While still in the ovary, the ovum is in the:
A. Primary oocyte
B. Secondary oocyte
C. Mature ovum
D. Zygote

A. Primary oocyte

Shortly before release from the follicle, the primary oocyte nucleus undergoes ___ and expels ___:
A. Mitosis; second polar body
B. Mitosis; first polar body
C. Meiosis; second polar body
D. Meiosis; first polar body

D. Meiosis; first polar body

After the first polar body is expelled, the oocyte becomes a:
A. Primary oocyte
B. Secondary oocyte
C. Mature ovum
D. Zygote

B. Secondary oocyte

The chromosomes of the secondary oocyte are:
A. Unpaired
B. Paired
C. Bivalent
D. Tetrad

A. Unpaired

Once 23 unpaired chromosomes are present, the oocyte is:
A. Implanted in endometrium
B. Arrested in meiosis I
C. Ovulated into abdominal cavity
D. Transformed into trophoblast

C. Ovulated into abdominal cavity

Granulosa cells attached to the ovum constitute the:
A. Zona pellucida
B. Corona radiata
C. Trophoblast layer
D. Cryptoid surface

B. Corona radiata

The inner surfaces of the fimbriae are lined with:
A. Squamous epithelium
B. Cuboidal epithelium
C. Transitional epithelium
D. Ciliated epithelium

D. Ciliated epithelium

The fimbrial cilia are activated by ovarian:
A. Progesterone
B. FSH
C. LH
D. Estrogen

D. Estrogen

Transport of sperm is aided by uterine and tubal contractions stimulated by:
A. Prostaglandins and oxytocin
B. Estrogen and progesterone
C. FSH and LH
D. Histamine and bradykinin

A. Prostaglandins and oxytocin

After penetrating granulosa layers, sperm must bind to and penetrate the:
A. Corona radiata
B. Zona pellucida
C. Uterine milk
D. Male pronucleus

B. Zona pellucida

Once a sperm enters the ovum, the oocyte will:
A. Arrest permanently
B. Degenerate immediately
C. Form mature ovum plus second polar body
D. Expel first polar body

C. Form mature ovum plus second polar body

On entering the ovum, the fertilizing sperm’s head swells to form a:
A. Male pronucleus
B. Zona pellucida
C. Corona radiata
D. Trophoblast cell

A. Male pronucleus

The 23 unpaired chromosomes of male and female pronuclei align to re-form:
A. 23 chromosomes
B. Triploid complement
C. 46 chromosomes
D. Tetraploid complement

C. 46 chromosomes

A fertilized ovum is called a:
A. Morula
B. Zygote
C. Blastocyst
D. Trophoblast

B. Zygote

Mature sperm carrying X versus Y chromosomes are distributed:
A. Mostly X
B. Mostly Y
C. All X
D. Half X, half Y

D. Half X, half Y

After fertilization, additional time required for tubal transport into the uterus is usually:
A. 3–5 days
B. 1–2 days
C. 7–10 days
D. 10–14 days

A. 3–5 days

Fallopian tubes are lined with a rugged structure that impedes ovum passage despite fluid current:
A. Smooth mucosa
B. Cryptoid surface
C. Squamous plaque
D. Endometrial villi

B. Cryptoid surface

For about the first 3 days after ovulation, which structure remains spastically contracted?
A. Infundibulum
B. Ampulla
C. Isthmus
D. Uterine cavity

C. Isthmus

Delayed transport through the fallopian tube allows:
A. Immediate implantation
B. Completion of meiosis I
C. Zona pellucida formation
D. Several stages of cell division

D. Several stages of cell division

The dividing ovum (per these notes) is called a:
A. Zygote
B. Blastocyst
C. Primary oocyte
D. Secondary oocyte

B. Blastocyst

The developing blastocyst remains in the uterine cavity for an additional:
A. 1–3 days
B. 3–5 days
C. 7–9 days
D. 10–12 days

A. 1–3 days

Before implantation, blastocyst nutrition comes from uterine endometrial secretions called:
A. Amniotic fluid
B. Placental blood
C. Yolk secretions
D. Uterine milk

D. Uterine milk

Implantation results from the action of cells developing over the blastocyst surface called:
A. Granulosa cells
B. Ciliated epithelium
C. Trophoblast cells
D. Theca interna

C. Trophoblast cells

In early implantation, which cells secrete proteolytic enzymes that liquefy adjacent endometrium?
A. Decidual cells
B. Endometrial glands
C. Granulosa cells
D. Trophoblast cells

D. Trophoblast cells

The term for the embryo plus associated membranes is:
A. Zygote
B. Conceptus
C. Morula
D. Blastocyst

B. Conceptus

Continued progesterone secretion causes endometrial cells to:
A. Swell further
B. Shed superficially
C. Undergo necrosis
D. Become ciliated

A. Swell further

After swelling and nutrient storage, endometrial cells become:
A. Theca cells
B. Cytotrophoblast
C. Decidual cells
D. Syncytiotrophoblast

C. Decidual cells

As trophoblast invades decidua, released nutrients are used by the:
A. Embryo
B. Ovary
C. Uterus
D. Placenta

A. Embryo

Placental nutrition becomes available after about the:
A. 8th day
B. 12th day
C. 16th day
D. 28th day

C. 16th day

Around 21 days after fertilization, blood begins to be pumped by the:
A. Maternal heart
B. Placenta
C. Decidua
D. Embryonic heart

D. Embryonic heart

Maternal blood surrounding trophoblastic cords is supplied by:
A. Umbilical arteries
B. Blood sinuses
C. Villi capillaries
D. Uterine veins

B. Blood sinuses

Which sequence correctly describes fetal blood flow through the placenta?
A. Two umbilical arteries → chorionic villi → one umbilical vein
B. One umbilical vein → chorionic villi → two umbilical arteries
C. Two umbilical veins → chorionic villi → one umbilical artery
D. One umbilical artery → chorionic villi → two umbilical veins

C. Two umbilical veins → chorionic villi → one umbilical artery

Maternal placental blood flow follows:
A. Uterine arteries → intervillous sinuses → uterine veins
B. Uterine veins → intervillous sinuses → uterine arteries
C. Umbilical vein → intervillous sinuses → uterine veins
D. Chorionic villi capillaries → uterine arteries → uterine veins

A. Uterine arteries → intervillous sinuses → uterine veins

Most nutrient transfer across placental membrane occurs by:
A. Primary active transport
B. Secondary active transport
C. Pinocytosis
D. Diffusion

D. Diffusion

The placenta’s major diffusion role includes transfer of:
A. Fetus → mother oxygen
B. Mother → fetus oxygen
C. Mother → fetus antibodies
D. Fetus → mother glucose

B. Mother → fetus oxygen

The placenta also supports diffusion of fetal:
A. Estrogens to mother
B. Progesterone to fetus
C. Excretory products to mother
D. hCG to maternal liver

C. Excretory products to mother

Placental permeability increases later in pregnancy mainly because:
A. Membrane thins, area expands
B. Membrane thickens, area shrinks
C. Maternal sinuses collapse
D. Villi capillaries regress

A. Membrane thins, area expands

The predominant hemoglobin type in fetal blood is:
A. Fetal hemoglobin
B. Adult hemoglobin
C. Methemoglobin
D. Myoglobin

A. Fetal hemoglobin

The principle that Hb carries more O₂ at low PCO₂ is the:
A. Root effect
B. Chloride shift
C. Haldane effect
D. Bohr effect

D. Bohr effect

Loss of CO₂ makes fetal blood more:
A. Acidic
B. Alkaline
C. Hypotonic
D. Hypercapnic

B. Alkaline

The only route for fetal CO₂ excretion is through the:
A. Fetal kidneys
B. Fetal lungs
C. Placenta
D. Amniotic fluid

C. Placenta

Glucose supply to trophoblast cells occurs via:
A. Simple diffusion
B. Facilitated diffusion
C. Primary active transport
D. Endocytosis

B. Facilitated diffusion

The placenta forms especially large quantities of:
A. FSH, LH, prolactin, ADH
B. Insulin, glucagon, GH, TSH
C. Cortisol, aldosterone, renin, ANP
D. hCG, estrogens, progesterone, hCS

D. hCG, estrogens, progesterone, hCS

In a nonpregnant woman, menstruation usually occurs about ___ days after ovulation:
A. 7
B. 10
C. 14
D. 21

C. 14

Sloughing of the endometrium in early pregnancy is prevented mainly by:
A. Progesterone
B. Human chorionic gonadotropin
C. Estrogen
D. Relaxin

B. Human chorionic gonadotropin

Glycoprotein that prevents corpus luteum involution is:
A. Human placental lactogen
B. Progesterone
C. Estrogen
D. Human chorionic gonadotropin

D. Human chorionic gonadotropin

If the corpus luteum is removed before ~7 weeks, what usually occurs?
A. Spontaneous abortion
B. Preterm labor
C. Normal gestation
D. Placental abruption

A. Spontaneous abortion

hCG stimulates fetal testes via ___ cells to produce testosterone:
A. Sertoli
B. Leydig
C. Interstitial
D. Germ

C. Interstitial

Placenta, like the corpus luteum, secretes:
A. Prolactin and oxytocin
B. Estrogen and progesterone
C. hCG and aldosterone
D. Thyroxine and cortisol

B. Estrogen and progesterone

Placental cells that secrete estrogen/progesterone are:
A. Syncytial trophoblast cells
B. Cytotrophoblast cells
C. Decidual cells
D. Granulosa cells

A. Syncytial trophoblast cells

Placental estrogen is synthesized mostly from adrenal:
A. Cholesterol directly
B. Androgenic steroid compounds
C. Amino acid precursors
D. Fatty acid substrates

B. Androgenic steroid compounds

Key estrogen precursors provided by maternal and fetal adrenals include:
A. Cortisol and corticosterone
B. DHEA and 16-OH DHEA
C. Testosterone and estradiol
D. Aldosterone and renin

B. DHEA and 16-OH DHEA

Late pregnancy pelvic ligament changes are mainly:
A. Increased ligament calcification
B. Decreased ligament elasticity
C. Relaxation of pelvic ligaments
D. Fibrosis of pelvic ligaments

C. Relaxation of pelvic ligaments

Marked breast ductal growth in pregnancy is most linked to high:
A. Estrogens
B. Progesterone
C. Aldosterone
D. Glucocorticoids

A. Estrogens

Enlargement of maternal external genitalia during pregnancy is driven mainly by:
A. Estrogens
B. hCG
C. Thyroxine
D. Aldosterone

A. Estrogens

Progesterone promotes pregnancy by decreasing:
A. Mammary ductal growth
B. Maternal thyroid size
C. Contractility of pregnant uterus
D. Placental diffusion capacity

C. Contractility of pregnant uterus

Progesterone supports the uterine lining by causing development of:
A. Granulosa cells
B. Decidual cells
C. Blood sinuses
D. Syncytial cords

B. Decidual cells

Hormone contributing to conceptus development even before implantation:
A. Estrogen
B. Progesterone
C. hCS
D. Aldosterone

B. Progesterone

Progesterone helps estrogen prepare the mother’s breasts for:
A. Lactation
B. Parturition
C. Ovulation
D. Menstruation

A. Lactation

Hormone increasing progressively in proportion to placental weight:
A. hCG
B. Human chorionic somatomammotropin
C. Progesterone
D. Thyroxine

B. Human chorionic somatomammotropin

Human chorionic somatomammotropin acts as a general:
A. Gonadotropin hormone
B. Mineralocorticoid hormone
C. Metabolic hormone
D. Antidiuretic hormone

C. Metabolic hormone

During pregnancy, which gland enlarges ≥50% and increases corticotropin, thyrotropin, prolactin?
A. Posterior pituitary
B. Adrenal medulla
C. Thyroid gland
D. Anterior pituitary

D. Anterior pituitary

Rate of adrenocortical secretion moderately increased in pregnancy:
A. Glucocorticoids
B. Mineralocorticoids
C. Catecholamines
D. Androgens

A. Glucocorticoids

Pregnant women usually have about a twofold increase in:
A. Cortisol
B. Thyroxine
C. Aldosterone
D. Prolactin

C. Aldosterone

The aldosterone rise in pregnancy can lead to:
A. Hyperthyroidism
B. Hypotension
C. Pregnancy-induced hypertension
D. Spontaneous abortion

C. Pregnancy-induced hypertension

Thyroid gland typically doubles in size, increasing production of:
A. Thyroxine
B. Progesterone
C. Aldosterone
D. hCG

A. Thyroxine

Parathyroid enlargement in pregnancy occurs because of mother’s:
A. Sleep deprivation
B. Diet
C. Placental weight
D. Uterine growth

B. Diet

Parathyroid-related adaptation may maintain normal Ca²⁺ by:
A. Calcium absorption from maternal bones
B. Renal calcium overexcretion
C. Reduced intestinal absorption
D. Decreased bone remodeling

A. Calcium absorption from maternal bones

Hormone secreted by corpus luteum and placenta that promotes high hCG and high estrogen/progesterone output:
A. Thyroxine
B. Aldosterone
C. hCS
D. Relaxin

D. Relaxin

Average maternal weight gain during pregnancy is about:
A. 25–35 lb
B. 10–15 lb
C. 40–50 lb
D. 55–65 lb

A. 25–35 lb

Beyond nutrition, milk also provides newborn:
A. Increased fetal hemoglobin
B. Higher aldosterone secretion
C. Placental oxygen diffusion
D. Protection against infection

D. Protection against infection

Colostrum is characterized by:
A. Mostly fat, minimal protein
B. Mostly fat, minimal lactose
C. Protein lactose, almost no fat
D. No protein, high fat

C. Protein lactose, almost no fat

Despite breast development, estrogen/progesterone inhibit:
A. Ductal system growth
B. Actual milk secretion
C. Prolactin release
D. Oxytocin receptor formation

B. Actual milk secretion

Hormones important for breast ductal growth include:
A. Oxytocin, ADH, estrogen, cortisol, TSH
B. Progesterone, FSH, LH, oxytocin, insulin
C. hCG, hCS, prolactin, oxytocin, estrogen
D. Estrogen, GH, prolactin, glucocorticoids, insulin

D. Estrogen, GH, prolactin, glucocorticoids, insulin

Postpartum vaginal discharge from placental-site autolysis is:
A. Lochia
B. Amniotic fluid
C. Colostrum
D. Mucus plug

A. Lochia

Labor pain signals reach CNS primarily via:
A. Visceral afferents only
B. Autonomic efferents
C. Somatic nerves
D. Lymphatic channels

C. Somatic nerves

After birth, continued uterine contraction causes placental:
A. Trophoblast proliferation
B. Decidual cell swelling
C. Oxytocin receptor loss
D. Shearing effect separates placenta

D. Shearing effect separates placenta

Full dilation with membrane rupture and delivery is:
A. First stage of labor
B. Second stage of labor
C. Third stage of labor
D. Latent phase only

B. Second stage of labor

Cervical softening/stretching with labor onset is:
A. Third stage of labor
B. Second stage of labor
C. First stage of labor
D. Fourth stage of labor

C. First stage of labor

First major obstruction to fetal expulsion is:
A. Uterine cervix
B. Pelvic inlet
C. Pubic symphysis
D. Placenta

A. Uterine cervix

Buttocks/feet-first entry into birth canal is:
A. Vertex presentation
B. Shoulder presentation
C. Occiput posterior
D. Breech presentation

D. Breech presentation

Intermittent labor contractions are beneficial because:
A. Fetal lungs need rest periods
B. Placental flow could stop
C. Oxytocin must be metabolized
D. Cervix must scar between waves

B. Placental flow could stop

Labor contraction waves typically go from the:
A. Fundus, spreading downward
B. Cervix, spreading upward
C. Isthmus, spreading outward
D. Cervix, spreading downward

A. Fundus, spreading downward

Another positive feedback mechanism is:
A. Cervical stretch lowers oxytocin
B. Uterus relaxation increases dilation
C. Cervix stretch releases oxytocin
D. Oxytocin blocks pituitary output

C. Cervix stretch releases oxytocin

Positive feedback during labor includes:
A. Fundus stretch stops contractions
B. Oxytocin inhibits cervical stretch
C. Cervix relaxes uterine body
D. Cervix stretch amplifies contractions

D. Cervix stretch amplifies contractions

Strong forces producing final parturition are:
A. Braxton Hicks contractions
B. Labor contractions
C. Postpartum afterpains
D. Cervical ripening waves

B. Labor contractions

Weak, slow rhythmic uterine contractions are:
A. Labor contractions
B. Afterpains
C. Braxton Hicks contractions
D. Tetanic contractions

C. Braxton Hicks contractions

Cervical stretching can increase oxytocin via:
A. Cervix stretch triggers oxytocin reflex
B. Placental diffusion increases oxytocin
C. Fetal kidneys secrete oxytocin
D. Maternal liver activates oxytocin

A. Cervix stretch triggers oxytocin reflex

Supporting evidence for oxytocin in labor:
A. Labor ends after hypophysectomy
B. Labor prolonged after hypophysectomy
C. Hypophysectomy prevents implantation
D. Hypophysectomy increases progesterone

B. Labor prolonged after hypophysectomy

Another pro-oxytocin change near term is:
A. Lower oxytocin secretion rate
B. Lower oxytocin receptor density
C. Reduced cervical stretch reflex
D. Oxytocin secretion rate rises

D. Oxytocin secretion rate rises

Evidence oxytocin matters near term includes:
A. More uterine oxytocin receptors
B. Fewer uterine oxytocin receptors
C. Fewer uterine gap junctions
D. Lower uterine excitability

A. More uterine oxytocin receptors

Near term, which ratio rises?
A. Progesterone-to-estrogen ratio
B. Oxytocin-to-prostaglandin ratio
C. Estrogen-to-progesterone ratio
D. Insulin-to-glucagon ratio

C. Estrogen-to-progesterone ratio

Hormones that increase uterine contractility via gap junctions:
A. Prolactin
B. Estrogens
C. Aldosterone
D. Relaxin

B. Estrogens

Hormone that inhibits uterine contractility during pregnancy:
A. Estrogens
B. Oxytocin
C. Prostaglandins
D. Progesterone

D. Progesterone

Two major drivers of parturition contractions are:
A. Fetal cortisol, uterine ischemia
B. Cervical dilation, membrane rupture
C. Hormonal excitability, mechanical changes
D. Oxytocin burst, uterine atony

C. Hormonal excitability, mechanical changes

Severe pregnancy hypertension is acutely treated with rapid:
A. Vasodilating agents
B. Loop diuretics
C. Beta blockers
D. Magnesium sulfate

A. Vasodilating agents

Preeclampsia plus clonic seizures/coma is:
A. Placental abruption
B. Eclampsia
C. Amniotic embolism
D. Postpartum endometritis

B. Eclampsia

Late-pregnancy hypertension with heavy proteinuria is:
A. HELLP syndrome
B. Gestational diabetes
C. Placenta previa
D. Preeclampsia

D. Preeclampsia