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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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
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.
A. Ease of repair,
B. Fewer break downs.
C. Lower blood loss.
D. Less Dyspareunia.
E. Less extension of the incision.
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.
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 ).
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.
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.
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
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.
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.
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.
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.
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
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.
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..
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.
C. Parturition.
D. Menopause.
E. Suckling.
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.
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.
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.
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.
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. 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.
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
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