MCQs in Obstetrics and Gynaecology

ANC

1. ANC should achieve the following objectives:

a) screening for problems (or complications) actual and
potential.
b) with normal pregnancy the woman is seen weekly.
c) USS is performed routinely in all ANC visits.
d) primary aim is to promote and protect the woman and her
unborn baby.
e) pregnancies at ‘risk’ are to be followed at PHC units.

2. Base-line investigations in ANC:

a) Hb, blood group and Rhesus factor.
b) urine for protein, glucose and ketone bodies.
c) X-ray pelvic organs to confirm diagnosis of pregnancy.
d) microbiological tests such as rubella, hepatitis-B and
VDRL.
e) routine urine culture and antibiotic sensitivity.

3. ‘High-risk’ pregnancies include the followings:

a) patients with previous history of CS.
b) a Para viii pregnant lady.
c) all primigravidae.
d) twin pregnancy.
e) a pregnant woman with renal transplant,

4. The aims of ANC follow-up must include:

a) maintain good health of pregnant women.
b) to follow the fetal wellbeing.
c) prepare for future breast feeding.
d) health education for all mothers.
e) Iron supplementation if needed.

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Antepartum Haemorrhage:
1. APH:
a) defined as vaginal bleeding after 20 weeks of pregnancy.
b) tense abdomen and absent fetal heart sounds indicate
placental abruption.
c) severe haemorrhage is an indication for urgent CS
regardless of gestational age.
d) ‘Couvelaire uterus’ is a common complication of placenta
praevia.
e) fetal mortality is not significantly high.

2. Vasa praevia causes bleeding from:

a) mother.
b) fetus.
c) fetomaternal.
d) cervix.
e) rectum.

3. In placenta praevia:
a) bleeding is recurrent, painless and with no obvious cause.
b) malpresentation and abnormal lie are common.
c) the presenting part is deeply engaged.
d) incidence is increased with previous CS.
e) the abdomen is soft and not tender.

4. In placental abruption:
a) placenta is always morbidly adherent.
b) placenta may partially cover the cervix.
c) the abdomen is tender and woody- hard.
d) sometimes there is no visible vaginal bleeding.
e) acute renal failure is a fatal complication.

5. Local causes of APH include:

a) cervical polyp.
b) urethral caruncle.
c) haemorrhoids.

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 d) cervical carcinoma.
e) vulval varicosities.

6. Possible complications with APH:

a) severe PPH.
b) Postmaturity.
c) DIC.
d) bilateral cortical necrosis.
e) puerperal sepsis.

7. Investigations for a patient with APH include:

a) Hb, blood group/cross-match and save.
b) USS.
c) Kleihauer test.
d) vaginal speculum examination to exclude local causes.
e) laparoscopy.

8. When managing a major placenta praevia:

a) blood should be cross-matched and ready for liberal
transfusion.
b) vaginal delivery is always appropriate.
c) consider maternal steroids in preterm pregnancy.
d) EUA may provoke torrential haemorrhage.
e) CS hysterectomy may be the last resort in case of
uncontrollable postpartum haemorrhage.

9. In concealed APH:
a) uterus is less than dates.
b) uterine contractions may be elicited.
c) fetal parts are easily identified.
d) PPH does not occur.
e) there is always visible vaginal bleeding.

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History and Clinical Examination:
1. Menstrual history should include:
a) menarche.
b) katamina.
c) the estimated date of delivery.
d) history of barrier method of contraception.
e) gestational age in weeks and days.

2. Fatima’s LMP was on 29th. of November 2006:

a) her EDD will be on 1.9. 2007.
b) her EDD will be on 3.9 2007.
c) EDD will be on 6.9. 2007.
d) gestational on 6.8. 2007 will be 36 weeks.
e) USS will give provide reliable dating if done in late
pregnancy.

3. Medical History should include:

a) history of diabetes and hypertension.
b) allergies.
c) blood transfusion.
d) smoking.
e) congenital malformation.

4. Past Obstetrical History includes:

a) early neonatal death.
b) instrumental delivery.
c) maternal birth trauma.
d) macerated stillbirths only.
e) spontaneous or induced labor.

5. Breast Examination:
a) look for symmetrical enlargement.
b) look for Montgomery’s tubercles.
c) nipples are expected to be everted.
d) on deep palpation four areas are palpated for breast lumps.
e) in case of IUGR milk can be expressed from the nipples.

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 6. Examination of Head and Neck look for:
a) glossitis and Stomatitis.
b) artificial denture.
c) 8 groups of lymph glands.
d) jugular pulsations.
e) Chloasma.

7. Inspection of the Abdomen:

a) surgical scars.
b) Striae Gravidarum.
c) Braxton-Hicks contractions.
d) in an obese patient visible fetal movements are seen.
e) cautery and tribal marks may be seen in some Sudanese
patients.

8. Obstetrical Examination:
a) the uterus is pushed to the right side by the enlarged left
ovary.
b) the breech can be identified as being broad, soft, irregular
and not balatable.
c) Pawlik’s grip helps identify the engagement of the
presenting part of the fetus.
d) the uterus can be palpable abdominally at 11 weeks
gestation.
e) fetal parts will be difficult to palpate with excessive liquor.

9. If the Uterus is Smaller than Dates the possibilities will

be:
a) mistaken dates.
b) molar pregnancy.
c) IUFD.
d) polyhdramnios.
e) IUGR.

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10. High Head in Primigravida will indicate:
a) CPD.
b) IUFD.
c) macrosomia.
d) oligohydramnios.
e) pelvic tumours.

++++++++++++++++++++++++++++++++++++++++++

Dr. Gobara: MCQs

1. During pregnancy a woman needs additional iron to

satisfy the demands of the fetus, placenta and her own
increasing Hb mass. The total iron need during pregnancy is
approximately:
a) 250 mg.
b) 800 mg.
c) 1350 mg.
d) 1900 mg.
e) 2500 mg.

2. The Amniotic fluid is characterized by:

a) normal green brown color.
b) volume of 300 ml at 20 weeks gestation.
c) volume of 100 ml at 10 weeks gestation.
d) has osmolarity more than that of maternal or fetal plasma.
e) it is of maternal origin only.

3. When Estimating the Gestational age, the following

Parameters are useful:
a) date of fruitful coitus plus 266 days to calculate the EDD.
b) Naegele’s formula provided that periods are regular.
c) date of ‘quickening’ plus 24 weeks to calculate EDD in
primigravida.
d) palpation of fetal parts by 20th weeks.
e) Sonographic estimations are reliable throughout pregnancy.

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4. Immunological tests for Diagnosis of Pregnancy:
a) depends on detection of Antigen hCG in maternal urine or
serum.
b) detection of Antigen with Antibody either polyclonal or
monoclonal.
c) Elisa is based on polyclonal antibody which detect hCG in
semen up to 1-2 m/v.
d) Fluoroimmuno assay (FIA) is highly precise in detecting
hCG as low as 1 mIV/ml and takes 2-3 hours.
e) direct agglutination test takes 2 minutes with a sensitivity of
0.2 IV hCG/ml.

5. The Pathophysiological Mechanism in Pregnancy Induced

Hypertension (PIH) is associated with:
a) endothelial damage and dysfunction.
b) exaggerated response to A II.
c) endothelial damage and dysfunction activates
platelets/coagulation systems.
d) neutrophil has a very minor role.
e) abnormal prostanoids production (PGI2/ TX2) is a cardinal
feature.

6. Cardio-pulmonary Changes during Normal Pregnancy

are associated with:
a) increase of plasma volume from 34 weeks gestation.
b) decrease in peripheral resistance is greater than increase of
cardiac output.
c) increase in pulmonary blood flow by 40 %.
d) increase in cardiac output (CO) by 50 %.
e) decrease in heart rate (HR) by 80 %.

7. Anatomical and Physiological in the Renal System during

Pregnancy:
a) dilatation of the renal tract persists for three weeks after
delivery.
b) the renal blood flow increases by 60 %.

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 c) the glomerular filtration rate (GFR) decreases by 20 %.
d) renal tubular reabsorption increases by 20 %.
e) urea and uric acid clearances are also raised causing a fall
in plasma level.

8. Factors affecting Fetal Growth:

a) genetic control predominate in the first half of pregnancy.
b) male fetus weighs 150-200 gm more the female fetus.
c) extreme maternal age (< 20 - >35 years) have big babies.
d) birth order (parity) has no effect on fetal weight.
e) high altitude increases birth weight by 100 gm for every
1000 meters altitude.

9. First Trimester Abortion may be due to:

a) inadequate oestrogen production.
b) chromosomal abnormality of the fetus.
c) incompetence of the internal cervical os.
d) maternal diabetes.
e) Cytotoxic drugs.

10. Complications of Hydatidiform Mole include:

a) Hyperemesis Gravidarum.
b) malignant change.
c) haemorrhage.
d) diabetes insipidus. .

e) development of ovarian cyst.

11. In Eclampsia:
a) magnesium sulphate is the drug of choice to abort and
prevent fits.
b) caesarean section (CS) must be carried out whether the
fetus is dead or alive.
c) hypotensive drugs are used to reduce the risk of CVA.
d) Ergometrine is the drug of choice in the third stage of
labor.
e) renal output is increased.

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12. There is an Increased Risk of developing PET with:
a) increasing paternal age.
b) high parity .
c) Hydatidiform mole.
d) maternal cardiac disease.
e) Diabetes mellitus.
+++++++++++++++++++++++++++++++++++++++++
Dr. Gobara: Problem-solving.

Problem NO. 1:
Zahra is 20 years of age, single presents with left iliac fossa
pain followed by vaginal bleeding (small amounts). Her last
period was 6 weeks prior to the onset of pain. Her periods
have been regular and she has not been using any kind of
hormonal treatment. She has admitted that she felt some
breast tenderness and felt nauseous first thing in the
morning. She has no significant past medical history. She
has never previously been pregnant.
On examination: she looks well, but has some guarding and
rebound tenderness in the left iliac fossa. She is afebrile and
has no vaginal bleeding. Examination confirmed tenderness
in the left iliac fossa and there is no unusual vaginal
discharge, her pregnancy test is positive.

(A) What is the most likely diagnosis ?

(B) What is the differential diagnosis ?

(C) How would make the diagnosis ?

(D) What is the optimum management for this patient ?

Problem NO. 2:

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A 23 years old primigravida was in El Sheikh Fadul Hospital
on 9/6/2007 late night because of severe headache and
epigastric pain for 2 days. She experienced the same
symptoms 2 weeks ago for which antimalarial treatment was
given. This time her headache was associated with visual
disturbances and facial swelling.
She is sure that her LMP was on 2/10/2006. On examination
her BP was 170/110 lower limb swelling. Midstream urine
sample showed + + of protein.

(A) What is the most likely diagnosis ?

(B) What is the immediate obstetrical complication if left

untreated ?

(C) What is her gestational age when she was seen at

hospital ?

(D) How many grams of protein per liter showed by the

dipsticks as + + in MSU ?

(E) What is the optimum goal for management ?

++++++++++++++++++++++++++++++++++++++++++++++

Dr. Yousif . MCQs

1. With regard to Massive PPH:
a) it complicates 5% of all pregnancies.
b) it is the third most common direct cause of maternal death
in the Sudan.
c) consumptive coagulapathy may worsen the prognosis.
d) if the cause is uterine atony, it is always managed by
hysterectomy.
e) blood transfusion may be needed.

2. With regards to Pulmonary Embolism:

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 a) maternal mortality may be more than 50%.
b) the risk is increased in pregnancy.
c) it is associated with high body mass index.
d) it is associated with operative delivery.
e) it is associated with first pregnancy and young age.

3. With regards to Amniotic Fluid Embolism:

a) incidence is 1 in 2000.
b) occurs most commonly immediately postpartum.
c) it is associated with artificial rupture of membranes.
d) it is an obstetric emergency.
e) it is a common cause of maternal death.

4. Morbid Adherance and Retained Placenta:

a) it is a significant cause of massive PPH.
b) more common in women under the age of 35 years.
c) more common in women with placenta praevia.
d) more common in with previous uterine scar.
e) more common in primigravida.
5. In Septic Shock:
a) maternal mortality is more than 20%/
b) the most common infective organism in pregnancy is
Escherichia coli.
c) there may an association with systemic inflammatory
response.
d) it is characterized by tachycardia of more than 90 bpm.
e) it is characterized by temperature of more than 38 degrees C.

6. Common Causes of Sepsis in Obstetric Cases include:

a) Chorioamnionitis.
b) pneumonia.
c) pancreatitis.
d) intracranial abscess.
e) polyhdramnios.

7. Regarding Breech Presentation:

a) fetal heart activity should be documented before ECV.

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 b) ECV reduces the incidence of CS significantly.
c) ECV is less likely to a success in a multipara.
d) CS is always the best mode of delivery in a multipara with
breech presentation.
e) CS is carried out to decrease neonatal mortality and
morbidity.
+++++++++++++++++++++++++++++++++++++++++++++
“Best Answer” in Obstetrics and Gynaecology: Dr. Yousif.

1. Primary Postpartum Haemorrhage (PPH):

a) it is due trauma of the genital tract in 30% of cases.
b) it is due to uterine atony in 80% of cases.
c) it is not related to fetal weight.
d) it is not related to liquor volume.
e) it is not related to twin pregnancy.

2. 4th Degree Perineal Tear involves the Anal Mucosa:

a) can be prevented by episiotomy.
b) it is best repaired under local anaesthesia.
c) rectovaginal fistula can occur even with expert repair.
d) it is less common after Ventouse than forceps delivery.
e) may result in an incomplete anatomical sphincter in at least
50% of cases.

3. All the Following result in Deep Vein Thrombosis except:

a) CS.
b) antenatal bed rest.
c) breast feeding.
d) antiphospholipid syndrome.
e) PID.

4. Unexplained Postpartum Collapse could be due to the

following except:
a) inverted uterus.
b) ruptured uterus.
c) amniotic fluid embolism.
d) retained placenta.

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 e) use of Syntocinon in the active management of the 3rd stage.

5. PPH is associated with the following except:

a) APH.
b) multiple pregnancy.
c) prolonged labor.
d) preterm labor.
e) polyhydramnios.

6. Breech Presentation:
a) ECV is contraindicated in a case with major placenta
praevia.
b) ECV should take place in out- patient clinic.
c) ECV cannot be performed after 34 weeks.
d) ECV is best performed in case of footling breech.
e) Anti-D is not required after ECV in Rh –ve. mother.

7. Breech Presentation:
a) incidence at term is 10%.
b) vaginal delivery is safe.
c) fully extended breech has the highest risk of cord prolapse.
d) external cephalic version is recommended at term.
e) CS should be recommended in all cases.

8. Malpresentations are associated with all of the following

except:
a) placenta praevia.
b) polyhydramnios.
c) multiple pregnancy.
d) grand multiparity.
e) previous CS.

9. The most common causes of Breech Presentations are:

a) Prematurity.
b) placenta praevia.
c) multiple pregnancy.
d) multiparity.

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 e) none of the above.

10. Mauriceau-Smellie-Veit Manoeuvre refers to a method

for:
a) ECV.
b) internal podalic version.
c) delivery of the aftercoming head in breech delivery.
d) breech extraction.
e) none of the above.

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Dr. Osman: MCQs (true & false)

1. The Menstrual Cycle is under control by:

a) the cerebellum.
b) the hypothalamic-pituitary-ovarian axis.
c) affected by higher centers in the brain.
d) the adrenal cortex.
e) the pancreas.

2. The Uterine Cycles consists of the following phases:

a) menstruation.
b) the secretory phase.
c) the Proliferative phase.
d) ovulation.
e) Luteal phase.

3. The Follicular development is controlled by:

a) F.S.H.
b) L.H.
c) Thyroid hormone.
d) Growth hormone.
e) Insulin.

4. fertilization usually occurs in:

a) the cornu of the uterus.

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 b) the Ampulla of the Fallopian tube.
c) the ovary.
d) the cervix.
e) the vagina.

5. The Followings are Signs of Ovulation:

a) slight rise in the body temperature.
b) pain in one iliac fossa.
c) diarrhoea.
d) breast engorgement and tenderness.
e) vomiting.

6. The Followings may play a role in initiation of labor:

a) oxytocin.
b) progesterone.
c) oestrogen.
d) prostaglandins.
e) hCG.

7. The preterm-prelabor rupture of membranes (PROM)

may be managed conservatively if:
a) there are no signs of infection.
b) the presentation is cephalic.
c) the CTG is normal.
d) the presentation is transverse.
e) there are signs of fetal distress.

8. During the Third Stage of Labor the placental separation

is recognized by:
a) relaxation of the uterus.
b) passage of a gush of dark blood per vagina.
c) lengthening of the cord.
d) rise of BP.
e) tachycardia.

9. The Followings are indications for Induction of Labor:

a) Prematurity.

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 b) IUGR.
c) prolonged labor.
d) Postmaturity.
e) P.I.H.

10. The First Stage of Labor is defined as:

a) from full cervical dilatation to the delivery of the fetus.
b) from full cervical dilatation to the delivery of the placenta.
c) from start of cervical dilatation till the cervix is fully
dilated.
d) from start of labor to full effacement of the cervix.
e) from delivery of the baby to delivery of the placenta.

11. The Followings are recognized to be “high-risk”

situations associated with the developing fetal distress in
labor:
a) Hypothyroidism.
b) IUGR.
c) prolonged labor.
d) previous CS.
e) labor which is induced with Syntocinon.

12. Labor may be induced with:

a) prostaglandin.
b) progesterone.
c) Syntocinon.
d) ARM.
e) Ergometrine.

13. Precipitate labor may be caused by:

a) high dose of Syntocinon.
b) high dose of Prostaglandin.
c) can cause fetal distress.
d) uterine rupture is a risk.
e) may be treated with a tocolytic drug.

14. Prolonged Labor may result from:

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 a) APH.
b) Postmaturity.
c) CPD.
d) inadequate uterine action.
e) more common in multipara.

15. Prematurity is defined as:

a) delivery between 24 and 37 weeks.
b) delivery between 37 and 39 weeks.
c) delivery before 24 weeks.
d) labor which results in baby weighing 2.5 kg.
e) labor which results in baby weighing 3.5 kg.

16. The following conditions can predispose to preterm

delivery:
a) APH.
b) bicornuate uterus.
c) intrauterine infection.
d) big baby.
e) congenital fetal anomalies.

17. The risk to the fetus from PPROM includes:

a) ascending uterine infection.
b) cord prolapse.
c) pulmonary hypoplasia.
d) skeletal deformities.
e) Hypoglycaemia.

18. Normally the Fetal Head enters the p Pelvic Brim

(engages):
a) in the occipito-transverse position and then rotates to
occipito-anterior.
b) in the occipito-posterior and then rotates to occipito-
anterior.
c) in occipito-posterior position and persists like that.
d) in the occipito-anterior then rotates to occipito-posterior.
e) occipito-transverse position and persists like that.

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19. Secretion of FSH is regulated by:
a) secretion of oestradiol (oestrogen) by the ovary.
b) by GnRH from the hypothalamus.
c) thyroid stimulating hormone.
d) by hCG.
e) insulin by the pancreas.

20. The following drugs are used for ovulation induction:

a) progesterone.
b) Clomiphene citrate.
c) GnRH analogue.
d) Tamoxifen.
e) oestrogen.

b) male fetu
s

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