SECTION A: MULTIPLE CHOICE QUESTIONS (20 MARKS)

INSRUCTIONS:
 Put your answer in the space provided
 Each correct response will be awarded one (1) mark

1. The following are various causes of physiological amenorrhoea except:-

(a) Before puberty
(b) During pregnancy
(c) Pituitary gland atrophy
(d) During lactation
(e) After menopause

2. In staging the carcinoma of cervix in which stage, will the tumor extend to the upper
third of the vagina.
(a) stage 1A
(b) Stage 1B
(c) Stage IIA
(d) Stage II B
(e) Stage III A

3. All of the following are complications of obstructed labour EXCEPT:-

(a) Paralysis of deep peroneal nerve
(b) Vesical vaginal fistula
(c) Rectal vaginal fistula
(d) Cephalo pelvic disproportion
(e) Uterine rupture

4. The best time to insert shirodkar suture in patients with cervical incompetence is:-
(a) Early first trimester
(b) Early second trimester
(c) Late third trimester
(d) Late second trimester

5. A 24 years old pregnant woman comes with history of amenorrhea for sixteen
weeks. She complains of slight lower abdominal pain which is associated with
minimal vaginal bleeding. On examination the fundal height was 16 weeks and fetus
is viable. Speculum examination revealed the cervix is closed with slight blood
oozing from cervical os. What is the most likely diagnosis?
a) Missed abortion
b) Complete abortion
c) Inevitable abortion
d) Threatened abortion
e) Spontaneous abortion.
6. A 26-year-old primigravid woman at 42 weeks' gestation was admitted in antenatal
ward. The prenatal course was significant for a positive group B Streptococcus
culture performed at 35 weeks. The patient was started on lactated Ringer's IV
solution. Sterile vaginal examination shows that the patient's cervix is long, thick,
and closed. Prostaglandin (PGE2) gel is placed into the vagina, and electronic fetal
heart rate monitoring is continued. In approximately 60 minutes, the fetal heart rate
falls to the 90s, as the tocodynamometer shows the uterus to be contracting every 1
minute with essentially no rest in between contractions. Which of the following was
most likely the cause of the uterine hyperstimulation?

a) IV fluids
b) Infection
c) Postdates pregnancy
d) Vaginal examination
e) Prostaglandin (PGE2) gel

7. A 35 year old lady had a twin pregnancy; first twin has been delivered 10 minutes
ago second twin has not yet delivered. What should be done next step?

a) Give ergometrine injection

b) Initiate oxytocin to enhance labour
c) Monitor blood pressure and pulse rate
d) Refer immediately for caesarian section
e) Assess the lie and presentation of the fetus

8. The following drug can be used to arrest and prevention of hirsutism in polycystic
ovarian syndrome:

a) Bromocriptine
b) Spinolactone
c) Methyldopa
d) Cimetidine
e) Androgens
9. After 2 days of expectant management of a patient with pre term premature rupture
of membrane who develops uterine tenderness and fever. What is the NEXT STEP in
management?

a) Immediate delivery
b) Obtain a full blood picture
c) Perform a biophysical profile
d) Continue with expectant management
e) Do ultrasound to confirm the gestation age

10. Pregnancy induced hypertension may be associated with:

a) An increase in fibrin degradation products

b) Decreased levels of serum transaminases
c) A decrease in a capillary permeability
d) Increase of platelet count
e) Hemodilution

11. Which of the following is the most common carcinoma in developing countries
a) Ovarian Ca
b) Breast Ca
c) Carcinoma of the Cervix
d) Endometrial Ca
e) Choriocarcinoma

12. Which of the following Degenerative changes is characterised by venous thrombosis

and interstitial haemorrhage
a) Hyaline degeneration
b) Atrophic degeneration
c) Red degeneration
d) Cystic degenearation
e) Fatty degeneration

13. One of the following is NOT a causative organism of Pelvic inflammatory disease
a) Group B streptococcal
b) Chlyamdia Trachomatis
c) Haemophilas influenza
d) Gonococci
e) Pseudomonas Aureginosa
14. Which of the following has the highest incidence of occurrence of Ectopic pregnancy
a) Ampulla
b) Fimbriae
c) Isthmus
d) Interstitial
e) Cornual

15. A 35 years old woman presents to you with a history of heavy and prolonged
menstrual bleeding associated with slight lower abdominal pain. What is the most
likely diagnosis?

a) Submucousal Fibroid
b) Pedunculated Fibroid
c) Subserosal Fibroid
d) Intramural Fibroid
e) Cervical Fibroid.

16. Which of the following is a complication of multiple pregnancy

a) Wrong date.
b) Endometriosis
c) Uterine fibroid
d) Torsion of ovary
e) Preterm delivery

17. Which of the following drug is given to mothers who have lost a baby in early hours
after delivery and are producing milk
a) Clomiphen
b) Duphaston
c) Bromocriptine
d) Mifepristone
e) Depoprovera

18. One of the following drug is an effective treatment of Ovarian Cysts

a) Nifedipine
b) Metformin
c) Duphaston
d) Combined Oral Contraceptives
 e) Vincristine

19. Dysfunctional Uterine bleeding can be caused by

a) Adenomyosis
b) PID
c) Pregnancy
d) Ectopic Pregnancy
e) Cervical Tear

20. Trial of scar is contraindicated in pregnant woman with one previous scar with one
of the following:

A. Adequate pelvis

B. Twin pregnancy

C. Singleton pregnancy

D. Previous scar as the only risk factor

E. Small for date fetus, cephalic presentation

SECTION B: MULTIPLE TRUE/FALSE QUESTIONS 10 MARKS
Instructions
 Write the word TRUE for correct statement and word FALSE for a wrong statement in
the space provided. DO NOT WRITE LETTER “T” OR “F”

 Half mark will be awarded for each correct response

1. A 25 year old G5P4 is admitted at 38 weeks gestation with sudden onset of painless vaginal
bleeding. Her Pulse rate is 110bpm and BP = 105/65 mmHg. On examination of abdomen is
soft, non – tender. The foetus is lying transversely and foetal heart rate is normal with a
baseline of 140b/min.
A. FALSE Mode of delivery should be planned when the GA reaches 40 weeks
B. TRUE Line of Management is by doing immediate caesarian section
C. FALSE Diagnosis is confirmed by speculum examination
D. TRUE Placenta praevia is the most probable diagnosis
E. FALSE Fetal death is a common complication

2. Regarding pre-eclampsia superimposed on chronic hypertension:

A. FALSE Proteinuria is absent
B. TRUE Patient prognosis is poor compared to other forms of Pregnancy induced
hypertension
C. FALSE Is diagnosed even before conception
D. FALSE Is diagnosed in a previously normotensive patient
E. TRUE Often, develops earlier in pregnancy than pre-eclampsia

3. Regarding severe anaemia in pregnancy:

A. TRUE Heart failure results from lack of oxygen in cardiac muscle
B. FALSE The most dangerous period is 1 hour after delivery
C. TRUE Closure of arterio-venous shunts of the placenta increases the risk
D. FALSE Auto-transfusion reduces chances of failure after delivery
E. TRUE Increase in blood pressure is not common

4. Regarding gestational trophoblastic diseases:

A. FALSE 50% of hydatidform moles progress to become choriocarcinoma
B. FALSE 25% of choriocarcinoma develop from moles
C. TRUE The chromosome in complete moles is almost always paternal in origin.
D. FALSE Partial moles nearly always present with viable fetal component.
E. FALSE Rapid enlargement of uterus is essential for diagnosis of choriocarcinoma.
 5. A 30 year old primegravida presents with fever and chills for 2 days. The following are
differential diagnoses:

A. TRUE Pyelonephritis

B. FALSE Severe anaemia

C. TRUE Uncomplicated malaria

D. FALSE Premature rupture of membrane

E. FALSE HIV infection

6. The following factor increases the risk for endometrial carcinoma:

A. TRUE Early menarche before 12 years
B. TRUE use of hormone replacement therapy with exogenous oestrogen alone
C. FALSE Early menopause before age of 48 of age
D. FALSE High parity
E. TRUE Obesity

7. 50-year-old woman who has been happily married for 18 years complains of irregular
vaginal bleeding. Which the following investigations should be performed to exclude the
cause?

A. TRUE Cervical smear

B. FALSE Full blood count

C. TRUE Speculum examination

D. TRUE Digital vaginal examination

E. FALSE Cervical swab for chlamydia

8. A 45 years old woman known diabetic comes to the antenatal clinic at 32 weeks
gestation age. The following are most likely foetal complications

A. FALSE Diabetic neuropathy

B. FALSE Diabetic retinopathy
C. TRUE Macrosomia.
D. TRUE Caudal regression syndrome
 E. FALSE Respiratory Distress syndrome

9. Regarding delivery of second twin the following should be done before attempting to
delivery second twin baby:

A. FALSE Should be delivered after 40 minutes

B. FALSE Fetal distress of second twin cannot occur if no cord prolapsed
C. TRUE Establish contraction in cases they are inadequate with oxytocin.
D. TRUE Assess the lie and presentation its possible
E. TRUE Assist delivery as in a single tone delivery

10. The relevant investigations for a woman presenting with hypertension at 24 weeks of
gestation includes:

A. TRUE Urinalysis
B. FALSE Liver function test
C. TRUE Obstetrics ultrasound
D. FALSE hCG hormonal assay
E. FALSE Urinary pregnancy test

SECTION C: MATCHING ITEM QUESTIONS: 10 MARKS

INSTRUCTIONS
 This section consists of two (2) questions with five options each
 Each correct response will be awarded one (1) mark.
 Match the responses from column B with the most appropriate items in Column A by
writing the letter of correct answer in the space provided USE CAPITAL LETTERS.
Each item in Column B is matched only once

1. Match the corresponding letterof medicine in Column A against the medical conditions in
column B.

1. Threatened abortion D
A. Dinoprostol
2. Pueperial psychosis E
B. Gentamycin
 3. Inevitable abortion A
C. Metformin
4. Hyperprolactinemia F
D. Duphastone
5. Postpartum depression H
E. Chlorpromazine

F. Bromocriptine

G. Ampicillin

H. Amitriptyline

2. Match the complications from column B with the responsible disease condition in column A

COLUMN A COLUMN B
Disease condition (Complication)
1. G Diabetes mellitus in pregnancy A. Ruptured uterus

2. D Rupture ectopic pregnancy B. Hypernatremia

3. A Obstructed Labor C. Torsion

4. F Cancer of cervix D. Shock

5. C Ovarian cyst. E. Diverticulitis

F. Recto-vaginal fistula

G. Pre-tem delivery.

H. Scaring and adhesion at pelvic

organ.

SECTION D: SHORT ANSWER QUESTIONS (20 MARKS)

Instructions:
 This section consists of eight (8) questions.
 Write your answer on the space provided.
  Write a readable handwrite; DIRT WORK IS NOT ALLOWED.

1. 32 years old nuliparous woman was come to the health centre with history of heavy and
prolonged menstrual bleeding for 6 months. On abdominal examination mass was palpable
on hypogastria region.

i. What is the most likely diagnosis (1 Mark)

ii. Outline three (3) differential diagnosis (3 Marks)
iii.
What investigation will you do to confirm the diagnosis at hospital level? (1
Mark)
Answer:

i. Diagnosis: Uterine fibroid

ii. Differential diagnosis

-Adenomyosis
-Pregnancy.
-Other uterine malignances (endometriosis, carcinoma)
-Ovarian tumors.

iii. Investigation:
- Abdominal pelvic Ultrasound

2. List five (5) differential diagnosis of large uterus for gestation age (5 Marks)
Answer:-
- Inaccurate menstrual history

- Polyhydramnious

- Hydatidiform mole

- Uterine myoma (fibroid)

- Closely attached adnexial mass

- Macrosomia/Hydrocephaly.

3. A 30 years old woman with amenorrhea for four (4) months was brought to the dispensary
with history of acute abdominal pain which started 6 hours ago. On examination she was
severely pale, BP 80/40mmHg, Pulse rate 120 Beat/min. and on abdominal examination
guarding and rebound tenderness were positive.

i. What is the most likely diagnosis? (1 Mark)

ii. How will you manage the patient at dispensary level? (3 Marks)

iii. What investigation will you order at hospital level to condition your diagnosis?
(1
Mark)

Answers:

i. Diagnosis: Ruptured ectopic pregnancy (1 mark)

ii. Management: (3 point each 1 mark)

- Resuscitation with IV fluids

- Insert urethral catheters

- Blood for grouping and cross-matching.

- Refer for urgent laparatomy.

Investigation: Obstetric Ultrasound

4. Define the following terms (5 Marks)

i. Arias-Stella reaction
Ans;
Is a benign change in the endometrium associated with the presence of
chorionic tissue.

ii. Alder’s Sign

Ans;
Sign used in diagnosis of Ectopic pregnancy where there is a presence of
fixed abdominal tenderness on turning the patient.

iii. Meig’s Syndrome

Ans;
 Is a triad of benign ovrian tumor with ascites and pleural effusion that
resolves after resection of the tumor.

iv. Krukenberg tumors

Ans;
Refers to the malignancy in the ovary that metastasized from a primary
site, classically the GIT although it can arise in other tissues.

v. Premenstrual Syndrome
Ans;
Refers to physical and emotional symptoms that occur in the one to two
weeks before a woman’s period.

SECTION E: GUIDED ESSAY QUESTIONS 30 MARKS

Instructions:

 This section consist of two (2) questions which are supposed to be answered in a
narrative way
 EACH QUESTION SHOULD start on a new page
 Write a readable handwrite ; DIRTY WORK IS NOT ALLOWED

1. A 35 years old gravida 6, Para 5 came to the delivery room at 32 weeks gestation with
complaints of headache lower abdominal pain and swelling of her lower limbs. 30 minutes
ago she noted bright red blood coming from her vagina, but currently not bleeding. She has
strong contraction every 3 minutes. On examination her BP is 150/100 mmHg, pulse rate is
110.6/min, respiration are 20b/min and temperature 36.7oC with hyper-reflexia of knee jerk.
The uterus is quite firm even between the contractions and very tender on palpation. Bedside
clotting time is 4 minutes. The urine is positive for protein. The foetal heart rate is 132b/min
and descent of 1/5. On vagina examination the cervix is 10cm dilated with intact membrane.
Describe the management of her condition and mode of delivery.

Answers:

The most likely diagnosis

Severe pre-eclampsia with abruptio placenta (2 Marks)

Investigations (3 Marks)
 Hb
 Blood grouping and X-match
 Platelet count/ FBP
 RFT
 LFT
 24 hour proteinuria collection
Treatment (7 Marks)
 Blood pressure control- Methydopa 250mg po
 Catheterization for monitoring urine output
 2 large bores IV canula
 3L of RL to replace 1 litre of blood loss or 1 unit of blood transfusion
 MgS04 4g IV in 200mls RL/Ns for 5 minutes and 5gm in 1 mls of 2% lignocaine in each
buttacks as loading dose I.M.
 Maintenance dose of either 5 mg mgS04 I.V mixed with 1 mls of 2% lignocaine in
alternative buttocks 4 hrly for 24 hrs to 48 hrs post delivery. OR 4g mgS04 in 500 mls Rl/NS
I.V 4 hourly for 24 hrs to 48 hrs post delivery.
 Monitor signs of mgS04 toxicity such as absence of reflexes, respiratory rate, more than
16bpm, urine output less than 30mls her calcium gluconate as antidote should be nearby.
Mode of Delivery (3
Marks)
 Vaginal delivery is the best by vacuum because the descent is 1/5, she is full dilated.
 Active management of 3rd stage of labour
 Assessment of any severe bleeding after delivery as the patient is at risk of PPH.

1. Mrs. Mmena is 55 years old postmenopausal woman comes to you with history of
vaginal bleeding for six (6) months. Vaginal bleeding is associated with post-coital
bleeding and foul smelling vaginal discharge. She also complaint about lower abdominal
pain, swelling of lower limb and passing blood in urine. On examination the patient is
wasted and pale. Abdominal examination revealed tender lower abdomen on deep
palpation with a mass palpable on the hypogastric region. Speculum examination shows
lesion of the cervix easily bleeds on touch. The cervix is enlarged irregular and firm.
Write an essay on your discussion based on diagnosis, risk and associated factor,
investigations and recommended treatment options. (15 marks)
Answer:-

a) Diagnosis.
 - Cancer of the cervix (1 Mark)

b) Risk factors: (5 points each 1 mark)

- Human Papilloma Virus type 16 as 18

- Herpes simplex virus

- Early age at first sexual intercourse.

- Multiple sexual partners.

- Intercourse with uncircumcised male partner.

- High parity

- Law social economic status

- Law immune system.

c) Investigation. (5 points each 1 mark)

 Hb-Level

 Chest X-ray

 Abdominal Ultrasound

 Colposcopy

 Cystoscopy

 Colonoscopy.

 Tissue biopsy for

histology.

 Urinalysis

 X-ray of the lower limb

d) Management (4 points each 1 mark)
 Surgery

 Radiation therapy

 Chemotherapy

 Combined therapy