Episiotomy and Lacerations.
***) Regarding episiotomy all of the following statements are true except:
Shorten the second stage
Reduce trauma to the fetal head
Reduce damage of the pelvic floor
It is usually followed by vaginal stenosis
Reduce the incidence of third degree tears
Answer: D* It is usually followed by vaginal stenosis
Caesarean Section CS.
***) All of the following are indications for cesarean section, except:
Transverse lie
Mento-posterior position
Fetal distress in the first stage
Twin pregnancy
Prolapsed pulsating cord
Answer: D* Twin pregnancy
***) A multigravida with mitral stenosis in labor with obvious cephalopelvic disproportion, best delivered with:
Cesarean section
Forceps delivery in the second stage
Vacuum delivery if cervix not fully dilated
Enhance labor by syntocinon (oxytocin)
Await spontaneous vaginal delivery
Answer: A* Cesarean section
***) All of the following are possible indications for classical cesarean section, except:
Carcinoma of the cervix
Impacted shoulder presentation
Severe adhesions in the lower uterine segment
Large cervical fibroid
Posterior placenta previa grade II
Answer: B* Impacted shoulder presentation
***) Indications for a Caesarian section include all of the following, except:
Cord prolapse
Previous Caesarian section
Fetal distress
Transverse lie
Migraine
Answer: E* Migraine
***) All the following are indications for caesarean section except one:
Prolapsed cord
Transverse lie at term
Placenta previa at term
Intrauterine fetal death at term
Previous for CS
Answer: D* Intrauterine fetal death at term
***) All of the following are indications to primary cesarean section except:
Prolapsed cord
Cord presentation
Mal presentation
Face presentation (mento-anterior)
Fetal distress
Answer: D* Face presentation (mento-anterior)
***) All of the following might be an indication to do classical cesarean section except one:
Transverse lie at term with the back down
Severe pelvic-abdominal adhesions
Previous cesarean section with severe pelvic-abdominal adhesions
Per mortem
Cephalopelvic disproportion
Answer: E* Cephalopelvic disproportion
Puerperal Complications OB51-OB56.
Postpartum Changes.
***) The period of time from the end of delivery until the reproductive organs have returned to normal is called:
Menopause
Puerperium
Perineum
Ante-partum
Intra-partum
Answer: B* Puerperium
***) Postpartum hemorrhage is diagnosed when blood loss exceeds:
100 cc
200 cc
300 cc
400 cc
500 cc
Answer: E* 500 cc
***) In postpartum hemorrhage the most common cause is:
Atonic uterus
Cervical tear
Uterine rupture
Retained placental tissue
Inversion of the uterus
Answer: A* Atonic uterus
***) Regarding post partum hemorrhage all of the following are predisposing factors, except:
Multiple pregnancies
Polyhydramnios
Giving syntometrine with the delivery of anterior shoulder
Prolonged labor
Precipitated labor
Answer: C* Giving syntometrine with the delivery of anterior shoulder
***) Concerning postpartum hemorrhage, all the following are true except:
More common in twin pregnancy than single pregnancy
Less common in primigravida than multigravida
The commonest cause is laceration of the cervix
It may be caused by bleeding from non-placental site
The prevention is by active management of the third stage of labor
Answer: C* The commonest cause is laceration of the cervix
***) Postpartum hemorrhage is caused by the following, except:
Prolonged labor
Retained parts of the placenta
Cervical tear
Full bladder
Toxemia of pregnancy
Answer: D* Full bladder
***) One of the following is the most common cause of primary post-partum hemorrhage:
Vaginal or cervical lacerations
Uterine inversion
Coagulopathy
Uterine rupture
Uterine atony
Answer: E* Uterine atony
***) The most common cause of secondary post-partum hemorrhage:
Uterine atony
Injury to birth canal
Low platelet count
Breast feeding
Retained parts of placenta superimposed by uterine infection
Answer: E* Retained parts of placenta superimposed by uterine infection
***) The most common symptom of acute inversion of the uterus is:
Postpartum hemorrhage
Uterine prolapse
Retained placenta
Retention of urine
Abdominal pain
Answer: A* Postpartum hemorrhage
***) After delivery of the baby and the placenta you discovered a firm raunded mass in the pelvis below the level of the umbilicus. The mass is most likely is:
Uterine fibroids
Ovarian cyst
Distended bowel
Pelvic kidney
Contracted uterus
Answer: E* Contracted uterus
***) Uterine atony might be caused by the following except:
Prolonged labor
Multiple pregnancy
Polyhydramnios
Uterine fibroids
Preterm labor
Answer: E* Preterm labor
***) Inversion of the uterus is almost always subsequent upon:
Multiple pregnancy
Polyhydramnios
Traction on the umbilical cord before separation
Abruption placenta
Difficult forceps delivery
Answer: C* Traction on the umbilical cord before separation
Postpartum Fever.
***) The commonest cause of maternal pyrexia in puerperium is:
Deep vein thrombosis
Endometritis
Engorged breasts
Subacute bacterial endocarditis
Urinary tract infection
Answer: B* Endometritis
***) The most common cause of post partum mastitis is one of the following:
Beta streptococci
E.Coli
Staphylococcus aureus
Streptococcus fecalis
Chlamydia trachomatis
Answer: C* Staphylococcus aureus
***) All of the following are possible predisposing factors for puerperal sepsis, except:
Prolonged rupture of membranes
Carrier of group A beta streptococci
Multiple vaginal examinations
Elective cesarean section
Non-proper surgical scrub
Answer: D* Elective cesarean section
***) Factors contributing to puerperal infection are the following, except:
Prolonged labor
Precipitate labor
Instrumental delivery
Excessive vaginal examination
Home delivery
Answer: B* Precipitate labor
***) The most common bacteria causing puerperal infection is:
Escherichia coli
Anaerobic streptococcus
Anaerobic staphylococcus
Aerobic streptococcus
Clostridium perfringes
Answer: B* Anaerobic streptococcus
***) Puerperal infection may be spread by several routes. The most common route that result in septic thrombophlebitis:
Venous
Lymphatic
Arterial
Direct extension
By inhalation of toxic materials
Answer: A* Venous
***) A patient with post-partum deep venous thrombosis complains of chest pain and dyspnea. The helpful investigation to diagnose pulmonary embolism is:
Lung spiral CT
Electrocardiogram (ECG)
Arterial blood gases
Chest auscultation
Chest X-Ray
Answer: A* Lung spiral CT
***) One of the following can cause subinvolution of the uterus after normal delivery:
Urinary tract infection
Gastroenteritis
Endometriosis
Monilial infection
Endometritis
Answer: E* Endometritis
***) Which of the following is the most common site of puerperal infection:
The upper urinary tract (kidneys)
The lower genital tract (infected lacerations and episiotomies)
The lower urinary tract (bladder)
The upper genital tract (endometrium)
The cardiovascular system (bacteremia and septic thrombophlebitis)
Answer: D* The upper genital tract (endometrium)