Mcq on normal and abnormal labor for undergraduate

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Undergraduate course lectures in OB&GYN PREPARED BY DR Manal Behery .Faculty of medicine ,Zagazig University

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Mcq on normal and abnormal labor for undergraduate

  1. 1. A-between 37 and 42 weeks from the lastmenstrual periodB- Before 37 weeks gestationC-After 42 weeks gestationD- After 24 weeks gestationANSWER A
  2. 2.  Gravidity› #of current and completedpregnancies of any kind Parity› # of completed pregnancies ≥ 20weeks› not delivered infants (e.g. twins)
  3. 3.  Nullipara Primipara Multipara Grand Multipara
  4. 4. T = Term deliveries ≥ 37 wksP = Preterm deliveries < 37 wksA = Abortions (< 20 wks)L = Living children
  5. 5. › 3rd Pregnancy› 1 Term delivery› 0 Preterm deliveries› 1 Abortion› 1 Living child
  6. 6. › 5th Pregnancy› 2 Term deliveries› 1 Preterm delivery› 1 Abortion› 0 Living children
  7. 7. › 2nd Pregnancy› 0 Term deliveries› 2 Preterm deliveries› 0 Abortions› 3 Living children
  8. 8. A. – longitudinal axis of the fetus in relation tothe oblique axis of the maternal uterusB. longitudinal axis of the fetus in relation to thetransverse axis of the maternal uterusC. longitudinal axis of the fetus in relation to thelong axis of the maternal uterusD. longitudinal axis of the fetus in relation to thelong axis of the maternal pelvisANSWER C
  9. 9.  Logitudinal transverse oblique
  10. 10. A. Relates to right or left side of maternal pelvisB. presenting or is the closest in proximity tothe birthing canalC. Ralated to long axis of motherD. First enter the pelvic cavityE. First felt by vaginal examinationANSWER B
  11. 11.  The part of the fetus that is presenting or is theclosest in proximity to the birthing canal Vertex Breech
  12. 12. A. position is either cephalic or breechB. attitude is either flexion ,OR deflexionC. position is the relationship of a landmark onthe presenting part to the right or left side ofthe pelvisD. Position is either oblique lognitudinal ortreasverseE .Attuide is landmark on presenting part thatdetermine positionANSWER C
  13. 13. OPLOTOAROTLOPROPLOAROA•LOT: 40%•ROT: 20%•OP: 20%
  14. 14. ?????
  15. 15. Left OcciputAnterior
  16. 16. ?????
  17. 17. RightOcciputPosterior
  18. 18. ?????
  19. 19. Left OcciputTransverse
  20. 20. The relationship of the fetalpresenting part to the level of theischial spines
  21. 21. A. Passage of bloody showB. Occurance of uterine contractionC. Excessive fetal movementD. Cervical dilation and effacementE. Gush of vaginal fluidANSWER D
  22. 22.  cervical change Effacemant :is shortening of the cervical canal(from a length of 3 cm to a circular aperture.
  23. 23. › Progressive dilation and effacementof cervix› Descent of fetus› Expulsion of fetus and placenta
  24. 24. A-Occur at regular intervalsB-Intervals get gradually smallerC-Intensity increasesD-Pain felt in the back and abdomenE-Pain stop with sedationF-Cervix dilateANSWER E
  25. 25. A-Occur At Irregular IntervalsB-Intensity doesnt changeC-Pain primarily in lower abdomenD-Pain usually relieved with sedationE-Cervix dilateANSWER E
  26. 26. A-Relaxion after uterine contractionB-Intensity of uterine contraction in upper andlower segmentC-The myometrium of the upper uterine becomeshorter after contractionD- the pacemaker in the right cornu of the uterusANSWER C
  27. 27. A. 5-1-1: contractions approximately every 5minutes lasting for 1 min for 1 hourB. Sudden gush of fluid from the vagina or aconstant leakage/wetnessC. Vaginal bleeding(bloody show)D.Decrease in fetal movement(kick counts should be 10 kicksin 2 hours)E All of the aboveANSWER E
  28. 28. A. Dilation ,presention and effacmentB. Effacement ,station and positionC. Dilation ,effacment ,and stationD. Station ,dilation and descentE. Presentation ,station ,and dilationANSWER C
  29. 29.  -3: 3 cm above the ischial spines0: at the ischial spines, engaged+3: 3 cm below the ischial spines
  30. 30. A. First stage of labor ends with delivery of fetusB. Second stage of labor is divded into latent andactive phaseC. Third stage of labor lasts one hoursD.Third stage of labor begins immediatelyafter delivery of the infant and ends withplacental deliveryANSWER D
  31. 31. A. Relfied by maternal position on left sideB. Compression of fetal head mediated by vagusC. Caused by umbilical cord compressionD. Is not worrisome if non recurrentE. Is mostly due to placental insufficancyANSWER E
  32. 32. A. Variability is the result of push pull ofsympathetic and para sympatheticB. Acceleration is > 2 elevation of baslind FHRabove 25 pbm in 30 min periodC. Acceleration with absent variability isreassuring traceD. Moderate variability and lasck of acclerationis worrisomeANSWER A
  33. 33. A. 50% or more of contractionB. All of contractionC. 25% or more of contractionD. One out of tree contractionANSWER A
  34. 34.  A-engagementB-flexionC-descentD-internal rotationE-extensionF-Backword rotation ANSWER F
  35. 35. A-Gush of bloodB-Lengthening of umbilical cordC-Rebound of the uterusD-All of the aboveANSWER D
  36. 36. A-IV oxytocin afterdelivery of ant shoulder.B-Controlled cord tractionC- Suprapubic massageD-Uterine massageANSWER C
  37. 37. A- Dilation and intensity of contractionB-Dilation and effecmantC-Dilation and descentD,Frequancy of contraction and descentE- All of the aboveANSWER C
  38. 38.  Part 2: ABNORMAL LABOUR
  39. 39. A-HydroceplusB- Occipto –anteriorC-Face presenationD- Occipto –PosteriorE-Ovarian massF- Shoulder dystociaAnswer B
  40. 40.  A-1 hr if multi,2hrs if nulli ,add 1hrs ifepidural B-2 hrs if mulli,3 hrs if nulli ,add 1hrs ifepidural C-1.5 hr if multi ,2.5 hrs, add 1 hr if epiduralANSWER A
  41. 41.  32 yo G1P0 36 weeks presented withcontractions. Looks uncomfortable, and iscontracting every 3 minutes but cervix is 2 cmand 50% effaced. Was seen the previous day withsimilar complaints and findings. Diagnosis:› Prolonged latent phase Management:› “Therapeutic Rest”
  42. 42.  24 yo P1001 39 weeks presented in labor.Contracting every 3 minutes but lookscomfortable. Progressed from 4 to 6 centimetersin 6 hours. Membranes intact. Estimated fetalweight – 3000 grams. Pelvis adequate onexamination. Vertex presentation. Diagnosis:Protracted active phase likely secondary to inadequatelabor (insufficient power) Management: Amniotomy, Oxytocin augmentation +/- IUPC
  43. 43.  32 yo P0000 Class C diabetic at 40 weeksundergoing labor induction. Contracting every 2-3 minutes. 7 cm dilation x 4 hours. Confirmedadequate labor with intrauterine pressurecatheter. Membranes ruptured, Estimated fetalweight – 4200 grams. Pelvis adequate onexamination. Vertex presentation. Diagnosis:› Arrest of dilatation likely secondary to cephalopelvicdisproportion/fetal macrosomia (Passenger too big forpelvis) Management: Cesarean Delivery
  44. 44.  28 yo P0101 at 42 weeks presented in labor. Historyof previous MVA with pelvic fracture. Contractingevery 2-3 minutes. 6 cm dilation x 4 hours.Confirmed adequate labor with intrauterinepressure catheter. Membranes ruptured, Estimatedfetal weight – 3200 grams. Constricted pelvic inletwith non-engaged fetal head. Vertex presentation. Diagnosis:› Arrest of dilatation likely secondary to cephalopelvicdisproportion/abnormal pelvis (Pelvis too small for pelvis) Management: Cesarean Delivery
  45. 45.  A-Chorioamnionitis B-Uterine rupture C-Reassuring FHR trace D-Pelvic floor injuryANSWER C
  46. 46.  A- Pinard manouverto deliver leg,rotate sacrumanterior,wrap trunk in tawel,deliver arm when scapulavisible,downward pr on maxilla to deliver the head B- Pinard manouverto deliver leg,rotate sacrumanterior,wrap trunk in tawel,deliver arm when scapulavisible,downward pr on mandible to deliver the head C- Pinard manouverto deliver leg,rotate sacrumposterior,wrap trunk in tawel,deliver arm when scapulavisible,downward pr on mandible to deliver the head ANSWER B
  47. 47. A-ant hip has a more rapid decent than post hipB- ant hip is beneath the symphysis pubis andintertrochanteric diameter rotates around a 45degree axisC- if post hip is beneath the symphysis pubis it hasto go through 225 degree axis rotationD-for sacrum ant or post position, the axis ofrotation is around 45 degreesAns: C
  48. 48. A- multiparityB-placenta previaC- presenting part engagementD- CPDAns: A
  49. 49. A- This is a rare presentation above inletB-brow presentation most of the time changes to facepresentationC- decent mechanism is completely different fromvertex presentationD-delivery is possible if mentum appears beneath thesymphysis.Ans:C
  50. 50. A-induction of laborB- internal rotation to make mentum ant positionC- observation to allow spontaneous rotationD- C/SAns:C
  51. 51. A-Forceps can be appliedB-manual rotation of the head can be doneC- manual rotation of the head can’t be doneD-there is no place for observationAns:D
  52. 52. • A-Ability to touch sacral promontory with index finger•B-Significant divergence of the pelvic side wall•C-Forward inclination of a straight sacrum•D-Sharp ischial spines with a narrow interspinous• diameterE -Narrow suprapubic archANSWER B•
  53. 53.  Obstetric: shortest anteroposterior diameterof pelvis Diagonal: distance from the lower margin ofthe symphysis to the promontory of the sacrumand subtracting 1.5cm (you want diagonalconjugate to be greater than 11.5cm)
  54. 54.  -normal female type male type- inlet triangular or heart-shaped
  55. 55.  -Ape-like type-Anteroposteriordiameters long, Transverse short, Sacrum long and narrow, Subpubic angle narrow
  56. 56.  All anteroposterior diameters are short, Transverse are long, subpubic angle is wide
  57. 57. A-Prolonged latent phase: question if false labor,treat with observation and sedation if neededB-Protraction disorder of active phase: augmentwith amniotomy or oxytocinC-Arrest disorder with adequate contractions: C-sectionD- All of the aboveAnswer D
  58. 58. • A-McRoberts Maneuver:sharply flexmaternal thigh• B-Cut episiotomy if needed for more roomC. Fundal pressureD-woods screw maneuverE. Delivery of the posterior armANSWER C
  59. 59. A-rotation of post. shoulder to deliver ant.shoulderB- abduction of shouldersC- flex of mother’s knees and suprapubicpressureD- rotation and extraction of ant. shoulderAns:BWoods screw=AMcRoberts m.=CZavanelli m.= repositioning of fetal head backinto the uterus and C/S
  60. 60. A-Maternal heart disease, pulmonarycompromiseB- prolonged first stage of labor,C-maternal exhaustionD- non-reassuring fetal heart rate patternANSWER B•
  61. 61. • A-inability to definitely determine position offetal vertexB-fetus with presentation other than vertex orface with chin anteriorC-fetus not engaged or above +2 stationD-CPD: inadequate pelvis, estimated fetal weight>4000gE-membranes ruptured or cervix fully dilatedF-fetus <34 weeks for vacuum delivery• ANSWER C
  62. 62. A-1st degree: involve the forchette, perinealskin and vaginal mucous membraneB-2nd degree: the fascia and muscles of theperineal bodyC-3rd degree: involve the anal CANALD-4th degree: extends through the rectalmucosa to expose the lumen of the rectum• ANSWER C•
  63. 63. Fourth-degreeFourth-degreePerineal tearPerineal tear
  64. 64. A- immediatelyB-3 months laterC- 6 months laterD- 9 months laterAns:A
  65. 65. Which of the following is appropriate deviceA- LOW FORCEPSB-MID FORCEPSC- SOFT CUP VACCUMD- PIPER FORCEPSANSWER A
  66. 66. This patient has a bishop score ofA- 4B-5C-6D-8ANSWER B
  67. 67. The most like explanation of deccleration isA- Maternal position on left lateral sideB- Uterine hyperstimulation from cervicalripening agentC- Compression of the fetal head mediated byvagusD- Umbilical cord compressionANSWER B
  68. 68. A- prior C-section or uterine scarB- Face mento anteriorC- labor dystociaD- Breech presentation<35 WKSE- fetal distressF- persistent mento posterior• ANSWER B•
  69. 69. THANK YOU

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