1. MERCADO, EUNICE F. Which of the following phrases best describes Reproductive Health?

a. absence of diseaseb. complete state of well-beingc. adequate coverage of contraceptiond. prevention of maternal death and sexually transmitted infections

Answer: BRationale: Within the framework of WHO's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health addresses the reproductive processes, functions and system at all stages of life.

Reference: World Health Organization 2012 (http://www.who.int/topics/reproductive_health/en/)

2. Mendoza, Rigel Faye R.Which of the following statements is/are component of Reproductive Health:

a. safe motherhoodb. management of abortion complicationsc. information and services on Family Planningd. prevention and management of sexual violencee. all of the above

Answer: E All of the aboveRationale: Reproductive Health includes: 1. Counseling, information, education, communication and clinical services in family planning;2. Safe motherhood, including antenatal care, safe delivery care and postnatal care, breastfeeding and infant and women’s health care;3. Gynecologic care, including prevention of abortion, treatment of complications of abortion and safe termination of pregnancy as allowed by law;4. Prevention and treatment of sexually transmitted diseases ( including HIV/AIDS), including condom distribution and universal precautions against transmission of blood-borne infections, voluntary testing and counseling 5. Prevention and management of sexual violence;6. Active discouragement of harmful traditional practices such as female genital mutilation;7, Reproductive health programs for specific groups such as adolescents, including information, education, communication and services.

Reference: Textbook of Obstetrics 3rd edition, Sumpaico, Andres, Capito, Carnero, Diamante, Gamilla, Page 2, Chapter 1.

3. MASTRILI, JESSICA MARIE T.Due to limited resources, which Reproductive Health program/s in the Western Pacific region will be prioritized according to WHO?

a. safe motherhood c. improve child mortalityb. family planning d. A and B are correct

ANSWER: BRATIONALE: “Reproductive health now includes, among others, family planning, safe motherhood, women’s healthcare …. However, due to limited resources and capacity, it is important to prioritize issues to address reproductive health…. Making pregnancy safer and family planning are the priority issues that need to be addressed.” (WHO Western Pacific Region, 2012)

Reference: WHO website, The scope of reproductive health work in the WHO Western Pacific Region (http://www.wpro.who.int/sites/rph/)

4. Tanhui, KristelFor the Millenium Development Goal, Maternal Mortality by year 2015 should be decreased by how many percent? a. 25 b. 50 c. 75 d. 85Answer: c. 75

Rationale: The fifth millennium development goal is to improve maternal health, reducing the maternal mortality ratio by 3 quarters.

Source: http://www.un.org/millenniumgoals/maternal.shtml (none available in williams)

5. Reyes, Katrina May T.Which branch of medicine is concerned with pregnancy, labor and puerperium and aims to promote health and well-being?

a) Obstetricsb) Reproductive Healthc) Perinatologyd) Midwifery

Answer: A. ObstetricsRationale: According to the Oxford English Dictionary, the word obstetrics is defined as "that branch of medicine that deals with childbirth and the care and treatment of the mother before and after birth."

In the contemporaneous sense, obstetrics is concerned with reproduction of humans. The specialty promotes health and well-being of the pregnant woman and her fetus through quality prenatal care. Such care entails appropriate recognition and treatment of complications, supervision of their labor and delivery, ensuring care of the newborn, and management of the puerperium to include follow-up care that promotes health and provides family planning options.

Reference: Cunningham, F. et al, Williams Obstetrics, 23rd edition, McGraw-Hills Company, Inc, 2010, Chapter 1. Overview of Obstetrics

6. REYES, RACHEL ANN Q.Which of the following is the best index of the quality of life and health in a society?

a) population density b) fertility rate c) maternal outcomed) life expectancy

Answer: CRationale: it is written in the book Chapter 1 Broad Perspective of the Overview Section that, “the importance of obstetrics is attested to by the observation that maternal and neonatal outcomes are universally used as an index of the quality of health and life in human society.”

Reference: Cunningham, Gary F., et al. Williams Obstetrics 22nd Edition Ebook, 2005. Page 7

7. RADIN, C PHILIP TEOMAR, II, A.Which of the following is NOT a prerequisite to livebirth?

a) AOG more than 20 weeks AOGb) Placenta deliveredc) Pulsation of the umbilical cord d) Breathing movement

Answer: B Rationale: Because according to Sumpaico’s Textbook of Obstetrics, live birth is the complete expulsion or extraction from the mother of a product of human conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction, breathes or shows any evidence of life, such as beating of the heart, pulsation of umbilical cord, or definite movement of voluntary muscles whether or not the umbilical cord has been cut or the placenta is attached. Heart beats are to be distinguished from transient cardiac contraction; respirations are to be distinguished from fleeting respiratory efforts of gasps. Delivering of the placenta is not a prerequisite to live birth.

Reference: Sumpaico W., et. al., Textbook of Obstetrics (Physiologic and Pathologic Obstetrics) 3rd edition, 2008. Page 7

08. ALPHA RANA M. HAYES (evals 1)Which of the following is/are true regarding effect/s of severe undernutrition during pregnancy of the fetus

a. starvation during later pregnancy can cause the baby to be lighter, shorter, and thinner at birth

b. early exposure to severe starvation is associated with increased CNS anomalies and schizophrenia-spectrum personality disorderc. severe dietary deprivation cause subsequent decrease mental performanced. all of the abovee. A&B

Answer: DRationale: If a pregnant woman is malnourished, it is understandable that the baby in the mother's womb is not receiving enough nutrients. In other words, the nutrients and trace minerals essential for developing a whole life are not provided in sufficient amounts. As a consequence, the baby will exhibit poor growth rate and low weight. Low-birth-weight is a significant contributor to infant mortality. Moreover, low birth-weight babies who survive are likely to suffer growth retardation with decrease mental performance throughout their childhood, adolescence and into adulthood.

Children born to starving mothers are more likely to develop schizophrenia, according to a new study of people conceived during the Chinese Famine of 1959 to 1961. The results support the idea that prenatal nutritional deficiency raises the risk of schizophrenia and provides hope that schizophrenia risk can be lowered by making sure pregnant women receive proper nutrition.

References: Sumpaico, Walfrido et. al (2008) Textbook of Obstetrics: Physiologic and Pathologic Obstetrics. 3rd Edition. Chapter 43. Quezon City: Association of Writers of the Philippine Textbooks of Obstetrics and Gynecology, Inc. Website: http://news.sciencemag.org/sciencenow/2005/08/02-03.html

9. NALDO, JACOB TIMOTHY C.Total births include livebirths:

a. 20 weeks AOG and above b. Fetal deaths 20 weeks AOG and above c. 20 weeks AOG and above and fetal deaths 24 AOG and above d. Fetal deaths 24 weeks AOG and above

Answer: ARationale: A Birth is defined as the complete expulsion or extraction form the mother of a fetus after 20 weeks AOG. A fetus or embryo removed or expelled from the uterus during the first half of gestation- 20 weeks or less or in the absence of accurate dating criteria and fetuses weighing <500 g are usually not considered as births, but rather termed as abortuses for purpose of vital statistics. A life birth is used to record a birth whenever the newborn at or sometime after birth breathes spontaneously or shows any other signs of life such as a heartbeat or definite spontaneous movement of voluntary muscles. Heartbeats are distinguished from transient cardiac contractions, and respirations are differentiated from fleeting respiratory efforts or gasps. Fetal death is defined as the absence of signs of life at or after birth.

Reference: Williams EDITION 23, PAGE # 3

10. SAMPELO, MA. CARMELA A.Birth rate is defined as number of:

a) Total births per 1000 populationb) Total births per 1000 pregnanciesc) Live births per 1000 populationd) Live births per 1000 total pregnancies

Answer: A. Total births per 1000 populationRationale: Just because birth rate is defined as Total births per 1000 population. Letter b is incorrect because of the statement “per 1000 pregnancies” which does not refer to rate of population change. Letter c and letter d are both incorrect because of the word “live births” not including the number of deaths per 1000 population. Reference: Williams 23rd edition, page 3

11. Ridao, Hanna Clare P.Perinatal period is defined as the period from 20 weeks AOG to:

a. deliveryb. 7 days of life

c. 28 days of lifed. 42 days of life

Answer: C. 28 days of lifeRationale: Perinatal period. The period after birth of an infant born after 20 weeks and ending at 28 completed days after birth. When perinatal rates are based on birthweight, rather than gestational age, it is recommended that the perinatal period be defined as commencing at 500 g.

Reference: Textbook of Obstetrics 3rd edition by Sumpaico, Andres, Capito, Carnero, Diamante and Gamilla page 7, Chapter 1,

12. VILLARUEL, ANDREA R.A woman delivered prematurely in a remote area with no health facility. What is your best evidence that the newborn is not an abortus?

a. Computed AOG based on the LMPb. Time when quickening was feltc. Crown to rump length of the newborn is 28cmd. Fundic height prior to delivery is above the umbilicus

Answer: CRationale: It was defined in Williams Obstetrics that an abortus is an embryo or fetus that is expelled or removed from the uterus, less than 20 weeks age of gestation and less than 500g in weight. To determine if it is an abortus or not, given the circumstances presented above, it is clear that at least the AOG will have to be discerned. AOG is generally obtained from the knowledge of the LMP because women usually know their last period. However, if the BEST evidence for AOG is desired, then it should be based on the crown to rump length of the newborn. This is the most accurate determinant because sometimes the AOG based on the LMP can be unreliable when on the other hand, the crown to rump length signifies fetal development and is something that can be directly measured, so therefore, gives little room for error.In the item above, it is noted that the newborn has a crown to rump length of 28 cm, which is usually a characteristic

of a fetus in its 32nd week of gestation. In this case, the mother did not deliver an abortus but instead, a fetus.

Reference: Williams Obstetrics, 23rd edition, Chapter 1 page 22, Chapter 4 page 78-80

13. MENDOZA, CHRISTIAN JULIUS P.

A premature infant was born at 27 to 28 weeks. The baby died on the 60th hour of life. This is considered:a) Fresh stillbirthb) Macerated stillbirthc) Early neonatal deathd) Late neonatal death

Answer: CRationale: According to Williams, Early neonatal death is defined as death of a liveborn neonate during the first 7 days after birth. Although the infant is premature, it is still considered a live birth, and it died within the first 7 days of life.

Reference: Williams Obstetrics, 23rd ed. Page 207; Chapter 8 (Prenatal Care)

14: ABIGAIL A. NAVORA 35 year old pregnant woman on her 34 to 35 weeks AOG delivered to a 2.5kg live baby girl. APGAR score 9-9. Ballard scoring of the newborn is 36 weeks. The baby did well post delivery. The delivery is considered as

a. pretermb. termc. post term

Answer: A Rationalization: Based on the question, the newborn is 36 weeks thus a preterm neonate. A preterm neonate is a neonate born before 37 completed weeks (chapter 1, pp.3). Term neonate is born anytime after 37 weeks of gestation and up until 42 completed weeks of gestation. Post term neonate is a neonate born anytime after completion of the

42nd week, beginning with the 295.Reference: Williams, chapter 1, pp.3

15. Morcilla, HannaA 35 y/o pregnant woman on her 34 to 35 weeks AOG delivered a 2.5 Kg, live baby girl, APGAR score 9-9. Ballard’s scoring of the newborn is 36 weeks. The baby did well post-delivery.The weight of the newborn is:

a. low birth weightb. appropriatec. large for gestational age

Answer: B

Rationale: The newborn is appropriate for gestational age since her birth weight falls between the 10th and 90th

percentile based on the Age of gestation.

Large for gestational age- Above the 90th percentile

Appropriate for gestational age- Between 10th and 90th percentile

Small for gestational age- Below the 10th percentileReference:

16. TECSON, KRISTOFFER S.A pregnant woman consulted because of increased vaginal discharge characterized as whitish to yellowish, non-foul smelling, unaccompanied by pruritus. She should be:

a) Prescribed with antibiotics for vaginal infectionb) Advised to use vaginal douchec) Reassured that it is normal leucorrhead) All of the abovee) A and B

Answer: CRationale: During pregnancy some women develop increased vaginal discharge (leucorrhea) which in many instances has no pathologic case. This is due to the increased mucus formation by cervical glands in response to hyperestrogenemia. If the secretion is troublesome and accompanied by pruritus and burning sensation, infections caused by trichomonas vaginalis, candida albicans or gardnerella vaginallis have to be considered.

Reference: Textbook of OBSTETRICS Sumpaico 3rd edition page 274

17. Sigua, RoxanneA 38 y/o (4-0-0-4), was in labor when a landslide hit her barangay. The parturient eventually died. This is considered a ____

a. Direct obstetricb. Indirect obstetric

c. Non-obstetricAnswer: C. Non-obstetric

Rationale: Non-obstetric deaths are maternal deaths due to traumatic causes such as suicide, accident, gun shot wound and similar conditions.

Reference: Chapter 1 page 8 Textbook of OBTETRICS 3rd Edition Sumpaico

18. RIVERA, ANGELA MAE M.Maternal Mortality Ratio is defined as the number of maternal deaths from the reproductive process over:

a. 10,000 populationb. 10,000 live birthsc. 100,000 populationd. 100,000 live births

ANSWER: DRATIONALE: Maternal mortality ratio is the number of women who die during pregnancy and childbirth, per 100,000 live births. The data are estimated with a regression model using information on fertility, birth attendants, and HIV prevalence.

Reference: http://data.worldbank.org/indicator/SH.STA.MMRT

19. OZAETA, KATHLEEN JOYCEMajority of Filipino mothers deliver at/in:

a. home assisted by a doctorb. home assisted by a midwifec. lying in clinics with a midwifed. hospital with nurses and doctors

Answer: BRationale: Based on the 2003 NDHS, about 60% of deliveries take place at home, usually attended by TBA’s (traditional birth attendants) or by midwives.

Reference: Textbook of Obstetrics (Physiologic and Pathologic Obstetrics) 3rd Edition by Walfrido W. Sumpaico, MD Page 5

20. PACIFICO, MA. PRISCILLA ELENA B.Considering that the leading cause of Maternal death is from the complications of labor, delivery and puerperium, the most effective way of improving maternal mortality is to improve the training of our:

a. hilots c. General Practitionersb. midwives d. Obstetrician-Gynecologists

Answer: B Rationale: In Sumpaico, it says that the training of traditional birth attendants in the past was not able to significantly reduce the morbidities and mortalities in labor “because of the admitted difficulties in detecting complications and the inability to give early interventions.” It was also mentioned that the local goal is for deliveries to be attended by skilled attendants with midwives in the frontline, probably considering that this is what the majority of the population can afford, and that over TBAs, midwives are the better option because they have already received adequate training (two to three-year programs) to oversee deliveries. All things considered, improving the training of midwives will help them become more capable in recognizing and handling complications and thus make them more efficient in administering health care services, especially to the pregnant women.

Reference: Sumpaico (Textbook of Obstetrics), 3rd Edition, page 12

21. MAGTIBAY, ARIANNE ASHLEYAs compared to gestational age, fertilization age is:

a) Less than 2 weeksb) Less than 4 weeksc) More than 2 weeksd) More than 4 weeks

Answer: A

Rationale: ‘Gestational age or menstrual age is time elapsed since the first day of the last menstrual period, a time that actually precedes conception. This starting time, which is usually about 2 weeks before ovulation and fertilization and nearly 3 weeks before implantation of the blastocyst, has traditionally been used because most women know their last period.”

Reference: Williams 23rd Edition, page 78, under “DETERMINATION OF GESTATIONAL AGE”

22. MAGNO, WARLYN GRACE L.The most accurate way of determining gestational age during early pregnancy is by:

A. last normal menstrual periodB. correlation with uterine sizeC. gestational sac sizeD. crown rump length

Answer: A.Rationale: The 3 basic methods used to help estimate gestational age (GA) are menstrual history, clinical examination, and ultrasonography. If the mother has a regular period and knows the first day of her last menstrual period, gestational age can be calculated from last menstrual period. Gestational age, or the age of the baby, is calculated from the first day of the mother's last menstrual period, a time that actually precedes conception. Since the exact date of conception is almost never known, the first day of the last menstrual period is used to measure how old the baby is.

Reference: Williams Obstetrics 23rd.CHM: Fetal Growth and Development: Introduction, Determination of Gestational Age

American Pregnancy Association, Promoting Pregnancy Wellness: http://www.americanpregnancy.org/index.htm

23. Parao, Angelo E. The developing zygote enters the uterine cavity as a :

A. BlastomereB. BlastocystC. MorulaD. Gastrula

Answer : BLASTOCYST. Rationale: The developing embryo enters the uterine cavity late in the first week of development and implants in the uterus.

Source : Williams Obstetrics, 22nd edition, page 52

24. Nano, Marjorie Ann J. A woman had a positive test done today yet she claims to have bleeding for three days just a week prior. This bleeding however was much less in amount than her usual menses. This decreased in amount of bleeding can be explained by:

a) corpus luteum deficiency c) pathologic abnormal pregnancyb) implantation bleeding d) hormonal imbalance

Answer: BRationale: The clinical findings and symptoms that may indicate an early pregnancy includes positive in pregnancy test and cessation of menses. On the case above, patient has a positive test but have bleeding. Uterine bleeding somewhat suggestive of menstruation occurs occasionally after conception. One or two episodes of bloody discharge, somewhat reminiscent of and sometimes mistaken for menstruation, which is common during first month of pregnancy. Such episode are interpreted to be physiological and most likely a cause of blastocyst implantation.

Reference: Cunningham, G.F, et al. (2005) William Obstetrics; Prenatal care. 23rd edition. [chapter 8 pp 191-193].USA. McGraw-hill Companies, Inc.

25. SALVACION, CARL LOUIE G.Diploid number of chromosomes is maintained despite fusion of two gametes due to reduction division, which occurs during:

a. first meiotic divisionb. second meiotic division

c. both are correctAnswer: A

Rationale: Reduction division: The first cell division in meiosis, the process by which germ cells are formed. A unique event in which the chromosome number is reduced from diploid (46 chromosomes) to haploid (23 chromosomes). Also called first meiotic division or first meiosis.

Reference: http://www.medterms.com/script/main/art.asp?articlekey=5263

26. Pamplona, Hayzelle P.The process of spermatogenesis begins at:

a) 12 weeks AOGb) 20 weeks AOGc) birthd) puberty

Answer: DRationale: Maturation of seminiferous tubules as well as production of spermatogonial stem cells by the primordial germ cells happens around this tie, that's why spermatogenesis occurs only during puberty.Reference: Sadler, T. W. Langman's Medical Embryology. 2000. U.S.A.: Lippincott Williams & Wilkins. 8th ed., page 23-29.

http://medical-embryology.blogspot.com/2007/06/spermatogenesis.html

27. SANDING, ELRIZA MYRHEL S.The process of oogenesis begins at:

a) 12 weeks AOGb) 20 weeks AOGc) Birthd) Puberty

Answer: A. 12 weeks AOGRationale: By the third month, rapid succession of mitoses soon reduces the size of the germ cells to the extent that these no longer are differentiated clearly from the neighboring cells. These germ cells are now called oogonia.

Reference: Williams 23rd edition, page 99

28. Xandra Regina MartinezA patient is on medication on low sperm count, knowing the length of time for spermatogenesis to be complete, how many days post-treatment is the best time to do a seminalysis?

a) 30b) 60c) 90d) 120

Answer: CRationale: Spermatogenesis takes 74 days to be complete. Therefore, the best time to do a seminalysis to evaluate the effectiveness of the medication is 90 days post-treatment to ensure that the process of spermatogenesis is already complete. An erroneous result will be obtained if seminalysis was made prior to completion of spermatogenesis (before 74 days) because the sperms will not be counted accurately for they are still immature.

Reference: Textbook of Medical Physiology, 11th Edition. Chapter 80. Page 997.

29. VERGARA, RENN MIGUEL R.Which process occurs with ovulation?

a) completion of the first meiotic divisionb) completion of the second meiotic divisionc) capacitationd) release of two polar bodies

Answer: ARationale: According to Williams, LH secretion peaks 10 to 12 hours before ovulation and stimulates the resumption of meiosis in the ovum with the release of the first polar body. Since it is the first polar body that is said to be released, it means that it is the FIRST MEIOTIC DIVISION that has occurred. Therefore, the first meiotic division is completed in ovulation. Also, as discussed in Constanzo, at the time of ovulation, the first meiotic division is completed. The second meiotic division is completed when an egg (arrested in metaphase II) is fertilized by a sperm cell, and thus releasing the second polar body. Capacitation is the change that occurs in sperm cells that enables it to penetrate the egg.

Reference: Williams Obstetrics 23 rd edition, page 40

Constanzo Physiology 3 rd edition, page 451

30. PANGHULAN, ALDEE RAY L.When is the maximum number of germ cells in the ovary achieved?

a. 12 weeks AOG in uterob. 20 weeks AOG in uteroc. at birthd. at puberty

Answer: B. 20 weeks AOG in utero

RATIONALE: From Williams Obstetrics 23rd edition Chapter 3, page 37, under “Follicular or Preovulatory Ovarian Phase”, it says: There are 2 million oocytes in the human ovary at birth, and about 400,000 follicles are present at the onset of puberty. But as mentioned by Dr. Conrado Crisostomo on his lecture in “Gametogenesis and Embryogenesis” (slide no. 26) that in utero, the number of oocytes reach its maximum number of germ cells in the ovary which Is 7 million during the 5 month or equal to 20 weeks age of gestation. After that, the number of cells will decrease. He

added that the majority of the germ cell degenerates on the 7th month AOG. At birth, a woman will only have 700,000 to 2 million primary oocytes. And at puberty it will have only 400,000 primary oocytes.

Reference was stated on the rationale.

31. MAGDAONG, MELAYNE JEWEL R.At what age in years does atresia of follicles start to accelerate?

e) 25f) 30g) 35h) 40

Answer: CRationalization: The remaining follicles are depleted at a rate of 1000 follicles/ month until age of 35, when this rate accelerates.

Reference: Williams. 23rd edition. Page 37

32. Mostajo, Joven Amor, Jr. T. Exposure to teratogens will cause major congenital anomalies between 4 to 8 weeks AOG because this is the period of:

a. Rapid differentiation c. increased cellular divisionb. Maximal growth d. optimal change in shape

ANSWER: (A) Rationale: Because the embryonic period is from the second through the eighth week. It encompasses organogenesis and is thus the most crucial with regard to structural malformations. The critical developmental period for each organ system.

REFERENCE: Williams obstetrics 23rd edition, Chapter 14. Teratology and Medications That Affect the Fetus.

33. ROBENNE MAREE A. TANWhat must happen for the completion of the second meiotic division in organogenesis:

A. LH surgeB. follicle size of 20 mmC. OvulationD. FertilizationAnswer: DRationale: Female gametes, undergo 2 successive meiotic divisions(meiosis 1&2). The primary oocytes that go through meiosis 1. The completion of the meiotic division in the chosen oocyte occurs a few hours before OVULATION. If the ovum is FERTILIZED, it hastily completes meiosis 2 and produce unequal cells called fertilized ovum (zygote).Reference: Williams obstetrics 22nd edition, Section II, chapter 3 implantation, embryogenesis, placental development -- pp. 39

34. PACCAL, PATRICK JULIUS G.Fertilization is complete within how many hours from ovulation?

a. 12b. 24c. 36d. 48

Answer: BRationale: Almost all pregnancies result when intercourse occurs during the 2 days preceding or on the day of ovulation but it is generally agreed that must take place within a few hours, and no more than a day after ovulation (12 – 24 hours).

Reference: William’s Obstetrics 23rd Edition, p47

35. RAMOS, GENIE ANNEWhat is the function of Human Chorionic Gonadotropin (HCG) during the early embryonic period?

a. source of hematopoiesisb. maintains endometrium in secretory phasec. prevents regression of the corpus luteumd. nourishes the developing embryo

ANSWER: CRATIONALE: The best known biological function of Hcg is the so-called recue and maintenance of function of the corpus luteum and that is the continued production of progesterone. HCG prevents the involution of the corpus luteum, the principal site of progesterone formation during the first 6 weeks. It is also known to stimulate fetal testicular testosterone secretion and promote relaxin secretion by corpus luteum.

Reference: William Obstetrics and Gynecology 23rd, Page 64 and 192

36. YU, PHILIP ANDREW S.Part of endometrium where implantation takes place:

c. Deciduas parietalisd. Deciduas verae. Deciduas capsularisf. Deciduas basalis

Answer: D. Decidua basalisRationale: It is the decidua directly beneath blastocyst implantation is modified by trophoblast invasion and becomes the decidua basalis.

Reference: Williams 23rd edition, page 44

37. Rellora, Lauren Victoria R.Which structure facilitates implantation by invading the adjacent endometrium and its blood vessels?

a) Cytotrophoblastb) Syncytiotrophoblastc) Extraembryonic coelomd) Inner cell mass

ANSWER: BRationale: The trophoblast is differentiated into the inner layer of cytotrophoblast and outer multinucleated syncytiotrophoblast. The former are the germinal cells and serve as the primary secretory cells of the placenta. As the embryo enlarges, the syncytiotrophoblast invades the maternal decidua basalis and is permeated by trophoblastic lacunae.

Reference: Cunningham, F., et.al. (2010). Implantation, Embryogenesis and Placental Development. Williams Obstetrics (23rd

ed., pp.49-51). United Sates of America: The McGraw-Hill Companies, Inc.

38. NAZARENO, CHRISTINEWhat significant event occurs during gastrula stage?

a. Neural formationb. GIT formationc. Bone mineralizationd. Differentiation of 3 germ layers

Answer: D

Rationale: The primary germ layers are formed and organized in their proper locations during gastrulation. 3rd week is the start of the embryonic period. During this time, there is gastrulation, which means that the embryonic disc is now well-defined, forming a trilaminar disc.

Reference: Williams 23rd Edition; p. 79

39. PATAUNIA, JOSAN JAN R.The epithelial lining of the respiratory passage, GIT and glands, and glandular cells of the liver and pancreas arise from the embryonic:

a. Ectodermb. Mesodermc. Endoderm

Answer: CRationale: DERIVATIVES

ENDODERM MESODERM ECTODERM• Gastrointesti

nal Tract – main organ

• Epithelial lining of the respiratory tract

• Parenchyma of the thyroid, parathyroid, liver and pancreas

• Reticular stroma of the tonsils and thymus

• Epithelial linging of the urinary bladder and urethra

• Epithelial lining of the

1. Intermediate Mesoderm• Excretory

units of the urinary system

• gonads2. Lateral plate

mesodermi) Dermis of

the skinj) Bonesk) Connective

tissuel) Sternumm) Costal

cartilagesn) Limb

muscleso) Body wall

musclesp) Wall of the

gut tubeq) Serous

Organs and structures that maintain contact with the outside world:

g. Central Nervous system

h. Peripheral nervous system

i. Sensory epithelium of the ear, nose, and eye

j. Epidermis including hair and nails

k. Subcutaneous glands, mammary glands, pituitary

tympanic cavity and auditory tube

membranes and fluid of the peritoneum, pleura and pericardium

3. Blood and blood vessels

gland, and enamel of the teeth

Reference: Langman’s Medical Embryology 11th Edition by T.W. Sadler. Chapter 6- THIRD TO EIGHT WEEK: THE EMBRYONIC PERIOD, pages 67 to 90.

40. LAMEDA, RANDALL M.In what portion of the endometrial cavity does implantation usually occur?

a. antero-fundalb. postero-fundalc. antero mid-portiond. postero mid-portion

Answer: b. postero-fundalRationale: Implantation occurs in upper most part which is the fundus, of uterine cavity in the posterior wall.

Reference: Williams 22nd Edition, Page Number 52, Chapter3: Implantation, Embryogenesis & Placental development

41. Crisanto MacaraegIn phase 2 of parturition, preparing the uterus for labor, these are uterine changes that occur EXCEPT:

a. marked increase in oxytocin receptors in the uterine musclesb. obliteration of the tight junction proteinc. cervical ripeningd. increase in surface area of the gap junction proteins

Answer: B Rationale: Gap junctions are not obliterated, they actually increase in surface area (choice D). Oxytocin stimulate contractions, thereby requiring an increase in receptors during phase 2 of parturition (choice A). Cervical ripening is a prominent feature of this phase, allowing cervical dilations (choice C) and sends a positive feedback for uterine contractions.

Reference: william's 23. Pages 136-141

42. Villarin, Lilia G. Which of the following is correct about the duration of pregnancy?

a) Average duration is 40 weeksb) Corresponds to 9 2/3 calendar monthsc) Corresponds to 9 lunar monthsd) All of the above

Answer: A = Average duration is 40 weeksRationalization: The duration of pregnancy, computed as time elapsed between the first day of the last menstrual period (LMP) and the birth of the fetus, approximately lasts for 280 days, or 40 weeks. This is equivalent to 9 1/3 calendar months, or 10 lunar months. This is so because most clinicians consider menstrual age as the gestational age.

Reference: Cunningham, F., et. al. (2010). Fetal Growth and Development. Williams Obstetrics (23rd ed., p. 78). United States of America: The McGraw-Hill Companies, Inc.

43. Montecalvo, Victor III

If the LMP was last December 13, 2011, when is the 280th

day of pregnancy using Naegele’s rule?

a. August 20, 2012 c. August 21, 2012b. September 20, 2012 d. September 6, 2012

Answer: BRationale: Naegele’s rule = LMP - 3 months, +7 days

Reference: ebook Williams obstetrics 22 edition, http://en.wikipedia.org/wiki/Naegele's_rule

44. MICLAT, FRANCES LEAH D.Which of the following is the correct order of development phase within 2 weeks after ovulation?

a. formation of free blastocyst - implantation of blastocyst - fertilizationb. fertilization – formation of free blastocyst – implantation of blastocystc. implantation of blastocyst – formation of free blastocyst – fertilizationd. any of the above

Answer: BRationale: Upon the union of the egg and sperm in the fallopian tube which is FERTILIZATION, the mature ovum becomes a zygote that then undegoes cleavage into blastomeres. As the blastomeres continue to divide, a solid mulberry-like ball of cells – the morula – is produced. Then gradual accmulation of fluid between the cells of the morula results in the FORMATION OF EARLY BLASTOCYST. In the early stages of of the human blastocyst, the wall of the primitive blastodermic vesicle consists of a single layer of ectoderm. As early as 4 to days after fertilization, the 58-cell blastula differentiates into five embryo-producing cells – the inner cell mass, and 53 cells destined to form trophoblasts. In a 58-cell blastocyst, the outer cells, called trophectoderm, canbe distinguished from the inner cell mass that forms the embryo. Then IMPLANTATION OF BLASTOCYST into the uterine wall is the common feature of all mammals. In women, it takes place 6or 7 days after fertilization. This process can be divided into three phases: (1) apposition (2) adhesion and (3) invasion.

Reference: Williams 23rd Edition , Pages 47-48

45. VERGARA, MELODY JOYCE S.At the earliest menstrual age (weeks) is fetal genitalia distinguishable as male or female?

a) 10b) 14c) 16d) 20

ANSWER: BRATIONALIZATION: At 12 Gestational Weeks the external genitalia are beginning to show definitive signs of male or female gender. Gender can be determined by experienced observers by inspection of the external genitalia by 14 weeks.

REFERENCE: Williams Obstetrics 23rd Edition, Chapter 04

46. Krizia Aira J. OclaritIn a normal development of fetus, at what menstrual age (Weeks) is the crown-rump length measure 25 cm and the weight is about 1100 grams?

a) 28b) 32c) 36d) 40

Answer: A. 28Rationale:

Menstrual Age Weight Height12 6 – 7 cm16 110 grams 12 cm20 300 grams 16 cm24 630 grams 21 cm28 1100 grams 25 cm

32 1800 grams 28 cm36 2500 grams 32 cm40 3400 grams 36 cm

Reference: William Obstetrics 23rd edition, page 79 -81

47. Sabrina Florence DL. O'NeillWhich of the following fontanels is situated at the junction of the sagittal and lambdoid sutures of the fetal head?

A.) CesserianB.) GreaterC.) PosteriorD.) Temporal

Answer: CRationale: Verbatim from the book: "The lesser or posterior fontanel is represented by a small triangular area at the intersection of the sagittal and lambdoid sutures". Answer B which is greater refers to the Anterior fontanel which is at the junction of the sagittal and coronal sutures while answer D refers to the temporal bones and it's sutures.

Reference: Chapter 4, Fetal Growth and Development, Williams 23rd Edition EBook for the Ipad

48. Rosales, Carol Zaidel M.Which of the structure is traversed by substances from maternal blood to fetal blood for transfer of oxygen and nutrients?

a) Syncytiotrophoblastb) Stroma of the intravillous spacec) Fetal capillary walld) All of the above

Answer: DRationalizationFrom Section 2: PHYSIOLOGY OF PREGNANCY, Chapter 5: Placenta and Fetal Membranes (page 71 of 1132)

The extravillous and villous trophoblasts are the embryonic fetal tissues of the anatomical interface of the placental arm; the vascular fetal membrane -the amnion and chorion laeve-is the fetal tissues of the anatomical interface of the paracrine arm of this system.

The placental arm of this system links the mother and fetus as follows: Maternal blood directly bathes the syncytiotrophoblast, the outer surface of the trophoblastic villi. This is a hemochorioendothelial type of placenta. The paracrine arm of this system links the mother and fetus through the anatomical and biochemical juxtaposition of (embryonic) chorionic leave and decidua parietalis tissue. Therefore at all sites of direct cell to cell contact, maternal tissues (deciduas and blood) are juxtaposed to embryonic states (trophoblast) and not to embryonic cells of fetal blood. This is an extraordinarily important arrangement for communication between fetus and mother and for maternal (immunological) acceptance of the conceptus.

Reference:Williams Obstetrics 21st Edition: F. Gary Cunningham (Editor), Norman F. Gant MD, Kenneth J., Md Leveno, Larry C., Iii, Md Gilstrap, John C., Md Hauth, Katharine D., Md Wenstrom, John C. Hauth, J. Whitridge Obstetrics Williams (Editor), Steven L. Clark, Katharine D. Wenstrom, by Mcgraw-Hill Professional (April 27, 2001).

49. RECIERDO, FRANCINE MARIE REGAYAWhat mechanism is involved in the transport of oxygen, carbon dioxide, and anesthetic gases in the syncytiotrophoblast?

a. simple diffusionb. selective and facilitated diffusionc. active transportd. all of the above

Answer. A.Rationale: Simple diffusion appears to be the mechanism involved in the transfer of oxygen, carbon dioxide, water and most electrolytes. Anesthetic gases also pass through the placenta rapidly by simple diffusion.

Reference: Williams 23rd edition, page 86

50. Sierra, Rei Fabbie F. Which glucose transport protein (GLUT) primarily facilitate glucose uptake by placenta?

a. GLUT-1 and GLUT-3 c. GLUT-5 and GLUT-6b. GLUT-2 and GLUT-4 d. GLUT-12 and GLUT-16

Answer: A. GLUT-1 and GLUT-3Rationale: GLUT-1 and GLUT-3 primarily facilitate glucose uptake by the placenta and are located in the plasma membrane of the microvilli of the syncytiotrophoblast (Korgun & colleagues,2005)

Reference: page 87, William’s Obstetrics 23rd edition

51. MARAVILLA, RACHELLE DIANE B.What is the main composition of amniotic fluid after 20 weeks gestation age?

a) ultrafiltrate of maternal plasmab) extracellular fluid that reflects the composition of fetal plasmac) fetal urined) mixture of the three above

Answer: CRationale: Ultrafiltrate of maternal plasma will be the main composition of amniotic fluid during early pregnancy. In addition to this extracellular fluid that reflects the composition of fetal plasma is the main composition of amniotic fluid during the beginning of second trimester which is around 17 weeks AOG. After 20 weeks AOG, on the other hand, the fetal skin will undergo cornification which will prevent the diffusion of the extracellular fluid; hence, the amniotic fluid, at this time, will largely be composed of fetal urine.

Reference: Williams 23rd EDITION, PAGES 88-89

52. ASUNCION, JESSICA B.Which of the following fetal vessels conveys the highest oxygen and nutrients?

A. Ductus VenosusB. Superior Vena CavaC. AortaD. Pulmonary Artery

Answer: ARationale: The ductus venosus is the major branch of the of the umbilical vein. The umbilical vein is responsible for delivering and oxygen and nutrient materials required for fetal growth and maturation. The ductus venosus traverses the liver and directly enters the inferior vena cava directly. Not supplying intervening tissues allows the ductus venosus to deliver well oxygenated blood directly to the heart.

Reference: Williams EDITION 23, PAGE # 89

53. VILLAMER, AILYN O.After Birth, what is the remnant of umbilical vein after it constricts or collapses?

a) umbilical ligaments c.) ligamentum teresb) ligamentum venosum d.) ductus ligamentus

ANSWER: C. LIGAMENTUM TERESRationale: The more distal portions of the hypogastric arteries, which course from the level of the bladder along the abdominal wall to the umbilical ring and into the cord as the umbilical arteries, undergo atrophy and obliteration within 3 to 4 days after birth. These become the umbilical ligaments, whereas the intra-abdominal remnants of the umbilical vein form the ligamentum teres. The ductus venosus constricts by 10 to 96 hours after birth and is anatomically closed by 2 to 3 weeks, resulting in the formation of the ligamentum venosum.

Reference: Williams Obstetrics 23rd edition, page 90

54. RIVERA, JAN ERIC A. Which of the following is the major site of fetal hemopoiesis during the first weeks of pregnancy?

a. placenta c. Liverb. yolk sac d. Placenta

Answer: b. yolk sacRationale: In the very early embryo, hemopoiesis is demonstrable first in the yolk sac. The next major site is the liver, and finally the bone marrow.

Reference: Williams Obstetrics, 23e Chapter 4. Fetal Growth and Development (e-book ginamit ko, di naka indicate yung page number.)

55. Soler, FidelWhat is the main immunoglobulin in the fetus that is being transferred across the placenta by receptor mediated process in syncytiotrophoblast?

a. IgM c. IgGb. IgA d. IgD

Answer: C. IgGRationale:Mechanisms of placental transferMost substances with a molecular mass of less than 500 Da pass readily through the placental tissue by simple diffusion. Also, some low molecular weight compounds undergo transfer facilitated by syncytiotrophoblast. These are usually those that are in low concentration in maternal plasma but are essentially for normal fetal development. Simple diffusion appears to be the mechanism involved in the transfer of oxygen, carbon dioxide, water and most electrolytes. Anesthetic gases also pass through the placenta rapidly by simple diffusion.Insulin, steroid hormones and thyroid hormones cross the placenta but at very slow rates. The hormones synthesize in situ in the trophoblasts enter both the maternal and fetal circulations, but not equally. Examples are concentrations of chorionic gonadotropin and placental lactogen, which are much lower in fetal plasma than in maternal plasma. Substances of high molecular weight usually do not traverse the placenta, but there are important exceptions such as immunoglobulin G, molecular weight 160,000 Da, which is transferred by way of a specific trophoblast receptor mediated mechanism.

Reference: Williams Obstetrics pg. 86

56. Matias, Jobell D.A fetus with amnionic membrane rupture before 20 weeks of gestation will have immature lung development. Which stage is most likely affected?

a. Pseudoglandular c. Terminal Sacb. Canalicular d. A and B

Answer: C. Terminal Sac

Rationale: Pseudoglandular stage entails the growth of the intrasegmental bronchial tree between the 5th and 17th

weeks. Canalicular stage is when the bronchial cartilage plates extend peripherally which happens from 16th to 25th

weeks. During this time, each terminal bronchiole gives rise to several respiratory bronchioles and each of these in turn divides into multiple saccular ducts. Terminal sac stage begins after 25 weeks and during this time, alveoli give rise to primitive pulmonary alveoli, the terminal sacs. So if the fetal membrane ruptures before 20 weeks of gestation, then the fetus already has nearly normal bronchial branching and cartilage development but has immature alveoli.

Reference: Williams Obstetrics, 23rd edition, pages 96 and 377.

57. SALVADOR, ZAFRIL JOSE S.R.In the anatomical development of fetal urinary system, what structure gives rise to the bladder and urethra?

a) Urogenital Sinusb) Intermediate Mesodermc) Mesonephrosd) Allantois

ANSWER: A – UROGENITAL SINUSRATIONALE: simply because:

•Urogenital Sinus – bladder and urethra•Intermediate Mesoderm – kidney and ureter

•Mesonephros – primitive urinary system which produces urine at 5 weeks AOG and degenerates by 11-12 weeks AOG.

•Allantois –mesoderm of the cord

REFERENCE: William’s 22nd edition, page 108.

58. Mendoza, JaimeA fetus with amniotic membrane rupture before 20 weeks of gestation will have an immature lung development. Which stage is likely affected?

a. Pseudoglandular c. Terminal sacb. Canalicular d. A and B

Answer: CRationale: The lungs develop in a proximo-distal fashion, divided into three stages. The pseudoglandular stage brings

about the growth of the intrasegmental bronchial tree occurs during the 5th and 17th weeks. The canalicular stage,

during the 16th to 25th weeks, gives rise to the bronchial cartilage and plates, extending peripherally. While the terminal sac stage develops only 15% of adult alveoli at birth and continues to grow from fetal life up to 8 years. The fetus with membrane rupture before 20 weeks and subsequent oligohydramnios usually exhibits nearly normal bronchial branching and cartilage development but has immature alveoli.

Source: Williams 22nd ed.

59. PARAS, ROBERT JULIUSWhen is genetic gender established as XY or XX?

a. ovulationb. fertilizationc. implantationd. expression of SRY gene

Answer: BRationale: “After fertilization, in the fallopian tube, the mature ovum becomes a zygote, a diploid with 46 chromosomes” (Williams, 2009). In human chromosomes, normal karyotypes for females contain two X chromosomes and are denoted 46,XX; males have both an X and a Y chromosome denoted 46,XY.

Reference: Williams, 2009 23rd Edition p. 48, & Sumpaico, 2008. 3rd Edition p. 83

60. Ramos, Iziah Rainier D.S.Which of the following conditions leads to female sexual differentiation?

a) Absence of male gonadb) Presence of SRY genec) Production of Mullerian- Inhibiting substanced) Presence of fetal ovary

Answer: ARationale: The male phenotypic sexual differentiation is directed by the function of fetal testis, so if male gonad is absent then the fetus will go into female sexual differentiation.

Reference: William’s Obstetric 22/e page 68 (e-book)

61. OLIVEROS, MARK JOSEPH N.Circulatory disturbances of the placenta include:

a. infarction c. calcificationb. thrombose formation d. all of the above

Answer: DRationale: The circulatory disturbances of the placenta are the following:•Placental infarctions (most common placental lesions) and maternal floor infarction (uncommon lesion wherein fibrinoid deposition occurs within the decidua basalis and usually is confined to the placental floor)

•Placental vessel thrombosis (usually associated with fetal growth restriction and stillbirth)•Calcification result from trophoblast aging, or impairment of uteroplacental circulation with infarction (degenerative lesions)

Reference: Section IV. Labor and Delivery, Chapter 27. Abnormalities of the Placenta, Umbilical cord, and membranes.

Williams Obstetrics 22nd edition Ebook

62. Marasigan, Al JosefHuman chorionic gonadotropin starts to be detected in the blood and urine of pregnant women at the time of:

a. blastocyst formationb. blastocyst implantationc. blastocyst differentiationd. blastocyst breakdown

ANSWER: BRATIONALE: If implantation occurs, the developing blastocyst will begin to produce human chorionic gonadotropin (hCG) and rescue the corpus luteum, thus maintaining progesterone production.

REFERENCE: WILLIAMS OBSTETRICS 22ND EDITION ebook. Section II. Anatomy and Physiology > Chapter 3. implantation, Embryogenesis, and Placental Development

63. Reyes, Kevin MatthewBlood with a higher oxygen content returns from the placenta to the fetus through the:

A. Umbilical arteriesB. truncal arteriesC. Umbilical veinD. Arcuate arteries

Answer: CRationale: in the placenta, the blood picks up oxygen and other nutrients and is then recirculated back through the umbilical vein.

Referrence: williams 22nd edition page 102 - 103

64. Soler, AlexanderThe following changes are seen in placental aging EXCEPT:

a) increased thickness of the syncityum b) formation of syncytial knotsc) thickening of the capillary basement membranesd) obliteration of fetal vessels

Answer: a. increased thickness of the syncytiumRationale: As the villi continue to branch and the terminal ramifications become more numerous and smaller, the volume and prominence of cytotrophoblasts decrease. As the syncytium thins and forms knots, the vessel becomes more prominent and lie closer to the surface. Later, the stroma becomes spindly and more closely packed. Another change in the stroma is the presence of Hofbauer cells, which likely are fetal macrophages. During the latter half of pregnancy, syncytial degeneration begins and syncytial knots are formed. Villous stroma undergoes hyalinization. Syncytium may then break away exposing connective tissue directly to maternal blood, which results to clotting. Around the edge of nearly every end placenta there is a dense yellowish white fibrous ring representing a zone of degeneration and necrosis, which usually is termed a marginal infarct.

Reference:

65. SAULOG, ROLDANOver-the-counter pregnancy test kits test for which placental hormone?

a) estrogenb) progesteronec) human placental lactogend) human chorionic gonadotropin

ANSWE R: DRationale: Detection of hCG in maternal blood and urine provides the basis of endocrine tests of pregnancy. Trophoblast cells produce hCG in amounts that increase exponentially following implantation. with a sensitive test the hormone can be detected in maternal plasma or urine by 8 to 9 days after ovulation. the doubling time of plasma hCG concentration is 1.4 to 2.0 days. hCG levels increase from the day of implantation and reach levels at 60 to 70 days. Thereafter, the concentration declines slowly until a nadir is reached at about 16 weeks.Estrogen, progesterone and human placental lactogen are not detected because a pregnancy test has a high specificity for the β-subunit of hCG.

Reference: Williams 23rd edition, pages 192-193

66. TALATALA, KITH ELGIN N.The umbilical cord at term normally has:a) two veins and one arteryb) two arteries and one veinc) two arteries and two veinsd) two arteries and valves of Hoboken

Answer: (B) TWO ARTERIES AND ONE VEINRationale: The cord at term normally has two arteries and one vein. The large umbilical vein carries oxygenated blood to the fetus. The two smaller umbilical arteries caries deoxygenated blood from the fetus to the placenta.

Reference: page 61, paragraph 3. Williams Obstetrics: 23rd Edition.

67. MENDOZA, ROI JOSEPHIn the development of the decidua, the portion directly beneath the site of blastocyst implantation is the?

a. decidua capsularis c. decidua parietalisb. decidua basalis d. chorion leave

Answer: B -Decidua Basalis Rationale: The portion of the decidua directly beneath the site of blastocyst implantation is modified by trophoblast invasion and becomes the decidua basalis.

Reference: Williams 22nd edition page 35

68. MANUEL, MARVILLO M.Which of these statements regarding human chorionic gonadotropin is incorrect?

a) It is the “pregnancy hormone”.b) It has biological activity very similar to luteinizing hormone.c) It is structurally related to luteinizing hormone, follicle stimulating hormone, and thyroid stimulating hormone.d) It is secreted by cytotrophoblasts.

ANSWER: DRationale: This so-called pregnancy hormone is a glycoprotein with biological activity similar to luteinizing hormone (LH). This hormone is structurally related to three other glycoprotein hormones – LH, FSH and TSH.

Before 5 weeks, , hCG is expressed in both syncytiotrophoblast and cytotrophoblast (Maruo and colleagues, 1992). Later, when maternal serum levels peak, hCG is produced almost solely in syncytiotrophoblasts (Beck and associates, 1986; Kurman and colleagues, 1984). At this time, hCG mRNAs for both α- and β- subunits in syncytiotrophoblasts are greater than at term (Hoshina and coworkers, 1982). This maybe an important consideration when hCG is used as a screening procedure to identify abnormal fetuses.

Reference: Williams Obstetrics 23rd Ed., Page number: 63

69. SILVALLANA, RICHELLE A.Which part of the hCG molecule is useful as a tumor marker for trophoblastic disease?

a) Nicked hCG molecule c. Beta subunitb) Alpha subunit d. Core-fragment of hCG

Answer: DRationale: there is no available for pathological study so it is only a persistent elevated serum of beta-hCG level is very

useful in diagnosing a trophoblastic disease. Among the parts of the hCG, it is only the beta subunit that can detect even small amounts of trophoblastic tissue.

Reference: Williams 23rd edition, page 262

70. Sorilla, Mae Angeli G.This statement is not true of human placentation.

a) Decidua and maternal blood are juxtaposed to fetal blood.b) It is hemochorioendothelial.c) Maternal blood in the intervillous space directly bathes the trophoblasts.d) Substances transferring from the mother to the fetus must traverse the intervillous space.

ANSWER: ARationale: The term hemochorial and the older term hemochorioendothial l are used to describe human placentation. The terms are derived as follows: hemo refers to maternal blood, which directly bathes the syncytiotrophoblast; chorio is for chorion–placenta, which in turn is separated from fetal blood by the endothelial wall of the fetal capillaries that traverse the villous core (hence the older term hemochorioendothelial). The following statements are true about human placentation which justifies that choice letter A is not true.

Reference: Williams 22nd Edition E-book, Williams Obstetrics > Section II. Anatomy and Physiology > Chapter 3. Implantation, Embryogenesis, and Placental Development

71. Manalang, Capella The following is not a function of trophoblast:

a) endocrineb) secretion of the hormone that maintains pregnancyc) nutrition of the conceptusd) implantation

Answer: BRationale: Because A,C & D is the normal part of function of trophoblast while secretion of the hormone that maintains pregnancy is the function of placental estrogen and progesterone.

Reference: OB Dewhursts textbook page 352

72. Patdu, Jacky A.In the maternal circulation of the placenta deoxygenated blood exists through the:

a. Vena cavab. Ovarian veinc. Uterine veind. Umbilical vein

Answer: CRationale: Looking at the maternal circulation during pregnancy, oxygenated blood runs from the heart leading its way to the Uterine Arteries, which feeds the uterus. After becoming delivering the oxygen through the placenta, the deoxygenated blood from the placenta will then be fed into the Uterine Veins, which will drain into the internal iliac and then into the common iliac vein.

Reference: William Edition 23, page 26

73. PAO, CHRISTEL V.An abnormal placenta has:

a) a weight of 500 gramsb) 10 to 38 cotyledonsc) an accessory lobed) intact fetal circulation

Answer: CRationale: The other choices are normally present in a normal placenta. Based on William’s Obstetrics, the accessory lobe may sometimes be retained in the uterus after delivery and may cause serious hemorrhage. In some cases, an

accompanying vasa previa may cause dangerous fetal hemorrhage at delivery, hence, an accessory lobe is considered to be part of an abnormal placenta.

Reference: Williams Obstetrics, 23rd edition, Chapter 27

74. Yaun, Pilipina Karla Mutya V. Which of the following is not a function of the amnion?

a) provides most of the tensile strength of the fetal membranesb) lipolysis for fetal nutritionc) maintenance of amniotic fluid homeostasisd) secretion of cytokines and vasopeptides

Answer: b. lipolysis for fetal nutritionRationale: Function of the amnion includes: it provides almost all of the tensile strength of the fetal membrane; it transports solutes and water to maintain amniotic fluid homeostasis; and it produces vasoactive peptides, and secretes growth factors and cytokines. By the process of elimination, since choices a, c, and d are all correct, we can surmise that choice b is not a function of the amnion. The placenta is the one that is responsible for fetal nutrition.

Source: Dr. Fortun’s Lecture: The Decidua, Placenta, and Placental hormones (2012)

75. MELISSA KATE D. MENDOZAThis placental hormone rescues and maintains the corpus luteum:

a) Human placental lactogenb) Estrogenc) Progesteroned) HCG

Answer: D. HCGRationale: Both hCG subunits are required for binding to the LH-hCG receptor in the corpus luteum and the fetal testis. LH-hCG receptors are present in a variety of tissues, but their role there is less defined. The best-known biological function of hCG is the so-called rescue and maintenance of function of the corpus luteum—that is, continued progesterone production.

Reference: William’s Obstetrics, 23 rd Edition, page 64

76. RAGASA, JOHN R.This placental hormone promotes growth of the endometrium:

a) human placental lactogenb) estrogenc) progesteroned) HCG

Answer: BRationale: Estrogen is the essential hormonal signal on which most events in the normal menstrual cycle depend.It is likely that estradiol and other bioactive estrogens cause replication of the endometrium indirectly (through actions on stromal cells and glandular hyperplasia). Follicular-phase production of estradiol is the most important factor I endometrial recovery following menstruation

Reference: Williams Obstetrics 23rd Edition, p. 41-42.

77. MATABUENA, MAIKA ALMINA F.Intraamniotic infection ( Chorioamnionitis) is best managed by:

a. immediate Cesarean sectionb. high forces extractionc. antibiotics and expedient deliveryd. steriods and assisted vaginal delivery

Answer: CRationale: Since chorioamnionitis is caused by wide variety of microorganisms, therefore it can be managed by antimicrobial administration and expedient delivery.

Reference: Williams Obstetrics 22nd ed. (2005) page 354

78. Rojas, Bianca B.A placenta with an accessory lobe will most likely lead to which complication during the third stage of labor.

a. infectionb. neurologic shockc. hemorrhaged. amniotic fluid embolism

Answer: C (hemorrhage)Rationale: Succenturiate Lobes. This variation describes one or more small accessory lobes that develop in the membranes at a distance from the periphery of the main placenta, to which they usually have vascular connections of fetal origin. It is a smaller version of the bilobed placenta, and although its incidence has been cited by Benirschke and Kaufmann (2000) to be as high as 5 percent, we have encountered these very infrequently. The accessory lobe may sometimes be retained in the uterus after delivery and may cause serious hemorrhage. In some cases, an accompanying vasa previa may cause dangerous fetal hemorrhage at delivery.

Reference: Williams, 22ndedition, SECTION IV - LABOR AND DELIVER, Chapter 27 Abnormalities of the Placenta, Umbilical Cord, and Membranes, page 619

79. Sadang Ronaldo B.Which placental hormone is used to monitor response to treatment of Choriocarcinoma?

a) human placental lactogenb) estrogenc) progesteroned) HUMAN CHORIONIC GONADORTROPHIC HORMONE

ANSWER:DRATIONALE: In 1991, FIGO revised the staging (for choriocarcinoma) to combine prognostic factors with anatomical staging. Two prognostic factors ( HCG>100,000 mIU/ml and duration of disease longer than 6y months from termination of the antecedent pregnancy). Table of prognostic factors including HCG also included in same page.

Reference: Sumpaico, 3rd edition, page number 542

80. ORPILLA, MARK JASON G.The concentration of human chorionic gonadotropin in serum is the same as its concentration in the urine

a) Trueb) False

Answer: A. True

Rationale: Maternal urine hCG also can be monitored and is composed of a variety of degradation products. The primary form of hCG in urine is the terminal degradation product of hCG, the β-core fragment. Its concentrations follow the same general pattern as that in maternal plasma, peaking at about 10 weeks. It is important, however, to recognize that the so-called β-subunit antibody used in most pregnancy tests reacts with both intact hCG, the major form in the plasma, and with fragments of hCG, the major forms found in urine.

Reference: Williams 22nd Edition Page 45 via Ebook

81. NABONG, MARCO PAULO C.Uterine hypertrophy in the second half of pregnancy is due to:

a. estrogenb. progesteronec. pressure exerted by the expanding products of conceptiond. all of the above

Answer: CRationale: Early in gestation, uterine hypertrophy probably is stimulated by chiefly by the action of estrogen and

perhaps that of progesterone. But after about 12 weeks, the increase in uterine size is related predominantly in some manner to pressure exerted by the expanding products of conception.

Reference: Williams Obstetrics 22nd edition. Chapter 5 Maternal Physiology. pp122

82. Maebritt Wincent M. Tibubos The delivery of most substances essential for growth and metabolism of the fetus and placenta as well as removal of most metabolic wastes, is dependent on:

a) Adequate perfusion of the placenta and intervillous spaceb) Total uterine blood flowc) Normal placentad) Presence of 2 uterine arteries and 2 vein in the umbilical cord

Answer: ARationale: According to William’s Obstetrics under Uteroplacental blood flow, the delivery of most substances essential for growth and metabolism of the fetus and placenta, as well as removal of most metabolic waste, is dependent on placental intervillous space [sic].

Reference: Chapter 5: Maternal Physiology p. 108. William’s Obstetrics 23rd Edition

83. Desiree Joy Anne M. TimtimanWhat is the basis for physiologic anemia in pregnancy?

a) More plasma than erythrocytes is added to the maternal circulationb) More erythrocyte than plasma is added to the maternal circulationc) Moderate erythroid hyperplasia is present in the bone marrowd) More water intake of the pregnant women due to increase water requirement

Answer: ARationale: More plasma than erythrocytes is added to the maternal circulation. Maternal blood volume begins to increase during the first trimester. By 12 mensrual weeks, plasma volume expands by approximately 15 percent compared with that of pregnancy. As shown in fig, maternal blood vol expands most rapidly

during 2nd trimester, and then rises at slower rate at 3rd trimester and plateau in the last few weeks of trimester. And the end product is more plasma than erythrocyte is usually added in the maternal circulation.

Reference: Chapter 5. Maternal Physiology section 2 p115. William’s Obstetrics 23rd Edition.

84. Villoso, Aaron Christian Earl I.Remission of some autoimmune disorders during pregnancy may be explained by.

a. suppressed Th1 response c. upregulation of Th2b. suppressed Tc1 cells d. all of the above

Answer: D. ALL OF THE ABOVE.Rationale: Pregnancy is thought to be associated with suppression of a variety of humoral and cell-mediated immunological functions to accommodate the "foreign" semiallogeneic fetal graft. One mechanism appears to involve suppression of T-helper (Th) 1 and T-cytotoxic (Tc) 1 cells, which decreases secretion of interleukin-2 (IL-2), interferon-γ, and tumor necrosis factor- (TNF-β). There is also evidence that a suppressed Th1 response is requisite for pregnancy continuation. Not all aspects of immunological function are depressed. For example, there is upregulation of Th2 cells to increase secretion of IL-4, IL-6, and IL-13.

Reference: Williams Obstetrics 23rd edition, page 116

85. TEE, JAN RAEMONThe increase in the cardiac silhouette on chest radiograph of pregnant patients is due to:

A. the heart is displaced to the left and upwardsB. the heart is rotated somewhat in its long axisC. the base is moved somewhat laterally from its usual positionD. some degree of pericardial effusion

ANSWER: AllRATIONALE: "As the diaphragm becomes progressively elevated, the heart is displaced to the left and upward and rotated somewhat on its long axis. As a result, the apex is moved somewhat laterally from its usual position, causing a larger cardiac silhouette on chest radiograph. Furthermore, pregnant women normally have some degree of benign pericardial effusion, which may increase the cardiac silhouette."

REFERENCE: William's 23rd edition, Chapter 5: Maternal Physiology

86. YUSINGBO, Iami Rio Patricia A.The pulmonary function that is affected by pregnancy is:

a. respiratory rateb. tidal volumec. inspiratory reserve volumed. vital capacity

ANSWER: B. Tidal VolumeRationale: Respiratory rate is unchanged during pregnancy, but tidal volume & resting minute ventilation increase significantly as pregnancy advances. Vital capacity remains unchanged as well as inspiratory reserve volume.The respiratory rate is essentially unchanged, but tidal volume and resting minute ventilation increase significantly as pregnancy advances. The functional residual capacity and the residual volume are decreased as a consequence of the elevated diaphragm. Peak expiratory flow rates decline progressively as gestation advances. Lung compliance is unaffected by pregnancy, but airway conductance is increased and total pulmonary resistance reduced, possibly as a result of progesterone. The maximum breathing capacity and forced or timed vital capacity are not altered appreciably. It is unclear whether the critical closing volume—the lung volume at which airways in the dependent parts of the lung begin to close during expiration—is changed.

Reference: Williams Obstetrics, 23rd edition e-book. Chapter 5 – Maternal Physiology. (No page number indicated in the ebook)

87. ROMERO, KRISTINE JOY V.The Physiologic dyspnea in pregnancy:

a) Results from increased tidal volume that lowers the PCO2b) Induced in large part by estrogen and to a lesser degree by progesteronec) Estrogen lowers the threshold centrallyd) Caused by the increased sensitivity of the chemoreflex response to CO2

Answer: A AND DRationale:•LETTER A IS THE CORRECT ANSWER BECAUSE: In pregnancy there is awareness of desire to breathe and may be interpreted as dyspnea which may suggest pulmonary or cardiac abnormalities even if there is no such abnormalities. This Physiologic dyspnea results from increased tidal volume that lowers the blood PCO2 slightly, which paradoxically causes dyspnea.•Letter B is not the correct answer because The increased respiratory effort and in turn the reduction in PCO2 is most likely induced in large part by progesterone and to a lesser degree by estrogen.•Letter C is not the correct answer because it is Progesterone that acts centrally.•LETTER D IS ALSO A CORRECT ANSWER BECAUSE: Progesterone acts centrally where it lowers the threshold and increases sensitivity of the chemoreflex response to CO2.

Reference: Williams Obstetrics 23rd edition Chapter 5, page 122

88. Pena, Abigail R.The clinical relevance of an increased glomerular filtration rate in pregnancy is/are:

a. increased urinary frequency in 90% of pregnant womenb. renal disease may not be diagnosed early because serum creatinine is decreased during normal pregnancyc. urinary infections are more virulentd. protein, amino acid and glucose excretion decrease

Answer: BRationale: Serum creatinine levels decrease during normal pregnancy from a mean of 0.7 to 0.5 mg/dl. Values of 0.9

mg/dl suggest underlying renal disease and should prompt further evaluation. (Lindheimer and associates, 2000). During the day, pregnant women tend to accumulate water as dependent edema and at night, while recumbent, they mobilize this fluids with dieresis. This reversal of the usual nonpregnant diurnal pattern of urinary flow causes nocturia, and urine is more dilute than in non pregnant women. Failure of a pregnant women to excrete concentrated urine after withholding fluid for approximately 18 hours does not necessarily signify renal damage.

Reference: Williams Obstetrics, 23rd edition page: 124

89. ORAA, MIKHAIL JOREX B.Which of the following urinalysis results in a pregnant woman indicates an abnormal finding? a. glucosuria b. proteinuria c. hematuria d. pyuriaAnswer: D

Rationale: Glucosuria in pregnancy is not usually abnormal. The appreciable increase in glomerular filtration, together with impaired tubular reabsorptive capacity for filtered glucose, accounts in most cases for glucosuria. Proteinurianormally is not evident during pregnancy except occasionally in slight amounts during or son after vigorous labor. Hematurai, if not the result of contamination during collection, most often suggest a diagnosis of urinary tract disease.

Reference: Williams Obstetrics 22nd

edition. Chapter 5 Maternal Physiology. page 138

90. OLIVA, MARK MOSES D.Pyrosis in pregnancy is due to?a. reflux of acidic secretions into the upper esophagus and altered position of the stomach.b. decreased lower esophageal sphincter tone.c. higher intraesophageal pressures and lower intragastric pressures in pregnant womend. esophageal peristalsis that has higher wave speed and higher amplitude

Answer: B. decreased lower esophageal toneRationale: Pyrosis which is common in late pregnancy is a retrosternal burning sensation caused by esophagitis from gastroesophageal reflux associated to relaxation of the lower esophageal sphincter so we outright the answer in choice A, because it refers to the problem in the upper esophagus which should be on the lower esophagus.

Choice C is also wrong because it states that Pyrosis is caused by higher intrasophageal pressure and lower intragastric pressure in pregnant women which should be the other way around, esophagus having a low pressure and the stomach having the higher pressure.

We also outright choice D, because peristalsis which has higher wave speed and higher amplitude should be on the stomach causing the gastric secretions to move up not in the esophagus.

Decreased lower esophageal sphincter tone is the right answer because pyrosis is caused by upward movement of gastric secretions caused by increased stomach tone and decreased lower esophageal sphincter tone.

Reference: Williams Obstetrics, Twenty-Third Edition (ebook), chapter 49 http://www.rightdiagnosis.com/sym/heartburn_in_pregnancy.htm

91. OMAPAS, SHEILAThe increased prevalence of choleserol gallstones in normal multiparesis women is caused by:

a. Decreased residual volume due to increased contractility of the gallbladderb. Estrogen impairing gallbladder contraction by inhibiting cholecystokinin-mediated smooth muscle stimulation.c. Stasis due to impaired emptying leading to increased bile cholesterol saturation.d. Increased dietary intake of cholesterol-laden food.

Answer: CRationale: Williams discusses impaired emptying as the cause of cholesterol accumulation and stone formation.

Reference: Williams, 23rd edition, pages 1073-1074.

92 Montillano, Ana Cristina N.

The thyroid gland undergoes moderate enlargement during pregnancy because of the following except:a) glandular hyperplasiab) increased vascularityc) increased thyrotropin concentrationd) none of the above

Answer: CRationale: To meet maternal and fetal need, the thyroid gland needs to increase its production of thyroid hormones. In order to accomplish it, the thyroid gland undergoes moderate enlargement during pregnancy caused by glandular hy-perplasia and increased vascularity. Total volume is inversely proportional to the serum thyrotropin concentration.

Source: William’s Obstetrics 23rd edition page 127

93. MACATANGAY, MIKHAILJON SAMUEL C.Which among the following is the least contributor to the increase weigh gain by 40 weeks of pregnancy?

a. fetus c. amniotic fluidb. placenta d. uterus

Answer: BRationale: Commulative increase in weight in 40weeks:

Fetus - 3400gPlacenta - 650gAmniotic fluid - 800Uterus - 970

Reference: Williams 23rd Edition page 112 Table 5-1

94. Siocon, Mariel L.Pitting edema of the ankles and legs late in pregnancy is because of:

a. increased venous pressure below the level of the uterusb. partial aortic occlusionc. increase in interstitial colloid osmotic pressured. increase in salt intake due to the increase requirement for sodium and potassium

Answer: ARationale: The accumulation of fluid is due to the occlusion of vena cava which then increases venous pressure below the level of the uterus. In normal pregnancy, blood volume expansion due to increase plasma volume and erythrocytes occurs in the first trimester. The increase in plasma volume decreases the hematocrit and hemoglobin concentration slightly hence the decrease in interstitial colloid osmotic pressure which favors formation of edema.

Reference: Page 115,130, Williams Obstetrics 23rd

edition

95. MACALINTAL, KATRINA CYRIL M.The distribution of proteins in pregnancy are in the following, EXCEPT:

a. fetus and placentab. uterine contractile proteinc. storm and ducts of the breastd. hemoglobin in the maternal blood

Answer: CRationale: "The products of conception, the uterus, and maternal blood are relatively rich in protein rather than fat or carbohydrate. At term, the fetus and placentatogether weigh about 4 kg and contain approximately 500 g of protein, or about half of the total pregnancy increase (Hytten and Leitch, 1971). The remaining 500 gis added to the uterus as contractile protein, to the breasts primarily in the glands, and to the maternal blood as hemoglobin and plasma proteins."

Reference: Williams Obstetrics, 23rd edition, Chapter 5 [no page noted since an ebook was used]

96. PURIFICACION, ARMIN JR. O

Hyperinsulinemia in pregnancy can be explained by:a. Decreased metabolism of insulinb. Pregnancy-induced state of peripheral insulin resistance (ANSWER)c. Suppression of glucagond. Decreased lipolysis

ANSWER: CRATIONALE: According to Williams 23rd Edition, "Normal pregnancy is characterized by mild fasting hypoglycemia, postprandial hyperglycemia, and hyperinsulinemia (Fig. 5-4). This increased basal level of plasma insulin in normal pregnancy is associated with several unique responses to glucose ingestion. For example, after an oral glucose meal, gravid women demonstrate both prolonged hyperglycemia and hyperinsulinemia as well as a greater suppression of glucagon (Phelps and associates, 1981). This cannot be explained by a decreased metabolism of insulin because its half-life during pregnancy is not changed (Lind and associates, 1977). Instead, this response is consistent with a pregnancy-induced state of peripheral insulin resistance, the purpose of which is likely to ensure a sustained postprandial supply of glucose to the fetus. Indeed, insulin sensitivity in late normal pregnancy is 45 to 70 percent lower than that of nonpregnant women (Butte, 2000; Freemark, 2006)."

Reference: E-Book Version of William's 23rd Edition, Copyright © The McGraw-Hill Companies. All rights reserved.Williams Obstetrics, 23e > Chapter 5. Maternal Physiology >

97. Reyes, Christian Lawrence L.The concentration of fat is increased with:

a. storage of fat occurring in the first trimester of pregnancy-storage of fat and deposition occurs in the midpregnancyb. deposition of fat at peripheral rather than central sites-fat is deposited at central sitesc. the fat becoming available for transfer in the second trimester-fat is available for transfer during the last trimester where fetal growth rate is maximald. progesterone setting the lipostat in the hypothalamusAnswer: DRationale: By the end of pregnancy, lipostat returns to its previous non-pregnant level and the added fat is lost.Reference:

98. Noche, Rizza Joyce C. The demand of the developing fetus for calcium is met normally by the following, EXCEPT:

a) Doubling maternal intestinal calcium absorptionb) Dietary intake of sufficient calciumc) Mobilization of calcium from maternal bonesd) None of the above

Answer: d. none of the above.Rationale: parathyroid hormone plasma concentration decreases during the first trimester and increases progressively throughout pregnancy from the low levels of calcium concentration present. Low calcium levels are due to increases in plasma volume, glomerular filtration rate and maternal transfer of calcium. Presence of estrogen blocks the action of the parathyroid hormone on bone resorption leading to a physiologic hyperparathyroidism of pregnancy, a mechanism to supply the fetus with adequate calcium.

1, 25–hydroxyvitamin D3 form is the biologically active compound that stimulates resorption of calcium from bone and absorption from the intestines. It starts with the ingestion or synthesis in the skin, where the liver converts vitamin D to 25–hydroxyitamin D3. The kidney, decidua and placenta is responsible for converting it to its active form with a serum level showing a decrease during normal pregnancies.

More and associates (2003) found that all markers of bone turnover increased during normal pregnancy and failed to reach baseline level of by 12 months postpartum. They concluded that the calcium needed for fetal growth and lactation may be drawn, at least in part, from the maternal skeleton.

Reference: Williams, p. 128

99. ROY, JAMES MAXIMILLIAN VMaternal anemia is characterized by:

a) Hemoglobin is less than 12 g/dlb) Serum ferritin levels less than 20 ng/Dlc) Decrease serum transferrind) A cause of fetal anemia

Answer: ARationale: Anemia is defined as hemoglobin concentration less than 12 g/dL in nonpregnant women and less than 10 g/dL during pregnancy or the puerperium. The modest fall in hemoglobin levels during pregnancy is caused by a relatively greater expansion of plasma volume compared with the increase in red cell volume.

Reference: Williams 23rd

Edition (E-Book), Chapter 51, Anemias, Fig. 51-1

100. VILLASENOR, MARICE VSerum concentrations of sodium and potassium are decreased slightly despite the increased total accumulations of sodium and potassium due to:

a) Expanded plasma volumeb) Enhanced tubular resorptionc) Increased glomerular filtration rated) Increased renal blood flow

Answer: BRationale: Although the glomerular filtration of sodium and potassium is increased, the excretion of these electrolytes is unchanged during pregnancy due to enhanced tubular resorption. And although there are increased total accumulations of sodium and potassium, their serum concentrations are decreased slightly because of expanded plasma volume.

Reference: Williams 23rd

Edition (E-Book), Chapter 5, Electrolyte and Mineral Metabolism