OBSTETRICS – PAST QUESTIONS

(2007-2019)
(Compiled by Shahroze Ahmed, N-66, Nishtar
Medical University)

CONTENTS
SR # Unit Page #
1 Physiologic Changes in Pregnancy 2
2 Antenatal Care 3
3 Normal Fetal Development & Growth 6
4 Assessment of Fetal Wellbeing 6
5 Prenatal Diagnosis 7
6 Antenatal Obstetric Complications 8
7 Multiple Pregnancy 11
8 Preterm Labor 12
9 Hypertensive Disorders of Pregnancy 13
10 Medical Complications of Pregnancy 15
11 Labor: Normal and Abnormal 19
12 Operative Delivery 25
13 Obstetric Emergencies 26
14 The Puerperium 29

1
▪ PHYSIOLOGIC CHANGES IN PREGNANCY
Changes in Cardiovascular System
1. Enlist three changes in the cardiovascular system during pregnancy. [Annual 2018]

2. Enlist two changes in the cardiovascular system during pregnancy. [Annual 2017]

3. A young primigravida books in the antenatal clinic. Describe the cardiovascular,

pulmonary and hematological changes in a normal singleton pregnancy.
[Supple 2017 held in 2018]

4. What are the normal physiologic changes in cardiovascular system during

pregnancy? [Annual 2014]

Changes in Respiratory System

1. Enlist two changes in the respiratory system during pregnancy. [Annual 2018]

2. Enlist two adaptations in the respiratory system during pregnancy. [Annual 2017]

3. A young primigravida books in the antenatal clinic. Describe the cardiovascular,

pulmonary and hematological changes in a normal singleton pregnancy. [Supple
2017 held in 2018]

Changes in Reproductive Tract

1. During pregnancy there are physiological changes in all maternal systems. Regarding
that, enlist the changes in reproductive tract in the following organs.
a) Uterus
b) Cervix
c) Vagina [Annual 2019]

2. Discuss the physiologic changes in the genital tract during pregnancy.

[Supple 2017 held in 2018]

Changes in Renal System

1. A primigravida has presented in antenatal clinic at 22 weeks of gestation she is very
much worried that she has developed gestational diabetes. As her urine examination
report shows ++ glycosuria.

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 a) How will you make sure whether she has developed gestational diabetes or not?
b) Which physiological change in renal system is responsible for this glycosuria?
c) What are normal physiological changes which take place in renal system?
[Supple 2011 held in 2012]

2. A 24-year-old PG at 28 weeks of pregnancy comes in OPD with an USG report

showing mild hydronephrosis of the right side and increased frequency of
micturition. Her urine complete examination is normal, serum urea and creatinine
are also normal.
a) Why she is having this problem?
b) How will you manage her? [Supple 2008 held in 2009]

Hematological Changes
1. A young primigravida books in the antenatal clinic. Describe the cardiovascular,
pulmonary and hematological changes in a normal singleton pregnancy.
[Supple 2017 held in 2018]

Endocrine Changes
1. Enlist changes in fasting plasma glucose concentrations in first half of pregnancy.
[Annual 2017]

▪ ANTENATAL CARE
Aims of Antenatal Care
1. What is the aim of antenatal care? [Annual 2019]

2. What are the aims of antenatal care? [Supple 2015 held in 2016]

3. A 19-year primigravida is brought to antenatal clinic for purpose of obtaining best

possible outcome for both mother and child.
a) What are the main aims of antenatal care?
b) How can you achieve these aims? [Annual 2012]

4. A G3P2+0 came for antenatal checkup at 12 weeks of pregnancy. What are the aims
of antenatal care? [Annual 2010]

3
Advice in Pregnancy
1. A primigravida is visiting the antenatal clinic for the first time after missing two
periods. Her urine for pregnancy test is positive. Enlist three dietary advices for
optimal weight control in pregnancy. [Annual 2017]

2. A 26-year-old primigravida presented to you in antenatal clinic at six weeks of

gestation for routine antenatal visit. On inquiry, she gives history of smoking.
a) What advice you will give her regarding smoking?
b) What are the risks associated with smoking? [Annual 2011]

3. A 24-year-old PG has come for antenatal checkup. Her LMP was two months back.
What advice will you give her? [Supple 2008 held in 2009]

BMI & Weight Assessment

1. A 24-year-old primigravida has come at 12 weeks of gestation for booking. Her BMI
is 29 kg/m2
a) Enlist three possible complications in the mother.
b) Enlist two possible complications to the fetus. [Annual 2018]

Booking Tests in Pregnancy

1. A G2P1A0 came to the antenatal clinic at 10 weeks of pregnancy for booking. You
evaluate her and give her booking investigations. What investigations you will give
her at the booking visit? [Annual 2019]

2. A primigravida is visiting the antenatal clinic for the first time after missing two
periods. Her urine for pregnancy test is positive. Enlist two investigations with an
indication why it will be carried out. [Annual 2017]

3. An elderly primigravida reports for booking at 8 weeks of gestation.

a) How will you evaluate her?
b) What investigations you will order for her?
c) Give plan for follow up antenatal visits for her. [Annual 2016]

4. A primigravida comes to antenatal clinic for booking. She is unsure of dates. Her past
medical, surgical and family history is not significant. General Physical Examination is
normal and per-abdominal examination fundal height is up to the level of umbilicus,

4
 a) What would be the gestational age with fundal height up to the level of
umbilicus?
b) What relevant investigations would you offer her? [Supple 2015 held in 2016]

5. What investigations you suggest at time of booking visit? [Annual 2012]

6. What investigations are routinely carried out at booking visit? And how they should
be planned? [Annual 2010]

7. A 24-year-old PG has come for antenatal checkup. Her LMP was 2 months back.
What are the investigations required? [Supple 2008 held in 2009]

8. A 38-year-old primigravida comes for routine antenatal visit. Her LMP was 3 months
back.
a) How is it different from a 24-year-old primigravida?
b) What investigations will you advise her? [Annual 2008]

9. A young multigravida is worried for screening tests. Comment on the utility of

various antenatal screening methods. [Supple 2007 held in 2008]

Miscellaneous
1. A primigravida at 15 weeks of gestation is present in OPD for antenatal booking.
a) What is dating scan and how it is helpful in antenatal care?
b) Outline steps of antenatal examination and how frequently you will call her for
antenatal visit. [Annual 2014]

2. A 26-year-old Mrs. Salma is married to her first cousin for 4 years. She has conceived
on treatment for the first time and comes for her antenatal booking at 21 weeks. Her
BMI is 36 and fundal height is 24 weeks.
a) List three most important things to be screened.
b) Mrs. Tara is G2P1 coming for antenatal checkup at 28 weeks. Her Hb is 9 gm/dl,
MCV 60 fl MCH 25 pg, MCHC 33 g/dl. Name two most probable diagnoses.
[Annual 2009]

5
▪ NORMAL FETAL DEVELOPMENT & GROWTH
Amniotic Fluid
1.
a) How is amniotic fluid produced?
b) What are its functions?
c) What are its abnormalities and what conditions lead to these abnormalities?
[Annual 2011]

▪ ASSESSMENT OF FETAL WELLBEING

Methods for Assessing Fetal Well-Being
1. A 28-year-old primigravida complains of diminished fetal movements at 32 weeks
gestation. Name with a single sentence explanation of fetal well-being methods
available at this point. [Supple 2017 held in 2018]

2. A G2P1+0 has presented in labor room at 30 weeks of gestation with complaints of

sluggish fetal movements.
a) What methods will you use to assess her fetal well-being?
b) Critically evaluate the current methods for assessment of fetal well-being.
[Supple 2011 held in 2012]

3. A G4P3+0 at 36 weeks of pregnancy comes with complaints of reduced fetal

movements.
a) What questions will you ask in history?
b) What are the investigations required? [Supple 2008 held in 2009]

Cardiotocograph
1.
a) Write down what is cardiotocograph.
b) Enlist and define the four features of CTG. [Supple 2018 held in 2019]

2. A primigravida presents at 36 weeks of gestation with the complaints of relaxed fetal

movements. Her antenatal CTG and biophysical profile was carried out.
a) What is the normal/reactive CTG?
b) Enlist variables of biophysical profile and total score. [Annual 2013]

6
3.
a) What is CTG? What are the features of normal CTG?
b) What is stress and non-stress CTG? [Annual 2008]

Use of Ultrasound
1. A G3, with previous 2 term normal deliveries, has presented in the outdoor at 20
weeks of pregnancy
a) Briefly give three important features you would look in ultrasound to assess fetal
well-being at this stage.
b) Enlist two indications for 3D ultrasound in assessing fetal wellbeing. [Annual
2018]

▪ PRENATAL DIAGNOSIS
Prenatal Diagnostic Tests
1. A 20-year-old G2P1 has come to antenatal clinic concerned for the wellbeing of her
baby. Her last baby was small for gestational age. Now she is at 18 weeks of
pregnancy.
a) Which single best investigation you will carry out at 18 weeks?
b) Enlist three reasons why you would carry the investigation.
c) When will you repeat this investigation? [Annual 2017]

2. A 42-year-old G3P2A0 at 18 weeks of gestation has previous alive and healthy

children. She had amniocentesis 2 weeks ago. Results show male fetus with trisomy
21.
a) Enlist four complications following amniocentesis.
b) What is alternative procedure to amniocentesis which yield quicker cell culture
for karyotyping?
c) After explaining result to the patient, what intervention should be discussed?
[Supple 2016 held in 2017]

3. Mrs. A G2P1 at 7 weeks of gestation presented in the antenatal clinic with history of
previous Down syndrome baby, who died at the age of five months due to
pneumonia. now she is very worried about her current pregnancy. She wants to
know:
a) What are different types of prenatal diagnostic tests available?
b) At what gestational age are they carried out?

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 c) What are their complications? [Annual 2011]

4. A 42-year-old elderly primigravida has come to you at 12 weeks of pregnancy. She is

concerned about the risk of fetal abnormalities in her child.
a) What screening tests will you advise her?
b) What diagnostic tests are available to diagnose fetal anomalies?
[Supple 2010 held in 2011]

5. A patient in the antenatal clinic presents with an ultrasound result at 12 weeks

gestation which reports nuchal translucency. What are the definitive diagnostic
investigations to be used in the antenatal period for genetic disorder, the usual
timing of these tests and the risks associated with probability of adverse outcomes
of these procedures? [Annual 2009]

Down Syndrome
1. A 32-year-old G2P1+0 at 6 weeks of gestation, previous baby with Down syndrome,
came to discuss the antenatal screening in the current pregnancy.
a) Discuss the non-invasive screening methods for Down syndrome.
b) If non-invasive tests show high risk for Down syndrome, what invasive tests
would you discuss with risks and benefits? [Supple 2015 held in 2016]

2. A G2P1 previous baby with Down syndrome attended antenatal clinic at 10 weeks of
gestation. She is very anxious to know if her fetus is normal or not.
a) What are the screening tests for Down syndrome in the first trimester of
pregnancy?
b) How will you confirm the diagnosis at this gestation?
c) How will you counsel the patient regarding the risk involved in this patient?
[Supple 2014 held in 2015]

▪ ANTENATAL OBSTETRIC COMPLICATIONS

Hyperemesis Gravidarum
1. A 28-year-old G2P0+1 at 10 weeks of gestation presents in Emergency Room with
history of excessive nausea and 6-7 episodes of vomiting per day. On examination,
she is markedly dehydrated.
a) What is this condition called?
b) Name two conditions which cause this problem.

8
 c) How will you evaluate the patient?
d) Enumerate three management options. [Supple 2016 held in 2017]

2. A 25-year-old primigravida presents to the essential clinic at 8 weeks gestation with

persistent vomiting.
a) What is your diagnosis?
b) How will you manage this patient?
c) If not treated properly what could be complication? [Annual 2012]

3. A young lady doctor who is primigravida at 7 weeks of gestation complains of

excessive vomiting every day.
a) Briefly comment on the etiology and pathophysiology the condition.
b) How will you manage her? [Annual 2007]

Urinary Tract Infection

1. A G2P0+1 reports at 30 weeks of pregnancy with clinical features of Urinary Tract
Infection.
a) How will you investigate her?
b) How will you manage her?
c) Enlist the associated feto-maternal risks. [Annual 2016]

Venous Thromboembolism
1. A primigravida at 8 weeks of gestation presented with painful swelling in right leg.
a) What is the most likely diagnosis?
b) Discuss physiological changes which increase the risk during pregnancy.
c) Discuss physiological changes in procoagulant factors during pregnancy.
[Supple 2015 held in 2016]

Oligohydramnios and Polyhydramnios

1. A G3P2 has presented in the antenatal clinic at 32 weeks. On examination, the
symphysis fundal height is 36 cm. You suspect polyhydramnios and plan a detailed
ultrasound examination.
a) Which five fetal causes of polyhydramnios can be detected with the help of
ultrasound?
b) What are 3 antepartum and 2 intrapartum complications associated with
polyhydramnios? [Annual 2019]

9
2. A 25-year-old primigravida at 30 weeks of gestation presented with reduced fetal
movements and small for dates baby.
a) What is the likely diagnosis?
b) Outline her management plan. [Annual 2007]

Fetal Malpresentation at Term

1. A primigravida comes in advance labor. She has been diagnosed as a case of
transverse lie with a prolapsed hand. How will you manage her? [Annual 2016]
2.
A primigravida at 36 weeks of gestation presented with USG report showing breech
presentation. She has heard about ECV. She wants to know:
a) What is ECV?
b) What are contraindications to ECV?
c) What are risks of ECV? [Annual 2011]

3. A second gravid with previous normal vaginal delivery has presented in the antenatal
clinic at 38 weeks of gestation with an ultrasound report showing breech
presentation of the fetus.
a) What option will you offer her for delivery?
b) What are the risks of external cephalic version?
c) What are the pre-requisites for external cephalic version (ECV)?
d) What are the selection criteria for normal vaginal delivery of breech fetus?
[Supple 2010 held in 2011]

4. A 36-year-old primigravida is followed up at the health center and referred to the

hospital antenatal clinic at 37 weeks of gestation. On abdominal examination, the
size of the uterus corresponds to the dates and head was not engaged but instead
felt in the fundus with a longitudinal lie.
a) What is the most likely presentation in this case?
b) What would you like to do before you allow this patient to deliver?
c) Mention three complications to this fetus that can occur during delivery.
[Annual 2009]

Rhesus Isoimmunization
1. A G2P1 having O-ve blood group presents at 28 weeks gestation with reports of
indirect Coombs’s test positive and antibody level of 10 IU/ml. her husband blood
group is B positive.

10
 a) What is the diagnosis?
b) Explain the physiology.
c) What can be done to prevent this? [Supple 2018 held in 2019]

▪ MULTIPLE PREGNANCY
Complications
1. A primigravida has presented in antenatal clinic at 14 weeks. On examination, she
was found to have symphysis fundal height larger than the dates. On ultrasound, she
is diagnosed to have twin pregnancy.
a) Enlist five maternal complications that can occur with twin pregnancy.
b) Enlist five fetal complications more common in twins than single pregnancy.
[Annual 2019]

2. A grand multiparous woman has been diagnosed on ultrasound scan at 14 weeks as

having twin pregnancy. What antenatal and postnatal complications you would
anticipate? [Annual 2014]

Antenatal Care
1. A 28-year-old primigravida attended antenatal clinic at 12 weeks of gestation. She
conceived after induction of ovulation. Her Body Mass Index (BMI) is 35. Previous
ultrasound at 8 weeks showed viable twins.
a) What are the obstetric risks to this patient?
b) What antenatal measures should be taken? [Annual 2015]

Delivery
1. A G3P2+0 at 37 weeks comes with labor pain 2 hours. She is diagnosed to have a
twin pregnancy and 1st twin is breech.
a) How will you manage her?
b) What is the criterion for twin labor? [Supple 2008 held in 2009]

11
▪ PRETERM LABOR
Preterm Labor
1. A 22-year-old G2P1 at 32 weeks of gestation gives history of preterm rupture of
membranes. On vaginal examination, cervix is 6 cm dilated. She delivers a 1700 gm
male baby with good Apgar score.
a) How will you evaluate the patient?
b) What are the complications of preterm delivery?
c) What is the management option? [Supple 2016 held in 2017]

2. A 23-year-old primigravida admitted with regular painful contractions at 30 weeks of

gestation. She also complains of blood-stained discharge. Vaginal examination
revealed 4 cm dilated cervix with intact membranes. Show is positive.
a) What is your diagnosis?
b) How will you manage this patient in first stage of labor?
c) What are the risk factors for poor progress of labor? [Annual 2015]

3. A 34-year-old primigravida presented in labor ward at 33 weeks of gestation. She is

complaining of regular painful contractions for 3 hours. On examination, cervix I s
soft, partially effaced and 3 cm dilated.
a) What is the possible diagnosis?
b) Write the measures to improve the outcome.
c) What are the possible complications if she delivers at this gestation?
[Annual 2013]

4. A primigravida has presented in labor room at 32 weeks of gestation with the

complaints of uterine contractions since last 5 hours.
a) What are the clinical criteria to label this patient as a case of preterm labor?
b) How will you manage this patient?
c) What are the fetal risks of prematurity?
d) Write 4 risk factors for preterm labor. [Supple 2010 held in 2011]

PPROM
1. A 22-year-old primigravida at 32 weeks of gestation presents with leaking per vagina,
for 2 hours. On examination, height corresponds with gestational age, cephalic
presentation, FHR: 140/min
a) Write down your diagnosis.

12
 b) Write down steroid prophylaxis.
c) Enlist three maternal and three fetal complications of this problem. [Supple 2018
held in 2019]

2. A 28-year-old female attended labor room at 30 weeks gestation with ruptured

membranes. There are no contractions.
a) What investigations will you do to confirm the diagnosis?
b) How will you manage this patient? [Annual 2015]

▪ HYPERTENSIVE DISORDERS OF PREGNANCY

Pre-eclampsia
1. A 28-year-old G2P0+1 known hypertensive at 18 weeks of gestation. She is worried
as her lab reports showing her Hb falls from 12 gm to 10 gm. She has no symptoms
of anemia and her red cell count is normal. Her blood pressure also remains normal
so she left anti-hypertensive medication.
a) Why her Hb falls as she had no symptoms of anemia?
b) Why her blood pressure remains normal during early pregnancy?
c) If her blood pressure rises after 2nd trimester, which medications you will
prescribe her? [Supple 2019 held in 2020]

2. A PG presents at 38 weeks with severe headache and BP 170/110 mm Hg. Fundal

height is 36 weeks with longitudinal lie, cephalic presentation & FHR = 150/min.
Urine complete examination reveals proteinuria.
a) Write down the most likely diagnosis.
b) Outline steps of management. [Supple 2018 held in 2019]

3. A G4P3+0 comes to you at 35 weeks of pregnancy with a Blood Pressure of 170/100

mm Hg and Proteinuria +1.
a) How will you evaluate her?
b) Give your management plan for her. [Annual 2016]

4. A primigravida at 37 weeks presents in emergency with complaints of headache and

nausea. She also complains of blurring of vision. On examination her blood pressure
is 170/110 mm Hg.
a) Enlist important investigations.
b) Outline the management plan. [Annual 2013]

13
5. A 28-year-old primigravida at 38 weeks gestation attending antenatal clinic was
found to have a blood pressure 180/120 mm Hg and two pluses of protein. She also
had a headache with nausea and vomiting over the past two days.
a) What is your diagnosis?
b) What investigations will you order?
c) What will be your management? [Annual 2012]

Eclampsia
1. An 18-year-old primigravida at 35 weeks of gestation has reported in emergency
with sudden onset of tonic-clonic fits since morning. Her blood pressure is 190/110
mm Hg.
a) Describe initial management of patient.
b) How and when will you deliver her? [Supple 2019 held in 2020]

2. A 20-year-old primigravida at 30 weeks of gestation was received in emergency with

the history of tonic and clonic fits for the last 6 hours. Her BP was 160/110 mm Hg
with proteinuria.
a) What is the diagnosis?
b) What other investigations are required?
c) What are the initial steps of management? [Annual 2017]

3. A primigravida at 34 weeks of gestation presents with history of fits for last three
hours. Her blood pressure is 160/80 mm Hg. Proteinuria is +++.
a) What is the likely diagnosis?
b) Enlist important investigations.
c) Outline the management plan. [Supple 2014 held in 2015]

4. A primigravida at 38 weeks presents in emergency with tonic clonic fits. On

examination, blood pressure was 180/120 mm Hg with generalized edema. Outline
plan of emergency management. [Annual 2009]

Fetal Growth Restriction

1. A 25-year-old in her 2nd pregnancy attends antenatal clinic for review at 36 weeks of
gestation. Her dates were confirmed by dating scan at 12 weeks. You assess that her
fundal height is 30 cm and she is also complaining of decreased fetal movements.
You are concerned about that fetus is SGA and advise USG. USG findings suggest

14
 fetal head and abdominal circumference are less than 5th centile for gestational age
and reduced liquor.
a) Which ultrasound findings are supporting your diagnosis of SGA?
b) How will you assess further fetal well-being? [Supple 2019 held in 2020]

2. A primigravida at 34 weeks of gestation confirmed by ultrasound presents with

decreased fetal movements for last two days. On abdominal examination, the fundal
height is 03 weeks with longitudinal lie and cephalic presentation. The fetal heart
rate is 130 beats/min.
a) What is the most likely diagnosis?
b) Outline the plan of management. [Supple 2014 held in 2015]

▪ MEDICAL COMPLICATIONS OF PREGNANCY

Renal Disease
1. A 32-year-old female, diagnosed with chronic renal disease presented in clinic. She is
keen to conceive.
a) What pre-pregnancy counselling would you advise?
b) What fetal risks are associated with chronic renal disease?
[Supple 2015 held in 2016]

Diabetes Mellitus
1.
a) Which women are at average or high risk for diabetes in pregnancy?
b) Discuss screening protocol for diabetes in the antenatal period.
[Supple 2017 held in 2018]

2. A G4P3 previous SVDs, presents in OPD at 32 weeks of pregnancy with history of one
still birth ad one early neonatal death. Her ultrasound reveals fetal macrosomia and
polyhydramnios. Her blood sugar fasting is 130 gm/dl & BSR is 240 g/dl.
a) What is this condition called?
b) Outline management plan.
c) When and how will you deliver the patient?
d) Enumerate the neonatal complications. [Supple 2016 held in 2017]

3. An obese 35-year-old primigravida is found to have two episodes of glycosuria in the

second trimester.

15
 a) What are the causes of glycosuria in pregnancy?
b) How will you confirm the diagnosis?
c) What are risks to the fetus and neonate in the case of impaired glucose
tolerance?
[Supple 2014 held in 2015]

4. A 39-year-old P1 presents for preconception counselling. She is known diabetic for 4

years taking oral hypoglycemic agents.
a) What are the most important points in preconception counselling of this patient?
b) What are the maternal and fetal risks? [Annual 2013]

5. A 35-year obese diabetic G2P1 books for antenatal clinic at 12 weeks gestation.
a) What are the risks involved in this pregnancy?
b) What steps will you take to improve the outcome? [Annual 2012]

6. A 42-year-old primigravida known diabetic has presented for antenatal booking at 12

weeks of gestation.
a) What are the risk factors in this patient?
b) What baselines investigations will be advised?
c) What specific test will you advise? [Supple 2011 held in 2012]

7. A G3P2+0 with previous two C-sections known diabetic for last four years on regular
insulin has presented in antenatal clinic at 30 weeks of gestation with complaints of
vaginal discharge and vulval itching.
a) What are the maternal and neonatal complications of diabetes?
b) How will you manage her? [Supple 2011 held in 2012]

8. A 38-year-old G4P3+0 patient with history of gestational diabetes mellitus in all

previous pregnancies is now at 12 weeks.
a) What maternal complications can occur?
b) What are fetal and neonatal complications? [Supple 2008 held in 2009]

9. A 27-year-old known diabetic primigravida presents at 12 weeks of gestation. What

are the risks to mother and baby? Outline her management.
[Supple 2007 held in 2008]

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10. A 36-year-old primigravida with diabetes and acute polyhydramnios at 34 weeks of
gestation presents in emergency. Outline the steps in evaluation and management of
this patient. [Annual 2007]

Thyroid Disease
1. A G2P0A1 presented in OPD with complaints of tiredness, cold intolerance and
hoarse voice. In investigations her TSH was raised and free T4 level was below
normal. She is a diagnosed case of hypothyroidism.
a) What is the incidence of hypothyroidism in pregnancy?
b) How often thyroid function test should be repeated in pregnancy?
c) What would be the fetal effects of suboptimal thyroxine replacement?
[Annual 2019]

Heart Disease
1. A 28-year-old primigravida with known mitral stenosis at 10 weeks of pregnancy has
come in the antenatal clinic.
a) Enlist two important points you would like to counsel to this patient.
b) Enlist three fetal risks to her baby. [Annual 2018]

2. A 23-year-old primigravida is a treated case of rheumatic heart disease and had

prosthetic valve at age of 10. She is 6 weeks by dates and on clinical examination is in
NYHA class 2.
a) What anticoagulant therapy is best for her during pregnancy and why?
b) By 32 weeks gestation, she suffered deterioration of cardiac issue and now is
with NYHA Class 4. Outline her management plan. [Supple 2017 held in 2018]

3. A 25-year-old primigravida presents in the Emergency Department with complaints

of shortness of breath for the last two hours. She is 12 weeks pregnant. Her pulse is
102/min and BP is 90/60 mm Hg. Her respiratory rate is 30/min, examination of her
chest reveals coarse crepitations.
a) What is the differential diagnosis?
b) What physiological changes have led to this condition?
c) What is the management of this patient? [Supple 2016 held in 2017]

4. A 21-year-old primigravida with 8 weeks of amenorrhea presented in Emergency

Room with shortness of breath. On examination, her pulse rate is 100/min. Blood

17
 Pressure is 90/60 and respiratory rate is 36. Chest examination reveals pulmonary
edema and low pitched mid-diastolic murmur.
a) What is your diagnosis?
b) Why she has presented at this gestational age?
c) How will you treat her? [Annual 2015]

5. A 22-year-old newly married lady has come for pre-pregnancy advice as she is known
case of congenital heart disease.
a) What issues in pre-pregnancy counselling you would like to discuss?
b) Enumerate six risk factors which can lead to heart failure due to preexisting heart
disease in pregnancy. [Annual 2014]

Anemias
1. A G4P3 presents at 29 weeks of gestation with hemoglobin report of 7 g/dl with
following red cell indices: MCV 66 fl, MCH 23 pg, MCHC 29 g/dl. Peripheral smear
shows microcytic hypochromic anemia. Serum ferritin = 8 ng/dl, Hb electrophoresis
is normal.
a) Write down your diagnosis.
b) Enlist steps of your management plan. [Supple 2018 held in 2019]

2. A 25-year-old female in her 5th pregnancy is seen in an antenatal clinic at 20 weeks

gestation. Hemoglobin concentration on routine blood test reveals 7.2 gm/dl.
a) What is your diagnosis?
b) What investigations will you ask to confirm your diagnosis?
c) Justify management. [Annual 2015]

3. A woman G8P6+1 age 35 years presents in antenatal clinic at 24 weeks with Hb 8.5
gm/dl. She reports lethargy and easy fatigability with off and on palpitations. Cardiac
disease is ruled out by cardiologist. What may be the problem of the lady and how it
can be managed? [Annual 2014]

4. A G2P4+2 has presented in emergency labor room at 37 weeks of gestation with

complaints of tachycardia, weakness and easy fatigability. Her pulse 106/min and
blood pressure is 110/70 mm Hg and pallor is ++.
a) What is your differential diagnosis?
b) What investigations will you advise her?

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 c) What are the risks of anemia in the mother and fetus? [Supple 2010 held in
2011]

5. A G6P5+1 came at 28 weeks of gestation with the complaints of weakness, headache

and lethargy. Her Hb was 8.5 gm%
a) What is the most likely cause of her problem?
b) Why she developed this problem?
c) How will you manage her? [Annual 2010]

Liver Disease
1. A 22-year-old primigravida at 30 weeks of pregnancy complains of malaise, vomiting
and epigastric pain along with yellow coloration of eyes.
a) What is the differential diagnosis?
b) Enumerate five relevant investigations.
c) How is the fetal outcome affected? [Supple 2017 held in 2018]

▪ LABOR: NORMAL AND ABNORMAL

Normal Labor & Management
1. A 22-year-old woman admitted in labor ward at 39+2 weeks gestation in her 2nd
pregnancy. She had previous normal vaginal delivery. She is having regular painful
uterine contractions and on examination cervix is 4 cm dilated. Her membranes are
intact. Midwife is intermittently auscultating fetal hearts, which is normal. Repeat
vaginal examination after 4 hours shows that cervical dilation is 5 cm, 50% effaced
and vertex is at -3 station.
a) What would be your next step to accelerate labor?
b) Vaginal examination after 2 hours shows same cervical dilation, uterine
contractions are 2-3 in 10 minutes. CTG is normal. What would you do further?
c) After two hours of augmentation of labor her cervical dilation is 6 cm, draining
thick meconium and fetal head had excessive molding and anterior fontanelle is
palpable. CT had late deceleration. How would you manage her further? What is
cause of failure of progress? [Supple 2019 held in 2020]

2. A primigravida has just delivered a baby. You are waiting for the placenta to deliver.
a) What signs you will observe for placental separation?
b) How will you active manage 3rd stage of labor? [Supple 2019 held in 2020]

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3. An unbook primigravida is admitted in emergency labor room. She gives history of
having labor pains for the last 2 hours. Briefly give three important relevant points in
history you would like to ask. [Annual 2018]

4. A primigravida comes with labor pains for 4 hours. Examination shows term
pregnancy with normal fatal heart sounds. Pelvic findings are cervix 80% effaced, 4
cm dilated membrane present Vx at station -1 and pelvis adequate. Give her
intrapartum management. [Annual 2016]

5. A woman who is G3P2+0 aged 28 years with previous all spontaneous vaginal
deliveries has come in early labor at 39 weeks. On examination, her cervix is 3 cm
dilated & 50% effaced, membrane is intact and head is at -2 station.
a) Explain the partographic components and during which phase of first stage you
start filling it?
b) What are the key principles of 1st stage management of normal labor?
[Annual 2014]

6. A 24-year-old primigravida presented in labor ward at 39 weeks of gestation. She is

complaining of regular painful uterine contractions for 4 hours along with blood-
stained discharge. Vaginal examination revealed partially effaced cervix 3 cm dilated.
Her FHR was 140/minute regular.
a) What is your diagnosis?
b) What measures you take in the management of normal labor? [Annual 2012]

7. A booked primigravida at 39+6 weeks of gestation presented in labor ward with

history of labor pain for five hours. How will you manage her labor? [Annual 2011]

8. A healthy G3P2+0 comes to you in labor. His first stage of labor was uneventful and
second stage has just started.
a) How do you plan to manage 3rd stage of labor? Describe the management. What
are the benefits of this management?
b) What are the signs of placental separation? [Annual 2010]

9. A 26-year-old PG has come in labor room with labor pains 6 hours. She is at 38 weeks
gestation and no risk factors in pregnancy.
a) What will you do to confirm the labor?
b) How will you manage if she is in labor? [Supple 2008 held in 2009]

20
10. A 28-year-old G4P3+0 with 39 weeks of pregnancy comes to labor room with labor
pains of 3 hours duration. She is 3 cm dilated when artificial rupture of membranes is
done. You see Grade 1 meconium. She has otherwise uncomplicated pregnancy with
all previous simple vaginal deliveries. How will you manage this case? [Annual 2008]

Fetal Assessment in Labor

1. Give two indications for continuous electronic fetal monitoring. [Annual 2018]

2. G2P1+0 presents at 38 weeks of gestation in active phase of labor. Her CTG shows
decelerations.
a) Discuss the parameters of Cardiotocography (CTG) you look for its interpretation.
b) Outline the management of her labor. [Supple 2015 held in 2016]

3. A primigravida is present with active phase of labor. What are different methods of
fetal assessment in labor? [Supple 2014 held in 2015]
4.
A woman who is G3P2+0 reports to labor ward at 38 weeks gestation having mild
labor pains for two hours. On pelvic examination, cervix is 4 cm dilated and 70%
effaced. Her admission cardiotocography (CTG) is reactive.
a) What are the features of reactive CTG?
b) What other methods are available for fetal monitoring during labor?
c) After 2 hours she still has same pelvic findings and her CTG trace shows late
deceleration. What would be your management? [Annual 2014]

5. You are monitoring the labor of G2P2+0 whose gestational age is more than 42
weeks.
a) Is she a high-risk case for developing intrapartum fetal distress?
b) What tools/tests are available to assess fetal well-being during labor?
[Annual 2010]

6. Mrs. Chohan is referred to your clinic because of an unplanned pregnancy. The

couple had not used any contraception after the last delivery. She suspected that she
had contracted venereal disease from her husband and was worried that this might
cause serious complications to baby. She was so anxious that she requested for
termination of pregnancy. Mrs. Chohan finally decided to continue the pregnancy
but defaulted antenatal follow-up. At 32 weeks of gestation, she was admitted to the

21
 antenatal ward because of regular uterine contractions. Speculum examination
revealed that the cervical os was effaced and 1 cm dilated.
a) What are the laboratory tests related to the investigation of the cause of this
condition? Name two.
b) Enlist five important features you should note during an ultrasound scan
examination.
c) How would you manage her if there was no contraindication for use of
tocolytics? [Annual 2009]

7. What can you do to assess the status of fetus in labor? [Annual 2008]

Partogram
1. What is the significance of a Partogram? [Supple 2014 held in 2015]

2. A primigravida at 39 weeks of gestation presents in Labor Room. Partogram is

plotted.
a) When should Partogram charting commence?
b) What are components of Partogram?
c) What is significance of plotting Partogram? [Supple 2016 held in 2017]

Abnormal Labor & Management

1.
a) Enumerate possible causes of poor progress of 2nd stage of labor.
b) Discuss outcomes of labor in occipitoposterior position. [Annual 2019]

2. A 20-year-old primigravida comes in labor at 40 weeks of gestation. She is having

uterine contractions for six hours. On examination her pulse is 80 b/min, BP 120/80
mm Hg. Fundal height is 38 cm with longitudinal lie, cephalic presentation and FHR
140 b/min. PV examination shows her to be 3 cm dilated with vertex at -3 station.
a) What is normal duration of labor?
b) What are causes of prolonged labor?
c) What will you do if she is not having adequate contractions?
[Supple 2018 held in 2019]

3. 32-year-old G3 is in labor for last 6 hours. She is at term and started with
spontaneous labor. Oxytocin infusion was started one hour back. Her CTG is showing

22
 normal baseline heart rate with good variability but with occasional type 1
decelerations. She has 4 cm dilation on vaginal examination.
a) Enlist three findings suggestive of cephalopelvic disproportion.
b) Suggest atleast two important points in her management plan at this stage.
[Annual 2018]

4. A 25-year-old primigravida is in second stage of labor for the last 1.5 hours. The head
is at ischial spine (zero station). Liquor is clear and fetal heart rate is within normal
range.
a) What are the causes of delay in second stage of labor?
b) How would you manage it? [Supple 2014 held in 2015]

5. A G2P1+0 with previous unexplained IUD at term has presented in active phase of
labor
a) How will you monitor her wellbeing?
b) How will you monitor progress of labor?
c) If there is any delay in first stage of labor, how will you correct it?
d) If there is any delay in 2nd stage of labor, what will be the management?
e) What will be the indications of C-section in this patient?
[Supple 2011 held in 2012]

6. A 22-year-old primigravida came 8 hours back in labor room with labor pains. She is
now fully dilated for 1 hour V b/w -1 and zero.
a) What are the possible causes of prolonged labor?
b) What should be done? [Annual 2008]

7. A 30-year-old primigravida has poor progress in 2nd stage of labor.

a) What is the most likely diagnosis?
b) What choices are available and how will you proceed to manage her?
[Annual 2007]

Fetal Compromise in Labor

1. A 30-year-old primigravida is in labor for last 8 hours. She is 6 cm dilated on vaginal
examination. Enlist three sings on CTG suggestive of fetal compromise.
[Annual 2017]

23
2. Enumerate the risk factors causing fetal compromise in labor requiring intensive
care. [Annual 2010]

Pain Relief in Labor

1. Enlist two contraindications for epidural analgesia. [Annual 2017]

2. A primigravida is your booked patient. During her antenatal visit at 36 weeks, she
wants to know about the pain relief measures available to her during labor.
a) What options will you give her?
b) What are the risks/complications of epidural analgesia?
c) What are the contraindications of epidural analgesia? [Supple 2010 held in 2011]

3. A 26-year-old lady doctor primigravida at 36 weeks gestation is anxious about

delivery. She is advised elective caesarean but is undecided about epidural or
general anesthesia. Comment on the advantages and disadvantages of each.
[Supple 2007 held in 2008]

4. Name the types of regional anesthetics blocks used for labor. Give pros & cons of
epidural anesthesia. [Annual 2007]

Labor in Special Circumstances

1. A 25-year-old primigravida at 38 weeks gestation admitted with gross rupture of
membranes. She was also having regular painful uterine contractions every 2-3
minutes interval. On vaginal examination her size was 4 cm dilated with fetal feet
palpable through the cervix. Fetal heart tracing was normal.
a) What is your diagnosis?
b) What is the suitable method to achieve delivery? [Annual 2012]

Induction of Labor
1. A primigravida came at 38 weeks of pregnancy with BP of 160/100 mm Hg and
proteinuria. Induction of labor has been decided.
a) How this patient should be evaluated before induction of labor?
b) What are the methods of induction of labor?
c) Enlist the complications of induction of labor. [Annual 2010]

24
Obstructed Labor
1. A G3P2+0 with previous two normal vaginal deliveries, had a trial of labor at home
by some dai, she presented in labor room with sings of obstructed labor,
a) What are the signs of obstructed labor?
b) What are the common causes?
c) How will you manage this patient? [Supple 2011 held in 2012]

▪ OPERATIVE DELIVERY
Perineal Repair
1. A primigravida delivered 2.8 kg baby spontaneously per vaginum. On inspection, 3rd
degree tear was found.
a) Define perineal tear.
b) How you establish the diagnosis of 3rd degree tear?
c) What is the management plan? [Annual 2015]

2. A 26-year-old primigravida waws delivered by outlet forceps and during delivery. She
suffered from 3rd degree perennial tear.
a) How will you manage her?
b) What are the complications associated with it? [Annual 2008]

Episiotomy
1. Regarding episiotomy enumerate the:
a) Indications
b) Timing
c) Types
d) Steps of suturing [Supple 2017 held in 2018]

Operative Vaginal Delivery

1. G3P2 previous SVD at term is fully dilated from last 2 hours. On PV examination,
vertex is at +2 position and right occipitotransverse. FHR: 110/min and patient is also
physically exhausted.
a) Which instrument would you apply in this patient?
b) What are the prerequisites for instrumental delivery? [Annual 2019]

25
2. A G5P4 is in second stage of labor for the last 2 hours. The senior obstetrician is
counseling her for a vacuum delivery.
a) Enlist three pre-requisites for vacuum delivery.
b) Enlist two possible complications to the mother. [Annual 2017]

3. A G2P1 presents in Emergency Labor Room at term with labor pains for 6-8 hours
and she is fully dilated after two hours. A baby boy of 3.8 kg delivered with outlet
forceps.
a) What are the prerequisites for instrumental delivery?
b) What are the risks associated with instrumental delivery?
[Supple 2016 held in 2017]

4. A primigravida at term is in second stage of labor for last two hours. Pelvic findings
are: os fully dilated. Vertex at +2 right occipitoposterior with membranes absent and
fetal heart sounds normal.
a) How would you manage her?
b) What are the maternal and fetal risks associated with the procedure?
[Supple 2015 held in 2016]

▪ OBSTETRIC EMERGENCIES
Antepartum Hemorrhage
1. A G4P2+1 came in shock like state at 34 weeks with profuse vaginal bleeding. She
died within 5-10 minutes of admission despite prompt resuscitation measures.
a) What type of maternal death it is?
b) What is the most likely cause of death in this patient?
c) How this death could have been avoided?
d) Enlist the causes of maternal death. [Annual 2010]

Placental Abruption
1. A 38-year-old G5P4 (previous spontaneous vaginal delivery) presents in emergency
with the complaints of painful moderate vaginal bleeding at term. On examination
her pulse is 120 bpm and BP is 80/50 mm Hg. Her abdomen is tense and tender on
examination,
a) What is the most likely diagnosis?
b) Outline the management plan of this obstetrical emergency. [Annual 2013]

26
2. G3P2A0 presents at 34 weeks of gestation with history of heavy vaginal bleeding,
abdominal pain and decreased fetal movements and on examination, uterus is tense
and tender.
a) What is the most likely diagnosis?
b) Give steps of management plan. [Annual 2009]

3. A lady G4P3 at 38 weeks of pregnancy with history of previous caesarean section

presents in emergency with profuse sweating, pulse 110/min and BP 90/60 mm Hg.
There is some bleeding P/V and fetal heart is absent.
a) What is the most likely diagnosis?
b) Outline her management. [Supple 2007 held in 2008]

Placenta Previa
1. A G3P2+0 with previous two C-sections has presented in emergency at 35 weeks of
gestation with the complaint of painless bleeding per vagina for last two hours. Her
vital signs are normal.
a) What is your probable diagnosis?
b) What investigations will you advise?
c) How will you manage the patient? [Supple 2010 held in 2011]

2. While undergoing antenatal care, a 27-year-old lady G3P1+1 at 30 weeks of

gestation presents with painless vaginal bleeding.
a) What is the most likely diagnosis?
b) How will you proceed to manage her? [Annual 2007]

Primary Postpartum Hemorrhage

1. You are the on-call doctor in labor ward and the nurse in-charge calls you in
emergency for a patient. She is P5+0 and delivered one hour back by spontaneous
vertex delivery. Her labor lasted for 7-8 hours. You examine her and she is bleeding
moderately. Her BP is 120/80 mm Hg, pulse is 90/min and she is conscious. Baby boy
weighing 4 kg is born with APGAR score of 8/10. You diagnose her as a case of
primary postpartum hemorrhage (PPH).
a) Give five causes of primary postpartum hemorrhage.
b) What are the steps of management you will take for her? [Annual 2019]

27
2. A 35-year-old P6 comes with bleeding PV after home delivery. She gives history of
profuse bleeding with clots. On examination her pulse is 120/min and BP 90/60 mm
Hg with cold clammy extremities.
a) What is the most likely cause of bleeding?
b) Enumerate important steps in the medical management of this lady.
[Supple 2018 held in 2019]

3. A G6P5+0 started to have excessive vaginal bleeding after delivery.

a) How will you evaluate her?
b) What emergency measures will you take to deal with this case?
c) What is the specific management of this case? [Annual 2016]

4. A woman who just had vaginal delivery is bleeding profusely from vagina.
a) Outline initial management.
b) Discuss complications of massive hemorrhage (PPH). [Annual 2012]

5. You are called to see a woman who has had a normal labor and delivery of a healthy
infant. She commenced bleeding profusely from her vagina soon after the delivery of
the placenta. Outline your steps of immediate and subsequent management of this
patient. [Annual 2009]

6. A 32-year-old G6P5+0 delivered by SVD and started bleeding from vagina, she had all
SVDs previously.
a) What is the diagnosis?
b) What measures you will take to manage her? [Supple 2008 held in 2009]

Eclampsia
1. An 18-year-old primigravida at 35 weeks of gestation has reported in emergency
with sudden onset of tonic-clonic fits since morning. Her blood pressure is 190/110
mm Hg.
a) Describe initial management of patient.
b) How and when will you deliver her? [Supple 2019 held in 2020]

2. A 20-year-old primigravida at 30 weeks of gestation was received in emergency with

the history of tonic and clonic fits for the last 6 hours. Her BP was 160/110 mm Hg
with proteinuria.
a) What is the diagnosis?

28
 b) What other investigations are required?
c) What are the initial steps of management? [Annual 2017]

3. A primigravida at 34 weeks of gestation presents with history of fits for last three
hours. Her blood pressure is 160/80 mm Hg. Proteinuria is +++.
a) What is the likely diagnosis?
b) Enlist important investigations.
c) Outline the management plan. [Supple 2014 held in 2015]

4. A primigravida at 38 weeks presents in emergency with tonic clonic fits. On

examination, blood pressure was 180/120 mm Hg with generalized edema. Outline
plan of emergency management. [Annual 2009]

Shoulder Dystocia
1.
a) What is shoulder dystocia?
b) Enumerate the risk factors.
c) List the steps to manage shoulder dystocia. [Annual 2013]

2. A multiparous patient who is delivery vaginally develops an emergency. Head is

partially delivered but shoulders are stuck.
a) What are the predicative risk factors for shoulder dystocia?
b) What are the dangers to the fetus/baby?
c) Outline the management. [Supple 2007 held in 2008]

▪ THE PEURPERIUM
Secondary Postpartum Hemorrhage
1. A 34-year-old delivered a full-term baby 2 weeks ago by vaginal delivery. She gives
history of low-grade fever, abdominal cramps, pungent lochia and heavy vaginal
bleeding for last 24 hours.
a) What is your probable diagnosis?
b) Enlist two investigations.
c) Outline management plan. [Annual 2018]

2. A 20-year-old woman, para one, presents in labor room after one week of normal
vaginal delivery with heavy bleeding per vagina for one day.

29
 a) Define secondary Post-Partum Hemorrhage (PPH).
b) What are the most common causes of secondary PPH?
c) How will you manage the patient? [Annual 2017]

3. A P1+0 presents in Emergency Room with secondary postpartum hemorrhage (PPH)

after delivery.
a) Define secondary PPH.
b) Enlist important causes of secondary PPH.
c) Outline the management of secondary PPH. [Supple 2015 held in 2016]

Thromboembolism
1. An obese 20-year-old had emergency cesarean section due to failed induction for
pre-eclampsia. She is given prophylactic antibiotic at the time of surgery. She is
discharged home two days later feeling well. Nine days later, she was admitted in
emergency with complains of low-grade fever, pyrexia 37-37.5 C. On examination,
her chest is normal and uterus is palpable just above pelvic brim. Her both legs are
swollen but left calf is also tender.
a) What is your diagnosis?
b) What risk factors are present for that disease in this patient?
c) What specific investigations and treatment you will plan for her?
[Supple 2019 held in 2020]

2. A 36-year-old para 4 delivered five days back by LSCS for obstructed labor has
presented in emergency with history of breathlessness for 1 hour, pain, redness and
swelling in right calf since morning.
a) What is most likely diagnosis?
b) What are risk factors for this problem in her?
c) How will you manage her? [Annual 2011]

Puerperal Pyrexia and Sepsis

1. A primiparous woman presented with pyrexia of 101 F on 6th day of her home
delivery.
a) What are the causes of pyrexia?
b) Name the investigations you will advise for her.
c) Outline the treatment plan. [Supple 2017 held in 2018]

30
2. A 30-year-old P2 presents in the labor ward with history of home delivery three days
back, high grade fever with rigors, dysuria and foul-smelling vaginal discharge.
a) What is the most likely diagnosis?
b) How will you manage her? [Supple 2014 held in 2015]

3. A 30-year-old para two presented in Emergency Room after seven days of

spontaneous vaginal delivery at home with fever of 38 C, rigors, dysuria and foul-
smelling vaginal discharge.
a) What is your most likely diagnosis?
b) What investigations are helpful to confirm your diagnosis?
c) How do you manage this patient? [Annual 2014]

4. A P3+0 had spontaneous vaginal delivery two days back. She has presented in
emergency with 102 C fever. On examination, her episiotomy wound is health, chest,
breast and legs are normal.
a) What is the most likely cause of her fever?
b) What are the most likely organisms involved?
c) What are the risk factors for puerperal sepsis?
d) What investigations will you advise? [Supple 2011 held in 2012]

5. A 35-year-old para 3 presented in the labor ward with the history of delivery at
home two days back with history of pyrexia, rigors, dysuria and foul-smelling vaginal
discharge.
a) What is the most likely diagnosis?
b) How will you manage her? [Annual 2011]

6. A 26-year-old lady presents 8 days following vaginal delivery by midwife at home

with pyrexia 38 C. How will you investigate and manage her? [Annual 2008]

7. A 35-year-old grand multipara developed pyrexia, rigors, dysuria and foul-smelling

lochia 3 days after delivery at home.
a) What is the most likely diagnosis?
b) How will you investigate and treat her? [Annual 2007]

Psychiatric Disorders
1. You are called out to evaluate a young lady delivered two days ago whom the family
describes as ‘depressed’. She is physically okay, has a healthy alive son.

31
 a) What are the psychiatric ailments in puerperium?
b) What can you do for her? [Supple 2007 held in 2008]

2. A 30-year-old P1 presents on the 5th postnatal day with complaints of restlessness,

confusion, fear and inability to sleep. Her husband is worried as she is not taking
interest in the baby and often has thoughts of self-harm.
a) What is your diagnosis?
b) How will you manage this patient?
c) What is the recurrence rate of this problem? [Annual 2013]

Breastfeeding
1. A P2+0 delivered by you decided not to breastfeed her baby.
a) How will you counsel her regarding breast feeding?
b) What breast problems she can develop if she does not start breast feeding and
how can they be managed? [Annual 2010]

Breast Disorders
1. A woman presents with high grade fever, chills and painful red swollen right breast
on 14th day of delivery.
a) What are the common breast conditions that commonly develop in puerperium?
b) What is the common infecting organism in this case?
c) How will you treat her? [Annual 2015]

2. A P2+0 has presented on the 4th postnatal day, normal vaginal delivery with
complaints of 102 F fever, rigors, chills and red, hot and tender left breast.
a) What is the most probable diagnosis?
b) What investigations will you advise?
c) How will treat her? [Supple 2010 held in 2011]

32