51. In a twin pregnancy, one baby has oligohydramnios and the other has polyhydramnios. What is the most likely diagnosis?
A) Twin reversed arterial perfusion (TRAP)
B) Twin-to-twin transfusion syndrome (TTTS)
C) Discordant growth
D) Chorioangioma
Explanation: TTTS occurs due to unequal blood flow through placental vascular anastomoses, leading to oligohydramnios in the donor twin and polyhydramnios in the recipient twin. Correct answer: B.
52. A pregnant lady presents with sudden breathlessness and collapses. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Amniotic fluid embolism
D) Pneumothorax
Explanation: Sudden breathlessness and collapse in pregnancy is most concerning for pulmonary embolism due to the hypercoagulable state of pregnancy. Correct answer: B.
53. What is the minimum amount of protein in urine required to diagnose pre-eclampsia?
A) 150 mg in 24 hours
B) 200 mg in 24 hours
C) 300 mg in 24 hours
D) 500 mg in 24 hours
Explanation: Pre-eclampsia is diagnosed with new-onset hypertension and proteinuria of ≥300 mg in 24 hours. Correct answer: C.
54. What is the normal range for amniotic fluid index (AFI)?
A) 3-20 cm
B) 5-25 cm
C) 8-18 cm
D) 10-30 cm
Explanation: Normal AFI ranges from 5-25 cm. Values below 5 indicate oligohydramnios, above 25 indicate polyhydramnios. Correct answer: B.
55. What is the normal range for AFI in the third trimester?
A) 5-20 cm
B) 10-25 cm
C) 12-30 cm
D) 15-35 cm
Explanation: In the third trimester, AFI normally ranges between 10-25 cm. Correct answer: B.
56. Which of the following is a cause of oligohydramnios?
A) Maternal diabetes
B) Renal agenesis
C) Fetal anemia
D) Twin pregnancy
Explanation: Renal agenesis leads to oligohydramnios because fetal urine production is a major source of amniotic fluid in later pregnancy. Correct answer: B.
57. A 20-week pregnant female presents with constipation. What is the most likely cause?
A) Hyperthyroidism
B) Decreased gut motility
C) Iron deficiency anemia
D) Dietary deficiency
Explanation: Pregnancy hormones (especially progesterone) decrease gut motility, leading to constipation. Correct answer: B.
58. A pregnant woman has an MCV of 110 fL. What should be checked next?
A) Iron studies
B) Folic acid level
C) Vitamin B12 level
D) Hemoglobin electrophoresis
Explanation: An elevated MCV (>100 fL) suggests macrocytosis, most commonly due to folate deficiency in pregnancy. Correct answer: B.
59. A pregnant lady with mitral stenosis is at highest risk for heart failure at which time?
A) First trimester
B) Second trimester
C) During labor
D) After delivery
Explanation: The immediate postpartum period carries the highest risk due to fluid shifts and increased preload. Correct answer: D.
60. A woman had previous deliveries at 34 and 32 weeks gestation. What is the most likely complication in this pregnancy?
A) Gestational diabetes
B) Preterm delivery
C) Preeclampsia
D) Placenta previa
Explanation: Previous preterm deliveries are the strongest predictor of subsequent preterm birth. Correct answer: B.
61. A term pregnant woman rapidly deteriorates after membrane rupture, with respiratory distress, hypotension, and loss of consciousness. What is the diagnosis?
A) Pulmonary embolism
B) Amniotic fluid embolism
C) Eclampsia
D) Septic shock
Explanation: Sudden cardiovascular collapse after rupture of membranes is classic for amniotic fluid embolism. Correct answer: B.
62. What is the recommended DVT prophylaxis for a post-cesarean patient with no prior history of DVT?
A) Early mobilization and hydration
B) Aspirin
C) LMWH
D) Compression stockings
Explanation: For low-risk patients, early mobilization and hydration are sufficient. Pharmacologic prophylaxis is reserved for high-risk cases. Correct answer: A.
63. What is the recommended head position for neonatal resuscitation?
A) Flexed
B) Extended
C) Neutral
D) Rotated
Explanation: The neutral position aligns the airway for effective ventilation during resuscitation. Correct answer: C.
64. What is the most common fetal presentation at the pelvic inlet in early labor?
A) Occiput anterior
B) Occiput posterior
C) Occiput transverse
D) Brow
Explanation: The fetal head typically enters the pelvis in the transverse position (OT) before rotating. Correct answer: C.
65. What is the most common fetal position associated with prolonged labor?
A) Occiput anterior
B) Occiput posterior
C) Occiput transverse
D) Face
Explanation: Persistent occiput transverse position is a common cause of arrest of labor. Correct answer: C.
66. A 37-week pregnant lady has an MCV of 65 fL. What is the next management step?
A) Oral iron therapy
B) Folate supplementation
C) Blood transfusion
D) Observe
Explanation: Severe microcytic anemia (MCV <70 answer:="" c.="" correct="" delivery.="" fl="" for="" may="" near="" prepare="" require="" span="" term="" to="" transfusion="">
67. A pregnant woman received pneumococcal vaccine in a previous pregnancy. What is recommended now?
A) No action needed
B) Booster dose
C) Repeat pneumococcal vaccine
D) Check antibody titers
Explanation: Pneumococcal vaccine is recommended in each pregnancy for high-risk patients. Correct answer: C.
68. What is the most common cause of placental abruption?
A) Trauma
B) Uncontrolled hypertension
C) Cocaine use
D) Thrombophilia
Explanation: Chronic hypertension is the leading risk factor for abruption due to vascular damage. Correct answer: B.
69. What are the effects of smoking during pregnancy?
A) Macrosomia
B) Reduced birth weight and preterm birth
C) Neural tube defects
D) Gestational diabetes
Explanation: Smoking causes fetal growth restriction and preterm delivery due to placental hypoxia. Correct answer: B.
70. How many units of cross-matched blood are typically prepared for massive PPH in placenta previa?
A) 2-3 units
B) 3-4 units
C) 5-6 units
D) 8-10 units
Explanation: Placenta previa carries high hemorrhage risk; 5-6 units are typically cross-matched. Correct answer: C.
71. What is the loading dose of MgSOâ‚„ for pre-eclampsia/eclampsia?
A) 2g
B) 4g
C) 6g
D) 8g
Explanation: The standard loading dose for MgSO₄ in pre-eclampsia/eclampsia is 4g IV over 15–20 minutes (Option B), followed by a maintenance infusion of 1g/hour to prevent seizures.
72. In a twin delivery, if the first baby is cephalic and the second is non-cephalic with intact membranes, what is the next step?
A) Emergency cesarean section
B) External cephalic version
C) Internal podalic version
D) Oxytocin augmentation
Explanation: Internal podalic version (Option C) is used to manually convert the second twin into a breech position for vaginal delivery if membranes are intact.
73. Which immunosuppressant drug is contraindicated in breastfeeding?
A) Azathioprine
B) Cyclosporine
C) Mycophenolate
D) Tacrolimus
Explanation: Mycophenolate (Option C) is teratogenic and contraindicated in breastfeeding due to risks of severe fetal malformations and immunosuppression in the infant.
74. How can pre-eclampsia be prevented in high-risk women?
A) Heparin
B) Aspirin
C) Calcium supplements
D) Vitamin D
Explanation: Low-dose aspirin (Option B, 75–150mg/day) started before 16 weeks reduces the risk of pre-eclampsia in high-risk pregnancies by inhibiting thromboxane-mediated vasoconstriction.
75. Why is aspirin given to a pregnant woman with a history of hypertension?
A) To treat active hypertension
B) To prevent pre-eclampsia
C) To reduce fetal growth restriction
D) To prevent preterm labor
Explanation: Aspirin (Option B) is prophylactic in women with risk factors (e.g., chronic hypertension) to reduce placental dysfunction and pre-eclampsia.
76. What is the management for an HIV-positive woman in labor?
A) Nevirapine alone
B) Zidovudine (AZT) during labor
C) Avoid breastfeeding
D) Emergency cesarean section
Explanation: Intrapartum IV zidovudine (Option B) reduces vertical HIV transmission, especially if viral load is uncontrolled.
77. What is a key intervention for domestic violence screening in pregnancy?
A) Routine police involvement
B) Mandatory counseling
C) Seeing women alone at least once
D) Immediate shelter referral
Explanation: Privacy ensures disclosure; guidelines recommend at least one confidential consultation (Option C) to assess safety.
78. Which antibiotic treats viral or atypical pneumonia in pregnancy?
A) Amoxicillin
B) Azithromycin
C) Ciprofloxacin
D) Doxycycline
Explanation: Azithromycin (Option B) covers atypical pathogens (e.g., Mycoplasma) and is safe in pregnancy.
79. What is the uterotonic protocol after uterine massage for PPH?
A) 5–10 IU oxytocin + 40 IU in 100mL
B) 10 IU IM oxytocin
C) 0.2mg ergometrine
D) 800mcg misoprostol
Explanation: Initial bolus (5–10 IU IV) followed by infusion (40 IU in 100mL, Option A) sustains uterine contraction.
80. What is the incidence of antepartum hemorrhage?
A) 1–2%
B) 2–5%
C) 5–10%
D) 10–15%
Explanation: APH occurs in 2–5% (Option B) of pregnancies, commonly due to placenta previa or abruption.
81. What is the next step for shoulder dystocia after delivering the head?
A) McRoberts maneuver
B) Suprapubic pressure
C) Episiotomy
D) Zavanelli maneuver
Explanation: Suprapubic pressure (Option B) helps disimpact the anterior shoulder by reducing the bisacromial diameter.
82. What is the first step in abdominal examination of a 38-week pregnant woman?
A) Auscultate fetal heart
B) Palpate fundus
C) Assess fetal movements
D) Measure SFH
Explanation: Fundal palpation (Option B) determines fetal lie and presentation before detailed Leopold maneuvers.
83. What effect does diazepam have on the fetus?
A) Bradycardia
B) Reduced variability
C) Hyperactivity
D) Polyhydramnios
Explanation: Benzodiazepines like diazepam (Option B) cross the placenta, causing CNS depression and reduced fetal heart rate variability.
84. In a primigravida, how often should vaginal exams be done in the passive phase of labor?
A) Hourly
B) Every 2 hours
C) Every 4 hours
D) Every 6 hours
Explanation: Excessive exams increase infection risk; 4-hour intervals (Option C) are standard unless complications arise.
85. What is the most common cause of transverse lie?
A) Uterine anomalies
B) Placenta previa
C) Multiple pregnancy
D) Polyhydramnios
Explanation: Compressed uterine space in twins (Option C) often leads to abnormal fetal lies (e.g., transverse).
86. What is the management for low-lying anterior placenta with bleeding at term?
A) Emergency cesarean section
B) Amniotomy
C) Oxytocin induction
D) Bed rest
Explanation: Symptomatic placenta previa (bleeding + low-lying placenta) requires cesarean delivery (Option A) to avoid hemorrhage.
87. A 38-week pregnant woman has a hand prolapse with cord prolapse and fetal bradycardia. What is the management?
A) Manual cord reduction
B) Type-1 cesarean under spinal anesthesia
C) Type-1 cesarean under general anesthesia
D) Forceps delivery
Explanation: General anesthesia (Option C) is faster for Category-1 cesarean (fetal distress) with prolapsed cord/hand.
88. Which cesarean type is indicated for non-reassuring fetal status without maternal compromise?
A) Type-1
B) Type-2
C) Type-3
D) Type-4
Explanation: Type-2 (Option B) is for urgent but non-emergent fetal distress without maternal instability.
89. What is a normal cardiovascular change in pregnancy?
A) Decreased heart rate
B) Increased heart rate
C) Reduced blood volume
D) Hypotension
Explanation: HR rises by 10–20 bpm (Option B) due to increased cardiac output and blood volume.
90. What is the advice for a non-pregnant CKD patient with GFR 20 who wants to conceive?
A) Proceed with pregnancy
B) Stabilize renal function first
C) Start dialysis
D) Avoid pregnancy permanently
Explanation: GFR <30 b="" fetal="" function="" maternal="" optimize="" outcomes="" pre-conception.="" ption="" renal="" span="" worsens="">
91. A patient has 3cm cervical dilation and a positive fibronectin test. What is the diagnosis?
A) Preterm labor
B) Cervical incompetence
C) Placental abruption
D) Chorioamnionitis
Explanation: Fibronectin + painless dilation (Option B) suggests cervical insufficiency, requiring cerclage.
92. When should anti-D prophylaxis be given to an Rh-negative woman with an Rh-positive partner?
A) 12 weeks + postpartum
B) 28–34 weeks + postpartum
C) Only after delivery
D) 20 weeks + 34 weeks
Explanation: Anti-D (Option B) is given at 28–34 weeks and within 72 hours post-delivery to prevent sensitization.
93. A woman with a previous thalassemia major baby is now 10 weeks pregnant. What test is needed?
A) Amniocentesis
B) Chorionic villus sampling (CVS)
C) Cordocentesis
D) NIPT
Explanation: CVS (Option B) at 10–12 weeks provides fetal DNA for early diagnosis of thalassemia major.
94. A 34-week pregnant woman has SFH 28cm but audible fetal heart sounds. What test is next?
A) Ultrasound
B) CTG
C) Amniocentesis
D) Doppler
Explanation: CTG (Option B) assesses fetal well-being when SFH lags behind gestational age (suspected IUGR).
95. A patient has late decelerations, poor progress, and 2 hours of pushing. What is next?
A) Emergency cesarean
B) Oxytocin + ARM
C) Vacuum delivery
D) Wait for spontaneous delivery
Explanation: Non-reassuring fetal status (late decelerations) + arrested labor mandates cesarean (Option A).
96. A postpartum woman has subinvolution, fever, and foul discharge. What is the cause?
A) Retained products of conception
B) UTI
C) Endometritis
D) Ovarian torsion
Explanation: RPOC (Option A) causes subinvolution, infection, and foul lochia, requiring ultrasound + evacuation.
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