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