E. 23. Which of the following fontanel is a small triangular area at the intersection of the sagittal and lambdoid sutures of the fetal head?
a. Temporal b. Caesarian
c. Greater d. Posterior Answer : D
Rationale : The lesser, or posterior, fontanel is represented by a small triangular area at the intersection of the sagittal and lambdoid sutures. The localization of these fontanels gives important information concerning the presentation and position of the fetus during labor.
Reference : William’s 23rd edition (online access, Accessmedicine.com)
24. In the anatomical development of fetal urinary system, what age of gestation (in weeks) is urine first produced?
a. 9 b. 12 c. 15 d. 18
Answer : B
Rationale: Urine usually is found in the bladder even in small fetuses. The fetal kidneys start producing urine at 12 weeks.
By 18 weeks, they are producing 7 to 14 mL/day, and at term, this increases to 27 mL/hr or 650 mL/day (Wladimiroff and Campbell, 1974).
Reference: William’s 23rd edition (online access, Accessmedicine.com)
24. In the fetal circulation, where does the well-oxygenated blood pass to reach the left side and eventually supply the heart and brain?
a. right AV valve b. criata dividena c. foramen ovale d. ductus arteriosus Answer : C
Rationale: In contrast to postnatal life, the ventricles of the fetal heart work in parallel, not in series. Well-oxygenated blood enters the left ventricle, which supplies the heart and brain, and less oxygenated blood enters the right ventricle, which supplies the rest of the body. The two separate
circulations are maintained by the structure of the right atrium, which effectively directs entering blood to either the left atrium or the right ventricle, depending on its oxygen content. This separation of blood according to its oxygen content is aided by the pattern of blood flow in the inferior vena cava. The well-oxygenated blood tends to course along the medial aspect of the inferior vena cava and the less oxygenated blood stays along the lateral vessel wall. This
aids their shunting into opposite sides of the heart. Once this blood enters the right atrium, the configuration of the upper interatrial septum—the crista dividens—is such that it
preferentially shunts the well-oxygenated blood from the medial side of the inferior vena cava and the ductus venosus through the foramen ovale into the left heart and then to the heart and brain (Dawes, 1962). After these tissues have extracted needed oxygen, the resulting less oxygenated blood returns to the right heart through the superior vena cava.
Reference: William’s 23rd edition (online access, Accessmedicine.com)
24. Nano,
Marjorie Ann J. 24. In the anatomical development of fetal urinary system, what age of gestation (in weeks) is urine first produced?
a. 9 b.12 c. 15 d. 18
Answer: b.
Rationale: According to the book, the fetal kidneys start producing urine at 12 weeks. By 18 weeks, they are
producing 7-14 ml/ day and at term, this increases to 27 ml/hr or 650 mL/day
Reference: Cunningham, G.F, et al. (2005) William Obstetrics;
Fetal growth and development. 23rd edition. [chapter 4 pp 95].USA. McGraw-hill Companies, Inc.
25. In the fetal circulation, where does the well-oxygenated blood pass to reach the left side and eventually supplies the heart and brain?
a. right atrioventricular valve b. crista dividenc
c. foramen ovale d. ductus arteriosus Answer: C
Rationale: once the blood enters the right atrium, the
configuration of the upper interatrial septum (crista dividens) shunts the well oxygenated blood from the medial side of the inferior vena cava and the ductus venosus through the
foramen ovale into the left heart and then to the heart and the brain.
Reference: Cunningham, G.F, et al. (2005) William Obstetrics;
Fetal growth and development. 23rd edition. [chapter 4 pp 89-90].USA. McGraw-hill Companies, Inc.
26. what substance/s is/are produced by type II pnemocytes
that spreads to line the alveolus to prevent alveolar collapse during expiration?
a. alveolar fluid b. glucocorticoids c. surfactant d. all of the above Answer: C
Rationale: there are more that 200 pulmonary cell types, but surfactant is formed specifically in type II pneumocyte that line the alveoli.
Reference: Cunningham, G.F, et al. (2005) William Obstetrics;
Fetal growth and development. 23rd edition. [chapter 4 pp 95-96].USA. McGraw-hill Companies, Inc.
25. Salvacion,
Karl Louie G. 25. In the fetal circulation, where does the well-oxygenated blood pass to reach the left side and eventually supplies the heart and brain?
•Right atrioventricular valve c. foramen ovale
•Crista dividens d. ductus
arteriosus
Answer: C. foramen ovale
Rationale: Once this blood enters the atrium, the
configuration of the upper interatrial septum, called the crista dividens, is such that it preferentially shunts the
well-oxygenated blood from the medial side of the inferior vena cava and the ductus venosus through the foramen ovale into the left heart and then to the heart and brain (Dawes, 1962).
After these tissues have extracted needed oxygen, the resulting less oxygenated blood returns to the right heart through the superior vena cava.
Reference: WILLIAMS OBSTETRICS - 22nd Ed. (2005) E-BOOK 26. What substance/s is/are produced by type II pneumocytes that spreads to line the alveolus to prevent alveolar collapse during expiration?
a.alveolar fluid c.
surfactant
b. glucocorticoids d. all of
the above
Answer: C. surfactant
Rationale: After birth, the terminal sacs must remain
expanded despite the pressure imparted by the tissue-to-air interface, and surfactant keeps them from collapsing. There are more than 40 cell types in the lung, but surfactant is formed specifically in the type II pneumonocytes that line the alveoli. These cells are characterized by multivesicular bodies that produce the lamellar bodies in which surfactant is
assembled.
Reference: WILLIAMS OBSTETRICS - 22nd Ed. (2005) E-BOOK
27. Circulatory disturbances of the placenta include:
•Infarcts c.
calcification
•Thrombosis d. all of
the above
Answer: D. all of the above
Rationale: CIRCULATORY DISTURBANCES. Placental
perfusion may be impaired by disruption of uterine vessels, placental vessels, or the intervillous space. Placental
Infarctions. These are the most common placental lesions, and their presence is a continuum from normal
changes to extensive and pathological involvement. Placental Vessel Thrombosis. When a stem artery from the fetal
circulation in the placenta is occluded, it produces a sharply demarcated area of avascularity. Necrosis of villous tissue develops from ischemia. Histopathological features include fibrinoid degeneration of the trophoblast, calcification, and ischemic infarction. If decidual artery occlusion is followed by hemorrhage, then placental abruption results.
Reference: WILLIAMS OBSTETRICS - 22nd Ed. (2005) E-BOOK 26. Pamplona,
Hayzelle P. 26. what substance is/are produced type II pneumocytes that spreads to line the alveolus to prevent alveolar collapse during expiration?
a. alveolar fluid b. gluccocorticoids
c. surfactant d. all of the above Answer: C
Rationalization: Surfactant, specifically SP A, is produced by type II pneumocyte.
Reference: Williams Obstetrics, 23rd ed. Page 96.
27. Circulatory disturbances of the placenta include:
a. infarcts b. thrombosis c. calcification d. all of the above Answer: D
Rationalization: Placental perfusion may be impaired by disruption of uterine vessels, placental vessels, or the intervillous space. Placental infarctions the most common placental lesions, and their presence is a continuum from normal changes to extensive and pathological involvement.
Placental vessel thrombosis thrombosis is when a stem artery from the fetal circulation in the placenta is occluded
producing a sharply demarcated area of avascularity. This will deprive only 5 percent of the villi of their blood supply.
Reference: Williams Obstetrics 22nd ed. Ebook.
28. Blood with a higher oxygen content returns from the placenta to the fetus through the :
a. umbilical arteries b. truncal arteries c. umbilical vein
d. arcuate arteries Answer: C
Rationalization: Oxygen and nutrient materials required for fetal growth and maturation are delivered from the placenta by the umbilical vein.
Reference: Williams Obstetrics, 23rd ed. Page 89.
27. Sanding,
Elriza Mhyrel S. 27. Circulatory disturbances of the placenta include:
e. infarcts f. thrombosis g. calcification h. all of the above
Answer: D. all of the above
Rationale: Placental perfusion disorders may be grouped into: those disrupted maternal blood flow to or within the
placenta and those that disturb fetal blood flow through the villi. A number of lesions can restrict intervillous blood flow such as maternal floor infarction, in which this condition deposits a dense fibrinoid layer on the placental basal plate, and acts as a blockade to normal maternal blood flow. These infarctions are associated with fetal growth restriction,
abortion, preterm delivery and stillbirths. Furthermore, thrombi are normally found in mature placentas but may become clinically significant if a large portion of villi is lost that may restrict fetoplacental blood flow. Another one is placental calcification, in which there is deposition of Calcium salts throughout the placenta and is associated with
nulliparity, higher socioeconomical status and greater maternal calcium levels.
Reference: Williams 23rd edition, pages 578-580
28. Blood with a higher oxygen content returns from the placenta to the fetus through the:
e. umbilical arteries f. truncal arteries g. umbilical vein h. arcuate arteries
Answer: C. umbilical vein
Rationale: Deoxygenated venous-like fetal blood flows to the placenta through the two umbilical arteries. Truncal arteries are perforating branches of the surface arteries that pass through the chorionic plate. Whereas, blood with significantly higher oxygen content returns from the placenta via a single umbilical vein to the fetus. Arcuate arteries supply the two layers of the endometrium.
Reference: Williams 23rd edition, page 58
29. Over-the-counter pregnancy test kits test for which placental hormone?
a. estogen b. progesterone
c. human placental lactogen d. human chorionic gonadotropin
Answer: D. human chorionic gonadotropin
Rationale: The intact HCG molecule is detectable in plasma of pregnant women 7-9 days after ovulation. Maternal urine contains the same variety of HCG degradation products as maternal plasma. The principal urinary form is the terminal degradation HCG product, which is the B-core fragment. It is important to recognize that the so-called B-subunit antibody used in most pregnancy tests reacts with both intact HCG.
Reference: Williams 23rd edition, page 63 28. Martinez,
Xandra 28. Blood with a higher oxygen content returns from the placenta to the fetus through the:
A. Umbilical Arteries B. Truncal Arteries C. Umbilical Vein D. Arcuate Arteries Answer: C (Umbilical Vein) Rationale:
Oxygen and nutrient materials required for fetal growth and maturation are delivered from the placenta by the single umbilical vein.
Reference: Williams Obstetrics, 23rd Edition. Chapter 4. Fetal Growth And Development.
29. Over-the-counter pregnancy test kits test for which placental hormone?
A. Estrogen B. Progesterone
C. Human placental lactogen D. Human chorionic gonadotropin
Answer: D (human chorionic gonadotropin)
Rationale:
The detection of hCG in blood or urine is almost always indicative of pregnancy.
Reference: Williams Obstetrics, 23rd Edition. Chapter 3.
Implantation, Embryogenesis, and Placental Development.
30. In the development of the deciduas, the portion directly beneath the site of blastocyst implantation is the:
A. Decidua Capsularis B. Decidua Basalis C. Decidua Parietalis D. Chorion Leave
Answer: B (Decidua Basalis)
Rationale: The spiral arterial system supplying the deciduas basalis directly beneath the implanting blastocyst, and
ultimately the intervillous space, is altered remarkably.
Reference: Williams Obstetrics, 23rd Edition. Chapter 3.
Implantation, Embryogenesis, and Placental Development.
29. Vergara,
Renn Miguel 29. Over-the-counter pregnancy test kits test for which placenta hormone
•estrogen
•progesterone
•human placental lactogen
•human chorionic gonadotropin
Answer: D
Rationale: Detection of hCG in maternal blood and urine provides the basis for endocrine tests of pregnancy;
Numerous commercial immunoassays including over the counter pregnancy test kits are available for measuring serum and urine levels of hCG.
Reference: Williams Obstetrics 23 rd edition, page 192-193 30. In the development of the decidua, the portion directly beneath the site of blastocyst implantation is the:
•decidua capsularis
•decidua basalis
•decidua parietalis
•chorion leave Answer: B
Rationale: Decidua directly beneath blastocyst implantation is modified by trophoblast invasion and becomes the
deciduas basalis.
Reference: Williams Obstetrics 23 rd edition, page 45
31. Which subunit of the hCG molecule is used as the tumor marker for trophoblastic disease?
•alpha
•beta
•delta
•none of the above
•Answer: B
Rationale: In confirmation of the diagnosis of gestational trophoblastic diseases, a system was adopted based
principally on clinical findings and serial serum measurement of human chorionic gonadotropin, particularly beta-hCG.
Reference: Williams Obstetrics 23 rd edition, page 257
30. Panghulan,
Aldee Ray 30.In the development of the deciduas, the portion directly beneath the site of blastocyst implantation is the:
a. deciduas capsuralis b. deciduas basalis c. deciduas parietalis d. chorio leave
ANSWER: B. decidua basalis
RATIONALIZATION: In human pregnancy, the decidual reaction is completed only with
blastocyst implantation. The portion of the decidua
directly beneath the site of blastocyst implantation is modified by trophoblast invasion and becomes the decidua basalis; that portion
overlying the enlarging blastocyst, and initially separating it from the rest of the uterine cavity, is the decidua capsularis
(Figure beside). The decidua capsularis is most prominent during the second month of pregnancy, consisting of decidual cells covered by a single layer of flattened epithelial cells without traces of glands. Internally, this portion of the decidua contacts the avascular, extraembryonic fetal
membrane, the chorion laeve. The remainder of the uterus is lined by decidua parietalis, sometimes called the decidua vera when decidual capsularis and decidua parietalis are joined.
SOURCE: Williams Obstetrics 21st edition e-book Chapter II page 61 of 1132
31. Which subunit of the hCG molecule is used as the tumor marker for trophoblastic disease
a. alpha b. beta c. delta d. gamma
ANSWER: B. beta
-Beta subunit is most important because it is easily measurable by present-day technology.
The rate of synthesis of the ß-subunit of hCG is believed to be limiting in the formation of the complete molecule.
Trophoblasts of normal placenta and those of hydatidiform mole and choriocarcinoma tissues secrete free a- and ß-subunits as well as intact hCG.
-Trophoblastic diseases are a group of pregnancy disorders including a complete hydatidiform mole, a partial mole, and choriocarcinoma.
-The use of total hCG measurement in gestational
trophoblastic diseases is an example of a tumor marker with 100% sensitivity and 100% specificity for trophoblast-tissue mass, with the amount of tumor tissue or mole being directly proportional to the circulating concentration of total hCG.
SOURCE: Williams Obstetrics 21st edition e-book page 191 of 1132 “The Placental Hormones”
32. The most invasive cell in human physiology is:
a. trophoblast b. Langhan cell c. white blood cell d. plasma cell
ANSWER: A. trophoblast
Trophoblast, a very special cell; “without it, you and I would not be here”. Responsible for implantation. Its invasiveness provides for attachment of the blastocyst to the uterus.
The decidua basalis contributes to the formation of the basal plate of the placenta, and differs histologically from the
decidua parietalis in two important respects. First, the spongy zone of the decidua basalis consists mainly of arteries and widely dilated veins; by term, the glands have virtually disappeared. Second, the decidua basalis is invaded by trophoblastic giant cells, which appear at the time of implantation. The number and depth of endometrial penetration of the giant cells varies greatly. Although
generally confined to the decidua, these cells may penetrate the myometrium. In such circumstances, their number and invasiveness may be so extensive as to be suggestive of choriocarcinoma to the inexperienced observer.
SOURCE: Williams Obstetrics 21st edition e-book Chapter II page 61 of 1132
31. Magdaong,
Melayne Jewel 31. MAGDAONG, MELAYNE JEWEL R.
Which sub-unit of the hCG molecule is used as the tumor marker for trophoblastic disease.
e. Alpha f. Beta g. Delta h. None Answer: B
Rationale: trophoblast cells produce hCG in amounts that increase exponentially following implantation. hCG consists of alpha and beta subunit. Antibodies were develop with high specificity for Beta subunit.
Reference: Williams 23rd edition. Pages 192-193. Chapter 8:
Pre natal care