Mount Kenya University · School of Medicine · Obstetrics
Paper details
- Paper: Obstetrics II CAT, 1 hour, answer all the questions. No date, university name or unit code is printed on the scan, so it is filed as undated.
- Structure: Section 1 has 30 multiple choice questions (best answer). Section B has 4 short answer questions (20 marks).
- What this page has: 26 of the 30 MCQs and all 4 short answers. MCQs 16, 19, 26 and 27 are left out, because their options are worded so loosely that no single answer is safe (maternal mortality denominators, water retention, vaginal changes and cervical softening).
- Topics tested: types of abortion, ectopic pregnancy, gestational trophoblastic disease, maternal, perinatal and neonatal mortality, the physiology of pregnancy (cardiovascular, haematological, urinary, digestive), antenatal screening and fundal height.
- Note: the scan has handwritten answers and notes. They were ignored.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Questions that need care: Q3, Q20 and Q22 have more than one defensible option or a faulty option list. The explanation says which option is best and why.
Multiple choice questions
1. A 24-year-old G2P1 had her last menstrual period 9 weeks ago. She presents with bleeding and passage of tissues per vagina. The bleeding is associated with lower abdominal pain. The most likely diagnosis is:
- A. Threatened abortion
- B. Inevitable abortion
- C. Incomplete abortion
- D. Twin pregnancy
- E. Ectopic pregnancy
2. Diabetic control is important before conception to reduce the incidence of:
- A. Maternal nephropathy
- B. Diabetic ketoacidosis
- C. Congenital anomalies
- D. Maternal retinopathy
- E. Caesarean section
3. Cardiac output is highest:
- A. In the first trimester
- B. In the second trimester
- C. In the third trimester
- D. During labour
- E. Immediately after delivery
4. Perinatal mortality rate is defined as:
- A. The number of perinatal deaths per thousand live births and stillbirths
- B. Deaths in the first week after birth
- C. All stillbirths plus deaths in the first week after birth
5. A patient has her last menstrual period 4 weeks ago. She denies symptoms such as nausea, fatigue, urinary frequency or breast tenderness. She thinks she may be pregnant because she has not had her period yet. She is very anxious to find out because she has a history of a previous ectopic pregnancy and wants early prenatal care. Which action is most appropriate at this time?
- A. No action is needed because the patient is asymptomatic, has not missed her period, and cannot be pregnant
- B. Order a serum quantitative pregnancy test
- C. Listen for fetal heart tones by Doppler equipment
- D. Perform an abdominal ultrasound
- E. Perform a bimanual pelvic examination to assess uterine size
6. An 18-year-old G2P1001 with the first day of her last menstrual period on May 7 presents for her first visit at 10 weeks. What is her estimated date of delivery?
- A. February 10 of the next year
- B. February 14 of the next year
- C. December 10 of the same year
- D. December 14 of the same year
- E. December 21 of the same year
7. Passage of some but not all placental tissue through the cervix at 9 weeks gestation. Match the description with the correct type of abortion.
- A. Complete abortion
- B. Incomplete abortion
- C. Threatened abortion
- D. Missed abortion
- E. Inevitable abortion
8. Fetal death at 15 weeks gestation without expulsion of any fetal or maternal tissue for at least 8 weeks. Match the description with the correct type of abortion.
- A. Complete abortion
- B. Incomplete abortion
- C. Threatened abortion
- D. Missed abortion
- E. Inevitable abortion
9. Uterine bleeding at 7 weeks gestation without any cervical dilation. Match the description with the correct type of abortion.
- A. Complete abortion
- B. Incomplete abortion
- C. Threatened abortion
- D. Missed abortion
- E. Inevitable abortion
10. Uterine bleeding at 12 weeks gestation accompanied by cervical dilation without passage of tissue. Match the description with the correct type of abortion.
- A. Complete abortion
- B. Incomplete abortion
- C. Threatened abortion
- D. Missed abortion
- E. Inevitable abortion
11. A 20-year-old G1P0 follows up after suction dilation and curettage for an incomplete abortion. She is asymptomatic, and her examination is normal. The pathology report reveals trophoblastic proliferation and hydropic degeneration with absence of vasculature, and no fetal tissue is identified. A chest X-ray is negative for metastatic disease. What is the best next step?
- A. Weekly human chorionic gonadotropin (hCG) titres
- B. Hysterectomy
- C. Single-agent chemotherapy
- D. Combination chemotherapy
- E. Radiation therapy
12. A 22-year-old G1P0 follows up after evacuation of a complete hydatidiform mole. She is asymptomatic and her examination is normal. Which would be an indication to start single-agent chemotherapy?
- A. A rise in hCG titres
- B. A plateau of hCG titres for 1 week
- C. Return of the hCG titre to normal at 6 weeks after evacuation
- D. Appearance of liver metastasis
- E. Appearance of brain metastasis
13. A 32-year-old has abdominal pain and vaginal bleeding. Her last menstrual period was 8 weeks ago and her pregnancy test is positive. She is tachycardic and hypotensive, with peritoneal signs, and a bedside ultrasound shows free fluid in the abdominal cavity. She is taken to the operating room for an emergency laparotomy. Which is the most likely diagnosis?
- A. Ruptured ectopic pregnancy
- B. Hydatidiform mole
- C. Incomplete abortion
- D. Missed abortion
- E. Torted ovarian corpus luteum cyst
14. Which is NOT a risk factor for an ectopic pregnancy?
- A. Fertility treatment
- B. IUD in situ
- C. Endometriosis
- D. Previous tubal infection
- E. Family history
15. Which is NOT a true statement with regard to a normal pregnancy?
- A. The resting heart rate increases by 15 to 20 beats per minute by the end of the third trimester
- B. The blood volume increases by 45%
- C. Polycythaemia develops
- D. There is a leucocytosis up to 18 000
- E. The bladder becomes an abdominal organ
17. Neonatal death is defined as death:
- A. Within the first 24 hours of life
- B. Within the first 4 weeks of life
- C. Within the first 1 year of life
- D. Within the first 2 weeks of life
- E. Of at least 28 weeks gestation
18. The following changes occur in blood coagulation factors during normal pregnancy:
- A. Increase in total serum fibrinogen
- B. Increase in factor VIII
- C. Increase in factor IX
- D. All of the above
- E. None of the above
20. The following changes in acid-base balance occur in normal pregnancy:
- A. Decrease in serum hydrogen concentration
- B. Reduction in plasma bicarbonate
- C. Increase in total base
- D. Acidosis
- E. Increase in organic acids
21. Progesterone in pregnancy causes relaxation of the smooth muscle of:
- A. The GI tract
- B. The uterus
- C. The ureters
- D. The blood vessels
- E. All of the above
22. The following changes occur in haemodynamics during normal pregnancy:
- A. Increase in systolic BP
- B. Increase in diastolic BP
- C. Increase in antecubital venous pressure
- D. Increase in femoral venous pressure
- E. All of the above
23. The following changes occur in the digestive tract during pregnancy:
- A. Hypochlorhydria
- B. Increase in gastric motility
- C. Increase in muscle tone
- D. Increase in pepsin secretion
- E. All of the above
24. The following changes occur in the urinary system during normal pregnancy:
- A. Increase in renal blood flow
- B. Increase in glomerular filtration rate
- C. Increase in the capacity of the kidney pelvis
- D. All of the above
- E. None of the above
25. The neonatal death rate is greatest during:
- A. Labour
- B. The first 24 hours of life
- C. The second week of life
- D. The third week of life
- E. The first 3 months of gestation
28. Folic acid supplementation should continue until at least ___ weeks of gestation:
- A. 12
- B. 26
- C. 36
- D. 24
29. Which of the following antenatal tests is NOT routinely done?
- A. Hepatitis C virus
- B. Rhesus D status
- C. Screening for anaemia
- D. Syphilis
- E. HIV
30. Where would you expect the fundus to rise to in a woman at 20 weeks of gestation?
- A. Around the belly button
- B. Halfway between the belly button and the pubic symphysis
- C. Halfway between the belly button and the breasts
- D. Up to the breasts