Obstetrics MCQ
1- A 23 year old female who is breastfeeding her 3 week old infant complains about breast pain and fever of 40C. On examination, the left breast is tender with a red and hard right upper quadrant. What is the most appropriate management?
a. Increase frequency of breastfeeding and analgesia
b. Perform manual milk extraction for 24 hours
c. Discontinue breastfeeding, analgesia and antibiotic therapy
d. Incise and drain the breast
e. Antibiotic therapy, continue breastfeeding from opposite breast.
2- A 29 Year old gravida 3 para 3 had a vaginal delivery 30 minutes ago. After delivery of the placenta, she continues to bleed and has now bled approximately 500 mls in the past 15 minutes. The most common cause of this condition is:
a. Lacerations
b. Retained placental tissues
c. Placenta accreta
d. Uterine Atony
e. Distended bladder
3- A 19 year old has chronic asymptomatic hepatitis B infection. She is 22 weeks pregnant. When considering the risk of transmission to her yet to be born baby, you would:
a. Give hepatitis B immunoglobulin to the mother at 37 weeks
c. Do antenatal screening test on the fetus using amniocentesis to determine status
d. Give the neonate Hepatitis B vaccine plus Immunoglobulins immediately after birth
e. Do nothing and reassure the mother since the risk of transmission is zero
4- A 24 year old primagravida has been in labor for 6 hours. During the past 2 hours of observation, the contractions have become shorter and are weak. The membranes are bulging and she has remained a5 5 cm dilation for this 2 hours period. The occiput is at station +1 and there is no molding of the fetal head. Which of the following should be the next step in management:
a. Administer ergometrine
b. Administer Oxytocin
c. Apply intracervical prostaglandin gel
d. Observe for another 4 hours
e. Perform artificial rupture of membranes
5- In twin pregnancies, which of the following is the most important complication:
a. Abruption
b. Anemia
c. Prematurity
d. Postpartum hemorrhage
e. Hypertension
6- Fetal scalp blood sampling is indicated when cardiotocogram tracing shows:
a. Early decelerations
b. Late decelerations
c. Accelerations
d. Reduced beat to beat variability
e. A baseline between 120 – 140 bbp
7- A 32 year old G3P2 is being evaluated at 16 weeks gestations. No physical abnormalities are found on maternal physical examination and the uterine size is consistent with dates. The alpha feto protein done as part of the maternal serum screen is found to be elevated to three times the normal value for that gestational age. The next step in management should be:
a. Ultrasound examination
b. Chromosomal studies
c. Serum acetylcholine esterase determination
d. Amniotic fluid AFP determination
e. Amniotic fluid electrophoresis
8- A 36 year old primagravida is in your clinic for her first prenatal visit. She is at 18 weeks gestation by dates. On performing a routine physical examination, which of the following skin findings are abnormal:
a. Chloasma
b. Telangectasias
c. Straie
d. Palmar erythema
e. Vulvar white epithelium
9- A 19 year old had her LMP 10 weeks ago and had a positive pregnancy test. She comes for her first antenatal visit. During examination, the uterus was palpated midway between the umbilicus and the symphysis pubis. This finding :
a. Is consistent with her dates, reassurance is adequate
b. Is abnormal, and should be investigated with an ultrasound
c. Is abnormal, she should be re-examined in 4 weeks to reevaluate
d. Is abnormal, she should have a repeat pregnancy test
e. Is abnormal, immediate evacuation of uterine contents is required
10- the finding in the above condition can be due to all of the following except:
a. Fetal renal agenesis
b. Uterine fibroids
c. Molar pregnancy
d. Multiple gestation
e. Incorrect dates
11- A 24 year old female of Asian origin presents for her first antenatal visit for complaints of vaginal bleeding. Her LNMP was 11 weeks ago. Examination showed a large for dates uterus, subsequent ultrasound showed a snow storm appearance. In this condition, you would expect to find all of the following except:
a. Early preeclampsia
b. Massive ovarian enlargement
c. Severe hyperemesis
d. Threatened abortions
e. Hyperthyroidism
f. Gestational Diabetes
12- a 31 year old female was found to have an abnormal 50g glucose tolerance testing done on 24 weeks gestation, the full test performed later confirmed the diagnosis of gestational diabetes. She had no history of diabetes in the past. Her HbA1c was still within normal range. This lady is at risk for each of the following except:
a. Infants with congenital malformations
b. Macrosomic infants
c. Polyhydramnois
d. Pre-eclampsia
e. Delayed fetal lung maturity
13- A 23 year old primagravida comes to the ER with severe headaches and blurring of vision. She is at 34 weeks gestation. On examination, her hands and feet were noted to be swollen. Her BP was 160/115. urine dipstick was 3+ for proteins. What is the most appropriate management in this case:
a. Admit to hospital, magnesium sulfate, hydralazine and induction of labor for rapid delivery
b. Admit to hospital, magnesium sulfate, hydralazine and Emergency C/section
c. Admit to hospital, magnesium sulfate, hydralazine, betamethasone and observe until fetal lung maturity is reached
d. Admit to hospital, bed rest and observation
e. Methyldopa orally, outpatient management
14- Polyhydramnois is associated with which of the following fetal or maternal conditions:
a. Potters syndrome
b. Anencephaly
c. Placental insufficiency
d. Posterior urethral valves
e. Prune belly syndrome
15- A 32 year old G5 P4 presents with an 8 week history of amenorrhea and symptoms suggestive of pregnancy. Physical examination reveals an irregular, enlarged uterus of 16 weeks size. U/S examination confirms the presence of an 8 week viable pregnancy and multiple fibroid uterus. The correct management for this patient is:
a. Termination of pregnancy with elective myomectomy 2 months after
b. Termination of pregnancy with concomitant myomectomy
c. Prudent observation with elective c/section at term
d. Prudent observation anticipating probable vaginal delivery
e. Myomectomy and follow pregnancy in usual way
16- Which of the following is the most common indication for which a c/section is required:
a. Breech presentation
b. Dystocia
c. Fetal distress
d. Placenta previa
e. Pre-eclampsia
17- A 26 year old primi gravida presents at 40 weeks in active labor with contractions every two minutes. She is diagnosed as having a transverse lie with the back up. Which of the following would be the most appropriate next step:
a. Start vasodilan
b. Perform external version
c. Prepare for an immediate c/section
d. Rupture membranes and perform internal version
e. Continue observation anticipating normal vaginal delivery
18- A 25 year old G3P2 at 15 weeks gestation was found to have bacteriuria. She is asymptomatic. The most appropriate management is:
a. Observation as she asymptomatic
b. Repeat culture
c. Treat with metronidazole orally
d. Treat with Ceftriaxone IM
e. Treat with Amoxicillin orally
19- An 18 year old primigravida at 30 weeks gestation works at a childcare center. She comes to your office complaining that she was in close contact with a child who had a rash that was later diagnosed as rubella. Her initial rubella screen was negative. The most appropriate management is:
a. Reassure mother, and offer vaccine after delivery
b. Vaccinate mother now
c. Repeat rubella titers
d. Terminate pregnancy
e. Give rubella immunoglobulins now
20- A 21 year old primigravida presents for her first prenatal visit at 11 weeks gestation which is confirmed by U/S. she has no risk factors. All of the following tests should be done at this stage EXCEPT:
a. Blood group and Rh type
b. Urine culture
c. Vaginal culture
d. Pap smear
e. Leukocyte count
21- A complete blood count done on a 22 year old primigravida at 28 weeks gestation shows Hb of 9.5 g/dl. She is asymptomatic. Initial Laboratory work done during her first antenatal visit was completely normal. Her anemia is most commonly due to:
a. Increased fetal demand and growth
b. Dietary deficiency
c. Abnormal absorption during pregnancy
d. Increased blood loss during pregnancy
e. Folate treatment
22- A 23 year old multipara comes to your office saying that she has not felt any fetal movement for the past 10 hours. She is at 20 weeks gestation. Your next step in management should be:
a. Perform a non stress test
b. Perform an U/S test
c. Perform a Doppler test
d. Reassure mother, and re –evaluate in the next 24 hours
e. Perform a speculum vaginal examination
23- A 24 year old g3 p2 presents to the clinic for a routine antenatal checkup. She is at 36 weeks gestation. Her last pregnancy reveals a group B streptococcus vaginal carrier state that was treated during labor. She has no complaints today. With regards to her current pregnancy, what is the most appropriate management:
a. Do a vaginal culture now
b. Do vaginal culture at 40 weeks gestation
c. Give ampicillin prophylaxis IV during labor
d. Do nothing now, and do nothing during labor since it was treated
e. Perform C/section at time of delivery
24- A 19 year old primigravida comes to the labor floor with regular uterine contractions every 2 minutes. She says her water broke 1 hour ago. She is at 38 weeks gestation. Pelvic examination shows that she is 4 cm dilated. She also complains of vaginal itching and pain around some localized, painful and ulcerative lesions on her right vaginal wall. History shows that she had genital herpes before pregnancy. The most appropriate management is:
a. Proceed with normal labor and treat mother with acyclovir
b. Proceed to C/section and treat mother with acyclovir
c. Give tocolytics to inhibit labor and culture lesions
d. Augment labor to minimize risk of infection, and give acyclovir to baby when born
e. Give tocolytics, observe and wait for natural resolution, then induce labor
25- a 32 year old multigravida at 31 weeks gestation is admitted to the birthing unit after a motor vehicle accident. She complains of sudden onset of moderate vaginal bleeding for the past hour. She has intense constant uterine pain and frequent contractions. Fetal heart tones are regular at 145 beats/minute. Mother’s vitals are normal. Her perineum is grossly bloody. The most probable diagnosis is:
a. Placenta previa
b. Abruptio placenta
c. Uterine rupture
d. Preterm labor
e. Vasa previa
26- the most appropriate next step in managing the above patient is:
a. Sterile vaginal exam
b. Ultrasound examination
c. Emergency C/section
d. Perform biophysical profile
e. Observation and vaginal induction of labor if bleeding continues
27- a 22 year old g2 p1 presents at 32 weeks gestation with a complaint of painless vaginal bleeding. She has history of uterine fibroids and her previous pregnancy was delivered via c/section due cephalopelvic disproportion. Ultrasound examination reveals a placenta implanted with 2 cm of the internal cervical os. There is no uterine tenderness and bleeding seems to have stopped. The best course of management in this patient is:
a. Allow home with limited activity
b. Admit to hospital, stabilize and monitor
c. Admit to hospital, stabilize, and C/section
d. Admit to hospital, stabilize and vaginal delivery
e. Admit to hospital and perform a double setup technique
28- a 32 year old gravida 3 para 0 at 13 weeks gestation presents to the ER with profuse vaginal bleeding after coitus. She also has mild abdominal cramps. Examination shows soft abdomen and the cervical os to be more than 2 cm in diameter and the presence of clots and tissues in the vaginal vault. U/S shows products of conception still present in the uterus. The most probable diagnosis in this case is:
a. Inevitable abortion
b. Threatened abortion
c. Incomplete abortion
d. Placental abruption
e. Traumatic bleeding
29- the most appropriate management of the above patient is:
a. Give oxytocin, and perform emergency dilatation and curettage
b. Close observation and conservative management
c. Close observation and serial BhCG measurement
d. Give oxytocin and perform emergency dilatation and evacuation
e. Give methotrexate and misoprostol
30- A 23 year old G2P1 at 38 weeks gestation is admitted to the birthing unit in the active phase of labor. Artificial rupture of membrane is performed to accelerate the progression of labor. Immediately after AROM, bright red vaginal bleeding is noted. Apt test done at the bed side was positive. The most appropriate next step in management is:
a. Emergency C/Section
b. Pelvic ultrasound examination
c. Observation in left lateral position and give oxygen
d. Give oxytocin to further augment labor, use forceps to extract fetus
e. Initiate tocolysis and perform amnioperfusion
31- A 24 year old G2 P1 was seen for the first antenatal visit at 12 weeks gestation. Her prenatal laboratory panel reveals blood type O negative. her indirect combos test is positive. She has been married to the same husband for 10 years and he is the father of both her pregnancies. She did not receive Rhogam during her last pregnancy. The next step in management should be:
a. Give Rhogam now
b. Give Rogham at 28 weeks
c. Get Rh antibody titers
d. Perform amniocentesis for bilirubin levels
e. Continue conservative management, the fetus is at ZERO risk
32- A 24 year old G2 P1 at 28 weeks gestation by dates presents to the labor unit complaining of regular uterine contractions every 5 minutes. She has mild chronic hypertension being treated with methyldopa. Examination shows the cervix to be dilated 3 cm and 80% effaced. Membranes are intact. Maternal and fetal vitals are normal. There are no other findings or complaints. U/S shows normal growing fetus and a normally implanted placenta. The best course of management in this case is:
a. Tocolysis using magnesium sulfate plus betamethasone to enhance fetal lung maturity
b. Tocolysis using ritodrine plus betamethasone to enhance fetal lung maturity
c. Tocolysis in contraindicated, augment labor plus prophylactic emperic antibiotics
d. Tocolysis is contraindicated, proceed to emergency C/section
e. Do nothing, the patient is in false labor
33- A 34 year old g3 p2 with gestational diabetes presents to the labor unit at 39 weeks gestation with regular uterine contractions and a cervix that is 5 cm dilated. Membranes were ruptured. 10 hours after presentation, the cervix is 8 cm dilated but meconium staining of amniotic fluid is now being noted and CTG is showing late decelerations. Fetal scalp sampling shows a PH of 7.1. the best next step in management is:
a. Emergency C/section
b. Augmentation of labor and forceps delivery
c. Repeat Scalp PH in 30 minutes, while giving O2 to mother in left lateral decubitus
d. Perform biophysical profile, and deliver if score between 0-4
e. Perform amnioperfusion with normal saline to dilute meconium, continue with normal vaginal delivery
34- A 29 year old g3p2 presents to the labor unit in labor. She is at 40 weeks gestation. Uterine contractions occur every 3 minutes, and the cervix is 5 cm dilated. A CTG machine is attached and the reading was reassuring. 30 minutes later, and while performing another pelvic examination, a gush of fluid comes out and you feel the presenting part being breach preceeded by a loop of the umbilical cord. The CTG starts showing fetal tachycardia with variable decelerations. The most appropriate management is:
a. Try to replace the cord inside the cervical os and monitor CTG for improvement
b. Give Oxytocin to augment labor and use forceps to accelerate delivery
c. Proceed to the operating theatre
d. Perform zavanelli maneuver
e. Give magnesium sulfate and perform external cephalic version
35- Shoulder dystocia occurs during:
a. Stage 1 latent phase of labor
b. Stage 1 active phase of labor
c. Stage 2 of labor
d. Stage 3 of labor
e. Can occur at any stage
Answers:
1- E
2- D
3- D
4- E
5- C
6- B
7- A
8- E
9- B
10- A
11- F
12- A
13- A
14- B NOTE: Prune belly syndrome is a rare birth defect affecting about 1 in 35,000 births. About 96% of those affected are male. Prune belly syndrome is a congenital disorder of the urinary system, characterized by a triad of symptoms. The syndrome is named for the mass of wrinkled skin that is often (but not always) present on the abdomens of those with the disorder. Other names for the syndrome include Abdominal Muscle Deficiency Syndrome, Congenital Absence of the Abdominal Muscles, Eagle-Barrett Syndrome, and Obrinsky Syndrome.
Symptoms
- A partial or complete lack of abdominal muscles. There may be wrinkly folds of skin covering the abdomen.
- Undescended testicles in males
- Urinary tract abnormality such as unusually large ureters, distended bladder, accumulation and backflow of urine from the bladder to the ureters and the kidneys
15- D
16- B
17- C
18- E
19- A
20- C
21- A
22- B (to look for fetal heart tones or activities)
23- C
24- B
25- B
26- B
27- B
28- C
29- A
30- A
31- C
32- A
33- A
34- C
35- C
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