Obstetric Examination: Common Diagnostic Procedures

This article provides information about several diagnostic procedures in obstetrics and explains answers to related multiple choice questions.

Note: The information provided in this article is for general knowledge and should not be considered as a substitute for professional medical advice.

I. Common Diagnostic Procedures in Obstetrics:

1. Pelvic Ultrasound:

• Conditions for optimal results:
  • Fasting for 4-6 hours prior to the ultrasound (to allow for bladder filling, leading to clearer images).
  • Voiding before the ultrasound (to empty the bladder, preventing interference with the images).
  • Note: It is not necessary to fast from food before a pelvic ultrasound.
• Purpose of Pelvic Ultrasound:
  • Evaluate the structure of the uterus, fallopian tubes, ovaries, and pelvic organs.
  • Detect abnormalities like uterine fibroids, ovarian cysts, ectopic pregnancy.
  • Monitor fetal growth during the first trimester.
  • Measure amniotic fluid levels.

2. Huhner Test:

• Purpose: To examine the penetration of sperm into cervical mucus.
• Procedure: Cervical mucus is collected after sexual intercourse and observed under a microscope.

3. Cervical Cytology Screening for Cancer:

• Most important aspect: Obtaining cells from the transition zone between squamous epithelium and columnar epithelium.
• Purpose: Early detection of cervical cancer.

4. Cervical Inspection:

• Purpose:
  • Identify benign cervical lesions.
  • Detect atypical lesions: white patches, patchy lesions…
  • Detect invasive cancer.
• Timing of cervical inspection: After the end of menstruation.

5. Hysterosalpingography (HSG):

• Purpose: Evaluate infertility and fallopian tube blockage.
• Number of images: 5 images.
• Complications: Infection, allergy, embolism.

6. Endocrine Cytological Examination:

• Purpose: Assess the effects of progesterone and estrogen.

7. Papanicolaou (Pap) Smear:

• Purpose: Detect cervical cancer cells.
• Types of cells: 5 types.

8. Postcoital Test:

• Timing: 8-12 hours after intercourse.
• Purpose: Examine sperm survival and motility in the vaginal environment.

9. Endometrial Biopsy:

• Timing: Any time.
• Purpose: Detect endometrial abnormalities.

10. Pelvic Laparoscopy:

• Purpose: Diagnose and surgically treat certain gynecological conditions.
• Organs to be observed: Uterus, fallopian tubes, ovaries, cul-de-sac, and ligaments.

11. Hormone Quantification:

• Timing: From day 1 to day 4 of the menstrual cycle.

12. Amniocentesis:

• Indications:
  • Post-term pregnancy.
  • Fetal scalp blood sampling for fetal distress diagnosis.
  • Diagnose amniotic fluid infection.
• Contraindications: Premature rupture of membranes.
• Complications:
  • Miscarriage.
  • Bleeding and hematoma in the muscles and placenta.
  • Amniotic fluid leakage.
  • Amniotic fluid infection.

13. Non-Stress Test (NST):

• Purpose: Predict the risk of fetal distress.
• Normal fetal criteria: Increased fetal heart rate response after fetal movement.

14. Ultrasound During Pregnancy:

• Purpose:
  • Diagnose fetal viability.
  • Diagnose intrauterine or ectopic pregnancy.
  • Diagnose single or multiple pregnancies.
  • Determine gestational age.
  • Monitor fetal growth.
  • Evaluate fetal structure.
  • Detect fetal abnormalities.
  • Measure amniotic fluid volume.

II. Multiple Choice Questions and Answers:

45. The necessary condition for a good pelvic ultrasound result is:

• Answer: A. Fasting for 4-6 hours beforehand.
• Explanation: As explained above, withholding urination allows the bladder to fill, leading to clearer ultrasound images.

46. Regarding the significance of different basal body temperature graphs, choose the correct answer:

• Answer: C. If the rise in body temperature lasts longer than 14 days, the possibility of pregnancy should be considered.
• Explanation: A biphasic basal body temperature chart is a sign of a normal ovulatory cycle. If the temperature increase lasts longer than 14 days, it could indicate pregnancy.

47. The Huhner Test aims to:

• Answer: D. Examine the penetration of sperm into cervical mucus.
• Explanation: The Huhner Test helps assess the ability of sperm to fertilize in the cervical environment.

48. The most crucial point in the cervical cytology screening for cancer technique is:

• Answer: D. Obtaining cells from the transition zone between squamous epithelium and columnar epithelium.
• Explanation: This transition zone is prone to the development of cervical cancer.

49. Which of the following images obtained through cervical inspection does NOT require biopsy:

• Answer: A. Ectropion.
• Explanation: Ectropion is a normal occurrence and does not require a biopsy.

50. In women of reproductive age, cervical inspection should be performed around which time of the menstrual cycle?

• Answer: C. Between days 6 and 12 of the menstrual cycle.
• Explanation: This period corresponds to the growth phase of the endometrium, making it easier to observe.

51. How many images are required for hysterosalpingography for infertility investigation?

• Answer: D. 5 images.
• Explanation: 5 images are needed to assess the entire structure of the uterus and fallopian tubes.

52. The purpose of endocrine cytological examination is, choose the most accurate answer:

• Answer: C. Assess the effects of progesterone and estrogen.
• Explanation: This examination assesses ovarian function and the effects of sex hormones.

53. When performing the Papanicolaou (Pap) smear for cervical cancer detection, how many cell types are classified?

• Answer: D. 5 types.
• Explanation: The 5 cell types are categorized based on morphology and cancer potential.

54. The purpose of cervical inspection is to identify:

• Answer: D. All of the above are correct.
• Explanation: Cervical inspection helps in the early detection of cervical pathologies.

55. When examining cervical mucus, we can assess:

• Answer: D. All of the above are correct.
• Explanation: Cervical mucus reflects the condition of the cervix, the influence of estrogen and progesterone.

56. The postcoital test is performed at:

• Answer: D. 8-12 hours after intercourse.
• Explanation: This timing allows for an assessment of sperm survival in the vaginal environment.

57. The timing for an endometrial biopsy is:

• Answer: D. Any time.
• Explanation: Endometrial biopsy can be performed at any time, depending on the purpose of the examination.

58. Which of the following is a correct indication for hysterosalpingography?

• Answer: A. Infertility of unknown cause.
• Explanation: Hysterosalpingography helps identify abnormalities in the structure of the uterus and fallopian tubes, which may be the cause of infertility.

59. The purpose of pelvic laparoscopy is:

• Answer: D. Both A and B are correct.
• Explanation: Pelvic laparoscopy facilitates both diagnosis and treatment of gynecological pathologies.

60. The primary organs to be observed during pelvic laparoscopy are:

• Answer: D. All of the above are correct.
• Explanation: Pelvic laparoscopy allows for the observation of all female reproductive organs.

61. The ideal time for basic hormone quantification is:

• Answer: B. From day 1 to day 4 of the menstrual cycle.
• Explanation: Hormone levels fluctuate throughout the menstrual cycle.

62. When performing pelvic laparoscopy, the primary organs to be observed are:

• Answer: D. All of the above are correct.
• Explanation: Pelvic laparoscopy enables the observation of all pelvic organs.

63. When a suspicious cervical lesion is detected, a biopsy should be taken from:

• Answer: C. The border between the lesion and healthy tissue.
• Explanation: Biopsy from this region helps accurately determine the extent of the lesion.

64. Cervical mucus with a “pupil-like” appearance, containing clear, thin fluid, easily forming threads is seen:

• Answer: B. On the day of ovulation.
• Explanation: Cervical mucus exhibits these properties on the day of ovulation, facilitating sperm movement into the uterus.

65. If an ultrasound shows a solitary ovarian tumor, hysterosalpingography with contrast media will reveal:

• Answer: B. Elongation of the fallopian tube on the side of the tumor.
• Explanation: Ovarian tumors can stretch the fallopian tube, leading to elongation.

66. If an ultrasound reveals a large ovarian tumor with multiple internal septa, which type of ovarian tumor is highly suspected?

• Answer: B. Mucinous cystadenoma.
• Explanation: Mucinous cystadenomas are often large in size and have multiple septa.

67. Possible complications of hysterosalpingography include:

• Answer: D. All of the above are correct.
• Explanation: Hysterosalpingography can lead to complications such as infection, allergy, and embolism.

68. The results of a Papanicolaou (Pap) smear are:

• Answer: D. All of the above are correct.
• Explanation: The Pap smear results can indicate the health status of the cervix, ranging from no abnormalities to the presence of cancerous cells.

69. Select the incorrect statement regarding changes in squamous epithelium (observed in the Pap smear):

• Answer: D. AGUS.
• Explanation: AGUS (Atypical Glandular Cells of Undetermined Significance) refers to atypical glandular cells, not squamous epithelium.

70. To assess ovarian endocrine activity and endometrial response, endometrial biopsy for GPBL (Gynecological Pathology Biopsy Lab) should be performed:

• Answer: D. Around days 21 to 23 of a 28-day menstrual cycle.
• Explanation: Endometrial biopsy at this time helps assess the effects of progesterone.

71. A highly acidic vaginal environment, with a pH less than 4, is favorable for:

• Answer: A. Yeast (Candida) growth.
• Explanation: An acidic vaginal environment favors the growth of Candida yeast.

72. A healthy 35-year-old woman has experienced a decline in vision, breast discharge, irregular and scanty menstruation in recent months. What is the first endocrine test to be performed for quantification?

• Answer: D. Serum Prolactin.
• Explanation: These symptoms could be signs of hyperprolactinemia.

73. The best course of action for a 42-year-old woman experiencing amenorrhea is:

• Answer: C. Oxytocin + ergometrine medication, followed by immediate curettage and GPBL.
• Explanation: Amenorrhea can be a sign of a serious condition requiring prompt management.

1601. When does the fetal embryo become visible on ultrasound?

• Answer: B. 7 weeks of amenorrhea.
• Explanation: The fetal embryo becomes clearly visible by the 7th week of pregnancy.

1602. When can fetal heartbeats be detected on ultrasound?

• Answer: C. 7 weeks of amenorrhea.
• Explanation: Fetal heartbeats can be observed via ultrasound starting from the 7th week of pregnancy.

1603. What is the average weekly growth rate of fetal biparietal diameter (BPD) before 30 weeks of gestation?

• Answer: B. 4mm per week.
• Explanation: Fetal BPD grows rapidly during the first trimester.

1604. At what fetal BPD measurement should hydrocephalus be considered (for a full-term fetus)?

• Answer: C. 110mm.
• Explanation: An excessively large fetal BPD could be a sign of hydrocephalus.

1605. What is the purpose of a non-stress test (NST)?

• Answer: B. To predict the risk of fetal distress.
• Explanation: The NST assesses fetal well-being and predicts the risk of fetal distress.

1606. One of the criteria for a normal NST:

• Answer: D. Increased fetal heart rate response after fetal movement.
• Explanation: An increased fetal heart rate response to movement indicates a healthy fetus.

1607. Which of the following is an INCORRECT indication for amniocentesis:

• Answer: D. Diagnosis of placenta previa.
• Explanation: Amniocentesis is not indicated for the diagnosis of placenta previa.

1608. When staining amniotic fluid using the Brosen and Gordon technique, what percentage of orange-colored cells indicates a mature fetus?

• Answer: D. >10%.
• Explanation: An orange-colored cell percentage above 10% indicates a mature fetus.

1609. In ectopic pregnancies, hCG levels are often below what value in 50% of cases?

• Answer: C. < 800 UI/l.
• Explanation: hCG levels in ectopic pregnancies are generally lower than in intrauterine pregnancies.

1610. The gestational sac can be observed on ultrasound from which week of amenorrhea?

• Answer: B. 4 weeks of amenorrhea.
• Explanation: The gestational sac becomes visible on ultrasound from the 4th week of pregnancy.

1611. The basic fetal heart rate is:

• Answer: C. 120-160 beats per minute (bpm).
• Explanation: A fetal heart rate within this range is considered normal.

1612. The normal intrinsic variability of the fetal heart rate is:

• Answer: C. 10-25 beats.
• Explanation: The normal intrinsic variability of the fetal heart rate is between 10 and 25 beats per minute.

1613. Bradycardia is defined as:

• Answer: B. <120 bpm.
• Explanation: Bradycardia is a fetal heart rate below 120 beats per minute.

1614. Tachycardia is defined as:

• Answer: C. >160 bpm.
• Explanation: Tachycardia is a fetal heart rate above 160 beats per minute.

1615. Amniocentesis is performed at what gestational age?

• Answer: D. 37 weeks.
• Explanation: Amniocentesis is indicated when the fetus is close to full-term to ensure fetal safety.

1616. The most accurate location for amniocentesis in the early stages of pregnancy is:

• Answer: C. Through the uterine body where the placenta is thinly attached.
• Explanation: Amniocentesis through this location helps avoid placental injury.

1617. The most common complication of amniocentesis is:

• Answer: B. Bleeding and hematoma in the muscles and placenta.
• Explanation: Amniocentesis can lead to bleeding and hematoma in the muscles and placenta.

1618. Amniocentesis is indicated for all of the following EXCEPT:

• Answer: C. Premature rupture of membranes.
• Explanation: Amniocentesis is not indicated in cases of premature rupture of membranes.

1619. Amniotic fluid color in cases of Rh blood group incompatibility is:

• Answer: A. Yellow.
• Explanation: Yellow amniotic fluid is a sign of fetal hemolytic disease.

1620. The following are causes of fetal bradycardia EXCEPT:

• Answer: A. Maternal anemia.
• Explanation: Maternal anemia is not a cause of fetal bradycardia.

1621. The gestational sac size at 5 weeks of gestation is:

• Answer: B. 10 mm.
• Explanation: The gestational sac size is approximately 10 mm at the 5th week of pregnancy.

1622. Contraindications for hysterosalpingography include:

• Answer: B. Confirming pregnancy.
• Explanation: Hysterosalpingography can be harmful to the fetus.

1624. HCG can be quantified approximately 10 days after ovulation. T/F

• Answer: T
• Explanation: hCG levels start to increase after fertilization and can be quantified around 10 days after ovulation.

1625. Monitoring the increase in hCG levels helps confirm the location of fetal implantation. T/F

• Answer: F
• Explanation: hCG levels do not indicate the location of fetal implantation.

1626. Intrinsic variability (IV) type 0: when the variability is below 5 beats per minute. This type of variability indicates fetal distress (but needs to be differentiated from fetal sleep). T/F

• Answer: T
• Explanation: IV type 0 is a sign of fetal distress.

1627. Bradycardia: defined as a baseline fetal heart rate (BFHR) below 120 bpm, or a decrease of over 30 beats from the normal BFHR, lasting for over 10 minutes. T/F

• Answer: T
• Explanation: Bradycardia is defined according to this criterion.

1628. Early deceleration: when the lowest point of the fetal heart rate tracing occurs before the highest point of the uterine contraction. T/F

• Answer: F
• Explanation: Early deceleration occurs when the lowest point of the fetal heart rate tracing coincides with the highest point of the uterine contraction.

1629. In normal labor, uterine contractions occur every 3-5 minutes, lasting 30-60 seconds, with an intensity of 50-75 mmHg. T/F

• Answer: T
• Explanation: These are normal parameters for uterine contractions during labor.

1630. List 4 purposes of ultrasound during the first trimester of pregnancy:

• A. (Diagnose fetal viability)
• B. (Diagnose intrauterine or ectopic pregnancy)
• C. (Diagnose single or multiple pregnancies)
• D. (Determine gestational age)

1631. Amniocentesis is a simple procedure used to observe …()… of amniotic fluid.

• (Color)

1632. The increase in …()… levels during pregnancy is reflected in changes in vaginal cells.

• (Hormones)

1633. If an abdominal ultrasound is performed, … () .. can be observed around the 7th week of pregnancy.

• (Fetal heart)

1634. …()… is assessed through ultrasound, normally within the range of 5-25 cm.

• (Amniotic fluid index)

1635. Obstetrical monitoring is used to continuously record … (a)… and …(b) …. during pregnancy and labor.

• a. Fetal heart rate
• b. Uterine contractions

1636. In obstetrical monitoring, the baseline fetal heart rate lies within the range of …(a)…., with an average of ….()…..

• a. 120-160 bpm
• b. 140 bpm

1637. Normally, the placenta is attached to the uterine body. If the placenta is ….()… then the relationship between the placental position and the cervical opening is recorded to diagnose placenta previa.

• (Low-lying in the lower segment)

1638. List the requirements necessary for ultrasound assessment of fetal adnexa.

• A. (Placenta)
• B. (Umbilical cord)
• C. (Amniotic fluid volume)

1639. List the types of intrinsic variability of the fetal heart rate recorded on obstetrical monitoring:

• A. (Variability type 0)
• B. (Variability type 1)
• C. (Variability type 2)
• D. (Variability type 3)

1640. Amniocentesis should only be performed when ..()….

• (Labor)

1641. The peak hCG level is reached during the ….()… week of pregnancy.

• (10)

1642. Today, ultrasound during pregnancy is a routine test, and pregnant women should undergo ultrasound at least …()… times during a pregnancy.

• (3)

1643. In the first trimester, if no fetal embryo is observed on ultrasound, it should be considered a missed abortion with fetal resorption. If the gestational sac is greater than what size in mm?

• C. 25 mm

1644. The best time for fetal anatomical ultrasound is:

• B. Weeks 16-20

1645. When is the stress test indicated?

• C. No fetal heart rate acceleration following fetal movement.

1646. Contraindications for the non-stress test:

• A. There are no contraindications for the non-stress test.

1647. Which of the following factors can affect the results of a non-stress test?

• ? (Further information is needed to answer this question.)

1648. To determine gestational age at 12 weeks, which factor is most accurate?

• C. Crown-rump length (CRL).

1649. Which of the following indications for amniocentesis is correct?

• C. Vertex presentation.

1650. Beta hCG testing is NOT required to:

• B. Determine fetal malformations.

1651. Causes of fetal tachycardia EXCEPT:

• C. Increased vagal nerve activity.

1652. Causes of false-positive hCG tests EXCEPT:

• D. When pregnancy is more than 1 month.

1653. Vaginal smears should NOT be performed:

• D. After sexual intercourse.

1654. Contraindications for hysterosalpingography include:

• D. Performed in the second half of the menstrual cycle.

1655. AFP (alpha-fetoprotein) is mainly synthesized by the fetal liver, excreted in fetal urine into amniotic fluid, and circulates in the maternal bloodstream. T/F

• T

1656. After oocyte retrieval, hCG should regress and disappear. If hCG levels rise again, a complication of choriocarcinoma should be suspected. T/F

• T

1657. Diagnosing late deceleration: when …(a)…. of the fetal heart rate tracing occurs after …(b)…. of the uterine contraction.

• a. Lowest point
• b. Highest point

1658. List the contraindications for amniocentesis:

• A. (Vaginal infection)
• B. (Placenta previa)
• C. (Intrauterine fetal demise)

1659. List 3 roles of ultrasound in guiding certain prenatal diagnostic procedures:

• A. (Amniocentesis)
• B. (Cordocentesis)
• C. (Chorionic villus sampling)

1660. List 4 purposes of hCG quantification in the first trimester of pregnancy?

• A. (Early pregnancy diagnosis)
• B. (Predicting miscarriage)
• C. (Ectopic pregnancy)
• D. (Diagnosing and monitoring hydatidiform mole.)

1661. Triple test quantification is used to detect which 2 fetal abnormalities:

• A. (Spina bifida)
• B. (Chromosomal abnormalities)

1662. List 4 first-trimester pregnancy abnormalities that can be investigated using ultrasound:

• A. (Ectopic pregnancy)
• B. (Molar pregnancy)
• C. (Fetal demise)
• D. (Miscarriage, abruption)

1663. Which of the following fetal malformations cannot be detected by ultrasound at 12 weeks of gestation?

• D. Cardiac defects

1664. The following are all correct indications for early amniocentesis EXCEPT:

• C. Maternal heart disease

Note:

• This article provides general knowledge and should not be considered as professional medical advice.
• If you have any health concerns, please consult