Mount Kenya University · Medical School · Department of Obstetrics and Gynaecology
Paper details
- Unit: Junior Clerkship in Reproductive Health 1 (Obstetrics I)
- Sitting: End-of-trimester CAT, Trimester 1 (September to December). The scan carries no date.
- Sections: Section 1, 40 multiple choice questions. Section 2, 4 short answer questions (20 marks).
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Topics tested: physiology of pregnancy, diagnosis of pregnancy, placenta and fetal circulation, abortion, ectopic pregnancy, molar pregnancy, safe motherhood, birth plan, preconception care.
Section 1: Multiple choice questions
1. Fetal nutrition is dependent on:
- A. Maternal nutrient stores
- B. Maternal diet
- C. Placental exchange
- D. Maternal metabolism
- E. All of the above
2. Maternal mortality is lowest in mothers between what age groups?
- A. 10 to 20
- B. 20 to 30
- C. 30 to 40
- D. 40 to 50
- E. 50 to 60
3. In a patient with a bicornuate uterus, pregnancy can give all these complications EXCEPT:
- A. Polyhydramnios
- B. Abortion
- C. Preterm labour
- D. Abnormal fetal lie
- E. Retained placenta
4. Which of the following is suggestive of ovulation?
- A. Basal body temperature drop of at least 0.5 °C in the second half of the cycle
- B. Day 21 oestrogen level is elevated
- C. Progesterone level on day 10 of the cycle is elevated
- D. Regular cycle with dysmenorrhoea
- E. Oligomenorrhoea
5. The follicular phase of the menstrual cycle is characterised by:
- A. Endometrial gland proliferation
- B. Decreased ovarian oestradiol production
- C. Progesterone dominance
- D. A fixed length of 8 days
- E. A reduction in aromatase activity
6. An involuted corpus luteum becomes a hyalinised mass known as a:
- A. Corpus delicti
- B. Corpus granulosa
- C. Graafian follicle
- D. Corpus atretica
- E. Corpus albicans
7. Ovulation occurs:
- A. Immediately after the LH surge
- B. 6 to 8 hours after the LH surge
- C. After the prolactin surge
- D. After follicles ripen in the ovary
- E. 36 hours after the LH surge
8. Endometrial changes during the menstrual cycle:
- A. The basal layer is responsive to hormonal stimulation
- B. The functional layer remains intact throughout the cycle
- C. The increased thickness of the endometrium in the proliferative phase is due to oestrogen action
- D. Oestrogen induces secretory changes and reduces mitotic activity
- E. The zona compacta and spongiosa form the basal layer
9. The following are presumptive skin signs of pregnancy EXCEPT:
- A. Chloasma
- B. Maculopapular rash
- C. Linea nigra
- D. Stretch marks
- E. Spider telangiectases
10. 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
11. In normal pregnancy, levels of all of the following hormones increase EXCEPT:
- A. Total thyroxine (T4)
- B. Parathyroid hormone (PTH) in the 2nd and 3rd trimesters
- C. Free cortisol
- D. Prolactin
- E. Oestradiol
12. The increase in blood volume in normal pregnancy is made up of:
- A. Plasma only
- B. Erythrocytes only
- C. More plasma than erythrocytes
- D. More erythrocytes than plasma
- E. All of the above
13. In the fetus, the most well-oxygenated blood is allowed into the systemic circulation by the:
- A. Ductus arteriosus
- B. Foramen ovale
- C. Right ventricle
- D. Ligamentum teres
- E. Ligamentum venosum
14. During normal pregnancy the glomerular filtration rate can increase by as much as:
- A. 10%
- B. 25%
- C. 50%
- D. 75%
- E. 100%
15. Fetal blood is returned to the placenta through:
- A. Hypogastric arteries
- B. Ductus venosus
- C. Portal vein
- D. Inferior vena cava
- E. Foramen ovale
16. Normally the pregnant woman hyperventilates. This is compensated by:
- A. Increased tidal volume
- B. Respiratory alkalosis
- C. Decreased PCO2 of the blood
- D. Decreased plasma bicarbonate
- E. Decreased serum pH
17. Regarding placental anatomy:
- A. The decidua capsularis forms part of the placenta
- B. The fetal side is divided into 30 to 40 cotyledons
- C. The intervillous space contains fetal blood
- D. The placenta is anatomically fully formed by 30 weeks
- E. Fetal blood vessels develop in the mesenchymal core of the chorionic villi
18. Which of the following does NOT accurately describe the placenta?
- A. 15 to 20 cm in diameter
- B. 2 to 4 cm thick
- C. Weighs about one sixth of the term infant
- D. Derived from maternal and fetal tissue
- E. The umbilical cord originates from the centre of the placenta in almost all cases
19. A sure (positive) sign of pregnancy is:
- A. Amenorrhoea
- B. Hegar's sign
- C. Nausea and vomiting
- D. Auscultation of the fetal heart
- E. Abdominal distension
20. A first-trimester pregnancy may be terminated by:
- A. Prostaglandin inhibitor
- B. Anti-progesterone
- C. Beta-sympathomimetic agonist
- D. Synthetic oestrogen
- E. Medroxyprogesterone
21. An ultrasound in the first trimester is done for:
- A. Placental localisation
- B. Detecting fetal weight
- C. Assessment of amniotic fluid volume
- D. Detection of fetal breathing
- E. Dating of the pregnancy
22. The following are normal symptoms of pregnancy EXCEPT:
- A. Backache from increased lumbar lordosis
- B. Lower abdominal and groin pain from stretch of the round ligaments
- C. Visual disturbance
- D. Calf pain from muscle spasm
- E. Increased vaginal discharge
23. A woman in early pregnancy is worried about several small raised nodules on both areolae. There are no other findings. Your immediate management is:
- A. Reassurance after thorough examination
- B. Needle aspiration of the nodules
- C. Surgical removal of the areola
- D. Mammography
- E. Radical mastectomy
24. The source of progesterone that maintains the pregnancy in early first trimester:
- A. Placenta
- B. Corpus luteum
- C. Corpus albicans
- D. Adrenal glands
- E. Endometrium
25. The average weight gain in a normal pregnancy is approximately:
- A. 5 to 10 kg
- B. 10 to 15 kg
- C. 15 to 20 kg
- D. 20 to 30 kg
- E. 30 to 40 kg
26. Which medication given before and during early pregnancy helps protect against neural tube defects?
- A. Vitamin B6
- B. Iron
- C. Folic acid
- D. Zinc
- E. Magnesium
27. A probable sign of pregnancy includes:
- A. Detection of fetal movement
- B. Enlargement of the abdomen
- C. X-ray demonstrating a fetus
- D. Lower abdominal cramps
- E. Nausea in the morning
28. A woman at 14 weeks had an abortion and was told it was complete. Which is true of a complete abortion?
- A. The uterus is usually bigger than dates
- B. The cervical os is open with tissue in the cervix
- C. Evacuation of the uterus is needed
- D. After a complete abortion there is minimal or no pain and minimal or no bleeding
- E. Follow up with beta-hCG for one year
29. Regarding cervical incompetence, all are true EXCEPT:
- A. Typically causes painful abortions
- B. Typically causes mid-trimester abortions
- C. Treated by Shirodkar suture, best placed early in the second trimester
- D. May lead to premature rupture of membranes
- E. Can occur in a patient with a history of cone biopsy
30. Regarding incomplete abortion, all are true EXCEPT:
- A. There is a history of tissue passed per vagina
- B. The cervix is open on vaginal examination
- C. Ultrasound shows retained products of conception
- D. Ultrasound shows an intact gestational sac with a non-viable fetus
- E. Management includes evacuation
31. The most common cause of first-trimester abortion:
- A. Chromosomal abnormalities
- B. Syphilis
- C. Rhesus isoimmunisation
- D. Cervical incompetence
- E. Bicornuate uterus
32. Of the proposed causes of recurrent pregnancy loss, the least likely is:
- A. Maternal trauma
- B. Maternal balanced translocation
- C. Paternal balanced translocation
- D. Luteal phase deficiency
- E. Autoimmune disease
33. Factors affecting the choice of methotrexate for ectopic pregnancy, EXCEPT:
- A. Size of the ectopic
- B. Presence or absence of cardiac activity
- C. Level of beta-hCG
- D. Parity of the patient
- E. Integrity of the tube
34. The most common cause of ectopic pregnancy is:
- A. History of pelvic inflammatory disease
- B. Congenital anomalies of the tube
- C. Endometriosis
- D. Tubal surgery
- E. Previous sterilisation
35. After evacuation of a molar pregnancy, beta-hCG falls to untraceable levels in about 90% of patients within:
- A. 2 weeks
- B. 4 weeks
- C. 8 weeks
- D. 10 weeks
- E. 12 weeks
36. Acceptable management of a possible ruptured ectopic pregnancy includes all EXCEPT:
- A. Exploratory laparotomy
- B. Diagnostic laparoscopy
- C. Partial salpingectomy
- D. Total salpingectomy
- E. Observation followed by methotrexate
37. Primordial follicle development is completed at:
- A. 8 weeks of gestation
- B. 12 weeks
- C. 16 weeks
- D. 20 weeks
38. A 29-year-old G2P0 at 19 weeks has heavy vaginal bleeding, a fundal height of 28 cm, a closed cervix, hCG 190,000 mIU/mL, and an ultrasound showing no fetal tissue, diffuse hydropic villi and bilateral large theca lutein cysts. The preferred management is:
- A. Bilateral ovarian cystectomies with ovarian fixation
- B. Dilatation and suction curettage with concurrent bilateral ovarian cystectomies
- C. Total abdominal hysterectomy and bilateral salpingo-oophorectomy
- D. Dilatation and suction curettage under ultrasound guidance
39. The most likely karyotype of a partial mole:
- A. 46,XX
- B. 46,XY
- C. Diandric triploidy
- D. Triploidy with two haploid sets of maternal origin
40. In threatened abortion at 15 weeks in a nulliparous patient:
- A. Pain is characteristic
- B. The internal os is often open
- C. Fainting is characteristic
- D. Vaginal bleeding is usually mild
- E. Absence of fetal movements suggests non-viability