1. A multigravida at 40 weeks requests induction because her husband is her only caretaker. There are no risk factors. What is the best management?
a) Induction of Labor (IOL)
b) Membrane sweep
c) Cesarean section
d) Expectant management
Key: b) Membrane sweep
Explanation: A membrane sweep is a non-invasive method to induce labor naturally. It reduces the need for formal induction while allowing spontaneous labor progression.
2. A mother at 38 weeks wants IOL for social reasons. What should you tell her?
a) Induction of labor
b) Cesarean section
c) Membrane sweep and counseling about neonatal risks
d) Admit and monitor
Key: c) Membrane sweep and counseling about neonatal risks
Explanation: Inducing labor before 39 weeks without medical necessity increases neonatal risks. Membrane sweep is a safer option.
3. A woman with a previous one C-section wants a vaginal birth. What is the safest method for IOL?
a) PGE2
b) PGE1
c) Cervical catheter
d) Oxytocin
Key: c) Cervical catheter
Explanation: A Foley catheter is the safest method for cervical ripening in a previous C-section case, as prostaglandins increase the risk of uterine rupture.
4. A patient with a previous C-section (3 years ago) experiences hypotension, tachycardia, and severe abdominal pain between contractions during labor. What is the most likely diagnosis?
a) Hypotension
b) Scar dehiscence
c) Uterine rupture
d) Placental abruption
Key: c) Uterine rupture
Explanation: Sudden-onset pain, hemodynamic instability, and fetal distress strongly indicate uterine rupture.
5. A multiparous woman is fully dilated and has a persistent mentoposterior position. What is the best management?
a) Expectant management
b) Manual rotation
c) Forceps delivery
d) Cesarean section
Key: d) Cesarean section
Explanation: Mentoposterior positions often lead to obstructed labor, making a C-section the safest option.
6. A 12-week pregnancy is diagnosed with a missed abortion. According to FIGO, what is the correct medical management?
a) Misoprostol 400 mcg every 3 hours
b) Misoprostol 800 mcg every 3 hours
c) Expectant management
d) Surgical evacuation
Key: b) Misoprostol 800 mcg every 3 hours
Explanation: The FIGO protocol recommends 800 mcg misoprostol every 3 hours for 2 doses to manage missed abortion medically.
7. A patient at 25 weeks had a car accident and has mild vaginal bleeding. What is the best test to assess fetal-maternal hemorrhage?
a) Type and screen
b) Apt test
c) Kleihauer-Betke (K-B) test
d) Complete blood count (CBC)
Key: c) Kleihauer-Betke (K-B) test
Explanation: The K-B test detects fetal red cells in maternal circulation, confirming fetal-maternal hemorrhage.
8. A patient with stress incontinence wants treatment. What is the first-line management?
a) Pelvic floor muscle training for 3 months
b) Biofeedback therapy
c) Electrical stimulation
d) Urodynamic studies
Key: a) Pelvic floor muscle training for 3 months
Explanation: Kegel exercises are the first-line treatment for stress urinary incontinence.
9. A 22-year-old woman at 22 weeks has positive IgM for Hepatitis B core antigen. What is the diagnosis?
a) Acute hepatitis B infection
b) Chronic hepatitis B infection
c) Recent vaccination
d) Inactive hepatitis B carrier
Key: a) Acute hepatitis B infection
Explanation: IgM anti-HBc positivity suggests a recent acute infection, distinguishing it from chronic carriers.
10. A teenage has has heavy bleeding ;hb is 5gm/dl IV fluids and blood trnsfusion is done . . What is the next best treatment?
a) Tranexamic acid
b) High-dose estrogen
c) IV fluids only
d) Blood transfusion
Key: b) High-dose estrogen
Explanation: IV estrogen stabilizes the endometrium in acute heavy bleeding cases before further management.
11. A 30-year-old multiparous woman with third-degree uterovaginal prolapse wishes to have more children. What is the best management?
a) Vaginal hysterectomy
b) Pessary
c) Sacrospinous fixation
d) Sacrohysteropexy
Key: d) Sacrohysteropexy
Explanation: This procedure preserves fertility while offering effective pelvic organ support.
12. A woman at 39 weeks has chorioretinitis, intracranial calcifications, jaundice, hepatosplenomegaly, and anemia in her newborn. What is the most likely cause?
a) Cytomegalovirus
b) Rubella virus
c) Treponema pallidum
d) Parvovirus
Key: a) Cytomegalovirus
Explanation: CMV is the most common congenital infection, leading to intracranial calcifications and chorioretinitis.
13. A pregnant woman presents with intense night-time itching on her palms and soles but no rash. What test confirms the diagnosis?
a) Serum liver function tests
b) Serum bile acids
c) Skin biopsy
d) Liver ultrasound
Key: b) Serum bile acids
Explanation: Intrahepatic cholestasis of pregnancy (ICP) is diagnosed with elevated total bile acids.
14. A 26-year-old primigravida at 37 weeks presents with a pruritic rash starting on her abdomen and extending to her thighs, sparing the face and arms. No bullae or vesicles are seen. What is the diagnosis?
a) Herpes gestationis
b) Pruritic urticarial papules and plaques of pregnancy (PUPPP)
c) Intrahepatic cholestasis of pregnancy
d) Pemphigoid gestationis
Key: b) Pruritic urticarial papules and plaques of pregnancy (PUPPP)
Explanation: PUPPP rash classically appears on the abdomen and spreads, sparing the face.
15. A 36-year-old G1P0 at 35 weeks presents with jaundice, confusion, and elevated liver enzymes. Labs show WBC = 25,000, Hct = 42%, platelets = 51,000, SGOT/PT = 287/350, glucose = 43 mg/dL, fibrinogen = 135 g/L. What is the diagnosis?
a) Hepatitis B
b) Acute fatty liver of pregnancy
c) Intrahepatic cholestasis of pregnancy
d) Severe preeclampsia
Key: b) Acute fatty liver of pregnancy
Explanation: Hypoglycemia, liver failure, and elevated ammonia levels; tlc indicate AFLP, a rare but life-threatening pregnancy complication.
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