Pregnancy OB02-OB04.

1. Diagnosis of Pregnancy.***) Signs and symptoms of pregnancy in the 1st trimester include all of the following, except:A. NauseaB. QuickeningC. Frequency of micturitionD. Soreness of breastE. Hegar's sign

Answer: B* Quickening

***) Which of the following hormones is produced by trophoblast:A. Luteinizing hormoneB. Follicle stimulating hormoneC. ProlactinD. Human chorionic gonadotropinE. Oxytocin

Answer: D* Human chorionic gonadotropin

***) Positive pregnancy test in the urine depends on the presence of:A. Human chorionic gonadotropinB. ProgesteroneC. EstrogenD. CalciumE. 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 nauseaB. Vaginal examinationC. Abdominal examinationD. 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. ProgesteroneB. ProlactinC. 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 kgB. The cardiac output has risen markedly by 40 percent during pregnancyC. There is a slight increase of pulse rate about 15 percentD. There is a decrease in red cell massE. 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 rateB. Stroke volumeC. Plasma volumeD. HematocritE. 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 aortaB. Pressure of the gravid uterus on vena cava inferiorC. Pressure of the gravid uterus on vena cava superiorD. Constipation during pregnancyE. 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 increaseB. Free cortisol concentration increaseC. Thyroxin binding globulin concentration increaseD. Free thyroxin index increaseE. Release of TSH is not increased

Answer: D* Free thyroxin index increase

***) In the normal pregnancy all of the following increase, except:A. Plasma volumeB. Hepatic blood flowC. Platelet countD. White cells countE. Cardiac output

Answer: C* Platelet count

***) Pregnancy leads to one of the following:A. Prolongation of stomach emptying time and increased acidityB. Shortening of stomach emptying time and increased acidityC. Shortening of stomach emptying time and decreased acidityD. Prolongation of stomach emptying time and no affection of acidityE. 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 swollenB. Excessive salivation may occurC. Heartburn (reflux esophagitis) is commonD. The stomach tends to empty more rapidlyE. Slow peristalsis of the bowel

Answer: D* The stomach tends to empty more rapidly

***) The cause of heartburn in pregnancy is:A. Increased gastric motilityB. Increased vagal nerve activityC. Gastro-esophageal refluxD. Duodeno-gastric refluxE. Increased gastric emptying

Answer: C* Gastro-esophageal reflux

***) Breast tissue of 2mm nodule is normal for which gestational age:A. 28 weeksB. 36 weeksC. 40 weeksD. 42 weeksE. 44 weeks

Answer: A* 28 weeks

Prenatal Care OB04-OB10.

1. Prenatal Visits.***) All of the following are aims of antenatal care, except:A. To monitor the well being of the fetusB. To establish and maintain the physical health of the motherC. The ideal time for first antenatal visit is before 14 weeks of pregnancyD. Screening for fetal congenital abnormalityE. Screening for endometrial carcinoma

Answer: E* Screening for endometrial carcinoma

***) The embryonic life starts at:A. The 3rd week after ovulationB. The 5th week after ovulationC. The 7th week after ovulationD. The 9th week after ovulationE. 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 careB. Localization of placenta in the first trimesterC. Antenatal fetal monitoringD. Correct timing of deliveryE. 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 ironB. 100 mg of ironC. 200 mg of ironD. 400 mg of ironE. 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 rhesusB. HemoglobinC. Serological tests for syphilisD. Rubella antibodiesE. Renal functional tests

Answer: E* Renal functional tests

***) All of the following are restriction on coitus during pregnancy, except:A. Threatened abortionB. History of premature laborC. History of post partum hemorrhageD. History of ante partum hemorrhageE. 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 heightB. The lie of the fetusC. Cephalo-pelvic disproportion D. The presentation of the fetal cephalic or breechE. 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 marginB. At the level of umbilicusC. Midway between umbilicus and pubic marginD. 2 cm above the pubisE. 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 datesB. Uterine fibroidC. Full bladderD. PolyhydramniosE. Multiple pregnancy

Answer: C* Full bladder

***) A large for date uterus may be due to all of the following conditions, except:A. Multiple pregnancyB. Hydatidiform moleC. OligohydramniosD. Uterine fibroid with pregnancyE. Error in dates

Answer: C* Oligohydramnios

***) Causes of large for date pregnancies are the following, except:A. Multiple pregnancyB. PolyhydramniosC. Hydatiform moleD. Intrauterine fetal deathE. Diabetes with pregnancy

Answer: D* Intrauterine fetal death

***) The following factors may lead to wrong dates of delivery, except:A. An irregular cycleB. Regular cycles but in excess of 28 days (35-42 days)C. Regular cycles of 28 daysD. Patient's poor memoryE. 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/dayB. Calcium tablets 1 gm/dayC. Vitamin E 200 mg/dayD. Vitamin B complexE. 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. SmokingB. Alcohol abuseC. Drug abuseD. Avoiding infectionE. 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 23rdB. April 7thC. March 28thD. April 23rdE. 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 abortionB. Following delivery of Rh-negative babyC. At 28 weeks of gestationD. Following ectopic pregnancyE. 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 incompetenceC. After amniocentesisD. After attacks of ante partum hemorrhageE. 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 husbandsB. Anti-D to be given at 28 weeks or 32 weeks for pregnant patient with Rh-positive husbandC. Anti-D to be given within 72 hours after delivery in a patient with Rh-positive fetusD. 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. JaundiceB. Heart failureC. Respiratory distress syndromeD. Congenital anomaliesE. 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. CytogeneticsB. Fetal maturityC. Detection of neural tube defect by measurement of alpha fetoproteinD. PolydactylyE. Rhesus disease

Answer: D* Polydactyly

***) Amniotic fluid is used to check up all of the following, except:A. Chromosome analysisB. Neural tube defectsC. Lung maturity of the fetusD. Fetal hemoglobinE. Inborn metabolic disease

Answer: E* Inborn metabolic disease

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

Answer: D* Female Edwards syndrome - 47 XX, +13

Medical Conditions in Pregnancy OB13-OB23.

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 classIs very common in multiple pregnancyIs prevented with adequate diet onlyCan usually be treated with oral ironIs 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 diseaseLack of iron supplementsPoor dietBleedingMal absorption

Answer: A* Sickle cell disease

***) All of the following are causes of iron deficiency anemia during pregnancy, except:Inadequate iron in the dietExcessive blood lossInfrequent pregnanciesAbnormal demand as in multiple pregnancyMal absorption

Answer: C* Infrequent pregnancies

***) Effects of iron deficiency anemia in pregnancy include all of the following, except:Increased plasma volumeIncreased cardiac outputDecreased peripheral resistanceOxygen dissociation curve shifted to the leftHeart 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 pregnanciesLow HCl acid in the stomachGrand multi-parous womenPoor dietAnticonvulsant 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 deficiencyVitamin B12 deficiencyFolic acid deficiencyVitamin B1 excessHypoxia

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 controlInsulin requirement usually increasesBlood sugar should be maintained at approximately 160 mg/dlPersistent hyperglycemia is worse than occasional hypoglycemiaGlycosylated 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 abnormalityThere is higher risk of fetal death during the last weeks of pregnancyUsually insulin requirement is increasedDelivery is always by caesarian sectionStabilization 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 microsomiaIncreased risk of placenta previaIncreased risk of abortionIncreased risk of congenital abnormalitiesIncreased risk of candidial vulvovaginitis

Answer: B* Increased risk of placenta previa

***) All of the following are effects of diabetes on pregnancy, except:Pre-eclampsiaIntrauterine fetal deathIncreased incidence of fetal congenital abnormalitiesOligohydramniosShoulder dystocia

Answer: D* Oligohydramnios

***) All of the following are associated with complications in pregnant patient with diabetes mellitus, except:Maternal ketoacidosisIntrauterine fetal deathTrichomonas infectionPolyhydramniosPre-eclamptic toxemia

Answer: C* Trichomonas infection

***) Indications of glucose tolerance test during pregnancy include all following, except:Family history of diabetesRenal glucosuriaUnexplained stillbirthPolyhydramniosDelivery 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 dietGood control of protein intakeOral hypoglycemic drugs in mild casesTwice daily mixture of short and medium acting insulinBed 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 deliveryMaternal deathMaternal head traumaNormoglycemiaDelivery 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-eclampsiaEssential hypertensionRenal artery stenosisPheochromocytomaCoarctation of aorta

Answer: A* Pre-eclampsia

***) Concerning pregnancy induced hypertension, all the following are true except:Common in women with diabetes mellitusTreatment includes furosemide (Lasix)Albuminuria is due to this conditionDelivery usually cure this conditionWill 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 pregnancyThe blood pressure decreases few days after deliveryThe hypertension is not necessarily to be associated with proteinuriaThe pregnancy should not exceed more than 40 weeksThe 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 diureticsPost partum pregnancy induced hypertension is the most dangerousRelief of pregnancy induced hypertension is achieved by anti-tetanus toxoidDeath of the fetus is usually followed by complete improvementFetus 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:MultiparityMultiple pregnancyChronic kidney diseaseDiabetes mellitusVesicular mole

Answer: A* Multiparity

***) The following conditions are associated with high frequency of pre-eclampsia, except:DiabetesMultiple pregnancyPolyhydramniosHydatiform molePlacenta previa

Answer: C* Polyhydramnios

***) The following statements regarding ante partum pre-eclampsia toxemia are true, except:Treatment with diuretics is of great valuePrimary treatment with diazoxide is contraindicatedPlasma uric acid level is elevatedMaterno-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 increasesThe plasma volume decreasesPlacental function tests values decreaseHb concentration increasesCreatinine 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 HGProteinuria of 2 g/24hDeep 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 headachePolyuriaEpigastric painExaggerated reflexesVisual disturbances

Answer: B* Polyuria

***) Signs and symptoms of impending eclampsia include all of following, except:HeadacheSacral edemaEpigastric painHyperreflexiaBlurring of vision

Answer: B* Sacral edema

***) Signs of fulminating pre-eclampsia include the following, except:HyperreflexiaEpigastric tendernessPoor urine outputMaternal weight lossProteinuria

Answer: D* Maternal weight loss

***) The usual manner of death in case of eclampsia is:Cerebral hemorrhageCongestive heart failureCardiac arrest during convulsionsUremiaHemorrhagic pneumonia

Answer: A* Cerebral hemorrhage

***) The complications of pre-eclampsia include all of the following, except:Abruption placentaPolyhydramniosIntrauterine growth retardationDecreased renal blood flowAbnormal liver enzymes

Answer: B* Polyhydramnios

***) In a case of pre-eclamptic toxemia at 40 weeks, the best management is:Induction of laborCesarean sectionGive methyldopa onlyGive diuretics (Lasix) onlyGive hydralazine only

Answer: A* Induction of labor

***) The most worrisome sign or symptom of serious pathology in late pregnancy is:Swollen anklesConstipationVisual changesNocturiaHeartburn

Answer: C* Visual changes

Heart and Pregnancy.***) Regarding changes in the heart during pregnancy, all the following are true except:Third soundDiastolic murmurSoft systolic murmurIncreased pulse rateSlight displacement of the apex

Answer: B* Diastolic murmur

***) Which of the following signs is diagnostic of heart disease in pregnancy:Diastolic heart murmurSoft systolic heart murmurTachycardiaArrhythmiaAccentuated 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 murmurDiastolic murmurAtrial fibrillationCardiac enlargementPalpation 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:TachycardiaEmotional upsetPhysical exerciseA systolic murmurLower 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 weeksSit upright in laborCould be considered for mitral valvotomy during pregnancyShould not be given ergometrine (oxytocin) in the third stage of laborShould 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 defectMarfan's syndromeUncompensated cardiac failureEisenmenger's syndromeSevere 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 trimesterIs associated with hydatiform moleIs associated with multiple pregnancyOccurs most commonly in multigravidaMay 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 liverViral hepatitisSevere pre-eclampsiaChlorpromazineErythromycin

Answer: D* Chlorpromazine

Urinary Tract Complications.***) The likely organism to cause urinary tract infection in pregnancy is:Group B streptococcusKlebsiella pneumoniaChlamydia trachomatisProteus speciesEscherichia coli

Answer: E* Escherichia coli

***) Asymptomatic bacteriuria means one of the following:Urine contains more than 1,000 organisms per milliliterUrine contains more than 2,000 organisms per milliliterUrine contains more than 5,000 organisms per milliliterUrine contains more than 10,000 organisms per milliliterUrine 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 leftTemperature is usually over 39CAntibiotic should be started before bacteriological results are availableThe incidence of pre-term labor is increasedIntravenous 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:PseudomonasKlebsiellaE.ColiProteusShigella

Answer: C* E.Coli

***) The following encourage pyelitis in pregnancy, except:Urinary stasisAbnormalities of the renal tract ConstipationDehydrationDiabetes mellitus

Answer: D* Dehydration

***) Management of acute pyelonephritis during pregnancy includes all of the following, except:Admission to the hospitalIV fluidsAntibioticsIntravenous pyelogram (IVP) following deliveryInduction of labor

Answer: E* Induction of labor

***) Pregnant patients with chronic renal disease have an increased of all of the following, except:Pre-eclampsiaAbortionStillbirthIntrauterine growth retardationPostmaturity

Answer: E* Postmaturity

***) All of the following may cause proteinuria during pregnancy, except:A result of contaminationUrinary tract infectionPre-eclampsiaCardiac disease in pregnancyVaricose veins in pregnancy

Answer: E* Varicose veins in pregnancy

***) All of the following complications of urinary tract may occur during pregnancy, except:Asymptomatic bacteriuriaUreteric colicLower urinary tract infection is uncommonHematuria 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 kidneysMaternal kidneysFetal adrenalsMaternal adrenalsMaternal liver

Answer: C* Fetal adrenals

***) An appropriate choice of antibiotics therapy for urinary tract infection in 15 weeks pregnant is:DoxycyclineTetracyclineCiprofloxacinNitrofurantoinMetronidazole

Answer: D* Nitrofurantoin

Infections in Pregnancy.***) Treponema pallidum is the cause for one of the following venereal diseases:ChancroidCondyloma acuminataLymphogranuloma venerumSyphilisGranuloma inguinalis

Answer: D* Syphilis

***) Transplacental transmission occurs in which of the following:ShigellaSyphilisDiphtheriaTyphoidCholera

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 pregnancyCongenital infection includes congenital cataract, patent ductus arteriosus and congenital deafnessIf contracted during the last trimester it will lead to intrauterine growth retardationGamma globulin given to the mother offers protection against fetal damageCongenital 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:BlindnessDeafnessHutchinson teethIntrauterine growth retardationHepatosplenomegaly

Answer: C*Hutchinson teeth

***) One of the following viral diseases may cause cataract, deafness and heart lesion of newborn:MeaslesRubellaCoxsackie virusCytomegalic inclusion bodiesHerpes zoster

Answer: B* Rubella

***) In a patient exposed to rubella infection in early pregnancy the proper management is:To give rubella vaccineTo advise the patient to have immediate terminationTo give immunoglobulin and assure the patientTo do rubella titre IgG, IgM and repeat after two weeksTo 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 weeksNo coitus for 6 weeksReturn to work only after 6 weeksRubella immunization for non-immune patientsNo 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 puerperiumRequire treatment with warfarin at all stages of pregnancyIs uncommon diagnosis during pregnancyIs frequently asymptomaticIs 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:AspirinBed rest and crepe bandagePhysiotherapyOral anticoagulantsHeparin

Answer: E* Heparin

Disseminated Intravascular Coagulopathy.***) Coagulation defects in pregnancy occur with all of the following conditions, except: Intrauterine fetal deathPlacenta previaAbruption placentaAmniotic fluid embolismSevere pre-eclampsia

Answer: B* Placenta previa

***) Clinical disseminated intravascular coagulopathy may occur in any of the following conditions, except:Missed abortionIncomplete abortionAmniotic fluid embolismSeptic abortionAbruptio placenta (accidental hemorrhage)

Answer: B* Incomplete abortion

***) Disseminated intravascular coagulation is characterized by all of the following, except:ThrombocytopeniaHigh fibrinogen levelHigh levels of fibrinogen degradation productsBleeding tendencyLow PO2

Answer: B* High fibrinogen level

***) Hypofibrinogenemia is characterized by:A failure of blood to clot in vitroPlasma fibrinogen of 500 mg percentDecreased platelets countDecreased leukocytes mobilityA 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 valuesSystemic allergiesBone marrow depressionCoagulopathyToxemia

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:CystitisThreatened abortionEctopic pregnancyMole pregnancyTwisted ovarian cyst

Answer: D* Mole pregnancy

***) All of the following are the features of complication of grand multi-parous woman, except:Iron deficient anemiaIncreased incidence of antepartum hemorrhageInfertilityRuptured uterusPost partum hemorrhage

Answer: C* Infertility

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

Answer: E* Re-evaluation six weeks after delivery

Bleeding in Pregnancy OB23-OB24.

First and Second Trimester Bleeding.***) Currently the leading cause of maternal mortality is:Hypertensive disorders of pregnancyHemorrhageSepsisObstetric anesthesiaInstrumental delivery

Answer: B* Hemorrhage

***) Vaginal bleeding in early pregnancy can be due to the following, except:Early abortionThreatened abortionEctopic pregnancyHydatidiform molePregnancy 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 cancerAnovulationUterine cancerSystemic bleeding diseaseThreatened abortion

Answer: E* Threatened abortion

Third Trimester Bleeding (Ante partum Hemorrhage).***) All of the following may cause ante-partum hemorrhage, except:Placenta previaAbruptio placentaVaginal varicoseCervical carcinomaMoniliasis

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 transfusionHospitalization, bed rest, ultrasound exam, prepare bloodImmediate CSExamination under anesthesia, than rupture of membranes and oxytocin dripInduction 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 membranesExpectant conservative treatmentCesarean sectionImmediate vaginal deliveryPelvic examination

Answer: B* Expectant conservative treatment

***) In ante-partum hemorrhage fetal blood cells could be identified in one of the following conditions:Placenta circumvallatePlacenta marginalisPlacenta membranaceaBattledore insertion of the cordVelamentous 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 dilatedThe pain is colicky in natureThe conceptual sac may be felt by pelvic examinationUsually there is no vaginal bleedingThe 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 closedThe fetal heart activity is heardHuman chorionic gonadotropin (hCG) injections should be givenThe vaginal bleeding is painlessEvacuation of the uterus is needed

Answer: E* Evacuation of the uterus is needed

***) A major hazard of missed abortion is:Pulmonary embolismSystemic allergiesBone marrow depressionCoagulopathyToxemia

Answer: D* Coagulopathy

***) All of the following are signs of missed abortion, except:Vaginal bleedingDistorted gestational sacAbsence of fetal heart activitySmall for gestational age uterusAbsence of fetal movements

Answer: A* Vaginal bleeding

***) In missed abortion all of the following are true, except:The uterus is larger than dateThe uterus is smaller than dateThe fetus is deadCan cause coagulopathyMenstruation does not occur

Answer: A* The uterus is larger than date

***) The most common type of bacteria present in septic abortion is:E.ColiPseudomonasBeta-hemolytic streptococcusBacteroidsPeptostreptococcus (anaerobic streptococcus)

Answer: E* Peptostreptococcus (anaerobic streptococcus)

***) The most common cause of abortion in the 1st trimester is:Physical traumaUterine retroversionAbnormality of the conceptusSystemic maternal infectionIncompetent cervix

Answer: C* Abnormality of the conceptus

***) The most common cause for 2nd trimester abortion is:Fetal abnormalityPlacental insufficiencyIncompetent cervixFibroid uterusRh isoimmunization

Answer: C* Incompetent cervix

***) One of the following is the commonest cause of vaginal bleeding during the first half of pregnancy:Hydatiform moleAbruptio placentaEctopic pregnancyAbortionPlacenta previa

Answer: D* Abortion

***) Criteria for abortion due to cervical incompetence include all of the following, except: First trimester abortionWater before bloodShort and minimal labor painsCervix admits number 8 hegar dilatorBarrel-shaped cervix by H.salpingogram

Answer: A* First trimester abortion

***) With cervical incompetence, all the following are true except:May be congenitalIt is associated with previous dilatationIt is associated with painless premature laborIt is diagnosed by follicular phase hysterographyIt 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 bleedingSlightly increasedModerately increasedMarkedly increased99 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 moleAbruption placentaEctopic pregnancyAbortionUterine rapture

Answer: D* Abortion

***) Therapy for threatened abortion should include:Progesterone injectionDilatation and curettageProlonged bed restRestricted activityProstaglandins suppositories

Answer: D* Restricted activity

***) Extrusion of an abortus from the fimbriated end of the tube is called:Spontaneous abortionDeliveryTubal abortionDecidual castAria-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 pregnancyThreatened abortionInevitable abortionPremature laborIncomplete 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:ChoriocarcinomaHydatidiform molePelvic inflammatory diseaseSeptic abortionTwisted ovarian cyst

Answer: D* Septic abortion

***) Definitive initial therapy in septic abortion is:Curettage after antibioticsHysterectomyBed rest and antibioticsHysterotomyOutpatient antibiotics

Answer: A* Curettage after antibiotics

***) The treatment of incomplete abortion in a patient of 10 weeks gestation is:Administration of syntocinon onlyAdministration of ergometrine onlyHysterectomyEvacuation of the uterusProstaglandin vaginal pessary

Answer: D* Evacuation of the uterus

***) The clinical features of threatened abortion include all the following except:Slight bleeding per vaginalSize of the uterus corresponds to period of amenorrheaMild abdominal painThe cervix is closedThe cervix is opened

Answer: D* The cervix is closed

Molar and Ectopic Pregnancy OB24-OB26.

Molar Pregnancy (Hydatidiform mole).***) Regarding hydatidiform mole, all the following are true except:Commoner in women of blood group A married to blood O menGroup AB women have the worst prognosisAre commoner in older gravidaAre complicated by ovarian cystCan 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 datesBilateral ovarian cysts (Lutein cysts) is commonAggravated morning sicknessTreatment is by suction, curettage regardless of the size of the uterusPregnancy is allowed after 6 months

Answer: E* Pregnancy is allowed after 6 months

***) The complications of hydatiform mole include all the following except:HemorrhageSepsis Perforation of the uterusInversion of the uterusChoriocarcinoma

Answer: D* Inversion of the uterus

***) Hydatiform mole (vesicular mole) is usually treated by:HysterectomyProstaglandin inductionSyntocinon inductionMethotrexateSuction-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 uterusThe most common site of implantation is the abdominal cavityIt may occur in the cervixPrevious infection is a major causeThere 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 bleedingShoulder pain is an important symptomThe isthmus of the tube is the commonest site of implantationIs often not diagnosed by osThe 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:FimbriaAmpullaIsthmusIntramuralParatubal

Answer: B* Ampulla

???) All of the following may be etiological factors of ectopic pregnancy, except:Previous infection of the tubesDelayed passage of the fertilized ovum down the tubeProgesterone pills for contraceptionIntrauterine contraceptive device IUCD usersIrregular periods

Answer: E* Irregular periods

***) All of the following may increase the incidence of ectopic pregnancy, except:Previous pelvic infectionUse of birth control pillsTubal surgeryPrevious appendicitisTubal abnormalities

Answer: B* Use of birth control pills

***) The ectopic pregnancy may be due to:Chronic salpingitisShort fallopian tubeLong uterine cavityUse of vaginal diaphragmContraceptive pills

Answer: A* Chronic salpingitis

***) All of the following are the clinical features of tubal pregnancy, except:The patient may have evidence of peritoneal irritationLower abdominal painAbdominal rigidityFaintingSevere vaginal bleeding

Answer: E* Severe vaginal bleeding

***) The most important symptom of ectopic pregnancy is one of the following:Severe bleedingPainAmenorrheaFaintingPelvic heaviness

Answer: B* Pain

***) Vaginal bleeding in ectopic pregnancy is due to:Rupture of the fallopian tubeRupture of the uterusVaginal lacerationPeritoneal hemorrhageHormone withdrawal

Answer: E* Hormone withdrawal

***) The following features suggest a diagnosis of ectopic pregnancy, except:Amenorrhea of 6-10 weeksAcute abdomenEnlarged uterusDecidual tissue at curettageVaginal bleeding

Answer: C* Enlarged uterus

***) Regarding ectopic pregnancy, all the following are true except:AmenorrheaVaginal bleedingAbdominal painElevated hCGEndometrium has always secretory changes

Answer: D* Elevated hCG

***) All true about ectopic pregnancy, except:Attacks of abdominal sharp stabbing painFainting attacksVaginal bleedingPeriod of amenorrheaPregnancy 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 abdomenHeavy vaginal bleedingCervical excitation on vaginal examinationLocalized tenderness in the pelvisTachycardia

Answer: B* Heavy vaginal bleeding

***) Ectopic pregnancy is confirmed by one of the following:Ultrasound examinationVaginal examinationCuldocentesishCG urine pregnancy testLaparoscopy

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 specimenAria-stella phenomen at D&C pathology specimenChorionic villi at D&C pathology specimenPositive pregnancy testPositive -hCG assay

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

***) Differential diagnoses of ectopic pregnancy are the following, except:Acute salpingitisAcute appendicitisAcute red degeneration of fibroidRupture ovarian cystVesicular mole

Answer: E* Vesicular mole

***) Differential diagnoses of ectopic pregnancy are the following, except:Rupture of a corpus luteum cystUterine abortionTorsion of fallopian tubeAcute appendicitisSpasmodic dysmenorrhea

Answer: E* Spasmodic dysmenorrhea

***) Of the following, which woman is at greater risk for ectopic pregnancy:Healthy woman on birth control pillsA woman with a past history of three incidents of pelvic inflammatory diseaseWoman with a history of endometriosisWoman with irregular mensesWoman 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 cavityThe ovarian surfaceThe cervixAmpulla of the fallopian tubeThe 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:EndometriosisAppendicitisUrinary tract infectionThreatened abortionEctopic pregnancy

Answer: E* Ectopic pregnancy

Placenta OB26-OB29.

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

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

***) Implantation of the blastocyte occurs after:1-2 days3-5 days6-8-days9-10 days12-14 days

Answer: C* 6-8-days

***) The method of choice of placental localization is:UltrasonographyAngiographySoft tissue placentographyUse of radioactive isotopesAmniography

Answer: A* Ultrasonography

***) All of the following are placental hormones, except:Follicular stimulating hormoneHuman placental lactogenProgesteroneEstrogenSomatotropine (growth hormone)

Answer: A* Follicular stimulating hormone

***) Human Placental Lactogen (hPL) can be elevated in all of the following, except: DiabetesTwinsHypertensionErythroblastosisBronchogenic carcinoma

Answer: C* Hypertension

Abnormalities of the Placenta.***) Placental abnormality characterized by an accessory lobe is termed:Placenta membranaceaPlacenta circumvallatePlacenta succenturiataPlacenta fenestrataPlacenta increta

Answer: C* Placenta succenturiata

***) One of the following is true concerning placenta succenturiata:The placenta is surrounded by a fibrous ringThe placenta contains fenestration in its centerThe placenta is connected to an accessory lobe by a small vessels and membraneThe chorionic plate is surrounded by a membranous structureThe 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 partThe umbilical cord is attached to the central membranesThe umbilical cord is attached to the margin of the placentaThe umbilical cord is attached to an accessory lobe of the placentaThe 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 pregnancyObesityChronic renal diseaseSevere anemiaProlonged pregnancy

Answer: B* Obesity

***) Placental insufficiency is caused by the following, except:Smoking in pregnancyDieting in pregnancyHypertensive disorders in pregnancyPost maturityMultiple pregnancy

Answer: B* Dieting in pregnancy

***) All of the following are causes of large placenta, except:Multiple pregnancyChronic renal diseaseSyphilisDiabetes mellitusHydrops fetalis

Answer: B* Chronic renal disease

Placenta Previa.***) In placenta previa all of the following statements are true, except:Causes painless vaginal bleedingVaginal examination is contraindicatedIs managed by caesarian section if covering the cervical osPresents with a woody hard uterusPredisposes 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 bleedingAbnormal presentationUnengaged headAbsence of fetal heartSoft abdomen

Answer: D* Absence of fetal heart

***) Vaginal examination is contraindicated in one of the following situations during pregnancy:Carcinoma of the cervixGonorrheaProlapsed cordPlacenta previaActive labor

Answer: D* Placenta previa

Abruptio Placenta.***) Concerning abruptio placenta, all the following are true except:It is a premature separation of normally implanted placentaThe uterus is tenderIn severe cases a central venous pressure line should be insertedThe vaginal bleeding is painlessThe 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 disordersFollowing delivery of first twinIn severe car accidentAfter rupture of membrane in oligohydramniosExternal cephalic version

Answer: D* After rupture of membrane in oligohydramnios

***) In abruptio placenta, all of the following may occur, except:ShockVaginal bleedingUterine tendernessConvulsionsFetal distress

Answer: C* Uterine tenderness

***) The most common complication of abruptio placenta is:Hepatic failureHeart failurePost partum hemorrhageAdrenal failureCerebral edema

Answer: C* Post partum hemorrhage

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

Answer: B* Eclampsia

***) The most consistent factor predisposing to abruption placenta is:Maternal hypertensionTraumaUterine decompressionMaternal parityMaternal age

Answer: A* Maternal hypertension

***) Treatment for severe placental abruption at term with 3cm dilated cervix is:HeparinBlood transfusionSteroid therapy for fetal lung maturityTocolytic therapyUrgent CS

Answer: E* Urgent CS

Placental Tumors.***) Choriocarcinoma is a primary tumor of:DeciduaUndifferentiated gonadal cellsMyometriumTrophoblastOvaries

Answer: D* Trophoblast

***) Choriocarcinoma may result from all of the following, except:Hydatidiform moleEndometriosisTerm pregnanciesEctopic pregnanciesAbortions

Answer: B* Endometriosis

***) The following are clinical features of choriocarcinoma, except:Irregular vaginal bleeding after pregnancyMetastases may present as lumps in the vaginaChoriocarcinoma is self-limited diseaseMay cause intraperitoneal hemorrhageMay cause amenorrhea

Answer: C* Choriocarcinoma is self-limited disease

***) Choriocarcinoma is treated by:SurgeryChemotherapyAntibioticsHormonesRadiotherapy

Answer: B* Chemotherapy

Multiple Gestation OB29-OB30.

Multiple Pregnancy.***) The following about twins pregnancy are true, except:Dizygotic are more common than monozygoticDizygotic incidence increases with maternal ageIn monozygotic twins a split at the 2 cells stage result in two placentasAll twins are at risk of growth retardationPolyhydramnios 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 previaDiabetes mellitusAcute pyelonephritisPlacental insufficiencyMal presentation

Answer: C* Acute pyelonephritis

***) All of the following are possible complications of multiple pregnancy, except:Abnormal presentationDysfunctional laborUmbilical cord prolapseCephalo-pelvic disproportionPostpartum hemorrhage

Answer: B* Dysfunctional labor

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

Answer: C* Oligohydramnios

***) Twin pregnancy shows an increase in the following complications, except:Accidental hemorrhagePre-eclamptic toxemia (PET)PolyhydramniosPost-partum hemorrhagePolycythemia

Answer: E* Polycythemia

***) Compared with single pregnancies, multiple pregnancies have a higher rate of the following except:AbortionAbnormal presentationProlapsed cordLung maturityPreterm delivery

Answer: D* Lung maturity

***) Multiple pregnancy is usually associated with increased incidence in all the following except:Ante partum hemorrhageAnemiaToxemia of pregnancyPremature laborMonilial genital infection

Answer: E* Monilial genital infection

***) The incidence of dizygotic twins is influenced by all of the following, except:RaceMaternal ageParityPaternal ageHeredity

Answer: D* Paternal age

***) In uniovular twins, all the following are true except:The first fetus commonly presents by the breechAnemia is commonThere is only one placentaPolyhydramnios is frequently presentPregnancy 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 identicalThey have only one placentaThey make up 1/3 of all twin pregnanciesThey are usually separated from one another by amnion and chorionThey 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 1stLabor usually occurs before termThe commonest presentation is verte and vertexPost partum hemorrhage is rareLabor 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 anoxiaHigh incidence of mal presentationHigh incidence of abruptio placentaMore surgical interventionThe second twin is heavier

Answer: E* The second twin is heavier

Growth Discrepancies OB30-OB33.

Intrauterine Growth Restriction IUGR.***) All of the following maternal factors are associated with IUGR, except:Poor nutrition with anemiaHeavy smokingToxemiaGestational diabetesAlcohol consumption

Answer: D* Gestational diabetes

Macrosomia.***) With fetal macrosomia all of the following complications are increased, except:Fetal asphyxiaBrachial plexus injuryPost partum hemorrhageCord prolapseNeonatal hypoglycemia

Answer: D* Cord prolapse

Polyhydramnios.***) All of the following may cause polyhydramnios, except:Diabetes mellitusMultiple pregnancyAnencephalic fetusFetal renal atresiaFetal esophageal atresia

Answer: D* Fetal renal atresia

***) Polyhydramnios could be associated with all of the following, except:Renal agenesisEsophageal atresiaAnencephalyDuodenal atresiaIlleal atresia

Answer: A* Renal agenesis

Oligohydramnios.***) All of the following anomalies are associated with severe maternal oligohydramnios, except:Potter's syndromeDysplastic kidneysPulmonary hypoplasiaMusculoskeletal abnormalitiesGastrointestinal tract obstructions

Answer: E* Gastrointestinal tract obstructions

***) All of the following are associated with oligohydramnios, except:Renal agenesisEsophageal atresiaPulmonary hypoplasiaUrethral atresiaAmnion nodosum

Answer: B* Esophageal atresia

Fetus and Delivery OB33-OB35.

Pelvis.***) The shortest antero-posterior diameter of the pelvis is:True conjugateDiagonal conjugateObstetrical conjugateAntero-posterior diameter of plane of midpelvisAntero-posterior diameter of inferior straight

Answer: C* Obstetrical conjugate

***) In young women the most common type of pelvis is:Anthropoid pelvisAndroid pelvisPlatypelloid pelvisGynecoid pelvisRachitic pelvis

Answer: D* Gynecoid pelvis

***) The android pelvis characteristically has the following, except:A narrow sacroischiatic notchA parallel pelvic side wallsA narrow sub-pubic angleA prominent ischial spinesA 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 suturesIt is the area between the 2 halves of the frontal and the 2 parietal bonesIt is the area bounded behind by the posterior fontanel and the lambdoidal sutureIt is the area bounded laterally by lines passing through the parietal eminencesIt 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 sutureThe area lies between the coronal and sagittal suturesThe area lies between the coronal and temporal suturesThe area lies between the anterior and lambdoid suturesThe 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 diameterOccipito-mental diameterSubmento-pregmatic diameterMento-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 cm9 cm12 cm8.5 cm8 cm

Answer: A* 9.5 cm

***) Regarding biparietal diameter, all the following are true except:The biparietal diameter is the distance between the parietal eminencesThe measurement is 9.5 cmIn vertex presentation it is the largest presenting diameterIt is measured by ultrasound scanning for the maturity of fetusIt 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 spinesBiparietal diameter and pelvic brimVertex and pelvic outletVertex and ischial spineHead 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 boneTemporal boneParietal boneOccipital boneEthmoid bone

Answer: C* Parietal bone

Malpresentation and Malposition.***) The transverse lie in multipara at term in labor best treated by:External versionInternal version and extractionPitocin inductionCesarean sectionInternal version, than oxytocin induction

Answer: D* Cesarean section

***) One of the following is absolute indication for cesarean section:Brow presentationAnterior face presentationOccipito-posterior positionRight occipital presentationTransverse 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:ChinMouthNoseAnterior fontanelOrbital ridge

Answer: D* Anterior fontanel

***) The most common cause of breech presentation is:PolyhydramniosPlacenta previaPrematurityHydrocephalusMultiple pregnancy (twin gestation)

Answer: C* Prematurity

***) Breech presentation is associated with the following, except:PrematurityPolyhydramniosOligohydramniosHydrocephalyPostmaturity

Answer: E* Postmaturity

***) Breech presentation diagnosed antenatally at 37 weeks gestation, is best managed by:Cesarean sectionExternal cephalic versionX-ray maturityUltrasonography and observationOxytocin 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 positionHydrocephalyContracted pelvisCompound presentationAnencephaly

Answer: E* Anencephaly

***) A high head at term could be due to the following except:Wrong datesCephalopelvic disproportionPlacental abruptionAn occipito-posterior positionPlacenta previa

Answer: C* Placental abruption

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

Answer: D* Cesarean section

Labor and Delivery OB35-OB38.

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 intervalsThere is demonstrable progressive dilatation of the cervixThey are not intensified by walkingLocated chiefly in lower abdomenShort 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 contractionsIntensity of uterine contractionsSoftening of the cervixEffacement of the cervixDilatation 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 ringUterus becomes globular, firm and ballotableSudden gush of bloodRise of uterine fundusElongation of the cord

Answer: A* Appearance of contraction ring

***) The third stage of labor follows one of the following:Rupture of the membranesFull dilatation of the cervixDelivery of the fetal headDelivery of the fetusDelivery 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:PethidineEpidural analgesiaCervical blockPudendal block analgesiaInhalation analgesia

Answer: D* Pudendal block analgesia

***) All of the following are indications of epidural anesthesia, except:Ante-partum hemorrhageHeart diseasePulmonary disordersPremature deliveryHypertension

Answer: B* Heart disease

Fetal Monitoring in Labor.***) The normal fetal heart rate in labor is:80-100 beats per minute100-120 beats per minute120-160 beats per minute160-180 beats per minute180-200 beats per minute

Answer: C*120-160 beats per minute

***) The most dangerous sign of imminent fetal death during fetal heart monitoring is:Early decelerationVariable decelerationLoss of beat to beat variabilityLate decelerationFetal tachycardia

Answer: D* Late deceleration

***) All of the following may cause fetal hypoxia, except:Maternal hypotensionSubserous fibroidUterine hyperactivityOcclusion of umbilical cordPlacental insufficiency

Answer: B* Subserous fibroid

Induction of Labor.***) The following may be used safely to accelerate labor, except:Intravenous oxytocinErgometrineProstaglandinRupture of membranesStimulation of the nipples

Answer: B* Ergometrine

Complications & Risks of Delivery OB40-OB49.

Preterm Labor PTL.***) All of the following may cause premature delivery, except:Abruptio placentaChronic hypertensive vascular diseasePlacenta previaOligohydramniosSmoking

Answer: D* Oligohydramnios

***) All of the following have been associated with an increased risk of preterm delivery except:Placenta previaOligohydramniosHyperemesis gravidarumFirst-trimester bleedingMultiple 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 testFerning testSchiller's testNile blue sulfateEvans blue test

Answer: C* Schiller's test

???) Premature ruptures of membranes risks include the following except:Premature laborCord prolapseFetal pneumoniaPlacental abruptionMaternal 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:AnemiaIncrease in subcutaneous fatLong fingernailsVernixFusion of fetal eye lids

Answer: C* Long fingernails

Umbilical Cord Prolapse.***) Prolapsed umbilical cord may occur in all of the following, except:PolyhydramniosTransverse liePlacenta previa centralisBreech presentationPrematurity

Answer: C* Placenta previa centralis

***) Pulsating cord prolapse at 4 cm cervical dilatation is best managed by:Augmentation of labor by oxytocin dripVacuum extractionBy giving prostaglandin vaginal tabletsBy putting the patient in knee chest position and wait for vaginal deliveryCesarean section

Answer: E* Cesarean section

Uterine Rupture.***) The commonest predisposing factor of rupture of uterus is:Previous CSUse of syntocinon (Oxytocin) non properlyForceps deliveryInternal cephalic versionVacuum extraction

Answer: A* Previous CS

***) Uterine rupture may be associated with all of the following except:AmniocentesisPrevious cesarean sectionMyomectomyAdministration of oxytocin or prostaglandinsDifficult forceps delivery or intrauterine manipulation

Answer: A* Amniocentesis

***) The most constant early symptom in uterine rupture during labor is:HematuriaHypotensionPainVaginal bleedingCessation of contractions

Answer: C* Pain

***) The first sign of rupture uterus is:Abdominal painTender scanUnexplained tachycardiaFetal distressVaginal bleeding

Answer: A* Abdominal pain

Operative Obstetrics OB49-OB51.

Operative Vaginal Delivery.***) Vacuum extraction is contraindicated in one of the following condition:Occipito-posterior positionGestational age 32 weeksOccipito-transverse positionIn patients with heart diseaseIn 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 stageReduce trauma to the fetal headReduce damage of the pelvic floorIt is usually followed by vaginal stenosisReduce 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 lieMento-posterior positionFetal distress in the first stageTwin pregnancyProlapsed pulsating cord

Answer: D* Twin pregnancy

***) A multigravida with mitral stenosis in labor with obvious cephalopelvic disproportion, best delivered with:Cesarean sectionForceps delivery in the second stageVacuum delivery if cervix not fully dilatedEnhance 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 cervixImpacted shoulder presentationSevere adhesions in the lower uterine segmentLarge cervical fibroidPosterior placenta previa grade II

Answer: B* Impacted shoulder presentation

***) Indications for a Caesarian section include all of the following, except:Cord prolapsePrevious Caesarian sectionFetal distressTransverse lieMigraine

Answer: E* Migraine

***) All the following are indications for caesarean section except one:Prolapsed cordTransverse lie at termPlacenta previa at termIntrauterine fetal death at termPrevious for CS

Answer: D* Intrauterine fetal death at term

***) All of the following are indications to primary cesarean section except:Prolapsed cordCord presentationMal presentationFace 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 downSevere pelvic-abdominal adhesionsPrevious cesarean section with severe pelvic-abdominal adhesionsPer mortemCephalopelvic disproportion

Answer: E* Cephalopelvic disproportion

Puerperal Complications OB51-OB56.

Postpartum Changes.***) The period of time from the end of delivery until the reproductive organs have returned to normal is called:MenopausePuerperiumPerineumAnte-partumIntra-partum

Answer: B* Puerperium

***) Postpartum hemorrhage is diagnosed when blood loss exceeds:100 cc200 cc300 cc400 cc500 cc

Answer: E* 500 cc

***) In postpartum hemorrhage the most common cause is:Atonic uterusCervical tearUterine ruptureRetained placental tissueInversion of the uterus

Answer: A* Atonic uterus

***) Regarding post partum hemorrhage all of the following are predisposing factors, except:Multiple pregnanciesPolyhydramniosGiving syntometrine with the delivery of anterior shoulderProlonged laborPrecipitated 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 pregnancyLess common in primigravida than multigravidaThe commonest cause is laceration of the cervixIt may be caused by bleeding from non-placental siteThe 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 laborRetained parts of the placentaCervical tearFull bladderToxemia of pregnancy

Answer: D* Full bladder

***) One of the following is the most common cause of primary post-partum hemorrhage:Vaginal or cervical lacerationsUterine inversionCoagulopathyUterine ruptureUterine atony

Answer: E* Uterine atony

***) The most common cause of secondary post-partum hemorrhage:Uterine atonyInjury to birth canalLow platelet countBreast feedingRetained 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 hemorrhageUterine prolapseRetained placentaRetention of urineAbdominal 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 fibroidsOvarian cystDistended bowelPelvic kidneyContracted uterus

Answer: E* Contracted uterus

***) Uterine atony might be caused by the following except:Prolonged laborMultiple pregnancyPolyhydramniosUterine fibroidsPreterm labor

Answer: E* Preterm labor

***) Inversion of the uterus is almost always subsequent upon:Multiple pregnancyPolyhydramniosTraction on the umbilical cord before separationAbruption placentaDifficult forceps delivery

Answer: C* Traction on the umbilical cord before separation

Postpartum Fever.***) The commonest cause of maternal pyrexia in puerperium is:Deep vein thrombosisEndometritisEngorged breastsSubacute bacterial endocarditisUrinary tract infection

Answer: B* Endometritis

***) The most common cause of post partum mastitis is one of the following:Beta streptococciE.ColiStaphylococcus aureusStreptococcus fecalisChlamydia trachomatis

Answer: C* Staphylococcus aureus

***) All of the following are possible predisposing factors for puerperal sepsis, except:Prolonged rupture of membranesCarrier of group A beta streptococciMultiple vaginal examinationsElective cesarean sectionNon-proper surgical scrub

Answer: D* Elective cesarean section

***) Factors contributing to puerperal infection are the following, except:Prolonged laborPrecipitate laborInstrumental deliveryExcessive vaginal examinationHome delivery

Answer: B* Precipitate labor

***) The most common bacteria causing puerperal infection is:Escherichia coliAnaerobic streptococcusAnaerobic staphylococcusAerobic streptococcusClostridium perfringes

Answer: B* Anaerobic streptococcus

***) Puerperal infection may be spread by several routes. The most common route that result in septic thrombophlebitis:VenousLymphaticArterialDirect extensionBy 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 CTElectrocardiogram (ECG)Arterial blood gasesChest auscultationChest X-Ray

Answer: A* Lung spiral CT

***) One of the following can cause subinvolution of the uterus after normal delivery:Urinary tract infectionGastroenteritisEndometriosisMonilial infectionEndometritis

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 OB56-OB57.

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:HeparinWarfarinTetracyclineDiazepamAspirin

Answer: A* Heparin

***) All of the following drugs are teratogenic, except:TetracyclineParacetamolThiazidesStilbestrolWarfarin

Answer: B* Paracetamol

***) All of the following drugs are contraindicated in pregnancy, except:TetracyclineIodidesDiphenylhydantoin (Epanutin)WarfarinPyridoxine

Answer: E* Pyridoxine

***) One of the following drugs can be safe if used during pregnancy:WarfarinSeptrinTetracyclineErythromycinChloramphenicol

Answer: D* Erythromycin

***) Which of the following drugs given during pregnancy can give "Grey Baby Syndrome":AmpicillinChloramphenicolGentamycinTetracyclineStreptomycin

Answer: B* Chloramphenicol

***) Regarding drugs in pregnancy, all the following are true except:Digitalis does not cross the placentaWarfarin crosses the placentaHeparin does not cross the placentaHydralazine causes relaxing vascular smooth muscleMethotrexate crosses the placenta

Answer: A* Digitalis does not cross the placenta

***) Brown discoloration of the teeth can occur in infants exposed in uterus to:PenicillinTetracyclineChloramphenicolGentamycinStreptomycin

Answer: B* Tetracycline

Breastfeeding and Drugs.***) Milk ejection reflex is affected by one of the following hormones:EstrogensProgesteroneHuman placental lactogenOxytocinChorionic gonadotropin

Answer: D* Oxytocin

***) All of the following drugs are contraindicated during breast feeding except one:Cytotoxic drugsChloramphenicolIodineHeparinThiouracil

Answer: D* Heparin

***) All of the following drugs are contraindicated during breast feeding except one:BromocriptineCephalosporinsErgotamineCimetidineTetracycline

Answer: B* Cephalosporins

Oxytocin.***) All of the following are true regarding oxytocin, except:Prolonged treatment can cause water intoxicationCan cause milk ejectionSingle rapid IV injection can cause transient hypotension, tachycardia and ECG changesIt is not effective when given orallyIt 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 contractionsComes from the anterior pituitary glandPossesses no antidiuretic activityHas long half lifeActs 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:HeadacheNausea and vomitingPolyuriaComaWeight gain

Answer: C* Polyuria

Immunizations.***) The first immunoglobulin produced in any immune response is:IgAIgMIgDIgEIgG

Answer: B* IgM

***) The only immunoglobulin can cross placenta:IgMIgAIgGIgEIgD

Answer: C* IgG

***) All of the following vaccines are contraindicated during pregnancy, except:German measlesTetanusMumpsPoliomyelitisHepatitis

Answer: B* Tetanus

***) All of the following vaccines can be given to the pregnant patient after the second trimester, except:Tetanus toxoid vaccineSmallpox vaccineCholera vaccineVaccination against hepatitis B virusTyphoid vaccine

Answer: B* Smallpox vaccine

***) Mumps in pregnancy is associated with:Increase fetal wastageLymph reduction defectMaternal pneumoniaNo major complicationsCongenital deafness

Answer: D* No major complications

???) Regarding immunization during pregnancy, which of the following vaccines would be the safest to receive:MumpsPoliomyelitisRabiesRubellaHIV

Answer: C* Poliomyelitis

Drugs.***) All of the following drugs have effect on the uterine muscle, except:SalbutamolCervidilIsoxsuprineClomiphene citrateMethergine

Answer: D* Clomiphene citrate

***) Regarding the actions of hydralazine, all the following are true except:Increased renal blood flowIncreased cardiac outputReflex tachycardiaSmooth muscle relaxationDecreased placental perfusion

Answer: E* Decreased placental perfusion*******************************************425) All of the following are complications of post-maturity, except:Meconium aspiration syndromeHypoglycemiaHypocalcemiaLoss of subcutaneous fatHyaline membrane disease

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

***) Which of the following is characteristic feature of acute gonococcal urethritis:DysuriaGenital ulcerationHigh feverGeneralized lymphadenopathySweating

Answer: 1* Dysuria