OBSTETRIC AND GYNAECOLOGY BANK OF QUESTIONS | CMT NTA LEVEL 5 | DOWNLOAD

OBSTETRIC AND GYNAECOLOGY BANK OF QUESTIONS | CMT NTA LEVEL 5 | DOWNLOAD

1. Mention five characteristics  of true labour ( 5 )

i. Regular contractions

ii. Progressive stronger contractions

iii. Presence of bloody show

iv. Cervix effaced and dilated

v. Head is fixed

vi. Sedation does not stop true labour

vii. Cephalic presentation.

viii. Pain is felt in the abdomen and radiating to the back

ix. Unassisted vaginal delivery

x. End with delivery of baby and other product of conception.

 

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2. A 39-year-old woman G6P4+1L4 with GA 34 weeks came to the health centre complaining of increasing tiredness and shortness of breath for 3 months, with frequent headaches and palpitations. She had no previous gynecological problems and takes no medication. On examination the woman is slim with pale conjunctivae and palm.

a. What is the likely diagnosis? ( 2 )

         Anemia in pregnancy

 

b. Mention three complications if the above condition remains untreated (3 )

 

Answer

i. Prematurity

ii. Abortion

iii. Heart failure

iv. Post-partum hemorrhage

v. Uterine inertia

vi. Shock

vii. Failing lactation

viii. Sub involution

ix. Puerperal sepsis

3. Mention 5 common organisms that cause Genital infections in pregnancy                                                                 (5)

i. E coli

ii. Klebsiella

iii. Proteus spp

iv. Pseudomonas

v. Enterococcus faecalis

vi. Staphylococcus aureus

vii. Staphylococcus saprophyticus

 

4. What are five (5) laboratory investigations you would order to an epileptic pregnant patient presents with Loss of Consciousness( 5)

i. FULL BLOOD PICTURE

ii. RANDOM BLOOD GLUCOSE

iii. LIVER FUNCTION TESTS

iv. RENAL FUNCTION TESTS

v. BLOOD SLIDE FOR MALARIA PARASITES

vi. SERUM ELECTROLYTES

 

 

5. Samira is a 27 years old pregnant woman with GA of 35 weeks came to the hospital after having 2 episodes of convulsions, she reported that before the attacks she always experience unpleasant smell, she also reported that this condition started when she was 10 years old. Her cousin has a similar condition. On examination she has stable vital signs.

a. What is the likely diagnosis? (2 )

Answer

Ø Epilepsy

 

b. Mention two investigations that can be ordered to confirm the diagnosis? (2 )

i. Electroencephalogram

ii. Magnetic resonance imaging

                 

c) What is the drug of choice can be given to the above diagnosis (1 )

Ø Phenobarbitone

 

6. A Pregnant mother presented at the clinic at gestation age of 37 weeks, with tiredness/general body weakness, headache, dizziness blood pressure of 100/60 mmHg, haemoglobin 6.2 gm/dl and palpitations.

a. What is the likely diagnosis? (1 )

Ø Severe anemia in pregnancy

 

 

b. Mention three investigations that can be order( 3)

 

              i) Full blood picture to determine the cause and type of anemia

              ii) Blood grouping and cross matching

              iii) Serum iron concentration

              iv) Iron binding capacity

              v) Transferrin saturation

c. How are you going to treat the above patient? ( 1 )

Ø Admit the patient and transfuse the patient whole blood or packed red blood cells

 

7. A 35 year old primegravida arrives at Buguruni RCH for first antenatal visit. The gestation age is 16 weeks. Outline FIVE important investigations which are needed in this case: (5 ).

Answer

a. Hemoglobin level

b. Urine for protein

c. Malaria

d. VDRL

e. HIV screening

f. Radom blood glucose

8. Mention five (5) clinical features of obstructed labour ( 5 )

             Answer

· Delayed/ no descent of the presenting part

· Moulding

· Caput formation

· Increasing lower abdominal pain and contrations

· Abnormal fetal heart rate

· Band’s ring

· Saucer shaped abdomen, very tender

· Cessation of contractions

·  Easily palpable fetal parts per abdomen

· Per vaginal bleeding

· Shock due to internal bleeding

 

 

SECTION E: ESSAY QUESTIONS (30 )

1. 29 years old prime gravida at a gestation age of 24 weeks presents at the dispensary with history of vomiting everything, fever and muscle ache. On examination she is ill looking, febrile, lethargic, cannot sit without support and jaundiced. MRDT test is done and was positive.  Discuss the management of this patient in terms of diagnosis, differential diagnosis, investigations, treatment and complications.

Answer

Provisional diagnosis (2 )

Complicated malaria

Differential diagnosis (3 ) -  any 3 @ 1

· Septicemia

· Enteric fever

· Urinary tract infection

· Meningitis

· Dengue

 

             Investigation (4 ) -  any 4 @ 1

· Blood slide for malaria parasites- will help to see the degree of parasitemia

· Full blood picture / hemoglobin level - to check hemoglobin level, White blood cell and platelets

· Serum electrolytes such as potassium, sodium, chlorine to rule out electrolyte imbalance

· Random blood glucose to check and treat hypoglycemia

· Renal function tests such as blood urea nitrogen and serum creatinine to rule out renal failure

· Liver function tests

· Urinalysis to rule out urinarly tract infection

· Widal test to rule enteric fever

 

 

 

Treatment- 4

· Intravenous artesunate 2.4 mg/kg at 0, 12 and 24 hour then continue with tablets ALU.

· Paractetamol 500 mg 8hly to control fever.

· Continue with feeding

 

Complications – (2 )  any 2 @ 1

· Coma, convulsions

· Anemia

· Acute renal failure

· Pulmonary edema

· Disseminated intravascular coagulopathy

· Hypoglycemia

· Metabolic acidosis

 

2. Discuss mastitis based on definition, risk factors, clinical features, management and complications ( 15 )

Introduction ( 2 )

• Mastitis is the inflammation of the breast tissue. It is common in the first 3 months breast feeding. Breast becomes painful, swollen and red.

 

Risk factors- 3  ( any 3 @ 1 )

· Previous history of mastitis

· Partial blockage of milk duct

· Over supply of milk

· Infrequent feedings

· Nipple cracking or excoriation

· Rapid weaning

· Illness in mother or baby

 

          Clinical features- 4  ( any 4 @ 1 )

· Breast pain

· Swelling

· Erythematous

· Fever

· Myalgia

· Chills

· Malaise

· Axillary lymphadenopathy associated with axillary pain and swelling

 

 

 

Management -3

· Stop lactation: from the affected breast and breast is emptied manually or by an electric pump.

· When the acute phase is over breast feeding can be resumed. Support the breast: over a pad of cotton wool.

· Antibiotic therapy: A sample of milk is sent for culture and sensitivity then antibiotic started. Flucloxacillin 500 mg/6 hours is suitable for 10-14 days. If allergic to penicillin: Erythromycin tab 500mg qdsx10-14 days.

 

· Analgesics – A: Ibuprofen500mg 8 hourly for 5 days  OR  Paracetamol 500-1000mg 8 hourly for 5 days  

 

Complications- 3  (any three complications)

· Breast abscess

· Inflammatory breast cancer

· Systemic symptoms e.g. fever, myalgia

· Inability to use the affected breast in case

· Recurrence mastitis