PGIS review - OB

PGIs Review 2025
Part 1 - OBSTETRICS

By Dyan Galeno, MD

Multiple Choice

What structure serves as a landmark in doing pudendal block through transvaginal approach?

• Ischial Spine

• Iliac Crest

• Ischial Tuberosity

• Sacral Promontory

TRANSVAGINAL – index finger inserted through the vagina to palpate the Ischial spine; needle is passed through vaginal mucous membrane through the ischial spine; on passing through the sacrospinous ligament, the anesthetic solution is injected




Williams Obstetrics 26th Edition: Maternal Anatomy Page 28

ISCHIAL SPINE

Multiple Choice

What is the diameter measured as the distance from the sacral promontory to the inferior margin of the pubic symphysis?

• True Conjugate

• Diagonal Conjugate

• Obstetric Conjugate

• Pelvic Conjugate

DIAGONAL CONJUGATE

a hand with the palm oriented laterally extends its index finger to the promontory

T - True conjugate
O - Obstetric conjugate
D - Diagonal conjugate

​Williams Obstetrics 26th Edition: Maternal Anatomy Page 27

Multiple Choice

All of the following structures forms part of the boundaries of the Pelvic inlet, Except?

• Sacral promontory

• Linea Terminalis

• Symphysis pubis

• Ischial tuberosities

Sacral promontory - Posterior
Linea Terminalis - Lateral
Symphysis pubis - Anterior

ISCHIAL TUBEROSITIES

​Williams Obstetrics 26th Edition: Maternal Anatomy Page 28

Multiple Choice

The pelvic inlet usually is considered to be contracted if its shortest anteroposterior diameter is less than?

• 10 cm

• 11 cm

• 12 cm

• 13 cm

10 cm

​Williams Obstetrics 26th Edition: Maternal Anatomy Page 28

Multiple Choice

After a spontaneous vaginal delivery, a laceration was noted at the middle third of the vagina. What is the blood supply?

• Middle Rectal Artery

• Inferior Vesical Artery

• Internal Artery

• Uterine Artery

Middle Rectal Artery

​Williams Obstetrics 26th Edition: Maternal Anatomy Page 16

Multiple Choice

A 31 year old, G2 P2 (2002) who delivered via spontaneous vaginal delivery one day prior complained of numbness on both lateral lower legs. You remembered that she was placed in a stirrup for more than two hours. What nerve might have been injured?

• Common fibular nerve

• Femoral nerve

• Obturator nerve

• Genitofemoral nerve

Common Fibular Nerve

Multiple Choice

The Skene's Gland is homologous to this structure in males:

• Prostrate Gland

• Penis

• Cowper's Gland

• Scrotum

Prostate Gland

Multiple Choice

A 33 year old, G2 P2 (2002), delivered via spontaneous vaginal delivery. All are done in the active management of the third stage of labor, Except?

• Delayed cord clamping

• Administration of intramuscular oxytocin after the delivery of the placenta

• Controlled cord traction

• All of the above

Administration of IM oxytocin

• Immediate prophylactic administration of uterotonic agent

• Properly timed cord clamping

• Controlled cord traction and counter traction

Multiple Choice

When creating a Pfannenstiel incision, which vessels should be anticipated halfway between the skin and fascia, several centimeters from the midline?

• External pudendal

• Inferior epigastric

• Superficial epigastric

• Superficial circumflex

Superficial Epigastric

Multiple Choice

A 27 year old woman comes to your clinic for prenatal check-up. She had 3 pregnancies in the past, one ending in miscarriage at 7 weeks, one vaginal delivery at 33 weeks and one primary low transverse cesarean section at 38 weeks. What is her OB score?

• G3 P1
  (1-1-1-2)

• G4 P2

  (2-0-1-2)

• G4 P2

  (1-1-1-2)

• G3 P2

  (1-1-1-2)

G4 P2 (1-1-1-2)

Currently Pregnant
1 term delivery
1 preterm delivery
1 miscarriage

Multiple Choice

Your patient had regular monthly menstrual cycle and claims that her last menstrual period (LMP) was February 28, 2025. She had a positive serum pregnancy test. Using the Naegele's rule, What is her estimated date of confinement?

• December 7, 2025

• November 7, 2025

• December 21, 2025

• November 21, 2025

December 7, 2025

Naegele's rule

Add 7 days
Subtract 3 months

Multiple Choice

A 32 year old woman came in for her first ultrasound which revealed 11 6/7 weeks age of gestation. Which of the following cellular processes has contributed most of the increase in her uterine size?

• Endometrial stromal hypertrophy

• Endometrial gland hyperplasia

• Myometrial fibroblast proliferation

• Myometrial smooth muscle hypetrophy

Myometrial smooth muscle hypertrophy

​​Williams Obstetrics 26th Edition: Maternal Physiology Page 51

Multiple Choice

A primigravida patient on her 6th week gestation came in for her first prenatal check-up. On assessment, the vagina and cervix appears violet in color. This is due to?

• Softening of the uterine isthmus

• Cervix becoming friable during pregnancy

• Hypervascularity and hyperemia in the skin and muscles of the perineum and vulva

• Increasing pressure in the abdominal wall and hypoxia in the vulvovaginal area

Hypervascularity and hyperemia in the skin and muscles of the perineum and vulva

Multiple Choice

The following are true regarding metabolic effects of pregnancy, Except?

• Mild fasting hypoglycemia

• Postprandial hyperglycemia

• Hyperinsulinemia

• Hypoinsulinemia

Hypoinsulinemia

Multiple Choice

A 33 year old, G3 P2 (2-0-0-2), who came in for her prenatal check-up. She is 22 weeks from her last menstrual period. Her complete blood count showed hemoglobin 110 mg/dL, hematocrit 0.33, white blood cell 11.28, normal platelet. What is the best advice to give her?

• Increase iron supplementation

• Reassure her that the result is normal

• Discontinue giving ferrous

• Repeat CBC after 2 weeks

Hemoglobin levels in pregnancy

Multiple Choice

Which of the following coagulations factors are unchanged during pregnancy?

• Protein C

• Fibrinogen

• Factor VII

• Antithrombin III

Coagulation Factors

Multiple Choice

Which of the following statements accurately describes the changes in respiratory physiology during pregnancy?

• Inspiratory capacity rises by 5 - 10 %

• Respiratory rate increases

• Tidal volume remains the same

• Functional residual capacity decreases by 50%

Inspiratory Capacity

LUNG VOLUMES

Multiple Choice

A 27 year old, G1 P0 who came in for prenatal check-up. She is currently 16 weeks age of gestation and is concerned about her gastrointestinal changes during pregnancy. Which of the following is correct?

• Gastric emptying time increases during pregnancy

• Lower esophageal sphincter tone is increased

• Intraesophageal pressures are lower during pregnancy

• Hemorrhoids are uncommon

Lower esophageal sphincter tone is increased.

Multiple Choice

A 29 year old, G1 P1 (1001), who came in for her follow-up and family planning. For breastfeeding women, the following are recommended contraceptives, except?

• Combined oral contraceptive pills

• Progestin only pills

• Progestin implants

• Medroxyproges-terone depot injectiob

Multiple Choice

What is the first sonographic evidence of pregnancy?

• Gestational Sac

• Pseudogestational Sac

• Yolk Sac

• Corpus luteum

CPG on Family Planning

Combined Oral Contraceptive Pills

• Not recommended as first line

• Negative impact of estrogen on lactation

GESTATIONAL SAC

Multiple Choice

During embryonic development, the following statements are true, except?

• Organogensis takes place during the embryonic period which begins from the third week from LMP through 8th week

• The cranial end of neural tube closes by 40 weeks from LMP and caudal end closes by 38 weeks.

• A cardiovascular system is formed by the 4th week

• Cardiac motion is discernable by 6th week

Cranial End = 38 days
Caudal end = 40 days

Multiple Choice

What is the proper sequence of embryo hematopoiesis starting from the earliest site?

• Yolk sac, Liver, Spleen and Bone Marrow

• Bone Marrow, Spleen , Liver and Yolk Sac

• Liver, yolk sac, spleen and Bone Marrow

• Yolk sac, spleen, liver and bone marrow

Yolk sac, Liver, Spleen and Bone Marrow

Multiple Choice

Which of the following statements best describes Braxton hicks contractions?

• Occurring at regular intervals

• Painless, irregular and unpredictable contractions

• Causes low back pain

• Intensity varies from 50 - 75 mmHg

Multiple Choice

Which of the following immunoglobulins crosses the placenta in large amounts?

• IgE

• IgA

• IgM

• IgG

IgG

Multiple Choice

The maximum function of the corpus luteum extends up to?

• 8 - 9 weeks

• 3 - 4 weeks

• 14 - 16 weeks

• 6 - 7 weeks

6 - 7 weeks

Multiple Choice

A 32 year old, G1 P0, came in for prenatal check-up. At what weeks age of gestation will the fundic height and gestational age be equal?

• 20 - 34 weeks

• 20 - 32 weeks

• 16 - 24 weeks

• 24 - 32 weeks

20 - 34 weeks

Multiple Choice

A primigravid patient came in for prenatal consult. Based on LMP, She is currently 11 weeks. As an OB-Gyne sonologist, you did a baseline ultrasound which revealed CRL at 7 5/7 weeks. After 1 month, she had a latest ultrasound which revealed 12 3/7 weeks. Which of these will you use for fetal aging?

• LMP

• Early ultrasound

• Latest ultrasound

• Repeat ultrasound

Early Ultrasound

​LMP. 11 weeks
UTZ 7 weeks 5 days
----------------------------
23 days discrepancy

Multiple Choice

The following are known congenital defects related to methimazole, except?

• Choanal atresia

• Esophageal atresia

• Patent ductus arteriosis

• Aplasia cutis

Methimazole embryopathy

Multiple Choice

A multigravid patient came in for consult due to missed menses. You requested a serum pregnancy test which revealed positive and on transvaginal ultrasound revealed intrauterine pregnancy 7 weeks age of gestation by CRL. She recalled that she consumed 1 bottle of beer per day for the past week. What could the child present at delivery, except?

• Short palpebral facial features

• Thin vermillon border of the upper lip

• Tetralogy of Fallot

• Head circumference <10th percentile

Multiple Choice

Which of the following gestational ages and weight typically define a miscarriage?

• Less than 20 weeks and less than 500 grams

• Less than 20 weeks and more than 500 grams

• Less than 24 weeks and more than 500 grams

• Less than 24 weeks and less than 500 grams

Less than 20 weeks and < 500 grams

Multiple Choice

Which of the following factors is least likely to be linked with higher first trimester miscarriage rates?

• Obesity

• Diabetes mellitus

• Parvovirus infection

• Maternal age > 40 years old

Multiple Choice

A 32 year old primigravida came in due to right lower quadrant pain. Her last menstrual period was 6 weeks ago and had a positive serum pregnancy test. On assessment, you noted a right lower quadrant direct tenderness and cervical motion tenderness. What is the most likely diagnosis?

• Pelvic inflammatory disease

• Interstitial Pregnancy

• Ampullary Pregnancy

• Appendicitic

Ampullary Pregnancy

Multiple Choice

Your patient is a 23 year old nulligravid desiring of pregnancy. Her last menstrual period was 7 weeks ago. She presents with complaints of vaginal spotting associated with intermittent right lower quadrant pain. Her ultrasound showed. This indicates an ectopic pregnancy but may also be seen with which of the following?

• Corpus luteum

• Ovarian endometrioma

• Molar Pregnancy

• Dermoid Cyst

"Ring of Fire"

Multiple Choice

Which of the following would most likely be associated with methotrexate failure during a medical management for ectopic pregnany?

• Ectopic mass 4.0 cm

• Serum b-hCG

  5,000 mIU/mL

• Prior Ectopic Pregnancy

• None

Multiple Choice

A G1P0, 27 years old, came in due to vaginal spotting. Her pelvic ultrasound revealed ectopic pregnancy measuring 2.8 cm, no fetal heart beat and serum b-hCG 5,000 mIU/mL. She is a candidate for medical management with methotrexate. Which of the following should be avoided during therapy?

• Folic Acid

• Sexual Contact

• Alcohol

• All of the above

Multiple Choice

A 19 year old G1P0 came in at your clinic due to vaginal bleeding at 8 weeks by her last menstrual period. On assessment, uterine fundus is midway between the umbilicus and symphysis pubis. Transvaginal ultrasound revealed no fetal heart beat with anechoic cystic spaces but without a fetus and serum b-hCG revealed 280,000 mIU/mL/ What is the most likely diagnosis?

• Incomplete Molar Pregnancy

• Complete Molar Pregnancy

• Heterotrophic Pregnancy

• Incomplete Abortion

Multiple Choice

You decided to perform a suction curettage to the patient. Which of the following is the most common risk associated with suction curettage?

• Uterine perforation

• Infection

• Hemorrhage

• Ashermann syndrome

Multiple Choice

Prior to molar pregnancy evacuation, a preoperative radiograph is typically obtained to exclude which of the following?

• Cardiomegaly

• Pleural effusion

• Hilar lymphadenopathy

• Trophoblastic deportation

Multiple Choice

What is the hallmark sign of gestational trophoblastic neoplasia?

• Seizures

• Hemoptysis

• Uterine bleeding

• Pelvic vein thrombosis

Multiple Choice

A 35 year old G2P1(1001) with 2 hour 75 grams OGTT result which revealed FBS 93.6 mg/dL, 1st hour 154 mg/dL, 2nd hour 164 mg/dL. She is on her 32nd week of pregnancy and you did a contraction stress test which revealed late decelerations following more than 50% of the contractions. What is the interpretation?

• Positive CST

• Negative CST

• Suspicious CST

• Unsatisfactory CST

Multiple Choice

A 38 year old elderly primigravida, 39 weeks AOG, came in for prenatal check-up. Her ultrasound revealed 1 episode of fetal breathing lasting for 30 secs, 2 discrete body or limb movements, 2 episodes of extremity extension and subsequent return to flexion, AFI 1.2 cm, What will be your management?

• Admit and Hydrate

• Admit and Induce

• Schedule for Cesarean Section

• Admit and repeat BPP after 24 hours

• 1 episode fetal breathing 30 secs

• 2 discrete body or limb movements

• 2 episodes of extremity extension and return

• AFI 1.2 cm

Multiple Choice

What are the components of the Modified Biophysical Profile?

• Tone and AFI

• AFI and NST

• NST and Tone

• Movement and AFI

Multiple Choice

What controls fetal heart rate accelerations?

• Autonomic function at brainstem level

• Aortic Baroreceptor reflexes

• Atrial natriuretic peptide

• Carotid Baroreceptor reflexes

Autonomic function at brainstem level

Multiple Choice

This indicates that the bisacromial diameter has rotated into the anteroposterior diameter of the pelvis?

• Descent

• Internal rotation

• External Rotation

• Expulsion

Multiple Choice

The following influences descent of the presenting part during labor, except?

• Direct myometrial pressure on the fundus on the breech

• Bearing down efforts of maternal abdominal muscles

• Extension and Straightening of the fetal body

• Resistance from the pelvis from the pelvic floor

Multiple Choice

This maneuver is done by grasping the fetal brow and suboccipital region through the abdominal wall with the fingers and firm pressure is directed downward in the axis of the inlet?

• Mueller Hills Maneuver

• Brandt Andrew's Maneuver

• Wood Corkscrew Maneuver

• Ritgen Maneuver

Multiple Choice

A G3P2(2002) came in due to bloody show. She is currently at 38 weeks age of gestation with gestational hypertension and gestational diabetes mellitus. How often should be the fetal heart beat be evaluated during the first stage of labor and during the second stage of the labor?

• At least every 15 minutes during the 1st stage and every 5 minutes during the 2nd stage

• At least every 30 minutes during the 1st stage and every 15 minutes during the 2nd stage

• At least every 20 minutes during the 1st stage and every 5 minutes during the 2nd stage

• At least every 15 minutes during the 1st stage and every 10 minutes during 2nd stage

Multiple Choice

Inappropriate leg positioning especially during prolonged second stage of labor causes compression of the common fibular nerve. How long will the symptoms resolved after delivery?

• within 6 weeks

• within 6 months

• within 12 months

• within 12 weeks

Multiple Choice

Regarding the second stage of labor, which one of the statements are true?

• Mean duration is 50 minutes for nulliparas and 20 minutes for multiparas

• Fetal heart rate auscultated at least every 10 minutes

• Cervical dilatation progresses at 1cm per hour

• Fetal heart rate auscultated at least every 30 minutes

Multiple Choice

The pathological retraction ring of Bandl is most commonly associated with which of the following?

• Uterine fibroids

• Obstructed labor

• Multiple Gestation

• Advanced Maternal Age

Multiple Choice

What are the cardinal movements of a fetus in face presentation?

• Descent - Internal Rotation - Flexion - Extension - External Rotation

• Descent - Flexion - Internal Rotation - External Rotation - Expulsion

• Internal Rotation - Descent - Flexion - Extension - External Rotation

• Internal Rotation - Flexion - Descent - Extension - External Rotation

Multiple Choice

All are done in the active management of the third stage of labor, except?

• Controlled cord traction

• Early cord clamping

• Delayed cord clamping

• Oxytocin administration

Multiple Choice

Which of the following is true regarding epidural analgesia during labor?

• It slows the first stage of labor and second stage of labor

• It has no effect on the first stage of labor and slows the second stage of labor

• It slows the first stage of labor and has no effect on the second stage of labor?

• It has no effect on the first and second stage of labor

Multiple Choice

A 32 year old primigravida 38 weeks age of gestation who came in due to regular uterine contractions which started 5 hours prior. On assessment, uterine contractions every 5 - 6 minutes, moderate to strong lasting for 50 seconds. Internal examination revealed 2 cm, 30% effaced, St-1, intact membranes. After 17 hours, IE revealed 2cm, 30% effaced, St-1, intact membranes. What is the diagnosis?

• Arrest of cervical dilatation

• Protracted active phase of labor

• Prolonged latent phase of labor

• Normal labor

Multiple Choice

A 27 year old primigravid 39 weeks age of gestation with diet controlled diabetes mellitus came in due to watery vaginal discharge. Internal examination revealed 1 cm, 30% effaced, St-2, RBOW. No uterine contraction was noted. Clinical pelvimetry was adequate. She was started on induction of labor. What is the total number of montevideo units?

• 235

• 242

• 196

• 200

Multiple Choice

Given the patient above. After 12 hours, Internal examination revealed 1 cm, 30% effaced, St-2, RBOW. Attending physician called for STAT CS. The following are the parameters that should be met for failed induction of labor, except?

• Adequate uterine contractions

• Internal examination >4cm

• Ruptured membranes

• Internal examination <4cm

Multiple Choice

A 34 year old 38 weeks age of gestation multigravida came in due to labor pains. Internal examination revealed fully dilated, fully effaced, St 0, RBOW. Contractions every 3 minutes, strong lasting for 50 seconds. After 1 hour repeat internal examination revealed fully dilated, fully effaced, St +1, RBOW. What is the management?

• Augment labor

• Cesarean section

• Observe progress of labor for another hour

• Forceps delivery

Multiple Choice

A 20 year old primigravida delivered to a 3.7 kg live baby girl via forceps extraction. She was immediately given intramuscular oxytocin and oxytocin drip. While on going episiorrhaphy, you noted vaginal bleeding. The uterus was well contracted however still with profuse vaginal bleeding. What is the most likely diagnosis?

• Uterine atony

• Lacerations of the cervix

• Uterine inversion

• Placenta accrete

• TONE (Uterine atony): Overdistention, relaxants, prolonged or rapid labor, chorioamniotis)

• TISSUE: Retained placenta, Placenta abnormality, extension cord traction

• TRAUMA: Injuries and tears

• THROMBIN: Coagulopathy, anticoagulation therapy

Multiple Choice

Which of the following statements accurately describes low lying placenta?

• The placenta is implanted in the lower uterine segment

• The placental edge covers the internal os but not completely

• The placental edge does not cover the internal os but lies within 1 cm wide perimeter

• The placental edge does not cover the internal os but lies within the 2cm wide perimeter.

Multiple Choice

A primigravida is in labor and an episiotomy is about to be done. Comparing to a midline episiotomy, an advantage of mediolateral episiotomy is?

• Less extension

• Ease of repair

• Minimal post-operative pain

• Faulty healing is rae

Multiple Choice

Outlet forceps delivery can safely be performed if the following criteria is met?

• Fetal station is at +2

• Sagittal suture is in AP diameter

• Fetal scalp is 3cm below the ischial spine

• Rotation exceeds < 45 degrees

Multiple Choice

A 31 year old primigravida underwent induction of labor and reached 2nd stage of labor after 28 hours. Before beginning to push she says she is too tired and desires an operative vaginal delivery. Which of the following precludes her from having an elective operative vaginal deliver?

• Head is at station +1

• Head is in occiput anterior position

• Scalp is visible at the introitus without labial separation

• Fetal station is between 0 and +2

Multiple Choice

A 20 year old, G1 P0, 6 weeks age of gestation by LMP came in for ultrasound. You noted a thick dividing membrane, 2 yolk sacs and two separate gestational sac on ultrasound. What is the most likely chorionicity and amnionicity?

• Dichorionic and diamnionic twinning

• Dichorionic and monoamnionic twinning

• Monochorionic and diamnionic twinning

• Monochorionic and monoamnionic twinning

Multiple Choice

A primigravida came in for her second trimester scan, you noted membrane 2mm and 2 separate placentas. What is the chorionicity of this patient and what do you call this sign?

• Dichorionic twin;

  T-sign

• Dichorionic Twin;

  Lambda sign

• Monochorionic Twin;

  Lambda sign

• Monochorionic Twin; T-sign

Multiple Choice

A 42 year old elderly primipara delivered via primary low transverse cesarean section 6 weeks ago due to uncontrolled blood pressure. She came in for family planning. Among the several contraceptive methods, what is not recommended to this patient?

• Combined contraceptive pills

• Copper IUDs

• Barrier Method

• None of the above

Multiple Choice

A 40 year old primigravida, 14 weeks age of gestation consults for follow-up and for prenatal check-up. She had history of gestational diabetes mellitus and initial BMI 27.3 kg/m². Her laboratories revealed hemoglobin 120mg/dL, FBS 89.5 mg/dL, HBsAg and RPR nonreactive, What is the recommended test for diabetes for this patient?

• FBS after 1 month

• 2H 75g OGTT immediately

• 2H 75g OGTT at 24 weeks

• 100 g OGCT at 24 weeks

Multiple Choice

A 27 year old, G1P1(1001) delivered via spontaneous vaginal delivery 2 weeks ago. She is against vaccinations thus her baby did not receive any vaccinations. She is Hepatitis B positive. When is the earliest that she can expect her menses to resume?

• 4 weeks

• 8 weeks

• 12 weeks

• 20 weeks

6 - 8 weeks

Multiple Choice

What is the correct distribution of nutritional intake concerning caloric intake as endorsed by American College of Obstetrician and Gynecologist?

• 30% fat

  30% protein

  40% CHO

• 25% fat

  20% protein

  55% CHO

• 25% fat

  25% protein

  40% CHO

• 30% fat

  20% protein

  55% CHO

Multiple Choice

A multigravida 38 years old with persistently elevated glucose level despite insulin administration. She had congenital anomaly scan at 24 weeks age of gestation. What is the most likely cardiovascular defect?

• Tetralogy of Fallot

• Mitral Valve Prolapse

• Patent Ductus Arteriosus

• Ebstein Anomaly

Multiple Choice

Which of the following findings are considered diagnostic for overt diabetes in pregnancy?

• Hemoglobin A1c 6%

• Glucosuria on urine dip

• Fasting plasma glucose 123 mg/dL

• Random plasma glucose 200mg/dL

Multiple Choice

There are four phases of parturition, which of the following statements best describes phase 2.

• Uterine activation, cervical ripening

• Uterine quiescence

  Cervical softening

• Uterine contraction

  Cervical dilatation

• Uterine involution

  Cervical remodeling

Multiple Choice

A G2P1(1001) on her 32nd week of gestation complains of non-painful uterine contractions. Internal Examination showed a close and soft cervix with no bleeding or abnormal discharge. At what phase of Parturition is the woman in?

• Phase 1

• Phase 2

• Phase 3

• Phase 4

Multiple Choice

Which of the following supports the theory that progesterone inhibits parturition?

• Progesterone withdrawal precedes labor

• Providing Progesterone delays labor

• Administration of progesterone receptor antagonist promotes labor

• All of the above

Multiple Choice

A 26 year old G2P1(1001) currently at 40 weeks age of gestation came in for induction of labor. On assessment, internal examination revealed 1cm, 30% effaced, Medium, St-2, intact BOW. What is her Bishop score?

• 3

• 2

• 1

• 4

Multiple Choice

A 37 year old G1P0 came in for induction of labor with an internal examination of 1cm, 30% effaced, Posterior, Medium, Cephalic, St-2, (+)BOW. Her BMI is 32 kg/m2 and the SEFW 3200 grams. Which of the following factors predicts a successful induction?

• Younger age

• Body mass index

• Estimated fetal weight

• Bishop score

Multiple Choice

A 39 year old, G3P2(2002), who came in due to labor pains. She was mounted after 7 hours of labor. Which of the following forceps is most appropriate in delivering the after coming head during vaginal breech delivery?

• Kielland Forceps

• Simpsons Forceps

• Tucker Mclane

• Pipers Forceps

Multiple Choice

A 35 year old, G2P1(1001), delivered to a 3.9 kg baby girl. The pedia resident on duty noted that the right arm is hanging limply with the forearm extended and internally rotated. What is the most likely diagnsosis?

• Klumpke's Paralysis

• Erb Palsy

• Humeral Fracture

• Clavicular Fracture

Multiple Choice

In which of the following mechanism of placental delivery does the placenta leave the body before the retroplacental hematoma?

• Duncan Mechanism

• Brandt-Andrews Mechanism

• Ritgen Mechanism

• Schultze Mechanism

Multiple Choice

Which of the following is a good candidate for vaginal breech delivery?

• G1P0, Fetal head hyperextended on latest scan

• G3P2(2002), single footling breech on internal examination

• G2P1(1001)

  Estimated fetal weight 3.4kg

• G3P2(1001), Estimated fetal weight 3kg with anencephaly

Multiple Choice

Patient DT, a 27 year old primigravida at 35 weeks age of gestation complains of headache. Her blood pressure is 170/100. Which of the following will show in her urinalysis?

• Proteinuria

• Ketonuria

• Hematuria

• Glucosuria

Multiple Choice

A 32 year old multigravida came in for her prenatal check-up. She is currently 39 weeks age of gestation by her last menstrual period. Her blood pressure is persistently at 140/90 mmHg and asymptomatic. On assessment, she had reassuring fetal heart beat and internal examination revealed 2 cm, 30% effaced, posterior, medium, St-2. What would be the appropriate mangement?

• Immediate Cesarean Section

• Induction of Labor

• Out patient observation

• Temporize until 40 weeks

Multiple Choice

A 33 year old, G1P0, 35 weeks age of gestation came in for headache and blurring of vision. Her blood pressure was 180/100 with note of good fetal heart beat. Within a few minutes, she developed generalized tonic clonic seizures. She was given magnesium sulfate drip. Which among the following should be monitord?

• Cardiac Rate

• Respiratory Rate

• Temperature

• Urine creatinine

Multiple Choice

A 28 year old primigravida with gestational hypertension came in for profuse vaginal bleeding and abdominal pain. She is currently 37 6/7 weeks ages of gestation by early ultrasound. At the ER, BP 80/50, CR 120bpm, RR 21 cpm. She had pale conjunctivae, palms and nailbeds, uterine contractions occurring every 1 - 2 minutes with good fetal heart beat. Internal examination 2cm, 30% effaced, St-2, +BOW. What is the most appropriate management?

• Admit for abdominal delivery

• Admit for vaginal delivery

• Admit and do expectant management

• Admit and do cervical ripening

Abruptio placenta

Multiple Choice

Which of the following emergent therapy for acute onset severe hypertension is correct?

• Hydralazine 10 - 20 mg IV initial dose then 5 -10 mg IV every 20 - 40 minutes

• Labetalol 10 - 20 mg IV initial dose then 20 - 80 mg every 20 - 30 minutes

• Nifedipine 5 - 10 mg initial dose then 10 - 20 mg every 30 minutes

• Nicardipine 10 mg/hr initial dose

Multiple Choice

Patient T, a 27 year old, G2 P1 (1001) 33 weeks age of gestation came in due to watery vaginal discharge. On assessment, Fundic height 30 cm, FHB 150s, Uterine contractions 1 in 10 minutes, Mild lasting for 50 seconds. Speculum revealed pooling of clear amniotic fluid. Internal examination revealed 1 cm, Beginning effacement, St-2. Which of the following is most appropriate management?

• Expectant management

• Single course of corticosteroids then augment labor

• Induction of labor

• Isoxsuprine drip

Multiple Choice

The following are mechanisms for intraamnionic infection leading to preterm labor and birth, except?

• Transplacental transfer of maternal systemic infection

• Flow of infection via the fallopian tubes

• Ascending infection

• None of the above

Multiple Choice

A 32 year old, G3 P0 (0020), came in due to missed menses and urine pregnancy test revealed positive. Her LMP was 11 weeks ago and on ultrasound there was note of short cervix. At what age of gestation is the best time to perform elective prophylactic cerclage?

• 16 and 18 weeks

• 12 and 14 weeks

• 14 and 16 weeks

• 18 and 20 weeks

Multiple Choice

A 29 year old, G1 P0, 33 weeks age of gestation came in due to irregular uterine contractions. On assessment, cervix 1 cm dilated, beginning effacement, St -2, (+) BOW. Attending physician decided to give corticosteroids, which of the following is correct?

• Dexamethasone 12mg IM every 12 hours x 4 doses

• Betamethasone 12 mg IM every 24 hours x 4 doses

• Dexamethasone 6mg IM every 12 hours x 4 doses

• Betamethasone 12mg IM every 24 hours x 2 doses

Multiple Choice

A 30 year old multigravida on her 25th week of gestation came in for prenatal check-up. She mentioned that her daughter has flu like symptoms, pruritic vascular lesions. The following statements are true, except?

• Highest vertical transmission is between 13 weeks and 20 weeks

• Administration of varicella zoster immune globulin if fetus is exposed 5 days prior to 2 days after delivery

• Fetus may develop chorioretinitis and cicatricial lesions

• The virus is cytotoxic for erythroid progenitor cells which may cause fetal anemia

Multiple Choice

What is the most common frequent infectious agent of non-immune hydrops?

• Parvovirus B19

• CMV

• ZIka virus

• Varicella zoster

Multiple Choice

A primigravida in her second trimester complains of vaginal discharge. On speculum examination, there was note of copious milky white, thin foul smelling discharge. How will you manage this patient?

• Assure her that this is a normal finding

• Given oral metronidazole

• Give topical azoles

• Inform patient that this is a sexually transmitted disease

Multiple Choice

A G2P0 at 13 weeks age of gestation came in due to yellowish vaginal discharge. NAAT revealed positive for chlamydia. Which of the following is the drug of choice that can be given as one dose?

• Azithromycin

• Amoxicillin

• Doxycycline

• Clindamycin

Multiple Choice

A 22 year old Primigravida on her 12th week age of gestation came in due to palpitations. You noted that she did not gain weight from the last time you saw her. Her laboratory results revealed decreased TSH and increased FT4. Which of the following is the best pharmacologic treatment for this patient?

• Methimazole

• Levothyroxine

• Propylthiouracil

• Radiation therapy

Multiple Choice

When does the fetus begin to concentrate and synthesize thyroid hormone?

• 14 weeks

• 12 weeks

• 10 weeks

• 16 weeks

Multiple Choice

Which of the following laboratory parameter/s will differentiate lupus flare and preeclampsia

• Creatinine

• SGPT and SGOT

• 24 hour urine protein

• C3 and C4 levels

Multiple Choice

A 32 year old, G1 P0, who came in due to vomiting. She is currently at 10 weeks from her last menstrual period She had 7 episodes of vomiting associated with nausea, dry lips and tongue and body weakness. Which of the following is true regarding the triad of hyperemesis gravidrum?

• Weight loss of 2kg or 3% of pre-pregnancy weight

• Electrolyte imbalance including hypokalemia, alkalosis and ketosis

• Nausea and vomiting

• None of the above

Multiple Choice

A 27 year old G1P0 at 20 weeks age of gestation came in due to frequency and dysuria. On assessment, she is afebrile with no costovertebral tenderness. She had a urine >100,00 colony forming units/mL of gram negative rods. If left untreated, what percentage of pregnant women will develop a symptomatic infection?

• 25%

• 35%

• 15%

• 45%

Multiple Choice

A 25 year old, G3P2(2002), at 20 weeks age of gestation came in due to shortness of breath which occurred daily and she had occasional nocturnal awakenings. She is currently using daily short acting B agonists. Which of the following fetal effects results from maternal respiratory alkalosis?

• Higher umbilical blood flow

• Low systemic resistance

• Low pulmonary vascular resistance

• Decreased cardiac output

Multiple Choice

A 38 year old, G2P1 (1001), who came in for prenatal check-up. She is currently at 28 weeks age of gestation. She was previously treated with Benzanthine penicillin G every 21 days for 5 years. She is comfortable on the exam table. She reports palpitations and dyspnea when climbing 2 flights of stairs. Which New York Heart Association Class best describes her?

• Class I

• Class II

• Class III

• Class IV