Obstetrics

1 of 1 sets

1. Which is the least frequent site of an ectopic pregnancy?

A. Fallopian tube
B. Cervix
C. Ovary
D. Abdominal cavity
E. Between the leaves of broad ligament
Answer:D

Explanation:- Fallopian Tubes:96% , Ovaries:2% & Cervix:<1%

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2. Perforation tends to occur earliest when an ectopic pregnancy is located in which
portion of fallopian tube ?
. c
A. Isthmic
te
B. Interstitial
a
C. Ampullary
q M
D. Infundibular
c
E. No difference
Answer:A
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Explanation:- If the implantation is located in the narrow isthmic portion of the tube(the narrowest
part), it will rupture very early, within 6 to 8 weeks; the distensible interstitial portion may be able to
retain the pregnancy up to 14 weeks of gestation, while the ampulla is the widest portion.

3. Which of the following does not occur in post partum pituitary necrosis :
A. signs of hypoglycaemia
B. Asthenia
C. Amenorrhoea
D. Galactorrhoea
E. Decreased libido
Answer:C

Explanation:- failure of lactation occurs due to decreased prolactin secretion due to anterior pituitary
insufficiency_ans_key_- Hypoglycemia is due to 2ry adrenal insufficiency_ans_key_- Amenorrhea
and decreased libido are due to gonadotropin insufficiency_ans_key_- Asthenia is the easy
fatigability due to – GH >> -- muscle bulk

4. The most dangerous symptom during pregnancy is:

A. PV bleeding
B. Ankle swelling
C. Hyperemesis
D. Cramps
E. none
Answer:A

5. The Arius-Stella reaction may be seen with all except :

A. Ectopic pregnancy
B. Birth control pills
C. Abortion
D. Trophoblastic disease
E. none
Answer:B

Explanation:- Arius – Stella reaction is a benign change in the endometrium associated with the
presence of chorionic tissue.

6. The passage of decidual cast in cases of ectopic pregnancy usually means :

A. Impending tubal rupture
B. Reabsorption of embryo
C. Pregnancy was intrauterine
D. Death of embryo
E. none
Answer:D

7. What is the most common side effect with MTX therapy for ectopic pregnancy
A. Transient pelvic pain 3 - 7 days after starting treatment
B. Stomatitis
C. Bone marrow suppression
D. Gastritis
E. none

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Answer:B

8. Prenatal diagnosis at 16 weeks of pregnancy can be performed using all of the

following, except:
A. Amniotic fluid
B. Maternal blood
C. Chorionic villi
D. Fetal blood
E. none
Answer:D

9. A primigravida presents to casualty at 32 weeks gestation with acute pain

abdomen for 2 hours, vaginal bleeding and decreased fetal movements. She should
be managed by;
A. Immediate cesarean section
B. Immediate induction of labor
C. Tocolytic therapy
D. Magnesium sulphate therapy
E. none
Answer:A

Explanation:- Bleeding that affects the fetal condition(manifested here by fetal distress) is an
indication of CS in Ante Partum Hemorrhage

10. Placenta previa, all true except :

A. Shock out of proportion of bleeding
B. Malpresentation
C. Head not engaged
D. Painless bleeding
E. none
Answer:A

Explanation:- Low lying placenta in the LUS interferes with normal adaptation of the fetal head to the
female pelvis>>head is usually not engaged

11. A 34wk GA lady presented with vaginal bleeding of an amount more of that of
her normal cycle. O/E uterine contracts every 4 min, bulged membrane, the cervix
is 3 cm dilated, fetus is in a high transverse lie and the placenta is on the posterior
fundus. US showed translucency behind the placenta and the CTG

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(Cardiotocography) showed FHR of 170, the best line of management is:
A. C/S immediately.
B. give oxytocin.
C. do rupture of the membrane.
D. amniocentisis
E. none
Answer:A

12. Most important cause of immediate post partum hemorrhage:

A. laceration of cervix
B. laceration of vagina
C. uterine atony
D. placental fragment retention
E. none
Answer:C

13. Factors favoring long anterior rotation include all except

A. Correction of the deflexion
B. Adequate pelvis
C. good pelvic floor
D. rupture of membranes
E. none
Answer:D

Explanation:- Adequate liquor is a factor favoring Long Anterior Rotation, not ROM

14. All following are indications for CS in OP except

A. Persistent oblique op
B. Long anterior rotation
C. Deep transverse arrest
D. Contracted pelvis
E. none
Answer:B

Explanation:- POP, DTA are obstructed and indications of CS Long Anterior Rotation of the head is
a good sign and the baby can be delivered vaginally

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15. Which vitamin deficiency is most commonly seen in a pregnant mother who is
on phenytoin therapy for epilepsy?
A. Vitamin B6
B. Vitamin B12
C. Vitamin A
D. Folic acid
E. none
Answer:D

Explanation:- Phenytoin inhibits the enzyme intestinal conjugase, an important enzyme in folic A.
metabolism inside the body, thereby causing folate deficiency

16. Uterine inertia is due to EXCEPT?

A. Over distension of uterus
B. Presence of fibroid uterus
C. Fetal malpresentations
D. Abruptio placenta
E. repeated interautrine manipulation
Answer:D

Explanation:- as A, B, C, E predispose to hypotonic uterine inertia

17. Exposure of female fetus to androgens may arrest differentiation of :

A. Mullerian duct
B. Ovary
C. Urogenital sinus
D. All of the above
E. None of the above
Answer:C

18. The risk for development of fetal macrosomia is increased in the following,
EXCEPT:
A. Primiparity.
B. Diabetes with pregnancy.
C. Post-term pregnancy.
D. Prior macrosomic infants.
E. none

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Answer:A

19. Complications of the third stage of labor include all of the following except :
A. Rupture uterus.
B. Postpartum hemorrhage.
C. Puerperal sepsis.
D. Retained placenta.
E. Obstetric shock.
Answer:A

20. Shock is out of proportion to the amount of bleeding in :

A. 1ry postpartum haemorrhage
B. Retained placenta
C. Acute puerperal inversion of uterus
D. Hypofibrinogenemia
E. none
Answer:B

Explanation:- retention of the placenta > 2h. may cause shock even in absence of haemorrhage

21. The gold standard in diagnosing ectopic pregnancy

A. Laparoscopy
B. Culdocenteris
C. Beta HCG
D. US
E. Progesterone
Answer:A

Explanation:- The gold Standard in diagnosis of ectopic is not US alone Nor BhCG alone, rather a
comiBnation of both:Absence of an intrauterine Gestational Sac + serum BhCG levels > the
discriminatory zone is the GOLD STANDARD.

22. Which method of terminating a molar gestation is never indicated

A. Suction curettage
B. Prostaglandic
C. Hypertonicsaline
D. Hysterotomy

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 E. Hyterectomy
Answer:C

23. Invasive molar tissue is most commonly found in

A. Myometrium
B. Vaginal wall
C. Ovary
D. Liver
E. Lungs
Answer:A

Explanation:- Invasive molar tissue(locally invasive) invades the myometrium, while metastatic
molar tissue (highly metsataic)is a different type which metastasizes to the lung, liver… .

24. A 31-year-old, HIV-positive woman, gravida 3, para 2, at 32-weeks' gestation

comes to the physician for a prenatal visit. Her prenatal course is significant for
the fact that she has taken zidovudine throughout the pregnancy. Otherwise, her
prenatal course has been unremarkable. She has no history of mental illness. She
states that she has been weighing the benefits and risks of cesarean delivery in
preventing transmission of the virus to her baby. After much deliberation, she has
decided that she does not want a cesarean delivery and would like to attempt a
vaginal delivery. Which of the following is the most appropriate next step in
management?
A. Contact psychiatry to evaluate the patient
B. Contact the hospital lawyers to get a court order for cesarean delivery
C. Perform cesarean delivery at 38 weeks
D. Perform cesarean delivery once the patient is in labor
E. Respect the patient's decision and perform the vaginal delivery
Answer:E

25. A 19-year-old primigravid woman at 42 weeks' gestation comes the labor and
delivery ward for induction of labor. Her prenatal course was uncomplicated.
Examination shows her cervix to be long, thick, closed, and posterior. The fetal
heart rate is in the 140s and reactive. The fetus is vertex on ultrasound.
Prostaglandin (PGE2) gel is placed intravaginally. One hour later, the patient
begins having contractions lasting longer than 2 minutes. The fetal heart rate falls
to the 70s. Which of the following is the most appropriate next step in
management?
A. Administer general anesthesia

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 B. Administer terbutaline
C. Perform amnioinfusion
D. Start oxytocin
E. Perform cesarean delivery
Answer:B

Explanation:- Quickly administer Terbutaline(Short Acting B2 Agonist) to decrease uterine

contractility (fetal HR is steeply decreasing)

26. Which one of the following is a risk factor for developing DVT?
A. Family history of thromboembolic disease.
B. Factor V Leiden.
C. Antiphospholipid syndrome.
D. Sepsis.
E. All of the above.
Answer:E

Explanation:- Septic thrombophlebitis is a condition characterized by venous thrombosis,

inflammation, and bacteremia (N.B.) : Factor V Leidenis the name given to a variant of human factor
V that causes a hypercoagulability disorder

27. Premature labour.

A. is associated with an increased risk of breech presentation.
B. is associated with uterine anomaly.
C. asymptomaticbacteruria is a proven risk factor.
D. is associated with genital tract infection.
E. All of the above
Answer:E

28. A 22-year-old woman in labor progresses to 7 cm dilation, and then has no

further progress. She therefore undergoes a primary cesarean section.
Examination 2 days after the section shows a temperature of 39.1 C (102.4 F),
blood pressure of 110/70 mm Hg, pulse of 90/min, and respirations of 14/min.
Lungs are clear to auscultation bilaterally. Her abdomen is moderately tender. The
incision is clean, dry, and intact, with no evidence of erythema. Pelvic examination
demonstrates uterine tenderness. Which of the following is the most appropriate
pharmacotherapy?
A. Ampicillin
B. Ampicillin-gentamicin

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 C. Clindamycin-gentamicin
D. Clindamycin-metronidazole
E. Metronidazole
Answer:D

29. A 19-year-old nulliparous woman in her 35th week of pregnancy presents with
nausea, blurred vision and a weight gain of 4.5 kg per week. Her blood pressure is
160/110 mmHg. Which of the following tests is the most suitable for the assessment
of fetal status?
A. amniocentesis for the measurement of the lecithin/ sphingomyelin (L/S) ratio
B. amniocentesis for the measurement of the creatinine level of the amnotic fluid
C. sonographiccephalometry
D. a non-stress test (NST)
E. an oxytocin challenge test (OCT)
Answer:D

30. All of the following can be used in hypertension in Pregnancy except

A. Hydralazine
B. Labetolol
C. Captopril
D. Alpha methyl DOP
E. none
Answer:C

Explanation:- Captopril is a teratogenic that may cause abnormally small head , Neural tube defects
, Heart defects, Underdeveloped lungs , Partial or complete absence of skull , ....etc

31. All are complications of illegal /Septic abortion except

A. Cerebral Hemorrhage
B. DIC
C. ARF
D. Bacterial Shock
E. none
Answer:A

32. A 31-year-old woman comes to the physician for follow-up after an abnormal
Pap test and cervical biopsy. The patient's Pap test showed a high-grade squamous

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intraepithelial lesion (HGSIL). This was followed by colposcopy and biopsy of the
cervix. The biopsy specimen also demonstrated HGSIL. The patient was counseled
to undergo a loop electrosurgical excision procedure (LEEP). Which of the
following represents the potential long-term complications from this procedure?
A. Abscess and chronic pelvic inflammatory disease
B. Cervical incompetence and cervical stenosis
C. Constipation and fecal incontinence
D. Hernia and intraperitoneal adhesions
E. Urinary incontinence and urinary retention
Answer:B

33. Female patient with history of irregular vaginal bleeding tender right iliac fossa
, CBC normal , B-HCG positive , most likely to be :
A. corpus luteum cyst
B. appendicitis
C. ectopic pregnancy
D. none of the above
E. none
Answer:C

Explanation:- corpus luteum cysts and appendicitis don’t show ++ B-hCG .

34. Cervical lesion (ectopy):

A. It is an ulcer of the cervix.
B. Should be treated in pregnant females.
C. Pap smear is advisable before management.
D. Commonly cause pain, dyspareunia & low back pain.
E. none
Answer:D

35. The foetal well-being can be assessed by all of the following, except ?
A. non-stress test
B. contraction stress test
C. ultrasound
D. oxytocin sensitivity test!!!
E. none
Answer:D

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36. In which of the following condition vaginal delivery is contraindicated?
A. Extended breech
B. Mento anterior
C. Twins with one vertex and one breech
D. all
E. none
Answer:A

Explanation:- Breech with extended legs: frank breech is an indication of CS

37. Which is contraindicated in trial of labour following Caesarian Section ?

A. History of Classical CS
B. Breech
C. X-ray pelivmetry not available
D. No previous vaginal delivery
E. none
Answer:B

38. A 20 year old full-term primigravida is brought to the casualty with labour
pains for last 24 hours and a hand prolapse. On examination, she has pulse 96/min,
BP 120/80 mm Hg, and mild pallor. The abdominal examination reveals the uterine
height at 32 weeks, the foetus in transverse lie and absent foetal heart sounds. On
vaginal examination, the left arm of the foetus is prolapsed and the foetal ribs are
palpable. The pelvis is adequate. What would be the best management option ?
A. External cephalic version
B. Decapitation and delivering the baby vaginally
C. Internal podalic version
D. Lower Segment Caesarean section
E. none
Answer:B

Explanation:- Because absent Fetal heart Sounds = Dead baby! >> Decapitation and delver
vaginally

39. Which one of the following is diagnosed by Spiegelberg criteria ?

A. Molar pregnancy
B. Ovarian pregnancy
C. Uterine pregnancy

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 D. Twin pregnancy
E. none
Answer:B

Explanation:- Spiegelberg criteria is used to diagnose Ovarian ectopic : via laparotomy/ laparoscopy
Four criteria for differentiating ovarian from other ectopic pregnancies:_new_line_1) The gestational
sac is located in the region of the ovary._new_line_2) The ectopic pregnancy is attached to the
uterus by the ovarian ligament._new_line_3) Ovarian tissue in the wall of the gestational sac is
proved histologically._new_line_4) The tube on the involved side is intact.

40. The presence of a retraction ring at the junction of upper and lower uterine
segment in labour indicates ?
A. Prolonged labour
B. Cervical dystocia
C. Obstructed labour
D. Precipitate labour
E. none
Answer:C

41. The indications of an elective caesarean section include all of the following,
except ?
A. Placenta Praevia
B. Cephalopelvic disproportion
C. Previous lower segment caesarean section
D. Carcinoma Cervix
E. none
Answer:C

Explanation:- isn’t it supposed to be cancer Cervix?? Previous CS IS an indication of elective CS!

42. Hyperemesis gravidarium in 1st trimester is seen with increased frequency in

allof the following except:
A. H. Mole
B. Twins
C. Pre-eclampsia
D. Primigravida
E. none
Answer:C

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Explanation:- H. mole and multifetal pregnancies++ risk of HEG because ++++ BhCG Primigravidas
are more prone to HEG

43. Most common indication for C/S :

A. malpresentations
B. antepartum hge
C. prematurity
D. previous c/s
E. contracted pelvis
Answer:D

44. Which of the follwing is responsible for inability to rotate anteriorly in the
occipitoposterior position :
A. Moderate size fetus
B. Gynecoid pelvis
C. Weak uterine contractions
D. Good levatorani muscle contractions
E. none
Answer:C

45. Ectopic pregnancy is differentiated from abortion by the fact that in ectopic
pregnancy :
A. Pain appears after vaginal bleeding
B. There is slight amount of bleeding
C. No enlargement of uterus
D. Histological examination of products of expulsion shows villi
E. none
Answer:D

46. Following a vaginal delivery, a woman develops a fever, lower abdominal pain
and uterine tenderness. She is alert, and her blood pressure and urine output are
good. Large gram positive rods suggestive of clostridia are seen in a smear of
cervix. management should include all except :
A. Immediate radiographic examination for gas in uterus
B. High dose antibiotic therapy
C. Hysterectomy
D. close observation for renal failure or hemolysis

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 E. none
Answer:C

Explanation:- Clostridia are anerobic gas producing organisms

47. Engaging diameter, in fully extended head :

A. Mento occipital
B. Submentobregmatic
C. Biparietal
D. Mentovertica
E. none
Answer:B

Explanation:- SubmentoBregmatic = 9.5 cm in fully extended = face presentation

48. A woman experiencing a molar pregnancy has an increased risk of which of the
following in subsequent gestations?
A. Stillbirth
B. Prematurity
C. Congenital malformations
D. Recurrent molar gestation
E. Cancer later in life
Answer:D

Explanation:- Recurrence rate is 1-2% in next gestations

49. A woman with a complete mole is most likely to present with which of the
symptoms?
A. Vaginal Bleeding
B. Excessive uterine size
C. Hypermesis
D. Prominent theca lutein cysts
E. Pre-eclampsia
Answer:A

Explanation:- Recurrent mild vaginal bleeding is the most common presenting symptom in the 1st
trimester.

50. Fetal hyperinsulinemia leads to:

A. Fetal macrosomia causes difficult vaginal delivery

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 B. Inhibition of pulmonary surfactant causing Intrauterine asphyxia
C. Decrease serum K causing respiratory distress syndrome
D. Neonatal hypoglycemia with myocardial injury
E. none
Answer:A

Explanation:- Fetal hyperglycemia>>hyperinsulinemia>>macrosomia due to :insulin++ lipogenesis

and glycogenesis, ptn synthesis (anabolic hormone)

51. The following are eitiological factors of atonic postpartum hge except :
A. prolonged labour
B. overdistension of uterus
C. full bladder
D. cervical lacerations
E. accidental he
Answer:D

Explanation:- Cervical lacerations are a cause of PPH , but not the atonic type

52. If the foetus is lying accros the uterus, with the head in the flank
A. Transverse lie
B. Cephalic lie
C. Breech lie
D. Frank lie
E. Oblique lie
Answer:A

53. Refers to the part of the foetus that occupies the lower segment of the uterus or
pelvic
A. The show
B. The version
C. The engagement
D. The lie
E. The presentation
Answer:E

54. Means the head is at the level of the ischial spines

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 A. Station +1
B. Station -1
C. Station -2
D. Station 0
E. Station +2
Answer:D

55. Engagement is said to occur when.......

A. The fetal head is within the maternal pelvis
B. The biparietal diameter of the fetal head is through the plane of the inlet.
C. The presenting part is just above the level of ischial spines.
D. The vertex is in transverse position
E. none
Answer:B

56. The following hormone is not produced by the placenta...

A. HCG
B. HPL
C. Prolactin
D. Estriol
E. none
Answer:C

57. Which is the most common cause of abnormal lie?

A. Polyhydramnios
B. Twin pregnancy
C. Uterine deformity
D. Pelvic tumour
E. Placenta praevia
Answer:A

58. Which of the following statements regarding vaginal breech birth is FALSE?
A. Increased risk if footling
B. In about 30% there is slow cervical dilatation in the first stage
C. CTG is advised

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 D. Pushing is not encouraged until the buttocks are visible
E. Epidural analgesia is mandatory
Answer:E

59. Refers to a maneuver which attempts to turn a breech baby to a cephalic

presentation
A. VEC
B. CEV
C. ECR
D. EVC
E. ECV
Answer:E

60. Refers to the part of the foetus that occupies the lower segment of the uterus or
pelvis
A. The show
B. The version
C. The engagement
D. The lie
E. The presentation
Answer:E

61. Engagement is said to occur when.......

A. The fetal head is within the maternal pelvis
B. The biparietal diameter of the fetal head is through the plane of the inlet.
C. The presenting part is just above the level of ischial spines.
D. The vertex is in transverse position.
E. none
Answer:B

62. After what age gestation would abnormal lie warrant hospital admission
A. 37
B. 40
C. 38
D. 39
E. 36

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Answer:A

63. The most common type of breech

A. Starling breech
B. Flexed breech
C. Explicit breech
D. Footling breech
E. Extended breech
Answer:E

Explanation:- Extended breech= Breech with extended legs

64. At which part of the pelvis are the transverse and anterior-posterior diameter
most similar?
A. Inlet
B. Mid-cavity
C. Outlet
D. none
E. all
Answer:B

65. Breech presentations occurs in ___ of term pregnancies

A. 1%
B. 3%
C. 8%
D. 4-10%
E. 5-6%
Answer:B

Explanation:- Percentage significantly increases in the preterm ..may reach up to 25%

66. Flexion of the fetal head occurs when it meets resistance from :
A. Pelvic floor
B. Cervix
C. Pelvic walls
D. Any of the above
E. None of the above

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Answer:A

67. A woman delivers a 9 lb baby with midline episiotomy & develops a 3rd degree
tear. Inspection shows that the following structures are intact.
A. Anal sphincter
B. Perineal body
C. Rectal mucosa
D. Perineal muscles
E. none
Answer:C

Explanation:- in third degree tears all are injured except. Rectal mucosa 9 lb. mean 9 pounds which
is the method of calculating weight abroad

68. Leopold maneuvers refers to :

A. delivery of head
B. External version
C. Internal version
D. Breech extraction
E. Examination of abdomen.
Answer:E

Explanation:- Leopold’s Maneuvers = Fundal Grip, Pelvic Grips (1st&2nd), Umbilical Grip, Pawlick’s
Grip.

69. Following changes occur in urinary system during normal pregnancy:

A. Increase in renal blood flow
B. Increase in glomerular filtration rate
C. Increase in capacity of kidney pelvis
D. All of the above
E. none
Answer:D

Explanation:- The well-known dilation of the ureters and renal pelvis begins by the second month of
pregnancy and is maximal by the middle of the second trimester,

70. Mechanism of labor in abortion stick ( use of stick to induce abortion)is due to
A. Necrosis of uterine endometrium and stimulation of uterine contraction
B. Oxytocin present in the stick

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 C. Prostaglandins present in the stick
D. All of the above
E. none
Answer:A

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