Obestetrics


Molar and Ectopic Pregnancy 

Molar Pregnancy (Hydatidiform mole).
***) Regarding hydatidiform mole, all the following are true except:
Commoner in women of blood group A married to blood O men
Group AB women have the worst prognosis
Are commoner in older gravida
Are complicated by ovarian cyst
Can be diagnosed by chest X-ray

Answer: E* Can be diagnosed by chest X-ray

***) In hydatiform mole pregnancy, all the following are true except:
Uterine size is larger than dates
Bilateral ovarian cysts (Lutein cysts) is common
Aggravated morning sickness
Treatment is by suction, curettage regardless of the size of the uterus
Pregnancy is allowed after 6 months

Answer: E* Pregnancy is allowed after 6 months

***) The complications of hydatiform mole include all the following except:
Hemorrhage
Sepsis
Perforation of the uterus
Inversion of the uterus
Choriocarcinoma

Answer: D* Inversion of the uterus

***) Hydatiform mole (vesicular mole) is usually treated by:
Hysterectomy
Prostaglandin induction
Syntocinon induction
Methotrexate
Suction-evacuation of the uterus

Answer: E* Suction-evacuation of the uterus

Ectopic Pregnancy.
***) Regarding ectopic pregnancy all of the following statements are true, except:
It is a pregnancy that implants outside the uterus
The most common site of implantation is the abdominal cavity
It may occur in the cervix
Previous infection is a major cause
There is an increase incidence among IUCD users

Answer: B* The most common site of implantation is the abdominal cavity

***) In ectopic pregnancy, all the following are true except:
Pain usually proceeds bleeding
Shoulder pain is an important symptom
The isthmus of the tube is the commonest site of implantation
Is often not diagnosed by os
The incidence is greater in women with IUCD

Answer: C* The isthmus of the tube is the commonest site of implantation

***) The commonest site for tubal ectopic pregnancy is:
Fimbria
Ampulla
Isthmus
Intramural
Paratubal

Answer: B* Ampulla

???) All of the following may be etiological factors of ectopic pregnancy, except:
Previous infection of the tubes
Delayed passage of the fertilized ovum down the tube
Progesterone pills for contraception
Intrauterine contraceptive device IUCD users
Irregular periods

Answer: E* Irregular periods

***) All of the following may increase the incidence of ectopic pregnancy, except:
Previous pelvic infection
Use of birth control pills
Tubal surgery
Previous appendicitis
Tubal abnormalities

Answer: B* Use of birth control pills

***) The ectopic pregnancy may be due to:
Chronic salpingitis
Short fallopian tube
Long uterine cavity
Use of vaginal diaphragm
Contraceptive pills

Answer: A* Chronic salpingitis

***) All of the following are the clinical features of tubal pregnancy, except:
The patient may have evidence of peritoneal irritation
Lower abdominal pain
Abdominal rigidity
Fainting
Severe vaginal bleeding

Answer: E* Severe vaginal bleeding

***) The most important symptom of ectopic pregnancy is one of the following:
Severe bleeding
Pain
Amenorrhea
Fainting
Pelvic heaviness

Answer: B* Pain

***) Vaginal bleeding in ectopic pregnancy is due to:
Rupture of the fallopian tube
Rupture of the uterus
Vaginal laceration
Peritoneal hemorrhage
Hormone withdrawal

Answer: E* Hormone withdrawal

***) The following features suggest a diagnosis of ectopic pregnancy, except:
Amenorrhea of 6-10 weeks
Acute abdomen
Enlarged uterus
Decidual tissue at curettage
Vaginal bleeding

Answer: C* Enlarged uterus

***) Regarding ectopic pregnancy, all the following are true except:
Amenorrhea
Vaginal bleeding
Abdominal pain
Elevated hCG
Endometrium has always secretory changes

Answer: D* Elevated hCG

***) All true about ectopic pregnancy, except:
Attacks of abdominal sharp stabbing pain
Fainting attacks
Vaginal bleeding
Period of amenorrhea
Pregnancy test is always positive

Answer: A* Attacks of abdominal sharp stabbing pain

***) Signs of ruptures ectopic pregnancy include the following, except:
Rebound tenderness in the abdomen
Heavy vaginal bleeding
Cervical excitation on vaginal examination
Localized tenderness in the pelvis
Tachycardia

Answer: B* Heavy vaginal bleeding

***) Ectopic pregnancy is confirmed by one of the following:
Ultrasound examination
Vaginal examination
Culdocentesis
hCG urine pregnancy test
Laparoscopy

Answer: E* Laparoscopy

***) Which of the following can be a definite diagnosis of intrauterine pregnancy to rule out ectopic pregnancy:
Decidual reaction at D&C pathology specimen
Aria-stella phenomen at D&C pathology specimen
Chorionic villi at D&C pathology specimen
Positive pregnancy test
Positive β-hCG assay

Answer: C* Chorionic villi at D&C pathology specimen

***) Differential diagnoses of ectopic pregnancy are the following, except:
Acute salpingitis
Acute appendicitis
Acute red degeneration of fibroid
Rupture ovarian cyst
Vesicular mole

Answer: E* Vesicular mole

***) Differential diagnoses of ectopic pregnancy are the following, except:
Rupture of a corpus luteum cyst
Uterine abortion
Torsion of fallopian tube
Acute appendicitis
Spasmodic dysmenorrhea

Answer: E* Spasmodic dysmenorrhea

***) Of the following, which woman is at greater risk for ectopic pregnancy:
Healthy woman on birth control pills
A woman with a past history of three incidents of pelvic inflammatory disease
Woman with a history of endometriosis
Woman with irregular menses
Woman with a past history of several attacks of UTI

Answer: B* A woman with a past history of three incidents of pelvic inflammatory disease

***) The most common implantation site for ectopic pregnancy is the:
Abdominal cavity
The ovarian surface
The cervix
Ampulla of the fallopian tube
The interstitial portion of the fallopian tube

Answer: D* Ampulla of the fallopian tube

***) A 24 year old patient married since 2 years. She is having 6 weeks amenorrhea and unilateral anneal pain, acute abdomen, rapidly falling hematocrit, hypertensive and positive pregnancy test. The most likely diagnosis is:
Endometriosis
Appendicitis
Urinary tract infection
Threatened abortion
Ectopic pregnancy

Answer: E* Ectopic pregnancy

Placenta 

The Placenta.
***) Where does fertilization take place:
In the ovary
In the fimbrial end of the fallopian tube
In the ampullary region of the fallopian tube
In the uterus
In the isthmic region of tube

Answer: C* In the ampullary region of the fallopian tube

***) Implantation of the blastocyte occurs after:
1-2 days
3-5 days
6-8-days
9-10 days
12-14 days

Answer: C* 6-8-days

***) The method of choice of placental localization is:
Ultrasonography
Angiography
Soft tissue placentography
Use of radioactive isotopes
Amniography

Answer: A* Ultrasonography

***) All of the following are placental hormones, except:
Follicular stimulating hormone
Human placental lactogen
Progesterone
Estrogen
Somatotropine (growth hormone)

Answer: A* Follicular stimulating hormone

***) Human Placental Lactogen (hPL) can be elevated in all of the following, except:
Diabetes
Twins
Hypertension
Erythroblastosis
Bronchogenic carcinoma

Answer: C* Hypertension

Abnormalities of the Placenta.
***) Placental abnormality characterized by an accessory lobe is termed:
Placenta membranacea
Placenta circumvallate
Placenta succenturiata
Placenta fenestrata
Placenta increta

Answer: C* Placenta succenturiata

***) One of the following is true concerning placenta succenturiata:
The placenta is surrounded by a fibrous ring
The placenta contains fenestration in its center
The placenta is connected to an accessory lobe by a small vessels and membrane
The chorionic plate is surrounded by a membranous structure
The placenta is horse-shaped in appearance

Answer: C* The placenta is connected to an accessory lobe by a small vessels and membrane

***) One of the following is true concerning a battledore placenta:
The umbilical cord is attached to its central part
The umbilical cord is attached to the central membranes
The umbilical cord is attached to the margin of the placenta
The umbilical cord is attached to an accessory lobe of the placenta
The umbilical cord is attached to two lobes of placenta

Answer: C* The umbilical cord is attached to the margin of the placenta

***) All of the following are common causes of placental insufficiency, except:
Prolonged hypertension disease in pregnancy
Obesity
Chronic renal disease
Severe anemia
Prolonged pregnancy

Answer: B* Obesity

***) Placental insufficiency is caused by the following, except:
Smoking in pregnancy
Dieting in pregnancy
Hypertensive disorders in pregnancy
Post maturity
Multiple pregnancy

Answer: B* Dieting in pregnancy

***) All of the following are causes of large placenta, except:
Multiple pregnancy
Chronic renal disease
Syphilis
Diabetes mellitus
Hydrops fetalis

Answer: B* Chronic renal disease

Placenta Previa.
***) In placenta previa all of the following statements are true, except:
Causes painless vaginal bleeding
Vaginal examination is contraindicated
Is managed by caesarian section if covering the cervical os
Presents with a woody hard uterus
Predisposes to postpartum hemorrhage

Answer: D* Presents with a woody hard uterus

***) All of the following are commonly associated with placenta previa, except:
Sudden onset of fresh bleeding
Abnormal presentation
Unengaged head
Absence of fetal heart
Soft abdomen

Answer: D* Absence of fetal heart

***) Vaginal examination is contraindicated in one of the following situations during pregnancy:
Carcinoma of the cervix
Gonorrhea
Prolapsed cord
Placenta previa
Active labor

Answer: D* Placenta previa

Abruptio Placenta.
***) Concerning abruptio placenta, all the following are true except:
It is a premature separation of normally implanted placenta
The uterus is tender
In severe cases a central venous pressure line should be inserted
The vaginal bleeding is painless
The management of choice is termination of pregnancy

Answer: D* The vaginal bleeding is painless

***) Abruptio placenta can be secondary to all of the following, except:
Hypertensive disorders
Following delivery of first twin
In severe car accident
After rupture of membrane in oligohydramnios
External cephalic version

Answer: D* After rupture of membrane in oligohydramnios

***) In abruptio placenta, all of the following may occur, except:
Shock
Vaginal bleeding
Uterine tenderness
Convulsions
Fetal distress

Answer: C* Uterine tenderness

***) The most common complication of abruptio placenta is:
Hepatic failure
Heart failure
Post partum hemorrhage
Adrenal failure
Cerebral edema

Answer: C* Post partum hemorrhage

***) The following are complications of placental abruption, except:
Renal cortical necrosis
Eclampsia
Afibrinogenemia
DIC (Disseminated Intravascular Coagulopathy)
Intrauterine growth retardation

Answer: B* Eclampsia

***) The most consistent factor predisposing to abruption placenta is:
Maternal hypertension
Trauma
Uterine decompression
Maternal parity
Maternal age

Answer: A* Maternal hypertension

***) Treatment for severe placental abruption at term with 3cm dilated cervix is:
Heparin
Blood transfusion
Steroid therapy for fetal lung maturity
Tocolytic therapy
Urgent CS

Answer: E* Urgent CS

Placental Tumors.
***) Choriocarcinoma is a primary tumor of:
Decidua
Undifferentiated gonadal cells
Myometrium
Trophoblast
Ovaries

Answer: D* Trophoblast

***) Choriocarcinoma may result from all of the following, except:
Hydatidiform mole
Endometriosis
Term pregnancies
Ectopic pregnancies
Abortions

Answer: B* Endometriosis

***) The following are clinical features of choriocarcinoma, except:
Irregular vaginal bleeding after pregnancy
Metastases may present as lumps in the vagina
Choriocarcinoma is self-limited disease
May cause intraperitoneal hemorrhage
May cause amenorrhea

Answer: C* Choriocarcinoma is self-limited disease

***) Choriocarcinoma is treated by:
Surgery
Chemotherapy
Antibiotics
Hormones
Radiotherapy

Answer: B* Chemotherapy

Multiple Gestation 

Multiple Pregnancy.
***) The following about twins pregnancy are true, except:
Dizygotic are more common than monozygotic
Dizygotic incidence increases with maternal age
In monozygotic twins a split at the 2 cells stage result in two placentas
All twins are at risk of growth retardation
Polyhydramnios is commoner in dizygotic than in monozygotic twins

Answer: C* In monozygotic twins a split at the 2 cells stage result in two placentas

***) Multiple pregnancy predisposes to the following, except:
Placenta previa
Diabetes mellitus
Acute pyelonephritis
Placental insufficiency
Mal presentation

Answer: C* Acute pyelonephritis

***) All of the following are possible complications of multiple pregnancy, except:
Abnormal presentation
Dysfunctional labor
Umbilical cord prolapse
Cephalo-pelvic disproportion
Postpartum hemorrhage

Answer: B* Dysfunctional labor

***) In multiple pregnancy all of the following are possible risk, except:
PET (Pre-eclampsia toxemia)
Preterm labor
Oligohydramnios
Anemia
Ante partum hemorrhage

Answer: C* Oligohydramnios

***) Twin pregnancy shows an increase in the following complications, except:
Accidental hemorrhage
Pre-eclamptic toxemia (PET)
Polyhydramnios
Post-partum hemorrhage
Polycythemia

Answer: E* Polycythemia

***) Compared with single pregnancies, multiple pregnancies have a higher rate of the following except:
Abortion
Abnormal presentation
Prolapsed cord
Lung maturity
Preterm delivery

Answer: D* Lung maturity

***) Multiple pregnancy is usually associated with increased incidence in all the following except:
Ante partum hemorrhage
Anemia
Toxemia of pregnancy
Premature labor
Monilial genital infection

Answer: E* Monilial genital infection

***) The incidence of dizygotic twins is influenced by all of the following, except:
Race
Maternal age
Parity
Paternal age
Heredity

Answer: D* Paternal age

***) In uniovular twins, all the following are true except:
The first fetus commonly presents by the breech
Anemia is common
There is only one placenta
Polyhydramnios is frequently present
Pregnancy induced hypertension is common

Answer: A* The first fetus commonly presents by the breech

***) Regarding monozygotic twins, all the following are true except:
They are always identical
They have only one placenta
They make up 1/3 of all twin pregnancies
They are usually separated from one another by amnion and chorion
They are more common if there is family history

Answer: D* They are usually separated from one another by amnion and chorion

Delivery in Multiple Pregnancy.
***) In twin delivery all are correct statements, except:
The 2nd twin is at greater risk than the 1st
Labor usually occurs before term
The commonest presentation is verte and vertex
Post partum hemorrhage is rare
Labor is not prolonged

Answer: D* Post partum hemorrhage is rare

***) In twin pregnancy the second twin has higher perinatal mortality because of all of the following, except:
High incidence of intrauterine anoxia
High incidence of mal presentation
High incidence of abruptio placenta
More surgical intervention
The second twin is heavier

Answer: E* The second twin is heavier

Growth Discrepancies 

Intrauterine Growth Restriction IUGR.
***) All of the following maternal factors are associated with IUGR, except:
Poor nutrition with anemia
Heavy smoking
Toxemia
Gestational diabetes
Alcohol consumption

Answer: D* Gestational diabetes

Macrosomia.
***) With fetal macrosomia all of the following complications are increased, except:
Fetal asphyxia
Brachial plexus injury
Post partum hemorrhage
Cord prolapse
Neonatal hypoglycemia

Answer: D* Cord prolapse

Polyhydramnios.
***) All of the following may cause polyhydramnios, except:
Diabetes mellitus
Multiple pregnancy
Anencephalic fetus
Fetal renal atresia
Fetal esophageal atresia

Answer: D* Fetal renal atresia

***) Polyhydramnios could be associated with all of the following, except:
Renal agenesis
Esophageal atresia
Anencephaly
Duodenal atresia
Illeal atresia

Answer: A* Renal agenesis

Oligohydramnios.
***) All of the following anomalies are associated with severe maternal oligohydramnios, except:
Potter's syndrome
Dysplastic kidneys
Pulmonary hypoplasia
Musculoskeletal abnormalities
Gastrointestinal tract obstructions

Answer: E* Gastrointestinal tract obstructions

***) All of the following are associated with oligohydramnios, except:
Renal agenesis
Esophageal atresia
Pulmonary hypoplasia
Urethral atresia
Amnion nodosum

Answer: B* Esophageal atresia

Fetus and Delivery 

Pelvis.
***) The shortest antero-posterior diameter of the pelvis is:
True conjugate
Diagonal conjugate
Obstetrical conjugate
Antero-posterior diameter of plane of midpelvis
Antero-posterior diameter of inferior straight

Answer: C* Obstetrical conjugate

***) In young women the most common type of pelvis is:
Anthropoid pelvis
Android pelvis
Platypelloid pelvis
Gynecoid pelvis
Rachitic pelvis

Answer: D* Gynecoid pelvis

***) The android pelvis characteristically has the following, except:
A narrow sacroischiatic notch
A parallel pelvic side walls
A narrow sub-pubic angle
A prominent ischial spines
A narrow outlet A-P diameter

Answer: B* A parallel pelvic side walls

Fetal Skull.
***) Regarding the head vertex, all the following are true except:
It is bounded in front by the anterior fontanel and the coronal sutures
It is the area between the 2 halves of the frontal and the 2 parietal bones
It is the area bounded behind by the posterior fontanel and the lambdoidal suture
It is the area bounded laterally by lines passing through the parietal eminences
It is felt in the majority of cases during vaginal examination

Answer: B* It is the area between the 2 halves of the frontal and the 2 parietal bones

***) The posterior fontanel is defined:
The area lies between the sagittal suture and the lambdoid suture
The area lies between the coronal and sagittal sutures
The area lies between the coronal and temporal sutures
The area lies between the anterior and lambdoid sutures
The area lies between the sagittal suture and biparietal bones

Answer: A* The area lies between the sagittal suture and the lambdoid suture

***) The longest anterio-posterior diameter of the fetal head is:
Occipito-frontal diameter
Suboccipito-pregmatic diameter
Occipito-mental diameter
Submento-pregmatic diameter
Mento-vertical diameter

Answer: E*Mento-vertical diameter

***) In normal developing fetus at 36 weeks pregnancy, the most like measurement of the BPD (biparietal diameter) of the head is:
9.5 cm
9 cm
12 cm
8.5 cm
8 cm

Answer: A* 9.5 cm

***) Regarding biparietal diameter, all the following are true except:
The biparietal diameter is the distance between the parietal eminences
The measurement is 9.5 cm
In vertex presentation it is the largest presenting diameter
It is measured by ultrasound scanning for the maturity of fetus
It has no relation to the engagement of the head in the pelvis

Answer: E* It has no relation to the engagement of the head in the pelvis

***) Engagement of the fetal head refers to the relationship between:
Biparietal diameter and ischial spines
Biparietal diameter and pelvic brim
Vertex and pelvic outlet
Vertex and ischial spine
Head and pelvic outlet

Answer: B* Biparietal diameter and pelvic brim

***) In primigravida at full-term in labor, the most common position of the head is:
ROT (right occiput transverse)
LOT (left occiput transverse)
LOA (left occiput anterior)
ROA (right occiput anterior)
DOP (direct occiput posterior)

Answer: C* LOA (left occiput anterior)

***) Cephalohematoma is most commonly found over the:
Frontal bone
Temporal bone
Parietal bone
Occipital bone
Ethmoid bone

Answer: C* Parietal bone

Malpresentation and Malposition.
***) The transverse lie in multipara at term in labor best treated by:
External version
Internal version and extraction
Pitocin induction
Cesarean section
Internal version, than oxytocin induction

Answer: D* Cesarean section

***) One of the following is absolute indication for cesarean section:
Brow presentation
Anterior face presentation
Occipito-posterior position
Right occipital presentation
Transverse arrest of the head

Answer: A* Brow presentation

***) In case of face presentation during labor, all of the following are felt on vaginal examination, except:
Chin
Mouth
Nose
Anterior fontanel
Orbital ridge

Answer: D* Anterior fontanel

***) The most common cause of breech presentation is:
Polyhydramnios
Placenta previa
Prematurity
Hydrocephalus
Multiple pregnancy (twin gestation)

Answer: C* Prematurity

***) Breech presentation is associated with the following, except:
Prematurity
Polyhydramnios
Oligohydramnios
Hydrocephaly
Postmaturity

Answer: E* Postmaturity

***) Breech presentation diagnosed antenatally at 37 weeks gestation, is best managed by:
Cesarean section
External cephalic version
X-ray maturity
Ultrasonography and observation
Oxytocin infusion of lower femoral epiphysis are seen by X-ray

Answer: B* External cephalic version

***) Non-engagement of the fetal head in the second stage of labor is due to all of the following, except:
Mal position
Hydrocephaly
Contracted pelvis
Compound presentation
Anencephaly

Answer: E* Anencephaly

***) A high head at term could be due to the following except:
Wrong dates
Cephalopelvic disproportion
Placental abruption
An occipito-posterior position
Placenta previa

Answer: C* Placental abruption

***) In face presentation with head not engaged in mento-posterior position the ideal treatment is:
Forceps delivery as mento-posterior
Forceps rotation to mento-anterior then forceps delivery
Vacuum delivery
Cesarean section
Internal podalic version and breech extraction

Answer: D* Cesarean section

Labor and Delivery 

Labor and Cervical changes.
***) False labor pains as compared to true labor pains are characterized by all of the following, except:
Contractions occur at irregular intervals
There is demonstrable progressive dilatation of the cervix
They are not intensified by walking
Located chiefly in lower abdomen
Short duration

Answer: B* There is demonstrable progressive dilatation of the cervix

***) Progress of labor is assessed by one of the following criteria:
Frequency of uterine contractions
Intensity of uterine contractions
Softening of the cervix
Effacement of the cervix
Dilatation of cervix

Answer: E* Dilatation of cervix

Labor Stages.
***) All of the following are signs of placental separation in third stage of labor, except:
Appearance of contraction ring
Uterus becomes globular, firm and ballotable
Sudden gush of blood
Rise of uterine fundus
Elongation of the cord

Answer: A* Appearance of contraction ring

***) The third stage of labor follows one of the following:
Rupture of the membranes
Full dilatation of the cervix
Delivery of the fetal head
Delivery of the fetus
Delivery of the placenta

Answer: E* Delivery of the placenta

Obstetric Anesthesia.
***) All the following types of analgesia are used during first stage of labor, except:
Pethidine
Epidural analgesia
Cervical block
Pudendal block analgesia
Inhalation analgesia

Answer: D* Pudendal block analgesia

***) All of the following are indications of epidural anesthesia, except:
Ante-partum hemorrhage
Heart disease
Pulmonary disorders
Premature delivery
Hypertension

Answer: B* Heart disease

Fetal Monitoring in Labor.
***) The normal fetal heart rate in labor is:
80-100 beats per minute
100-120 beats per minute
120-160 beats per minute
160-180 beats per minute
180-200 beats per minute

Answer: C*120-160 beats per minute

***) The most dangerous sign of imminent fetal death during fetal heart monitoring is:
Early deceleration
Variable deceleration
Loss of beat to beat variability
Late deceleration
Fetal tachycardia

Answer: D* Late deceleration

***) All of the following may cause fetal hypoxia, except:
Maternal hypotension
Subserous fibroid
Uterine hyperactivity
Occlusion of umbilical cord
Placental insufficiency

Answer: B* Subserous fibroid

Induction of Labor.
***) The following may be used safely to accelerate labor, except:
Intravenous oxytocin
Ergometrine
Prostaglandin
Rupture of membranes
Stimulation of the nipples

Answer: B* Ergometrine

Complications & Risks of Delivery  
Preterm Labor PTL.
***) All of the following may cause premature delivery, except:
Abruptio placenta
Chronic hypertensive vascular disease
Placenta previa
Oligohydramnios
Smoking

Answer: D* Oligohydramnios

***) All of the following have been associated with an increased risk of preterm delivery except:
Placenta previa
Oligohydramnios
Hyperemesis gravidarum
First-trimester bleeding
Multiple gestation

Answer: B* Oligohydramnios

Premature Rupture of Membranes PROM.
***) The following tests can be used for the diagnosis of premature rupture of membranes, except:
Nitrazine test
Ferning test
Schiller's test
Nile blue sulfate
Evans blue test

Answer: C* Schiller's test

???) Premature ruptures of membranes risks include the following except:
Premature labor
Cord prolapse
Fetal pneumonia
Placental abruption
Maternal septicemia

Answer: D* Placental abruption

Prolonged Pregnancy (Postmaturity).
***) A patient presented in labor claiming to be at 43 week gestation. Which of the following neonatal findings would support the diagnosis of a post-mature infant:
Anemia
Increase in subcutaneous fat
Long fingernails
Vernix
Fusion of fetal eye lids

Answer: C* Long fingernails

Umbilical Cord Prolapse.
***) Prolapsed umbilical cord may occur in all of the following, except:
Polyhydramnios
Transverse lie
Placenta previa centralis
Breech presentation
Prematurity

Answer: C* Placenta previa centralis

***) Pulsating cord prolapse at 4 cm cervical dilatation is best managed by:
Augmentation of labor by oxytocin drip
Vacuum extraction
By giving prostaglandin vaginal tablets
By putting the patient in knee chest position and wait for vaginal delivery
Cesarean section

Answer: E* Cesarean section

Uterine Rupture.
***) The commonest predisposing factor of rupture of uterus is:
Previous CS
Use of syntocinon (Oxytocin) non properly
Forceps delivery
Internal cephalic version
Vacuum extraction

Answer: A* Previous CS

***) Uterine rupture may be associated with all of the following except:
Amniocentesis
Previous cesarean section
Myomectomy
Administration of oxytocin or prostaglandins
Difficult forceps delivery or intrauterine manipulation

Answer: A* Amniocentesis

***) The most constant early symptom in uterine rupture during labor is:
Hematuria
Hypotension
Pain
Vaginal bleeding
Cessation of contractions

Answer: C* Pain

***) The first sign of rupture uterus is:
Abdominal pain
Tender scan
Unexplained tachycardia
Fetal distress
Vaginal bleeding

Answer: A* Abdominal pain

Operative Obstetrics 

Operative Vaginal Delivery.
***) Vacuum extraction is contraindicated in one of the following condition:
Occipito-posterior position
Gestational age 32 weeks
Occipito-transverse position
In patients with heart disease
In patients with previous caesarian section

Answer: B* Gestational age 32 weeks

Episiotomy and Lacerations.
***) Regarding episiotomy all of the following statements are true except:
Shorten the second stage
Reduce trauma to the fetal head
Reduce damage of the pelvic floor
It is usually followed by vaginal stenosis
Reduce the incidence of third degree tears

Answer: D* It is usually followed by vaginal stenosis

Caesarean Section CS.
***) All of the following are indications for cesarean section, except:
Transverse lie
Mento-posterior position
Fetal distress in the first stage
Twin pregnancy
Prolapsed pulsating cord

Answer: D* Twin pregnancy

***) A multigravida with mitral stenosis in labor with obvious cephalopelvic disproportion, best delivered with:
Cesarean section
Forceps delivery in the second stage
Vacuum delivery if cervix not fully dilated
Enhance labor by syntocinon (oxytocin)
Await spontaneous vaginal delivery

Answer: A* Cesarean section

***) All of the following are possible indications for classical cesarean section, except:
Carcinoma of the cervix
Impacted shoulder presentation
Severe adhesions in the lower uterine segment
Large cervical fibroid
Posterior placenta previa grade II

Answer: B* Impacted shoulder presentation

***) Indications for a Caesarian section include all of the following, except:
Cord prolapse
Previous Caesarian section
Fetal distress
Transverse lie
Migraine

Answer: E* Migraine

***) All the following are indications for caesarean section except one:
Prolapsed cord
Transverse lie at term
Placenta previa at term
Intrauterine fetal death at term
Previous for CS

Answer: D* Intrauterine fetal death at term

***) All of the following are indications to primary cesarean section except:
Prolapsed cord
Cord presentation
Mal presentation
Face presentation (mento-anterior)
Fetal distress

Answer: D* Face presentation (mento-anterior)

***) All of the following might be an indication to do classical cesarean section except one:
Transverse lie at term with the back down
Severe pelvic-abdominal adhesions
Previous cesarean section with severe pelvic-abdominal adhesions
Per mortem
Cephalopelvic disproportion

Answer: E* Cephalopelvic disproportion

Puerperal Complications 

Postpartum Changes.
***) The period of time from the end of delivery until the reproductive organs have returned to normal is called:
Menopause
Puerperium
Perineum
Ante-partum
Intra-partum

Answer: B* Puerperium

***) Postpartum hemorrhage is diagnosed when blood loss exceeds:
100 cc
200 cc
300 cc
400 cc
500 cc

Answer: E* 500 cc

***) In postpartum hemorrhage the most common cause is:
Atonic uterus
Cervical tear
Uterine rupture
Retained placental tissue
Inversion of the uterus

Answer: A* Atonic uterus

***) Regarding post partum hemorrhage all of the following are predisposing factors, except:
Multiple pregnancies
Polyhydramnios
Giving syntometrine with the delivery of anterior shoulder
Prolonged labor
Precipitated labor

Answer: C* Giving syntometrine with the delivery of anterior shoulder

***) Concerning postpartum hemorrhage, all the following are true except:
More common in twin pregnancy than single pregnancy
Less common in primigravida than multigravida
The commonest cause is laceration of the cervix
It may be caused by bleeding from non-placental site
The prevention is by active management of the third stage of labor

Answer: C* The commonest cause is laceration of the cervix

***) Postpartum hemorrhage is caused by the following, except:
Prolonged labor
Retained parts of the placenta
Cervical tear
Full bladder
Toxemia of pregnancy

Answer: D* Full bladder

***) One of the following is the most common cause of primary post-partum hemorrhage:
Vaginal or cervical lacerations
Uterine inversion
Coagulopathy
Uterine rupture
Uterine atony

Answer: E* Uterine atony

***) The most common cause of secondary post-partum hemorrhage:
Uterine atony
Injury to birth canal
Low platelet count
Breast feeding
Retained parts of placenta superimposed by uterine infection

Answer: E* Retained parts of placenta superimposed by uterine infection

***) The most common symptom of acute inversion of the uterus is:
Postpartum hemorrhage
Uterine prolapse
Retained placenta
Retention of urine
Abdominal pain

Answer: A* Postpartum hemorrhage

***) After delivery of the baby and the placenta you discovered a firm raunded mass in the pelvis below the level of the umbilicus. The mass is most likely is:
Uterine fibroids
Ovarian cyst
Distended bowel
Pelvic kidney
Contracted uterus

Answer: E* Contracted uterus

***) Uterine atony might be caused by the following except:
Prolonged labor
Multiple pregnancy
Polyhydramnios
Uterine fibroids
Preterm labor

Answer: E* Preterm labor

***) Inversion of the uterus is almost always subsequent upon:
Multiple pregnancy
Polyhydramnios
Traction on the umbilical cord before separation
Abruption placenta
Difficult forceps delivery

Answer: C* Traction on the umbilical cord before separation

Postpartum Fever.
***) The commonest cause of maternal pyrexia in puerperium is:
Deep vein thrombosis
Endometritis
Engorged breasts
Subacute bacterial endocarditis
Urinary tract infection

Answer: B* Endometritis

***) The most common cause of post partum mastitis is one of the following:
Beta streptococci
E.Coli
Staphylococcus aureus
Streptococcus fecalis
Chlamydia trachomatis

Answer: C* Staphylococcus aureus

***) All of the following are possible predisposing factors for puerperal sepsis, except:
Prolonged rupture of membranes
Carrier of group A beta streptococci
Multiple vaginal examinations
Elective cesarean section
Non-proper surgical scrub

Answer: D* Elective cesarean section

***) Factors contributing to puerperal infection are the following, except:
Prolonged labor
Precipitate labor
Instrumental delivery
Excessive vaginal examination
Home delivery

Answer: B* Precipitate labor

***) The most common bacteria causing puerperal infection is:
Escherichia coli
Anaerobic streptococcus
Anaerobic staphylococcus
Aerobic streptococcus
Clostridium perfringes

Answer: B* Anaerobic streptococcus

***) Puerperal infection may be spread by several routes. The most common route that result in septic thrombophlebitis:
Venous
Lymphatic
Arterial
Direct extension
By inhalation of toxic materials

Answer: A* Venous

***) A patient with post-partum deep venous thrombosis complains of chest pain and dyspnea. The helpful investigation to diagnose pulmonary embolism is:
Lung spiral CT
Electrocardiogram (ECG)
Arterial blood gases
Chest auscultation
Chest X-Ray

Answer: A* Lung spiral CT

***) One of the following can cause subinvolution of the uterus after normal delivery:
Urinary tract infection
Gastroenteritis
Endometriosis
Monilial infection
Endometritis

Answer: E* Endometritis

***) Which of the following is the most common site of puerperal infection:
The upper urinary tract (kidneys)
The lower genital tract (infected lacerations and episiotomies)
The lower urinary tract (bladder)
The upper genital tract (endometrium)
The cardiovascular system (bacteremia and septic thrombophlebitis)

Answer: D* The upper genital tract (endometrium)

Drugs and Pregnancy 

Drugs and Pregnancy.
***) The following drugs are not given in pregnancy, except:
Tetracycline
Thiazides
Chloramphenicol
Heparin
Warfarin

Answer: D* Heparin

***) These drugs cross the placenta to the fetus, except:
Heparin
Warfarin
Tetracycline
Diazepam
Aspirin

Answer: A* Heparin

***) All of the following drugs are teratogenic, except:
Tetracycline
Paracetamol
Thiazides
Stilbestrol
Warfarin

Answer: B* Paracetamol

***) All of the following drugs are contraindicated in pregnancy, except:
Tetracycline
Iodides
Diphenylhydantoin (Epanutin)
Warfarin
Pyridoxine

Answer: E* Pyridoxine

***) One of the following drugs can be safe if used during pregnancy:
Warfarin
Septrin
Tetracycline
Erythromycin
Chloramphenicol

Answer: D* Erythromycin

***) Which of the following drugs given during pregnancy can give "Grey Baby Syndrome":
Ampicillin
Chloramphenicol
Gentamycin
Tetracycline
Streptomycin

Answer: B* Chloramphenicol

***) Regarding drugs in pregnancy, all the following are true except:
Digitalis does not cross the placenta
Warfarin crosses the placenta
Heparin does not cross the placenta
Hydralazine causes relaxing vascular smooth muscle
Methotrexate crosses the placenta

Answer: A* Digitalis does not cross the placenta

***) Brown discoloration of the teeth can occur in infants exposed in uterus to:
Penicillin
Tetracycline
Chloramphenicol
Gentamycin
Streptomycin

Answer: B* Tetracycline

Breastfeeding and Drugs.
***) Milk ejection reflex is affected by one of the following hormones:
Estrogens
Progesterone
Human placental lactogen
Oxytocin
Chorionic gonadotropin

Answer: D* Oxytocin

***) All of the following drugs are contraindicated during breast feeding except one:
Cytotoxic drugs
Chloramphenicol
Iodine
Heparin
Thiouracil

Answer: D* Heparin

***) All of the following drugs are contraindicated during breast feeding except one:
Bromocriptine
Cephalosporins
Ergotamine
Cimetidine
Tetracycline

Answer: B* Cephalosporins

Oxytocin.
***) All of the following are true regarding oxytocin, except:
Prolonged treatment can cause water intoxication
Can cause milk ejection
Single rapid IV injection can cause transient hypotension, tachycardia and ECG changes
It is not effective when given orally
It can cause contraction of the lower uterine segments

Answer: E* It can cause contraction of the lower uterine segments

***) Regarding oxytocin, one of the following is true:
Induces vigorous sustained uterine contractions
Comes from the anterior pituitary gland
Possesses no antidiuretic activity
Has long half life
Acts on myoepithelial cells of the mammary glands

Answer: E* Acts on myoepithelial cells of the mammary glands

***) All of the following are complications of Syntocinon (oxytocin) toxicity, except:
Headache
Nausea and vomiting
Polyuria
Coma
Weight gain

Answer: C* Polyuria

Immunizations.
***) The first immunoglobulin produced in any immune response is:
IgA
IgM
IgD
IgE
IgG

Answer: B* IgM

***) The only immunoglobulin can cross placenta:
IgM
IgA
IgG
IgE
IgD

Answer: C* IgG

***) All of the following vaccines are contraindicated during pregnancy, except:
German measles
Tetanus
Mumps
Poliomyelitis
Hepatitis

Answer: B* Tetanus

***) All of the following vaccines can be given to the pregnant patient after the second trimester, except:
Tetanus toxoid vaccine
Smallpox vaccine
Cholera vaccine
Vaccination against hepatitis B virus
Typhoid vaccine

Answer:  B* Smallpox vaccine

***) Mumps in pregnancy is associated with:
Increase fetal wastage
Lymph reduction defect
Maternal pneumonia
No major complications
Congenital deafness

Answer: D* No major complications

???) Regarding immunization during pregnancy, which of the following vaccines would be the safest to receive:
Mumps
Poliomyelitis
Rabies
Rubella
HIV

Answer: C* Poliomyelitis

Drugs.
***) All of the following drugs have effect on the uterine muscle, except:
Salbutamol
Cervidil
Isoxsuprine
Clomiphene citrate
Methergine

Answer: D* Clomiphene citrate

***) Regarding the actions of hydralazine, all the following are true except:
Increased renal blood flow
Increased cardiac output
Reflex tachycardia
Smooth muscle relaxation
Decreased placental perfusion

Answer: E* Decreased placental perfusion
*******************************************
425) All of the following are complications of post-maturity, except:
Meconium aspiration syndrome
Hypoglycemia
Hypocalcemia
Loss of subcutaneous fat
Hyaline membrane disease

Answer: C* Hypocalcemia (It may lead to Hypercalcemia)

***) Which of the following is characteristic feature of acute gonococcal urethritis:
Dysuria
Genital ulceration
High fever
Generalized lymphadenopathy
Sweating

Answer: 1* Dysuria


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