Name: Rev 12: Obstetrics 4 ( 160 Marks)

I. Choose the most correct single answer: (1 Mark each)

1. A triple test is performed for Down screening at 16wks in a 40yrs old woman. The results
suggest a high risk for trisomy 21. What would the results typically show:
a. reduced AFP, reduced estriol, increased B-HCG
b. increased AFP, reduced estriol, increased B-HCG
c. reduced AFP, increased estriol, increased B-HCG
d. reduced AFP, increased estriol, reduced B-HCG
e. increased AFP, increased estriol, increased B-HCG

2. A patient who wishes to have cell free fetal DNA (cff DNA) testing enquires about how
soon it can be done. What would u advice:
a. 1st trimester
b. early 2nd trimester
c. late 2nd trimester
d. 3rd trimester
e. just before conception

3. The approximate incidence of breech presentation at 28wks GA is:

a. 4%
b. 8%
c. 10%
d. 15%
e. 20%

4. The single best predictor for a successful VBAC:

a. spontaneous labor pains
b. previous vaginal birth
c. previous cesarean section at full dilatation
d. BMI˂30
e. epidural analgesia

5. A 35yrs old PG has been admitted at 27wks GA with confirmed PPROM. CBC is normal
and high vaginal swab is culture negative. The most appropriate ttt for her:
a. no antibiotics till culture suggest growth
b. commence oral erythromycin
c. commence IV augmentin
d. commence low dose aspirin
e. commence LMWH

6. This serological test is routinely done at antenatal booking:

a. hepatitis A
b. hepatitis B
c. influenza
d. CMV
e. varicella
7. Breast feeding immediately after delivery can reduce the risk of bleeding by causing
uterine contraction. Which hormone is released to cause this?
a. VEGF
b. oxytocin
c. prolactin
d. prostacyclin
e. prostaglandin F2α

8. During labor, occipito-posterior position is favored in which type of pelvis:

a. android
b. platypeloid
c. anthropoid
d. gynecoid
e. mixed type

9. A 20yrs old PG presents with history of vomiting and nausea. She is 12wks pregnant. In
hyperemesis gravidarum, what would u give to prevent Werniche’s encephalopathy?
a. vitamin B1
b. vitamin B2
c. vitamin B6
d. vitamin B12
e. pantothenic acid

10. A woman delivered 30minutes ago and had retained placenta with 600ml blood loss.
Which drug would u first recommend after diagnosing a retained placenta:
a. IV oxytocin infusion
b. umbilical vein oxytocin injection
c. IM ergometrine
d. IM carboprost
e. umbilical artery oxytocin injection

11. The cardiovascular system undergoes immense physiological changes in pregnancy. All
the following undergo changes in pregnancy EXCEPT:
a. cardiac output
b. central venous pressure
c. heart rate
d. stroke volume
e. systemic vascular resistance

12. A 35yrs old P1 in labor with a face presentation. A junior doctor is keen to learn more
about this presentation. What is the engaging diameter in a face presentation?
a. bitemporal diameter
b. occipito-frontal diameter
c. submento-bregmatic diameter
d. suboccipito-bregmatic diameter
e. vertico-mental diameter
13. The length of suboccipito-bregmatic diameter:
a. 8.5cm
b. 9.5cm
c. 10cm
d. 11.5cm
e. 13cm

14. A 30yrs old PG presents in spontaneous labor at 41wks. PV: cervix is fully dilated, vertex
is direct occipito-posterior. What will be the distending diameter of the vulva:
a. bitemporal
b. occipito-frontal
c. submento-bregmatic
d. suboccipito-bregmatic
e. vertico-mental

15. You are attending a teaching session on labor management. By what mechanism is the
head delivered in a face presentation:
a. extension
b. external rotation
c. flexion
d. internal rotation
e. restitution

16. A low risk PG is admitted in spontaneous labor at term with intact membranes. She is
contracting regularly. The cervix is fully effaced and 5cm dilated, occipito-anterior with no
caput or moulding and station -1. Four hrs later, she is 6cm dilated, all the other findings are
unchanged, FHS is normal. What is ur diagnosis and recommended management:
a. adequate progress in 1st stage, vaginal examination in 4hrs
b. adequate progress in 1st stage, vaginal examination in 2hrs
c. delay in 1st stage, amniotomy and vaginal examination in 2hrs
d. delay in 1st stage, amniotomy and vaginal examination in 4hrs
e. delay in 1st stage, amniotomy and oxytocin

17. A woman is being treated with MgSO4 for severe pre-eclampsia. There is concern about
magnesium toxicity. What is the first sign of magnesium toxicity?
a. bradycardia
b. decreased urine output
c. loss of deep tendon reflexes
d. reduced consciousness
e. respiratory depression

18. You are teaching a midwife how to perform McRobert maneuver. Which of the following
best describes Mc Robert?
a. extension and abduction of maternal hips
b. extension and adduction of maternal hips
c. flexion and abduction of maternal hips
d. flexion and abduction of maternal knees
e. flexion and adduction of maternal hips

19. A 30yrs old PG is admitted in labor at 36wks. PV: cervix is 6cm dilatation, membranes
have just ruptured and soon blood stained liquor is detected. FHR then changed and showed
a sinusoidal rhythm. Most appropriate management:
a. augmentation with oxytocin
b. cesarean section
c. fetal blood sampling
d. NST
e. ultrasound with Doppler

20. A 25yrs old PG with twin pregnancy has just had a 24wks US showing twin 1 with a deep
pocket of liquor (DPL) measuring 1.4cm, twin 2 with DPL of 10.8cm. Most likely diagnosis:
a. chromosomal abnormality of twin 1
b. CMV
c. discordant fetal growth
d. twin reversed arterial perfusion
e. twin to twin transfusion syndrome

21. A 35yrs old P3 VD at 39wks presents with no fetal movements. Diagnosis of IUFD is
made and misoprostol is given to induce labor. Repeated doses are given until contractions
start. Contractions develop quickly then she reports continuous severe pain. O/E she is
profoundly shocked with tender abdomen and profuse vaginal bleeding. She is taken to
theater and laparotomy is performed, but unfortunately the woman dies. An inquiry is held
and the dose of misoprostol used is criticized for being too high. Suitable dose in this case is:
a. misoprostol 25-50mcg 4hourly
b. misoprostol 200mcg 4hourly
c. misoprostol 400mcg 4hourly
d. misoprostol 200mcg 4hourly, followed by misoprostol 25 to 50mcg 4hourly
e. misoprostol 400mcg 4hourly, followed by misoprostol 25-50mcg 4hourly

22. A 36yrs old obese PG labors spontaneously at term. The fetal head delivered, but the
midwife can’t deliver the shoulders. Shoulder dystocia occurred, and help is called. Before
doing Mc Robert, most appropriate immediate course of action:
a. downward traction of the fetus
b. posterior axilla sling with foley catheter
c. routine axial traction of fetus
d. Rubin maneuver
e. Zavanelli maneuver

23. A 28yrs old PG labors spontaneously at 40wks+6. 1st stage of labor is augmented at 5cm
and lasted for 11hrs. After 2hrs of passive 2nd stage, she pushes for another 2hrs and is
exhausted. O/E the fetus is cephalic, 2/5 of head is palpable in abdomen, cervix is fully
dilated, direct OP with 2+caput and 3+moulding, station -1. She is contracting strongly at
4/10min. CTG is normal and epidural is working well. Best management:
a. cesarean section
b. continue pushing and reassess in an hour
c. trial of Kieland forceps in theater
d. trial of outlet forceps in theater
e. trial of ventouse delivery in theater

24. A 32yrs old presents at 10wks GA, based on her LMP, this is her 3rd pregnancy. Her sons
aged 4 and 2yrs are fit and healthy. All the following are risk factors to offer her screening
for gestational diabetes EXCEPT:
a. BMI above 30
b. family history of diabetes
c. family origin with a high prevalence of diabetes
d. previous macrosomic baby weighing 4.5kg or above
e. previous type 2 diabetes

25. Flights of more than 4hrs are known to be increase the risk of:
a. abruption placentae
b. antepartum depression
c. DVT
d. PROM
e. PTL

26. Drugs prescribed in pregnancy, have their positive effects outweighs any harm on mother
and fetus. Based on this, which of the following would be discouraged for antenatal use:
a. indomethacin
b. labetalol
c. low dose aspirin
d. LMWH
e. metformin

27. A 20yrs old PG at 33wks, presents with 6hrs H/O of painful regular uterine contractions.
O/E: average sized fetus, longitudinal lie, cephalic presentation, FHR: 155bpm. PV: fully
effaced cx, 5cm dilated with intact membranes. Best next step:
a. administer IM betamethasone
b. start IV atosiban
c. start oral nifedipine
d. insert cervical cerclage
e. recommend emergency cesarean section

28. A 20yrs old PG at 36wks comes to ANC. US confirms breech presentation with normal
growth and liquor. She has no medical or obstetric disorders. She is deciding between
planned vaginal or elective CS. the following is correct in her counseling:
a. ECV may b offered and has around 60% success rate for conversion to cephalic
b. footling is considered favorable for VD
c. if opting for VD, induction at 38wks is recommended to avoid excessive fetal growth
d. LSCS and VD birth have similar rates of maternal morbidity
e. LSCS and VD birth have similar rates of perinatal and early neonatal morbidity

29. U r seeing a 30yrs old PG at her booking visit. Her sister had DVT last year. She has
heard that pregnancy increases risk for venous thrombosis and wants u to address her
concern. Most appropriate action:
a. heparin
b. low dose aspirin
c. reassure
d. test for thrombophilia
e. warfarin

30. A 35yrs old Rh-ve woman is pregnant for 3rd time. Her 1st child is 5yrs and Rh+ve.
During her 2nd pregnancy, 2yrs ago, she was found iso-immunized and lost her baby due to
hydrops at 24wks. She subsequently had a divorce and is now re-married and pregnant for
third time. Most important investigation in this situation:
a. maternal anti-D antibody levels
b. maternal blood group/ Rh typing
c. maternal blood test for B-HCG
d. maternal hemoglobin level
e. paternal blood group/ Rh typing

31. A pregnant lady at 36wks has undergone ECV for breech presentation. She is known Rh-
ve and non-sensitized. She had anti-D injections at 28wks. The following best suits her:
a. anti-D is not needed as she had already received it at 28wks
b. 300IU of anti-D at once
c. 300IU of anti-D if the test of fetal blood group is positive
d. 300IU of anti-D within 72hrs
e. postnatal anti-D administration only

32. A 2ndGP0 at 14wks had previous midtrimesteric abortion. TVS shows cervical length of
28mm. best ttt option:
a. abdominal/ laparoscopic cerclage
b. expectant management
c. history indicated cerclage
d. US indicated cerclage
e. US surveillance of the cervix

33. Clinical signs suggesting sepsis include all the following EXCEPT:
a. hypothermia
b. polyuria
c. pyrexia
d. tachycardia
e. tachypnea

34. The following is not a hallmark in AFLP:

a. DIC
b. elevated liver enzymes
c. hypoglycemia
d. jaundice
e. proteinuria

35. The following are known obstetric complications of cholestasis in pregnancy EXCEPT:
a. intrauterine deaths
b. maternal pruritis
c. meconium stained liquor
d. neonatal jaundice
e. PTL

36. The following are category B/C drugs in pregnancy EXCEPT:

a. aspirin
b. cyclophosphamide
c. prednisolone
d. sulphamethoxazole
e. heparin

37. All the following about thyroid hormones in pregnancy are true EXCEPT:
a. free T3 level is unchanged
b. increased thyroid binding globulin in blood
c. total T3 and T4 levels are increased
d. TSH rises in 3rd trimester
e. T3 crosses the placental barrier

38. Regarding hyperthyroidism in pregnancy, select the correct statement:

a. during pregnancy, ttt is aimed at keeping thyroid hormones at lower limit of normal range
b. fetal hypothyroidism is a common complication in these patients
c. pregnancy worsens thyroid status especially in 3rd trimester
d. propylthiouracil can be safely continued in pregnancy
e. propylthiouracil don’t cross the placenta

39. The following statement regarding metformin use in pregnancy is true:

a. it has no reported adverse fetal outcomes
b. it is licensed for use during pregnancy
c. it is effective in achieving good glycemic control in pregnancy
d. it is classified as a category C drug
e. lactic acidosis is a complication

40. The following are pre-existing risk factors for development of type 2 DM EXCEPT:
a. ART
b. increased parity
c. maternal age
d. maternal BMI
e. maternal HTN
41. A 35yrs old PG at 36wks has a one day H/O of headache and blurred vision. Her BP is
180/110. Urine analysis shows +++protein. One week earlier, her BP was 120/70 and no
proteinuria. The most appropriate INITIAL drug to administer:
a. IM betamethasone
b. IV MgSO4
c. IV furosemide
d. IV diazepam
e. oral methyldopa

42. A PG at 29wks has been diagnosed with gestational diabetes on her OGTT. Her FBS was
225gm/dl. Which of the following ttt option best suits her?
a. dietary modification alone
b. diet+ exercise
c. insulin+ diet+ exercise
d. metformin+ diet+ exercise
e. glibenclamide+ diet+ exercise

43. Severe twin to twin transfusion syndrome diagnosed before 26wks is best treated by:
a. amnioreduction
b. laser ablation of vessels
c. selective fetal reduction
d. septostomy
e. termination of pregnancy

44. The following is the least likely to be a complication of LSCS:

a. anal sphincter injury
b. bladder dome injury
c. colonic perforation
d. intra-abdominal hemorrhage
e. transient tachypnea of newborn

45. A PG at term is in 2nd stage, after delivery of fetal head, shoulder dystocia was diagnosed
and McRoberts maneuver had not effected the delivery of the shoulders. Next best step:
a. all four position
b. delivery of posterior arm
c. suprapubic pressure
d. internal rotation maneuvers
e. Zavanelli maneuvers

46. Elective CS is best recommended to prevent shoulder dystocia in which of the following:
a. all women at term with suspected macrosomia
b. diabetic women with suspected macrosomia
c. prelabor rupture of membranes at term
d. previous shoulder dystocia
e. women with previous two cesarean births
47. Of the following, the most consistent finding in uterine rupture is:
a. abnormal CTG
b. acute scar tenderness
c. hematuria
d. maternal tachycardia
e. severe abdominal pain referred to the shoulder tip

48. A gestational diabetic PG at 38wks in spontaneous labor was assessed at 1pm and had
progressed to 5cm cx dilatation. She was examined at 5pm and was found to be 6cm dilated,
50%effaced with intact membranes and station 0. Next appropriate step:
a. adequate progress and PV in 4hrs
b. AROM+ oxytocin + PV in 2hrs
c. AROM+ oxytocin+ PV in 4hrs
d. AROM+ PV in 2hrs
e. AROM+ PV in 4hrs

49. Regarding the third stage of labor, which of the following is correct:
a. active management reduces the risk of hemorrhage and shortens 3rd stage compared to
physiological management
b. early cord clamping achieves better infant hematological outcomes than delay cord
clamping
c. if actively managed, the mean duration is 30minutes
d. if the placenta is retained, then its manual removal should only be conducted under GA
e. physiological management involves cord clamping, and placenta is delivered by controlled
cord traction, but no use of oxytocin

50. The correct sequence of events in relation to mechanism of labor in vertex presentation:
a.descent, flexion, engagement, internal rotation, restitution, external rotation, extension, expulsion
b.descent, engagement, flexion, extension, restitution, external rotation, internal rotation, expulsion
c.engagement, descent, flexion, extension, restitution, external rotation, internal rotation, expulsion
d.engagement, descent, flexion, internal rotation, restitution, external rotation, extension, expulsion
e.engagement, descent, flexion, internal rotation, extension, restitution, external rotation, expulsion

51. A 25yrs old PG at 40wks is in 2nd stage of labor. She has been pushing actively for 2hrs
and is exhausted. CTG shows baseline of 150bpm, normal variability, occasional
accelerations and infrequent variable decelerations. She is contracting 3-4/10min. PV: fully
dilated, fetal head direct occipitoanterior, station +1. Most appropriate next step:
a. cesarean section delivery
b. episiotomy
c. fetal blood sampling
d. instrumental delivery
e. start IV oxytocin augmentation

52. A 25yrs PG at 40wks, in 2nd stage of labor, has been actively pushing for 1hr. CTG shows
a baseline of 180bpm, reduced baseline variability, no accelerations and frequent atypical
variable decelerations. She is contracting 3-4/10min. PV reveals fully dilated cx with fetal
head direct occipito-anterior, station +1. Most appropriate next step:
a. cesarean delivery
b. episiotomy
c. fetal blood sampling
d. instrumental delivery
e. start IV oxytocin augmentation

53. U r evaluating a woman who has been in 1st stage for the past 10hrs. The following is the
least relevant information for further clinical management:
a. cervical dilatation and rate of change
b. ethnicity
c. parity
d. the woman’s emotional state
e. uterine contraction

54. A 23yrs old PG is in threatened preterm labor at 32wks. Corticosteroids are

administered. While explaining the rational of this ttt, the following are correct EXCEPT:
a. steroids are known to be safe to the mother
b. they reduce the risk of intraventricular hemorrhage
c. they reduce the risk of maternal inflammation
d. they reduce the risk of neonatal deaths
e. they reduce the risk of RDS

55. A 28yrs old PG has leaking fluid per vagina for the past 3hrs at 32wks. On speculum
examination, leakage of clear amniotic fluid is confirmed. She is clinically stable with no
signs of infection. US shows singleton fetus in cephalic presentation, AGA, normal liquor and
Doppler. It is correct to say:
a. almost 10% of pregnancies have PPROM
b. frequent digital examination is recommended to help to assess her Bishop score
c. erythromycin should be given orally for 10days following diagnosis of PPROM
d. if NICU beds are available, it is better to deliver her immediately after steroids cover
e. vaginal PGE2 can be used for inducing her labor now

56. A G3P2 at term is undergoing an emergency CS under GA, as she presents in labor with
previous 2CS & APH. During CS, an anterior low-lying placenta fails to separate after
delivery of the baby. Clear cleavage plane can’t b identified. The bleeding is minimal. She
has consented to a sterilization. The following ttt options best suited her:
a. attempt to separate placenta and cesarean hysterectomy if bleeding occurs
b. elective cesarean hysterectomy
c. leaving the placenta in situ with postoperative methotrexate
d. removal of the bulk of the placenta and cord and closure
e. removal of the placenta piecemeal and closure of bleeding points.

57. The following is recommended as a method of induction of labor:

a. extra-amniotic PGE2
b. intracervical PGE2
c. intravaginal PGE2
d. sublingual PGE2
e. oral PGE2

58. A PG at 35wks has an US today revealing a breech baby. Incidence of breech at term is:
a. ˂1%
b. 1-2%
c. 3-4%
d. 4-8%
e. 8-10%

59. A 38wks pregnant woman developed 1ry genital Herpes. She is now treated with
acyclovir. She has now confirmed ROM. the following ttt best suited her:
a. CS after adequately nil per oral (6hrs)
b. CS after steroids cover (24- 48hrs)
c. immediate CS
d. immediate induction of labor with IV acyclovir
e. induction of labor after 24hrs with IV acyclovir

60. U have just examined a woman in postpartum ward complaining of breast pain and
discomfort. She has postpartum mastitis. all the following r ttt options for her EXCEPT:
a. analgesics
b. antibiotics if infective mastitis
c. gentle hand expression to promote drainage
d. local measures like hot and cold compress
e. stopping breastfeeding

61. A 32yrs old woman presents to delivery suite with 3days history of worsening pelvic pain
and vaginal bleeding with clots. She is at 5days postnatal having delivered her baby by
ventouse at 41wks. Her BMI is 32, BP: 130/ 80, pulse: 108bpm, temp 37.9. She has pelvic
tenderness on examination. Most likely diagnosis:
a. cervical carcinoma
b. bacterial vaginosis
c. endometritis
d. UTI
e. uterine rupture

62. The drug that is most likely contraindicated for maternal use when breastfeeding is:
a. cabergoline
b. LMWH
c. nifedipine
d. POP
e. warfarin

63. Incidence of clinically recognized miscarriage in pregnancy is about:

a. less than 1%
b. 1-2%
c. 5-10%
d. 10-20%
e. 20-30%

64. All the following routes of administration are used for misoprostol EXCEPT:
a. oral
b. subdermal
c. sublingual
d. rectal
e. vaginal

65. A 20yrs old at 12wks, has a 2days H/O of vaginal bleeding and lower abdominal pain. US
shows a 25mm fetal pole with absent FHR. Pelvic examination reveals her cx to be a 4cm
dilated with bulging intact membranes. The most likely diagnosis:
a. cervical incompetence
b. incomplete abortion
c. inevitable abortion
d. pregnancy of uncertain viability
e. threatened abortion

66. A 29yrs old woman pregnant at 6wks, is diagnosed to have a right tubal ectopic
pregnancy by TVS. The following would enable use of systemic methotrexate:
a. ectopic adnexal mass is 5x4cm in size
b. initial serum HCG 1000IU/L
c. presence of FHR in ectopic pregnancy
d. US evidence of hemoperitoneum ˃50ml
e. woman has had previous salpingostomy so further salpingectomy is contraindicated

67. A 29yrs old woman pregnant in 6wks, presents with slight vaginal spotting. TVS shows
no evidence of intrauterine or extrauterine pregnancy. A serum B-HCG is measured at
initial presentation and 48hrs later. The following B-HCG results are suspicious for ectopic:
a. 500, 1200
b. 800, 200
c. 1000, 400
d. 1000, 3000
e. 2000, 2500

68. A pregnant patient presents with mild bleeding and no abdominal pain, TVS shows CRL
of 5mm and no fetal heart beats. Most appropriate management plan:
a. advise to carry out a pregnancy test in 3 weeks
b. offer medical management of miscarriage
c. offer rescan after 7days
d. offer rescan in 48hrs
e. offer surgical management of abortion
69. The following is not an example of gestational trophoblastic disease:
a. chorioangioma
b. choriocarcinoma
c. complete mole
d. partial mole
e. placental site trophoblastic tumor

70. A PG at 34wks has been diagnosed with cholestasis and started ursodeoxycholic acid. She
is very concerned about the fetal wellbeing. The following investigation would accurately
predict the risk of fetal death:
a. fetal growth scans every 2-3wks
b. no such test is available
c. routine CTG monitoring once or twice weekly
d. transcervical amnopscopy for detection of meconium
e. weekly umbilical artery Doppler

71. A 24yrs old G2P0010 at 22wks presents for initial ANC. she had miscarriage 6months ago
while she was travelling abroad. She has H/O of migraine headache. US: intrauterine
pregnancy with FHR: 154. Prenatal screening reveals Rh-ve and antibody +ve. The father is
Rh+ve. What is the lowest titre that u start concern about development of fetal hydrops:
a. 1:4
b. 1:8
c. 1:16
d. 1:64
e. 1:256

72. A common complication of epidural and spinal anesthesia is:

a. maternal hypotension
b. maternal hyperventilation
c. fetal tachycardia
d. titanic uterine contractions
e. chorioamnionitis

73. Which of the following is not a sign of active labor:

a. bloody show
b. palpable contractions
c. nausea and vomiting
d. fever and chills
e. maternal pain

74. A 37yrs old G3P1103 at 10wks+3 presents for ANC. she has chronic hypertension, type 2
DM, smokes one packet per day. Her last pregnancy was induced at 35wks due to
preeclampsia. Risk factors for development of preeclampsia in current pregnancy include all
the following EXCEPT:
a. smoking
b. DM
c. H/O of preeclampsia in last pregnancy
d. advanced maternal age
e. chronic hypertension

75. A 25yrs old G1P0 at 31wks presents with BP: 160-170/ 110- 120, severe headache. PLT:
72000, AST: 226, creatinine: 1.4. Ur plan is:
a. betamethasone and expectant management
b. hydralazine and expectant management
c. MgSO4 and expectant management
d. immediate delivery
e. MgSO4, hydralazine, betamethasone and immediate delivery

76. A 24yrs old G1P0 at 28wks+5 presents for routine ANC. she has increased discharge
today. She notices little urine continued to leak after going to bathroom. She continued to feel
like water is leaking from the vagina. There is no vaginal bleeding or abdominal pain. The
discharge is clear odorless. The first step in evaluating this patient:
a. amni-dye test/ tampon test
b. US to check AFI
c. sterile speculum examination
d. amniSure test
e. amniocentesis to rule out choriomanionitis

77. The following is most likely to improve outcome in a patient with PPROM:
a. tocolysis
b. administration of betamethasone
c. hospital observation and bed rest
d. augmentation of labor
e. immediate CS

78. A 33yrs old G2P0101 at 34wks is evaluated with US for fetal size less than dating. Fundal
height today is 31wks. She had US at 22wks showing normal anatomy and growth in the 30th
percentile. She has history of drug abuse. She delivered her first child at 36wks after
PPROM. Her US today shows small fetus with head and abdominal circumference at the 5 th
percentile and femur length less than 10th percentile, there r abnormal findings with the
placenta. The following placental conditions do NOT increase a fetus risk for IUGR:
a. chronic placental abruption
b. placenta previa
c. thrombosis
d. chorioamnionitis
e. marginal cord insertion

79. A 25yrs old PG at 9wks comes for her ANC visit. Series of blood test and urine analysis
were done. She is asymptomatic and asks why these tests must be performed. U counsel her:
a. even though she is asymptomatic, she is still at risk of STDs and this is one way to screen them
b. asymptomatic bacteriuria if not treated has been associated with higher rates of chorioamnionitis
c. she is at increased risk of having asymptomatic bacteriuria compared to non pregnant patients
d. asymptomatic bacteriuria increases her risk of cystitis, pyelonephritis, and preterm birth
e. u r worried that she has pyelonephritis

80. A 23yrs old G2P0101 at 28wks comes for urgent visit. She complains of severe vaginal
irritation and increased thin, gray discharge. She denies leakage of fluid, vaginal bleeding or
contractions. The baby is moving well. She has no dysuria, or frequency. On speculum
examination, there is no leakage of fluid. A wet mount and KOH show clue cells and positive
Whiff test, no hyphae. If this had gone untreated, it would increase the risk::
a. increased risk of neonatal blindness
b. increased risk of neonatal sepsis and admission to NICU
c. increased risk of PPROM
d. increased risk of placental abruption
e. increased risk of congenital malformations

81. A 32yrs old comes for pre-conceptional counseling. She had epilepsy at 12yrs old and is
currently on phenytoin and carbamazepine. She has been seizure free for 1.5yrs. She and her
husband are planning to conceive within the next year. What should u advice to decrease the
risks for the coming pregnancy:
a. stop all seizure medications
b. optimize her seizure regimen to minimum number of medications with least possible dose
c. start taking prenatal vitamin and 400mcg folic acid
d. keep the same dose of both medications and start taking 4mg of folic acid
e. a transition off both her current medications and start taking valproic acid for monotherapy

82. The following ttt are most appropriate for varicose veins in pregnangy:
a. diuretics
b. pressure stockings and lower extremity elevation
c. low sodium diet and fluid restriction
d. surgical intervention
e. antihypertensive medication

83. A 39yrs old G1P0 at 11wks presents for NT screening. She has no medical or family H/O,
but is worried for her age. NT revealed increased thickness. Best next step:
a. repeat the test in 1week
b. repeat the test in 2weeks
c. offer CVS now
d. offer amniocentesis now
e. offer termination of pregnancy

84. A 34yrs old G2P0010 at 39wks presents to ER in active labor. She has moderate aortic
stenosis, no symptoms of heart failure or arrhythmia. Best management to minimize her
cardiovascular risks during the intrapartum and postpartum period:
a. start ampicillin for endocarditis prophylaxis
b. monitor intake and output, place early epidural, plan instrumental delivery to shorten 2nd stage
c. proceed immediately to CS to minimize cardiac stress
d. admit to ICU and place CVP
e. to maintain cardiac output, give lasix to decrease afterload

85. A 22yrs old G2P1001 at 39wks presents with contractions /3min for the past 2hrs. She
denies now ROM or vaginal bleeding or decreased DFMC. PV: cx 2cm dilated, 50%effaced,
station -2. Her cervical examination last week was the same. U decide to have her ambulate
and repeat cervical examination after 2hrs. After 2hrs, the patient is painfully contracting,
requesting epidural, her cx is 4cm dilated, 100% effaced, station -1. U admit her to labor
ward for expectant management, she receives epidural for pain control. Which of the
following will cause u to recommend a CS at this time:
a. fetus in right occiput posterior position
b. maternal hypotension
c. development of vaginal bleeding with decrease in hematocrite from 33 to 32
d. repetitive fetal decelerations to 80beats per minute with absent variability
e. her slow progress in labor

86. Labor is divided into stages and phases, that r used for communication about progress of
labor. First stage:
a. begins at the time of full cervical dilatation
b. has a latent phase that ends with dilatation exactly at 6cm
c. has an active phase that begins with repetitive contractions
d. has an active phase with at least 1cm/hr dilatation in nulliparous
e. has a latent phase with a rapid rate of cervical change

87. A 28yrs old G1P0 woman presents at 10wks for her initial ANC visit. In addition to
routine screening, she wishes to obtain screening for Down. The highest sensitivity
investigation will b through:
a. NT at 11wks
b. combined NT, PAPPA, B-HCG at 12wks
c. maternal serum triple test (AFP, estriol, B-HCG) at 17wks
d. second trimester ultrasound
e. sequential screening with combined screening in first trimester and quad screening in second

88. A 33yrs old G3P2012 presents with amenorrhea for 6months. Her pregnancy test is –ve.
She has been increasingly fatigued lately and her hair becomes more brittle and coarse. She
denies any other medical problems, she had no surgeries. She breastfed for 6months after
her most recent child without difficulty. O/E: HR: 58, BP normal, skin is coarse and dry.
CBC, PRL, FSH, estradiol are normal, TSH is markedly elevated and T4 is low. U
recommend T4 replacement. She is hoping to have another pregnancy and wonders about
how the medication will affect that pregnancy, u inform her that:
a. she will need less thyroid medication during pregnancy
b. she will be able to stop her thyroid medication in pregnancy
c. her thyroid medication will not need adjustment because the fetus autoregulates its own thyroid
d. she will need more medication during pregnancy
e. the dose of her thyroid medication will be tripled upon confirmation of pregnancy till the end
89. A 34yrs old afro-american presents at her 12wks GA (diamniotic-dichorionic twin
pregnancy). she has H/O of poorly controlled chronic hypertension, she is taking 200mg
labetalol and her BP today 134/80. She used to smoke, but quit now due to pregnancy. Her
mother and sister have diabetes, and she was told to be pre-diabetic few yrs ago. U counsel
her that her pregnancy is at risk for a number of complications due to her twin gestation,
chronic hypertension, H/O of insulin resistance. U explain that she is at increased risk of
PTL, PPROM, preeclampsia, need for CS and IUGR, but may not b SGA. What is the
difference between the terms SGA, and IUGR:
a. SGA refers to the fetus, whereas IUGR is specific to neonates
b. IUGR describes growth disorders related only to placental or maternal disease
c. SGA refers to growth disturbance owing to chromosomal abnormalities or toxins
d. SGA refers to a neonate in whom cause of small size is uncertain, whereas IUGR describes
the fetus and suggests an intrauterine etiology for growth restriction
e. IUGR refers to a neonate in whom the cause of growth disruption is not identified, whereas
SGA refers to a fetus and suggests a known cause for growth restriction.

90. A 24yrs old G1P0 at 25wks presents for routine ANC. she is sexually active, her BMI: 29,
physical examination is unremarkable. She was surprised to be screened +ve for diabetes,
and was never told to have diabetes before. Most likely etiology of her diabetes:
a. type 2 DM- autoimmune destruction of B-islet cells
b. type 1 DM- elevated progesterone level
c. gestational Diabetes- HPL effect
d. type 1 DM- pre-existing peripheral insulin resistance
e. gestational diabetes- recently acquired HCV infection

91. A 25yrs old PG presents to ER with vaginal bleeding. Her LMP was 6wks ago. O/E,
temp: 37, BP: 115/80, pulse: 75, RR: 16. PV: small amount of dark blood in vagina, cx is 1-
2cm dilated, uterus is mildly enlarged, AVF and non tender. Urine pregnancy test is +ve. US:
intrauterine gestational sac with yolk sac, no fetal pole or cardiac motion. ur diagnosis:
a. incomplete abortion
b. threatened abortion
c. ectopic pregnancy
d. missed abortion
e. inevitable abortion

92. A 21yrs old woman undergoes hysteroscopy and curettage for persistent uterine bleeding
after her term VD 8months ago. Pathology shows: choriocarcinoma with invasion of
myometrium, B-HCG: 50.000. The following is NOT currently indicated:
a. imaging for distant metastatic lesions
b. surgical intervention with hysterectomy
c. chemotherapy
d. close surveillance of serum B-HCG
e. reliable contraception

93. The following is the most reassuring when assessing FHR:

a. FHR: 140 with marked variability
b. FHR: 100 with minimal variability
c. FHR: 150 with moderate variability
d. FHR: 90 with absent variability
e. FHR: 190 with moderate variability

94. A 25yrs old G2P1 at 36wks, presents to ER with painful uterine contractions every 2-
4min for the last hour. She was late in ANC, her first US was at 28wks, was normal, no
anomalies, normal liquor, anterior placenta with velamentous insertion of the cord, Doppler
showed crossing of the fetal vessels on internal os. After that, she lost follow up till she
presents today. She denies any fluid leakage or vaginal bleeding. PV: cx is 6cm dilated,
90%effaced, FHR reactive with no deceleration. Most appropriate plan:
a. expectant management, VD
b. AROM, Intrauterine pressure catheter (IUPC), VD
c. emergency CS
d. oxytocin augmentation
e. continuous CTG monitoring, and CS whenever distress occurs

95. A 38yrs old G1P0 presents at 34wks with painful uterine contractions for the last 2hrs.
She denies fluid leakage or discharge. She reports vaginal bleeding that started 30min ago.
She has unremarkable medical H/O, but has surgical H/O of myomectomy in which a large
anterior fibroid was removed. O/E, she was afebrile, vital signs stable. US: fetus vertex,
normal AFI, no retroplacental hematoma, posterior placenta. On speculum examination:
100cc bright blood in the vaginal vault, no leakage, no ferning. Her cx is 3cm dilated, FHR:
120s with moderate variable decelerations down to 60s with each contraction, she is
contracting every 2-4min. the most likely cause of her APH is:
a. PPROM
b. uterine rupture
c. cervical laceration
d. placenta previa
e. vasa previa

96. A 34yrs old G4P3003 at 34wks presents to ER with hematuria, dysuria and occasional
contractions for 1week. She also notes occasional spotting over the last 3days. She denies any
leakage or discharge, back or flank pain but has had some suprapubic discomfort. She had
an anatomy US at 24wks showing normal fetal anatomy, normal AFI, anterior complete
placenta previa. She has unremarkable medical history, and has H/O of previous 3CS. All
the following are appropriate tests to determine etiology of hematuria EXCEPT:
a. urine analysis
b. urine culture
c. sterile speculum examination
d. CT scan of abdomen and pelvis
e. abdominal ultrasound of uterus

97. A 14yrs old girl presents in OPD with irregular vaginal bleeding for the last 2-3months.
She has been rather stressed out with her school which adversely affected her routine life and
can’t recollect her dates or menstrual pattern well. She was on pill for the past year. Lately,
she lost appetite with nausea, vomiting and fullness of lower abdomen. She has lost weight in
the last 3months due to poor food intake. O/E: vesicles are seen in the vagina close to cervical
os. Most likely diagnosis:
a. contact dermatitis
b. genital herpes
c. molar pregnancy
d. sarcoma Botryoides
e. vaginal carcinoma

98. A 7wks pregnant has H/O of 3 consecutive first trimesteric abortions. She is 28yrs old,
her lupus anticoagulant, anticardiolipin are negative. Her hormonal levels including
progesterone are normal, US is normal. She has unremarkable medical history, and there is
no H/O of consanguinity. Etiology of her miscarriages remains unexplained. Best ttt for her:
a. aspirin
b. aspirin and LMWH
c. HCG injections
d. progesterone supplementation
e. reassurance and expectant ttt

Questions 99- 100: A 25 years old woman, presented with 3 days missed period and a
quantitative HCG of 500mIU/ml. No pelvic pain or vaginal bleeding. TVS revealed an empty
uterus and left adnexal cyst 2 cm in diameter.
99. What is your interpretation?
a. Normal intrauterine pregnancy.
b. Complete abortion.
c. Data are too early to conclude.
d. Ectopic pregnancy.
e. Vesicular mole.
100. What is the best management for this case?
a. Antibiotics.
b. Methotrexate therapy.
c. Follow up by US after 1 week.
d. Urgent laparoscopy.
e. Needle aspiration of the cyst.

Questions 101- 102: A 26 years old PG presents at 36 weeks for ANC. Examination and US
show complete breech presentation 2.5 kg, with normal amniotic fluid index (AFI).
101. What would you recommend for this case?
a. Wait for spontaneous breech delivery.
b. Induction of labor.
c. Urgent cesarean delivery.
d. Spontaneous correction is the rule.
e. Council for external cephalic version.
102. Fetal head is delivered in flexion in which of the following conditions:
a. Direct occipito anterior.
b. Direct mento-posterior.
c. Persistent brow.
d. After coming head in breech presentation.
e. Neglected shoulder.

Questions 103- 104: A 25 years old, 3rdG P2 with previous vaginal deliveries presents at 40
weeks gestation. She had an uncomplicated pregnancy & reports good fetal movements. PV
examination reveals closed, formed and posterior cervix. Fetus is cephalic -1 station.
103. How can you manage this case?
a. Cesarean section.
b. Vaginal misoprostol.
c. Oxytocin infusion.
d. Fetal kick count monitoring.
e. Check fetal lung maturation before making an action.
104. A week later, she returns anxious about decreased fetal movements. Examination is the
same. How would you proceed with her?
a. Urgent cesarean section.
b. Non stress test (NST) to assess fetal well-being.
c. Artificial rupture of membranes.
d. Reassurance and recheck after 2weeks.
e. Mild sedatives.

Questions 105- 106: A 30 years old G3P2 CS, 32 weeks gestation, presents with gush of fluid
from vagina with no labor pains. Although the fetus is kicking well, yet, she is worried about
her baby’s condition.
105. How would you proceed with this lady?
a. Induction of labor.
b. Cesarean section.
c. Tocolytics.
d. Antibiotics and steroids.
e. Non stress test (NST).
106. If you manage this lady conservatively, what would you prefer for follow up?
a. Daily CTG and Doppler study.
b. Bacteriologic culture and sensitivity for the leaking fluid.
c. Blood culture.
d. Temperature chart, C-reactive protein with monitoring fetal movements.
e. No role for conservative management in this case.

Questions 107- 108: A 22 years old PG, 34 weeks, presents with painless moderate vaginal
bleeding. Her BP is 90/60 and HR: 105 b/min.
107. The most appropriate next step:
a. Digital examination to detect exact amount of bleeding.
b. Speculum examination to detect source of blood.
c. Abdominal ultrasound.
d. Vaginal pack.
e. Tight abdominal binder.
108. If the diagnosis of placenta previa complete centralis is confirmed by ultrasound and the
bleeding continues, what will be your management?
a. Conservative management.
b. Induction of labor by prostaglandins.
c. Induction of labor by oxytocin infusion.
d. Immediate CS.
e. Cesarean hysterectomy.

Questions 109- 110: A 19 years old PG at 38 weeks, is admitted for induction of labor with
intravaginal prostaglandin, due to uncontrolled diabetes. She started having contractions.
109. The following clinical management is recommended:
a. CTG application.
b. Intravenous antibiotics.
c. Foley’s catheter insertion.
d. Fetal scalp electrode.
e. Forceps delivery.
110. One hour later, the contractions became more frequent, each lasting longer than 2
minutes. The fetal heart rate falls persistently to the 70/minutes. Most appropriate next step
in management:
a. General anesthesia.
b. Terbutaline.
c. Amnioinfusion.
d. Oxytocin.
e. Cesarean delivery.

Questions 111- 112: A 21 years old PG at 39 weeks, presents with painful contractions every
3 minutes. PV: cervix is 5 cm dilated, 60% effaced, FHS: 150/minutes and reactive. Two
hours later, PV: cervix is 7 cm dilated; 90% effaced and fetal head is at station +1. FHS
shows deceleration with onset of uterine contractions and returns to normal at their end.
111. Which of the following is the most appropriate next step in management?
a. Expectant management.
b. Oxytocin infusion.
c. Cesarean delivery.
d. Intravenous atropine.
e. Vacuum assisted vaginal delivery
112. The neonatal care includes:
a. IV Glucose.
b. Sodium bicarbonate administration.
c. IV adrenaline.
d. Clear airways.
e. IV antibiotics.

Questions 113- 114: A healthy 30 years old G2P0, at 36 weeks gestation with cerclage in
place, presents with labor pains and intact membranes.
113. Initial management will be:
a. Tocolytics.
b. Cesarean section.
c. Analgesics.
d. Removal of cerclage.
e. Artificial rupture of membranes.
114. Complications most liable to occur in this patient:
a. Cervical lacerations
b. Chorio-amnionitis.
c. Past date.
d. Fetal distress.
e. Placental separation.

Questions 115- 116: A 37 years old PG, at 32 weeks, presents with unilateral painful lower
limb edema. She started having respiratory embarrassment this morning. She is not in labor
and has irrelevant medical and surgical history.
115. Most probable diagnosis:
a. Physiological orthostatic edema.
b. Heart failure.
c. Nutritional edema.
d. Thromboembolic event.
e. Preeclampsia.
116. Your management will include:
a. Immobilization and heparin.
b. Low dose aspirin.
c. Encourage ambulation and rehydration.
d. Magnesium sulfate loading dose.
e. IV digitalis.

Questions 117- 118: An anemic 39 years old, G5 P5, presented with postpartum hemorrhage
following spontaneous vaginal delivery one hour ago. BP: 90/50 and pulse 120/min.
117. The risk factors of postpartum hemorrhage in this case include all the following
EXCEPT:
a. Age above 35 years.
b. Spontaneous onset of labor.
c. Prolonged labor.
d. Multiparity.
e. Anemia.
118. The next step in the management should be:
a. Vaginal pack.
b. Resuscitation and anti-shock measures.
c. B-Lynch sutures.
d. Bilateral ligation of the internal iliac arteries.
e. Selective embolization of the uterine arteries.

Questions 119- 120: A 25 years old, 2nd GP1, in labor. Cervix is 4 cm dilated and 50%
effaced. The fetal heart rate is 180/minute showing persistent late deceleration.
119. Which of the following clinical management should be done?
a. Continue CTG application and expectant management.
b. Cesarean section.
c. Oxytocin infusion.
d. Oxygen mask and close fetal monitoring.
e. Forceps delivery.
120. At the time of delivery, the fetus had meconium aspiration, with Apgar score of 2 at 1
minute post-delivery. The next step in this neonatal management:
a. Endotracheal tube and oxygen.
b. Adrenaline infusion.
c. Umbilical catheterization.
d. IV glucose 5%.
e. Tracheostomy and tracheal aspiration.

Questions 121- 122: A 35 years old, G3P2, with previous 1 CS due to hypertension, presents
at 36 weeks complaining of severe headache and reduced fetal movements. Her BP is 150/90
and ultrasound reveals asymmetric growth restriction and amniotic fluid index 3.
121. Which of the following investigations must be done?
a. Complete blood picture.
b. Liver and kidney functions tests.
c. Doppler flow studies.
d. Urine albumin.
e. All of the above
122. Possible complications for this case include all the following EXCEPT:
a. Eclampsia.
b. Accidental hemorrhage.
c. Intrauterine fetal death.
d. Shoulder dystocia.
e. Residual hypertension after delivery.

Questions 123- 124: A 37 years old G3P2 presents for follow up after methotrexate treatment
for ectopic pregnancy 1 week ago. Now she has lower abdominal pain, with moderate left
lower quadrant tenderness. HCG value doubled over the past week and TVS shows
persistent sac with fluid in Douglas pouch.
123. Which of the following is the most appropriate next step in management?
a. Expectant management.
b. Repeat methotrexate.
c. Laparoscopy.
d. Transvaginal aspiration of ectopic.
e. Hysterectomy.
124. The patient should be advised to:
a. Postpone next pregnancy for one year.
b. HCG follow up for one year.
c. Combined oral contraceptive pills are contraindicated.
d. Intrauterine device is preferably avoided.
e. No increased risk of ectopic pregnancy in subsequent pregnancies.
125. A 32yrs old G5P4 presents with 8weeks amenorrhea and suggestive symptoms of
pregnancy. PV revealed an irregular enlarged uterus 16wks. Ultrasound confirms the
presence of an 8weeks viable pregnancy and a multiple fibroid uterus. Best management of
this patient:
a. termination of pregnancy with concomitant myomectomy
b. close observation with elective CS at term
c. close observation anticipating possible vaginal delivery
d. myomectomy and follow pregnancy in usual way
e. elective CS and concomitant myomectomy

126.A newly born showed a HR of 120bpm at 1minute, respiratory effort is good, there is
strong cry, muscle tone is active, reflex irritability is absent, color is pink with blue
extremities. Apgar score is:
a. 5
b. 6
c. 7
d. 8
e. 9

127. A 24 yrs old G1P0, with LMP 8wks ago, is seen in ER. She has abdominal cramping and
heavy vaginal bleeding with clots. Examination reveals a soft abdomen with mild lower
abdominal tenderness, vagina is filled with blood and clots. The cervical os is opened and
tissue protruding. The uterus is enlarged 6weeks. Most likely diagnosis:
a. ectopic pregnancy
b. threatened abortion
c. placenta praevia
d. incomplete abortion
e. complete abortion

128. The pathology report following a therapeutic abortion shows Arias-stella reaction. The
most appropriate next step for this patient would be:
a. repeat a pregnancy test
b. laparoscopy
c. reassure the patient
d. repeat D&C
e. antibiotics and echbolics

129. An O-ve female whose husband is O+ve, Rh immunoglobulin should be given in all
EXCEPT:
a. artificial rupture of membranes
b. amniocentesis
c. spontaneous abortion
d. therapeutic abortion
e. ECV

130. In the first 100days of pregnancy, HCG titer doubles:

a. every day
b. every week
c. every 2days
d. every 2weeks
e. every 2months

131. Choose the correct statement regarding the lower uterine segment during pregnancy:
a. It develops from the uterine isthmus.
b. It starts to develop in the 3rd trimester.
c. It has a well-developed thick muscle wall.
d. It is covered by adherent visceral peritoneum.
e. Contracts and retracts during labor.

132. A 44 year old female P4+1 with a proved diagnosis of complete vesicular mole. Uterine
size was found to be 20 weeks size as confirmed by ultrasound. Most appropriate treatment:
a. A course of Chemotherapy should be given first.
b. Dilatation and curettage.
c. Medical abortion.
d. Hysterectomy.
e. Hysterotomy.

133. An 8 weeks PG, suddenly felt lower abdominal colic followed by minimal vaginal
bleeding after sexual intercourse. PV revealed a closed cervix and ultrasound confirmed a
living intrauterine gestational sac. What is the most appropriate management?
a. Immediate hysterotomy.
b. Medical abortion.
c. Surgical evacuation.
d. Expectant treatment.
e. Cervical cerclage.

134. A healthy 30years old PG presents at 34wks GA. She has been experiencing abdominal
discomfort that increases after eating especially when in the recumbent position. A series of
tests is performed. She has normal vital signs, an unremarkable examination. Fundal height
is of 33cm and negative urine analysis. The following are abnormal test results:
a. alkaline phosphatase double that of the reference range
b. hemoglobin of 9gm/dl
c. serum albumin of 3g/dl
d. serum creatinine level of 0.8mg/dl
e. all of the above

135. A 31yrs old woman G6P0 (0231), comes at 10weeks gestation with a history of having
progressively earlier deliveries, all without painful contractions. Her first child was born at
34weeks and survived, the next delivered at 26weeks, the next two at 22weeks, and the last
one at 20weeks. No congenital abnormalities were found. O/E, her uterus is 10-12weeks size.
FHS are normal, cervix is soft, 2cm dilated and mildly effaced. Your diagnosis is:
a. genetic disease
b. incompetent cervical os
c. premature labor
d. progesterone lack
e. uterine fibroid

136. During delivery of a 3.8kg infant, the mother sustained a third degree perineal
laceration with involvement of the rectal mucosa. The best course of action is:
a. leave the tear to heal primarily by itself, because of contamination
b. pack the defect open for secondary closure
c. repair the anal sphincter and perineal muscles only
d. repair the defect in layers
e. repair the defect en mass

137. A 25yrs old G3P0 has an arrest of labor for 4hours with no cervical change from 6cm, -
1station. She has been on oxytocin with adequate contractions for the last 2hours. The fetus
has a reassuring FHS. The best management is:
a. continue oxytocin
b. increase oxytocin
c. offer vaccum extraction
d. offer forceps delivery
e. cesarean section

138. A 20yrs old PG presents at 39weeks. She has a headache and a loss of appetite. Her face
and hands are swollen, and she can’t wear her rings. Her BP is 170/90 with protein +1. The
fetus has a reassuring monitoring. The best treatment for her preeclampsia is:
a. magnesium sulfate
b. delivery either by cesarean or by vaginal
c. an antihypertensive drug that does not affect uterine blood flow
d. gentle dieresis with careful monitoring of intake and output
e. close observation

139. The diagnosis of valvular heart disease in pregnancy is made when there is:
a. history of rheumatic fever
b. arrhythmia
c. diastolic murmur
d. soft systolic murmur
e. water hammer pulse

140. You are evaluating a pregnant woman for her hemoglobin of 8.3. Her folate levels are
deficient. Which results are secondary to the folic acid deficiency:
a. microcytic anemia
b. megaloblastic anemia
c. aplastic anemia
d. G6PD deficiency
e. hemolytic anemia
141. A pregnant patient at 16weeks gestation has normal BP, proteinuria (4g/day), serum
albumin 2g/dl, creatinine 0.8mg/dl and peripheral edema. Most appropriate diagnosis is:
a. pregnancy induced hypertension
b. nephrotic syndrome
c. polycystic kidney disease
d. chronic renal failure
e. hypoalbuminemia

142. The increase RBCs during pregnancy:

a. causes the hematocrite to rise
b. is due to the prolonged life span of the erythrocytes
c. is due to increased production of erythrocytes
d. results despite decreased levels of erythropoiesis in maternal plasma
e. is due to decrease destruction by the spleen

143. The relationship of the long axis of the fetus to the long axis of the mother is:
a. lie
b. presentation
c. position
d. attitude
e. engagement

144. A 32yrs old G2P0 (0101) who had a classical CS in her last pregnancy due to prolapsed
pulsating cord at 32weeks. She presents at 34weeks with abdominal cramps and pain. Best
method to determine the extent and severity of uterine damage when uterus rupture is:
a. transabdominal ultrasonography
b. TVS
c. MRI
d. CT
e. exploratory surgery

Questions 145- 150, for each of the clinical scenarios, select the most appropriate clinical
management. All scenarios refer to a 25yrs old woman at 40wks and in spontaneous onset labor,
low risk pregnancy. Each option from the list can be used once, more than once or not at all:
a. cesarean section
b. start CTG
c. PGs
d. IV Fluids and analgesics
e. instrumental (forceps or ventouse) delivery
f. IV oxytocin
g. repeat PV at suitable interval

145. in 2nd stage of labor. Active pushing for 2hrs. CTG shows deep deceleration. Fetal head
visible at the vulva at peak of maternal expulsive effort. Epidural on, uterine contractions
are 4/10min.
146. Appearance of meconium-stained liquor following amniotomy at 5cm cervical
dilatation. Intermittent FHR monitoring prior amniotomy, showed normal FHR.

147. Progressed from 5 to 9cm cervical dilatation in 4hrs. Intact membranes. Uterine
contractions 2-3/10min. intermittent FHR monitoring shows normal FHR, no urge to push.

148. CTG decelerations for 40min then prolonged deceleration for 4min without recovery.
Currently FHR 80bpm. cx 5cm. membranes ruptured 3hrs ago. Woman in left lateral
position. No epidural. No oxytocin augmentation. Contractions 2/10min.

149. Ruptured membranes for 24hrs with no onset of uterine contractions. FHR 150bpm.
maternal temp 37.1, pulse: 100bpm. IV antibiotics started. Cx closed, firm and uneffaced.

150. Quick recovery variable decelerations on CTG for 40min. baseline FHR 165bpm.
contractions 5-6/10min. vaginal PG inserted an hour ago and just removed. Cx 5cm with
ruptured membranes. No vaginal bleeding or uterine contractions.

Questions 151- 154: select the most appropriate diagnosis for each clinical situation described.
Each lettered option may be used once, more than once, or not at all.
a. first stage arrest
b. second stage arrest
c. failed induction of labor
d. prolonged first stage
e. prolonged second stage

151. No progress in descent for 4hours in a fully dilated nulliparous woman with an epidural
or 3hours or more in a multiparous woman with an epidural.

152. No cervical change for 4hours with adequate uterine contractions at 6cm dilatation with
membranes rupture in primigravida.

153. Failure to generate regular contractions and cervical change after at least 24hrs of
oxytocin, and with amniotomy previously done.

154. Failure of delivery of the fetus while the cervix in fully dilated for an hour in
primigravida.

For each statement, Mark True/ False:

155. Leopard maneuver helps is delivery in case of shoulder dystocia.
156. Reversed diastolic flow is an indication for immediate fetal delivery.
157. Ritgen maneuver should be done in all cases of vaginal delivery in second stage.
158. Continuous electronic fetal monitoring help in decreasing the rates of CS.
159. Grave’s disease is the commonest cause of hyperthyroidism during pregnancy.
160. Partial molar pregnancy has a better prognosis than complete molar pregnancy.
Best of Luck