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BAYCOG RESIDENTS’ IN-SERVICE REVIEW
OBSTETRICS
Name: ____________________________
Hospital: __________________________
Year Level:_________________________
Score: ____________________________
PRE-NATAL CARE (Dr. Olivar)
1. A Gravida 1 Para 0 patient has her EDC on April 8, 2010. She has a BMI of 24 kg. Her ideal weight
gain for the entire duration of pregnancy will be:
a. 25-35 lbs
b. 28 – 40 lbs
c. 15 – 25 lbs
d. 10 – 15 lbs
2. Which is NOT a recommended laboratory examination during the 1st prenatal visit?
a. CBC, blood typing
b. VDRL
c. Pap smear
d. Oral glucose tolerance test (OGTT)
3. The typical component/s of routine prenatal care is/are:
a. complete and updated clinical history
b. BP and weight
c. fundic height and assessment of fetal activity
d. All of the above
4. A woman first seen on the second trimester (16th week) is advised to return for prenatal visitsa. every 3 months until the 3rd trimester
b. monthly until 28 weeks
c. weekly until 28 weeks
d. monthly until 37 weeks
5. To determine the precise gestational age in a woman with irregular menstrual
cycles, the BEST advice isa. Pregnancy test on the 1st month
b. Measure fundic height at 4th month
c. Counting fetal movements at 5th month
d. Ultrasonogram between 8-16 weeks
6. One of the following conditions does NOT qualify a pregnant patient as “high-risk”:
a. chronic hypertension
b. diabetes mellitus
c. age 25 years at 1st pregnancy
d. previous stillbirths and abortions
7. If a pregnant woman has a strong family history of diabetes mellitus and she is obese, she is advised:
a. OGCT on the 1st PNCU
b. FBS on the 1st visit
c. OGTT at term
d. OGCT at 24-28 weeks
8. Which of the following immunizations is allowed during pregnancy?
a. Measles-mumps-rubella (MMR)
b. Hepatitis B
c. Varicella
d. Poliomyelitis
9. Use of this supplement is routinely advised after the 1st half of pregnancy:
a. iron 27 mg/day
b. iodine
c. zinc
d. vitamin A and B complex
10. The drug of choice for a pregnant woman complaining of fishy-smelling vaginal discharge and
positive for bacterial vaginosis is:
a. Penicillin
b. Tetracycline
c. Metronidazole
d. Miconazole
DYSTOCIA (Dr. Roque)
1. The functional division of labor where descent of the presenting part occurs is in the
a. preparatory division
b. dilatational division
c. pelvic division
d. latent phase
2. The chief characteristic of an effective uterine contraction during labor is
a. strong contractions with fundal dominance
b. hypertonic fundus and relaxed lower uterine lsegment
c. uniform contractility of upper and lower uterine segments
d. relaxed upper segment and a contractile lower uterine segment
3. The stage of labor that gives the general efficiency of the uterus
a. latent phase
b. acceleration phase
c. maximum slope
d. deceleration phase
4. The prognosis for a vaginal birth in face presentation is better in
a. mento-anterior position
b. mento-lateral position
c. mento-posterior position
d. any position
5. Wood’s corkscrew maneuver used in shoulder dystocia
a. 180 degrees rotation of the impacted anterior shoulder
b. 180 degrees rotation of the impacted posterior shoulder
c. the more easily accessible fetal shoulder is pushed towards
anterior chest wall of the fetus
d. the posterior arm of the fetus is swept across the chest,
followed by delivery of the arm
6. Which is true of malpresentation ?
a. Brow presentation is the rarest presentation, commonly unstable
and often converts to a face or occiput presentation.
b.When the long axis forms an acute angle, an oblique`lie results.
c. In most cases of compound`presentation, the prolapsed arm should
be left alone since usually it will not interfere with labor
d. Most often, occiput posterior positions undergo spontaneous rotation
followed by uncomplicated delivery
e. All of the above
7. Which is not a predisposing factor to breech presentation?
a. multiparity
b. oligohydramnios
c. uterine anomalies
d. posterior implantation of the placenta
e. fetal anomalies
8. Which of the ff. situation has the greatest risk for the mother and infant?
a. rupture of an intact uterus
b. rupture of a previous uterine scar
c..pathologic contraction ring
d. dehiscence of a uterine scar
9. Etiology of uterine inertia
a. contracted pelvis
b. abnormal uterine muscle
c. administration of analgesia
d. imbalance of the endocrine system
e. a, b, c only
f. all of the above
10. Which of the following assess the midpelvis?
a. diagonal conjugate
b. prominence of the ischial spines
c. estimation of the coccygeal prominence
d. curvature of the sacrum
e. b and d only
f. a, b, and c only
THE PUERPERIUM (Dr. Pelaez-Crisologo)
1. Placental site involution is usually completed at ____ weeks post-partum.
a. 2
b. 4
c. 6
d. 8
2. Mrs. A.A. has just delivered to her 1st baby, term, 2800 grams. She is anxious about starting
breastfeeding. You can reassure her that the following are true re: breastfeeding:
a. The milk supply may appear insufficient, but encouraging the baby’s suckling will make it
adequate
b. Vitamin K administration is necessary to prevent hemorrhagic disease of the newborn
c. Vitamin D supplementation is necessary is recommended for purely breastfed infants, as
recommended by the American Academy of Physicians (AAP)
d. All of the above
e. None of the above
3. In almost one-third of cases of late post-partum uterine infection, the causative organism was
cited to be:
a. Neisseria gonorrhea
b. Escherichia coli
c. Chlamydia trachomatis
d. Group-B streptococcus
e. Pseudomonas aeroginosa
4. In relation to the preceding question, it would thus seem prudent that antibiotic coverage should
include:
a. Azithromycin
b. Metronidazole
c. Ceftriaxone
d. Vancomycin
e. Penicillin
5. The usual order of appearance of lochia in the puerperium is as follows:
a. Rubra, alba, serosa
b. Serosa, rubra, alba
c. Rubra, serosa, alba
d. Alba, rubra, serosa
e. Serosa, alba, rubra
f. Alba, serosa, rubra
6. As recommended by the ACOG, which of the following contraceptive agents may be safely given
to breastfeeding women at 2 to 3 weeks post-partum?
a. Depomedroxyprogesterone acetate
b. Progestin-only pills
c. Hormonal implants
d. Combine extrogen-progestin contraceptives
e. None of the above
7. Mrs. O.A. a 24 year old primipara, just gave birth 2 days ago and has attempted to start
breastfeeding. She calls you complaining that her breasts are tender, firm and nodular. She
reports a fever of 38.5oC. Most common cause of this fever is probably:
a. Mastitis
b. Endometritis
c. Breast abscess
d. Breast fever/engorgement
8. In relation to the preceding question, how would you advise the Mrs. O.A,?
a. Stop breastfeeding
b. Apply ice pack and take analgesics
c. Admission for intravenous antibiotics
d. Surgical intervention
9. The following are is/are the effect/s of early ambulation in the otherwise uncomplicated puerperal
patient EXCEPT:
a. Decreased Constipation
b. More frequent bladder complications
c. Reduced incidence of venous thromboembolism
d. Reduced incidence of pulmonary embolism
10. Because of the combination of uterotonics and analgesia during delivery, it may be common to
encounter urinary retention in the parturient. What is/are the recommended practice point/s to
observe when dealing with parturients?
a. Advise voluntary voiding within 4 hours after normal delivery
b. Insert in-dwelling catheter immediately post-partum for patients given epidural anesthesia
during vaginal delivery
c. Give antibiotics routinely post partum
d. There is no need to check for genital tract hematomas
HYPERTENSION IN PREGNANCY (Dr. Ziganay)
A 24-year old G1P0 you were seeing in the OPD consulted the ER for headache, blurring of vision and
epigastric pain. Your history and examinations revealed the following: AOG 34 weeks; BP 150/90; FH
28cm; EFW 1.4-1.6kg; (+) limd uterine contractions; (-) edema; urine albumin +1
1. What is the likely diagnosis?
a. Gestational hypertension
b. Eclampsia
c. Preeclampsia, severe
d. Preeclampsia, mild
2. What will be your plan?
a. Admit the patient for control of labor and observation
b. Admit with plan to deliver
c. Send the patient home and advise return visits at 3 to 4 days interval
d. Send the patient home wih medications and advise follow up after 2 weeks
3. The epigastric pain in the above case
a. is frequently accopanied by jaundice, pruritus and fever
b. is responsive to antacids and H2 blockers but not to proton pump inhibitors
c. Results from hepatocellular necrosis, eshcemia and edema that stretches the glisson
capsule
d. is not a sign to terminate the pregnancy
4. Antihypertensive drugs not used in the treatment of severe hypertension with preeclampsia
a. Ace inhibitors
b. Labetalol
c. Nifedipine
d. Hydralazine
5. Strategy proven effective in preventing or modifying the severity of preeclampsia
a. Magnesium supplementation
b. Fish oil supplementation
c. Calcium supplementation
d. None of the above
6. Analgesia of choice in hypertensive pregnant women
a. Spinal anesthesia
b. Epidural anesthesia
c. Pudendal block
d. General anesthesia
7. In which of the following conditions is preeclampsia least likely to develop?
a. Multigravida
b. Molar pregnancy
c. Twin gestation
d. History of hypertension
8. Which among the choices below is monitored when administering MgSO4?
a. Calcaneal reflex
b. Respiration
c. Plasma calcium levels
d. Cardiac output
9. True about MgSO4?
a. It is given to treat hypertension
b. It is discontinued right after delivery
c. It is inferior to phenytoin in preventing eclamptic seizures
d. It is the drug of choice for the prevention of eclampsia
10. Which is not a criteria for HELLP?
a. Microangiopathic hemolysis
b. AST less than 70 u/l
c. ALT at least twice the level of normal
d. Platelets less than 100,000/m3
High Risk Pregnancy (Dr. Teh)
1. Doppler velocimetry studies of umbilical artery suggestive of a normal finding is:
A. Increase diastolic blood flow
B. Decrease diastolic blood flow
C. Absent diastolic blood flow
D. Reversed diastolic blood flow
2. Which of the following are the complete components of biophysical profile?
A. Fetal movement, Fetal heart rate, Fetal breathing, NST, AFI
B. Fetal breathing, Fetal movement, Fetal Tone, NST, AFI
C. Fetal heart rate, Fetal tone, Fetal movement, NST, AFI
D. Fetal tone, Fetal heart rate, Fetal breathing, NST, AFI
3. Which of the following is NOT true of transabdominal ultrasound?
A. 1st trimester scan will require full urinary bladder
B. It is best used after the 1st trimester
C. Visual of larger ovarian mass is better compared with transvaginal
D. It uses lower frequency transducer hence has poor tissue penetration
4. Which of the following is an indication for 1st trimester ultrasound?
A. Estimation of fetal weight
B. Determination of fetal presentation
C. Hypogastric pain with amenorrhea of 2 months (+) pregnancy test
D. Determination of amniotic fluid index
5. The following hormones are part of the triple screen of trisomy 21 EXCEPT:
A. hCG
C. Estriol
B. AFP
D. hPL
6. An invasive technique of prenatal diagnosis of disease wherein amniotic fluid is withdrawn from uterine
cavity is:
A. Chorionic villus sampling
C. Amniocentesis
B. Cordocentesis
D. Blastomere sampling
7. Fetal condition associated with < 0.4 MOM level of alpha-fetoprotein in the amniotic fluid is:
A. Gastroschisis
C. Anencephaly
B. Spina bifida
D. Trisomy 21
8. Which of the following cardiac diseases is considered as moderate risk during pregnancy?
A. Corrected tetralogy of Fallot
C. Mitral stenosis, FC I-II
B. Pulmonic disease
D. Previous myocardial infarction
9. Part of the antepartal management of gravido-cardiac patient EXCEPT:
A. Increase of oral fluids
C. Digoxin
B. Decrease physical activity
D. Iron supplementation
10. The following are pat of the management of acute asthmatic attack in a gravid patient EXCEPT:
A. Beta-agonist treatment
C. Continuous oxygenation
B. Corticosteroids
D. Limit fluid infusion
11. Which of the following is TRUE regarding TB in pregnancy?
A. All anti-TB medications are withhold during pregnancy
B. Neonatal TB occurs in 50% of cases if gravid patient with active TB is untreated
C. Neonatal TB can’t be acquired through aspiration of infected secretions
D. It increases the incidence of post-term delivery
12. Which of the following thyroid function tests would you expect to increased during normal pregnancy?
A. TSH
C. Total T4
B. Free T3
D. TRH
13. Correct statement regarding management of thyrotoxicosis in pregnancy.
A. Anti-thyroid drugs are not given during the 1st trimester
B. Therapeutic drugs is to achieve a euthyroid or slightly hypothyroid state
C. Radioactive Iodine is a relative contraindication in the management
D. Steroids are part of the treatment regimen in case of thyroid storm
14. Neonatal effects of Maternal Hypothyroidism EXCEPT:
A. Transient thyrotoxicosis
C. Goiter
B. Mental retardation
D. Hypothyroidism
15. Which of the following is TRUE of hypothyroidism in pregnancy?
A. Diagnosis is made in the presence of low FT4 & THS level
B. Therapeutic drugs is to achieve a euthyroid or slightly hypothyroid state
C. Risk for preeclampsia and abruption placenta are increased
D. Weekly serum TSH is done to monitor response to treatment
16. Screening test for Gestational DM is the:
A. 50-mg OGCT
C. 50-g OGCT
B. 50-g OGTT
D. 100-mg OGTT
17. A Class A1 GDM patient is characterized by which of the following?
A. FBS is more than 105mg/dl
B. Patient is managed by giving insulin
C. 2-hr post-prandial blood sugar of < 120mg/dl
D. Strongly associated with unexplained stillbirth
18. Post-partum follow-up test for patients with GDM:
A. 50-gm OGTT
C. 75-gm OGTT
B. 75-gm OGCT
D. 100-gm OGTT
19. The following are complications in the neonate delivered from a mother with uncontrolled blood sugar
EXCEPT:
A. Hyperglycemia
B. Hypocalcemia
C. Hyperbilirubinemia
D. Respiratory distress syndrome
20. True in the management of gestational DM
A. FBS should be kept at <105mg/dL
B. Insulin should be started if the 2-hr post-prandial is > 120mg/dL
C. Carbohydrates comprise 20 -25 % of her caloric requirement
D. Exercise is discourage
OBSTETRICAL HEMORRHAGE (Dr. Ramirez)
1. What is the biggest single cause of maternal deaths in the Philippines?
a.
b.
c.
d.
Hypertension
Infection
Malignancy
Hemorrhage
2. What is the most common cause of postpartum hemorrhage in 90% of cases?
a. Blood dyscrasia
b. Uterine atony
c. Trauma to the genital tract
d. Retained placental tissues
3. What is the most common cause of late post partum hemorrhage?
a. Uterine subinvolution
b. Rupture of the uterus
c. Vaginal laceration
d. Uterine atony
4. What is an important component therapy in fluid replacement of hypovolemic shock?
a. Fresh whole blood
b. Lactated Ringer’s solution
c. Fresh frozen plasma
d. A & B
5. What does compatible whole blood contains which makes it ideal for the treatment of hypovolemia
from catastrophic acute hemorrhage?
a. Erythrocytes
c. Fibrinogen
b. All clotting factors
d. RBC’s and all clotting factors
6. A 36 y/o, G5P4 presents with complete uterine inversion with placenta still attached. What is the
most appropriate management?
a. Manual reposition of the uterus followed by manual extraction of the placenta
b. Manual extraction of the placenta followed by manual reposition of the uterus
c. Manual reposition of the uterus followed by leaving the placenta in place
d. Manual reposition of the uterus followed by spontaneous expulsion of the placenta
7. In women with asymptomatic bleeding during the third trimester, ultrasound becomes mandatory
to
.
a. Diagnose abruptio placenta
b. Recognize placenta accreta
c. Rule out placenta previa
d. Diagnose uterine rupture
For Nos 8 – 10:
Case:
A 28 y/o, G6P5 at 30 weeks’ gestation comes to the ER with profuse and painless vaginal bleeding. BP80/50 mmHg, PR-110/min. The fetal monitor shows a non-reactive tracing.
8. What is the most likely diagnosis?
a. Marginal sinus rupture
b. Placenta previa
c. Abruptio placenta
d. Vasa previa
9. What is the basis for the diagnosis?
a. Profuse vaginal bleeding
b. Hypotension
c. Non-reactive fetal tracing
d. Painless vaginal bleeding
10. What is the most appropriate treatment?
a. Double set-up examination
b. Cesarean delivery
c. Vaginal delivery
d. Expectant management
For Nos. 1 – 3:
Case:
Artificial rupture of membranes has just been performed in a normotensive G2P1 while in active labor.
Immediate vaginal bleeding and fetal bradycardia occur.
1. Which of the following should be highly considered?
a. Uterine rupture
b. Vasa previa
c. Placenta previa
d. Abruptio placenta
2. What is the classic triad of symptoms of the above condition present in this patient?
a. Vaginal bleeding, active labor, fetal bradycardia
b. Fetal bradycardia, artificial rupture of membranes, normotensive
c. Artificial rupture of membrane, vaginal bleeding, fetal bradycardia
d. Vaginal bleeding, active labor, artificial rupture of membranes
3. What is the cause of hemorrhage in this patient?
a. Rupture of the decidual arteries
b. Dilatation of the internal cervical os
c. Separation of the placenta
d. Rupture of the fetal vessels
For Nos. 4 – 7:
Case:
A 35 y/o, G2P1 at 34 weeks’ gestation presents with profuse vaginal bleeding and severe
abdominal pain associated with frequent uterine contractions. BP-90/60 mmHg, PR-120/min.,
FHT-90/min. Pelvic exam reveals a 2 cm dilated cervix, partially effaced, station 0.
4. What is the most likely diagnosis?
a. Placenta previa
b. Abruptio placenta
c. Normal labor
d. Uterine rupture
5. What is the basis for the diagnosis in the above condition?
a. Ultrasound findings
b. Fetal bradycardia
c. Pelvic exam findings
d. Clinical symptomatology
6. What procedure will confirm the diagnosis?
a. I.E. under double set-up
b. Measurement of intrauterine pressure
7. What is the most appropriate management?
a. Vaginal delivery
augmentation
b. IV tocolysis
c. Amniotomy
d. Sonography
c. Oxytocin
d. Cesarean delivery
For Nos. 8 – 10:
Case:
After abdominal delivery due to Abruptio placenta, the patient bled profusely. Laboratory
findings reveal: Hb-7mg/dl, fibrinogen-120mg/dl, platelet count-40,000/ml, fibrinogen-fibrindegradation products-110mg/ml.
8. What is the most likely diagnosis?
a. Uterine atony
b. Consumptive coagulopathy
c. Utero-placental apoplexy
d. Convelaire uterus
9. In severe forms of this condition, which of the following can prevent acute renal failure?
a.
b.
c.
d.
Transfusion of packed RBC
Intravenous diuretics
Volume replacement
Cryoprecipitate
10. What is the best blood component to correct this complication?
a. Fresh whole blood
b. Cryoprecipitate
c. Antifibricolytic
d. Fresh frozen plasma