OBSTETRICS MCQS MODULE 3

1. A female of 28 years presented in antenatal OPD with history of vaginal

discharge for the last 04 days. She was at 25 weeks of gestation. She also
gave history of recurrent spotting, lower abdominal pain and dysuria. On
examination, she had mucopurulant vaginal discharge and afebrile.
What is most likely diagnosis?

a)    Bacterial vaginosis

b)    Chlamydia.
c)    Gonorrhoea.
d)    Trichomoniasis.

Key:      C
         
2. A 22-year-old , G2P1    presents in antenatal clinic    to
show her reports at 22 weeks of gestation . She has Rh -
ve blood group & Rh antibody levels are 2    IU/ml. What
is the most appropriate next step in the management?

a) Anti-D injection
b) Cell free fetal DNA
c) Middle cerebral artery doppler
d) Serial Anti-D levels

Key:b
 3.     An unbooked 20-year-old primigravida presents in
antenatal clinic for booking visit at 14 wks of gestation .
Ultrasound scan shows twin pregnancy with lambda
sign. Which is the most likely diagnosis?

a) Dichorionic diamniotic twins

b) Monoamniotic conjoined twins
c) Monchorionic diamniotic twins
d) Monchorionic monoamniotic twins
Key:a

4. A    38 -year -old primigravida has come for antenatal

check up at 36 weeks of gestation. Ultrasound shows
biparietal diameter of 36 wks , femur length of 32 wks &
AFI of 6cm. What is the most appropriate doppler study
in this case?

a) Middle cerebral artery

b) Umbilical vein
c) Umbilical artery
d) Uterine artery
Key:c

             
 5. A 26-year-old G2P1 attends antenatal clinic at gestational
amennorhea of 6 wks. She had metallic    cardiac valve
replacement 1 year back and is on anticoagulant therapy .
She needs review of anticoagulation regarding her   
pregnancy. Which would be the most appropriate
anticoagulant    for her ?

a) Loprin
b) LMWH
c) Rivaroxaban
d) Warfarin
Key: b

6.      A 20- year- old G3P2 woman at 37 weeks gestation comes with painful uterine contrations and
complains of dark vaginal blood mixed with some mucous. What will be    the most likely cause of
her bleeding?
                        a.    Bloody show⁕
                        b.    Cervical erosion
                        c.    Placenta abruption
                      d.      Vasa previa

KEY A

7. A 30- year- old female came to antenatal clinic at 20 weeks of pregnancy, with history of
significant exposure to chicken pox one day back. She does not remember to have had chickenpox
before.    What is the most suitable immediate management option for her?
a. Give oral acyclovir for 7 days
b. Give VZ immunoglobulin immediately. ⁕
c. Just reassurance and wait
d. Termination of pregnancy

KEY B
8..    A 30 -year- old primigravida, known epileptic came in antenatal clinic at 8 wk of gestation. She
is already taking anti epileptic drugs. She is anxious to know the effect of these drugs on the fetus.
Which of the following drug is most teratogenic?

a. Carbamazepine
b. Lamotrigene
c. Phenytoin
d. Sodium valproate⁕

KEY D

MCQ ON ECLAMPSIA/ PRE-ECLAMPSIA/HELLP

1. A 20-year-old PG at 32 weeks of gestation presented with complaints of
constant headache that is not relieved by paracetamol, and black spot in
her vision. On examination her B. P is 150/100mmhg and urine dipstick
shows +1 proteinuria, suddenly she developed Tonic-clonic seizures. Which
of the following is the best step in her management?
A.LOW DOSE ASPIRIN
B. PHENYTOIN
C. ANTIHYPERTENSIVE MEDICATION
D. MAGNESIUM SULPHATE
E. C-SECTION

KEY.            (D)
2. A 22year old PG is being cared for on the postpartum unit after induction of
labor at 37 weeks for severe pre- Eclampsia /imminent Eclampsia. She is on
magnesium sulphate for seizure prophylaxis. On examination she is found to
be somnolent and her speech is slurred, respiratory rate is 15 breaths/min
and urine output is 15cc/hr., her deep tendon reflexes are absent. Which is
the most likely cause of her symptoms?
A. HYPERTENSIVE STROKE
B. MAGNESIUM SULPHATE TOXICITY
 C. TRANSIENT ISCHEMIC ATTACK
D. VENOUS THROMBOEMBOLISM
  
KEY.    (B)

3.A 32year old PG at 39 weeks gestation presented with sudden onset of

epigastric pain associated with nausea and vomiting. On examination her B.P is
150/100mmhg, urine dipstick shows +2 proteinuria. Her SFH is 34cm, L/C, FCA+ve,
she is found to have RUQ tenderness. Her blood results shows mild anemia, low
platelets, elevated liver enzymes and hemolysis. What is the most likely diagnosis?
A. ACUTE FATTY LIVER OF PREGNANCY
B. CHOLECYSTITIS
C. HELLP SYNDROME
D. ACUTE HEPATITIS
    KEY. ( C )

MCQs ON THROMBOEMBOLISM.
1.A 30-year-old G2P1 at 20 weeks of gestation presented in opd with swelling of
left leg for the last 3 days. On examination there was gross swelling of her left leg
as compared to right leg. what is the most appropriate investigation in this case?
A. CT. PULMONARY ANGIOGRAM
B. DOPPLER ULTRASOUND OF BOTH LEGS
C. MRI OF LEFT LEG
D. V/Q SCAN OF LUNGS
KEY. (B)

2.A 38-year-old G2P1 at 37 weeks undergoes a primary C-Section for

malpresentation of twins. Immediately after deliver of babies patient became
hypoxic, tachypneic, tachycardic and hypotensive. Despite resuscitation patient
could not be revived. On Autopsy fetal hair and squamous cells were found in
pulmonary circulation. What is the most likely diagnosis?
A. AMNIOTIC FLUID EMBOLISM
B. CARDIAC ARREST
C.PULMONARY EMBOLISM
D.RESPIRATORY ARREST
KEY.    ( A )

Item Writing Template

Stem:    Eighteen years old primigravida came first time for antenatal visit at 8 weeks. On
examination, she is    anxious and gives hx of mechanical heart valves and was on
warfarin,
Lead in: how will you manage her,

Option list:
a) Stop warfarin and counsel about teratogenicity
b) Advice low molecular weight heparin
c)advice folic acid and involve multidisciplinary team regarding change of drug and dose
adjustment
c) Counsel about complications
Key: c

Stem: a 34 yr lady with known case of epilepsy came in antenatal clinic at 8 weeks, she
is on polytherapy, she is taking multiple drugs including sodium valporate. .she had
her last fit three years ago,
Lead in :what will you advice her


Option list:
a) Stop all drugs

b)take high dose folic acid    and switch to monontherapy

c)continue    polytherapy and medication
d)get termination of pregnancy as high risk of teratogenicity

Key: b
Item Writing Template

Stem: A 27 years age lady presented in her second pregnancy at 28 weeks of

gestation. She gave H/O shortness of breath for the last 03 days. She also
gave history of dysuria, lower abdominal pain and polydipsia polyuria. On
investigation her bsr was 306mg/dl. She also gives hx of difficult delivery of
shoulders in her last delivery,.how will you optimize her blood sugars.
Lead in: What will be the most appropriate answer?
 Option list:
A: admit and monitor blood sugars and start on s/c insulin sliding scale

B: get her ogtt done

C: lifestyle change

D: start her on oral hypoglycemics

Key: a
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                                            Medical disorders in pregnancy

Item Writing Template
 Stem:
A female of 32 years presented in antenatal OPD with known case of asthma. She is
primigravida with ga of 10 weeks, she is on inhaled corticosteroids, she wants
information regarding her medication,
What is most likely answer, ?

Option list:
a)    inhaled corticosteroids are safe in pregnancy and no association with fetal morbidity or
malformation,
b)    there is an increasd risk of cleft lip and palate
c)    increased risk of fetal growth restriction
d) she should stop medication
Key:      a
                      

Topic pregnancy with renal disease,

Primigravida 28 years of age presented in antenatal opd with chronic kidney
disease, she had serum creatinine <110micromol/l, minimal proteinuria,and well
controlled hypertension,.how will you counsel her regarding pregnancy,
A. Little or no effect on long term maternal renal function.
B. She should avoid conception
C. High risk for maternal and fetal morbidity and mortality.
D. Highest risk of complications with accelerated decline of renal function
Key, a

Pregnancy with thyroid disease

A 22 yr lady already on thyroxine presented at 22 weeks for antenatal checkup,
how will you manage her,
a. Get Full thyroid replacement with aim of euthyroidism
b. Get maternal thyroid function tests every month
c. she    should stop thyroxine,
d. she should get thyroidectomy
key a.