Arba Minch University

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF MEDICINE, DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

FINAL WRITTEN OPERATIVE OBGYN EXAM FOR CMSC MIDWIFERY

STUDENTS

Read the Instructions carefully:

 The exam has two part ( MCQs and essay part)

 Exam contains 30 MCQs & 10 page including cover
 Each MCQs has one best answer
 Each MCQs contain two mark
 Write your name & ID on separate answer sheet
 Time allowed is 2 hours
 Switch off your mobile
 Any misconduct leads to INVALID RESULT!!!

DON'T TURN THIS PAGE UNTIL YOU ARE TOLD TO DO SO!!!

Best wish!!

Prepared by Dr. Mekonnen & Dr. Teshome

May02, 2023

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Part-I: Choose the best answer from the given alternatives.
1. Of the following indications for primary cesarean delivery, which is least common?
A. Fetal jeopardy
B. Labor dystocia
C. Placenta previa
D. Malpresentation
2. A 34-year-old primigravida at 39 weeks’ gestation undergoes primary cesarean delivery
on maternal request. Compared to a woman with a vaginal delivery, which of the
following adverse neonatal outcomes is more likely to occur?
A. Infection
B. Birth trauma
C. Respiratory distress syndrome
D. Hypoxic ischemic encephalopathy
3. A 30-year-old G3P3 presents to the emergency department on postoperative day 4
complaining of 24 hours of severe abdominal pain and intractable nausea and vomiting.
Her oral temperature is 39 ºC; she is tachycardic with a heart rate of 140 bpm and appears
pale and diaphoretic. What is the best next step in management?
A. Intravenous antibiotics
B. Exploratory laparotomy
C. Placement of nasogastric tube, bowel rest
D. Blood transfusion
4. Failure to recognize dextrorotation of the uterus prior to hysterotomy increases the risk of
damage to which structure?
A. Left ureter
B. Right ureter
C. Left uterine artery
D. Right uterine artery

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 5. All of the following are true regarding forceps and vacuum delivery except:
A. Vacuum requires more clinical skills than forceps
B. Vaccum is preferred more in HIV patients than forceps
C. Forceps is more associated with fetal facial injury
D. Vacuum has more chance of formation of cephalhaematoma
6. What is the most common source of microorganisms causing surgical site infection?
A. Contaminated surgical equipment Patient
B. Postoperative nursing staff
C. Patient
D. Anesthetist
E. Surgeon
7. What proportion of patients having a surgical procedure will develop a surgical site
infection?
A. 5% C. 15%
B. 10% D. 20% E. 25%
8. A healthy 39-year-old woman with no significant past medical history attends a
preoperative assessment clinic. She is due to undergo a total abdominal hysterectomy for
heavy menstrual bleeding following a local anaesthetic endometrial ablation that was
unsuccessful. She is fit and well. What preoperative investigation is required?
A. Chest X-ray
B. Coagulation screen
C. Electrocardiogram
D. Full blood count
E. Renal function tests
9. A 31-year-old, gravida 3, para 3 Jehovah’s Witness begins to bleed heavily 2 days after a
cesarean section. She refuses transfusion and says that she would rather die than receive any
blood or blood products. You personally feel that you cannot watch her die and do nothing.
Appropriate actions that you can take under these circumstances include
A. Telling the patient to find another physician who will care for her
B. Transfusing her forcibly
C. Letting her die, giving only supportive care

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 D. Getting a court order and transfusing
E. Having the patient’s husband sign a release to forcibly transfuse her
10. A 27-year-old woman who has previously received no prenatal care presents at term. On
ultrasound, she is shown to have a placenta previa, but she refuses a cesarean section for any
reason. Important points to consider in her management include
A. Court-ordered C/S have almost always been determined to achieve the best
management
B. The obstetrician’s obligation to the supposedly normal fetus supersedes the obligation
to the healthy mother
C. The inclusion of several people in this complex situation raises the legal risk to the
physician
D. Child abuse statutes require the physician to get a court order to force a cesarean
section
E. A hospital ethics committee should be convened to evaluate the situation
11. Prior to performing the abdominal hysterectomy, you give the patient informed consent. All
of the following are key elements of informed consent except:
A. The patient must have the ability to comprehend medical information
B. Alternatives to the procedure must be presented
C. If the patient is incapable of providing consent, the procedure should be abandoned
D. The risks of the procedure must be present
E. he benefits of the procedure must be presented
12. A 36-year-old female has been in labor for over 12 hours. She has been pushing for 2 hours
and on examination the fetal head in determined to be occiput anterior with a cervical
examination of complete dilatation, 100% effaced and + 2 station. You have elected to
perform an operative vagina delivery as the fetal tracing is becoming less reassuring. Which
one of the following statements are true?
A. Cephalohematoma is more common with forceps delivery than vacuum delivery
B. The Malmstrom vacuum extractor is a fl exible silastic cup and is more widely used in
the United States
C. This would be classified as a midforcep delivery

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 D. Scalp abrasions or lacerations are the most common injury associated with vacuum
delivery
E. Cervical and vaginal lacerations following operative vaginal delivery has an incidence of
less than 1%
13. A 32-year-old woman returns to your care five months after the birth of her child. She had a
postpartum hemorrhage following the vaginal delivery of her son, requiring emergency
surgery and multiple blood transfusions. She complains of fatigue and constipation, and
states that her periods have not returned despite the fact that she has not been able to
breastfeed. Her laboratory test reveals an FSH level of 1.2 mIU/mL, TSH of 0.3 IU/mL, and
prolactin of 1 ng/mL. The most likely etiology of her Secondary amenorrhea is:
A. Asherman’s syndrome
B. Polycystic ovary syndrome
C. Functional hypothalamic amenorrhea
D. Sheehan’s syndrome
E. Kallman’s syndrome
14. A 51-year-old woman, para -1, presents to your office with complaints of heavy menstrual
flow that has been persistent over the last 6 weeks, occurring after a 7-month break from her
periods. Her periods were monthly and regular until she was 46 years old. The review of
systems is negative, and she specifically denies lightheadedness. Her speculum examination
is unremarkable. The bimanual examination reveals a slightly enlarged, regular-contour,
anteverted uterus that is nontender to palpation. The next best step in management is:
A. Low-dose oral contraceptive pill C. Dilation and curettage
B. Endometrial biopsy D. Endometrial ablation
15.A 46-year-old woman, gravida 6, para 4, presents complaining of a 2-year history of heavy
menstrual flow lasting 9 days, with occasional episodes of soaking her clothes and bed sheets
with menstrual blood. She has a history of bilateral tubal ligation. Her menses occur every 26
days, and she denies any bleeding between menses. The rest of her history is unremarkable.
The test most likely to aid in diagnosis would be:
A. Menstrual calendar D. Pelvis Ultrasound
B. Pregnancy test E. TSH
C. Endometrial biopsy

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16. What type of morbidity is less likely to be associated with vacuum extraction than with
forceps delivery?
A. Cephalohematoma
B. Low Apgar score at 5 minutes
C. Neonatal jaundice
D. Retinal hemorrhage
E. Vaginal and perineal trauma
17. You are asked to assess a woman’s perineum after a vaginal delivery. There is an extensive
tear disrupting the superficial muscle and 70 % of the external anal sphincter. There is no
disruption of the internal anal sphincter. How would you classify this perineal trauma?
A. Second degree tear C. 3b tear E. Fourth degree tear
B. 3a tear D. 3c tear
C. 3b tear
18. Sequential use of instruments increases neonatal trauma. By what factor is the incidence of
subdural and intracranial hemorrhage increased in this situation?
A. 1.5 times C. 3-4times
B. 2–3 times D. Up to5times E. 10times
C. 3–4 times
19.A 48-year-old woman attends the gynecology clinic complaining of heavy menstrual
bleeding (HMB) and occasional intermenstrual bleeding. Her hemoglobin level is 11.2 g/l.
An ultrasound scan demonstrated no obvious abnormality. What other investigation is
required?
A. Coagulation screen C. Endometrial biopsy
B. Diagnostic hysteroscopy D. Pelvis MRI scan
20. A 15-year-old girl is seen in the pediatric gynecology clinic due to persistent vaginal
discharge. Examination reveals the following: The partial removal of the clitoris and the
prepuce is noted. The hymen is intact. The possibility of female genital mutilation (FGM) is
raised. What type of FGM is this?
A. Type I C. Type III
B. Type II D. Type IV E. It is not classed as FGM
C. Type III

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21. Compared with mediolateral episiotomy, the main drawback of midline episiotomy is which
of the following?
A. Surgical repair is more difficult.
B. It is more likely to break down.
C. There is increased blood loss.
22. It is more likely to extend into a third- or fourth-degree laceration following repair of a
fourth-degree laceration, which of the following should be avoided in the postpartum period?
A. Stool softeners C. Enemas
B. Antibiotics D. Ice packs to the perineum
23. Which of the following describes forceps that are applied to the fetal head with the scalp
visible at the introitus without manual separation of the labia?
A. Midforceps
B. Low forceps
C. Inlet forceps
D. Outlet forceps
24. . Prerequisites for forceps application include all EXCEPT which of the following?
A. Head is engaged.
B. Membranes are ruptured.
C. Cervix is completely dilated.
D. Late fetal heart rate decelerations are absent.
25. Which of the following is the preferred total negative pressure generated prior to initiation
of traction during vacuum extraction?
A. 0.2 kg/cm2 C. 1.2 kg/cm2
B. 0.8 kg/cm2 D. 1.6 kg/cm
26. Centering the vacuum cup over the flexion point provides which of the following
advantages?
A. Extends the fetal head
B. Minimizes traction forces
C. Delivers the smallest diameter through the pelvic outlet D. All of the above
27. All of the following are advantages of transverse uterine incision, except:
A. Less lateral extension

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 B. Less blood loss,
C. Less need for bladder dissection,
D. Easier approximation
28. All of the following are advantages of transverse uterine incision, except:
A. Quick entry
B. Better exposure
C. Better cosmetics
D. Less neurovascular damage
29. A 25-year-old P-II mother who had a history of cesarean delivery two months ago for G-III
MASF in LFSOL with a good baby outcome. Currently, she presents with a complaint of
tingling sensations and numbness on her upper labia majora and upper medial thigh for the
last 6 weeks. What types of nerves are damaged during cesarean delivery?
A. Illioinquinal nerve
B. Illiohypogastric nerve
C. Femoral nerve
D. Pudendal nerve
30. Which one of the following is NOT true about cervical cancer?
A. Screening for cervical cancer must start at the age of 30 years regarding sexual activity
B. Visual inspection with Lugol iodine is more sensitive than VIA but equally specific
C. Dysplastic epithelium turns white after application of acetic acid is called as aceto white
D. All women who screen for cervical cancer should be offered HIV testing and counseling

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Part-II: Write each question clearly and precisely on a separate paper sheet.
1. Discuss phases of wound healing? ( 8point)
2. This is a 28-year-old primate gravid woman whose gestational age is 42 completed weeks
from a 9-week ultrasound. She came for regular ANC contact; an ultrasound was done;
EFW = 4500 g with RBPP, so the surgeon decided to do an operation tomorrow. Discuss the
following question based on the given case:
A. Define Cesarean delivery (2point)
B. Discuss Patient preparation for Cesarean delivery (4point)
C. Discuss types of uterine incision and closure techniques of uterine incision and selection
of suture materials (2point)
D. Post-operative care and follow up (2point)
3. This is a 36-year-old GVPIV mother who has been amenorrheic for the last 9 months and has

no ANC contact. She was complaining of pushing down pain of 18 hours duration at home,

then she went to the local health center, and immediately on arrival, the HC referred her to

the primary hospital. You are working there, and along the way, she has complained of

continuing abdominal pain. On arrival, she is exhausted; BP = 100/60, PR = 125, RR = 24,

T0 = 37.1C; her abdomen is tender; FHB = 88; her cervix is fully dilated; and there is

minimal blood on examining her figures.

A. What is your diagnosis (2 points)?

B. Discuss clearly patient preparation for operation (4 points).

C. What type of abdominal skin incisions would be preferred for this patient (2 points)?

D. What definitive or conservative operation would you perform for this patient (2 points)?

E. Enumerate the postoperative care and follow up for this patient (2 points).

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4. A 36-year-old GVPIV mother who undergoes cesarean delivery for an indication of G-III

MSAF in the late first stage of labor also gave consent for permanent contraception.

A. List types of tubal surgery for permanent contraception (4 points).

B. How do you differentiate the tubes from others' structures (2 points)

C. Which stitch materials are used for the procedure (2 points)?

D. What do you advise the patient upon discharge (2 points)?

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