAL CAPILLARY WALL. Although this histological barrier separates the blood in the maternal and fetal circulations, it does not function like a simple physical barrier. In fact, throughout pregnancy, syncytiotrophoblast actively or passively permits, facilitates and adjusts the amount and rate of transfer of a wide range of substances to the fetus.
Reference: Williams Obstetrics 23rd ed Jezreel Joy
B. Javier 49. What mechanism is involved in the transfer of oxygen, carbon dioxide, and anesthetic gases through the syncytiotrophoblast? a. Simple diffusion c. Active transport
b. Selective and facilitated diffusion d. All of the above Answer: A Simple diffusion
Rationale: Oxygen, carbon dioxide, water and anesthetic gases are low molecular weight compounds transported through simple diffusion. According to Williams (22nd Edition), Most substances with a molecular mass less than 500 d diffuse readily through placental tissue. Molecular weight is clearly important in determining the rate of transfer by diffusion. Simple diffusion, however, is by no means the only mechanism of transfer of low-molecular-weight compounds. Simple diffusion appears to be the mechanism involved in the transfer of oxygen, carbon dioxide, water, and most (but not all) electrolytes. Anesthetic gases also pass through the placenta rapidly by simple diffusion. Example of Selective and facilitated diffusion is Ascorbic Acid, because it’s concentration is two to four times higher in fetal plasma than in maternal plasma (Morriss and associates, 1994), that is why it can’t traverse the placenta
Reference: Williams Obstetrics, 22nd edition (e-book) p. 58
Dizon, Ron 50. Which glucose transport proteins (GLUT) primarily facilitate glucose uptake by the placenta?
a. GLUT 1 and 3 b. GLUT 2 and 4 c. GLUT 5 and 6 d. GLUT 12 and 14 Answer: A (GLUT 1 and 3)
Rationale: GLUT 1 and 3 primarily facilitate glucose uptake by the placenta and are located in the plasma membrane of the microvilli of the syncytiotrophoblast Source: p 87, Williams Obstetrics 23rd edition
Daniel Christophe r J. Carreon
51. What is the main composition of amniotic fluid after 20 weeks gestation age? a. Ultrafiltrate of maternal plasma
b. Extracellular fluid that reflects the composition of fetal plasma c. Fetal urine
d. Mixture of the three above Answer: c. Fetal urine
Rationalization: “By the beginning of the second trimester, it consists largely of
extracellular fluid that diffuses through the fetal skin and thus reflects the composition of fetal plasma (Gilbert and Brace, 1993). After 20 weeks, the cornification of fetal skin prevents this diffusion, and amnionic fluid is composed largely of fetal urine.”
Reference: Williams Obstetrics, 23rd edition, page 88, Amnionic Fluid Lapitan,
Jemelyn R. 52. Which of the following fetal vessels convey the highest oxygen and nutrients?a. Ductusvenosus b. Superior vena cava
c. Aorta
d. Pulmonary artery Answer: A. Ductusvenosus
Rationale: Blood with significantly higher oxygen content returns from the placenta via a single umbilical vein to the fetus. Among the four choices above, the ductusvenosus is the most proximal vessel to the placenta and umbilical vein. The ductusvenosus will therefore convey blood with the highest concentrations of oxygen and nutrients.
Reference: p. 56, Chapter 3, Section 2, Williams Obstetrics, 23rd edition Luna, Juan
Carlos
53. After birth, what is the remnant of umbilical vein after it constricts or collapses? a. Umbilical ligaments
b. Ligamentumvenosum c. Ligamentumteres d. Ductusligamentus Answer: C. Ligamentumteres
Rationale: The fate of the following vessels are as follows: Umbilical arteries Umbilical ligaments
Ductursvenosusligamentumvenosum Ductusarteriosusductusligamentus Umbilical vein ligamentumteres
Reference: Chapter 4. Fetal Growth and Development page 89-90. William’s Obstetrics
Jonathan B.
Ancheta 54. Which is the main immunoglobulin in the fetus that is being transferred across the placenta by receptor mediated process in syncytiotrophoblast? a. IgM b. IgA c. IgG d. IgD e. Answer: c. IgG
Rationale: Insulin, steroid hormones, and thyroid hormones cross the placenta, but at very slow rates. The hormones synthesized in situ in the trophoblasts enter both the maternal and fetal circulations, but not equally. Examples are concentrations of
chorionic gonadotropin and placental lactogen, which are much lower in fetal plasma than in maternal plasma. Substances of high molecular weight usually do not traverse the placenta, but there are important exceptions, such as
immunoglobulin G—molecular weight 160,000 Da—which is transferred by way of a specific trophoblast receptor–mediated mechanism.
Reference: Williams Obstetrics 23rd edition,
Chapter 4: Fetal Growth and Development, Mechanism of Transfer Han Joo
Yeon 55. ----Agoncillo,
Andre Luis R.
56. A parturient on her 39th week of pregnancy is in active labor for 2 days. How would you explain the dark-greenish-black appearance of Amniotic fluid after the rupture of membrane?
a.This normally happens in a mature fetus.
b. Arginine vasopressin release from the fetal pituitary stimulates the colon to contract.
c. It is reassuring sign of fetal status.
d. There is a high chance of small intestinal bowel obstruction.
ANSWER: B Arginine vasopressin release from the fetal pituitary stimulates the colon to contract.
Rationale: AVP stimulates the smooth muscle of the colon to contract, resulting in intra-amnionic defecation (DeVane and
co-workers, 1982; Rosenfeld and Porter, 1985). References: Williams Edition 23rd page 94 Ferrer,
Jan-Michael A. 57. In the anatomical development of fetal urinary system, what structure gives rise to bladder and urethra? a. urogenital sinus
b. intermediate mesoderm c. mesonephros
d. allantois
Answer: a. urogenital sinus
Rationale: Letter a is correct. During the 4th to 7th week of development, the cloaca divides into the urogenital sinus anteriorly and the anal canal posteriorly. Three (3) portions of the urogenital sinus can be distinguished: the upper & largest part will be the urinary bladder, the narrow pelvic part which in male gives rise to the prostatic and membranous parts of the urethra and lastly, the phallic part.
Letter b is incorrect since derivatives of the intermediate mesoderm
include the nephrogenic cord and the ureteric bud, which give rise to the kidneys and ureters, respectively.
Letter c is incorrect since the mesonephros gives rise to the efferent ductules of the testis, the epididymis, vas deferens, seminal vesicle, and vestigial structures such as the appendix testis, appendix epididymis, and paradidymis. Letter d is incorrect since the allantois develops into a fibrous cord, the urachus, which runs from the fetal bladder to the umbilicus.
Reference:
• Sadler, T.W., Langman’s Medical Embryology 11th edition (Chapter 15, page 243)
• http://en.wikipedia.org/wiki/Mesonephros . Obtained from the World Wide Web on February 23, 2012
• http://wiki.medpedia.com/Development_of_Urinary_System . Obtained from the World Wide Web on February 23, 2012
• http://www.medscape.com/viewarticle/465897_5 . Obtained from the World Wide Web on February 23, 2012
Aguila, Julie Ann Dianne M.
58. A fetus with an amniotic membrane rupture before 20 weeks of gestation will have an
Imamture lung development. Which stage is likely affected? a. pseudoglandular
b. canalicular c. terminal sac d. A and B
ANSWER: B. Canalicular stage
RATIONALE: Lung development occurs in three stages: pseudoglandular, canalicular, and terminal sac. For every stage, a particular part of the bronchial stage develops. At age of gestation week 5 to 17, the pseudoglandular stage occurs which allows the growth of the fetus' intersegmental bronchial tree. At the 16th to 25th week of gestation, the canalicular stage occurs and the previosly
formed terminal bronchiole becomes respiratory bronchioles, and eventually divide to become multiple saccular ducts.
And as the case implies in the question above, an amnionic membrane rupture before the 20th week of gestation an immature lung development is to be expected since at that time, the canalicular stage has not yet completed. However, normal bronchial branching and cartilage development may be expected as a result of a completed pseudoglandular stage.
REFERENCE: Williams, 22nd edition. page 66 (ebook) Joyce Ann
R. Garcia 59. When is the genetic gender established as XY or XX?a. ovulation b. fertilization
c.implantation
d. expression of SRY gene Answer: B.
Rationale: Genetic gender – XX or XY- is established at the time of FERTILIZATION, but for the first 6 weeks, development of male and female embryos is
morphologically indistinguishable.
Reference: Williams Obstetrics, 23rd edition. p. 99 Atienza,
Emmanuel
60. Which of the following conditions leads to a female sexual differentiation? a. absence of male gonad
b. presence of SRYgene
c. production of Mullerian-inhibiting substance d. presence of fetal ovary
ANSWER A RATIONALE:
Testes development is directed by a gene called the SRYgene or TDF gene. Mullerian-inhibiting substance prevents the development of the uterus, fallopian tube, and upper vagina.
Presence of fetal ovary is also seen in pseudohrmaphroditism. Absence of the testes leads to female sexual differentiation Reference: Williams 22nd edition page 113-116
Lao,
Charles 61. Circulatory disturbances of the placenta includea. Infarction b. Thrombose formation
c. Calcification d. All of the above Answer: D
Rationale:
Circulatory Disturbance
Fetal thrombotic vasculopathy • Villi may thrombose w/ obstruction distally
• Common in mature placenta
o May be pathological if large portion villi lost
Hematoma • Associated w/ miscarrianges, abruption, fetal
growth restriction, preterm delivery, adherent placenta
• Retroplacental
o Between placenta + decidua • Marginal
o Between chorion + decidue o Subchorionic hemorrhage • Subchorial
o A.k.a. Breus mole o Along intervillous space • Subamnionic
o Between placenta + amnion o Fetal vessel origin
plate
• Associated w/ nulliparity, higher socioeconomic status, high maternal Ca levels
• Degree of calcifications on US does NOT correlate well with neonatal outcome
Villous infarction • Caused by uteroplacental disease
• Common in mature placenta
o BUT if numerous, can get placental insufficiency • May be associated w/ PET or SLE
Perivillousfibrinoid deposition • Yellow-white nodules w/in placenta
• Normal part of placental aging
o Slow maternal blood flow currents around individuals villus
• Blood statis + fibrin deposition • Diminishes oxygentation to villus
Maternal floor infarction • Deposition of dense, fibrinoid layer on placental
basal plate
o May be associated w/ maternal thrombophilia • Block maternal blood flow
• Associated w/ fetal growth restriction, abortion, preterm delivery, stillbirths
Reference: Williams, OBSTETRICS Espinoza,
Faith Kristine R.
62. Human chorionic gonadotropin starts to be detected in the blood and urine of pregnant women at the time of:
a. blastocyst formation b. blastocyst implantation c. calcification
d. all of the above Answer: B
Rationale: The human chorionic gonadotropin (hCG) molecule can be detected in the plasma of a pregnant woman about 7 to 9 days after the midcycle surge of the luteinizing hormone (LH) that precedes ovulation, so it is most likely that hCG enters the maternal blood at the time of blastocyst implantation. Maternal urine contains the same variety of hCG degradation products as maternal plasma. Thus, hCG levels in the urine can be detected at the time of blastocyst implantation as well.
Reference: Williams, 23rd Edition, Page 63-64. Angeles,
Patricia Khaye Danao
63. Blood with 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
RATIONALE: According to Sumpaico (2008), the fetal circulation is described as different from the adult circulation due to the fact that oxygenated blood from the placenta passes through the single umbilical vein. All nutrients for fetal growth and development are delivered to the fetal heart by the umbilical vein in the umbilical cord. Also, Cunningham (2010) supported this fact by stating that the oxygenated blood from the mother passes in the placenta through the umbilical vein. Saying that the oxygenated blood is carried by the umbilical vein, therefore this vessel is the one that carries a higher oxygen content in the fetal circulation.
RESOURCES: W. Sumpaico (2008). Texbook of Obstetrics: Physiologic and
Pathologic Obstetrics 3rd edition, page 181 and 216. OVT-Graphic Inc: Philiipines. F. Cunningham (2010). Williams Obstetrics
Galang,
Kim 64. The Following changes are seen in “placental aging”, except:a. Increased thickness of the syncytium b. Formation of syncytial knots
c. Thickening of the capillary basement membranes d. Obliteration of fetal vessels
Answer: A. Increased Thickness of the syncytium
Rationale: The answer is letter A since in placental aging or maturation, decreased syncytiotrophoblastic thickness happens to meet the fetal metabolic requirements
by increasing the efficiency of transport and exchange between the mother and fetus.
Reference: Pages 54-55, Chapter 3, Section II of Williams Obstetrics 23rd edition Billiones,
Kim Irving D.
65. Over-the-counter pregnancy test kits test for which placental hormone? a. estrogen
b. progesterone
c. human placental lactogen d. human chorionic gonadotropin
ANSWER: D human chorionic gonadotropin
RATIONALE: Human chorionic gonadotropin (HCG) is produced almost exclusively in the placenta. It is detectable in maternal plasma, and its metabolism products, such as the -core fragment may be detectable in the urine. Most pregnancy testsβ contain the -subunit antibody which reacts with both the intact HCG molecule andβ the -core fragment, the latter being the major form present in the urine.β
Reference: William’s Obstetrics. 22nd edition, Chapter 3: Implantation, Embryogenesis, and Placental Development
Bayting,
Ormalyn B. 66. The umbilical cord as term normally has:A. Two veins and one artery B. Two arteries and one vein
C. Two arteries and two veins
D. Two arteries and valves of Hoboken Answer: B. Two arteries and one vein
Rationale: In the umbilical cord, or funis, three umbilical vessels may be seen. One umbilical vein wherein the blood coming from the mother flows and two arteries wherein blood coming from the fetus exits.
Reference: Williams Obstetrics 23rd edition. Page 62 Basul,
Charine 67. In the development of the decidua, the portion directly beneath the site of blastocyst implantation is the: A. decidua capsularis
B. decidua basalis C. decidua parietalis D. decidua laeve
Answer: B. decidua basalis
Rationale: The decidua of pregnancy is composed of three parts based on its anatomical location. The portion of the decidua directly beneath the site of blastocyst implantation is modified by trophoblast invasion and becomes the decidua basalis. The portion overlying the enlarging blastocyst and initially
separating it from the rest of uterine cavity is the decidua capsularis; the chorion leave is the avascular extraembryonic fetal membrane in contact with decidua capsularis and the decidua parietalis is the lining of the remainder of the uterus. Reference: Sumpaico 3rd edition, Page 158
Garcia , Paul Mitchell L.
68. Which of these statements regarding human chorionic gonadotropin is incorrect?
a. It is the “pregnancy hormone”
b. It has biological activity similar to luteinizing hormone
c. It is structurally related to lutenizing hormone, follicle stimulating hormone, and thyroid stimulating hormone
d. It is secreted by cytotrophoblasts Answer: none of the above
Rationale: Human chorionic gonadotropin : • So-called pregnancy hormone
• Similar activity to lutenizing hormone (LH)
• Glycoprotein ( structurally related to LH, FSH and TSH) • Mostly synthesized in the placenta, (cytotrophoblast and
syncytiotrophoblast)
McGraw-Hill, 2010. P 63 Ereno,
Ephraim Adrian
69. Which part of the HCG molecule is useful as a tumor marker for trophoblastic disease a. nicked hCG molecule b. alpha subunit c. beta subunit d. core-fragment of hCG Answer: A
Rationale: The nicked forms of hCG predominate in hydatidiform mole or choriocarcinoma.
Reference: Sumpaico, Textbook of Obstetrics, 3rd ed., page 194 Lim,
Gerriane R. 70. This statement is not true of human placentation:a. Decidua and maternal blood are juxtaposed to fetal blood. b. It is hemochorioendothelial
c. Maternal blood in the intervillous space directly bathes the trophoblasts. d. Substances transferring from the mother to the fetus must transverse the intervillous space.
ANSWER: A. Decidua and maternal blood are juxtaposed to fetal blood. Rationalization: The term hemochorial is used to describe human
placentation. It derives from hemo referring to maternal blood, which directly bathes the syncytiotrophoblast, and chorio for chorion (placenta). The older term hemochorioendothelial takes into consideration that chorionic tissue is separated from fetal blood by the endothelial wall of the fetal capillaries that traverse the villous core. At all sites of direct cell-to-cell contact, maternal tissues (both decidua and blood) are justaposed to EXTRAEMBRYONIC CELLS (trophoblasts) and not the embryonic cells or fetal blood. The placenta links mother and fetus by indirect interaction with maternal blood that spurts into the intervillous space from
uteroplacental vessels. Maternal blood bathes the outer syncytiotrophoblast to allow exchange of gases and nutrients with fetal capillary blood within connective tissue at the villous core. Fetal and maternal blood are not normally mixed in this hemochorial placenta. There is also a paracrine system that links mother and fetus through the anatomical and biochemical juxtaposition of extraembryonic chorion laeve of fetal origin and maternal decidua parietalis. Maternal blood in the intervillous space directly bathes the trophoblasts. Transfer of substances, i.e oxygen and nutrients, from mother to fetus is accomplished first by transfer of intervillous space into the synctiotrophoblast. There is no direct transfer from maternal to fetal blood.
RESOURCE: Williams 23rd edition, Chapter 3 (Implantation, Embryogenesis, and Placental Development: Introduction) page 51
Balboa, Barbara Kate P.
71. The following is NOT a function of the trophoblast a. Endocrine
b. Secretion of the hormone that maintains pregnancy c. Nutrition of the conceptus
d. Implantation
Answer: B Secretion of the hormone that maintains pregnancy Rationale: A, C, and D are the only functions of the trophoblast.
*The hormone that maintains pregnancy is ESTROGEN, which is primarily secreted by the Ovaries.
Reference: 23rd Ed. Of Williams, Page no.49 Abejuela,
Yoti 72.LOA
Gonzales, Daniel Abraham
73. An abnormal placenta has: a. a weight of 500 grams b. 10-38 cotyledons c. an accessory lobe d. intact fetal circulation Answer: C
increase to 650 grams at 40 weeks AoG), with 10-38 cotyledons and intact circulation. Accessory lobes may be retained in the uterus and may cause hemorrhaging if untreated.
Reference: Williams Obstetrics (E-book), Chapter 3, Chapter 27 Anacay,
Denise B. 74. Which of the following is not a function of the amnion?a. Provides most of the tensile strength of the fetal membranes b. Lipolysis for fetal nutrition
c. Maintenance of amniotic fluid homeostasis d. Secretion of cytokines and vasopeptides Answer: B. Lipolysis for fetal nutrition
Rationale: The amnion provides almost all tensile strength of the fetal
membranes. It is metabolically active, is involved in solute and water transport for amnionic fluid homeostasis, and produces an impressive array of bioactive
compounds.
Reference: William’s Obstetrics 23rd Edition Chapters 3 pages 59-61
Alcazaren, Ramon Michael Christophe r S.
75. The placental hormone rescues and maintains the corpus luteum: a. Human placental lactogen
b. Estrogen c. Progesterone d. HCG
Answer: D, Human chorionic Gonadotropin
Rationale: The best-known biological function of HCG is the so-called rescue and maintenance of function of the corpus luteum – that is, continued progesterone production.
Reference: Williams Obstetrics 23rdedition , Implantation, Embryogenesis and Placental Development page 64.
Ebdani,
Alea D. 76. This placental hormone promotes the growth of the endometrium.a) human placental lactogen b) estrogen
c) progesterone d) HCG
Answer: b) estrogen
Rationale: During pregnancy, the extreme quantities of estrogens cause enlargement of the mother’s uterus or endometrium. HPL acts on maternal lipolysis with increased levels of circulating free fatty acids. This provides a source of energy for maternal metabolism and fetal nutrition. Also it has an anti-insulin or "diabetogenic" action. Progesterone facilitates the maintenance of pregnancy. . HCG is for the rescue and maintenance of function of corpus luteum-that is, continued production of progesterone and secretion of relaxin
References: Williams Obstetrics, 23rd ed. Chapter 3. Implantation, Embryogenesis, and Placental Development
Guyton and Hall, Textbook of medical physiology 11th ed. Chapter 81.Female Physiology before the Pregnancy and Female Hormones
Genoroso, Veronica H.
77. Intraamnionic infection (chorioamnionitis) is best managed by: a) Immediate Caesarean section
b) High forceps extraction
c) Antibiotics and expedient delivery d) Steroids and assisted vaginal delivery
Answer: C. Antibiotics and expedient delivery
Rationale: Chorioamnionitis can complicate term pregnancy and preterm delivery and cause Prelabor Rupture of Membranes (PROM). Management of PROM may be different depending on how far along is the pregnancy. However, the constant management for PROM is a course of antibiotics be it <24 weeks or >34 weeks along the pregnancy. The preferred route of delivery is vaginal and the use of steroids is shown to be beneficial but is only used when the fetus may be delivered preterm (24-34weeks) but the lung is immature.
Obstetrics by Sumpaico et al, 3rdEd. Chapter 44. Basnet,
Archana 78. A placenta with an accessory lobe will most likely lead to which complication during third stage of labor? A. Infection
B. Neurologic Shock C. Hemorrhage
D. Amniotic Fluid Embolism Answer: C. HEMORRHAGE
Rationalize: The accessory lobe may sometimes be retained in the uterus after delivery and may cause serious hemorrhage in some cases, accompanying vasa previa may cause dangerous fetal hemorrhage at delivery.
References: chapter 27, abnormalities of the placenta, umbilical cord, and membrane.
Williams obstetrics edition 23rd De Leon,
Jana Pamela Y.
79. Which placental hormone is used to monitor response to treatment of choriocarcinoma?
a. a. Human placental lactogen b. b. Estrogen
c. c. Progesterone
d. d. Human chorionic gonadotropin ANSWER: D
Rationale: The amniotic fluid concentration of hCG early in pregnancy is similar to maternal plasma. Urine concentration of hCG follows the pattern of maternal
plasma. Significantly, higher plasma levels are found in pregnancy with hydatidiform mole or choriocarcinoma.
Reference: Sumpaico, Textbook of Obstetrics, 3rd ed., page 194. Lopez,
Edison 80.concentration in the urine.The concentration of human chorionic gonadotropin in serum is the same as its Choices: True or False
Answer: False
Rationale: Both Serum and Urine hcg tests are done to measure the amount of hcg in the mother to determine pregnancy. Though there are a lot of studies pertaining to urine hcg as inaccurate compared to serum hcg tests it is still without a doubt a trusted test to perform. But there is a wide range of values for hcg which differs in both serum and urine. Thus it is best to use both tests for pregnancy test.
References: http://www.babymed.com/hcg-level
http://www.babyhopes.com/articles/bloodtestmoreaccurate.html David
Layug
81. Uterine Hypertrophy in the second half of pregnancy is due to: A. Estrogen
B. Progesterone
C. Pressure exerted by the expanding products of conception D. All of the above
Answer: C. Pressure exerted by the expanding products of conception Rationale: Estrogen and Progesterone cause the hypertrophy of the uterus during the 1st 12 weeks of pregnancy. 12 weeks and up, the hypertrophy is predominated by the pressure exerted by the expanding products of conception.
Reference: Williams Obstetrics 23rd Edition (Maternal Physiology) Pages 107-108 Fernandez,
Edna Joyce M.
82. The delivery of most substances essential for growth and metabolism of the fetus and placenta, as well as removal of most metabolic wastes, is dependent on:
a. adequate perfusion of the placental intervillous space b. total uterine blood flow
c. normal placenta
d. presence of 2 arteries and 1 vein in the umbilical cord Answer: a. adequate perfusion of the placental intervillous space Rationale:
- The delivery of most substances essential for growth and metabolism of the fetus and placenta, as well as removal of most metabolic wastes, is
dependent on adequate perfusion of the placental intervillous space. - The placenta is the organ of transfer between mother and fetus
- At the maternal-fetal interface, there is transfer of oxygen and nutrients from the mother to the fetus and carbon dioxide and metabolic wastes from fetus to mother.
- There are no direct communications between fetal blood, which is contained in the fetal capillaries of the chorionic villi, and the maternal blood, which remains in the intervillous space
- Bidirectional transfer depends on the process that permits or aids the transport through the syncytiotrophoblast of the intact chorionic villi.
- Maternal blood in the extravascular compartment, that is, the intervillous space, is the primary biologic unit of maternal-fetal transfer.
- In determining the effectiveness of the human placenta as an organ of transfer, atleast 10 variables are important:
o The concentration of the substace in maternal plasma, and the extent to which it is bound to another compound, such as carrier protein. o The rate of maternal blood flow through the intervillous space o The area available for exchange across the villous trophoblast
epithelium
o If the substance is transferred by simple diffusion, the physical properties of the trophoblastic tissue
o For any substance actively transported, the capacity of the
biochemical machinery of the placenta for effecting active transfer o The amount of the substance metabolized by the placenta during
transfer
o The area for exchange across the fetal intervillous capillaries o The concentration of the substance in the fetal blood
o Specific binding or carrier proteins in the fetal or maternal circulation. o The rate of the fetal blood flow through the villous capillaries. Reference: p. 108, Ch. 5 Maternal Physiology
pp. 83 - 85, Ch. 4 Fetal Growth and Development 23rd ed. Williams Obstetrics
Feliciano, Christian Mico G.
83. . What is the basis for the physiologic anemia in pregnancy? A. More plasma than erythrocytes is added to the maternal circulation B. More erythrocyte than plasma is added to the maternal circulation C. Moderate erythroid hyperplasia is present in the bone marrow
D. More water intake of pregnant women due to increase water requirement Answer: A
Rationale: Anemia of pregnancy is a condition of pregnancy characterized by a reduction in the concentration of hemoglobin in the blood. It may be physiologic or pathologic. In physiologic anemia of pregnancy, the reduction in concentration results from dilution because the plasma volume expands more than the
erythrocyte volume. The hematocrit in pregnancy normally drops several points below its pregnancy level.
References:
anemia of pregnancy. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved February 23 2012 from
http://medical-dictionary.thefreedictionary.com/anemia+of+pregnancy
Rationale: Plasma volume begins to increase during the sixth week of pregnancy. There is no significant increase in erythrocyte production during the first trimester. Dilutional anemia is first apparent by seventh to eighth week. Increase in
erythrocyte production is apparent during the second trimester. Lowest hemoglobin explainable by dilutional effect (the physiologic anemia of pregnancy) is 11 g/dl in first trimester and 10g/dl in second and third trimesters. Physiologic anemia of pregnancy is normochromic, is normocytic, does not worsen during the third trimester, and does not require additional evaluation or specific treatment. References:
Greer, J. P., & Wintrobe, M. M. (2008). Wintrobe's clinical hematology. (12,
illustrated ed., p. 1240). Lippincott Williams & Wilkins, 2008. Retrieved February 23 2012 from http://books.google.com/books?
gnancy&source=bl&ots=fEFNgBShTt&sig=YfhAQuWc0sX_-
DYh4LScrDn99KU&hl=en&sa=X&ei=UFpGT7GwDY-ViAeKv8ChDg&ved=0CG0Q6AEwCQ Bejasa,
Cana
84. Remission of some autoimmune disorders during pregnancy may be explained by:
a. suppressed Th1 response b. suppressed Tc1 response c. upregulation of Th2
d. all of the above
Answer: (d) All of the above Rationale:
Pregnancy has been assumed to be associated with suppression of a variety of humoral and cell-mediated immunological functions in order to accommodate the "foreign" semiallogeneic fetal graft. One important mechanism appears to involve the suppression of T-helper (Th) 1 and T-cytotoxic (Tc) 1 cells, which decreases secretion of interleukin (IL)-2, interferon- , and tumor necrosis factor- .γ β However, not all aspects of immunological function are depressed. For example, there is upregulation of Th2 cells to increase secretion of IL-4, IL-6, and IL-13. Reference: Williams Obstetrics, 23rd Edition. Page 116
Galicia, Jose Maria F.
85. The increase in cardiac silhouette on chest radiograph of pregnant patients is due to the following EXCEPT:
a. the heart is displaced to the left and upward b. the heart is rotated somewhat on its long axis
c. the base is moved somewhat laterally from its usual position d. some degree of pericardial effusion
Answer: C
Rationale: It’s the apex that is moved somewhat laterally from its usual position and not the base.
Reference: Williams Obstetrics 23rd Edition, Chapter 5 (E-Book) Lugtu,
Ryan Christophe r B.
86. The pulmonary function that is affected by pregnancy is:
a. respiratory rate c. inspiratory reserve volume b. tidal volume d. vital capacity
ANSWER: B
RATIONALE: Because during pregnancy the respiratory rate is essentially unchanged, but tidal volume and resting minute ventilation increase significantly as pregnancy advances. Reported significantly increased mean tidal volume—0.66 to 0.8 L/min compared with non pregnant women.
REFERENCE: William’s Obstetrics 23rd edition e-book,Chapter 5 Caraveo,
Julien Nicole C.
87. The physiology dyspnea in pregnancy:
a. results from increased tidal volume that lowers the blood PCO2
b. induced in large part by estrogen and to a lesser degree by progesterone c. estrogen lowers the threshold centrally
d. caused by the increased sensitivity of the chemoreflex response to CO2 ANSWER: A
RATIONALE:because the answer in letter B is false, it is not induced largely by estrogen but progesterone. Same as the answer in letter C, progesterone is the one which lowers the threshold centrally. Letter D answer is the result of progesterone action.
REFERENCE: Williams 23rd Edition, p. 122
Eufracio, Ma. Christine Angela D.
88. The clinical relevance of any increased glomerular filtration rate in pregnancy is/ are:
a. increased in rurinary frequency in 90% of pregnant women
b. renal disease may not be diagnosed earlier because serum creatinine is decreased during normal pregnancy
c. urinary infection are more virulent