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Test 1: Antenatal care

  1. An extra-uterine pregnancy is suggested by:
    • A uterus that is larger than expected for the duration of pregnancy.
    • Morning sickness and breast tenderness.
    • Lower abdominal pain and vaginal bleeding.
    • The absence of fetal movements.
  2. A woman should book for antenatal care:
    • Before she falls pregnant.
    • When she has missed her second menstrual period.
    • When she first feels fetal movements.
    • When she is 28 weeks pregnant.
  3. When a patient has had a Caesarean section:
    • The type of uterine incision is of no importance.
    • Only those patients who had a vertical lower segment incision may be allowed to labour normally.
    • Only those patients who had a transverse lower segment incision may be allowed to labour normally.
    • Only those patients who had a transverse lower segment incision for a non-recurring indication may be allowed to labour normally.
  4. Which of the following risk factors from a patient’s past obstetric history carries the highest risk in a subsequent pregnancy?
    • A previous Caesarean section.
    • An infant weighing more than 4000 g at birth.
    • A previous perinatal death.
    • A previous ectopic pregnancy.
  5. A woman books for antenatal care at 12 weeks gestation. Which of the following in her present obstetric history would worry you most?
    • Flu-like symptoms associated with a rash.
    • Nausea and vomiting in the mornings.
    • Heartburn and constipation.
    • Slight ankle oedema.
  6. The last normal menstrual period may be used to calculate the duration of pregnancy:
    • If that was the last menstrual period while the patient was on her last packet of oral contraceptive pills.
    • If the patient has a regular cycle and she was not on contraceptives.
    • If the last menstrual period had started earlier and had been shorter than the patient would have expected.
    • Patient information about their last menstrual period is always wrong.
  7. A cervical smear for cytology must be done during the first antenatal visit as part of the gynaecological examination:
    • In all women.
    • Only if the cervix appears abnormal.
    • In all women 30 years or more who have not had a previous smear which was reported as normal.
    • Only if there is a symptomatic vaginal discharge (e.g. itchy or burning).
  8. The abdominal examination is a useful assessment of the duration of pregnancy:
    • From 8 to 12 weeks.
    • From 10 to 16 weeks.
    • From 13 to 17 weeks.
    • From 18 to 24 weeks.
  9. If a patient is 10 weeks pregnant:
    • The fundus will be palpable 2 cm above the pelvic symphysis.
    • The fundus is not palpable abdominally and it is, therefore, not possible to determine whether the dates correlate with the size of the uterus.
    • It would be better to ask her to return in 6 weeks time for booking.
    • The uterine size may be determined by doing a bimanual vaginal examination with fair accuracy.
  10. The best method of assessing the duration of pregnancy by physical examination at 18 or more weeks is:
    • The symphysis-fundus measurement.
    • Bimanual palpation of the uterus on vaginal examination.
    • Palpation of the abdomen.
    • To establish the lie of the fetus and assess the size of the fetal head.
  11. If the uterine fundus is just below the umbilicus (20 weeks) and the patient is 18 weeks pregnant by dates:
    • The dates must be considered correct and used to determine the duration of pregnancy.
    • The fundal height must be considered correct and used to determine the duration of pregnancy.
    • An ultrasound examination must be requested and the result used to determine the duration of pregnancy.
    • The average duration of 19 weeks must be accepted as the correct duration of pregnancy.
  12. A uterus that is smaller than expected may be due to:
    • A breech presentation.
    • An intra-uterine death.
    • Polyhydramnios.
    • None of the above.
  13. Antenatal ultrasound examination is an accurate method of determining the duration of pregnancy up to:
    • 28 weeks.
    • 24 weeks.
    • 20 weeks.
    • 16 weeks.
  14. During the antenatal period ultrasonography must be done between 18 and 22 weeks:
    • On very obese patients where determination of the duration of pregnancy is difficult.
    • On patients needing elective delivery, e.g. those with 2 previous Caesarean sections.
    • On patients with a history of severe pre-eclampsia before 34 weeks gestation.
    • In all of the above patients.
  15. Which of the following results indicate active syphilis?
    • A negative RPR.
    • A positive RPR plus a negative TPHA.
    • A positive RPR plus a positive TPHA.
    • A CIN III lesion on cervical cytology smear.
  16. A positive VDRL indicates the presence of syphilis if:
    • The titre is 1:4 or more.
    • The titre is 1:8 or more.
    • The titre is 1:16 or more.
    • Any titre is present.
  17. Syphilis in pregnancy should be treated with:
    • Nitrofurantoin (Macrodantin).
    • Benzathine penicillin (Bicillin LA or Penilente LA).
    • Tetracycline.
    • Ampicillin.
  18. Blood should be taken to determine the presence of anti-D antibodies at 26, 32 and 38 weeks in:
    • All Rh-negative patients with an anti-D titre of 1:8 or more.
    • All Rh-negative patients.
    • All Rh-positive patients.
    • All pregnant patients.
  19. How often should a woman at low risk, who lives near a clinic, visit the antenatal clinic between 28 and 34 weeks?
    • Weekly.
    • Every 2 weeks.
    • Once a month.
    • No visit is required between these dates.
  20. The visit at 34 weeks is important because:
    • The fetus now becomes viable and the patient must monitor the fetal movements.
    • A vaginal examination must be done on patients who are at risk of preterm labour to determine whether there are cervical changes.
    • The lie and presentation of the fetus are now important and have to be carefully determined.
    • A repeat ultrasound examination must now be done on patients who had ultrasonography at 18 and 22 weeks.