TESTBANK Beckmann and Ling’s Obstetrics and Gynecology 8th Edition Casanova

TESTBANK Beckmann and Ling’s Obstetrics and Gynecology 8th Edition CasanovaTable of Contents Chapter 1: Women’s Health Examination and Women’s Health Care Management .............................................. 2 Chapter 2: The Obstetrician–Gynecologist’s Role in Screening and Preventive Care ............................................. 9 Chapter 3: Ethics, Liability, and Patient Safety in Obstetrics and Gynecology .................................................................. 14 Chapter 4: Embryology and Anatomy ................................................................................................................................... 18 Chapter 5: Maternal–Fetal Physiology ................................................................................................................................ 25 Chapter 6: Preconception and Antepartum Care .................................................................................................................. 32 Chapter 7: Genetics and Genetic Disorders in Obstetrics and Gynecology .................................................................... 43 Chapter 8: Intrapartum Care .................................................................................................................................................... 51 Chapter 9: Abnormal Labor and Intrapartum Fetal Surveillance....................................................................................... 59 Chapter 10: Immediate Care of the Newborn ...................................................................................................................... 68 Chapter 11: Postpartum Care .................................................................................................................................................. 76 Chapter 12: Postpartum Hemorrhage .................................................................................................................................... 84 Chapter 13: Multifetal Gestation ............................................................................................................................................... 89 Chapter 14: Fetal Growth Abnormalities: Intrauterine Growth Restriction and Macrosomia ....................................... 96 Chapter 15: Preterm Labor .................................................................................................................................................... 103 Chapter 16: Third-Trimester Bleeding.................................................................................................................................. 111 Chapter 17: Premature Rupture of Membranes .............................................................................................................. 117 Chapter 18: Post-term Pregnancy ........................................................................................................................................ 123 Chapter 19: Ectopic Pregnancy and Abortion .................................................................................................................... 129 Chapter 20: Endocrine Disorders .......................................................................................................................................... 139 Chapter 21: Gastrointestinal, Renal, and Surgical Complications................................................................................. 141 Chapter 22: Cardiovascular and Respiratory Disorders .................................................................................................. 146 Chapter 23: Hematologic and Immunologic Complications .......................................................................................... 155 Chapter 24: Infectious Diseases ............................................................................................................................................ 161 Chapter 25: Neurologic and Psychiatric Disorders .......................................................................................................... 171 Chapter 26: Contraception .................................................................................................................................................... 173 Chapter 27: Sterilization ......................................................................................................................................................... 179 Chapter 28: ................................................................................................................................................................................ 186 Chapter 29: Sexually Transmitted Infections ..................................................................................................................... 194 Chapter 30: Pelvic Support Defects, Urinary Incontinence, and Urinary Tract Infection ............................................ 205 1 | P a g eChapter 31: Endometriosis ................................................................................................................................................... 213 Chapter 32: Dysmenorrhea and Chronic Pelvic Pain ...................................................................................................... 219 Chapter 33: Disorders of the Breast .................................................................................................................................... 228 Chapter 34: Gynecologic Procedures ................................................................................................................................. 235 Chapter 35: Human Sexuality ............................................................................................................................................... 241 Chapter 36: Sexual Assault and Domestic Violence ........................................................................................................ 246 Chapter 37: Reproductive Cycles ......................................................................................................................................... 249 Chapter 38: Puberty ................................................................................................................................................................ 255 Chapter 39: Amenorrhea and Abnormal Uterine Bleeding ........................................................................................... 263 Chapter 40: Hirsutism and Virilization ................................................................................................................................. 268 Chapter 41: Menopause ........................................................................................................................................................ 276 Chapter 42: ................................................................................................................................................................................ 284 Chapter 43: Premenstrual Syndrome and Premenstrual Dysphoric Disorder .......................................................... 289 Chapter 44: Cell Biology and Principles of Cancer Therapy ........................................................................................... 294 Chapter 45: Gestational Trophoblastic Neoplasia .............................................................................................................. 299 Chapter 46: Vulvar and Vaginal Disease and Neoplasia ................................................................................................. 305 Chapter 47: Cervical Neoplasia and Carcinoma ............................................................................................................... 313 Chapter 48: Uterine Leiomyoma and Neoplasia ............................................................................................................... 322 Chapter 49: Cancer of the Uterine Corpus ........................................................................................................................... 327 Chapter 50: Ovarian and Adnexal Disease ........................................................................................................................ 333 Chapter 1: Women’s Health Examination and Women’s Health Care Management 1: Elevating the head of the examining table approximately 30 degrees facilitates a: the observation of the patient's responses b: the ability of the patient to comfortably look around to distract her from the examination c: the contraction of the abdominal wall muscle groups, making the examination easier d: comfortable blood pressure measurement e: the physician not being distracted by eye contact with the patient 2: 2 | P a g eWhich of the following uterine positions is most associated with dyspareunia? a: Midposition, retroflexed b: Retroverted, anteflexed c: Anteverted, anteflexed d: Retroverted, retroflexed e: Midpostion, anteflexed 3: Inquiry concerning adult and child history of sexual abuse should be included in the sexual history a: if time permits b: in visits where there are suspicious physical findings but not otherwise c: in visits where sufficient time is allotted d: in all new patient visits e: in visits where a specific indication is noted 4: Peau d'orange change in the breast is associated with a: edema of the lymphatics b: jaundice c: too vigorous breastfeeding d: overly tight undergarments e: galactorrhea 5: Which kind of speculum is often most suitable for examination of the nulliparous patient? a: Morgan's speculum b: 3 | P a g eEndoscopic speculum c: Ling speculum d: Graves speculum e: Pederson speculum 6: Which uterine configuration is most difficult to assess for size, shape, configuration, and mobility? a: Midposition b: Anteverted c: There is no difference in difficulty d: Retroverted 7: Which type of speculum is most appropriate for the examination of a parous menstrual woman? a: Ling speculum b: Graves speculum c: Pederson speculum d: Endoscopic speculum e: Morgan's speculum 8: Menopause is defined as the cessation of menses for greater than e: 24 months 9: In a woman describing sufficiently frequent sexual encounters, infertility typically is described as a failure to conceive after 4 | P a g ea: 3 months b: 9 months c: 12 months d: 18 months e: 6 months 10: During bimanual examination of the adnexa in normal premenopausal women, the ovaries are palpable e: about one-quarter of the time 11: If a patient becomes uncomfortable with a topic during a history-taking session, the best response of the physician is to a: address the patient's discomfort in a positive and supportive manner b: discontinue discussion of the topic to avoid further patient discomfort c: discontinue discussion to avoid damage to the patient-physician relationship d: continue after making a joke to relieve tension e: ignore the discomfort and proceed with questioning 12: Which of the following statements about the steps in the breast examination is correct? e: Inspection is done first 13: 5 | P a g eQuestions that promote the physician's fullest understanding of the patient's situation are best characterized as a: compassionate b: chronological c: sympathetic d: emphatic e: evidence based 14: The last menstrual period is dated from the 15: The passage of clots during menstruation a: is always abnormal b: may be either normal or abnormal c: is always normal d: is extremely rare 16: In the abbreviation of the obstetric history-G[1] P[2] [3] [4] [5]-"1" stands for the number of a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions 6 | P a g e17: a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions 18: In the abbreviation of the obstetric history-G[1] P[2] [3] [4] [5]-"3" stands for the number of a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions 19: a: living children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions 20: In the abbreviation of the obstetric history-G[1] P[2] [3] [4] [5]-"5" stands for the number of a: 7 | P a g eliving children b: pregnancies c: term pregnancies d: preterm pregnancies e: abortions 21: Tanner's classification with respect to the breast relates to changes in the breast before and after lactation b: associated with malignancy c: associated with maturation d: associated with galactorrhea e: associated with fibrocystic changes 22: The rectovaginal examination should be performed a: after 52 years of age b: at the initial patient visit c: only for the evaluation of chronic pelvic pain d: only when there are symptoms of pelvic relaxation e: at intervals of 5 years 23: In the gynecologic history, it is often possible to distinguish between vaginitis and pelvic inflammatory disease by inquiring about the duration of the pain b: the symptoms present (fever/chills, itching) c: the timing of pain in relation to menses d: the association of pain with body position e: the use of topical medications 8 | P a g e24: The most common reason for failure to visualize the cervix during the speculum examination is a: failure to use lubricant b: a full bladder c: failure to fully insert the speculum d: use of a speculum that has not been warmed e: use of the wrong speculum 25: Prehypertension is defined as a blood pressure range of a: 80-90/120-139 b: 90-100/120-139 c: 80-90/110-129 d: 70-80/110-129 e: 70-80/120-139 ANS: 1-25. [A, D, D, A, E, D, B, C,C,C,A,E,D,A,B,B,C,D,E,A,C,B,E,C,A] Chapter 2: The Obstetrician–Gynecologist’s Role in Screening and Preventive Care 1: The sensitivity of a screening test is defined as the proportion of a: unaffected individuals that test positive b: affected individuals that test positive c: unaffected individuals that test negative d: 9 | P a g eaffected individuals that test negative 2: The specificity of a screening test is defined as the proportion of a: affected individuals that test negative b: unaffected individuals that test positive c: affected individuals that test positive d: unaffected individuals that test negative 3: Counseling an obese patient to lose weight is an example of a: secondary prevention b: primary prevention c: empathy d: engagement 4: In women, the thyroid-stimulating hormone screening test should be performed at what interval? a: Every 1-2 years from age 40 years, then yearly after age 50 years b: Every 5 years after age 50 years c: Annually from puberty or from the onset of sexual activity d: Every 5 years from age 19 years, then every 3-5 years after age 65 years 5: The Pap smear for cervical dysplasia should be performed at what interval? a: 10 | P a g eEvery 2-3 years after age 30 years if three consecutive annual tests are negative b: Every 5 years from age 19 years, then every 3-5 years after age 65 years c: Every 1-2 years beginning at age 65 years d: Every 1-2 years from age 40 years, then yearly after age 50 years 6: A cholesterol/lipid profile should be performed for women without risk factors at what interval? a: Every other year from age 40 years, then yearly after age 50 years b: Every 5 years after age 45 years c: Every 3-5 years after age 65 years d: Every 5 years from age 19 years, then every 3-4 years after age 65 years 7: A mammography to detect breast cancer should be performed at what interval in women at average risk? a: Every 1-2 years after age 65 years b: Every 5 years after age 19 years, then every 3-4 years after age 65 years c: Every other year from age 40 years, then yearly after age 50 years d: Every 3-5 years after age 45 years 8: A colonoscopy to detect colorectal cancer should be performed at what interval for women at average risk? a: Every 10 years starting at age 50 years b: Every 1-2 years starting at age 40 years c: Every 10 years starting at age 65 years d: Every 10 years from age 19 years, then every 3-4 years after age 65 years 11 | P a g e9: Which of the following is the most appropriate screening mechanism for cervical dysplasia? a: Pap smear b: Serum HPV titer c: HPV-DNA testing d: Colposcopy of suspicious lesions 10: Which of the following is the most appropriate screening mechanism for colorectal cancer? a: Hemogram b: Colonoscopy c: Physical examination of suspicious lesions d: CT scan 11: Which of the following is the most appropriate screening mechanism for thyroid disease? a: Thyroid-stimulating hormone b: Free thyroxine c: Yearly physician examination d: Thyroid-binding globulin 12: What is the appropriate interval for Pap testing in women who have had a total hysterectomy for reasons other than cervical dysplasia? a: 12 | P a g eEvery 2 years following the hysterectomy b: Every 5 years following the hysterectomy c: No additional Pap testing is needed d: Every year following the hysterectomy 13: In sexually active women age 25 or younger, regular screening for Chlamydia should occur a: only if the woman is at high risk for infection b: every 3-5 years c: annually d: every 2 years 14: Bone mineral density testing is recommended for women without risk factors for osteoporosis beginning at what age? a: 40 years b: 65 years c: 50 years Testing is not recommended for women with no risk factors 15: A 40-year-old woman comes for an initial visit. Her BMI is 30 and she had previously given birth to an infant weighing 9.5lb. Which of the following initial screening tests is indicated for this patient? a: Fasting blood glucose b: Colonoscopy c: 13 | P a g eTSH level d: Bone mineral density testing ANS: [b,d,b,b,a,b,c,a,a,b,a,c,c,b,a] Chapter 3: Ethics, Liability, and Patient Safety in Obstetrics and Gynecology 1: The principle that the patient should be given what is "due" most closely matches the principle of a: justice b: nonmaleficence c: beneficence d: autonomy 2: The principle that there should be respect for the patient's right to make choices based on her beliefs and values best matches the principle of a: beneficence b: nonmaleficence c: justice autonomy 3: The principle that there is a duty not to inflict harm or injury best matches the principle of a: 14 | P a g enonmaleficence b: autonomy c: justice d: beneficence 4: The principle that there is a duty to promote the well-being of the patient best matches the principle of a: justice b: autonomy c: beneficence d: nonmaleficence 5: A 32-year-old patient has delivered at 23 weeks of gestation, 3 days after premature rupture of the membranes. She has discussed the circumstances with her obstetrician and requests that no attempts at resuscitation should be made. At delivery there are rare gasping, breathing movements. The pediatrician recommends that intubation be done. In this case, the individual with the clearest primary responsibility for this decision is the a: obstetrician b: pediatrician c: hospital risk manager d: mother e: hospital attorney 15 | P a g e6: Respect for patient wishes (autonomy) primarily requires that there be assessment of which of the following? a: Cost of the proposed treatment b: The legal risk to the physician and hospital c: Patient's ability to consider information d: Physician's concurrence with the patient's wishes e: Standards of care 7: A 62-year-old woman with newly diagnosed stage III ovarian cancer refuses chemotherapy. She wants to "go home to die." The next step in evaluating this patient is to a: determine insurance coverage for this action b: call the family for a conference c: accept the patient's wishes and discharge her from the hospital d: call the state medical licensing board and hospital attorney e: assess the patient's comprehension and look for evidence of impaired decision making 8: If a pregnant woman rejects medical recommendations, relying on care given in similar cases would be an example of a: principle-based ethics b: virtue-based ethics c: feminist ethics d: communication-based ethics e: case-based ethics 9: The concept of informed consent best relates to the principle of 16 | P a g ea: autonomy b: justice c: beneficence d: nonmaleficence 10: Paternalism violates the ethical principle of a: nonmaleficence b: beneficence c: standard of care d: justice e: autonomy 11: The person with primary responsibility to providing informed consent is a: the person or physician's staff assigned the task b: the patient c: the social worker assigned to the patient d: the hospital administrator e: the physician 12: In medical liability cases the complaint comes from the 17 | P a g ea: defendant b: judge c: jury d: attorney e: plaintiff 13: Most medical errors are associated with a: the use of care guidelines b: the use of medications c: the use of standards of care d: the use of hospital regulations e: the use of improper surgical technique ANS:[a,d,a,c,d,c,e,e,a,e,e,e,b] Chapter 4: Embryology and Anatomy 1: The genital system develops from the embryonic a: yolk sac b: endoderm 18 | P a g ec: mesoderm d: ectoderm e: cytotrophoblast 2: The urogenital ridges give rise to elements of the a: cardiovascular system b: reproductive system c: muscular system d: skeletal system e: gastrointestinal system 3: Congenital adrenal hyperplasia ultimately affects the development of the genitalia of female fetuses through the a: stimulation of cortisol production b: stimulation of cortisone production c: stimulation of androgen production d: inhibition of the SRY gene e: inhibition of the WNT4 gene 4: Primary oocytes first appear at what stage of development 19 | P a g ea: In the primordial follicles b: At puberty c: In the primary sex cords d: At birth e: In the embryonic yolk sac 5: Primordial germ cells can be identified during the third week of development in the a: vaginal plate b: urogenital sinus c: cortical cords d: gonadal ridge e: yolk sac 6: In the female, which of the following persists to form the major parts of the reproductive tract? a: Mesonephric (wolffian) ducts b: Prmary sex cords c: Paramesonephric (Mullerian) ducts d: Gubernaculum 7: Gartner cysts result from remnants of the a: 20 | P a g etunica albuginea b: primary sex cords c: Mullerian ducts d: mesonephric ducts 8: Transverse ultrasonography can begin to reliably distinguish between the two sexes at about how many weeks of gestation a: 15 weeks b: 5 weeks c: 10 weeks d: 20 weeks e: 25 weeks 9: Which of the following results in the absence of the uterus? a: Degeneration of the Mullerian ducts b: Degeneration of the mesonephric ducts c: Lack of fusion of the inferior parts of the paramesonephric ducts d: Failure of migration of the primordial germ cells 10: Which of the following results in the formation of a double uterus (uterus didelphys)? a: Lack of fusion of the inferior parts of the Mullerian ducts b: 21 | P a g eFailure of migration of the primordial germ cells c: Degeneration of the mesonephric ducts d: Degeneration of the Mullerian ducts 11: The labia minora develop from the a: urogenital folds b: labioscrotal swellings c: urogenital sinus d: genital tubercle 12: The labia majora develp from the a: labioscrotal swellings b: urogenital sinus c: genital tubercle d: urogenital folds 13: The clitoris develops from the a: urogenital folds b: genital tubercle c: labioscrotal swellings d: urogenital sinus 14: In the female, the embryologic homologue of the penis is the 22 | P a g ea: frenulum b: labia majora c: labia minora d: clitoris 15: The false pelvis and the true pelvis are separated by the a: linea terminalis b: acetabulum c: obturator membrane d: pelvic outlet e: sacrospinous ligament 16: The diagonal conjugate is defined as the distance a: between the true and false pelvis b: between the lower border of the pubis anteriorly and the lower sacrum at the level of the ischial spines c: between the upper border of the pubis anteriorly and the lower sacrum at the level of the ischial spines d: measured at the greatest width of the superior aperture e: between the ischial spines 17: Which of the following contains the uterine arteries and veins and the ureters? a: Infundibulopelvic ligament b: 23 | P a g eBroad ligament c: Uterosacral ligament d: Sacrospinal ligament e: Cardinal ligament 18: The ligament that provides primary support to the uterus is the a: uterosacral ligament b: infundibulopelvic ligament c: broad ligament d: sacrospinal ligament e: cardinal ligament 19: The epithelial lining of the fallopian tube is a: Columnar b: Transitional c: Simple squamous d: Stratified columnar e: Stratified squamous 20: The fallopian tubes enter into which part of the uterus a: Fundus b: Cornu c: 24 | P a g eSQ junction d: Lower uterine segment e: Mesosalpinx 21: The two main anatomic divisions of the uterus are the corpus and the a: uterotubal junction b: cornu c: fundus d: isthmus e: cervix ANS: [c,b,c,a,e,c,d,a,a,a,a,a,b,d,a,b,b,a,a,b,e] Chapter 5: Maternal–Fetal Physiology 1: Oxygen crosses the placenta by a: pinocytosis b: facilitated diffusion c: simple diffusion d: active transport e: phgocytosis 2: Glucose crosses the placenta by a: facilitated diffusion b: simple diffusion c: 25 | P a g eactive transport d: phagocytosis e: pinocytosis 3: Amino acids cross the placenta by a: facilitated diffusion b: active transport c: pinocyctosis d: simple diffusion e: phagocytosis 4: Pregnancy has what effect on gastric motility? a: Gastric motility typically remains the same b: The effect on gastric motility is unpredictable c: Gastric motility typically increases d: Gastric motility typically decreases 5: Pregnancy has what effect on gastric reflux? a: The effect on gastric reflux is unpredictable b: Gastric reflux is typically unaffected c: Gastric reflux typically decreases d: Gastric reflux typically increases 6: 26 | P a g e"Morning sickness" typically begins during which weeks of pregnancy? a: 1-3 weeks b: 16-22 weeks c: 10-12 weeks d: 14-18 weeks e: 4-8 weeks 7: Changes in gastrointestinal motility during pregnancy are related to increased levels of human chorionic gonadotropin c: estrogen d: oxytocin e: progesterone 8: Transit time in the stomach and small bowel increases by what percent in the second and third trimesters of pregnancy? a: 60%-70% b: 1%-15% c: 45%-60% d: 30%-45% 27 | P a g ee: 15%-30% 9: Epulis is a pregnancy-related vascular swelling of the pharynx c: nares d: gums e: epiglottis 10: Which of the following pulmonary measurements is decreased in pregnancy? a: Carbon dioxide pressure b: Tidal volume c: Oxygen pressure d: Oxygen requirement e: Residual volume 11: During pregnancy, total body oxygen consumption a: decreases by 50% from nonpregnant levels c: increases by 50% from nonpregnant levels d: decreases by 20% from nonpregnant levels e: increases by 70% from nonpregnant levels 12: 28 | P a g eBy term in a normal pregnancy, maternal blood volume a: increases by 15% b: increases by 50% c: decreases by 15% d: decreases by 35% e: increases by 35% 13: Iron supplementation in pregnancy is mainly used to maintain maternal hemoglobin concentration d: prevent iron deficiency in both the mother and the fetus e: prevent iron deficiency in the fetus 14: Which of the following measures of pulmonary function decreases in late pregnancy? a: Tidal volume b: Residual volume c: Respiratory rate d: Expiratory volume e: Inspiratory capacity 15: The increased nasal stuffiness and perception of increased nasal secretions during prenancy are associated with increased airway conductance d: decreased airway conductance e: mucosal hyperemia 16: Maternal arterial blood gas analysis during pregnancy would show 29 | P a g ea: mild metabolic acidosis b: mild respiratory alkalosis c: mild metabolic alkalosis d: mild respiratory acidosis e: moderate metabolic alkalosis 17: As compared with the nonpregnant state, the risk of thromboembolism during pregnancy a: is not effected by pregnancy d: is increased during pregnancy and decreased in the puerperium e: is decreased during pregnancy and increased in the puerperium 18: Displacement of the maternal heart during pregnancy is caused by a: constriction of the anteroposterior diameter of the thorax b: enlargement of the liver c: elevation of the diaphragm d: widening of the mediastinum e: increased lung volume 19: Which of the following best describes the change in position of the maternal heart during pregnancy? Displaced downward and to the left into a more vertical position e: Displaced further into the thoracic cavity 20: When do changes in maternal cardiac output begin during pregnancy? 30 | P a g ea: Early second trimester b: First trimester c: Late first trimester d: Third trimester e: Late second trimester 21: As compared with the nonpregnant state, the overall increase in maternal cardiac output during pregnancy is approximately 50%-60% e: 60%-80% 22: Which of the following factors contributes to the changed maternal cardiac output during pregnancy? a: Increased peripheral vascular resistance b: Decreased maternal heart rate c: Increased stroke volume d: Decreased stroke volume e: Increased venous return 23: During pregnancy, maternal ciculating blood volume increases about how much over nonpregnant levels? 5% e: 15% 24: When does the increase in circulating maternal blood volume reach its peak during pregnancy? 31 | P a g ea: 18 weeks b: 32 weeks c: 12 weeks d: 38 weeks e: 24 weeks 25: What percent of cardiac output does the uterus receive at term? a: 10% e: 50% 26: Occlusion of the vena cava by the gravid uterus results in shunting of venous return from the lower extremities primarily through the a: mesenteric circulation b: portal vein circulation c: paravertebral circulation d: ovarian circulation e: renal circulation ANS: [c,a,b,d,d,e,d,e,d,a,b,e,b,b,e,b,b,c,b,b,a,c,c,b,c,c] Chapter 6: Preconception and Antepartum Care A 22-year-old primigravida patient who is approximately 3 months' pregnant expresses concern that she has not felt the baby move yet. She should be informed that "quickening" generally occurs at how many weeks of gestation? a: 32 | P a g e12-14 b: 8-10 c: 22-24 d: 18-20 2: Congestion and a bluish color of the vagina in early pregnancy is called a: Stoppard sign b: Newman sign c: Hegar sign d: Chadwick sign 3: A softening of the cervix on physical examination in early pregnancy is referred to as a: Doderlein sign b: Hegar sign c: Naegele sign d: Chadwick sign 4: Fetal heart tones in a normal, viable pregnancy may routinely be heard by simple, nonelectrically amplified auscultation at or beyond how many weeks of gestational age? 33 | P a g ea: 12-14 b: 18-20 c: 21-23 d: 15-17 5: Commonly used electronic Doppler devices will usually detect fetal heart tones initially at approximately how many weeks of gestation? a: 12 b: 10 c: 8 d: 14 6: A 21-year-old patient whose last menstrual period started 3 weeks ago calls the doctor's office because she is concerned that she might be pregnant. She should be informed that home urine pregnancy tests typically become positive approximately how many weeks following the first day of the last normal menstrual period? a: 6 b: 2 c: 4 d: 34 | P a g e8 7: A 30-year-old patient with a history of ectopic pregnancy presents with 5 weeks of amenorrhea and a positive home pregnancy test. Intrauterine pregnancy is generally detectable by transvaginal ultrasonography when the beta- human chorionic gonadotropin concentration is greater than a: 5,000-6,000 mIU/mL b: 3,000-4,000 mIU/mL c: 1,000-2,000 mIU/mL d: 500-750 mIU/mL 8: "Normal" pregnancy lasts 40 weeks from the first day of the last menstrual period with a margin of error of how many weeks? a: 1 b: 4 c: 3 d: 2 9: A woman comes for her initial prenatal visit and wants to know her estimated date of delivery (EDD). Her last menstrual period began January 14. According to Naegele's rule, her EDD will be a: October 1 b: 35 | P a g eOctober 14 c: October 21 d: October 28 10: In normal singleton pregnancy, from 18 weeks of gestation until 36 weeks of gestation, the fundal height in centimeters is roughly equal to a: one-half the number of weeks of gestational age b: the number of weeks of gestational age minus 5 c: the number of weeks of gestational age d: twice the number of weeks of gestational age 11: In a woman with a BMI in the normal range, the generally prescribed recommendation for weight gain during pregnancy is a: 15-20 lb b: 25-35 lb c: 50-55 lb d: 40-45 lb 12: A 25-year-old primigravida patient at 24 weeks of gestation has gained 8 lb since her last prenatal visit a month ago. What is the most appropriate initial intervention? a: Insulin b: 36 | P a g eDietary counseling c: Hospitalization d: Metformin 13: A 25-year-old G2P1 patient at 20 weeks of gestation is concerned that her child will be breech like her first child was. She can be informed that cephalic presentation occurs in what percentage of deliveries? a: 15% b: 3.5% c: 95% d: 1% 14: At 36 weeks of gestation, examination in the office reveals that the fetus is in breech presentation. Breech presentation occurs in what percentage of deliveries? a: 3.5% b: 1% c: 95% d: 15% 15: An ultrasound performed at 30 weeks of gestation shows the fetus to be lying transverse. An explanation of the implications of this finding may include the reassurance that shoulder presentation occurs in what percentage of deliveries? 37 | P a g ea: 3.5% b: 95% c: 1% d: 15% 16: An abnormal contraction stress test includes which of the following fetal heart rate findings? a: Decreases in response to maternal respirations b: Increases in response to maternal position change c: Decreases in response to a uterine contraction d: Increases in response to fetal movement 17: A biophysical profile in which there is one or more episodes of fetal breathing in 30 minutes, three or more discrete movements in 30 minutes, opening/closing of the fetal hand, a nonreactive nonstress test, and no pockets of amniotic fluid greater than 1 cm would have a total score of a: 4 b: 8 c: 2 d: 6 18: Exclusive of the fetal heart rate reactivity, which of the following elements of the biophysical profile is generally 38 | P a g econsidered most important? a: Fetal breathing b: Qualitative amniotic fluid volume c: Fetal tone d: Gross body movement 19: Repetitive decelerations following each contraction when three contractions occur in a 10-minute window is generally an indication of a: fetal well-being b: nonreassuring fetal status c: increased placental blood flow d: reduced amniotic fluid 20: At how many weeks of gestational age does phospholipid production increase, resulting in a positive phosphatidylglycerol test? a: 33 b: 31 c: 35 d: 29 21: In counseling a patient about activities during the antepartum period, which of the following activities is generally 39 | P a g econtraindicated? a: Regular, non-weight-bearing activity on a three-times-per-week schedule b: Bathtub bathing c: Supine exercises d: Air travel after 28 weeks 22: A 20-year-old pregnant patient requests information about food cravings in pregnancy. She should be informed that pica is often associated with which of the following? a: Hyperthyroidism b: Anemia c: Substance abuse d: Diabetes 23: At the initial prenatal visit, a 30-year-old primigravida woman asks about traveling for business purposes. Which of the following recommendations is appropriate? a: Limit air travel to the first two trimesters b: Avoid travel of any kind after 36 weeks c: Avoid extended periods of inactivity d: Use seat belts up to 20 weeks of gestation 24: The FDA category PRF X carries what important clinical implication? a: Animal reproduction studies have demonstrated an adverse fetal effect and there are no controlled human studies b: 40 | P a g eControlled human studies demonstrate no evidence of risk in pregnancy in any trimester c: Adequate studies have demonstrated positive evidence of fetal risk d: Animal reproduction studies have not demonstrated fetal risk and there are no controlled human studies 25: A 24-year-old pregnant woman asks about the use of medications given prior to pregnancy by her other physicians. Which FDA pregnancy risk factor category is characterized by the presence of human studies in which there is no demonstrable fetal risk during pregnancy? a: D b: C c: B d: A 26: Which of the following effects to the fetus is associated with maternal ingestion of tetracyclines? a: Hemolytic anemia b: Irreversible arthropathies c: Discoloration of deciduous teeth d: Hyperbilirubinemia 27: Fetal abnormal facies, cleft lip or palate, and microcephaly are associated with maternal ingestion of which of the following drugs during pregnancy? a: Heparin b: 41 | P a g eThiazide diuretics c: Sulfonamides d: Phenytoin 28: A 23-year-old pregnant woman who complains of constipation should be informed that physiologic constipation in pregnancy is associated with a: increased bulk b: decreased water absorption c: decreased blood flow to the gut d: increased transit time 29: Due to the position of the fetus, round ligament pain is often more pronounced a: in the center b: on the right side c: on the left side d: in the fundus 30: For which of the following conditions should all pregnant women be tested? a: Tay-Sachs b: Sickle cell disease c: Tuberculosis d: 42 | P a g eHIV ANS:[d,d,b,b,a,c,c,d,c,c,b,b,c,a,c,c,d,b,b,c,c,b,c,c,d,c,d,d,b,d] Chapter 7: Genetics and Genetic Disorders in Obstetrics and Gynecology 1: A DNA replication error that results in one amino acid being substituted for another is termed a(n) a: Missense mutation b: Deletion mutation c: Nonsense mutation d: Insertion mutation 2: During which phase of meiosis is an error most likely? a: Anaphase I b: Meiosis II c: Metahase I d: Prophase I 3: Which of the following is an example of euploidy? a: 47, XXY b: 46, XX c: 45, X d: 69, XXX 4: 43 | P a g eTrisomy 21 is an example of which type of chromosomal anomaly? a: Ring chromosome b: Aneuploidy c: Euploidy d: Deletion mutation 5: A Robertsonian translocation in the mother increases the risks to her fetus of which of the following conditions? a: Spina bifida b: Anencephaly c: Fragile X syndrome d: Down syndrome 6: Which of the following conditions is inherited through autosomal dominant inheritance? a: Tay-Sachs disease b: Huntington disease c: Phenylketonuria d: Cystic fibrosis 7: The parents of a child found to have Marfan syndrome are planning to conceive in the future, and inquire about the inheritance pattern of this condition. They should be informed that the inheritance pattern is a: multifactorial b: 44 | P a g eautosomal dominant c: X-linked d: autosomal recessive 8: In autosomal dominant inheritance, the affected parent passes the disease to a: twice as many male offspring as females b: one-half of the offspring c: twice as many female offspring as males d: one-half of female offspring 9: First trimester screening tests are performed to determine the risk of what abnormality in addition to trisomy 13 and trisomy18? a: Hemophilia b: Klinefelter syndrome c: Turner syndrome d: Down syndrome 10: A woman who has previously had a child with a neural tube defect should take a daily prenatal vitamin in subsequent pregnancies that contains how much folic acid? a: 40 mg b: 0.04 mg c: 0.4 mg 45 | P a g ed: 4 mg 11: An ultrasound confirms a 7-week intrauterine gestation. If nuchal transparency measurement is to be used to aid in the detection of Down syndrome, the next ultrasound should be performed in how many weeks? a: 8 b: 2 c: 4 d: 12 12: Trisomy 16 is characterized by which of the following clinical scenarios? a: Rarely survives to 3 years of age b: Multisystem failure within a year of birth c: Cardiac arrest within 3 days of birth d: No live births 13: Which of the following is more common than trisomy 18 (Edwards syndrome)? a: Turner syndrome b: Trisomy 21 (Down syndrome) c: Trisomy 13 (Patau syndrome) d: Cridu chat syndrome 46 | P a g e14: Individuals with which of the following chromosomal abnormalities are most likely to live into adulthood? a: Trisomy 21 b: Trisomy 16 c: Trisomy 13 d: Trisomy 18 15: First trimester screening reveals that a woman is at increased risk for carrying a fetus with Down syndrome. She elects to undergo amniocentesis. This is typically performed between what weeks of gestation? a: 8 and 10 weeks b: 15 and 20 weeks c: 22 and 26 weeks d: 30 and 34 weeks 16: During her initial visit for this pregnancy, a couple inquires about the potential value of chorionic villus sampling. Which of the following conditions cannot be diagnosed by this technique? a: Down syndrome b: Trisomy 13 c: Trisomy 18 47 | P a g ed: Neural tube defects 17: A 33-year-old patient comes to you for her annual gynecologic exam. In the course of obtaining her history, she tells you that her aunt was diagnosed with breast cancer at age 49 and that her grandfather had lung cancer. She is not of Ashkenazi Jewish origin. You tell her that you recommend which of the following? a: HPNCC testing b: BRCA 1 and BRCA 2 testing c: Annual clinical breast exams and no further testing at this time d: BRCA 1 testing only 18: The level of alpha-fetoprotein in amniotic fluid is normal in which of the following conditions? a: Anencephaly b: Spina bifida c: Omphalocele d: Postmaturity 19: The increased availability of what test has resulted in a declining reliance on PUBS? a: FISH b: Early amniocentesis c: Fetoscopy d: CVS 20: 48 | P a g eWhich of the following is an accurate description of a germ cell? a: Two sets of chromosomes b: Gamete c: 2n d: Diploid 21: Which of the following karyotypes is an example of mosaicism? a: 46, XX/XY b: 47, XXY c: 47, XXX d: 45, X 22: In autosomal recessive disorders, which parent(s) is/are usually affected? a: Father always b: Both c: Mother usually d: Neither 49 | P a g e23: Color blindness has what kind of inheritance pattern? a: Autosomal dominant b: X-linked c: Multifactorial d: Autosomal recessive 24: In counseling a couple about the role of first trimester screening, the difference between the "triple screen" and the "quadruple screen" should be described as the addition of which marker? a: hCG b: Estriol c: MSAFP d: Inhibin A 25: In obtaining informed consent regarding chorionic villlus sampling (CVS), the provider should inform the patient that which of the following is the most common complication? a: Infection b: Bleeding c: Pregnancy loss d: 50 | P a g eLimb reduction ANS: [a,a,d,b,d,b,b,b,d,d,c,d,b,a,b,d,c,d,a,b,a,d,b,d,b] Chapter 8: Intrapartum Care A 22-year-old primigravid patient at 38 weeks gestation calls the office stating that she has had "bloody show." She should be informed that this is related to which of the following? a: Quickening b: Effacement of the cervix c: Braxton Hicks contractions d: Lightening 2: True labor is associated with contractions that the patient feels in what area? a: Low abdomen b: Bilateral round ligaments c: Low back d: Uterine fundus 3: A 23-year-old primigravid patient at 36 weeks of gestation asks under what circumstances she should call the office. Which of the following would warrant a phone call? a: Loss of the mucus plug b: Back pain c: Contractions every 10 minutes d: Decreased fetal movement 4: 51 | P a g eWhen is the optimal time for auscultation of fetal heart tones during labor? a: At the peak of a contraction b: Immediately following a contraction c: Halfway between contractions d: Immediately prior to a contraction 5: The portion of the fetus that is lowest in the birth canal is defined by what term? a: Lie b: Position c: Attitude d: Presentation 6: Which of the following accurately describes the uterine wall during a true contraction? a: Not easily indented b: Expuisitely tender to palpation c: Changes shape d: Indents by itself 7: In a vertex presentation, if the anterior fontanel is palpated on the maternal left and the posterior fontanel is felt on the maternal right, what is the position? 52 | P a g ea: ROT b: LOT c: OA d: OP 8: Fetal station is defined by the relationship of the presenting part and by which maternal anatomic landmark? a: Pubic symphysis b: Ischial spines c: Coccyx d: Sacral promontory 9: Engagement of the fetal head in labor can be misinterpreted under what circumstances? a: Maternal obesity b: Epidural anesthesia c: Molding d: Ruptured membranes 10: A 30-year-old multiparous patient at 37 weeks of gestation presents to the hospital completely dilated. Which of the following describes this stage of labor? a: 53 | P a g eFirst b: Third c: Second d: Fourth 11: The third stage of labor is marked by which of the following events? a: Delivery of placenta b: Removal of epidural catheter c: Repair of episiotomy d: Inspection for lacerations 12: Which of the cardinal movements of labor best reflects the adequacy of the bony pelvis? a: Flexion b: Expulsion c: Internal rotation d: Engagement 13: When does the greatest rate of descent occur? a: Latent phase of first stage of labor b: 54 | P a g eSecond stage of labor c: Prior to the onset of labor d: During extension of the fetal head 14: Oral intake in labor is restricted due to what concern? a: Diarrhea b: Reflux c: Decreased gastrointestinal peristalsis d: Nausea 15: A 25-year-old primigravid patient verbalizes a desire to avoid electronic fetal monitoring while in labor. She should be informed that intermittent auscultation of fetal heart tones is appropriate in which of the following clinical circumstances? a: Maternal temperature of 101 degrees F b: Third trimester bleeding c: Low-risk term pregnancy d: Intrauterine growth restriction 16: Pain during the first stage of labor is due to which of the following event? a: Maternal position b: Dilation of cervix c: Effacement of cervix d: Descent of fetal presenting part 55 | P a g e17: A 29-year-old primigravid patient at term presents complaining of labor contractions. She is found to be 4 cm dilated with reassuring fetal rate tracings. The most appropriate anesthetic technique to provide pain relief during labor and delivery for this patient is which of the following? a: Epidural b: Spinal c: Pudendal d: General 18: Maternal "pushing" efforts prior to the second stage of labor are associated with which of the following outcome? a: Abruptio placentae b: Swelling of the cervix c: Uterine prolapse d: Fetal compromise 19: What finding at the time of rupture of membranes is most likely to represent an emergent situation? a: Meconium staining of fluid b: Blood-tinged fluid c: Potential for infection d: Prolapsed umbilical cord 20: 56 | P a g eThe presence of molding and/or caput succedaneum prior to the second stage of labor is suggestive of which significant finding? a: Fetal anomaly b: Inadequate anesthesia c: Birth canal insufficient to allow passage of fetus d: Excessive uterine contractions 21: If an episiotomy is needed, when should it be performed? a: After the perineum is thinned b: Prior to the fetal head reaching the perineum c: Just after a contraction d: After a perineal laceration has started forming 22: Excessive traction to the neck during a vaginal delivery can be associated with injury to which of the following structure(s)? a: Strap muscles b: Trachea c: Thyroid gland d: Brachial plexus 23: 57 | P a g eUterine inversion is associated with what aspect of postpartum management? a: Inspection of the birth canal b: Exploration of the uterine cavity c: Traction on the umbilical cord d: Manual removal of placenta 24: What degree is an obstetric laceration that extends to the rectal sphincter but not the mucosa? a: Third b: First c: Fourth d: Second 25: Which technique of labor induction allows for the greatest variability in dosing? a: Amniotomy b: Membrane stripping c: Oxytocin d: Prostaglandins 26: A 36-year-old pregnant woman with a history of previous classical cesarean delivery requests a trial of labor after cesarean delivery. She should be informed of which of the following? 58 | P a g ea: TOLAC is available if the fetus is not breech b: TOLAC is contraindicated c: TOLAC is available if epidural anesthesia is not used d: TOLAC can be done if no oxytocin is used ANS:[b,d,d,b,d,a,a,b,c,c,a,d,b,c,c,b,b,a,b,d,c,a,d,c,a,c,b] Chapter 9: Abnormal Labor and Intrapartum Fetal Surveillance Which of the following is the best predictor of successful vaginal birth? a: Clinical pelvimetry b: Radiographic pelvimetry c: Descent of the presenting part during labor d: CT pelvimetry 2: A 30-year-old primigravid patient at term progresses from 4 cm dilation to 7 cm in 5 hours. How would this labor be described? a: A protraction disorder b: An arrest disorder c: A normal labor d: A prolonged latent phase