Name: Rev 9: Obstetrics 1 ( 140 Marks)

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

1. Placenta is normally developed from which of the following:
a. chorion frondosum and decidual lateralis
b. chorion frondosum and deciduas basalis
c. chorion frondosum and deciduas capsularis
d. chorion leave and deciduas capsularis
e. chorion leave and deciduas basalis

2. During an abdominal examination of a 30weeks gestation PG. fundal level was found to be higher than
the corresponding period of amenorrhea. Commonest cause will be:
a. miscalculation
b. malpresentation
c. contracted pelvis
d. PROM
e. placental insufficiency

3. Warning symptoms in pregnancy include all the following EXCEPT:

a. gush of fluid escaping per vagina
b. decreased quickening
c. vaginal bleeding
d. abdominal pains
e. constipation

4. What is the most common cause of first trimesteric abortion?

a. chromosomal abnormalities
b. Rhesus iso-immunization
c. cervical incompetence
d. bicornuate uterus
e. intra-uterine viral infections

5. Cervical incompetence is characterized by one of the following:

a. abortions usually occur in 1st trimester
b. commonly is associated with blighted ovum
c. abortions are associated with severe abdominal pain
d. IUFD occurs before abortion
e. cervix is less than 2.5cm in length

6. A 19years old female with a proved diagnosis of complete vesicular mole was found to have bilateral
moderate sized ovarian cysts on ultrasound. As regards these cysts:
a. surgical removal is mandatory
b. chemotherapy is needed after evacuation of the mole to treat these cysts
c. hormone dependent and will regress spontaneously after evacuation
d. laparoscopic biopsy is needed to confirm benign nature
e. mostly is a coincidentally discovered unrelated ovarian pathology

7. A 25years old woman, presented to outpatient clinic as she had a delayed cycle for 15days and a
quantitative serum HCG level of 5000mIU/ml. no pelvic pain or vaginal bleeding was reported by the
patient. TVS revealed an empty uterus with some fluid in Douglas Pouch and a 2cm cystic mass on left
adnexa. How can you proceed in this case:
a. normal pregnancy finding and re-do ultrasound after 10days
b. ectopic pregnancy is diagnosed
c. repeat HCG after 48hours to detect doubling for definite diagnosis
d. needle aspiration of Douglas pouch to identify nature of pelvic fluid
e. hysteroscopic evaluation of uterine cavity is requested before concluding a diagnosis

8. A 10weeks PG, suddenly expressed lower abdominal colic with excess vaginal bleeding with clots. PV
revealed opened cervix, US confirmed the GA. Most appropriate management:
a. immediate hysterectomy
b. medical abortion
c. surgical evacuation
d. expectant treatment after patient stabilization
e. urgent cervical cerclage

9. During an antenatal checkup of a 12weeks pregnant primigravida, a living fetus was found with CRL
corresponding to 11weeks and nuchal translucency thickness was 4mm. how can you interpret these data:
a. normal checkup for follow up
b. nuchal translucency should be repeated after 4weeks
c. down syndrome is suspected
d. check maternal viral antibodies
e. Rh antibody titer should be requested

10. A sure evidence of onset of labor is:

a. abdominal pain
b. expulsion of mucus streaked with blood (Show)
c. rupture of membranes
d. head engagement
e. cervical dilatation

11. A PG during labor, PV examination revealed a 4cm dilated cervix, 60% effaced. Membranes were intact
and head was occipito-anterior position at 0 station. After 2hours, PV showed a 6cm dilated cervix, 90%
effaced, still intact membranes and a head at same station. According to the given data, how can you
describe this labor course:
a. hypotonic inertia
b. obstructed labor
c. latent phase of labor
d. normal progress
e. precipitate labor

12. During management of 2nd stage of normal labor, if the head is allowed to extend after crowning. Vulva
will be maximally distended by:
a. suboccipito-bregmatic diameter
b. suboccipito-frontal diameter
c. occipito-bregmatic diameter
d. occipito-frontal diameter
e. biparietal diameter
13. During 3rd stage of normal labor, signs of placental separation include:
a. more marked uterine contractions
b. patient had a reflex bearing down
c. elongation of the cord
d. distension of the uterine fundus
e. perineum is maximally distended

14. In management of third stage of normal labor:

a. conservative management is associated with less risk of post-partum hemorrhage
b. duration till placental delivery should not exceed ½ an hour
c. estimated blood loss from placental site is about 1liter
d. Ritgen maneuver may be used to enhance placental separation
e. manual separation of placenta is routinely done

15. A PG with occipito-posterior malposition during labor. The cervix became fully dilated, head at station -
1, the membranes ruptured spontaneously with clear liquor, no delivery occurred for 2 hours, but uterine
contractions became infrequent. Your likely diagnosis is:
a. 1ry hypotonic inertia
b. obstructed labor
c. rupture uterus
d. cervical dystocia
e. shoulder dystocia
16. In the previous case, best management would be:
a. immediate cesarean section
b. forceps application
c. ventouse delivery
d. avoid bearing down and give sedation
e. oxytocin and wait for spontaneous rotation

17. Which of the following is an indication of CS in breech delivery:

a. breech with extended legs (frank breech)
b. complete breech
c. estimated fetal weight is between 2.5kg and 3.5kg
d. sacro-anterior position
e. extended fetal neck as detected by ultrasound

18. Fetal head is delivered in flexion in one 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

19. Contraindications for oxytocin to augment labor include:

a. premature fetus
b. hypotonic uterine inertia
c. maternal hypertension
d. previous cesarean section
e. all cases with antepartum hemorrhage
20. An 8th gravida, para 7 during 2nd stage of labor had cessation of uterine contractions and slight vaginal
bleeding. Fetal head receded up. Her BP became 100/60 and pulse rate became 120/minute with disturbed
conscious level. What is your 1st differential diagnosis:
a. accidental hemorrhage
b. obstructed labor
c. rupture uterus
d. uterine inertia
e. constriction ring opposite fetal neck
21. What will be your next step in management in this case:
a. ask the patient to bear down maximally aided by fundal pressure to enhance labor
b. trial of ventouse fetal head extraction
c. fluid replacement and oxytocin drip to regain uterine contractions
d. urgent blood transfusion and immediate laparotomy
e. general anesthesia to relax the constriction ring

22. During conservative management in cases of PROM, choose the correct statement:
a. should not continue more than 1week
b. frequent vaginal examination is done to assess cervical dilatation
c. antibiotics and corticosteroids are contraindicated
d. cesarean section should be done later in all cases
e. serial leucocytic count and C-reactive protein estimation to detect early infection

23. During continuous monitoring of 1st stage of labor in a primipara with PROM, fetus had repeated
attacks of bradycardia unrelated to uterine contractions pattern. How can you explain this pattern of
bradycardia:
a. fetal distress
b. fetal congenital anomalies
c. head compression during labor
d. insignificant, as long as it returns to normal
e. cord compression

24. The following fetal congenital anomalies is commonly associated with polyhydramnios:
a. renal agenesis
b. hydrocephalus
c. anencephaly
d. down syndrome
e. conjoined twins

25. A 35years old multipara with previous 3CS, 34weeks pregnant, presented for routine ANC. Ultrasound
revealed low lying anterior wall placenta. How can you counsel this case:
a. this is an insignificant finding as she will deliver by cesarean section
b. risk of hysterectomy is a major concern
c. placental insufficiency is highly expected
d. immediate termination should be considered
e. placenta usually migrates up

26. A PG 36weeks gestation was known to be hypertensive since her last check that was 1 week ago. She
presented to ER with acute abdominal pain. Her BP 110/70 and her pulse rate was 120/minute. Abdominal
examination revealed hard tender uterus and absent fetal heart. What is your provisional clinical diagnosis:
a. rupture hemorrhagic ovarian cyst
b. red degeneration of fibroid
c. concealed accidental hemorrhage
d. rupture uterus
e. hypertonic uterine activity

27. A 30years old multipara, 32weeks gestation was admitted to ER with sudden onset of painless mild
vaginal bleeding. Patient was vitally stable. Hb level was 10.5g/dl and ultrasound revealed a normal fetus in
breech presentation with anterior wall placenta 2cm away from the cervix. What is most appropriate
management for this case:
a. immediate CS
b. induction of labor
c. conservative management
d. urgent blood transfusion
e. external cephalic version

28. Which of the following is an advantage of medio-lateral episiotomy over median type:
a. less bleeding
b. less dyspareunia
c. less faulty healing
d. less extension to anal sphincter
e. easier repair

29. What is the most common indication of cesarean section:

a. repeat CS
b. contracted pelvis
c. oversized fetus
d. fetal distress
e. malpresentation

30.In the recovery room one hour after outlet forceps delivery, your patient was found to have an 8x5cm
expanding bluish tense painful swelling in the right labia majora extending to lower vagina. What is the
most appropriate management of this patient:
a. compression and vaginal pack
b. incision and drainage
c. laparotomy for internal iliac artery ligation
d. discharge patient and recheck after 1week
e. hemostatic and analgesics

31. A 23years old PG, 322 weeks gestation came to ER with severe headache, irritability and blurring of
vision. Her BP was 180/110, urine test for albumin ++++. Most appropriate management for this case:
a. reassurance, mild analgesics a nd recheck after few days
b. control hypertension and wait till fetal maturity
c. fetal BPP and Doppler indices will determine time of termination
d. diuretics and anytihypertensive till spontaneous onset of labor
e. admission, IV MgSo4 infusion, antihypertensive and urgent termination
32. An 8weeks pregnant PG, 23years old, presented with intractable vomiting for 3days and marked sense
of fatigue. No other GIT symptoms. Patient was vitally stable but had a dry tongue and urine analysis
showed ketonuria and depleted urinary chloride. Best management will be:
a. reassurance as it is a self-limited condition
b. encourage oral feeding and antiemetics
c. advice termination of pregnancy
d. prevent oral feeding and give IV fluids in a hospital
e. emergency upper endoscopy should be requested before treatment

33. A 30years old PG, known to have a rheumatic mitral stenosis attended to ER during 1st stage of labor.
Choose the most appropriate statement as regard management:
a. CS should be urgently done
b. digitalis is contraindicated
c. analgesics should be avoided
d. bearing down in 2nd stage should be minimized
e. ergometrine should be given after 3rd stage

34. A 24years old multipara underwent a vaginal delivery of a term infant. After delivery, the placenta
wasn’t delivered spontaneously for about 60minutes. Next step for this patient:
a. repeat fundal pressure to expel placenta
b. hysterectomy
c. manual removal of the placenta under anesthesia
d. exert marked traction on the cord to pull the placenta out
e. cut the cord and leave the placenta for spontaneous autolysis.

35. A PG was admitted to the ER about 1hour following home vaginal delivery with severe vaginal bleeding.
Bleeding was bright red, continuous and uterus was felt firmly contracted. How can manage this case:
a. resuscitation, ecbolic and uterine massage
b. resuscitation and urgent hysterectomy
c. resuscitation and urgent internal iliac artery ligation
d. resuscitation and vaginal exploration under anesthesia
e. resuscitation and vaginal pack

36. A sure diagnosis of 2nd stage of labor is:

a. Full cervical dilatation.
b. Abdominal pains are more frequent.
c. Involuntary bearing down.
d. Rupture of membranes.
e. Head engagement.

37. A PG in labor, P.V examination revealed a 1cm dilated cervix, 50 % effaced. Membranes were intact
and head was occipito-anterior position at 0 station. After 2 hours, reexamination showed a 2cm dilated
cervix with same effacement, still intact membranes and head at same station. According to the given data,
how can you describe this labor course?
a. Hypotonic uterine inertia.
b. Obstructed labor.
c. Latent phase of labor.
d. Active phase of labor.
e. Precipitate labor.
38. During management of 2nd stage of normal labor, if the head is allowed to extend BEFORE crowning,
vulva will be maximally distended by:
a. Suboccipito-bregmatic diameter.
b. Suboccipito-frontal diameter.
c. Occipito-bregmatic diameter.
d. Occipito-frontal diameter.
e. Biparietal diameter.

39. During the 3rd stage of normal labor, signs of placental separation include one of the following:
a. Uterine muscle relaxation.
b. Patient had an involuntary bearing down.
c. Elongation of the cord that recedes back.
d. Fundal uterine bulge.
e. Vaginal bleeding.

40. A PG with occipito-posterior malposition in labor. When the cervix became 8cm, head was at -2 station
with mild pelvic caput. Membranes ruptured spontaneously with thick green liquor and uterine
contractions became infrequent. The best management would be:
a. Oxytocin injections.
b. Caesarian section.
c. Foceps application.
d. Ventouse delivery.
e. Epidural anesthesia.

41. Which of the following is encouraging for a trial of vaginal delivery in breech presentation?
a. Previous full term breech delivery.
b. Footling presentation.
c. Estimated fetal weight is between1.5 kg to 2 kg.
d. Buttocks are felt at level of pelvic brim.
e. Extended fetal head as detected by ultrasound.

42. Fetal head is delivered in extension in one of the following conditions:

a. Direct occipito anterior.
b. Face to pubis.
c. Direct mento posterior.
d. Persistent brow.
e. After coming head in breech presentation.

43. A 25 years old 2nd Gravida Para1 at 15 weeks gestation had undergone U.S showing 2 babies with 2
separate placentae and 2 amniotic sacs. Counseling this woman about higher risk for all the following
complications EXCEPT:
a. Preterm labor.
b. Placenta previa.
c. Twin to twin transfusion.
d. Pre eclampsia.
e. Post-partum hemorrhage.
44. A 19 years old female with a proved diagnosis of complete vesicular mole of 18 weeks size and was found
to have bilateral moderate sized ovarian cysts on ultrasound. The best line of treatment is:
a. Dilatation and curettage.
b. Suction evacuation.
c. Abdominal hysterotomy and ovarian cystectomy.
d. Vaginal evacuation combined with laparoscopic removal of cysts.
e. A course of chemotherapy is needed before surgical intervention.

45. A 25 years old G1 +0, presented with delayed cycle for 5 days and a quantitative serum hCG level of
1000 mIU/ml. No pelvic pain or vaginal bleeding was reported by the patient. TVS revealed an empty
uterus. How can you proceed in this case?
a. Reassurance and follow up after 1 month.
b. Ectopic pregnancy is diagnosed.
c. Repeat hCG after 48 hour to detect doubling for definite diagnosis.
d. Immediate laparoscopy to evaluate.
e. Hysteroscopic evaluation of uterine cavity is requested before concluding a diagnosis.

46. A 5 weeks PG, suddenly expressed lower abdominal colic followed by mild vaginal bleeding. P.V
revealed a closed cervix and ultrasound confirmed the gestational age. How can you council this patient?
a. The chance for pregnancy to continue is about 10%.
b. She will have a trial for medical evacuation.
c. Surgical evacuation should be done.
d. Rest and progesterone supplementation will be beneficial.
e. Urgent cervical cerclage will help.

47. Contraindications for oxytocin to augment labor include:

a. Premature fetus.
b. Hypertonic uterine inertia.
c. Maternal hypertension.
d. Premature rupture of membranes.
e. All cases with antepartum hemorrhage.

48. A diabetic short stature PG had a fully dilated cervix and strong uterine contractions for 1
hour. F.H.R was reassuring. Fetus is cephalic, +1 station with ruptured membranes. All of the followings
are true regarding possible complications for this case EXCEPT:
a. 1ry Post-partum hemorrhage.
b. 2ry hypotonic uterine inertia.
c. Obstructed labor.
d. Cervical dystocia.
e. Shoulder dystocia.

49. A second gravida, para 1, previous C.S had a trial for vaginal delivery. When cervix became fully
dilated, uterine contractions ceased off, slight vaginal bleeding occurred and fetal head receded up. What is
your 1st differential diagnosis?
a. Uterine inertia.
b. Accidental hemorrhage.
c. Obstructed labor
d. Rupture uterus.
e. Constriction ring opposite fetal neck.
50. Regarding conservative management of premature rupture of membranes, choose the correct
statement:
a. Should be attempted in cases with drained liquor in 2st trimester.
b. Vaginal examination should be avoided.
c. Antibiotics and corticosteroids are contraindicated.
d. Caesarian section should be done later in all cases.
e. Could be continued so long as no clinical evidence of severe chorioamnionitis .

51. A 26-year-old PG was diagnosed with IUFD in the 20th week gestation. As she was markedly depressed,
she refused any intervention at this time. Five weeks later, she presented again for management due to
failure of spontaneous expulsion. The following laboratory parameter has the priority to be monitored:
a. Hemoglobin and hematocrite levels.
b. Fibrinogen level.
c. Blood urea nitrogen (BUN) level.
d. Serum creatinine level.
e. Quantitative H.C.G level.

52. During continuous monitoring of 1st stage of labor in a primipara, fetus had repeated attacks of
bradycardia. This coincided with peak of uterine contractions and lasted for a short period after the
contraction ends. How can you explain this pattern of bradycardia?
a. Fetal asphyxia.
b. Fetal congenital anomalies
c. Head compression during labor.
d. Insignificant, as long as it returns to normal.
e. Cord compression.

53. Which one of the following fetal congenital anomalies is commonly associated with oligohydramnios?
a. Renal agenesis.
b. Hydrocephalus.
c. Anencephaly.
d. Down syndrome.
e. Esophageal atresia.

54. The following fetal condition is commonly associated with elevated maternal serum α fetoprotein?
a. Microcephally.
b. Anencephally.
c. Major cardiac anomalies.
d. Down syndrome.
e. In born error of metabolism.

55. A 40 years old multipara underwent a vaginal delivery of a term infant. After fetal delivery, the placenta
wasn’t delivered spontaneously for about 10 minutes. Next step for this patient:
a. Forcible fundal pressure.
b. Exert marked traction on the cord to pull the placenta out.
c. Brandt Andrew maneuver.
d. Hysterectomy is considered.
e. Cut the cord and leave the placenta for spontaneous autolysis.
56. A PG was admitted to the E.R about 1 hour following home vaginal delivery with severe vaginal
bleeding. Bleeding was dark red, intermittent and uterus was felt lax. How will you manage her:
a. Ecbolics and uterine massage.
b. Urgent hysterectomy.
c. Urgent exploratory laparotomy
d. Vaginal and uterine pack.
e. Hysteroscopic evaluation of uterine cavity.

57. A PG 36 wks GA, presented to ER with acute abdominal pain. Her B.P was 110/70 and her pulse rate
was 120/minute. Abdominal examination revealed hard tender uterus and absent fetal heart. Ultrasound
revealed a large retro placental hematoma. Which of the followings could be the most probable etiology?
a. Rupture uterus.
b. Associated surgical condition.
c. Pathologically adherent placenta.
d. Preeclampsia.
e. Hypertonic uterine action.

58. Warning symptoms in pregnancy include one of the followings:

a. Constipation.
b. Increased quickening.
c. Persistent headache.
d. Heart burn especially after meals.
e. Muscle cramps.

59. A 23 years PG, 32 weeks gestation came to the E.R with irritability and blurring of vision.
Her B.P was 180/110, urine test for albumin was +++. Choose the most appropriate statement for this case:
a. Sometimes, it is a temporary condition and resolves spontaneously.
b. Fetal lung maturation should be assessed before making an obstetric decision.
c. Magnesium sulphate therapy is of no value in this condition.
d. Diuretics could be used for initial control.
e. Urgent termination is recommended .

60. An 8 weeks PG, 23 years old, presented with early morning nausea and vomiting for 10 days that she
can’t tolerate taking her folic acid supplement. No other GIT symptoms apart from lower abdominal
heaviness. Patient was vitally stable with unremarkable laboratory results. Best management will be:
a. Reassurance as it is a self-limited condition.
b. Intestinal antiseptics could be given for a week.
c. Prevent oral feeding and give I.V fluids for few days.
d. Upper endoscopy should be requested before treatment.
e. Missed abortion is suspected.

61. A 30 years old PG, known to have a rheumatic mitral stenosis attended to E.R during 1st stage of labor.
Choose the most appropriate statement as regard management:
a. C.S should be urgently done.
b. Digitalis is contraindicated.
c. Analgesics should be avoided.
d. Excess glucose saline infusion should be pushed into circulation.
e. Ergometrine should not be routinely given during the 3rd stage.
62. One of the followings is an indication for classic upper segment caesarian section?
a. Previous lower segment C.S.
b. Preterm fetus.
c. Twin pregnancy.
d. Placenta accreta.
e. Posterior fundal placenta.

63. A patient sustained a perineal laceration during delivery, it involved vagina, perineal skin and
perineal muscles including external anal sphincter but rectal mucosa is still intact. This laceration is
classified as:
a. First degree perineal tear.
b. Second degree perineal tear.
c. Third degree perineal tear.
d. Forth degree perineal tear.
e. Just incomplete perineal tear.

64. What is the 1st evidence of magnesium sulphate toxicity when used for treatment of eclampsia?
a. Disturbed conscious level.
b. Absent knee jerk.
c. Oliguria.
d. Respiratory embracement.
e. Absent fetal beat to beat variability on continuous fetal monitoring.

65. As regard the umbilical cord choose the correct statement:

a. It originates from fetal endoderm.
b. Normal length is about 70 cm.
c. It contains 1 umbilical vein carrying oxygenated blood.
d. False knots are commonly associated with fetal asphyxia.
e. Velamentous cord insertion refers to cord insertion at the placental edge.

66. Choose the correct statement regarding lower uterine segment

a. It starts to be formed at third month.
b. It is covered by a thin visceral peritoneum.
c. It is more active during labor.
d. It becomes shorter and thicker during labor.
e. It contains well-developed middle oblique muscle fibers.

67.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.

68.During an abdominal examination of a 30 wks gestation PG, fundal level was found to be higher than the
corresponding period of amenorrhea. All the following could be a cause EXCEPT:
a. Miscalculation.
b. Polyhydramnios.
c. Contracted pelvis.
d. Multi-fetal pregnancy.
e. Associated fibroid with pregnancy.

69.Which of the following is considered a warning symptom in pregnancy?

a. Gush of fluid per vagina.
b. Increased fetal movements.
c. Breast tenderness.
d. Nausea and vomiting.
e. Heart burn.

70.Recurrent pregnancy loss could be due to all of the following Except:

a. Genetic and chromosomal abnormalities.
b. Antiphospholipid syndrome.
c. Subserous uterine myoma.
d. Septate uterus.
e. Cervical incompetence.

71.A 47 year old female P4+1 with a proved diagnosis of complete vesicular mole. Uterine size was found to
be 24 weeks size as confirmed by ultrasound. Choose the most appropriate treatment:
a. A course of Chemotherapy should be given first.
b. Dilatation and curettage.
c. Medical abortion.
d. Hysterectomy.
e. Hysterotomy.

72.Which of the following is characteristic for true labor pains?

a. Stationary in frequency and strength.
b. Pains could be relieved by sedatives and antispasmodics.
c. Usually coincide with rupture of membranes.
d. Starts after fetal head engagement.
e. Associated with bulging of membranes.

73.As regard management of 2nd stage of normal labor;

a. Fundal pressure is mandatory to help fetal head expulsion.
b. Bearing down is discouraged.
c. Episiotomy is routinely done in primipara.
d. Head is allowed to extend after crowning.
e. After head delivery, anterior shoulder is delivered first.

74.During 3rd stage of labor, one of the following is not related to placental separation:
a. Reflex bearing down.
b. Uterus becomes harder.
c. Elongation of the umbilical cord.
d. Gush of blood.
e. Suprapubic fullness.

75.In management of third stage of normal labor:

a. Active placental delivery is associated with higher risk of post-partum hemorrhage.
b. Duration till placental delivery should not exceed 30 minutes.
c. Estimated blood loss from placental site is about 1 liter.
d. Ritgen maneuver may be used to enhance placental separation.
e. Manual separation of placenta is routinely done.

76. Failed long rotation in occipito-posterior malposition with deep transverse arrest of head during labor
may be due to:
a. Strong uterine contractions.
b. Well flexed fetal head.
c. Gynecoid pelvis.
d. Early rupture of membranes.
e. Rigid perineum

77.A 35 year’s old, multipara with previous 3CS, at 34 weeks, presented for routine ANC. Ultrasound
revealed low lying anterior wall placenta with defective plane of cleavage from the myometrium. How can
you counsel this case?
a. This is insignificant as she will deliver by cesarean section.
b. Delivery in a 3ry care hospital should be planned.
c. Placental insufficiency is highly expected.
d. Immediate termination should be considered.
e. Placenta usually migrates up.

78.Choose the correct statement regarding diabetes with pregnancy:

a. No change in insulin requirements during pregnancy.
b. Intrauterine growth retardation commonly occurs.
c. Oligohydramnios develops with poor diabetes control.
d. Neonatal hyperglycemia usually develops after labor.
e. Fetal open neural tube defects are common.

Questions 79- 80: A 23 years old PG, at 34 weeks gestation, complains of headache and blurring of vision.
Her BP was 130/80; urine test reveals epithelial cells with 1+ albumin.
79. Choose the most appropriate management for this case:
a. Analgesics and recheck after few days.
b. Antihypertensive and wait till fetal maturity.
c. Diuretics and antihypertensive till spontaneous onset of labor.
d. Fetal Doppler indices will determine time of termination.
e. Antihypertensive, IV MgSO4 infusion and urgent termination.
80. When Mg so4 therapy is used for treatment of PIH, all the following should be monitored to prevent
toxicity EXCEPT:
a. Conscious level.
b. Knee jerk.
c. Urinary output.
d. Respiratory rate.
e. Serum Mg level.

Questions 81- 82: A 25 years old woman, presented with a missed period for 1 week and an IUD in situ.
Quantitative HCG level was 500mIU/ml. No pelvic pain or vaginal bleeding. TVS revealed an empty uterus
with IUD displaced in cervical canal and left adnexal cyst 2 cm in diameter.
81.What is your interpretation?
a. Normal intrauterine pregnancy.
b. Complete abortion.
c. Data are not conclusive.
d. Ectopic pregnancy.
e. Vesicular mole.
82.What is the best management for this case?
a. Antibiotics.
b. Repeat HCG after 2 days.
c. Follow up by US after 1 week.
d. Urgent laparoscopy.
e. Needle aspiration of the cyst.

Questions 83- 84: A 26 years old P2+2, with previous precipitate vaginal deliveries, presents at 38 weeks
gestation for routine ANC. Examination and US show complete breech presentation +/- 3 kg, with normal
amniotic fluid index (AFI).
83.What would you recommend for this case?
a. Wait for spontaneous breech delivery.
b. Induction of labor.
c. Cesarean delivery.
d. Spontaneous correction is the rule.
e. Council for external cephalic version.
84.Fetal head is delivered in flexion in which of the following conditions:
a. Lt occipito anterior.
b. Direct occipito-posterior.
c. Direct mento-posterior.
d. Persistent brow.
e. Shoulder presentation.

Questions 85- 86: A PG at 29 weeks, not known to be diabetic, but has a positive family history of diabetes
mellitus. Her FBS was 120 mg/dl.
85.Which of the following treatment option best suits her?
a. No treatment.
b. Dietary modification.
c. Metformin.
d. Insulin.
e. Termination of pregnancy.
86.Choose the correct statement regarding diabetes with pregnancy:
a. No change in insulin requirements during pregnancy.
b. There is higher incidence of past date.
c. Oligohydramnios develops with poor diabetic control.
d. Neonatal hypoglycemia usually develops after labor.
e. Increased fetal movements correlate well with poor diabetic control.

Questions 87- 88: A 25 years old, 3rdG P2 with previous vaginal deliveries, presents at 36 weeks gestation
with diminished fetal movements. PV examination reveals closed, formed and posterior cervix. Fetus is
cephalic -1 station.
87.How can you manage this case?
a. Reassurance as subjective perception of fetal movement is insignificant.
b. Vaginal misoprostol.
c. Oxytocin infusion.
d. Fetal scalp PH.
e. Fetal biophysical profile.
88.After 10 days, she returns with fluid leak from the vagina and vague abdominal discomfort.
Examination is the same. How would you proceed with her?
a. Cesarean section.
b. Oxytocin infusion.
c. Vaginal prostaglandins.
d. Artificial rupture of membranes.
e. Check fetal lung maturation before making an action.

Questions 89- 90: A 30 years old G3P2 with previous myomectomy, at 20 weeks gestation, presents with
gush of fluid 1 week ago with no pains. Ultrasound revealed AFI of 1 cm. Temperature is 38.5 C, TLC is
18000. The fetus is living by ultrasound.
89.How would you manage this case?
a. Vaginal misoprostol.
b. Hysterotomy.
c. Emergency cerclage.
d. Antibiotics and follow up.
e. Non stress test (NST).
90.Expected complications for this fluid leak include?
a. Septic shock.
b. Hypovolemic shock.
c. Spontaneous scar dehiscence.
d. Amniotic fluid embolism.
e. Accidental hemorrhage.

Questions 91- 92: A 22 years old PG, pregnant 34 weeks, presents with painless continuous vaginal
bleeding. Her BP is 90/60 and pulse: 105 b/min. Ultrasound reveals placenta previa covering the cervix.
91.The most appropriate next step:
a. Digital examination to detect cervical dilatation.
b. Speculum examination to detect source of blood.
c. I.V fluids and blood transfusion.
d. Vaginal pack.
e. Tight abdominal binder.
92.On doing CS for this case, placental site bleeds heavily though the uterus was contracting.
a. Hysterectomy.
b. Vigorous uterine massage and ecbolics.
c. Bilateral internal iliac ligation.
d. Uterine pack.
e. Concomitant vaginal exploration for possible cervical tear.

Questions 93- 94: 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.
93.Which of the following complications is expected in this case?
a. Shoulder dystocia.
b. Constriction ring.
c. Placental abruption.
d. Rupture uterus.
e. Neonatal hyperglycemia.
94.After 6 hours, the contractions became more frequent, each lasting longer than 2 minutes. Spontaneous
rupture of membranes occurred at 4 cm dilatation with thick greenish liquor. Fetal head is felt 1 cm above
ischial spines. Most appropriate next step in management:
a. General anesthesia.
b. Terbutaline.
c. Amnioinfusion.
d. Oxytocin.
e. Cesarean delivery.

Questions 95- 96: A 21 years old PG, pregnant 39 weeks, presents with painful contractions every 3
minutes. PV: cervix is 5 cm dilated, 60% effaced, FHS: 130/minutes. Three hours later, PV: cervix is 6 cm
dilated; 60% effaced with intact membranes and fetal head at 0 station. FHS shows deceleration with onset
of uterine contractions and returns to normal at their end.
95.Which of the following is the most appropriate next step in management?
a. Observe for another 2 hours.
b. Oxytocin infusion.
c. Cesarean delivery.
d. Intravenous atropine.
e. Artificial rupture of membranes.
96.The neonatal care includes:
a. Consider intensive resuscitation.
b. Sodium bicarbonate administration.
c. IV adrenaline.
d. Clear airways.
e. IV antibiotics.

Questions 97-98: A healthy 30 years old G2P0, at 32 weeks gestation presents with infrequent labor pains
with intact membranes.
97. Initial management will be:
a. Tocolytics.
b. Cesarean section.
c. Analgesics.
d. Emergency cerclage.
e. Augment labor by oxytocin.
98.Complications most liable to occur in this patient:
a. Cervical dystocia.
b. Retained placenta.
c. Neonatal respiratory distress syndrome.
d. Intrauterine fetal distress.
e. Placental separation.

Questions 99- 100: A 37 years old PG, at 32 weeks, presents with bilateral lower limbs edema more marked
on Rt side with tender calf muscle. She is not in labor and has irrelevant medical and surgical histories.
99. Most probable diagnosis:
a. Physiological orthostatic edema.
b. Heart failure.
c. Nutritional edema.
d. Deep venous thrombosis.
e. Renal edema.
100. Your investigations will include:
a. Kidney functions.
b. Echo heart studies.
c. Coagulation profile.
d. Lower limbs Doppler studies.
e. Lower limbs angiography.

Questions 101- 102: An anemic 39 years old, G5 P5, presented with rupture uterus and intraperitoneal
hemorrhage during spontaneous vaginal delivery at home.
101. Risk factors of rupture uterus in this case include all of the followings EXCEPT:
a. Maternal anemia.
b. Pelvic osteomalacia
c. False sense of security.
d. Weak uterine muscles with excess fibrous tissues.
e. Pendulous abdomen.
102. Best management includes:
a. Cesarean section.
b. Hysterectomy.
c. B-Lynch sutures.
d. Laparoscopy.
e. Selective embolization of the uterine arteries.

Questions 103- 104: A 25 years old, 2nd GP1, in labor. Cervix is 7cm dilated and 80% effaced with recent
rupture of membranes. The basal fetal heart rate is 120 - 140/minute but falls occasionally to 100/ minute
unrelated to uterine contractions.
103.How can you explain the FHR pattern?
a. Normal pattern.
b. Cord compression.
c. Head compression.
d. Fetal distress.
e. Fetal anemia.
104.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 105- 106: A 35 years old, G3P2, with previous 1 CS due to hypertension, presents at 32 weeks
complaining of severe headache and reduced fetal movements. Her BP is 150/90 and ultrasound reveals
asymmetric growth restriction and AFI: 3.
105.Which of the following investigations is correlated to her condition?
a. Glycosylated hemoglobin.
b. Fetal Doppler.
c. Fetal anomaly scan.
d. Hepatitis B surface antigen.
e. All of the above.
106.Possible complications for this case include all the following EXCEPT:
a. Eclampsia.
b. Accidental hemorrhage.
c. Intrauterine fetal death.
d. Delayed fetal lung maturation.
e. Premature labor.

Questions 107- 108: A 37 years old G3P2 presents for follow up after methotrexate treatment for ectopic
pregnancy 1 week ago. Now she has lower abdominal discomfort. HCG dropped from 1800mIU/ml to 1500
over the past week. TVS shows minimal fluid in Douglas pouch.
107. Which of the following is the most appropriate next step in management?
a. Expectant management.
b. Add vaginal misoprostol.
c. Laparotomy.
d. Transvaginal aspiration of ectopic.
e. Hysterectomy.
108.The patient should be advised to:
a. Postpone next pregnancy for one year.
b. Follow up HCG for one year.
c. Combined oral contraceptive pills are contraindicated.
d. Mirena intrauterine device is preferable for contraception.
e. Increased risk of ectopic pregnancy in subsequent pregnancies.

Questions 109- 113: A 25 years old woman P1 +0, lactating for 9 months with irregular cycles, presents with
absent period for 8 weeks. She is on progesterone only pills for contraception.
109.Differential diagnosis for this amenorrhea may include all the followings EXCEPT?
a. Thyroid disorder.
b. Sheehan’s syndrome.
c. Lactational amenorrhea.
d. Polycystic ovarian disease.
e. New pregnancy.
110.The most recommended investigation that you will first order is:
a. Serum prolactin.
b. Vaginal ultrasound.
c. Serum progesterone.
d. FSH and LH.
e. Free T3, T4, TSH.
111.If this case is proved to be pregnant, knowing that her LMP was on 30 April 2020, what will be her
EDD?
a. 1st week of February 2021.
b. Last week of February 2021.
c. 1st week of January 2021.
d. Last week of January 2021.
e. Last of December 2020.
112.If intrauterine gestational sac of 5 weeks size with no pulsations is detected. How can explain these
findings to the patient?
a. Missed abortion is confirmed.
b. Higher risk of fetal anomalies.
c. Concomitant ectopic tubal pregnancy should be excluded.
d. Partial mole is suspected.
e. Her menstrual age is unreliable and re check after 1 week.
113.If this patient becomes very irritable about your findings, what else you can request?
a. Endometrial curettage.
b. Detect doubling of HCG.
c. Request 3-D ultrasound.
d. Genetic studies for both parents.
e. Laparoscopy.

Questions 114- 118: An 8 weeks pregnant 2ndG P1, presented with severe vaginal bleeding following
intercourse. Cervix was opened and ultrasound revealed a single intrauterine living embryo.
114.What will be your diagnosis?
a. Threatened abortion.
b. Inevitable abortion.
c. Incomplete abortion.
d. Missed abortion.
e. Vesicular mole.
115.What is the management for bleeding in this case?
a. Rest, progesterone supplementation and follow up.
b. Vaginal misoprostol.
c. Urgent cerclage.
d. Laparotomy.
e. Surgical evacuation.
116.She is Rh –ve while her husband is Rh +ve. What will be your next step?
a. No risk for maternal sensitization.
b. Anti D should be given.
c. Anti D should be given if the mother is sensitized.
d. Anti D should not be given before 28 weeks.
e. Anti D should be given only after delivery.
117.One week after management, she returns back with high fever, persistent vomiting, generalized
tenderness and rebound tenderness all over the abdomen. What is the most probable cause?
a. Colitis.
b. Torsion of theca lutein cysts.
c. Incomplete abortion.
d. Infected cerclage.
e. Perforated uterus.
118.What is the expected complication for this case?
a. Septic shock.
b. Recurrence.
c. Malignant transformation.
d. Preterm labor.
e. Cervical dystocia.

Questions 119- 123: A 3rd G P0, pregnant 32 weeks presents with an attack of mild painless vaginal bleeding
for one day. She is normotensive and ultrasound reveals mild IUGR with fundal posterior placenta.
119.What will be your next step for diagnosis?
a. PV examination under anesthesia.
b. Speculum examination.
c. Amniocentesis.
d. MRI.
e. Laparoscopy.
120.If this patient is allowed for conservative treatment, all the followings labs are correlated to her
condition EXCEPT?
a. Complete blood count.
b. Blood group and Rh type.
c. PT, PTT, INR.
d. Eye fundus examination.
e. Protein C, Protein S, Antithrombin III levels
121.Which medications you need to give to this patient?
a. Antibiotics.
b. Tocolytics.
c. Oral anticoagulant.
d. Corticosteroids.
e. No medications are needed now.
122.What would be your suggested management?
a. Follow up.
b. Oxytocin and artificial rupture of membranes.
c. Prostaglandins to induce cervical ripening.
d. Immediate CS.
e. Counsel about possible cesarean hysterectomy.
123.Possible fetal risk in this case include all the followings EXCEPT:
a. Fetal congenital anomalies.
b. Intrauterine fetal death.
c. Premature labor.
d. Oligohydramnios.
e. Preterm premature rupture of membranes.

For questions 124- 128, choose the SINGLE most appropriate answer from the below list of options. Each
option may be used once, more than once or not at all.
a. Labor observation.
b. Oxytocin infusion.
c. Prostaglandins.
d. Caesarian section.
e. Forceps delivery.
f. Artificial rupture of membranes.

124. A 20 year old PG, pregnant 32 weeks was admitted to E.R with infrequent abdominal pains and fluid
escape from vagina. Examination revealed a 4 cm cervical dilatation, 60% effaced and a foot was coming
out from the cervix. Pelvic cavity was felt adequate and buttocks were felt at -1 station.

125. A full term pregnant, P3+1 had a fully dilated cervix for 1 hour with ruptured membranes, cephalic
presentation, occipito- anterior position, station -2. About 2 contractions were felt every minute.

126. A PG, 34 weeks pregnant with occipito-posterior position, +1 station, had a fully dilated cervix for 1
hour with intact membranes and infrequent uterine contractions. FHR is reassuring.

127. A 42 weeks pregnant P2+0, presented to ER with vague infrequent abdominal pains. Examination
revealed average sized cephalic fetus with audible fetal heart. On PV examination, the cervix was central, 4
cm dilated, 50% effaced, head at zero station with ruptured membranes.
128. A PG with full term twin pregnancy ,dichorionic diamniotic, presented during the 1 st stage of labor
.Her examination revealed a 7 cm dilated cervix ,90% effaced, 1st presenting fetus in a transverse lie with
intact membranes.

For questions 129- 133, choose the SINGLE most appropriate answer from the below list of options. Each
option may be used once, more than once or not at all.
a. Placenta previa.
b. Accidental hemorrhage.
c. Rupture uterus.
d. Vaginal lacerations.
e. Vasa previa.
f. Cervical pathology.

129. P1+0, full term pregnant, previous CS, during the 1st stage of spontaneous labor had cessation of
uterine contractions, continuous mild vaginal bleeding and hematuria. Fetal heart monitoring showed
severe fetal bradycardia.

130. P3 +2, 34 weeks pregnant, had a sudden attack of profuse fresh painless bleeding. She claimed that she
had similar attacks of bleeding, though mild at 24 weeks pregnancy. No available previous ultrasound
reports.

131. A 32 weeks pregnant elderly PG presented to ER by severe lower abdominal pain with hard uterus of
36 weeks size and absent fetal heart. Mild vaginal bleeding was present with deteriorating general
condition.

132. A full term pregnant P1+ 0 was admitted during the 1st stage of labor. Polyhydramnios was diagnosed
clinically and by ultrasound. Sudden gush of fluid escaped from vagina while she was going to WC,
followed by mild attack of fresh bleeding.

133. A full term P1+0 had undergone instrumental forceps delivery for a prolonged labor after which she
had a mild vaginal bleeding and markedly deteriorating general condition with undelivered placenta.

Mark True or False for the below statements:

134. In monozygotic twins, if splitting of fertilized ovum occurred at day 1 to day 3 of fertilization, the result
will be dichorionic diamniotic identical twins.

135. In eclampsia cases treated by Mg sulphate infusion, loss of knee reflex is the earliest evidence of Mg
sulphate toxicity.

136. Increased fetal nuchal translucency thickness more than 3 mm at 20 weeks gestation is highly
suggestive of Down syndrome.

137. Slowing of fetal heart with onset of uterine contractions denotes fetal distress.
138. A rising transverse groove on maternal abdomen during labor may denote obstructed labor.
139. Commonest medical disorder encountered during pregnancy is iron deficiency anemia.
140. Commonest cause of maternal mortality in Egypt is obstetric hemorrhage.

Best of Luck