Sample MCQ questions 1. a. b. c. d. e. Mechanisms of labour in a primigravida.

During the frist stage, the uterine muscle contracts and retracts. The cervix becomes effaced during the latent phase The average length of the first stage is 12 hours Voluntary effort is essential during the second stage to achieve a spontaneous vaginal delivery Braxton ic!s contractions do not occur before "# $ee!s.

True% &, B, ' (alse% D,) Voluntary effort is not essential, a paraplegic $oman can have a normal delivery. 2. a. b. c. d. e. igh*ris! features for abnormal glucose tolerance in pregnancy include Maternal $eight more than 1++ !g at boo!ing ,aternal first degree relative $ith diabetes (oetal microsomia on ultrasound -ingle episode of glycosuria at "# $ee!s ,resence of oligohydramnios.

True% & (alse% B,', D, ) & maternal, not paternal, first*degree relative is a high*ris! feature. (oetal macrosomia, not foetal microsomia, and polydraminios are high*ris! features for abnormal glucose tolerance. ". a. b. c. d. e. True% (alse% &ll pregnant $omen are still screened for syphilis The Veneral Disease .esearch /aboratory 0VD./1 slide test is a specific serological test. The VD./ test remains positive for ever once the mother has been infected. 'ongenital syphilis causes s!eletal damage to the neonate. Treatment of syphilis in early pregnancy $ill not protect the foetus 2ntreated syphilis may result in prematurity. ', ) &,B,D

)very pregnant $oman is screened for syphilis, therefore this is a fair 3uestion. 4assermann reaction and VD./ are not specific tests and $ith successful treatment they usually become negative. The reason for continued screening is that early treatment can protect the foetus. 5. a. b. c. d. e. True% (alse% Binovular t$ins May occur as a result of fertilsiation of a single ovum &re more common in $omen under the age of "6 years. &re more common in tall $omen, ave a separate chorion and amnion &re at increased ris! of t$in*t$in transfusion ', D &, B, )

6. a. b. c. d. e.

Maternal mortality 7s defined as the death of a $oman associated $ith pregnancy or $ith childbirth $ithin 28 days of that event. 7n )ngland the incidence is 8*# per 1+,+++ births. The most common cause is haemorrhage 7ncludes deaths associated $ith therapeutic termination. The ma9ority of anaesthetic deaths in the last triannual report $ere associated $ith epidurals.

True% D (alse% &, B, ', ) Defined as death occurring $ithin 52 days. The missing :ero in B ma!es it false ; important to read the 3uestion carefully. #. a. b. c. d. e. True% (alse% ,ulmonary embolism 7s the commonest cause of maternal death. Three 3uarters occur follo$ing delivery 7s more common follo$ing an operative delivery 7s preceded by signs of a deep venous thrombosis in the ma9ority of cases. & ventiliation*perfusion scan is contraindicated during pregnancy. B, ' &, D, )

,regnancy induced hyptertension<pre eclampsia is the commonest cause of maternal death. =. a. b. c. d. e. .ecognised causes of spontaneous preterm labour include ,olyhydramnios ,re*eclampisa ,revious ceasarean section >estational diabetes ,yelonephritis.

True% &, ) (alse% B, ', D The presence of pre*eclampsia may lead to early delivery to avoid complications? it is not spontaneous and this is the !ey $ord in the stem,. >estational diabetes is associated $ith polyhydramnios $hich may lead to preterm delivery but diabetes itself does not cause preterm labour. This is an example of reading too much into the 3uestion. 8. a. b. c. d. e. True% (alse% @. a. b. c. d. e. 7n cases of premature rupture of the membranes, chorioamnionitis should be suspected if The maternal $hite cell count rises & maternal pyrexia occurs /i3uor stops draining (oetal movements increase The foetal heart becomes tachycardic &, B, ) ',D ,hysiology of pregnancy 'ardiac output increases by up to 5+A. & systolic in9ection murmur can occur >lomerular filtration rate decreases by 5+A. The vital capacity of the lungs rises to$ards term ypochloryhdria occurs because of regurgitation of al!aline chyle from the intestine

True% &, B, ) (alse% ', D >lomerular filtration rate increases by 5+A. The vital capacity decreases due to splinting of the diaphragm.

1+. a. b. c. d. e.

Breech presentation at "8 $ee!s gestation 'omplicates "A of all labours 5+A $ill be a fran! or extended breech 7s associated $ith higher ris! of foetal abnormality May be associated $ith a uterine abnormality More commonly presents as a footling breech in primigravidae.

True% &, ', D (alse% B, ) #+A of breech babies $ill be fran! or extended at "8 $ee!s. The incidence of footling breach increases $ith increased parity. 11. a. b. c. d. e. -eptic &bortion ) 'oli is one of the commonest infective organisims 7nfection is confined to the decidua in 8+A of cases. .e3uires urgent evacuation of the uterus as first line management May lead to long term infertility .arely occurs before 12 $ee!s gestation.

True% &, B, D, ) (alse% ' igh dose broad spectrum antibiotics should be given before an evacuation is performed. 12. a. b. c. d. e. There is an increased ris! of ovarian cancer associated $ith Bulliparity Breast cancer ,rolonged oral contraceptive use -ocial class V ormone replacement therapy use.

True% &, B (alse% ', D, ) ,rolonged use of the oral contraceptive pill protects against ovarian carcinoma. 7t is more common among social classes 7 and 77. ormone replacement therapy does not appear to increase the ris!. 1". a. Vaginal 'andida 7nfection 7s the commonest of all infection during pregnancy

b. c. d. e.

'an be reduced by $ashing underear at temperatures greater than 8+o'. 7s more common during the proliferative phase of the menstrual cycle. 7nade3uate therapy is the most li!ely cause of chronic infections 7s more common in $omen using the progesterone only pill.

True% &, B, D (alse% ', ) &lmost 5+A of pregnant $omen $ill demonstrate asymptomatic vaginal colonisation. The gro$th of candida is increased at the end of the luteal phase. Cestrogen*containing oral contraceptives predispose to candida infection. 15. a. b. c. d. e. Transvaginal ultrasound of the pelvis .e3uires a full bladder -hould not be peformed in a $oman $ho is menstruating 'an detect a foetal heart at six $ee!s gestation -hould not be performed in a $oman $ith suspected genital herpes 'an accurately diagnose deposits of endometriosis.

True% ' (alse% &, B, D, ) Cne of the advantages of a transvaginal ultrasound is that it does not re3uire a full bladder. 7t can be performed during menstruation or during vaginal bleeding from a miscarriage. The transvaginal ultrasound can detect a foetal head from 6 $ee!s gestation on$ards. 16. a. b. 4hen prescribing the combined oral contraceptive pill Mothers $ho are not breast feeding should be advised to $ait at least six $ee!s after delivery before starting the pill Cne should advise that if a pill is missed, provided it is not more than 25 hours late, it can be ta!en and the pac!et continued $ithout the ris! of pregnancy. Barrier contraception is needed for the first 15 days $hen starting the first pill pac!et. 7t can be started on the first day after a first trimester termination & previous history of cervical intraepithelial neoplasia is a contraindication.

c. d. e.

True% D (alse% &, B, ', ) & significant number of $omen $ho do not breast feed $ill ovulate before their six $ee! postnatal visit. They should be advised to start the combined oral contraceptive pill 15*21 days follo$ing delivery. Barrier contraception is re3uired for seven days if the pill is started on the first day of a period.

1#. a. b. c. d. e.

.ecurrent miscarriage The ris! of miscarriage rises after the age of "6 years. Cver half the cases are associated $ith anovulatory cycles ,rogesterone support is of proven benefit. 'ongential uterine abnormalities account for 16A of cases. ,arental !aryotyping should be performed.

True% &, B, ) (alse% ', D B causes confusion. 'andidates assume that all cycles $ere anovulatory and hence a $oman could not become pregnant. 7n fact, she $ill ovulate occasionally. 'on genital uterine abnormality accounts for 6A. Daryotyping should be performed to loo! for balanced translocations. 1=. a. b. c. d. e. Dysfunctional uterine bleeding 7n the ma9ority of cases is associated $ith anovulatory cycles 7s improved by a therapeutic dilation of the cervix and curettage of the uterine cavity May be helped by ethamsylate May be associated the leiomyoma -hould be considered a relative contraindication to fitting a standard intrauterine contraceptive device.

True% ', ) (alse% &, B, D Dysfunctional bleeding by definition is diagnosed $hen no cause can be found. ence, anovulation and leiomyoma are false. & curettage is a diagnostic procedure. &n intrauterine contraception device is associated $ith an increased menstrual blood loss. & Mirena 72'D could be used here. Cne $ould not normally fit a standard 72'D in a $oman $ho already has heavy periods.

18. a. b. c. d. e.

7n vitro fertili:ation 07V(1 7s associated $ith a multiple pregnancy rate of 15*25A The success rate is the same for a "2 year old as it is for a 5+ year old )gg collection re3uires laparoscopy. 7s associated $ith a lo$er incidence of congenital abnormalities than spontaneous pregnancies. /egally, no more than three embryos can be transferred at any one time.

True% &, ) (alse% B, ', D The success falls significantly after the age of "8 years. )gg collection can be performed using vaginal ultrasound guided needle aspiration. /ocal anaesthesia and sedation are used. 1@. a. b. c. d. e. 'ervical 7ntraepithelial neoplasia 0'7B1 " is characterised by 7nvasion through the basement membrane -pontaneous remission during pregnancy & smear containing dys!aryotic cells & blood stained vaginal discharge (ull thic!ness loss of stratification and polarity in the epithelium.

True% ', ) (alse% &, B, D 7nvasion though the basement membrane signifies invasive carcinoma. '7B " is asymptomatic and does not present $ith blood stained discharge. 2+. a. b. c. d. e. ,elvic endometriosis is characteristically associated $ith Vaginal adenosis ydronephrosis .ectal Bleeding ,rolonged use of an intrauterine contraceptive device aematometra

&ll false ,elvic endometriosis can rarely be associated $ith hydronephrosis and rectal bleeding but these are not characteristically associated $ith it. 21. .ecognised causes of post menopausal bleeding include

a. b. c. d. e.

,reinvasive carcinoma of the cervix Benign teratoma of the ovary &trophic vaginitis -ubserous fibroids epatic cirrhosis

True% ' (alse% &, B, D, ) epatic cirrhosis may lead to clotting disorders $hich could possibly lead to post menopausal bleeding but really this is pushing it too farE 0their $ords not mine ; -a:1

Sample MCQ Questions 2 1. a. b. c. d. e. 2. a. b. c. d. e. 3. a. b. c. d. e. 5. a. b. uman 7muunodeficiency virus 0 7V 0"1 7s a retrovirus &symptomatic infection has no significant effect on pregnancy complication Does not influence the mode of delivery &bout 16A of babies $ill remain 7V positive at six months of age 'an be isolated from cervical secretions. ,ostnatal Blues 051 2sually start bet$een day " and day 6 May be prolonged by anaemia &re more common among $omen $ho have a normal delivery &re prevented by night sedation Cccur most often in $omen discharged early from hospital igh -erum *fetoprotein may be associated $ith the presence of foetal 081 >lucose*#*phosphate dehydrogenase deficiency Do$n -yndrome Turner -yndrome 'ystic fibrosis ,osterior urethral valves The follo$ing drugs are contraindicated during pregnancy 0@1 'aptopril Metronida:ole

c. d. e. 6. a. b. c. d. e. #. a. b. c. d. e. =. a. b. c. d. e.

'lindamycin vaginal cream Tetracycline Thyroxine The follo$ing provide an accurate assessment of placental function antenatally 01"1 2rinary oestradiol /i3uor volume assessment uman placental lactogen (oetal movement charts 2mbilical artery Doppler blood flo$ studies .ecognised causes of a high head at term include 0161 Begro mothers Deflexed head 2terine fibroid ,revious caesarean section ,olyhydramnios Beonatal 9aundice 02+1 7s associated $ith raised levels of con9ugated bilirubin Cccurs in 6+A of $ell babies in the second or third day of life & bilirubin of "6+ mol<1 in a term baby of ".6!g $eight $ould re3uire phototherapy. Cccurs more commonly follo$ing a vacuum delivery & raised bilirubin level at nine days $ould most commonly be associated $ith infection. 4hen counselling a mother about a home delivery at her boo!ing visit, the follo$ing should be regarded as contraindications 02@1 ,revious breech delivery .hesus*negative mother -ho$ si:e less than three 4ell controlled hyperglycemia ,revious ectopic pregnancy

8. a. b. c. d. e.

@. a. b. c.

2terine fibroids may be associated $ith 0"11 7ntermenstrual bleeding >enuine stress incontinence ,olycythaemia

d. e. 1+. a. b. c. d. e. 11. a. b. c. d. e. 12. a. b. c. d. e.

2rinary fre3uency Delayed involution postpartum )ndometrial carcinoma 0"21 Cccurs rarely before the age of 5+ 7s more common among multiparous $omen 7s associated $ith diabetes 7s nearly al$ays s3uamous in nature -hould be treated $ith prothiadine ,olycystic ovarian syndome classically leads to 0"#1 irsutism 7nfertility ,remature menopause Dysmenorrhoea Cbesity 7ncreased ris! of ectopic 0tubal1 pregnancy is associated $ith 0"@1 Vasectomy Tubal ligature Dana:ole 'lomiphene citrate .eversal of sterilisation

1". a. b. c. d. e. 15. a. b. c. d. e. 16. a.

Dana:ol 05"1 .educes high*density lipoproteins 7ncreases oestradiol levels -uppresses ovulation May cause acne May be associated $ith voice changes The follo$ing may give rise to postmenopausal bleeding 0561 'ervical intraepithelial neoplasia )ndometrial polyp Vulval Dystrophy Treatment $ith tibolone 'ontinuous combined hormone replacement therapy .elative contraindications to Moderate hypertension .T include 06+1

b. c. d. e. 1#. a. b. c. d. e. 1=. a. b. c. d. e.

eavy cigarette smo!ing yperlipidaemia Varicose veins Ctosclerosis 7nfertility caused by tubal damage 06#1 &ccounts for 1+A of cases of primary infertility 7s most commonly caused by chlamydial infection May follo$ a suction termination of pregnancy May be diagnosed by an air insufflation test May be treated by ovulation inducion and intrauterine insemination -urgery for stress incontinence of urine 06=1 &ims to elevate the bladder nec! about the pelvic diaphragm -hould only be performed if the diagnosis has been confirmed by urodynamic assessment May lead to voiding difficulties 'an be associated $ith detrusor instability postoperatively as a success rate of 86A associated $ith an anterior vaginal colporrhaphy.