Obstetrics


·      Pregnancy 

1.    Diagnosis of Pregnancy.
***) Signs and symptoms of pregnancy in the 1st trimester include all of the following, except:
A.    Nausea
B.     Quickening
C.     Frequency of micturition
D.    Soreness of breast
E.     Hegar's sign

Answer: B* Quickening

***) Which of the following hormones is produced by trophoblast:
A.    Luteinizing hormone
B.     Follicle stimulating hormone
C.     Prolactin
D.    Human chorionic gonadotropin
E.     Oxytocin

Answer: D* Human chorionic gonadotropin

***) Positive pregnancy test in the urine depends on the presence of:
A.    Human chorionic gonadotropin
B.     Progesterone
C.     Estrogen
D.    Calcium
E.     Cortisol

Answer: A* Human chorionic gonadotropin

***) A suspicion of pregnancy at 3 wks GA may be confirmed by one of the following:
A.    History of morning sickness and nausea
B.     Vaginal examination
C.     Abdominal examination
D.    Immunological pregnancy test (hCG)
E.     Breast examination

Answer: D* Immunological pregnancy test (hCG)

***)  Which of the following hormones decreases after the first trimester of pregnancy:
A.    Progesterone
B.     Prolactin
C.     Human Chorionic Gonadotropin (HCG)
D.    Human Placental Lactogen (HPL)
E.     Estrogen

Answer: C* Human Chorionic Gonadotropin (HCG)

2.    Pregnancy & Physiological Changes.
***) All of the following statements are true, except:
A.    The maximum weight increase in the uncomplicated pregnancy is 12.5 kg
B.     The cardiac output has risen markedly by 40 percent during pregnancy
C.     There is a slight increase of pulse rate about 15 percent
D.    There is a decrease in red cell mass
E.     Fibrinogen level increases during pregnancy

Answer: D* There is a decrease in red cell mass

***) Regarding cardiovascular system in normal pregnancy, the following are increased except:
A.    Heart rate
B.     Stroke volume
C.     Plasma volume
D.    Hematocrit
E.     Red blood cells

Answer: D* Hematocrit

***) Blood volume is increased from the total volume during pregnancy at near term by about:
A.    10%
B.     20%
C.     25%
D.    45%
E.     100%

Answer: D*45%

***) Regarding supine hypotension one of the following is true:
A.    Pressure of the gravid uterus on the aorta
B.     Pressure of the gravid uterus on vena cava inferior
C.     Pressure of the gravid uterus on vena cava superior
D.    Constipation during pregnancy
E.     Excessive heart burn

Answer: B* Pressure of the gravid uterus on vena cava inferior

***) In pregnancy concerning maternal blood the following are correct, except:
A.    Plasma transcortin concentration increase
B.     Free cortisol concentration increase
C.     Thyroxin binding globulin concentration increase
D.    Free thyroxin index increase
E.     Release of TSH is not increased

Answer: D* Free thyroxin index increase

***) In the normal pregnancy all of the following increase, except:
A.    Plasma volume
B.     Hepatic blood flow
C.     Platelet count
D.    White cells count
E.     Cardiac output

Answer: C* Platelet count

***) Pregnancy leads to one of the following:
A.    Prolongation of stomach emptying time and increased acidity
B.     Shortening of stomach emptying time and increased acidity
C.     Shortening of stomach emptying time and decreased acidity
D.    Prolongation of stomach emptying time and no affection of acidity
E.     Prolongation of stomach emptying time and decrease acidity

Answer: E* Prolongation of stomach emptying time and decrease acidity

***) All of the following occur in alimentary tract during pregnancy, except:
A.    The gums become swollen
B.     Excessive salivation may occur
C.     Heartburn (reflux esophagitis) is common
D.    The stomach tends to empty more rapidly
E.     Slow peristalsis of the bowel

Answer: D* The stomach tends to empty more rapidly

***) The cause of heartburn in pregnancy is:
A.    Increased gastric motility
B.     Increased vagal nerve activity
C.     Gastro-esophageal reflux
D.    Duodeno-gastric reflux
E.     Increased gastric emptying

Answer: C* Gastro-esophageal reflux

***) Breast tissue of 2mm nodule is normal for which gestational age:
A.    28 weeks
B.     36 weeks
C.     40 weeks
D.    42 weeks
E.     44 weeks

Answer: A* 28 weeks

·      Prenatal Care 

1.    Prenatal Visits.
***) All of the following are aims of antenatal care, except:
A.    To monitor the well being of the fetus
B.     To establish and maintain the physical health of the mother
C.     The ideal time for first antenatal visit is before 14 weeks of pregnancy
D.    Screening for fetal congenital abnormality
E.     Screening for endometrial carcinoma

Answer: E* Screening for endometrial carcinoma

***) The embryonic life starts at:
A.    The 3rd week after ovulation
B.     The 5th week after ovulation
C.     The 7th week after ovulation
D.    The 9th week after ovulation
E.     The 11th week after ovulation

Answer: C* The 7th week after ovulation

***) All of the following factors may reduce intrauterine death of the fetus, except:
A.    Proper antenatal care
B.     Localization of placenta in the first trimester
C.     Antenatal fetal monitoring
D.    Correct timing of delivery
E.     Prevention of prematurity

Answer: B* Localization of placenta in the first trimester

***) In preventing anemia during pregnancy the ideal oral iron compound is:
A.    20 mg of iron
B.     100 mg of iron
C.     200 mg of iron
D.    400 mg of iron
E.     1000 mg of iron

Answer: A*20 mg of iron

***) All of the following are ideal routine blood tests carried out at first visit to an antenatal clinic, except:
A.    Blood grouping and rhesus
B.     Hemoglobin
C.     Serological tests for syphilis
D.    Rubella antibodies
E.     Renal functional tests

Answer: E* Renal functional tests

***) All of the following are restriction on coitus during pregnancy, except:
A.    Threatened abortion
B.     History of premature labor
C.     History of post partum hemorrhage
D.    History of ante partum hemorrhage
E.     When membranes are ruptured

Answer: C* History of post partum hemorrhage

***) Abdominal palpation in the latter half of pregnancy reveals all of the following, except:
A.    The fundal height
B.     The lie of the fetus
C.     Cephalo-pelvic disproportion
D.    The presentation of the fetal cephalic or breech
E.     Whether the presenting part in engaged or not

Answer: C* Cephalo-pelvic disproportion

***) At 16 weeks of pregnancy, the uterine fundus is felt at:
A.    Just above the pubic margin
B.     At the level of umbilicus
C.     Midway between umbilicus and pubic margin
D.    2 cm above the pubis
E.     2 cm above the umbilicus

Answer: C* Midway between umbilicus and pubic margin

***) At 14 weeks pregnancy a uterus may felt large for dates because of the following, except:
A.    Wrong dates
B.     Uterine fibroid
C.     Full bladder
D.    Polyhydramnios
E.     Multiple pregnancy

Answer: C* Full bladder

***) A large for date uterus may be due to all of the following conditions, except:
A.    Multiple pregnancy
B.     Hydatidiform mole
C.     Oligohydramnios
D.    Uterine fibroid with pregnancy
E.     Error in dates

Answer: C* Oligohydramnios

***) Causes of large for date pregnancies are the following, except:
A.    Multiple pregnancy
B.     Polyhydramnios
C.     Hydatiform mole
D.    Intrauterine fetal death
E.     Diabetes with pregnancy

Answer: D* Intrauterine fetal death

***) The following factors may lead to wrong dates of delivery, except:
A.    An irregular cycle
B.     Regular cycles but in excess of 28 days (35-42 days)
C.     Regular cycles of 28 days
D.    Patient's poor memory
E.     Breast feeding

Answer: C* Regular cycles of 28 days

***) To reduce the risk of recurrence of neural tube defects in a woman planning to get pregnancy, she should be advised to take:
A.    Iron tablets 20 mg/day
B.     Calcium tablets 1 gm/day
C.     Vitamin E 200 mg/day
D.    Vitamin B complex
E.     Folic acid tablets 4 mg/day

Answer: E* Folic acid tablets 4 mg/day

***) Counseling of a pregnant woman during antenatal care should include advice and education on all of the following except one:
A.    Smoking
B.     Alcohol abuse
C.     Drug abuse
D.    Avoiding infection
E.     Water consumption

Answer: E* Water consumption

***) The last menstrual period for a lady was June 30, the expected date of delivery is approximately:
A.    March 23rd
B.     April 7th
C.     March 28th
D.    April 23rd
E.     March 7th

Answer: B* April 7th

2.    Prenatal Screening.
***) The most sensitive prognostic test in Rh-disease of pregnancy is:
A.    Antibody titer
B.     Past history
C.     Spectrophotometric examination of the amniotic fluid
D.    Urinary bilirubin level
E.     Fetal movements

Answer: C* Spectrophotometric examination of the amniotic fluid

***) Indication of anti-D administration to Rh-negative mothers married to Rh-positive husbands includes all the following except:
A.    Following abortion
B.     Following delivery of Rh-negative baby
C.     At 28 weeks of gestation
D.    Following ectopic pregnancy
E.     Following amniocentesis

Answer: B* Following delivery of Rh-negative baby

***) All of the following are indications for anti-D-gamma-globulin administration, except:
A.    Abortion caused by blighted ovum
B.     Abortion secondary to cervical incompetence
C.     After amniocentesis
D.    After attacks of ante partum hemorrhage
E.     To Rh-negative unsensitized mother giving birth to Rh-positive fetus

Answer: A* Abortion caused by blighted ovum

***) Regarding the prevention of Rh-isoimmunization, all the following are true except:
A.    All Rh-negative women should marry Rh-negative husbands
B.     Anti-D to be given at 28 weeks or 32 weeks for pregnant patient with Rh-positive husband
C.     Anti-D to be given within 72 hours after delivery in a patient with Rh-positive fetus
D.    Anti-D to be given in Rh-negative patients with abortion (blighted ovum)
E.     Anti-D immunoglobulin causes severe neonatal jaundice

Answer: D* Anti-D to be given in Rh-negative patients with abortion (blighted ovum)

***) The most common cause of fetal death in uterus in Rh-isoimmunization is:
A.    Jaundice
B.     Heart failure
C.     Respiratory distress syndrome
D.    Congenital anomalies
E.     Kernicterus

Answer: E* Kernicterus

Prenatal Diagnosis.
***) The following information may be obtained from aspiration of amniotic fluid in the 2nd and 3rd trimester of pregnancy, except:
A.    Cytogenetics
B.     Fetal maturity
C.     Detection of neural tube defect by measurement of alpha fetoprotein
D.    Polydactyly
E.     Rhesus disease

Answer: D* Polydactyly

***) Amniotic fluid is used to check up all of the following, except:
A.    Chromosome analysis
B.     Neural tube defects
C.     Lung maturity of the fetus
D.    Fetal hemoglobin
E.     Inborn metabolic disease

Answer: E* Inborn metabolic disease

***) Which one of the following karyotyping is not matching:
A.    Normal male - 46 XY
B.     Turner syndrome - 45 XO
C.     Female Down syndrome - 47 XX, +21
D.    Female Edwards syndrome - 47 XX, +13
E.     Klinefelter syndrome - 47 XXY

Answer: D* Female Edwards syndrome - 47 XX, +13(47xx + 18)

·      Medical Conditions in Pregnancy 

1.    Iron Deficiency Anemia.
***) The most common anemia during pregnancy is:
A.    Iron deficiency anemia
B.     Pernicious anemia
C.     Sickle cell anemia
D.    Thalassemia
E.     Hemolytic anemia

Answer: A* Iron deficiency anemia

***) Regarding iron deficiency anemia in pregnancy, all the following are true except:
Is related to social class
Is very common in multiple pregnancy
Is prevented with adequate diet only
Can usually be treated with oral iron
Is more common in multi parous women

Answer: C*Is prevented with adequate diet only

***) Factors causing iron deficiency anemia in pregnancy are all of the following, except:
Sickle cell disease
Lack of iron supplements
Poor diet
Bleeding
Mal absorption

Answer: A* Sickle cell disease

***) All of the following are causes of iron deficiency anemia during pregnancy, except:
Inadequate iron in the diet
Excessive blood loss
Infrequent pregnancies
Abnormal demand as in multiple pregnancy
Mal absorption

Answer: C* Infrequent pregnancies

***) Effects of iron deficiency anemia in pregnancy include all of the following, except:
Increased plasma volume
Increased cardiac output
Decreased peripheral resistance
Oxygen dissociation curve shifted to the left
Heart failure may occur in severe cases

Answer: D* Oxygen dissociation curve shifted to the left

Folate Deficiency Anemia.
***) Folic acid deficiency during pregnancy may occur from the following, except:
Multiple pregnancies
Low HCl acid in the stomach
Grand multi-parous women
Poor diet
Anticonvulsant therapy in epileptic pregnant women

Answer: B* Low HCl acid in the stomach

***) In folic acid deficiency during pregnancy the earliest changes are:
Erythrocyte macrocytosis
Megaloblastic anemia
Low concentration of serum folate
Increased urinary formiminoglutamic acid (FIGLA)
Hypersegmentation of neutrophils

Answer: C* Low concentration of serum folate

***) Megaloblastic anemia in pregnancy is mainly due to:
Iron deficiency
Vitamin B12 deficiency
Folic acid deficiency
Vitamin B1 excess
Hypoxia

Answer: C* Folic acid deficiency

Diabetes Mellitus DM.
***) In a pregnant patient with diabetes mellitus, all the following are true except:
Glucosuria is unreliable sign of control
Insulin requirement usually increases
Blood sugar should be maintained at approximately 160 mg/dl
Persistent hyperglycemia is worse than occasional hypoglycemia
Glycosylated Hb gives indication of previous long-term blood sugar levels

Answer: C* Blood sugar should be maintained at approximately 160 mg/dl

***) In diabetes mellitus associated with pregnancy all of the following statements are true, except:
There is higher risk of congenital abnormality
There is higher risk of fetal death during the last weeks of pregnancy
Usually insulin requirement is increased
Delivery is always by caesarian section
Stabilization of diabetes should be done as early as possible during pregnancy

Answer: D* Delivery is always by caesarian section

***) All of the following are adverse effect of diabetes on pregnancy, except:
Increased risk of microsomia
Increased risk of placenta previa
Increased risk of abortion
Increased risk of congenital abnormalities
Increased risk of candidial vulvovaginitis

Answer: B* Increased risk of placenta previa

***) All of the following are effects of diabetes on pregnancy, except:
Pre-eclampsia
Intrauterine fetal death
Increased incidence of fetal congenital abnormalities
Oligohydramnios
Shoulder dystocia

Answer: D* Oligohydramnios

***) All of the following are associated with complications in pregnant patient with diabetes mellitus, except:
Maternal ketoacidosis
Intrauterine fetal death
Trichomonas infection
Polyhydramnios
Pre-eclamptic toxemia

Answer: C* Trichomonas infection

***) Indications of glucose tolerance test during pregnancy include all following, except:
Family history of diabetes
Renal glucosuria
Unexplained stillbirth
Polyhydramnios
Delivery of 4.5 kg baby

Answer: B* Renal glucosuria

***) In a pregnant patient with history of diabetes in both parents, the probability of abnormal glucose metabolism is:
10%
25%
50%
75%
100%

Answer: C*50%

***) Which one of the following contributes to good control of diabetes in pregnancy:
300 mg carbohydrate per day diet
Good control of protein intake
Oral hypoglycemic drugs in mild cases
Twice daily mixture of short and medium acting insulin
Bed rest in the last 3 months of pregnancy

Answer: D* Twice daily mixture of short and medium acting insulin

***) In diabetes with pregnancy, there is an increased incidence of:
Traumatic delivery
Maternal death
Maternal head trauma
Normoglycemia
Delivery at home

Answer: A* Traumatic delivery

Hypertension.
***) Pre-existing raised blood pressure before pregnancy or in early pregnancy may be due to the following, except:
Pre-eclampsia
Essential hypertension
Renal artery stenosis
Pheochromocytoma
Coarctation of aorta

Answer: A* Pre-eclampsia

***) Concerning pregnancy induced hypertension, all the following are true except:
Common in women with diabetes mellitus
Treatment includes furosemide (Lasix)
Albuminuria is due to this condition
Delivery usually cure this condition
Will recur in 30% of cases in subsequent pregnancies

Answer: B* Treatment includes furosemide (Lasix)

***) Concerning gestational hypertension, all the following are true except:
The blood pressure rises all through pregnancy
The blood pressure decreases few days after delivery
The hypertension is not necessarily to be associated with proteinuria
The pregnancy should not exceed more than 40 weeks
The blood pressure rises in the third trimester

Answer: A* The blood pressure rises all through pregnancy

***) One of the following statements regarding pregnancy induced hypertension is true:
Can be relieved by use of diuretics
Post partum pregnancy induced hypertension is the most dangerous
Relief of pregnancy induced hypertension is achieved by anti-tetanus toxoid
Death of the fetus is usually followed by complete improvement
Fetus is usually large for date

Answer: B* Post partum pregnancy induced hypertension is the most dangerous

Eclampsia and Pre-eclampsia.
***) All of the following conditions are more likely to be associated with pre-eclampsia, except:
Multiparity
Multiple pregnancy
Chronic kidney disease
Diabetes mellitus
Vesicular mole

Answer: A* Multiparity

***) The following conditions are associated with high frequency of pre-eclampsia, except:
Diabetes
Multiple pregnancy
Polyhydramnios
Hydatiform mole
Placenta previa

Answer: C* Polyhydramnios

***) The following statements regarding ante partum pre-eclampsia toxemia are true, except:
Treatment with diuretics is of great value
Primary treatment with diazoxide is contraindicated
Plasma uric acid level is elevated
Materno-placental blood flow falls to less than 50%
There is increased incidence of PET in future pregnancies

Answer: A* Treatment with diuretics is of great value

***) The following about a patient developing proteinuric hypertension (pre-eclampsia) in pregnancy are true, except:
Serum uric acid concentration increases
The plasma volume decreases
Placental function tests values decrease
Hb concentration increases
Creatinine clearance increases

Answer: E* Creatinine clearance increases

***) One of the following is a grave sign of severe pre-eclampsia:
A PCV (Packed cell volume) of 55%
BP 160/100 mm HG
Proteinuria of 2 g/24h
Deep tendon reflex with 3+/4+
Edema of lower limbs up to the knees

Answer: D* Deep tendon reflex with 3+/4+

***) All the following are symptoms or signs of impending eclampsia, except:
Severe headache
Polyuria
Epigastric pain
Exaggerated reflexes
Visual disturbances

Answer: B* Polyuria

***) Signs and symptoms of impending eclampsia include all of following, except:
Headache
Sacral edema
Epigastric pain
Hyperreflexia
Blurring of vision

Answer: B* Sacral edema

***) Signs of fulminating pre-eclampsia include the following, except:
Hyperreflexia
Epigastric tenderness
Poor urine output
Maternal weight loss
Proteinuria

Answer: D* Maternal weight loss

***) The usual manner of death in case of eclampsia is:
Cerebral hemorrhage
Congestive heart failure
Cardiac arrest during convulsions
Uremia
Hemorrhagic pneumonia

Answer: A* Cerebral hemorrhage

***) The complications of pre-eclampsia include all of the following, except:
Abruption placenta
Polyhydramnios
Intrauterine growth retardation
Decreased renal blood flow
Abnormal liver enzymes

Answer: B* Polyhydramnios

***) In a case of pre-eclamptic toxemia at 40 weeks, the best management is:
Induction of labor
Cesarean section
Give methyldopa only
Give diuretics (Lasix) only
Give hydralazine only

Answer: A* Induction of labor

***) The most worrisome sign or symptom of serious pathology in late pregnancy is:
Swollen ankles
Constipation
Visual changes
Nocturia
Heartburn

Answer: C* Visual changes

Heart and Pregnancy.
***) Regarding changes in the heart during pregnancy, all the following are true except:
Third sound
Diastolic murmur
Soft systolic murmur
Increased pulse rate
Slight displacement of the apex

Answer: B* Diastolic murmur

***) Which of the following signs is diagnostic of heart disease in pregnancy:
Diastolic heart murmur
Soft systolic heart murmur
Tachycardia
Arrhythmia
Accentuated first heart sound

Answer: A* Diastolic heart murmur

***) Which of the following physical signs is least likely to indicate organic heart disease in pregnant woman:
Systolic murmur
Diastolic murmur
Atrial fibrillation
Cardiac enlargement
Palpation of a thrill

Answer: A* Systolic murmur

***) The following are factors which may lead to heart failure in patient with heart disease in pregnancy, except:
Tachycardia
Emotional upset
Physical exercise
A systolic murmur
Lower limbs edema

Answer: D* A systolic murmur

***) In a pregnant patient with mitral stenosis, all the following are true except:
To have labor induced at 38 weeks
Sit upright in labor
Could be considered for mitral valvotomy during pregnancy
Should not be given ergometrine (oxytocin) in the third stage of labor
Should have elective forceps delivery unless spontaneous delivery is very rapid

Answer: A* To have labor induced at 38 weeks

***) Pregnancy is contraindicated in all of the following conditions except:
Uncorrected atrial septal defect
Marfan's syndrome
Uncompensated cardiac failure
Eisenmenger's syndrome
Severe mitral stenosis

Answer: A* Uncorrected atrial septal defect

Hyperemesis Gravidarum HG.
***) Concerning hyperemesis gravidarum, all the following are true except:
Usually occurs in the first trimester
Is associated with hydatiform mole
Is associated with multiple pregnancy
Occurs most commonly in multigravida
May require admission to the hospital

Answer: D* Occurs most commonly in multigravida

Jaundice in Pregnancy.
***) The following may cause jaundice during pregnancy, except:
Acute fatty atrophy of the liver
Viral hepatitis
Severe pre-eclampsia
Chlorpromazine
Erythromycin

Answer: D* Chlorpromazine

Urinary Tract Complications.
***)  The likely organism to cause urinary tract infection in pregnancy is:
Group B streptococcus
Klebsiella pneumonia
Chlamydia trachomatis
Proteus species
Escherichia coli

Answer: E* Escherichia coli

***) Asymptomatic bacteriuria means one of the following:
Urine contains more than 1,000 organisms per milliliter
Urine contains more than 2,000 organisms per milliliter
Urine contains more than 5,000 organisms per milliliter
Urine contains more than 10,000 organisms per milliliter
Urine contains more than 100,000 organisms per milliliter

Answer: E* Urine contains more than 100,000 organisms per milliliter

***) Regarding acute pyelonephritis with pregnancy, all the following are true except:
Right kidney is more affected than the left
Temperature is usually over 39°C
Antibiotic should be started before bacteriological results are available
The incidence of pre-term labor is increased
Intravenous pyelography IVP should be done promptly

Answer: E* Intravenous pyelography IVP should be done promptly

***) In acute pyelonephritis during pregnancy the most common causative organism is:
Pseudomonas
Klebsiella
E.Coli
Proteus
Shigella

Answer: C* E.Coli

***) The following encourage pyelitis in pregnancy, except:
Urinary stasis
Abnormalities of the renal tract
Constipation
Dehydration
Diabetes mellitus

Answer: D* Dehydration

***) Management of acute pyelonephritis during pregnancy includes all of the following, except:
Admission to the hospital
IV fluids
Antibiotics
Intravenous pyelogram (IVP) following delivery
Induction of labor

Answer: E* Induction of labor

***) Pregnant patients with chronic renal disease have an increased of all of the following, except:
Pre-eclampsia
Abortion
Stillbirth
Intrauterine growth retardation
Postmaturity

Answer: E* Postmaturity

***) All of the following may cause proteinuria during pregnancy, except:
A result of contamination
Urinary tract infection
Pre-eclampsia
Cardiac disease in pregnancy
Varicose veins in pregnancy

Answer: E* Varicose veins in pregnancy

***) All of the following complications of urinary tract may occur during pregnancy, except:
Asymptomatic bacteriuria
Ureteric colic
Lower urinary tract infection is uncommon
Hematuria due to varicose veins in the bladder (hemangioma)
Acute urine retention

Answer: C* Lower urinary tract infection is uncommon

***) Urinary estriol during pregnancy is mainly derived from:
Fetal kidneys
Maternal kidneys
Fetal adrenals
Maternal adrenals
Maternal liver

Answer: C* Fetal adrenals

***) An appropriate choice of antibiotics therapy for urinary tract infection in 15 weeks pregnant is:
Doxycycline
Tetracycline
Ciprofloxacin
Nitrofurantoin
Metronidazole

Answer: D* Nitrofurantoin

Infections in Pregnancy.
***) Treponema pallidum is the cause for one of the following venereal diseases:
Chancroid
Condyloma acuminata
Lymphogranuloma venerum
Syphilis
Granuloma inguinalis

Answer: D* Syphilis

***) Transplacental transmission occurs in which of the following:
Shigella
Syphilis
Diphtheria
Typhoid
Cholera

Answer: B* Syphilis

***) All of the following statements concerning congenital rubella infection are true, except:
Most congenital infection occur during the first 8 weeks of pregnancy
Congenital infection includes congenital cataract, patent ductus arteriosus and congenital deafness
If contracted during the last trimester it will lead to intrauterine growth retardation
Gamma globulin given to the mother offers protection against fetal damage
Congenital infection can lead to fetal death or prematurity

Answer: D* Gamma globulin given to the mother offers protection against fetal damage

***) The effects of rubella on the fetus include the following, except:
Blindness
Deafness
Hutchinson teeth
Intrauterine growth retardation
Hepatosplenomegaly

Answer: C*Hutchinson teeth

***) One of the following viral diseases may cause cataract, deafness and heart lesion of newborn:
Measles
Rubella
Coxsackie virus
Cytomegalic inclusion bodies
Herpes zoster

Answer: B* Rubella

***) In a patient exposed to rubella infection in early pregnancy the proper management is:
To give rubella vaccine
To advise the patient to have immediate termination
To give immunoglobulin and assure the patient
To do rubella titre IgG, IgM and repeat after two weeks
To ignore patient's complaint

Answer: D* To do rubella titre IgG, IgM and repeat after two weeks

***) A patient has been discharged following normal delivery, discharge counseling and would include one of the following:
No driving for 4 weeks
No coitus for 6 weeks
Return to work only after 6 weeks
Rubella immunization for non-immune patients
No place for breast feeding in the puerperium

Answer: D* Rubella immunization for non-immune patients

Deep Vein Thrombosis.
***) In venous thrombosis, all the following are true except:
Less common antenatally than in puerperium
Require treatment with warfarin at all stages of pregnancy
Is uncommon diagnosis during pregnancy
Is frequently asymptomatic
Is more dangerous antenatally than postnatal

Answer: B* Require treatment with warfarin at all stages of pregnancy

***) The treatment of choice of deep vein thrombosis during pregnancy is:
Aspirin
Bed rest and crepe bandage
Physiotherapy
Oral anticoagulants
Heparin

Answer: E* Heparin

Disseminated Intravascular Coagulopathy.
***) Coagulation defects in pregnancy occur with all of the following conditions, except:
Intrauterine fetal death
Placenta previa
Abruption placenta
Amniotic fluid embolism
Severe pre-eclampsia

Answer: B* Placenta previa

***) Clinical disseminated intravascular coagulopathy may occur in any of the following conditions, except:
Missed abortion
Incomplete abortion
Amniotic fluid embolism
Septic abortion
Abruptio placenta (accidental hemorrhage)

Answer: B* Incomplete abortion

***) Disseminated intravascular coagulation is characterized by all of the following, except:
Thrombocytopenia
High fibrinogen level
High levels of fibrinogen degradation products
Bleeding tendency
Low PO2

Answer: B* High fibrinogen level

***) Hypofibrinogenemia is characterized by:
A failure of blood to clot in vitro
Plasma fibrinogen of 500 mg percent
Decreased platelets count
Decreased leukocytes mobility
A decrease in erythrocytes

Answer: A* A failure of blood to clot in vitro

***) A major hazard of fetal demise after 20 weeks is:
Increase in human chorionic gonadotropin values
Systemic allergies
Bone marrow depression
Coagulopathy
Toxemia

Answer: D* Coagulopathy

Maternal Risks in Pregnancy.
***) All of the following can be categorized as high risk pregnancy, except:
Diabetes mellitus
Hypertension disease
Mal presentation of the fetus
Previous cesarean section
Edema of the lower extremities

Answer: E* Edema of the lower extremities

***) In early pregnancy, lower abdominal pain could be caused by all the following, except:
Cystitis
Threatened abortion
Ectopic pregnancy
Mole pregnancy
Twisted ovarian cyst

Answer: D* Mole pregnancy

***) All of the following are the features of complication of grand multi-parous woman, except:
Iron deficient anemia
Increased incidence of antepartum hemorrhage
Infertility
Ruptured uterus
Post partum hemorrhage

Answer: C* Infertility

***) The treatment of choice in a patient with a cystocele during pregnancy is:
Anterior repair operation in the first trimester
Repair 2 weeks after delivery
Anterior repair operation in the second trimester
Immediate repair after delivery of the placenta
Re-evaluation six weeks after delivery

Answer: E* Re-evaluation six weeks after delivery

Bleeding in Pregnancy 

First and Second Trimester Bleeding.
***) Currently the leading cause of maternal mortality is:
Hypertensive disorders of pregnancy
Hemorrhage
Sepsis
Obstetric anesthesia
Instrumental delivery

Answer: B* Hemorrhage

***) Vaginal bleeding in early pregnancy can be due to the following, except:
Early abortion
Threatened abortion
Ectopic pregnancy
Hydatidiform mole
Pregnancy with ovarian cyst

Answer: E* Pregnancy with ovarian cyst

***) The most likely cause of abnormal genital bleeding in a 22 year old woman is:
Cervical cancer
Anovulation
Uterine cancer
Systemic bleeding disease
Threatened abortion

Answer: E* Threatened abortion

Third Trimester Bleeding (Ante partum Hemorrhage).
***) All of the following may cause ante-partum hemorrhage, except:
Placenta previa
Abruptio placenta
Vaginal varicose
Cervical carcinoma
Moniliasis

Answer: E* Moniliasis

***) 32 weeks intrauterine pregnancy with mild vaginal bleeding, which appeared suddenly, uterus is soft, good FSH, oblique lie, one of the following is the proper management:
Vaginal examination with starting of blood transfusion
Hospitalization, bed rest, ultrasound exam, prepare blood
Immediate CS
Examination under anesthesia, than rupture of membranes and oxytocin drip
Induction with prostaglandin vaginal supports

Answer: B* Hospitalization, bed rest, ultrasound exam, prepare blood

***) Mild painless vaginal bleeding at 33 weeks of pregnancy should be treated by:
Artificial rupture of membranes
Expectant conservative treatment
Cesarean section
Immediate vaginal delivery
Pelvic examination

Answer: B* Expectant conservative treatment

***) In ante-partum hemorrhage fetal blood cells could be identified in one of the following conditions:
Placenta circumvallate
Placenta marginalis
Placenta membranacea
Battledore insertion of the cord
Velamentous insertion of the cord

Answer: E* Velamentous insertion of the cord

Spontaneous Abortions.
***) In inevitable abortion, all the following are true except:
The cervical os will be dilated
The pain is colicky in nature
The conceptual sac may be felt by pelvic examination
Usually there is no vaginal bleeding
The uterine size is compatible

Answer: D* Usually there is no vaginal bleeding

***) One of the following is true in a case of incomplete abortion:
The internal cervical os is closed
The fetal heart activity is heard
Human chorionic gonadotropin (hCG) injections should be given
The vaginal bleeding is painless
Evacuation of the uterus is needed

Answer: E* Evacuation of the uterus is needed

***) A major hazard of missed abortion is:
Pulmonary embolism
Systemic allergies
Bone marrow depression
Coagulopathy
Toxemia

Answer: D* Coagulopathy

***) All of the following are signs of missed abortion, except:
Vaginal bleeding
Distorted gestational sac
Absence of fetal heart activity
Small for gestational age uterus
Absence of fetal movements

Answer: A* Vaginal bleeding

***) In missed abortion all of the following are true, except:
The uterus is larger than date
The uterus is smaller than date
The fetus is dead
Can cause coagulopathy
Menstruation does not occur

Answer: A* The uterus is larger than date

***) The most common type of bacteria present in septic abortion is:
E.Coli
Pseudomonas
Beta-hemolytic streptococcus
Bacteroids
Peptostreptococcus (anaerobic streptococcus)

Answer Beta-hemolytic streptococcus


***) The most common cause of abortion in the 1st trimester is:
Physical trauma
Uterine retroversion
Abnormality of the conceptus
Systemic maternal infection
Incompetent cervix

Answer: C* Abnormality of the conceptus

***) The most common cause for 2nd trimester abortion is:
Fetal abnormality
Placental insufficiency
Incompetent cervix
Fibroid uterus
Rh isoimmunization

Answer: C* Incompetent cervix

***) One of the following is the commonest cause of vaginal bleeding during the first half of pregnancy:
Hydatiform mole
Abruptio placenta
Ectopic pregnancy
Abortion
Placenta previa

Answer: D* Abortion

***) Criteria for abortion due to cervical incompetence include all of the following, except:
First trimester abortion
Water before blood
Short and minimal labor pains
Cervix admits number 8 hegar dilator
Barrel-shaped cervix by H.salpingogram

Answer: A* First trimester abortion

***) With cervical incompetence, all the following are true except:
May be congenital
It is associated with previous dilatation
It is associated with painless premature labor
It is diagnosed by follicular phase hysterography
It is common cause of second trimester abortion

Answer: D* It is diagnosed by follicular phase hysterography

***) If a patient who has threatened abortion did not abort, the risk of the fetus being abnormal is:
The same as in patient without bleeding
Slightly increased
Moderately increased
Markedly increased
99 to 100%

Answer: B* Slightly increased

***) A 23 year old lady G1P0, 6 weeks pregnant has developed bleeding over the past 2 days. Which of the following is the likely cause of her bleeding:
Hydatidiform mole
Abruption placenta
Ectopic pregnancy
Abortion
Uterine rapture

Answer: D* Abortion

***) Therapy for threatened abortion should include:
Progesterone injection
Dilatation and curettage
Prolonged bed rest
Restricted activity
Prostaglandins suppositories

Answer: D* Restricted activity

***) Extrusion of an abortus from the fimbriated end of the tube is called:
Spontaneous abortion
Delivery
Tubal abortion
Decidual cast
Aria-Stella phenomenon

Answer: C* Tubal abortion

***) A 26 year old woman whose last menstrual period was 2.5 months ago develops bleeding, uterine cramps, and passes tissues per vagina. Two hours later she is still bleeding heavily, the most likely diagnosis is:
Twin pregnancy
Threatened abortion
Inevitable abortion
Premature labor
Incomplete abortion

Answer: E* Incomplete abortion

***) A 24 year old woman, 10 weeks pregnant presented with vaginal bleeding, lower abdominal pain and temperature 39.5 degrees and a history of introducing sharp object per vagina for self abortion. The most likely diagnosis is:
Choriocarcinoma
Hydatidiform mole
Pelvic inflammatory disease
Septic abortion
Twisted ovarian cyst

Answer: D* Septic abortion

***) Definitive initial therapy in septic abortion is:
Curettage after antibiotics
Hysterectomy
Bed rest and antibiotics
Hysterotomy
Outpatient antibiotics

Answer: A* Curettage after antibiotics

***) The treatment of incomplete abortion in a patient of 10 weeks gestation is:
Administration of syntocinon only
Administration of ergometrine only
Hysterectomy
Evacuation of the uterus
Prostaglandin vaginal pessary

Answer: D* Evacuation of the uterus

***) The clinical features of threatened abortion include all the following except:
Slight bleeding per vaginal
Size of the uterus corresponds to period of amenorrhea
Mild abdominal pain
The cervix is closed
The cervix is opened

Answer: D* The cervix is closed

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