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

1. 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.

 

2. Mary has a 24 weeks pregnancy; comes to the health facility for her regular visit. On examinations the vital sign were normal, per abdomen revealed fundal height of 28, the fetal heart rate was essentially normal.  One of the following is the most likely diagnosis

A. Missed abortion

B. Polyhydramnious

C. Oligohydramnious.

D. Intrauterine fetal death

E. Intrauterine fetal growth restriction

 

3. Ashura is having a history of Primary infertility and she is highly demanding to have a child like other women. Which of the following method can be done to help her to have children?

A. In vitro fertilization

B. Oral contraceptives

C. Bilateral tubal ligation

D. Depo-Provera injection

E. Intrauterine contraceptive device

 

4. Which of the following is clinical sign of Mild Pre Eclampsia

A. Hyperreflexia

B. Oligohydromnious

C. Respiratory distress

D. Protein in urine of 1+ or less.

E. Blood pressure of above 160/110mmHg

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5. 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.

 

6. Which of the following is indications for caesarian section:

A. Severe anaemia

B. Prolonged labour

C. Sickle cell crisis in pregnancy

D. Previous history of cervical tear

E. Past history of postpartum hemorrhage

 

7. A 50 years old woman Para 12 all children alive.  She was diagnosed to have cancer of the cervix about one year ago. Which of the following is the most likely risk factor for her to develop the condition?

A. High social economic status.

B. Sexual Transmitted Diseases

C. Cigarette smoking

D. High Parity

E. Los Parity

 

8. 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

 

9. A 28 years old lady has 4 years in her marriage without conception; she was examined several times and found to have normal reproductive organs with ovulation failure. Which of the following drug may help to induce ovulation?

A. Flupentixol

B. Metiformin

C. Clomiphen

D. 5-Fluorouracil

E. Chlomphenical

 

 

10. Which of the following is a sperm function test?

A. Testicular biopsy test

B. Prolation test

C. Hysterosalpingography test

D. Endometrial test

E. Hamster egg penetration test

 

11. Septic abortion may initiate coagulation disorder through:

A. Degranulation of mast cells leading in release of histamine

B. Activation of complement system and fibronolysis

C. Release of endotoxin leading to endotoxic shock

D. Production of fibrin degradation products

E. Activation of prostaglandins production

 

12. 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

 

13. A 23 – year-old primegravida at 38 weeks gestation in active stage of labour at 6cm cervical dilatation with ruptured membrane. On vaginal examination, the fetal nose, eyes and lips is palpated.  The fetal heat rate is 140 beats per minute.  What is the presentation?

A. Compound presentation

B. Vertex presentation

C. Brow presentation

D. Nasal presentation

E. Face presentation

 

14. 30 years old, G5P4 presents at the delivery room in active phase of labour. She had uterine rupture in the previous delivery which was successfully repaired.  The best mode of delivery will be:

A. Emergency caesarean section

B. Elective caesarean delivery

C. Spontaneous vaginal delivery

D. Assisted vaginal delivery

E. Caesarean hysterectomy

 

 

15. The appropriate management of the foetus  in mentum anterior face presentation is:

A. Forceps rotation in the second stage of labour to convert to anterior - posterior  

B. Perform an internal podalic version with breech extraction when cervix is full dilated.

C. Manual conversion of the baby to vertex in the second stage of labour.

D. Leave for spontaneous labour with vaginal delivery

E. Immediate caesarian section without labour

 

16. 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. Haemo dilution

 

17. Which of the following is the most ideal method of delivery of patient with severe abruption placenta and fetal demise?

A. Caesarean section after 5 units of cryoprecipitate

B. Caesarean section after blood replacement

C. Immediate caesarean section

D. Vacuum delivery

E. Vaginal delivery

 

18. The management of a woman with pre-eclampsia presenting with severe headache, blurred vision and epigastric pain at 32 weeks include one of the following:

A. Needs very close monitoring including fetal movements charting

B. Institute dexamethasone to hasten lung maturity before delivery

C. Should be hospitalized or have bed rest at home

D. Institute diazepam and delivery immediately

E. Should be delivered immediately

 

19. A 32-year-old gravid 3 Para 2 come to labour ward at 32 weeks gestation with complaints of sudden gush of fluid vaginally about 4 hours prior to admission.  She reports no vaginal bleeding and feels very active fetal movement.  What is the NEXT STEP in the management of this patient?

A. Perform a vaginal examination every 2 hours until delivery

B. Perform a sterile speculum examination

C. Expectant management

D. Begin antibiotics

E. Begin oxytocin

 

 

20. What kind of test can confirm the presence of amniotic fluid?

A. Keihauer – Betke test

B. Coomb’s test

C. Triple screen

D. Ferning test

E. Cough test

 

21. 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

 

22. An incompetent cervix is most frequently diagnosed by:

A. Sonography

B. Passage of Hegar’s dilator number  8 through the internal os

C. History

D. Hysterography

E. Examination under anaesthesia

 

23. Although vacuum extractor is very useful in assisting the second stage of labour, it is contraindicated in:

A. All pregnancies in this decade because of possible mother to child transmission of HIV

B. Post date pregnancy because of hardening of the fetal skull

C. Fetal distress as it may aggravate asphyxia

D. Premature pregnancy below 34 weeks

E. Pregnancy induced hypertension

 

24. 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

 

25. A 17 years old lady presents with fainting, lower abdominal pain, vomiting and slight vaginal bleeding.  Looks pale, blood pressure is 80/50 mmHg, pulse rate 110/min.  Urine for pregnancy test is positive.  The most likely diagnosis will be:

A. Dysfunctional uterine bleeding

B. Twisted ovarian cyst

C. Threatened abortion

D. Complete abortion

E. Ectopic pregnancy

 

26. 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

 

27. A 31-year-old woman comes to the physician for follow-up after an abnormal Pap test and cervical biopsy. The patient's Pap test showed a high-grade squamous intraepithelial lesion (HGSIL). This was followed by colposcopy and biopsy of the cervix. The biopsy specimen also demonstrated HGSIL. The patient was counseled to undergo a loop electrosurgical excision procedure (LEEP). Which of the following represents the potential long-term complications from this procedure? 

A.  Abscess and chronic pelvic inflammatory disease

B. Cervical incompetence and cervical stenosis 

C. Urinary incontinence and urinary retention

D. Hernia and intraperitoneal adhesions

E. Constipation and fecal incontinence

 

28. A 22 years girl came to you with a history of vaginal discharge associated with lower abdominal pain. Which investigations are you going to order?

A. Vaginal  discharge wet preparation  

B. Contrast Pelvic ultrasound

C. Hysterosalpingography

D. Stool examination

E. Urine analysis

 

29.  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

 

30. A 16-year-old nulligravid woman comes to the emergency department because of heavy vaginal bleeding. She states that she normally has heavy periods every month but missed a period last month and this period has been unusually heavy with the passage of large clots. She has no medical problems, has no history of bleeding difficulties, and takes no medications. Her temperature is 37 C, blood pressure is 110/70 mm Hg, pulse is 96/minute and respirations are 12/minute. Pelvic examination shows a moderate amount of blood in the vagina, a closed cervix, and a normal uterus and adnexae. Hematocrit is 30%. Urine hCG is negative. Which of the following is the most appropriate management? 

A. Oral contraceptive pills

B. Expectant management

C. Sub-total Hysterectomy

D. Antibiotics and anticoagulant

E. Dilatation of cervix and curettage  

 

 

 

 

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. The following factors contribute to fluids retention during pregnancy:

A. FALSE Haemoconcentration

B. TRUE Increased table salt intake

C. FALSE Increased thirst threshold level

D. TRUE Decrease in plasma oncotic pressure

E. FALSE Increased absorption of the protein he the gut

 

3. 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

 

4. 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

 

5. 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.

 

6. 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

 

7. 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

 

 

8. 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

 

9. Regarding  primary infertility:-

A. TRUE    Male infertility can be caused by cryptochidism

B. TRUE    Fertility rate decline after the age of 35 years.

C. FALSE        Hysterosalpingography is recommended after ovulation.

D. TRUE    Smoking decrease the size of testicles.

E. FALSE        Infertility occurs in 25% of couples in their reproductive lives.

 

10. Clinical features of Postpartum Blues includes

A. TRUE Rapid fluctuating mood.

B. TRUE Fatigue

C. FALSE Difficult in breathing                               

D. TRUE         Depressed mood

E. TRUE Drowsiness

 

11. 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.

 

12. 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

 

 

 

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 complications from column B  with the responsible disease condition in column A  

	COLUMN A Disease condition		COLUMN B (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.

 

 

 

2. Match the management options for disease condition from column B with the respective disease condition in column A.

 

	COLUMN A (Disease condition)		COLUMN B (management)
1.	G Threatened abortion	A.	Total abdominal hysterectomy
2.	E Incomplete abortion below 12 wks.	B.	Dilatation and curettage + Antibitotics
3.	B Missed abortion	C.	Misoprostol.
4.	C Inevitable abortion	D.	Give antibiotics only at home.
5.	F Septic abortion.	E.	Manual vacuum aspiration
		F.	Broad spectrum antibiotics
		G.	Bed rest.
		H.	Manual removal of placenta.

 

3. Match the following findings related to infertility from COLUMN A against their causes from COLUMN B

COLUMN A (Findings)			COLUMN B (Causes)
1	G	Low semen volume	A. Syphilis
2	H	Acidic semen	B. Gonorrhoea
3	D	Azoospermia	C. Human Immune Virus
4	E	Asthenospermia	D. Genital tract obstruction
5	F	Pituitary necrosis	E. Sperm structural defects
			F. Sheehan’s syndrome
			G. Ejaculation dysfunction
			H. Ejaculatory duct obstruction

 

 

 

 

 

4. Match the following clinical features from column B with their corresponding disease conditions from column A

		COLUMN A	COLUMN B
		DISEASE CONDITION	CRITERIA
1	F	Circulatory collapse	A. Impaired consciousness
2	D	Pulmonary oedema	B. Easy bleeding
3	E	Haemoglobinuria	C. Acidosis breathing
4	C	Respiratory distress	D. Congested Lung
5	A	Acute confusion state	E. Dark brown urine
			F. Low systolic Blood Pressure and fast Pulse Rate
			G. Severe palmar pallor
			H. Pyelonephritis

 

 

 

SECTION D: SHORT ANSWER QUESTIONS 40 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. Pregnant woman at GA of 30 weeks reported to your dispensary with history of polydypsia, polyphagia and polyuria.  Lab investigations revealed FBG of 12mmol/L.

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

ii. Mention four (4) maternal effects of the above illness   (4 Marks)

Answer:

i. Diagnosis: Gestation Diabetes.   (1marks)

ii. Maternal Effects: (4 point each 1 mark)

· Pregnancy induced hypertension.

· Infection

· DKA

· Diabetic neuropathy

· Diabetic gastropathy

· Cardio-renal complications/myocardial infarction,

· Diabetic nephropathy.

· Obstructed labour due to big body

2. 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

 

3. 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.

 

4. You were called to review a 35 years old pregnant woman at gestation age of 33 weeks to your dispensary with history of painless vaginal bleeding which is bright-red moderate in amount with no abdominal distension.  She has history of caesarean section of the previous pregnancy.  On examination she was pale, BP 90/50mmHg Pulse rate 110/min

 

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

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

iii. What relevant investigations will you order at hospital level?    (1 Mark)

 

Answer:

i. Most likely diagnosis : Placenta praevia   (1 Mark)

ii. Management:          (3 points each 1 point)

- Resuscitation of the mother (IV Fluid )

- Catheterization

- Hb level

- Blood grouping and cross-matching.

- Urgently refer the patient.

 

iii) Investigations: Obstetric ultrasound.    (1 Mark)

 

 

 

5. Outline five (5) differential diagnosis of pelvic inflammatory disease     (5 Marks)

 

Answer:-   (5 points each 1 mark)

- Acute appendicitis

- Diverticulitis

- Torsion of ovarian cyst

- Tubal pregnancy (Ectopic pregnancy)

- Mesenteric vein thrombosis

 

 

6. 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.

iii. Investigation: Obstetric Ultrasound  ( 1 Mark)

 

 

7. You have been called to review the full term pregnant woman (primegravida) in labour ward who was in labour for about 13 hours.  On doing pelvic assessment cervix was 9 cm dilated, with excessive moudling and caput, sacral promontory was easily reached and prominent ischial spines.

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

ii. What is the treatment at hospital level?  (1 Mark)

iii. Outline 3 maternal complications of the above diagnosis     (3 Marks)

Answer:

 

i. Diagnosis: Obstructed labour.   (1 Mark)

 

ii. Treatment: Emergency caesarian section    (1 Mark)

 

iii. Complications:  (3 points each 1 mark)

- Infection

- Obstetric fistula

- Thrombo–embolism

- Ruptured uterus

- Post partum hemorrhage

- Paralytic ileus

- Electrolyte imbalance

 

 

8. A 37 years old woman with pregnancy at 36 weeks gestation age, presented at your Health centre with a history of generalized body swelling for 1 week, headache and blurred vision for 1 day with no convulsions.  Her BP is 180/120mmHg and urinalysis revealed protein 3+.

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

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

iii. Mention one complication (1 Mark)

Answer:

i. Diagnosis: Severe Pre-eclampsia      (1 Mark)

 

ii. Management at health centre level:              (3 point each 1 mark)

- Control BP

- Prevent fits using magnesium sulphate

- Urgently refer the patient to the hospital.

 

iii. Complications:      (1 point, 1 mark)

- Intrauterine foetal death

- Foetal distress

- Intrauterine growth restriction.

 

 

1. Mention five Ante-partum foetal testing (assessment)          (2.5 Marks)

Answers:

i. Foetal movement assessment

ii. Non stress test

iii. Biophysical profile

iv. Modified biophysical profile

v. Contraction stress test

vi. Growth ultrasound

vii. Doppler studies

 

 

2. Explain three ways the combined oral contraceptive pill protects against pregnancy  

Answers:

a.  Mechanisms   (3 Marks)

i. Prevent ovulation by suppression of hypothalamic releasing factors

ii. Thicken the woman’s cervical mucus resulting in less sperm penetration

iii. Alter and thin the endometrial make the endometrial lining less receptive to implementation.

 

 

3. Mention four (4) signs of placental separation following delivery.                    (4 Marks)

Answers:

Four signs of placenta separation

· A fresh show (gush) of blood from the vagina

· Umbilical cord lengthens outside the vagina

· The fundus of the uterus rises up

· The uterus becomes firm and globular.

 

4. A 27 years old lady present to you with the history of lower abdominal pain, lower back pain, fatigued and painful sexual intercourse for one month.  On pelvic examination, cervical excitation test was positive.

a. Mention four (4) differential diagnosis                       (4 Marks)

Answer:

i. Acute appendicitis

ii. Diverticulitis

iii. Torsion of ovarian cyst

iv. Tubal pregnancy ectopic pregnancy)

v. Mesenteric vein thrombosis

 

 

5. A 38 year old pregnant woman at gestation age of 12 weeks present to hospital with the history of heavy vaginal bleeding containing clots and abdominal pain all for 2 days.  On speculum examination: Open cervix and some clots of blood coming out. Outline the  treatment plan for this patient;          (2.5 Marks)

i. Set IV line and give IV infusion preferably Normal saline/Ringer lactate

ii. Evacuation  of retained product of conception

iii. Blood transfusion if in shock

iv. Oral haematenics

v. Post abortion contraceptive.

vi. Antibiotics

 

6. Mwajuma, delivered a healthy baby with no complications four days ago present at Health centre  with foul smelling per vagina discharge, abdominal pain and fever. On examination she was very sick, febrile with body Temperature of 39⁰C, Blood Smear for malaria parasite was negative, abdomen was not distended, Rebound tenderness was positive.

 

a. What is her provisional diagnosis

Puerperal Sepsis (1 Mark)

b. Outline the treatment plan for her diagnosis.                        (3 Marks)

· IV fluids Ringer’s lactate /Normal saline

· Antibiotics e.g. Ampicillin IV, Metronidazole IV, Gentamycin I/M

· Antipyretic e.g. Paracetamol tablets,

· Monitor vital signs Blood Pressure, Pulse R Body Temperature, and Respiration rate

· Input /output chart

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 36.7^oC 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 3^rd stage of labour

· Assessment of any severe bleeding after delivery as the patient is at risk of PPH.

 

 

2. A 24 years primigravida at the gestation of 16 weeks by date, attend antenatal clinic for routine check up.  The attending nurse at the antenatal clinic told her that her fundal height was equivalent to 24/40, BP = 130/80mmHg and that she had neither palpated foetal parts nor detected the foetal heart beats.  The ordered ultrasound showed features of “snow storm” appearance.   Describe the management of this patient.

Answer: 

The most likely diagnosis

Complete hydrated form mole (2 Marks)

A complete mole arises when an empty ovum is fertilized by haploid sperm that duplicates its chromosomes or by two haploid chromosomes

Investigations: (2 Marks)

· Serum B-hCg or UPT

· FBP

· Blood grouping and cross-match

a. Treatment: (7 Marks)

· Suction curettage

· I.V. line with oxytocin

· Blood transfusion if bleeding is excessive after clinical assessment

· Laparotomy set up should be readily available as hysterectomy, hysterectomy or bilateral hypogastria artery ligation may be necessary if perforation or haemorrhage occurs.

· Rh negative patients should receive and D at the time of procedures.

b. Follow-up:  (4 Marks)

· Duration is 1 to 2 years

· Schedule visits plus measure serum hCg in the following order

· Weekly during treatment until 3 consecutively normal levels (normally after 3 weeks)

· Monthly for 3 months, then 3 monthly for 9 months.

· Then after every 6 months for one year.

· Patient should not conceive  for 2 years (contraceptive) preferable barrier method otherwise COC

 

 

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

 

 

2. A 36 years old woman comes to your dispensary complaining of fever, chills and lower abdominal pain associated with irregular menstrual bleeding. Also she reports increased menstrual cramping and vaginal discharge with abnormal colour and foul smelling and pain during sexual intercourse.  On examination generally stable with body temperature of 380C. Abdominal examination revealed tender lower abdomen and cervical excitation test positive.Write an essay based on the diagnosis, risk factors, deferential diagnosis, investigations and treatment.

Answers:

a) Pelvic inflammatory disease (PID)     (1 Mark)

b) Risk factors (5 points each 1 marks)

- Sexually active age group

- Multiple sexual partners

- Past history of PID

- Insertion of an IUCD

- Immunodeficiency

- Excessive douching.

 

c)  Differential diagnosis (3 points each 1 mark)

- Acute appendicitis

- Diverticulitis.

- Torsion of ovarian cyst

- Ectopic pregnancy.

 

d)  Investigations,  (3 points each1 mark)

- Wet preparation for microscopic examination

- Culture and sensitivity

- Laparoscopy

- Abdominal ultrasound

 

e) Treatment   (3 points each 1 mark)

- Antibiotics

o Acute PID - Broad spectrum antibiotics ,  e.g Ceftriaxone 500mgs IM

o Chronic PID – Doxyclline, Metronidazole and Amoxicillin

- Analgesics

- Treat sex partners

- Use condom during all period of treatment.