Obstetrics & Gynecology 7

1. Question

In pregnancy, which of these statements is correct?

The red cell mass usually increases by approximately 50%
The plasma volume usually increases by about 50%
The uterine blood flow usually increases by about 50%
The maternal pulse rate usually increases by about 50%
The maternal pulse pressure usually increases by about 50%

2. Question

A 24-year old primigravida was seen at the antenatal clinic at a gestational age of 37 weeks and noticed to have a blood pressure of 160/100 mmHg and bilateral pitting pedal edema. Choose the appropriate option.

Immediate urinalysis to exclude glycosuria is essential.
The serum uric acid level is likely to be high
Hydralazine should be administered intramuscularly to lower the blood pressure to normal
The patient should be counseled to keep a fetal kick chart to monitor the fetus until the 40th week of gestation
A caesarean section should be done immediately

3. Question

Which of the following imaging technique is appropriate in assessing the size and location of uterine fibroids?

Plain Abdominal X-ray
Magnetic Resonance Imaging
Hysterosalpingography
Pelvic Ultrasonography
Sonohysterography

4. Question

Which statement is correct regarding a blood pressure of  170/110 mmHg in a pregnant woman?

Should be delivered regardless of gestation
Has pre-eclampsia, if associated with edema
Needs immediate anti-hypertensive treatment
Is best treated with diazepam
Must only be treated if proteinuric and in labour

5. Question

A 29 year old Confidential Secretary had a Manchester Repair operation done. In which way may her subsequent reproductive function be affected?

Increased sexual urge
Anovulatory infertility
Recurrent first trimester abortions
Cervical cancer
Cervical dystocia

6. Question

Risk factors for cancer of the endometrium include the following, EXCEPT

Obesity
Low parity
Prolonged unopposed use of estrogen
Low socio-economic status
Diabetic mellitus

7. Question

In evaluating for abnormalities of puberty,

The absence of thelarche in girls by 9 yrs, and testicular development by 10 yrs is significant
The use of height, weight, and BMI charts are not mandatory
A history of regressed developmental milestones is important
Development of pubic hair before 14 yrs of age may not be significant
Sickle cell disease may be a cause of precocious puberty

8. Question

An unbooked 36-year old grandmultipara was admitted in labour. She ruptured her membranes as she was being rushed to the hospital. Examination revealed a prolapsed umbilical cord, pulsating strongly, at a cervical dilatation of 9cm. The fetus had a vertex presentation and the pelvis was adequate. Appropriate measures include the following, EXCEPT

Replacement of the umbilical cord into the vagina to keep it warm as urgent preparations for delivery are made.
An immediate caesarean section
An immediate forceps delivery
An immediate vacuum extraction
Setting up a syntocinon infusion to enhance uterine contractions and hasten spontaneous vaginal delivery

9. Question

Which of the following is the chemical used in delineating abnormal area of the cervix during colposcopy

Acetic Acid
Radioactive Iodine
Hematoxylin and Eosin
Toluidine Blue
Gentian Violet

10. Question

The Manchester operation, which is false

Involves anterior colporraphy
Involves posterior colpoperineorraphy
Does not preserves the cervix
Is recommended for persons who want to preserve fertility
Is also called Forthergill operation

11. Question

A 28-year-old multipara experienced a generalized seizure 40 minutes after a normal vaginal delivery. She probably had?

Bacterial Meningitis
Epilepsy
Food poisoning
Tropical ataxic neuropathy
Eclampsia

12. Question

A 26-year old primigravida patient presented with anorexia, nausea, right hypochondrial pain of 10 days’ duration and jaundice of 2 days’ duration at 34th week of gestation. Which of the following statements is true?

The least likely diagnosis is viral hepatitis
Rest is an essential part of management
Carbohydrate intake should be restricted
A high protein diet can be commenced if the level of serum amino-transferases is falling
A caesarean section should be done immediately

13. Question

A 26-year old nulliparous patient presents with a 6 year history of irregular menstruation. She has also noticed that she has gained a lot of weight and was having to remove a lot of facial hair. Which of the following statement about her is correct?

The most likely diagnosis is endometriosis
The plasma level of androgens is not likely to be raised
The plasma level of luteinizing hormone is likely to be raised
The plasma level of follicle stimulating hormone is likely to be raised
The urinary 17-ketosteroids are normal

14. Question

Concerning delivery the following is incorrectly matched:

Extended legs – Pinard manouvre
Extended arms -Woodscrew manouvre
After coming head – Mauriceau- Smellie Viet manouvre
Footling presentation – Caesarian Section
Placenta – Brandt- Andrews method

15. Question

A 32 year old Para 3+0 lady presents with irregular vaginal bleeding, Passage of vesicles and cough after 4 months of amenorrhea. Which of the following test will be useful in the management of her condition?

Sputum microscopy for acid-fast bacilli (AFB).
Ultrasonography
CA 125 assay
Hysteroscopy
Pelvic angiography

16. Question

The following modalities are commonly used to treat cervical intraepithelial neoplasia EXCEPT

Cryotherapy
Colporrhaphy
Colpocleisis
Loop excision procedure
Carbon dioxide laser vaporisation

17. Question

Hormones secreted by the ovaries include the following EXCEPT

Relaxin
Inhibin A
Estradiol
Luteinizing Hormone
Aldosterone

18. Question

The following are correctly matched:

Pelvic inlet A-P diameter
Pelvic mid cavity transverse diameter -13.5cm
Pelvic outlet transverse diameter -12cm
Sub occipito bregmatic diameter -10.5cm
Mentovertical diameter -13cm

19. Question

In Rokitansky syndrome,

The uterus is absent or rudimentary
The vaginal is absent
The presenting symptom is secondary amenorrhea
The ovarian function is normal
Vulva development is abnormal

20. Question

The following can be used to ripen the cervix except:

Laminarian tent
Distended balloon of foley’s catheter
Prostaglandin inhibitors
Oxytocin
Syntometrine

21. Question

In the prevention of Rhesus disease iso-immunization, anti D should not be given to Rhesus negative women:

Within 72 hours of delivery of a Rhesus positive child
Who are known to have Rh antibodies, within 72 hrs of delivery
Following a termination of pregnancy, even when the father is known to be heterozygous
When an ECV has been performed
Following a small APH

22. Question

Patients with Turner’s syndrome characteristically have

Normal clitoris
Normal vagina
Normal uterus
Normal ovaries
Well-developed breasts

23. Question

The following are contraindications to external cephalic version during the antenatal period EXCEPT

Multiple pregnancy
Antepartum hemorrhage
Rhesus-negative mother
Ruptured membranes
Singleton pregnancy

24. Question

In normal pregnancy, the following physiological changes take place:

Increase in plasma volume of 80%.
Decrease in cardiac output of 40%.
Increase in stroke volume of 20%.
A mid-trimester increase in blood pressure.
Increase in blood cell volume of 80%.

25. Question

Upon abdominal palpation of a pregnant woman at 37 weeks gestation , the fetal head is felt in the in the uterine fundus, the fetal back to the mother’s left flank and the fetal heart tones to the left above maternal umbilicus. What position does this represent?

Left occipito-posterior
Left occipito-anterior
Left sacro-anterior
Left sacro-posterior
Left mento-anterior

26. Question

A 32-year old multipara started bleeding per vaginum 10 days after a spontaneous vertex delivery of a live male infant. Probable cause of this include

Uterine atony
Ruptured uterus
Retained products of conception
Uterine fibroid
Uterine didelphys

27. Question

Signs suggestive of ovulation does not include:

Regular menstrual cycles.
Decreased progesterone level in the follicular phase.
Presence of basophilic vaginal squames with vesicular nuclei, in the luteal phase of the cycle.
Secretory endometrium on day 21 of the cycle.
An increased LH: FSH ratio.

28. Question

The following drugs can cross the “placental barrier” when administered in clinical doses during pregnancy EXCEPT

Magnesium Sulphate
Diazepam
Pethidine
Insulin
Fractionated Heparin

29. Question

The following are germ-cell tumours of the ovaries EXCEPT

Gonadoblastoma
Gynandroblastoma
Choriocarcinoma
Endodermal sinus tumour
Dysgerminoma

30. Question

The following drugs are contraindicated in pregnancy:

Streptomycin.
Methotrexate.
Metronidazole.
Tetracycline.
None of the above

31. Question

The high plasma concentration estrogen seen during the late follicular phase of the normal menstrual cycle occurs as a result of

Peripheral conversion of androstenedione
Steroidogenic activity of developing follicles in the ovaries
Ovulation
Altered renal function
Corpus luteum steroidogenesis

32. Question

The following are recognised causes of vulval ulcers EXCEPT

Tuberculosis
Lymphogranuloma venerum
Donovanosis
Behcet’s disease
Syphilis

33. Question

The following signs / symptoms are associated with the climacteric except:

Osteoporosis
Vasomotor instability
Anxiety.
Dyspareunia.
Post-coital bleeding

34. Question

Contraindications to the use of combined oral pills include the following, EXCEPT

Lactation
Migraine
previous history of cholestatic jaundice of pregnancy
previous PID
blood dyscrasias

35. Question

Which one of these statements is true regarding septic abortion?

It is a more common cause of maternal death than malaria
Should be treated by immediate curettage in all cases.
Married women are more affected than teenagers
May predispose to primary infertility in affected patients
Is frequently due to a combination of staphylococcus and streptococcus.

36. Question

GnRH analogues may be used in all of these except

For the induction of ovulation.
In the treatment of uterine fibroids.
In the assisted conception techniques.
In medical induction of abortion.
All of the above

37. Question

Multiple pregnancy is associated with

Discordant growth
Decreased incidence of placenta abruption
Decreased incidence of placenta previa
Oligohydramnios
Polycythemia in the twins

38. Question

Which of these is an indication for hysterectomy?

Interstitial pregnancy
Pelvic abscess not responding to antibiotic treatment.
Pelvic endometriosis.
Gestational trophoblastic disease.
Early invasive cervical cancer.

39. Question

Concerning Placenta Previa:

It is defined as a placenta that is wholly located in the lowest segment.
Type 2 placenta previa partially covers the internal cervical os.
It is associated with painful vaginal bleeding in the 3rd trimester of pregnancy.
It may be asymptomatic.
Its presence at 30 weeks gestation always necessitates elective caesarean Section at Term.

40. Question

The following agents enhance ‘Insulin Resistance’ in diabetic pregnant woman, EXCEPT

increased free cortisol levels
human placental lactogen
high progesterone levels
prolactin
high oestradiol levels

41. Question

The following are features of severe birth asphyxia EXCEPT

Profound hypertonia
‘Cerebellar Cry’
Severe Convulsions
Respiratory Failure
Hyporeflexia

42. Question

Which of the following can cause Dysfunctional Uterine Bleeding?

Endometriosis
Endometrial polyp
Functional ovarian cysts
Polycystic ovarian disease
Luteal phase deficiency

43. Question

Irreversible cause of delayed puberty in girls includes

diabetes mellitus
hyperprolactinaemia
hypothyroidism
Kallman’s syndrome
anorexia nervosa

44. Question

A 28-year old man undergoing investigations for infertility had a semen volume of 4 ml, a sperm count of 85 million per ml with 65% normal forms and 35% with purposeful forward movement. What does the patient have?

Oligozoospermia
Asthenozoospermia
Teratozoospermia
Polyzoospermia
Normozoospermia

45. Question

Regarding Bartholin cysts, which of the following statements is correct?

Is only painful when it is infected
Are situated on the inner side of the bulb of the vestibule
Can also result from blockage of the duct of para-urethral gland
Are usually congenital
Can be caused by human papilloma virus

46. Question

Which statement is correct regarding natural menopause?

It can only be defined retrospectively
It occurs later in smokers
It commonly has pruritus as a symptom
It occurs significantly earlier in short-statured women
It occurs later than average in nulliparous compared to parous women

47. Question

Which of the following statements about cervical carcinoma is correct?

It is the least common malignant tumour in Nigerian women
It is usually an endodermoid carcinoma
The invasive type is best diagnosed by culdoscopy
It is often found in association with human papilloma virus infection of the cervix
It responds well to cytotoxic drugs

48. Question

Normal menstrual cycle is characterized by which of the following?

The average cycle length of 32 days
The range of cycle length between 21 to 35 days
The average duration of blood flow of 8 days
The normal blood loss in a cycle of 150 mls
Occurrence of 10 times a year

49. Question

Which of the following is not an identifiable predisposing factor to hypertensive disorders of pregnancy?

Age
Parity
Partner’s blood pressure
Obesity
Smoking

50. Question

Which of the following is commonly found in neonates of women with diabetes mellitus on the 2nd day of life?

Macrosomia
Hyperglycemia
Hypercalcemia
Anemia
Polycythemia