williams obstetrics 23rd edition study guide
TRANSCRIPT
ROGERS • SANTIAGO-MUNOZ • WORLEY
1. Obste tr ics in Pers pec ti ve .....................................2
2. Mat e rn al A n a to m y ..................................................8 , 4. Fetal Gr ow th and D e v e lo p m en t.....................21
3. Im pl an ta ti on , Em bry oge nes is, and 5. Ma ter na l P h ys io lo gy ...........................................27
Placenta l Development ........................... : ........14 & p a r , u r j t i o n ................................................... ...........3 3
M M SECTION 3
8 . Prenatal C ar e .......................... .............................45
9. A b o r t io n ..................................................................50
10. Ect opi c Pregnancy ...............................................56
11. Gesta tional TrophoblasticDisease..................61
14. Teratology and Medic ations That
Aff ect th e F e tu s ......................................................77
15. An tepar tum Assessm ent ................................... 82
16. Feta l Im a g in g ..........................................................8 8
17. Normal Labor and Delivery..................... .......96 23 .
18. I n tr a p a rt u m A s s e s s m e n t .......................... . . . . 1 0 1 24.
19. Obstetrical Anesthesia............................... . .. .1 06 25.
2 0 . Abno rm al Labor........................................... . . . . 1 1 2
2 1 . Disorders of Amnionic Fluid Volume ... . . . . 117 26.
2 2 . Labor Induction............................................. . . . . 1 2 2 IL
1 32
H ys te re c to m y.......................................................1 37
Cord, and M e m b r a n e s ......................................147
SECTION 5 S|9?
FETUS AND NEWBORN
28. The Newborn In fant .15 6 29. Diseases and Injuries of the Fetus
a nd N e w b o r n .......................................................161
PUERPERIUM
31. Puerperal Infection.
,168 32. Contraception.
.178
,184
OBSTETRIC COMPLICATIONS
190 38. Feta l Growth Disorders ........................... .......216
196 39. Mul t i fe ta l Gestat ion ................................. ........2 2 1
205 40. Reproduct ive Tract Abnormal i t ies....... .......22 6
2 1 0
41. General Considerations and Maternal 51. Hematological Disorders............................... 78 6
Eva lu ati on......................................................... 23 4 52. Diabetes ............................................................. 791
42. Critical Care and Trauma ............................. 23 9 53. Thyroid and Other Endocrine Disord ers.. . .296
43. O b e s i ty .............................................................. 24 4 54. Connect ive-Tissue Disorders........................ 301
44. Cardiovascular Diseases............................. 249 55. Neurological and Psychiatric Disorders... 307
45. Chronic Hypertension.................................. 254 56. Dermatological Disorders............................. 31?
46. Pulmonary Disorders..........................: ........ 259 57. Neop las ti c D iseases....................................... 31 7
47. Thromboembol ic Disorders. . .................... 26 5 58. In fect io us Dise as es ......................................... 3? ?
48. Renal and Urinary Tract Disorders 27 0 59. Sexually Transmitted Diseases................... 32 8
49. Gastrointestinal Disorders.......................... . . .276
Disorders.......................................................... . . .281
Index 335
OVERVIEW
Obstetrics in Perspective
1 -1 . Which o f the f ollowing is an example o f an indir ect
mater nal death?
b. Aspir ation f ollowing eclampsia seizur e
C. Hemorr hage f ollowing uter ine atony
d . Aor tic r uptur e secondar y to Mar f an syndr ome
1-2. T he f er tility r ate is the number of live bir ths per 1,000
f emales aged?
b. 11 -59
c. 15 -44
d . 18^9
1-3. A death o f a newbor n at 5 days o f lif e due to congen
ital hear t disease would be classif ied as which o f the
f ollowing?
d. Ear ly neonatal death
1-4. Which o f the f ollowing corr ectly identif ies the tr ends
in f er tility and live bir th r ates in the United States since
2002 ?
a . Ther e has been no change in either r ate.
b. Fer tility and live bir th r ates have incr eased.
C. Fer tility and live bir th r ates have decr eased.
d . Fer tility r ate has decr eased but live bir th r ate is
incr eased.
1 -5 . What statistic is def ined by the r ed line in this f igur e?
,0
oc
N e o n a t a l m o r t a l i ty
F e t a l m o r t a l i ty
,44+ -++0
Y e a r
Repr oduced, with per mission, f r om Cunningham F G , Leveno KJ, Bloom SL, er al:
Williams Obstetr ics, 23r d ed. New Yor k , McGr aw-Hill, 2010.
a. Stillbir th r ate
b. Inf ant death r ate
C. Per inatal mor tality r ate
d. None o f the above
1-6. Most inf ant deaths occur in which o f the f ollowing
gr oups?
C. Inf ants with congenital inf ections
d. Inf ants with congenital anomalies
1-7. Appr oximately what per centage o f pr egnant women
exper ience sever e mater nal mor bidity?
a. 0.1%
b. 0.5%
C. 2%
d. 5%
1-8. Which o f the f ollowing events has contr ibuted to the r ise
in the U . S. cesar ean deliver y r ate?
a. Incr ease in deliver ies per f or med by midwives
b. Decline in vaginal bir ths f ollowing cesar ean deliver y
C. Reduction in r eimbur sement by insur ance companies
f or cesar ean deliver y
d. Impr oved outcomes in inf ants with congenital abnor
malities deliver ed by cesar ean deliver y
Obstetrics in Perspective
1-9. On the basis o f an Amer ican College o f Obstetr icians
and Gynecologists sur vey, which of the f ollowing is the
most common citation f or obstetr ic malpr actice claims?
3 ! Shoulder dystocia
C. Stillbir th or neonatal death
d . Neur ologically impair ed neonate
1-10. Adolescent pr egnancy accounts f or what per centage
o f the total number o f unintended pr egnancies in the
United States?
a. 5%
b. 10!
c. 25%
d. 33%
1-11. What per centage o f the gr oss domestic pr oduct curr ently
goes towar d health car e?
3 ! 6#
b. 16%
C. 26%
d. 36%
1-12. The f ield o f obstetr ics encompasses all EXCEPT which
o f the f ollowing?
a. Pr enatal car e
b. Management o f labor
C. Inf er tility tr eatments
d. Immediate newbor n car e
1-13. “Pr eter m” def ines neonates bor n bef or ewhat gestational
age?
a. 34 completed week s
b. 36 completed week s
C. 37 completed week s
d. 38 completed week s
1-14. What is the leading indication f or hospitalization dur ing
pr egnancy not r elated to deliver y?
a. Inf luenza
b. Diabetes mellitus
d. None o f the above
1-15. The curr ent number o f abor tions per f or med annually in
the United States appr oximates which o f the f ollowing?
a. 100,000
b. 500,000
C. 1,000,000
d. 2,000,000
1-16. Ver y low-bir thweight newbor ns ar e def ined as those
whose bir thweight lies below which o f the f ollowing
thr esholds?
d. 2 , 0 0 0 g
1-17. Which of the f ollowing is def ined as the number of
mater nal deaths that r esult f r om the r epr oductive
pr ocess per 1 0 0 , 0 0 0 live bir ths?
a. Mater nal mor tality r ate
b. Mater nal mor tality r atio
C. Dir ect mater nal death r ate
d. Pr egnancy-r elated death r ate
1-18. Including spontaneous abor tions, induced abor tions,
and live bir ths, what was the appr oximate number o f
pr egnancies in 2006?
a. 4 million
b. 5 million
C. 6 million
d. 7 million
1-19. Which r acial / ethnic gr oup has the highest f etal death
r ate in the United States?
a. White
b. Black
C. Asian
d. Hispanic
1-20. Fetal death in the United States is def ined as which o f the
f ollowing?
b. Death af ter 20 week s’ gestation
C. Death with a bir thweight gr eater than 500 g
d. All o f the above
1-21. Registr ation o f live bir ths is curr ently assigned to which
national agency?
b. National Institutes of Health
C. Depar tment o f Health and Human Ser vices
d . National Center f or Health Statistics
1-22. Which o f the f ollowing is NOT among the top thr ee
causes o f pr egnancy-r elated death?
a. Embolism
4 Overview
1-23 . What is the aver age number o f live bir ths per woman in
the United States?
a. l
b. 2
c. 3
d. 4
1-24. What was the cesar ean deliver y r ate in the United States
in 2006?
a. 21!
b. 28%
c. 31%
d. 36%
1-25 . Which o f the f ollowing contr ibuted to the tr end on this
gr aph?
1-26. Goals o f Healthy People 2010 and 2020 include all
EXCEPT which o f the f ollowing?
a. Reduce mater nal mor tality r ates
b. Reduce nonmater nal death r ates
C. Reduce the r ate o f pr eter m deliver y
d . Decr ease the dispar ity o f outcomes between whites
and ethnic / r acial minor ities
Y e a r
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, et al: "Williams
Obstetr ics, 23 r d ed. New Yor k , McGr aw-Hill, 2010
3. Contr aception
d. All of the above
cited Header cited
1-1 d p. 3 Definitions 1-14 d p. 4 Pregnancy-Related Care
1-2 c p. 3 D efinitions 1-15 c p. 4 Table 1-1
1-3 d p. 3 D efinitions 1-16 c p. 3 D efinitions
1-4 c p. 4 Pregnancy Rates 1-17 b p. 3 Definitions
1-5 c p. 5 Figure 1-1 1-18 b p. 4 Pregnancy Rates
1-6 a p. 5 Infant Deaths 1-19 b P-5 Figure 1-2
1-7 b p. 6 Severe Maternal Morbid ity 1-20 d p. 3 D efinitions
1-8 b p. 7 Rising Cesarean Delivery Rate 1-21 d p. 2 Vital Statistics
1-9 d p. 9 Table 1-5 1-22 c p. 6 Table 1-2
1-10 c p. 10 Figure 1-5 1-23 b p. 4 Pregnancy Rates
1-11 b p. 11 Healthcare Reform 1-24 c p. 7 Rising Cesarean Delivery Rate
1-12 c P- 2 Introduction 1-25 d p. 6 Figure 1-3
Maternal Anatomy
2 -1 . Which o f the f ollowing in gener al is tr ue o f ver tical
abdominal incisions?
a . Heal better than Pf annenstiel incisions
b. Follow ver tically or iented der mal f iber s (Langer lines)
C. Yield inf er ior cosmetic r esults compar ed with tr ans
ver se incisions
d. Sustain decr eased later al tension
2 -2 . The f emor al ar ter y gives r ise to all EXCEPT which o f
the f ollowing vessels?
2 -3 . Which der matome appr oximates the level o f the
umbilicus?
b. T12
c. T10
d. LI
2-4. Which vulvar str uctur e is homologous to the male
scr otum?
d. Labia ma jor a
2 -5 . With r egar d to the vestibule, which of the f ollowing
statements is corr ect?
a. It is der ived f r om embr yonic ur ogenital membr anes.
b. The poster ior por tion between the f our chette and the
vaginal opening is called the f ossa annular es.
C. It is per f or ated by f our openings,
d. The f ossa navicular is is usually obser ved only in nulli-
par ous women.
2 -6 . The inter nal pudendal ar ter y supplies which o f the
f ollowing?
C. Distal vaginal wall
d. Bladder tr igone
-cec; with per missio n, f r om Cunn ingham F G , Leveno KJ, Bloom SL , et al: Williams
:cs. lo r d ed. New Yor k , McGr aw-Hill, 2010.
a. super f icial cir cumf lex iliac ar ter y
b. Exter nal pudendal ar ter y
C. !r .:;r :or epigastr ic ar ter y
d. ' _rrr f _cial epigastr ic ar ter y
Mate rna l Ana tom y
2-7. The vagina and its investing musculatur e ar e supplied by 2-11. Which o f the f ollowing is tr ue r egar ding the uter us?
all EXCEPT which o f the f ollowing ar ter ies? $ _ j t measur es 8 to 9 cm in length in nullipar ous
women.
b. It weighs 50 to 70 g in the par ous woman.
C. In the nullipar a, the f undus and the cer vix ar e o f
equal length,
d. T he cer vix is composed mainly o f muscle.
2-12. The cer vix contains little o f which of the f ollow compo
nents?
d. Elastin
2-13. Concer ning the endometr ium, which o f the f ollowing is
tr ue?
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL, et al: Williams
Obstetr ics, 2 3r d ed. N ew Yor k , McGr aw-Hill, 2010.
a. Inf er ior r ectal ar ter y
b. Per ineal ar ter y
C. Pudendal ar ter y
d . Poster ior labial ar ter y
2-8. Which o f the f ollowing is tr ue concer ning the anal
sphincter s?
a. The exter nal anal sphincter r eceives blood supply
f r om the super ior r ectal ar ter y.
b. The inter nal anal sphincter contr ibutes the bulk of
anal canal r esting pr essur e.
C. The exter nal anal sphincter measur es 3 to 4 cm in
length.
d . The exter nal sphincter r emains in a state o f constant
r elaxation.
2-9. The per ineal body is f or med par tly by which o f the f ol
lowing muscles?
b. Gluteus maximus muscle
C. Bulbocaver nosus muscle
d. Levator ani muscle
2-10. Which o f the f ollowing is the potential space between
the anter ior sur f ace of the uter us and the poster ior wall
o f the bladder ?
b. Rectovaginal septum
C. Mor ison pouch
d. Vesicouter ine space
Repr oduced, with per mission, f r om Hoff man BL: Abnor mal uter ine bleeding. In: Schor ge
JO , Schaff er JI, Halvor son LM , et al., eds. Williams Gynecology. New Yor k , McGr aw-Hill,
2008, Figur e 8-2.
a . The basal ar ter y comes dir ectly f r om the ar cuate
ar ter y.
b. Spir al ar ter ies extend dir ectly f r om r adial ar ter ies.
C. The f unctionalis layer contains spir al ar ter ies and
r adial ar ter ies.
d. The spir al ar ter ies extend dir ectly f r om the ar cuate
ar ter y.
A rc u a te a rt e ry
Uter ine ar te ry
Basa l a r te ry
Basa l is layer
E n d o m e t r ia l v e i n
M y o m e t r i u m
U t e r u s l u m e n
Epi the l ium
Uter ine g lands
V e n o u s s i n u s o i d s
Funct iona l i s layer
Ana to m y and Phy siolog y
2-14. Dur ing postpar tum tubal ster ilization, which o f the
f ollowing corr ect anatomical inf or mation may assist
you?
a . The f allopian tube lies anter ior to the r ound liga
ment.
b. The f allopian tube lies poster ior to the uter oovar ian
ligament.
C. The r ound ligament lies anter ior to the f allopian
tube.
d. The uter oovar ian ligament lies anter ior to the r ound
ligament.
2-15. The ar ter y that r uns thr ough this str uctur e (arr ow)
dir ectly ar ises f r om which o f the f ollowing?
2-17. The r ight ovar ian vein empties into which o f the f ollow
ing veins?
C. Inter nal iliac vein
d. Exter nal iliac vein
2 -1 8. Ovar ian vessels ar e f ound in which o f the f ollowing liga
ments?
d. Inf undibulopelvic
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, et al: Williams
Obstetr ics, 2 3r d ed. N ew Yor k , McGr aw-Hill, 2010.
a. Sampson ar ter y
b. Inter nal iliac ar ter y
C. Uter ine ar ter y
d. Obtur ator ar ter y
2-16. The ovar ian ar ter y is a dir ect br anch of which o f the
f ollowing vessels?
b. Aor ta
d. Exter nal iliac ar ter y
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL , et al: Williams
Obstetr ics, 2 3r d ed. N ew Yor k , McGr aw-Hill, 2010.
a. Aor ta
b. Exter nal iliac ar ter y
C. Inter nal iliac ar ter y
d. No ne o f the above
2-2 0 . The uter ine ar ter y is a main br anch o f which o f the
f ollowing vessels?
d. Iliolumbar ar ter y
2-19. The comm on iliac ar ter y ar ises dir ectly f r om which o f
the f ollowing?
Mh f ^c V f h fm
BchfcVa
2 - 21 . T he inter nal pudendal ar ter y ar ises f r om which o f the
f ollowing vessels?
C. Vaginal ar ter y
d. Inf er ior epigastr ic ar ter y
2-22 . Fr om pr oximal (uter us) to distal (f imbr ia), the corr ect
pr ogr ession o f f allopian tube anatomy is which o f the
f ollowing?
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KL , Bloom SL, et aJ: Williams
Obstetr ics, 22 nd ed. New Yor k , McGr aw-Hill, 2006. http: // www.accessr nedicine.com.
Figur e 1.
a. Isthmus, inf undibulum, ampulla
b. Isthmus, ampulla, inf undibulum
C. Inf undibulum, ampulla, isthmus
d. Ampulla, inf undibulum, isthmus
2~2 3. Which o f the f ollowing bone(s) f or ms the pelvis?
a. Innominate
d . All o f the above
2 -24. Which o f the f ollowing is tr ue r egar ding r elaxation o f the
pelvic joints at ter m in pr egnancy?
a . It allows f or an incr ease in the tr ansver se diameter of
the midpelvis.
b. It r esults in mar k ed mobility o f the pelvis at ter m
because o f a downwar d gliding movement o f the
sacr oiliac (SI) joint.
C. Displacement of the SI joint incr eases outlet diame
ter s by 1.5 to 2.0 cm in the dor sal lithotomy position,
d . It is per manent and not accentuated in subsequent
pr egnancies.
Mate rna l Ana tomy
2-2 5 . The shor test anter oposter ior diameter o f the pelvic inlet
is which o f the f ollowing?
a. Tr ue con jugate
b. Obstetr ical con jugate
C. Diagonal con jugate
d. None o f the above
2-26 . The clinical evaluation o f the pelvic inlet r equir es dir ect
measur ement of which diameter ?
a. Tr ue con jugate
b. Obstetr ical con jugate
C. Diagonal con jugate
2-27. Engagement occur s when the bipar ietal diameter of
the f etal head descends below the level o f which o f the
f ollowing?
a. Midpelvis
C. Pelvic f loor
d. Ischial tuber osities
2-28. In this f igur e, which o f the f ollowing is demonstr ated?
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno K J, Bloom SL, et al: Williams
Obstetr ics, 23r d ed. New Yor k , McGr aw-Hill, 2010.
a. Impor tant pelvic outlet diameter s
b. Ischial tuber osities
C. Midpelvis ischial spines
Anato m y and Phy siolog y
2-29 . What is the narr owest pelvic dimension that must be
navigated by the f etal head?
a. Inf er ior str ait
b. Obstetr ical con jugate
C. Inter spinous diameter
d . Tr ansver se diameter o f the pelvic inlet
2-30 . Which o f the f ollowing is tr ue o f the midpelvis?
a. It is measur ed at the level o f the ischial tuber osities.
b. It usually measur es no mor e than 9 cm.
C. It is measur ed at the level o f the ischial spines,
d . It usually is the lar gest pelvic diameter .
2 - 3 1 . Which o f the f ollowing is the most common pelvic
shape?
C. Andr oid pelvis
d. Gynecoid pelvis with andr oid tendency
2 - 3 2 . The pubococcygeus muscle is now pr ef er ably called
which o f the f ollowing?
a. Pubor ectalismuscle
b. Iliococcygeus muscle
CHAPTER 2 ANSWER KEY
Le t te r
Page
Quest ion
Let ter
Page
cited Header c i ted
2-1 c p. 14 Skin 2-17 a p. 26 Blood Vessel
2-2 c p. 14 B lood S upply 2-18 d p. 26 B lood Vessel
2-3 c p. 15 Inne rva tion 2-19 a p. 27 Figure 2-16
2-4 d p. 15 Labia Majora 2-20 b p. 27 Figure 2-16
2-5 a p. 16 Vest ibule 2-21 b p. 27 Figure 2-16
2-6 c p. 18 V as cu la r a nd L ym p h atic Su pp ly 2-22 b p. 28 Fallop ian Tubes
2-7 a p. 20 Figure 2-5 2-23 d p. 29 Pelvic Bones
2-8 b p. 20 Ana l S ph in c te r 2-24 c p. 29 Pelvic Joints
2-9 c p. 21 P erineal Body 2-25 b p. 31 Pelvic In le t
2 -10 d p. 21 U terus 2-26 c p. 31 Pelvic In le t
2-11 c p. 21 Size and Shape 2-27 b p. 31 Pelvic in le t
2-12 a p. 23 Cervix 2-28 c p. 31 Pelvic Inlet
2-13 b p. 24 Endome t r i um 2-29 c p. 31 M idp e lv is
2-14 c p. 25 L igaments 2-30 c p. 32 Midpe lv is
2-15 c p. 26 Figure 2-15 2-31 a p. 32 Pelvic Shapes
implantation, Embryogenesis, and Placental Development
3 -1 . The nor mal length o f the aver age menstr ual cycle r anges
between which o f the f ollowing values?
a . 14—28 days
d. 30-40 days
3 -2 . O f the 2million oocytes in the human ovar y pr esent
at bir th, appr oximately how many ar e pr esent at the
onset of puber ty?
a. 200,000
b. 300,000
c. 400,000
d. 500,000
3 -3 . Which hor mone is r equir ed f or the late-stage
development o f antr al f ollicles?
a. Luteinizing hor mone (LH)
b. Follicle-stimulating hor mone (FSH)
C. Es tr adiol
d. Andr ostenedione
3 -4. Dur ing the f ollicular phase o f the menstr ual cycle,
estr ogen is pr imar ily pr oduced by which cells of the
dominant f ollicle?
C. Gr anulosa
d. Endometr ial
3 -5. The pr ocess thr ough which the cor pus luteum develops
f r om the r emains o f the Gr aaf ian f ollicle is called which
o f the f ollowing?
a. Luteinization
b. Thecalization
C. Decidualization
d. Gr aaf ian tr ansf or mation
3 -6 . What is the peak ovar ian pr ogester one pr oduction
dur ing midluteal phase?
b. 25-50 mg / d
d. 75-100 mg / d
3-7 . Which o f the f ollowing is the most biologically potent
natur ally occurr ing estr ogen?
a . Estr iol
b. Estr one
C. Estetr ol
d. 17|3-estr adiol
3 -8 . Which o f the f ollowing is the endometr ial layer that is
shed with ever y menstr ual cycle?
a . Basalis layer
b. Decidual layer
C. Luteinized layer
d. Functionalis layer
3 -9 . Which o f the f ollowing is the f ir st h istological sign of
ovulation?
a. Cessation o f glandular cell mitosis
b. Vacuoles at the apical por tion o f the secr etor y
nonciliated cells
C. Secr etion o f glycopr otein and mucopolysacchar ide
by secr etor y nonciliated cells
d. Subnuclear vacuoles and pseudostr atif ication in the
basal por tion o f the glandular epithelium
3 - 10 .
3 - 11 .
-+,+ .
In the f ollowing f igur e, the spir al ar ter ies ar e identif ied
by which letter ?
E pith eliu m ----------— •— ''7 i .
C a p i l l a r i e s--------- --------------------------------i f > U / i £T * \ \ j JK J y J r
Ve no us si n u s--------------- | f S m w y Su r l n T r ) i t I B ?g " r H ~t Funct ional is
Endomet r ia l g land -----------------------------> 4 l f ( \ J) Ws l ayer
A rt e ry A -
A rt e ry B -
A rt e ry C -
A rt e ry D
Basal is layer
Myomet r ium
Uter ine ar te ry --------------------------------
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, et al. Williams Obstetr ics, 2 3r d ed. New Yor k :
McGr aw-Hill, 2010.
consistent with the menstr ual phase?
a. A
b. B
c. C
d. D
3
2
16 Ana tomy and Phys io logy
3 -12. Which pr ostaglandin plays a r ole in vasoconstr iction o f
the spir al ar ter ies, leading to menstr uation?
a. PG E j
d. PG F2a
3 -13. In sequence f r om letter s A to C , please identif y the thr ee
types o f deciduas in the f igur e below:
a. Basalis, capsular is, par ietalis
b. Capsular is, basalis, par ietalis
C. Par ietalis, basalis, capsular is
d. Par ietalis, capsular is, basalis
3 -1 5 . The placenta does not per f or m which o f the f ollowing
f unctions f or the f etus?
a. Renal
b. Hepatic
C. Adr enal
d. Pulmonar y
3 -16. At 5 days postf er tilization, the blastocyst is r eleased f r om
which surr ounding str uctur e?
a. Mor ula
=X^YiV <
XVcVa
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, er al: Williams Obstetr ics,
23 r d ed. New Yor k , McGr aw-Hill, 2010.
3 -14. What is the Ni tabuch layer ?
a . A layer o f the decidua composed o f lar ge, distended
glands
b. An ar ea o f the decidua with lar ge, closely pack ed
epithelioid, polygonal cells
C. A zone o f f ibr inoid degener ation in which the invad
ing tr ophoblasts meet the decidua
d. An ar ea o f super f icial f ibr in deposition at the bottom
o f the inter villous space and surr ounding the anchor
ing villi
3 -17. Which o f the f ollowing gives r ise to the chor ionic str uc
tur es that tr anspor t oxygen and nutr ients between f etus
and mother ?
d. Endovascular tr ophoblast
3-18 .
Repr oduced, with per mission, f r om Str eeter G L. A human embr yo [Mateer ] o f the pr esomite per iod. Contr ib Embr yol 1920; 9:389.
3-19 . Which o f the f ollowing statements is accur ate r egar ding
the chor ion f r ondosum?
a . Is the same as the chor ion laeve
b. Is the mater nal component o f the placenta
C. Is the avascular ar ea that abuts the decidua par ietalis
d. Is the ar ea o f villi in contact with the decidua basalis
3-20 . Mater nal r egulation o f tr ophoblast invasion and vascular
gr owth is mainly over seen by which o f the f ollowing?
a . Decidual natur al k iller (dNK) cells
b. C D 4 + T cells
C. Pr ogester one
d. Cellular adhesion molecules
3 - 21 . All EX CEPT which o f the f ollowing is tr ue r egar ding
f etal f ibr onectin?
a. Is a matr ix metallopr oteinase
b. Is also k nown as “tr ophoblast glue”
C. Is a pr ognostic indicator o f pr eter m labor
d. Plays a r ole in tr ophoblast invasion o f the en
dometr ium
3-23 . End diastolic blood f low can be identif ied in the f etal
umbilical ar ter y by the end of which week o f pr egnancy?
a. 10
b. 12
c. 14
d. 16
3-24 . Regar ding the or ientation o f spir al bloodvessels in r ela
tionship to the uter us, which o f the f ollowing is tr ue?
a . Both ar ter ies and veins ar e par allel to the uter ine wall
b. Both ar ter ies and veins ar e per pendicular to the uter
ine wall
C. Ar ter ies ar e per pendicular , and veins ar e par allel to
the uter ine wall
d. Veins ar e per pendicular , and ar ter ies ar e par allel to
the uter ine wall
Which o f the labeled str uctur es in the f ollowing f igur e 3-22 . Remodeling o f mater nal spir al ar ter ies by invading tr o-
will eventually become the umbilical cor d? phoblasts is completed by which week (s) o f pr egnancy?
a. A a. 8
b. B b. 12
2
18 A n a to m y an d P hys io lo gy
3-25 . The phenomenon that descr ibes how f etal cells can be
come engr af ted in the mother dur ing pr egnancy and
then be identif ied decades later is called which o f the
f ollowing?
C. Hemochor ial invasion
d. Immunological neutr ality
3-26 . The amnion is composed o f all EX CEPT which o f the
f ollowing?
a. Lymphatics
d. A cellular zo naspongiosa
3 - 27 . Which o f the f ollowing is accur ate r egar ding Meck el
diver ticulum?
a. Is the allantoic duct r emnant
b. Is a f ailur e o f the r ight umbilical vein to involute
C. Is an extr aabdominal r emnant o f the umbilical vesicle
d. Is a f ailur e o f the intr aabdominal por tion o f the um
bilical vesicle to atr ophy
3-28 . As shown in this f igur e, blood coming f r om the placenta
to the f etus tr avels f r om the umbilical vein into which o f
the f ollowing?
b. The hepatic vein
C. The ductus venosus
O x y g e n a t e d
M i x e d
D e o x y g e n a t e d
Repr oduced, with per missio n, f r om Cunn ingham F G , Leveno KJ, Bloom SL , et al: W illiams Obstetr ics, 23 r d cd.
New Yor k , McGr aw-Hill, 2010.
mplantation, Embryogenesis, and Placental Development
3-29. The amino acid sequence o f die a-subunit o f human
chor ionic gonadotr opin (hCG ) is identical in all
EXCEPT which o f the f ollowing?
a. LH
C. FSH
d. Thyr oid-stimulating hor mone (TSH)
3 -30. Abnor mally low levels o f hC G may be f ound in which of
the f ollowing?
b. Ectopic pr egnancy
d. Gestational tr ophoblastic disease
3 -3 1 . Known biological actions o f h C G include all EXCEPT
which o f the f ollowing?
a. Mater nal thyr oid stimulation
b. Inhibition o f r elaxin secr etion
C. Sexual diff er entiation o f the male f etus
d . Rescue and maintenance o f the cor pus luteum
3-32. Which o f the f ollowing has the gr eatest pr oduction r ate
o f any k nown human hor mone?
a. Pr ogester one
b. Human placental lactogen
d. hC G
3-33. Among placental peptide hor mones, which o f the f ol
lowing has shown a corr elation with bir thweight?
3. Leptin
b. Activin
C. Inhibin
d. Neur opeptide Y
3-34. Which o f the f ollowing is tr ue o f bilater al oophor ectomy
at 9 week s’ gestation?
a. Will cause miscarr iage
b. Will cause a signif icant dr op in pr ogester one levels
C. Will not alter the excr etion o f ur inar ypr egnanediol
d. No ne o f the above
3~35 . What is the pr ecur sor of placental pr ogester one?
a . Fetal high-density lipopr otein (HD L) cholester ol
b. Fetallow-density lipopr otein (LDL) cholester ol
C. Mater nal HD L cholester ol
d. Mater nal L D L cholester ol
3-36. Besides being anX-link ed disor der that aff ects male
f etuses, tr ue statements r egar ding ichthyosis include
which o f the f ollowing?
a . It is seen with f etal adr enal hypoplasia.
b. It is seen with f etal adr enal hyper plasia.
C. It is associated with f etal placental sulf atase
def iciency.
d . It is associated with f etal placental ar omatase
def iciency.
3-37. Which o f the f ollowing conditions is associated with
elevated estr ogen levels in pr egnancy?
a. Down syndr ome
d . Fetal placental ar omatase def iciency
CHAPTER 3 ANSWER KEY
Quest ion Let te r Page
n u m be r a n sw er c ited Header c i ted
3-1 b p. 37 The Ova r ian Cyc le
3-2 t p. 37 Fo l li cul ar or P reovu la to r y
Ovarian Phase
Ovarian Phase
Ovarian Phase
Ovarian Phase
Ovarian Phase
A ct io n
Cyc le /Pro l i fe ra t ive and
Preovu la tory Endometr ia l
Phase
3-9 d p. 42 Secretory o r P ostovu la tory
Endometr ial Phase
3-11 d p. 38 Dat ing o f Endometr ium,
Figure 3-2
3-12 d p. 44 P r os ta g la n di ns a nd
Mens t rua t i on
3-13 d p. 45 Dec idua l S t ruc ture /F igure 3-8
3 -14 c p. 46 Decidual Histology
3-15 c p. 47 I m p l a n ta t io n , P l ac en ta l
Fo rma t i on and Membrane
D e v e l o p m e n t
3-16 c p. 47 Ovum Fert i l izat ion and Zygote
Cleavage
3 -17 a p. 49 T rophob las t D i f f e ren t i a ti on
3-18 a p. 51 Figure 3-15, Early Trophoblast
Invasion
Quest ion Let te r Page
n u m be r a n s w er c ite d Header c i ted
3-19 d p. 52 Deve lopment o f Chor ion and
Decidua
3 -20 a p. 53 Materna l Regu la t ion o f
Trophoblast Invasion and
Endome t r i um
3-22 c p. 54 Invasion of Spiral Arter ies
3-23 a p. 56 Fetal Circulation
3 -24 c p. 57 Maternal Circulat ion
3-25 a p. 58 Breaks in the Placental
"Bar r ie r "
3 -26 a p. 59 The Amn ion /S t ruc tu re
3-27 d p. 62 Cord Deve lopment
3 -28 c p. 62, 90 Cord Structure and
Funct ion/F igure 4-12
3-29 b p. 63 hCG/Chemical Character ist ics
3-30 b p. 64 Sign i f icance o f abnormal ly
high or lo w hCG levels
3-31 b p. 64 Known Biological Funct ions of
hCG
Lac togen /Chemica l
3-34 c p. 67 Placental Progesterone
Product ion
Rates
Def ic iency
3-37 b p. 71 Materna l Condi t ions That
A ff e c t P la ce nt a l Est ro ge n
Product ion
Feta! Growth and Development
4 -1 . Apatient r epor ts that the f ir st day of her last menstr ual
per iod was Apr il 10. On the basis o f Naegele r ule, her
due date is which o f the f ollowing?
a . Januar y 17
d. July 3
4-2. The length o f the embr yonic per iod is which o f the
f ollowing?
a. 6 week s
b. 8 week s
C. 12 week s
d. 14 week s
4 -3 . The image below is o f a human embr yo at 22 days’
gestation. The ar ea mar k ed “A” r epr esents which o f the
f ollowing?
Repr oduced, with per mission, f r om Cunningham FG , Leveno KJ, Bloom SL, etal: Williams
Obstetr ics, 23r d ed. New Yor k , McGr aw-Hill, 2010.
a. Amnion
d. Bladder
4-4. At 28 week s’ gestation, what is the chance o f sur vival
without physical or neur ological impair ment?
a. 50%
b. 65%
c. 90%
d. 100%
4 -5 . Which o f the f ollowing f etal head diameter measur e
ments is the lar gest?
a. Bitempor al
b. Bipar ietal
d. Occipitomental
4 -6 . The shif ting or sliding o f the f etal head bones to per mit
acc ommodation o f the f etal head to the mater nal pelvis
is r ef err ed to as which o f the f ollowing?
a . Caput
b. Yielding
C. Molding
d. Flexion
4-7. Uter oplacental blood f low at ter m measur es appr oxi
mately which o f the f ollowing?
a. 50-100 mL / min
b. 100-300 mL / min
C. 700-900 mL / min
d. 1,200-1,400 mL / min
The f ollow ing image applies to questions 4—8 and 4—9.
A nato m y and Ph ys io logy
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL , eta l: Williams
Obstetr ics, 23 r d ed. New Yor k , McGr aw-Hill, 2010.
4 -8 . Which o f the f ollowing sequences corr ectly names the
labeled f etal head bones?
a. A is the f r ontal bone, B is the par ietal bone, and C is
the occipital bone.
b. A is the par ietal bone, B is the occipital bone, and C is
the f r ontal bone.
C. A is the tempor al bone, B is the f r ontal bone, and C is
the occipital bone,
d. A is the f r ontal bone, B is the tempor al bone, and C is
the par ietal bone.
4 -9 . The sutur e that is bor der ed by the bones labeled A and B
is which o f the f ollowing?
a. Fr ontal sutur e
b. Cor onal sutur e
C. Sagittal sutur e
d. Lambdoid sutur e
4-10. Which o f the f ollowing sequences corr ectly names the
labeled f etal head diameter s?
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL , et al. Williams
Obstetr ics, 2 2 nd ed. New Yor k : McGr aw-Hill, 2005.
a. A is suboccipitobr egmatic, B is occipitof r ontal, and
C is occipitomental.
b. A is occipitof r ontal, B is suboccipitobr egmatic, and
C is occipitomental.
C. A is occipitomental, B is occipitof r ontal, and C is
suboccipitobr egmatic.
d. A is occipitof r ontal, B is occipitomental, and C is
suboccipitobr egmatic.
4-11. Fetal blood oxygen stor es ar e suff icient to sustain the
f etus f or what time length?
3. 30 seconds
b. 60 -120 seconds
C. 3—4 minutes
d. 5—7 minutes
4-12. Car bon dioxide (CO % ) tr ansf er f r om the f etus to the
mother is f avor ed due to which o f the f ollowing mecha
nisms?
a. Oxygen tr aver ses the chor ionic villus mor e r apidly
than car bon dioxide.
tr ansf er .
C. Par tial pr essur e o f CO % in the umbilical ar ter ies is less
than in mater nal inter villous blood,
d . Fetal blood has less aff inity f or CO % than does mater
nal blood.
Fetal Growth and Development
4 -13. Oxygen, car bon dioxide, and water ar e tr ansf err ed acr oss
the placenta via which mechanism?
a. Facilitated diff usion
b. Simple diff usion
d. Carr ier -mediated diff usion
4 -14. Which of the f ollowing hor mones block s mater nal pe
r ipher al uptak e and use o f glucose while pr omoting mo
bilization and use of f r ee f atty acids by mater nal tissues?
a . Human chor ionic gonadotr opin (hCG)
b. Human placental lactogen (HPL)
C. Relaxin
d. Leptin
4 - 1 5 . Which o f the f ollowing statements about placental
tr anspor t is tr ue?
3. The placenta concentr ates a lar ge number o f amino
acids.
b. Lar ge pr oteins ar e f r eely tr ansf err ed acr oss the pla
centa.
C. Copper levels ar e higher in f etal plasma than mater
nal plasma because o f carr ier -mediated tr ansf er ,
d. Vitamin C cr osses the placenta by simple diff usion.
4 -16. Which o f the f ollowing immunoglobulins cr osses the
placenta in lar ge amounts?
a. Immunoglobulin A
b. Immunoglobulin E
C. Immunoglobulin M
d. Immunoglobulin G
4 -17. Amnionic f luid is composed lar gely o f f etal ur ine star ting
at what gestational age?
C. 30 week s
d. 40 week s
4 -18. Fetal k idneys star t pr oducing ur ine at what gestational
age?
b. 16 week s
C. 12 week s
d . 8 week s
4-19. Which o f the f ollowing statements about f etal cir cula
tion is corr ect?
a . Ventr icles o f the f etal hear t wor k in ser ies.
b. The oxygen content o f the blood enter ing the lef t
ventr icle is less than that enter ing the r ight ventr icle.
C. The r ight atr ium dir ects enter ing blood to the lef t
atr ium or r ight ventr icle depending on the oxygen
content o f the blood.
d. Most o f the r ight ventr icular output enter s the pul
monar y vasculatur e.
4-20. What per centage o f r ight ventr icular output goes to the
lungs?
a. 15%
b. 30%
c. 45%
d. 60%
4 - 2 1 . When do the distal hypogastr ic ar ter ies under go atr ophy
and obliter ation postnatally?
b. 3—4 days af ter bir th
C. 1week af ter bir th
d. 6 months o f age
4 -2 2 . The umbilical ar ter ies become which of the f ollowing?
3. Ligamentur n ter es
b. Ligamentum venosum
d. Umbilical ligaments
4 -2 3. Hemoglobin content o f f etal blood at ter m is which o f
the f ollowing?
d. 24g / dL
4-24. Fetal hemopoiesis is f ir st seen in which o f the f ollowing?
a. Bone marr ow
d. Kidneys
4 -2 5 . Fetoplacental blood volume at ter m is which o f the f ol
lowing?
Anato m y and Phy siolog y
4-26. Fetal hemoglobin F is pr oduced at which o f the f ollow
ing sites?
4-27. Which o f the f ollowing statements about immunoglob
ulin is corr ect?
a . Th e bulk o f mater nal IgG tr anspor t to the f etus oc
cur s in the second tr imester .
b. Incr eased levels o f IgM ar e f ound in newbor ns with
congenital r ubella, cytomegalovir us inf ection, or
toxoplasmosis.
C. Th e newbor n acquir es signif icant passive immunity
f r om the absor ption o f humor al antibodies ingested
in colostr um.
d. Pr eter m neonates have an adequate amount o f pr o
tective mater nal antibodies.
4-28. WTtich o f the f ollowing f etal activities, not pr esent until
24 week s, is the last to develop?
a. Opening the mouth
C. Br eathing
d. Suck ing
4-29. In r egar d to the passage o f uncon jugated bilir ubin acr oss
the placenta, which o f the f ollowing is corr ect?
a . It only passes f r om the f etal to the mater nal side.
b . It only passes f r om the mater nal to the f etal side.
C. It is not exchanged to any signif icant degr ee between
mother and f etus,
d. It is bidir ectional.
4-3 0 . W'hich o f the f ollowing is corr ect in r egar d to f etal ur ine?
a. At ter m, the f etus pr oduces 650 mL / d.
b. It is hyper tonic with r espect to f etal plasma.
C. Hemorr hage and hypoxia r esult in incr eased ur ine
output.
d . Fetal k idneys star t to pr oduce ur ine at 6 week s’ gesta
tion.
4 - 3 1 . Th e limits o f f etal viability ar e deter mined by which o f
the f ollowing pr ocess?
a . Hepatic development
b. Fetal immunocompetence
C. Kidney f or mation
d. Pulmonar y gr owth
4-3 2 . Ninety per cent o f sur f actant (dr y weight) is which o f the
f ollowing?
d. Water
4 -33 . Which o f the f ollowing statements r egar ding the sex-
deter mining r egion is tr ue?
a. It is located on the long ar m o f the Y chr omosome.
b. It dir ects development o f the testis.
C. It is expr essed in sper matozoa.
d . It is located on chr omosomes 4 and 8.
4 -34 . Which o f the f ollowing stimulates the f etal testes to
secr ete testoster one?
b. 5a-dihydr otestoster one
d. HPL
4-35. You ar e ask ed to see a newbor n with genital ambigu
ity. An image o f the newbor n is pr ovided. Imaging and
blood tests have conf ir med that this baby is 46, X X and
has a uter us, f allopian tubes, and upper vagina, No testes
ar e pr esent. The diagnosis is which o f the f ollowing?
a. Dysgenetic gonads
C. Male pseudoher maphr oditism
d. Female pseudoher maphr oditism
R epr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL , et al: Williams
Fetal Growth and Developmen
4 -36. In the case o f 21 -hydr oxlase def iciency, which o f the
f ollowing dr ugs can be administer ed to the mother to
r educe genital vir ilization in the f etus?
a. Dexamethasone
d. Pr ogester one
4 -37. A 25-year -old nulligr avida pr esents with a histor y of
pr imar y amenorr hea. She has an extr emely shor t vagina,
no axillar y hair , and Tanner stage 5 br east development.
A i image o f the patient’s per ineum is pr ovided below.
Which o f the f ollowing is the lik ely diagnosis?
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL, et al: Williams
Obstetr ics, 22 nd ed. N ew Yor k , McGr aw-Hill, 2005.
a . Congenital adr enal hyper plasia
b. Female pseudoher maphr oditism
C. Andr ogen insensitivity syndr ome
d. Tur ner syndr ome (46,X)
CHAPTER 4 ANSWER KEY
Let ter
Page
cited
4-8 a p. 84
4-9 b p. 84
4-10 a p. 84
4-11 b p. 86
4-12 d p. 86
4-13 b p. 86
4-14 b p. 87
4-15 a p. 88
4-16 d p. 88
Header c i ted
Age
Quest ion Let ter Page
n u m b e r a n s w e r c it ed
4 -20 a p. 89
4-21 b p. 90
4-22 d p. 90
4-23 c p. 91
4-25 a p. 91
4-26 c p. 92
4-28 d p. 93
4-31 d p. 96
4-32 b p. 96
4-33 b p. 101
4 -35 d p. 102
4 -36 a p. 102
4 -3 7 c p. 103
Header c i ted
Figure 4-19
N e w b o r n
Geni ta l Ambigu i ty o f the
N e w b o r n
Maternal Physiology
5 -1 . In the nonpr egnant woman, the uter us is an almost
solid str uctur e weighing appr oximately which o f the
f ollowing?
Y) 130 g
5-2 . Uter ine blood f low near ter m is which o f the f ollowing?
a. 50 -100 mL / min
W) 10 0-300 mL / min
c. 450 to 600 mL / min
Y) 1,000-1,400 mL / min
5 -3 . In the image below, cer vical ever sion is demonstr ated.
What k ind o f epithelium mak es up this por tion o f the
cer vix?
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, et al: Williams
Obstetr ics, 2 3r d ed. New Yor k , McGr aw-Hill, 2010.
a. Columnar
W) Squamous
Y) Br ush bor der cells
5-4. In pr egnancy, the midline o f the abdominal sk in be
comes especially pigmented and is called which o f the
f ollowing?
W) Lineaa lba
d. Linea nigr a
5 -5 . By the thir d tr imester , which o f the f ollowing descr ibes
the mater nal basal metabolic r ate?
a. Decr eased by 5%
b. Incr eased by 10% to 20% compar ed with the non
pr egnant state
C. Incr eased an additional 2 5 % above nor mal pr eg
nancy values in women with twin gestations
d . No ne o f the above
5-6 . The gr aphic illustr ates which o f the f ollowing points?
(LMP = last menstr ual per iod; MP = menstr ual
per iod.)
•E 284 - E tn
Weeks o f p regnancy
Repr oduced, with per mission, f r om Cunn ingham FG , et al: Williams Obstetr ics, 22nd
ed. N ew Yor k , McGr aw-Hill, 2005.
a . Mater nal plasma osmolality incr eases over all in pr eg
nancy.
W) Mater nal plasma osmolality decr eases ear ly in pr eg
nancy.
C. Mater nal plasma osmolality is aff ected most by in
cr eases in sodium.
d. Mater nal plasma osmolality does not change dur ing
pr egnancy.
A nato m y an d Phy siolog y
5-7. The pr oducts o f conception, mater nal blood volume
expansion, br east gland gr owth, and uter ine gr owth
account f or how many gr ams o f pr otein accr ued dur ing
pr egnancy?
a. 250 g
b. 500 g
c. 750 g
d. 1,000 g
5 -8. The gr aphic concer ning insulin and glucose levels dur
ing pr egnancy suggests which o f the f ollowing?
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL, et al: Williams
Obstetr ics, 2 3r d ed. New Yor k , McGr aw-Hill, 2010.
a. M ild f asting hyper glycemia
b. Postpr andial hypoglycemia
d . Hyper insulinemia
5 -9 . Concer ning f at metabolism dur ing pr egnancy, which o f
the f ollowing is tr ue?
a . Incr eased f at stor es ar e stor ed per ipher ally.
b. Tr iacylglycer ol and cholester ol levels ar e incr eased,
but low-density lipopr oteins (LDL) and ver y low-
density lipopr oteins (VLDL) ar e decr eased.
C. Mechanisms r esponsible f or changes in f at levels
include lipolytic and decr eased lipopr otein lipase
activities in adipose tissue,
d. None o f the above.
5 -10. Which o f the f ollowing occur s dur ing pr egnancy?
a . 500 mEq o f sodium and 200 mEq o f potassium ar e
r etained.
b. Total ser um calcium levels decline dur ing pr egnancy.
C. The f etal sk eleton accr ues appr oximately 70 g o f
calcium by ter m,
d. Ser um magnesium levels incr ease.
5 -11. As illustr ated by this gr aphic, which o f the f ollowing
occur s dur ing pr egnancy?
Repr oduced, with per m ission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, etal: Williams
Obstetr ics, 23r d ed. N ew Yor k , McGr aw-Hill, 2010.
a . Hematocr it incr eases dur ing pr egnancy.
b. Red cell volume does not incr ease until 20 week s.
C. Total blood volume incr eases 40% dur ing pr egnancy,
d. Hematocr it incr eases due to incr eased r ed cell volume
r elative to plasma volume.
5 -12. This gr aphic suggests which o f the f ollowing?
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL, etal: Williams
Obstetr ics, 23 r d ed. N ew Yor k , McGr aw-Hill, 2010.
a. Ser um ir on is unchanged in the f ir st tr imester .
b. Ser um f err itin is incr eased in the second tr imester .
C. Ser um tr ansf err in is incr eased by the end o f pr eg
nancy.
Materna l Physiology
5 -13. Concer ning ir on r equir ements in pr egnancy, which o f
the f ollowing is tr ue?
a. 500 mg o f ir on is r equir ed f or nor mal pr egnancy.
b. O f the ir on r equir ement, 300 gm is used f or the in
cr eased total volume of cir culating er ythr ocytes.
C. Ir on r equir ements o f pr egnancy ar e usually not avail
able f r om ir on stor es in most women,
d. 500 mg o f ir on is tr ansf err ed to the placenta and
f etus.
5 -14. Concer ning immunological f unction dur ing pr egnancy,
which of the f ollowing is tr ue?
a. Th l r esponse is suppr essed.
b. Ther e is up r egulation of T-cytotoxic cells.
C. Th2 cells ar e downr egulated.
d. All o f the above
5 -15. Concer ning the coagulation system in pr egnancy, which
o f the f ollowing is tr ue?
a . Fibr inogen levels ar e incr eased to a median o f 300
mg / dL.
b. Decr eases in platelet concentr ation ar e solely due to
hemodilution.
d. Mean platelet count is 250,000 / [iL.
5 -1 6 . The gr aphic shown above demonstr ates which o f th e
f ollowing points?
a. Car diac output incr eases between 20 and 40 week s’
gestation.
b. Hear t r ate incr eases when pr egnant women ar e sit
ting compar ed with lying supine.
C. Str ok e volume incr eases when pr e g n an t w o m e n a r e
supine compar ed with lying on their sides,
d . Car diac output incr eases postpar tum while sitting
compar ed with lying supine.
!Supine
7 0 -
5 0
2 0 - 2 4 2 8 - 3 2 3 8 - 4 0 6 - 8 w e ek s’
We eks ’ gestation PP
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL, et al: ‘Williams
Obstetr ics, 2 3r d ed. N ew Yor k , McGr aw-Hill, 2010.
5-17. This table illustr ates which o f the f ollowing points?
a . Mean ar ter ial pr essur e is signif icantly incr eased in
pr egnancy.
"b. Ser um colloid osmotic pr essur e is similar between
pr egnant and nonpr egnant patients.
C. The COP-PCWP gr adient is signif icantly decr eased
in pr egnancy.
d. Incr eased lef t str ok e wor k index indicates pr egnancy
is a continuous high output state.
TABLE 5 -1 . Central Hemodynamic Changes in 10 Normal Nulliparous Women Near Term and Postpartum
Pregnant3 (35 -38 wks) * Postpartum (11 -13 wks) Changeb
Mean arterial pressure (mm Hg) 90 ± 6 86 ± 8 NSC
Pulmonary capillary wedge pressure (mm Hg) 8 ± 2 6 ± 2 NSC
Central venous pressure (mm Hg) 4 ± 3 4 ± 3 NSC
Heart rate (bea ts/m in) 83 ± 10 71 ± 10 + 17%
Cardiac output (L/min) 6.2 ± 1.0 4.3 ± 0.9 + 43%
Systemic vascular resistance (dy ne /se c/c m -5 ) 1210 ± 266 1530 ± 5 2 0 -2 1 %
Pulmonary vascular resistance (dyne /sec /cm -5 ) 78 ± 22 119 ± 4 7 -3 4 %
Serum colloid osmotic pressure (mm Hg) 18.0 ± 1.5 20.8 ±1.0 - 1 4 %
COP-PCWP gradient (mm Hg) 10.5 ± 2.7 14.5 ± 2 . 5 -2 8 %
Left ventricular stroke work index ( g /m /m 2) 48 ± 6 41 ± 8 NSC
aMeasured in lateral recumbent posit ion.
bChanges signif icant unless NSC = no signif icant change.
COP = col loid osm otic pressure; PCWP = pulm onary ca pi l lary wedg e pressure.
A nato m y a nd Phy siolog y
5 -18. Which o f the f ollowing ar e tr ue r egar ding angiotensin II
and its eff ects?
a . Nor motensive nullipar as ar e r ef r actor y.
b. Hyper tensive patients become and then r emain r e
f r actor y.
C. Vascular r esponse is pr obably estr ogen r elated,
d . Incr eased r ef r actor iness o f vessels r esults pr imar ily
f r om changes in angiotensin II str uctur e.
5 -19. Wh ich statement below is corr ect?
a. Tidal volume and r esting minute ventilation decr ease
signif icantly as pr egnancy advances.
b. Functional r esidual capacity and r esidual volume
incr ease as a r esult o f an elevated diaphr agm dur ing
pr egnancy.
C. Incr eases in minute ventilation ar e dr iven pr imar ily
by low expir ator y r eser ve volume,
d. Lung compliance is unaff ected by pr egnancy.
5 -20. Concer ning acid-base equilibr ium dur ing pr egnancy,
which o f the f ollowing is tr ue?
a. Physiologic dyspnea r esults f r om slightly decr eased
tidal volume that lower s CO 2 levels.
b. Plasma bicar bonate decr eases f r om 26 to appr oxi
mately 22 mmol / L.
C. Estr ogen acts centr ally, wher e it appear s to lower the
thr eshold and incr ease the sensitivity o f the chemor e-
f lex r esponse to CO 2 .
d. The mater nal oxygen-disassociation cur ve is shif ted
to the r ight.
5 -21 . Th is gr aphic illustr ates which o f the f ollowing?
Nonpregnant 0-2 0 20-3 0 30-40
Weeks' gestation
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, et al: Williams
Obstetr ics, 2 3r d ed. New Yor k , McGr aw-Hill, 2010.
a . Glomer ular f iltr ation r ate (GFR) incr eases dur ing
pr egnancy
b. Eff ective r enal plasma f low decr eases dur ing pr eg
nancy
C. Filtr ation f r action is mildly incr eased by the end o f
pr egnancy
d. All o f the above
5 -22 . Concer ning the ur inar y system dur ing pr egnancy, which
o f the f ollowing is tr ue?
a . Ser um cr eatinine levels incr ease f r om a mean o f 0.5
mg to 0.7 mg / dL.
b. Glucosur ia is always abnor mal.
C. Af ter the uter us r ises out o f the pelvis, ur eter al dila
tion occur s exclusively on the r ight side,
d. Bladder pr essur e incr eases f r om 8 cm H zO ear ly in
pr egnancy to 2 0 cm H 2O at ter m.
5 -23 . Concer ning the gastr ointestinal (GI) tr act dur ing pr eg
nancy, which o f the f ollowing is tr ue?
3. Gastr ic emptying time is incr eased in each tr imester ,
b. Pyr osis is caused by r ef lux o f acidic secr etions into the
lower esophagus.
C. Epulis is a systemic highly vascular swelling o f mu
cosal membr anes,
A na to m y an d Phy siolog y
CHAPTER 5 ANSWER KEY
5 -2 c p. 108 Uteroplacental Blood Flow
5 -3 a p. 109 Cervix
5 -4 d p. 111 Hyperpigmentation
5 -5 b p. 111 Metabo lic Changes
1. Obste tr ics in Pers pec ti ve .....................................2
2. Mat e rn al A n a to m y ..................................................8 , 4. Fetal Gr ow th and D e v e lo p m en t.....................21
3. Im pl an ta ti on , Em bry oge nes is, and 5. Ma ter na l P h ys io lo gy ...........................................27
Placenta l Development ........................... : ........14 & p a r , u r j t i o n ................................................... ...........3 3
M M SECTION 3
8 . Prenatal C ar e .......................... .............................45
9. A b o r t io n ..................................................................50
10. Ect opi c Pregnancy ...............................................56
11. Gesta tional TrophoblasticDisease..................61
14. Teratology and Medic ations That
Aff ect th e F e tu s ......................................................77
15. An tepar tum Assessm ent ................................... 82
16. Feta l Im a g in g ..........................................................8 8
17. Normal Labor and Delivery..................... .......96 23 .
18. I n tr a p a rt u m A s s e s s m e n t .......................... . . . . 1 0 1 24.
19. Obstetrical Anesthesia............................... . .. .1 06 25.
2 0 . Abno rm al Labor........................................... . . . . 1 1 2
2 1 . Disorders of Amnionic Fluid Volume ... . . . . 117 26.
2 2 . Labor Induction............................................. . . . . 1 2 2 IL
1 32
H ys te re c to m y.......................................................1 37
Cord, and M e m b r a n e s ......................................147
SECTION 5 S|9?
FETUS AND NEWBORN
28. The Newborn In fant .15 6 29. Diseases and Injuries of the Fetus
a nd N e w b o r n .......................................................161
PUERPERIUM
31. Puerperal Infection.
,168 32. Contraception.
.178
,184
OBSTETRIC COMPLICATIONS
190 38. Feta l Growth Disorders ........................... .......216
196 39. Mul t i fe ta l Gestat ion ................................. ........2 2 1
205 40. Reproduct ive Tract Abnormal i t ies....... .......22 6
2 1 0
41. General Considerations and Maternal 51. Hematological Disorders............................... 78 6
Eva lu ati on......................................................... 23 4 52. Diabetes ............................................................. 791
42. Critical Care and Trauma ............................. 23 9 53. Thyroid and Other Endocrine Disord ers.. . .296
43. O b e s i ty .............................................................. 24 4 54. Connect ive-Tissue Disorders........................ 301
44. Cardiovascular Diseases............................. 249 55. Neurological and Psychiatric Disorders... 307
45. Chronic Hypertension.................................. 254 56. Dermatological Disorders............................. 31?
46. Pulmonary Disorders..........................: ........ 259 57. Neop las ti c D iseases....................................... 31 7
47. Thromboembol ic Disorders. . .................... 26 5 58. In fect io us Dise as es ......................................... 3? ?
48. Renal and Urinary Tract Disorders 27 0 59. Sexually Transmitted Diseases................... 32 8
49. Gastrointestinal Disorders.......................... . . .276
Disorders.......................................................... . . .281
Index 335
OVERVIEW
Obstetrics in Perspective
1 -1 . Which o f the f ollowing is an example o f an indir ect
mater nal death?
b. Aspir ation f ollowing eclampsia seizur e
C. Hemorr hage f ollowing uter ine atony
d . Aor tic r uptur e secondar y to Mar f an syndr ome
1-2. T he f er tility r ate is the number of live bir ths per 1,000
f emales aged?
b. 11 -59
c. 15 -44
d . 18^9
1-3. A death o f a newbor n at 5 days o f lif e due to congen
ital hear t disease would be classif ied as which o f the
f ollowing?
d. Ear ly neonatal death
1-4. Which o f the f ollowing corr ectly identif ies the tr ends
in f er tility and live bir th r ates in the United States since
2002 ?
a . Ther e has been no change in either r ate.
b. Fer tility and live bir th r ates have incr eased.
C. Fer tility and live bir th r ates have decr eased.
d . Fer tility r ate has decr eased but live bir th r ate is
incr eased.
1 -5 . What statistic is def ined by the r ed line in this f igur e?
,0
oc
N e o n a t a l m o r t a l i ty
F e t a l m o r t a l i ty
,44+ -++0
Y e a r
Repr oduced, with per mission, f r om Cunningham F G , Leveno KJ, Bloom SL, er al:
Williams Obstetr ics, 23r d ed. New Yor k , McGr aw-Hill, 2010.
a. Stillbir th r ate
b. Inf ant death r ate
C. Per inatal mor tality r ate
d. None o f the above
1-6. Most inf ant deaths occur in which o f the f ollowing
gr oups?
C. Inf ants with congenital inf ections
d. Inf ants with congenital anomalies
1-7. Appr oximately what per centage o f pr egnant women
exper ience sever e mater nal mor bidity?
a. 0.1%
b. 0.5%
C. 2%
d. 5%
1-8. Which o f the f ollowing events has contr ibuted to the r ise
in the U . S. cesar ean deliver y r ate?
a. Incr ease in deliver ies per f or med by midwives
b. Decline in vaginal bir ths f ollowing cesar ean deliver y
C. Reduction in r eimbur sement by insur ance companies
f or cesar ean deliver y
d. Impr oved outcomes in inf ants with congenital abnor
malities deliver ed by cesar ean deliver y
Obstetrics in Perspective
1-9. On the basis o f an Amer ican College o f Obstetr icians
and Gynecologists sur vey, which of the f ollowing is the
most common citation f or obstetr ic malpr actice claims?
3 ! Shoulder dystocia
C. Stillbir th or neonatal death
d . Neur ologically impair ed neonate
1-10. Adolescent pr egnancy accounts f or what per centage
o f the total number o f unintended pr egnancies in the
United States?
a. 5%
b. 10!
c. 25%
d. 33%
1-11. What per centage o f the gr oss domestic pr oduct curr ently
goes towar d health car e?
3 ! 6#
b. 16%
C. 26%
d. 36%
1-12. The f ield o f obstetr ics encompasses all EXCEPT which
o f the f ollowing?
a. Pr enatal car e
b. Management o f labor
C. Inf er tility tr eatments
d. Immediate newbor n car e
1-13. “Pr eter m” def ines neonates bor n bef or ewhat gestational
age?
a. 34 completed week s
b. 36 completed week s
C. 37 completed week s
d. 38 completed week s
1-14. What is the leading indication f or hospitalization dur ing
pr egnancy not r elated to deliver y?
a. Inf luenza
b. Diabetes mellitus
d. None o f the above
1-15. The curr ent number o f abor tions per f or med annually in
the United States appr oximates which o f the f ollowing?
a. 100,000
b. 500,000
C. 1,000,000
d. 2,000,000
1-16. Ver y low-bir thweight newbor ns ar e def ined as those
whose bir thweight lies below which o f the f ollowing
thr esholds?
d. 2 , 0 0 0 g
1-17. Which of the f ollowing is def ined as the number of
mater nal deaths that r esult f r om the r epr oductive
pr ocess per 1 0 0 , 0 0 0 live bir ths?
a. Mater nal mor tality r ate
b. Mater nal mor tality r atio
C. Dir ect mater nal death r ate
d. Pr egnancy-r elated death r ate
1-18. Including spontaneous abor tions, induced abor tions,
and live bir ths, what was the appr oximate number o f
pr egnancies in 2006?
a. 4 million
b. 5 million
C. 6 million
d. 7 million
1-19. Which r acial / ethnic gr oup has the highest f etal death
r ate in the United States?
a. White
b. Black
C. Asian
d. Hispanic
1-20. Fetal death in the United States is def ined as which o f the
f ollowing?
b. Death af ter 20 week s’ gestation
C. Death with a bir thweight gr eater than 500 g
d. All o f the above
1-21. Registr ation o f live bir ths is curr ently assigned to which
national agency?
b. National Institutes of Health
C. Depar tment o f Health and Human Ser vices
d . National Center f or Health Statistics
1-22. Which o f the f ollowing is NOT among the top thr ee
causes o f pr egnancy-r elated death?
a. Embolism
4 Overview
1-23 . What is the aver age number o f live bir ths per woman in
the United States?
a. l
b. 2
c. 3
d. 4
1-24. What was the cesar ean deliver y r ate in the United States
in 2006?
a. 21!
b. 28%
c. 31%
d. 36%
1-25 . Which o f the f ollowing contr ibuted to the tr end on this
gr aph?
1-26. Goals o f Healthy People 2010 and 2020 include all
EXCEPT which o f the f ollowing?
a. Reduce mater nal mor tality r ates
b. Reduce nonmater nal death r ates
C. Reduce the r ate o f pr eter m deliver y
d . Decr ease the dispar ity o f outcomes between whites
and ethnic / r acial minor ities
Y e a r
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, et al: "Williams
Obstetr ics, 23 r d ed. New Yor k , McGr aw-Hill, 2010
3. Contr aception
d. All of the above
cited Header cited
1-1 d p. 3 Definitions 1-14 d p. 4 Pregnancy-Related Care
1-2 c p. 3 D efinitions 1-15 c p. 4 Table 1-1
1-3 d p. 3 D efinitions 1-16 c p. 3 D efinitions
1-4 c p. 4 Pregnancy Rates 1-17 b p. 3 Definitions
1-5 c p. 5 Figure 1-1 1-18 b p. 4 Pregnancy Rates
1-6 a p. 5 Infant Deaths 1-19 b P-5 Figure 1-2
1-7 b p. 6 Severe Maternal Morbid ity 1-20 d p. 3 D efinitions
1-8 b p. 7 Rising Cesarean Delivery Rate 1-21 d p. 2 Vital Statistics
1-9 d p. 9 Table 1-5 1-22 c p. 6 Table 1-2
1-10 c p. 10 Figure 1-5 1-23 b p. 4 Pregnancy Rates
1-11 b p. 11 Healthcare Reform 1-24 c p. 7 Rising Cesarean Delivery Rate
1-12 c P- 2 Introduction 1-25 d p. 6 Figure 1-3
Maternal Anatomy
2 -1 . Which o f the f ollowing in gener al is tr ue o f ver tical
abdominal incisions?
a . Heal better than Pf annenstiel incisions
b. Follow ver tically or iented der mal f iber s (Langer lines)
C. Yield inf er ior cosmetic r esults compar ed with tr ans
ver se incisions
d. Sustain decr eased later al tension
2 -2 . The f emor al ar ter y gives r ise to all EXCEPT which o f
the f ollowing vessels?
2 -3 . Which der matome appr oximates the level o f the
umbilicus?
b. T12
c. T10
d. LI
2-4. Which vulvar str uctur e is homologous to the male
scr otum?
d. Labia ma jor a
2 -5 . With r egar d to the vestibule, which of the f ollowing
statements is corr ect?
a. It is der ived f r om embr yonic ur ogenital membr anes.
b. The poster ior por tion between the f our chette and the
vaginal opening is called the f ossa annular es.
C. It is per f or ated by f our openings,
d. The f ossa navicular is is usually obser ved only in nulli-
par ous women.
2 -6 . The inter nal pudendal ar ter y supplies which o f the
f ollowing?
C. Distal vaginal wall
d. Bladder tr igone
-cec; with per missio n, f r om Cunn ingham F G , Leveno KJ, Bloom SL , et al: Williams
:cs. lo r d ed. New Yor k , McGr aw-Hill, 2010.
a. super f icial cir cumf lex iliac ar ter y
b. Exter nal pudendal ar ter y
C. !r .:;r :or epigastr ic ar ter y
d. ' _rrr f _cial epigastr ic ar ter y
Mate rna l Ana tom y
2-7. The vagina and its investing musculatur e ar e supplied by 2-11. Which o f the f ollowing is tr ue r egar ding the uter us?
all EXCEPT which o f the f ollowing ar ter ies? $ _ j t measur es 8 to 9 cm in length in nullipar ous
women.
b. It weighs 50 to 70 g in the par ous woman.
C. In the nullipar a, the f undus and the cer vix ar e o f
equal length,
d. T he cer vix is composed mainly o f muscle.
2-12. The cer vix contains little o f which of the f ollow compo
nents?
d. Elastin
2-13. Concer ning the endometr ium, which o f the f ollowing is
tr ue?
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL, et al: Williams
Obstetr ics, 2 3r d ed. N ew Yor k , McGr aw-Hill, 2010.
a. Inf er ior r ectal ar ter y
b. Per ineal ar ter y
C. Pudendal ar ter y
d . Poster ior labial ar ter y
2-8. Which o f the f ollowing is tr ue concer ning the anal
sphincter s?
a. The exter nal anal sphincter r eceives blood supply
f r om the super ior r ectal ar ter y.
b. The inter nal anal sphincter contr ibutes the bulk of
anal canal r esting pr essur e.
C. The exter nal anal sphincter measur es 3 to 4 cm in
length.
d . The exter nal sphincter r emains in a state o f constant
r elaxation.
2-9. The per ineal body is f or med par tly by which o f the f ol
lowing muscles?
b. Gluteus maximus muscle
C. Bulbocaver nosus muscle
d. Levator ani muscle
2-10. Which o f the f ollowing is the potential space between
the anter ior sur f ace of the uter us and the poster ior wall
o f the bladder ?
b. Rectovaginal septum
C. Mor ison pouch
d. Vesicouter ine space
Repr oduced, with per mission, f r om Hoff man BL: Abnor mal uter ine bleeding. In: Schor ge
JO , Schaff er JI, Halvor son LM , et al., eds. Williams Gynecology. New Yor k , McGr aw-Hill,
2008, Figur e 8-2.
a . The basal ar ter y comes dir ectly f r om the ar cuate
ar ter y.
b. Spir al ar ter ies extend dir ectly f r om r adial ar ter ies.
C. The f unctionalis layer contains spir al ar ter ies and
r adial ar ter ies.
d. The spir al ar ter ies extend dir ectly f r om the ar cuate
ar ter y.
A rc u a te a rt e ry
Uter ine ar te ry
Basa l a r te ry
Basa l is layer
E n d o m e t r ia l v e i n
M y o m e t r i u m
U t e r u s l u m e n
Epi the l ium
Uter ine g lands
V e n o u s s i n u s o i d s
Funct iona l i s layer
Ana to m y and Phy siolog y
2-14. Dur ing postpar tum tubal ster ilization, which o f the
f ollowing corr ect anatomical inf or mation may assist
you?
a . The f allopian tube lies anter ior to the r ound liga
ment.
b. The f allopian tube lies poster ior to the uter oovar ian
ligament.
C. The r ound ligament lies anter ior to the f allopian
tube.
d. The uter oovar ian ligament lies anter ior to the r ound
ligament.
2-15. The ar ter y that r uns thr ough this str uctur e (arr ow)
dir ectly ar ises f r om which o f the f ollowing?
2-17. The r ight ovar ian vein empties into which o f the f ollow
ing veins?
C. Inter nal iliac vein
d. Exter nal iliac vein
2 -1 8. Ovar ian vessels ar e f ound in which o f the f ollowing liga
ments?
d. Inf undibulopelvic
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, et al: Williams
Obstetr ics, 2 3r d ed. N ew Yor k , McGr aw-Hill, 2010.
a. Sampson ar ter y
b. Inter nal iliac ar ter y
C. Uter ine ar ter y
d. Obtur ator ar ter y
2-16. The ovar ian ar ter y is a dir ect br anch of which o f the
f ollowing vessels?
b. Aor ta
d. Exter nal iliac ar ter y
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL , et al: Williams
Obstetr ics, 2 3r d ed. N ew Yor k , McGr aw-Hill, 2010.
a. Aor ta
b. Exter nal iliac ar ter y
C. Inter nal iliac ar ter y
d. No ne o f the above
2-2 0 . The uter ine ar ter y is a main br anch o f which o f the
f ollowing vessels?
d. Iliolumbar ar ter y
2-19. The comm on iliac ar ter y ar ises dir ectly f r om which o f
the f ollowing?
Mh f ^c V f h fm
BchfcVa
2 - 21 . T he inter nal pudendal ar ter y ar ises f r om which o f the
f ollowing vessels?
C. Vaginal ar ter y
d. Inf er ior epigastr ic ar ter y
2-22 . Fr om pr oximal (uter us) to distal (f imbr ia), the corr ect
pr ogr ession o f f allopian tube anatomy is which o f the
f ollowing?
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KL , Bloom SL, et aJ: Williams
Obstetr ics, 22 nd ed. New Yor k , McGr aw-Hill, 2006. http: // www.accessr nedicine.com.
Figur e 1.
a. Isthmus, inf undibulum, ampulla
b. Isthmus, ampulla, inf undibulum
C. Inf undibulum, ampulla, isthmus
d. Ampulla, inf undibulum, isthmus
2~2 3. Which o f the f ollowing bone(s) f or ms the pelvis?
a. Innominate
d . All o f the above
2 -24. Which o f the f ollowing is tr ue r egar ding r elaxation o f the
pelvic joints at ter m in pr egnancy?
a . It allows f or an incr ease in the tr ansver se diameter of
the midpelvis.
b. It r esults in mar k ed mobility o f the pelvis at ter m
because o f a downwar d gliding movement o f the
sacr oiliac (SI) joint.
C. Displacement of the SI joint incr eases outlet diame
ter s by 1.5 to 2.0 cm in the dor sal lithotomy position,
d . It is per manent and not accentuated in subsequent
pr egnancies.
Mate rna l Ana tomy
2-2 5 . The shor test anter oposter ior diameter o f the pelvic inlet
is which o f the f ollowing?
a. Tr ue con jugate
b. Obstetr ical con jugate
C. Diagonal con jugate
d. None o f the above
2-26 . The clinical evaluation o f the pelvic inlet r equir es dir ect
measur ement of which diameter ?
a. Tr ue con jugate
b. Obstetr ical con jugate
C. Diagonal con jugate
2-27. Engagement occur s when the bipar ietal diameter of
the f etal head descends below the level o f which o f the
f ollowing?
a. Midpelvis
C. Pelvic f loor
d. Ischial tuber osities
2-28. In this f igur e, which o f the f ollowing is demonstr ated?
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno K J, Bloom SL, et al: Williams
Obstetr ics, 23r d ed. New Yor k , McGr aw-Hill, 2010.
a. Impor tant pelvic outlet diameter s
b. Ischial tuber osities
C. Midpelvis ischial spines
Anato m y and Phy siolog y
2-29 . What is the narr owest pelvic dimension that must be
navigated by the f etal head?
a. Inf er ior str ait
b. Obstetr ical con jugate
C. Inter spinous diameter
d . Tr ansver se diameter o f the pelvic inlet
2-30 . Which o f the f ollowing is tr ue o f the midpelvis?
a. It is measur ed at the level o f the ischial tuber osities.
b. It usually measur es no mor e than 9 cm.
C. It is measur ed at the level o f the ischial spines,
d . It usually is the lar gest pelvic diameter .
2 - 3 1 . Which o f the f ollowing is the most common pelvic
shape?
C. Andr oid pelvis
d. Gynecoid pelvis with andr oid tendency
2 - 3 2 . The pubococcygeus muscle is now pr ef er ably called
which o f the f ollowing?
a. Pubor ectalismuscle
b. Iliococcygeus muscle
CHAPTER 2 ANSWER KEY
Le t te r
Page
Quest ion
Let ter
Page
cited Header c i ted
2-1 c p. 14 Skin 2-17 a p. 26 Blood Vessel
2-2 c p. 14 B lood S upply 2-18 d p. 26 B lood Vessel
2-3 c p. 15 Inne rva tion 2-19 a p. 27 Figure 2-16
2-4 d p. 15 Labia Majora 2-20 b p. 27 Figure 2-16
2-5 a p. 16 Vest ibule 2-21 b p. 27 Figure 2-16
2-6 c p. 18 V as cu la r a nd L ym p h atic Su pp ly 2-22 b p. 28 Fallop ian Tubes
2-7 a p. 20 Figure 2-5 2-23 d p. 29 Pelvic Bones
2-8 b p. 20 Ana l S ph in c te r 2-24 c p. 29 Pelvic Joints
2-9 c p. 21 P erineal Body 2-25 b p. 31 Pelvic In le t
2 -10 d p. 21 U terus 2-26 c p. 31 Pelvic In le t
2-11 c p. 21 Size and Shape 2-27 b p. 31 Pelvic in le t
2-12 a p. 23 Cervix 2-28 c p. 31 Pelvic Inlet
2-13 b p. 24 Endome t r i um 2-29 c p. 31 M idp e lv is
2-14 c p. 25 L igaments 2-30 c p. 32 Midpe lv is
2-15 c p. 26 Figure 2-15 2-31 a p. 32 Pelvic Shapes
implantation, Embryogenesis, and Placental Development
3 -1 . The nor mal length o f the aver age menstr ual cycle r anges
between which o f the f ollowing values?
a . 14—28 days
d. 30-40 days
3 -2 . O f the 2million oocytes in the human ovar y pr esent
at bir th, appr oximately how many ar e pr esent at the
onset of puber ty?
a. 200,000
b. 300,000
c. 400,000
d. 500,000
3 -3 . Which hor mone is r equir ed f or the late-stage
development o f antr al f ollicles?
a. Luteinizing hor mone (LH)
b. Follicle-stimulating hor mone (FSH)
C. Es tr adiol
d. Andr ostenedione
3 -4. Dur ing the f ollicular phase o f the menstr ual cycle,
estr ogen is pr imar ily pr oduced by which cells of the
dominant f ollicle?
C. Gr anulosa
d. Endometr ial
3 -5. The pr ocess thr ough which the cor pus luteum develops
f r om the r emains o f the Gr aaf ian f ollicle is called which
o f the f ollowing?
a. Luteinization
b. Thecalization
C. Decidualization
d. Gr aaf ian tr ansf or mation
3 -6 . What is the peak ovar ian pr ogester one pr oduction
dur ing midluteal phase?
b. 25-50 mg / d
d. 75-100 mg / d
3-7 . Which o f the f ollowing is the most biologically potent
natur ally occurr ing estr ogen?
a . Estr iol
b. Estr one
C. Estetr ol
d. 17|3-estr adiol
3 -8 . Which o f the f ollowing is the endometr ial layer that is
shed with ever y menstr ual cycle?
a . Basalis layer
b. Decidual layer
C. Luteinized layer
d. Functionalis layer
3 -9 . Which o f the f ollowing is the f ir st h istological sign of
ovulation?
a. Cessation o f glandular cell mitosis
b. Vacuoles at the apical por tion o f the secr etor y
nonciliated cells
C. Secr etion o f glycopr otein and mucopolysacchar ide
by secr etor y nonciliated cells
d. Subnuclear vacuoles and pseudostr atif ication in the
basal por tion o f the glandular epithelium
3 - 10 .
3 - 11 .
-+,+ .
In the f ollowing f igur e, the spir al ar ter ies ar e identif ied
by which letter ?
E pith eliu m ----------— •— ''7 i .
C a p i l l a r i e s--------- --------------------------------i f > U / i £T * \ \ j JK J y J r
Ve no us si n u s--------------- | f S m w y Su r l n T r ) i t I B ?g " r H ~t Funct ional is
Endomet r ia l g land -----------------------------> 4 l f ( \ J) Ws l ayer
A rt e ry A -
A rt e ry B -
A rt e ry C -
A rt e ry D
Basal is layer
Myomet r ium
Uter ine ar te ry --------------------------------
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, et al. Williams Obstetr ics, 2 3r d ed. New Yor k :
McGr aw-Hill, 2010.
consistent with the menstr ual phase?
a. A
b. B
c. C
d. D
3
2
16 Ana tomy and Phys io logy
3 -12. Which pr ostaglandin plays a r ole in vasoconstr iction o f
the spir al ar ter ies, leading to menstr uation?
a. PG E j
d. PG F2a
3 -13. In sequence f r om letter s A to C , please identif y the thr ee
types o f deciduas in the f igur e below:
a. Basalis, capsular is, par ietalis
b. Capsular is, basalis, par ietalis
C. Par ietalis, basalis, capsular is
d. Par ietalis, capsular is, basalis
3 -1 5 . The placenta does not per f or m which o f the f ollowing
f unctions f or the f etus?
a. Renal
b. Hepatic
C. Adr enal
d. Pulmonar y
3 -16. At 5 days postf er tilization, the blastocyst is r eleased f r om
which surr ounding str uctur e?
a. Mor ula
=X^YiV <
XVcVa
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, er al: Williams Obstetr ics,
23 r d ed. New Yor k , McGr aw-Hill, 2010.
3 -14. What is the Ni tabuch layer ?
a . A layer o f the decidua composed o f lar ge, distended
glands
b. An ar ea o f the decidua with lar ge, closely pack ed
epithelioid, polygonal cells
C. A zone o f f ibr inoid degener ation in which the invad
ing tr ophoblasts meet the decidua
d. An ar ea o f super f icial f ibr in deposition at the bottom
o f the inter villous space and surr ounding the anchor
ing villi
3 -17. Which o f the f ollowing gives r ise to the chor ionic str uc
tur es that tr anspor t oxygen and nutr ients between f etus
and mother ?
d. Endovascular tr ophoblast
3-18 .
Repr oduced, with per mission, f r om Str eeter G L. A human embr yo [Mateer ] o f the pr esomite per iod. Contr ib Embr yol 1920; 9:389.
3-19 . Which o f the f ollowing statements is accur ate r egar ding
the chor ion f r ondosum?
a . Is the same as the chor ion laeve
b. Is the mater nal component o f the placenta
C. Is the avascular ar ea that abuts the decidua par ietalis
d. Is the ar ea o f villi in contact with the decidua basalis
3-20 . Mater nal r egulation o f tr ophoblast invasion and vascular
gr owth is mainly over seen by which o f the f ollowing?
a . Decidual natur al k iller (dNK) cells
b. C D 4 + T cells
C. Pr ogester one
d. Cellular adhesion molecules
3 - 21 . All EX CEPT which o f the f ollowing is tr ue r egar ding
f etal f ibr onectin?
a. Is a matr ix metallopr oteinase
b. Is also k nown as “tr ophoblast glue”
C. Is a pr ognostic indicator o f pr eter m labor
d. Plays a r ole in tr ophoblast invasion o f the en
dometr ium
3-23 . End diastolic blood f low can be identif ied in the f etal
umbilical ar ter y by the end of which week o f pr egnancy?
a. 10
b. 12
c. 14
d. 16
3-24 . Regar ding the or ientation o f spir al bloodvessels in r ela
tionship to the uter us, which o f the f ollowing is tr ue?
a . Both ar ter ies and veins ar e par allel to the uter ine wall
b. Both ar ter ies and veins ar e per pendicular to the uter
ine wall
C. Ar ter ies ar e per pendicular , and veins ar e par allel to
the uter ine wall
d. Veins ar e per pendicular , and ar ter ies ar e par allel to
the uter ine wall
Which o f the labeled str uctur es in the f ollowing f igur e 3-22 . Remodeling o f mater nal spir al ar ter ies by invading tr o-
will eventually become the umbilical cor d? phoblasts is completed by which week (s) o f pr egnancy?
a. A a. 8
b. B b. 12
2
18 A n a to m y an d P hys io lo gy
3-25 . The phenomenon that descr ibes how f etal cells can be
come engr af ted in the mother dur ing pr egnancy and
then be identif ied decades later is called which o f the
f ollowing?
C. Hemochor ial invasion
d. Immunological neutr ality
3-26 . The amnion is composed o f all EX CEPT which o f the
f ollowing?
a. Lymphatics
d. A cellular zo naspongiosa
3 - 27 . Which o f the f ollowing is accur ate r egar ding Meck el
diver ticulum?
a. Is the allantoic duct r emnant
b. Is a f ailur e o f the r ight umbilical vein to involute
C. Is an extr aabdominal r emnant o f the umbilical vesicle
d. Is a f ailur e o f the intr aabdominal por tion o f the um
bilical vesicle to atr ophy
3-28 . As shown in this f igur e, blood coming f r om the placenta
to the f etus tr avels f r om the umbilical vein into which o f
the f ollowing?
b. The hepatic vein
C. The ductus venosus
O x y g e n a t e d
M i x e d
D e o x y g e n a t e d
Repr oduced, with per missio n, f r om Cunn ingham F G , Leveno KJ, Bloom SL , et al: W illiams Obstetr ics, 23 r d cd.
New Yor k , McGr aw-Hill, 2010.
mplantation, Embryogenesis, and Placental Development
3-29. The amino acid sequence o f die a-subunit o f human
chor ionic gonadotr opin (hCG ) is identical in all
EXCEPT which o f the f ollowing?
a. LH
C. FSH
d. Thyr oid-stimulating hor mone (TSH)
3 -30. Abnor mally low levels o f hC G may be f ound in which of
the f ollowing?
b. Ectopic pr egnancy
d. Gestational tr ophoblastic disease
3 -3 1 . Known biological actions o f h C G include all EXCEPT
which o f the f ollowing?
a. Mater nal thyr oid stimulation
b. Inhibition o f r elaxin secr etion
C. Sexual diff er entiation o f the male f etus
d . Rescue and maintenance o f the cor pus luteum
3-32. Which o f the f ollowing has the gr eatest pr oduction r ate
o f any k nown human hor mone?
a. Pr ogester one
b. Human placental lactogen
d. hC G
3-33. Among placental peptide hor mones, which o f the f ol
lowing has shown a corr elation with bir thweight?
3. Leptin
b. Activin
C. Inhibin
d. Neur opeptide Y
3-34. Which o f the f ollowing is tr ue o f bilater al oophor ectomy
at 9 week s’ gestation?
a. Will cause miscarr iage
b. Will cause a signif icant dr op in pr ogester one levels
C. Will not alter the excr etion o f ur inar ypr egnanediol
d. No ne o f the above
3~35 . What is the pr ecur sor of placental pr ogester one?
a . Fetal high-density lipopr otein (HD L) cholester ol
b. Fetallow-density lipopr otein (LDL) cholester ol
C. Mater nal HD L cholester ol
d. Mater nal L D L cholester ol
3-36. Besides being anX-link ed disor der that aff ects male
f etuses, tr ue statements r egar ding ichthyosis include
which o f the f ollowing?
a . It is seen with f etal adr enal hypoplasia.
b. It is seen with f etal adr enal hyper plasia.
C. It is associated with f etal placental sulf atase
def iciency.
d . It is associated with f etal placental ar omatase
def iciency.
3-37. Which o f the f ollowing conditions is associated with
elevated estr ogen levels in pr egnancy?
a. Down syndr ome
d . Fetal placental ar omatase def iciency
CHAPTER 3 ANSWER KEY
Quest ion Let te r Page
n u m be r a n sw er c ited Header c i ted
3-1 b p. 37 The Ova r ian Cyc le
3-2 t p. 37 Fo l li cul ar or P reovu la to r y
Ovarian Phase
Ovarian Phase
Ovarian Phase
Ovarian Phase
Ovarian Phase
A ct io n
Cyc le /Pro l i fe ra t ive and
Preovu la tory Endometr ia l
Phase
3-9 d p. 42 Secretory o r P ostovu la tory
Endometr ial Phase
3-11 d p. 38 Dat ing o f Endometr ium,
Figure 3-2
3-12 d p. 44 P r os ta g la n di ns a nd
Mens t rua t i on
3-13 d p. 45 Dec idua l S t ruc ture /F igure 3-8
3 -14 c p. 46 Decidual Histology
3-15 c p. 47 I m p l a n ta t io n , P l ac en ta l
Fo rma t i on and Membrane
D e v e l o p m e n t
3-16 c p. 47 Ovum Fert i l izat ion and Zygote
Cleavage
3 -17 a p. 49 T rophob las t D i f f e ren t i a ti on
3-18 a p. 51 Figure 3-15, Early Trophoblast
Invasion
Quest ion Let te r Page
n u m be r a n s w er c ite d Header c i ted
3-19 d p. 52 Deve lopment o f Chor ion and
Decidua
3 -20 a p. 53 Materna l Regu la t ion o f
Trophoblast Invasion and
Endome t r i um
3-22 c p. 54 Invasion of Spiral Arter ies
3-23 a p. 56 Fetal Circulation
3 -24 c p. 57 Maternal Circulat ion
3-25 a p. 58 Breaks in the Placental
"Bar r ie r "
3 -26 a p. 59 The Amn ion /S t ruc tu re
3-27 d p. 62 Cord Deve lopment
3 -28 c p. 62, 90 Cord Structure and
Funct ion/F igure 4-12
3-29 b p. 63 hCG/Chemical Character ist ics
3-30 b p. 64 Sign i f icance o f abnormal ly
high or lo w hCG levels
3-31 b p. 64 Known Biological Funct ions of
hCG
Lac togen /Chemica l
3-34 c p. 67 Placental Progesterone
Product ion
Rates
Def ic iency
3-37 b p. 71 Materna l Condi t ions That
A ff e c t P la ce nt a l Est ro ge n
Product ion
Feta! Growth and Development
4 -1 . Apatient r epor ts that the f ir st day of her last menstr ual
per iod was Apr il 10. On the basis o f Naegele r ule, her
due date is which o f the f ollowing?
a . Januar y 17
d. July 3
4-2. The length o f the embr yonic per iod is which o f the
f ollowing?
a. 6 week s
b. 8 week s
C. 12 week s
d. 14 week s
4 -3 . The image below is o f a human embr yo at 22 days’
gestation. The ar ea mar k ed “A” r epr esents which o f the
f ollowing?
Repr oduced, with per mission, f r om Cunningham FG , Leveno KJ, Bloom SL, etal: Williams
Obstetr ics, 23r d ed. New Yor k , McGr aw-Hill, 2010.
a. Amnion
d. Bladder
4-4. At 28 week s’ gestation, what is the chance o f sur vival
without physical or neur ological impair ment?
a. 50%
b. 65%
c. 90%
d. 100%
4 -5 . Which o f the f ollowing f etal head diameter measur e
ments is the lar gest?
a. Bitempor al
b. Bipar ietal
d. Occipitomental
4 -6 . The shif ting or sliding o f the f etal head bones to per mit
acc ommodation o f the f etal head to the mater nal pelvis
is r ef err ed to as which o f the f ollowing?
a . Caput
b. Yielding
C. Molding
d. Flexion
4-7. Uter oplacental blood f low at ter m measur es appr oxi
mately which o f the f ollowing?
a. 50-100 mL / min
b. 100-300 mL / min
C. 700-900 mL / min
d. 1,200-1,400 mL / min
The f ollow ing image applies to questions 4—8 and 4—9.
A nato m y and Ph ys io logy
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL , eta l: Williams
Obstetr ics, 23 r d ed. New Yor k , McGr aw-Hill, 2010.
4 -8 . Which o f the f ollowing sequences corr ectly names the
labeled f etal head bones?
a. A is the f r ontal bone, B is the par ietal bone, and C is
the occipital bone.
b. A is the par ietal bone, B is the occipital bone, and C is
the f r ontal bone.
C. A is the tempor al bone, B is the f r ontal bone, and C is
the occipital bone,
d. A is the f r ontal bone, B is the tempor al bone, and C is
the par ietal bone.
4 -9 . The sutur e that is bor der ed by the bones labeled A and B
is which o f the f ollowing?
a. Fr ontal sutur e
b. Cor onal sutur e
C. Sagittal sutur e
d. Lambdoid sutur e
4-10. Which o f the f ollowing sequences corr ectly names the
labeled f etal head diameter s?
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL , et al. Williams
Obstetr ics, 2 2 nd ed. New Yor k : McGr aw-Hill, 2005.
a. A is suboccipitobr egmatic, B is occipitof r ontal, and
C is occipitomental.
b. A is occipitof r ontal, B is suboccipitobr egmatic, and
C is occipitomental.
C. A is occipitomental, B is occipitof r ontal, and C is
suboccipitobr egmatic.
d. A is occipitof r ontal, B is occipitomental, and C is
suboccipitobr egmatic.
4-11. Fetal blood oxygen stor es ar e suff icient to sustain the
f etus f or what time length?
3. 30 seconds
b. 60 -120 seconds
C. 3—4 minutes
d. 5—7 minutes
4-12. Car bon dioxide (CO % ) tr ansf er f r om the f etus to the
mother is f avor ed due to which o f the f ollowing mecha
nisms?
a. Oxygen tr aver ses the chor ionic villus mor e r apidly
than car bon dioxide.
tr ansf er .
C. Par tial pr essur e o f CO % in the umbilical ar ter ies is less
than in mater nal inter villous blood,
d . Fetal blood has less aff inity f or CO % than does mater
nal blood.
Fetal Growth and Development
4 -13. Oxygen, car bon dioxide, and water ar e tr ansf err ed acr oss
the placenta via which mechanism?
a. Facilitated diff usion
b. Simple diff usion
d. Carr ier -mediated diff usion
4 -14. Which of the f ollowing hor mones block s mater nal pe
r ipher al uptak e and use o f glucose while pr omoting mo
bilization and use of f r ee f atty acids by mater nal tissues?
a . Human chor ionic gonadotr opin (hCG)
b. Human placental lactogen (HPL)
C. Relaxin
d. Leptin
4 - 1 5 . Which o f the f ollowing statements about placental
tr anspor t is tr ue?
3. The placenta concentr ates a lar ge number o f amino
acids.
b. Lar ge pr oteins ar e f r eely tr ansf err ed acr oss the pla
centa.
C. Copper levels ar e higher in f etal plasma than mater
nal plasma because o f carr ier -mediated tr ansf er ,
d. Vitamin C cr osses the placenta by simple diff usion.
4 -16. Which o f the f ollowing immunoglobulins cr osses the
placenta in lar ge amounts?
a. Immunoglobulin A
b. Immunoglobulin E
C. Immunoglobulin M
d. Immunoglobulin G
4 -17. Amnionic f luid is composed lar gely o f f etal ur ine star ting
at what gestational age?
C. 30 week s
d. 40 week s
4 -18. Fetal k idneys star t pr oducing ur ine at what gestational
age?
b. 16 week s
C. 12 week s
d . 8 week s
4-19. Which o f the f ollowing statements about f etal cir cula
tion is corr ect?
a . Ventr icles o f the f etal hear t wor k in ser ies.
b. The oxygen content o f the blood enter ing the lef t
ventr icle is less than that enter ing the r ight ventr icle.
C. The r ight atr ium dir ects enter ing blood to the lef t
atr ium or r ight ventr icle depending on the oxygen
content o f the blood.
d. Most o f the r ight ventr icular output enter s the pul
monar y vasculatur e.
4-20. What per centage o f r ight ventr icular output goes to the
lungs?
a. 15%
b. 30%
c. 45%
d. 60%
4 - 2 1 . When do the distal hypogastr ic ar ter ies under go atr ophy
and obliter ation postnatally?
b. 3—4 days af ter bir th
C. 1week af ter bir th
d. 6 months o f age
4 -2 2 . The umbilical ar ter ies become which of the f ollowing?
3. Ligamentur n ter es
b. Ligamentum venosum
d. Umbilical ligaments
4 -2 3. Hemoglobin content o f f etal blood at ter m is which o f
the f ollowing?
d. 24g / dL
4-24. Fetal hemopoiesis is f ir st seen in which o f the f ollowing?
a. Bone marr ow
d. Kidneys
4 -2 5 . Fetoplacental blood volume at ter m is which o f the f ol
lowing?
Anato m y and Phy siolog y
4-26. Fetal hemoglobin F is pr oduced at which o f the f ollow
ing sites?
4-27. Which o f the f ollowing statements about immunoglob
ulin is corr ect?
a . Th e bulk o f mater nal IgG tr anspor t to the f etus oc
cur s in the second tr imester .
b. Incr eased levels o f IgM ar e f ound in newbor ns with
congenital r ubella, cytomegalovir us inf ection, or
toxoplasmosis.
C. Th e newbor n acquir es signif icant passive immunity
f r om the absor ption o f humor al antibodies ingested
in colostr um.
d. Pr eter m neonates have an adequate amount o f pr o
tective mater nal antibodies.
4-28. WTtich o f the f ollowing f etal activities, not pr esent until
24 week s, is the last to develop?
a. Opening the mouth
C. Br eathing
d. Suck ing
4-29. In r egar d to the passage o f uncon jugated bilir ubin acr oss
the placenta, which o f the f ollowing is corr ect?
a . It only passes f r om the f etal to the mater nal side.
b . It only passes f r om the mater nal to the f etal side.
C. It is not exchanged to any signif icant degr ee between
mother and f etus,
d. It is bidir ectional.
4-3 0 . W'hich o f the f ollowing is corr ect in r egar d to f etal ur ine?
a. At ter m, the f etus pr oduces 650 mL / d.
b. It is hyper tonic with r espect to f etal plasma.
C. Hemorr hage and hypoxia r esult in incr eased ur ine
output.
d . Fetal k idneys star t to pr oduce ur ine at 6 week s’ gesta
tion.
4 - 3 1 . Th e limits o f f etal viability ar e deter mined by which o f
the f ollowing pr ocess?
a . Hepatic development
b. Fetal immunocompetence
C. Kidney f or mation
d. Pulmonar y gr owth
4-3 2 . Ninety per cent o f sur f actant (dr y weight) is which o f the
f ollowing?
d. Water
4 -33 . Which o f the f ollowing statements r egar ding the sex-
deter mining r egion is tr ue?
a. It is located on the long ar m o f the Y chr omosome.
b. It dir ects development o f the testis.
C. It is expr essed in sper matozoa.
d . It is located on chr omosomes 4 and 8.
4 -34 . Which o f the f ollowing stimulates the f etal testes to
secr ete testoster one?
b. 5a-dihydr otestoster one
d. HPL
4-35. You ar e ask ed to see a newbor n with genital ambigu
ity. An image o f the newbor n is pr ovided. Imaging and
blood tests have conf ir med that this baby is 46, X X and
has a uter us, f allopian tubes, and upper vagina, No testes
ar e pr esent. The diagnosis is which o f the f ollowing?
a. Dysgenetic gonads
C. Male pseudoher maphr oditism
d. Female pseudoher maphr oditism
R epr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL , et al: Williams
Fetal Growth and Developmen
4 -36. In the case o f 21 -hydr oxlase def iciency, which o f the
f ollowing dr ugs can be administer ed to the mother to
r educe genital vir ilization in the f etus?
a. Dexamethasone
d. Pr ogester one
4 -37. A 25-year -old nulligr avida pr esents with a histor y of
pr imar y amenorr hea. She has an extr emely shor t vagina,
no axillar y hair , and Tanner stage 5 br east development.
A i image o f the patient’s per ineum is pr ovided below.
Which o f the f ollowing is the lik ely diagnosis?
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL, et al: Williams
Obstetr ics, 22 nd ed. N ew Yor k , McGr aw-Hill, 2005.
a . Congenital adr enal hyper plasia
b. Female pseudoher maphr oditism
C. Andr ogen insensitivity syndr ome
d. Tur ner syndr ome (46,X)
CHAPTER 4 ANSWER KEY
Let ter
Page
cited
4-8 a p. 84
4-9 b p. 84
4-10 a p. 84
4-11 b p. 86
4-12 d p. 86
4-13 b p. 86
4-14 b p. 87
4-15 a p. 88
4-16 d p. 88
Header c i ted
Age
Quest ion Let ter Page
n u m b e r a n s w e r c it ed
4 -20 a p. 89
4-21 b p. 90
4-22 d p. 90
4-23 c p. 91
4-25 a p. 91
4-26 c p. 92
4-28 d p. 93
4-31 d p. 96
4-32 b p. 96
4-33 b p. 101
4 -35 d p. 102
4 -36 a p. 102
4 -3 7 c p. 103
Header c i ted
Figure 4-19
N e w b o r n
Geni ta l Ambigu i ty o f the
N e w b o r n
Maternal Physiology
5 -1 . In the nonpr egnant woman, the uter us is an almost
solid str uctur e weighing appr oximately which o f the
f ollowing?
Y) 130 g
5-2 . Uter ine blood f low near ter m is which o f the f ollowing?
a. 50 -100 mL / min
W) 10 0-300 mL / min
c. 450 to 600 mL / min
Y) 1,000-1,400 mL / min
5 -3 . In the image below, cer vical ever sion is demonstr ated.
What k ind o f epithelium mak es up this por tion o f the
cer vix?
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, et al: Williams
Obstetr ics, 2 3r d ed. New Yor k , McGr aw-Hill, 2010.
a. Columnar
W) Squamous
Y) Br ush bor der cells
5-4. In pr egnancy, the midline o f the abdominal sk in be
comes especially pigmented and is called which o f the
f ollowing?
W) Lineaa lba
d. Linea nigr a
5 -5 . By the thir d tr imester , which o f the f ollowing descr ibes
the mater nal basal metabolic r ate?
a. Decr eased by 5%
b. Incr eased by 10% to 20% compar ed with the non
pr egnant state
C. Incr eased an additional 2 5 % above nor mal pr eg
nancy values in women with twin gestations
d . No ne o f the above
5-6 . The gr aphic illustr ates which o f the f ollowing points?
(LMP = last menstr ual per iod; MP = menstr ual
per iod.)
•E 284 - E tn
Weeks o f p regnancy
Repr oduced, with per mission, f r om Cunn ingham FG , et al: Williams Obstetr ics, 22nd
ed. N ew Yor k , McGr aw-Hill, 2005.
a . Mater nal plasma osmolality incr eases over all in pr eg
nancy.
W) Mater nal plasma osmolality decr eases ear ly in pr eg
nancy.
C. Mater nal plasma osmolality is aff ected most by in
cr eases in sodium.
d. Mater nal plasma osmolality does not change dur ing
pr egnancy.
A nato m y an d Phy siolog y
5-7. The pr oducts o f conception, mater nal blood volume
expansion, br east gland gr owth, and uter ine gr owth
account f or how many gr ams o f pr otein accr ued dur ing
pr egnancy?
a. 250 g
b. 500 g
c. 750 g
d. 1,000 g
5 -8. The gr aphic concer ning insulin and glucose levels dur
ing pr egnancy suggests which o f the f ollowing?
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL, et al: Williams
Obstetr ics, 2 3r d ed. New Yor k , McGr aw-Hill, 2010.
a. M ild f asting hyper glycemia
b. Postpr andial hypoglycemia
d . Hyper insulinemia
5 -9 . Concer ning f at metabolism dur ing pr egnancy, which o f
the f ollowing is tr ue?
a . Incr eased f at stor es ar e stor ed per ipher ally.
b. Tr iacylglycer ol and cholester ol levels ar e incr eased,
but low-density lipopr oteins (LDL) and ver y low-
density lipopr oteins (VLDL) ar e decr eased.
C. Mechanisms r esponsible f or changes in f at levels
include lipolytic and decr eased lipopr otein lipase
activities in adipose tissue,
d. None o f the above.
5 -10. Which o f the f ollowing occur s dur ing pr egnancy?
a . 500 mEq o f sodium and 200 mEq o f potassium ar e
r etained.
b. Total ser um calcium levels decline dur ing pr egnancy.
C. The f etal sk eleton accr ues appr oximately 70 g o f
calcium by ter m,
d. Ser um magnesium levels incr ease.
5 -11. As illustr ated by this gr aphic, which o f the f ollowing
occur s dur ing pr egnancy?
Repr oduced, with per m ission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, etal: Williams
Obstetr ics, 23r d ed. N ew Yor k , McGr aw-Hill, 2010.
a . Hematocr it incr eases dur ing pr egnancy.
b. Red cell volume does not incr ease until 20 week s.
C. Total blood volume incr eases 40% dur ing pr egnancy,
d. Hematocr it incr eases due to incr eased r ed cell volume
r elative to plasma volume.
5 -12. This gr aphic suggests which o f the f ollowing?
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL, etal: Williams
Obstetr ics, 23 r d ed. N ew Yor k , McGr aw-Hill, 2010.
a. Ser um ir on is unchanged in the f ir st tr imester .
b. Ser um f err itin is incr eased in the second tr imester .
C. Ser um tr ansf err in is incr eased by the end o f pr eg
nancy.
Materna l Physiology
5 -13. Concer ning ir on r equir ements in pr egnancy, which o f
the f ollowing is tr ue?
a. 500 mg o f ir on is r equir ed f or nor mal pr egnancy.
b. O f the ir on r equir ement, 300 gm is used f or the in
cr eased total volume of cir culating er ythr ocytes.
C. Ir on r equir ements o f pr egnancy ar e usually not avail
able f r om ir on stor es in most women,
d. 500 mg o f ir on is tr ansf err ed to the placenta and
f etus.
5 -14. Concer ning immunological f unction dur ing pr egnancy,
which of the f ollowing is tr ue?
a. Th l r esponse is suppr essed.
b. Ther e is up r egulation of T-cytotoxic cells.
C. Th2 cells ar e downr egulated.
d. All o f the above
5 -15. Concer ning the coagulation system in pr egnancy, which
o f the f ollowing is tr ue?
a . Fibr inogen levels ar e incr eased to a median o f 300
mg / dL.
b. Decr eases in platelet concentr ation ar e solely due to
hemodilution.
d. Mean platelet count is 250,000 / [iL.
5 -1 6 . The gr aphic shown above demonstr ates which o f th e
f ollowing points?
a. Car diac output incr eases between 20 and 40 week s’
gestation.
b. Hear t r ate incr eases when pr egnant women ar e sit
ting compar ed with lying supine.
C. Str ok e volume incr eases when pr e g n an t w o m e n a r e
supine compar ed with lying on their sides,
d . Car diac output incr eases postpar tum while sitting
compar ed with lying supine.
!Supine
7 0 -
5 0
2 0 - 2 4 2 8 - 3 2 3 8 - 4 0 6 - 8 w e ek s’
We eks ’ gestation PP
Repr oduced, with per mission, f r om Cunn ingham FG , Leveno KJ, Bloom SL, et al: ‘Williams
Obstetr ics, 2 3r d ed. N ew Yor k , McGr aw-Hill, 2010.
5-17. This table illustr ates which o f the f ollowing points?
a . Mean ar ter ial pr essur e is signif icantly incr eased in
pr egnancy.
"b. Ser um colloid osmotic pr essur e is similar between
pr egnant and nonpr egnant patients.
C. The COP-PCWP gr adient is signif icantly decr eased
in pr egnancy.
d. Incr eased lef t str ok e wor k index indicates pr egnancy
is a continuous high output state.
TABLE 5 -1 . Central Hemodynamic Changes in 10 Normal Nulliparous Women Near Term and Postpartum
Pregnant3 (35 -38 wks) * Postpartum (11 -13 wks) Changeb
Mean arterial pressure (mm Hg) 90 ± 6 86 ± 8 NSC
Pulmonary capillary wedge pressure (mm Hg) 8 ± 2 6 ± 2 NSC
Central venous pressure (mm Hg) 4 ± 3 4 ± 3 NSC
Heart rate (bea ts/m in) 83 ± 10 71 ± 10 + 17%
Cardiac output (L/min) 6.2 ± 1.0 4.3 ± 0.9 + 43%
Systemic vascular resistance (dy ne /se c/c m -5 ) 1210 ± 266 1530 ± 5 2 0 -2 1 %
Pulmonary vascular resistance (dyne /sec /cm -5 ) 78 ± 22 119 ± 4 7 -3 4 %
Serum colloid osmotic pressure (mm Hg) 18.0 ± 1.5 20.8 ±1.0 - 1 4 %
COP-PCWP gradient (mm Hg) 10.5 ± 2.7 14.5 ± 2 . 5 -2 8 %
Left ventricular stroke work index ( g /m /m 2) 48 ± 6 41 ± 8 NSC
aMeasured in lateral recumbent posit ion.
bChanges signif icant unless NSC = no signif icant change.
COP = col loid osm otic pressure; PCWP = pulm onary ca pi l lary wedg e pressure.
A nato m y a nd Phy siolog y
5 -18. Which o f the f ollowing ar e tr ue r egar ding angiotensin II
and its eff ects?
a . Nor motensive nullipar as ar e r ef r actor y.
b. Hyper tensive patients become and then r emain r e
f r actor y.
C. Vascular r esponse is pr obably estr ogen r elated,
d . Incr eased r ef r actor iness o f vessels r esults pr imar ily
f r om changes in angiotensin II str uctur e.
5 -19. Wh ich statement below is corr ect?
a. Tidal volume and r esting minute ventilation decr ease
signif icantly as pr egnancy advances.
b. Functional r esidual capacity and r esidual volume
incr ease as a r esult o f an elevated diaphr agm dur ing
pr egnancy.
C. Incr eases in minute ventilation ar e dr iven pr imar ily
by low expir ator y r eser ve volume,
d. Lung compliance is unaff ected by pr egnancy.
5 -20. Concer ning acid-base equilibr ium dur ing pr egnancy,
which o f the f ollowing is tr ue?
a. Physiologic dyspnea r esults f r om slightly decr eased
tidal volume that lower s CO 2 levels.
b. Plasma bicar bonate decr eases f r om 26 to appr oxi
mately 22 mmol / L.
C. Estr ogen acts centr ally, wher e it appear s to lower the
thr eshold and incr ease the sensitivity o f the chemor e-
f lex r esponse to CO 2 .
d. The mater nal oxygen-disassociation cur ve is shif ted
to the r ight.
5 -21 . Th is gr aphic illustr ates which o f the f ollowing?
Nonpregnant 0-2 0 20-3 0 30-40
Weeks' gestation
Repr oduced, with per mission, f r om Cunn ingham F G , Leveno KJ, Bloom SL, et al: Williams
Obstetr ics, 2 3r d ed. New Yor k , McGr aw-Hill, 2010.
a . Glomer ular f iltr ation r ate (GFR) incr eases dur ing
pr egnancy
b. Eff ective r enal plasma f low decr eases dur ing pr eg
nancy
C. Filtr ation f r action is mildly incr eased by the end o f
pr egnancy
d. All o f the above
5 -22 . Concer ning the ur inar y system dur ing pr egnancy, which
o f the f ollowing is tr ue?
a . Ser um cr eatinine levels incr ease f r om a mean o f 0.5
mg to 0.7 mg / dL.
b. Glucosur ia is always abnor mal.
C. Af ter the uter us r ises out o f the pelvis, ur eter al dila
tion occur s exclusively on the r ight side,
d. Bladder pr essur e incr eases f r om 8 cm H zO ear ly in
pr egnancy to 2 0 cm H 2O at ter m.
5 -23 . Concer ning the gastr ointestinal (GI) tr act dur ing pr eg
nancy, which o f the f ollowing is tr ue?
3. Gastr ic emptying time is incr eased in each tr imester ,
b. Pyr osis is caused by r ef lux o f acidic secr etions into the
lower esophagus.
C. Epulis is a systemic highly vascular swelling o f mu
cosal membr anes,
A na to m y an d Phy siolog y
CHAPTER 5 ANSWER KEY
5 -2 c p. 108 Uteroplacental Blood Flow
5 -3 a p. 109 Cervix
5 -4 d p. 111 Hyperpigmentation
5 -5 b p. 111 Metabo lic Changes