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Obstetrics quiz

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Question 1
What does asymmetrical intrauterine growth restriction (normal head circumference with reduced abdominal circumference) suggest?
A
Placental insufficiency
B
Chromosomal disorder
Question 1 Explanation: 
If the placenta is not supplying adequate blood to the fetus the body directs prioritises brain development at the expense of the body. As a result the abdominal circumference decreases whilst the head circumference remains normal.
Question 2

By James Heilman, MD

Which sign is present on this pregnant abdomen?

A
Striae gravidarum
B
Stria albicans
C
Linea nigra
Question 2 Explanation: 
Linea nigra can be seen on this image. This occurs in around 3/4 of pregnancies. It's described as a vertical line of increased pigmentation running down the centre of the pregnant abdomen. The increased pigmentation occurs over the linea alba which is stretched during pregnancy to accommodate the developing foetus.
Question 3
Which of the following statements describes the third stage of labour correctly?
A
The third stage begins once the baby is born and ends once the placenta and membranes have been expelled from the uterus.
B
The third stage begins once the baby and placenta have been expelled from the uterus and ends when the uterus contracts down to its normal size.
C
The third stage begins once the baby is born and ends 24 hours after the time the baby was born.
Question 4
What does symmetrical intrauterine growth restriction (both the head circumference and abdominal circumference are lower than normal) suggest?
A
Placental insufficiency
B
Chromosomal disorder
Question 4 Explanation: 
Symmetrical IUGR usually suggests a baby has a chromosomal disorder. This is because in a healthy baby the head circumference should remain normal, even if there is significant placental insufficiency, as the body makes sure the brain receives the necessary fuel at the expense of the rest of the body. That's why in placental insufficiency the abdominal circumference is reduced but the head circumference is normal (asymmetrical IUGR).
Question 5
Which of the following are recognised causes of intrauterine growth restriction (IUGR)?
A
Alcohol
B
Smoking
C
Hypertension
D
Diabetes
E
Pre-eclampsia
F
Hypercholesterolaemia
Question 5 Explanation: 
IUGR can occur for a large number of reasons . Smoking accounts for around 30-40% of IUGR cases.
Question 6
Which of the following are risk factors for pre-eclampsia?
A
Obesity (BMI >35)
B
First pregnancy
C
Family history of pre-eclampsia in mother or sisters
D
Maternal age > 40
E
Change of partner
Question 7
Which of the following methods is the correct way to calculate the estimated date of delivery (EDD)?
A
First day of last menstrual period (LMP) + 8 months and 1 week
B
Last day of LMP + 8 months and 1 week
C
First day of LMP + 9 months
D
First day of LMP + 9 months and 1 week
Question 7 Explanation: 
The correct way to calculate the EDD is to add 9 months and 1 week onto the first day of the last normal menstrual period. This method may not be reliable if a woman is unsure about when her last menstrual period was. As a result ultrasound is used to more accurately date pregnancies.
Question 8
At 28 weeks gestation where would you expect to feel the uterine fundus?
A
Xiphisternum
B
Symphysis pubis
C
Umbilicus
D
Halfway between xiphisternum and umbilicus
Question 9
What is the most common cause of postpartum haemorrhage?
A
Vulval or vaginal lacerations
B
Uterine atony
C
Uterine rupture
D
Retained placenta
Question 9 Explanation: 
The most common cause of PPH is uterine atony, however retained placenta and vaginal lacerations also account for a significant proportion of PPH. Uterine atony describes a state in which the uterus can no longer effectively contract. Because the uterus cannot contract the blood vessels which were supplying the placenta are not compressed and can therefore bleed profusely. A uterus can become atonic for a number of reasons such as prolonged labour, large baby, multiple pregnancy and retained placenta.
Question 10
Which of the following is thought to be a cause of hyperemesis gravidarum?
A
Over eating
B
Underlying infection
C
High levels of circulating HCG
D
Psychological issues
Question 10 Explanation: 
Hyperemesis gravidarum is a severe form of morning sickness in which women suffer with excessive nausea and vomiting which prevents them taking in adequate amounts of food and water. It is thought to be caused by high levels of circulating HCG. This is supported by the fact that it's more common in multiple pregnancies and also tends to only affect women during the first 12 weeks of pregnancy.
Question 11
Which 2 of the following does a "membrane sweep" involve?
A
Use of finger to separate the amniotic membrane from the cervix.
B
Release of prostaglandins
C
Rupture of membranes
D
Significant bleeding
Question 11 Explanation: 
A midwife usually performs an internal examination on the mother and uses their finger to separate the amniotic membranes from the walls of the cervix. This causes release of prostaglandins which can kickstart the labour process.
Question 12
Which of the following statements describe the first stage of labour correctly?
A
Starts when the effaced cervix is 3cm dilated and ends when the cervix is fully dilated at 10cm.
B
Onset of painful contractions to full effacement of the cervix. The membranes are still intact.
C
Starts when regular painful contractions begin and ends when the cervix is fully effaced and dilated to 5 cm.
Question 13
At 36 weeks gestation where would you expect to find the uterine fundus?
A
Xiphisternum
B
Umbilicus
C
Halfway between umbilicus and xiphisternum
D
Symphysis pubis
Question 14
At what stage of gestation would you expect a nulliparous women to begin to feel foetal movements?
A
10-12 weeks
B
14-16 weeks
C
22-24 weeks
D
18-20 weeks
Question 14 Explanation: 
Most women will become aware of foetal movements around 18-20 weeks. However if a women has had previous pregnancies they often notice movements earlier (around 15-18 weeks).
Question 15
What is the definition of postpartum haemorrhage (PPH)?
A
Loss of >200ml of blood from the vagina during delivery
B
Loss of >200ml of blood from the vagina within 24 hours of delivery
C
Loss of >500ml of blood from the vagina during delivery
D
Loss of >500ml of blood from the vagina within 24 hours of delivery
Question 15 Explanation: 
Primary postpartum haemorrhage is defined as a loss of blood >500ml from the vagina within 24 hours of delivery. If the blood loss is between 500-1000ml it is defined as a minor PPH. If the blood loss is more than 1000ml it is defined as a major PPH.
Question 16
Which of the following need to be present for a women to be diagnosed with pre-eclampsia?
A
Hypertension
B
Visual disturbance
C
Hypotension
D
Proteinurea
E
Haematuria
Question 16 Explanation: 
Pre-eclampsia is defined as the presence of both hypertension and proteinuria during pregnancy.
Question 17
At 12 weeks gestation where would you expect to feel the uterine fundus?
A
Xiphisternum
B
Symphysis pubis
C
Halfway between umbilicus and xiphisternum
D
Umbilicus
Question 18
Which of the following are complications of induction?
A
Uterine rupture
B
Caesarian section
C
Uterine hyper-stimulation
D
IUGR
E
Prolapsed cord
Question 18 Explanation: 
Induction of labour increases the risk of a number of complications. The uterus can become over stimulated causing prolonged contractions which can starve the baby of oxygen. It can also cause contractions to be so powerful they cause rupture of the uterus. Finally if a women is induced to early it can result in prolonged labour.
Question 19
Which period of gestation does the 1st trimester represent?
A
1-12 weeks
B
1-10 weeks
C
1-13 weeks
D
1-11 weeks
Question 19 Explanation: 
The first trimester refers to the first 12 weeks of pregnancy.
Question 20
Which period of gestation does the 3rd trimester represent?
A
27-39 weeks
B
28-40 weeks
C
30-41 weeks
D
29-40 weeks
Question 20 Explanation: 
The third trimester starts at 29 weeks and ends at 40 weeks.
Question 21
At 22 weeks gestation where would you expect to find the uterine fundus?
A
Halfway between umbilicus and xiphisternum
B
Umbilicus
C
Xiphisternum
D
Symphysis pubis
Question 22
Which period of gestation does the 2nd trimester represent?
A
10-20 weeks
B
15-30 weeks
C
13-28 weeks
D
14-29 weeks
Question 22 Explanation: 
The second trimester begins at 13 weeks and ends at 28 weeks.
Question 23
Which 2 of the following are drugs which can be used to induce labour?
A
Labetalol
B
Misoprostol
C
Nitrogen oxide
D
Syntocinon
Question 23 Explanation: 
Syntocinon is a synthetic form of oxytocin. Oxytocin causes uterine contractions and cervical dilatation. Misoprostol is a prostaglandin which causes thinning of the cervix and uterine contraction.
Question 24
Which of the following are causes of postpartum haemorrhage?
A
Uterine atony
B
Retained Placenta
C
Coagulapathy
D
Vaginal or vulval lacerations
Question 24 Explanation: 
All of the above are potential causes of PPH with uterine atony been the most common. Coagulopathy is a rare cause, accounting around 1% of PPH.
Question 25
Which of the following is a prostaglandin commonly used in induction of labour?
A
Atenolol
B
Labetalol
C
Misoprostol
Question 25 Explanation: 
Misoprostol is inserted vaginally and causes effacement of the cervix in addition to uterine contraction.
Question 26
Which of the following statements describes the second stage of labour correctly?
A
The second stage begins at full dilatation of the cervix and ends when the baby is born.
B
The second stage begins at full dilation of the cervix and ends once the baby and placenta have been expelled from uterus.
C
The second stage begins when the cervix is 7 cm dilated and ends when the cervix reaches full dilatation.
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