1) You were called urgently to see Amna who has just delivered after

being 24 hours in labour , and she developed severe vaginal bleeding

after delivery of the placenta. She has no injury, she is now Para v111+
0.

what is your diagnosis?!

................................PPH.............................................

a) What is the most likely cause of her bleeding?!

……………………………uetaine atonia…………………………………………………….

mention 3 other possible causes for her bleeding.

1-....................................returnd of product..................................................

2-.................................DIC.....................................................

3-...............................adhernt placenta.......................................................

b) Mention one procedure you do to help in stopping her bleeding

…………………………uteraine massage……………………………………………………..

c) Mention two drugs you may need to use?!

1- ………………………oxytocin…………………………………...

2- …………………………ergometrine……………3…Misoprostol…………………

d) If the bleeding could not be controlled, mention two procedures (non surgical) to help in
stopping the bleeding.

1- …………………………bimanual compression…………………………………………….

2-……………………………………folly ballone cathter…………………………………….

e) Mention two urgent life-saving measures you do?!

1- ………………………………call for hellp ………………………………………..

2-…………………………………ABCs………………………………….…….

f) Mention two risk factors for her condition?

1- …………………………prolong labour……………………………………………….

2- ……………………………grand multipra……………………………………………..

G) mention ONE immediate & ONE late complication of her condition.

immediate.................shock.................................................................

late...............................shehaan syndrome...............................................................

2) Amna is 25 years old in her second pregnancy at 30 weeks

gestation, was admitted 3 days ago with history of watery vaginal
discharge. She has no other complain.

1- What examination you do to confirm the diagnosis?!

……………sterile……per vaginal examination……………………………………………

2- Mention 3 investigations needed in her case?

a- …………………uss…………………………………………………

b- …………………………alfa fetoprotein……………………………………………………

c-……………………………………creatinie & urea………………………………………………

3- What are the 2 medications you are going to give in her case?

a- …………………………antibiotic……………………………………

b- .................................dexamethasone........................................................

4- What symptoms and signs she may develop? (Mention 3)

a-..……………………pyrxia……………………………
b- …………………tachycardia………………………………

c- ………………………offensive vaginal discharge………………………

5- What is the main cause of increased perinatal mortality?!

......................................septic shock........................................................

3) A 25 years primigravida presented to the labour room at 36 weeks

gestation with severe frontal headache and generalized oedema. The
pulse was 110/min ,B.P =170/110mmHg, and urine contains +++ of
albumin.

1-What is the most likely diagnosis?

………………pre eclampsia …..........................................................

2-Mention two life saving steps you do?

a-............call for hellp, c mgso4

D……….. termination of pregnancy ............................

b-............ABCs.......

3-if she developed fits, mention two drugs used to stop fits?

b-...............diazepam.................................................................................

a-..............mgso4....................................................................................

4-if the baby was alive, the cervix was 3 cm dilated how and when are you
going to deliver her?
a- When..........immedately by induction...................................................

b- How (mode of delivery)...................................vaginal.............................

5-Mention two blood investigations other than Hb and blood grouping you
would ask for?
 a-.................................platelet..................rft.............................................

b-..................lft.....................................coagulation profile.....................

6- Mention two maternal and one fetal complications of her condition?

b-....................................hellp syndrome ...........................................

a-......................................eclampsia............................................

c-........................................fetal distress........& preterm labour....................

7- Mention two risk factors for this condition?

a-……………………………HTN………………………………...............................

b-………………………primarygravida…………………………….……………………………..

8- Mention one drug used to reduce blood pressure in this condition?

..……………………………..………………………… hydralazine………………………

4) A 35 year old Para 2+0 presented to the antenatal clinic at 36

weeks. Examination revealed B.P of 150/80 mm.Hg with breech
presentation.

a- Mention two types of breech you know?

1-………compelete…………………………............................

2- ...........incompelet.............……………………………………………………….

b- Mention 3 predisposing factors for breech presentation?

1- ....................polyhydromoius......................................................................

2-........................premature.......................................................................
3-................................palcenta previa...............................................................

c- Mention one manouvre for correction of breech?

…………………………ECV……………………………………..

d- Mention three contraindications for this manouvre?

1-......................................APH....................................................

2-....................MUltipregnancy.............................................................

3-............................pervoius scar C/s..............................................................

e- Mention two complications of this manouvre?

1-..............................................rupture of uterus.............................................

2-...................................preterm labour ....................................................

f- In her case are you going to do this manouvre, why?!

................…………………no because has HTN………………………………

g- Mention three methods for delivery of the aftercoming head?

1-........................burn marchal.......................................................................

2-.........................forecepse......................................................................

3- ...................................mauriceu smelli veit.....................................................

h- If, in her case, the breech presentation persist till term how are you going
to deliver her?

…………………………………C/S………………………………………………….
5) A 38 years grand multipara, known diabetic, presents to the ANC
clinic, at 32 weeks gestation, her B.P 120/75, FL 36 weeks, she is sure
of her date, her last delivery was by CS.

mention another type of diabetes during prgnancy.

..................................gestential DM....................................................

A) mention 3 causes of FL more than date in her case.

1-........................................polyhydromonius..............................................

2-.................................placeta previa.................................................

3-.......................................macrosomnia ............................

B) mention ONE investigation to diagnose the cause of FL larger than date.

.........................................uss.........................................................

C) mention 3 complications that may occur to a diabetic mother during

pregnancy.

1-......................................preeclampsia ............................................

3-...............................obstructed labour.................................................

2-.........................................UT..infection.........................................

D) mention 2 foetal complications during pregnancy.

.2 -...............................conginital anomilis ...............................................

1-......................................abortion........................................

E) mention 2 immediate complications to the newborn.

. 1-...............................................hypo CA.......................................

2-....................................................HYPOTHERMIA..............................

F) mention 6 indications of OGTT.

1- prevoius macrosomic

2- prevoius still birth

3- family history frist degree

4- obesity

5- previous or current poly hydraminous & iufd

6-reccurant abortion

H) mention 2 blood investigations to follow up her control during pregnancy.

1-.........................................BG.............................................

2-..........................................Hb A1C............................................

I) if the pt is well controlled during pregnancy, when & how you rae going to
deliver her?!

when...............................at 37 ................to prevent IUFD......................................

how......................................Elective C/S................................................

6) 28 year old lady, G IV PIII+ 0, all were by NVD, at 32 weeks gestation

she reported vaginal bleeding for ONE day,exam reveled, FL 32 weeks,
longitudinal lie, breech presentation, with normal FHS .

A) what do we call this type of bleeding?!

.......................................APH...........................................

B) mention 3 possible causes of vaginal bleeding at this GA.

1-.......................................placeta previa ...............................................

2-.........................................abruptio placentae.............................................

3-.........................................vasa pervia.............................................

if the pt came with abdominal pain & generalized tenderness.

C) what is the most likely diagnosis?!

..................................................abruptio ....................................

D) mention 3 predisposing factors for this condition.

1-.......................................HTN..............................................

2-........................................TRAUMA.............................................

3-..............................................FOLAL DEFICINCY.......................................
E) mention 2 situations in which you will deliver the fetus before completing
37 weeks.

1-.............maternal distress sever bleeding ..................................

2-...................fetal distress.........................................................

F) mention 3 complications that may occur after delivery.

1-......................................PPH................................................

2-.......................................DIC ...............................................

3-....................................RENAL FAILURE..................................................

G) if the presentation persist till term, what will be the mood of delivery?!

....................C/S................................................

H) mention 3 investigations to be done for this pt.

1-.....................................FBG.................................................

2-...................................COAGULATION PROFILE .......................................

3-........................................................RFT..............................

7) A 22 years primigravida at 35 weeks gestation was brought by

midwife with convulsions for the last 2 hours, she had 2 attacks of
seizures at home. O/E: she was semiconscious, PR 110 PBM, B.P
160/110 mmHg, urinary albumine +++, FL 36 weeks, longitudinal lie,
cephalic presentation, foetal heart rate 160 bpm, PV exam cervix is
long with closed os.

A) what is the diagnosis?!

.................................eclampsia...........

B) mention 2 immediate life saving measures you will do.

1-..................................call for hellp....................................................

2-......................................abcs................................................

C) mention 2 drugs you will use to control her fits.

1-.....................................mg so4...............................................
2-.......................................diazpam...............................................

D) when & how you are going to deliver her?!

when.................................immedate

how............................................EMERGENCY C/s..........................................

E) mention 2 seroius maternal complications that might occur during the first
24 hours post partumly.

1-................................PPH......................................................

2-..................................hellpsyndrome....................................................

F) mention 2 blood investigations other than Hb & blood group you would
request.

1-...................................platelte...................................................

2-......................................LFT................................................

8) A 18 years primigravida, unbooked, presented at labour at 30 weeks

gestation, fundal height correspond to the date, breech presentation,
foetal heart rate is 140 bpm, PV exam showed cervix of 75%
effecement, 3 cm dilated & intact membranes.

A) what we called this type of labour?!

..........................................preterm labour.........................................................

B) mention 3 causes of it.

1-.....................................IDiopathic.................................................

2-........................................premature rupture of membrane.....................

3-.................................anemia & malnutrition........................................................

C) what is your managenment?!

1-..................hospital delivery.......C/S.............................................................

2-.......................vit.K..............................................................

3-...................anathesia......................................................................
D) what is major threat to foetal life if born immediately?!

.................................RDS....((Respirotary distress syndrome))............................

E) what are the causes of neonatal morbidity & mortality associated with
prematurity?!

1-...................................infection...............& haematological disorder..............

2-....................................hypothermia..................................................

3-..........................................malnitrition...............................................

If such presentation persist till term.

F) mention 3 types of breech presentation

1-.............................complete.........................................................

2-......................incomplete................................................................

3-.......................footinling..................................................................

G) what is most common cause of it?!

........................prematurity............................................

H) mention OTHER 3 causes of it.

1-........................uteriane anomlie............................................................

2-..........................fetal anomile............................................................

3-............................polyhydrominous.............................................................

I) mention 3 options for delivery.

1-..................vaginal delivery....................................................................

2-.....................ECV...& vaginal delivery.................................

3-...............................C/S..........................................................

J) mention 3 methods to deliver the after coming head.

1-..........................forecepes delivery..................................

2-........................burns marshall..............................................................
3-.......................jaw flextion shoulder traction (mauriceau).........................

K) what is the antepartum management?! & at what GA you will perform it?!

...............................ECV.........................................................

GA.............AT 37.....................................................................

L) mention 3 complications of it.

1-.......................fetal bradychardia....................................

2-.........................abrubtio placentae...................................

3-........................preterm labour.................................................

9) A 28 year old lady P6+1 ,last two were by C/S, presented to the
labour ward at 34 week geststation C/O vaginal bleeding for the last 48
hours. the bleeding is moderate in amount & some times contains
clots. O/E she was stable, PR 90 bpm, B.P 110/80 mmHg, FL 34 weeks,
+ve foetal heart sounds & movement.

a- what is your provisional diagnosis?!

......................................APH.........................................................

b- how would you confirm the diagnosis?!

.....................................USS..............................................................

c- if the diagnosis is confirmed, mention 2 predisposing factors for it.

1-...................................grand multipra...................................................

2-........................pervoius C/S..............................................................

d- mention 2 urgent steps you will do after addmission.

1-........................call for hellp..............................................................

2-............................ABCs..........................................................

e- when you are going to deliver her if she remain stable?!

......................................AT 37....................................................
f- what serious condition you may face during operation?!

..................................bleeding.......................................................

& what is due to?!....placenta incrita..........................................................

g- what would you do if you could not control it?!

..............hestoctomy..........................................................

10) A 25 year old primigravida, presented to to the labour room at 36

weeks gestation with severe frontal headache, generalized body
swelling, PR 110bpm, B.P 170/110 mmHg, urine albumine +++.

a- what is the most likely diagnosis?!

.............................sever pre eclampsia..............................................

b- mention 2 life saving measures.

1-........addmission..............call for hellp.............................................

2-.................ABCs....... AntiHTN............termination of pregnancy.......................

c- if she develope fits, mention 2 drugs to stop the fits.

1-.................................Mgso4.....................................................

2-....................................diazpam..................................................

d- mention 4 can be used during pregnancy to lower the blood pressure.

1-......................................methyldopa................................................

2-.....................................nifidpine.................................................

3-....................................... hydralazine...............................................

4-..................................labtalol....................................................

e- which one of above mentiond drugs is the best to lower her blood pressure,
& the rout of addminsteration?!

...........................methyldopa act centrally.........................................................

f- if the foetus is alife, cervix is 3 cm dilated, how & when you are going to
deliver her?!
when.....................immediatly......................................

how......................vagina......................................

11) A young primigravida, 16 year old with poor ANC,at term she was
brought by her relatives & midwife & she was in labour for 2 days. The
midwife added that the patient ruptured her membranes 14 hours ago,
her contractions were forceful, she was short, dehyderated, with
aceton smell, not pale, pulse 100 bpm, BP 100/60 mmHg. Head not
engaged, cervix 6 cm dilated with caput formation.

a) what is the proplem of this patient?!

........................................obstructed labour....................................................

b) mention 2 possible causes of her proplem.

1-......................primarygravida................................................................

2-.......................age 3 short...............................................................

c) when is the head is expected to engage in a:

primigravida.....................before 3or 4 week before delivery.............................

multipara..................before or with onset labour...........................................

d) mention 3 important investigations you will order for her.

1-..............................Hb........................................................

2-.............................Urine analysis.........................................................

3-.........................alpha fetoprotine.............................................................

e) if the foetal heart sounds were heared & 160 bpm, how you are going to
deliver her?!

...................emergency C/S........................................................................

f) mention 2 complications that may occur after delivery.

1-.............................bleeding.........................................................

2-.....................................infection.................................................
g) mention 3 complications that may occur after the week after delivery.

1-....................................sepsis..................................................

2-....................................DVT..................................................

3-..................................vulvovaginal fistula....................................................

12) A 25 year old P II+0 patient, who delivered 2 weeks ago, was
brought to the casualty with fever & swelling & pain of the left leg. She
gave history of prolonged difficult labour at home. O/E tepreture was 38
C, swollen, hot & tender left leg. Other system examination were
normal.

a) what s the possible diagnosis?!

....................................DVT.........................................................

b) mention one investigation to confirm the diagnosis.

.............................dopplar uss................................................................

c) mention 3 predisposing factors for this condition.

1-....................................haemophilla..................................................

2-.......................................prologed labour...............................................

3-.....................................delayin mobilization.................................................

d) mention 2 other labrotary investigations you need to do.

1-............................CBC..........................................................

2-.........................coagulation factor.............................................................

e) what drug you will use in the first 48 hours?!

.................................heparine........................................................

f) what drug you will use then.

.......................warfarine..................................................................

g) in the case of the last drug, mention 2 investigations for follow up.
1-................(....doplar & dopplex ).....uss.............................................................

2-..............................chest Xray........................................................

h) mention 3 prophylactic measures to prevent this condition.

1 low dose of aspirin

2 low molecular of heparine

3 Vit K

i) what is serious complication that may occur if this condition is not properly
diagnosed & treated?!

...........Venousthromboembolism.....................................................................

13) 36 year old grandmultipara presented to the ANC clinic at 32

weeks gestation, USS showed twins pregnancy.

a) mention 2 types of twin pregnancy.

1-......................Bizygot................................................................

2-..........................Unizygot............................................................

b) if she came early in the pregnancy, mention two clinical features that may
suggest diagnosis of twin pregnancy.

1-............................hypereminous gravidarum.................................................

2-...........................lower limb odema...........................................................

c) mention 2 findings in the examination that support the diagnosis of twin

pregnancy.

1-...............................fetal leval more than date................................................

2-.......multiple fetal of (heart sound & limb.)...................................................

d) if this patient develope vaginal bleeding in the 34 weeks gestation, mention

2 causes of this bleeding.

1-...............................placenta pervia.......................................................
2-...............................abruptio placentae.......................................................

e) mention 4 other complications that may occur during pregnancy.

1-......................anemia..............................................................

2-.............................hypereminous gravedarum .....................

3-..............................polyhydrominous.....................................

4-......................................PIH................................................

f) mention 3 steps in after delivery of the 1st twin in order to deliver the 2nd
twin.

1-.................examination....(abdomen & vaginal.......)....................................

2-...............................ECV.......................................................

3-.............oxytoncin.........................................................................

g) if she develope post-partum haemorrhage, what is the most

likelypredisposing factor for this?!

....................................Uteraine atonia.....................................................

14) A 28 year old primigravida, at 39 weeks gestation, presented with

spontaneous ROMs, the cervix is 4 cm dilated, 100% effaed, cephalic
presentation, FHR 170 bpm.

a) what is the best method for monitoring FHR during labour?!

..........................................CTG..........................................................

b) how frequent you are going to assess progress of labour in this patient?!

............................every 15 min..............................................................................

c) mention 2 signs may indicate failure to progress in this patient.

1-.........................................cx no dilitation ........................................

2-............................................no defficint contraction..........................................

d) if 6 hours later the cervix is 6 cm dilated, FHR is 100 bpm, what is the
diagnosis?!

1-...............................fetal distress.......................................................

2-..........................................prologed actice phase........................................

e) how you are going to deliver her?!

....................................emegency C/S...................................................

f) mention 3 steps you take to prepare this patient for mode of delivery you
choose.

1-...............................................ABO GROUP & RH.......................................

2-...................................CANNULA..................................................

3-...............................................Urine cathter........................................