Myles chapter based MCQ(section 4)

1. The term occipito posterior position indicates that:

a. The occiput fails to rotate forwards instead the sinciput reaches the pelvic floor and
rotates forwards
b. The sinciput fails to rotate forward instead the occiput reaches the pelvic floor and
rotates forward
c. The occiput rotates forwards and the sinciput reaches the pelvic floor first
d. The sinciput rotates forward and the instead the occiput fails to reach the pelvic floor
2. In the mechanism of occipito-posterior positions during the mechanism of occipito
posterior position when the shoulders enter the pelvis in the right oblique diameter the
anterior shoulder reaches the pelvic floor first and rotates 1/8 of a circle. This movement
is known as:
a. Restitution
b. External rotation of the head
c. Internal rotation of the shoulders
d. Lateral flexion of the shoulder
3. During the mechanism of occipito-posterior position restitution is said to take place
when the occiput turns:
a. 2/8 of a circle
b. 1/8 of a circle
c. 3/8 of a circle
d. 2/3 of a circle
4. On vaginal examination when the sagittal suture is found in the transverse diameter of
the pelvis and both fontanelles are palpable in an occipito posterior position, neither the
sinciput nor the occiput leads. This denotes:
a. Long internal rotation
b. Short internal rotation
c. Deep transverse arrest
d. Shoulder dystocia
5. On vaginal examination during the second stage of labour in occipito-posterior position
the anterior fontanelle is felt:
a. In front of the symphysis pubis
b. Behind the symphysis pubis
c. In front of the sacrum
d. Behind the sacrum
6. When the head is deflexed at the onset at the onset of labour extension sometimes occurs
instead of flexion. If extension is complete then:
a. Vertex presentation results
 b. Breech presentation results
c. Shoulder presentation results
d. Face presentation results
7. The perineum may rupture in the center during labour in an occipito-posterior position,
this is known as:
a. Button hole tear
b. Labia tear
c. Anal sphincter tear
d. Uretheral tear
8. The following are complications that may occur following birth from an occipito-
posterior position EXCEPT:
a. Perineal bruising
b. Obstructed labour
c. Intracranial hemorrhage
d. Cryotorchidism
9. When the attitude of the fetal head is one of complete extension the occiput of the fetus
will be in contact with the spine and the ___________ will present:
a. Mentum
b. Brow
c. Buttocks
d. Face
10. The causes of face presentation are the following EXCEPT:
a. Anterior obliquity of the uterus
b. Contracted pelvis
c. Oligo hydraminous
d. Congenital malformations
11. There are _______ positions in face presentations
a. 3
b. 4
c. 6
d. 8
12. All BUT one of the following are positions of face presentation:
a. Right mentosuperior
b. Left mentoanterior
c. Right mentolateral
d. Left mentolateral
13. On abdominal palpation during intrapartum, the diagnosis of face presentation feels
prominent with a groove between the:
a. Neck and back
b. Chest and abdomen
c. Head and back
 d. Back and buttocks
14. To determine the position in face presentation the ____________ must be located:
a. Mentum
b. Sinciput
c. Glabella
d. Fontanelle
15. In the mechanism of face presentation, when the chin reaches pelvic floor and rotates 1/8
of a circle this in face presentation movement is termed:
a. Restitution
b. Extension
c. Internal rotation of the head
d. External rotation of the head
16. All the following are possible outcomes of labour in face presentation EXCEPT:
a. Mento-anterior positions
b. Prolonged labour
c. Mento-posterior positions
d. Mento-superior positions
17. When conducting delivery of face presentation:
a. The sinciput is held back to decrease extension until the head is born
b. The sinciput is held back to increase extension until the head is born
c. The occiput is held back to increase extension until the head is born
d. The occiput is held back to decrease extension until the head is born
18. Immediately following rupture of the membrane when conducting delivery in face
presentation a vaginal examination should be performed to exclude:
a. Meconieum stained liquor
b. Occult cord
c. Cord presentation
d. Cord prolapse
19. In mentoposterior positions, rotation and descent depend on :
a. Whether the mentum is lower than the sinciput
b. Whether the occiput is lower than the sinciput
c. Whether the vertex is lower than the sinciput
d. Whether the sinciput is lower than the mentum
20. When the face appears at the vulva during the birth of the head in face presentation,
extension must be maintained by holding back the ________________ and permitting
the ________ to escape under the symphysis pubis
a. Sinciput, occiput
b. Sinciput, mentum
c. Mentum, sinciput
d. Mentum, occiput
21. Complications of face presentation are the following EXCEPT:
 a. Obstructed labour
b. Cerebral hemorrhage
c. Extensive perineal laceration
d. Precipitate labour
22. _____________________ presentation occurs when the fetal head is partially extended
with the frontal bone, bounded by the anterior fontanelle and the orbital ridges and lies
at the pelvic brim
a. Brow
b. Face
c. Breech
d. Shoulder
23. When the fetus lies with its long axis across the long axis of the uterus
_________________ is likely to present:
a. Brow
b. Face
c. Breech
d. Shoulder
24. The presenting diameter in brow presentation is the _______________ diameter:
a. Submento vertical of 11.5cm
b. Submentobregmatic of 9.5cm
c. Mento vertical of 13.5cm
d. Occipito frontal of 11.5cm
25. All BUT one of the following are causes of shoulder presentation:
a. Hydramnios
b. Placenta abruption
c. Macerated fetus
d. Placenta previa
26. All BUT one of the following are the complications of shoulder presentation:
a. Cord prolapse
b. Prolapsed arm
c. Nuchal cord
d. Impacted shoulder
27. The lie that varies from one examination to another between longitudinal and oblique or
transverse instead of remaining longitudinal after 36 weeks of gestation is defined as:
a. Stable lie
b. Unstable lie
c. Transverse lie
d. Longitudinal lie
28. When a hand or occasionally a foot lies along the head, the presentation is said to be:
a. Hand presentation
b. Foot presentation
 c. Compound presentation
d. Face presentation
29. The following are useful techniques to help lower the operative birthrate EXCEPT:
a. One to one care in labour
b. Uprightbirthing posture or mobilization
c. Physiological management of second stage of labour
d. Active management of second stage of labour with syntocinol
30. Fetal indications for forceps delivery are the following EXCEPT:
a. Malposition of the fetal head
b. Delivery of the after coming head
c. Osteogenesis imperfecta
d. Fetal compromise
31. Maternal indications for forceps delivery are the following EXCEPT:
a. Aortic valve disease
b. Hemorrhage due to placental abruption
c. Severe hypertensive diseases
d. Shoulder dystocia
32. The following are contraindications to an instrumental vaginal birth EXCEPT:
a. When the vertex is greater or equals to 1/5th palpable abdominally
b. In gestation of greater than 36 weeks
c. Before full dilatation of the cervix
d. When the operator is inexperienced
33. The prerequisites for any vaginal birth are the following EXCEPT:
a. The fetal head must be greater than 1/5th palpable per abdomen
b. The cervix must be fully dilated
c. Adequate pelvis ascertained by clinical pelvimetry
d. Rupture of the membranes must be confirmed
34. For the procedure of a vacuum extraction, the woman’s legs should be placed into the:
a. Supine position
b. Knee chest position
c. Lithotomy position
d. Left lateral position
35. A more common inhalational analgesia used in obstetrics for epidural nerve block
during ventouse extraction is:
a. Nitrous oxide
b. Oxygen
c. Isoflorane
d. Nitrogen
36. When conducting a vacuum delivery the operating vacuum pressure should be between
_____ and __________:
a. 0.1 and 0.2 kg/cm2
 b. 0.2 and 0.4kg/cm2
c. 0.6 and 0.8 kg/cm2
d. 0.9 and 0.12 kg/cm2
37. During vacuum extraction, traction is provided along a track defined by:
a. The coccyx
b. The illio-pectineal line
c. The curve of carus
d. The symphysis pubis
38. The maximum time for application of the vacuum cup to the fetal head to birth should
ideally be:
a. Less than or equal to 15 minutes
b. Greater than or equal 15 minutes
c. Less than or equal to 5 minutes
d. Greater than or equal to 10 minutes
39. During instrumental delivery ________________ forceps are used when the leading part
of the fetal head has reached below the level of the ischial spines :
a. Low cavity
b. Mid-cavity
c. High cavity
d. Lateral cavity
40. ________________ forceps are used when the head has descended to the level of the
pelvic floor during instrumental delivery:
a. Side cavity
b. High cavity
c. Mid-cavity
d. Low cavity
41. ______ is a type of original forcep which is designed to deliver the fetal head at a station
at or above the pelvic brim.
a. Kielland’s forceps
b. Wrigley’s forceps
c. Simpson’s forceps
d. Anderson’s forceps
42. The following are maternal complications of instrumental vaginal birth EXCEPT
a. Trauma/soft tissue damage
b. Dysuria or urinary retention
c. Rupture of the uterus
d. Hemorrhage
43. The following are neonatal complications of instrumental vaginal birth EXCEPT
a. Marks and bruises on the baby’s face
b. Cepha-haematoma
c. Facial palsy
 d. Talipes
44. In order to aid clear communication between health care professionals, it is
recommended that the urgency of caesarian section should be documented using the
following standardized scheme EXCEPT
a. Immediate threat to the life of the woman or fetus
b. Delivery timed to fit the doctor and fetus
c. No maternal or fetal compromise but needs early delivery
d. Maternal or fetal compromise which is not immediately life-threatening
45. A ____ incision usually performed with the skin as subcutaneous tissues incised using a
transverse curvilinear incision at a level of two finger breadths above the symphysis
pubis is known as:
a. Bikini line incision
b. Vertical incision
c. Oblique incision
d. Upper abdominal incision
46. The preferred incision technique in caesarian section that reduces the incidence of
dehiscence of uterine scar in any subsequent pregnancy or birth is:
a. Upper uterine segment technique
b. Lower uterine segment technique
c. Oblique uterine segment technique
d. Vertical uterine segment technique
47. Women having a caesarian section should be placed on thromboprophylaxis medication
immediately because they are at the risk of:
a. Disseminated intravascular coagulation
b. Myocardial infarction
c. Venous thromboembolism
d. Intracranial hemorrhage
48. A low molecular weight anticoagulant medication used to slow down, thin and help to
dissolve blood is:
a. Motrin
b. Naproxen
c. Perindopril
d. Heparin
49. After recovery from anesthesia in caesarian section, observations should be recorded
every ______ in the immediate recovery period and thereafter every _____ for 2 hours
a. 5 minutes, 30 minutes
b. 10 minutes, 30 minutes
c. 15 minutes, 30 minutes
d. 15 minutes, 20 minutes
50. After discontinuation of treatment for women who had pain control analgesia with
opioids, routine hourly monitoring of respiratory rates, sedation and pain scores should
be recorded throughout treatment for at least:
a. 30 minutes
b. 2 hours
c. 1 hour
d. 1 1/2 hours
51. Once the woman is transferred to postnatal ward after caesarian section, the blood
pressure, temperature, respirations and pulse must be checked every:
a. 4 hours
b. 1 hour
c. 2 hours
d. 3 hours
52. Removal of the urinary bladder catheter should be carried out once the woman who had
regional anesthesia during a caesarian section is mobile, not sooner than:
a. 2 hours
b. 6 hours
c. 12 hours
d. 8 hours
53. The pudendal nerve emerges from the spine at the level of _____ to _____ vertebrae
where local anesthetic is infiltrated into the tissue around it.
a. S3-S4
b. S1-S2
c. S2-S3
d. S2-S4
54. The pudendal nerve is an area situated between ______ and _____
a. Pudendal artery and sacrospinous ligament
b. Pudendal artery and illiococcygeal nerve
c. Pudendal artery and sacrococcygeal nerve
d. Bulbocarvenosus and transverse perineal muscles
55. The two most commonly employed regional anesthetic techniques are those of epidural
and intrathecal. The epidural space is the space located within _______
a. Bony spinal canal just outside pia mater
b. Bony spinal canal just inside the pia mater.
c. Bony spinal canal just outside the dura mater
d. Bony canal just inside the dura mater
56. The _____ is a commonly used anatomical landmark for lumbar epidural injections:
a. Ileum
b. Iliac crest
c. Iliac spine
d. Obturator foramen
57. For an intrathecal anesthesia, the injections are performed:
a. Below the second thoracic vertebral body
b. Fourth thoracic vertebral body
c. Above the second lumbar vertebral body
d. Below the second vertebral body

58. The epidural space in the adult lumbar spine is only _____ to ____ millimeters deep:
a. 0.5-2
b. 3-5
c. 1-2
d. 2-4
59. The following are factors associated with the failure to achieve epidural analgesia
EXCEPT:
a. Obesity
b. Cervical dilatation of more than 7cm
c. Previous history of spinal surgery
d. Anorexia
60. The predisposing factors that may cause Mendelson’s syndrome are the following
EXCEPT:
a. The woman’s age
b. Pressure from the gravid uterus
c. Effect of progesterone relaxing smooth muscles
d. Analgesics administered during labour
61. A usual prophylactic treatment regime for women having an elective cesarean operation
is two doses of _________ approximately ________ hours apart:
a. Oral acetomorphine 150mg, 5 hours apart
b. Oral ranitidine 250 mg, 8 hours apart
c. Oral ranitidine 150mg, 8 hours apart
d. Oral acetomorphine 300mg, 5 hours apart
62. During cesarean section ______________ is a technique whereby pressure is exerted on
the cartilaginous ring below the larynx to occlude the esophagus and prevent reflux:
a. Suprapubic pressure
b. Fundal pressure
c. Laryngeal pressure
d. Cricoid pressure
63. The Situation Background Assessment and Recommendation (SBAR) tool consist of
standardized prompt questions about the condition of an individual in the following
stages EXCEPT:
a. Situation
 b. Background
c. Assessment
d. Retrieval
64. __________________ is a term used when a fetal blood vessel lies over the cervical os
in front of the presenting part
a. Vasa previa
b. Occult cord
c. Cord prolapse
d. Cord presentation
65. _________________ occurs when the umbilical cord lies in front of the presenting part
with the fetal membranes intact:
a. Vasa previa
b. Occult cord
c. Cord prolapse
d. Cord presentation
66. When the cord lies in front of the presenting part and the fetal membranes are ruptured.
This is defined as:
a. Cord prolapse
b. Vasa previa
c. Cord presentation
d. Occult cord
67. __________________ is said to occur when the cord lies alongside but not in front of
the presenting part
a. Vasa previa
b. Cord prolapse
c. Occult cord prolapse
d. Cord presentation
68. The following are causes of cord prolapse EXCEPT:
a. High head
b. Post maturity
c. Multiparity
d. Malpresentation
69. Immediately the diagnosis of cord prolapse is made, the time should be noted and the
midwife must call for urgent assistance then oxygen is administered to the woman by
face mask at:
a. 4 liters per minute
b. 2 liters per minute
c. 3 liters per minute
d. 6 liters per minute
70. The risks of cord prolapse to the fetus are hypoxia and death as a result of compression.
To relieve cord compression, the woman should adopt _____ position.
 a. Lateral position
b. Supine position
c. Knee-chest position
d. Lithotomy position
71. To further prevent compression when cord prolapse is diagnosed, the bed should be
placed in____ position
a. Orthopnic position
b. Cardiac position
c. Jack-knife position
d. Trendelenburg position
72. _____ is the position when the woman can be helped to lie on her left side with a wedge
or pillow elevating her legs to relieve pressure on the cord.
a. Exaggerated supine position
b. Exaggerated sim’s position
c. Left-lateral position
d. Exaggerated fowler position
73. A bladder technique used to relieve pressure in a diagnosed compression in cord
prolapse is the use of a self-retaining 16g Folley catheter to instill approximately _____
a. 500-700ml of sterile saline into the bladder
b. 100-200ml of sterile saline into the bladder
c. 200-300ml of sterile saline into the bladder
d. 500-1000ml of sterile saline into the bladder
74. Antenatal risk factors for shoulder dystocia are the following EXCEPT:
a. Post-term pregnancy
b. Maternal age over 35
c. Prematurity
d. Maternal obesity
75. In a case of shoulder dystocia:
a. The anterior shoulder becomes trapped behind or on the symphysis pubis
b. The anterior shoulder becomes trapped behind the hollow of the sacrum
c. The anterior shoulder becomes trapped below the sacral promontory
d. The anterior shoulder becomes trapped on the ischial spines
76. Which of the following is not a HELPERR mnemonic for shoulder dystocia?
a. Help
b. Episiotomy need assessed
c. Legs in McRobert’s position
d. Pressure fundally
77. In labour, risk factors that have been consistently linked with shoulder dystocia include
the following EXCEPT
a. Oxytocin augmentation
b. Prolonged labour
 c. Prolonged second stage
d. Precipitate labour
78. The non-invasive procedures for the management of shoulder dystocia are the following
EXCEPT
a. Symphysiotomy
b. Change in position
c. McRobert’s maneuver
d. All four’s position
79. ______ is a maneuver that requires the midwife to insert a whole hand into the vagina
and identify the fetal chest then by exerting pressure onto the posterior shoulder, rotation
is achieved.
a. Rubin maneuver
b. Wood’s maneuver
c. Zavanelli’s maneuver
d. Gaskin maneuver
80. _______ maneuver is achieved by assisting the woman onto her hands and knees when
there is shoulder dystocia.
a. Rubin maneuver
b. Wood’s maneuver
c. Zavanelli’s maneuver
d. Gaskin maneuver
81. The following are fetal outcomes following shoulder dystocia EXCEPT
a. Fetal asphyxia
b. Brachial plexus injury
c. Cryptorchidism
d. Erb’s palsy
82. Rupture of the uterus is one of the most serious complications in midwifery and
obstetric. A complete rupture of the uterus involves:
a. Tearing of the uterine wall but not the perimetrium.
b. A tear in the wall of the uterus with or without expulsion of the uterus
c. Rupture of the uterine wall but the fetal membranes remain intact
d. Involves tearing of the myometrium only with the membranes intact
83. Rupture of the uterus can be precipitated in the following circumstances EXCEPT
a. Use of oxytocin in high parity women
b. Use of prostaglandin to induce labour
c. Obstructed labour
d. Use of tocolytic agents
84. The key signs of rupture of uterus are the following EXCEPT
a. Abdominal pain
b. Normal fetal heart rate and pattern
c. Vaginal bleeding
 d. Maternal tachycardia
85. Amniotic fluid embolism occurs when…
a. Amniotic fluid enters the maternal circulation via uterus or placental site
b. Amniotic fluid enters the fetus via the maternal circulation
c. Amniotic fluid enters the uterus via the placental site
d. Amniotic fluid enters the placenta via the uterus
86. The initial phase in which the woman’s body responds to amniotic fluid embolism is:
a. Development of left ventricular failure
b. Hemorrhage and coagulation disorder
c. Pulmonary vasospasm
d. Uncontrolled hemorrhage
87. The predisposing factors to amniotic fluid embolism are the following EXCEPT
a. Artificial rupture of membrane
b. Insertion of an intrauterine catheter
c. Internal podalic version
d. Insertion of catheter into bladder
88. The key signs and symptoms of amniotic embolism are the following EXCEPT
a. Cyanosis
b. Tachycardia
c. Hypertension
d. Disseminated intravascular coagulation
89. The clinical signs and symptoms of amniotic fluid embolism include the following
EXCEPT
a. Uterine hypotonus
b. Cardiac arrest
c. Respiratory distress
d. Fetal compromise
90. The complications of amniotic fluid embolism are the following EXCEPT:
a. Severe hemorrhage
b. Hypervolemic hypertension
c. Uterine atony
d. Acute renal failure
91. Disseminated intravascular coagulation is likely to occur within _____ minutes of initial
collapse in a case of amniotic fluid embolism
a. 60
b. 40
c. 50
d. 30
92. A _____ degree of acute inversion of the uterus is said to occur when the fundus
protrudes to or beyond the introitus and is visible:
a. First degree
 b. Second degree
c. Third degree
d. Fourth degree
93. A _____ degree of acute inversion of the uterus is said to occur when the body or corpus
of the uterus is inverted to the internal os.
a. First degree
b. Second degree
c. Third degree
d. Fourth degree
94. ______ inversion of the uterus classified according to the timing of the event, occurs
after the first 24hours and within four weeks during birth.
a. Acute inversion
b. Severe inversion
c. Chronic inversion
d. Sub-acute inversion
95. The causes of acute inversion of the uterus are the following EXCEPT:
a. Use of fundal pressure
b. Primiparity
c. Long umbilical cord
d. Sudden emptying of a distended uterus
96. In order to prevent inversion of the uterus during active management of third stage of
labour:
a. Palpate uterine fundus to confirm contraction
b. Observe for gush of blood
c. Palpate uterine fundus to confirm for second twin
d. Do controlled cord traction
97. The major sign of acute inversion of the uterus is profound shock and usually
haemorrhage. The blood loss is within a range of:
a. 300-500ml
b. 800-1800ml
c. 900-1300ml
d. 300-1000ml
98. Where there is a major degree of inversion of the uterus, the uterus:
a. May be palpable abdominally
b. May be felt upon vaginal examination
c. May be seen at the vulva
d. Bleeding may or may not be present

99. The immediate management of acute inversion of the midwife is to replace the uterus
by:
a. Pushing the fundus towards the umbilicus along the direction of the vagina.
 b. Pushing the fundus with the palm of hand along the direction of the vagina
towards the anterior fornix
c. Lifting the uterus towards the umbilicus in the direction of the vagina
d. Pushing the fundus with the palm of hand along the direction of the vagina
towards the posterior fornix
100. The maneuver used in the replacement of acute inversion of the uterus is known
as:
a. Johnson’s Maneuver
b. Rubin Maneuver
c. Benson’s Maneuver
d. Jack Ryan Maneuver
101. The medical management of acute inversion of the uterus are the following
EXCEPT
a. Instillation of several liters of warm saline through a given set into the vagina
b. Surgical correction through a laparotomy
c. Surgical correction via symphysiotomy
d. Using a soft ventouse cup to seal off the introitus.
102. If replacement cannot be achieved immediately in acute uterine inversion:
a. The foot of the bed can be raised to reduce traction on the uterine ligaments and
ovaries
b. The head of the bed can be raised to reduce traction on the uterine ligaments and
ovaries
c. The woman should be placed in Fowler’s position
d. The woman should be placed in Knee-chest position
103. During basic life support, chest compression is performed _____ to _____ times
to a depth of ______
a. 90 to 100 times per minute, 5cm
b. 100 to 120 times per minute, 5cm
c. 110-120 times per minute, 7cm
d. 85-120 times per minute, 7cm
104. During resuscitation give two rescue breathes after ____ chest compressions
a. 10
b. 20
c. 30
d. 40
105. Each rescue breathe given during resuscitation should last for only:
a. 4 seconds
b. 3 seconds
c. 2 seconds
d. 1 second
106. ______ is the result of a reduction in intravascular volume such as in severe
hemorrhage during childbirth.
a. Hypovolemic shock
b. Septic shock
c. Anaphylactic shock
d. Cardiogenic shock
107. ________ occurs with a severe generalized infection
a. Cardiogenic shock
b. Anaphylactic shock
c. Septic shock
d. Hypovolemic shock
108. Impaired ability of the heart to pump blood which may be apparent following a
pulmonary embolism is known as:
a. Septic shock
b. Cardiogenic shock
c. Anaphylactic shock
d. Hypovolemic shock
109. _______ results from insult to the nervous system as in uterine inversion
a. Septic shock
b. Cardiogenic shock
c. Hypovolemic shock
d. Neurogenic shock
110. The stage of shock in which the fall in cardiac output produces a response from
the sympathetic nervous system through the activation of receptors in the aorta and
carotid arteries is known as:
a. The initial stage of shock
b. Final irreversible stage of shock
c. Compensatory stage of shock
d. Progressive stage of shock
111. ______ stage of shock leads to multi organ failure.
a. The initial stage of shock
b. Progressive stage of shock
c. Compensatory stage of shock
d. Final irreversible stage of shock
112. The combined effect of _____ and _____ hormone secreted during shock cause
vasoconstriction, increased cardiac output and a decrease in urinary output
a. Naloxone, Renin
b. Estrogen, Progesterone
c. Relaxin, Adrenaline
d. Adrenaline, Aldosterone
113. In the event of shock the body is able to compensate for loss of up to _____
percent of blood volume principally by vasoconstriction.
a. 10
b. 5
c. 20
d. 15
114. In the event of shock:
a. Levels of both carbon dioxide and arterial oxygen levels fall
b. Levels of carbon dioxide rise and arterial oxygen levels fall
c. Levels of carbon dioxide fall and arterial oxygen levels rise
d. Levels of carbon dioxide and arterial oxygen remain the same.
115. As the kidneys fail in the event of shock, urinary output _____
a. Falls to less than 20mls per hour
b. Rises to more than 20mls per hour
c. Rises to more than 25mls per hour
d. Rises to more than 30mls per hour
116. Increased permeability causes edema in the lungs which exacerbates the existing
problem of diffusion of ______ during shock.
a. Carbon dioxide
b. Blood
c. Surfactant
d. Oxygen
117. Metabolism of waste products does not occur in the event of shock leading to the
buildup of ____ and ____ in the blood.
a. Histidine, Pepsin
b. Lysine, Ammonia
c. Lactic acid, Ammonia
d. Pepsin, Lactic acid
118. Crystalloid solutions given in cases of shock are:
a. Normal saline, Ringer’s lactate, Glucose
b. Normal saline, Albumin, Ringer’s lactate
c. Fresh frozen plasma, Albumin , Glucose
d. Ringer’s lactate, Normal saline, Fresh frozen plasma
119. ______is a reliable objective tool for measuring coma.
a. Mankoski scale
b. Glasgow coma scale
c. Wong-Baker scale
d. Visual analog scale
120. All BUT one of the following are key points for managing hypovolemic shock
a. Call for help
b. Identify source of bleeding and control temporarily if able
 c. Gain venous access using two wide bore-cannulae
d. Rapidly infuse anti-emetic to correct loss
121. Normal central venous pressure values within _____ range in pregnancy indicates
that the vascular space is well filled:
a. +5 and +10 cmH2O
b. +2 and +4cmH2O
c. +6 and +8 cmH2O
d. +3 and +6 cmH2O
122. The main points of entry for an infection associated with pregnancy and child
birth are:
a. Breast and placenta
b. Breast and uterus
c. Placental site and perennial wounds
d. Nasal site and perennial wounds
123. What does the acronym MEOWS stand for in obstetrics?
a. Modified Evaluative Obstetric Warning Score
b. Modified Early Obstetric Warning Score
c. Modified Evaluative Obstetric Women’s Score
d. Modified Experimental Obstetric Warning Score
124. The recommended post-natal care pathway is divided into three “time bands”
which cover the post-natal period. These are:
a. The first 6 hours after birth, the first 3-7 days, the period from day 8 to around 6-8
weeks
b. The first 1 hour after birth, the first 2-7 days, the period from day 8 to around 6-8
weeks
c. The first 24 hours after birth, the first 2-7 days, the period from day 8 to around 6-
8 weeks.
d. The first 6 hours after birth, the first 4-10 days, the period from day 8 to around 6-
8 weeks

125. Post-natal care observations to record vital signs will need to be taken during
the______
a. First 1 hour after birth
b. First 2 hours
c. First 4 hours
d. First 6 hours
126. During the post-natal period, it is usual for the blood pressure to return to the
normal range within ____ after birth.
a. 24 hours
b. 6 weeks
c. 72 hours
 d. 48 hours
127. A common problem for most mothers regardless of whether they have chosen to
breastfeed or formula-feed on post-natal day 3 and 4 is:
a. Mastitis
b. Cracked nipples
c. Breast engorgement
d. Blocked nipples
128. Oxytocin which acts upon the uterine muscle and assists separation of the
placenta after birth is secreted from the:
a. Pineal gland
b. Anterior lobe of pituitary gland
c. Hypothalamus
d. Posterior lobe of pituitary gland
129. The overall reduction in the size of the uterus after birth occurs through a process
of :
a. Coagulation
b. Autolysis
c. Hemolysis
d. Zymolysis
130. Partial coverage of what remains of the inner surface of the uterine lining apart
from the placental site regenerates within______ after birth.
a. 7-10 days
b. 2-4 days
c. 6-11 days
d. 3-10 days
131. On abdominal palpation soon after placental expulsion, the fundus of the uterus
should be located:
a. Laterally slightly above the symphysis pubis
b. Anteriorly slightly below the fundus
c. Centrally slightly below the umbilicus
d. Inferiorly slightly below the symphysis pubis
132. All BUT one of the following are processes of involution
a. Ischaemia
b. Autolysis
c. Phagocytosis
d. Haemorrhage
133. The cramping type of pains caused by involuntary contractions two to three days
after child birth are more commonly associated with:
a. Multiparity and breastfeeding
b. Primiparity and breastfeeding
c. Nulliparity and breastfeeding
 d. Paraparous and breastfeeding
134. The lochia consists of the following EXCEPT
a. Lanugo
b. Vernix
c. Blood
d. Placenta
135. The following are measures to alleviate perennial pain and discomforts EXCEPT
a. Oral analgesia
b. Localized heating
c. Bathing
d. Application of voltarol suppositories
136. The following are standard of conduct for the midwife’s record keeping
EXCEPT
a. Keep clear and accurate records
b. Complete records at your convenience
c. Do not tamper with original records
d. Ensure all records are kept securely
137. Secondary post-partum hemorrhage is where there is excessive or prolonged
vaginal loss from:
a. 6 hours after birth and for up to 10 weeks post-partum
b. 12 hours after birth and for up to 8 weeks post-partum
c. 12 hours after birth and for up to 6 weeks post-partum
d. 48 hours after birth and for up to 6 weeks post-partum
138. The volume of blood loss in primary post-partum hemorrhage is:
a. Less than 200mls
b. Less than 300mls
c. 400 mls
d. Greater than 500mls
139. After childbirth, if there is no evidence of vaginal hemorrhage and there is a weak
and rapid pulse rate with the woman in a state of shock, this may indicate the formation
of a:
a. Haematoma
b. Hemangioma
c. Meningioma
d. Melanoma
140. On abdominal palpation of the uterus after child birth when the uterus is found to
be deviated to one side. This might be as a result of:
a. Bruised bladder
b. Full bladder
c. Empty bladder
d. Contracted bladder
141. Sub involution of the uterus is said to occur where the uterus:
a. Increases in size, feels thin on palpation and is less well contracted
b. Contracts progressively, well contracted and firm
c. Fails to follow the expected progressive reduction in size, feels “boggy” on
palpation and is less well contracted.
d. Fails to follow the progressive increase in size, dry on palpation and is less well
contracted.
142. The bacteria responsible for the majority of puerperal infection arrives from the:
a. Streptococcal and Staphylococcal species.
b. Salmonella and Clostridium welchii species
c. Streptococcal and Salmonella species
d. Escherichia coli and Staphylococcal species.
143. For women who have undergone an operative birth, abdominal palpation to assess
uterine involution can be undertaken after _____ has elapsed after surgery.
a. 12 hours
b. 24 hours
c. 48 hours
d. 3 or 4 days
144. Which of these nutrients aids wound healing by contributing energy for leucocyte,
macrophage and fibroblast function?
a. Fats
b. Carbohydrates
c. Proteins
d. Vitamin C
145. The nutrient that reduces tissue damage from free radical formation in its
contribution to wound healing is:
a. Vitamin A
b. Vitamin B
c. Vitamin E
d. Vitamin C
146. The mineral zinc contributes to wound healing by:
a. Increasing cell proliferation, epitheliazation and collagen strength
b. Collagen synthesis and leucocyte formation
c. Oxygen delivery and reduction of tissue damage
d. Neutrophil function and macrophage migration
147. Factors that are associated with poor healing of perennial wound include all BUT
one of the following
a. Poor housing
b. Increased stress
c. Poor diet
d. Parity
148. To aid healing and reduce infection for woman who has undergone caesarian
section it is now usual for the wound dressing to be removed after the:
a. First 6 hours
b. First 12 hours
c. First 24 hours
d. First 48 hours
149. Which of the following is not a feature of deep venous thrombosis
a. Unilateral edema of the ankle
b. Stiffness/Pain of the ankle
c. Positive Homan’s sign
d. Negative Homan’s sign
150. The following group of women have more risk of developing complications
linked to blood clot:
a. Women who are anorexic
b. Women who had epidural anesthesia
c. Women who are anemic
d. Women who had prolonged labour
151. During pregnancy, many women experience pain of discomfort from backache as
a result of:
a. Diastasis of the lamboid suture
b. Diastasis of the abdominal muscles
c. Diastasis of the muscles of the gluteal muscles
d. Diastasis of the pectoral muscles
152. Which of these is not a continence problem that women who have sustained
pelvic floor damage during birth may suffer from:
a. Cystocele
b. Rectocele
c. Vaginal prolapse
d. Mycele
153. After birth it is estimated that about 3-10% of women will suffer from faecal
incontinence, this is associated with the following EXCEPT
a. Primiparity
b. Instrumental birth
c. Multiparity
d. Severe perennial injury
154. In order to alleviate constipation during post-natal period:
a. A diet that includes soft fiber, increased fluids and the use of non-irritant
prophylactic aperients can be prescribed.
b. A diet that includes soft fiber, decreased fluids and the use of irritant prophylactic
aperients can be proscribed.
 c. A diet that includes hard fiber, increased fluids and the use of irritant prophylactic
aperients can be proscribed.
d. A diet that includes soft fiber, decreased fluids and the use of non-irritant
prophylactic aperients can be proscribed.
155. A predisposing risk factor for anemia in post-natal period is _____ during
pregnancy:
a. Tocopherol deficiency
b. Iron deficiency
c. Vitamin B12 deficiency
d. Impaired Red blood cells production
156. The hemoglobin level of less than 7g/dl during the post-partum period of a
woman is rated as:
a. Normal anemia
b. Mild anemia
c. Moderate anemia
d. Severe anemia
157. During the post-natal period, oral iron is given where the level of the woman’s
haemoglobin is _____
a. Less than 11g/dL
b. More than 11g/dL
c. Less than 12g/dL
d. More than 12g/dL
158. A term used to refer to the fear of giving birth is:
a. Trypanophobia
b. Latrophobia
c. Tocophobia
d. Aichmophobia
159. The frequency, strength and duration of uterine contractions can be affected by
fear and anxiety which increases the level of:
a. Estrogen
b. Adrenaline
c. Progestrone
d. Adolstrone
160. Provision of adequate information to the woman during the period of pueperium
will serve to:
a. Diminish woman’s anxiety level, enable women to maintain control over decision
making and facilitate choice.
b. Increase emotional distress, impede choice and control decision
c. Enable husbands to maintain control over decision making, facilitate choice,
increase women’s anxiety
 d. Promote women’s anxiety level, impedes choice and enable women to maintain
control over decision making.
161. Normal emotional changes during pregnancy in the first trimester are:
a. Pleasure, stress, anxiety about antenatal screening and diagnostic test
b. Pleasure, disappointment, excitement, increased femininity
c. Anxiety , sleep disturbances/nightmares, Loss or increased libido
d. Increased feelings of detachment from work commitment, anxiety about labour
pain.
162. The pueperium is when the woman is readjusting physiologically, socially and
psychologically to motherhood. This period is from:
a. Birth to 10-15 weeks post-partum
b. Birth to 8-10 weeks post-partum
c. Birth to 2-6 weeks post-partum
d. Birth to 6-8 weeks post-partum
163. After childbirth, the woman’s mood appears to be a barometer. She may start to
regain a sense of proportion and normality between:
a. 6 and 12 weeks
b. 1 and 2 weeks
c. 2 and 4 weeks
d. 3 and 4 weeks
164. The post-natal blues is a transitory state experienced by women. The onset
typically occurs between:
a. Day 1 and 2 post-partum
b. Day 6 and 7 post-partum
c. Day 3 and 5 post-partum
d. Day 8 and 9 post-partum
165. Which of these phenomena is an obstetric condition where women fear they or
their baby are in danger of dying:
a. Puerperal blues
b. Obstetric Post-traumatic stress disorder
c. Puerperal depression
d. Obstetric psychosis
166. Mild to moderate perinatal psychiatric disorders are:
a. Neurotic disorders, schizophrenia, psychotic disorders
b. Bipolar illness, depression, schizophrenia
c. Schizophrenia, post-traumatic stress disorder, psychotic disorder
d. Phobic anxiety state, panic disorder, obsessive compulsive disorder
167. People who have persistent severe problems throughout their adult life in dealing
with stress and strains of normal life are said to be suffering from:
a. Personality disorders
b. Learning disability
 c. Personal adjustment reactions
d. Psychotic disorder
168. All BUT one of the following are risk factors that predispose a pregnant woman
to perinatal mental illnesses:
a. Previous fertility problems
b. Previous obstetric loss
c. Social and relationship problems
d. Dietary choices
169. Which of these is the most severe form of post-partum affective disorder
a. Puerperal blues
b. Puerperal psychosis
c. Post-natal depression
d. Post-traumatic stress disorder
170. The most important causative factors for puerperal psychosis:
a. Biological factors
b. Chemical factors
c. Physical factors
d. Social factors
171. Puerperal psychosis is an early onset condition that commonly develops suddenly
between:
a. Day 5 and day 8 of birth
b. Day 1 and day 3 of birth
c. Day 3 and day 7 of birth
d. Day 7 and day 10 of birth
172. All BUT one of following are earlier signs of puerperal psychosis:
a. Hallucinations
b. Purposeless activity
c. Uncharacteristic behavior
d. Irritation and fleeting anger
173. In spite of its severity, majority of the women who suffer from puerperal
psychosis completely recover over:
a. 12-33 months
b. 3-6 months
c. 12-24 months
d. 1-2 months
174. The measurement scale that was developed to identify women who may have
postpartum depression is:
a. Edison’s post-natal depression scale
b. Enrique’s post-natal depression scale
c. Edinburg post-natal depression scale
d. Ellison’s post-natal depression scale
175. The term postnatal depression should only be used for a non-psychotic depressive
illness of mild to moderate severity which arises within:
a. 1-3 months of birth
b. 4-5 months of birth
c. 4-6 months of birth
d. 6-9months of birth
176. The following are risk factors for developing puerperal post-natal depression
EXCEPT
a. Family history
b. Traumatic birth
c. Spontaneous vaginal delivery
d. Still birth
177. Which these terms best describes the inability to feel pleasure in
normally pleasurable activities in post-natal depression.
a. Perionychia
b. Agraphia
c. Macrognathia
d. Anhedonia
178. Which of following is NOT a symptom of severe depressive illness?
a. Broken sleep and early wakening
b. Increased appetite and weight gain
c. Extreme tiredness and lack of vitality
d. Impaired concentration and slowing of mental functioning
179. In mental health, the acronym OCD denotes:
a. Obstetric-Compulsive disorder
b. Operational-Compulsive disorder
c. Obsessive-Compulsive disorder
d. Organized-Compulsive disorder
180. The mother-infant relationship in most women who suffer from severe post-natal
depressive illnesses include all BUT of the following:
a. Maintain high standards of physical care for their infants
b. Find smiling and talking to their babies difficult
c. Feel a deep sense of guilt and incompetence
d. Show hostility and excessive aggressive behavior towards infants
181. The commonest mental condition following childbirth affecting up to 10% of all
women post-partum is:
a. Mild post-natal depressive illness
b. Severe post-natal depressive illness
c. Puerperal psychosis
d. Puerperal blues
182. The three(3) components to the management of perinatal psychiatric disorders are
the following EXCEPT
a. Psychological treatment
b. Physiological treatment
c. Pharmacological treatment
d. Social intervention
183. The most important aspect of preventive management of perinatal mental
illnesses are all BUT one of the following:
a. Promote early identification
b. Close surveillance
c. Daily visit by perinatal psychiatric nurse and midwife for the first 2 weeks.
d. Contact and support in the late weeks
184. In a woman who has a previous history of bipolar illness or puerperal psychosis,
consideration should be given to starting medication:
a. Day 4 postnatally
b. Day 6 postnatally
c. Day 1 postnatally
d. Day 3 postnatally
185. The Group of drugs used to treat the manic component of bipolar illnesses and
long-term to prevent relapses of the condition are known as:
a. Mood stabilizers
b. Antipsychotics
c. Anticonvulsants
d. Antidepressants
186. In a breast-feeding woman, the excretion of tricyclic antidepressants in breast
milk is:
a. High
b. Very low
c. Moderate
d. Very high
187. In the newly breast-fed new-born baby whose mother is on antidepressants,
adverse effects can be minimized by dividing the dose:
a. Five times daily
b. Four times daily
c. Thrice daily
d. Twice daily
188. The exposure of the baby to psychotropic medication in breast milk will depend
on the following EXCEPT:
a. Volume of milk
b. Frequency of feeding
c. Weight and age
 d. Composition of the breast milk
189. A midwifery definition of pain is:
a. A complex, personal, subjective multifactorial phenomenon.
b. A simple, personal, subjective multifactorial phenomenon.
c. A complex, personal, objective multifactorial phenomenon.
d. A complex, impersonal, objective multifactorial phenomenon.
190. Pain is influenced by which of the following:
a. Biological, Psychological, Socio-cultural and economic factors
b. Biological, Physiological, Socio-cultural and economic factors
c. Biological, Psychological, environmental and economic factors
d. Biological, Religious, Socio-cultural and economic factors
191. Which of the following is NOT a factor that affects the intensity and amount of
pain experienced by women in labour:
a. Tolerance of pain
b. Maternal age
c. Coping mechanism
d. Cultural characteristics

192. Studies agree that mobility and position during improves both the woman’s
experience and outcome of labour. Which one of these is NOT an advantage in the
mobility and positioning during labour.
a. More effective uterine active action
b. Shorter labour
c. Less oxytocin augmentation
d. Increase need for pharmacological analgesia
193. In cases of acute pain, pain sensations are transmitted along:
a. A-delta fiber
b. B-delta fiber
c. A-alpha fiber
d. B-alpha fiber
194. ‘Somatic sensation’ refers to the sensory function of the:
a. Tongue and skin
b. Ears and body walls
c. Skin and body walls
d. Eyes and skin
195. The receptors whose stimulation gives rise to pain are known as:
a. Mechanoreceptors
b. Nociceptors
c. Thermoreceptors
 d. Ruffini corpuscles
196. Pain from an internal organ such as the uterus may be felt in the back or in the
labia. This sort of pain is commonly called:
a. Inferred pain
b. Deferred pain
c. Referred pain
d. Severed pain
197. The most widely used and accepted theory of pain is:
a. The Gate-control theory
b. The Specificity theory
c. The Intensity theory
d. The Pattern theory
198. Pain of labour is associated with an increased respiratory rate. This may cause:
a. An increase in the PaCO2 level
b. A decrease in the PaCO2 level
c. An increase in the PaO2 level
d. A decrease in the PaO2 level

199. The non-pharmacological methods of pain control are:

a. Homeopathy, hydrotherapy and music therapy
b. Homeopathy, hydrotherapy and chemotherapy
c. Radio therapy, homeopathy and transcutaneous electrical nerve stimulation
d. Aromatherapy, diversional therapy, radio therapy
200. Which of the following is NOT a contraindication to regional analgesia?
a. Local or systemic sepsis
b. Lack of sufficient trained midwives
c. Patient refusal
d. Patient consent
201. Which of this is NOT a disadvantage of epidural analgesia?
a. Ineffective blocks
b. More frequent monitoring of vital signs
c. Effective pain relief
d. Lengthens first stage of labour
ANSWER KEY (206 AND ABOVE) 15. C
16. D
1. A 17. B
2. C 18. D
3. B 19. A
4. C 20. B
5. B 21. D
6. D 22. A
7. A 23. D
8. D 24. C
9. D 25. B
10. C 26. C
11. C 27. B
12. A 28. C
13. C 29. C
14. A 30. C
31. D 72. B
32. B 73. A
33. A 74. C
34. C 75. A
35. A 76. C
36. C 77. D
37. C 78. A
38. A 79. B
39. B 80. D
40. D 81. C
41. A 82. B
42. C 83. D
43. D 84. B
44. B 85. A
45. A 86. C
46. B 87. D
47. C 88. C
48. D 89. A
49. C 90. B
50. B 91. D
51. A 92. C
52. C 93. B
53. D 94. D
54. A 95. C
55. C 96. A
56. B 97. B
57. D 98. A
58. B 99. D
59. D 100. A
60. A 101. C
61. C 102. A
62. D 103. B
63. D 104. C
64. A 105. D
65. D 106. A
66. A 107. C
67. C 108. B
68. B 109. D
69. A 110. C
70. C 111. B
71. D 112. D
113. A 154. A
114. B 155. B
115. A 156. D
116. D 157. A
117. C 158. C
118. A 159. B
119. B 160. A
120. D 161. B
121. A 162. D
122. C 163. A
123. B 164. C
124. C 165. B
125. D 166. D
126. A 167. A
127. C 168. D
128. D 169. B
129. B 170. A
130. A 171. C
131. C 172. A
132. C 173. B
133. A 174. C
134. D 175. A
135. B 176. C
136. B 177. D
137. C 178. B
138. D 179. C
139. A 180. D
140. B 181. A
141. C 182. B
142. A 183. D
143. D 184. C
144. B 185. A
145. C 186. B
146. A 187. C
147. D 188. D
148. C 189. A
149. D 190. A
150. A 191. B
151. B 192. D
152. D 193. A
153. C 194. C
195. B
196. C
197. A
198. B
199. A
200. D
201. C