Questions 1-2 A 23 years old PG, at 34 weeks gestation, complains of severe headache, irritabiltiy and blurring

of vision. Her BP was 180/110; urine test for albumin++++.

1. Choose the most appropriate management for this case:
a. Analgesics and recheck after few days.
b. Antihypertensive and wait till fetal maturity.
c. Diuretics and antihypertensive till spontaneous onset of labor.
d. Fetal Doppler indices will determine time of termination.
e. Antihypertensive, IV MgSO4 infusion and urgent termination.

2.What is the first evidence of MgSO4 toxicity when used for treatment of eclampsia?
a) Disturbed conscious level.
b) Absent knee jerk.
c) Oliguria.
d) Respiratory embracement.
e) Absent fetal beat to beat variability on continuous fetal monitoring.

Questions 3-4: A 25 years old woman, presented with 3 days missed period and an quantitative HCG level of
500mIU/ml. No pelvic pain or vaginal bleeding. TVS revealed an empty uterus and left adnexal cyst 2 cm in
diameter.
3.What is your interpretation?
a. Normal intrauterine pregnancy.
b. Complete abortion.
c. Data are too early to conclude
d. Ectopic pregnancy.
e. Vesicular mole.

4.What is the best management for this case?

a. Antibiotics.
b. Repeat HCG after 2 days.
c. Follow up by US after 1 week.
d. Urgent laparoscopy.
e. Needle aspiration of the cyst.

Questions 5-6: A 26 years old primigravida presents at 36 weeks for her routine ANC. Examination and US show complete
breech presentation 2,5 kg, with normal amniotic fluid index (AFI).
5. What would you recommend for this case?
a) Wait for spontaneous breech delivery.
b) Induction of labor.
c) Urgent cesarean delivery.
d) Spontaneous correction is the rule.
e) Council for external cephalic version.

6. Fetal head is delivered in flexion in which of the following conditions:

a) Direct occipito anterior.
b) Direct mento-posterior.
c) Persistent brow.
d) After coming head in breech presentation.
e) Neglected shoulder.
Questions 7-8: A primigravida at 29 weeks has been diagnosed with gestational diabetes on her QGTT. She is not known
to be diabetic, but has a positive family history of diabetes mellitus. Her FBS was 375gm/dl.
7. Which of the following treatment option best suits her?
a) Dietary modification alone.
b) Diet and exercise.
c) Insulin, diet and exercise.
d) Termination of pregnancy.
e) Oral hypoglycemics, diet and exercise.

8. Choose the correct statement regarding diabetes with pregnancy:

a) No change in insulin requirements during pregnancy.
b) Intrauterine growth retardation commonly occurs.
c) Oligohydramnios develops with poor diabetes control.
d) Neonatal hyperglycemia usually develops after labor.
e) Sudden IUFD may occur with poor diabetic control.

Questions 9-10: A 25 years old, 3rdG P2 with previous vaginal deliveries presents at 40 weeks gestation. She had an
uncomplicated pregnancy & reports good fetal movements. PV examination reveals closed, formed and posterior cervix.
Fetus is cephalic -1 station.
9. How can you manage this case?
a) Cesarean section.
b) Vaginal misoprostol.
c) Oxytocin infusion.
d) Fetal kick count monitoring.
e) Check fetal lung maturation before making an action.
10. A week later, she returns anxious about decreased fetal movements. Examination is the same. How would you
proceed with her?
a) Urgent cesarean section.
b) Non stress test (NST) to assess fetal well-being.
c) Artificial rupture of membranes.
d) Reassurance and recheck after 2weeks.
e) Mild sedatives.

Questions 11-12: A 30 years old G3P2, previous 2 CS, 32 weeks gestation, presents with gush of fluid from vagina with no
labor pains. Although the fetus is kicking well, yet, she is worried about her baby's condition.
11. How would you proceed with this lady?
a) Induction of labor.
b) Cesarean section.
c) Tocolytics.
d) Antibiotics and steroids.
e) Non stress test (NST).

12. If you manage this lady conservatively, what would you prefer for follow up?
a) Daily CTG and Doppler study.
b) Bacteriologic culture and sensitivity for the leaking fluid.
c) Blood culture.
d) Temperature chart, C-reactive protein with monitoring fetal movements.
e) No role for conservative management in this case.
Questions 13-14: A 22 years old primigravida, pregnant 34 weeks, presents with painless moderate vaginal bleeding. Her
BP is 90/60 and HR: 105 b/min.
13. The most appropriate next step:
a) Digital examination to detect exact amount of bleeding.
b) Speculum examination to detect source of blood.
c) Abdominal ultrasound.
d) Vaginal pack.
e) Tight abdominal binder.

14. If the diagnosis of placenta previa complete centralis is confirmed by ultrasound and the bleeding continue, what will
be your management?
a) Conservative management.
b) Induction of labor by prostaglandins.
c) Induction of labor by oxytocin infusion.
d) Immediate CS.
e) Cesarean hysterectomy.

Questions 15-16: A 19 years old PG at 38 weeks, is admitted for induction of labor with intravaginal prostaglandin, due to
uncontrolled diabetes. She started having contractions.
15. The following clinical management is recommended:
A) CTG application.
b) Intravenous antibiotics.
c) Foley's catheter insertion. ·
d) Fetal scalp electrode.
e) Forceps delivery

16. One hour later, the contractions became more frequent, each lasting longer than 2 minutes. The fetal heart rate falls
persistently to the 70/minutes. Most appropriate next step in management:
a) General anesthesia.
b) Terbutaline.
c) Amnioinfusion.
d) Oxytocin.
e) Cesarean delivery.

Questions 17-18: A 21 years old primigravida, pregnant 39 weeks, presents with painful contractions every 3 minutes. PV:
cervix is 5 cm dilated, 60% effaced, FIIS: 150/minutes and reactive. Two hours later, PV: cervix is 7 cm dilated; 90%
effaced and fetal head is at station +1. FHS shows deceleration with onset of uterine contractions and returns to normal
at their end.
17. Which of the following is the most appropriate next step in management?
a) Expectant management.
b) Oxytocin infusion.
c) Cesarean delivery.
d) Intravenous atropine.
e) Vacuum assisted vaginal delivery

18. The neonatal care includes:

a) IV Glucose.
b) Sodium bicarbonate administration.
c) IV adrenaline.
d) Clear airways,
e) IV antibiotics.
Questions 19-20: A healthy 30 years old G2P0, at 36 weeks gestation with cerclage in place, presents with labor pains and
intact membranes.
19. Initial management will be:
a) Tocolytics.
b) Cesarean section.
c) Analgesics.
d) Removal of cerclage.
e) Artificial rupture of membranes.

20. Complications most liable to occur in this patient:

a) Cervical lacerations
b) Chorio-amnionitis.
c) Past date.
d) Fetal distress.
e) Placental separation.

Questions 21-22: A 37 years old PG, pregnant 32 weeks, presents with unilateral painful lower limb edema. She started
having respiratory embarrassment this morning. She is not in labor and has irrelevant medical and surgical history.
21. Most probable diagnosis:
a) Physiological orthostatic edema.
b) Heart failure.
c) Nutritional edema.
d) Thromboembolic event.
e) Preeclampsia.

22. Your management will include:

a) Immobilization and heparin.
b) Low dose aspirin.
c) Encourage amþulation and rehydration.
d) Magnesium sulfate loading dose.
e) IV digitalis.

Questions 23-24: An anemic 39 years old, G5 P5, presented with postpartum hemorrhage following spontancous vaginal
delivery one hour ago. BP: 90/50 and pulse 120/min. .
23. The risk factors of postpartum hemorrhage in this case include all the following EXCEPT:
a) Age above 35 years.
b) Spontaneous onset of labor.
e) Prolonged labor.
d) Multiparity..
e) Anemia.

24. The next step in the management should be:

a) Vaginal pack.
b) Resuscitation and anti-shock measures.
c) B-Lynch sutures.
d) Bilateral ligation of the internal iliac arteries.
e) Selective embolization of the uterine arteries.
Questions 25-26: A 25 years old, 2nd GP1, in labor. Cervix is 4 cm dilated and 50% effaced. The fetal heart rate is
180/minute showing persistent late deceleration.
25. Which of the following clinical management should be done?
a) Continue CTG application and expectant management.
b) Cesarean section.
c) Oxytocin infusion.
d) Oxygen mask and close fetal monitoring.
e) Forceps delivery.

26. At the time of delivery, the fetus had meconium aspiration, with Apgar score of 2 at 1 minute post-delivery. The next
step in this neonatal management:
a) Endotracheal tube and oxygen.
b) Adrenaline infusion.
c) Umbilical catheterization.
d) IV glucose 5%.
e) Tracheostomy and tracheal aspiration.

Questions 27-28: A 35 years old, G3P2, with previous 1 cesarean delivery due to hypertension, presents at 36 wecks
complaining of severe headache and reduced fetal movements. Her BP is 150/90 and ultrasound reveals asymmetric
growth restriction and amniotic fluid index 3.
27. Which of the following investigations must be done?
a) Complete blood picture.
b) Liver and kidney functions tests.
c) Doppler flow studies.
d) Urine albumin.
e) All of the above

28. Possible complications for this case include all the following EXCEPT:
a) Eclampsia.
b) Accidental hemorrhage.
c) Intrauterine fetal death.
d) Shoulder dystocia.
e) Residual hypertension after delivery.
Questions 29-30: A 37 years old woman, G3P2 presents for follow up after methotrexate treatment for ectopic pregnancy
1 week ago. Now she has lower abdominal pain, with moderate left lower quadrant tenderness. HCG value doubled over
the past week and TVS shows persistent sac with fluid in Douglas pouch.
29. Which of the following is the most appropriate next step in management?
a) Expectant management.
b) Repeat methotrexate.
c) Laparoscopy.
d) Transvaginal aspiration of ectopic.
e) Hysterectomy.

30. The patient should be advised to:

a) Postpone next pregnancy for one year.
b) HCG follow up far. one year.
c) Combined oral contraceptive pills are contraindicated.
d) Intrauterine device is preferably avoided.
e) No increased risk of ectopic pregnancy in subsequent pregnancies