Key points
- Practice questions written for revision, not copies of any exam. They follow the single-best-answer vignette style of final and licensing exams.
- Topics: antenatal care, hypertensive disorders of pregnancy, postpartum haemorrhage, ectopic pregnancy, gestational diabetes, labour, contraception, pelvic inflammatory disease and cervical screening.
- Each explanation covers why the answer is right and why the distractors are wrong.
- Management follows WHO and widely used international guidance. Check your local protocol before treating a patient.
Questions
1. A 28-year-old woman at 34 weeks has a blood pressure of 165/112 mmHg, severe headache, visual disturbance and 3+ proteinuria. What is the first-line drug to prevent eclamptic seizures?
A. Diazepam
B. Magnesium sulphate
C. Phenytoin
D. Phenobarbital
E. Nifedipine alone
Answer: B. Severe pre-eclampsia with neurological symptoms needs magnesium sulphate to prevent and treat eclampsia, together with an antihypertensive such as labetalol, nifedipine or hydralazine, and planned delivery. Monitor reflexes, respiratory rate and urine output for magnesium toxicity, and keep calcium gluconate ready as the antidote.
2. A woman delivers a term baby and then bleeds heavily. The uterus is soft and boggy above the umbilicus. What is the most likely cause and first action?
A. Retained placenta; manual removal
B. Uterine atony; uterine massage and oxytocin
C. Genital tract trauma; surgical repair only
D. Coagulopathy; give fresh frozen plasma
E. Uterine inversion; replace the uterus
Answer: B. A soft, boggy uterus indicates uterine atony, the commonest cause of postpartum haemorrhage. Start with uterine massage, empty the bladder and give oxytocin, then tranexamic acid, further uterotonics (misoprostol, ergometrine, carboprost), a balloon tamponade and surgery if bleeding continues. Remember the four Ts: tone, trauma, tissue and thrombin.
3. A woman with 7 weeks of amenorrhoea has sudden lower abdominal pain, vaginal spotting and dizziness. The pulse is 120/min and the blood pressure is 85/50 mmHg. A pregnancy test is positive. What is the next step?
A. Outpatient review in a week
B. Resuscitate and arrange urgent surgery for a ruptured ectopic pregnancy
C. Methotrexate
D. Oral antibiotics
E. Repeat pregnancy test in 48 hours
Answer: B. Shock with a positive pregnancy test and abdominal pain is a ruptured ectopic pregnancy until proved otherwise. Give oxygen, large-bore access and fluids or blood, and go to theatre. Methotrexate is only for stable, unruptured ectopics with low beta-hCG and no heartbeat.
4. A 30-year-old at 26 weeks has a fasting glucose of 5.8 mmol/L and a 2-hour value of 9.0 mmol/L on a 75 g oral glucose tolerance test. What is the diagnosis and first-line management?
A. Type 1 diabetes; insulin immediately
B. Gestational diabetes; diet and exercise, then insulin or metformin if targets are not met
C. Normal pregnancy
D. Pre-existing type 2 diabetes; sulfonylureas
E. Diabetes insipidus
Answer: B. Using IADPSG and WHO thresholds, a fasting value of 5.1 mmol/L or more, a 1-hour value of 10 or more, or a 2-hour value of 8.5 or more diagnoses gestational diabetes. Treat first with diet, exercise and glucose monitoring, then metformin or insulin. Sulfonylureas are generally avoided.
5. A woman at 39 weeks has been in labour for 18 hours. Cervical dilatation has been 6 cm for 4 hours, with adequate contractions. The fetal heart rate is normal. What does this suggest, and what is the next step?
A. Normal progress; wait
B. Prolonged active phase (arrest); assess the "three Ps" (power, passenger, passage) and consider caesarean section
C. Precipitate labour
D. Failed induction only
E. Placental abruption
Answer: B. No cervical change for 4 hours in the active phase with adequate contractions is arrest of labour, which suggests cephalopelvic disproportion or malposition. Assess the power (contractions), passenger (size, position) and passage (pelvis), and usually proceed to caesarean section. Plot progress on a partograph.
6. A 24-year-old has lower abdominal pain, fever, cervical motion tenderness and purulent vaginal discharge. What is the diagnosis and the key long-term risk?
A. Appendicitis; none
B. Pelvic inflammatory disease; infertility and ectopic pregnancy
C. Ovarian cyst; none
D. Endometriosis; cancer
E. Urinary tract infection; renal failure
Answer: B. Lower abdominal pain with cervical motion tenderness suggests pelvic inflammatory disease, usually from Chlamydia trachomatis and Neisseria gonorrhoeae. Treat early with broad-spectrum antibiotics covering both, and treat the partner. Tubal damage causes infertility and raises the risk of ectopic pregnancy.
7. A woman has a missed period, brown vaginal discharge, a uterus larger than dates and a very high beta-hCG. The ultrasound shows a "snowstorm" pattern with no fetus. What is the diagnosis?
A. Threatened miscarriage
B. Complete hydatidiform mole
C. Ectopic pregnancy
D. Twin pregnancy
E. Fibroid uterus
Answer: B. A complete hydatidiform mole causes a uterus large for dates, a high hCG and a snowstorm ultrasound. Treat with suction evacuation, then follow hCG until it is normal, because gestational trophoblastic neoplasia can follow. Advise reliable contraception during follow-up.
8. Which contraceptive method is contraindicated in a woman with migraine with aura?
A. Progestogen-only pill
B. Copper intrauterine device
C. Combined oral contraceptive pill
D. Condoms
E. Levonorgestrel intrauterine system
Answer: C. Migraine with aura raises the risk of ischaemic stroke, and oestrogen adds to that risk, so combined methods are contraindicated (WHO category 4). Progestogen-only methods and non-hormonal options are safe. Other contraindications include smoking over age 35, a history of venous thromboembolism and uncontrolled hypertension.
9. A 35-year-old has a normal Pap smear and a positive high-risk human papillomavirus test. What is the best approach under most international screening guidelines?
A. No follow-up
B. Triage further (for example genotyping or cytology) and arrange colposcopy if indicated
C. Immediate hysterectomy
D. Antibiotics
E. Repeat in 10 years
Answer: B. A positive high-risk HPV test needs triage, which may include cytology, genotyping or colposcopy depending on local guidelines. HPV 16 and 18 cause most cervical cancers. HPV vaccination in girls before sexual debut is the best prevention, and WHO recommends HPV testing as the preferred screening method.
10. A woman at 30 weeks has painless, bright-red vaginal bleeding. The uterus is soft and non-tender, and the fetal heart is normal. What must not be done before an ultrasound?
A. Check the blood pressure
B. Digital vaginal examination
C. Take blood for group and crossmatch
D. Fetal monitoring
E. Insert intravenous access
Answer: B. Painless bleeding in the third trimester suggests placenta praevia, and a digital examination can trigger torrential bleeding. Confirm the diagnosis by ultrasound first. Placental abruption, in contrast, is usually painful with a hard, tender uterus.
11. Which investigation is most useful to date a pregnancy accurately in the first trimester?
A. Fundal height at 20 weeks
B. Crown-rump length on ultrasound
C. Quickening
D. Maternal weight gain
E. Urine pregnancy test
Answer: B. Crown-rump length between 7 and 13 weeks gives the most accurate gestational age, accurate to within about 5 to 7 days. Last menstrual period is useful only if the cycle is regular and the date is certain. Fundal height is a screening tool for growth later in pregnancy.
12. A mother who is HIV positive delivers a baby. What is the most important measure to reduce mother-to-child transmission?
A. Stop breastfeeding in all settings
B. Maternal antiretroviral therapy for life and infant prophylaxis
C. Caesarean section for all
D. Isolation of the baby
E. Vitamin A for the baby
Answer: B. Lifelong maternal antiretroviral therapy that suppresses the viral load, with prophylaxis for the infant, reduces transmission to under 2%. Where formula is not safe, breastfeeding with maternal therapy is acceptable under WHO guidance. Caesarean section is reserved for obstetric reasons or a high viral load near delivery.
References
- World Health Organization. Recommendations on antenatal care, intrapartum care and postpartum haemorrhage.
- FIGO and RCOG guidelines on hypertension in pregnancy and gestational diabetes.
- Obstetrics by Ten Teachers. CRC Press.
- Williams Obstetrics. McGraw-Hill.