Self-assessment: Questions




Chapter 1




  • 1.

    Bartholin’s glands:



    • A.

      Are located on either side of the urethra


    • B.

      Lead into ducts of length around 0.5 cm


    • C.

      Are commonly the site of cyst formation


    • D.

      Are drained by ducts opening between the labia minora and the vaginal introitus


    • E.

      Are endocrine glands



  • 2.

    The vagina:



    • A.

      Is closely related anteriorly to the trigone of the bladder and the urethra


    • B.

      Has the rectum as its only direct relation posteriorly


    • C.

      Is composed of striated muscle


    • D.

      Has a pH in the sexually mature non-pregnant female of 2.0–3.0


    • E.

      Is lined by glandular epithelium



  • 3.

    In regard to the uterus and its supporting structures, which one of the following statements is true?



    • A.

      Posteriorly, the uterosacral ligaments and their peritoneal covering form the lateral boundaries of the rectouterine pouch (of Douglas)


    • B.

      Laterally, the broad ligaments form an important supporting structure for the uterus


    • C.

      In about 50% of women, the uterus lies in a position of retroversion in the pouch of Douglas


    • D.

      In labour, the isthmus (lower segment) of the uterus plays a significant role in expulsion of the fetus


    • E.

      The anterior ligaments and utero-vesical folds play an important role in maintaining anteversion of the uterus



  • 4.

    The ovary:



    • A.

      Lies in close relation to the internal iliac vessels


    • B.

      Derives its blood supply from the ovarian artery which arises from the internal iliac artery


    • C.

      Is covered by ciliated columnar epithelium


    • D.

      Is supported laterally by the suspensory ligament which lies in close relation to the ureter


    • E.

      Contains Graafian follicles which are found only in the central medulla of the organ



  • 5.

    With regard to the uterus, which one of the following is correct?



    • A.

      Lymphatic drainage from the lower part of the uterus passes to the superficial inguinal and adjacent superficial femoral nodes


    • B.

      Uterine pain is mediated through sympathetic afferent nerves passing up to T11/T12 and L1/L2


    • C.

      The uterine artery lies beneath the ureter at the point where the ureter enters the bladder


    • D.

      The blood supply of the uterus is derived entirely from the uterine artery


    • E.

      The isthmus (lower segment) of the uterus is partly innervated by the pudendal nerve






Chapter 2




  • 1.

    Which one of the following is the most likely reason for a premature menopause occurring at the age of 38 years in a woman previously delivered of two children?



    • A.

      Radiotherapy directed at the left breast following lumpectomy of a breast malignancy at the age of 36 years


    • B.

      Tamoxifen therapy given following the breast surgery


    • C.

      The six months of cytotoxic chemotherapy given following completion of the radiotherapy detailed above


    • D.

      Cytotoxic chemotherapy given following excision of a Wilm’s tumour from her left kidney at the age of 10 years


    • E.

      Excision of an endometrioma from her right ovary five years ago



  • 2.

    Which one of the following best describes normal follicular growth occurring in a 25 year-old woman?



    • A.

      About 100 ovarian follicles show obvious follicular growth in each menstrual cycle


    • B.

      In most women one follicle is selected to become the dominant follicle on about day 5–6 of that cycle


    • C.

      The dominant follicle grows by about 1 cm per day from days 6 to 14 of the cycle


    • D.

      The follicle ruptures when it reaches about 4 cm in diameter


    • E.

      A separate but adjacent follicle becomes the corpus luteum



  • 3.

    Which one of the following statements about meiosis is correct?



    • A.

      Meiosis is the mechanism of production of the seven million germ cells found in the ovary at 6 months of fetal life


    • B.

      The first meiotic division is completed prior to birth of the baby concerned


    • C.

      The second meiotic division commences at the time of attachment of the sperm to the oocyte


    • D.

      Rearrangements of the genes within the chromosomes occurs after the male zygote chromosomes have entered the nucleus and combine with those of the female zygote


    • E.

      The delay between the end of the first meiotic division and the commencement of the second meiotic division is the cause of the increased chromosome abnormality rate seen in women who conceive after the age of 37 years



  • 4.

    Which one of the following statements about the process of fertilization in the human female is correct?



    • A.

      It usually occurs within the outer end of the Fallopian tube


    • B.

      The female gamete determines the sex of a resulting fetus


    • C.

      A twin pregnancy is due to failure of the normal inhibitory process, where further sperm are prevented from entering the oocyte following attachment of the first sperm to the Zona pellucida


    • D.

      Fertilization can occur up to six days after ovulation


    • E.

      Sperm capacitation to facilitate fertilization occurs within the seminiferous epithelium of the testis



  • 5.

    Which one of the following facts about implantation is correct?



    • A.

      Implantation usually occurs about two days after fertilization


    • B.

      At the time of implantation the embryo is usually at the eight-cell stage


    • C.

      hCG is produced by the implanting embryo soon after implantation has commenced


    • D.

      If the endometrial appearance at the time of implantation is proliferative, the pregnancy is lost as a spontaneous miscarriage


    • E.

      If implantation occurs, the period is always delayed and a urinary pregnancy test performed two to three days after the day the period was expected, will be positive






Chapter 3




  • 1.

    Which one of the following facts about the human placenta is correct?



    • A.

      It is not very invasive


    • B.

      It contributes to the high levels of circulating oxytocin in the mother


    • C.

      It needs glucose and amino acids from the mother to grow


    • D.

      It does not help in excretory functions of the fetus


    • E.

      It is richly innervated



  • 2.

    Regarding the rise in cardiac output, which one of the following is correct? It



    • A.

      occurs in late pregnancy


    • B.

      is entirely driven by a rise in stroke volume


    • C.

      is associated with a rise in afterload


    • D.

      can precipitate heart failure in women with heart disease


    • E.

      causes an increase in pulmonary arterial pressure



  • 3.

    Considering respiratory function in pregnancy, which one of the following statements is correct?



    • A.

      Progesterone sensitizes the adrenal medulla to CO 2


    • B.

      Maternal P a O 2 rises by ~15%


    • C.

      There is no increase in maternal 2,3-DPG


    • D.

      Maternal oxygen-carrying capacity rises by ~18%


    • E.

      There is an 80% increase in minute ventilation



  • 4.

    Considering renal function in pregnancy, which one of the following statements is correct?



    • A.

      Most increase in renal size occurs in late pregnancy


    • B.

      The ureters are floppy and toneless


    • C.

      The rise in GFR activates the renin-angiotensin system


    • D.

      About 1800 mmol sodium are retained during pregnancy


    • E.

      Urinary tract infections are less common in pregnancy



  • 5.

    In relation to endocrine function in pregnancy, which one of the following statements is correct?



    • A.

      Insulin resistance develops


    • B.

      Glycosuria is not common


    • C.

      The thyroid involutes


    • D.

      The gut absorbs more calcium but less is lost in the urine


    • E.

      The increased skin pigmentation is caused by thyroid-stimulating hormone






Chapter 4




  • 1.

    In early placental development, which one of the following is correct?



    • A.

      The outer cytotrophoblast invades the endometrial cells and the myometrium


    • B.

      Decidual cells do not support the invading trophoblasts


    • C.

      With the placental invasion large lacunae are formed and are filled with fetal blood


    • D.

      Chorion frondosum forms the placenta


    • E.

      Chorion laevae forms the placenta



  • 2.

    Which one of the following is correct regarding the umbilical cord?



    • A.

      It has two veins and one artery


    • B.

      The arterial blood has more oxygen


    • C.

      One artery and one vein is compatible with fetal growth and a live baby


    • D.

      Cord artery has a systolic pressure of 120 mmHg


    • E.

      Cord venous pressure is 70 mmHg



  • 3.

    Which one of the following is correct regarding placental transfer?



    • A.

      Transfer of placental gases is by simple diffusion


    • B.

      Transfer of glucose is by simple diffusion


    • C.

      In active transport the concentration of the substrate transported in fetal blood is lower than on the maternal blood.


    • D.

      Low molecular weight substrates are transported by pinocytosis


    • E.

      Fetal cells do not get transferred to the maternal circulation



  • 4.

    Placental function includes all of the following except:



    • A.

      Gaseous exchange


    • B.

      Fetal nutrition


    • C.

      Removal of waste products


    • D.

      Endocrine function


    • E.

      A barrier for infections



  • 5.

    Regarding amniotic fluid, which one of the following is correct?



    • A.

      Polyhydramnios is associated with fetal anomaly


    • B.

      Amniocentesis for karyotyping carries no risk to the pregnancy


    • C.

      The only complication of long standing severe oligohydramnios is postural deformities


    • D.

      Most cases of intrauterine growth restriction have normal liquor volume


    • E.

      Amnio infusion is a standard procedure for variable decelerations observed on the cardiotocography






Chapter 5




  • 1.

    Which one of the following statements is true of perinatal mortality?



    • A.

      Perinatal mortality is an indication of the wealth of the nation


    • B.

      Knowing the circumstances around perinatal mortality helps countries to build better maternity units


    • C.

      It is an important indication of maternal health and the standard of maternal and neonatal care


    • D.

      The World Health Organization has set targets of perinatal mortality for each country


    • E.

      The World Bank gives financial incentives to countries that have the best perinatal mortality rates



  • 2.

    Which one of the following statements is true of stillbirth?



    • A.

      Stillbirth is an indication of the standard of intrapartum care


    • B.

      Using the Wigglesworth Classification, around 30% are classified as of unknown antecedent


    • C.

      The most common cause of stillbirth is intrapartum stillbirth


    • D.

      The region with the highest stillbirth rate in the world is in the Caribbean


    • E.

      There was a statistically significant reduction in the stillbirth rate in the UK in 2008 compared to the year before



  • 3.

    Which one of the following statements is true of neonatal deaths?



    • A.

      Low birth weight is a well-known direct cause


    • B.

      In low resource countries, tetanus remains one of the most important causes of neonatal deaths


    • C.

      The neonatal death rates related to prematurity in developing countries have shown a significant fall


    • D.

      The majority of deaths related to neonatal tetanus occur around the 3rd week of life


    • E.

      The best investment to improve the neonatal death rates is to build more neonatal intensive care units



  • 4.

    Which one of the following statement most accurately describes maternal deaths?



    • A.

      Direct maternal deaths arise from complications or their management which are unique to pregnancy, occurring during the antenatal, intrapartum or postpartum periods


    • B.

      Coincidental causes occur when two or more causes are noted to cause a mother’s death


    • C.

      The maternal mortality rate in the UK is defined as the number of direct and indirect deaths per 100 000 live births


    • D.

      Maternal mortality rates reflect the state of antenatal care of a country


    • E.

      Can be reduced by increasing the number of doctors and midwives



  • 5.

    Which one of these statements is true of maternal mortality?



    • A.

      Group B Streptococcus is a major cause of maternal mortality


    • B.

      Cardiac disease is the leading cause of direct deaths in the UK


    • C.

      Group A Streptococcus sepsis is easily recognized and treated


    • D.

      Group A Streptococcus sepsis was the leading cause of maternal deaths in the UK between 2006 and 2008


    • E.

      Venous thromboembolism is now a rare cause of death






Chapter 6




  • 1.

    Which of the following are not included in basic clinical skills in obstetrics?



    • A.

      Ensuring verbal and non-verbal communication in a logical sequence


    • B.

      Eliciting physical signs (general, systemic and obstetric examinations)


    • C.

      Differentiating normal pregnancy associated changes from abnormal deviation


    • D.

      Arriving at a provisional diagnosis


    • E.

      Performing a fetal anomaly scan at 22 weeks



  • 2.

    In eliciting an obstetric history, which of the following is correct?



    • A.

      Previous obstetric history is relatively unimportant as management decisions are made on how the current pregnancy has progressed


    • B.

      The first date of the last menstrual period (LMP) is a reliable indicator of the expected date of delivery (EDD)


    • C.

      The pre-ovulatory period is fairly constant whereas the post-ovulatory period shows a wide variation in a typical menstrual cycle


    • D.

      Ultrasound scan in the third trimester accurately determines the gestational age


    • E.

      Hormonal contraception may be associated with a delay in ovulation in the first cycle after discontinuation



  • 3.

    Regarding symptoms of pregnancy, which one of following statements is true?



    • A.

      Nausea and vomiting commonly occur 10 weeks after missing the first period


    • B.

      Increased frequency of micturition tends to worsen after the first 12 weeks of pregnancy, as the uterus rises above the symphysis pubis


    • C.

      Morning sickness persist throughout pregnancy in most women


    • D.

      Plasma osmolality gradually increases with advancing gestation


    • E.

      There is an increased diuretic response after water loading when the woman is sitting in the upright position



  • 4.

    During pregnancy, which of the following statements is correct?



    • A.

      Blood pressure is recorded with the patient lying flat on her back to get the most accurate reading


    • B.

      Blood pressure should be recorded on different positions during each antenatal visit, alternating the blood pressure cuff on different arms


    • C.

      If inferior vena cava compression is not recognized for a prolonged period, fetal compromise may occur secondary to a reduction in utero-placental circulation


    • D.

      Diastolic pressure should be taken with the fourth Korotkoff sound (i.e. fading of the sound)


    • E.

      Benign ‘flow murmurs’ due to the hyperdynamic circulation are common and are of no significance



  • 5.

    In pelvic examination during pregnancy, which of the following is correct?



    • A.

      Routine pelvic examination to confirm pregnancy and gestation at booking should be performed, even in settings where an ultrasound scan is freely available


    • B.

      Digital vaginal examination is contraindicated in later pregnancy in cases of antepartum haemorrhage until placenta praevia can be excluded


    • C.

      Routine antenatal radiological pelvimetry has been shown to be of value in predicting outcome of labour in primigravid women


    • D.

      In a normal female or gynaecoid pelvis, because the sacrum is evenly curved, maximum space for the fetal head is provided at the pelvic outlet


    • E.

      Diameter of the diagonal conjugate is approximately 3.5 cm greater than the obstetric diameter






Chapter 7




  • 1.

    Antenatal screening for infection is to provide the best outcome for the mother and the fetus/newborn. Which one of the following investigations is not recommended as part of routine antenatal care?



    • A.

      Hepatitis B


    • B.

      Cytomegalovirus


    • C.

      Syphilis


    • D.

      Rubella


    • E.

      HIV/ AIDS



  • 2.

    Which of the following statements is true of Group B streptococcus?



    • A.

      It is a gram negative bacteria


    • B.

      It is not a commensal organism


    • C.

      It is associated with an increased risk of preterm birth


    • D.

      Screening is routine in the antenatal period in all countries


    • E.

      If Group B streptococcus was found in urine culture there is no need to treat in labour



  • 3.

    There is a risk of gestational diabetes in all of the following except :



    • A.

      Previous macrosomic baby weighing >4.5 kg


    • B.

      Maternal BMI >35


    • C.

      First degree relatives with Diabetes Mellitus


    • D.

      Gestational diabetes in previous pregnancy


    • E.

      Adolescent pregnancy



  • 4.

    Extra folic acid supplementation is recommended in all the following except :



    • A.

      Previous child with neural tube defects


    • B.

      Women on anti-epileptic medication


    • C.

      Women with diabetes mellitus


    • D.

      Maternal obesity with a BMI>35


    • E.

      Mothers who had a previous Down syndrome baby



  • 5.

    Which one of the following statements are incorrect in pregnancy:



    • A.

      Mothers are encouraged to take reasonable exercise


    • B.

      Coitus in pregnancy is not contraindicated


    • C.

      Moderate alcohol consumption is not harmful in pregnancy


    • D.

      Smoking is harmful to the fetus


    • E.

      Paracetamol is a safe drug in pregnancy






Chapter 8




  • 1.

    With regard to an antepartum haemorrhage at 36 weeks, the commonest cause is:



    • A.

      Placenta previa


    • B.

      Placental abruption


    • C.

      Idiopathic


    • D.

      A cervical lesion


    • E.

      Vasa previa



  • 2.

    With regard to hypertension in pregnancy, which one of the following statements is correct?



    • A.

      The diastolic reading is taken as the fourth Korotkoff sound


    • B.

      A diastolic reading of >90 mmHg is more significant than a systolic reading of >150 mmHg


    • C.

      Pre-eclampsia is defined as the development of hypertension after 20 weeks


    • D.

      The most important regulatory factor of maternal blood pressure in pregnancy is a fall in peripheral resistance


    • E.

      The HELLP syndrome is a mild variant of pre-eclampsia



  • 3.

    In twin pregnancy, which of the following statements is true?



    • A.

      The prevalence of identical (monozygotic) twins varies from country to country


    • B.

      The twin peak sign is most commonly seen on a first trimester ultrasound in dizygotic twins


    • C.

      Miscarriage is less common then in singleton pregnancies


    • D.

      Preterm delivery is increased by a factor of two with respect to a singleton pregnancy


    • E.

      The feto-fetal (twin–twin) transfusion syndrome presents only after 24 weeks gestation



  • 4.

    The causes of an unstable lie include all of the following except :



    • A.

      Placenta previa


    • B.

      Polyhydramnios


    • C.

      Subseptate uterus


    • D.

      Primiparity


    • E.

      Twin pregnancy



  • 5.

    In prolonged pregnancy, which one of the following statements is correct?



    • A.

      All babies show signs of the post-maturity syndrome


    • B.

      Can be accurately determined from the mother’s last menstrual period in 90% of cases


    • C.

      May indicate the presence of a fetal anomaly


    • D.

      Is only associated with an increase in perinatal morbidity, not mortality


    • E.

      Is managed by induction of labour at 40 weeks gestation






Chapter 9




  • 1.

    Anaemia in pregnancy is most frequently caused by:



    • A.

      Sickle cell disease


    • B.

      Folate deficiency


    • C.

      B12 deficiency


    • D.

      Thalassaemia


    • E.

      Iron deficiency



  • 2.

    Which of the following does not increase the risk of gestational diabetes?



    • A.

      South-East Asian ethnicity


    • B.

      A family history of diabetes


    • C.

      Age <18 years


    • D.

      Polycystic ovarian syndrome


    • E.

      Obesity



  • 3.

    In acute venous thromboembolism in pregnancy, which one of the following statements is true?



    • A.

      Is more likely to occur in the right leg compared to the left


    • B.

      Can be diagnosed by the use of d -dimer measurements


    • C.

      Is two times more likely than in the non-pregnant state


    • D.

      Is a leading cause of maternal mortality in the developed world


    • E.

      Is treated by warfarin in the first instance



  • 4.

    Compared to women with a normal body mass index, obesity in pregnancy is associated with:



    • A.

      An increased risk of pre-eclampsia


    • B.

      Similar pregnancy outcomes


    • C.

      A higher normal birth rate


    • D.

      A lower miscarriage rate


    • E.

      Similar efficacy of ultrasound screening



  • 5.

    Concerning epilepsy and pregnancy, which of the following statements is true?



    • A.

      The majority of women will have an increase in seizure frequency in pregnancy


    • B.

      Women with epilepsy have a 4–5% chance of having a child who develops epilepsy


    • C.

      Sodium valproate is the anti-epileptic of choice


    • D.

      400 µg of folic acid should be taken pre-conceptually and throughout the first trimester


    • E.

      Breast-feeding should be avoided



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Mar 2, 2019 | Posted by in OBSTETRICS | Comments Off on Self-assessment: Questions
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