Obs.

MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

OB-GYN Department

Obstetrics
MCQs
Benha-Bank
First Edition 2022

Prepared by Professors:
Dr/ Ahmed Walid Anwar Morad
Dr/ Ahmed Samy Saad

MCQs Bank
OBESTETRICS

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

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 Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

CONTENT
Title page
 Chapter 1: Reproductive Biology 1-3
 Chapter 2: Physiological Changes During pregnancy 4-14

 Chapter 3: Antenatal Care 15-22

 Chapter 4: Bleeding in early pregnancy 23-27
I. Abortion
II. Ectopic pregnancy
III.Gestational trophoblastic diseases
 Chapter 5: Antepartum Hemorrhage 28-31
 Chapter 6: Postpartum Hemorrhage Post
 Chapter 7: Medical Disorders with Pregnancy 35-39
1) Hyperemesis Gravidarum
2) Hypertensive disorders
3) Diabetes mellitus with pregnancy
4) Anemia with pregnancy
5) Thyroid Diseases in Pregnancy
6) Cardiovascular Diseases
7) Urinary Tract Diseases in pregnancies
8) Epilepsy in pregnancies
9) Liver diseases & Miscellaneous disorders in pregnancies
 Chapter8: Rh isoimmunization and ABO incompatibility 40-45
 Chapter9: IUGR and IUFD 46-49
 Chapter 10: Post-term and induction of labor (IOL) 50-57
 Chapter 11: Preterm Labor and PROM 58-62
 Chapter 12: Fetal assessment 63-66

 Chapter 13: The Neonates 67-68

 Chapter 14: Anatomy of the female genital tract, bony pelvis and fetal 69-73
skull
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 Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy
 Chapter 15: Labor and Fetal Surveillance and Mechanism of Labor 74-78
 Chapter 16: Malposition & Malpresentation 79-83
 Chapter17: Multiple Pregnancy 84-89
 Chapter 18: Operative Obstetrics 93-95
 Chapter 19: Puerperium and Puerperal Sepsis
 Chapter 20: Prenatal Infections

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Chapter 1: Reproductive Biology

1. Fertilization is the union of male (sperm) and female (oocyte) gametes to form the
zygote results in the following events:
A. The oocyte completes the 2nd meiotic division.
B. Restoration of diploid number of chromosomes.
C. Genetic sex identification.
D. Induction of cleavage
E. All answers are correct
2. The primordial germ cells appear in the yolk sac of the embryo by the end of:
A. The 2nd week
B. The 3rd week
C. The 4th week (reach indifferent gonads).
D. The 6th week
3. What is the site of fertilization?
A. The distal 1/3 of fallopian tube (Ampulla)
B. The middle 1/3 of fallopian tube
C. The proximal 1/3 of fallopian tube.
D. Uterine cavity
4. What is the implantation stage of embryo?
A. Zygote
B. Morula
C. Blastocyst
D. 4 cell stage
5. Zygote reaches the uterine cavity as:
A. 32 celled
B. 16 celled (Morula)
C. 8 celled
D. 2 celled
6. The solid mass of cells formed by 8 Blastomeres or more is termed:
A. Zygote
B. Morula
C. Blastocyst
D. 4 cell stage
7. Syncytiotrophoblast and cytotrophoblast differentiate on what day after the fertilization?
A. 6 days
B. 8 days
C. 10 days
D. 12 days
8. What is the most common site of blastocyst implantation?
A. Posterior surface of upper uterine segment (2/3 of cases)
B. Anterior surface of upper uterine segment (1/3 of cases)
C. Lower uterine segment
D. Fallopian tube

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy
9. The decidua lying directly under the site of blastocyst invasion is called:
A. Decidua basalis
B. Decidua capsularis
C. Decidua parietalis
D. Decidua vera
10. The implantation of blastocyst follows fertilization by:
A. 1 to 2 day
B. 3 to 4 days
C. 6 to 7 days (20th -22nd day of menstrual cycle)
A. 10 to 11 days (completed implantation)
11. Cleavage means:
A. Repeated mitotic division of the zygote resulting in an increasing number of
cells, nuclear mass without cell growth.
B. Blastomeres of Morula are tightly backed & cannot be distinguished
(Compaction)
C. Zygote is still contained within the zona pellucida
D. Complete implantations of blastocyst
12. Embryoblast is differentiated into 2 cell layers; the Epiblast and Hypoblast. These two
layers are sandwiched between two balloons: the primitive yolk sac and the amniotic
cavity. What is the Embryoblast?
A. Inner cell mass
B. Outer cell mass (Trophoblast)
C. Extra-embryonic mesoderm
A. Intra-embryonic mesoderm
13. Regarding Fertilization & implantation:
A. Fertilization occurs in the inner third of the fallopian tube.
B. The sperm head penetrates through the corona radiata & zona pellucida
while the tail remains outside.
C. The 2ND meiotic division is completed before fertilization.
D. Implantation occurs at the Morula stage.
E. The trophoblast invades the endometrium & differentiates into an
outer cytotrophoblast & an inner syncytiotrophoblast.
14. Physiological changes in the reproductive system include:
A. There is no change in the vagina.
B. The uterus 1st enlarges by hyperplasia then by hypertrophy.
C. There is no change in the cervix.
D. Estrogen has no role in the changes that occur during pregnancy.
E. Lower segment of the uterus will be formed in the 1st trimester.
15. The embryonic period extends from:
A. Fertilization through 6 weeks.
B. Fertilization through 8 weeks
C. Week 2 through 8 weeks.
D. Week 2 through 12 weeks
16. The time interval between fertilization to Morula reaching the uterine cavity is:
A. One day
B. 3 days
C. 4 days (17-18th day of menstrual cycle)
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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy
D. 6 days

17. What is the clinical significance of the finding of a single umbilical artery on examination
of the umbilical cord after delivery?
A. Insignificant
B. Occurs in 10% of newborns
C. May be associated with aneuploidy or other congenital anomalies
D. Equally common in newborn of diabetic and non-diabetic mothers
18. In which type of Placenta the vessels separate before reaching margin:
A. Circumvallate
B. Velamentous
C. Marginata
D. Battledore
19. Morbidly adherent placenta to the myometrium is due to lack of:
A. Nitabuch fibrinoid layer
B. Chorion frondosum
C. Penetration of villi into the muscle bundles
D. Superficial compact layer
20. By which day after fertilization, is placental circulation established:
A. 10th day
B. 13th day
C. 15th day
D. 17th day
21. The fetal period extends from:
A. Fertilization through 6 weeks.
B. Fertilization through 12 weeks
C. 9th week till term
D. 12th Week till term

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Chapter 2: Physiological Changes During pregnancy

1. The following are presumptive (probable) skin signs of pregnancy except:
A. Chloasma
B. Maculo-papular rash
C. Linea Nigra
D. Stretch Marks
E. Spider Telangiectases
2. What is the suspected change of the resting pulse in pregnancy?
A. Decreased by 20 bpm.
B. Decreased by 10 to 15bpm.
C. Unchanged.
D. Increased by 10 to 15 bpm.
E. Increased by 20 bpm.
3. Normally, pregnancy in 2nd trimester is characterized by all of the
following EXCEPT:
A. Elevated fasting plasma glucose.
B. Decreased fasting plasma glucose.
C. Elevated postprandial plasma insulin.
D. Elevated postprandial plasma glucose.
E. Elevated plasma triglycerides.
4. Which of the following is an abnormal cardiovascular change during
Pregnancy?
A. Increase cardiac output
B. Increase venous return
C. Increase peripheral resistance
D. Increase pulse rate
E. Increase stroke volume
5. Amniotic fluid secretion is a dynamic process as it is replaced every 3 hours.
What is the main source of amniotic fluid in the second half of pregnancy?
A. Secretion by amnion
B. Diffusion from maternal plasma through amniotic membrane(1st half)
C. Fetal secretion e.g., lung & saliva
D. Fetal urination (500mlk/day)
6. Which of the following hormones is decreased during normal
pregnancy?
A. Parathyroid hormone (PTH) in the 2nd & 3rd trimesters.
B. Total thyroxin (T4)
C. Free cortisol.
D. Prolactin.
E. Estradiol
7. The umbilical arteries give rise to the following structure after birth:
A. Ligamentum Arteriosus.
B. Medial umbilical ligaments.
C. Ligamentum teres.
D. Ligamentum venosum
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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy
8. The single umbilical vein gives rise to the following structure after
birth:
A. Ligamentum Arteriosus.
B. Lateral umbilical ligament.
C. Ligamentum teres.
D. Ligamentum venosum
9. Clotting factor decreased in pregnancy is:
A. VIII
B. X
C. XIII
D. Fibrinogen
10. In pregnancy peak level of HCG occurs at:
A. Early gestation (first 8-11 weeks)
B. Mid gestation
C. Late gestation
D. Prelabor
11. The lateral umbilical ligament is a remnant of:
A. Umbilical arteries.
B. Umbilical vein.
C. Inferior epigastric arteries.
D. Urachus (median umbilical ligament)
12. In the fetus, the most well oxygenated blood is allowed into the
systemic circulation by the:
A. Ductus Arteriosus.
B. Foramen ovale.
C. Rt. Ventricle.
D. Ligamentum teres.
E. Ligamentum venosum
13. Physiological anemia during pregnancy is a normochromic normocytic
anemia that occurs as a result of:
A. Low iron stores in all women.
B. Blood lost to the placenta
C. Increased plasma volume more than RBCs mass.
D. Increased cardiac output resulting in greater red cell destruction.
E. Decrease RBC lifespan during pregnancy
14. Changes in the urinary tract system in pregnancy include:
A. Increase the glomerular filtration rate (GFR).
B. Decrease in renal plasma flow (RPF).
C. Marked increase in both GFR & RPF when the patient is supine.
D. Decrease glucose and protein excretion.
E. Increase in BUN & creatinine.
15. How can the maternal blood volume change during normal pregnancy?
A. Remains stable.
B. Decreases 10%.
C. Increases 10%
D. Increases up to 40%
E. Decreases up to 40%.

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16. During pregnancy, maternal estrogen levels increases markedly. Most of
this estrogen is produced by the:
A. Ovaries.
B. Adrenals.
C. Testes.
D. Placenta.
E. Uterus.
17. Which of the following skin lesions is characteristic physiological
change of pregnancy?
A. Vitiligo
B. Pemphigus
C. Tinea
D. Chloasma
18. During normal pregnancy, the renal blood flow & glomerular
filtrate rate (GFR) can increase as much as:
A. 10%.
B. 25%.
C. 50%.
D. 75%.
E. 100%.
19. Fetal blood is returned to the umbilical arteries & the placenta through:
A. Hypogastric arteries. (internal iliac arteries)
B. Ductus Venosus.
C. Portal vein.
D. Inferior vena cava.
E. Foramen ovale.
20. During which of the following conditions would the serum Prolactin level be
greatest:
A. Sleep.
B. Ovulation
C. Parturition
D. Menopause
E. Suckling
21. In normal pregnancy, all of the following are true EXCEPT:
A. Glucosuria increases.
B. Plasma aldosterone concentration falls.
C. Creatinine clearance is increased.
D. Folate excretion is increased.
E. The presence of less than 300mg of proteins in 24hours urine collection
is considered normal

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22. In normal pregnancy, which of the following physiological

parameters decrease?
A. Glomerular filtration rate.
B. Stroke volume.
C. Peripheral vascular resistance.
D. Plasma volume.
E. White blood cells.
23. A woman presents to the antenatal clinic at 30 weeks of gestation with
vulval varicosities. What is the most likely cause?
A. Decreased vascular resistance
B. Increased cardiac output
C. Infection
D. Pressure effect of the gravid uterus on the inferior vena cava
E. Increased plasma volume
24. Regarding placental anatomy:
A. The decidua capsularis forms part of the placenta.
B. The fetal side of the placenta is divided into 30-40 cotyledons.
C. The intervillous space contains fetal blood.
D. Anatomically the placenta id fully formed by 30 weeks.
E. Fetal blood vessels develop in the mesenchyme core of the chorionic villi.
25. Regarding Renal changes in pregnancy, all of the following are true EXCEPT:
A. Blood flow is increased by 10%.
B. Glomerular filtration rate is increased by 50%.
C. Plasma urea will be reduced.
D. Glycosuria could be normal.
E. Mild hydronephrosis is normal.
26. Consequences of fluid retention, all of the following are CORRECT EXCEPT:
A. Hemoglobin concentration decreases.
B. Hematocrit falls.
C. Serum albumin falls.
D. Stroke volume increases.
E. Renal blood flow increases
27. Normally the pregnant woman hyperventilates. This is compensated by:
A. Increased tidal volume.
B. Respiratory alkalosis.
C. Decreased Pco2 of the blood.
D. Decreased plasma bicarbonate.
E. Decreased serum pH.
28. Regarding renal tract during pregnancy, the following are true EXCEPT:
A. The ureters are dilated.
B. The renal pelvis calyces are dilated.
C. The right side is affected more than the left side.
D. The primigravida shows more changes then multigravida.
E. The bladder tone increases.
29. Which of the following does NOT accurately describes the placenta in
humans:
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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy
A. 15-20 cm in diameter.
B. 2-4 cm thick.
C. Weighs about 1/6 of what the term infant does.
D. Formed from Chorion laeve and decidua basalis.
E. Umbilical cord originates from the center of the placenta in all most of
the cases.
30. Which of the following is probably responsible for
physiologic hyperventilation during pregnancy?
A. Large fluctuations in plasma bicarbonate.
B. Increased estrogen production.
C. Increased progesterone production.
D. Decreased functional residual volume.
E. Decreased plasma PO2
31. Which of the following vessels is still active after fetal birth?
A. Ductus Arteriosus.
B. Umbilical arteries.
C. Ductus Venosus.
D. Hepatic portal vein.
E. Umbilical vein.
32. What is the source of fetal & neonatal IgM?
A. It is almost entirely fetal in origin
B. It is almost entirely maternal in origin.
C. It is approximately 75% maternal & 25% fetal in origin.
D. It is 50% maternal, 50% fetal in origin.
E. It is 25% maternal, 75% fetal in origin.
33. Spinbarkeit is a term which means the test for detection of:
A. Crystallization of the cervical mucus.
B. Thickening of the cervical mucus.
C. Mucous secretion of the cervix.
D. Threading of the cervical mucus.
E. Thinning of the cervical mucus.
34. Which of the following is not a cause of Placental insufficiency?
A. Smoking in pregnancy
B. Post maturity.
C. Dietary insufficiency in pregnancy
D. Hypertensive disorder in pregnancy
35. How can the resting pulse be affected in normal pregnancy?
A. Increased by 10-15 beats/min.
B. Decreased by 30 beats /min.
C. Decreased by 10-15 beats/min.
D. Unchanged.
E. Increase by 30 beats/min.

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36. What is the normal change of prolactin level during pregnancy?

A. Drops at the end of gestation just before delivery of the infant.
B. Drops Just after the delivery of the infant.
C. Drops as the placenta is delivered.
D. It can increase 10-20times during pregnancy than normal non pregnant
value. Its level falls by 50% even after birth in breast feeding women and
normalized within 7 days postpartum if woman is non-breast feeding.
37. What is a cause of Polyhydramnios? (Is not a cause of Oligohydraminos)
A. Anencephaly
B. Renal agenesis
C. Post term pregnancy
D. Urinary obstruction
E. Poor placental perfusion
38. Which of the following hormones are not synthesized by placenta?
A. Prolactin.
B. HCG.
C. HPL.
D. Progesterone.
E. Estriol.
39. Polyhydramnios is associated with the following condition
A. Intrauterine growth restriction
B. Fetal kidney agenesis
C. Tracheo-oesophageal fistula/ abdominal wall defect/ open neural tube
defect/ GIT obstruction
D. Hind water leakage
40. All the following are possible causes of Polyhydramnios, EXCEPT:
A. Diabetes
B. Multiple pregnancy
C. Fetus with hydrops fetalis
D. Fetus with duodenal atresia or neural tube defect
E. IUGR/ renal agenesis (Potter's syndrome)
41. What is the most common cause of Polyhydramnios?
A. Twin pregnancy.
B. Diabetes.
C. Hydrops fetalis.
D. Anencephaly.
E. Idiopathic.
42. Using your knowledge of normal maternal physiology, what is your
diagnosis if a 38 weeks’ pregnant patient developed tachycardia,
diaphoresis, nausea, vomiting, pallor, weakness, lightheadedness, and
dizziness while lying supine on your examination table:
A. Postural hypotension.
B. Supine hypotensive syndrome
C. Amniotic fluid embolism
D. Accidental hemorrhage
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43. Using your knowledge of normal maternal physiology, which of the following
would employ if a 38 weeks’ pregnant patient become faint while lying supine on
your examination table:
A. Blood transfusion.
B. Turning the patient on her side. (the patient should be tilted 15° to the left by
placing rolled towels beneath the spinal board)
C. Oxygen by face mask.
D. I.V. saline solution.
44. Which of the following would normally be expected to increase
during pregnancy?
A. Plasma creatinine.
B. Thyroxin-binding globulin.
C. Hematocrit..
D. Hair growth.
45. Which one is false about the placenta and umbilical cord?
A. 10% maternal contribution only
B. U.C covered with Chorion
C. U.C contain Wharton jell
D. Placental lobes are the functional units. (cotyledon)
46. Pregnant lady with Polyhydramnios, the cause could be:
A. Fetus with esophageal-atresia
B. Fetus with polycystic kidney disease
C. Fetal growth restriction
D. Potter’s syndrome
E. Patient is taking anti-epileptic drugs
47. Skin changes during pregnancy should include:
A. Chloasma.
B. Striae.
C. Palmer erythema.
D. All answers are correct
48. Regarding Placental function:
A. hCG is a glycoprotein composed of alpha & β subunits. It's secreted by
cytotrophoblast.
B. Human Placenta Lactogen enhances insulin action & improves
glucose tolerance.
C. Progesterone causes vasodilatation of blood vessels & contraction of
uterine smooth muscle.
D. Placental Corticotrophin releasing hormone increases ACTH & cortisol
&causes vasoconstriction of the feto-placental blood vessels.
E. Estrogen is secreted by the feto-placental unit responsible for the growth
of the myometrium & angiogenesis.

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Chapter 3: Antenatal Care

1. Which of the following is a sure (absolute) sign of pregnancy?
A. Amenorrhea
B. Hegar's sign
C. Nausea and vomiting
D. Auscultation of fetal heart
E. Abdominal distension
2. The Expected date of delivery of a human pregnancy can be calculated:
A. From a change in the patient's weight.
B. As 10 lunar months after the time of ovulation.
C. As 40 weeks after last normal menstrual period.
D. As 280 days from the last full moon.
E. As 36 weeks after the last menstrual period.
3. What is the expected date of delivery (EDD) if the last menstrual period was
first of June? {EDD=LNMP+7+9months}
A. March 23.
B. April 8.
C. March 1.
D. March 8
4. The obstetric code 3211 means: TPAL
A. Total pregnancies ( 3); Preterm (2); Abortion (1) ; Living children (1)
B. Total pregnancies (2); Preterm (1); Abortion (1) ; Living children (3)
C. Total pregnancies ( 1); Preterm (1); Abortion (3) ; Living children (2)
D. Total pregnancies ( 1); Preterm (2); Abortion (3) ; Living children (1)
5. Fatima conceived by IVF. The date of embryo transfer is 15 September. What is
the expected date of delivery (EDD)? {EDD=DET-7+9months}
A. December 8.
B. June 8.
C. June 22.
D. June 1
6. Which of the following is a probable (presumptive) signs of pregnancy?
A. Ultrasound visualization of embryo
B. Auscultation of fetal heart
C. Radiological demonstration of fetus from 16 weeks onwards.
D. Amenorrhea/Nausea and vomiting/ frequency of micturition
7. Booking investigations include all the following, EXCEPT:
A. Liver function test.
B. CBC.
C. Ultrasound examination.
D. Blood group
E. Rh typing
8. Which of the following Vaccines is unsafe during pregnancy?
A. Tetanus Toxoid.
B. Hepatitis B.

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C. Influenza.
D. MMR (Measles, Mumps, & Rubella).
E. Rabies.
9. What is the average weight gain during normal pregnancy?
A. 5-10 kg.
B. 10-15 kg.
C. 15-20 kg.
D. 20-25 kg.
E. 25-30 kg.
10. First trimester pregnancy may be terminated by
A. Prostaglandin inhibitor
B. Anti-progesterone
C. β sympathomimetic agonist
D. Synthetic estrogen
E. Medroxy progesterone
11. Regarding the frequency of antenatal visits which of the following is correct:
A. First 28 weeks gestation: Once per month
B. 28-36 weeks gestation: Twice per month.
C. Weekly from 36 weeks gestation till delivery
D. Frequency of antenatal may be doubled in high risk pregnancy.
E. All answers are correct
12. The term placental sign or Hartman sing denotes:
A. Alteration of fetal HR on pressing the fetal head into the pelvis..
B. Spotting at the expected time of menses on early months of pregnancy
rd
C. Permanent lengthening of the umbilical cord in 3 stage of labor.
D. Antepartum hemorrhage of fetal origin following ROM.
13. Primigravida 18 weeks gestation has right-sided groin pain. Pain is sharp and
occurring with movement and exercise. She denies any change in urinary or bowel
habits. She also denies any fever or chills. The application of a heating pad helps
alleviate the discomfort. What is the most likely etiology?
A. Round ligament pain
B. Appendicitis
C. Preterm labor
D. Kidney stone
E. Urinary tract infection
14. Folic Acid supplementation reduces the risk of:
A. Neural tube defects.
B. Preeclampsia
C. Placenta previa
D. Down’s syndrome
15. Brownish black pigmented area in the midline of pregnant woman stretching from
xiphisternum to symphysis pubis is termed:
A. Linea Nigra.
B. Linea alba
C. Chloasma gravidarum
D. Striae gravidarum

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16. The source of progesterone that maintains the pregnancy during early 1ST
trimester is:
A. Placenta.
B. Corpus luteum (1st 8-10 weeks of gestation.
C. Corpus albicans.
D. Adrenal glands.
E. Endometrium
17. Which of the following is not a feature of pseudocyesis?
A. Auscultation of FHS.
B. Amenorrhea
C. Abdominal enlargement
D. Nausea and vomiting
18. Which of the following ultrasonic measurements may be used to confirm
gestational age?
A. Crown rump length in the 1st trimester
B. Nuchal pad thickening
C. Amniotic fluid volume
D. Yolk sac volume
E. Biophysical profile
19. If your patient is 8 weeks pregnant which one of the following USS measurements
is most useful is useful for dating of pregnancy:
A. Crown rump length
B. Biparietal diameter
C. Femur length
D. Placental grading
E. Abdominal circumference
20. An Ultrasound in the 1st trimester of pregnancy is done for:
A. Placental localization
B. Detecting of fetal weight
C. Assessment of amniotic fluid volume
D. Detection of fetal breathing
E. Dating of the pregnancy.
21. During abdominal examination of a pregnant female; fundal level is larger
than period of amenorrhea. Which of the following is a possible cause?
A. Wrong calculation of gestational age.
B. Oligohydraminos
C. IUGR
D. Transverse lie.
22. A woman has a previous history of delivery of a baby with chromosomal anomaly,
between 16-18 weeks of the current pregnancy triple lab test shows; B.hCG is higher;
however Alpha fetoprotein (AFP) and free unconjugated estriol are lower than the
reference range. This means increased risk of which of the following:
A. Down’s syndrome (Trisomy 21)
B. Edward syndrome (Trisomy 18)
C. Trisomy 13

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D. Turner syndrome
23. We can detect the fetal heart beat by Sonography (Transvaginal) at:
A. 5 weeks
B. 6 weeks
C. 7 weeks
D. 8 weeks
E. 9 weeks
24. Which of the following is a normal finding of umbilical artery Doppler?
A. Reduced EDF (End Diastolic Flow)
B. Absent EDF
C. Reversed EDF
D. Diastolic flow increases as gestation advances
25. Counseling of a pregnant woman during early prenatal care should
include detection of & information on:
A. Smoking.
B. Alcohol abuse.
C. Drug abuse.
D. Avoiding infections.
E. All of the above.
26. Which of the following complications cannot be prevented by Antenatal care can?
A. Anemia due to iron deficiency or folic acid deficiency.
B. UTI of pyelonephritis.
C. Macrosomia.
D. Preterm labor.
E. Rh immunization.
28. Low alpha feto protein found in:
A. IUFD
B. Multiple pregnancy
C. Some Ovarian Cancer
D. Trisomy 21
E. Neural tube defect
29. US measurement of Nuchal translucency in the 1st trimester is used is a marker used
for:
A. NTD.
B. Trisomy
C. Hydrops fetalis
D. Fetal skeletal anomalies
30. Which of the following is a routine laboratory studies at booking?
A. Electrolytes.
B. Urinary estriol.
C. Serum glumatic-oxaloacetic transaminase.
D. Hemoglobin.
31. Hypoplasia & yellow discoloration of the primary teeth has occurred in infants
whose pregnant mothers were treated with drug:
A. Sulphonaudes.

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B. Penicillin.
C. Streptomycin.
D. Dihydrostretomycin.
E. Tetracycline.
27. An increase in vaginal discharge may be noted during pregnancy due to which of the
following causes:
A. Bacterial.
B. Caused by Trichomonas.
C. Caused by Candidiasis.
D. Physiological.
E. All of the above
28. Which of the following cannot cross the placenta to the fetus?
A. Warfarin
B. Diazepam
C. Heparin
D. Aspirin
E. Tetracycline
29. Which of the following is/are needed by women in increased amount during
pregnancy?
A. Iron.
B. Folic acid.
C. Protein.
D. Calcium.
E. All of the above.
30. What is the last fetal blood vessel to show changes in IUGR?
A. Ductus Venosus
B. Ductus Arteriosus
C. Middle cerebral artery
D. Umbilical artery.
31. Post-term pregnancy means that the gestational is:
A. More than 40 weeks
B. More than 42 weeks (294 days)
C. More than 37 weeks
D. 37-40 weeks.
32. Which of the following conditions is NOT associated with sinusoidal FHR pattern?
A. Rh-Isoimmunization
B. Rupture vasa previa
C. Twin-Twin Transfusion Syndrome (TTTS)
D. NON of the above.
33. The following statements are all TRUE about vomiting in pregnancy, EXCEPT:
A. May be severe enough to induce loss of weight & hospital admission.
B. Is commonest in the third trimester
C. Associated with multiple pregnancy
D. Is associated with trophoblastic disease
E. Is associated with urinary tract infection

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

34. The following measures are usually performed during a routine antenatal visit for
a healthy uncomplicated pregnancy at 36 weeks gestations' EXCEPT:
A. Symphysis-fundal height.
B. Maternal blood pressure.
C. Maternal weight.
D. Mid-steam urine specimen (MSU) for culture & sensitivity.
E. Listening to the fetal heart.
35. Which of the following is NOT a presumptive symptom/sign of pregnancy?
A. Cessation of menstruation.
B. Visualization of fetal movement by US
C. Nausea & vomiting.
D. Breast changes.
E. Darkening of the skin on the palms of the hands.
36. The hypertrophy & softening of the cervix that occurs early in gestation is called:
A. Goodll's sign.
B. Chadwick's sign.
C. Braxton Hick's contraction.
D. Von fernwald's sign.
E. Cullen's sign.
37. The pulsation in the vaginal fornix that occurs early in gestation is called:
A. Chadwick's sign.
B. Goodll's sign.
C. Osiander's sign.
D. Cullen's sign
38. Uterine contractions felt during bimanual examination are termed:
A. Goodll's sign.
B. Chadwick's sign.
C. Braxton Hick's contraction.
D. Palmer's sign
E. Cullen's sign
39. Tetanus toxoid is protective against tetanus for both mother and neonate. In unprotected
woman two doses of tetanus toxoid (0.5 ml for each as intramuscular injection) are given
one month apart. The first dose is given between 16-20 weeks. What is about woman who
is immunized in the past?
A. A booster dose of 0.5ml IM is given preferably up to 4 weeks before EDD.
B. No need for booster dose.
C. Receives 2 doses one month apart.
D. Receive prophylactic penicillin at time of delivery.
40. During bimanual examination, the two fingers in the anterior fornix can be
approximated to fingers of the abdominal hand behind the uterus due to softening of
the lower part of the uterus and its emptiness. This sign can be elicited between 6-
10weeks but not after as the growing conception will fill the whole uterine cavity.
This is termed:
A. Hegar's sign.
B. Chadwick's sign.
C. Braxton Hick's contraction.
D. Von fernwald's sign.
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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy
E. Cullen's sign.
41. During early pregnancy, a pelvic examination may reveal that one adnexa is
slightly enlarged. This is most likely due to:
A. A parovarian cyst.
B. Fallopian tube hypertrophy.
C. Ovarian neoplasm.
D. Follicular cyst.
E. Corpus luteal cyst.
42. Arnoux sign is:
A. Gallop rhythm FHR (overlapping of HR of two fetuses in twin )
B. Two FHS heard at 2 different sites
C. Two FHS with a difference of more than 10 beats/min
D. Slowing FHR when head is pushed into the pelvis
43. The followings are considered normal symptoms of pregnancy EXCEPT:
A. Backache due to an increased lumbar lordosis.
B. Lower abdominal pain and groin pain due to stretch of round ligaments.
C. Visual disturbance.
D. Calf pain due to muscle spasm.
E. Increased vaginal discharge.
44. Which of the following is not an initial visit (at booking/ 1 st trimester) investigation
in low risk pregnancy?
A. Blood group &Rh Factor.
B. Urine analysis for albumin and sugar.
C. Antibodies for rubella, HBV and syphilis.
D. Maternal serum alpha fetoprotein/ glucose tolerance test/ indirect comb test
45. Which of the following vaccines is absolutely contraindicated during pregnancy?
A. Hepatitis B.
B. Cholera.
C. Rabies.
D. Yellow fever vaccine (any live attenuated vaccine)
E. Cullen's sign
46. A clinical sign in which there is an irregular softening and enlargement of the uterine
fundus near the area of implantation during early gestation is called:
A.Goodll's sign.
B. Chadwick's sign.
C. Braxton Hick's contraction.
D. Von fernwald's sign {Piskacek's sign).
E. Cullen's sign

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

Chapter 4: Bleeding in early pregnancy

(I) Abortions:
1. Spontaneous termination of pregnancy before age of fetal viability is termed:
A. Abortion
B. Miscarriage
C. Ectopic pregnancy
D. Vesicular mole
2. The incidence of Abortion is:
A. 15% of all pregnancy; 80% of which in the first trimester
B. 15% of all pregnancy 80% of which in the second trimester
C. 80% of all pregnancy 15% of which in the first trimester
D. 80% of all pregnancy 15% of which in the second trimester
3. What is percentage of spontaneous 1st trimester abortions show
chromosomalabnormalities?
A. 1%.
B. 10%.
C. 25%.
D. 50-80%.
4. Regarding missed abortion, all of the following are CORRECT,
EXCEPT:
A. Patient may present with loss of the symptoms of pregnancy
B. Per vaginal bleeding may be one of the presenting symptom
C. Immediate evacuation should be done once the diagnosis is made
D. Disseminated intra-vascular coagulation is one of its serious
complications.
E. Ultrasound should be done to confirm the diagnosis
5. Etiological factors in spontaneous abortion include:
A. Chromosomal abnormalities
B. Placental abnormalities
C. Maternal disease
D. Uterine abnormalities
E. All of the above
6. What is the most common cause of 1st trimester abortion?
A. Chromosomal abnormalities
B. Congenital uterine anomalies
C. Luteal phase defect
D. Anti-phospholipid antibody syndrome
7. What is the only prenatal infection that can cause recurrent abortion?
A. Cytomegalic virus
B. Syphilis
C. Toxoplasmosis
D. Rubella

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

8. A p1+1 female, has 6 weeks amenorrhea with positive urine pregnancy test.
TVUS exam shows single intrauterine gestational sac (>25mm), CRL (>7MM),
yolk sac (>7mm) with no fetal cardiac activity. What is the most likely
diagnosis?
A. Missed abortion
B. Threatened abortion
C. Pregnancy of uncertain viability
D. Pregnancy of unknown location
9. A p1+1 female, has 6 weeks amenorrhea with positive urine pregnancy test.
She has an attack of mild bright red vaginal bleeding associated with mild
dull aching Suprapubic pain radiating to the back. TVUS exam shows single
intrauterine gestational sac with fetus (CRL =8mm), & fetal cardiac activity is
present. The cervical internal os is closed. What is the most likely diagnosis?
A. Missed abortion
B. Threatened abortion
C. Pregnancy of uncertain viability
D. Incomplete abortion.
10. A p2+1 female, has 7 weeks amenorrhea with positive urine pregnancy test.
She has an attack of severe vaginal bleeding with passage of tissues
associated with severe colicky Suprapubic pain radiating to the back. TVUS
exam shows absent intrauterine gestational sac or embryo but the uterine
cavity and the opened cervical internal os contain ruminants of tissues. What
is the most likely diagnosis?
A. Missed abortion
B. Complete abortion
C. Incomplete abortion
D. Cervical abortion
11. 14 weeks pregnant woman had abortion and she was told that it is a
complete abortion. This is true regarding complete abortion:
A. Uterus is usually bigger than date
B. Cervical OS is opened with tissue inside the cervix
C. Need to have evacuation of the uterus
D. After complete abortion there is minimal or no pain and minimal or no
bleeding
E. Follow up with β-hCG for one year.

12. What is the most useful investigation in a woman has 3 consecutive

spontaneous abortions in the second trimester?
A. Hysterosalpingiogram
B. Chromosomal analysis

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

C. Endometrial biopsy
D. Thyroid function tests
E. Anti-phospholipid antibodies
13. A pregnant woman has a history of repeated 2 nd trimester; painless rupture of
membrane with expulsion of a living fetus. There is a decrease in the period of
gestation with each abortion. The most probable cause of recurrent abortion in this
case is:
A. Cervical insufficiency
B. Chromosomal abnormalities
C. Toxoplasmosis
D. Anti-phospholipid antibody syndrome
14. Regarding cervical incompetence, all of the following are true, EXCEPT:
A. Typically causes painful abortions
B. Can be diagnosed in non-pregnant sate by passage of Hegar n. 8 dilator or
Foley catheter balloon filled with 1cm saline through cervical canal or
funneling of cervix in premenstrual HSG.
C. Can be diagnosed during pregnancy by TVUS if (Cervical length <25mm;
diameter of internal os > 8mm; cervical index = funnel length +1/ length of
cervical canal ≥0.52)
D. Is treated by (cervical cerclage) Shirodkar or Macdonald suture
preformed at 12-14 weeks gestation
E. Can occur in patient with history of cone biopsy
15. The most common etiology for spontaneous 1st trimester abortion is:
A. Chromosomal anomaly in 50-60% of gestations.
B. Chromosomal anomaly in 20-30% of gestations.
C. Maternal hypothyroidism.
D. Maternal Diabetes.
E. Cervical incompetence.
16. Causes of first trimester abortion
A. Chromosomal abnormalities
B. Cervical incompetence
C. Bicornuate uterus
D. Preeclampsia
17. First trimester pregnancy may be terminated by
A. Prostaglandin inhibitor
B. Anti-progesterone/ Misoprostol
C. β sympathomimetic agonist
D. Synthetic estrogen
E. Medroxy-progesterone
18. Which of the following is not a Cause of recurrent abortion?
A. TORCH Infection
B. Cervical incompetence
C. Uterine pathology
D. Chromosomal abnormalities.

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

19. Which of the following is true regarding Incompetent cervix?

A. Is a cause of 1st trimester pregnancy loss
B. Is not diagnosed by history
C. Cervical cerclage is indicated for funneling of normal length cervix
D. Abdominal cerclage is indicated in cases of suggested cervical insufficiency
with failed vaginal cerclage.
20. Which of the following is contraindicated in the management of a patient with
threatened abortion?
A. Ultrasound
B. Physical examination
C. CBC
D. Dilatation and curettage.
21. A 26-year-old Primigravida with 8 weeks threatened abortion, ultrasound
would most likely reveal:
A. An intact intrauterine gestational sac with embryo with cardiac activity
B. Pseudo-gestational sac
C. Feral heart motion in the adnexa
D. Blighted ovum (i.e., Empty gestational sac)
E. Gestational sac >25mm without embryo.
22. A 27- year- old married (G3P1+1) has 10 weeks amenorrhea, & positive urine
pregnancy test. She developed vaginal bleeding, uterine cramps, and passed some
tissue per vagina. Two hours later she began to bleed heavily:

I. The most possible diagnosis is:

A. Hydatiform mole
B. Incomplete abortion
C. Threatened abortion
D. Inevitable abortion
E. Ectopic pregnancy
II. The bleeding in this case is most likely due to:
A. Retained products of conception
B. Ruptured uterus
C. A systemic coagulopathy
D. Bleeding hemorrhoids
E. Vaginal lacerations
III. The treatment of choice in this case is:
A. Hysterotomy
B. Vaginal packing
C. Compression of the hemorrhoids
D. Uterine evacuation & curettage
E. Fresh frozen plasma

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

23. 14 weeks pregnant woman had abortion. TVUS shows empty uterus
confirming the diagnosis of complete abortion. Which of the following
statement is true regarding the diagnosis of complete abortion?
A. Uterus is usually bigger than period of amenorrhea.
B. Cervical OS is opened with tissue inside the cervix
C. After complete abortion there is minimal or no pain and minimal or no
bleeding
D. Theca lutein cysts are common finding in cases of complete abortion.
24. Clinical criteria for diagnosing antiphospholipid syndrome include all except
A. History of vascular thrombosis
B. > 3 consecutive abortions at <10 weeks
C. Death of congenitally malformed fetus at >10 weeks
D. Premature birth before 34 weeks due to severe preeclampsia or placental
insufficiency
25. Antibodies tested for diagnosing antiphospholipid syndrome includes all
except:
A. Anti-cardiolipin antibody
B. Lupus anticoagulant
C. Anti β2 glycoprotein
D. Maternal antiplatelet leukocyte antibodies
26. Q11.What is the treatment of choice for APLA
A. Heparin
B. Low dose aspirin
C. Heparin + low dose aspirin
D. Heparin + warfarin
27. Ultrasound features suggestive of cervical incompetence include
A. Cervical length<3 cm
B. Internal os width>1.5 cm
C. Bulging of membranes into internal os
D. All of the above
28. Which of the following is the least likely to be a suggested etiology for recurrent
pregnancy loss?
A. Maternal trauma.
B. Maternal balanced translocation.
C. Paternal balanced translocation.
D. Luteal phase deficiency.
E. Autoimmune disease.
29. What is the gold standard for diagnosing luteal phase deficiency?
A. Endometrial biopsy
B. Serum Progesterone
C. Serum estrogen
D. Serum prolactin
30. In cases of bleeding in early pregnancy; anti-D immunoglobulin is given for:
A. Threatened abortion <12 weeks.
B. Complete abortion <12 weeks if no medical or surgical interventions were

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy
done
C. Rh positive pregnant.
D. Threatened abortion if bleeding is heavy, recurrent or associated with pain.
31. Which of the following is not a clinical criterion for inevitable abortion?
A. Fever.
B. Pain.
C. Dilated cervix.
D. Bleeding.
E. Continuation of pregnancy is hopeless.
32. Which of the following is a clinical finding in Threatened abortion?
A. The presence of empty sac by ultrasound.
B. Disappearance of pregnancy symptoms.
C. Passage of vaginal vesicles.
D. The cervix is dilated.
E. Vaginal bleeding.
33. Which of the following may be helpful in the treatment of a case of
threatened abortion?
A. Bed rest
B. Oral Stilbosterol
C. Curettage
D. Urgent admission to hospital
E. I.M Tranexemic acid
34. Regarding threatened abortion:
A. Anti-D should be given to Rh- positive mother.
B. All patients should be admitted to the hospital.
C. Ultrasound should be done to confirm the diagnosis.
D. Vaginal examination will reveal severe pain.
E. The patient has vaginal bleeding and tissue passage per vagina.
35. Therapy in threatened abortion should include:
A. Progesterone IM
B. D & C
C. Prolonged bed rest
D. Restricted activity
E. Prostaglandin suppositories
36. A woman has a history of recurrent 2nd trimester abortion. Patient typically presented
with painless cervical dilation and bulging fetal membranes in the second trimester,
followed by the rapid delivery of a Previable infant. What is the most likely diagnosis?
A. Cervical insufficiency
B. Antiphospholipid antibody syndrome
C. Syphilis
D. Chromosomal abnormalities
37. Which of the following complications may be caused by Missed abortion?
A. Disseminated Coagulopathy (DIC)
B. Bone marrow depression
C. Rupture uterus
D. Skin allergies

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

38. Which of the following is not a cause of bleeding in early pregnancy?

A. Vesicular mole
B. Cervical cancer
C. Threatened abortion
D. Ectopic pregnancy
E. Vasa praevia
39. Asherman syndrome presents as:
A. Amenorrhea
B. Infertility
C. Recurrent abortion
D. All answers are possible
40. Which of the following is not of incompetent cervical os?
A. Cervical laceration
B. Cervical Conization
C. Abnormal collagen tissue
D. Cervical intraepithelial neoplasia
41. Risk factors for recurrent abortion include:
A. Maternal age
B. Previous miscarriage
C. Obesity
D. All of the above
42. Which of the following is not a cause of recurrent abortion?
A. Diabetes
B. Thyroid diseases
C. Anemia
D. PCOS
43. What is the most common cause of vaginal bleeding during the first & second
trimester of pregnancy?
A. Abortion
B. Ectopic pregnancy
C. Hydatiform mole
D. Abruptio placenta
E. Uterine rupture
44. Which of the following conditions may be associated with a mid-trimester
abortion?
A. Recurrent pelvic infection
B. Maternal smoking
C. Uterine anomalies
D. Sickle cell disease
E. Hyperemesis gravidarum
45. What is the most common paternal chromosomal abnormality
responsible for recurrent pregnancy loss?
A. Trisomy
B. Monosomy
C. Balanced reciprocal translocation
D. Triploidy

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

46. What is the most Specific anti-phospholipid antibody?

A. Anti-B2 glycoprotein
B. Lupus anticoagulant
C. Anti-cardiolipin IgM
D. Anti-cardiolipin IgG
47. 22 years old lady (G6P0+5) has history of recurrent missed abortion at 12-14 weeks;
now she is pregnant at 12 weeks but unfortunately TVUS reveals missed abortion.
Which of the following investigations is not necessary?
A. VDRL of mother & father (syphilis causes recurrent abortion with increased
gestational age at each abortion
B. Anti-cardiolipin antibodies (ACA)
C. Lupus anticoagulant antibodies
D. karyotype
48. What is the uterine anomaly that is most commonly implicated in the etiology of
recurrent abortions?
A. Septate uterus (65%)
B. Unicornuate uterus
C. Uterus Didelphys
D. Arcuate uterus
49. 22 years old lady with history of recurrent pregnancy loss; which of the following
investigations you will do to confirm diagnosis?
A. Dilute Anti-Russell viper venom antibody (anti lupus antibody)
B. Prothrombin time
C. Bleeding time
D. Clot stability test.
50. 23 years old lady (G4P0+4) has history of 4 consecutive spontaneous abortion
before 10th week of gestation. She has past history of recurrent DVT. Patient shows
positive high titer Anti-cardiolipin antibodies IgG in two occasions 12 weeks apart.
& condition is diagnosed as antiphospholipid antibody syndrome. Which of the
following is not a recommended option in the next pregnancy?
A. Start heparin once intrauterine pregnancy is detected by US without
waiting cardiac pulsation and continued till the onset of labor.
B. Repeat testing for antiphospholipid antibodies during pregnancy
C. Start Aspirin once urine pregnancy test is positive and continued
throughout pregnancy to be stopped 7 days before onset of labor.
D. Immunoglobulin therapy is the second line therapy.

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

(II) Ectopic pregnancies:

51. What is the commonest site of ectopic
pregnancy?
A. Cesarean scar (<1%)
B. Cervix (<1%)
C. Ovary (3%)
D. Fallopian Tubes (95%)
52. What is the commonest site of tubal ectopic pregnancy?
A. Isthmus (12%)
B. Interstitial (2-4%)
C. Ampulla (70%)
D. Infundibular (Fimbrial) (11%)
53. What is the most common predisposing factor
of ectopic pregnancy?
A. History of pelvic inflammatory disease
B. Congenital anomalies of the tube
C. Endometriosis
D. Tubal surgery
E. Previous sterilization
54. What is the drug used for medical treatment of ectopic pregnancy?
A. Methotrexate
B. Misoprostol
C. Mifepristone
D. Methylergometrine
55. What is the hormone responsible for Decidual reaction and Arias Stella reaction in
ectopic pregnancy?
A. Progesterone
B. Estradiol
C. Human chorionic gonadotropins
D. Human Placental Lactogen (HPL)
56. During postpartum counseling for contraception; the lady asked your advice about
the contraceptive method associated with high incidence of ectopic pregnancy.
What is this?
A. Mirena (LNG-IUS)
B. Copper IUCD
C. Salpingectomy
D. Condom
57. Most valuable diagnostic test in a case of suspected ectopic pregnancy:
A. Serial b-hCG levels
B. Combined Serial b-hCG levels & Transvaginal USG
C. Progesterone measurement
D. Culdocentesis
58. The most common cause of ectopic pregnancy is:
A. History of pelvic inflammatory disease
B. Congenital anomalies of the tube

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy
C. Endometriosis
D. Tubal surgery
E. Previous sterilization
59. Concerning ectopic pregnancy, which of the following is the false statement?
A. Can only be diagnosed after it has ruptured
B. Is associated with uterine enlargement
C. High incidence of early rupture when it is situated in the isthmus of the
fallopian tube
D. Heterotopic pregnancy means coexistence of intrauterine and extrauterine
pregnancy and it is a complication of assisted conception
60. Lower abdominal pain and six weeks' gestation:
A. Could be gallstones
B. Vaginal examination is contraindicated.
C. Left iliac fossa pain is diagnostic of appendicitis.
D. Placental abruption should be considered.
E. Combined B.HCG & TVUS has reliable diagnostic information.
61. The endometrial change of ectopic pregnancy:
A. Glandular cystic hyperplasia
B. Decidual transformation
C. Secretory changes with chorial cell
D. Atypical hyperplasia
E. Proliferation endometrium

62. Which of the following is a contraindication to medical treatment in

ectopic pregnancy?
A. An intact tubal pregnancy.
B. The size is less than 3cm.
C. The presence of hemoperitoneum.
D. The absence of fetal cardiac activity.
E. A serum β-hCG of 1500.

63. What is the trend of serum quantitative β subunit of HCG in a patient with
ectopic pregnancy?
A. Rise in a rate greater than expected.
B. Rise at rate consistent with the normal curve.
C. Rise at a slower than expected.
D. Plateau.
E. Progressively fall
64. A young woman with previous history of PID has 6-weeks amenorrhea& positive
pregnancy test. She presents with colicky pelvic pain, right adnexal mass, tender
right adnexal and cervical motion tenderness. She is haemodynamically stable.
Transvaginal US shows empty uterus. What is the most likely Diagnosis?
A. Ovarian cyst
B. Ectopic pregnancy
C. Complete abortion
D. Acute appendicitis

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

65. A serum progesterone value less than 5ng/ml can exclude the diagnosis of
viable pregnancy with a certainty of:
A. 20%
B. 40%
C. 60%
D. 80%
E. 100%
66. In normal pregnancy, the value of β-hCG doubles every:
A. 2 days.
B. 4 days.
C. 8 days.
D. 10 days.
E. 14 days.
67. The β-hCG curve in maternal serum in a normal pregnancy peaks at:
A. 6 weeks of pregnancy.
B. 7 weeks of pregnancy.
C. 10 weeks of pregnancy.
D. 14 weeks of pregnancy.
E. 18 weeks of pregnancy
68. A young woman has 6-weeks amenorrhea & positive pregnancy test. She presents
with right iliac dull aching pain that increases with cough, tenderness, and rebound
tenderness at point over the right side of the abdomen that is one-third of the
distance from the anterior superior iliac spine to the umbilicus. She is
haemodynamically stable. Transvaginal US shows a viable 6 weeks intrauterine
pregnancy. What is the most likely Diagnosis?
A. Ovarian cyst
B. Ectopic pregnancy
C. Complete abortion
D. Acute appendicitis
69. A young woman has 6-weeks amenorrhea& positive pregnancy test. She presents
with colicky pelvic pain, TVUS reveals empty uterus with right adnexal cystic mass
3cm in diameter with a non-pulsating fetal echo. She is haemodynamically stable.
What is your optimum management?
A. Methotrexate with HCG monitoring at the 4th & 7th day and 15% decline in
original HCG level is considered satisfactory.
B. Diagnostic laparoscopy followed by observation
C. Exploratory laparotomy and salpingectomy
D. Repeat ultrasound next 24 hours to confirm the diagnosis
70. The Pseudo-Decidual sac is an ultrasonography finding that has the following
criteria except:

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

A. Present in 20% of cases of ectopic pregnancy

B. Ovoid in shape and occupies central position in the endometrial cavity
C. Poorly defined margin.
D. Has double Decidual sac sign
E. Dilatation and curettage
71. A young woman has 6-weeks amenorrhea& positive pregnancy test. TVUS reveals
empty uterus with no adnexal masses. B.HCG level is 1000mIU/ml. She is
haemodynamically stable. What is your optimum management?
A. Measure the original HCG level and repeated its measurement after
48hours. A rise of HCG by 66% is strongly suggestive of IU pregnancy.
B. Start methotrexate therapy
C. Exploratory laparotomy and salpingectomy
D. Diagnostic laparoscopy to confirm diagnosis.
72. What is the standard management of a pregnant woman with diagnosed ectopic
pregnancy with the following criteria; sever pallor, generalized abdominal pain&,
tenderness; blood pressure is 70/50mmHg; & pulse 130/min?
A. Observation followed by Methotrexate
B. Diagnostic laparoscopy followed by observation
C. Repeat ultrasound next 24 hours to confirm the diagnosis
D. Exploratory laparotomy and salpingectomy
E. Dilatation and curettage
73. Which of the following factors are not involved in the choice of Methotrexate
as a treatment for ectopic pregnancy?
A. Size of the ectopic
B. Presence or absence of cardiac activity
C. Level of β-hCG
D. Parity of the patient
E. Integrity of the tube
74. During abdominal exploration for disturbed ectopic pregnancy; how can
you differentiate between cornual and angular pregnancy?
A. In angular pregnancy; round ligament lies lateral to it.
B. In angular pregnancy; round ligament lies medial to it.
C. In cornual pregnancy; round ligament lies lateral to it.
D. Both angular and cornual pregnancy lies medial to round ligament.
75. Following evacuation of a molar pregnancy, the median time for β-hCG titers
to fall to untraceable levels in about 90% of patients within:
A. 2 weeks.
B. 4 weeks.
C. 6 weeks.
D. 10 weeks. (7 weeks in partial mole & 9 weeks in complete mole)

76. A 25 year-old G3 P1+1 presents to the emergency room with 6-week amenorrhea
complaining of lower abdominal colicky pain. She had mild vaginal bleeding but
no passage of tissue & pregnancy test is Positive.

II) The patient's most possible diagnosis is:

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

A. Complete abortion.
B. Missed abortion.
C. Threatened abortion.
D. Ectopic pregnancy.
III) The most important step in this patient's evaluation should be:
A. Transvaginal Sonography.
B. Physical exam.
C. CBC.
D. Quantitative β-hCG..
IV) Transvaginal Ultrasonography would most likely reveal:
A. Absent Fetal heart motion.
B. An intact intrauterine gestational sac.
C. A discrete yolk sac motion.
D. A Thickened endometrium with gestational sac.
E. Fetal heart motion in the adnexa.
77. What is the most common symptom of ectopic pregnancy?
A. Excessive vaginal bleeding.
B. Abdominal pain.
C. Syncope.
D. Decrease pregnancy associated symptoms
78. The chances of subsequent intrauterine pregnancy following ectopic
pregnancy in a woman who has had a previous term pregnancy would be
about:
A. 80%
B. 60%
C. 40%
D. 20%
79. Which of the following is a protective factor of ectopic?
A. Gonococci Salpingitis (PID)
B. Tubal surgery
C. Combined OCP
D. TB salpingitis
E. Previous ectopic
80. Pregnancy of unknown location is diagnosed when a woman with a positive
pregnancy test and ultrasonography exam:
A. Demonstrate intrauterine pregnancy
B. Fail to Demonstrates intrauterine pregnancy or extrauterine pregnancy
C. Fail to demonstrate extrauterine pregnancy
D. Fail to demonstrate intrauterine pregnancy
81. What is the cause of shoulder pain in ectopic pregnancy?
A. Distension of the tube. (Dull aching pain)
B. Irritation of the diaphragm by hemoperitoneum.
C. Rupture of the tube (Stabbing pain)
D. Abortion (expulsion) of tubal pregnancy (Colicky Pain)
82. A pregnant lady with diagnosed undisturbed ectopic pregnancy receives

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

methotrexate therapy. Two days later she developed sever deep seated pelvic
pain. Patient is haemodynamically stable and ultrasonography exam shows no free
fluid in the pelvis or the abdomen. What is your management plan?
A. Laparoscopy to confirm diagnosis of ruptured ectopic pregnancy.
B. Only analgesics and close observation as separation pain is a common
finding in women under medical therapy for ectopic pregnancy.
C. Immediate laparotomy with salpingectomy.
D. Fail to demonstrate intrauterine pregnancy
83. Which of the following is a contraindication of Methotrexate Treatment in ectopic?
A. β-hCG < 1500
B. No fetal heart.
C. Hemoperitoneum
D. Gestational sac < 3 cm
E. Patient is not available for follow up.
84. A 22 years old pregnant lady (G3P2) at 26 weeks gestation presented with
recurrent vague abdominal pain. Abdominal examination shows easily palpation of
fetal parts. Abdominal ultrasound shows single viable fetus with unstable lie, AFI =
10cm, placenta is posterior and uterus is small sized, not surrounding the fetus &
retracted into the pelvis suggesting rupture uterus. During exploratory laparotomy;
the following finding are present: a) tubes and ovaries are intact with no evidence
of tubal or ovarian ectopic; b) there is no abnormal connection (fistula) between
the uterus and the abdominal cavity, c) the pregnancy is related solely to the
peritoneal surface. What is the most likely diagnosis?
A. Primary abdominal pregnancy (Studdiford's criteria)
B. ovarian pregnancy (The Spielberg criteria)
C. Cesarean scar pregnancy
D. Cervical ectopic pregnancy
85. During exploratory laparotomy of a haemodynamically unstable pregnant woman
with diagnosed ruptured ectopic pregnancy; the following finding are present: a)
fallopian tube as the affected site is intact b) the fetal sac occupies the normal
position of the ovary c) the ovary is connected to the uterus by ovarian ligament
and d) histopathology reveals ovarian tissues in the sac wall. What is the most
likely diagnosis?
A. Disturbed tubal pregnancy
B. Disturbed ovarian pregnancy (The Spielberg criteria)
C. Cesarean scar pregnancy
D. Cervical ectopic pregnancy
86. A 23 years old pregnant lady (G3P2) comes with 7 weeks amenorrhea, abdominal
pain and vaginal bleeding. She had a past history previous 2 LSCS, & urine
pregnancy test is positive. TVUS finding shows; empty uterus and cervical canal,
gestational sac is seen in the lower part of the uterus implanted over the scar
niche. There is thin myometrium between bladder and gestational sac. What is the
most likely diagnosis?
A. Primary abdominal pregnancy (Studdiford's criteria)
B. ovarian pregnancy (The Spielberg criteria)
C. Cesarean scar pregnancy

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D. Cervical ectopic pregnancy

87. Regards the management of ectopic pregnancy; which of the following statement is
correct?
A. β-hCG titer has a role in the Diagnosis & management of ectopic pregnancy.
B. D&C is the treatment of choice
C. Methotrexate should be used if the patient haemodynamically unstable
D. Shoulder pain is referred from tubal abortion
88. Which of the following are factors can not affect the choice of
Methotrexate as treatment for ectopic pregnancy, EXCEPT:
A. Size of the ectopic
B. Presence or absence of cardiac activity
C. Level of β-hCG
D. Parity of the patient
E. Hemodynamic stability of the patient.
.

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(III) Gestational Trophpblastic Diseases (GTD):

1. Hydatidiform (Vesicular) mole is a benign neoplasm of the:
A. Chorion
B. Amnion
C. Uterus
D. Decidua
2. Hydatidiform mole is histologically characterized by:
A. Hydropic degeneration of villous stroma with preserved villous pattern
B. Nonproliferation of syncytiotrophoblast
C. Nonproliferation of cytotrophoblast
D. Neovascularization of chorionic villi.
3. Risk Factors of gestational trophoblastic disease include all of the following,
EXCEPT:
A. Far East Asian
B. age under 20
C. Diet high Folic acid
D. Age above 40
E. Diet lower beta carotene
4. Accurate diagnosis of Hydatiform mole can be made by
A. Elevated β-hCG
B. Ultrasound
C. Pelvic examination
D. Chest radiography
E. Absence of fetal heart in a 16 week sac
5. What is the tumor marker for placental site trophoblastic tumors?
A. β-hCG (Tumor marker for Choriocarcinoma)
B. Human placental Lactogen (HPL)
C. Alpha fetoprotein
D. CA125
6. A 35 years old female has 6 weeks amenorrhea and positive urine pregnancy
test. She complains of persistent vaginal bleeding, nausea, vomiting for 2 weeks.
Local examination shows uterus is larger than period of amenorrhea, doughy in
consistency & absence of fetal heart sounds. US show snow storm appearance of
the uterus with bilateral theca lutein cysts.
A. What is the most probable diagnosis? Complete Hydatidiform mole
B. What is the most common fetal karyotype? 46 XX (90%) Mainly of paternal
origin
C. What is the ideal management? Suction evacuation
D. What is the gold standard for diagnosis? Histopathology
E. How can you follow this patient after suction evacuation? Monitor B.hCG
weekly until being negative for 3 consecutive samples then monthly for 6

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months.
F. What is the median time for resolution (B.hCG return to non-pregnant
level? 7 weeks for partial mole and 9 weeks in complete mole
G. Risk of recurrence in subsequent pregnancy? 1-4%
H. What is the risk of persistent gestational trophoblastic disease? 15-20%
I. What is the risk of Choriocarcinoma? 4%
7. Evacuation of Hydatiform mole may be complicated by:
A. Hemorrhage necessitating transfusion.
B. Acute respiratory distress.
C. Both.
D. Neither.
8. What is the most frequent site for metastasis from malignant gestational
trophoblastic neoplasms?
A. Brain.
B. Lung. (Cannon balls appearance).
C. Liver.
D. Kidneys.
E. Vulva.
9. 40-year- old patient complains of persistent irregular vaginal bleeding 7
month after delivery of full term baby. Curettage is performed and
histopathology reveals Choriocarcinoma. B.hCG level is 200000IU/L. what is
the next management step?
A. Repeat serum HCG after 4 weeks
B. Start intramuscular methotrexate
C. Start treatment with multi-agents combination chemotherapy
D. Hysterectomy
10. Signs and symptoms of Hydatiform mole include the following EXCEPT :
A. 1st trimester bleeding
B. A Uterus larger than expected gestational age
C. Hypothyroidism
D. Preeclampsia
E. Nausea and vomiting
11. What is the contraception of choice following Hydatiform mole?
A. Combined oral contraception after B.hCG level becomes negative.
B. IUCD
C. LNG-IUS
D. Barrier methods
12. Hydatiform mole is characterized by all of the following EXCEPT:
A. Theca-lutein cyst of the ovary.
B. Severe Hyperemesis.
C. Uterus larger than date.
D. Hyperthyroidism.
E. Elevated maternal blood sugar level.
13. What is the treatment of theca lutein cysts of Hydatiform mole?

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A. Ovarian cystectomy.
B. Oophorectomy.
C. Suction evacuation of molar pregnancy.
D. Combined oral contraception pills.
E. Cyst aspiration.
14. The patient with gestational trophoblastic Neoplasia is at higher risk of
developing Choriocarcinoma if the disease develops after:
A. Spontaneous abortion.
B. Full-term pregnancy.
C. Hydatiform mole.
D. Ectopic pregnancy.
15. Which of the following are indications for prophylactic chemotherapy after
evacuation of molar pregnancy?
A. Maternal age ≥40 years.
B. B.hCG level ≥ 100000IU/L
C. Theca lutein cyst ≥6 cm.
D. All answers are possible

Chapter 5: Antepartum Hemorrhage:

1. Common causes of antepartum hemorrhage (APH, bleeding from or within the
female genital tract after the age of fetal viability (24 weeks' gestation) and before
birth of a baby includes which of the following?
A. Abortion
B. Cervical cancer
C. Abruption placenta
D. Ectopic pregnancy
E. Vasa praevia
2. What is the most common cause of ante partum hemorrhage?
A. Abruption placenta (1/200 deliveries)
B. Placenta previa (1/300-400 deliveries)
C. Placenta accreta (1/533 deliveries)
D. Vasa praevia (1/2000-3000 deliveries)
3. When placenta is located partially or totally into the lower uterine segment; it is
termed:
A. Placenta praevia
B. Vasa praevia
C. Placenta accreta
D. Circumvallate placenta
4. Which of the following statements is not correct regarding the lower uterine
segment?
A. Lowest part of the uterus formed by expansion of isthmus uteri

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B. Covered loose visceral peritoneum & membranes are loosely adherent to

it.
C. Thin muscle wall formed only of 2 muscle layers
D. Active in labor ( contracts & retracts)
5. Rania (G3P2) 23 years old at 27 weeks' gestation presented with painless, causeless,
recurrent vaginal bleeding. On examination vital signs corresponds to the amount of
vaginal bleeding; lax abdomen with easily palpation of fetal parts, audible FHS.
Ultrasonography exam shows that the placenta is implanted into the lower uterine
segment with the leading placental edge within less than 2 cm from internal os.
What is the most likely diagnosis?
A. Low-lying placenta
B. Placenta previa incomplete centralis
C. Placenta previa complete centralis
D. Placenta previa marginalis
6. A 34 years old G3P2 at 36 weeks' gestation presented with premature rupture of
membrane with mild vaginal bleeding. The woman is haemodynamically stable.
Fetal distress is documented with sinusoidal FHR pattern on CTG. US shows bilobate
placenta. What is the most probable diagnosis?
A. Placenta previa
B. Cervical cancer
C. Abruptio placenta
D. Vasa praevia
7. Fetal red cells are detected in maternal circulation by:
A. Amniocentesis
B. Indirect Coombs’ test
C. Chorion villus sampling
D. Kleihauer-Betke test
8. Velamentous insertion of the cord is associated with an increased risk for:
A. Premature rupture of the membranes.
B. Fetal bleeding with PROM.
C. Torsion of the umbilical cord.
D. Fetal malformation.
E. Uterine malformations.
9. When Vasa previa is diagnosed in early labor, the best treatment is:
A. Spontaneous delivery.
B. Tocolytic agents to prevent uterine contraction.
C. Forceps delivery as soon as the cervix is dilated.
D. C-section & prepare for shocked baby
10. When Vasa previa is diagnosed with fully dilated cervix, the best treatment is:
A. Spontaneous delivery.
B. Tocolytic agents to prevent uterine contraction.
C. Forceps delivery to short 2nd stage of labor.
D. C-section.

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11. 34 years old G3P2 presents to labor room at 36 weeks' gestation with 4cm cervical
dilatation and 2 uterine contractions every 10min & each lasts 30 sec. on artificial
rupture of membranes (ARM); mild fresh vaginal bleeding is seen and CTG shows
fetal late deceleration with sinusoidal FHR pattern (fetal distress) . The woman is
haemodynamically stable. US shows bilobate placenta. What is the treatment of
choice for this condition?
A. Emergency caesarian section
B. Emergency caesarian section and prepare for shocked baby
C. Intrauterine fetal blood transfusion
D. Wait for spontaneous vaginal delivery
12. Which of the following is not a typical feature of placenta previa?
A. Painless bleeding
B. Self-limited first bleeding episode.
C. post coital bleeding may be complaint
D. Commonly associated with coagulopathy
E. The uterus tends to be soft and non-tender
13. A 33 year old woman at 37 weeks' gestation presents with mild vaginal bleeding.
By Sonogram exam she has placenta previa marginalis posterior, she has
infrequent labor pain. FHR decreases when fetal head is pushed down into pelvis
(stall-worthy sign). Which of the following is the best management for her?
A. Augmentation of labor
B. Artificial rupture of the membrane
C. Give Tocolytic drugs
D. Caesarean section
14. Which of the following cases of placenta previa can be delivered vaginally when
appropriate?
A. Major degrees of placenta previa
B. Placenta previa marginalis anterior
C. Placenta previa marginalis posterior (dangerous PP)
D. Fetal age less than 32 weeks
E. Severe bleeding of fetal distress irrespective to gestational age
15. A 33 year old woman at 34 weeks' gestation presents with moderate to severe
vaginal bleeding. By Sonogram exam she has placenta previa major degree, which
of the following is the best management for her?
A. Induction of labor
B. Give Tocolytic drugs
C. Caesarean section
D. Expectant management
E. Artificial rupture of the membrane
16. 34 years old G3P2 presents to labor room at 36 weeks' gestation with 4cm cervical
dilatation and 2 uterine contractions every 10min & each lasts 30 sec. on artificial
rupture of membranes (ARM); mild fresh vaginal bleeding is seen and CTG shows
fetal bradycardia with sinusoidal FHR pattern (fetal distress) . The woman is
haemodynamically stable. Emergency caesarian section was done but baby is not
saved. No evidence of placenta previa or abruptio placenta. What is the most likely
diagnosis?
A. Vasa previa
B. Placenta accreta
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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy
C. Cervical malignancy
D. Battledore placenta

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17. Which of the following is an indication of conservative management of placenta

previa?
A. Patient is shocked
B. Patient is in labor
C. Ultrasound shows fetal anomalies incompatible with life
D. Gestational age less than 37 weeks with no other indications for active
management
18. What is the most common fetal complication of placenta previa?
A. Low birth weight
B. IUFD
C. Prematurity
D. Congenital fetal malformation
19. What is the most common fetal complication of abruptio placenta?
A. Low birth weight
B. IUFD
C. Prematurity
D. Congenital fetal malformation
20. What is the most common cause of disseminated intravascular coagulopathy (DIC)
in obstetrics?
A. Abruptio placentae
B. Sepsis e.g., Chorioamnionitis
C. Preeclampsia with sever features.
D. Amniotic fluid embolism
21. Regarding Abruption placenta:
A. Postpartum hemorrhage occurs only when there is Hypofibrinogenaemia
B. Usually there is no fetal distress.
C. Antepartum hemorrhage due to premature separation of normally situated
placenta.
D. Never to be associated with antecedent hypertension
E. On Examination the abdomen is usually soft and lax
22. Regarding management of Placenta previa; what is the true statement?
A. Bleeding occurs due to premature separation of normally situated placenta
at 13 weeks of gestation.
B. TVUS is an essential tool for diagnosis and classification of PP.
C. Screening for coagulopathy is a cornerstone for its management.
D. The fetal heart rate is usually abnormal.
23. In placenta previa: Which is true?
A. It is common Primigravida
B. All patients should be induced with prostaglandin pessaries
C. Digital examination is mandatory to exclude local causes
D. May cause abnormal lie
E. Causes recurrent painful bleeding

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24. A known preeclampsia lady, 25 years old G2P1 at 32 weeks' gestation presented
with sudden sever constant abdominal pain& mild vaginal bleeding. Blood pressure
is 80/50mmHg; pulse is 120/min; uterus is at the level of xiphoid process, uterus is
woody hard, with difficult palpation of fetal parts& FHS is inaudible. What is the
most likely diagnosis?
A. Abruptio placenta
B. Vasa previa
C. Placenta previa major degrees
D. Rupture uterus
25. 26 years old G2P1 at 30 weeks' gestation presented with sudden sever constant
abdominal pain& mild vaginal bleeding following her husband kick in her belly.
Blood pressure is 80/45mmHg; pulse is 125/min; uterus is at the level of xiphoid
process, uterus is woody hard, with difficult palpation of fetal parts& FHS is 80/min.
What is the management of choice?
A. Maternal resuscitation and immediate caesarian section
B. Wait for spontaneous vaginal delivery
C. Give Tocolytic
D. Conservative management.
26. Antepartum hemorrhage: Which is true?
A. Is any bleeding from the genital tract during any stage of labor
B. vaginal examination is mandatory for its assessment
C. May be caused by cervical carcinoma
D. Is always painless
E. All patients should be delivered by Caesarian Section
27. Which of the following is an abnormal value regarding coagulation profile during
pregnancy?
A. D-Dimer < 0.5mg/L
B. Fibrin degeneration product (FDP) < 10ug/dL
C. Platelet count < 100000/uL
D. Fibrinogen (150-600mg/Dl)
28. A pregnant woman G5P4, 30 weeks gestation; presents with a placenta praevia
of a major Degree and fetus is malformed.Which of the following will be the best
management?
A. Caesarian section
B. Induce with PG E2
C. Oxytocin drip
D. Rupture of membranes
E. Forceps delivery in the second stage to accelerate delivery.
29. Abruptio placenta:
A. Is defined as premature separation of low lying placenta.
B. The risk of recurrence is 80%. (only 12%)
C. The etiology of placental abruption is usually known.
D. Ultrasound is highly sensitive for diagnosis of placental
abruption. (only 25% sensitivity)
E. The most predisposing condition is maternal Hypertension.

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

30. Management of Placental Abruption includes all of the following EXCEPT:

A. Coagulation studies.
B. Expectant management in cases of IUFD. (wait & see is contraindicated)
C. Augmentation of labor.
D. Artificial rupture of Amniotic membrane.
E. Intensive I.V. fluid replacement.
31. What are the most common risk factors for accidental hemorrhage?
A. Diabetes.
B. Increased maternal age, Multiparity, hypertension & cigarette smoking.
C. Intrauterine growth retardation.
D. Rh isoimmunization.
E. Multiple pregnancies.
32. Which of the following is a contraindication for the use of amnio-hook?
A. Placenta previa
B. Abruptio placenta
C. IUGR
D. Face presentation
E. Breech presentation
33. 25 years old G3P1+1 at 31 weeks' gestation presented with sudden sever constant
abdominal pain& moderate vaginal bleeding. Blood pressure is 90/60mmHg; pulse is
110/min; uterus is at the level of xiphoid process, uterus is woody hard, with
difficult palpation of fetal parts& FHS is inaudible. Serum fibrinogen 50mg/dL & D-
Dimer is 0.7mg/L. What is the first management option?
A. Immediate caesarian section
B. Wait for spontaneous vaginal delivery
C. Management of DIC( Fresh frozen plasma/ Cryoprecipitate/ platelet/
recombinant factor VII)
D. Conservative management
34. A uterus with extravasation of blood into the myometrium & beneath the
uterine serosa that is demonstrated at laparotomy in severecases of abruption
placenta is termed:
A. Couvelaire uterus.
B. Active uterus
C. Placental perfusion
D. Atonic uterus
35. Which of the following is NOT a complication of abruption placenta ?
A. Postpartum hemorrhage
B. Consumptive hemorrhage
C. Fetal demise
D. Acute renal failure
E. Subsequent ectopic
36. A case of central placenta previa with anencephaly fetus should be delivered by:
A. Cesarean section
B. Induction of labour
C. Hall breech extraction
D. Application of Willet’s forceps

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy
37. Which of the following signs is most useful in predicting the absence of placental
abruption following trauma?
A. Absence of uterine contraction
B. Absence of vaginal bleeding
C. Presence of normal fetal heart tones
D. Absence of tense , painful uterus
E. Absence of nausea and vomiting

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy
38. A 19 -year- old patient (G2 P1 + 0). At 33 weeks of gestation presented to emergency
with vaginal bleeding. Which one of the following is contraindicated?
A. Admit the patient
B. Resuscitate the patient
C. Do digital examination immediately
D. Cross-match blood
E. Do ultrasound
39. In the management of placenta previa centralis (major degrees):
A. Once diagnosis is made, the treatment should urgent caesarean section
B. Patient may stay at home if she is living near the hospital
C. Vaginal examination should be done carefully to confirm diagnosis
D. Delivery by Cesarean section is done once fetal maturity is achieved
(completed 37 weeks)
E. If the baby is premature liberal blood transfusion is the treatment of
choice for severe hemorrhage
40. The likely causes of ante -partum hemorrhage in 33 weeks pregnant women has
recurrent attack of vaginal bleeding with proven fundal placenta are:
A. Subserous uterine fibroid
B. Diabetes
C. Anemia
D. Dichorionic Diamniotic (DCDA) twin pregnancy (one fundal placenta+ one
placenta previa)
41. A 19 year old Primigravida is noted to have a low-lying placenta on an US at 24
weeks gestation. Which of the following is the most appropriate management?
A. Schedule cesarean delivery at completed 37 weeks..
B. Reassess placental position at 33-34 weeks.
C. Recommend immediate termination of pregnancy.
D. Reassess placental position digitally by vaginal examination 32-34 weeks.
42. Which of the following is not a sign of abruptio placenta?
A. Vaginal bleeding.
B. Absence of uterine contractions.
C. Blood stained amniotic fluid.
D. Abnormal fetal heart rate.
E. Tense painful uterus.
43. Which of the following patients would be most likely to have a placenta previa?
A. 19-year-old G1, P0, Vertex presentation.
B. 24-year-old G2, P1, cephalic presentation, 2/5 palpable.
C. 34-year-old G5, P3+ 1(abortion), vertex presentation.
D. 36-year-old G7, Previous 5 LSCS, P6, transverse lie.
E. 28-year-old G3, P1+1(abortion), head at 0 station
44. Routine pelvic examination is contraindicated in which of the following situations
during pregnancy:
A. Carcinoma of the cervix.
B. Gonorrhea.
C. Placenta previa and PROM.

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

D. Active labor.
E. Prolapsed cord.
45. Placenta previa is more likely to be found in a pregnancy associated with:
A. Multiple pregnancies.
B. Previous manual removal of placenta.
C. Pyometra.
D. IVF pregnancy.
E. Previous C-section..
46. Which of the following is the most common cause of vaginal bleeding complicating
preterm labor?
A. Placental abruption.
B. Vaginal laceration.
C. An endocervical polyp.
D. Placenta previa.
47. All are complication of abruptio placenta EXCEPT:
A. Macrosomia
B. IUFD
C. DIC
D. PPH
E. Uterine atony

Chapter 6: Postpartum Hemorrhage and Coagulation

disorder

1. Active management of 3rd stage of labor includes: (WHO recommendation to

prevent PPH)
A. Giving Oxytocin after delivery of the baby
B. Delayed cord clamping (between 1-3 min of birth)
C. Delivery of placenta by controlled cord traction (Modified Brandt Andrews
technique)
D. All of the above ( all answers in combination)
2. Retained placenta is defined when there is failure of placental delivery after
fetal birth or prolonged 3rd stage for:
A. More than 30 min
B. 15 min
C. One hour
D. Two hours
3. Postpartum hemorrhage is defined as genital tract blood loss:
A. More than 500ml following vaginal delivery
B. More than 1000ml following CS.
C. Causes drop of hematocrit value by 10% following delivery.

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy

D. All answers are correct

4. What is the commonest cause of primary postpartum hemorrhage?
A. Atony
B. Trauma.
C. Retained placenta.
D. Coagulopathy
5. What is the commonest cause of secondary postpartum hemorrhage?
A. Choriocarcinoma
B. Subinvolution of the uterus.
C. Retained placental tissues.
D. Uterine fibroid
6. Which of the following is NOT a cause of postpartum hemorrhage?
A. Fetal macrosomia.
B. Polyhydramnios.
C. Placenta previa.
D. Abruptio placenta.
E. Postdate pregnancy.
7. Regarding postpartum hemorrhage:
A. May occur as a consequence of Antepartum hemorrhage.
B. Ends with Hypercoagulable state
C. Hysterectomy is the first the first line of treatment
D. Diagnosed only when the placenta is still undelivered
8. Regarding Secondary postpartum hemorrhage:
A. Is diagnosed when bleeding occurs 72 hours after delivery
B. Contra indicate breast feeding
C. The commonest cause is the cervical tears
D. Very common when the patient delivers a congenitally abnormal baby
E. Choriocarcinoma could be a cause
9. Regarding the obstetric shock index (OSI); what are the correct statements?
A. OSI = Heart rate/ systolic blood pressure
B. Its normal value during pregnancy 0.7-o.8
C. OSI > 1 indicates massive hemorrhage and need for blood transfusion
D. All answers are correct
10. 30 years old G5P5 female complains of sever 1ry postpartum hemorrhage
following VD that necessities blood transfusion. After how many blood units
Fresh Frozen Plasma (FFP) should be given?
A. 1
B. 2
C. 3
D. 4
11. 30 years old G5P5 female had a normal vaginal delivery; she received 5IU

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oxytocin IV with delivery of anterior shoulder of the baby and controlled cord
traction is applied soon after it. Placenta is not delivered for 30 min. provided
that patient is vitally stable; what is the appropriate management?
A. Start oxytocin infusion and observe further for a period of 30 min
B. Administer Ergometrine and wait for 30 min more
C. Manual separation under general anesthesia
D. Intra-umbilical vein injection with oxytocin
12. 24 years old G3P3 female had 1ry PPH following a normal vaginal delivery; active
management of 3rd stage of labor with complete delivery of placenta and
membranes; what is the first-step management?
A. Insert 2 large bore cannula and start intravenous fluids.
B. Uterine massage
C. Start oxytocin infusion
D. Palpate uterus to determine its consistency.
13. 40 years old G6P5+1 female had 1ry PPH following a normal vaginal delivery;
with complete delivery of placenta and membranes. Uterus is atonic & failed to
contract with Oxytocics. Blood pressure is 90/60mmHg; pulse is 115/min. patient
is immediately resuscitated. What is the next step?
A. Insert intrauterine balloon tamponed.
B. Hysterectomy
C. Bilateral Internal iliac Artery Ligation
D. Apply B-Lynch suture

14. Atonic Postpartum hemorrhage is best managed with :

A. Intra-venous progesterone
B. 5 units oral syntocinon and uterine massage
C. Uterine massage
D. Uterine massage with 40 units syntocinon in 500 ml D5 % NS to be given
Intravenously
15. Ergometrine to control postpartum hemorrhage :
A. Is contraindicated in patient with high blood pressure
B. Is safe in cardiac patient
C. It will not act on the smooth muscle of the blood vessels
D. Intravenous root is the only way to be given
E. It can be used for induction of labor
16. Which of the following is not a recognized cause of DIC (disseminating
intravascular coagulation) ?
A. Ectopic pregnancy
B. Septic abortion
C. Preeclampsia without sever features
D. The use of tampons
E. IUFD
17. Regarding the coagulation profile In DIC: Disseminating intravascular coagulation;

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Obs. MCQs Bank Dr/Ahmed Walid & Dr/ Ahmed Samy
Which of the following is the correct?
A. The level of FDP (Fibrinogen degeneration products) is low
B. Platelet count is high
C. Bleeding time is prolonged
D. PT and PTT are normal
E. The Fibrinogen level is high
18. Clinical Presentation of DIC includes the following EXCEPT:
A. Bleeding from IV sites
B. Hematuria
C. Failure active surgical hemostasis
D. Increase temperature (fever)
E. Epistaxis
19. The treatment of DIC may include the following EXCEPT:
A. Heparin
B. Fresh Frozen Plasma
C. Platelet transfusion if platelet count less than 50000/uL
D. Leukocyte transfusion
E. Cryoprecipitate if fibrinogen less than 1gm/L
20. A woman has severe pain in the vagina and urine retention following
normal vaginal delivery. On examination she is pale; pulse 115/min;
blood pressure is 85/60mmHg. Vaginal examination shows large soft
mass in the left later vaginal wall. What is your management?
A. Tight vaginal packing
B. Analgesics and observation
C. Drain
D. Drain and insert figure of 8 sutures
21. A woman went into unexplained shock immediately after normal vaginal
delivery (sudden postpartum collapse). What is the most likely cause?
A. Eclampsia.
B. PPH.
C. Uterine inversion.
D. Amniotic fluid embolism
22. A woman went into shock immediately after normal vaginal delivery (sudden
postpartum collapse). The collapse is preceded by abrupt onset respiratory
distress. What is the most likely cause?
A. Eclampsia.
B. PPH.
C. Uterine inversion.
D. Amniotic fluid embolism
23. The following statements regarding Syntometrine are correct EXCPT:
A. Syntometrine is composed of syntocinon & Ergometrine.
B. Syntometrine (1 mL) contains 5 IU of synthetic oxytocin and 0.5 mg of
Ergometrine maleate.
C. Syntometrine is used prophylactically in the management of 3rd stage of
labor.

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D. Syntometrine is contraindicated in cardiac patients.

E. Syntometrine affects the smooth muscles of blood vessels.

24. 24 years old G2P1 female delivered vaginally followed by delivery of an intact
placenta. 45 min later she develops sever attack of PPH. US exam shows retained
placental tissues. What is the suspected type of placenta?
A. Placenta succenturiate.
B. Placenta accreta
C. Placenta fenestrate
D. Placenta membranacea.

Chapter 7: Medical Disorders with Pregnancy

1) Hyperemesis Gravidarum
1. What percentage of pregnant women suffer from hyperemesis gravidarum?
A. 0.2% to 3.6%
B. 4.0% to 6.2%
C. 10% to 12%
D. 10% to 20%
2. Which of the following is part of the definition of hyperemesis gravidarum?
A. Nausea and vomiting that persist throughout pregnancy
B. Vomiting that appears after 20th week of gestation.
C. Severe nausea and vomiting with weight loss greater than 5% of pre-
pregnancy body weight
D. Vomiting upon arising more than five days per week
3. Thiamine (vitamin B1) deficiency results in which potential maternal
complication of hyperemesis gravidarum?
A. Renal failure
B. Esophageal rupture
C. Wernicke encephalopathy
D. Osmotic demyelination syndrome.
4. Which of the following gestational hormones may be hypothesized as a cause of
hyperemesis gravidarum?
A. Estrogen
B. Progesterone
C. Human Chorionic Gonadotropins
D. Human Placental Lactogen.
5. Which of the following bacteria has been investigated as a cause of
hyperemesis gravidarum?
A. Helicobacter pylori
B. Salmonella
C. Staphylococcus aureus

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D. Group B streptococcus
6. Thiamine replacement is essential prior to initiating hydration therapy in the
patient with hyperemesis gravidarum because:
A. Dextrose causes the body to metabolize thiamine stores, which may result in
Wernicke encephalopathy.
B. Vomiting may be exacerbated
C. Severe anemia may occur.
D. May cause dehydration.
7. Which of the following might be evident in a urine analysis in the patient with
hyperemesis gravidarum?
A. Glucosuria
B. Albuminuria
C. Ketonuria
D. Specific gravity will be decreased.
8. Which of the following signs and symptoms would be expected in a patient with
hyperemesis gravidarum?
A. Ketotic breath smells
B. Dehydration (Dry mucous membrane)
C. Elevated pulse
D. All answers are possible.

2) Hypertensive Disorders in Pregnancies:

9. Blood pressure tends to fall in the first half of normal pregnancy due to:
A. Increase glomerular filtration rate
B. Decrease systemic vascular resistance
C. Activation of renin angiotensinogen system
D. Increase systemic vascular resistance
10. Blood pressure tends to rise to the preconception level towards the end of 3 rd
trimester of normal pregnancy due to:
A. Increase glomerular filtration rate
B. Decrease systemic vascular resistance due to high progesterone level
C. Activation of renin angiotensinogen system
D. Increase systemic vascular resistance due to high progesterone level.
11. A pregnant female, has a history of receiving preconception antihypertensive
therapy. During pregnancy (new-onset serum creatinine= 1.5mg/dl& new-onset
proteinuria& difficult control of blood pressure). The most likely diagnosis is:
A. Preeclampsia
B. Gestational hypertension
C. Chronic hypertension with superimposed preeclampsia.
D. Chronic hypertension.
12. A pregnant female, has a history of receiving preconception angiotensin
converting enzymes as an antihypertensive therapy. What is your advice during

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pregnancy?
A. Discontinue angiotensin converting enzyme therapy & use labetalol
B. Continue angiotensin converting enzymes therapy
C. Use labetalol in addition to angiotensin converting enzymes therapy.
D. Add low dose aspirin.
13. A pregnant female, 24 wks gestation has new-onset (Blood Pressure 160/110
mmHg / (Serum bilirubin= 1.4mg/dl)/ (Low serum Haptoglobin)/ (Platelet
count=75000/cc)/ Alanine transferase enzyme 3 folds more than the upper
normal limit. What is the most likely diagnosis?
A. HEELLP Syndrome
B. Preeclampsia with sever features
C. Chronic hypertension.
D. Chronic hypertension with superimposed preeclampsia.
14. The pathogenesis of preeclampsia involves:
A. Failure of spiral artery remodeling with placental hyper-perfusion.
B. Failure of spiral artery remodeling with placental hypo-perfusion
C. Increase placental growth factors (PIGF)
D. Functional activity of VEGF exceeds that of soluble fms-like tyrosine kinase 1
15. Therapeutic termination of early pregnancy is indicated in:
A. Maternal pulmonary hypertension
B. Preeclampsia without sever features
C. HbA1C <10%
D. Triplet pregnancy
16. A pregnant woman with Preeclampsia developed right upper quadrant
abdominal. What is the possible cause of this symptom?
A. Cholycystitis
B. Pancreatitis
C. Tension of the liver capsule
D. Gastric ulcer
17. First wave trophoblastic invasion occurs at 8-10 weeks of gestation affects:
A. Decidual portions of Spiral arteries
B. Myometrial portions of Spiral arteries
C. Myometrial portions of radial arteries
D. Myometrial portions of Arcuate arteries
18. What is the threshold for definition of significant proteinuria during pregnancy?
A. Urinary proteins ≥ 300mg/24h urine collection
B. Urinary proteins ≥ 300mg/L of urine
C. Urinary proteins ≥ 150mg/24h urine collection
D. Urinary proteins ≥ 150 mg/L of urine
19. What is the threshold for definition of significant proteinuria during pregnancy?
A. Protein/ creatinine ratio ≥ 0.3
B. Protein/ creatinine ratio < 0.3
C. Urinary proteins ≥ 300mg/L of urine
D. Detection of clouds with boiling of urine that disappears with addition of
10% acetic acid.

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20. A pregnant woman at 34 weeks gestation; her blood pressure is 155/100mmHge;

serum creatinine is 0.4 mg/dL on admission and becomes 0.9mg.dL 3 days later.
What is the best management for this patient?
A. Termination of pregnancy
B. Follow up by repeated renal function tests
C. Increase the dose of antihypertensive therapy
D. Start MgSO4 therapy
21. Which of the following is an indication of diuretics in pregnancy induced
hypertension?
A. Treatment Pulmonary edema
B. Treatment of peripheral edema
C. Treatment of hypertension.
D. Anticonvulsant therapy as it reduces cerebral edema.
22. Which of the following tests are not used as predictors of preeclampsia?
A. Persistent diastolic notch at 24 weeks
B. Cell free fetal DNA in maternal blood
C. Mean arterial blood pressure in the second trimester (MAP-2) >90 mmHg
D. Increased functional activity of VEGF over soluble fibrin tyrosine kinase-1
23. When the blood pressure in a pregnant lady is 125/80mmHge; her mean arterial
blood pressure is:
A. 85mmHge
B. 90mmHge.
C. 95mmHge
D. 100mmHge
24. The risk of superimposed preeclampsia in pregnant woman with chronic
hypertension is:
A. 5%
B. 10%.
C. 20%
D. 30%
25. A pregnant (22 weeks gestation) lady with chronic hypertension; her blood
pressure was controlled on ACE inhibitors; what is your management advice?
A. Replace ACE inhibitors with labetalol as it induce low birth weight,
Oligohydraminos, neonatal oliguria and renal failure
B. Continue ACE inhibitors
C. Stop ACE inhibitors as it causes CVS & CNS fetal malformation.
D. Add labetalol to ACE inhibitors for better control.
26. A pregnant (12 weeks gestation) lady; her BMI is 30kg/m². She is diabetic; twin
gestation with past history of preeclampsia in the previous pregnancy. What is
your management advice to prevent preeclampsia?
A. Low dose aspirin at bed time from 12-16 weeks up to 36 week of gestation.
B. Calcium supplement in women with adequate dietary calcium
C. Control body weight during pregnancy.
D. Stop smoking
27. What is the general incidence of preeclampsia in Egypt?
A. < 1%

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B. 2- 3%
C. 5-10%
D. 20- 25%
28. What is the pattern of blood volume change In preeclampsia?
A. Increase
B. Decrease
C. Initially decrease then increase
D. Remains the same.
29. Which of the following is true regarding Eclampsia?
A. Ergometrine should be avoided in the third stage of labor
B. Caesarean section must be carried out in all cases
C. Hypotensive drugs should not be used
D. Urinary output is increased
E. Antidiuretic drugs are essential in all cases
30. What is the mechanism of action of alpha-methyldopa?
A. Direct vasodilator
B. Calcium channel blocker
C. Decrease release of noradrenaline through central effect.
D. Induce diuresis.
31. Antihypertensive therapy is used initially in preeclampsia to prevent stroke.
According to NICE; they are initiated when blood pressure> 150/100mmHge; and
the target blood pressure is:
A. 135/85mmHge
B. 140/90mmHge
C. 120/80mmHge
D. 90/60mmHge
32. What is the mechanism of action of labetalol?
A. Direct vasodilator
B. Calcium channel blocker
C. Alpha & Beta adrenergic blocker.
D. Induce diuresis
33. Immediate appropriate response to an initial eclamptic seizure includes all
ofthe following, EXCEPT:
A. Maintain adequate oxygenation
B. Administer Magnesium Sulphate
C. Prevent maternal injury
D. Ultrasound for fetal growth
E. Monitor the fetal heart rate
34. The main role of antihypertensive drug for hypertension inpregnancy is to
reduce the:
A. Incidence of IUGR
B. Incidence of placental abruption
C. Incidence of fetal death
D. Risk of maternal complications such as stroke
35. A pregnant lady with new onset unexplained seizure receives MgSO4. She

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experience absent knee reflex, respiratory rate is 12/min, & urine output is
10ml/h. what is your management advice?
A. Stop MgSO4 & give Calcium Gluconate slowly intravenous (10ml of 10%
solution in 10min)
B. Stop MgSO4
C. Adjust the dose of MgSO4
D. Give diuretic to increase urine output
36. Which of the following is not a risk factors for preeclampsia ?
A. Elderly primigravida
B. Positive history of preeclampsia in previous pregnancies
C. Positive history of macrosomic baby
D. Positive family history of hypertension
37. Preeclampsia is less likely to be associated with an increased the risk of?
A. Placental Abruption
B. Pulmonary edema
C. Prolonged duration of labor
D. Delivery of a small for gestational age infant
E. Cerebral vascular accident (CVA)
38. Eclampsia is defined as:
A. New onset unexplained seizures in preeclampsia women
B. Epileptic fits during pregnancy
C. Prolonged coma during pregnancy
D. Seizures and coma secondary to metabolic cause during pregnancy
39. Which of the following Eclampsia fits has the worst prognosis?
A. Antepartum
B. Intrapartum
C. Postpartum
D. Intrapartum & postpartum
40. How can you explain return of blood pressure to the non-connectional level
towards the end of 3rd trimester in normal non-complicated pregnancy?
A. Activation of the renin–angiotensin system (Increased blood volume &
systemic vascular resistance)
B. Increased progesterone results in Decreasing systemic vascular resistance
C. Increased vascular sensitivity to circulating catecholamines
D. Increased heart rate.
41. Which of the following medications is used as fetal Neuroprotective agents?
A. MgSO4 between 29 & 32 weeks gestation
B. MgSO4 after 32 weeks gestation
C. Dexamethasone
D. Alpha methyldopa
42. What is the incidence of Eclampsia in cases of preeclampsia without sever
features?
A. 0.6%
B. 2-3%

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C. 5-10%
D. 10-20%
43. Which of the following is a criterion of bad prognosis of Eclampsia?
A. Deep prolonged coma
B. Postpartum onset
C. SBP< 160mmHge
D. Respiratory rate < 16/min
44. Which of the following medications is contraindicated for management of 3rd
stage of labor in preeclampsia women?
A. Ergometrine
B. Oxytocin
C. Misoprostol
D. Alpha methyldopa
45. Fetus of Pregnancy induced hypertension is at high risk for:
A. IUGR.
B. Postdate.
C. Macrosomic baby.
D. Congenital fetal anomaly.
46. Which of the following is less known complications of preeclampsia?
A. Abruptio placenta.
B. Uterine rupture.
C. Placental insufficiency.
D. IUFD.
47. In preeclampsia with Severe features the patients have a decrease in :
A. Plasma volume.
B. Response to pressor amines.
C. Total body sodium.
D. Uric acid.
48. What is the most common cause of acute renal failure in pregnancy?
A. Preeclampsia and Eclampsia.
B. Drug abuse.
C. SLE.
D. Placenta previa.
49. 36 years old pregnant women (18 weeks gestation) admitted to ER with blood
pressure 170/110. The patient has positive family history of hypertension but
has no history of receiving antihypertensive medication before. Echo exam
shows left ventricular hypertrophy, fundus exam shows retinal AV narrowing
with retinal exudate. Patient protein /creatinine ratio is 0.1. The most likely
diagnosis in this case is:
A. Chronic hypertension.
B. Chronic hypertension with superimposed preeclampsia
C. Gestational hypertension.
D. Preeclampsia
50. Immediately following delivery of preeclampsia woman; she has a soft floppy
uterus with moderate genital bleeding. Examination reveals no genital tract

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laceration. Which of the following is the best for treatment of such condition?
A. 20 units Oxytocin in a 500 ml of D5W is given IV.
B. 0.2 mg IV Ergometrine.
C. 0.5 mg oral Ergometrine.
D. 0.5 mg IM Ergometrine.
51. Pregnancy induced proteinuric hypertension is not associated with:
A. An increase in creatinine clearance.
B. An increase in serum uric acid level.
C. Plasma volume decreases.
D. Hemoglobin concentration increases.
52. Regarding preeclampsia, significant proteinuria is defined as:
A. 300 mg/24 hour urine.
B. 100 mg/24 hour urine.
C. 200 mg/24 hour urine.
D. > 500 mg/24 hour urine.
53. HELLP syndrome is characterized by all of the following EXCEPT:
A. Prolongation of the partial thromboplastin time.
B. Elevation of Liver enzymes.
C. Hemolysis.
D. Platelet count< 100000/cc.

54. Which of the following is the most common presenting prodromal sign or
symptom in patient withEclampsia?
A. Headache.
B. Right upper quadrant pain.
C. Edema.
D. Visual disturbance.
E. Severe hypertension.
55. An initial management of eclamptic seizure includes all of the following
EXCEPT:
A. Attempt to abolish the seizure by administrating I.M. diazepam.
B. Maintain adequate Oxygenation and clear air way.
C. Administer Mg SO4 (4gm slowly IV as a loading dose followed by 1-2gm IV
as a maintenance dose).
D. Prevent maternal injury.
E. Monitor the fetal heart rate.
56. The most consistent finding in Eclampsia patients is:
A. Convulsions.
B. Hyperreflexia.
C. Protein /creatinine ratio> 0.3.
D. Generalized edema.
E. Diastolic blood pressure greater than 110 mmHg.
57. Eclampsia diagnosed before 20 weeks of gestation is most commonly seen in
women with:
A. Gestational trophoblastic diseases.

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B. A history of chronic hypertension.

C. Multiple gestations.
D. A history of epilepsy.
E. A history of choric renal diseases.
58. Which of the following is the most common complication of Eclampsia?
A. Intracranial hemorrhage.
B. MgSO4 toxicity.
C. Pulmonary edema
D. Recurrent seizures even following administration of MgSO4.
E. Maternal death.
59. The anticonvulsant action of Mg sulphate is mediated through the
following mechanisms; EXCEPT:
A. Inhibiting smooth muscle contractility by competitively blocking intracellular
calcium channels.
B. Mild Subcortical inhibition.
C. Reversal of cerebral arterial vasoconstriction.
D. Inhibition of platelet aggregation.
E. Release of endothelial prostacyclin.
60. Which of the following antihypertensive drugs are contraindicated during
pregnancy?
A. Captopril (ACE INHIBITOR).
B. Labetalol.
C. Methyldopa.
D. Hydralazine.
E. Nifedipine.
61. A pregnant woman with untreated chronic hypertension asks medical
advice. The physician advised her to strictly treat severe chronic
hypertension in pregnancy in order to decrease the:
A. Risk of Maternal Complications such as Stroke.
B. Incidence of IUGR.
C. Incidence of Placental abruption.
D. Incidence of Preeclampsia.
62. What is the aim of using antihypertensive therapy in pregnancy induced
hypertension?
A. Reduce the risk of CVA in the mother.
B. Reduce the placental blood flow.
C. Reduce the risk of CVA in the fetus.
D. Prevent hypertensive renal disease.
63. Which of the following laboratory tests would be most suggestive of
preeclampsia?
A. Elevated uric acid.
B. Elevated bilirubin.
C. Decreased hematocrit.
D. Elevated lactate dehydrogenase (LDH).
E. Elevated creatinine.

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64. What is the drug of choice to prevent convulsions in Eclampsia?

A. Magnesium Sulfate.
B. Hydralazine.
C. Labetalol.
D. Diazepam
65. Albumin and globulins are two main plasma proteins; which of them is the
predominating protein in the proteinuria of Eclampsia woman?
A. More albumin than globulin
B. Only albumin
C. Only globulin
D. Neither albumin nor globulin
66. The massive proteinuria in Eclampsia contains?
A. More albumin than globulin
B. Only albumin
C. Only globulin
D. Neither albumin nor globulin
67. 35 years old pregnant woman (24 weeks gestation) admitted to ER with sever
edema particularly around your eyes and in her ankles and feet. Protein
/creatinine ratio is 12 (massive proteinuria). What is the most likely diagnosis of
this case?
A. Nephrotic syndrome
B. Preeclampsia
C. Physiological edema of pregnancy
D. Chronic hypertension with superimposed preeclampsia
68. Which adverse pregnancy outcome is less likely to be increased in pregnancies
complicated by chronic hypertension?
A. Post-term birth
B. Fetal growth restriction
C. Pre-term birth
D. Perinatal death
69. Which of the following is the most common cause of maternal death in
Eclampsia?
A. Cerebral hemorrhage
B. Infection.
C. Uremia
D. Metabolic acidosis.

70. Which of the following is not a criterion of preeclampsia with sever features?
A. Platelet count > 100000/cc.
B. New onset cerebral or visual symptoms
C. Pulmonary edema
D. Serum creatinine> 1.1mg/dl

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71. Which of the following is associated with the decrease of the risk of the
development of preeclampsia?
A. Closed spaced pregnancies.(< 10 years)
B. Body mass index (BMI >35 kg/m2)
C. Multiple gestations.
D. Preeclampsia with a previous pregnancy.
E. Pregnancies with new paternity, or donor sperm IVF
72. Pregnancy induced hypertension is more common in all the following EXCEPT:
A. Primigravida.
B. Multiple pregnancies.
C. Patients with pre-existing hypertension.
D. Smoking.
E. Women with diabetes mellitus.
73. 30 weeks pregnant Primigravida (32 weeks gestation) presented with
blood pressure of150\95 mmHg and proteinuria +3 by dipstick, which
one of the following is done?
A. Estimation of protein/ creatinine ratio to confirm proteinuria, CBC.
Liver function, & renal function tests
B. Immediate caesarian section.
C. Send her home and to be seen after 4 weeks.
D. Advice to not get pregnant again.
E. Macrosomia is a recognized complication of this problem.
74. What is the first clinical evidence of magnesium sulfate toxicity?
A. Loss of deep tendon reflexes
B. Respiratory depression
C. Cardiac arrest
D. Neonatal depression
75. The following are correct concerning women with chronic hypertension in
labor, EXCEPT:
A. Shouldn't have epidural analgesia.
B. Can be safely given IV syntocinon.
C. Shouldn't be given Ergometrine as a routine in the 3rd stage.
D. Should have continuous fetal heart rate monitoring.
E. IV labetalol is a safe antihypertensive drug.
76. False proteinuria during pregnancy may be caused by:
A. Urinary Tract Infection.
B. Pre-eclamptic toxemia.
C. Nephrotic syndrome.
D. Contaminated with vaginal discharge.
77. What is the mechanism of action of alpha methyldopa?
A. Acts centrally to decrease sympathetic activity.
B. Increase peripheral vascular resistance.
C. Increase sodium and water retention.
D. Direct vasodilator.
E. Decrease the cardiac output.

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78. Which of the following is less likely to occur in markedly obese

pregnant women?
A. Hypertension.
B. Diabetes mellitus.
C. Thromboembolism.
D. Fetal growth restriction.
E. Difficult intubation during anesthesia.

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3) Diabetes in Pregnancy
1. Gestational diabetes is defined as:
A. DM with onset or first recognition during pregnancy that is not clearly
overt diabetes
B. DM that deteriorates during pregnancy.
C. DM with onset during 1ST half of pregnancy
D. DM that treated only with diet regulation
2. Carbohydrate metabolism during 1st half of pregnancy is manifested by:
A. Fasting hyperglycemia & postprandial hyperglycemia
A. Fasting hypoglycemia & postprandial hyperglycemia
B. Fasting hypoglycemia & postprandial hypoglycemia
C. Fasting hyperglycemia & postprandial hypoglycemia
3. Pregnancy is a Diabetogenic stat especially during 2nd half of pregnancy:
WHY?
A. Insulin resistant due to Increase anti-insulin hormones
B. Increase insulin requirement
C. Increase insulin requirement & Insulin resistant due to Increased anti-
insulin hormones &
D. Decrease gluconeogenesis.
4. According to Priscilla White classification Gestational diabetes is
controlled with diet alone if:
A. Fasting blood sugar >105 mg/dl& 2h Postprandial blood sugar>120mg/dl
B. It is associated with nephropathy
C. Fasting blood sugar<105 mg/dl& 2h Postprandial blood sugar<120mg/dl
D. It is associated with proliferative retinopathy.
5. Pregnant woman with Pregestational diabetes is more liable to develop
hypoglycemia: WHY?
A. Decrease glucose intake due to nausea and vomiting.
B. Decrease of the renal glucose reabsorption capacity
C. Glucose consumption in uterine contraction
D. All answers are possible.
6. The woman with latent Diabetes Mellitus has the following characters:
A. Non diabetic woman that has diabetic OGTT on exposure to stress.
B. Diabetic OGTT in asymptomatic woman.
C. Diabetic OGTT in symptomatic woman
D. Blood sugar is higher than normal but is not high enough to diagnose DM.
7. Regarding phases of DM; Gestational diabetes represents a state of:
A. Latent diabetes.
B. Potential diabetes.
C. Chemical diabetes.
D. Pre-diabetes

8. Gestational diabetes is NOT associated with an increased risk of:

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A. Cesarean section
B. Shoulder dystocia
C. Fetal macrosomia
D. Intrauterine growth restriction
9. What is the incidence of developing type 2 DM in women with previous
history of Gestational diabetes?
A. 20% within 20 years
B. 50% within 20 years
C. 20% within 10 years
D. 50% within 20 years
10. How can you explain development of RDS in infant of diabetic mothers?
A. Congenital fetal anomalies
B. Hyperinsulinemia inhibit cortisol maturation effect on the fetal lung.
C. Placental vascular insufficiency
D. Hyperglucagonemia
11. How can you explain delayed passage of meconium in infant of diabetic
mothers?
A. Congenital fetal anomalies
B. Hyperinsulinemia causing GIT hypomotility.
C. Metabolic alkalosis
D. Hyperglucagonemia causing GIT hypomotility
12. What is the first-line medical treatment to Control of gestational diabetes?
A. Insulin
B. Diet
C. Oral hypoglycemic agents
D. Insulin and diet
13. Infants of diabetic mother (gestational diabetes) have a decreased risk
of:
A. Hypoglycemia
B. Hypoinsulinemia
C. Hypocalcaemia
D. Hyperbilirubine
E. Polycythemia
14. What is the commonest congenital anomaly in infant of diabetic mother?
A. Caudal regression syndrome
B. Neural tube defect
C. Congenital heart diseases (VSD & TGA)
D. Renal agenesis
15. What is the pathognomonic congenital anomaly in infant of diabetic mother?
A. Caudal regression syndrome (sacral agenesis)
B. Neural tube defect
C. Congenital heart diseases (VSD & TGA)
D. Renal agenesis

16. How can you diagnose Pregestational diabetes?

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A. Fasting blood sugar ≥ 126mg/dl.

B. HbA1C ≥ 6.5%
C. Random blood sugar ≥ 200mg/dl
D. All answers are possible
17. A pregnant woman has a previous history of gestational diabetes, delivery of
congenitally malformed macrosomic infant. What is the optimal time for
screening of diabetes during current pregnancy?
A. At 24-28 weeks of gestation
B. At booking
C. At booking and if negative repeat at 24-28 weeks of gestation.
D. No need for screening for gestational diabetes.
18. A pregnant woman with Pregestational DM has a previous history of delivery of
congenitally malformed macrosomic infant. What is the optimal time for
screening of diabetes during current pregnancy?
A. At 24-28 weeks of gestation
B. At booking
C. At booking and if negative repeat at 24-28 weeks of gestation.
D. No need for screening for gestational diabetes as it is already diabetic.
19. Asymptomatic pregnant woman has positive urine sample for glucose. However
3h OGTT shows normal fasting and 120min OGTT with peak blood sugar in
between exceeds the renal threshold. What is the most likely diagnosis?
A. Renal glycosuria
B. Alimentary glycosuria
C. DM.
D. Lacosuria.
20. Asymptomatic pregnant woman has positive urine sample for glucose. However
the patient has positive Osazone Test & Negative Glucose Oxidation test. What is
the most likely diagnosis?
A. Renal glycosuria
B. Alimentary glycosuria
C. DM.
D. Lacosuria
21. In one step OGTT which of the following blood sugar values are diagnostic for
gestational diabetes?
A. Fasting blood glucose ≥ 92mg/dl
B. 1h postprandial blood glucose ≤180mg/dl
C. 2h postprandial blood glucose ≤153mg/dl
D. 3h postprandial blood glucose ≥140mg/dl
22. The best screening test for gestational
diabetes
A. Fasting blood sugar
B. Random blood sugar
C. Glucose challenge test
D. A glycated hemoglobin (HbA1c) test
23. Infant of diabetic mother is likely to have the following cardiac anomaly:
A. Coarctation of aorta
B. Fallot's tetralogy

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C. Ebstein anomaly
D. Transposition of great vessels
24. Hyperglycemia in late pregnancy is associated with:
A. IUGR.
B. Fetal macrosomia.
C. Congenital anomalies.
D. Postmaturity.
25. Infant of diabetic mother is likely to have delayed passage of meconium. Why?
A. Increased GIT motility due to Hyperglucagonemia secondary to neonatal
hyperglycemia.
B. Decreased GIT motility due to Hyperglucagonemia secondary to neonatal
hypoglycemia.
C. Congenital anomalies.
D. Neonatal hypocalcaemia & hypomanganesemia.
26. Screening test for gestational DM that has high sensitivity is:
A. A glycated hemoglobin (HbA1c) test
B.50 gram glucose challenge test.
C.Blood Fractosamine.
D.Random blood sugar.
27. Which of the following contraception is absolutely contraindicated in diabetic
women with vascular changes?
A. IUCD
B. COC.
C. Barrier contraception.
D. Progesterone only pills.
28. Who is screened for gestational diabetes?
A. Only women with risk factors.
B. All pregnant women.
C. Women with previous history of gestational diabetes.
D. Only women under the age of 25 years.
29. If the pregnant woman has one-hour glucose challenge test (> 140mg/dl). What
is the next step?
A. Patient is asked to return for 100gm glucose tolerance test.
B. Gestational diabetes is diagnosed.
C. Insulin therapy.
D. Oral hypoglycemic therapy.
30. Which of the following is a less possible complication for BABY in a Gestational
Diabetes affected pregnancy?
A. Fetal demise.
B. Macrosomia
C. Birth trauma
D. Cardiac anomalies
31. Complete the following statement: First and foremost management of
Gestational Diabetes should be through.................
A. Regular monitoring of blood sugar.
B. Weekly sonogram

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C. Insulin therapy.
D. Life style modification (diet& exercises).
32. Which of the following is the best way to prevent gestational diabetes?
A. Weight loss during first trimester.
B. Practicing life style modification before getting pregnant.
C. Taking insulin.
D. Regular testing of blood glucose.
33. Which of the following is the best method to monitor blood sugar control over
the last 3 months?
A. HbA1C.
B. Serial Random Blood Sugar
C. Serial Fasting blood Sugar.
D. Fractosamine (A glycated Albumin).
34. Pregnancy is contraindicated in diabetic female if she has:
A. HbA1C >12% due to high risk of CFMF.
B. Begin retinopathy
C. Previous history of gestational diabetes.
D. History of gestational diabetes in the previous pregnancy
35. A pregnant female with diagnosed gestational diabetes (GDMA1) received only
life style modification for 2 weeks. Her FBS is 100mg/dl & 2h-PP blood sugar is
13mg/dl. What is the next step?
A. Continue life style modification alone.
B. Start oral hypoglycemic therapy.
C. Insulin therapy.
D. Measure HbA1C before any therapy.
36. Which of the following is the less likely an indication for hospitalization of
pregnant diabetic women?
A. Fetal congenital anomalies.
B. Early to adjust the dose of medication,
C. Late (36 w) for planned delivery or
D. Any time of complication
37. Polyhydramnios is most likely occurs in pregnant women with:
A. High blood pressure.
B. Urinary tract anomalies.
C. Diabetes.
D. Post-mature pregnancy.
38. A pregnant diabetic woman has morning hyperglycemia preceded by midnight
hypoglycemia: what is the most probable diagnosis?
A. Somogyi effect.
B. Dawn phenomenon.
C. Normal glucose profile during pregnancy.
D. Very low evening insulin dose
39. A pregnant diabetic woman has morning hyperglycemia preceded by midnight
normal or high blood glucose level: what is the next management step?
i. Increase basal insulin or adjust timing to improve control.
ii. Decrease evening insulin or adjust timing to improve control.

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iii. Add oral hypoglycemic.

iv. Monitor growth hormone level.
40. Which of the following items in a pregnant patient's History suggests the
possibility of her having diabetes:
A. IUGR
B. 1st trimester bleeding.
C. Diabetic husband.
D. Unexplained stillbirths.
41. Insulin deficiency is associated with
A. Reduced lipolysis
B. Increased ketogenesis
C. Increased gluconeogenesis.
D. Increased glycolysis
42. Complete the statement: After delivery, the baby of a full term well managed
Gestational Diabetes pregnancy...
A. Should have vital signs monitoring more frequently
B. Should be monitored for sings of hypoglycemia for at least 12h
C. Should be formula fed to ensure stable blood sugar.
D. Should be admitted to NICU.

43. In a pregnant woman with gestational DM Class A1; What is the optimum time
ofpregnancy termination?
A. At 40 weeks
B. 2 weeks before the time of previous delivery
C. Once maturity is documented.
D. At 40 -42 weeks of gestation
44. Insulin deficiency is associated with
A. Reduced lipolysis
B. Increased ketogenesis
C. Increased gluconeogenesis.
D. Increased glycolysis
45. During pregnancy, blood tests for diabetes are more abnormal than in non-
pregnant state. This is due to:
A. Decreased insulin
B. Increased absorption from the GI tract
C. Increased production of placental anti-insulin hormones
D. Estrogen decreases and progesterone increases.
E. Haemoconcentration
46. 12-weeks Postpartum; 75gm OGTT was done for a woman with history of
Gestational diabetes. All test results are normal. What is your advice?
A. Repeat the test annually.
B. Repeat the test every 3 years
C. No need to repeat the test.
D. Continue insulin therapy.

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47. Gestational diabetes should be suspected in all the following conditions,

EXCEPT:
A. A strong family history of diabetes.
B. Previous history of macrosomic baby.
C. Polydipsia and polyuria.
D. History of unexplained fetal loss.
E. Polyhydramnios.
48. Infants of diabetic mothers (IDM) are at risk of one of the following:
A. Low Hemoglobin.
B. Hypercalcemia.
C. Hyperglycemia.
D. Respiratory distress syndrome.
49. Extra Insulin requirements of pregnant diabetic women are needed during:
A. The 1st half of pregnancy.
B. During lactation.
C. The 2nd half of pregnancy.
D. The immediate postpartum period.
50. Gestational Diabetes Mellitus (GDM) is associated with:
A. Increased risk of spontaneous miscarriage.
B. Increased risk of fetal CNS malformations
C. Increased risk of fetal cardiac malformations.
D. IUGR.
51. GDM is associated with an increased risk of all the following EXCEPT:
A. C-section.
B. Shoulder dystocia.
C. Fetal Macrosomia.
D. IUFD.
E. IUGR.
52. IDM in woman with GDM are at an increased risk of becoming:
A. Obese adults.
B. Type II diabetes.
C. Neither
D. Both.
53. Which of the following complications are less likely to occur in pregnant
woman with Type I diabetes?
A. Preeclampsia.
B. Congenital fetal malformation.
C. Maternal diabetic ketoacidosis.
D. Macrosomic baby.
54. Which of the followings is a known complication of diabetes in pregnancy?
A. Fetal microsomia (small baby).
B. Fungal infection.
C. Oligohydraminos.

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E. Iron deficiency anemia.

55. Regards congenital anomalies in diabetic pregnant female; which of
thefollowing is the correct:
A. Sacral agenesis is pathognomonic.
B. Sacral agenesis is the commonest
C. Congenital heart diseases are pathognomonic.
D. Transposition of great vessels is pathognomonic
56. Infants of diabetic mothers (IDM) are at risk of one of the following:
A. Polycythemia
B. Hyperglycemia
C. Microsomia
D. Respiratory distress syndrome
57. The serum insulin level in the newborn infant of a diabetic mother
incomparison to the infant of a norm-glycemic mother is generally:
A. Higher
B. The same as in norm-glycemic mother
C. Lower
D. Extremely labile
58. How can you explain high incidence of RDS in infant of diabetic mother even at
term?
A. Fetal Hyperinsulinemia inhibit cortisol maturational effect on the lung
B. Decreased cortisol secretion..
C. Fetal congenital anomalies.
D. Fetal cardiomyopathy.
59. The most common congenital anomaly associated with diabetes is:
A. Neural tube defect.
B. Renal agenesis
C. Sacral agenesis.
D. Congenital heart disease.
60. Risk factors for the development of gestational diabetes include all
thefollowing, EXCEPT:
A. Obesity.
B. History of PCOS or metabolic syndrome.
C. Previous history of IUFD.
D. Previous history of IUGR.
E. Previous history of gestational diabetes.

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(4) Anemia in Pregnancy:

1. Anemia during pregnancy is defined as:
A. Hb% <11gm/dl during 1st& 3rd trimester or < 10.5gm% during 2nd
trimester
B. Hb <10.5gm/dl
C. Hb <11gm/dl
D. Serum ferritin <15ugm/L
2. What is the cause of physiological anemia during pregnancy?
A. Hemodilution due to increase plasma volume by 30-40% ;however red
cell mass increases by 10-15%
B. Iron deficiency anemia
C. Dietary deficiency of folic acid and vitamin B12
D. Decrease life-span of RBCs
3. What is the total amount of iron needed by the fetus during
pregnancy?
A. 300mg (Fetal needs)
B. 400mg (200mg lost in urine &stool +200mg lost at time of delivery)
C. 500mg (used for maternal RBCS)
D. 1000mg (Total amount of iron needed during pregnancy/ 4-6mg daily)
4. What is the most common type of anemia during pregnancy?
E. Iron deficiency anemia
F. Sickle cell anemia
G. Megaloplastic anemia
H. Anemia of chronic diseases
5. Which of the following tests is most sensitive for the detection of
iron stores depletion during pregnancy?
A. Serum ferritin
B. Serum Iron
C. Serum transferrin
D. Serum iron binding capacity
6. In pregnant female which of the following reflects the level of iron:
A. Transferrin level
B. Ferritin level
C. Hemoglobin level
D. Iron binding capacity
7. What is the early indicator of iron deficiency anemia during
pregnancy?
A. Serum ferritin as it is the storage form of iron(<30mcg/L =IDA)
B. Serum Iron
C. Serum transferrin
D. Serum iron binding capacity
8. In iron deficiency anemia during pregnancy; which of the following

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9. What is the most sensitive index of iron deficiency anemia?

A. Mean corpuscular hemoglobin concentration (MCHC) as it is
independent on RBCs count
B. Mean corpuscular volume (MCV)
C. RBCs distribution width (RDW)
D. Mean corpuscular hemoglobin (MCH)
10. Which of the following iron metabolism parameters is increased?
A. Serum Transferrin & total iron binding capacity (TIBC)
B. Serum ferritin & total iron binding capacity (TIBC)
C. Serum Iron
D. Serum iron binding capacity
11. What are the WHO recommendations for iron and folic acid
supplementation during pregnancy?
A. 30-60 mg elemental iron + 400ug folic acid
B. 30-60 mg elemental iron + 500ug folic acid
C. 100 mg elemental iron + 400ug folic acid
D. 100 mg elemental iron + 500ug folic acid
12. What is the 1st parameter to increase after oral iron?
A. Reticulocyte count (within 7-10 days)
B. Ferritin level
C. Hemoglobin level
D. Iron binding capacity
13. In pregnant female with anemia, iron supplement should be given
for how many days for replenishment of iron stores even after
correction of anemia:
A. 2 months
B. 3 months
C. 6 months
D. 12 months
14. Which of the following is not an indication of blood transfusion in
anemic woman during pregnancy?
A. Moderate anemia (7- 10gm%)
B. Severe anemia (< 7gm%) during pregnancy after 36 weeks gestation
C. Refractory anemia
D. Anemia due to active blood loss
E. Anemia associated with infection
15. One unit of blood transfusion increases hemoglobin level by:
A. 0.8-1gm/dl
B. 0.2-0.4gm/dl
C. 1-2gm/dl
D. 2gm/dl
16. Folic acid deficiency results in:
A. Microcytic anemia.
B. Megaloplastic anemia with hyper-segmented neutrophils.

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C. Aplastic anemia.
D. G6PD deficiency
17. A pregnant lady with diagnosed sickle cell anemia; her management includes all
the following except:
A. Folic acid supplements (5mg/day) to support rapid RBCs turn over.
B. Hydroxyurea.
C. Prophylactic penicillin.
D. Postnatal thromboprophylaxis for up to 6 weeks
E. Vaginal delivery is preferred under regional anesthesia.
18. Birth weight of a baby can be mainly increased by:
A. Cessation of smoking
B. Aspirin
C. Calcium and vitamin D supplement
D. Bed rest
19. Sickle cell anemia has the following features except:
A. Autosomal recessive disease so if both parents are carrier the chance of
born of an affected baby is 25%
B. Increases the risk of urinary tract infections.
C. Pregnancy can precipitate crises.
D. Hydroxyurea is the recommended treatment during pregnancy

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5) Thyroid Diseases in Pregnancy

1. During normal uncomplicated pregnancy; the following thyroid function tests are
normal EXCEPT:
A. Decrease serum TSH
B. Decrease serum total T3& T4.
C. Normal serums free T3&T4.
D. Increase serum TSH
2. A pregnant lady complains of difficulty to gain weight even with good appetite;
nervousness, anxiety, irritability& pulse is 114beats/min. Her serum TSH is
0.1mU/L (normal range is 0.45 and 4.5 mU/L) and frees T4 is 10ng/dl (normal
range is 0.8 to 1.8ng/dL). What is the most likely diagnosis?
A. Hypothyroidism
B. Hyperthyroidism
C. Thyroid storm.
D. Pheochromocytoma
3. A pregnant lady complains feeling tired, hoarse voice, weight gain, face swelling,
inability to withstand cold temperature and dray skin with loss of eye brow. Her
serum TSH is 7mU/L (normal range is 0.45 and 4.5 mU/L) and frees T4 is 0.1ng/dl
(normal range is 0.8 to 1.8ng/dL). What is the most likely diagnosis
A. Hypothyroidism
B. Hyperthyroidism
C. Thyroid storm.
D. Depression
4. A 29 year old Primigravida woman at 11 weeks of gestation diagnosed
hyperthyroidism. Which of the following is a suitable management option?
A. Radioactive iodine uptake study.
B. Radioactive iodine therapy.
C. Methimazole.
D. Propylthiouracil
5. Hypothyroidism during pregnancy is least associated with:
A. Early abortion.
B. Menorrhagia.
C. Thromboembolism.
D. Galactorrhea
6. Hypothyroidism is associated with the following clinical conditions except:
A. Recurrent abortion.
B. PTL.
C. Polyhydramnios.
D. PIH

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6) Cardiovascular Diseases

61. Which of the following is not a normal finding in cardiovascular system during
pregnancy?
A. ECG-right axis deviation
B. Pulse rate increase & diastolic blood pressure decrease
C. First heart sound is prominent and spilt
D. Ejection systolic murmur heard over aortic area
62. What are the most common cardiac diseases during pregnancy?
A. Mitral stenosis (Acquired valvular diseases)
B. Atrial septal defect (Congenital heart disease)
C. Fallot’s Tetralogy (Cyanotic congenital heart diseases)
63. What is the heart disease with maximum risk of maternal deaths during
pregnancy?
A. Mitral stenosis
B. Atrial septal defect
C. Fallot’s tetralogy
D. Eisenmenger syndrome
64. What is the most common cause of maternal mortality from heart diseases
during pregnancy?
A. Mitral stenosis
B. Atrial septal defect
C. Fallot’s tetralogy
D. Eisenmenger syndrome
65. Which of the following is not a contraindication to pregnancy in women with
heart diseases? (is not an indication of therapeutic abortion)
A. Any heart disease belongs to NYHA class 1 or 2
B. Sever mitral stenosis (mitral valve area <1cm²) or sever symptomatic aortic
stenosis
C. Pulmonary hypertension
D. Previous peripartum cardiomyopathy or Ejection fraction < 30%
E. Eisenmenger syndrome or coarctation of aorta
66. What is the most common time of heart failure during pregnancy? Risk In this
order
A. Immediate postpartum
B. Second stage of labor
C. Late first stage of labor
D. Between 28-32 weeks of gestation
67. Which of the following conditions is not a contraindication of Ergometrine?
A. Gestational diabetes
B. Organic cardiac diseases as it increases the right-side overload &precipitate
heart failure.
C. Retained second twin
D. Severe Preeclampsia and Eclampsia as it can cause sudden rise of blood

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pressure
F. Rh negative mother as it increases the chance of fetomaternal transfusion
68. Tocolytic of choice in cardiac patient is
A. MgSO4
B. Atosiban
C. Alcohol
D. Calcium channel blockers
69. Disseminated intravascular coagulation has a recognized association with:
A. IUFD
B. Multiple pregnancy
C. Iron deficiency
D. Diabetic mother
70. Which of the following is unlikely to be risk Factors for DVT?
A. Hyperthyroidism
B. Smoking
C. Operative delivery
D. Lupus anticoagulation
E. Maternal weight over 80 kg
71. A high risk pregnancy includes all of the EXCEPT:
A. Gestational diabetes.
B. Cardiac disease in pregnancy.
C. History of IUFD in previous pregnancy.
D. Bleeding in pregnancy.
E. Candida infection in pregnancy.
72. Which of the following is the most common heart disease in pregnancy?
A. Cardiomyopathy
B. Previous myocardial infarction
C. Hypertension
D. Thyroid disease
E. Congenital heart disease (CHD)
73. What is the most serious disadvantage of switching from Warfarin to heparin
during pregnancy in women with mechanical heart prosthesis?
A. The risk of embryopathy is increased.
B. The risk of thrombo-embolism is increased.
C. The need for self-injection.
D. Hemorrhage is more likely.
74. According to the New York Heart Association classification, a patient with
cardiac disease in pregnancy & marked limitation of physical activity would
be:
A. Class I.
B. Class II.
C. Class III.
D. Class IV.

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75. A pregnant lady with rheumatic heart disease deliveries unexpectedly;

while she is on Heparin and excessive bleeding occurs, what is the proper
initial intervention?
A. Administration of protamine sulphate.
B. Administration of vitamin K.
C. Administration of Tranexemic acid..
D. Infusion of fresh frozen plasma.
76. A pregnant lady with Mechanical prosthetic valve deliveries unexpectedly;
while she is on Warfarin therapy and excessive bleeding occurs, what is the
proper initial intervention?
A. Administration of protamine sulphate.
B. Administration of vitamin K.
C. Administration of Tranexemic acid..
D. Infusion of fresh frozen plasma.
77. What is your management advice to decrease the incidence of
postpartum pulmonary edema in a woman with cardiac disease?
A. Giving IV Furosemide (diuretic) after placental delivery.
B. Giving antibiotic prophylaxis agonist infective endocarditis.
C. Active management of 3rd stage of labor.
D. Giving prophylactic anticoagulant therapy.
78.AA pregnant lady with cardiac disease shows spontaneous onset of labor.
Patient becomes fully dilated for an hour with regular uterine
contractions (3/10 minutes) each lasts 45 seconds. What is your
management advice?
A. Use forceps or vacuum to shorten the 2nd stage.
B. Giving epidural analgesia for pain relief.
C. Augment uterine contraction with oxytocin.
D. Keep the patient in standing position.
79. Which of the following symptoms is most indicative of heart disease
inpregnancy?
A. Tachypnea.
B. Syncope with exertion.
C. Tachycardia.
D. Peripheral edema.
E. Fatigue.
80. Which of the following tests is used to ensure optimum therapeutic
anticoagulant effect of Heparin during pregnancy?
A. Activated Partial Thromboplastin Time (APTT) should be maintained at a level
of 1.5 to 2.5 times baseline value.
B. Bleeding time.
C. Prothrombin time.
D. Thrombin time.

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7) Urinary Tract Diseases in pregnancies

75. During routine antenatal care of a pregnant woman; her urine analysis shows
presence of bacterial count of the same species more than 100000/ml in
midstream clean-catch urine in 2 occasions without urinary tract symptoms.
What is the most likely diagnosis?
A. Urine contamination (bacterial count < 10000/ml).
B. Asymptomatic Bacteriuria.
C. Acute Pyelonephritis.
D. Acute cystitis
76. Which of the following is normally present in urine of a pregnant woman in 3rd
trimester?
A. Lactose
B. Glucose.
C. Fructose.
D. Galactose
77. Which of the following is not a normal change of urinary system during
pregnancy?
A. Anatomical: increase kidney size by 1cm& dilatation of collecting system
B. Glomerular hemodynamics: increase RBF & GFR
C. Tubular function: altered resorption of protein, glucose, amino acids and
uric acid.
D. Electrolyte balance: increase total Na, K, Plasma volume & decrease set
point for thirst & ADH release
E. Decrease RBF& GFR
78. What is the effect of pregnancy induced hypertension (PIH) on glomerular
filtration rate (GFR)?
A. GFR increases
B. GFR decreases
C. GFR remains unchanged
D. GFR increase or decrease
79. A 25-years-old Primigravida with 22 weeks of pregnancy has a 1st episode of
asymptomatic Bacteriuria. The risk of developing acute pyelonephritis is:
A. zero
B. 5%
C. 10%
D. 25%
80. How can you explain the increased risk of UTI during pregnancy?
A. Urine stasis either due to mechanical compression of ureter by gravid
uterus or hormonal effect of progesterone; plus Glycosuria & proteinuria
that favor infection
B. Glycosuria
C. Congenital anomalies of maternal urinary system
D. Mechanical compression of the ureter.
81. Which of the following is not a risk factor for urinary tract infection during

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pregnancy?
A. Diabetes
B. Hypertension
C. Sickle cell trait
D. Vesicoureteral reflux
82. Sickle cell trait is a risk factor for which of the following urinary tract disorders
during pregnancy:
A. Renal failure
B. Asymptomatic Bacteriuria.
C. Acute Pyelonephritis.
D. Acute cystitis
83. Regarding pyelonephritis with pregnancy; which of the following is False?
A. Most common organism E coli (70%)
B. Usually occur after 16 weeks gestation.
C. Generally bilateral; if unilateral it is most common in the left side.
D. It complicates only 1-3% ofpregnancies
E. Antimicrobial suppression therapy (Nitrofurantoin 1oomg daily at bed time)
should be continued throughout pregnancy to prevent recurrence (30-40%)
84. A pregnant woman (20 weeks gestation) admitted to ER with fever, headache,
burning micturition, frequency and urgency. She has severe pain and tenderness
at renal angle and Suprapubic region. Urine analysis shows increased pus cells &
WBCs. What is the most likely diagnosis?
A. Acute cystitis
B. Acute pyelonephritis
C. Asymptomatic Bacteriuria
D. Red degeneration of uterine fibroid.
85. A 33 years old female with history of renal transplantation 3 months ago;
sheasked your advice for future pregnancy which is:
A. Delay conception for 1-2 years after transplant & shift to safest
immunosuppression therapy.
B. Pregnancy is contraindicated.
C. Pregnancy can be allowed at any time.
D. Check renal function if normal Pregnancy is allowed
immediately.
86. Which of the following is false regards acute pyelonephritis in pregnancy?
A. Can be preceded with asymptomatic Bacteriuria
B. I.V. antibiotics and fluids should be used in severe cases
C. Occur in 60% of pregnant women
D. when recurrent should be investigated
E. May lead to premature labor

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8) Epilepsy in pregnancies
1. Which vitamin deficiency is most frequently seen in a pregnant woman who is on
phenytoin therapy for epilepsy?
A. Vitamin B6
B. Vitamin B12
C. Vitamin A
D. Folic acid
2. Which of the following statements is FALSE in relation to pregnant women with
epilepsy?
A. Risk of Congenital fetal malformation increased 2-3 folds with antiepileptic
drugs (AED).
B. Seizure frequency rises in nearly 70% of women
C. Breastfeeding is recommended for women with epilepsy taking AEDs
D. Folic acid supplementation may reduce the risk of neural tube defect
E. Measure baseline AED level, preferably before she gets pregnant or early
in her pregnancy then should then be checked at the end of each
trimester.
F. Women with epilepsy are able to have a spontaneous vaginal delivery.
3. A 24-year-old Primigravida with juvenile myoclonic epilepsy comes to you at 18
weeks gestation with concern regarding continuing sodium-valproate treatment.
Your advice is:
A. Add Lamotrigine to sodium valproate (polytherapy)
B. Taper sodium valproate and add Lamotrigine
C. Switch on to carbamazepine
D. Continue sodium valproate with regular monitoring of serum levels
E. Disorders of Amniotic fluid volume
4. Which of the following vitamins should be prescribed for pregnant ladies on
antiepileptic drugs to reduce risk of postnatal bleeding in the child?
A. Cyanocobalamin
B. Pyridoxine
C. Folic Acid
D. Vitamin K

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9) Liver diseases & Miscellaneous disorders in

pregnancies:
1. A woman with 12 weeks pregnancy has abnormal pap smear. What is the best
management option?
A. Cone biopsy
B. Colposcopy.
C. Hysterectomy.
D. Repeat pap smear
2. Which female genital malignancy is most common during pregnancy?
A. Ovarian (10.5%).
B. Endometrial.
C. Cervical (13.5%).
D. Tubal
3. Which female malignancy is most common during pregnancy?
A. Thyroid (10.6%).
B. Lymphoma (12.1%).
C. Cervical (13.5%).
D. Breast (16.2%)
4. Which of the following corticosteroid cannot be used for fetal lung maturity?
A. Betamethasone
B. Dexamethasone
C. Hydrocortisone
D. Methylprednisolone due to poor placental transfer.
5. Smoking in pregnancy causes:
A. IUGR
B. PIH
C. Postpartum hemorrhage
D. Malpresentation
6. A syndrome of multiple congenital anomalies including microcephaly, cardiac
anomalies & IUGR has been described in babies of women who are heavy users
of:
A. Ethyl Alcohol
B. Barbiturates
C. Amphetamines
D. Heroin
7. Maternal near miss refers to:
A. A woman presented by a life threatening condition but has survived.
B. A woman presented by a life threatening condition but has died
C. A woman presented by a life threatening condition required blood
transfusion
D. Contraceptive failure in teenage
8. What is the best diagnostic test for cholestasis of pregnancy?
A. Bile acids
B. Serum alkaline phosphatase

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C. Serum bilirubin
D. ALT & AST
9. A pregnant woman developed idiopathic cholestasis. Which of the following is
unlikely to be present?
A. Intense itching is the 1st symptom
B. Increase liver transaminases.
C. Serum bilirubin > 5 mg/dl.
D. Maximum incidence during 3rd trimester
10. What is the treatment of choice for intrahepatic cholestasis during pregnancy?
A. Ursodeoxycholic acid (UDCA)
B. Cholestyramine.
C. Steroids.
D. Antihistaminic
11. What is the optimum gestational age for termination of pregnancy with
intrahepatic cholestasis?
A. 36 weeks
B. 38 weeks
C. 40 weeks
D. 42 weeks.
12. A 33-years-old pregnant lady has nausea, vomiting, jaundice, normal blood
pressure & normal temperature. She has hypoglycemia, thrombocytopenia, raised
liver transaminases, raised ammonia level, ketonuria & proteinuria. What is the
most likely diagnosis:
A. Acute fatty liver of pregnancy
B. HELLP Syndrome
C. Obstetric cholestasis.
D. Viral hepatitis.
13. A pregnant lady is diagnosed to be HBsAg positive. Which of the following is the
best way to prevent infection to the child?
A. HB immunoglobulin to the child at birth then Full course of
hepatitis B vaccine (at 5, 1, 6 months of life)
B. Hepatitis vaccine to the child
C. Hepatitis B immunoglobulin to the mother
D. Hepatitis B immunization to mother
14. A mother is HBsAg positive and anti HBeAg positive. What is the risk
oftransmission of HBV to the child?
A. 0%
B. 10-15%
C. 50%
D. 90%
15. Which of the following type of viral hepatitis infection during pregnancy is
associated with highest maternal mortality?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C

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D. Hepatitis E
16. Which of the following type of viral hepatitis infection during pregnancy is
associated with highest risk of perinatal transmission?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis E

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Chapter 8: Rh isoimmunization and

ABOincompatibility
1. Regarding Rh factor all of the following are correct EXCEPT:
A. Protein (antigen) limited to RBC wall in 85% of population.
B. Fetal Rh-antigen is present at time of fertilization (38th day of conception).
C. Genotype is determined by the inheritance of 3 pairs of genes on the distal
end of the short-arm of chromosome-1, with autosomal dominant
transmission.
D. The gene "d" has no antigenic expression. So there are only 5 effective
antigens (C, c, D, E & e)
E. Rh +ve individual may be DD- homozygous (35%), Dd-heterozygous (50%)
2. RH incompatibility occurs with:
A. Rh –ve father & Rh+ve mother
B. Rh –ve mother & Rh –ve father
C. Rh –ve mother & Rh +ve father
D. Rh +ve mother & Rh +ve father
3. Why the first baby is safe in Rh incompatibility pregnancy?
A. Only IgM is formed and it is of large molecular weight and cannot cross the
placenta.
B. Antibody titer is very low during primary immune response
C. The formed IgG is ineffective against fetal RBCs
D. Massive hemolysis is compensated by increased erythropoiesis.
4. Why incidence of Rh isoimmunization is only 2-16% of cases?
A. Immunogenic non-responders found in 30% of Rh–ve women.
B. Very small volume of FMH: Critical sensitizing volume: 0.1 ml
C. Strength of the antigenic stimulus
D. Co-existence of ABO incompatibility: reduces the risk of Rh-sensitization by
50-70%
E. All answers are correct
5. Which of the following doesn't require anti-D treatment during 1st trimester of
pregnancy?
A. Threatened abortion< 12 weeks.
B. Ectopic pregnancy
C. Evacuation of Partial vesicular mole
D. Evacuation of retained product of conception
E. Threatened abortion with excessive bleeding.
6. A primigravida attends to the outpatient clinic at 13 weeks gestation for
antenatal care. Her blood group is B /Rh positive. What is the next step in the
management?

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A. Determine fetal blood group

B. Determine her husband blood group
C. Perform ultrasound scan
D. Perform rhesus antibody titer.
7. A Rh negative women has increase the chances of being immunized during
pregnancy when:
A. Performing External cephalic version.
B. Maternal anemia.
C. Premature labor.
D. Maternal Thyrotoxicosis.
E. Multiple pregnancies
8. Rh –ve mother doesn't receive Anti-D immunoglobulin in her previous
pregnancy. In the current pregnancy indirect coombs test is positive. The
following will complicate the current pregnancy:
A. Fetal anemia
B. Abnormal umbilical artery Doppler
C. Oligohydraminos
D. Fetal anemia or Hydrops Fetalis
9. What is the source of fetal and neonatal IgM?
A. It is almost entirely maternal in origin
B. It is 50% maternal, 50% fetal in origin
C. It is 25% maternal, 75% fetal in origin
D. It is almost entirely fetal in origin serve as one of supposed markers of perinatal
infection
10. When Anti-D prophylaxis should be given?
A. Should be given to all sensitized Rhesus negative women after delivery
B. Should be given to all Rhesus negative women who give birth to Rhesus
positive babies.
C. Should be given to all Rhesus positive women who give birth to Rhesus
D. Should be given to all women who's babies are Rhesus negative
11. In Rhesus Iso-immunization, which of the following tests may be helpful?
A. Maternal serum bilirubin level
B. AF bilirubin
C. Rhesus antibody titer in liquor
D. Maternal hemoglobin
E. Baby gender
12. RH disease:
A. Occurs when the mother is Rh+
B. Occurs when the father is RH -ve.
C. Occurs when the fetus is Rh +ve & mother Rh -ve
D. Can never occurs in the 1st pregnancy
E. Antibodies are formed against maternal RBCs
13. At 28 weeks of gestation, amniocentesis reveals AF bilirubin determined by
the analysis of the change in Optical Density of AF at 450 nm on the spectral

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absorption curve (delta OD450) of 0.2 which is at the top of 3rd zone of Lilly
curve. What is the appropriate management?
A. Intrauterine fetal transfusion
B. Immediate Delivery
C. Plasmapheresis
D. Repeat amniocentesis after one week.

14. In ABO incompatibility:

A. The mother has to be blood group O
B. The fetus has to be Blood group A or B
C. First baby is affected
D. It is an antigen antibody reaction
E. All answers are correct
15. Which of the following maternal antibodies doesn't cause erythroblastosis
fetalis?
A. Anti-Lewis
B. Anti-nuclear antibodies
C. Anti-E
D. Anti-D
16. How can you distinguish Fetal RBCs from maternal RBCs?
A. Shape
B. Resistance to acid elution
C. Lack of Rh factor
D. Lower amounts of hemoglobin
17. Rh –ve, indirect coombs test (ICT) –ve mother (Non-sensitized) receives
Anti-D immunoglobulin at 28 weeks gestation. What should be done after
child birth at 37 weeks of gestation?
A. Anti-D should be given to the mother within 72 hours of delivery
only if the child is Rh +ve.
B. Anti-D should be given to the mother irrespective to the child is
Rh.
C. Anti-D should be given to the mother only if the child is Rh -ve.
D. Anti-D should be given to the mother only if the direct coombs
test is positive.
18. Fetal manifestations of erythroblastosis fetalis may include all of the
following EXCEPT:
A. Splenic enlargement
B. Fetal Polycythemia
C. kernicterus
D. Placental edema
E. Hepatomegaly
19. What is the gold standard test for diagnosis of fetal anemia in erythroblastosis
fetalis?
A. Middle Cerebral Artery Doppler (MCAD) Velocimetry.
B. Fetal blood sampling (Cordocentesis).

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C. CTG.
D. Amniotic fluid bilirubin. Quantified by spectrophotometry by assessing
the change in Optical density at 450nm
20. If blood must be given without adequate cross matching, the best to use is:
A. AB Rh-positive.
B. AB Rh-negative.
C. O Rh-positive.
D. O Rh-negative.
E. A Rh-positive.
21. What are the characteristic CTG findings in cases of erythroblastosis fetalis
(sever fetal anemia)?
A. A sinusoidal pattern with loss of normal baseline variability
B. Early deceleration
C. Late deceleration
D. Variable deceleration
22. At 28 weeks of immune hydrops fetalis gestation, the Middle Cerebral Artery
Doppler (MCAD) Velocimetry {MCA PSV ≥ 1.5 MoM }. What is the next step?
A. Fetal blood sampling via cordocentesis should be performed
B. Immediate Delivery
C. Intrauterine fetal transfusion
D. Plasmapheresis
E. Repeat amniocentesis after one week.
23. A Rh negative woman with a history of stillborn at 38weeks due to hemolytic
diseases, her husbands-genotype CDE/cde. In her current pregnancy which of
the following statements is CORRECT:
A. There is 50% chance that her baby will be Rh negative.
B. 100% of her babies will be Rh positive.
C. Immunoglobulin should not be given regardless of baby's Rh status.
D. Immunoglobulin should be given regardless of baby's Rh status.
E. By history alone, she should not be allowed to go after 36/52.

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Chapter 9: IUGR and IUFD:

1. Intrauterine growth restriction (IUGR) is defined when:

A. Birth weight is below the tenth percentile of the average of
gestational age
B. Birth weight is below the 20 percentile of the average of
gestational age
C. Birth weight is below the 30 percentile of the average of
gestational age
D. Weight of baby is less than 1000 gm
2. All are the causes of intrauterine growth retardation EXCEPT:
A. Anemia
B. Pregnancy induced hypertension
C. Maternal heart disease
D. Gestational diabetes
3. Which of the following tests is not useful in management of
intrauterine fetal growth restriction (IUGR)?
A. Fetal kick chart
B. Cardiotocography CTG non stress test
C. Chorionic villous sampling
D. Biophysical profile
E. Umbilical cord Doppler waveforms
4. Best parameter for ultrasound evaluation of IUGR is:
A. Placental membrane
B. Length of femur
C. Abdominal circumference
D. BPD
5. A lady of 158 cm height with Hb of 11gm%, BP of 160/110 mm Hg and 12 kg gain
during her pregnancy delivered an IUGR baby, the cause of IUGR in this case is:
A. Increased Maternal weight gain
B. Short stature
C. Hypertensive disorders of pregnancy
D. Anemia
6. The following are possible complications of IUGR EXCEPT :
A. Intrauterine death
B. Severe hypoxia and fetal distress in labor
C. Meconium aspiration
D. Hypoglycemia
E. Post maturity
7. Maternal causes for intrauterine growth restriction may one of these EXCEPT:
A. Hypertensive diseases with pregnancy

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B. Chronic renal diseases with pregnancy

C. Smoking and alcoholism
D. Cyanotic heart disease
E. Rheumatic mitral stenosis
8. Abnormal fetal karyotyping is responsible for up to...........% of IUGR.
A. 10%
B. 20%
C. 30%
D. 40%
9. Which of the following is not a Risk factor for shoulder dystocia ?
A. Maternal obesity.
B. IUGR.
C. Macrosomia.
D. Maternal diabetes.
E. Prolonged second stage of labor.
10. If IUGR is diagnosed; the management should include:
A. Ruling out Congenital anomalies
B. Immediate delivery is indicated.
C. C-section is the only way in those cases.
D. Steroids should not be administrated in causes post maturity.
11. What is the commonest cause of IUFD ?
A. True knots in the cord.
B. Gestational diabetes mellitus.
C. Unexplained.
D. Infections.
E. Complete placental abruption.
12. The most accurate method for diagnosis of IUFD is :
A. No fetal movement by the mother
B. Decrease in symptoms & signs of pregnancy
C. Recurrent bleeding per vagina
D. Absence of fetal heart sound by Doppler
E. Absence of fetal heart by real time UUS movement
13. What is the most common chromosomal abnormality in the abortuses ?
A. Balanced translocation.
B. Unbalanced translocation.
C. Triploidy.
D. Trisomy.
E. Turner (45 XO).
14. Which of the following is not a Cause of IUGR?
A. Constitutional small mother. (cause of small for gestational age)
B. Fetal urinary tract anomalies.
C. Premature rupture of membranes.
D. Placental insufficiency.
15. Which of the following is/are causes for a uterus that is small for

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gestation during pregnancy?

A. Multiple pregnancy
B. IUGR
C. Fibroid
D. Polyhydramnios
E. Incorrect dating of pregnancy
16. Shoulder dystocia means:
A. Prolonged fetal head to body delivery time more than 60 seconds
B. Failure of the fetal body delivery after head delivery despite the use of
routine gentle downward and backward traction
C. Additional obstetric maneuvers are needed to deliver the fetal body after
delivery of the head.
D. All answers are possible.
17. Perinatal period:
A. Extends from the 28th week of gestation to the 7th day of life
B. Extends from the 22nd week up to the 7th day of life. (Extended perinatal
period)
C. Extends from birth up to 28 days of life (Neonatal period)
D. Refers to the first 7 days (The early neonatal period)
18. What is the most serious maternal complication of IUFD?
A. Hypofibrinogenaemia./ DIC
B. Acute amnionitis.
C. Acute psychosis.
D. Pelvic thrombophlebitis.
E. Infertility.
19. A 30-year-old G3P0 woman who is 28-weeks pregnant presents for a prenatal
care visit. She reports occasionally feeling her baby move but has not kept count
over the past several weeks. She denies any bleeding, loss of fluid, or
contractions. Her previous pregnancies resulted in spontaneous abortions at 12
and 14 weeks. She has had no surgeries. On physical exam, fetal heart tones are
not detected. Abdominal ultrasound shows a 25-week fetal demise. The patient
requests an autopsy on the fetus. What is the best next step in management?
A. Caesarean delivery
B. Induction of labor at term
C. Dilation and curettage
D. Dilation and evacuation
E. Induction of labor now
20. In cases of IUFD:
A. A cause can be identified in most cases.
B. Immediate delivery is indicated.
C. More common with good antenatal care.
D. Fetal chromosome should not be done.
E. Careful examination of the newborn is important.

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Chapter 10: Post-term and induction of labor (IOL)

1. Which of the following is a contraindication of induction of labor?
A. Sever P E T at 36 weeks
B. Gestational diabetes on insulin at 39 weeks
C. History of upper segment caesarian section
D. Post term pregnancye.
E. Chorioamnionitis
2. Which of the following is a contraindication of induction of labor?
A. Sever preeclampsia
B. Diabetes mellitus-controlled with high dose of insulin
C. Prolonged rupture of membrane without uterine contraction
D. IUFD ( intrauterine fetal death)
E. History of previous 3 C/S.
3. Which of the followings is an indication for induction of labor?
A. Placenta previa.
B. Post-term gestation.
C. Cord presentation.
D. Prior classical cesarean section.
E. Active genital herpes.
4. The most common reason for postdate pregnancy is:
A. Inaccurate gestational age. (Wrong calculation)
B. Fetal anencephaly.
C. Oligohydraminos.
D. IUGR.
E. Advanced maternal age.
5. A woman comes with postdated pregnancy at 42 weeks. The initial
evaluation would be:
A. Induction of labour
B. Review of previous menstrual history
C. Cesarean section
D. USG
6. Post-term labour is seen in:
A. Polyhydramnios
B. PPROM
C. Anencephaly
D. Multiple pregnancy
7. In post-term pregnancy all the followings are true EXCEPT:
A. It is defined as a gestational age beyond 43 weeks.
B. Associated with meconium stained liquor.
C. The fetus has long nails.
D. May results in Oligohydraminos.
E. Not associated with respiratory distress syndrome.

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8. During artificial rupture of membrane in induction of post-term pregnancy.

The suspected color of liquor in this case is:
A. Green - meconium stained →(fetal distress in conditions other than breech
or transverse position).
B. Golden yellow - Rh-incompatibility.
C. Greenish yellow (saffron) →Postmaturity.
D. Dark colored → in concealed hemorrhage.
E. Dark brown (tobacco juice) → in case of IUD.
9. Which of the followings is a contraindication for Oxytocin infusion to
induce labor?
A. Irregular first stage labor.
B. Transverse lie.
C. Preeclampsia
D. Gestational hypertension
10. Risks and complications of induction of labor include all the following,
EXCEPT :
A. Failed induction.
B. Atonic postpartum hemorrhage.
C. Uterine Hyperstimulation leading to fetal hypoxia.
D. Prostaglandin may cause hypothermia due to its direct effect on thermo
regularity centers in the brain.
E. Ruptured uterus in grand multipara of patients with previous C-section.
11. Actions of Oxytocin
include:
A. Production of transient hypertension.
B. Increase in uterine muscle contractility.
C. Anti-diuretic activity.
D. Activation of myoepithelial cells of the breast.
E. All of the above

12. Regarding induction of labor all statements are false, EXCEPT:

A. Chance of success is not dependent on the cervical bishop score.
B. Is indicated in patient with mitral stenosis.
C. Vaginal prostaglandin pessaries reduce the induction of delivery interval.
D. In indicated at 40 weeks gestation.
E. All diabetic women should be induced at 38 weeks of gestation.
13. Which of the following is not a complication of Amnio-hook (artificial ROM)?
A. Amniotic fluid embolus
B. Cord prolapse
C. Abruptio placenta
D. IUGR
E. Fetal distress
14. Which of the following is an indication for induction of labor:
A. Placenta previa.
B. Post-term gestation.
C. Cord presentation.
D. Prior classical C-section.
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E. Active genital herpes.
15. Complications of artificial rupture of membranes include all the following,
EXCEPT :
A. Abruptio placenta.
B. Amniotic fluid embolism.
C. Fetal distress.
D. Meconium aspiration.
E. Cord prolapse.
16. What is the 1/2 life of Oxytocin:
A. < 1 min.
B. 3 min.
C. 10 - 15 min.
D. 20 - 30 min.
17. Which of the following has NOT been shown to stimulate (induce) labor:
A. Amniotomy.
B. Prostaglandins.
C. Enemas.
D. Breast stimulation.
E. Overeating
18. A contraindication to the use of Oxytocin for stimulating labor at term is:
A. Dead fetus.
B. Hypertonic uterine dysfunction.
C. Hypotonic uterine dysfunction.
D. Twin gestation.
E. Prior history of one LSCS.
.

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Chapter 11: Preterm Labor and PROM

1. Which of the following drugs is NOT a Tocolytic?
A. Salbutamol ventolin
B. Diazepam (valium)
C. Calcium channel blocker
D. Indomethacin non-steroidal anti-inflammatory drugs
E. Ritodrine (β agonist).
2. A pregnant female at 31 weeks of gestation complains of sudden gush
of watery fluid per vaginae. The most likely diagnosis is:
A. Preterm prelabor rupture of membrane
B. Premature rupture of membrane.
C. Term rupture of membrane.
D. Artificial rupture of membrane
3. Premature rupture of membrane is most strictly defined as rupture at any time
prior to:
A. A stage of fetal viability.
B. The 2ND stage of labor.
C. The onset of labor.
D. The 32ND week of gestation.
E. The 38th week of gestation
4. If labor does not start within 18-24h of PROM, there is an increased
risk of:
A. Infection of the uterus and fetus
B. Birth defects.
C. Prolonged labor
D. Obstructed labor
5. PPROM means:
A. Preterm pre-labor rupture of membrane
B. Preterm rupture of membrane.
C. Pre-labor rupture of membrane
D. Premature rupture of membrane
6. Latency period in PPROM means:
A. Period of active uterine contraction cervix dilates from 4 to 10 cm (active
phase of cervical dilatation)
B. Cervix becomes soft and thin, and starts 1st 3cm of cervical dilatation
(latent phase of cervical dilatation)
C. Period from PROM to delivery of the fetus. (Interval period)
D. Period from PROM to the onset of labor
7. What is the most common cause of preterm labor that is responsible
for 30% of preterm labor?
A. PROM
B. Preeclampsia
C. PPROM

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D. Gestational diabetes mellitus.

8. Complication of pregnancy that predispose to preterm labor includes all the
following EXCEPT :
A. Polyhydramnios
B. Urinary tract infection
C. 25 years old primigravida.
D. Premature rupture of membranes
E. Multiple pregnancy
9. What is the main risk factor for PPROM?
A. Subclinical of clinical genital tract infection
B. Preeclampsia
C. Current Vaginal bleeding
D. Previous history of PPROM
10. The diagnosis of premature rupture of the membrane depends on all of the
following EXCEPT:
A. History of fluid loss per vagina
B. Visualization of amniotic fluid in the vagina by sterile speculum
C. Positive Amniosure test
D. Positive fern test
E. Positive methylene blue test
11. Which of the following is contraindicated during conservative
management of prelabor rupture of membranes?
A. Frequent vaginal examination to assess cervical dilatation
B. serial complete blood count to diagnose rising of WBC
C. Close monitoring of maternal vital signs
D. Ultrasound to assess fetal weight and amount of liquor
E. Monitoring of the fetus by doing cardiotocogram
12. What is the wrong statement regarding Surfactant?
A. Surface-active complex of phospholipids and proteins
B. Is secreted by type II pneumocytes
C. After 38 weeks the ratio to sphingomyelin is 2:1.
D. Its secretion is suppressed by betamethzone.
13. Which of the following is a risk factor for spontaneous preterm labor?
A. Fetus with anencephaly
B. Oligohydraminos
C. Maternal hypothyroidism
D. Bacterial Vaginosis
E. Transverse lie of the fetus
14. Prostaglandin synthesis is inhibited by:
A. Progesterone.
B. Indomethacin.
C. ACTH.
D. Prolactin-inhibiting factor.
E. Thyroid hormone.
15. Which of the following is NOT possible Cause of premature labor?
A. Multiple pregnancy

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B. Polyhydramnios
C. Bicornuate utures
D. Anencephaly
E. Perinatal infection.
16. A positive Nitrazine test is:
A. Strong evidence of rupture of the membranes.
B. Presumptive evidence of intact membranes.
C. An evidence of intact membranes.
D. Presumptive evidence of intact membranes.
17. What is the AmnioSense?
A. Absorbent pad that change its color from yellow to green at Ph>6.5
(indicative for amniotic fluid.
B. Test Strip for detect placental alpha microglobuline-1 in AF. (Amniosure)
C. Test Strip for detect 2 proteins in AF (Placental protein -12 & alpha
fetoprotein) (ROM-PLUS)
D. Test Strip for detect IGFBP-1(Insulin Like Growth Factor Binding Protien-1 in
AF. (ACTIM PROM)
18. What is the organism that can cause chorioamnionitis without PPROM?
A. E. Coli
B. Bacteroides
C. Listeria Monocytogenous.
D. Stap. Aureus.
19. What is the most serious complication of preterm premature rupture of
membrane(PPROM) at 28 weeks?
A. Fetal compression anomaly.
B. Pulmonary hypoplasia.
C. Intrauterine infection.
D. Limb contraction.
E. Abruptio placenta.
20. The following are obstetrics causes for premature labor EXCEPT :
A. Multiple pregnancy
B. Multiparity
C. Premature preterm rupture of the membrane
D. Cervical incompetence
E. Uterine congenital anomalies
21. Which of the following is not diagnostic for prelabor Rupture of membranes ?
A. +ve fern test.
B. Pooling of amniotic fluid on speculum examination.
C. Contraction seen on the CTG.
D. +ve nitrazine test.
E. Observing amniotic fluid draining through the cervix during speculum
examination.
22. Early signs of premature labor include all of following EXCEPT:
A. Increased vaginal discharge
B. Increased uterine contraction

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C. Low back pain

D. Cervical dilatation to 4 cm
E. Worsening pelvic pressure
23. A G3P2 lady at 28 weeks gestation complains of sudden gush of watery fluid per
vagina. One week later she developed fever, foul smelling vaginal discharge,
maternal and fetal tachycardia, tender uterus, leukocytosis and positive CRP. What
is the most likely diagnosis?
A. Chorioamnionitis.
B. Prelabor rupture of membrane
C. Chronic abruptio placentae
D. Vaginitis
24. Which of the following is an indication to Tocolytic therapy?
A. Severe PET.
B. Severe antepartum hemorrhage.
C. IUGR.
D. Chorioamnionitis.
E. Preterm breech presentation.
25. Dexamethasone is indicated in which of the following condition :
A. Premature labor to prevent neonatal respiratory distress syndrome
B. Ectopic pregnancy to enhance fetal lung maturity
C. Spontaneous rupture of membrane at 39 week
D. At 38 weeks severe abruption placenta
E. Threatened abortion
26. A G3P2 lady at 37 weeks gestation complains of sudden gush of watery fluid per
vagina without labor pain. What is management of choice?
A. Induction of labor
B. Emergency Cesarean section
C. Giving course of corticosteroids
D. Give magnesium sulphate as a neuroprotective
27. Amnioinfusion refers to the instillation of fluid into the amniotic cavity. What is
the recommendation about its use in PROM?
A. Is neither recommended in women with PROM during labor nor in very
preterm PROM as a method to prevent lung hypoplasia
B. is recommended in women with PROM during labor nor in very preterm
PROM as a method to prevent lung hypoplasia
C. Is recommended in women with PROM during labor to decrease cord
compression.
D. is recommended in women with Previable PPROM
28. Drugs used to inhibit preterm labor include:
A. Phenobarbitone.
B. Prostaglandins.
C. Calcium channel blockers (inhibitors).
D. Anticholinergic drugs.
E. Dexamethasone.

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29. All of these drugs can be used as Tocolytic to stop labor, EXCEPT:
A. Salbutamol ventolin
B. Methotrexate
C. Calcium channel blocker
D. Indomethacin non-steroidal anti-inflammatory drugs
E. Ritodrine (beta-2 adrenergic-agonist)
30. In which of the following conditions can we use Tocolytic therapy?
A. Cardiac disease.
B. Severe hypertension.
C. Clinical chorioamnionitis.
D. Intrauterine fetal death.
E. Non-reassuring fetal status
31. Which of the following complications may be associated with ruptured
appendix &peritonitis?
A. Fetal growth restriction
B. Oligohydraminos
C. Chorioamnionitis
D. Preterm birth
E. Placental abruption
32. Why prostaglandin synthesis inhibitors are not generally used as
Tocolytics ?
A. Are ineffective
B. Produce marked hypertension
C. May cause premature closure of the fetal Ductus Arteriosus
D. Are too expensive
E. Are associated with lactic acidosis
32. Side effects of β sympathomimetic include all of the following, EXCEPT:
A. Tachycardia
B. Pulmonary edema
C. Headache
D. Premature closure of Ductus Arteriosus
E. Palpitation
33. Ritodrine is a b adrenergic receptor agonist that is used to stop pretermlabor.
Which of the following is a major maternal risk of its use?
A. Hypertension.
B. Decreased plasma glucose.
C. Cardiac arrhythmias.
D. Asthma
E. Decreased serum potassium.
34. The following are known causes of preterm labor EXCEPT:
A. Maternal hypoxia
B. Intrauterine fetal death
C. Polyhydramnios
D. Multiple pregnancy
E. Cervical incompetence

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35. A premature birth has been defined as:

A. Before 37 completed weeks' gestation.
B. Prior to the period of viability.
C. Weighing less than 1000 g.
D. Weighing more than 1000g but less than 2500g

Chapter 12: Fetal assessment

1. In fetal circulation:
A. Oxygenated blood goes along the umbilical arteries
B. The fetal lung is bypassed by means of Ductus Venosus
C. The foramen ovale connects the two ventricles
D. Most of the blood entering the right atrium flows into the left atrium
E. The blood in the umbilical arteries is more oxygenated that blood inumbilical Vein
2. A pregnant lady with persistent late, variable deceleration with cervical dilatation
of 6 cm shifted to OT for surgery. Which of the following is not done?
A. Supine position
B. O2 inhalation
C. IV fluid
D. Subcutaneous terbutaline
E. Stop oxytocin infusion
3. Which of the following is an indicator of fetal wellbeing?
A. Prolonged tachycardia (> 160 bpm) or Fetal scalp blood pH < 7.2
B. Prolonged bradycardia (< 110 bpm for at least 5 minutes)
C. Presence of FHR acceleration on CTG
D. Reduced fetal heart rate variability
E. Severe variable and late deceleration
4. Which of the following is not a Component of biophysical profile?
A. Fetal movement
B. Placental thickness
C. Fetal tone
D. Fetal breathing movement
E. Amniotic fluid volume assessment
5. Antenatal fetal monitoring can NOT be accomplished by:
A. Fetal kick chart.
B. Fetal scalp sampling.
C. Non-stress test.
D. Obstetric U/S & Biophysical profile.
E. Acoustic stimulation.
6. Which of the following procedures allow the earliest retrieval of DNA for
prenatal diagnosis in pregnancy?

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A. Fetoscopy.
B. Amniocentesis.
C. Percutaneous Umbilical Blood Sampling (PUBS)
D. Chorionic Villi Sampling (CVS)
E. Fetal biopsy.
7. Which of the following is not considered antenatal fetal assessment procedures?
A. Fetal biophysical profile.
B. Fetal Doppler Velocimetry.
C. Fetal biometry.
D. Fetal Cardiotocography.
E. Fetal blood sugar sample
8. When chorionic villous biopsy is done before ten weeks of gestation it causes
which of the following adverse effects
A. Fetomaternal hemorrhage
B. Cardiac defects
C. Limb defects
D. Renal defects
9. Early deceleration is NST
A. Associated with unengaged head
B. Associated usually with brain hypoxia
C. Decrease in the fetal beat that peaks after uterine contraction
D. Indication of C-section.
E. Results from increased vagal tone secondary to head compression.
10. Late deceleration is caused by
A. Fetal movement
B. Fetal hypoxia secondary to Placental insufficiency
C. Umbilical Cord compression
D. Head compression.
11. Cardiotocography (CTG) is the most commonly used test for antepartum and
Intrapartum fetal surveillance. Negative predictive value of Normal CTG (% of
fetuses with a normal CTG that will be born non-hypoxic) is
A. 60%-70%
B. 70%-80%
C. 80%-90%
D. >90%
12. Patients with high risk pregnancy should have:
A. Fetal biophysical profile.
B. Follow-up in ANC every 6 weeks
C. Fetal kick chart.
D. Fetal maternal transfusion
E. Fetal amniotomy

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13. Positive predictive value of pathological CTG (% of fetuses with a abnormal

CTGthat will be born hypoxic)

A. 40%-50%
B. 50%-60%
C. 60%-70%
D. >70%
14. Which of the following is correct regarding a normal antenatal Doppler
ultrasound study?
A. A diastolic notch in the uterine arteries should always be absent
B. The Ductus Venosus flow shows a positive A wave
C. The pulsatility index (PI) of middle cerebral artery is always lower than PI of
umbilical artery
D. the umbilical artery diastolic flow is absent in third trimester
E. the umbilical cord has two veins and one artery
15. Repetitive late decelerations most commonly indicate:
A. Fetal academia.
B. Fetal hypoxia.
C. Fetal sleep state.
D. Head compression.
E. Cord compression
16. Electronic fetal monitoring:
A. Has high specificity but low sensitivity.
B. Has low specificity but high sensitivity.
C. Has low specificity & sensitivity.
D. Has high specificity & sensitivity.
E. Has moderate sensitivity & specificity.
17. What is the uterine blood flow at term:
A. 50 ml/min.
B. 100 to 150 ml/min.
C. 300 to750 ml/min.
D. 500 to 750 ml/min.
E.200 ml/min.
18. Regarding Fetal blood pH:
A. Can only be measured postnatal.
B. Is not a reliable way of assessing fetal distress
C. Is dangerous to perform & should not be done.
D. Of 6.9 is considered to be normal.
E.Can be measured during labor.
19. Fetal hemopoiesis first occurs in:
A. Yolk sac
B. Liver
C. Spleen
D. Bone marrow
20. The following are major indicators of fetal asphyxia:
A. Old meconium at the time of induction of labor.
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B. Loss of acceleration.
C. Deep type I deceleration in the 2ND stage of labor.
D. Type II (late) decelerations with tachycardia.
E.Excessive fetal movements
21. Regarding the biophysical profile:
A. It is usually done in labor
B. Never include an non-stress test.
C. Includes fetal movement, fetal tone, fetal breathing, fetal heart rate &amniotic
fluid.
D. Includes a Doppler study.
E. Includes tone, movement & breathing.

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Chapter 13: The Neonates

1. A low APGAR score at one minute means that:
A. The newborn has a need for immediate resuscitation.
B. It Is highly correlated with late neurologic squeal.
C. Has the same significance in premature & term infants.
D. Is a useful index of resuscitative efforts.
2. APGAR's score between 8-10 indicates:
A. No depression.
B. Mild depression
C. Severe depression
D. Fetal death
3. Which of the following parameter is not included in APGAR's score?
A. Blood pH.
B. Skin color.
C. Muscle tone.
D. Pulse (Heart rate).
E. Respirations
F. Grimace (reflex irritability)
4. Immediate therapy for infants with suspected meconium should routinely
include:
A. Corticosteroid
B. Antibiotics
C. Sodium bicarbonate
D. Clearing of the airway
E. Giving O2 under positive pressure
5. You’re assessing the one minute APGAR score of a newborn baby. On
assessment, you note the following about your newborn patient: weak cry, some
flexion of the arm and legs, active movement and cries to stimulation, heart rate
145, and pallor all over the body and extremities. What is your patient’s APGAR
score?
A. APGAR 5
B. APGAR 9
C. APGAR 12
D. APGAR 6
6. You’re assessing the five minute APGAR score of a newborn baby. On
assessment, you note the following about your newborn patient: heart rate 97,
no response to stimulation, flaccid, absent respirations, cyanotic throughout.
What is your patient’s APGAR score?
A. APGAR 2
B. APGAR 3
C. APGAR 0
D. APGAR 1
7. Regarding the scenario in the question above, when would you reassess the

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APGAR?
A. 2 minutes after the previous APGAR assessment
B. 15 minutes after the previous APGAR assessment
C. 5 minutes after the previous APGAR assessment
D. No reassessment of the APGAR score is needed.
8. A newborn's five minute APGAR score is 5. Which of the following nursing
interventions will you provide to this newborn?*
A. Routine post-delivery care
B. Continue to monitor and reassess the APGAR score in 10 minutes.
C. Some resuscitation assistance such as oxygen and rubbing baby’s back
and reassess APGAR score.
D. Full resuscitation assistance is needed and reassess APGAR score.

Chapter 14: Anatomy of the female genital

tract, bonypelvis and fetal skull

1. Diagonal conjugate diameter is defined as:

A. Antero-posterior diameter of pelvic inlet that extends from lower border of
symphysis pubis to the tip of sacral promontory. (12.5cm)
B. Antero-posterior diameter of pelvic inlet that extends from most bulging
point on the back of symphysis pubis to the tip of sacral promontory.
(10.5cm)
C. Antero-posterior diameter of pelvic inlet that extends from upper border of
symphysis pubis to the tip of sacral promontory. (11cm)
D. Antero-posterior diameter of pelvic outlet that extends from lower border
of symphysis pubis to the tip of sacrum. (11cm)
2. During clinical pelvimetry of a pregnant Primigravida; the diagonal conjugate
diameter is 12.6cm. Therefore the anatomical conjugate diameter is:
A. 11.1cm
B. 11cm
C. 10.5cm
D. 10cm
3. What is the type of pelvis if the inlet is triangular, side walls of the cavity are
convergent and subpubic angle is narrow?
A. Gynaecoid
B. Anthropoid
C. Android
D. Platypelloid
4. The only pelvis with AP diameter more than transverse diameter is:
A. Gynaecoid
B. Anthropoid
C. Android
D. Platypelloid

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5. What is the type of pelvis if the inlet is slightly transverse ova, parallel side walls
of the shallow cavity with optimal wide subpubic angle 90-100?
A. Gynaecoid
B. Anthropoid
C. Android
D. Platypelloid
6. What is the most common type of female pelvis?
A. Gynaecoid
B. Anthropoid
C. Android
D. Platypelloid
7. What is the Thom's role or dictum?
A. The sum of Bituberous and Posterior Sagittal Diameters should be > 15cm
to allow delivery of an average sized head
B. The sum of interspinous and anterior Sagittal Diameters should be > 15cm
to allow delivery of an average sized head
C. Distance between the midpoint of inferior border symphysis pubis and the
edge of a round disc of diameter 9.4 cm. (Waste space of Morris)
D. Obstetric AP diameter of pelvic outlet
8. Diagonal conjugate is defined as the distance between:
A. Lower border of symphysis pubis and tip of sacrum
B. Upper border of symphysis pubis and the sacral promontory
C. Lower border of symphysis pubis and the sacral promontory
D. Lower border of symphysis pubis and the third piece of sacrum
9. The shortest diameter of fetal head is:
A. Biparietal diameter
B. Suboccipitofrontal diameter
C. Occipitofrontal diameter
D. Bitemporal diameter
10. Anterior Asynclitism is diagnosed when:
A. Sagittal suture approaches the sacral promontory
B. Sagittal suture approaches the symphysis
C. Sagittal suture is oblique in the pelvis
D. Head is deflexed
11. During PV examination of a pregnant Primigravida in labor; lowermost portion of
presenting fetal part is felt at ischial spine. This means that the station is:
A. zero
B. -1
C. +1
D. -2
12. Partogram is a graphic record of:
A. Fetal growth
B. Fetal well being
C. Labor events
D. Involution
13. Internal rotation of the fetus occurs:
A. At brim of the pelvis
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B. As the head reaches the pelvic floor/ at the level of ischial spine
C. At the outlet
D. During delivery of the head
14. Regarding angle of inclination; all the following are correct EXCEPT:
A. Angle between plane of pelvic inlet and horizontal (55°).
B. Assessed radiographically, by measuring the angle between the front of the
L5 vertebra and plane of inlet and subtracting this from 180°.
C. Increased angle of inclination causes delayed engagement& descent of
fetal head
D. Decreased angle of inclination Favors occipitoposterior position
15. Information's obtained from lateral plate X-ray pelvimetry involves all the following
EXCEPT:
A. Sacral curve
B. True conjugate diameter of the inlet
C. Bispinous diameter
D. Pelvic inclination
16. Cephalopelvic disproportion (CPD) is best assessed by:
A. Ultrasound
B. CT scan
C. Clinical pelvic assessment (tests of Cephalopelvic disproportion)
D. X-ray pelvimetry
17. If both ala of the sacrum are absent the pelvis is termed:
A. Naegele’s pelvis (absence of one sacral ala)
B. Robert's pelvis
C. Rachitic pelvis
D. Triradiate pelvis
18. It is best to use ................. to judge the adequacy of the pelvis for labor:
A. Trial of labor
B. CT scan
C. X-ray pelvimetry
D. Clinical pelvimetry

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Chapter 15: Labor and Fetal Surveillance and

Mechanism ofLabor:
1. Hyperextension of the fetal head is found in:
A. Vertex presentation
B. Face presentation
C. Shoulder presentation
D. Breach presentation
2. Cardinal movements of labour are: [PGI 00]
A. Engagement → descent → flexion → internal rotation → extension → restitution → external
rotation → expulsion
B. Engagement → flexion → descent → internal rotation → extension → expulsion
C. Engagement → flexion → descent → external rotation → expulsion
D. Engagement → extension → internal rotation → external rotation → expulsion
3. Stages of labor
A. The first stage commences at the time of membrane rupture
B. The cervix dilates at consistent rate of 3 cm per hour in the first stage
C. Forceps or ventose may be useful in slow progress of the late 1st stage
D. The third stage end with the delivery of the placenta and membranes
E. Syntometrine is a combination of oxytocin and Ergometrine which is
used in the treatment of secondary postpartum hemorrhage (PPH)
4. Which of the following characteristics indicated that the pelvis is
unfavorable to vaginaldelivery? (Contracted pelvis)
A. Obstetric conjugate is less than 10 cm
B. Sacral promontory cannot be felt.
C. Ischial spines are not prominent.
D. Subpubic arch accepts 2 fingers.
E. Inter-tuberous diameter accepts 4 knuckles on pelvic exam.
5. Fetal lie means:
A. Passage of the widest transverse diameter of presenting part through pelvic inlet.
B. Overlapping of fetal skull bones.
C. Fetal lie describes the long axis of the fetus to the long axis of the mother.
D. The relationship of the fetal parts to one another.
6. The second stage of labor is defined as a stage of:
A. Expulsion of the fetus
B. Separation of the placenta.
C. Effacement of the cervix.
D. Expulsion of the placenta.
E. Dilation of the cervix.
7. If the pelvis has small posterior sagittal diameter, convergent sidewalls,
prominent ischial spines, and narrowpubic arch; It is termed:
A. Android pelvis.
B. Gynaecoid pelvis.
C. Anthropoid pelvis.
D. Platypelloid pelvis.

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.
8. A pelvic inlet is felt to be contracted if :
A. The anterior-posterior diameter is only 12 cm.
B. Sacral promontory can be easily felt during vaginal examination.
C. The mother is short.
D. Thom's role or dictum< 15 cm (The sum of Bituberous and Posterior Sagittal
Diameters)
9. Prolong latent phase is/are seen in:
A. Placenta praevia
B. Abruptio placentae
C. Unripe cervix/ Excessive sedation/ Early epidural analgesia
D. Effective uterine contraction
10. What is the only type of pelvis with anterior-posterior diameter more than its transverse
diameter?
A. Gynaecoid
B. Android.
C. Anthropoid pelvis.
D. Platypelloid pelvis
11. What is the least common type of female pelvis?
A. Gynaecoid
B. Android.
C. Anthropoid pelvis.
D. Platypelloid pelvis
12. During clinical pelvimetry, which of the following is routinely measured:
A. Bi-ischial diameter.
B. Transverse diameter of the inlet.
C. Shape of the pubic arch. (subpubic angle)
D. Flare of the iliac crest.
E. Elasticity of the Levator muscles.
13. Obstetric axis is an imaginary line corresponds to the course taken by
fetal head during its passage through the pelvic cavity. This axis is best
described as:
A. A straight line.
B. A curved line, 1ST directed anteriorly then caudal.
C. J-shaped as the fetal head descends downward & backward up to ischial spin then
passes downward & forward.
D. A curved line runs parallel to the sacral curve.
E. None of the above.
14. If four- fifth (4/5) of the fetal head is palpable per abdomen, this indicates that:
A. Four-fifth of the head is below the pelvic brim.
B. Indicates that the head is engaged.
C. Indicated that forceps may be used safely.
D. Indicates that the lowermost part of fetal head is at the level of the ischial spines.
E. Non-engagement of the fetal head.
15. A female at 35 weeks of gestation has mild labour pains for 10 hours and cervix
is persistently 1 cm dilated but non-effaced. What will be the next appropriate
management?
A. Sedation and wait
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B. Augmentation with oxytocin
C. Cesarean section
D. Amniotomy & Augmentation with oxytocin
16. Commonest cause of non-engagement of fetal head at term, in primi is:
A. Cephalo-pelvic disproportion (CPD)
B. Polyhydramnios
C. Brow presentation
D. Hydrocephalus
17. Which of the following is a criterion for False labour pain?
A. Uterine contraction are regular with progressively increasing frequency ,
intensity and duration
B. It is not associated with cervical dilatation.
C. Formation of the bag of waters
D. Progressive descent of presenting part
E. Cervical dilatation
18. What is the best method to assess the progress of labour?
A. Station of head
B. Rupture of membrane
C. Contraction of uterus
D. Partogram
19. Mrs Mona G3 P2 a full term pregnant female is admitted in labor. On
examination, she has uterine contractions 2 in 10 minutes, lasting for 30-35
seconds.
On P/A examination 3/5th of the head is palpable per abdomen.
On P/V examination-cervix is 4 cm dilated & membranes are intact.
On repeat examination 4 hours later, cervix is 5 cm dilated, station is
unchanged, and cervicograph remains to the right of the alert line. Which of
the following statements is true?
A. The head was engaged at the time a of presentation
B. Her cervicographical progress is satisfactory
C. Protracted active phase dilatation is defined as a cervical dilatation of
less than 1 cm per hour. Her cervicographical status suggests
intervention
D. On repeat examination, her cervicograph should have touched the
action line
20. Percentage of women who deliver on the expected date of delivery:
A. 4%
B. 15%
C. 50% (within one week)
D. 80% (within 2 weeks)
21. What is the average rate of cervical dilatation during active phase of labour in
primi?
A. 1.2 cm/hour
B. 1.5 cm/hour
C. 1.7 cm/hour
D. 2 cm/hour
22. What is the Living ligature of the uterus?
A. Endometrium
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B. Middle layer of myometrium
C. Inner layer of myometrium
D. Perimetrium
23. What are the Signs of Placental separations during 3rd stage of labor?
A. A gush of Bleeding.
B. The fundus of uterus rises up due to descent of placenta and the uterus becomes
firm globular.
C. Lengthening of the umbilical cord and traction on the cord is not transmitted to
the fundus.
D. Presentation of the placenta at the cervical os.
E. All of the above.
24. Spontaneous vaginal delivery at term is usually incompatible with the
persistence of which of the following fetal positions:
A. Occiput left posterior
B. Mentum posterior.
C. Mentum anterior.
D. Occiput anterior.
E. Sacrum posterior.
25. The relation of the fetal parts to one another determines:
A. Presentation of the fetus.
B. Lie of the fetus.
C. Attitude of the fetus.
D. Position of the fetus.
26. The relationship of the long axis of the fetus to the long axis of the mother is
called:
A. Lie.
B. Presentation.
C. Position.
D. Attitude.
27. Engagement is defined as:
A. When the presenting part goes through the pelvic inlet.
B. When the presenting part is at the level with the ischial spines.
C. When the greatest Biparietal diameter of the fetal head passes the pelvic
inlet.
D. When the greatest Biparietal diameter of the fetal head is at the level of
ischial spines
28. The denominator is a bony landmark on the presenting part used to denote the
position. In a vertex presentation, the position is determined by the
relationship of whatfetal part to the Mother's pelvis:
A. Mentum.
B. Sacrum.
C. Acromian.
D. Occiput.
E. Sinciput.

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.
29. The fetal head may undergo changes in shape during normal delivery due
to overlapping of skull bones. This is termed:
A. Cephalohematoma.
B. Subdural hematoma.
C. Molding.
D. Hydrocephalus.
E. None of the above.
30. If the large fontanel is the presenting part, what is the presentation?
A. Vertex.
B. Sinciput
C. Face.
D. Brow.
31. We can determining fetal presentation & position clinically by:
A. Cullen's sign.
B. Leopold's maneuver.
C. Mauriceau-Smelli-Veit maneuver.
D. Carful history taking.
32. A transverse lie of the fetus is least possible in the presence of:
A. Normal term fetus.
B. Placenta previa.
C. Pelvic contraction.
D. Preterm fetus.
E. Grand Multiparity.
33. What is the station where the lowermost bony part of the presenting part is at
the level of the ischial spines
A. - 2
B. -1.
C. 0.
D . +1 .
E . +2 .
34. Compared with a mid-line episiotomy the medio-lateral episiotomy has an
advantage of:
A. Ease of repair
B. Fewer break downs
C. Lower blood loss
D. Less dyspareunia
E. Less extension of the incision
35. A patient had a laceration of the premium during delivery; it involved the
muscles of perineal body but not the anal sphincter. Such a laceration would
be classified as :
A. First degree
B. Second degree
C. Third degree
D. Forth degree
36. A patient had a laceration of the premium during delivery; it involved the
muscles of perineal body and the anal sphincter. Such a laceration would be

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classified as :
A. First degree
B. Second degree
C. Third degree
D. Forth degree
37. An unstable lie is associated with all the following EXCEPT :
A. Prematurity
B. Grand Multiparity
C. Placenta previa
D. Fundal fibroid
E. Cervical fibroid
38. Which of the following statements about episiotomy is FALSE?
A. Median (midline) episiotomy is generally considered to be less painful
than medio-lateral episiotomy.
B. Medio-lateral or lateral episiotomy may be associated with more
bloodloss than median one.
C. Indications for episiotomy include avoiding an imminent perineal tear,
the use of forceps, breech delivery, & the delivery of premature
infants.
D. The earlier the episiotomy is done during delivery, generally the more
beneficial it will be un speeding delivery.
E. Episiotomy incisions are repaired anatomically in layers.
39. What is an episiotomy?
A. It is an incision made in the perineum to widen the birth canal to ease vaginal
delivery.
B. A medication given for pain during childbirth.
C. It is a surgical procedure used to deliver a baby through incisions in the abdomen
and uterus.
D. An injection given to numb the perineum.
40. Timing of Episiotomy is:
A. It is done after the head crown appear (crowning).
B. It is done after head engagement.
C. After delivery of the placenta
D. During 1st stage of labor
41. Define the first stage of labor:
A. Start with onset of labor and ends with fully Dilation of the cervix
B. Starts with full cervical dilatation and ends with fetal delivery.
C. Starts with fetal delivery and ends with expulsion of placental & membranes.
D. Stage of 2 hours observation after 3rd stage of labor.
42. What is the heart rate of a normal fetus
at term:
A. 80-100 bpm.
B. 100-120 bpm.
C. 120-160 bpm.
D. 160-180 bpm.
43. Which of the following is abnormal finding in normal labor:
A. Progressive cervical dilation.
B. Increasing intensity of contractions.
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C. Uterine relaxation between contractions.
D. Moderate bleeding.
E. Moderate pain.
44. Bishop score includes all the following parameters EXCEPT:
A. Dilation of the cervix.
B. Position of the cervix.
C. Type of the presenting part of the fetus.
D. Effacement of the cervix.
E. Consistency of the cervix.
45. Regarding functions of Prostaglandins:
A. Maintain the corpus luteum of early pregnancy.
B. Have no role in the development of menorrhagia.
C. Are involved in the onset of labor.
D. Have no rule in the development of dysmenorrhea.

46. Early deceleration is :

A. Associated with unengaged head of the fetus.
B. Associated usually with brain asphyxia.
C. A decrease in the fetal heart beat that peaks after the peak of uterine
contraction.
D. An indication of C-section.
E. Results from increased vagal tone secondary to head compression.
47. The normal cord pH is:
A. 6.1.
B. 6.2.
C. 7.0.
D. 7.1.
E. 7.2.
48. The bishop score is used to predict :
A. The state of the fetus at the time of delivery.
B. The success rate of the induction of the labor.
C. The fetal condition in the uterus.
D. The maternal wellbeing in labor.
E. The maternal wellbeing postpartum.
49. Which of the following fetal scalp pH results indicates immediate
delivery:
A. 7.30.
B. 7.22.
C. 7.18.
E. 7.25
50. The volume of amniotic fluid is:
A. Maybe predicted by Ultrasound (AFI or length of deep vertical pocket)
B. Is reduced in sever rhesus disease
C. Increases following amniocentesis
D. Is increased in sever preeclampsia
E. Is closely related to the fetal crown-rump length in the 3rd trimester ofPregnancy

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51. The best method to diagnose Cephalo-pelvic disproportion in the absence of

gross pelvic abnormality is:
A. Ultrasound.
B. A maternal stature of less than 158 cm.
C. Trial of labor.
D. X-ray pelvimetry.
E. Pelvic examination.
52. Maternal mortality is lowest in mothers between what age groups:
A. 10 - 20.
B. 20 - 30.
C. 30 - 40.
D. 40 - 50.
E. 50 - 60.
53. Umbilical cord prolapse is associated with all the following, EXCEPT :
A. Post maturity.
B. Cephalo pelvic disproportion.
C. Multiparity.
D. Footing breech presentation.
E. Polyhydramnios.
54. What is the next step management if meconium stained amniotic fluid is observed after
artificial rupture of membrane during induction of labor?
A. Amnio-infusion
B. Close observation
C. Fetal scalp blood sample
D. Immediate C/S

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Chapter 16: Malposition & Malpresentation

1. What is the commonest type of fetal presentation?
A. Breech
B. Shoulder
C. Brow
D. Vertex
2. What is the commonest cause of breach presentation?
A. Prematurity.
B. Contracted pelvis
C. Placenta previa
D. Oligohydraminos
3. Compound presentation is most consistently associated with :
A. Prematurity.
B. Advanced maternal age Uncoordinated uterine contractions.
C. Diabetic pregnant woman.
D. Large pelvic vessels.
4. Complete breech means:
A. Flexion at hip joint and extension in knee joint
B. Flexion at hip joint and flexion at knee joint
C. Extension at the hip joint
D. Flexion at knee joint and extension at the hip joint
E. Flexion of one leg at hip joint and extension of the other leg at the hip
joint
5. Loveset maneuver is useful for management of breech with:
A. Extended legs
B. Flexed legs
C. Extended arm
D. Nuchal displacement of arm
6. What is the fetal presentation when on per vaginal examination, the anterior fontanelle
and supraorbital ridge is felt in the second stage of labour?
A. Brow presentation
B. Deflexed head
C. Flexed head
D. Face presentation
7. What is the percentage of breach presentation at term?
A. 1%
B. 3.5%
C. 7%
D. 97%
8. What is the engaging diameter in brow presentation?
A. Mento-vertical
B. Mento bregmatic
C. Suboccipito bregmatic
D. Occipitofrontal

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9. Which of these techniques is not used for delivery of after coming head in breech
presentation?
A. Burns-Marshall method
B. Forceps delivery
C. Modified Mauriceau-Smelli-Veit technique
D. Lovset’s maneuver
10. A 30-year-old multigravida presented with transverse lie with hand prolapse in 2nd stage
of labour with dead fetus. The treatment of choice is:
A. Classical cesarean section
B. LSCS
C. Craniotomy
D. Decapitation
11. What is the Diameter of engagement in face presentation when the face is fully
extended?
A. Mentovertical
B. Submentovertical (engaging diameter when the face is not fully extended) 11.5cm
C. Suboccipitobregmatic
D. Submentobregmatic (9.5cm)
E. Suboccipitovertical
12. What is the most unfavorable presentation for vaginal delivery?
A. Mento posterior
B. Mento anterior
C. Occipito posterior
D. Deep transverse arrest
13. What is route of delivery of transverse lie?
A. Artificial rupture of membrane
B. Oxytocin infusion
C. Cesarean section
D. Forceps delivery
14. What is the best management in mento-posterior presentation?
A. Vaginal delivery
B. Forceps delivery
C. Manual rotation
D. Caesarean section
15. Which of the following is a cause of recurrent breech presentation?
A. Multiparity
B. Polyhydramnios
C. Congenital uterine anomaly
D. Placenta previa
16. Occipitoposterior represents 20% of vertex presentation in which the occiput is directed
backward and the head shows certain degree of deflexion. What is the commonest
cause of occipitoposterior position of fetal head during labor?
A. Maternal obesity
B. Multiparity
C. Deflexion of fetal head
D. Android pelvis
17. Bandl’s ring is seen in which of the following conditions:
A. Premature labor
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B. Precipitate labor
C. Obstructed labor
D. Injudicious use of oxytocic
18. What is the first maneuver to be done in case of shoulder dystocia?
A. McRoberts
B. Wood’s corkscrew
C. Lovset's
D. Zavanelli
19. A 25-year-old G2P1 woman at 40 weeks’ gestation is obese and diabetic. She is in labor
that progresses through the stages of labor normally. During delivery of the infant, the
head initially progresses beyond the perineum and then retracts. Gentle traction does
not facilitate delivery of the infant. Which of these options is the first step in the
management?
A. Abduct mothers thigh and apply Suprapubic pressure
B. Apply fundal pressure
C. Flex mothers thigh against her abdomen while she is lying on her back
D. Push infants head back into the uterus and do cesarean section
E. Do a symphiosotomy.
20. A 27-year-old G2P1 woman at 40 weeks’ gestation has previous LSCS. She is in labor and
presented with Hematuria which is sign of:
A. Impending rupture of scar
B. Urethral trauma
C. Prolong labour
D. Sepsis
21. Breech presentation: Which is true?
A. Forceps can be used for after coming head
B. Constitutes 10% of all term deliveries
C. Common in post term labor
D. Vacuum extraction can be used when cervix is fully dilated
E. External cephalic version is best performed between 32-34 weeks
gestation.
22. Which of the following is contraindication for delivery using vacuum
extraction?
A. Second twins in vertex presentation
B. post term pregnancy
C. Face presentation
D. Occipito transverse position
E. Chorioamnionitis

23. 35-year-old female comes with obstructed labor and is febrile and dehydrated with
IUFD and cephalic presentation. Which is the best (safest) way to manage?
A. Cesarean section
B. Craniotomy
C. Decapitation
D. Forceps extraction
24. Umbilical cord prolapse is most likely to occur with:
A. Frank breech.
B. Complete breech.
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C. Single footling breech.

D. Double footling breech.
25. The most frequent severe complication of vaginal breech delivery:
A. Cord prolapse.
B. Spinal cord injury.
C. Head entrapment (retained after-coming head).
D. Cord avulsion.
E. Placental Separation
26. The least incidence of uterine rupture occurs with:
A. One LSCS (0.2- 0.9%)
B. Classical section (2- 9%)
C. Inverted T shaped incision (4- 9%)
D. Low vertical incision (1-7%)
E. Multiple LSCS (0.9-1.8%)
27. Presence of Bandl’s ring on the uterus in labor suggests:
A. Cervical dystocia
B. Colicky uterus
C. Hypertonic lower uterine segment
D. Obstructed labour
28. The major cause of serious neonatal morbidity & mortality for infants with
breech presentation is:
A. Birth trauma.
B. IUGR.
C. Cord prolapse.
D. Associated congenital anomalies.
E. Cerebral palsy.
29. The most common complication of External Cephalic Versions:
A. Placental separation. (most serious)
B. Fetomaternal hemorrhage.
C. Non reassuring fetal heart rate (Persistent fetal bradycardia).
D. Inability to convert the fetus to the vertex presentation.
E. Reversion of the fetus to breech presentation.
30. Which of the following is not a possible cause of breech presentation?
A. Sub-serous fundal fibroid
B. Prematurity
C. Multiple pregnancy
D. Placenta previa
E. Bicornuate uterus
31. Which of the following is contraindicated for delivery using Vacuum
extraction?
A. Face presentation
B. 38 weeks gestation
C. Chorioamnionitis
D. Post-term pregnancy

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32. In breech presentation:
A. Frank breech is the commonest type.
B. Brachial plexus injury is a recognized complication.
C. Prolapse of the umbilical cord can occur.
D. Fetal mortality is increased.
E. All of the above.
33. External cephalic version (ECV) is the trans-abdominal manual rotation of breach fetus
into cephalic presentation, It is best to be performed between 34-36 weeks of
gestation. The breech presentation at term after ECV is:
A. 1- 1.5%
B. 5%
C. 10%
D. 50%
34. What is the false regarding Breech presentation?
A. Accounts for up to 3.5 % term pregnancies
B. May be diagnosed on clinical examination of the abdomen
C. May be associated with fetal anomaly
D. Is a contraindication for vaginal delivery
E. Makes Intrapartum hypoxia more likely than is true of
cephalicpresentation
35. An infant presents as a breech presentation and delivered without assistance
as far as the umbilicus. The reminder of the body is manually assisted by the
obstetrician. This is called :
A. Version and extraction
B. Spontaneous breech delivery
C. Assisted breech delivery
D. Total breech extraction
E. Pipers of the after-coming head
36. At 40 week gestation, a fetus was felt to be breech presentation diagnosed
through Leopold's maneuvers and confirmed by ultrasonography scan. The
breech is engaged, and the uterus was irritable. Pelvimetry was within normal
limits and the estimated fetal weight was 4.4 kg. Which of the following
should be done?
A. Cesarean section
B. External cephalic version
C. Internal podalic version
D. Oxytocin induction
37. All are causes of breech EXCEPT:
A. Prematurity.
B. Increased maternal age.
C. Congenital anomalies.
D. Hydrocephalus.
E. Pelvic tumor.
38. The following are contraindication to external cephalic version, EXCEPT:
A. Contracted pelvis
B. Placenta previa
C. Multiple pregnancy

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D. Presence of cervical suture in site (cerclage)
E. Scared uterus
39. A 24-year-old G1 P0, Rh-negative, 36 weeks a breech presentation and is
considering external cephalic version. She should be told :
A. She should be offered general anesthesia
B. The procedure can be done with Oligohydraminos
C. Prophylaxis with anti-globulin D can wait until after delivery
D. Engagement of the presenting part is not considered a contraindication
to version
E. Tocolysis with intravenous Ritodrine has been shown to improve the
results of external version + Prophylaxis with anti-D immunoglobulin
40. External cephalic version is contraindicated in all of these conditions EXCEPT
A. Scarred uterus
B. Multiple pregnancy
C. Placenta previa
D. Severe maternal hypertension
E. Gestational diabetes

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Chapter 17: Multiple Pregnancy:

1. According to Hellin’s law chances of Triplet pregnancy are:
A. 1 in 60
B. 1 in 80
C. 1 in (80)²
D. 1 in (80)³
2. Monochorionic monoamniotic twin occurs if division occurs:
A. <3 days (Dichorionic Diamniotic)
B. 4-8 days (Monochorionic Diamniotic)
C. > 8 days (Monochorionic Monoamniotic)
D. >14 days (Conjoined Twin)
3. Multiple pregnancy increases with:
A. White people more than black
B. Increasing maternal age
C. With Bromocriptine use for infertility treatment
D. Decreasing parity
E. After ovarian diathermy for polycystic ovary syndrome
4. The most common cause of uterine size-date disproportion:
A. Fetal macrosomia
B. Polyhydramnios
C. Inaccurate last menstrual period date
D. Multiple pregnancy
E. Molar pregnancy
5. In superfecundation which of the following is seen:
A. Fertilization of 2 ova released at same time, by sperms released at intercourse on 2
different occasions
B. Fertilization of two ova released in different menstrual cycles (Superfetation)
C. Fertilization of 2 ova released at same time by sperms released at single intercourse
D. High chance of achieving multiple pregnancies.
6. Which of the following is known to be the commonest presentation in twins?
A. Breech, cephalic
B. Cephalic, breech
C. Cephalic, cephalic
D. Breech, breech
E. Cephalic, transverse
7. The risk of postpartum uterine atony is associated with:
A. Hypotension.

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B. Epidural anesthesia.
C. Median episiotomy.
D. Twin pregnancy.
E. Labor associated with an active rate of change of 2.3 cm per hour.
8. In twin deliveries: Which is true?
A. The first twin is at greater risk than the second
B. They usually go post date
C. Epidural analgesia is best avoided
D. Commonest presentation is cephalic and second breach
E. There is increased risk of postpartum hemorrhage
9. The most common cause of perinatal death in mono-amniotic twin is:
A. Cord entrapment.
B. Cord prolapse.
C. Twin-twin transfusion syndrome.
D. Lethal congenital anomalies.
E. Placental abruption
10. The major cause of the increased risk of morbidity & mortality among twin gestation
is:
A. Gestational diabetes.
B. Placenta previa.
C. Malpresentation.
D. Preterm delivery.
E. Congenital anomalies.
11. Regarding Hyperemesis gravidarum, which one of the following items is TRUE?
A. Is a complication of multiple pregnancy
B. Not known to happen in molar pregnancy
C. Worsen in missed abortion
D. Liver function test is not required
E. Urine for culture and sensitivity is not important
12. Twins can be diagnosed by :
A. Large uterus after delivery of the first twin
B. Uterus bigger than date during pregnancy
C. Ultrasonography
D. Auscultation
E. All answers are possible
13. Monozygotic twins, All of the following are correct EXCEPT :
A. Has a constant incidence of 1:250 births
B. Has a constant incidence 1:600 births
C. Is not related to induction of ovulation

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D. Constitutes 1/3 of twins
E. Is not affected by heredity
14. What is the most appropriate route for delivery in twins If twin A is in a transverse lie
& twin B is vertex?
A. C-section.
B. Internal podalic version followed by breech extraction.
C. Both
D. Neither.
15. Which of the following is not a complication of multiple pregnancy?
A. Increase incidence of preeclampsia
B. Polyhydramnios
C. Increase incidence of preterm labor
D. Increase incidence of gestational diabetes
E. Increase incidence of placenta previa
16. Selective fetal reduction in multiple pregnancy by intra-cardiac injection of potassium
chloride under ultrasonic guidance is done at :
A. 8-10 weeks
B. 11-13 weeks
C. 13-15 weeks
D. 16-18 weeks
17. A 26-year-old primigravida with a twin gestation at 30 weeks presents for a USG. The
sonogram indicates that the fetuses are both male and the placenta appears to be
diamniotic and Monochorionic. Twin B is noted to have AFI < 5cm and to be much
smaller than twin A. In this clinical scenario ,all of the following are concerns for twin A
EXCEPT:
A. Congestive Heart Failure
B. Anemia
C. Polyhydramnios
D. Widespread thrombosis
18. Multiple Gestation is frequently associated with all of the following EXCEPT:
A. Hypertension.
B. Hydramnios.
C. Fertility drugs.
D. Post-maturity.
E. Pre-term labor
19. Excessive increased level of β-HCG is expected in :
A. Ectopic pregnancy.
B. Pregnancy of diabetic mothers.
C. Twin pregnancy.
D. Incomplete abortion.

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E. Cervical carcinoma.
20. Uncomplicated triplet should be delivered by:
A. 34 weeks
B. 35 weeks
C. 37 weeks
D. 38 weeks
21. The following are true for dizygotic twins EXCEPT:
A. Fertilization of more than one egg by more than one sperm
B. Most common type of twins represents 2/3 of cases
C. Both twins are identical & of the same sex.
D. There are two Chorions & two amnions
E. Placenta may be separated or fused
22. Blood chimerism is maintained by: (A chimerism is defined as an organism that contains
different cells derived from two or more distinct zygotes.)
A. Monochorionic dizygotic twins
B. Dichorionic dizygotic twins
C. Vanishing twins
D. Monochorionic monozygotic twins
23. Regarding twin pregnancies all of the following are correct EXCEPT:
A. It has a higher incidence of preterm labor
B. Mal-presentation of one of the main factors leading to increase incidence of C/S
C. Abruptio placenta may occur with the sudden decompression of the uterus
immediately after delivery of the first twin
D. Dexamethasone is useful in case preterm labor
E. Identical or monozygotic twin arise from fertilization of two ovum
24. The following factors affect the incidence of dizygotic multiple pregnancy EXEPT :
A. Induction of ovulation
B. Increase maternal age
C. Heredity
D. Race
E. Nulliparity
25. Monochorionic monoamniotic twin (MCMA) twins have a high risk of fetal death
due to cord entangling and should be delivered by caesarean section:
A. Between 32+0 and 34+0 weeks
B. > 35 weeks
C. 37 weeks
D. 40 weeks
26. Selective fetal growth restriction is defined as:
A. A twin pregnancy in which one fetus has EFW<10th centile and the intertwine

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EFW discordance is>25%
B. A twin pregnancy in in which both twins have EFW<10th centile
C. EFW discordance is>25% between twins
D. Constitutional Small Fetus
27. Twin peak sign seen in:
A. Monochorionic diamniotic
B. Dichorionic monoamniotic
C. Conjoined twins
D. Diamniotic dichorionic

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Chapter 18: OPERATIVE OBSTETRICS

1. A woman delivers a 4kg infant with a midline episiotomy and suffers a third degree
tear. Inspection shows which of the following structures is intact:
A. Anal sphincter
B. Rectal mucosa
C. Perineal body
D. Perineal muscle
2. A woman delivers a 4kg infant with a midline episiotomy and suffers a tear involving
anal sphincter and anorectal mucosa. What is the degree of perineal tear?
A. 1st degree (perineal skin)
B. 2nd degree (perineal muscles not sphincter)
C. 3rd degree( anal sphincter)
D. 4th degree
3. Obstructed labor: Which is true?
A. Diagnosis only when the cervix is fully dilated
B. Usually predicted before onset of labor
C. More common in developed countries
D. Mento-posterior position could be a cause
E. X-ray pelvimetry is essential to predict cephalo-pelvic disproportion in
Primigravida
4. Which of the following is an absolute indication to caesarean section?
A. Previous uterine scar
B. Transverse lie
C. Breech
D. Vaginal atresia
5. Which is the best uterine scar in a patient having Caesarian section?
A. Transverse upper segment
B. Longitudinal upper segment
C. Transverse lower segment
D. Longitudinal lower segment
E. A T-shaped incision
6. Which of the followings is a contraindication to a trial of labor after cesarean delivery?
A. Previous classical incision.
B. Previous LSCS.
C. Previous IUFD.
D. Ultrasound estimation of fetal weight of 3500g.
7. Which of the following is a contraindication of Forceps delivery?
A. Deep transverse arrest

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B. After coming head
C. Brow presentation
D. Maternal heart disease
8. Ventouse in 2nd stage of labour is contraindicated in:
A. Persistent Occipito-posterior position (AI 00)
B. Heart disease
C. Uterine inertia
D. Preterm labour
9. Prolapse of umbilical cord: Which is true?
A. Not an indication for caesarean section when baby viable at 36 weeks
B. Diagnosed when membranes are still intact
C. Is more common when fetus acquires an abnormal lie
D. Incidence is 5%
10. Which of the following is not a basic component of an obstetric forceps?
A. Blade
B. Handle
C. Lack
D. Stem
E. Shank
11. Which instrument is not a basic of a laparoscopic set :
A. Abdominal Trocar
B. Hegar dilator
C. Veress needle
D. Light source
E. CO2 inflation set.
12. Which of the following obstetric forceps facilitates is used for correction of Asynclitism
of head?
A. Long curved obstetric forceps
B. Short curved obstetric forceps
C. Keilland’s forceps
D. Piper’s forceps
13. The lower segment of the uterus is physically identified during cesarean section, by:
A. Loose attachment of visceral peritoneum
B. Dilated venous sinuses
C. Deflection of uterine artery towards upper segment
D. Thinness of its wall as compared to the upper segment
14. Which one of these is an absolute indication for Caesarian section?
A. Twin pregnancy
B. Breech presentation
C. Severe PET
D. Major degree placenta previa

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E. IUGR
15. Indications for instrumental delivery include all the followings EXCEPT:
A. Prolonged second stage of labor.
B. Fetal distress.
C. Transverse lie.
D. Breech presentation.
E. Maternal cardiac disease
16. Which of the following is not an Immediate complication of C-section ?
A. Complications of anesthesia.
B. Bladder injury.
C. Thromboembolism.
D. Colon injury.
E. Hemorrhage
17. Head engaged and reached the pelvic floor. The treatment indicated in this obstetric
situation is:
A. Outlet forceps
B. High forceps
C. Mid forceps
D. Low forceps
18. Prerequisites for instrumental delivery include all the followings EXCEPT:
A. Cephalic presentation
B. Engaged head.
C. Full dilation of the cervix.
D. Rupture of membranes.
E. The presence of epidural analgesia
19. All are contraindications to VBAC except:
A. Lower segment C-section
B. Classical C-Section.
C. Rupture uterine
D. Contracted pelvis
20. What is the only indication for internal podalic version in modern obstetrics?
A. Delivery of second baby of twins
B. Oblique lie
C. Transverse lie
D. Breech presentation
21. Which of the following neonatal morbidities is not related to forceps delivery?
A. Fractured skull
B. Sepsis
C. Nerve palsies
D. Cephalohematoma
E. Intracranial hemorrhage

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22. Pre-requisite for instrumental delivery include all of the following EXCEPT:
A. Cervix fully dilated.
B. Ruptured membranes.
C. Fetal head engaged.
D. Fetal head at -2 station.
E. Empty catheterized bladder.
23. A newborn is noted to have a soft pitting swelling of the scalp that crosses skull
sutures. It is present at birth and resolve spontaneously within 24-48h.This is most
probably a:
A. Caput succedaneum.
B. Subdural hemorrhage.
C. Cephalohematoma.
D. Subarachnoid hemorrhage.
E. Tentorial tear.
24. A newborn is noted to have a darkened swelling of the scalp that does not cross the
midline. This is most probably a:
F. Caput succedaneum.
G. Subdural hemorrhage.
H. Cephalohematoma.
I. Subarachnoid hemorrhage.
J. Tentorial tear.
25. Which of the following anesthetic technique will produce the greatest uterine
relaxation?
A. Spinal block.
B. Caudal.
C. Nitrous oxide.
D. Halothane.
E. Para-cervical.
26. What is the most common cause of anesthetic death in obstetrics :
A. Failed intubation.
B. Hemorrhage.
C. Stroke.
D. Reaction to medication.
E. Aspiration pneumonitis
27. The following are absolute indication for C-section EXCEPT:
A. Face presentation.
B. Shoulder presentation.
C. Cervical cancer.
D. Fibroids in the lower uterine segment.
E. Previous classical C-section.
28. Advantage of lower segment caesarean section over the classic incision includes:
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A. Ease of repair
B. Decreases blood loss
C. Lower probability of subsequent uterine rupture
D. Decreases danger of intestinal obstruction
E. All of the above

29. Keilland's forceps :

A. May be used if the head is not engaged
B. Have no cephalic curve
C. Have knobs on the shank which point towards the Sinciput
D. Have a sliding lock in the order to correct Asynclitism
E. Can be used with axis traction
30. Which of the following are absolute indications for Caesarean Section?
A. Hydrocephalus
B. Abruptio placenta
C. Preterm Labor
D. Active primary genital herpes
E. Sever preeclampsia

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Chapter 19: Puerperium and Puerperal Sepsis

1. Puerperium last for:
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. 8 weeks
2. Following delivery, uterus becomes a pelvic organ after:
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. 8 weeks
3. The hormone responsible for lactation is:
A. Estrogen.
B. Progesterone.
C. Prolactin.
D. HCG
4. Normal lactation is seen in:
A. Maternal anxiety
B. Antibiotic therapy
C. Cracked nipple
D. Breast abscess
E. Bromocriptine therapy
5. Regarding Puerperium:
A. The uterine fundus should not be palpable abdominally by 14 days after delivery
B. The incidence of postpartum depression is 50%
C. Refer to the first 6 months after delivery
D. The lochia usually persist for 7 weeks
E. Fever due to engorged breast occurs on the second day after delivery

.
6. What is the most common complication of breast feeding?
A. Puerperal mastitis.
B. Amenorrhea.
C. Pregnancy.
D. Excessive weight loss.
E. Breast abscess.

7. Oxytocin in the Puerperium is responsible for :

A. Involution of the uterus
B. Initiation of lactation
C. Resumption of menses
D. Sub-involution of the uterus
E. Postpartum mastitis

8. Which of the following is the greatest predisposing cause of puerperal infection?

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A. Coitus during late pregnancy
B. Poor nutrition
C. Retained placental tissue.
D. Maternal exhaustion
9. Involution of uterus takes – weeks:
A. 4
B. 6
C. 12
D. 20
10. In Puerperium the lochia seen p/v is in which of the following sequences:
A. Lochia alba-Lochia serosa-Lochia rubra
B. Lochia serosa-Lochia rubra-Lochia alba
C. Lochia alba-Lochia rubra-Lochia serosa
D. Lochia rubra-Lochia serosa- Lochia alba
11. In non-lactating female; the first menstrual flow usually begins........... weeks after delivery:
A. 2-4 weeks
B. 4-6 weeks
C. 6-8 weeks
D. 8-10 weeks
E. More than 10 weeks
12. What is the most common site of puerperal infection?
A. Episiotomy wound
B. Placental site
C. Vaginal laceration
D. Cervical laceration
13. Puerperal pyrexia is a rise of temperature ≥…………(degree F) measured orally on
separate occasions 24 hours apart (excluding the 1st 24h) within the first 10 days
following delivery.
A. 99
B. 99.5
C. 100
D. 100.4 F (38C®)
14. Postpartum amenorrhea -galactorrhea syndrome is :
A. Ahumada del Castillo
B. Ciari-formmel
C. Budd-chiari
D. Sheehan's
E. Simmonds
15. Postpartum depression is the most common psychiatric complication of childbirth, affecting 5%
to 15% of women who have recently given birth. If left untreated, postpartum depression is
associated with potentially adverse consequences for the mother, her infant, and her family.
What is the recurrence risk of postpartum depression?
A. 5%.
B. 20%.
C. 70%.
D. 95%.
16. Infectious maternal (puerperal) morbidity is defined as:
A. Death of mother.
B. High rectal temperature in the first ten days in one occasion.
C. Postpartum hemorrhage.
D. On oral temperature of 38_ C or more on 2 separate occasions during the first
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24 days postpartum.
E. On oral temperature of 38_ C or more on 2 separate occasions during the first
10 days postpartum.
17. The most common bacteria isolated from cases of puerperal infection is:
A. E.coli.
B. Anaerobic streptococcus.
C. Anaerobic staphylococcus.
D. Aerobic streptococcus.
E. Clostridium perfringens.
18. Immediately after the completion of a normal labor, the uterus should be :
A. Firm & contracted at the level of the umbilicus.
B. At the level of the symphysis pubis.
C. Immobile.
D. Atonic.
E. Boggy
19. Postpartum, the decidua becomes necrotic and is normally cast off within five to six
days as :
A. Decidual cast
B. Placental remnants
C. Lochia
D. Carunculae myrtiforms
20. How can breast feeding accelerate the involution of the uterus?
A. The increased level of prolactin.
B. The release of oxytocin.
C. The increased level of estrogen.
D. The decreased level of progesterone.
E. The decreased level of HPL.
21. Which of the following is the most likely causes of a fever in a women on the second day
postpartum:
A. Atelectasis (Day zero)
B. UTI (Day 1-2)
C. Endometritis. (day 2-3)
D. Breast engorgement (day 3-5)
E. Wound infection (day 4-5)
F. Pelvic septic thrombophlebitis (day 5-6)
G. Mastitis (day 7)

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22. In the mother, suckling leads to which of the following response:

A. Decrease of Oxytocin.
B. Increase of Prolactin-inhibiting hormone.
C. Increase of hypothalamic dopamine.
D. Increase of pituitary Prolactin secretion.
E. Increase of LH-releasing hormone.
23. After parturition, endometrium regenerates from the decidual:
A. Basal zone.
B. Compact zone.
C. Functional zone.
D. Spongy zone.
24. Which of the following is not a routine postnatal maternal check ?
A. Serum blood sugar 2 hr. p. p.
B. Breast examination.
C. Pap smear.
D. Bimanual vaginal examination.
E. Contraceptive counseling.
25. Risk factors of postpartum Endometritis include all of the following, EXCEPT:
A. Prolonged labor
B. Prolonged rupture of membranes
C. Multiple vaginal exams
D. Prolonged monitoring with an intrauterine pressure catheter
E. Gestational diabetes.
26. Which of the following is not included in Symptoms and signs of
puerperal endometritis?
A. Malodorous vaginal discharge.
B. Lower abdominal pain.
C. Fever.
D. Good uterine Involution
E. Uterine tenderness on palpation.
27. Breast feeding :
A. Should be discontinued if breast infection is suspected
B. Should be started until 3 days postpartum
C. Should be replaced by bottle feeds if the patient had a caesarean section
D. Has a role in involution of the fetus
E. Should not be supplemented with iron
28. All the following methods inhibit lactation EXCEPT :
A. Restriction of fluid and diuretics
B. Tight breast binder and analgesics
C. estrogen hormone in large dose
D. Thyroxin hormone
E. Dopamine agonist

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Chapter 20: Prenatal Infections:

1. A woman exposed to chicken pox at a gestational age of 14 weeks. She does not
give a history of having a disease before. What is the next management step?
A. Give varicella vaccine as soon as possible after exposure.
B. Give varicella Zoster immunoglobulin followed by vaccine as soon as
possible after exposure
C. Test maternal blood for varicella Zoster antibodies.
D. Administer varicella zoster immunoglobulin as soon as possible after
exposure.
2. A woman exposed to chicken pox at a gestational age of 14 weeks. She does not
give a history of having a disease before. What is the next management step if
you know that the maternal antibodies for varicella zoster are negative?
A. Give varicella vaccine as soon as possible after exposure.
B. Give varicella Zoster immunoglobulin followed by vaccine as soon as
possible after exposure
C. Test maternal blood for varicella Zoster antibodies.
D. Administer varicella zoster immunoglobulin as soon as possible after
exposure.
3. If a woman exposed to chicken pox at a gestational age of 39 weeks. She has
single cephalic fetus. What is your management choice to decrease neonatal
infection?
A. Give varicella vaccine to the neonate soon after birth.
B. Give varicella Zoster immunoglobulin to the neonate soon after birth
C. Immediate termination of pregnancy.
D. Continue pregnancy for at least one week.
4. If a woman developed chicken pox 2 days ago. She is admitted in labor. What is
your management choice to decrease neonatal infection?
A. Give varicella vaccine to the neonate soon after birth.
B. Give varicella Zoster immunoglobulin to the neonate soon after birth
C. Immediate caesarian section.
D. Prevent breastfeeding.
5. A woman exposed to rubella infection at a gestational age of 11 weeks. She gives
a history of having a rubella vaccine during childhood. She had IgG antibodies
against rubella on routine checking. What is the appropriate management?
A. Reassure that she is unlikely to develop rubella.
B. Immediate termination of pregnancy.
C. Administer acyclovir to the mother.
D. Administer immunoglobulin to the mother
6. A woman exposed to rubella infection at a gestational age of 11 weeks. Her
immune status is unknown. What is the appropriate management?
A. Reassure that she is unlikely to develop rubella.
B. Immediate termination of pregnancy.

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C. Test maternal serum rubella specific IgG &IgM immediately and after 3
weeks.
D. Administer immunoglobulin to the mother
7. What is the most common single defect caused by rubella infection?
A. Sensorineural hearing loss.
B. Cataract
C. Patent Ductus Arteriosus.
D. Intracranial calcification
8. Which of the following perinatal infection has a higher risk of fetal infection in
the first trimester?
A. Rubella.
B. Cytomegalic virus
C. Toxoplasmosis.
D. Syphilis
9. What is the most common time of toxoplasma infection?
A. 1st trimester.
B. 2nd trimester
C. 3rd trimester.
D. During vaginal delivery
10. What is the treatment of choice for pregnancy complicated by toxoplasmosis to
decrease the risk of congenital infection?
A. Pyrimethamine plus sulfadiazine.
B. Spiramycin
C. Doxycycline.
D. Acyclovir
11. What is the treatment of choice for pregnancy complicated by toxoplasmosis if
fetal infection is confirmed (after 18 weeks gestation)?
A. Pyrimethamine plus sulfadiazine plus folic acid till delivery.
B. Spiramycin
C. Doxycycline.
D. Acyclovir
12. During antenatal counseling; a woman with a history of recurrent abortion that
asked about the possibility of toxoplasmosis as a cause. Her physician stated
that; toxoplasmosis is not a cause for recurrent infection but may cause sporadic
abortion; maternal infection with toxoplasmosis doesn't mean fetal infection.
What is the gold standard method for diagnosis of fetal infection?
A. Detection of toxoplasma in the amniotic fluid by PCR.
B. Hydrocephalus by ultrasound
C. Detection of maternal Toxoplasmosis IgM.
D. Detection of maternal Toxoplasmosis IgG
13. Which of the following perinatal infection can cause recurrent abortion?
A. Rubella.
B. Cytomegalic virus

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C. Toxoplasmosis.
D. Syphilis
14. Which of the following is not a transplacental infection?
A. Cytomegalovirus.
B. Toxoplasma
C. Rubella
D. Syphilis
E. Gonorrhea
15. What is the congenital infection with minimal teratogenicity effect on the fetus?
A. Cytomegalovirus.
B. Rubella
C. Syphilis
D. Human immunodeficiency virus (HIV)
16. Which of the following is not a constant finding in chorioamnionitis?
A. Maternal pyrexia
B. Maternal tachycardia.
C. Tender uterus
D. Fetal bradycardia
E. Increased white-cell count in the mother
17. In HIV infection which of the following is CORRECT ?
A. It is DNA virus
B. Virus can be isolated from saliva
C. Breast feeding increase transmission to the baby
D. Caesarean section increase transmission of infection to the baby
E. Negative HIV antibodies guarantees absence of infection
18. Rubella’s eye manifestation on the newborn is mainly:
A. Cataract.
B. Microcephaly
C. Retinopathy
D. Exophthalmos
19. Which of the following is NOT considered a high risk pregnancy :
A. Gestational diabetes
B. Cardiac disease in pregnancy
C. Candida infection in pregnancy
D. Bleeding in pregnancy
E. Patient with history of previous IUFD
20. Genital tract Candida occurs more frequent in all these patients EXCEPT :
A. Diabetic
B. On long term antibiotic therapy
C. Thyrotoxicosis
D. On oral contraceptive pills
E. Pregnant
21. Regarding Rubella immunization :
A. Rubella negative patients should be vaccinated during pregnancy

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B. Rubella vaccine is a Toxoid

C. The majority of pregnant patients are rubella non immune
D. Breast feeding should be inhibited if vaccine is given postnatal
E. Pregnancy should be avoided for 3 months after vaccination
22. Regarding Rubella vaccination, choose the correct answer :
A. It's a live attenuated virus.
B. Should be given in pregnancy in non-immune mother.
C. Should be given to all pregnant mothers in the 1st antenatal visit.
D. Pregnancy should be avoided for one year after the vaccination.
E. It's a toxoid.
23. The following are characteristic findings in neonatal rubella infection, EXCEPT :
A. Deafness.
B. Spina bifida.
C. Congenital heart disease.
D. Cataracts.
24. Which of the following maternal infections may cross the placenta?
A. Herpes genitals.
B. Parvovirus B19.
C. Toxoplasmosis.
D. Chicken pox.
E. Cytomegalovirus.
25. Which of the following are the predominant bacteria in vagina duringpregnancy?
A. Pepto-streptococci.
B. Listeria monocytogenes.
C. Lactobacilli.
D. Streptococcus Agalatia.
E. Staphylococcus.
26. Which of the following is not included in a triad of congenital toxoplasmosis?
A. Chorioretinitis
B. Brain calcification
C. Hydrocephalus
D. Spina bifida
27. A pregnant woman with Active vulval herpes infection, How would you
manage her?
A. Give acyclovir & then deliver
B. Vaginal Delivery & give the baby prophylactic acyclovir
C. Vaginal Delivery & give the mother prophylactic acyclovir
D. Caesarian section
28. How to prevent infection of a neonate of a mother who is viral hepatitis B
positive?
A. we give the baby both single dose immunoglobulin at birth and liveattenuated
vaccine at 0, 1, 6 months of birth
B. Immediate delivery by caesarian section
C. Avoid early artificial rupture of membrane during vaginal delivery
D. Give the antiviral therapy throughout pregnancy and labo

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