AFLAX GROUP

OBSTETRICS COMPREHENSIVE TEST

Instructions to candidates:
1. The paper consists of 10 pages (including the cover page),
and three parts MCQs, EMQs, & short answer questions
2. Total marks required are 100 points
3. Passing mark is equal or more than 70 points
4. Total time allowed is 2 hours (plus 10 min reading time)
5. Instructions for each question are written clearly above it.
Read them carefully.

Date: 06.03.2015

McWarsame.

Part one: MCQs

Directions: Select the ONE BEST
response to each question. Each
question is worth 1 points.
1.
1. Each of the following is a risk
factor for shoulder dystocia
except:
A. Maternal gestational
diabetes
B. Fetal hydrocephaly
C. Maternal obesity
D. Fetal macrosomia
2.
2. Each of the following is a
maneuver that is useful when
encountering shoulder dystocia
except:
A. Cephalic replacement
B. Suprapubic pressure
C. Fundal pressure
D. Intentional fracture of the
fetal clavicle
E. Delivery of posterior arm
3.
3. Each of the is a risk factor of
placenta previa except:
A. Prior cesarean section
B. Hypertension
C. Multiple gestation
D. Prior uterine curettage
4.
4. Each of the following is a typical
feature of placenta previa
except:
A. Painless bleeding
B. Commonly associated with
coagulopathy
C. First episode of bleeding is
usually self-limited
D. Associated with postcoital
spotting
5.
5. A 33 y/o women at 37 weeks
gestation, confirmed by first
trimester sonography, presents
with moderately severe vaginal

bleeding. She is noted on

sonography she had a placenta
previa. Which of the following is
the best management for this
patient?
A. Induction of labor
B. Tocolysis of labor
C. Cesarean delivery
D. Expectant management
E. Intrauterine transfusion
6.
6. A 22 y/o G1 P0 women at 34
weeks gestation presents with
moderate vaginal bleeding and
no uterine contractions. Which
of the following sequence of
examination is most
appropriate?
A. Speculum, ultrasound, digital
B. Ultrasound, digital, speculum
C. Digital, ultrasound, speculum
D. Ultrasound, speculum, digital
7.
7. An 18 y/o women is noted to
have a marginal placental
previa on an ultrasound
examination at 22 weeks
gestation. Which of the
following is the most
appropriate management?
A. Scheduled cesarean delivery
at 39 weeks
B. Schedule amniocentesis at
36 weeks and deliver by
cesarean if the fetal lungs
are mature
C. Schedule for MRI exam at 35
weeks to assess for possible
percreta involving the
bladder
D. Reassess placental position
at 32 weeks
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E. Recommend termination of
pregnancy
8.
8. In which of the following
conditions would consumptive
coagulopathy most likely be
seen?
A. Placental abruption
B. Placenta previa
C. Gestational diabetes
D. Multiple gestation
E. Gestational trophoblastic
disease
9.
9. In which of the following
conditions is ultrasound an
accurate and sensitive method
of diagnosis?
A. Placental abruption
B. Placenta previa
C. Neither
D. Both
10.
10.Each of the following is a risk
factor for abruption placenta
except:
A. Hypertension
B. Premature rupture of
membranes
C. Trauma
D. Marijuana use
E. Uterine leiomyoma
11.
11.Which of the following regarding
placental abruption is most
correct?
A. External bleeding is
necessary to make the
diagnosis
B. The clinical presentation is
fairly predictable
C. Couvelaire uterus arises
from blood seeping into the
myometrium
D. Vaginal delivery is
contraindicated
E. It is associated with chronic
hypertension but not
preeclampsia
12.

12. Umbilical cord prolapse is

LEAST common with which one
of the following?
A. Transverse lie
B. Footling breech presentation
C. Frank breech presentation
D. Complete breech
presentation
E. Oblique lie
13.
13.Each of the following
maneuvers improves
oxygenation to the placenta
except:
A. Supine position
B. Correct hypotension
C. Correct hypoxia
D. Stop oxytocin
14.
14.Each of the following is an
indication for cesarean delivery
due to maternal HSV except:
A. Lesions noted on the cervix
B. Lesions noted on the vagina
C. Lesions noted the posterior
thigh
D. tingling of the perineal
region
15.
15.Which of the following is the
LEAST likely fetal/neonatal
sequence of HSV?
A. Transplacental infection
B. Encephalitis
C. Disseminated neonatal
infection
D. Conjunctivitis
E. Gastrointestinal infection
16.
16.Each of the following is a
diagnostic criteria for
preeclampsia with severe
symptoms except:
A. Elevated liver function test
B. Proteinuria 5g in a 24-hour
period
C. 4+ pedal edema
D. Platelet count of 50,000/uL
17.
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17.Which of the following is the

most mechanism whereby
eclampsia leads to maternal
mortality?
A. Intracerebral hemorrhage
B. Myocardial infarction
C. Electrolyte abnormalities
D. Aspiration
18.
19.
20.
21.
22.
23.
18.A 33 y/o women at 29 weeks
gestation is noted to have blood
pressures of 150/90 and 2+
proteinuria. The platelet count
and liver function test were
normal. Which of the following
is the best management for this
patient?
A. Induction of labor
B. Cesarean section
C. Antihypertensive therapy
D. Expectant management
24.
19.18 y/o primigravida at 32 weeks
Pt comes to the hospital
complaining of a headache and
fatigue for the last 3 days. She
denies any bleeding, abdominal
pain, or vision change. +FM.
FH=30 cm, FHT=130. UA=1+
protein. BP140/94.
25.Which of the following is her
most accurate diagnosis?
A. Elevated BP
B. Mild pre-eclampsia
C. Severe pre-eclampsia
D. Gestational hypertension
26.
20.A 22 y/o G2P1 Comes to MCH
for regular prenatal care at 26
weeks. Complaining of LBP.
FH=25 cm. FHT=150. Urine
no protein. No vag. bleeding,
HA, abd. pain, or vision change.
+FM. BP= 150/90. Repeat BP 1

week later is unchanged. Which

of the following is her most
accurate diagnosis?
A. Gestational hypertension
B. Chronic hypertension
C. Mild pre-eclampsia
D. White coat hypertension
27.
21.All of the following are risk
factors of preeclampsia except:
A. Elevated BMI
B. Twins found on ultrasound
C. Smoking
22.Which of the following has been
proven effective for the
prevention of preeclampsia in
women known to be at risk?
A. Vitamin C
B. Vitamin E
C. Bed rest
D. Low dose ASA
28.
23.Which of the following
medications should be avoided
to treat hypertension in women
of childbearing age who are not
taking birth control?
A. Hydralazine
B. Nifedipine
C. HCTZ
D. Labetalol
29.
24.A 28 y/o G4P3 Comes to ER at
38 weeks c/o water broke. She
c/o mild HA but no abd pain, no
vag bleeding, no vision change.
+FM. FHT 150. BP 160/105. UA
2+ protein. How would you
manage this patient?
A. Admit her for induction and
delivery
B. Expectant management with
follow up in one week or
sooner if labor begins
C. Expectant management with
follow up when she is 40
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weeks or sooner if labor

begins
D. Admit for observation. If no
labor begins within 8 hours
discharge the patient to
follow up in 3 days or sooner
if labor begins.

no pregnancy in the uterus.

Which of the following is the
best next step?
A. Laparoscopy
B. Methotrexate
C. Repeat the BhCG level in 48
hr
D. Dilatation and curettage

30.
31.
32.
25.The cervix of a 19 y/o G1PO at
39 weeks gestation is noted to
change from 2cm to 3cm over 4
hour. Which of the following is
the most likely diagnosis?
A. Normal labor
B. Prolonged late phase
C. Arrest of active phase
D. Arrest of descent
33.
26.A 25 y/o women G2P1 at 41
weeks gestation is noted to
change her cervix from 6cm to
9cm over 2hr. which of the
following is the most likely
diagnosis?
A. Normal labor
B. Prolonged late phase
C. Arrest of active phase
D. Arrest of descent
34.
27.A 30 y/o G1 P0 at 39 weeks
gestation, who does NOT have
an epidural catheter, is
completely dilated, pushing for
2 hr at 0 station. Which of the
following is the most likely
diagnosis?
A. Normal labor
B. Prolonged late phase
C. Arrest of active phase
D. Arrest of descent
35.
28.A 22 y/o women at 8 weeks
gestation has vaginal spotting.
Her physical exam reveals no
adnexal masses. The BhCG level
is 400 Miu/mL, and a
transvaginal ultrasound shows

36.
37.
38.
39.
29.Which of the following is LEAST
likely to be associated with
preterm delivery?
A. Incompetent cervix
B. Hydramnios
C. Uterine fibroids
D. Abdominal pregnancy
E. Hydrops fetalis
40.
30.Which of the following is the
first sign of magnesium toxicity?
A. Respiratory depression
B. Cardiac depression
C. Loss of deep tendon reflexes
D. Seizures
41.
31.Which of the following tocolytics
has been shown to reduce the
incidence of RDS, IVH, and NEC
in preterm delivery?
A. Nifedipine
B. MgSO4
C. Salbutamol
D. Indomethacin
42.
32.What is the primary reason for
giving tocolytics in preterm
labor?
A. To prevent preterm labor
B. To allow time to give
corticosteroids
C. To prevent RDS
D. To prevent NEC
43.
33.Each of the following is a
common causative organism of
UTI in pregnancy except:
A. E.coli
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B. Klebsiella species
C. Proteus species
D. Bacteroides species
44.
34.Which of the following is the
most commonly isolated
etiologic agent causing
pyelonephritis in pregnancy?
A. Proteus species
B. Candida species
C. E.coli
D. Klebsiella species
35.Which of the following is most
common cause of septic shock
in pregnancy?
A. Pelvic inflammatory disease
B. Pyelonephritis
C. Wound infection
D. Mastitis
45.
36.When a pregnant women with a
pyelonephritis does on improve
on adequate antibiotic therapy
for 48 hr
46.And experiences continued
severe flank tenderness and
fever, each of the following
should be considered except:
A. Obstruction of the urinary
tract
B. Perinephric abscess
C. Resistant organism
D. Drug fever, and stop
antibiotic
47.
37.Which of the following is a
reason for the hypercoaguable
state in pregnancy?
A. Venous stasis
B. Decreased clotting factors
levels.
C. Elevated platelet count
D. Endothelial damage
48.
38.Which of the following is the
most common location of DVT
after gynecologic therapy?
A. Inferior vena cava
B. Lower extremities
C. Ovarian vein

D. Superior vena cava

E. Subclavian vein
49.
39.Which of the following is the
most common cause of
postpartum hemorrhage?
A. Uterine atony
B. Uterine laceration
C. Coagulopathy
D. Uterine inversion
E. Retained placenta
50.
51.
40.A 34 y/o women is noted to
have significant uterine
bleeding after a vaginal delivery
complicated by placenta
abruption. She is noted to be
bleeding from multiple
venipuncture sites. Which of the
following is the best therapy?
A. Immediate hysterectomy
B. Packing of the uterus
C. Hypogastric artery ligation
D. Correction of coagulopathy
52.
41.Which of the following are NOT
among the risk factor for
puerperal infection?
A. Poor antiseptic technique
B. Prolonged labor/ruptured
membranes
C. External cephalic version
D. Forceps delivery
53.
42.The risk for macrosomia is
increased in the following
except:
A. Nulliparity
B. Diabetes with pregnancy
C. Post-term pregnancy
D. Prior macrosomic pregnancies
54.
43.Which of the following is a risk
factor for developing DVT?
A. Family history of
thromboembolic disease
B. Factor V lieden
C. Antiphospholipid syndrome
D. All of the above
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55.
D. Nifedipine
44.All of the following can be used
56.
in hypertension in pregnancy
57.
except:
58.
A. Hydralazine
59.
B. Labetalol
60.
C. Captopril
61.
45.Which is the LEAST frequent site of an ectopic pregnancy?
A. Fallopian tube
B. Cervix
C. Ovary
D. Abdominal cavity
46.
47.The following complications during pregnancy increase the risk of postpartum
hemorrhage (PPH) except:
A. Hypertension
B. Macrosomia
C. Twin pregnancy
D. Hydramnios
48.
49.Which vitamin deficiency is most commonly seen in a pregnant mother who is
on phenytoin therapy for epilepsy?
A. Vitamin B6
B. Vitamin B12
C. Vitamin A
D. Folic acid
50.
51.Which is the most common cause of abnormal lie?
A. Polyhydramnios
B. Twin pregnancy
C. Uterine deformity
D. Pelvic tumour
E. Placenta praevia
52.
53.Leopold maneuvers refers to:
A. delivery of head
B. External version
C. Internal version
D. Breech extraction
E. Examination of abdomen.
54.
55.The following hormone is NOT produced by the placenta...
A. HCG
B. HPL
C. Prolactin
D. Estriol
56.
57.
58.
59.
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60.
61.
62.
63.
64.

65.
I.

Part two: EMQs

each question is worth 3 marks

Disorders of placentation:

66.
67.Directions: Match the single most likely placental abnormality described A-E
to the clinical situation 1-3. Each letter must only be used once.
68.
A. Placenta accreta
B. Placenta increta
C. Placenta percreta
D. Placenta polyp
E. Placenta hemangioma
69.

1. A 33 y/o G5 P4 women at 38 weeks gestation has had three prior

cesarean deliveries and is currently suspected of having a placenta
Previa. []
2. A 25 y/o women at 34 weeks gestation is noted to have a placenta
Previa. Up on cesarean section, bluish tissue densely adherent
between the uterus and maternal bladder is noted. []
3. When the placenta of a certain patient is sent for histology analysis,
the pathologist states that there is a defective decidua basalis layer
where the placenta villi abut against the myometrium of the uterus.
[]
70.

II.

Antepartum haemorrhage:
71.
72. A Placenta praevia
praevia
73. B Placenta abruption
infection
74. C Complete miscarriage
75.

D Threatened miscarriage

G Vasa

E Ectopic pregnancy

H Vaginal

F Cancer of the cervix

I None

76.
For each description below, choose the SINGLE most appropriate
answer from the above list of options. Each option may be used once,
more than once, or not at all.
77.
78.
1. A 32-year-old woman presented to the delivery suite. She was
28 weeks pregnant in her second pregnancy. An ultrasound scan at 12
weeks had confirmed a twin pregnancy. She was admitted complaining
of bleeding per vaginum; this was bright red in nature and painless.
[.]
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79.
2. A 34-year-old woman presents to casualty. She has a history of
pelvic inflammatory disease. She is 7 weeks pregnant by her dates.
She is complaining of left-side abdominal pain and brown discharge. On
examination, she is tender in the left iliac fossa and the cervix is
closed. [.]
80.
3. A 32-year-old woman presented to the delivery suite. She was
34 weeks pregnant in her first pregnancy. She was admitted
complaining of severe abdominal pain and bright red bleeding and
clots per vaginum. On examination, the uterus was painful and there
were palpable contractions. []
81.
III.
Postpartum pyrexia
82.
83.A Pylelophritis
abscess
84.B Mastitis
infection
85.
C Pneumonia
86.

D Meningitis

G Breast

E Endometritis

H Chest

F Wound infection

87.
For each description below, choose the SINGLE most appropriate
answer from the above list of options. Each option may be used once,
more than once, or not at all.
88.
89.
1. A 30-year-old woman is admitted from home. She had an
uncomplicated pregnancy and a normal vaginal delivery 4 days
previously. She presented with feeling generally unwell associated with
heavy, fresh, vaginal bleeding and clots. On examination, she has a
temperature of 38.3C. Abdominal examination reveals mild
suprapubic tenderness. Vaginal examination revealed blood clots and
the cervix admits a finger and is enlarged and bulky. []
90.
91.
2. A 26-year-old woman is admitted 7 days after having a
Caesarean section, which was performed for failure to progress after
augmentation for prolonged rupture of the fetal membranes. She is
generally unwell and complains of a foul-smelling vaginal discharge.
On examination, she has a temperature of 39.0C. Abdominal
examination reveals suprapubic tenderness. Vaginal examination
confirms the offensive discharge and uterine tenderness. [..]
92.
93.
3. A 32-year-old woman is seen 3 days after having a Caesarean
section. The Caesarean section was performed as an emergency for
placental abruption and was carried out under general anaesthesia.
She is complaining that she is generally unwell and has been coughing
up green sputum. On examination, she has a temperature
94.
of 38.0C and a pulse of 90 beats per minute. The respiratory
rate is 30 inspirations per minute and she using her accessory
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respiratory muscles. Abdominal and pelvic examinations are

unremarkable. Chest examination reveals purulent sputum and coarse
crackles of auscultation. []
95.
96.
97.
98.
99.
100.
101.
102.

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103.
104.
105.
106.
107.

108.

Part 3: Short answer questions

1. A 26-year-old woman presents in clinic at 30 weeks gestation. The

community midwife has referred her because she is large for dates.
An ultrasound scan has demonstrated polyhydramnios. Discuss the
possible causes of polyhydramnios in this pregnancy?
109.
110.
Maternal causes:
111.

...3 marks
112.
Fetal causes:
113.

.3 marks
114.
Placental causes:
115.

.3 marks
116.
2. A 25 y/o G2 P1 women is delivering at 42 weeks gestation. She is
moderately obese, but the fetus appears clinically to be about 3700g
weight. After a 4-hour
117.
First stage of labor and a 2-hour second stage of labor, the fetal
head delivers but is noted to be retracted back toward the patients
introitus. The fetal shoulders do not deliver, even with maternal
pushing.
118.
What is your definitive diagnosis?
119.

..4 marks
120.

121.

What is your next best step in management?

4 marks

122.

123.

124.
What is a likely complication that can occur because of this
situation?
125.
Maternal complication:
126.

2 marks
127.
Neonatal complication:


2 marks

128.
129.
130.
131.
132.
133.

BTAWFII8
JAMEE3AN.

134.