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Nelson Textbook of Pediatrics, 2-Volume Set, 20e

After more than 75 years, Nelson Textbook of Pediatrics remains your indispensable source for definitive, state-of-the-art answers on every aspect of pediatric care. Embracing the new advances in science as well as the time-honored art of pediatric practice, this classic reference provides the essential information that practitioners and other care providers involved in pediatric health care throughout the world need to understand to effectively address the enormous range of biologic, psychologic, and social problems that our children and youth may face.

MRCPCH MasterCourse: Two Volume Set with DVD and website access

MRCPCH MasterCourse: Two Volume Set with DVD and website access, 1e (MRCPCH Study Guides) (Vol. 2) Pap/DVD/Ps Edition

Te Linde’s Operative Gynecology

Te Linde’s Operative Gynecology has been the premier text in the field of gynecologic surgery for more than 60 years. This text covers all of the aspects of gynecologic surgery – from the most general topics of surgical ethics to instruction on detailed surgical procedures. General background/pathology for surgical problems is covered as are patient/treatment selection, step-by-step surgical techniques and post-operative concerns.

Physiological Changes During pregnancy:

Physiological Changes During pregnancy: 

1. The following are presumptive skin signs of pregnancy except: A. Chloasma B. Maculo-papular rash C. Linea Nigra D. Stretch Marks C. Spider Telangiectases 

2. The resting pulse in pregnancy is: 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. All are CORRECT, EXCEPT, Pregnancy is associated with: A. Increase cardiac output B. Increase venous return C. Increase peripheral resistance D. Increase pulse rate E. Increase stroke volume 

5. During normal pregnancy: Which is true? A. Estradiol is the principal circulating estrogen B. The blood pressure increases in first and second trimester C. The tidal volume is reduced D. In The second half of pregnancy, amniotic fluid is mostly contributed fetal urine E. Maternal hydroureters should be taken always as a serious pelvic condition 

6. In normal pregnancy, all of the following are true EXCEPT: F. Glucosuria increases. G. Plasma aldosterone concentration falls. 

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H. Creatinine clearance is increased. I. Folate excretion is increased. J. The presence of less than 300mg of proteins in 24hours urine collection is considered normal 

7. In normal pregnancy, levels of all of the following hormones increases EXCEPT: A. Total thyroxine (T4) B. Parathyroid hormone (PTH) in the 2ND & 3RD trimesters. C. Free cortisol. D. Prolactin. G. Estradiol  

8. The increase in blood volume in normal pregnancy is made up of: A. Plasma only. B. Erythrocytes only. C. More plasma than erythroblasts. D. More Erythrocytes than plasma. E. All of the above. 

9. 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  

10. 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. Increase in the amount of dead space in the urinary tract. E. Increase in BUN & creatinine. 

11. Lowered Hemoglobin during normal pregnancy is a physiological finding. It's mainly due to: A. low iron stores in all women. B. Blood lost to the placenta C. Increased plasma volume. D. Increased cardiac output resulting in greater red cell destruction. E. Decreased reticulocytosis  

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12. The Maternal blood volume in normal pregnancy: A. remains stable. B. Decreases 10%. C. Increases 10% D. Increases up to 40% E. Decreases up to 40%. 

13. 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. 

14. During normal pregnancy, the renal glomerular filtrate rate (GFR) can increase as much as: A. 10%. B. 25%. C. 50%. D. 75%. E. 100%. 

15. Fetal blood is returned to the umbilical arteries & the placenta through: A. Hypogastric arteries. B. Ductus venosus. C. Portal vein. D. Inferior vena cava. E. Foramen ovale. 

16. In normal physiological changes in pregnancy, all of the following are increased EXCEPT: A. Glomerular filtration rate. B. Stroke volume. C. Peripheral resistance. D. Plasma volume. E. White blood cells. 

17. 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. 

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18. 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  

19. During Pregnancy, all of the following are CORRECT EXCEPT: A. There will be hyperplasia & hypertrophy of the uterine muscle. B. Estradiol will increase the columnar epithelial of the endocervix. C. Estrogen will increase the glandular duct. D. Progestin & HPL will decrease the number of glands. E. Prolactin will be antagonized by the effect of estrogen  

20. 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 then the left side. D. The primigravida shows more changes then multigravida. E. The bladder tone increases. 

21. As pregnancy advances, which of the following hematological changes occurs? A. Plasma volume increases proportionally more than red cell volume. B. Red cell volume increases proportionally more than plasma volume. C. Plasma volume increases & red cell volume remains constant. D. Red cell volume decreases & plasma volume remains constant. E. Neither plasma volume nor red blood cell volume changes. 

22. Which of the following would normally be expected to increase during pregnancy: A. Plasma creatinine. B. Thyroxin-binding globulin. C. Hematocrit. D. Core temperature. E. Hair growth. 

23. The supine position is important during late pregnancy because it may cause all of the following EXCEPT: A. Complete occlusion of the inferior vena cave. B. A significant decrease in maternal ventilatory capacity. C. Hypotension & syncope. D. A significant reduction in renal blood flow & glomerular filtration. E. Augmentation of the cardiovascular effects due to high conduction  

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24. 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 

25. 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. 

26. The resting pulse in pregnancy is : A. Decreased by 30 beats /min. B. Decreased by 10-15 beats/min. C. Unchanged. D. Increase by 30 beats/min. E. Increased by 10-15 beats/min. 

27. After birth, all of the following vessels constrict EXCEPT: A. Ductus arteriosus. B. Umbilical arteries. C. Ductus venosus. D. Hepatic portal vein. E. Umbilical vein. 

28. Select the most correct statement about fetal & neonatal IgM: A. It is almost entirely maternal in origin. B. It is approximately 75% maternal & 25% fetal in origin. C. It is 50% maternal, 50% fetal in origin. D. It is 25% maternal, 75% fetal in origin. E. It is almost entirely fetal in origin  

29. Which one is true about the placenta: A. 10% maternal contribution only B. U.C covered with chorion C. U.C contain wharlton jell D. Placental lobes are the functional units. 

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30. Spinnbarkheit is a term which means : A. Crystallization of the cervical mucous. B. Thickening of the cervical mucous. C. Mucous secretion of the cervix. D. Threading of the cervical mucous. E. Thinning of the cervical mucous. 

31. 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. Placental Corticotropin releasing hormone increases ACTH & cortisol & causes vasoconstriction of the feto-placental blood vessels. D. Estrogen is secreted by the feto-placental unit responsible for the growth of the myometrium & angiogenesis. E. Progesterone causes vasodilatation of blood vessels & contraction of uterine smooth muscle. 

32. 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 mesenchymal core of the chorionic villi. 

33. Which of the following does NOT accurately describes the placenta in humans: A. 15-20 cm in diameter. B. 2-4 cm thick. C. Weighs about 1/6 of what the term infant does. D. Delivered from maternal & fetal tissue. E. Umbilical cord originates from the center of the placenta in all most of the cases. 

34. Maternal serum Prolactin levels in pregnancy are highest: A. At the end of gestation just before delivery of the infant. B. Just after the delivery of the infant. C. As the placenta is released. D. The 3RD to 4TH day postpartum. E. During breast feeding. 

35. All of the following causes Oligohydromnios EXCEPT: A. Renal agenesis B. Poor placental perfusion 

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C. Post term pregnancy D. Anencephaly E. Urinary obstruction 

36. Placental insufficiency is caused by all the following, EXCEPT: A. Smoking in pregnancy. B. Post maturity. C. Dietary insufficiency in pregnancy. D. Hypertensive disorder in pregnancy. 

37. All the following hormones are products of placental synthesis, EXCEPT : A. HCG. B. HPL. C. Prolactin. D. Progesterone. E. Estriol. 

38. 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 

39. Pregnant lady with polyhydramnios, the cause could be: A. Fetus with oesophageal-atresia B. Fetus with polycystic kidney disease C. Fetal growth restriction D. Hyperprolactinaemia during pregnancy E. Patient is taking anti epileptic drugs 

40. Polyhydramnios is associated with the following condition A. Intrauterine growth restriction B. Fetal kidney agenesis C. Diabetes insipidus D. Tracheo-oesophageal fistula E. Hind water leakage 

41. 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 

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42. Which of the following causes of polyhydramnios is more common: A. Twin pregnancy. B. Diabetes. C. Hydrops fetalis. D. Anencephaly. E. Idiopathic. 

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. C. Oxygen by face mask. D. I.V. saline solution. 

1. Skin changes during pregnancy should include: A. Chloasma. B. Striae. C. Palmer erythema. D. Vascular spiders. E. All of the above

Embryology of Female genital tract, Malformations, intersexuality and Puberty:

Embryology of Female genital tract, Malformations, intersexuality and Puberty:

In patient with bicornuate uterus when getting pregnant can get all these complication, EXCEPT:

Polyhydramnios

Abortion

Preterm labor

Abnormal fetal lie

Retained placenta

In Turner's syndrome:

A chromosomal structure of 45 XY is characteristic

Secondary amenorrhea is usual

Ovaries are streak

The ovaries are multicystic

Phenotypically are male

Sexual differentiation

Development of male genitalia depends on the presence of functioning testes and responsive end organs

Due to the absence of testes XX fetus exposed to androgens in uteri will NOT be musculinized

The development of the female genital requires presence of the ovary

45 XO fetus will have normal ovaries

The development of the testes does not require presence of the Y chromosome

Turner syndrome: Which is true?

Genetically is 46 X O

Has testis in inguinal area

Usually presents with primary amenorrhea.

Has low I.Q

Usually tall

Androgen insensitivity syndrome: Which is true?

Genotype is 46 XX

Phenotype they are female but with ill-developed breast

Usually have secondary amenorrhea

They have testes that should be kept to produce hormones

They have no uterus

The karyotype of patient with Androgen insensitivity Syndrome is

46XX

46XY

47XXY

45XO

45 XY

In Turner syndrome the following are usually present EXCEPT:

the ovary are usually well developed.

The nipple are widely spaced

The girls are of short stature

Has web neck

The condition can be diagnosed by chromosomal

Regarding Androgen insensitivity syndrome all true EXCEPT:

The chromosomal sex is 46XX.

Scant or no pubic and axillary hair.

No uterus

Normal female external genetailia

Breast are usually well develop

Which is not true about Turner's syndrome:

Short stature

Buccal smear is chromatin positive

The majority are 45XO

Very low urinary estrogen titer

High pituitary gonadotropin titer.

Androgen Insensitivity Syndrome:

The characteristic features include normal uterus and breast development, and ambiguous genitalia.

The Karyotyping is 46XX.

They have normal female testosterone level.

Gonadectomy must be performed after puberty because of the increased risk of malignancy.

Estrogen replacement therapy is not indicated because they have enough estrogens to produce breast development.

While evaluating a 30-year-old woman for infertility, you diagnosed a bicornuate uterus. You explain that additional testing is necessary because of the woman's increased risk of congenital anomalies in which system?

Skeletal.

Hematopoietic.

Urinary.

Central nervous.

Tracheoesophageal.

Development stage:

Testosterone is secreted by Sertoli cells.

Anti-müllerian hormone is secreted by Leydig cells.

Anti-müllerian hormone is responsible for involution of normal müllerian system.

Bicornuate uterus can cause all of the following EXCEPT:

Abortions

Abnormal fetal lie.

Infertility.

Retained placenta.

Congenital anomalies of the baby.

In Turner’s syndrome patients, all of the following are true EXCEPT:

The streak ovaries should be removed surgically due to 25% tendency to be malignant.

Are usually less than 5 feet tall.

Have raised FSH levels.

Have female internal genitalia.

Have normal but infertile external genitalia.

The adenxea Uteri include all of the following EXCEPT:

Ovary.

Fallopian tubes.

Uterus.

Broad ligament.

Round ligament.

In the development of external genitalia:

Genital tubercles from the labia minora.

Genital smoothing from the labia majora.

Genital fold from scrotum in male.

Chlydrotestone is essential for muscularity of external genitalia.

Müllerian system develops to external genitalia.

Congenital uterine malformations causes all of the following EXCEPT:

Spontaneous abortions.

Premature labor.

Pregnancy induced hypertension.

Abnormal fetal lie.

May Obstruct labor.

Ovarian Dysgenesis is associated with the elevation of which of the following hormones.

Pituitary Gonadotropins.

Estradiol.

Estriol.

Pregnandiol.

Progesterone.

Confirmation of the diagnosis of Turner syndrome is best done by:

Gyn PV examination.

Pregnantriol estimation.

Hysterosalpingography (HSG)

Chromosomal analysis (Karyotyping).

Estimation of hypophyseal gonadotropins.

In cases of androgen insensitivity syndrome the following findings are true EXCEPT:

The chromosomal sex is 46 XX

Scant or no pubic or axillary hair.

No uterus.

Normal female external genitalia.

Breast are usually well developed.

In testicular feminization syndrome:

There are usually normal testes.

Kalman's syndrome is a recognized cause.

Breast development is usually lacking.

There's usually very low testosterone level.

The karyotype is 46 XX.

In Turner's syndrome, the following are usually observed EXCEPT:

The ovaries are usually well developed.

The nipples are widely spaced.

The girl is of short stature.

Has a webbed neck.

The condition can be diagnosed by chromosomal analysis.

Regarding the Development of internal genital organs:

The uterus, fallopian tubes, cervix & upper vagina develop from the mesophrenic duct.

The testes secretes testosterone which cause regression of the müllerian ducts in the male fetus.

The vagina is formed by the Urogenital sinus.

Müllerian agenesis (Mayer- Rokittanky - Kuster - Huser syndromes) is characterized by the absence of the uterus & upper vagina with normal female external genetailia & 46 XX.

Bicornuate uterus & uterus didelphus result from vertical fusion defects of the müllerian ducts.

Regarding puberty, all of the following are true EXCEPT:

It is the transitional period of development during which an individual matures from childhood to sexual & reproductive maturity.

Breast budding is the 1ST visible sign of puberty.

The maximum growth velocity occurs at 12 years.

The age of menarche has decreased over the last 3-4 decades due to improved nutrition, general health & lifestyle changes.

Thelarche marks the attainment of reproductive maturity.

Turner's syndrome is associated with :

Absent uterus

Normal breast development

Primary amenorrhea

Hirsutism

Normal height

Anomalies or the uterus can be associated with the following EXCEPT:

Urinary tract abnormalities.

Recurrent pregnancies loss.

Preterm labor.

Müllerian tract anomalies.

F.    Polycystic ovary.

First endocrine influence in 2ry sexual characters:

Secretion of delta-4 Androstenedione from the adrenal gland

Pineal body maturation

Pituitary maturation

Hypothalamic down regulation.

Follicular growth (in non-ovulating follicle) is usually followed by:

Ovulation.

Cyst formation.

Atresia.

Arrest.

Regression.

The normal sequence of pubertal changes in the female is:

Thelarche, Maximal growth velocity, menarche.

Maximal growth velocity, Thelarche, menarche.

Thelarche, menarche, maximal growth velocity.

Menarche, maximal growth velocity, Thelarche.

Menarche, body weight, Thelarche.

The barr body is:

The condensed nonfunctioning X chromosome.

The darkest, widest band found on chromosomes.

On extra lobe on the female polymorpholnuclear leukocytes.

Found only in females.

The largest chromosome in the female genotype.

The most common cause of precocious puberty is :

Idiopathic.

Gonadoblastoma.

Albright syndrome.

Abnormal skull development.

Granulosa cell tumor.

The normal sequence of puberty is :

Thelarche , adrenarche, growth, menarche.

Menarche, adrenarche, thelarche ,growth.

Growth. thelarche, adrenarche, menarche

Adrenarche , thelarche, growth, menarche

Thelarche , menarche, adrenarche, growth.

Labor and Fetal Surveillance and Mechanism of Labor:

Labor and Fetal Surveillance and Mechanism of Labor: 

1. Hyperextension of the fetal head is found in: 

A. Vertex presentation 

B. Face presentation 

C. Shoulder presentation 

D. Breach presentation 

E. Hydrocephalic baby  

2. 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. The third stage end with the delivery of the placenta and membranes 

D. Forceps or ventose may be useful in slow progress of the late 1st stage 

E. Syntometrine is a combination of oxytocin and Ergometrine which is used in the treatment of secondary postpartum haemorrhage (PPH) 

3. All the following characteristics are applied to a pelvis favorable to vaginal delivery EXCEPT: 

A. Sacral promontory can not be felt. 

B. Obstetric conjugate is less than 10 cm. 

C. Ischial spines are not prominent. 

D. Subpubic arch accepts 2 fingers. 

E. Intertuberous diameter accepts 4 knuckles on pelvic exam. 

4. In the fetus: 

A. The coronal suture lies between the two parietal bones. 

B. The umbilical artery normally contains one artery and two veins. 

C. Fetal lie describes the long axis of the fetus to the long axis of the mother. 

D. Entanglement of the umbilical cord is common in diamniotic twins. 

E. The anterior Fontanelle is usually closed by the time of labor. 

5. Which of the following terms best describes the pelvic type of small posterior saggital diameter, convergent sidewalls, prominent ischial spines, and narrow pubic arch?
A. Android.
B. Gynecoid.
C. Anthropoid.
D. Platypelloid.
E. Mixed. 

6. The second stage of labor involves: 

A. Separation of the placenta. 

B. Effacement of the cervix. 

C. Expulsion of the placenta. 

D. Dilation of the cervix. 

E. Expulsion of the fetus. 

7. Which is true? 

A. Position – cephalic. 

B. Station – level of ischial spines. 

C. Presentation – flexion. 

8. A pelvic inlet is felt to be contracted if :
A. The anterio-posterior diameter is only 12 cm.
B. The transverse diameter is only 10 cm .
C. Platypelloid pelvis.
D. The mother is short.
E. The patient had a previous C-section. 

9. During clinical pelvimerty, which of the following is routinely measured:
A. Bi-ischeal diameter.
B. Transverse diameter of the inlet.
C. Shape of the pubic arch.
D. Flare of the iliac crest.
E. Elasticity of the levator muscles. 

10. At term, the ligaments of the pelvis change. This can result in:
A. Increasing rigidity of the pelvis.
B. Degeneration of pelvic ground substance.
C. Decreasing width of the symphysis.
D. Enlargement of the pelvic cavity.
E. Posterior rotation of the levator muscles. 

11. During clinical pelvimetry, which of the following is routinely measured:
A. True conjugate.
B. Transverse diameter of the inlet.
C. Shape of the pubic arch.
D. Flare of the iliac crest.
E. Elasticity of the levator muscles. 

12. During the delivery, the fetal head follow the pelvic axis. The axis is best described as:
A. A straight line.
B. A curved line, 1ST directed anteriorly then caudal.
C. A curved line, 1ST directed posteriorly then caudal.
D. A curved line, 1ST directed posteriorly then cephalic.
E. None of the above. 

13. A head of level (one fifth) indicates:
A. Indicates that one fifth of the head is below the pelvic brim.
B. Indicates that the head is engaged.
C. Indicated that forceps may not be used.
D. Indicates that head is at the level of the ischial spines.
E. Always occur in a term brow presentation. 

14. In a vertex presentation, the position is determined by the relationship of what fetal part to the Mother's pelvis:
A. Mentum.
B. Sacrum.
C. Acromian.
D. Occiput.
E. Sinciput. 

15. Signs of Placental separation after delivery include:
A. Bleeding.
B. Changes of uterine shape from discoid to globular.
C. Lengthening of the umbilical cord.
D. Presentation of the placenta at the cervical os.
E. All of the above. 

16. The persistence of which of the following is usually incompatible with spontaneous delivery at term:
A. Occiput left posterior
B. Mentum posterior.
C. Mentum anterior.
D. Occiput anterior.
E. Sacrum posterior. 

17. An unstable lie is related to all of the following EXCEPT: 

A. Prematurity. 

B. Grand multiparty. 

C. Placenta previa. 

D. Fundal fibroid. 

E. Cervical fibroid. 

18. 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.
E. None of the above. 

19. 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.
E. None of the above. 

20. Engagement is strictly defined as:
A. When the presenting part goes through the pelvic inlet.
B. When the presenting part is 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.
E. None of the above.  

21. The fetal head may undergo changes in shape during normal delivery. The most common etiology listed is:
A. Cephalohematoma.
B. Molding.
C. Subdural hematoma.
D. Hydrocephalus.
E. None of the above. 

22. If the large fontanel is the presenting part, what is the presentation?
A. Vertex.
B. Sinciput.
C. Breech.
D. Face.
E. Brow. 

23. Methods of determining fetal presentation & position include: 

A. Cullen's sign. 

B. Leopold's maneuver. 

C. Mauriceau-Smelli-Veit maneuver. 

D. Carful history taking. 

E. All of the above. 

24. A transverse lie of the fetus is least likely in the presence of: 

A. Placenta previa. 

B. Pelvic contraction. 

C. Preterm fetus. 

D. Grand multiparity. 

E. Normal term fetus. 

25. What is the station where the presenting part is at the level of the ischialspines 

A. -2 . 

B. -1 . 

C. 0 . 

D. +1 . 

E. +2 . 

26. A primpara is in labor and an episiotomy to be cut. Compared with a mid line episiotomy, an advantage of medio-lateral episiotomy is: 

A. Ease of repair 

B. Fewer break downs 

C. Lower blood loss 

D. Less dyspareunia 

E. Less extension of the incision 

27. A patient sustained 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
E. Fifth degree 

28. An unstable lie is associated with all the following EXCEPT :
A. Prematurity
B. Grand multiparity
C. Placenta previa
D. Fundal fibroid
E. Cervical fibroid 

29. A primipara is in labor & and an episiotomy is about to be cut. Compared with a midline episiotomy, an advantage of mediolateral episiotomy.
A. Ease of repair,
B. Fewer break downs. 

C. Lower blood loss.
D. Less Dyspareunia.
E. Less extension of the incision. 

30. Which of the following statements about episiotomy if FALSE:
A. Median (midline) episiotomy is generally considered to be less painful the mediolateral episiotomy.
B. Mediolateral or lateral episiotomy may be associated with more blood loss 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. 

31. Regarding Episiotomy:
A. Commonly done in Left medio lateral side.
B. External anal sphincter is included in episiotomy.
C. It is done after the head crown appear ( crowning ). 

32. The first stage of labor :
A. Separation of the placenta.
B. Effacement of the cervix.
C. Expulsion of the placenta.
D. Ends with fully Dilation of the cervix.
E. Expulsion of the fetus. 

33. 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.
E. There is no baseline heart rate. 

34. Repetitive late decelerations most commonly indicate:
A. Fetal academia.
B. Fetal hypoxia.
C. Fetal sleep state.
D. Fetal efforts of maternal sedation.
E. Rapid cervical dilation  

35. 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. 

36. 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. 

37. Regarding Fetal blood pH:
A. Can only be measured postnatally.
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. 

38. The following are major indicators of fetal asphyxia:
A. Old meconium at the time of induction of labor.
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 

39. Which of the following is NOT a characteristic of normal labor:
A. Progressive cervical dilation.
B. Increasing intensity of contractions.
C. Uterine relaxation between contractions.
D. Moderate bleeding.
E. Moderate pain. 

40. Bishop score includes all the followings EXCEPT:
A. Dilation of the cervix.
B. Position of the cervix.
C. The presenting part of the fetus.
D. Length of the cervix.
E. Consistency of the cervix.. 

41. During which of the following conditions would the serum Prolactin level be greatest: A. sleep. B. Ovulation.
C. Parturition. 

D. Menopause.
E. Suckling. 

42. Regarding 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.
E. Are small polypeptides. 

43. 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. 

44. The normal cord pH is :
A. 6.1.
B. 6.2.
C. 7.0.
D. 7.1.
E. 7.2. 

45. 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 well being in labor.
E. The maternal well being postpartum. 

46. Which of the following fetal scalp pH results should prompt immediate delivery: A. 7.30. B. 7.22. C. 7.18. D. 7.26. E. 7.25 

47. The volume of amniotic fluid is:
A. Is closely related to the fetal crown-rump length in the 3rd trimester of 

A. Pregnancy 

B. Maybe predicted by Ultrasound 

C. Is reduced in sever rhesus disease 

D. Increases following amniocentesis E. Is increased in sever pre-eclampsia 

48. Fetal nutrition is dependent on: 

A. Maternal nutrient stores. 

B. Maternal diet. 

C. Placental exchange. 

D. Maternal metabolism. 

E. All of the above. 

49. Cephalopelvic disproportion in the absence of gross pelvic abnormality can be diagnosed by: 

A. Ultrasound. 

B. A maternal stature of less than 158 cm. 

C. Trial of labor. 

D. X-ray pelvimetry. 

E. Pelvic examination. 

50. 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. 

51. Umbilical cord prolapse is associated with all the following, EXCEPT :
A. Post maturity.
B. Cephalo pelvic disproportion.
C. Multiparity.
D. Footing breech presentation.
E. Anencephaly. 

52. In a Case of labor with meconium stained amniotic fluid, your next step is: 

A. Amnio-infusion 

B. Close observation 

C. Fetal scalp blood sample

 D. Immediate C/S 

Anatomy of the female genital tract, bony pelvis and fetal skull:

Anatomy of the female genital tract, bony pelvis and fetal skull: 

1. Uterine Cervix: 

A. Is the portion of the uterus below the isthmus 

B. External OS cell lining is columnar epithelium 

C. Laterally is attached to the round ligament 

D. The cervical canal is covered with stratified squamous epithelium 

E. Can be dilated with dilators without the need of anesthesia  

2. The main support of the uterus is provided by 

A. The round ligament 

B. The cardinal ligament 

C. The infandilo-pelvic ligament 

D. The integrity of the pelvis 

E. The broad ligament 

3. The most important muscle in the pelvic floor is: 

A. Bulbo cavernousus. 

B. Ischio-cavernosus. 

C. Levator ani. 

D. Superficial transverse Perineal muscle. 

E. Deep transverse Perineal muscle. 

4. The pelvis includes which of the following bones: 

A. Trochanter, hip socket, ischium, sacrum & pubis. 

B. Ilium, ischium, pubis, sacrum & coccyx. 

C. Ilium, ischium & pubis. 

D. Sacrum, Ischium, ilium & pubis. 

E. Trochanter, sacrum, coccyx, ilium & pubis. 

5. The joint between the two pubic bones is called the: 

A. Sacroiliac joint. 

B. Pubis symphysis. 

C. Sacrococcygeal joint. 

D. Piriformis. 

E. Intervertebral joint 

6. The greatest diameter of the fetal head is: 

A. Occipitofrontal . 

B. Occipitomental . 

C. Suboccipit bregmatic   

D. Bitemporal . 

E. Biparietal . 

7. Molding of the fetal head: 

A. Usually cause brain damage. 

B. Becomes progressively easier as gestational age increase. 

C. Increase the difficulty of delivery. 

D. Does NOT have time to occur in breech delivery. 

E. Does not happen when maternal pelvis is adequate. 

8. The main blood supply of the vulva is: 

A. Inferior hemorrhoidal artery.

 B. Pudendal artery. 

C. Ilioinguinal artery. 

D. Femoral artery. 

E. Inferior Hypogastric artery. 

9. The following are typical in the female bony pelvis EXCEPT: 

A. Has a transverse diameter of the inlet greater than the antero-posterior diameter. 

B. Has an obstetric conjugate of 11-12 cm. 

C. Is funnel shaped. 

D. Has an obtuse greater sciatic notch. 

E. Has a pubic angle greater than 90 degrees. 

10. Regarding fetal head, Choose the CORRECT answer: 

A. Can be delivered vaginally in persistent occipito-mental Presentation. 

B. Will show Spalding's sign within 12 hours of Intrauterine death. 

C. Can be delivered vaginally in persistent brow presentation. 

D. Is likely to be a vertex presentation when the head is deflexed. 

E. Considered to be engaged when the Biparietal diameter passes the level of the pelvic inlet. 

11. The ovarian artery is a branch of: 

A. Common iliac artery. 

B. Internal iliac artery. 

C. Aorta. 

D. Hypogastric artery. 

E. Sacral artery. 

12. The normal lining of the fallopian tube is: 

A. Squamous epithelium. 

B. Transitional epithelium. 

C. Cuboidal epithelium. 

D. Columnar epithelium with cilia. 

E. Fibrous connective tissue. 

13. The cilia of the fallopian tube has the following function: 

A. Remove the zona pellucida which surrounds the ovum. 

B. Transport the ovum towards the uterus. 

C. Enhance the rapid division of the zygote. 

D. Transport the ovum towards the peritoneal cavity. 

E. Has a bactericidal function to prevent peritoneal function