Obs and gynae data bank

Obs and gynae data bank

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  1 CLINICAL OFFICERS FINAL EXAM:GYNAE AND OBSTETRICS DATA BANK
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  2 SECTION A: Circlethe correct answer (25 marks). You Lose ¼ mark for each wrong answer. 1. Zambia is addressing the millennium development goal number five by the year 2015: What is the specific reproductive health problem being addressed? a. Reduction of child mortality per 100,000 live births b. Reduction of TB per 100,000 live births c. Reduction of maternal deaths per 100,000 live births d. Reduction of HIV deaths per 100,000 live births e. Reduction in neonatal mortality 2. The criteria to consider for post exposure prophylaxis therapy against HIV is: a. Have the base line HIV test result b. Obtain Full Blood count result c. Establish Viral load d. Establish CD4 Count e. HVS smear 3. Alcohol drinking during pregnancy may lead to: a. Fetal alcoholism during teen years b. Neonal diabetes c. Low Apgar score at birth d. Neonatal withdraw seizures e. Diabetis 4. Control of Diabetes during pregnancy is best achieved with: a. Diabetic Diet b. Antibiotics. c. Insulin therapy d. Dionil therapy e. Malaria presumptive treament 5. Amenorrhoea at 50 years of age is commonly associated with: a. Pregnancy b. Family Planning c. Dysfunction uterine bleeding d. Endometriosis e. Menopause 6. In uterine fibromyomata, management of labour in full term pregnancy with normal progress of labour often is an indication for:
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  3 a. Caesarean section b.Vacuum assisted delivery c. Medical augmentation of labour d. Spontaneous vaginal delivery e. Home delivery 7. Which of the following test does confirm diagnosis of amniotic leakage per vagina: a. Protein in urine b. Fern test c. PCR d. Full blood count e. Culture and sensitivity 8. Uterine couvelaire is a complication that can occur in one of the obstetric surgical procedures. Which of the following procedure would cause the complication? a. Caesarean Section b. Medical induction of Labour c. Total hysterectomy d. Bilateral tubal ligation e. Shirodka suture(ciclage) 9. During Focused Antenatal care danger signs are discussed with mothers. Which of the following is an emergency sign? a. Productive cough once this morning b. Vomiting once this morning c. Insomia for one day d. Drinking of 1litre of fluids today e. Per vaginal bleeding twice today 10. Inevitable abortion is often associated with anomaly problems. Which anomaly is important for clinicians to include for investigations when abortion occurs. a. Uterus incompetence test b. Urine incontinent test c. Cervical incompetence test d. Vesical vaginal test e. Syphilis test 11. Menopause can be caused by one of the procedure listed below. a. Hystorotomy b. Total Hysterectomy
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  4 c. Bilateral TubalLigation d. Mastitectomy e. VVF repair 12. The criteria to start PMTCT always as rule follow: a. Base line HIV positive test irregardless of consent b. Base line HIV negative test & client consent c. Base line HIV positive test & client consents d. Base line Viral load and patient consents e. Baseline Sti tests should be negative 13. Endometriosis lesion on the thigh in child bearing age can best be treated by: a. Short term pill therapy b. Long term pill therapy c. Cervical Dilatation and currettage d. Cauterisation e. Antibiotic ointment 14. The average weight gain per week for a mother during normal pregnancy is: a. 1.0kg b. 2.0kg. c. 1.5kg d. 0.7kg e. 0.2kg 15. What is the good practice for management of placenta previa type 3? a. Admit at RHC and wait for SVD b. Refer for hospital C/Section delivery c. Give IEC and mother to come when labour starts d. Give Oxytocin stat to induce labour e. Allow mother to decide when to admit her for labour. 16. One Indication for induction of labour is a. Premature labour at 3rd stage. b. Premature labour at 2nd stage c. Post dates d. Premature labour in breech presentation. e. Wrong dates for LMP 17. In Obstructed labour factors are many. Which is the common factor: a. Diabetis. b. Placenta previa Totalis
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  5 c. Full bladder d.Cephalo pelvic disprortion e. Twin pregnancy 18. The first breast milk after delivery is a yellowish fluid and nutritious for the neonate. What is it called: a. Haemacele. b. Lactalbumin c. Caseinnogen d. Colostrum e. Protein 19. Breast cancer when diagnosed early is: a. Curerable with surgery b. Curerable with antibiotic c. Curerable with vitamin therapy d. Curerable with hormone therapy e. Curerable with chemotherapy for 3months 20. The Choice management for premature rupture of membranes are 36 weeks pregnancy is: a. Start antibiotics and plan for delivery in hospital b. Admit to hospital and augment labour. c. Start Antibiotics and treat as outpatient until labour starts d. Antibiotics and order emergency caesarean section e. Give analgesics and bed rest 21. Zambia is addressing the millennium development goal number five by the year 2015: What is the specific reproductive health problem being addressed? a. Reduction of child mortality per 100,000 live births b. Reduction of TB per 100,000 live births c. Reduction of maternal deaths per 100,000 live births d. Reduction of HIV deaths per 100,000 live births 22. The criteria to consider for post exposure prophylaxis therapy against HIV is: a. Do base line HIV testing b. Do a Full Blood count c. Do Viral load d. Do CD4 Count 23. Alcohol drinking during pregnancy may lead to:
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  6 a. Fetal alcoholismduring teen years b. Neonal diabetes c. Low Apgar score at birth d. Neonatal withdraw seizures 24. Control of Diabetes during pregnancy is best achieved with: a. Diabetic Diet b. Antibiotics. c. Insulin therapy d. Dionil therapy 25. Luteum gravidate Test is true positive following Amenorrhoea at: a. 2 weeks history of amenorrhoea b. 21 days post coitus. c. after 4 weeks of amenorrhoea d. 10 weeks of amenorrhoea 26. In uterine fibromyomata, management of labour in full term pregnancy with normal progress of labour often is an indication for: a. Caesarean section b. Vacuum assisted delivery c. Medical augmentation of labour d. Spontaneous vaginal delivery 27. Which of the following test does confirm diagnosis of amniotic leakage per vagina: a. Protein in urine b. Fern test c. PCR d. Full blood count 28. Uterine couvelaire is a complication that can occur in one of the obstetric surgical procedures. Which of the following procedure would cause the complication? a. Caesarean Section b. Medical induction of Labour c. Total hysterectomy d. Bilateral tubal ligation 29. During Focused Antenatal care danger signs are discussed with mothers. Which of the following is an emergency sign? a. Productive cough once this morning b. Vomiting once this morning
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  7 c. Insomia forone day d. Drinking excessive water, 4litres today 30. Inevitable abortion is often associated with anomaly problems. Which anomaly is important for clinicians to include for investigations when abortion occurs. a. Uterus incompetence test b. Urine incontinent test c. Cervical incompetence test d. Vesical vaginal test 31. Menopause can be caused by one of the procedure listed below.: a. Hystorotomy b. Total Hysterectomy c. Bilateral Tubal Ligation d. Mastitectomy 32. The criteria to start PMTCT always as rule follow: a. Base line HIV positive test irregardless of consent b. Base line HIV negative test & client consent c. Base line HIV positive test & client consents d. Base line Viral load and patient consents 33. Endometriosis lesion on the thigh in child bearing age can best be treated by: a. Short term pill therapy b. Long term pill therapy c. Cervical Dilatation and currettage d. Cauterisation 34. The average weight gain per week for a mother during normal pregnancy is: a. 1.0kg b. 0.2kg. c. 0.5kg d. 0.7kg 35. What is the good practice for Cord controlled traction of the placenta? a. Give Antibiotics after delivery of the placenta b. Give diazepam before procedure c. Give IV Fluids during procedure d. Give Oxytocin stat if uterine atony occurs.
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  8 36. One Indicationfor Augmentation of labour is a. Premature labour at 3rd stage. b. Premature labour at 2nd stage c. Premature labour at latent phase d. Premature labour in breech presentation. 37. In Obstructed labour factors are many. Which is the common factor: a. Stool Impaction. b. Placenta previa Totalis c. Full bladder d. Cephalo pelvic disprortion 38. The first breast milk after delivery is a yellowish fluid and nutritious for the neonate. What is it called: a. Haemacele. b. Lactalbumin c. Caseinnogen d. Colostrum 39. The Fibrods in young women: a. Are main cause of primary infertility b. Are main cause of early abortion c. Are mainly symptom free d. Are main cause of pre-eclampsia 40. The Choice management for premature rupture of membranes are 36 weeks pregnancy is: a. Start antibiotics and plan for delivery in hospital b. Admit to hospital and augment labour. c. Start Antibiotics and treat as out patient until labour starts d. Antibiotics and order emergency caesarean section. 41. The cervical assessment is good guide for a positive response to induction of labour. What is the quantitative method employed: a. Apgar score b. Bishop score c. Third degree score d. Four hour interval score 42. Which strategy would reduce unplanned pregnancies among the adolescents? a. Encourage abstinence education messages only. b. Encourage one partner messages only. c. Encourage Parents to choose partners for their daughters.
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  9 d. Encourage FamilyPlanning activities of ABC. 43. The common disorder in embryology abortion during the first trimester is: a. Drugs b. Uterine anomalies c. Genetic causes d. Cervical incompetence 44. Which of the complaints is not a danger sign during the first 6 days of Post partum period? a. Swollen tender calf b. Red and swollen Breast c. Red Lochia d. Moderate per vaginal bleeding 45. The dye test in gynaecology practice is ordered to exclude or confirm: a. b. Vesical vaginal fistula c. Bladder schistosomiasis d. Endometriosis e. Anal abscess 46. The management of hydatidiform mole recommends that: a. Patient stays at least 2 years pregnant free b. Patient stays at least 1 years pregnant free c. Patient stays at least 3years pregnant free d. Patient stays at least half a year pregnant free. 41. The criteria to consider for post exposure prophylaxis therapy against HIV is: f. Have the base line HIV test result g. Obtain Full Blood count result h. Establish Viral load i. Establish CD4 Count j. HVS smear 42. Alcohol drinking during pregnancy may lead to: a. Fetal alcoholism during teen years b. Neonal diabetes c. Low Apgar score at birth d. Neonatal withdraw seizures e. Diabetis 43. Control of Diabetes during pregnancy is best achieved with: f. Diabetic Diet
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  10 g. Antibiotics. h. Insulintherapy i. Dionil therapy j. Malaria presumptive treament 44. Amenorrhoea at 50 years of age is commonly associated with: f. Pregnancy g. Family Planning h. Dysfunction uterine bleeding i. Endometriosis j. Menopause 45. In uterine fibromyomata, management of labour in full term pregnancy with normal progress of labour often is an indication for: f. Caesarean section g. Vacuum assisted delivery h. Medical augmentation of labour i. Spontaneous vaginal delivery j. Home delivery 46. Which of the following test does confirm diagnosis of amniotic leakage per vagina: f. Protein in urine g. Fern test h. PCR i. Full blood count j. Culture and sensitivity 47. Uterine couvelaire is a complication that can occur in one of the obstetric surgical procedures. Which of the following procedure would cause the complication? f. Caesarean Section g. Medical induction of Labour h. Total hysterectomy i. Bilateral tubal ligation j. Shirodka suture 48. During Focused Antenatal care danger signs are discussed with mothers. Which of the following is an emergency sign? f. Productive cough once this morning g. Vomiting once this morning h. Insomia for one day i. Drinking of 1litre of fluids today j. Per vaginal bleeding twice today 49. Inevitable abortion is often associated with anomaly problems. Which anomaly is important for clinicians to include for investigations when abortion occurs. f. Uterus incompetence test g. Urine incontinent test h. Cervical incompetence test i. Vesical vaginal test j. Syphilis test
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  11 50. Menopause canbe caused by one of the procedure listedbelow.: a. Hystorotomy b. Total Hysterectomy c. Bilateral Tubal Ligation d. Mastitectomy e. VVF repair 51. The criteria to start PMTCT always as rule follow: a. Base line HIV positive test irregardless of consent b. Base line HIV negative test & client consent c. Base line HIV positive test & client consents d. Base line Viral load and patient consents e. Baseline Sti tests should be negative 52. Endometriosis lesion on the thigh in child bearing age can best be treated by: a. Short term pill therapy b. Long term pill therapy c. Cervical Dilatation and currettage d. Cauterisation e. Antibiotic ointment 53. The average weight gain per week for a mother during normal pregnancy is: a. 1.0kg b. 2.0kg. c. 1.5kg d. 0.7kg e. 0.2kg 54. What is the good practice for management of placenta previa type 3? a. Admit at RHC and wait for SVD b. Refer for hospital C/Section delivery c. Give IEC and mother to come when labour starts d. Give Oxytocin stat to induce labour e. Allow mother to decide when to admit her for labour. 55. One Indication for induction of labour is a. Premature labour at 3rd stage. b. Premature labour at 2nd stage c. Post dates d. Premature labour in breech presentation. e. Wrong dates for LMP 56. In Obstructed labour factors are many. Which is the common factor: a. Diabetis. b. Placenta previa Totalis c. Full bladder d. Cephalo pelvic disprortion e. Twin pregnancy 57. The first breast milk after delivery is a yellowish fluid and nutritious for the neonate. What is it called:
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  12 a. Haemacele. b. Lactalbumin c.Caseinnogen d. Colostrum e. Protein 58. Breast cancer when diagnosed early is: a. Curerable with surgery b. Curerable with antibiotic c. Curerable with vitamin therapy d. Curerable with hormone therapy e. Curerable with chemotherapy for 3months 59. The Choice management for premature rupture of membranes are 36 weeks pregnancy is: a. Start antibiotics and plan for delivery in hospital b. Admit to hospital and augment labour. c. Start Antibiotics and treat as outpatient until labour starts d. Antibiotics and order emergency caesarean section e. Give analgesics and bedrest 60. The cervical assessment is good guide for a positive response to induction of labour. What is the quantitative method employed: a. Apgar score b. Bishop score c. Third degree score d. Four hourinterval score 61. Which strategy would reduce unplanned pregnancies among the adolescents? a. Encourage abstinence education messages only. b. Encourage one partner messages only. c. Encourage Parents to choose partners for their daughters. d. Encourage Family Planning activities of ABC. 62. The common disorder in embryology abortion during the first trimester is: a. Drugs b. Uterine anomalies c. Genetic causes d. Cervical incompetence 63. Which of the complaints is not a danger signduring the first 6 days of Post partum period? a. Swollen tender calf b. Red and swollen Breast c. Red Lochia d. Moderate per vaginal bleeding 64. The dye test in gynaecology practice is ordered to exclude or confirm: a. Vesical vaginal fistula b. Bladder schistosomiasis c. Endometriosis d. Anal abscess 65. The management of hydatidiform mole recommends that:
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  13 a. Patient staysat least 2 years pregnant free b. Patient stays at least 1 years pregnant free c. Patient stays at least 3years pregnant free d. Patient stays at least half a year pregnant free. Answer True or False on each statement – 1mark each correct answer About informed choice in Family Planing - 1mrk each  Provide the Family Planning method the client desires __true  Tailor information to what you think as a provider_ __________  Clients have the right to turn down Family Planning ___true_________  Husbands have fewer rights to Family Planning__ _false___________  Depo provera is reserved for working clients only__false__________ A criterion for use of LAM in mothers is advised if:  Fully breastfeeding TRUE  is more than 6 months post partum TRUE  Menses have not returned yet TRUE  Less than 6 months post partum TRUE  Is HIV positive TRUE Breast cancer when diagnosed early is:  Curerable with surgery T  Curerable with antibiotic F  Curerable with vitamin therapy F  Curerable with hormone therapy T  Curerable with chemotherapy for 3months T 1. Early abortion Occurs in at least 10% of all the pregnancies T Can be prevented with a cerclage of the cervix T The prognosis for a next pregnancy is poor T Is in most cases due to chromosomal abnormalities T 2. Chronic PID Can cause dyspareunia T Is frequently caused by Chlamydia infection T Makes enlargement of the adnexes F Is accompanied by severe lower abdominal pain T
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  14 3. Ectopic Pregnancy Cancause shoulder pain T Can be treated with Metothrexate in early stages T Is found mainly in women after multiple pregnancies T Is mainly caused by damaged tubes after repeated T 4. Male infertility Is very rare …F………………….. Can be caused by heavy smoking………T………….. Is improving with different sexual partners…F……….. Can be caused by the varicosis of the spermatic vein…T………… 5. Cervicalcarcinoma Can cause contactbleedings T Is usually causing some lower abdominal pain T Is preventable through vaccination T Is rare in southern African countries F SECTION C: SHORT ANSWER QUESTIONS. CHOOSE and write focused short notes on any THREE (3) of the questions listed below (5mrks EACH) 1. Endometriosis therapy in child bearing 2. Cervical cancer 3. Discuss early abortion and focused management 4. Outline the diagnosis of Hydatidi formmole 5. Abruptio Placentae 6. List the indications for cone biopsy 7. Stage placenta previae and indicate the focused intervention 8. Counselling process for Prevention of mother to child transmission 9. Elective Caesarean Section 10. Staging of endometrial carcinoma 11. Emergency contraceptives and their indications 12. Complications of Diabetes in pregnancy 13. Use of Vacuum Extraction in labour 14. Postpartum Psychosis 15. Ectopic Pregnancy 16. Ruptured Uterus 17. Molar pregnancy 18. Prolapsed Cord 19. Preterm lab 20. Featal distress in first stage of labour 21. Urine incontinency in women during puerperium 22. Family Planning Services for the Youth in Zambia
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  15 Write the answerto each of the statement/condition (A) below: Condition/Statement(A) Treatment/Answer (2mrk each) 1. Antidote for Magnesium Sulphate toxicity _____________________ 2. What common organism causes Perineal ulcerations _____________________ 3. What urine test is helpful to diagnose Pre – eclampsia ____________ 4. First line drug of choice to treat Treponema Pallidum is__________________ 5. First line drug to treat Vaginal Candidiasis is____________________ State the causative organism/factor associatedwith the disease or condition – 1 mark each Condition State causative or associatedcause 1. Abruptio Placenta ___________________________ 2. Haemolytic disease of baby at birth ___________________________ 3. Chancroid ___________________________ 4. Mastitis in Breast feeding ___________________________ 5. Drug associatedwith multiple pregnancy ____________________ 6. Cervical cancer ___________________________ 7. Early Abortion ___________________________ 8. Chronic diarrhoea in AIDS ___________________________ 9. Jaundice of a new born who is stable ___________________________ 10. Preterm Labour ____________________________ SECTION D: ESSAY OR CASE STUDY QUESTION TO ANSWER (15mrks) Essay (2000 words) 1. Focused Anti natal services are important for pregnant mothers. Discuss the services that are offered and appropriate information and education that ought to be given to mothers during the first visit 2. What does millennium development (MDG) goal number five address? What is being done in Zambia to attain this MDG’s objectives? 3. Ante partum Haemorrhage is common in pregnancy. What is the importance of this condition in Obstetrics?
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  16 4. Discuss thedetailed management of a para one with advanced uterine mayomentrial fibromatous. 5. Discuss the management of a 30 yrs old woman with an abnormal pap smear result at the first level health facility 6. Outline the focused management of the active third stage labour 7. What is the necessity of the partograph and what are the parameters covered during it`s use? 8. Discuss the augmentation of labour and it`s contra indications 9. What is Bishop Score in obstetric practice? When is the Bishop Score favourable? 10. Outline the appropriate management of confirmed case of Eclampsia in full term viable pregnancy 11. Discuss management of obstetric shock due to haemorrhage in a mother who has just delivered at your labour room. A case study 12. Mrs OBGY delivered one month ago uneventfully. She opted to exclusively breast feed her baby. For 2days now she has felt unwell. She has a painful right breast. Night temp is 37.8ْ C. She has failed to nurse her baby on the breast for 5 hrs today. She decided to consult you the clinical officer. Answer the following in the spaces provided (Total 15mrks) 1. What is your focused diagnosis? 2mrks 2. What Lab investigation would you order to confirm the causative organism? 2mrks 3. State the common causative agent for her breast condition ______________________________________________________________(1mark) 4. Prescribe the appropriate management (5mrks)
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  17 5. State twocommon complications of the diagnosis? a. ______________________1mrk b ___________________1 mrk 6. What specific IEC would you tell the mother as regards breast feeding the infant taking into account the right breast is painful (3mrk). Case presentation: 6. A new mother para 1, delivered normally 10hrs ago and was discharged home uneventful with the baby. While at home resting in bed, the husband discovered she suddenly developed seizures and became unconscious. She was rushed to the hospital. Vitals were Temperature 37ْ C, Bp 130/90, Comatose. During exam she began seizuring again. Answer the following: b. What is your Primary Diagnosis?___________________________ 2marks c. What differential diagnosis would you worry about? ___________________________________________ 2marks d. What laboratory test would you order to exclude the differential diagnosis? ____________________________________________ 2marks e. What drug would you order to control the seizures immediately and by what route would you give it? Drug______________________________________ 2marks Route_____________________________________ 2marks f. What would you do about her Blood pressure? ____________________________________________________2mrks g. List two complications of the diagnosis? 1.________________________________________ 1mrk 2.________________________________________ 1mrk h. Prescribe the nursing care for this patient? List. 6mrks ____________________________________________________________