20 QUESTIONS ON OB

1. All of the following hormones are products of placental synthesis or products of

production except

a. human chorionic gonadotropin (hCG)

b. human placental lactogen
c. prolactin
d. progesterone
e. estriol
ANSWER: C – prolactin is not produced by the placenta; for the most part, it is a
product of the anterior lobe of both the maternal and fetal pituitary glands.

2. Human placental lactogen, the growth hormone of pregnancy, is characterized by

all of the following statements except

a. it elevates free fatty acids

b. it elevates plasma insulin levels
c. it induces lipolysis
d. it inhibits gluconeogenesis in the mother
e. it stimulates glucose uptake in the mother
ANSWER: E – human placental lactogen induces changes in the maternal
physiology, which encourage growth of the fetus. It induces lipolysis, elevating
free fatty acids, which provide energy for the mother. It elevates plasma insulin
levels, which favors protein synthesis, ensuring a source of amino acids for the
fetus, and it inhibits gluconeogenesis and glucose uptake in the mother, which
allows for the transfer of materials to the fetus, thus contributing to fetal growth.

3. Excessive high levels of human chorionic gonadotropin would be expected in

which of the following conditions?

a. choriocarcinoma
b. hyatidiform mole
c. twin gestation
d. ectopic pregnancy
ANSWER: A – choriocarcinoma, hyatidiform mole and twin gestations are
associated with higher than normal levels of human chorionic gonadotropin
(HCG).

4. All of the following complications are typical of the second trimester of

pregnancy except

a. premature labor
b. cervical incompetence
c. premature rupture of membranes
d. placental abruption
 e. round ligament pain
ANSWER: D – cervical incompetence is the biggest concern during the second
trimester. The incompetence can be accompanied by either premature labor or
premature rupture of membranes or both.

5. A woman in her second trimester of pregnancy is likely to experience

a. round ligament pain

b. lightening
c. Braxton-Hicks contractions
d. bloody show
ANSWER: B – round ligament pain is common between 14 and 20 weeks AOG
and subsides thereafter; it is caused by the stretching of the round ligaments as the
uterus grows.

6. An abnormal finding during a normal pregnancy is

a. a weight gain of 11 lbs at 20 weeks

b. fetal heart tones at 13 weeks detected by Doppler
c. the fundus of the uterus at the level of the umbilicus at 20 weeks
d. real-time ultrasonographic evidence of fetal heart motion 4 weeks after the
last menstrual period.
ANSWER: E – it is not possible to see fetal heart motion by real-time
ultrasonography until 6-7 weeks after the last menstrual period or 2-3 weeks after
the first missed menses.

7. Maternal folate deficiency has been implicated in the etiology of

a. abruptio placentae
b. anencephaly
c. preeclampsia and eclampsia
d. intrauterine growth retardation
ANSWER: A – folic acid deficiencies are known to cause megaloblastic anemia
and have been implicated in reproductive problems, such as abruption placentae,
pregnancy-induced hypertension (preeclampsia and eclampsia), and fetal
abnormalities, such as neural tube defects.

8. The first stage of labor is characterized by

a. cervical dilation
b. pushing
c. the active phase
d. crowning
ANSWER: B – during the first stage of labor, the cervix gradually dilates up to
10 cm. The active phase is characterized by progressive cervical dilation. Pushing
 begins with the second stage of labor when the cervix is completely dilated.
Crowning occurs late in the second stage just before the infant’s head is delivered.

9. Ruptured membranes are always associated with

a. a positive nitrazine test

b. uterine contractions
c. ferning of dried amniotic fluid
d. chorioamnionitis
ANSWER: B – because of the alkaline nature of amniotic fluid, it turns nitrazine
paper blue, registering a positive test. When amniotic fluid is dried on a slide and
observed through a microscope, a ferning pattern appears because of tiny crystals
that form due to the slat content of the fluid.

10. Characteristics or associated findings with late decelerations include all of the
following except

a. they are seen in patients with preeclampsia

b. they may be associated with respiratory alkalosis
c. they are associated with a decreased utero-plancental blood flow
d. they usually are accompanied by a decreased PO2
e. they usually are accompanied by an increased PCO2
ANSWER: B – late decelerations are indications of a decreased uteropalcental
blood flow and often reflect hypoxemis or acidosis in the fetus.

11. The infant of a diabetic mother is at risk for all of the following except

a. increased perinatal death rate

b. hypocalcemia
c. hyperglycemia
d. neural tube defect
e. macrosomia
ANSWER: C – the effects of diabetes on the fetus and infant can be considerable,
especially uncontrolled diabetes. There is an increase in fetal abnormalities, such
as neural tube defects. Macrosomia is common, and the perinatal death rate is
higher than normal. The newborn may demonstrate hypocalcemia and
hypoglycemia. The insulin secretion that has been stimulated in the fetus by the
high levels of glucose from the mother continues after and can drop the newborn
blood glucose to dangerously loe levels.

12. Signs of heart disease in pregnancy include

a. lower extremity edema

b. systolic murmurs
c. increased respiratory effort
d. arrhythmias
 ANSWER: D – only arrhythmias are diagnostic of heart disease in pregnancy.

13. The most common cause of vaginal bleeding complicating premature labor is

a. a vaginal laceration
b. an endocervical ployp
c. cervical dilatation
d. placenta previa
e. placental abruption
ANSWER: C – During premature labor when the cervix begins to dilate and
efface, the separation of the placenta and membranes may produce vaginal
bleeding.

14. The most accurate and definitive documentation of fetal life is made by

a. fetoscope
b. Leopold maneuver
c. B-scanner
d. Real-timer ultrasound
e. Doppler ultrasound
ANSWER: D - Real –time ultrasound provides an excellent display of fetal
movement, particularly the heart, and, therefore, is of immense value in
demonstrating fetal life.

15. All of the following signs or symptoms characterize placenta previa except

a. painless vaginal bleeding

b. increased uterine tone
c. thinning of the lower uterine segment
d. early third-trimester bleeding
e. erythroblastosis
ANSWER: B – Increased uterine tome is one of the cardinal signs of abruptio
palcentae and is due to the bleeding behind the placenta as it prematurely
separates from the uterus.

16. Mechanisms of heat loss in the newborn include all of the following except

a. evaporation
b. convection
c. condensation
d. radiation
e. conduction
ANSWER: C – Newborns must be kept warm as they can lose heat rapidly by
evaporation, convection, conduction, and radiation and become cold stressed.

17. Signs and symptoms associated with a hytidiform mole include all of the
 following except

a. first-trimester bleeding
b. a uterus larger than the expected gestational age
c. hypothyroidism
d. preeclampsia at 14 weeks gestation
e. nausea and vomiting
ANSWER: C – Hyperthyriodism is seen in a molar pregnancy, but not
hypothyroidsm, as a result of binding of the human chorionic gonadotropin
molecule by the thyroid-stimulating hormone receptor sites and hyperfunction of
the gland.

18. The main health hazard of menopause is

a. cardiovascular disease
b. pelvic relaxation
c. endometrial cancer
d. depression
e. osteoporosis
ANSWER: E – Because of the consequences of bone rarefaction, osteoporosis is
the main health hazard associated with menopause.

19. All the following statements concerning the Apgar score are true except

a. it is formulated by assessing heart rate, respiratory effort, skin color,

muscle tone, and reflex response.
b. It is used to determine the necessity and degree of resuscitative efforts
c. It predicts the likelihood of the infant developing mental retardation
d. Severely depressed infants should have Apgar scores of 3 or less
e. Resuscitative efforts should not be delayed to formulate the Apgar score.
ANSWER: C – it does not predict ultimate outcome, although infants with a
severely depressed Apgar score at 20 minutes are at high risk for developing
cerebral palsy.

20. The best predictor of ovulation is

a. estrogen peak
b. luteinizing hormone (LH) surge
c. follicle-stimulating hormome surge
d. onset of the LH surge
e. preovulatory rise in the progesterone
ANSWER: D – The onset of the luteinizing hormone surge, which occurs 28-32
hours prior to ovulation is the most reliable indicator of the timing of ovulation.