otlewlng is not true aboutthe

female false
n ticsabeve the linea teminalis pclvis
oterior boundary is
thefower part
Its size and shape have of the
anterior
s lateral remarkatble abdominal wall
bovndaics are the iliac obstetric importance
IES
posterior boundary fossae
are the
lumbarvertebrae
enstrual cyEla Is a:
Period whcn there is
blecding that results
Series of from the sheddlng of
physiological changes that the
Nrticulacly in the take place cndometrium
reproductive system every month ln a
Series of woman's body and
anatomical changes that
take place eveny
particularly in the month In a woman'sbody
Senes of anatomicalreproductive system
and physiologlcal
and
omans body and particularty In the changes that take place every month in
a
All Lhe reproductive system,
above
9. 1t isimportant to revicw the overtlme
trend of maternal welght
antenatal period because galn durlng
Poor wwcight gain may indicates
fetal death
The fast incresein body weightintrauterine
may predict devclopment of gestational
mellitus. diabetes
he fast increase In body mnass indices maybe predictive of pre-eclampsia
All the above
cOnly B and C are correct
19. Regarding determinationof the date of confinement

Naegele's rule assumes ovulation takes place on day 14 of the clrcle

Naegele's ule assumes an accurate recollection of UNP
Dating by USS 5Is more accurate in carty pregnancy than Nacgcle's rule In case of
Uncertain LMP
d. Dating by U5S is considered accurate in early pregnancy becaUse there ls minimal
variation in fetal size between individual pregnancies
All the above

11.The followingsigns or symptoms Is NOT present In a 12week pregnancy

Chadwick's
Quickening
UItasonographlc
sign

lb5)
fetal actions

d. Amenorrhca
e. Hegar's sign

12. When determining foctal station

part is at the level pclvic brim
3)
Zero station is whcn the presenting
part is assessed in relation to-ischial spines 4
The presenting brim
of nths from pelvic
Reported In parts
behind the level ischial tuberositles
Negative numbers are part
e is synonymous withh
descent of the presenting
It

changes oCCur during normal pregnancy

13-he following cardiovascular

a. Rise of cardiac output

Decreased heart rate
vascular resistance
Ca lncreased systemic
Decreased (luld rctentlon
d.
the incrcase stroke volume
Decreased prcload volume while
 14.During pregnancy
The stomach
Acld oroduyY
0ction
increasee
increa ses in the stomach
Transit time food in thre small intestine
d increases
Folate absocebi
increasee
e Tron'absocn
orption decreases

15. Regarding the symptoms and signs of prcgnancy;

a
Morning sickess of pregnany usually comnences about 6 weeks
term and persists tiif
b) Frequency of urination usually starts in first trimester, gradually dimtnlshes as the
uterus ises up into the abdomen and reappears
near the end of pregnancy
C. Frequency of urinationcommences In first trimester
and persists tllterm.
d. Easy fatigability Is mainly experienccd ncar term
and provides a diagnostic clue.
Chadwick slgn Is concluslve evidence of
pregnancy.

16. Regarding beta-hCGin carly normal pregnany.

Its tests may detect LH due to the shared

alpha chain.
b. Its production peaks at around 20 of gestation
'Its levels are bclow normal in hydatidiforrn mole
Its levcls are lower in singlcton than multiple pregnancy
Its levcls are lower than cctopicpregnancy

17.During early pregnancy,human chorionic goriadotrophin hormmone

Is produccd by the corpus luteum
Is produced by the mesoderm
Maintains the corpus luteum for productlon of prog esterone
U. May be detecte as early as day 8 and peaks up at 20 w¢ck
e. Maintalns the folcles for producton f
productiop of prdgesterone

18. Thc presence of ocdena In uncornplicated pregnancy

Indicates cither moderate anaenia or pre-eclampsia
Is common in pregnancy
Should be treated early before it complicates
Carries a poor prognosis for the fetus
All the above

19.Which of the following Is the cardinal sign of true labour?

Palpable uteine contractions
Progressive dilatation of the cevix
Efacemeit of the cervix
Engagement of presenting part of the uterus
Severe abdominalpain
20.The normal fctal heart rate is:

140 beats pcr minute

200- 140 beats per minute
120- 140 beats per minute
120- 160 beats per minute
110- 140 beats per minute
 16. Dianmeters of various fetal
parts are
e importaut during delivery. As delivery of
the breech occurs,
increasingly larger diameters of the body
enter the pelvis as
follows;
a. Biparetal, bisacromial, bitrochantericdiameters
b. Biscromial bitrochanterie,
biparictal,diameters
YBitochanteric, bisacromial, biparietal
diamctcrs
Te)
Bitrochantcric,bisaromial and occipito-frontal
diameters
Bitrochanteric,suboccipito-frontal,biparictal
diametcrs

17. Thc most likely diaguosis of a patient presentiug with obesity,

oligomenorrioea,
in fertility and tbeniga cularçement of both ovarics is:
ba Follicular cyst
(b)Mucinous cystic adenoma
S Sex cord and stromal tumour
d Polycystic ovarian discase
c Theca lutcal cyst

18. The foljowing is true regardiug

autiretroviral therapy during pregnancy
The recommended first linc treatmcnt is abacavir + didanos
b/Thc recomnended lirst +
saquinavir
linc trcatmcnt is zidovudinc +
lanivudine+ncvirapinc
Efavirenz should replace the use of nevir
Virapine,
d Because pregnancy itselfis associatcd with
decreased immunity, ART should Lc
started when CD4+ is above
200/al.
Nevirapinc associated hyper-sensitivity reaction
C
are less common
19Wbat wouldyou recommend as a first lide of mapagenent of conditiou in a t4
ycar old girl wbo attaied menarcbe 5 montbs ago ow prescuting
with severc
prolonged painiss vagioal bleeding for & days witbou t auy pelvic mass?
a Evacuation
b. Hystejetomy
c. Dilationand therapeutic curctuage
@ Conbined oral contraceptive pills
Danazol

20. Iu addtdon toLospltallzatlou aud uutiliypertensives lie manngement ofa

womau ntiug witl severe headacie, blurred vision
with pre-eclompsin presenting and
cpigastric pain ut 32 weclis should include:

a. movemcnts monitoring and plan dclivery if moverments decrcasc

Fetal

.
b. Dexamcthazoneand fetal movcments charting.plan delivery at 38 wecks
fa) Mapgnesium
a)
sulphate and Icrmination ofpregnancy
Dexamethazone hasten maturity and teminate pregnancy
to

Diazepam and cmcrgencyCacssarcan delivery.

immediatcly.
afer 24 --48 hours
 EuA -Tauthe

the blank space in column A the letter from column B that

3. Fill in
Best corresponds to the female genital structures in column A.

Column A Column B
i Fallopian tubes A Genital tubercle
1GLower thirú of the Genital swellings
vagna
it Labia minora Urogenitalsinus
iv A Clitoris Urethral fold 1.
v& Labia majora Müllerian
Wolffian
ducts
duct
G Cloaca membrane
H Urogenital diaphragm

4. Fillin the blank space in column A the letter from column B hat
Best corresponds to the malpresentations/malpositions in column
A.

Column A Column B
iA Face
ii D Brow 8
C
Submentobregmatic
Suboccipitobregmatic
iB Vertex
-D
Biparietal diameter
duht
ivF POPP Mentovertical
E Bimastoid diameter
V Hs "Sinciput
F Occipitofrontal
GSubmentovertical
H Suboccipitofrontal
S. The ditferentialdiagnoses include the following

Threstened abortion
b) aran failure
C Persistent luteal cyst
d. En dccervicalpolyp v
e Epithelial ovariantumor

6. The most likely diagnosis of a 19 year old girl presenting with

prima
rimary amenorrhea, broad chest, webbed neck, height less than
130 cm and features of congenital heart disease is;
a Premature ovarian failure
b Asherman syndrome
S Testicularfeminizingsyndrome
d Congenital adrenal hyperplasia
9Trner's syndrome (AS, x)
7 The condition of the above mentioned girl may be a result of
Chromosomally abnorm
Excessive dilataatiohality
tdtdton and curettage
C Elevated levels of FSH and LH in blood
d. Chiamydia infection in pregnancy
e. Syphilis in pregnancy

s. Which of the following drugs can be used

to arrest and prevention
of hirsuitism in the polycystic ovary
syndrome
a. Oral contraceptives
Spinolactone, CAn - h lcosthrone LompnelJ
Cimetidine
C.

d. Androgens
e, Bromocriptine-A len ferkl hJ galchakee

9. Regarding determination of the date of confinement LuMP (Sturh

a Naegcle's rule assumes ovulation takes place on day J4 of the circle
b Naegele's rule assumes an accurate recollection of LMP
S Dating by USS is more accurate in early pregnancy than Naegele'srule
In case of uncertain LMP

d Dating by USS is considered accuratein eariy pregnancy because

there is minimal variation in fetal size between individual pregnancies
6A theabove
 Fill 1
the blank space in
columnA from cofumn 6 that
hestc0rresponds to the clinical features of the sy thendrome
in
colunin A which are. One option can be used only once.

Column A Column B
A-Kalinann's syndrome B A. Sexual infantilism and streaked gonads
S.MCune-Albright syndromes BCystic changes in bones
A.Tuner's Svndromett A C,Retarded bone age
Sitver Syndrome c
D.spogonadotrophic hypogonadism
ang syndromee E.Hypergonadotrophic hynogonadism
F.Heterosexual precocious puberty
GAmenorrheoa and musculinization
vagina
H. Normal breasts, no sexual hair,uteruskupper

SECTION D: SHORT ANSWER QUESTION (5MARKS)

Answer this question.
Instructions:

your hospital following 2 hours

in

was primigravida, referred to

Mrs. that sacral
at your hospital you find
G
labour at health center. On arrival spine prominent
reached about 12cm,
promoMory was easily allowed only 3
(LScm on each side and the ischial tuberosity
about
knuck
going to compute the
obstetrical
a, Describe how are you
marks) part of the
conjugate?(3 of your patient as
b. Mcntion the mode
of delivery
for your answer.( 2marks)
management, and give reason

ALL THE BEST

9
 gonadotropbin bormone
11. During early pregnancy, humau chorionic
-a. Isproduced by the corpus lutcum
from the mesoderm layer
Iproduced by the tissues developing

cMaintains the corpus luteum for production of progesterone

as carly as day & and peaks up at

20 wecks
May be detccted
for production ofproducliorof progesterone
Maintains the follicles

presenting witb printar

12. What uost likcly diagnosis of a 19 year old girl
is the
less than 130 cm and features of
ancnorrhoca,broad chcst, webbed neck, heigbt
congenital heart disease?
a Premature ovarian failurc
b. Asheman syndrome
C. Testicular feminizing syndrome
a) Congenital adrenal tiyperplasia

Turner's syndrome
amcuorrioca,galactorrhoca and
13. A patient at the agc of30 ycars prescating ivith

be treatcd switb
infertility for 4 ycars could presumptively

.
as Clomiphenc citrate

b. Gonadotrophin relcasing hononc agonists

c. Noy steroidanti-inflammatory drugs

Hónonal replaccmcnt therapy
Bromocriptinc

The lower segmentof tbe uterus

14.

a. Develeps fully during labour

Tessily identitiabie
. ineter
during
in trimester
y
fally late
contractions
SDevelops
Is involved during utcrin
peritoncum
of the werus that is fixed covered by the
Is that part

fetus undcrgoes duriup ts

in positionand attitude tbat the
The series of changes
15.
cnual Is also tericd us:
birth cn
passage througi the
&. Tho prpcass of dollvery

b. Labour

C. Eiigagertient
d/Dercent
of lnhour
\GMechnnism
11. Bleeding continuing for four weeks after delivery

(A) most likely to be due retained products of conception

e C.
Is
May be physiological
Is associated
to

with cancer of the endometrium

D. Is commonly due to choriocarcinoma
E. May be associated with eariy use of combinc oral

12. In locked twins, the:

hrst twin is alwayscephalic and second breech

6First twin is alwaysbrcech and second cephalic
Both twins are brcech
d Both twins are cephalic
Twins can present in any presentation

13. Post-abortion care package

at reducing maternal and paternal
& ls essentially a strategy aimed
and morbidity
b Mainty foeuses on abortions of unplanred pregnancies
Involves counseling both couples for contraceptive
methods
comprehensive reproductive health care
OReInvolves linkage to the
the above
caused by
4 Early trimester abortions are mainly
abChromosomalmalformation
abnormalitics
of the uterus
Congenital
TORCHES infecti

d. Luteal phase deect

mellitus
e. Diatbetes

infeçtions have
been implicated for
15. The following bacterial
membranes and chorioamnionitis
prematurely rupturcd gonorrhoae
a StreptococcUS
DYONenes and Neisseria pyogenes
and Streptococcus
StreptococcUs agalactaciae monocytogcnes
orrhoac and Listeria
Neisseria gonorrh typhi
and Salmonella
Listeria monocYtogenes gonorrhoae
and Neisscria
e StreptococcUs 3galactaciae
the follo wing are recommended
In addition antihypertensives
to
16.
severe pre cclampsia. delivery at 38/40
for patients with nitoring, and plan
monite at 38/40
fetal heart and plan delivery
a. Bed rest, heart monitoring, rery at 38/40
fetal and plan delivery
b. Hospitalization,
fetal hcart monitoring,
of thc gestational
age
MgS04, hospitalization, 24 hours regardless age
plan delivery within of the gestational
. MgS04, delivery regardless
C. MgS04,
perform Caesarean
 13.Thefollowingis
1s the sequential series of the mechanisms of abcu
Vertex present
Csentation
RA Engageme
ment, flexlon, Internal rotation, extension and external Gie
T30 Engaceme
gement, Internal rotation, flexion, extension and external roiaiica
( Engager
Fnoaeexlon, internal rotation, external rotation and extensor
flexion, extenslon, internal rotation and external rotation
E. tngagement, flexlon, internal rotation, external
rotation and extensic

14.Gestational

2
Bls mostly
diabotes
Is basically reversed

likely media
pregnangy physiolog lcai changes in glucose metebnt
edlated by hurnan placental lactogen
G. Is associated with more
compllcatlons than
pre-existing
O. Usually requlres Insulln diabetes melri
therapy In the majority of
E. Is best managed by oral cases
hypoglycemlcs in early trimester
15.In obstructcd labour;
A, Vacuum delivery is Importantif in
se cond stage,
B. Moulding plus one (+) Indicates
Irreducible,
C. Forceps dellvery is better than
D. Mid pelvic obstruction, vacuum,
dellvery may be assisted by
Coesarean sectlon is high vacuum extracticn
recommended
16.The functionsof the amnlotic
fluld Includeto:
A, Permit fetal lung
B. Prevent adhesions maturation
between the
C. Permit fetal movements fetus and membranes
D. Protect the fetus from
mechanicaltrauma/injuY
GAll the above
17.The chances of vertical
HIV transnission in the
prolonged breast feeding without cOmmunity that practice
A. 40 S0% - $
intcrventions 3re approximatetv
20- 30%
KO Less than
More than
20%
75%
E. 50- 75%

18.The following term has been

correctiy matchcd with its appropriate
definition.

Posture: The rclation of the long axis of the etus to that of the mother
Position: That portlon of the body of the
fetus that is either foremost within
canal or In closest proximity to it
C. Presentatior

D.
presentin
Fetal abut
becomes markedv
the abdomen; the legs hent
eonucn
tationThe relatlon of an arbitrartly chosen portion of the feal
or er Side of the maternal

co the thighs
birth ganas
a manher that (he
lexed
ha
s
e arches of The fet rese
Upon the anterior surfaPae
(E) Descent. The degree of descentof the prespnting part into the birth canas
s
relation to the level of the ischlal spines
 he wonnan complaining of menorrhagia, the
following is trues
zept
Inhibitots of
plasminogen activation and
b NSAIDS ike mefanamic acid can be used fibrinolysis are effective
)Levorneqesterol IUCD worsen
the menorrhagia
Pelvic to exclude leiomyoma is advised

None ol the above is true

30. The pathological fractures in senile is most probably due to

a Obesity
b.
Estrogn deficiency
tn senile
in senile alud agilclduty pecp

Increa% production of androstenedione

d. Poor bone vascularization
)Allof above is true

SECTION B: MULTIPLE TRUE FALSE QESTIONS

/ (40 MARKS)

Instructions:
Write the wund True for each true statement and the word False for a
wrong staterient, Half a mark will be awarded to each correct responseand
thesame will be deducted for each incorrect response.

1. Which anong the following are NOT causes of malposition?

a. FASEP.ndulous abdomen in multiparous women.

b. TeuE_Anthropoid pelvis

cFALLE Nndroid pelvis

d. FAUL Ilat sacrum

e. FASENone of the above

the method
2. The following part of the bony pelvis is matched with
recommended to assess its adequacY ( dimension) in obstetrics
a LRuE Pelvic inlet: Estimate diagonal conjugate and compuie for
obstetnt conjugate
b. FEFalse pelvis: UitrasonographyY
and curving
Mid pelvic cavity: Estimate interspinous diameter
of th acrum
d. lRuE_ Pelvic Assess the
outlet: protrusions of ischeal tuberosities

e Eru Subpubic angie: X-Rays pelvimetry

SECTION A: MULTIPLE CHOICE QUESTIONS
Instructions:
(30 MARKS)
most
Circle
will
tihe correct
be uwarded for each correct response
answer. No penalty for
incorrect response. onfe rk
1. The abnormal menstrual
Ipattern associated with short folliulhr
phas: is called
a Morechagia, Vey hee bludng ny eothuahen alNuld
(b Muometrorrha
ègia
Olnenorc
rocd,
Akvulatory bieeding

2.Shecha's
syndrome;
HXM.ay bea comolica and curettaoe
wtk er dilatiorn
Is associated amenorrhea.
dary
Tends to ran i

d. Can result from pitiuitan

e, ll problen1 arises in
in the
the nypothalamus

3.The following is true about ovarian cycle

a. Ilnsynonymous with endometrial cycle
b. Luteal phasc follows secretory phase
Lutea phase follows ovulatory phase

e Nese ronoWs ovulatory phase

corpus luteum is associated with elevatd oestrogen
an progestèrond

Amina v.t a 14 year old girl (5 months after menarche) was admitted in the
9ynaecitgical ward with history of severe prolonged pnless vaginat
bleedine or 8
days. She had no any pelvic mass on exaInination or by
ultrasout Use thhe above clinical history to answer the following twb
questions.

Ces
4. The tullowing could be recommended as a first line of

management
a. Evacuation
Hyrterectoy
O
C
b.

Diatption and therapeutic curettage

Combined oral contraceptive pills
Danazol
e.
taphtcf
Hlone

SthyeLetsy
 6. Post-zbortion gare package

yASt Is ctscntially a strategy aimedatrcducing maternal and patemat moa

and morbidity
S1But Involves treatrment of incormplete abortion and potentially ife-thrcater

Es
Aec
licationc
Maihly focuses on abortions of unplancd pregnancics
Invelveš counseling both couples for contraceptive methods
Vé TeuE Invdlves linkagc to the comprchensive reproductive hcalith care

7. It is importantto review the over tine tred of materoal weipit gain durig
aptenatal peridd because
a (RutPoor weight gain indicates intrauterine fotal death
ob. TPc Thc fast increasc in body weight may prcdict devclopmentof cestaten
diabetes and hence increascd risk forcangenital anomaliesof ite fes
AALg The fast increasc in body wcight may predict devclopment of intraisa
9 growth
d.t restriction

The fast incrcase in body mass indices may predict development o H

cclampsia
Duy The poor incrcasc in body weight may predict mnalnutrition in pregnan

8. The following is/are associated with the use of alcolhol during prepuatee

euE intrauterinc growth restriction

b. congenital heart discase
mental rctardation

d. ats spina bifida

Ghes atypical facial appearance
 SECTION B: MULTIPLE TRUE/FALSE QUESTIONS (20 MARICS)

Instructions:
Wnte the word True for cach true statcment and the word False lor a wrong
statement

* Hall a inark vwill be awarded to cach correct response and the same will be dediucted
forcach incorrectsesponse.

1.The folowingbormon() it/are aotproduced by the placenta.

Human chorionic gonadotropin F

bFpysLHuman plcental Lactogen

Ct Prolactin

.ESE Progestcrone F
TPuE Eztriol T

3.The following factors predispose an adolesceut woman to anacmia in preguane

Disproportional increasc in maternal bood volune versus rod blood cet: F

mass
Au
VE e

CoPlaccnta
Rapid growlh during adolessence
Menstrual blood loss
Poor dict of low bioavailability
pracvia
leading to inerease needs for uon

3.Thefolowinytreatrments caa be used in the condition witlh which tley are pired
1euE GnRH analogue: Filroids T
. 9E Intrauterine device' post-coital contaception T
Cis-platinun: Cancer af cervix
4Clomiphenc citrate: Asheman syndrome
Medroxyptogcsterone acetate: post mernopausal blceding

TheSollowiug describes the Lormoual depcndency of leiomyon

4.
atHavo uostrogan roaupture
b. Tt May enlarge with oral contraccptives

Od c
c (AEMsy be Ssocisted witlh
13E Muyshrink during pucrperium
fAtSEUsyally shrinks afler
inifertility

menopause

prcgn ancy
S.The followlug cardlovascular cluanges occur during

Rise of cardiac output

Decreased hcart rate
Lncrcaspd systernís vascular resistance
fuid retention

Decrcised prcload volurne whilethe incrcase stroke voline

 19, The tollowing are,estregen
combined preparations connmenly used in manenh
EthinyloestraCptives
oresthisterone and
stre V
OEthinyloestradiol and mestrangt
Estrone and mestranl
E Ethinyloestradiol and gestrone

20.Thefollowing condition nimicsnost closely

the clinical features ot
camplete mole
A Polyhydramnicus
B Fibrold in pregnancy

rnone producing tumours of the ovary

Multiple pregnancy

SECTION 2: TRUE AND FALSE QUESTIONS (20 MARKS)

Instructions:
nce che word rug for each true statement and the word Ealse for a wrong

be detueted oroc cach incorrect response

to cach corect response and the sase

1 Cigarctte moking during pregnancy is assaciated with

A
.FLE Ectoplc pregnanc
Prmature rupture
T

of embranes |
2 Placental barier

TLaEThe
he thinnu
thinncst arcas consstmainly of the cytetrophoblast celts, to ts
TB. LHofbauer cells are comnonl senn ItCl

TLTRaOygen by simple ditfuslon

crosses it

FX0
BE. Tgis fuly developed in the sccondary chorionic
Approxiately 80% cf the barrier ls involved
villi

in material exchange

Kgs
3. EIfacement

T6TEUsualy
in nermat labeur

as the degree'of thinningot the

defined
precedes dilatation in primigravide
uterus

TcSSPUsUally occurs simuitaneouswith dilatation ef the cervix in mtie

D.rBEls onc of the Indicators ef true 1abour
benEAlways becames fulyin the active nhase af first stage ot tabeur
16.Regarding syphilis
a. HALSE The presence of the chancre is diagnostic of secondary syphilis
b. Chancre is characterized by single, painful, clebn-based
induratcd ulcer in

(he anogenital area

C. FALri The presence of the diffuse non-pruritus,indurated rash
indicatesprimary
SYphilis
d. PAtuE The presence of the condylomata lata indicatestertiary syphilis
e. 1uE Can be treated with Benzathine penicillin G, doxycycline and
ceftriaxone

SECTION C: MATCHING ITEMS QUESTIONS (30 MARKS)

1. Fill in the blank space in column A the letter from column B that
best corresponds to the purpose of the manoeuvre in column A.

Column A Column B
iA Chadwick's sign A Minute, red elevationson the
skin
D inea nigra Marked enlargement of the
uterus
ii E Hegar' s sign Stretchingand breakdown of
deep collagen deposits
iv Melasma gravidarum D Brownish-black coloration of
the midline of the abdominal
skin
C striae gravidarum E Darkening of the nipples of the
breast
F Softening of the cervix and
uterus
G Hyperpigmentation of the skin
and face
H Blue coloration of the cervix ,
 The bony pelvis
3. May sustain
(Slscomposed minor
of the
fractures in case of strong
precipitated
sacrum, coccyx and
1as one innonminate labour
two innon
bone which is fomed bones.
and pubis by fusion of
of the ilium, ischium
.Hasthree innpminate

t
sacrolliac
bones which are
joined to the sacrum
Synchondroses at the
e. Has two
innominate bones which are
iljac bones joined to the symphysis pubis
by th
18.
Regadihg managemnent of
het
Once the head is delivery
and nares must bedelivered the face is immediately wiped and the
b suctioned mouth
The heart rate can be
Cord deternined by palpating the base of
the umbilical
The infant should not
be placed supinewith

e to the side the head lowered

and turned
Tominimize heat loss, the baby
sthould not be
Persistent heartbeat of
100/min Wipe dry
or more after birth
resuscitation requires pronpt
19. It is important to
revicw the overtime trcnd
weight gain during antenatal of maternat
period because
a. Poor weight gain indicates intrauterine fetal death
The fast increase inbody weight may
diabctes mellitus and hence predict development of gestational
increased risk for congenital
fetus anomalies of the
C. The fast increasein body weight may preict
grqwth development of intrauterine
restriction
d. The fast increasein body mass
indices maybc
All theabove predictive of pre-cclampsia

20. Which of the following is the best management for

second stage fetat distressin
a. Administer antibiotic - ciplofloxacin
Deliver by vacuum extraction
if the descent level
is less than 2/5
Administer oxytocin followed by fundal pressure
to hasten deliver,
d. Administer i.v. dextrose fluid and thcn oxytocin
drip to hasten deliver
Deliverby caesarean section if the descent level is
less
6. Regarding the fetal skul.

O The anterior fontanelle is at the junction of the sagialand coronal sutures

The anterior fontanelle closes in the first nine months of infancy
c The smallest AP diameter is the sub-occipito-frontal diameter
d. The vettex is delineated by the anterior and posterior fontanclles and the frontal

cminences

. c. Moulding in labour only

The following
of voice in a
condition
affects the face,

30 year old wvoman who was initially normal.

ta) Congenital adrcnal hyperplasia
vault and base

may cause amenorrhoca,breast atropliy and deepenivg

Germcell tumours of the ovary

5 Testicular feminization syndromie
Adr enal tumours

Breast tumours

8, Tbe following is true about ovarian cycle

tssynonynouswith cndometrial cycle

Luteal phasc follows sccretory phase
)Luteal phase follows ovulatory phaseV
d Follicular phase follows ovulatory phase
with clevated oestrogen and
C. Degcncration of corpus luteum is associated
progestcrone

-9. The coudition presenting with 'powdtrbura'peritoneal lesions, dysmenorrliora

dysparcunia and infertility:

is usuallyassociated with contact vaginal
bleeding
a.

causes increased ocstrogen rclcase

b. usually
best reatcd with combincd'oral contraceptives
s
(a)may also prgscnt with bilateral blocked tubes block and extensive pclvic

adhesionsV
hormone
Ghas lesions hat usually grow in size on cxposurc to thyroid

10, What is the nost likely diaguosis amoug the followiug of womau presentleg
tlhe

abuurual vuplual bleellug, u mnx* rlslug frum the vary and very seatlk
swltlu

Sertoli-Leydig Cell tumours

(b)Thecoma Epithelial ovarian tumour

d)Dyspeminoma
Teratona
 SECTION C:
MATCHING ITEMS QUESTIONS
1. Match the lettered
itemsfrom the
premises in the space responses to the
provided. One option can be numbered n
Uscd cniy ance
PREMISES
RESPONSES
fMesttanol-F A.
TANorethistergng - Progesterane only pills
B Copper IUD(ParaGard) Barrier
Mirena
method A
DNonoxinol-g
ginal foam
BLevonorgestrèlreleasingc E

contraceptive gency intrauterane System

agent
Micns G. Ethinylestradieptve
agent
H. Implants
2, Fill in theblank spa
pace in column A the
corresponds to the condition would youletter from column B that best
prescrlbe the drug in colurn

PREMISES RESPONSES
c
C Danazo!
Cevical ripening
F Tamoxilen DKF
A
Endoma
H
MisoprostolD
Clomiphene
Endometrial cancer
E Bromocriptine FE Galactorrhoea
Oligospermia
Post coital bleeding
Unovulation.

SECTION D: SHORT ANSWvER QUESTIONS (20 MARKS)

Instructions: Each question carries five marks. Answer all questios

Outline clearly the principlesof management of this condition presenting

with 12 wecks of
amenorrhoca, cxcessive nausea and fundal height
appcarance and ovarian cyst. (S mre)Ynow store

. riks)

Outline the parametersassessed using Bishep score.

SECTION B: MULTIPLE TRUE/ FALSE QUESTIONS (20 MARKS)
Instructions:
Wite the word True for each true statement and the word False for a wrong
statement. Half a mark will be awarded to each correct response and the same
will be deducted for each incorrect response.

The WHO guitelines recommend to start immediately charting the

1

partogram if the patient is found in the following stages of labour

a. Latent phase: when contractions are at least 2 in 10 minutes,
lasting more than 20 seconds
b. .Active phase: regardless of the presence of contractions
Active phase: when contractions are at least 1 in 10 minutes,
lasting greater than or equal to 20 seconds
d. Spontancous upture of membranes: even without contractions
F. Induction of labour:just before contractions commence

2. The MgSO..7H0used in management of cclampsia

Relieves cerebral vasospasmn
b. IReverses the distal cerebral arterial vasoconstriction leading to
prevent vascular endothelial damage
Has a wide safety margin
TL High dose can cause suppression of the respiratory centre
It toxicity can be reversed by using calcium gluconate

3 Cervical incompctence
Is a cause trimester abortion
of first
comitalT
b. PMay be td withnrevious
instrurnental delivery
O.
aonbsed by follicular phase hysterography
diagnos
s
associated with painless premature labour

4. In scvere ancmia in pregnancy,

Heart failure results frorm cardiac muscle oxygen tack,
T
The most dangerus period is 1 hours after delivery,
Closureof arterio-venous shuntsof the placenta increases the risk.

F
Aito-transfusion reduces chances of failure after delivery,
C. Increase in blood pressure is uncommon

5. When determining fetal station

Zero stationis when the presenting part is at the level pelvic brim
b. J. Isdetermined by the presenting part in relation to ischial spines
Reported in parts of fifths from pelvic brim
Negative numbers are behind the ischial spines
4 1It is synonymous with descent

6 Fut ycas
fSH, LHt1Sy
cnd ofiilraation cxanminiion

nen - h CG S
 SECTION A: MULTIPLE CHOICE QUESTIONS (20 MARKS)
Instructions:
Circde the most correct answer,tio
penalty for incorrect response.
be awarded foreach Gne mark ill
correct response.

1. In general, when does

ovulation occur?
14daysafter onsct of menstruation
Uu 14 davs prior to the
C 21 aysafter sct of menses
C Z8 days after lenstruation
the
menses
C. Any day of the cycle
2. What is the shortest diamcter
of the pelvic cavity?
Diagonal conjugate
interspinous

d oLconjugate
conjugate
Crical
C. Oulique diameter of the inlet

3. The normal sequence of

appearance of sexual characteristics in a gir

atreast buds, pubic hair, vaginal secretions

b. Pubichair, breast
devclopmcnt,oxilary hair
Pelvic fernale contour, ac
OyBreast buds, pubic hair and axillary hair
Aillary Yhair
hair, breast buds, pubi hair

4,The following conditions commonly cause secondary amenorrhoca

Voniancy
E Cryptoamenorrhoca
Anorexia nervosa
d.Ashcrman's syndrone
C. Shcchan's syndrorme

S. Which of the following conditions is more likety to pres cnt with

primary amenorrhoea, recurrentpain and pelvis nass that gets
worse during periods
a. Adcnomyosis x
b. Endometriosis
C. Uterus unicornis
Congenital adrenalhyperplasia
Menstrual outfiow obstruction

2Firs ycars cnd of irst routien CKamination

 TANZANIAN TIIAINING CINTRE FOR INTERNATIONALIIEALTIH.
IEAKAItA-AMO SCIIOOL

DETARTMENT OF OBSTETHCS AND GYNAECOLOGY

END Or yEAR ONE WIUTTEN EXAMINATION

Candidate No:

10 08.2007 Time 2% lours

Date:

Geueral ustruetions:

Read all instruction given under cachh section very carefully

Read thc question carcully before aisweing iem
Wiite your cxamination nunber on each sct of pape you uce

Antwer all questions

This paper consists of ive cctions

TOTAL SCORED
SECIIONS
MAIKS
Muliple CheiceQueation
Trueralse Ouestions 30
IMultiple
10
Matchine Ouestions
Short Aswer Ouestions
TGnided ESSay Ouestions

TOTAL.MARKS
 SECTION A: MULTIPLE CHOICE QUESTIONS (20 MARKS)
Instructions: Encircle the letter preceding the most correct answer
be awarded for each
Ore
correctly answered staternent. Atternpt
all questiGns

1. In thefetus
The umbilical arterles carry
oxygenated blood
The ductus venosus short clrcults
tho caplilaries of the livers/r
The right atelum contalns
only
oxygegated blood
The foramen ovale connects the
venlcles of the heart
The ductus arterlosus jolns the
aprta proxlmal to the
aortic arch

2 complication of pregnancy that

radiologlcally
Spalding'sslgn may lead to: prescnts with positive

A. Decreased breast mllk production

B. Fact
C ELPegnancy growth rate
evated blood pressure
Postp
Stpartum haemorrhage
Fetal dlstress

3. As opposed to monozygotic, dizygotic

twin pregnancy
A. Vsmore
assoclatcd wlth congenital
maiformatlons
Results from fertillzatlon
C. Is ess likely to be
of a single
ovum that divides into two zygotes
monoamnlonic, rlonlc twin pregnancy,/
D IsAnorelkecly to have Twin-TwinTransfdston
E. Hasa more less simllar
prevalence all over tie worid

4. AcO mplete breech presentatlon Is best descrlbed by the

following
A) The knees and hlps of
Tne knees are vte
jecUS are lexed
and the hlps are flexed
C. The arms, knees and hips are
fiexed completely
D. The knees and hips are
extended
E None pf the above

.5. The foltow

Tolowing arc recommended trcatments/procedures for the
conditionswith whlch they are palred:

KA) Simple hysterectony: Carcinoma in situ of the cervixy

Radical hysterecto
noma In sltu of the carvix
(Myomectomy Suh
blood trane iorolds
Whole vere anaermla in labour
e
S Hormorial therapy: Metastatic Cervical cancer
E
SECTION C: MATCHING ITEMS
Z.Fill in the blank space in QUESTIONS (10 MARKS)
column A the letter from column B that
best corresponds to the clinical
features ofthecondition in column
which are associated with
infertitity. One option can
A

only once. be used

Column A
Column B
LD Severe chronic anaemia A. Couvelaire uterus

HELLP Syndrome
-B. Craniopagus and thoracopagus
Abruptioplacenta C. Uterine rupture
Multiple pregnancy
D. Wide pulse pressure
Placenta praevia -E.-Periportal hacmorrhagic necrosis
F. High fetal
presenting part
G. Hepatitis
H. Short pulse pressure

2. Fillin the blank spaces in column A the lctter from column

mostcorrect characteristics B with the
of typical peivis in column A.

Column A Column D
A Android pelvis A Heart-shaped inlet and sidewalls converging in
BAnthropaid pelvis the cavity and nare
HPlatypetloid pelvis D. Oval inlet withwipuiC
than
arch
transverse diameter
v.CGynaecoid pelvis and sacrum inclincd posteriorty, common for
POPP
V. Einternediate-type C. Round inletand straight side walls of the cavity
pelvis and wide subpubic arch
D. Oblquely truncated, bent cylinder vith
Srcdtest
height posterioriy and
shorter
E. Much more frequent than pure types.
F. Conmonly seen in patients with kyphosis or
SColiosis
G. Its walls are partly bony and partly ligamentous
H. Oval inlet with wider transverse than AP
diameter,cavity with flattened posterior wall,
comman for deep transverse arrest

cxamination
Fst yras cndof firt toation
 SECTION A: MULTIPLE CHOICE oUESTIONS (20 MARKS)

Instructions:
Circle thc letter ofùe corect answer, One mark will be awardcdfor cach corTect
Tesponse

1. In-the fetus

a. The unbilical arteies carry oxygenated blood

b The ductus venosus short citcuits the capillaries of pheliver
The right atriun contains only oxygenated blaod
The forarnen ovale connects the ventricles ofthe heart
O) The ductus arteriosus joins the aorta proximal to the aortic arch

2. Sevcrealrdomioal pain, fainting attacks due tohypovolemiaaud rcbound

tenderness of the abdomen in carly pregaancy ia absencc of vaginal blecding is

more likely found iu:

a Thrcatcncd abortion
b. Molarpregnancy
c. Cogetalcd abruptio placenta

d. Anacmia in pregnancy
Ruptured cctopic pregnancy

The following scries outlines the uormal scquence in early buman developent

2 Embryo,blastomeres, morula, zygote and fetus

veote enmbrvo, and fetus
b Dlastoneres, moria
Tvgotc, cmbryo,
lashvo onula and
and
fetus,

fetus

\E OZyBote, blastommorula,
Conceptus, blastormeres,
zygote and tetus

the uteres?
Which of the following is one of the main supports of
4,

Broad ligaments
Infundibulopelvic ligaments
the ovary
Round ligancnt of

)Cudinal liguments
Llgamants of the

Uterine arteryr
branch of commonBiliac
il artery
(a) 1s a direct

Gives branches Uiat suppy

Gives branches that
supply
e
cervix and upper
vajgina

nd nosterior wall of the btadder

2 cm latcral to the internal
os
below the urctcr about
Crosses the ovary
of the utferus and
blo0d supply
d
c Provides the main
 A patient who
labour
has had one previous Caesarcan
Scction and is in
4
a.
FShould be delivered by Caesarean section
b. Should not have an immcdiately.
CT
1
epidural anesthesia.
Is at increased
risk of uterine
sectionv ruptureif the previous
was complicated by infection. Caesarcan
d.

C. T Labour should not be

Should be delivered by
in breech
augmented with syntocinon.
Caesarean scctionif the index
fetus presents
7. Gestational diabetes is
Basically
exaggerated physiological changes in
during
pregnancy. glucosemetabolism
EMediatedby high production of insulin in the body
Mediatcd by diabctogenichormones
including humnan placental
lactogen
d. FMost commonly treated with insulin
e. More commonly associated with congenital anomalies than type 1
dicabetes

B, Thc following classes of heart

diseases havc bccn correctlydescribed
based on the New York Heart Association, clinical classification
Class I: Cardiacdisease and slightly compromised heart
activity
Class II: Cardiacdisease and no limitation of physical activity
Class II: Cardiacdisease and slight limitation of physical
activity
d. TClass I1I: Cardiac disease and marked limitation of physical
activity.
e. Class IV: Cardiac disease andynarked limitation of physical,
activity Che

B'SI GNS
-Peynar
pers

Amenorren (3 LincA Nrg

Nes
Brcst dnrek tndan (13t Ar

7 Fustyae tpd of irq rotation cxaminaion

Perm
2. Fill n the blank spaces in column A the letter from column
the most correct B with
characteristics of typical pelvis in
column A.

Colunm A
Column B
FEUterus A. The blood supply to
.A Ovary
tnfundibulopelvic
s organ enters the
,
abla
majora vC ligament.
B. The venous drainage to
iv. B !allopian tube this organ empties
into the renal vein on the
left.
V. Bladder C. The blood supply to this orqan is
derived
from branches of the inferior mesenteric
artery.
D. The blood supply to this
pre
redosnantly derivedS internal
pudendal artery.
E. Three branches of the anterior
division of
the internal iliac artery
supply this organ.
F. The blood supply to this
organ cross
the ureters 2 cm lateral to the cervix over
G. The medial two-thirds of this
organ drain
via the
pampiniform plexus to the ovarian
veins.
H. Three branches of the posterior
division of
the internal iliac
arterY this organ.
1. The blood supply to this
organ is derived
s
from branches of the superior
mesenteric
ter
J. The blood supply to this organ
enters thef
round ligament
12
Effacement in
normal labour
afntels defined as the degree
ofthinning the
e4E Usually
precedes dilatation in
of uterus
TRue Usually occurs primigravide
simultaheous with dilatation of the
altiparas cervix in
TRels one of the
indicators of true labour
eAlways becomes the active phase of
fully in
first stage of labour
13 The following are recommended in the management of labour
HIV positive women in

Active management of first stage of

labour
bTLuEAvoid early rupture of membranes
when there
nt labour
is normal progress
c HaLE immediate suction of the newborn
d.FAlE Pertormepisiotomy to facilitate second stage of
TP4E caesarean section to reduce transmission of HIVlabour
e.
to the baby
14 The followving management approaches
for reproductive tract
infections have been appropriately described
1CuE Etiological laboratory approach: Target treatment based on
high index of
clinical suspicion
b. TeuE Etiological laboratory approach: Identify the
causative agents
and then qive
specific treatent
C. TRuE Etiological clinical approach: Target treatment based on
sUspected causative
agents diagnosed clinically
Syndromic approach: Identify clinical syndrome followed by
Specific
treatment
e. TeuE Syndromic approach: Give treatment based on both clinical
and laboratory
findings

15.Human chorionic gonadotropin hormone

FAUis produced only by cytotrophoblast cells
a.
bTiAu6 maintains production of progesterone from the corpus luteum
cTRE has an a subunit that is structurally similar to that of luteinizing
hormone
fA Has
d.

eTRUE when
subunit
in excess
a subunit which pregnancy specific
is associated with hyperemesis gravidarum
8 suspicion of pregnancy of eight weeks gestation may be
confirnncd by
a FAUCvginal examination
fEabdominal
b examination
cFoLEIcast examination
dPut aY immunological pregnancy test
eTeUE an ultrasonic scan

9 Asherman's syndrome

a ud is characterized
by infertility, recurrent abortion and menorrhagia F
b:RuE Otcurs puerperal curettage T
cRshacmorrhage
after
associatedwith obstetric complication
f
including post-partum

d.fAst May be treated by forceps F

e.TauE May be treated by a Foley's catheter

10. Regarding common problems in pregnancy

a.FAUE Lower back pain is the result of decreased activity as pregnancy
proureSsesP
b. TRUt rtegular contractions, are rare and are harmful F
C Round ligament pain is caused by the rapid expansion of the

d.1 TeuE unnary frequency is associated with decreased elasticity of

bladuer muscles
blaC T
e. Eionstipation is the result of increassed progesterone levels

11 At term, the following are true for labour

a.TiRuG Over 90% of babies present by the vertex.
position.k
bLAB The head enters the pelvis in the occipito-lateral largest diameter k
C.FA LE Lagagement
of the presenting head is when the
of 1

diameter has entered the pelvic brim.

duje aehead head

normally
e
delivers
engaaed
in
it
an
is
occipito-anterior
almost at station
position.
zero
e.rRE Vhen the
-
 3. When determining fetal station
e Zero
a
station is when the presenting
part is at the level pelvic
Is determined by the presenting part in
CReported in parts of fifths relation to ischial spines
d. 1@ME from pelvic brim
Negative numbers are
behind the ischial spines
It is synonymous
with descent
4. The following liver function
a.T
terum alkaline phosphates
changes
eeu n pregnancy:
b. tSerum cholesterol
Serum albumin
concentration
concentration is
falis

reduced T
-
d. euE Serum globulin rises
Transaninases concentration falls T

5. Clinical pelvimetry allows

FAU6.
1CU5.
e direct estimation of

Obstetric conjugate diameter

bC
Diagonal conjugate diameter
c.TAaa True conjugate diameter
d.TRL5 Transverse diameter of the pelvic brim
Fe. rcE
Interspinousdiameter

6. The following factors contribute to fluid retention during

pregnancy
Sodium retention
TREincreased thirst threshold
Decrease in plasma oncotic pressure
d.FAUElfaemoncecentration
e. TeuLincreased absorption of protein in the qut

7. A Regarding the_anatomy of the reproductive tract, the

a. TrAuE_The embryo in uterine cavity is lined by the decidua parietalis

b. TaLrE_ Oviducts emerge from the cornua of the uterus
c.Fe_ Uterine muscles undergo remarkable hyperplasia during
prcgnancy
wed Pu Ureter crosses over the uterine artery about 2 cm lateral to
7c
e. T cervix.
Symphysis pubis has a certain degree of mobility during pregnancy
15. Induction of labour is almost
3. Pr absolutely contraindicated in
tged
pregnancy
b. Hexvtdisease

2)Dtes Plonntat
mellitus

Pnta pracvia
O
insufficiency

16. The following is not true about the vaginal

opening introitus
AOpenng may be covered by a thin
b Usm the presence of an sheath called the hymnen
intact hymen for
erroneous determining virginity is
C Sote womnen are born without
d The Itvmen can be perforated hymens
by mnany different
No of the above events

17. Which of the following

is likely to be a cause of secondary
amenorrea?
a. Deluy ed puberty
b.
Mayc-Rokitansky-Kuester-Hauser
G Prolactinoma syndromne
d. Goitdal
dysgenesis
e. Androgen insensitivity

18. During embryonic

development
a The uterus
develop from the Wolffian duct
b.
Testosterone stimulatesdevelopment
duct of the
the
development of Mullerian
e The vary in the female develop
from the genital ridge
Conienital anomalies develop
as a result of genetic-plus
enviroSmental factors
Cand D are correct
19. The scrotum
and labia majora
from. embryological are primary
derived
Cloa ca fold

Cal phallus
membrane
u Genital tubercle
Genital swelling