1. Median duration of pregnancy is:
A) 265 Days
B) 270 Days
C) 280 Days
D) 290 Days
Explanation: The median duration of human pregnancy is 280 days (40 weeks) calculated from the first day of the last menstrual period (Naegele's rule).
2. Patient's last LMP was 7 March 2024. What will be EDD?
A) 7 Dec 2024
B) 10 Dec 2024
C) 14 Dec 2024
D) 21 Dec 2024
Explanation: Using Naegele's rule: Add 7 days (7→14 March), subtract 3 months (March→December), same year = 14 Dec 2024.
3. 30-year-old woman with VDRL-positive syphilis. Definitive test is:
A) RPR test
B) Ziehl-Neelsen stain
C) PCR
D) FTA-ABS test
Explanation: FTA-ABS is the gold standard confirmatory test for syphilis after positive screening (VDRL/RPR).
4. 28-year-old Rh-D negative non-sensitized woman at 16 weeks with vaginal bleeding. Appropriate anti-D dose:
A) 50 IU
B) 100 IU
C) 150 IU
D) 250 IU
Explanation: 250 IU anti-D covers 15-20 weeks gestation. Standard dose for sensitizing events after 12 weeks.
5. 34-week primigravida with BP 150/100, albumin +3, platelets 30,000/cmm. Most likely cause of thrombocytopenia:
A) Autoimmune thrombocytopenia
B) HELLP syndrome
C) Incidental thrombocytopenia
D) SLE
Explanation: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe variant of pre-eclampsia.
6. Neuroprotective tocolytic for preterm labor at 30 weeks:
A) Beta sympathomimetics
B) NSAIDs
C) Magnesium sulphate
D) Calcium channel blockers
Explanation: MgSO4 reduces cerebral palsy risk by 30% when given <32 a="" as="" for="" neuroprotection="" not="" span="" tocolytic="" weeks="">
7. 35-week primigravida with jaundice. Which hepatitis carries worst prognosis?
A) Hepatitis A
B) Hepatitis B
C) Hepatitis C
D) Hepatitis E
Explanation: Hepatitis E in pregnancy has 20-25% mortality rate due to fulminant hepatic failure.
8. Used for prevention of preterm birth:
A) Oxytocin
B) Progesterone antagonists
C) Tocolytics
D) Corticosteroids
Explanation: Tocolytics (e.g., nifedipine, atosiban) delay delivery for 48 hours to allow steroid administration.
9. G2P1 at 28 weeks with contractions (3/10 mins), cervix 2cm/60%/-3. Next step:
A) Emergency C-section
B) Expectant management
C) Tocolytics with steroids
D) Oxytocin augmentation
Explanation: Tocolytics to delay delivery + steroids for fetal lung maturation (betamethasone 12mg IM x2 doses).
10. Fetus with ventriculomegaly, microcephaly, intracranial calcifications:
A) Toxoplasmosis
B) Rubella
C) Cytomegalovirus
D) Zika virus
Explanation: CMV is the most common congenital infection causing periventricular calcifications and microcephaly.
11. Primigravida with mitral stenosis in labor. Best analgesia:
A) Spinal
B) Epidural
C) General anesthesia
D) Nitrous oxide
Explanation: Epidural provides controlled pain relief without rapid hemodynamic changes seen with spinal anesthesia in mitral stenosis.
12. PPH management after failed uterine massage and oxytocin:
A) Hysterectomy
B) B-Lynch suture
C) Uterine artery ligation
D) Balloon tamponade
Explanation: Uterine artery ligation (O'Leary stitch) is second-line surgical management for atonic PPH.
13. Doppler shows reversal in diastolic flow. Diagnosis:
A) Fetal anemia
B) Gestational diabetes
C) Severe utero-placental insufficiency
D) Twin-twin transfusion
Explanation: Reversed end-diastolic flow (REDF) indicates critical placental insufficiency requiring urgent delivery.
14. Symptoms on minimal activity but normal at rest. NYHA class:
A) NYHA-1
B) NYHA-2
C) NYHA-3
D) NYHA-4
Explanation: NYHA Class II = symptoms with ordinary activity (Class III = symptoms with minimal activity).
15. Pregnant lady with 4 previous miscarriages at 10 weeks. How to document?
A) G4 P0
B) G5 P0
C) G5 P0+4
D) G1 P0+4
Explanation: Gravida 5 (current + 4 previous), Para 0+4 (0 term deliveries, 4 pregnancy losses <20 span="" weeks="">
16. 20-year-old primigravida at 36 weeks with BP 160/110. Drug of choice:
A) Methyldopa
B) Nifedipine
C) Labetalol
D) Hydralazine
Explanation: Labetalol (alpha/beta blocker) is first-line for acute severe hypertension in pregnancy.
17. Ventouse advantage over forceps:
A) Faster delivery
B) Better for rotational deliveries
C) Less perineal/vaginal damage
D) Higher success rate
Explanation: Ventouse causes less maternal trauma but has higher failure rates than forceps.
18. Fetal abnormality from maternal warfarin use:
A) Renal agenesis
B) Neural tube defect
C) Claw hand
D) Nasal hypoplasia
Explanation: Warfarin causes fetal warfarin syndrome (nasal hypoplasia, stippled epiphyses, CNS abnormalities).
19. Parvovirus B19 infection in pregnancy causes:
A) Microcephaly
B) Limb defects
C) Hydrops with raised MCA velocity
D) Cataracts
Explanation: Parvovirus B19 causes fetal anemia → hydrops (detected by elevated MCA-PSV >1.5 MoM on Doppler).
20. Optimal time for dating scan:
A) 6-8 weeks
B) 8-10 weeks
C) 11-14 weeks
D) 15-18 weeks
Explanation: 11-14 weeks combines accurate dating with nuchal translucency screening (part of combined test).
21. Anomaly scan timing:
A) 14-16 weeks
B) 16-18 weeks
C) 18-22 weeks
D) 22-24 weeks
Explanation: Detailed fetal anatomy survey is best performed at 18-22 weeks gestation.
22. Both parents are thalassemia minor carriers. Risk of thalassemia major in baby:
A) 10%
B) 15%
C) 25%
D) 50%
Explanation: Autosomal recessive inheritance pattern gives 25% risk for homozygous affected offspring.
23. Primigravida in labor with absent membranes, anterior fontanelle and nose palpable. Presentation:
A) Brow
B) Shoulder
C) Vertex
D) Face
Explanation: Brow presentation diagnosed when anterior fontanelle and nasal bridge are both palpable.
24. Antihypertensive causing PDA:
A) ACE inhibitors
B) Labetalol
C) Methyldopa
D) Hydralazine
Explanation: ACE inhibitors cause fetal renal tubular dysplasia and patent ductus arteriosus (PDA).
25. Glycemic control target in GDM:
A) <5 .5="" mmol="" span="">
B) <6 .5="" mmol="" span="">
C) <7 .8="" mmol="" span="">
D) <8 .5="" mmol="" span="">
Explanation: Postprandial glucose should be <7 .8="" gdm.="" in="" macrosomia="" mmol="" reduce="" risk="" span="" to="">
26. Contraindicated drug in asthma:
A) Oxytocin
B) Prostaglandin E1
C) Prostaglandin F2α
D) Magnesium sulfate
Explanation: PGF2α causes bronchoconstriction and is absolutely contraindicated in asthma.
27. Vaginal bleeding + tender distended abdomen:
A) Uterine rupture
B) Placenta previa
C) Ovarian torsion
D) UTI
Explanation: Classic triad of uterine rupture: pain, bleeding, and abdominal tenderness (often with fetal distress).
28. Vaginal bleeding + tender abdomen (no uterine rupture option):
A) Placenta previa
B) Placental abruption
C) Vasa previa
D) Cervicitis
Explanation: Abruption presents with painful bleeding and uterine tenderness (often with hypertonia).
29. Thromboembolism prophylaxis in pregnancy:
A) Warfarin
B) Unfractionated heparin
C) LMWH
D) Aspirin
Explanation: LMWH (e.g., enoxaparin) is preferred due to safety profile and no need for monitoring.
30. Pelvic bones include:
A) Femur, sacrum, coccyx
B) Ilium, ischium, femur
C) Sacrum, coccyx, ischium, pubis, ilium
D) Pubis, sacrum, femur
Explanation: The pelvis consists of two innominate bones (each with ilium, ischium, pubis) + sacrum + coccyx.
31. Pudendal nerve block anesthetizes:
A) L2-L4
B) L5-S1
C) S2-S4
D) T10-L1
Explanation: Pudendal nerve (S2-S4) provides sensation to lower vagina/perineum.
32. Test for GDM:
A) Random glucose
B) HbA1c
C) OGTT at 24-28 weeks
D) Fasting glucose
Explanation: 75g OGTT between 24-28 weeks is diagnostic (fasting ≥5.1, 1h ≥10.0, 2h ≥8.5 mmol/L).
33. Normal fetal heart rate:
A) 80-120 bpm
B) 100-140 bpm
C) 110-160 bpm
D) 120-180 bpm
Explanation: Normal FHR is 110-160 bpm (tachycardia >160, bradycardia <110 span="">
34. Ideal BMI for conception:
A) 15-20
B) 17-22
C) 18.5-24.9
D) 20-30
Explanation: Normal BMI range (18.5-24.9) optimizes fertility and reduces pregnancy complications.
35. Best episiotomy angle:
A) 30°
B) 45°
C) 60°
D) 90°
Explanation: 60° mediolateral episiotomy reduces risk of anal sphincter injury compared to midline.
36. Brow presentation diameter:
A) 9.5 cm
B) 11 cm
C) 12 cm
D) 13 cm
Explanation: Brow presents with mento-vertical diameter (13.5 cm) - largest fetal diameter, usually requires C-section.
37. ARM followed by blood gush + fetal bradycardia:
A) Placenta previa
B) Abruption
C) Vasa previa
D) Uterine rupture
Explanation: Vasa previa causes painless bleeding + fetal distress when membranes rupture (fetal blood loss).
38. Postpartum leg pain/swelling. Immediate investigation:
A) Chest X-ray
B) D-dimer
C) Doppler US of legs
D) Plain X-ray
Explanation: Doppler ultrasound is first-line to diagnose DVT in pregnancy/postpartum.
39. Diazepam effect on fetus:
A) CNS malformations
B) Limb defects
C) Reduced variability
D) Bradycardia
Explanation: Benzodiazepines cause "floppy infant syndrome" and reduced fetal heart rate variability.
40. Toxoplasmosis treatment in pregnancy:
A) Acyclovir
B) Penicillin
C) Spiramycin
D) Mebendazole
Explanation: Spiramycin reduces placental transmission before 18 weeks (pyrimethamine-sulfadiazine after 18 weeks if fetal infection).
41. A 30-year-old woman (Gravida 3, Para 2+0) with previous C-sections presents at 38 weeks with labor pains and liquor drainage. On examination: SFH 36 cm, contractions 2/10 mins, absent FHS, cervix long/firm, OS 2 cm dilated, grade III liquor. Management?
A) Maintain IV line
B) Leave for spontaneous labor
C) Induce labor with PGE2
D) Augment labor with syntocinon
E) Emergency caesarean section
Explanation: Absent fetal heart sounds (FHS) + grade III meconium-stained liquor + previous C-sections indicate fetal distress and risk of uterine rupture. Emergency C-section is life-saving. Correct answer: E.
42. A postpartum female with sickle cell disease wants effective contraception. Best option?
A) Combined oral pills
B) Progesterone-only pill
C) Copper IUD
D) Barrier methods
Explanation: Progesterone-only pills (POPs) are safe in sickle cell disease as they avoid estrogen-induced thrombosis. Combined pills are contraindicated due to hypercoagulability. Correct answer: B.
43. A primigravida with poor labor progress due to dysfunctional uterine activity (hydrated, pain relief given). Next step?
A) Artificial rupture of membranes (ARM)
B) Augmentation with syntocinon
C) Caesarean section
D) Repeat vaginal examination after 2 hours
Explanation: After ensuring hydration and analgesia, reassess cervical progress. Augmentation (B) is considered only if no progress after reassessment. Correct answer: D.
44. Which antiepileptic drug causes neural tube defects?
A) Phenytoin
B) Lamotrigine
C) Levetiracetam
D) Carbamazepine
Explanation: Lamotrigine is associated with neural tube defects (e.g., spina bifida). Valproate is highest-risk but not listed here. Correct answer: B.
45. Which drugs are strictly avoided in pregnancy?
A) Antibiotics
B) Cytotoxic drugs
C) Antihypertensives
D) Antacids
Explanation: Cytotoxic drugs (e.g., methotrexate) are teratogenic, causing fetal malformations or pregnancy loss. Correct answer: B.
46. Which fetal prominence defines position in cephalic presentation?
A) Chin
B) Occiput
C) Sacrum
D) Frontal bone
Explanation: The occiput is the landmark for cephalic presentations (e.g., "occiput anterior"). Correct answer: B.
47. A pregnant woman presents with urgency, frequency, flank pain, and fever. Likely diagnosis?
A) Cystitis
B) Acute pyelonephritis
C) Appendicitis
D) Preterm labor
Explanation: Flank pain + fever = pyelonephritis, a UTI complication requiring IV antibiotics. Correct answer: B.
48. Best treatment for hyperthyroidism in pregnancy?
A) Radioactive iodine
B) Propylthiouracil (PTU)
C) Methimazole
D) Propranolol
Explanation: PTU is preferred in 1st trimester due to lower risk of fetal anomalies vs. methimazole. Correct answer: B.
49. Twin pregnancy: one with oligohydramnios, the other with polyhydramnios. Diagnosis?
A) Twin reversed arterial perfusion (TRAP)
B) Twin-to-twin transfusion syndrome (TTTS)
C) Discordant growth
D) Chorioangioma
Explanation: TTTS involves unequal blood flow via placental anastomoses, causing oligo/polyhydramnios. Correct answer: B.
50. A term HIV+ woman is about to deliver. Next step?
A) Avoid breastfeeding
B) Give zidovudine (AZT)
C) Emergency C-section
D) Postpartum vaccination
Explanation: Intrapartum zidovudine reduces vertical HIV transmission risk. Correct answer: B.
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