Principles 3

Question 1

Routine investigations in booking :

List 6

Answer 1

PCV
urinalysis
blood group
genotype
obstetric ultrasound
retroviral screening

Question 2

retroviral screening includes :

————,_________ and other __________ infections

Answer 2

HBAg, VDRL

TORCHS

Question 3

Routine medication:

________,___________ , vitamin A, D, B-complex,__________,__________________ for malaria as appropriate

Answer 3

hematinic ; folic acid

tetanus toxoid

intermittent preventive therapy

Question 4

Follow-up visits after booking

• Every ____ weeks until ———- weeks, every ______ weeks until ____ weeks, _______ until delivery

Answer 4

4; 28

2; 36

weekly

Question 5

Confirming fetal viability is done in which trimester ?

Answer 5

First

Question 6

Most Accurate information of
gestational age is found out from a scan done in which trimester ?

Answer 6

First

Question 7

Diagnosing multiple gestation can be done in which trimester ?

Answer 7

First

especially chronicity

Question 8

Identifying markers of chromosomal anomaly is done in which trimester ?

Answer 8

First

Question 9

Detecting any fetal structural
abnormalities or its marker is done in _______ trimester

Answer 9

Second

Question 10

Scan to know placental location is done in which trimester ?

Answer 10

Second

Question 11

Estimation of amniotic fluid volume is done in what trimester

Answer 11

Second

Question 12

Non-identical (____zygotic or ____ternal) Twins - 80% of cases

• They are ___zygotic, ____chorionic, and ___amniotic

Arises spontaneously from _____________ at ovulation __________________
- Highest incidence is among Africans especially the Yoruba ethnic group

Answer 12

Di; Fra

di; di; di

release of 2 eggs

both of which are fertilized

Question 13

Identical (_____zygotic) Twins - 20% of cases
May be _____chorionic or _____chorionic

Answer 13

Mono ; mono; di

Question 14

Identical twins

Majority of the monochorionic are _____amniotic but the dividing membrane is thin (1
layer)
Fetuses are always _______ sex

Arises from a _____________ that ____________________

Answer 14

di; same

single fertilized ovum

splits into two identical structures

Question 15

Type of monozygotic twin formed depend on ???

Answer 15

when after conception the split occurs

Question 16

Type of monozygotic twin formed

• Within 3 days:???
• Between day 4 and 8: ??
• Between day 9 and 12:???
• After day 12: ________ or _________ twin (e.g thoracophagus, craniopagus)

Answer 16

dichorionic diamniotic

monochorionic diamniotic

monochorionic monoamniotic

conjoined ; Siamese

Question 17

Complications of twin gestation: Fetal

Developmental anomaly
_____________
_____hydramnios
Intauterine growth restriction
____________ syndrome (monochorionic twin)
_______________(monoamniotic twin)
_________ second twin

Answer 17

Malpresentation

Poly; Twin-twin transfusion

Cord accident

Retained

Question 18

A retained second twin refers to the situation where the _______________ in a _______________ is _________ within __________ after the first twin’s delivery.

Answer 18

second twin

twin pregnancy

not delivered

30 minutes

Question 19

PELVIC ORGAN PROLAPSE (POP)

POP: is the ________ of the genital organs beyond _____________________
• Prevalence: 41-50% of women over the age of 40 years

Answer 19

descent

their normal anatomical confines

Question 20

Predisposing factors to POP

• Obstetric factors:

• _______________ of labor
•__________ with _________ cervix
•_____ parity with ______ birth spacing
•______ repair of perineal tear
•_________ home delivery
•___________ vaginal delivery

Answer 20

Prolonged 2nd stage

Bearing down; undilated

High; short; Poor

Unsupervised; Instrumental

Question 21

Predisposing factors to POP

• Pelvic surgery (specifically __________)
  -______________ _________
• Injury to _______ nerves: as in spina bifida, diabetic neuropathy, presacral tumour etc.
• Collagen abnormalities e.g.________ disease

Answer 21

hysterectomy

Postmenopausal ; atrophy

sacral; Marfan

Question 22

Precipitating factors of POP : any cause of increased intra-abdominal pressure

-_______
-Chronic _______
- _______
-Chronic _______
-Abdominal mass
- _______ of _______

Answer 22

Obesity
Chronic cough
Heavy lifting
Chronic constipation
Blowing of trumpet

Question 23

Classification of POP
• Anterior vaginal wall prolapse
-___________ (urethral descent)
-____________ (bladder descent)
-________________ (descent of bladder and urethra)

Answer 23

Urethrocele

Cystocele

Cystourethrocele

Question 24

Classification of POP

• Posterior vaginal wall prolapse
__________ (rectal descent)
____________ (small bowel descent)

Answer 24

Rectocele

Enterocele

Question 25

Classification of POP •_________ vaginal wall prolapse •__________ vaginal wall prolapse •__________ vaginal wall prolapse

Answer 25

Anterior Posterior Apical

Question 26

Classification of POP Apical vaginal wall prolapse •Uterovaginal (________ descent with —————- of vaginal apex) •Vault (____________ _________ of vaginal apex)

Answer 26

uterine; inversion post-hysterectomy; inversion

Question 27

Grading of Uterovaginal Prolapse First degree: the ___________ is ___________ the introitus Second degree: the ________ is _________ the introitus Third degree: the ___________ is ________ the introitus

Answer 27

external os ; not beyond cervix; beyond whole uterus ; beyond

Question 28

Third degree uterovaginal prolapse is termed ___________ and is usually accompanied by ___________ and __________

Answer 28

procidentia cystourethrocele ; rectocele

Question 29

Clinical Features of POP •Sensation of vaginal fullness or '___________' •Feeling of _____________ per vaginam •Protruded mass per vaginam which becomes more prominent on ________/_________ __________ _________ pain _________ vaginal discharge or vaginal ________ (if ulcerated; decubitus ulcer)

Answer 29

sitting on a ball something coming down straining ; coughing Dyspareunia; Low back Foul smelling; bleeding

Question 30

Conservative measures of treatment of POP • Indication: asymptomatic women, those with ______ degree prolapse - Pelvic floor muscle exercises (______ exercises) - ________________ therapy (in post-menopausal women) - __________

Answer 30

mild; kegel Estrogen replacement Pessaries

Question 31

Examples of pessaries e.g. _________________ pessaries, _________ pessaries etc.

Answer 31

silicon rubber-based ring Gellhorn

Question 32

Indications for pessary treatment - During __________ or ____________ (to facilitate involution) - Patient is ________ for surgery -__________ not complete -While awaiting surgery -Patient's ________

Answer 32

pregnancy ; puerperium not fit ; wish

Question 33

Asherman's syndrome: is ______________________ and ________________ due to ________________ and synechiae as a result of irreversible damage to the basal layer of the ___________[

Answer 33

persistent amenorrhea secondary infertility intrauterine adhesions endometrium

Question 34

Causes of Asherman’s syndrome - Overzealous __________ of the uterine cavity -_________ endometritis -__________ -Post-__________ - Following _______________

Answer 34

curettage; Tuberculous Schistosomiasis; myomectomy caesarean section

Question 35

Diagnosing Asherman’s syndrome -____________________: filling defects are seen in the areas of adhesion - Sonohysterography or hysteroscopy is the gold standard

Answer 35

Hysterosalpingography

Question 36

Treatment of Asherman’s Syndrome _____________ ____________ : this is the removal of the intrauterine adhesions under direct vision via an hysteroscope to separate the uterine wall -______________________________ : this is inserted to maintain the patency between separated uterine walls -________________________ : has been shown to reduce recurrence

Answer 36

Hysteroscopic adhesiolysis Intauterine device e.g. Lippie's loop (ideal) or copper T Combine oral contraceptive pill