TEST BLUEPRINT

Obstetrics and Gynecology

Weights Recall Compreh Applic

ension ation
Content
/I.Obstetrics (70)
A. Describe the Maternal Adaptations to Pregnancy 4 2 2
B. Discuss the Antepartum Management of Normal Pregnancy 6 3 1 3
C. Normal Labor and Delivery
1. Discuss Mechanisms and conduct of Normal Labor and 7 6 1
Delivery
2. Describe Intrapartum Fetal Surveillance 5 2 1 1
3. Discuss the General Principles of Analgesia and Anesthesia
During Labor 1 1
4. Describe the Management of the Newborn 5 2 3
5. Discuss Labor Induction 2 2
D. Abnormal Labor (Dystocia)
1. Discuss Abnormalities of the Expulsive Forces 1 1
2. Describe Abnormal Presentation, Position, and
Development of 3 2 1
The Fetus
3. Discuss Dystocia due to Pelvic Contraction 3 2 1
E. Operative Obstetrics
1. Classify Operative Vaginal Delivery 1 1
2. Discuss the Technique for Breech Delivery 1 1
3. Discuss the Indications and Techniques for Cesarian 2 2
Delivery
F. Abnormalities of the Puerperium
1. Discuss the Changes and Disorders of the Puerperium 3 3
G. Reproductive Success and Failure
1. Discuss the different types of Abortion 2 1 1
2. Describe the etiology, signs and symptoms, and
management of 1 1
Ectopic Pregnancy
3. Describe the Incompetent Cervix 1 1
H. Placental Disorders 1 1
I. Common Complications of Pregnancy
1. Discuss Hypertensive Disorders of Pregnancy 4 3 1
2. Discuss the Different causes of Obstetrical Hemorrhage 5 2 3
3. Discuss Postterm Pregnancy 3 1 2
4. Discuss Multifetal Pregnancy 4 1 3
J. Medical and Surgical Complications of Pregnancy 5 3 2

II. Gynecology (30)

A. Discuss the Benign Diseases of the Female Reproductive Tract 8 6 2
B. Discuss the Different Genitourinary tract Infection and Sexually
Transmitted Diseases 5 2 3
C. Discuss Benign Breast Diseases 2 2
D. Gynecologic Oncology
1. Discuss Endometrial Cancer 5 2 3
2. Describe and Treat Intraepithelial Disease and Cancer of the
Cervix, Vagina, and Vulva 2 1 1
3. Discuss the different types of Ovarian Cancer 7 4 2 1
4. Describe Fallopian Tube Cancer 1 1

Total: 100 57 36 7
 CEBU INSTITUTE OF MEDICINE
OBSTETRICS AND GYNECOLOGY

NAME ___________________________________________ GROUP NO. _____ I.D. NO. _______

DIRECTION: Each question below is followed by four possible answers. Select the one best
response and mark the appropriate spaces on the answer sheet provided for.

1. A 21 y.o. primigravida 36 weeks gestation was seen at the ER for epigastric pain and vomiting.
Prenatal course was unremarkable. PE: BP: 170/110. Abdomen: FHT: 140/min. Uterine contractions
mild, every 5 mins, 30 seconds duration. Pelvic exam: 3 cm dilated, 80% effaced station -3, intact
membranes, vertex. All laboratory tests normal except for ++ proteins in the urinalysis. The most
likely diagnosis is:
A. Mild Preeclampsia
B. Severe Preeclampsia
C. Superimposed Preeclampsia on Chronic Hypertension
D. Gestational Hypertension
2. Epigastric pain is most likely a result of:
A. hyperemesis gravidarum
B. gastritis
C. labor pains
D. stretching of the Glisson’s capsule

3. A severely preeclamptic woman suddenly develops respiratory depression after the

administration of hydralazine and magnesium sulfate. Respiratory depression is due to:
A. impending eclampsia
B. hydralazine toxicity
C. Magnesium sulfate toxicity
D. Pulmonary embolism

4. Which of the following agents should be administered?

A. a rescue dose of Magnesium sulfate
B. Heparin
C. Narcan
D. Calcium Gluconate

5. Acardiac twin is hypothesized to result from:

A. Ischemic necrosis from vascular thrombosis
B. Suboptimal placental implantation site of affected twin
C. Artery to artery placental shunt
D. Splitting late in gestation after embryonic disc has formed

6. In which of the following twin presentation combinations is interlocking likely to occur?

A. cephalic-cephalic
B. cephalic-breech
C. cephalic-transverse
D. breech-cephalic
7. A procedure which involves turning the fetus in order to effect delivery by breech extraction is:
A. External cephalic version
B. Internal cephalic version
C. Partial breech extraction
D. Internal podalic version
8. Indication/s for a cesarean delivery in multifetal pregnancy is:
A. first twin larger than second twin
B. term twin fetuses in cephalic presentation
C. triplets
D. All of the above

9. The type of twinning which places the woman at highest risk for perinatal and pregnancy
complications is:
A. Dizygotic, dichorial
 B. Monochorionic, monoamnionic
C. Monochorionic, diamnionic
D. Dichorionic, diamnionic

10. For external version to be performed, for it to be successful, which of the following should
be given?
A. IVF C. antacids
B. Tocolytic agent D. Xylocaine

11. Mrs. R.B., G3P2, is in active labor. AOG 39 weeks. Had prior CS for fetal distress. Uterine
contractions 60-90 sec, 2-3 min intervals. IE: 8 cm, cephalic, intact membranes, station +2. FHT:
RLQ, 150/min. The thing to do is:
A. VBAC C. Low forceps delivery
B. C.S. D. Mid forceps extraction

12. To help in the delivery of the aftercoming head for a successful partial breech extraction, what
particular maneuver should be performed?
A. forward roll C. abdominal rescue
B. Bracht’s maneuver D. Pinard’s maneuver

13. Mrs. B.R. is for her regular prenatal check-up. She is 25 weeks gestation. On abdominal
palpation, her fetus is found to be in breech presentation. The thing to do is:
A. do an external cephalic version
B. get an UTZ
C. allay the mother’s fear that such finding is expected at that time
D. tell her she will have a C.S. at term

14. Which of the following is a possible sign of pelvic inlet contraction?

A. premature rupture of membranes
B. Arrest of station +2
C. Bishop score of 9
D. Transverse Diameter of 12.0 cm.

15. At what plane of the pelvis do you find the narrowest pelvic diameter?
A. pelvic inlet C. midpelvis
B. pelvic outlet D. plane of the greatest pelvic dimensions

16. What effect does epidural anesthesia have on the progress of labor?
A. lengthening of both 1st & 2nd stage of labor
B. slowing fetal heart rate
C. hastens both the 1st & 2nd stage of labor
D. increased fetal heart rate variability

17. What do H. Mole and multifetal pregnancy have in common?

A. uterine compatible to missed period
B. uterine size in smaller re; missed period
C. in 50% of cases, uterine size is larger re: missed period
D. no change in uterine size

18. Bilateral large lutein cysts are usually observed in large H. Moles. The thing to do is:
A. Do a bilateral salpingo-oophorectomy
B. Do a bilateral oophorectomy
C. Do a TAHBSO
D. Just leave it after evacuation of H. Mole

19. Mrs. E.M., 32 y.o. multipara, came in for sudden onset of profuse painless vaginal bleeding. She
is 30 weeks AOG. On admission, bleeding has stopped. No uterine contractions. The thing to do is:
A. do an internal exam C. do an abdominal UTZ
B. do a TVS D. do a C.S.

20. A 27 y.o. multipara came to the prenatal office with a recent UTZ result of placenta occupying
the entire internal os. She is 38 weeks AOG. Patient is not in labor. The thing to do is:
 A. do a pelvic evaluation C. Wait for spontaneous labor to set in
B. do a C.S. D. Repeat UTZ

21. A primigravida came in with severe on and off hypogastric pain accompanied by moderate
vaginal bleeding. She is 12 weeks gestation. IE: 3 cm dilated cervix, intact membranes. The thing to
do is:
A. give a tocolytic agent C. careful, watchful waiting
B. give oxytocic D. do Dilatation & Curettage

22. Which of the following surgical procedures is a conservative management of tubal pregnancy?
A. Salpingostomy C. Salpingooophorectomy
B. Salpingiectomy D. Hysterectomy

23. Presence of Arias-Stella phenomenon in endometrial scrapings is a pathognomonic finding of:

A. Abortion C. Pregnancy
B. Ectopic pregnancy D. H. Mole

24. A primigravida came in hypovolemic shock with a pregnancy at 35 weeks AOG. Uterus
hypertonic, dilated cervix at 8 cm. The thing to do is:
A. Vaginal delivery C. Forceps Extraction
B. Cesarean section D. Oxytocin administration

25. What do abruption placenta and missed abortion have in common?

A. risk of future infertility
B. higher incidence of OB complications in future pregnancies
C. risk of development of DIC
D. Hypertonic Uterine Contractions

26. Which of the following is a procedure for the management of incompetent cervix?
A. Hungtinton’s C. Mc Donald’s
B. Hauttain’s D. Porro’s

27. Which of the following is used to ripen the cervix before labor induction?
A. Syntocinon C. Methylergonovine
B. Ergonovine D. Misoprostol

28. Which of the following is a surgical induction method used to augment labor?
A. Oxytocin infusion C. Stripping of the membranes
B. Amniotomy D. Misoprostol administered vaginally

29. Which of the following is a criterion for outlet forceps extraction?

A. Fetal skull has reached the pelvic floor
B. Rotation is greater than 45 degrees
C. Leading point of fetal skull is station +1
D. Fetal skull has not reached the pelvic floor

30. Gridiron feel of the ribs signifies that the presentation is:
A. face C. shoulder
B. breech D. vertex

31. In what instances is a classical cesarean section performed?

A. posteriorly located placenta previa
B. ill formed lower uterine segment, shoulder presentation
C. breech presentation
D. Repeat cesarean section

32 In what type of cesarean section are post-operative adhesions usually encountered?

A. LTCS C. Kronig’s incision
B. Classical C.S. D. T-incision

33. An abnormal condition which develops with the extreme thinning of the lower uterine segment in
obstructed labor:
 A. Bandl ring C. Contraction ring
B. Physiologic retraction ring D. Cervical effacement

34. This phase of the active phase of labor is reflective of the fetopelvic relations:
A. Latent phase C. Deceleration phase
B. Acceleration phase D. Phase of maximum slope

35. What mechanism of placental extrusion starts at the periphery and the maternal surface is the
first to appear at the vulva:
A. Ritgen mechanism C. Schultze mechanism
B. Duncan mechanism D. Sheep mechanism

36. The relationship of the long axis of the fetus to that of the mother, either longitudinal or
transverse is called:
A. Fetal presentation C. Fetal Position
B. Fetal lie D. Fetal attitude

37. The lateral deflection of the fetal to a more anterior or posterior position in the pelvis is called:
A. Rotation C. Engagement
B. Extension D. Asynclitism

38. The edematous swelling of a portion of the fetal scalp over the cervical os before complete
cervical dilatation following prolonged labor is:
A. Caput Succedaneum C. Cephalhematoma
B. Molding D. Crowning

39. This maneuver allows control of the delivery of the head by exerting forward pressure on the
chin while exerting pressure superiorly against the occiput:
A. Mauriceau maneuver C. Ritgen maneuver
B. Pinard maneuver D. Zavanelli maneuver

40. Which of the following is not a presumed benefit of amniotomy during labor?
A. More rapid progress of labor
B. Prevents prolapse of the umbilical cord
C. Opportunity to apply electrode for fetal monitoring
D. Early detection of amniotic fluid staining.

41. During the "Fourth Stage" of labor, the patient should be closely monitored for postpartum
hemorrhage most likely due to :
A. Vulvar hematoma C. Uterine atony
B. Perineal bleeding D. Uterine inversion

42. An episiotomy is performed when the head is visible during a contraction to a diameter of:
A. 3-4 cm. C. 7-8 cm.
B. 5-6 cm D. 9-10 cm.

43. In external electronic fetal monitoring, the characteristic of baseline fetal heart activity that
serves as an important index of cardiovascular function is:
A. rate C. fetal arrhythmia
B. accelerations D. beat to beat variability

44. The most common deceleration patterns encountered during labor attributed to umbilical cord
occlusion would be:
A. early deceleration C. prolonged deceleration
B. late deceleration D. variable deceleration

45. All of the following are clinical areas for the use of amnioinfusion EXCEPT:
A. in an attempt to dilute of wash out thick meconium
B. to avoid cord prolapse in PROM
C. treatment of variable or prolonged decelerations
D. prophylactically in cases of known oligohydramnios
46. A normal response to vibroacoustic stimulation in assessing fetal well-being would be:
A. fetal movement of at least 2 kicks in 15 seconds
B. deceleration momentarily of fetal heart rate with a fetal movement
C. acceleration of at least 15 bpm for at least 15 sec.
D. increased beat to beat variability 10-30

47. Vaginal discharges in the puerperium described as white to yellowish-white in color after about
the 10th day from delivery:
A. lochia rubra C. lochia alba
B. lochia serosa D. show

48. Mastitis during lactation and the puerperium is most commonly caused by this organism:
A. Streptococcus C. Clostridium
B. Staphylococcus D. Bacteroides

49. The following are the most common pathogens causing puerperal pelvic infections EXCEPT
A. Streptococci C. Enterococcus
B. Peptococcus D. Candida

50. What is the most common organism, particularly in parenteral drug abusers, with acute
endocarditis?
A. Staphylococcus aureus, coagulase positive
B. Streptococcus pneumoniae
C. Neisseria gonorrheae
D. Group B Streptococcus

51. How should non-pregnant patients under the age of 35 who are tuberculin-positive but x-ray
negative be treated?
A. Rifampicin 10 mg/kg daily for 12 months
B. Streptomycin for 12 months
C. Isoniazid 300 mg daily for 12 months
D. Pyridoxine for 12 months

52. What is the most common presenting symptom of renal stones in pregnant women?
A. flank pain C. hematuria
B. abdominal discomfort D. infection

53. What is the caloric requirement per ideal body weight of a woman with gestational diabetes?
A. 20-25 kcal/kg C. 40-45 kcal/kg
B. 30-35 kcal/kg D. 50-55 kcal/kg

54. Which of the following is relatively contraindicated in pregnancy for the management of
gallstones?
A. Laparoscopic cholecystectomy
B. Endoscopic retrograde cholangiopancreatography
C. Laparotomy at 12 weeks’ gestation
D. Intraoperative Cholangiography

55. Outcomes of postterm pregnancies include the following, EXCEPT:

A. Meconium aspiration C. Polyhydramnios
B. Fetal macrosomia D. Shoulder dystocia

56. Postterm infants may present with:

A. unusual alertness C. long nails
B. increased subcutaneous fat D. Shiny skin

57. A 40 year old G1P0, married for 10 years, came in for decreased fetal movement. Menses
claimed to be regular, computed AOG is 41 weeks, a known diabetic. Pertinent P.E.: FH 40 cm, FHT
150/min, cephalic, cervix closed, CTG revealed poor beat-to-beat variability. The best thing to do is:
A. induce labor C. do C-section
B. do BPS D. do NST
58. Neonatal death occurs in growth restricted neonates in:
A. 10% C. 3%
B. 5% D. 1%

59. The following perinatal morbidity/mortality are associated with fetal growth restriction, EXCEPT:
A. Meconium Aspiration Syndrome C. Birth asphyxia
B. Fetal demise D. Neonatal hypoglycemia

60. A 45 year old G11P10 chronic smoker, came in for labor pains. Admitting diagnosis: PUFT,
Chronic HPN with Superimposed Severe Preeclampsia. She delivered few minutes after admission.
We would be expecting a neonate who is:
A. Symmetrically growth restricted C. Plethoric
B. Asphyxiated D. Asymmetrically growth restricted

61. The following are screening methods to identify growth restriction, except:
A. serial fundic height measurement C. Doppler velocimetry
B. serial sonography D. Amniocentesis

62. The following are causes of growth restriction, EXCEPT:

A. smoking C. substance abuse
B. congenital anomalies D. living in low altitude places

63. Maternal blood volume during pregnancy:

A. is increased as a result of an increase in plasma
B. is increased as a result of an increase in erythrocytes
C. is increased as a result of both increase in plasma & erythrocytes
D. remains the same as that in non-pregnant state

64. Hydronephrosis and/or hydroureter in pregnancy is:

A. more common on the right side
B. more common on the left side
C. expected to develop bilaterally
D. is always pathologic

65. Maternal plasma levels of androstenedione and testosterone are increased during pregnancy.
However, little or no testosterone enters the fetal circulation because of:
A. rapid excretion of these hormones in the kidneys
B. rapid conjugation of these hormones in the maternal liver
C. the near complete conversion of the hormones to 17B-estradiol by the trophoblast
D. total peripheral conversion of the hormones to estrone

66. As a consequence of the elevation of the diaphragm during pregnancy, the following pulmonary
functions are decreased:
A. tidal volume and minute ventilatory volume
B. functional residual capacity and residual volume
C. minute oxygen uptake
D. lung compliance

67. A young woman missed her period and had a pregnancy test. Her last menstrual period started
on 29 December 2003 and ended on 2 January 2004. Her PMP was from 1-5 December 2003. Her
expected date of delivery is on:
A. 9 October 2004 C. 29 September 2004
B. 5 October 2004 D. 8 September 2004

68. The above patient consulted you on 18 February 2004. At this time, the calculated age of
gestation is:
A. 11 weeks 2 days C. 7 weeks 2 days
B. 10 weeks 5 days D. 6 weeks 5 days

69. Using a DeLee fetal stethoscope, the fetal heart tones can be heard:
A. between 6-7 weeks age of gestation (AOG)
B. between 8-11 weeks AOG
 C. between 12-15 weeks AOG
D. between 16-19 weeks AOG

70. A woman who claims to be 5 months pregnant comes to you for prenatal check-up. Based on
her declared LMP, the calculated AOG is 22 weeks. ON PE, the fundal height of this woman should
be around:
A. 18 cm C. 26 cm
B. 22 cm D. 30 cm

71. Self breast examination is best done (on) ________ of the menstrual cycle.
A. anytime D. days 14-21
B. days 3-5 E. days 24-28
C. days 8-10

72. The most reliable mammographic finding suggestive of breast cancer is:
A. clusters of microcalcification C. solid tumor
B. isolated calcifications D. fatty necrosis

73. Using the Bethesda system for reporting a Pap smear result, a patient with a smear consistent
with HPV infection would be classified as:
A. HGSIl C. ASCUS
B. reactive atypia D. LGSIL

74. The proper approach to unsatisfactory colposcopy in a patient with persistent LGSIL is
A. Conization C. LEEP
B. Laser ablation D. Cryotherapy

75. The most important diagnostic tool/s for the early diagnosis and management of ectopic
pregnancy is/are:
A. Laparoscopy C. Transvaginal sonogram
B. Serum B-HCG D. Culdocentesis

76. Endometriosis is most commonly seen in this age group:

A. Prepubertal C. Reproductive
B. Adolescent D. Menopausal

77. The most common adnexal mass in the adolescent age group is:
A. mature cystic teratoma C. functional cyst
B. Myoma uteri D. uterovaginal anomaly

78. Ovarian tumors in the reproductive age group:

A. are most likely malignant C. are mostly epithelial tumors
B. comprise 2/3 of all ovarian tumors D. are usually incidental findings

79. A pelvic finding that suggests the possibility of ovarian malignancy

A. poor blood flow C. ascitis
B. cystic mass D. smooth contour

80. A solid germ cell tumor in the adolescent age group is best managed with
A. excision of tumor only C. oophorectomy only if the other ovary is normal
B. oophorectomy D. oophorectomy, hysterectomy & adjuvant chemotherapy

81. Most germ cell tumors are unilateral, EXCEPT

A. endodermal sinus tumor C. Dysgerminoma
B. immature teratoma D. Embryonal carcinoma

82. Endometrial hyperplasia and carcinoma are most likely associated with this type of ovarian
tumor
A. Sertoli Leydig tumor C. serous tumors
B mucinous tumors E. Embryonal carcinoma
C. granulosa cell
83. The most common and earliest mode of spread in ovarian cancer is
A. retroperitoneal lymphatic channels C. transcoelomic
B. pelvic and para-aortic lymph nodes D. Hematogenous

84. A 55 y.o. female, 4 years menopause, presents with 5 cm cystic-solid mass. You will
A. observe for 3-6 months C. suppress with oral contraceptives
B. remove mass surgically D. radical surgery

85. The standard primary therapy for Sex Cord-Stromal tumors is/are
A. surgery alone C. surgery, radiotherapy
B. surgery, chemotherapy D. surgery. Chemotherapy, radiotherapy

86. A 55 y.o. post-menopausal woman presents with pelvic discomfort, irregular vaginal bleeding
and breast tenderness. She is not on any medications. On pelvic exam, her vagina is moist, the
uterus is slightly enlarged, and a 7 cm mobile mass was palpated at the right adnexa. Your most
likely diagnosis is:
A. Mature cystic teratoma C. Endometrial cancer
B. Granulosa cell tumor D. Dysgerminoma

87. Associated histologic feature or tumor marker with serous ovarian tumors
A. Psammoma body C. Call-Exner body
B. CA 125 D. alpha-feto protein

88. The most common presentation of ovarian cancer is

A. pelvic mass C. abdominal pain
B. pressure symptom D. no symptoms

89. An important pre-operative procedure for all ovarian carcinoma is

A. Barium enema C. bowel cleansing
B. Intravenous pyelography D. renal function studies

90. The most common physical finding in early tubal carcinoma is

A. hydrops tubae profluens C. pelvic mass
B. pelvic pain D. abnormal bleeding

91. Patients with atypical hyperplasia will subsequently develop invasive cancer in ____% of
patients:
A. 1 C. 8
B. 4 D. 29

92. The advantage of myomectomy over hysterectomy is:

A. decreased post-operative infection rate
B. low risk recurrence
C. preservation of hormonal function
D. preservation of reproductive function

93. In endometrial hyperplasia, the most important determinant of malignant potential is

A. mitotic rate C. Obesity
B. grading D. Cellular atypia

94. Therapeutic amenorrhea for the treatment of endometrial hyperplasia without atypia may be
achieved with
A. Cyclic OCPs C. NSAIDS
B. Continuous progestins D. Clomiphene Citrate

95. The most common tumor of the uterus is:

A. leiomyoma C. Endometrial Polyp
B. adenomyosis D. teratoma

96. The most common type of myoma degeneration in pregnancy is:

A. cystic C. carneous
B. hyaline D. fatty
97. Postmenopausal women with abnormal uterine bleeding should have a:
A. total hysterectomy C. pregnancy test
B endometrial biopsy D. thyroid panel

98.. Diagnostic criteria for bacterial vaginosis include all of the following EXCEPT
A. green, foamy vaginal discharge
B. clue cells on microscopic examination of vaginal discharge
C. pH of vaginal fluid > 4.5
D. (+) Whiff test

99. A 7 y.o. girl was brought to you due to bloody, foul-smelling vaginal discharge resistant to
antibiotic treatment. The most likely diagnosis/pathogen is
A. foreign body C. Trichomoniasis
B. Gonorrhea (PPNG) D. pinworm infection

100. A 29 y.o. secretary consults you for copious frothy greenish vaginal discharge associated with
fishy odor. Speculum exam confirmed her complaints, plus a strawberry like cervix. This is
pathognomonic of
A. Vaginal candidiasis C. Trichomoniasis
B. Bacterial vaginosis D. Chronic Cervicitis

END OF EXAMINATION.