1. Postpartum Infection : Obstetrics MCQ
Woman delivered 7 days back, reported with fever since 2 days. Which one of the following is the most likely cause?
c) Episiotomy infection
Correct Answer: b) Endometritis.
After childbirth a woman’s genital tract has a large bare surface, which is prone to infection. The most common infection causing puerperal fever is genital tract sepsis caused by contaminated medical equipment or unhygienic medical staff who contaminate the mother’s genital tract during childbirth.
2. Hyperemesis gravidarum
Nausea and vomiting are common in pregnancy. Hyperemesis gravidarum, however, is a much more serious and potentially fatal problem. Findings that should alert the physician to the diagnosis of hyperemesis gravidarum early in its course include…
a) Electrocardiographic evidence of hypokalemia
b) Metabolic acidosis
Correct Answer: d) Urinalysis for ketones.
A sign of starvation, ketones may be harmful to fetal development. Ketones build up when the body needs to break down fats and fatty acids to use as fuel. This is most likely to occur when the body does not get enough sugar or carbohydrates. Amount of ketonuria also helps physician in guiding the treatment.
3. The liquor amnii : Obstetrics MCQ
a) Volume is approximately 1 L at 36 weeks
b) In early pregnancy arises by transfer of fluid across the fatal skin
c) The pH is usually >5.6 and d) Has bacteriostatic properties
e) Is increased by giving the mother a NSAID
Correct Answer: a,b and d.
Corrected False statements: c) Compared with blood amniotic fluid pH is slightly acidic at 7.0. this fact may be used as a diagnostic test for PROM. e) NSAIDs reduce fetal urine production reducing amniotic fluid. Some-times Indomethacin is prescribed in polyhydramnios.
All of the following causes oligohydramnios except:
a) Renal agenesis
b) Poor placental perfusion
c) Post term pregnancy
Correct Answer: d) Anencephaly.
Impaired swallowing reflex in anencephaly, which leads to inability for amniotic fluid to be swallowed by fetus, leading to polyhydramnios.o
5. Round ligament pain
Primi 18 weeks gestation has right-sided groin pain. Pain as sharp and occurring with movement and exercise. She denies any change in urinary or bowel habits. She also denies any fever or chills. The application of a heating pad helps alleviate the discomfort. What is the most likely etiology?
a) Round ligament pain
c) Preterm labor
d) Kidney stone
e) Urinary tract infection
Correct Answer: a)
Round ligament pain is a sharp pain or jabbing feeling often felt in the lower abdomen or groin area on one or both sides. It is one of the most common complaints during pregnancy and is considered a normal part of pregnancy. It is most often felt during the second trimester. Exercise may cause the pain, as will rapid movements such as: sneezing, coughing, laughing, rolling over in bed, standing up too quickly. The round ligament supports the uterus and stretches during pregnancy. It connects the front portion of the uterus to the groin. These ligaments contract and relax like muscles, but much more slowly. Any movement that stretches these ligaments, by making the ligaments contract quickly, can cause a woman to experience pain.
6. Vulval Varicosities : Obstetrics MCQ
A woman presents to the antenatal clinic at 30 weeks of gestation with vulval varicosities. What is the most likely cause ?
a) Decreased vascular resistance
b) Increased plasma volume
c) Increased cardiac output
e) Pressure effect of the gravid uterus on the inferior vena cava
Correct Answer: e) Pressure effect of the gravid uterus on the inferior vena cava.
The effect of smooth muscle relaxation and compression of the inferior vena cava by a gravid uterus will cause stasis and lead to varicosities in the dependent area.
7. Collapse during Pregnancy
Whilst you are attending to a patient in the antenatal ward, the patient collapses and becomes unresponsive. You open their airway but they are not breathing. What should you do next?
a) Commence artificial ventilation
b) Commence cardiac compressions
c) Get help
d) Give a precordial thump
e) Left lateral tilt
Correct Answer:c) Get help.
Basic and Advanced Life Support guidelines highlight the need to get help if a patient has collapsed and is unresponsive. You should then place the patient in left lateral tilt and commence cardiac compressions at a rate of 30:2.
8. DVT in Pregnancy : Obstetrics MCQ
Deep vein thrombosis in pregnancy is more common in left leg because
a) Dextrorotation of uterus
b) Left common iliac vein is more tortuous
c) Inferior vena cava is on right side
d) Left ovarian artery is a branch of aorta
e) Left lateral position is more common during pregnancy
Correct Answer: None.
Left-sided DVT is more common in pregnancy (88%)also proximal DVT, restricted to the femoral or iliac veins, is also more common (> 60% of cases). Compression of the left common iliac vein by the right common iliac artery is the only plausible explanation for predominance of left-sided deep vein thrombosis. May-Thurner syndrome is anatomical variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. It is present in over 20% of the population.
9. DVT in Pregnancy
A pregnant woman present with a unilateral leg swelling and a suspicion of DVT, the best diagnostic method is:
a) USG Doppler
b) D- Dimer
d) PT/INR e) MRI
Correct Answer: a) USG Doppler.
The current initial test of choice in the evaluation of suspected DVT is Venous compression ultrasonography (CUS) of the lower extremity veins.
CUS has been shown to be more than 95% sensitive and specific for proximal lower extremity DVT. In pregnancy, CUS should be performed with the patient in the left lateral decubitus position and with Doppler analysis of flow variation during respiration to maximize the study’s ability to diagnose pelvic DVT.
However, if the CUS study is equivocal, if Doppler testing is abnormal, or if suspicion of pelvic DVT is high, further evaluation with magnetic resonance imaging (MRI) is recommended. D-dimer testing is often used in the diagnosis of DVT in nonpregnant patients due to its high negative predictive value. Pregnancy decreases the specificity of d-dimer testing.
10. True regarding SLE in pregnancy EXCEPT
a) Causes recurrent abortion
b) Lupus anticoagulant in an anticoagulant in vitro
c) Causes eclampsia
d) Corticosteroids are contraindicated
Correct Answer: d)
Corticosteroids are not contraindicated in a pregnant woman who is suffering from SLE.
11. Breech : Obstetrics MCQ
The incidence of breech presentation at term is :
Correct Answer: c) 3.5%.
In the third period from the 36th gestational week onward, the incidence of cephalic and breech presentation remain stable, i.e. breech presentation around 3-4% and cephalic presentation approximately 95%.
12. Complete breech : Obstetrics MCQ
a) Flexion at hip joint and extension in knee joint
b) Flexion at hip joint and flexion at knee joint
c) Extension at the hip joint
d) Flexion at knee joint and extension at the hip joint
e) Flexion of one leg at hip joint and extension of the other leg at the hip joint
Correct Answer: b) Flexion at hip joint and flexion at knee joint
13. Umbilical cord prolapse most likely occur with
a) Frank breech.
b) Complete breech.
c) Single footling breech.
d) Double footling breech.
Correct Answer: c) Single footling breech.
It is rare at term but relatively common with premature fetuses. Among full-term, cephalic, cord prolapse is quite rare, occurring in 0.4 percent. Among frank breech incidence is 0.5 percent, among complete breeches 4 to 6 percent, and among footling breeches 15 to 18 percent.
14. The commonest cause of IUFD is
a) True knots in the cord.
b) Gestational diabetes mellitus.
e) Complete placental abruption.
Correct Answer: c) Unexplained.
A large proportion of IUFD seem to occur in otherwise healthy babies and the cause often cannot be explained.
However, many stillbirths are linked to placental complications. This means that for some reason the placenta is not functioning properly.
A poorly functioning placenta may be the direct cause of the stillbirth, or it may have contributed to the baby’s death because the baby’s growth and development have been held back.
15. Anemia in Pregnancy : Obstetrics MCQ
The most common type of anemia in pregnancy is due to
a) Iron deficiency.
b) Sickle cell disease.
c) Folate deficiency.
d) Hemolytic disease.
e) Vitamin B12 deficiency.
Correct Answer: a)
Iron-deficiency anemia is the most common type of anemia in pregnancy and also in non-pregnant. Anaemia is the most common nutritional deficiency disorder in the world. WHO has estimated that prevalence of anaemia in developed and developing countries in pregnant women is 14 percent in developed and 51 per cent in developing countries.
16. Iron Level in Pregnancy
In a pregnant female which of the following depicts the level of iron :
a) Transferrin level
b) Serum ferritin level
c) Haemoglobin level
d) Iron binding capacity
e) Serum Iron
Correct Answer: a) and d).
Both transferrin and TIBC testing are used to gauge iron levels and diagnose iron deficiency. Iron level is determined by measuring the quantity of iron bound to the protein transferrin. Transferrin, which is formed in the liver, is the major carrier of iron in the bloodstream. Total iron-binding capacity measures amount of the transferrin isn’t carrying iron. Ferritin—the major iron-storage protein—is measured to determine the amount of iron stored in the body.
17. Indications for Cesarean Section
The following is/are always indications for Cesarean Section
b) Abruptio placenta
c) Preterm Labor
d) Active primary genital herpes
e) Sever pre-eclampsia
Correct Answer: d) Active primary genital herpes.
A Cesarean section is recommended for women who develop primary genital herpes within six weeks of delivery. Around 70% of neonatal infections result from asymptomatic HSV shedding during delivery.
Cesarean section for the prevention of neonatal herpes has not been evaluated in randomized controlled trials and may not confer complete protection.
18. Most common complication of Cesarean Section
a) Urinary bladder injury
b) Postoperative endometeritis
c) Aspiration pneumonia
e) Bowel Injury
Correct Answer: b)
Postpartum endometritis refers to infection of the decidua. The infection may also extend into the myometrium (called endomyometritis) or involve the parametrium (called parametritis). Postpartum endometritis is a common cause of postpartum febrile morbidity and also is the commonest complication after cesarean section.
19. Prophylaxis of PPH during cesarean section in a low risk woman.
a) 20 u Oxytocin @ fast
b) 20 u Oxytocin @ 60 drops/ min
c) 20 u Oxytocin @ 30 drops/ min
d) 10 u Oxytocin @ 60 drops/ min
e) 10 u Oxytocin @ 30 drops/ min
f) Inj. Prostodin (PGF2 alpha) 125 mcg i/m
g) Tab. Misoprost (PGE1) 400 mcg sublingual
Correct Answer: e) 10 u Oxytocin @ 30 drops/ min.
WHO recommends 10U of Oxytocin for prevention of PPH. 10U:500ml = 20000mIU/1000ml = 20mIU/ml. If we start at 30 drops /min, 40mIU/min will be infusion rate. Oxytocin has amino-acid homology similar to arginine vasopressin. Thus not surprisingly, it has similar antidiuretic action, and when infused at dosages of 20mIU/min or more, renal free water clearance decreases markedly. If aqueous fluid are infused in appropriate amounts along with oxytocin, water intoxication can lead to convulsions, coma, and even death. So the drop rate for 10U oxytocin drip should not be more than 30drops/ min.
20. Breech – Normal Delivery or Cesarean Section
At 39 week gestation, a fetus is in breech presentation. The breech is well down in the pelvis, cx is 3 cm dilated and the uterus was irritable. Estimated fetal weight is 3.4 kg. which of the following should be done ?
a) Cesarean section
b) External cephalic version
c) Internal podalic version
d) Oxytocin induction
e) Short trial of labor
Correct Answer: a) Cesarean section.
Cesarean section carries a reduced perinatal mortality and early neonatal morbidity for babies with a breech presentation at term compared with planned vaginal birth. Planned cesarean section is less costly than planned vaginal birth because of greater number of babies with neuro-developmental delay. (excluding possible future costs related to complications of a scarred uterus). Gravida does not change the mode of delivery when it comes to breech delivery.
21. Wound Infection after Cesarean Section
D8 after a cesarean delivery, complaining of redness and pain at her incision. She was feeling well after the operation until 4 days ago, when she developed pain and redness around her incision. General physical examination is normal. Erythema and induration around the incision present along with fluctuant mass on one side. Which of the following is most appropriate next step in management ?
a) Expectant management
b) Oral antibiotics only
c) IV antibiotics only
d) Incision and drainage
Correct answer: d) Incision and drainage.
This patient most likely has a wound abscess as there is fluctuant mass. The proper treatment for a wound abscess is with incision and drainage. Oral or IV antibiotics only may not resolve the abscess. Antibiotics often do not penetrate the abscess cavity. In the process of the incision and drainage, the fascia should be checked to ensure that it is intact. As long as the fascia is intact and there is no intra-abdominal process, there is no need for laparotomy.
22. Wound Infection : Obstetrics MCQ
D10 of cesarean section, with abdominal pain, a high fever. A red, warm and swollen area is noted on her abdominal wall around the scar. She reports that the area of redness has rapidly increased in size. Blisters have developed around the margins. What is the likely diagnosis?
c) Herpes zoster
e) Necrotising fasciitis
Correct Answer: e) Necrotising fasciitis.
The above description is apt for necrotising fasciitis, which develops rapidly in the deep tissues and spreads along the fascia. Cellulitis is a diffuse inflammation of dermis. It mainly affect limbs. Erysipelas is more superficial but well defined.
23. Chorionic Villous Biopsy
When chorionic villous biopsy is done before ten weeks it causes which of the following adverse effects
a) Fetomaternal haemorrhage
b) Cardiac defects
c) Limb defects
d) Renal defects
Correct Answer: c) Limb defects.
(RCOG: 2010) CVS should not be performed before 10 completed weeks of gestation. It is usually performed between 11 (11+0 ) and 13 (13+6 ) weeks of gestation.
The association between CVS, oromandibular limb hypoplasia and isolated limb disruption defects has been debated since the issue was first raised in 1991 when a cluster of five babies with limb reduction defects was reported among a series of 289 women undergoing transabdominal CVS between 8 and 9 (9+3) weeks. A subsequent analysis showed no difference in the rate of this abnormality compared with the population incidence, although the vast majority of procedures were performed after 10 weeks of gestation. Although a few publications subsequently appeared
to support this association, most found few, if any, cases of oromandibular limb hypogenesis syndrome and an incidence of limb reduction defects no higher than the background incidence. Despite reassuring reports, most units stopped performing CVS before 10 weeks of gestation and thus most subsequent analyses include later procedures only.
Furthermore, CVS before 11 (11+0) weeks can be technically difficult to perform, owing to a smaller uterus and thinner placenta.
24. Maternal Serum Alpha Fetoprotein
Maternal Serum alpha fetoprotein is elevated in all the following EXCEPT
a) Open spina bifida
b) Esophageal atresia
c) Post maturity
e) Bronchial aplasia
Correct Answer: c) Post maturity
MSAFP above normal is seen in multiple gestation, when there is placental abruption, as well as in a number of fetal abnormalities, such as neural tube defects including spina bifida and anencephaly, and abdominal wall defects. Rarely, high MSAFP is due to endodermal sinus tumor (EST) or another germ cell tumor containing EST. These tumors can occur in the pregnant woman (often as an ovarian tumor) or in the fetus.
Chorionic villus sampling (CVS) is associated with fetal limb reduction if performed too early in gestation. What is the earliest appropriate gestational age to perform CVS ?
a) 8 weeks
b) 9 weeks
c) 10 weeks
d) 11 weeks
e) 12 weeks
Correct Answer d) 11 weeks.
CVS should not be performed before 10 completed weeks of gestation because of limb reduction defects. Furthermore, CVS before 11 weeks can be technically difficult to perform, owing to a smaller uterus and thinner placenta. (Ref: RCOG Guideline). It is usually carried out between the 11th and 14th weeks of pregnancy.
26. All of the following are neural tube defect except
e) Spina bifida
Correct Answer: d and f.
Holoprosencephaly is a cephalic disorder in which the prosencephalon (the forebrain of the embryo) fails to develop into two hemispheres.
27. Fetal Alcohol Syndrome
Which of the following features BEST describes the fetal alcohol syndrome ?
a) Elfin facies, irritability, and supravalvular aortic stenosis
b) Growth deficiency with microcephaly, developmental delay, and short palpebral fissures
c) Intrauterine growth retardation, triangular-shaped face, and clinodactyly of the fifth finger
d) Short stature, webbed neck, and pulmonic stenosis
e) Weakness, club feet, immobile face, and inadequate respirations
Correct Answer: b) Growth deficiency with microcephaly, developmental delay, and short palpebral fissures
28. Patau Syndrome
Renal abnormalities, omphalocele, holoprosencephaly and polydactyly are clinical features compatible with which genetic syndrome ?
a) Down syndrome
b) Edwards syndrome
c) Fetal alcohol syndrome
d) Gardner syndrome
e) Patau syndrome
Correct Answer: e) Patau syndrome.
This is a classical presentation of trisomy 13 . Establish whether the presentations are mid-line structures because Patau syndrome often presents in this way (especially in examination settings). Edwards syndrome (trisomy 18) often presents with a ventricular septal defect, facial clefts, clenched hands and rocker-bottom feet.
"Authored By Dr.Niraj Mahajan"
MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.Read more [+]