Obstetrics & Gynecology 6

1. Question

The following statements about breech delivery are correct except:

Breech extraction is more hazardous than assisted breech delivery.
Pipers forceps are best suited for delivery of the after-coming head.
The Mauriceau – Smellie – Viet and Burns Marshall manouvers are used for delivery of the after-coming head.
Breech delivery is not associated with any complication(s).
External cephalic version has a place in the management of breech presentation.

2. Question

Disorders of sexual differentiation should be considered in the following infants except

Bilaterally nonpalpable testes
Maternal prenatal exposure to androgens
Scrotal or perineal hypospadias
Maternal preeclampsia
Hypospadias and unilateral non-palpable gonad

3. Question

In events of Puberty,

Thelarche requires Progesterone
Puberche requires estrogen
Menarche requires GnRH from the pituitary
Menarche requires FSH and LH from the hypothalamus
The median weight for Menarche is 51.1kg

4. Question

The Manchester operation, which is false

May be ring or shelf type
Are used as therapeutic test
Infections are not complications envisaged
They are the most popular form of conservative therapy
They can be used both during and after pregnancy

5. Question

Zatuchini-Andros scoring system (ZASS) is useful in assessing undiagnosed breech for delivery. The following statement is not true about the system:

Score of 3 or less (≤ 3): do caesarean section.
Score of 6 or more (≥ 6): allow for vaginal breech delivery.
Some of the parameters used for the scoring include parity, gestational age in weeks and estimated foetal weight in gram.
Previous vaginal breech delivery, cervical dilatation and station are not included in the parameters used for scoring.
Newman scoring index is different from Zatuchini-Andros scoring system.

6. Question

The following investigation is not useful in evaluation of disorders of sexual differentiation

7-hydroxyprogesterone
Testosterone and other steroid metabolites
Ultrasonography.
Retrograde urethrogram
None of the above

7. Question

Concerning skin incision in caesarean section,

Sub-umbilical incision is less vascular but gives poor exposure
Pfannenstiel incision is a curved incision 4cm above the pubic symphysis.
Sub-umbilical gives better cosmetics results than Pfannenstiel incision
Cohen’s incision is a curve incision placed slightly lower than Pfannenstiel.
Transverse suprapubic incision is generally preferable to a vertical midline incision in uncomplicated caesarean section.

8. Question

The following statement is correct:

Fetal presentation refers to the part of the fetus that occupies the upper uterine segment.
Abnormal fetal presentation is any fetal presentation to the maternal pelvis/lower uterine segment other than cephalic/vertex.
Abnormal fetal presentation is cephalic presentation.
Fetal presentation is same as fetal lie.
Face and brow presentations are normal presentations because they are not associated with any complications.

9. Question

Which of the following is true?

47 XXY – Down’s syndrome
46 XY – Testicular feminisation
45X/46XXY – Turner’s syndrome
46 XXX – Klinefelter’s syndrome
45 XO – Noonan’s syndrome

10. Question

The parts of the forceps are as follows:

Handle- lock -shank – blade
Handle – shank – lock – blade
Handle – blade- lock
shank-handle-blade
lock- blade- lock

11. Question

Abnormal fetal presentation include the following except:

Brow presentation.
Compound presentation.
Face presentation.
Cephalic presentation.
All of the above.

12. Question

In physiological changes in pregnancy, blood volume expansion

Increases gradually in second trimester
Plateau at about 35 weeks
Plasma – increases by 30%
Hypovolemia of pregnancy compensates for the maternal blood loss at delivery ( 500ml – Vaginal, 1000ml – C/S)
The most marked expansion occurs in extra cellular volume (ECV) with some increase in intra cellular water.

13. Question

condition that must be fulfilled before embarking on Forceps delivery

the cervix must not be fully dilated
fetal head must not be engaged
the bladder must be empty
the estimated fetal weight must be less than 4.5kg
the membrane may not be ruptured

14. Question

The following statement is not correct about face presentation:

Face presentation occurs in about 1:500 deliveries.
Face presentation is associated with prematurity and anencephaly.
Face presentation results in the presentation of submento-bregmatic diameter of the fetal head to the pelvic brim.
Face presentation results in the presentation of suboccipito-bregmatic diameter of the fetal head to the pelvic brim.
Face presentation is due to complete extension of the fetal head.

15. Question

Concerning cardiac output changes in pregnancy,

cardiac output increases by 40%
stroke volume increases by 50%
stroke volume Peak value at 32 weeks’ GA
Maximum CO is associated with 50% increase in stroke volume and a 30% rise in HR.
Resting HR – decreases progressively over the course of gestation – average at term 15 beats/min more than non-pregnancy state

16. Question

The advantage of Forceps over Vacuum:

it can be safely used to deliver premature infant with birthweight less than 1.5kg
it is easily learnt
it does not occupy space
it has in-built safety mechanism
it can be used in the late first stage of labour

17. Question

Best matched delivery option in the management of abnormal fetal presentations include:

Footling breech: spontaneous vaginal delivery.
Brow presentation of term baby with mento-vertical diameter (13.5cm): caesarean section.
Shoulder presentation at term: assisted vaginal breech delivery.
All types of breech presentations: spontaneous vaginal delivery.
None of the above

18. Question

Concerning heart murmur and rhythm changes in pregnancy

Systolic ejection murmur – can be detected in 90% or more gravida
First heart sound may be split, with decrease loudness of both portions
Third heart sound is quite
Continuous murmur or bruits is not heart
Sinus tachycardia is absent.

19. Question

Outlet Forceps is used when

the leading point of the fetal skull is at station +2
the leading point of the fetal skull is on the pelvic floor
the head is engaged
the fetal scalp is visible at the introitus without separating the labia
the point of the fetal skull is above station +2

20. Question

Which of the following is true

Nuchal translucency can be used as a third trimester screening test for Down’s syndrome
The dating scan is not useful for determining chorionicity in twins
The biophysical profile should routinely be performed at booking
The dating scan can confirm fetal viability
The anomaly scan is routine done at 13 weeks

21. Question

Concerning development of placenta

Principal component is maternal – chorion frondosum
It begins at 4 weeks and is completed by 12th week
From 16th weeks, placenta grows in thickness and circumference
Circular Disc with diameter of 15-20cm and thickness of about 2.5cm at its center weighs about 500gm
Proportion to the weight of the baby being roughly 1:6 at term

22. Question

Patients who are most suitable candidates for trial of labour after caesarean section are those

with prior classical incision
with recurring conditions
with prior vaginal delivery
Had two previous caesarean sections
postdated pregnancy

23. Question

Regarding ultrasound measurements

Pregnancies should ideally be dated using ultrasound between 24 to 28 weeks gestation
When measurement of nuchal translucency in the ﬁrst trimester is 1.5 mm or more, it is associated with an increased risk of fetal cardiac anomalies and aneuploidy
The crown-rump length is the most accurate dating parameter up to 13+6 weeks gestation age
Trisomy 1 is the most common aneuploidy associated with increased nuchal translucency
Cardiac defects are not associated with increased nuchal translucency

24. Question

Concerning placental structure at term

The syncytio-trophoblast becomes relatively thicker at places overlying the fetal capillaries and thin at other areas containing extensive endoplasmic reticulum
The cyto-trophoblast is abundant
Basement membrane becomes thinner
Stroma contains dilated vessels along with all the constituents and large Hofbauer cells
These cells have IgG surface receptors and can express class MHC molecules

25. Question

Concerning management of Benign Trophoblastic disease

Anti-hypertensives are not useful
A mole of 14 weeks is treated by suction curettage(12WKS)
Pulmonary metastasis is usual and is not an indication for chemotherapy in patients with high HCG levels
Progressively high B-HCG levels from 4-6 weeks post evacuation is an indication for chemotherapy
Monthly chest X-ray is recommended

26. Question

Which of the following is NOT associated with increased nuchal translucency

Hydrocephalus
Agenesis, hypoplasia, and dysplasia of the lung
Atresia and stenosis of the small intestine
Osteodystrophies
None of the above

27. Question

Concerning uteroplacental circulation,

Mature placenta has a volume of about 1000ml of blood.
Blood in the intervillous space is completely replaced about 6-8 times/minutes
Intervillous space pressure is about 10-15 mm Hg during uterine relaxation and 30 – 40 mm Hg during uterine contraction
Cytotrophoblastic invasion into the spiral arteries – 8 weeks of pregnancy
Secondary invasion of trophoblast converts the spiral arteries into small bore uteroplacental arteries

28. Question

Concerning Benign Trophoblastic disease, which of these is false?

Complete type is associated with evidence of fetus
Partial mole has evidence of the presence of a fetus
High levels of B-HCG cause thyrotrophic effects
Cigarette smoking is a recognized risk factor
None of the above

29. Question

Concerning the Combined test

Late third – trimester test based
Does not include Nuchal translucency
Involves measuring Free β – HCG only
Pregnancy – associated plasma protein A (PAPP – A) is part of the test
Maternal age is not used

30. Question

Amniotic Fluid

Faintly acidic
High specific gravity
Golden colour in Rh incompatibility
Greenish yellow in abruptio
pale straw colour in early pregnancy

31. Question

Stage 1 cancer of the cervix,

Is confined to the uterus
May not be visible on clinical examination
Has a better prognosis than stage 1 cancer of the endometrium
May be treated with intra-cavitary radiation and external radiotherapy
All of the above

32. Question

Concerning development of the genital ducts, which of the following is true

Both male and female embryos have two pairs of genital ducts
The mesonephric ducts play an important role in the development of the female reproductive system
The paramesonephric ducts have a leading role in the development of the male reproductive system
Till 28 weeks, the genital system is in an indifferent state, when both pairs of genital ducts are present
None of the above

33. Question

Concerning Amniotic fluid volume

50ml at 8weeks
400mls at 10 weeks
Reaches its peak of 1L at 40weeks
At term, it measures about 600 – 800 mls
As the pregnancy continues post term, further increase occurs.

34. Question

Invasive carcinoma of the cervix, which is true

Is commonly an adenocarcinoma
Can present as vaginal discharge
Is often diagnosed at laparoscopy
Is common in nulliparous women
Is treated by cone biopsy

35. Question

Concerning the development of the female genital duct

In female embryos, the paramesonephric ducts regress because of the absence of testosterone
Paramesonephric ducts develop because of the absence of mullerian inhibiting substance (MIS)
Female sexual development depends on the presence of ovaries or hormones
The mesonephric ducts form most of the female genital tract
The mesonephric ducts fuse in the midline to form the uterus and upper part of the vagina

36. Question

Turner Syndrome has the following characteristic/ features,

Complete absence or a partial abnormality of one arm of X chromosome
About 90% has mosaic form such as 45X/46XX or 45 X/ 47XY
Narrow carrying angle
shield chest with widely spaced nipple
secondary amenorrhea

37. Question

Concerning colposcopy, which of these is true

Crazy paving appearance is not associated with malignancy of the cervix
Application of 10 % acetic acid highlights healthy areas as aceto white 5%
Schiller’s test identifies normal squamous epithelium
Lugol’s iodine shows dark brown staining of abnormal epithelium
None of the above

38. Question

In the development of the female external genitalia, which of these does not occur

Growth of the primordial phallus gradually ceases and becomes clitoris
Urogenital folds fuses posteriorly to form the frenulum of the labia minora
The unfused parts of the urogenital folds form the labia minora
Labia majora are homologous to the scrotum
None of the above

39. Question

Concerning Utero-vaginal agenesis

15% primary amenorrhea
No secondary sexual development
Abnormal external female genitalia
Male range testosterone level
karyotype 46xy

40. Question

Carcinoma of the vulva:

Does not ulcerate until it is advanced
Spreads initially to iliac nodes via vaginal lymphatics
Seldom involves lymph nodes at time of presentation
Is equally amenable to treatment by surgery and radiotherapy
All of the above

41. Question

Concerning anomalies of the hymen and vagina

Anomalies of the vagina is never associated with other genital tract anomalies or with extragenital abnormalities, particularly of the urinary tract.
Vaginal agenesis is the congenital absence of the vagina with variable uterine development
Vaginal anomalies do not present with primary amenorrhea
The diagnosis of vaginal anomalies cannot be made on examination of the vagina.
Pelvic or renal ultrasound is not useful in evaluation

42. Question

Androgen insensitivity Syndrome

Is X linked recessive trait
Failure of normal masculinization of the external genitalia in chromosomally XX individuals.
5-alpha reductase deficiency
Normal androgen receptor.
Abnormal testosterone receptor

43. Question

Bartholin’s cysts

Should always be excised to prevent recurrence
Are situated in the inner side of the posterior end of the labium majora
May be infected by Gonorrhea
Are usually bilateral
Is not easily confused with hidradenoma

44. Question

In the Mayer-Rokitansky-Kuster-Hauser syndrome, which of the following is false

Congenital absence of the vagina with variable uterine development.
The vagina is always present
It results from agenesis of the Müllerian duct system
It is usually accompanied by cervical and uterine agenesis
Patients often exhibit extragenital anomalies

45. Question

Premature ovarian failure

Menopause before the age of 30 years
Auto-immune disease is the most common cause
Before puberty or in adolescent – constitutional abnormalities.
Causes mostly primary amenorrhea
Iatrogenic factors is the most common cause

46. Question

Bacterial vaginosis, which is true

Is the commonest cause of vaginal discharge
Is commoner with women with an IUCD in situ
Is associated with a decrease in vaginal pH and the number of anaerobes
Is diagnosed by the presence of clue cells on macroscopy
Causative organisms include Gardnarella, Bacteroides and Lactobacillus

47. Question

Incidence of breech presentation at term is:

3 – 4 %
50%
1%
28%
14%

48. Question

Uterine anomalies may cause

Increased risks of miscarriage
Intrauterine growth restriction
Cervical incompetence
All of the above
None of the above

49. Question

Concerning menstrual cycle,

The median age of menarche is 13-16 years.
Primary amenorrhea is the absence of menstruation by the age of 14 years in the presence of secondary sexual characteristics
Secondary amenorrhea is absence of menses 12 months in a woman who previously had normal menstrual function.
Polymenorrhea is menstrual interval greater than 21 days.
Primary amenorrhea is absence of menstruation by 16 years.

50. Question

Concerning pessaries, which is false

May be ring or shelf type
Are used as therapeutic test
Infections are not complications envisaged
They are the most popular form of conservative therapy
They can be used both during and after pregnancy