END OF YEAR EXAM

MBChB OBS 310

PAPER 1
OBSTETRICS
3hrs paper duration
The paper has 2 sections
Section A has multiple choice questions single best answer (60 marks)
Section B has 20 definitions and clinical scenarios (40 marks)
ANSWER ALL QUESTIONS
The whole paper adds up to 100%

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 SECTION A
Answer the following multiple choice questions by picking the best answer
1. The field of obstetrics encompasses the following except which of the
following
A. Prenatal care
B. Management of labor
C. Infertility treatment
D. Immediate newborn care
2. Which of the following is defined as the sum of stillbirths and neonatal deaths
per 1000 total births
A. Fetal death rate
B. Neonatal mortality rate
C. Perinatal mortality rate
D. Stillbirth rate
3. Which of the following conditions contributes the LEAST to pregnancy related
deaths in Zambia?
A. Hemorrhage
B. Thromboembolism
C. Hypertensive disorders in pregnancy
D. Anesthetic complications
4. The perineal body is formed partly by which of the following muscles
A. Levator ani muscles
B. Gluteus maximus
C. Bulbocavernosus
D. Ischiocavernosus
5. Uterine blood flow near term most closely approximates which of the
following?
A. 150ml/min
B. 350ml/min
C. 550ml/min

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D. 850ml/min
6. The average blood loss for a vaginal delivery approximates which of the
following?
A. 500mls
B. 1000mls
C. 700mls
D. Somewhere between A and C
7. A long umbilical cord may be associated with which of the following?
A. Cord prolapse
B. Cord false knots
C. Cord pseudocysts
D. Velamentous insertion
8. Which of the following approximates the weight of the placenta at term?
A. 200g
B. 500g
C. 1000g
D. 1500g
9. A patient reports that the first day of her last menstrual period was
September 19th. Based on naegele rule, what is her due date?
A. July 10th
B. June 14th
C. June 26th
D. December 12th
10. The limits of fetal viability are determined by which of the following?
A. Kidney function
B. Pulmonary growth
C. Heart development
D. Fetal hepatic development

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11. Preconception evaluation of a woman with diabetes mellitus should include
all of the following EXCEPT
A. Hemoglobin A1C
B. Retinal examination
C. Bone density testing
D. Urinary protein testing
12. Which of the following anti-seizure medications when taken as
monotherapy is associated with the highest risk of congenital malformations
A. Phenytoin
B. Valproic acid
C. Phenobarbitone
D. Carbamazepine
13. Which of the following obstetric complications is not increased in obese
patients
A. Hypertension
B. Fetal anomalies
C. Caesarean deliveries
D. Group b streptococcal carrier frequency
14. Common reasons cited by women for not attending antenatal care include
the following
A. Lack of money
B. The pregnancy is not yet big enough
C. Long queues at antenatal clinics
D. All of the above
15. Fetal movements are typical felt for the first time at approximately what
gestation age in weeks?
A. 8
B. 14
C. 16
D. 18

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16. All of the following conditions have increased risk in smokers except which
one?
A. Preeclampsia
B. Preterm birth
C. Placenta abruption
D. Sudden infant death syndrome
17. How much elemental ion should be given to pregnant women at a minimum
as supplement?
A. 15mg
B. 27mg
C. 42mg
D. 60mg
18. What is the most common class of fetal malformations?
A. Cardiac
B. Cleft palate and lip
C. Neural tube defects
D. Ventral wall abnormalities
19. What is the normal amniotic fluid volume at term in milliliters?
A. 300
B. 800
C. 1200
D. 1500
20. Which of the following medications is associated with oligohydramnios
when taken in the latter half of pregnancy?
A. Hydralazine
B. B-blockers
C. Calcium channel blockers
D. Angiotensin enzyme receptor blockers

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21. Which of the following is true about the modified biophysical profile?
A. is superior to other forms of fetal surveillance
B. It combines non stress testing with fetal breathing assessment
C. It is normal if the amniotic fluid index is 5cm and NST is reactive
D. It has a false negative rate of 4.8/1000 and a false positive rate of 1.5%
22. HIV and pregnancy. Which of the following is true?
A. An HIV test must be done during antenatal period
B. HIV in pregnancy Is currently a huge public health concern
C. HAART is commenced after first trimester
D. 70% of transmission occurs antepartum
23. In multiple pregnancy, which of the following is true ?
A. Identical twins are the commonest type of twinning
B. Malpresentation are common in labor
C. Oxytocin is contraindicated when delivering the second twin
D. If second twin is in transverse lie, caesarean section is indicated
24. Regarding heart disease in pregnancy
A. It’s a common cause of maternal mortality in Zambia
B. Pregnancy termination is warranted when the condition is diagnosed
early in pregnancy
C. Ischemic heart disease patients should undergo c section
D. There is no limitation in physical activity in women who are class 1 new
York
25. About shoulder dystocia. Chose the MOST correct option
A. It occurs more commonly in primigravida compared to multigravidas
B. Fundal pressure has a role in the management
C. It can occur in babies less than 3 kg
D. Mc Roberts maneuver involves exaggerated extension of maternal hips
26. Vaginal delivery is contraindicated in the presence of:
A. Previous caesarean section for CPD
B. Cord prolapse in second stage

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 C. Transverse lie of the second twin
D. Previous uterine rupture
E. In a patient with a previous ectopic pregnancy
27. Regarding oxytocin, one of these is FALSE
A. It can cause uterine rupture
B. Fetal distress is not a complication
C. It can lead to water intoxication
D. Is a neuropeptide
E. It is also produced by men
28. About magnesium sulphate. Which of the following is TRUE?
A. It causes respiratory depression
B. It is nephrotoxic
C. The antidote is calcium sulphate
D. Its indicated in all patients with pre-eclampsia
29. In Puerperal pyrexia, which one of these is FALSE
A. Commonly results in maternal mortality
B. Usually appears 2 – 10 days after delivery
C. Cannot be caused by chlamydia
D. Temperatures have to be AT LEAST 38 degrees
30. In PPROM, which of these is NOT an indication for delivery?
A. Oligohydramnios
B. Maternal tachycardia
C. Fetal tachycardia
D. Meconium stained liquor
31. Which of the following is TRUE about active management of the third stage
of labor?
A. Monitoring of blood pressure, pulse, and per vaginal bleeding half
hourly for the first hour should be done.
B. Delivery of the cord by controlled cord traction with counter traction
over the supra pubic area is important

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 C. Bimanual compression of the uterus is important
D. Administration of 10 iu of oxytocin iv within 5 minutes of delivery of the
baby
32. In induction of labor, which one of the following is TRUE ?
A. Determining the station is important
B. Posterior position of the cervix makes it easier
C. A Bishop score of 6 is favourable
D. It can be associated with maternal hyponatremia
33. Elements of the Bishop score used for assessment of inducibility include the
following EXCEPT:
A. Fetal lie
B. Cervical dilatation
C. Cervical position
D. Station
E. Cervical effacement
34. Drug used to treat PPH is: except
A. Oxytocin
B. ergometrine
C. Progesterone
D. Prostaglandin
E. Tranexamic acid
35. The consequences of Rh incompatibility are not serious during first pregnancy
because:
A. Antibodies are not able to cross placenta
B. Antibody titer is very low during primary immune response
C. IgG generated is ineffective against fetal red cells
D. Massive hemolysis is compensated by increased erythropoiesis
36. Anti-D prophylaxis should be given in all of the following conditions EXCEPT
A. Medical abortion for 63 days pregnancy
B. Amniocentesis at 16 weeks

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 C. Intrauterine transfusion at 28 weeks
D. Manual removal of Placenta
37. Advantages of medium episiotomy over mediolateral episiotomy are all
EXCEPT:
A. Less blood loss
B. Easy repair
C. Extension of the incision is easy
D. Muscle are not cut
38. Classical caesarean section is not indicated in
A. Carcinoma cervix
B. Cervical fibroid
C. Previously repaired VVF
D. Previous classical cesarean section
E. In a difficult transverse lie CS
39. Absolute indication to caesarean section
A. Previous uterine scar
B. Previous CS
C. Transverse lie
D. Breech
E. Classical caesarean section
40. Contraindication of Vacuum Extraction EXCEPT:
A. Prematurity
B. Brow presentation
C. Fetal distress
D. Floating head
E. Undilated cervix
41. Puerperium last for:
A. 2 weeks
B. 4 weeks
C. 6 weeks

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 D. 8 weeks
E. 42 weeks
42. Length of umbilical cord is:
A. 10-30 cms
B. 30-100cms
C. 100-250 cms
D. 250-400 cms
43. Most common cause for maternal mortality in Zambia is:
A. Infection
B. Obstructed labor
C. Hemorrhage
D. Anemia
44. Elderly primigravida is above the age of:
A. 30 years
B. 35 years
C. 37 years
D. 45 years
E. 40 years
45. Which statement is correct regarding calculating expected date of delivery
(EDD)?
A. Pregnancy is dated from conception
B. The last menstrual period (LMP) is reliable if the cycles are irregular
C. The average length of pregnancy is 280 days
D. LMP defined dates are more accurate than those calculated from USS
E. Head circumference may be used to date a pregnancy until 25 weeks.
46. Which best describes the reproductive history of a woman at 12/40 with a
previous twin delivery and a stillbirth at 27/40?
A. G3P3
B. G3P4
C. G4P4

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 D. G4P3
E. G4P2
47. An infant is delivered at 27/40 and taken to the neonatal unit. Which problem
is most likely to be experienced?
A. Incomplete formation of the epidermis from the mesoderm
B. Excessive vernix formation
C. Lanugo shedding
D. Thermoregulation due to thin skin
E. Lack of hair follicle development
48. Which of the following is NOT an increased risk in multiple pregnancy?
A. Placenta praevia
B. Diabetes mellitus
C. Pre-eclampsia
D. Malpresentation
E. Intrauterine growth restriction (IUGR)
49. Choose the option that is less common after Caesarean delivery than after
vaginal delivery:
A. pulmonary embolism
B. Postpartum hemorrhage
C. Post-natal depression
D. Amniotic fluid embolism
E. Infection
50. Which of the following reasons for performing Caesarean section contributes
least to the total Caesarean section rate?
A. Malpresentation
B. Placenta praevia
C. Previous Caesarean section
D. Dystocia
E. Suspected fetal compromise

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51. Which of the following is not a factor classically implicated in postpartum
hemorrhage
A. Tone.
B. Trauma
C. Tamponade
D. Thrombin
E. Tissue
52. The components of the Apgar score include all accept:
A. Appearance
B. Pulse rate
C. Good eye opening
D. Activity
E. Respiratory effort
53. Physiological anaemia in pregnancy occurs as a result of ;

A. Poor dietary standards

B. Decreased red cell volume
C. Increased blood cells
D. Increased plasma volume

54. If labour occurs prior to 37 weeks gestation, it is referred to as

A. False labour
B. Normal labour
C. Premature labour
D. Post-mature labour
E. Preterm labour

55. The manoeuvre used to to deliver the extended head in a breech is called;

A. Loveset
B. Burns Marshal
C. Mauricaeu Smellie Veit
D. Zavanelli’s

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56. Management of the patient with prolapsed of the umbilical cord is aimed at;

A. Increased pressure on the cord, thereby relieving or preventing the

development of fetal anoxia
B. Preventing maternal hypoxia
C. Relieving pressure on the cord, thereby relieving or preventing the
development of fetal anoxia
D. Ensuring “normal” vaginal delivery for the mother.

57. The classic indication of rapture of the uterus is;

A. sudden, stabbing abdominal pain accompanied by sensation that something

is giving way
B. A sudden gush of blood from vaginal canal
C. Sudden, severe cramping pain in the lower back and flank
D. Cessation of uterine contraction

58. The correct sequency of lochia in the puerperium is as follows;

A. Lochia rubra, alba and serosa

B. Lochia serosa, rubra nad alba
C. Lochia alba, serosa and rubra
D. Lochia rubra, serosa and alba

59. Which of the following changes in kidney functioning occurs during normal
pregnancy?

A. Blood urea nitrogen values increases

B. Glomerular filtration rate increases
C. Renal plasma flow remains relatively constant
D. Renal tubular re-absorption rate decreases

60. The middle layer of the myometrium is made up of;

A. Longitudinal musckle fibres

B. Circular muscle fibres
C. Oblique interlacing muscle fibres

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 D. Vertical muscle fibres

SECTION B
1 .Define the following terms and conditions (20 marks)
1. Bishop score
2. Direct Maternal death
3. Latent phase of labor
4. Vertex presentation
5. Puerperium
6. Cord presentation
7. Amniotic fluid index
8. Precipitate Labor
9. Frank breech
10. HELLP syndrome
11. Secondary postpartum hemorrhage
12. Puerperal pyrexia
13. Sub-involution of uterus
14. Couvelaires uterus
15. Naegele rule
16. Sheehan’s syndrome
17. Lightening
18. Lochia
19. Linear nigra
20. Pica
2. Woman admitted in the outpatient department complains of having a sudden
gush of clear fluid followed by excessive vaginal bleeding. Her last normal
menstrual period was on 17/01/2021. (10 marks)
a) What is the most likely diagnosis (2marks)
b) What are the 3 common differential diagnosis (3marks)
c) How will you confirm this diagnosis? (2mark)
d) How will you manage the patient ?(3 marks)

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3. A forty four-year-old primigravida presents at 19 weeks in her first pregnancy.
She has a blood pressure of 160/100 mmHg and urine dipstix shows 3+
proteinuria. Complaining of slight headache and is very sure of her dates and
gestation age.(10marks)
a) What is the most likely diagnosis and what is the rationale for your
decision? (3marks)
b) What are the differential diagnosis? (2 marks)
c) Why is U/S scan specifically important in this patient?(2marks)
d) What other 4 investigations will you do? (2marks)
e) The patient is eventually diagnosed with severe pre-eclampsia what are the
principles of management of severe pre-eclampsia? (1mark)
4. Describe the physiological changes of pregnancy in the cardiovascular and
respiratory system (10marks)

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