Junior Clerkship in Reproductive Health (MBOG 4200): end of year examination, 4 July 2019

Mount Kenya University · Medical School · Department of Obstetrics and Gynaecology

Paper details

• Unit: MBOG 4200, Junior Clerkship in Reproductive Health
• Sitting: End-of-year main examination, 4 July 2019, 8:00 AM, University Examination 2018/2019, Trimester 3 (May to August)
• Time allowed: 3 hours. Paper One.
• Section A: multiple choice questions, best answer, 70 marks
• What this page has: MCQs 1 to 66. MCQs 67 to 70 and Section B (written questions) were not in the scanned file, so they are not published here.
• Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme. A few questions are badly worded, and those are marked so you know to expect discussion.
• Topics tested: physiology of pregnancy, fetal circulation, labour and mechanisms, pelvis, fetal heart rate, pre-eclampsia, antepartum haemorrhage, ectopic pregnancy, puerperium, caesarean section, gynaecological oncology, infertility, contraception, prolapse and urogynaecology.

1. All are correct EXCEPT. Pregnancy is associated with:

• A. Increased cardiac output
• B. Increased venous return
• C. Increased peripheral resistance
• D. Increased pulse rate
• E. Increased stroke volume

2. Lowered haemoglobin during normal pregnancy is a physiological finding. It is mainly due to:

• A. Low iron stores in all women
• B. Blood lost to the placenta
• C. Increased plasma volume
• D. Increased cardiac output causing greater red cell destruction
• E. Decreased reticulocytosis

3. After birth, all of these vessels constrict EXCEPT:

• A. Ductus arteriosus
• B. Umbilical arteries
• C. Ductus venosus
• D. Hepatic portal vein
• E. Umbilical vein

4. During clinical pelvimetry, which is routinely measured?

• A. Bi-ischial (intertuberous) 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

5. The fetal head follows the pelvic axis. The axis is best described as:

• A. A straight line
• B. A curved line, first directed anteriorly then caudal
• C. A curved line, first directed posteriorly then anteriorly
• D. A curved line, first directed posteriorly then cephalic
• E. None of the above

6. In a vertex presentation, the position is determined by the relationship of which fetal part to the mother's pelvis?

• A. Mentum
• B. Sacrum
• C. Acromion
• D. Occiput
• E. Sinciput

7. Signs of placental separation after delivery include:

• A. Bleeding
• B. Change in 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

8. 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

9. Which statement about episiotomy is FALSE?

• A. A median episiotomy is generally less painful than a mediolateral one
• B. A mediolateral episiotomy may be associated with more blood loss than a median one
• C. Indications include avoiding an imminent tear, forceps, breech delivery and premature infants
• D. The earlier the episiotomy is done, the more beneficial it is in speeding delivery
• E. Episiotomy incisions are repaired anatomically in layers

10. The heart rate of a normal term fetus:

• A. 80 to 100 bpm
• B. 100 to 120 bpm
• C. 120 to 160 bpm
• D. 160 to 180 bpm
• E. There is no baseline heart rate

11. Repetitive late decelerations most commonly indicate:

• A. Fetal alkalosis
• B. Fetal hypoxia
• C. Fetal sleep state
• D. Fetal effects of maternal sedation
• E. Rapid cervical dilatation

12. The Bishop score includes all of the following EXCEPT:

• A. Dilatation 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

13. The following are typical of the female bony pelvis EXCEPT:

• A. Transverse diameter of the inlet greater than the anteroposterior diameter
• B. Obstetric conjugate of 11 to 12 cm
• C. Funnel shaped
• D. Obtuse greater sciatic notch
• E. Pubic angle greater than 90 degrees

14. The main blood supply of the vulva is:

• A. Inferior haemorrhoidal artery
• B. Pudendal artery
• C. Ilioinguinal artery
• D. Femoral artery
• E. Inferior hypogastric artery

15. Regarding the fetal head, choose the CORRECT answer:

• A. Can be delivered vaginally in persistent mentoposterior position
• B. Shows 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. Is considered engaged when the biparietal diameter passes the level of the pelvic inlet

16. The cilia of the fallopian tube function to:

• A. Remove the zona pellucida
• B. Transport the ovum towards the uterus
• C. Enhance rapid division of the zygote
• D. Transport the ovum towards the peritoneal cavity
• E. Have a bactericidal function

17. Glycogen is seen in the lumina of endometrial glands:

• A. During the luteal phase
• B. During pregnancy only
• C. During pre- and post-ovulatory phases
• D. During the proliferative phase only

18. Monilial vaginitis occurs frequently in pregnancy because:

• A. Glycosuria is commoner
• B. The vagina contains more glycogen
• C. Higher vaginal acidity suppresses other organisms
• D. All of the above
• E. None of the above

19. Clinical findings of PCOS (PCOD) include all EXCEPT:

• A. Obesity
• B. Oligomenorrhoea
• C. Infertility
• D. Tall stature

20. The commonest cause of death in cancer of the cervix is:

• A. Infection
• B. Uraemia
• C. Haemorrhage
• D. Cachexia
• E. Distant metastasis

21. HPV types ____ account for about 70% of cervical cancers:

• A. 45 and 46
• B. 31 and 33
• C. 14 and 16
• D. 16 and 18
• E. 12 and 14

22. The fetus lies across the uterus with the head in the flank:

• A. Transverse lie
• B. Cephalic lie
• C. Breech lie
• D. Frank lie
• E. Oblique lie

23. Which means the head is at the level of the ischial spines?

• A. Station +1
• B. Station -1
• C. Station -2
• D. Station 0
• E. Station +2

24. The part of the fetus that occupies the lower segment of the uterus or pelvis is called:

• A. The show
• B. The version
• C. The engagement
• D. The lie
• E. The presentation

25. Poor prognostic factors for malignant change in trophoblastic disease include:

• A. Disease following a normal delivery
• B. Beta-hCG above 80,000 mIU/ml
• C. Disease following an abortion
• D. A and C
• E. A and B

26. True of oral contraceptive pills:

• A. They decrease the risk of ovarian cancer
• B. They are contraindicated in parous women with endometriosis
• C. They are contraindicated in young nulliparous girls
• D. All of the above
• E. None of the above

27. True about vesicovaginal fistula (VVF):

• A. Should be repaired at least 2 months after delivery
• B. Surgical repair is the only mode of treatment
• C. Amenorrhoea is a very common finding
• D. The commonest cause in Kenya is surgery
• E. The diagnosis is by direct inspection of the anterior vaginal wall with a Sims speculum

28. The most common cause of male factor infertility is:

• A. Cryptorchidism
• B. Testicular failure
• C. Obstruction
• D. Varicocele
• E. Impotence

29. The most common site of endometriosis is:

• A. The pouch of Douglas
• B. The ovary
• C. The posterior surface of the uterus
• D. The broad ligament
• E. The pelvic peritoneum

30. A classical caesarean section is:

• A. A vertical incision in the upper uterine segment
• B. A vertical incision in the lower uterine segment
• C. A vertical incision from the upper to the lower segment
• D. A transverse incision in the lower segment
• E. None of the above

31. Regimens recommended by the Ministry of Health for simple malaria in pregnancy:

• A. Oral quinine
• B. Fansidar
• C. Artemisinin
• D. Artemether-lumefantrine
• E. Parenteral chloroquine

32. The following favours mother-to-child transmission of HIV:

• A. HIV type 2
• B. HIV type 1
• C. High CD4 count
• D. Seroconversion in pregnancy
• E. HAART

33. Nausea during the first cycle of pills. Select the most appropriate response:

• A. Stop pills and resume after 7 days
• B. Continue pills as usual
• C. Continue pills and use an additional contraceptive
• D. Take an additional pill
• E. Stop pills and seek a medical examination

34. A gravida 6 para 4+1 admitted with severe pre-eclampsia. True:

• A. After control of blood pressure she should have a caesarean section as the quickest mode of delivery
• B. Her blood vessels show an abnormal reaction to vasopressor agents
• C. A bleeding profile is part of the work-up to diagnose intravascular coagulopathy
• D. B and C
• E. None of the above

35. About renal changes in pregnancy, the following are true EXCEPT:

• A. GFR increases by 50%
• B. Renal plasma flow increases by 50%
• C. Oestrogens are responsible for general ureteric relaxation
• D. There is decreased predisposition to urinary tract infections
• E. There is increased creatinine clearance

36. Indications for medical (methotrexate) treatment of ectopic pregnancy include the following EXCEPT:

• A. Absence of cardiac activity
• B. Beta-hCG below 5000 mIU/ml
• C. Unruptured ectopic
• D. An ectopic greater than 3.5 cm
• E. An ectopic less than 3.5 cm

37. Active management of the third stage of labour (AMTSL) involves:

• A. A balloon tamponade to enhance involution
• B. Delivery of the placenta by controlled cord traction with counter-traction over the suprapubic area
• C. Monitoring BP, pulse, GCS and vaginal bleeding every 20 minutes for one hour
• D. Pelvic floor exercises
• E. Administration of 10 IU oxytocin IM on the anterior thigh within 10 minutes of delivery of the baby

38. A 23-year-old at 33 weeks has a headache, BP 166/112 mmHg and proteinuria ++. The most adequate management:

• A. Hydralazine 5 mg IV every 15 min plus MgSO4 4 g IM
• B. Hydralazine 5 mg IV every 30 min until BP is under 160/100 plus MgSO4, dexamethasone 24 mg within 24 hours and induction of labour after this time
• C. Hydralazine, MgSO4, dexamethasone, then conservative management after BP control
• D. BP control and emergency caesarean section
• E. None of the above

39. A 25-year-old at 32 weeks is pale, dehydrated, pulse 120, BP 90/60, fundal height 36 cm, hard tender uterus, no fetal heart, scanty blood PV, pink cervix. Most likely diagnosis:

• A. Placental abruption
• B. Placenta praevia type IV
• C. Cervical carcinoma
• D. Severe placental abruption with IUFD and DIC
• E. Vasa praevia with IUFD

40. Regarding her management:

• A. Two peripheral lines, FBC, clotting profile, transfusion and emergency caesarean
• B. Immediate induction of labour using a Foley catheter
• C. General measures for all APH, AROM, correction of DIC and emergency caesarean
• D. General measures for all APH, AROM, correction of DIC and induction of labour
• E. General measures for all APH, AROM, correction of shock and DIC and induction of labour

41. A 22-year-old has severe right inguinal and right shoulder pain, tenderness, minimal vaginal bleeding, free intra-abdominal fluid, hCG 1600, BP 90/42, pulse 105. Next best step:

• A. Pelvic MRI
• B. Abdominal X-ray
• C. IV fluids and monitor
• D. Exploratory laparotomy
• E. Administer methotrexate

42. Risk factors for puerperal infection EXCEPT:

• A. Poor antiseptic technique
• B. Prolonged labour or ruptured membranes
• C. External cephalic version
• D. Forceps delivery
• E. Bacterial vaginosis

43. Among the commonest causative organisms of puerperal infection, the following are anaerobes EXCEPT:

• A. Klebsiella
• B. Peptococcus species
• C. Peptostreptococcus
• D. Bacteroides fragilis
• E. Proteus mirabilis

44. The following affect wound healing EXCEPT:

• A. Steroid therapy
• B. Proper apposition of layers
• C. Immune status
• D. Infection
• E. Cancer

45. A physiological change in the puerperium:

• A. Maternal heart rate reduced by 20 to 30 beats per minute
• B. Endometrium is physiologically restored within 15 days
• C. Increased water retention
• D. Oedema reabsorption
• E. Foul-smelling vaginal discharge

46. A complication of caesarean section:

• A. Deep venous thrombosis
• B. Amniotic fluid embolism
• C. Puerperal infection
• D. Neighbouring organ injury
• E. All of the above

47. Predisposing factors for preterm labour:

• A. Cervical incompetence
• B. Previous preterm delivery
• C. Socio-economic disadvantage
• D. All of the above
• E. None of the above

48. True about the partograph:

• A. Started at 3 cm cervical dilatation
• B. Baseline fetal heart rate of 110 to 160 beats per minute
• C. Always deliver by caesarean section when the patient reaches the action line
• D. The alert line means do a caesarean section
• E. Ruptured membranes cannot be done

49. Softening of the cervix in the second month of pregnancy is known as:

• A. Hegar's sign
• B. Braxton Hicks sign
• C. Goodell's sign
• D. Chadwick's sign
• E. None of the above

50. In cervical incompetence, which is true?

• A. The diagnosis is made only after an abortion occurs
• B. It is a habitual mid-trimester abortion
• C. Rupture of membranes is not a feature
• D. The only treatment is a cerclage

51. Using Naegele's rule, the EDD for an LMP of 10 March:

• A. December 3
• B. December 7
• C. December 10
• D. December 17
• E. November 17

52. Correct about menopause:

• A. Progesterone levels rise
• B. The pituitary stops secreting LH
• C. LH levels rise
• D. The number of oocytes in the ovary remains constant until menopause
• E. Androgen levels remain unchanged

53. The female reproductive tract helps sperm transport by:

• A. Providing an acidic environment to keep spermatozoa active
• B. Preventing spermatozoa from swimming into the peritoneal cavity
• C. Regulating sperm transport so cells reach the site of fertilisation around ovulation
• D. Trapping sperm in the cervical os for many days
• E. Providing an alkaline environment

54. True about semen analysis:

• A. Identifies men with high-quality fertile sperm
• B. Identifies men with low sperm concentrations that might affect fertility
• C. Identifies men with gynaecomastia
• D. Can always be used to predict fertility
• E. Does not assess motility

55. You will suspect PID in all EXCEPT:

• A. Early coitarche
• B. Previous abortion
• C. Previous contraceptive use
• D. Previous ectopic pregnancy
• E. Previous treatment for an STI

56. Immune rejection of the fetus is prevented by:

• A. hCG
• B. HPL
• C. Oestrogen
• D. Progesterone
• E. All of the above

57. The commonest presentation of molar pregnancy:

• A. Perforation of the uterus
• B. Vaginal bleeding
• C. Breathlessness
• D. Hyperthyroidism
• E. Haemoptysis

58. A 28-year-old has amenorrhoea after treatment for an incomplete miscarriage. Most likely diagnosis:

• A. Post-abortion endometritis
• B. Pelvic inflammatory disease
• C. Asherman syndrome
• D. Kallmann syndrome
• E. All of the above

59. Seen in a partial mole:

• A. Triploidy
• B. Haploidy
• C. Polyploidy
• D. Diploidy
• E. All of the above

60. All are consistent with antiphospholipid syndrome EXCEPT:

• A. Hydatidiform mole
• B. Arterial or venous thrombosis
• C. Mid-trimester fetal loss
• D. Placental abruption
• E. None of the above

61. Incorrect statement on the management of uterovaginal prolapse:

• A. Can include physiotherapy and pelvic floor exercises
• B. Involves assessment of bladder function where urinary symptoms are present
• C. Exclusion of a pelvic mass contributing to the prolapse
• D. Oestrogen replacement may benefit premenopausal women

62. The most appropriate statement on oestrogen replacement therapy:

• A. It causes ulceration of the vaginal wall
• B. It can cause carcinoma of the vaginal wall
• C. It can help improve mild vaginal prolapse
• D. It can cause dyspareunia

63. Regarding bladder innervation:

• A. The sympathetic system is active during bladder emptying
• B. The parasympathetic system is active during bladder filling
• C. The pelvic nerve is involved in bladder emptying
• D. The hypogastric nerve is involved in bladder emptying

64. In the Baden-Walker classification, a third-degree uterine prolapse is characterised by:

• A. Descent up to the hymen
• B. Descent below the ischial spines
• C. Descent beyond the introitus
• D. Minimal descent

65. The main cause of abnormal uterine bleeding in a 13-year-old girl:

• A. Trauma
• B. Ectopic pregnancy
• C. Anovulation
• D. Polycystic ovarian disease

66. In the medical treatment of menorrhagia, which is true?

• A. Danazol is not associated with serious side effects
• B. GnRH analogues are useful in long-term treatment of menorrhagia
• C. Combined oral contraceptives can be used
• D. GnRH analogues are the treatment of choice