FACULTY OF HEALTH SCIENCES

End of course Obstetrics & Gynecology

MBALE CAMPUS

GROUP ONE
DATE: 15th /09/2017, Friday
Time: 9.00AM - 12.00 MIDDAY
Candidates Name:……………………………………………………................................
Registration Number:………………………………………………....................................

INSTRUCTIONS TO CANDIDATES
1. Write your Name and registration number clearly in the spaces provided
2. Read each question carefully before starting to answer

1. A 31-year-old G3P0 woman at 32 weeks gestation is being managed

expectantly for preeclampsia with severe features remote from term. Her blood
pressure is 155/100 on methyldopa (Aldomet) 500 mg three times a day. Her
recent 24-hour urine had 4.6 grams of protein. An ultrasound revealed a fetus
with adequate growth, having an estimated fetal weight in the 10th percentile.
Her labs are normal, except for a uric acid of 9.0 mg/dL; hematocrit 42%
(increased from 37%); and platelet count 97,000. Which of these findings
necessitates delivery at this time?
A. Elevated uric acid
B. Thrombocytopenia
C. Proteinuria
D. Poorly controlled blood pressures
E. Hemo-concentration

2. A 34-year-old healthy G4 Para 2+1 woman presents for a health maintenance

examination. She has not seen a gynecologist since she had a tubal ligation
six years ago. She has been married for 12 years. She has no history of
abnormal Pap tests or sexually transmitted infections. The patient’s physical
examination is normal, except for acetone white lesion noted at the 12:00
o’clock position on her external cervical os. Which of the following is the most
appropriate next step in the management of this patient?
A. Annual Pap tests
B. Pap test in three years
C. Biopsy the lesion
D. Perform a large loop excision of transitional zone
E. Perform cervical conisation
3. A 28-year-old Primigravida previously healthy woman is brought into the
emergency department by her husband following a seizure at home. She had
been complaining of a severe headache for two days prior to this, and had
been feeling more and more fatigued and short of breath since the delivery of
their child three months ago. She has been breastfeeding, and began to have
vaginal spotting one month ago. Her neurologic and physical examinations are
unremarkable and her pelvic exam reveals a normal uterus with no adnexal
masses. Her work-up reveals multiple nodules on chest X-ray and within the
brain and liver, suspicious for metastasis. Choriocarcinoma is highly
suspected. Which of the following tests will confirm the diagnosis in this
case?
A. Quantitative Beta-hCG
B. Serum CA-125
C. Trans-vaginal ultrasound
D. Fine needle aspiration of the liver lesions
E. Biopsy of a chest nodule

4. A 50-year-old G2P1+0 woman has a history of menorrhagia, pelvic pain,

dyspareunia, dysmenorrhea, constipation and occasional spotting in between
periods. She has a three-year history of urinary urgency and frequency. The
patient is concerned that she has fibroids, as her close friend was recently
diagnosed with fibroids. What is the symptom most commonly associated with
leiomyomas?
A. Inter-menstrual spotting
B. Menorrhagia
C. Dyspareunia
D. Dysmenorrhea
E. Urinary symptoms

5. A 27-year-old G1 woman at 36 weeks gestation is undergoing an induction

of labor for preeclampsia with severe features. She complains of a headache,
right upper quadrant pain and seeing spots. Admission vital signs are: blood
pressure 180/120, respiratory rate 20, pulse 92. In addition to 10 hours of
oxytocin, she is receiving intravenous magnesium sulfate 2 g /hour. During the
past two hours her urine output has decreased to 15 mL per hour (down from
40 mL/h) and her respiratory rate is now 10. What is the next best step in the
management of this patient?

A. Continue magnesium sulphate

B. Decrease magnesium sulphate to 1 gram/hour
C. Administer calcium gluconate
D. Increase oxytocin drip
E. Caesarean delivery now

6. A 39 years old women Para 6 has presented with complaint of post coital
bleeding for the past three months. Your first investigation should be:
A. Dilatation & curettage
B. Cone biopsy of cervix
C. Pap smear
D. Colposcopy
E. Laparoscopy
7. The loading dose of magnesium sulfate is given via

A. IV over 5 minutes, followed by deep Im injection into each buttock

B. IV over 5 minutes, followed by deep IM injection into one buttock
C. simultaneous IV and IM injections
D. IV bolus, followed by deep IM injection into each buttock
E. IV bolus only

8. Repeat administration of magnesium sulfate should be withheld if

A. respiratory rate is 18/minute, patellar reflexes are 1+, urinary output is 250
mL over the preceding 4-hour period
B. respiratory rate is 20/minute, patellar reflexes are 2+, urinary output is 180
mL over the preceding 4-hour period
C. the woman is breastfeeding
D. Respiratory rate is 18/minute, patellar reflexes are absent, urinary output is
100 mL over the preceding 4-hour period.
E. Respiratory rate is 18/minute, patellar reflexes are absent, urinary output is
160 mL over the preceding 4-hour period.

9. About renal physiological changes during pregnancy, the following are true
EXCEPT
A. Glomerular filtration rate increases by 50%
B. Renal plasma flow increases by 50%
C. Estrogens are responsible for ureteric relaxation.
D. The platelet count increases by 25 %.
E. There is increased creatinine clearance.
10. Lady undergoes total radical hysterectomy for Stage 2A Ca Cervix and
sentinel lymph node is positive for cancer cervix. Next step of management
A. Chemotherapy
B. Radiotherapy
C. Chemo radiotherapy
D. Surgery.
E. Follow-up

11-G2 P1 28 yrs female comes to the clinic with the chief complaint of reduced
fetal movement. Her gestational age is uncertain. In ultrasound AF is normal
and the fetus is reported as term. What should be done for her?
A-Doppler velocimetry
B-labor induction
C- Immediate C/S
D- US twice weekly

12- How to manage breast engorgement in women who do not choose

breastfeeding her new born?
A-oral analgesics
B-warm compress
C-broad spectrum antibiotic
D-bromocriptine
13-G2 P1 28 years female comes to the clinic with the chief complaint of
reduced fetal movement. Her gestational age is uncertain. In ultrasound AF is
normal and the fetus is reported as term. What should be done for her?
A-Doppler velocimetry
B-labor induction
C- Immediate C/S
D- US twice weekly

14-Which is true about puerperal changes

A- Total number of uterine muscular cells is not reduced
B-vaginal rugae occur in the third month from delivery
C-uterine connective tissue won’t change
D-uterine is re-epithelialized totally in the first week of pregnancy

15-What is wrong about weight loss after delivery?

A -5-6 kg weight loss after delivery is due to uterine evacuation and blood loss
B-2-3 kg is lost because of diuresis
C-2 kg is lost because of third space volume reduction
D-most women reach to pre pregnancy weight by the second month after delivery

16- A 26 year old woman complains of vaginal bleeding for three months after
delivery. In gynecologic exam uterine size is normal and cervix is closed. What
is the first step to be taken?
A-ultrasonography
B-beta subunit
C-Doppler sonography
D-curettage

17- For a case of severe preeclampsia (BP=180/95) Mg SO4 and C/S is ordered.
An hour after C/S BP falls to 110/75. What is the reason of BP fall?
A-Delivery removes the effect of vasospasm
B-anesthetic drugs
C-hemorrhage
D-MgSO4 effect

18-Which is true about blindness after eclampsia?

A-It has a bad prognosis
B-It lasts about 1 month
C-it is transient and lasts from 4 hours to 8 days
D-in some people it causes permanent blindness
19- A 40 years old woman / G3/P2 /GA=35 wks/ BP=210/110 is in seizure. What
is the best way to control her seizure?
A-Phenytoin loading dose of 1000 mg/h IV
B- Diazepam and creatinine measurement
C- Amobarbital sodium 250 mg IV
D- MgSO4 4-6 gr as loading dose
20-A pregnant woman GA=29 wks / severe headache/ blurred vision/ BP=
200/120 has gone through routine tests and MgSO4 infusion. What other steps
should be taken?
A-IV hydralazine 20 mg + IV verapamil 10 mg
B-IV hydralazine 5 mg
C- IV labetalol 80 mg
D- Sub-lingual nifedipine 10 mg +thiazide 10 mg

21-A woman with high blood pressure, proteinuria,

Cr>1.5 mg/dl, has an episode of seizure after 4 hours from her delivery. What
treatment do you suggest?
A-14 gr of MgSO4as the loading dose and then 2.5 gr q4h up to 24 h after delivery
B-7 gr of MgSO4 as the loading dose and then 2.5 grq4h up to 24 h after the last
seizure
C-14 gr of MgSO4 as the loading dose and then 2.5 gr q4h up to 24h after the last
seizure
D-7 gr of MgSO4 as the loading dose and then 2.5 gr q4h up to 24h after delivery

22-Which is wrong for visual disturbances of preeclampsia?

A-it is because of occipital region lesions
B-if blindness does not resolve within a week, it will remain permanently
C- It is because of retinal artery spasm that can resolve by MgSO4
D-it is because of retinal detachment that is most often unilaterals

SECTION B: FILL IN THE RIGHT ANSWERS

QUESTION ONE

SCENARIO
24. M. P is a 30-year-old nullipara who presents to the Gynaecological Outpatients’
Clinic with one year history of increasingly heavy, painful period’s menstruation. She
visited a general practitioner who told her she has an abdominal lump with a
diagnosis of fibroid.
I. What are the five risk factors? (05 marks)
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II. What are your physical findings on abdominal and pelvic examination? (05
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III. Outline the management options for this patient (05 marks)
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25. Mrs Bazira is a 39 year old Gravida 5 Para 4+0 who presents to you in labor
ward with a one day history of abnormal vaginal bleeding. You make a diagnosis of
Abruptio Placentae
a) Mention five risk factors for abruption placentae (5
marks)
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b) Outline your management (5 Marks)

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26 Give five maternal complications associated with this condition (5 marks)

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SECTION C
27. LC is a 16-year-old primigravida at 35 weeks’ gestation who is referred from
Budaka Health Centre four with a history of headache and swelling of lower limbs for
two days. Her blood pressure is elevated at 160/110 mm Hg and pulse of 98 beats
per minute. She still feels foetal movements.
TASK 1
What are the common risk factors for this condition? [MARKS: 10]

TASK 2
What important additional information would you search for in the history and
physical evaluation of this patient? [20 MARKS]

TASK 3
Describe how you would manage her. [20 MARKS]