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Obstetrics quiz

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Question 1
Which of the following is a prostaglandin commonly used in induction of labour?
A
Misoprostol
B
Atenolol
C
Labetalol
Question 1 Explanation: 
Misoprostol is inserted vaginally and causes effacement of the cervix in addition to uterine contraction.
Question 2
Which of the following are complications of induction?
A
Caesarian section
B
Uterine rupture
C
IUGR
D
Uterine hyper-stimulation
E
Prolapsed cord
Question 2 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 3
Which of the following methods is the correct way to calculate the estimated date of delivery (EDD)?
A
Last day of LMP + 8 months and 1 week
B
First day of LMP + 9 months and 1 week
C
First day of last menstrual period (LMP) + 8 months and 1 week
D
First day of LMP + 9 months
Question 3 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 4
Which 2 of the following does a "membrane sweep" involve?
A
Release of prostaglandins
B
Use of finger to separate the amniotic membrane from the cervix.
C
Rupture of membranes
D
Significant bleeding
Question 4 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 5
Which of the following statements describe the first stage of labour correctly?
A
Starts when regular painful contractions begin and ends when the cervix is fully effaced and dilated to 5 cm.
B
Onset of painful contractions to full effacement of the cervix. The membranes are still intact.
C
Starts when the effaced cervix is 3cm dilated and ends when the cervix is fully dilated at 10cm.
Question 6
Which period of gestation does the 3rd trimester represent?
A
30-41 weeks
B
27-39 weeks
C
29-40 weeks
D
28-40 weeks
Question 6 Explanation: 
The third trimester starts at 29 weeks and ends at 40 weeks.
Question 7
Which of the following statements describes the third stage of labour correctly?
A
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.
B
The third stage begins once the baby is born and ends once the placenta and membranes have been expelled from the uterus.
C
The third stage begins once the baby is born and ends 24 hours after the time the baby was born.
Question 8
Which of the following need to be present for a women to be diagnosed with pre-eclampsia?
A
Hypotension
B
Visual disturbance
C
Proteinurea
D
Hypertension
E
Haematuria
Question 8 Explanation: 
Pre-eclampsia is defined as the presence of both hypertension and proteinuria during pregnancy.
Question 9
What does symmetrical intrauterine growth restriction (both the head circumference and abdominal circumference are lower than normal) suggest?
A
Chromosomal disorder
B
Placental insufficiency
Question 9 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 10
Which of the following is thought to be a cause of hyperemesis gravidarum?
A
Over eating
B
Underlying infection
C
Psychological issues
D
High levels of circulating HCG
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
What is the definition of postpartum haemorrhage (PPH)?
A
Loss of >500ml of blood from the vagina within 24 hours of delivery
B
Loss of >200ml of blood from the vagina during delivery
C
Loss of >200ml of blood from the vagina within 24 hours of delivery
D
Loss of >500ml of blood from the vagina during delivery
Question 11 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 12
At 22 weeks gestation where would you expect to find the uterine fundus?
A
Xiphisternum
B
Symphysis pubis
C
Halfway between umbilicus and xiphisternum
D
Umbilicus
Question 13
Which of the following are causes of postpartum haemorrhage?
A
Coagulapathy
B
Uterine atony
C
Vaginal or vulval lacerations
D
Retained Placenta
Question 13 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 14

By James Heilman, MD

Which sign is present on this pregnant abdomen?

A
Striae gravidarum
B
Linea nigra
C
Stria albicans
Question 14 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 15
At 36 weeks gestation where would you expect to find the uterine fundus?
A
Xiphisternum
B
Halfway between umbilicus and xiphisternum
C
Umbilicus
D
Symphysis pubis
Question 16
Which 2 of the following are drugs which can be used to induce labour?
A
Nitrogen oxide
B
Syntocinon
C
Labetalol
D
Misoprostol
Question 16 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 17
At 28 weeks gestation where would you expect to feel the uterine fundus?
A
Xiphisternum
B
Halfway between xiphisternum and umbilicus
C
Umbilicus
D
Symphysis pubis
Question 18
At what stage of gestation would you expect a nulliparous women to begin to feel foetal movements?
A
18-20 weeks
B
14-16 weeks
C
10-12 weeks
D
22-24 weeks
Question 18 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 19
What is the most common cause of postpartum haemorrhage?
A
Vulval or vaginal lacerations
B
Uterine atony
C
Retained placenta
D
Uterine rupture
Question 19 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 20
Which period of gestation does the 2nd trimester represent?
A
15-30 weeks
B
14-29 weeks
C
13-28 weeks
D
10-20 weeks
Question 20 Explanation: 
The second trimester begins at 13 weeks and ends at 28 weeks.
Question 21
Which of the following statements describes the second stage of labour correctly?
A
The second stage begins when the cervix is 7 cm dilated and ends when the cervix reaches full dilatation.
B
The second stage begins at full dilatation of the cervix and ends when the baby is born.
C
The second stage begins at full dilation of the cervix and ends once the baby and placenta have been expelled from uterus.
Question 22
Which of the following are recognised causes of intrauterine growth restriction (IUGR)?
A
Diabetes
B
Hypertension
C
Smoking
D
Pre-eclampsia
E
Hypercholesterolaemia
F
Alcohol
Question 22 Explanation: 
IUGR can occur for a large number of reasons . Smoking accounts for around 30-40% of IUGR cases.
Question 23
Which period of gestation does the 1st trimester represent?
A
1-13 weeks
B
1-10 weeks
C
1-12 weeks
D
1-11 weeks
Question 23 Explanation: 
The first trimester refers to the first 12 weeks of pregnancy.
Question 24
Which of the following are risk factors for pre-eclampsia?
A
Change of partner
B
Maternal age > 40
C
Family history of pre-eclampsia in mother or sisters
D
Obesity (BMI >35)
E
First pregnancy
Question 25
At 12 weeks gestation where would you expect to feel the uterine fundus?
A
Halfway between umbilicus and xiphisternum
B
Xiphisternum
C
Umbilicus
D
Symphysis pubis
Question 26
What does asymmetrical intrauterine growth restriction (normal head circumference with reduced abdominal circumference) suggest?
A
Chromosomal disorder
B
Placental insufficiency
Question 26 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.
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