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Obstetrics I,II,III &gynecology final comprehensive examination for

4thyear regular midwifery students

Instructions
1) read the instructions carefully
2) switch of your mobile
3) write your identification carefully
4) don’t open the page until you told to do so
5) this exam containsu
 50MQC-50%
NAME___________

ID NO.___________

Signature__________

Time allowed-6omin

Prepared by: worku .m

PART-I –Multiple choices

Choose the best answer from the give alternative and encircle
it (each 1pt)
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1. A 30years old gravid II Para I mother is presented at 38weeks +5days with marked
decrease in fetal movement for two days. The attending gynecologist did the
standard biophysical profile (BPP) for thirty minutes and found: 3 fetal gross body
movement, 2 episode of extremity extension and subsequent return to flexion, 2
episode of rhythmic breathing lasting 30 seconds, 2 accelerations of 15 beats/min
for 20 minute, a single vertical pocket of amniotic fluid that measures 2-cm . What
will be the BPP score?
a. 6
b. 8
c. 9
d. 10 A

2. For the case scenario described under Q1, which one of the management option is
appropriate

a. The biophysical profile is reassuring and the test can be repeated in a week
timeo A

b. The biophysical profile is unequivocal and other means of fetal testing is

recommended

c. The biophysical profile is poor and prompt cesarean delivery is recommended

d. The biophysical profile is poor and the test should be repeated in 4-6hours time

3. A 30years old mother who conceived after ovulation inductions has delivered to
twin female babies at 36weeks spontaneously. The babies were in a separate sac
(diamniotic) but single placenta (monochorionic). Which one of the following is true
about this pregnancy?
a. It is unlikely to have single placenta and double amniotic cavity and
most likely the placenta is also separate but fused
b. This is a monozygotic twinning with possible division within the first
three days of fertilization
c. This is a dizygotic twinning that is possibly induced by ovulation
induction
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d. This is a monozygotic twinning with possible separation between day 3

and day 8 A
4. A 32-year-old primigravid with regular 28-day menstrual cycle and on no prior
contraception was having uneventful course of the pregnancy. Her gestational age
from LNMP is 42weeks+2days. Term sized uterus, cervix 2cm dilated, 40%
effacement, medium and posterior. Station is at -3cm and the pelvis is grossly
adequate. Ultrasound was done and BPP is reassuring and estimated fetal weight of
3200gm. What is the Bishop Score?
a. Unfavorable A(3)
b. Intermediate
c. Favorable
d. Incomplete
5. Referring to Q4 which one of the following management options is the best?
a. Continue monitoring with weekly BPP
b. Induction of labor
c. Priming with prostaglandin and induction A
d. Cesarean delivery

6. A 24year- old Primigravida mother on ZDV 300mg twice a day since 28weeks of
gestation was admitted at 37weeks with the cervical dilatation of 5cm. Membrane
was intact. She brought the laboratory results: CD4 count 520, viral RNA
400copies/ml. Which one of the following is in appropriate measure?

a. Start on ZDV 600mg, nevirapine 200mg and lamivudine 150mg A

b. Follow the progress of labor with partograph
c. Keep the membrane intact and avoid frequent pelvic examination
d. Continues ARV prophylaxis no need of additional drug because the lab
result is normal
7. The post partum care of the case described under Q6 involves all of the following
except
a. Single dose of NVP and ZDV for 4weeks for the neonate A
b. Combivir (AZT+3TC) for 7days for the mother
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c. Dried blood spot (DBS) at 6weeks for the neonate to test for DNA PCR
d. Exclusive breast feeding or exclusive replacement feeding
8. All of the following are true about severe polyhydramnios, except
a. Is diagnosed when single vertical pocket of amniotic fluid exceeds 24cm
b. Is usually due to severe fetal malformations
c. Can be managed by amniocentesis
d. Carries risk of abruptiony
e. Carries risk of cord compression A
9. Which of the following is false about Asymmetric intrauterine growth restriction
(IUGR)
a. The insult usually occurs in the last phasea
b. Chromosomal abnormalities are the common causes A
c. Is usually a benign condition
d. It mainly affects the cell size than cell number

10. A 25-year-old mother was admitted in second stage of labor and delivered to
her second baby by SVD. Up on reviewing her chart her blood group and Rh
is A-ve and that of her husband is A+ve. She took anti-D during her previous
delivery and indirect Coombs test is negative. The blood group and Rh of the
baby O+ve. Which one of the following is true about the case?

a. It is impossible have O+ve baby if both parents are A blood type A

b. No need for anti-D as she received it and immunized during the
previous delivery
c. The ABO compatibility in this case is protective for Rh isoimmunization
d. It is possible have O+ve baby if both parents are A blood type
11. The most definitive principal management of eclampsia is

a. Delivery A c. control convulsion

b.Drug management d.mechanical management

12. Which of the following is not a dysmaturity syndrom

a.Failure of fetal grow d. Clear amniotic fluid A
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b.Loss of subcutaneous tissue e. .Long nails

c.Wrinkled skin

13. .Accurate diagnosis of post term pregnancy is made by accurate dating ie if LNMP
is supported by the following criteria :except

a.+ve pregnancy test by 6wks from the LNMP

b.Bimanual examination that in the second trimester to confirm gestation age A

c.Fetal heart tone at 20wks by fetoscope

d.Confirmatory by U/S prior to 26wks of gestational age

14. . Which of the following is not true aboutdetermination of zaygosity

a.Twin- twin transfusion is almost common in dz A
b. Twins of opposite sex are almost always DZ

c, Monochorionic placentation indicate monozygosity

E. Dichorionic twins of similar sex may be DZ or Mz

15. . all are the indications of caesarean section for retained second twin except
a. Fetal macrosomia d. borderline fetal heart sound
b. cervix retracting and not dilating e Cord prolapse
c. Hypotonic uterine dysfunction A
16. 45. The following are prerequisites for trial of scar, Vaginal Birth
After Cesarean, except
a. Clinically adequate pelvis
b. Estimated fetal weight less than 4kg
c. Previous successful vaginal delivery A
d. Facility for managing rupture
e. Maternal consent

17. All of the following are component of active management third stage labor except

d. 10IU oxytocin IM or erygometrine 2mg IM or IV

e. Controlled cord traction (CCT) with each contraction

f. CCT when there is sign f placental separation A

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g. Uterine massage

– 18 . Failed vacuum is considered in all except

a. Failure to descend with each pull
b. More than two pop offs
c. Maternal refusal for the application
d. Failure to deliver after half an hour of application
e. none

19.The presenting diameter of mento anterior face presentation is

A. Occipito frontal

B. Sub ociptobregmatic

C. Sub mentobregmatic A

D. Sub mentovertical

E. Biparietal
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19.The best predictor for success of vaginal birth after cesarean section (VBAC) is

A. Previous vaginal delivery

B. Prior indication for Breech presentation
C. Previous successful VBAC
D. Non recurring
E. Previous indication for fetal distress

20.What is MCrobert maneuver to release shoulder dystocia

A. Rotation of post shoulder to deliver anterior shoulder

B. Abduction of shoulders
C. Flexion of mother’s knees and supra pubic pressure A
D. Rotation and extraction of anterior shoulder
E. Repositioning of fetal head back in to the uterus and C/S

21.A woman 3o years old GII Para I EFW of 2kg, presents with face
presentation. How do you manage her delivery?

A. Induction of labor
B. Internal rotation to make mentum anterior position
C. Observation to allow spontaneous rotation A
D. C/S
E. Forceps assisted delivery

22.Which criterion applies to low forceps?

A. The fetal head leading point should be on station ≥2 A

B .The fetal head leading point should be above station≥2

C .The fetal head is on the pelvic floor

D .Sagital suture is ant-post

E .Rotat ion is less than 45 degre

23..In breech presentation what is the name of the maneuver .The shoulder is
grasped by one hand and the legs are grasped by the other hand then the
newborn is pooled toward mother’s abdomen?
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A Pinard

B modified Prague

C Bracht

D Meuriceu

E Burns marshal

24. Vesico vaginal fistula following obstructed labor should be repaired

A. 10 days later
B. Within 3 month A
C. At any time
D. 6 month
E. Immediately

25. In occiput posterior position

A. Vaginal birth cannot occur

B. The woman should not give birth in squatting position
C. Vaccum extraction should not be performed
D. The expulsive phase may be prolonged A
E. The presenting diameter is mento vertical
26. A 23-year-old woman (gravida 2, para 2) calls her physician 7 days postpartum
because she is concerned that she is still bleeding from the vagina. It would be
appropriate to tell this woman that it is normal for bloody lochia to last up to
A. 2 days A
B. 5 days
C. 8 days
D. 11 days
E. 14 days

27. . A 27-year-old has just had an ectopic pregnancy. Which of the following events
would be most likely to predispose to ectopic pregnancy?
A. Previous tubal surgery A
B. Pelvic inflammatory disease (PID)
C. Use of a contraceptive uterine device (IUD)
D. Induction of ovulation
E. Exposure in utero to diethylstilbestrol (DES)
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28. The most important reason that PID must be recognized and treated promptly is
prevention of:

A. Infertility A
B. Ectopic Pelvic pain syndrome
C. pregnancy
D. Tubo-ovarian abscess
E. Pelvic adhesive disease
29. Which of the following is not positive sign of pregnancy?
A. Identi fication of fetal heart tones
B. Postive pregnancy test
C. Perception of fetal movement by the examiner A
D. Identification of fetus by ultrasound
30. Of the followings are component of reassuring fetal heart pattern except

A .A baseline FHR of 120-160 bpm.

B. Absence of FHR deceleration.

C .Age appropriate FHR acceleration.

D .Normal FHR variability(5-25 bpm).

E . late deceleration phase

31.which one of the following is not Features of sinusoidal fetal heart rate pattern

A . Normal base line HR with regular oscillations

B .Amplitude of 5-15 bpm

C .2- 5 cycles per min frequency

D .Fixed long term variability

E .Absence of acceleration

32.. Which of the following is not important for the Diagnosis of fetal distress.

A .Moderate to severe deceleration with absent beat to beat variability.

B .Early deceleration with absent beat to beat variability.

C .Fetal bradycardia

D .Hypoxia with metabolic acidosis

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33. in which type of breech presentation Ischial tuber cities, sacrum and its spines,
genitals and the anus are usually palpable during vaginalexamination.

A. frank breech A

B .Complete breech

C.footling breech

D. Extended breech

34. Refer urgently if the following specific breech-related conditions are identified:
except

A. Footling breech

B. Estimated fetal weight of > 3500 gm

C. Previous CS, Rh-isoimmunization,
D. Elderly multi paraous women
E. Uterine dysfunction, prolonged labor or failure to progress in labor
35.which one of the following is not recommended during Assisted Vaginal breech
delivery

A. Minimum manipulations

B. Place patient in a lithotomy position

C. Empty bladder
D. Ascertain cervix is Partial dilated

E. Bear down with contractions

F. Deliver spontaneously up to the umbilicus

36.. Descent Zero out of fifth means

A. The head is floating

B. The head is fixed
C. Station is Zero
D. The whole head has entered the pelvic cavity
E. The head is crowning

37. A 21-year-old has difficulty voiding 6 h postpartum. The least likely cause is which of
the following?
A. Preeclampsia
B. Infusion of oxytocin after delivery
C. Vulvar hematoma
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D. Urethral trauma
E. Use of general anesthesia

38. What anesthetic agent is most ideal for replacing an inverted uterus?

A. Spinal analgesia
B. Thiopental
C. Succinylcholine
D. Halothane

39. The treatment of metritis should include

A. IV ampicillin or IV gentamicin or IV metronidazole

B. iv ampicillin, plus iv gentamicin and iv metronidazole
C. a combination of oral antibiotics
D. a broad spectrum oral antibiotic

40. When performing abdominal aortic compression to control postpartum hemorrhage,

the point of compression is
A. just below and slightly to the right of the umbilicus
B. just below and slightly to the left of the umbilicus
C. just above and slightly to the right of the umbilicus
D. just above and slightly to the left of the umbilicus A

41. Findings diagnostic of cephalopelvic disproportion are

A. cervical dilation plotted to the right of the alert line on the partograph
B. uterine contractions in the latent phase with an unengaged fetal head
C. Secondary arrest of descent of the head in the presence of good contraction A
D. grade 3 molding of the fetal head

42. The most common clinical presentation of ectopic pregnancy is

A. Pain A C. Amenorrhea
B. Bleeding D. Adenexal mass

43. The most common clinical presentation of ectopic pregnancy is

A. Pain C. Amenorrhea
B. Bleeding D. Adenexal mass

44.. Single out, the clinical sign which is an indication of expectant

Management of ectopic pregnancy

A. HCG level <1000 mIu/ml A C. Non viable fetus.

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B. HCG Level <1500mIu/ml D. Unruptured tube

45. One of the following is true about pelvic inflammatory disease

A. 85 % of PID occurred following Gynecological & obstetrical procedure

B. 90 % of the causative organism are normal flora of the vagina
C. Hematological spread is common
D. PID is common during pregnancy b/c of maternal immunity

46. .One of the following is not true about spontaneous abortion

A. Mostly occur in the first trimester

B. The Incidence decrease when gestational age increase
C. Risk decrease with increasing maternal age
D. Risk increase with increasing paternal age

47. Which classification is the best for management of abortion?

A. Etiological classification
B. Clinical classification
C. depend on its GA

D. depend on its legality

48. .Which of the following is true about the anatomic changes of pueriperium

A. Uterus changes from 1000gm to 100gm

B. The endometrial lining regenerates rapidly
C. Uterine funds palpates little below the symphysis
D. The uterus is palpable at 6 weeks A

49. when do you say asphyxia of the fetus based on the APGARscore interpretation.

A. APGARscore less than 04 in the first minut

B. APGARscore less than 05 in the first minut

C. APGARscore less than 05 in the last 5th minut

D. APGARscore less than 07 in the last 5th minut

50. One of the following fetal component of partograph is record every 30 minutes

A. Fetal heart beat A D.contraction

B. Maternal pulse
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C. Blood pressure