Obstetrics MCQ

1- A 23 year old female who is breastfeeding her 3 week old infant

complains about breast pain and fever of 40C. On examination, the
left breast is tender with a red and hard right upper quadrant. What is
the most appropriate management?
a. Increase frequency of breastfeeding and analgesia
b. Perform manual milk extraction for 24 hours
c. Discontinue breastfeeding, analgesia and antibiotic therapy
d. Incise and drain the breast
e. Antibiotic therapy, continue breastfeeding from opposite breast.
2- A 29 Year old gravida 3 para 3 had a vaginal delivery 30 minutes ago.
After delivery of the placenta, she continues to bleed and has now
bled approximately 500 mls in the past 15 minutes. The most common
cause of this condition is:
a. Lacerations
b. Retained placental tissues
c. Placenta accreta
d. Uterine Atony
e. Distended bladder
3- A 19 year old has chronic asymptomatic hepatitis B infection. She is
22 weeks pregnant. When considering the risk of transmission to her
yet to be born baby, you would:
a. Give hepatitis B immunoglobulin to the mother at 37 weeks
b. Give the neonate hepatitis B immunoglobulin immediately after
birth
c. Do antenatal screening test on the fetus using amniocentesis to
determine status
d. Give the neonate Hepatitis B vaccine plus Immunoglobulins
immediately after birth
e. Do nothing and reassure the mother since the risk of
transmission is zero

4- A 24 year old primagravida has been in labor for 6 hours. During the
past 2 hours of observation, the contractions have become shorter and
are weak. The membranes are bulging and she has remained a5 5 cm
dilation for this 2 hours period. The occiput is at station +1 and there
is no molding of the fetal head. Which of the following should be the
next step in management:
a. Administer ergometrine
b. Administer Oxytocin
c. Apply intracervical prostaglandin gel
d. Observe for another 4 hours
e. Perform artificial rupture of membranes
5- In twin pregnancies, which of the following is the most important
complication:
a. Abruption
b. Anemia
c. Prematurity
d. Postpartum hemorrhage
e. Hypertension
6- Fetal scalp blood sampling is indicated when cardiotocogram tracing
shows:
a. Early decelerations
b. Late decelerations
c. Accelerations
d. Reduced beat to beat variability
e. A baseline between 120 140 bbp

7- A 32 year old G3P2 is being evaluated at 16 weeks gestations. No

physical abnormalities are found on maternal physical examination
and the uterine size is consistent with dates. The alpha feto protein
done as part of the maternal serum screen is found to be elevated to
three times the normal value for that gestational age. The next step in
management should be:
a. Ultrasound examination
b. Chromosomal studies
c. Serum acetylcholine esterase determination
d. Amniotic fluid AFP determination
e. Amniotic fluid electrophoresis
8- A 36 year old primagravida is in your clinic for her first prenatal visit.
She is at 18 weeks gestation by dates. On performing a routine
physical examination, which of the following skin findings are
abnormal:
a. Chloasma
b. Telangectasias
c. Straie
d. Palmar erythema
e. Vulvar white epithelium
9- A 19 year old had her LMP 10 weeks ago and had a positive
pregnancy test. She comes for her first antenatal visit. During
examination, the uterus was palpated midway between the umbilicus
and the symphysis pubis. This finding :
a. Is consistent with her dates, reassurance is adequate
b. Is abnormal, and should be investigated with an ultrasound
c. Is abnormal, she should be re-examined in 4 weeks to
reevaluate
d. Is abnormal, she should have a repeat pregnancy test
e. Is abnormal, immediate evacuation of uterine contents is
required

10the finding in the above condition can be due to all of the

following except:
a. Fetal renal agenesis
b. Uterine fibroids
c. Molar pregnancy
d. Multiple gestation
e. Incorrect dates
11A 24 year old female of Asian origin presents for her first
antenatal visit for complaints of vaginal bleeding. Her LNMP was 11
weeks ago. Examination showed a large for dates uterus, subsequent
ultrasound showed a snow storm appearance. In this condition, you
would expect to find all of the following except:
a. Early preeclampsia
b. Massive ovarian enlargement
c. Severe hyperemesis
d. Threatened abortions
e. Hyperthyroidism
f. Gestational Diabetes
12a 31 year old female was found to have an abnormal 50g
glucose tolerance testing done on 24 weeks gestation, the full test
performed later confirmed the diagnosis of gestational diabetes. She
had no history of diabetes in the past. Her HbA1c was still within
normal range. This lady is at risk for each of the following except:
a. Infants with congenital malformations
b. Macrosomic infants
c. Polyhydramnois
d. Pre-eclampsia
e. Delayed fetal lung maturity

13A 23 year old primagravida comes to the ER with severe

headaches and blurring of vision. She is at 34 weeks gestation. On
examination, her hands and feet were noted to be swollen. Her BP was
160/115. urine dipstick was 3+ for proteins. What is the most
appropriate management in this case:
a. Admit to hospital, magnesium sulfate, hydralazine and
induction of labor for rapid delivery
b. Admit to hospital, magnesium sulfate, hydralazine and
Emergency C/section
c. Admit to hospital, magnesium sulfate, hydralazine,
betamethasone and observe until fetal lung maturity is reached
d. Admit to hospital, bed rest and observation
e. Methyldopa orally, outpatient management
14Polyhydramnois is associated with which of the following fetal
or maternal conditions:
a. Potters syndrome
b. Anencephaly
c. Placental insufficiency
d. Posterior urethral valves
e. Prune belly syndrome
15A 32 year old G5 P4 presents with an 8 week history of
amenorrhea and symptoms suggestive of pregnancy. Physical
examination reveals an irregular, enlarged uterus of 16 weeks size.
U/S examination confirms the presence of an 8 week viable pregnancy
and multiple fibroid uterus. The correct management for this patient
is:
a. Termination of pregnancy with elective myomectomy 2 months
after
b. Termination of pregnancy with concomitant myomectomy
c. Prudent observation with elective c/section at term
d. Prudent observation anticipating probable vaginal delivery
e. Myomectomy and follow pregnancy in usual way

16Which of the following is the most common indication for

which a c/section is required:
a. Breech presentation
b. Dystocia
c. Fetal distress
d. Placenta previa
e. Pre-eclampsia
17A 26 year old primi gravida presents at 40 weeks in active labor
with contractions every two minutes. She is diagnosed as having a
transverse lie with the back up. Which of the following would be the
most appropriate next step:
a. Start vasodilan
b. Perform external version
c. Prepare for an immediate c/section
d. Rupture membranes and perform internal version
e. Continue observation anticipating normal vaginal delivery
18A 25 year old G3P2 at 15 weeks gestation was found to have
bacteriuria. She is asymptomatic. The most appropriate management
is:
a. Observation as she asymptomatic
b. Repeat culture
c. Treat with metronidazole orally
d. Treat with Ceftriaxone IM
e. Treat with Amoxicillin orally
19An 18 year old primigravida at 30 weeks gestation works at a
childcare center. She comes to your office complaining that she was in
close contact with a child who had a rash that was later diagnosed as
rubella. Her initial rubella screen was negative. The most appropriate
management is:
a. Reassure mother, and offer vaccine after delivery
b. Vaccinate mother now
c. Repeat rubella titers
d. Terminate pregnancy
e. Give rubella immunoglobulins now

20A 21 year old primigravida presents for her first prenatal visit at
11 weeks gestation which is confirmed by U/S. she has no risk factors.
All of the following tests should be done at this stage EXCEPT:
a. Blood group and Rh type
b. Urine culture
c. Vaginal culture
d. Pap smear
e. Leukocyte count
21A complete blood count done on a 22 year old primigravida at
28 weeks gestation shows Hb of 9.5 g/dl. She is asymptomatic. Initial
Laboratory work done during her first antenatal visit was completely
normal. Her anemia is most commonly due to:
a. Increased fetal demand and growth
b. Dietary deficiency
c. Abnormal absorption during pregnancy
d. Increased blood loss during pregnancy
e. Folate treatment
22A 23 year old multipara comes to your office saying that she
has not felt any fetal movement for the past 10 hours. She is at 20
weeks gestation. Your next step in management should be:
a. Perform a non stress test
b. Perform an U/S test
c. Perform a Doppler test
d. Reassure mother, and re evaluate in the next 24 hours
e. Perform a speculum vaginal examination

23A 24 year old g3 p2 presents to the clinic for a routine antenatal

checkup. She is at 36 weeks gestation. Her last pregnancy reveals a
group B streptococcus vaginal carrier state that was treated during
labor. She has no complaints today. With regards to her current
pregnancy, what is the most appropriate management:
a. Do a vaginal culture now
b. Do vaginal culture at 40 weeks gestation
c. Give ampicillin prophylaxis IV during labor
d. Do nothing now, and do nothing during labor since it was
treated
e. Perform C/section at time of delivery
24A 19 year old primigravida comes to the labor floor with
regular uterine contractions every 2 minutes. She says her water broke
1 hour ago. She is at 38 weeks gestation. Pelvic examination shows
that she is 4 cm dilated. She also complains of vaginal itching and
pain around some localized, painful and ulcerative lesions on her right
vaginal wall. History shows that she had genital herpes before
pregnancy. The most appropriate management is:
a. Proceed with normal labor and treat mother with acyclovir
b. Proceed to C/section and treat mother with acyclovir
c. Give tocolytics to inhibit labor and culture lesions
d. Augment labor to minimize risk of infection, and give acyclovir
to baby when born
e. Give tocolytics, observe and wait for natural resolution, then
induce labor
25a 32 year old multigravida at 31 weeks gestation is admitted to
the birthing unit after a motor vehicle accident. She complains of
sudden onset of moderate vaginal bleeding for the past hour. She has
intense constant uterine pain and frequent contractions. Fetal heart
tones are regular at 145 beats/minute. Mothers vitals are normal. Her
perineum is grossly bloody. The most probable diagnosis is:
a. Placenta previa
b. Abruptio placenta
c. Uterine rupture
d. Preterm labor
e. Vasa previa
26-

the most appropriate next step in managing the above patient is:

a.
b.
c.
d.
e.

Sterile vaginal exam

Ultrasound examination
Emergency C/section
Perform biophysical profile
Observation and vaginal induction of labor if bleeding
continues

27a 22 year old g2 p1 presents at 32 weeks gestation with a

complaint of painless vaginal bleeding. She has history of uterine
fibroids and her previous pregnancy was delivered via c/section due
cephalopelvic disproportion. Ultrasound examination reveals a
placenta implanted with 2 cm of the internal cervical os. There is no
uterine tenderness and bleeding seems to have stopped. The best
course of management in this patient is:
a. Allow home with limited activity
b. Admit to hospital, stabilize and monitor
c. Admit to hospital, stabilize, and C/section
d. Admit to hospital, stabilize and vaginal delivery
e. Admit to hospital and perform a double setup technique
28a 32 year old gravida 3 para 0 at 13 weeks gestation presents to
the ER with profuse vaginal bleeding after coitus. She also has mild
abdominal cramps. Examination shows soft abdomen and the cervical
os to be more than 2 cm in diameter and the presence of clots and
tissues in the vaginal vault. U/S shows products of conception still
present in the uterus. The most probable diagnosis in this case is:
a. Inevitable abortion
b. Threatened abortion
c. Incomplete abortion
d. Placental abruption
e. Traumatic bleeding
29a.
b.
c.
d.
e.

the most appropriate management of the above patient is:

Give oxytocin, and perform emergency dilatation and curettage
Close observation and conservative management
Close observation and serial BhCG measurement
Give oxytocin and perform emergency dilatation and
evacuation
Give methotrexate and misoprostol

30A 23 year old G2P1 at 38 weeks gestation is admitted to the

birthing unit in the active phase of labor. Artificial rupture of
membrane is performed to accelerate the progression of labor.
Immediately after AROM, bright red vaginal bleeding is noted. Apt
test done at the bed side was positive. The most appropriate next step
in management is:
a. Emergency C/Section
b. Pelvic ultrasound examination
c. Observation in left lateral position and give oxygen
d. Give oxytocin to further augment labor, use forceps to extract
fetus
e. Initiate tocolysis and perform amnioperfusion
31A 24 year old G2 P1 was seen for the first antenatal visit at 12
weeks gestation. Her prenatal laboratory panel reveals blood type O
negative. her indirect combos test is positive. She has been married to
the same husband for 10 years and he is the father of both her
pregnancies. She did not receive Rhogam during her last pregnancy.
The next step in management should be:
a. Give Rhogam now
b. Give Rogham at 28 weeks
c. Get Rh antibody titers
d. Perform amniocentesis for bilirubin levels
e. Continue conservative management, the fetus is at ZERO risk
32A 24 year old G2 P1 at 28 weeks gestation by dates presents to
the labor unit complaining of regular uterine contractions every 5
minutes. She has mild chronic hypertension being treated with
methyldopa. Examination shows the cervix to be dilated 3 cm and
80% effaced. Membranes are intact. Maternal and fetal vitals are
normal. There are no other findings or complaints. U/S shows normal
growing fetus and a normally implanted placenta. The best course of
management in this case is:
a. Tocolysis using magnesium sulfate plus betamethasone to
enhance fetal lung maturity
b. Tocolysis using ritodrine plus betamethasone to enhance fetal
lung maturity
c. Tocolysis in contraindicated, augment labor plus prophylactic
emperic antibiotics
d. Tocolysis is contraindicated, proceed to emergency C/section

e. Do nothing, the patient is in false labor

33A 34 year old g3 p2 with gestational diabetes presents to the
labor unit at 39 weeks gestation with regular uterine contractions and
a cervix that is 5 cm dilated. Membranes were ruptured. 10 hours after
presentation, the cervix is 8 cm dilated but meconium staining of
amniotic fluid is now being noted and CTG is showing late
decelerations. Fetal scalp sampling shows a PH of 7.1. the best next
step in management is:
a. Emergency C/section
b. Augmentation of labor and forceps delivery
c. Repeat Scalp PH in 30 minutes, while giving O2 to mother in
left lateral decubitus
d. Perform biophysical profile, and deliver if score between 0-4
e. Perform amnioperfusion with normal saline to dilute
meconium, continue with normal vaginal delivery
34A 29 year old g3p2 presents to the labor unit in labor. She is at
40 weeks gestation. Uterine contractions occur every 3 minutes, and
the cervix is 5 cm dilated. A CTG machine is attached and the reading
was reassuring. 30 minutes later, and while performing another pelvic
examination, a gush of fluid comes out and you feel the presenting
part being breach preceeded by a loop of the umbilical cord. The CTG
starts showing fetal tachycardia with variable decelerations. The most
appropriate management is:
a. Try to replace the cord inside the cervical os and monitor CTG
for improvement
b. Give Oxytocin to augment labor and use forceps to accelerate
delivery
c. Proceed to the operating theatre
d. Perform zavanelli maneuver
e. Give magnesium sulfate and perform external cephalic version
35a.
b.
c.
d.
e.

Shoulder dystocia occurs during:

Stage 1 latent phase of labor
Stage 1 active phase of labor
Stage 2 of labor
Stage 3 of labor
Can occur at any stage

Answers:
1- E
2- D
3- D
4- E
5- C
6- B
7- A
8- E
9- B
10- A
11- F
12- A
13- A
14- B
NOTE: Prune belly syndrome is a rare birth defect affecting
about 1 in 35,000 births. About 96% of those affected are male. Prune belly
syndrome is a congenital disorder of the urinary system, characterized by a triad
of symptoms. The syndrome is named for the mass of wrinkled skin that is often
(but not always) present on the abdomens of those with the disorder. Other names
for the syndrome include Abdominal Muscle Deficiency Syndrome, Congenital
Absence of the Abdominal Muscles, Eagle-Barrett Syndrome, and Obrinsky
Syndrome.

Symptoms

A partial or complete lack of abdominal muscles. There may be wrinkly folds of

skin covering the abdomen.
Undescended testicles in males
Urinary tract abnormality such as unusually large ureters, distended bladder,
accumulation and backflow of urine from the bladder to the ureters and the
kidneys

15- D
16- B
17- C
18- E
19- A
20- C
21- A
22- B (to look for fetal heart tones or activities)
23- C
24- B
25- B

26- B
27- B
28- C
29- A
30- A
31- C
32- A
33- A
34- C
35- C