Self-assessment: Questions

Chapter 1

1.
What is the most appropriate description of the arterial supply of the pelvis?
- A.
  The external iliac artery arises at the level of the lumbosacral articulation and passes over the pelvic brim
- B.
  The anterior division provides the superior, middle and inferior vesical arteries that provide the blood supply for the bladder
- C.
  The uterine artery initially runs downward in the subperitoneal fat under the superior attachment of the broad ligament
- D.
  The uterine artery crosses the ureter approximately 0.5 cm from the lateral fornix of the vagina
- E.
  The ovarian arteries descend behind the peritoneum on the surface of the corresponding obturator internus muscle until they reach the brim of the pelvis
2.
The vagina:
- A.
  Is closely related anteriorly to the trigone of the bladder and the urethra
- B.
  Has the rectum as its only direct relation posteriorly
- C.
  Is composed of striated muscle
- D.
  Has a pH in the sexually mature non-pregnant female of 2.0–3.0
- E.
  Is lined by glandular epithelium
3.
In regard to the uterus and its supporting structures, which of the following statements is true?
- A.
  Posteriorly, the uterosacral ligaments and their peritoneal covering form the lateral boundaries of the rectouterine pouch (of Douglas)
- B.
  Laterally, the broad ligaments form an important supporting structure for the uterus
- C.
  In about 50% of women, the uterus lies in a position of retroversion in the pouch of Douglas
- D.
  In labour, the isthmus (lower segment) of the uterus plays a significant role in expulsion of the fetus
- E.
  The anterior ligaments and uterovesical folds play an important role in maintaining anteversion of the uterus.
4.
The ovary:
- A.
  Lies in close relation to the internal iliac vessels
- B.
  Derives its blood supply from the ovarian artery, which arises from the internal iliac artery
- C.
  Is covered by ciliated columnar epithelium
- D.
  Is supported laterally by the suspensory ligament, which lies in close relation to the ureter
- E.
  Contains Graafian follicles, which are found only in the central medulla of the organ
5.
With regard to the uterus, which one of the following is correct?
- A.
  Lymphatic drainage from the lower part of the uterus passes to the superficial inguinal and adjacent superficial femoral nodes
- B.
  Uterine pain is mediated through sympathetic afferent nerves passing up to T11–T12 and L1–L2
- C.
  The uterine artery lies beneath the ureter at the point where the ureter enters the bladder
- D.
  The blood supply of the uterus is derived entirely from the uterine artery
- E.
  The isthmus (lower segment) of the uterus is partly innervated by the pudendal nerve

Chapter 2

1.
What is the most appropriate statement relating to spermatozoa?
- A.
  The tail contains a coiled helix of mitochondria that provides the ‘powerhouse’ for sperm motility
- B.
  During their passage through the Fallopian tubes, the sperm undergo the final stage in maturation (capacitation), which enables a more efficient transport along the last section of tube
- C.
  Seminal plasma has a high concentration of galactose, which is the major source of energy for the spermatozoa
- D.
  The sperm head fuses with the oocyte plasma membrane, and the sperm head and midpiece are engulfed into the oocyte by phagocytosis
- E.
  Sperm migration is at a rate of 6 mm/min, nearly all due to sperm motility
2.
Which one of the following best describes normal follicular growth occurring in a 25-year-old woman?
- A.
  About 100 ovarian follicles show obvious follicular growth in each menstrual cycle
- B.
  In most women one follicle is selected to become the dominant follicle on about day 5–6 of that cycle
- C.
  The dominant follicle grows by about 1 cm per day from days 6 to 14 of the cycle
- D.
  The follicle ruptures when it reaches about 4 cm in diameter
- E.
  A separate but adjacent follicle becomes the corpus luteum
3.
Which one of the following statements about meiosis is correct?
- A.
  Meiosis is the mechanism of production of the 7 million germ cells found in the ovary at 6 months of fetal life
- B.
  The first meiotic division is completed prior to birth of the baby
- C.
  The second meiotic division commences at the time of attachment of the sperm to the oocyte
- D.
  Rearrangements of the genes within the chromosomes occur after the male zygote chromosomes have entered the nucleus and combine with those of the female zygote
- E.
  The delay between the end of the first meiotic division and the commencement of the second meiotic division is the cause of the increased chromosome abnormality rate seen in women who conceive after the age of 37 years
4.
Which one of the following statements about the process of fertilization in the human female is correct?
- A.
  It usually occurs within the outer end of the Fallopian tube
- B.
  The female gamete determines the sex of a resulting fetus
- C.
  A twin pregnancy is due to failure of the normal inhibitory process, where further sperm are prevented from entering the oocyte following attachment of the first sperm to the zona pellucida
- D.
  Fertilization can occur up to 6 days after ovulation
- E.
  Sperm capacitation occurs within the seminiferous epithelium of the testis
5.
Which one of the following facts about implantation is correct?
- A.
  Implantation usually occurs about 2 days after fertilization
- B.
  At the time of implantation the embryo is usually at the eight-cell stage
- C.
  Human chorionic gonadotropin (hCG) is produced by the implanting embryo soon after implantation has commenced
- D.
  If the endometrial appearance at the time of implantation is proliferative, the pregnancy is lost as a spontaneous miscarriage
- E.
  If implantation occurs, the period is always delayed, and a urinary pregnancy test performed 2–3 days after the day the period was expected will be positive

Chapter 3

1.
What is the most appropriate statement regarding immunology in pregnancy?
- A.
  The villous trophoblast never expresses human leucocyte antigen (HLA) class I or class II molecules
- B.
  The extra-villous trophoblast never expresses HLA class I or class II molecules
- C.
  The main type of decidual lymphocytes are the uterine plasma cells
- D.
  The Th1:Th2 cytokine ratio shifts towards Th1 in pregnancy
- E.
  The thymus shows some reversible involution during pregnancy, apparently caused by the oestrogen-driven exodus of lymphocytes from the thymic cortex
2.
Regarding the rise in cardiac output, which one of the following is correct?
- A.
  It occurs in late pregnancy
- B.
  It is entirely driven by a rise in stroke volume
- C.
  It is associated with a rise in afterload
- D.
  It can precipitate heart failure in women with heart disease
- E.
  It causes an increase in pulmonary arterial pressure
3.
Considering respiratory function in pregnancy, which one of the following statements is correct?
- A.
  Progesterone sensitizes the adrenal medulla to CO ₂
- B.
  Maternal P _a O ₂ rises by ≈15%
- C.
  There is no increase in maternal 2,3-DPG
- D.
  Maternal oxygen-carrying capacity rises by ≈18%
- E.
  There is an 80% increase in minute ventilation
4.
Considering renal function in pregnancy, which one of the following statements is correct?
- A.
  Most increase in renal size occurs in late pregnancy
- B.
  The ureters are floppy and toneless
- C.
  The rise in glomerular filtration rate (GFR) activates the renin–angiotensin system
- D.
  About 1800 mmol sodium is retained during pregnancy
- E.
  Urinary tract infections are less common in pregnancy
5.
In relation to endocrine function in pregnancy, which one of the following statements is correct?
- A.
  Insulin resistance develops
- B.
  Glycosuria is not common
- C.
  The thyroid involutes
- D.
  The gut absorbs more calcium but less is lost in the urine
- E.
  The increased skin pigmentation is caused by thyroid-stimulating hormone

Chapter 4

1.
In early placental development, which one of the following is correct?
- A.
  The outer cytotrophoblast invades the endometrial cells and the myometrium
- B.
  Decidual cells do not support the invading trophoblasts
- C.
  With the placental invasion, large lacunae are formed and are filled with fetal blood
- D.
  Chorion frondosum forms the placenta
- E.
  Chorion laevae forms the placenta
2.
Which one of the following is correct regarding the umbilical cord?
- A.
  It has two veins and one artery
- B.
  The arterial blood has more oxygen
- C.
  One artery and one vein are compatible with fetal growth and a live baby
- D.
  Cord artery has a systolic pressure of 120 mmHg
- E.
  The vessels are surrounded by a hydrophobic mucopolysaccharide called Wharton’s jelly
3.
Which one of the following is correct regarding placental transfer?
- A.
  Transfer of placental gases is by simple diffusion
- B.
  Transfer of glucose is by simple diffusion
- C.
  In active transport the concentration of the substrate transported in fetal blood is lower than on the maternal blood
- D.
  Low-molecular-weight substrates are transported by pinocytosis
- E.
  Amino acids are transferred by facilitated diffusion
4.
Placental function includes all of the following except:
- A.
  Gaseous exchange
- B.
  Fetal nutrition
- C.
  Removal of waste products
- D.
  Endocrine function
- E.
  A barrier for infections
5.
Regarding amniotic fluid, which one of the following is correct?
- A.
  Polyhydramnios is associated with fetal anomaly
- B.
  On average amniotic fluid volume at 38 weeks’ gestation is 500–600 mL
- C.
  The only complication of long-standing severe oligohydramnios is postural deformities
- D.
  Most cases of intrauterine growth restriction have normal liquor volume
- E.
  Amnio-infusion is a standard procedure for variable decelerations observed on the cardiotocography

Chapter 5

1.
Which one of the following statements is true of perinatal mortality?
- A.
  Perinatal mortality is an indication of the wealth of the nation
- B.
  Perinatal mortality rate describes the number of stillbirths and early neonatal deaths per 105 total births
- C.
  It is an important indication of maternal health and the standard of maternal and neonatal care
- D.
  The World Health Organization has set targets of perinatal mortality for each country
- E.
  The World Bank gives financial incentives to countries that have the best perinatal mortality rates
2.
Which one of the following statements is true of stillbirth?
- A.
  Stillbirths are the number of stillbirths per 105 total births.
- B.
  Using the Wigglesworth Classification, around 30% are classified as of unknown antecedent
- C.
  The most common cause of stillbirth is intrapartum stillbirth
- D.
  The region with the highest stillbirth rate in the world is in the Caribbean
- E.
  Using modern classifications, the most common cause of stillbirth is fetal growth restriction
3.
Which one of the following statements is true of neonatal deaths?
- A.
  Low birth weight is a well-known direct cause
- B.
  In low-resource countries, tetanus remains one of the most important causes of neonatal deaths
- C.
  The neonatal death rates related to prematurity in developing countries have shown a significant fall
- D.
  In the UK (CMACE) extreme prematurity accounts for nearly half of the neonatal deaths
- E.
  The best investment to improve the neonatal death rates is to build more neonatal intensive care units
4.
Which one of the following statements most accurately describes maternal deaths?
- A.
  Direct maternal deaths arise from complications or their management, which are unique to pregnancy, occurring during the antenatal, intrapartum or postpartum periods
- B.
  Coincidental causes occur when two or more causes are noted to cause a mother’s death
- C.
  The maternal mortality rate in the UK is defined as the number of direct and indirect deaths per 100,000 live births
- D.
  Maternal mortality rates reflect the state of antenatal care of a country
- E.
  They can be reduced by increasing the number of doctors and midwives
5.
Which one of these statements is true of maternal mortality?
- A.
  Group B streptococcus is a major cause of maternal mortality
- B.
  Cardiac disease is the leading cause of direct deaths in the UK
- C.
  Group A streptococcus sepsis is easily recognized and treated
- D.
  Group A streptococcus sepsis was the leading cause of maternal deaths in the UK between 2006 and 2008
- E.
  Venous thromboembolism is now a rare cause of death

Chapter 6

1.
What is the most appropriate description of recognized physiological changes in pregnancy?
- A.
  Breast lumps are a physiological variant in pregnancy
- B.
  A reddish-brownish pigmentation over the cheeks should prompt the investigation of possible concomitant lupus (systemic lupus erythematosus [SLE])
- C.
  A reduction in Hb concentration is principally due to reduced red cell production
- D.
  The pelvic shape becomes more gynaecoid under the influence of hormonal change in pregnancy
- E.
  The pelvic inlet is bounded posteriorly by the sacral promontory and anteriorly by the superior pubic rami and upper margin of the pubic symphysis
2.
In eliciting an obstetric history, which of the following is correct?
- A.
  Previous obstetric history is relatively unimportant, as management decisions are made on how the current pregnancy has progressed
- B.
  The first date of the last menstrual period (LMP) is a reliable indicator of the expected date of delivery (EDD)
- C.
  The pre-ovulatory period is fairly constant, whereas the post-ovulatory period shows a wide variation in a typical menstrual cycle
- D.
  Ultrasound scan in the third trimester accurately determines the gestational age
- E.
  Hormonal contraception may be associated with a delay in ovulation in the first cycle after discontinuation
3.
Regarding symptoms of pregnancy, which one of following statements is most appropriate?
- A.
  Nausea and vomiting commonly occur 10 weeks after missing the first period
- B.
  Hyperemesis gravidarum is characterized by excessive vomiting in the third trimester
- C.
  Increased frequency of micturition tends to worsen after the first 12 weeks of pregnancy as the uterus rises above the symphysis pubis
- D.
  Plasma osmolality gradually increases with advancing gestation
- E.
  There is an increased diuretic response after water loading when the woman is sitting in the upright position
4.
During pregnancy, which of the following statements is correct?
- A.
  Blood pressure is recorded with the patient lying flat on her back to get the most accurate reading
- B.
  Blood pressure should be recorded on different positions during each antenatal visit, alternating the blood pressure cuff on different arms
- C.
  If inferior vena cava compression is not recognized for a prolonged period, fetal compromise may occur secondary to a reduction in uteroplacental circulation
- D.
  Diastolic pressure should be taken with the fourth Korotkoff’s sound (i.e. fading of the sound)
- E.
  Benign ‘flow murmurs’ due to the hypodynamic circulation are common and are of no significance
5.
In pelvic examination during pregnancy, which of the following is correct?
- A.
  Routine pelvic examination to confirm pregnancy and gestation at booking should be performed, even in settings where an ultrasound scan is freely available
- B.
  Digital vaginal examination is contraindicated in later pregnancy in cases of antepartum haemorrhage until placenta praevia can be excluded
- C.
  Routine antenatal radiological pelvimetry has been shown to be of value in predicting outcome of labour in primigravid women
- D.
  In a normal female or gynaecoid pelvis, because the sacrum is evenly curved, maximum space for the fetal head is provided at the pelvic outlet
- E.
  The diameter of the pelvic inlet is usually longer in the anteroposterior (AP) diameter than the transverse diameter

Chapter 7

1.
Antenatal screening for infection is designed to provide the best outcome for the mother and the fetus/newborn. Which one of the following investigations is not recommended as part of routine antenatal care?
- A.
  Hepatitis B
- B.
  Cytomegalovirus
- C.
  Syphilis
- D.
  Rubella
- E.
  HIV
2.
What is the most appropriate statement regarding group B streptococcus?
- A.
  It is a Gram-negative bacteria
- B.
  It is not a commensal organism
- C.
  It is associated with an increased risk of pre-term birth
- D.
  Screening is routine in the antenatal period in all countries
- E.
  If group B streptococcus is found in urine culture, there is no need to treat subsequently in labour
3.
There is an increased risk of gestational diabetes in all of the following except:
- A.
  Previous macrosomic baby weighing >4.5 kg
- B.
  Maternal body mass index (BMI) >35
- C.
  First-degree relatives with diabetes mellitus
- D.
  Gestational diabetes in previous pregnancy
- E.
  Maternal age <20
4.
Extra folic acid supplementation is recommended in all of the following except:
- A.
  Previous child with neural tube defects
- B.
  Women on anti-epileptic medication
- C.
  Women with diabetes mellitus
- D.
  Maternal obesity with a body mass index (BMI) >35
- E.
  Mothers who had a previous Down’s syndrome baby
5.
Which one of the following is the most appropriate advice in pregnancy?
- A.
  Mothers are encouraged to reduce exercise and rest routinely
- B.
  Anti-D Ig is routinely administered after complete spontaneous miscarriage at 8 weeks’ gestation
- C.
  Moderate alcohol consumption is not harmful in pregnancy and is reasonable
- D.
  Smoking is harmful to the fetus and should be stopped promptly
- E.
  Paracetamol is proven to be a safe drug in pregnancy

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