Anatomy & Physiology.

The Sacrum consists of:

a) Five fused vertebrae
b) Four fused vertiebrae
c) Three fused vertebrae
d) None of the above

The pelvis with a heart shaped brim is called:-

a) gynaecoid
b) android
c) anthropoid
d) platypelloid

The three (3) parts of the innominate bone meet in the:

Acetabulum
Ilium
Ischium
Pubis

The measurement between the sacral promontory to a point 1.25cm down on the
posterior border of the symphysis pubis is known as:
a) Anatomical conjugate
b) Diagonal conjugate
c) Obstetric conjugate
d) True conjugate

The anterior posterior diameter of the birth canal is one of the important
measurements of the pelvis and is known as the:
Diagonal conjugate
Transverse conjugate
Conjugate vera
Transverse diameter

The ischial spines are one of the most important landmarks of the female pelvis
because ;
All diameters are measured from there
Determine the adequacy of the pelvic outlet
Determine the adequacy of the pelvic inlet
Are not felt during vaginal examination

In the normal female pelvis the smallest diameter of the pelvic outlet is :
Bituberous
Bispinous
Antero-posterior
Oblique

Which part of the pelvis divides the greater and lesser sciatic notches lying 2.5cm
above the ischio-tuberositis :
Acetabulum
 Ischial spine
Pubic bone
Sacrum

The breasts are stabilized by the:

Suspensory ligaments
Pectoralis major muscle
Superficil fascia
Axillary tail

Each breast lies on one side of the sternum and extends from the level of the:-
a) 1st to 5th rib
b) 2nd to 6th rib
c) 3rd to 7th rib
d) 4th to 8th rib

Colostrum does not appear in pregnancy until after the:

a) 12th week
b) 16th week
c) 18th week
d) 20th week

The hormone responsible for the production of milk is:

a) progesterone
b) prolactin
c) oxytocin
d) oestrogen

The lining of the uterus is formed by:

a) Circular layer
b) Fibrous tissue
c) Squamous epithelium
d) Columnar epithelium ?cuboidal

The lower half of the uterus is lined with:- ?

a) muscle coat
b) connective tissue
c) transitional epithelium
d) stratified epithelium

The following ligaments support the uterus except:

a) Transverse cervical ligaments
b) Broad ligament
c) Utero sacral ligament
d) Pubo cervical ligament

The blood supply to the vulva is by the:-

a) middle rectal artery
b) gluteal artery
c) superior vesico artery
 d) pudendal artery

The functional unit of the ovary after puberty is the:

a) Luteal cell
b) Corpus luteum
c) Graafian follicle
d) Primordial follicle

The primordial follicles contained in the cortex of each ovary of the female child are
approximately:
a) 50,000
b) 100,000
c) 200,000
d) 300,000

Each woman has an individual menstrual cycle, the average cycle is taken to be:
a) 14 days
b) 21 days
c) 28 days
d) 30 days

Once a sperm enters the female reproductive tract, it is capable of fertilizing the ovum
for:
a) only less than an hour
b) hours to a day
c) more than a week
d) one month

During the process of gametogenesis, the male and female sex cells divide and then
contain:
a diploid number of chromosomes in the nuclei
a haploid number of chromosomes in the nuclei
Twenty two pairs of autosomes in their nuclei
Forty six pairs of chromosomes in their nuclei

Another term for pregnancy is:-

a) conception
b) gestation
c) fertilization
d) parturition

The different type of immunological tests carried out to confirm pregnancy is based
on the amount of:-
a) estriol excreted in the urine
b) progesterone excreted in urine
c) HCG excreted in urine
d) Relaxin excreted in urine

Human chorionic gonadotrophin is found in the:

a) Urine during pregnancy
 b) Blood at all times
c) Urine only at night
d) Menstrual flow

All are positive signs of pregnancy EXCEPT:

a) Feeling of fetal parts
b) Positive gravidex test
c) Fetal heart sound heard on auscultation
d) Ultrasound confirmation

Which one of the following is a probable sign of pregnancy?

Amenorrhea
Breast changes
Insomnia
Growth of the uterus

Oestrogens cause:
a) Secretory endometrial changes .
b) Hypertrophy of the uterus
c) Relaxation of smooth muscle
d) Secretion of breast milk

In pregnancy the muscle fibres of the uterus increase in size by a process of:
Hypertrophy
Hypertrophy and hyperplasia
Hyperplasia and autolysis
Aplasia

The uterus rises out of the pelvis and becomes an abdominal organ at about the:
a) 5th week of pregnancy
b) 8th week of pregnancy
c) 10th week of pregnancy
d) 12th week of pregnancy

The marked reduction in the size of the uterus after delivery is most rapid during the:
first week
second week
third week
fourth week

Involution of the uterus is caused by the phenomenon of:

prostaglandin
oxytocin
hormones
autolysis

At the completion of labour the uterus weighs approximately

a) 1000gms
b) 1500gms
c) 500gms
 d) 60gms

The developing cells are called a foetus from the:

a) End of the second week of life
b) Implantation of the fertilized ovum
c) Time the fetal heart is heard
d) Eigth week to the time of birth.

As the embryo develops the heart develops from:

a) Endoderm
b) Ectoderm
c) Yolk sac
d) Mesoderm

During embryonic development the stage following the zygote is:

a) Trophoblast
b) Morula
c) Blastocyst
d) Fetus

Progesterone is secreted in relatively large quantities by which of the following

structures?
a) Corpus luteum
b) Adrenal cortex
c) Endometrium
d) Pituitary gland

The main function of progesterone is to:-

a) establish secondary male sex characteristics
b) rupture follicles for ovulation to occur
c) develop female reproductive organs
d) prepare the uterus to receive a fertilized ovum

The anterior pituitary gland produces:

a) Follicle Stimulating hormone and Leutinising hormones
b) Follicle Stimulating releasing hormone and leutinising releasing hormone.
c) Oestrogen
d) Progesterone

The outer most membrane that helps form the placenta is the:
a) Amnion
b) Yolk sac
c) Chorion
d) Allantois

The normal uterine contractions originate from:

a) Cornua
b) Fundus
c) Isthmus
 d) Cervix

Growth is most rapid during which phase of prenatal development:-

a) Implantation
b) First Trimester
c) Second trimester
d) Cardiac arrhythmias

The elongated diameter in brow presentation is:

a) Occipito-frontal
b) Meto-vertical
c) Sub-mentobregmatic
d) Sub-occipitobregmatic

In brow presentation the diameter which attempts to engage is the :-

a) submento vertical
b) submento bregmatic
c) suboccipito bregmatic
d) mento vertical

Face presentation:-
a) has an engaging diameter of 10.2cm
b) never delivers vaginally
c) may occur following an occipito posterior position
d) has the sinciput as a demonimator

In moulding of the fetal skull in a well flexed head the elongating diameter is the:-
a) submento bregmatic
b) mento-ver tical
c) suboccipito bregmatic
d) occipito frontal

A fold of dura mater which divides the cerebellum is:

a) Hypothalalmus
b) Tenortium cerebelli
c) Falx cerebri
d) Basal ganglia

In vertex presentation. The fetal head usually enters the pelvic inlet so that the
anteroposterior diameter of the head occupies which plane of the pelvic inlet?
a) Longitudinal
b) Right oblique
c) Transverse
d) Left oblique

The pelvic brim inclines at an angle of approximately:

a) 70°
b) 65°
c) 60°
d) 55°
Prominent ischial spines and a narrow sub-pubic arch are associated with a:
a) gynaecoid pelvis
b) anthropoid pelvis
c) android pelvis
d) platypelloid pelvis

In the fetal skull the lambdoidal suture lies between the two:
a) frontal and two parietal bones
b) frontal bones
c) parietal bones
d) parietal and occipito bones

The brow is the area between the :

a) orbital ridges and coronal sutures
b) anterior and posterior fontenelle
c) two parietal eminences
d) posterior fontanelle and foramen magnum

The superficial muscles of the pelvic floor comprises of:

a) ischiocavernosus, membranous sphincter, transverse pernei
b) ischio cavernosus, iliococcygeus, membranous sphincter.
c) Iliocavernosus, iliococcygeus, transverse perinei
d) Ischiococcygeus, bulbocavernosus, external sphincter.

The condition in which the fundal dominance is lost and the contractions start and last
longer in the lower uterine segment is known as:-
a) colicky uterus
b) hypertonic uterine action
c) reversed polarity
d) tonic contractions

One of the following is not true about the physiology of the second stage of labour.
a) contractions become stronger and more frequent
b) the presenting part reaches the brim
c) the mother feels the urge to push
d) the secondary powers come into play

Which of the following is conclusive sign of the second stage of labour?

a) spontaneous rupture of membranes
b) sweating and shivering
c) full dilatation of the cervix
d) show

One of the following is NOT a physiological change in the first stage of labour:-
a) effacement of cervix
b) dilatation of the os
c) contraction and retraction of the uterus
d) blood pressure may fall significantly
An increase in vaginal secretions during pregnancy known as leuchorrhoea is caused
by increased:
a) metabolic rate
b) functioning of the Batholin gland
c) production of oestrogen
d) supply of sodium chloride to the cells of the vagina

Heartburn during pregnancy is a symptom thought to result from:

a) Excessive secretion of hydrochloric acid by the gastric glands in response to
increase in appetite
b) Tendancy of acid contents of the compressed and upwards displaced
stomach to reflux into the lower oesophagus.
c) Friction of the parietal pericardium against the diaphragm elevated by the
enlarging uterus
d) Gastritis due to hyperacidity and hyperperistalsis provoked by emotional stress
of impending motherhood.

Physiological anaemia in pregnancy occurs as a result of:

a) Poor dietary standard
b) Poor sanitation
c) A drop in blood pressure
d) Haemodilution

The physiological increase in blood volume produces:

a) Increased haemoglobin level
b) Reduction in platelet count
c) Reduction in leucocyte count
d) Increase in cardiac output

The time of ovulation can be determined by taking the basal temperature. During
ovulation the basal temperature:
Drops markedly
Drops slightly and then rises
Drops markedly and remains low
Rises suddenly and then falls

The perineum lies between the vagina and the rectum. This structure has:
a) a single strong elastic muscle
b) a strong elastic tendon
c) a tendon to which muscles are attached
d) two strong muscles, the anal and the transverse perineal

A patient with small breasts in her first pregnancy is worried about the ability to feed
her baby. The nurse could correspond correctly to the patient by telling her that:
a) she probably would be unable to feed her baby
b) the size of the breast does not influence the amount of lactation
c) mothers with small breasts usually have less difficulty feeding their babies
d) the baby would be better fed by means of formula

The time sequence of changes that occur at puberty in the female is:
 a) appearance of axillary and pubic hair, breast development and menarche
b) menarche, breast development and appearance of axillary and pubic hair.
c) Breast development, menarche and appearance of axillary and pubic hair.
d) Breast development, appearance of axillary and pubic hair and menarche

Which ovarian hormones are produced by the graafian follicle and the cells of the
corpus luteum?
a) progesterone and gonadotrophin
b) oestrogen and progesterone
c) gonadotrophin and follicle stimulating hormone
d) follicle stimulating hormone and oestrogen

Normally the uterus is:

a) attached anteriorly to the bladder wall
b) suspended and freely movable in the pelvic cavity
c) suspended between the bladder and the rectum
d) attached posteriorly to the anterior wall of the sacrum

Which of the following describes the normal position of the uterus?

Prependicular and antiflexed
Antiverted and retroverted
Antiverted and antiflexed
Retroverted and retroflexed

The post ovulatory increase in body temperature is brought about by:

a) gonadotrophins
b) oestrogen
c) progesterone
d) gonadotrophin releasing hormone

The shape of the cervical os in a nullipara is:

a) round
b) transverse
c) oblong
d) truncated

Cervical mucus is NOT receptive to spermatozoa when it is:

a) clear, abundant and acellular
b) turbid and thick
c) under the influence of oestrogen
d) in the pre-ovulatory phase

Which of the following is true about the letdown reflex?

it occurs unilaterally
it is under voluntary control
it is usually felt by the mother as a tingling or drawing sensation in the nipple
it is not affected by external stimuli

The external male reproductive organs include:

Testes and scrotum
 Penis ductus deferens and urethra
Scrotum and penis
Prostate gland and semens

The internal organs of the female reproductive organs include:

a) mons pubis, vagina and clitoris
b) vagina, uterus and fallopian tubes
c) cervix, labia minora and clitoris
d) corpus luteum and vestibule

The chorion is:

also referred to as the yolk sac
the finger like projection that develops from the outermost embryonic membrane
the innermost embryonic membrane
the outermost embryonic membrane

Monozygotic twins:
a) are 3-4 times as common as binovular twins
b) develop from a single ovum
c) develop from more than one ovum
d) are also referred to as fraternal twins

The cerebral membranes and blood vessels of the fetal skull include the following
EXCEPT:
a) Falx
b) Tentorium
c) Straight sinus
d) periosteum

The great vein of Galen is made up of many blood vessels from the brain. It joins or
runs into :
a) Straight sinus
b) Interior longitundinal sinus
c) Confluens
d) Lateral sinus

The placenta is made up of lobes known as:

a) parietal
b) cotyledons
c) alveoli
d) chorionic villi

Anteriorly the bladder is related to the:

a) pelvic floor muscles
b) utero-vesicular pouch
c) symphysis pubis
d) cervix

The bones of the fetal skull are formed from:

a) membrane
 b) bone
c) cartilage
d) fibrous tissue

The average increase in weight of the uterus in pregnancy is:

a) 300-400gms
b) 500-600gms
c) 700-800gms
d) 900-1000gms

The lowest readings of systolic and diastolic blood pressure during pregnancy occurs
in the:
a) 16th-24th week
b) 14th-16th week
c) 12th–14th week
d) 10th-12th week

The inner lining of a non-pregnant uterus is called:

myometrium
parametrium
endometrium
decidua

The fetal skull is divided into three regions:

vault, face and sinciput
base, occiput and sinciput
occiput, face and base
vault, base and face

Haemodilution in pregnancy is caused by:

a) an increase in red blood cells
b) a decrease in red blood cells
c) vasodilation
d) increased plasma and RBC

To assist involution there is continuing secretion of:

a) oxytocin
b) progesterone
c) oestrogen
d) aldosterone

Anteriorly the relation of the uterus is the utero-vesicular pouch and:

a) bladder
b) rectum
c) ureters
d) symphysis pubis

The ovary is attached to the back of the broad ligament by the:

mesovarian
inguinal ligament
 round ligament
ovarian ligament

The bladder is a musclular distensible organ which acts as a reservoir for urine. It’’s
capacity is:
a) 500mls
b) 450mls
c) 250mls
d) 750mls

The lower uterine segment develops from:

a) isthmus
b) vagina
c) fundus
d) vestibule

The vagina is lined by:

a) transitional epithelium
b) columnar epithelium
c) ciliated epithelium
d) squamous epithelium

The true conjugate measures:

a) 12cm
b) 11cm
c) 10cm
d) 13cm

The angle of the pelvic brim when a person is standing upright measures:
a) 30 degress
b) 45 degrees
c) 60 degrees
d) 50 degrees

Which of the following pelvis’ had no wings (alae) of the sacrum?

a) Justo-minor
b) Naegle pelvis
c) Platypelloid pelvis
d) Robert’s pelvis

The fibrous band which runs from the apex of the bladder up to the anterior
abdominal wall to the umbilicus is:
a) Merciers bar
b) Muscles of Bell
c) Urachus
d) Visceral pelvic fascia

Occipto frontal diameter of the fetal skull measures:

a) 9.5cm
b) 12cm
 c) 10cm
d) 11.5cm

Protective factors are present in breast milk as well as in colostrums EXCEPT:

a) Protective immunoglobulins
b) Lactoferin
c) Lysomes
d) Lactic acid

The lining of the fallopian tubes has folds called:

a) Rugae
b) Plicae
c) Arbor vitae
d) Mesovarium

What is the denominator?

a) the part of the fetus which lies at the pelvic brim
b) The part of the presentation which determines the fetal position
c) The relationship between the denominator to the six areas of the pelvic brim
d) When the occiput points to the sacrum and the sagittal suture is in the antero-
posterior diameter of the pelvis

The base of the trigone of the urinary bladder rests on:

a) Upper half of the anterior vaginal wall
b) Upper part of the uterus
c) Lower part of the rectum
d) Lower part of the vagina

During pregnancy proliferation of the alveoli in the breast is caused by:

a) Oestrogen
b) Progesterone
c) Prolactin
d) Oxytocin
Labour.
The first step in processing delivery instruments is:-
a) cleaning
b) decontamination
c) high level disinfection
d) sterilization

The ischial spines are designated as an important landmark in labour and delivery
because the distance between the spines is:
a) A measurement to the floor of the pelvis
b) A measurement to the inlet of the birth canal
c) The widest measurement of the pelvis
d) The narrowest diameter of the pelvis.

Successful sedation in labour will depend on one of the following:

a) Mother’s condition
b) Parity of Mother
c) Degree of pain
d) Degree of cervical dilatation
(? Which of these)

In normal circumstances the third stage of labour should last for:

a) 20 minutes
b) 30 minutes
c) 40 minutes
d) 60 minutes

As you inspect the placenta, vessels which run off into the membranes indicate:
a) Retained membranes
b) Retained succenturiate lobe
c) Placenta accrete
d) Placenta circumvalata

When ergometrine 0.5mg is given with the delivery of the anterior shoulder, the
placenta must be delivered within 10 minutes in order to:
a) Control post-partum haemorrhage
b) Prevent severe pain
c) Prevent retention of placenta due to closure of the cervical os.
d) Prevent excessive contractions of the uterus in the third stage of labour.

The following is true about active management of the third stage of labour EXCEPT:-
a) reduces blood loss
b) lengthens the third stage of labour
c) shortens the third stage of labout
d) minimises the time at which a woman is at risk of haemorrhage

The immediate priority of a midwife soon after delivery of placenta and membranes is
to:-
a) inspect the genital tract for lacerations
b) give the baby to the mother for early bonding
c) examine the placenta for completeness
d) check that the uterus is well contracted

In labour frequent emptying of the bladder is encouraged to:

a) help the woman pass urine
b) Know whether the woman can pass urine
c) Prevent delay in labour
d) Prevent perineal tear

The most acceptable type of episiotomy to be performed by the midwife is the:

a) Median
b) Lateral
c) Bilateral
d) Medio-lateral

During delivery, an episiotomy if necessary, is most commonly done to:-

a) prevent lacerations and tearing at birth
b) limit postpartum discomfort
c) stretch the perimeum
d) reduce trauma to the fetus

The duration of labour is calculated from the time:

a) Membranes rupture
b) Backache is severe
c) Show is passed
d) Regular contractions begin

Duration of labour is calculated from the time:

a ‘show’ is passed
regular uterine contractions are reported by the woman
Regular uterine contractions are monitored by the woman
Membranes rupture

The onset of the second stage of labour can positively be confirmed when:
a) The mother vomits
b) The mother feels uterine contractions
c) No cervix is felt on vaginal examination
d) The presenting part is visible in the vagina

Physiological ring which occurs between the upper and lower segment in labour is
called:
a) Retraction ring
b) Bandl’s ring
c) Contraction ring
d) Membranous ring

The most active part of the uterus during labour is:

a) Cornua
b) Upper uterine segment
c) Lower uterine segment
 d) Internal uterine os

One of the following is a physiological change occurring in the second stage of

labour:
a) Dilatation of the cervix
b) The pelvic floor is displaced
c) Development of retraction ring
d) Formation of bag of waters

During uterine contractions, the blood flow to the utero-placental circulation is:-
a) unchanged
b) increased
c) decreased
d) doubled

When the head is palpated 3/5 abdominally, what will be the station vaginally?
a) 0 cm
b) -1 cm
c) -2 cm
d) -3 cm

Station plus 2 means that the:

a) Presenting part is 2 cms above the ischial spines
b) Biparietal diameter is at the level of the ischial spines
c) Presenting part is 2cms below the ischial spines
d) Presenting part is 2 cms above the level of the pelvic brim

When assessing the adequacy of the pelvis, the midwife feels for the following
EXCEPT:-
a) curvature of the spine
b) sacro-spinous ligament
c) prominence of the ischial spines
d) lower boarder of the symphysis pubis

When the membranes rupture the first thing a midwife does is to:
a) Clean the vulva and make the woman comfortable.
b) Encourage the mother to push
c) Advice the woman to move about
d) Do a vaginal examination to exclude cord prolapse.

During the delivery of the placenta the midwife should:

a) Always wait for signs of separation
b) Deliver the placenta as soon as syntometrine has been given
c) Always give syntometrine before delivering the placenta
d) Wait 10 minutes to allow syntometrine to work.

The weak uterine contractions may be due to:

a) Premature labour
b) Prolonged labour
 c) Precipitate labour
d) Early rupture of membranes
(? Which of these)

Following artificial rupture of membranes, uterine contractions are stimulated by an

intravenous infusion of:
Syntocinon
Syntometrine
Vasopressin
Ergometrine

The following are the factors on which the successful trial of labour depends except:
a) The strength of uterine contractions
b) The “give” of the pelvis
c) Early rupture of membranes
d) The degree of moulding of the fetal head.

The outcome of persistent occipito posterior position in labour is:

a) Face presentation
b) Brow presentation
c) Vertex
d) Face to pubis

A third degree tear:

a) Maybe repaired by an experienced midwife
b) May extend into the lower bowel
c) Involves severe damage to the urinary bladder
d) Must be repaired by a doctor.

A woman in labour is receiving an intravenous infusion of 1000mls of 5% glucose in

water with 10 units of oxytocin. The midwife checking the contractions notices a
contraction that exceeds one (1) minute. The first action by the midwife should be:
a) Notify the doctor immediately
b) Check the fetal heart
c) Turn off the intravenous infusion
d) Prepare for delivery

Which of the following is NOT a cause in the delay of the first stage of labour?
a) Atonic uterus
b) Intravenous oxytocin
c) Malpresentation
d) Full bladder

Which perineal tissue will not be torn in a third degree tear?

a) skin and fourchette only
b) skin, fourchette, vaginal wall and pelvic floor muscles
c) anal sphincter
d) clitoris

How would you deal with a very unco-operative mother in labour:-

 a) beat her
b) scold her
c) involve the husband and the rest of the family
d) allow her to develop trust in you.

The position of a woman in early labour should be:

a) right lateral position
b) any position the woman feels comfortable
c) a comfortable sitting position
d) lithotomy position

If a mother is bleeding from a cervical tear the first treatment is:-

a) reassurance
b) blood transfusion
c) local pressure to stop the bleeding
d) elevate the foot of the bed

Which of the following indications on the partograph will quickly alert a midwife of a
difficult labour.
a) excessive fetal movements
b) mild moulding
c) undescending fetal head
d) cervical dilatation is to the left of the alert line

The active management of the third stage of labour is practiced to minimize or

prevent post partum haemorrhage. It is achieved by:-
a) giving oxytocin 10 I.U after birth of the baby or the anterior shoulder and
delivery of the placenta by controlled cord traction.
b) Shortening the third stage of labour
c) Delivering the placenta by controlled cord traction and giving syntometrine 1
ml intramuscularly.
d) Allowing the placenta to separate and descend to the lower uterine segment.

As you are taking care of Mrs Musonda while she is in labour you notice that she
becomes restless, her face is flushed and she is perspiring profusely and feels she is
going to vomit. These are symptoms indicative of:-
a) maternal distress
b) second stage of labour
c) latent stage of labour
d) late stage of labour

Which of the following would you not do in the second stage of labour?
Encourage the woman to push during a contraction.
Stay with a woman while she is pushing.
Encourage the woman to push continuously until the baby is born.
Wipe the woman’s face between pushes.

During the third stage of labour the midwife’s left hand is placed at the fundus of the
uterus to assess:
separation of the placenta
 relaxation and retraction of muscles
full bladder
presence of a contraction

Which of the following are you NOT likely to assess on vaginal examination?
a) membranes
b) presentation
c) adequacy of inlet
d) position

The condition in which the fundal dominance is lost and the contractions start and last
longest in the lower uterine segment is known as:
a) colicky uterus
b) hypertonic uterine action
c) reversed polarity
d) tonic contractions

The crucial / dangerous experience for a midwife during labour and childbirth is
during the:
first stage of labour
second stage of labour
0-6 hours after delivery of the baby
Third stage of labour

When the fetal head escapes under the symphysis pubis, it is said to be:
a) at zero ‘0’ station
b) engaged
c) effaced
d) crowned

In a deflexed, (military attitude of ) fetal head the diameter which sweeps the
perineum at birth is:
a) occipito frontal diameter
b) occipito bregmatic diameter
c) suboccipito bregmatic diameter
d) suboccipito frontal diameter

The recommended type of episiotomy for a midwife is:

a) ‘J’ shaped
b) Medial lateral
c) Lateral
d) Button holing

During labour the midwife must be aware that fetal heart deceleration is evidenced by
a fetal heart rate of:
140-160 beats per minute
120-140 beats per minute
130-150 beats per minute
80-100 beat per minute
Which of the following observations will help the midwife to assess the fetal
condition:
Descent of the presenting part
Fetal heart rate
Maternal respiration
Vaginal examination

Which of the following drugs is likely to be prescribed in the late first stage of labout?
a) Morphine
b) Pethidine
c) Pethiloran
d) Valium

A midwife may prevent perineal tears by:

a) Instructing the woman to bear down with a contraction
b) Instructing the woman to pant between contractions
c) Stretching the perineum
d) Maintain flexion of the head to allow smaller diameter to distend the
perineum

The following are true signs of labour EXCEPT:

a) Cervical dilatation
b) Rhythmic regular painful uterine contractions
c) Engagement of the fetal head
d) ‘Show’

In vertex presentation the head is born at perineal phase by movement of:

a) Flexion
b) Extension
c) Expulsion
d) Restitution

Which of the following is NOT an indication for performing an episiotomy?

a) elderly primagravida
b) complicated vaginal bleeding
c) fetal distress in second stage of labour
d) maternal distress in the second stage of labour

The purpose of breathing technique in labour is to:

a) increase pain perception
b) provide oxygenation and aid relaxation
c) diversional therapy
d) obviate the need for analgesics

When caring for a woman in labour who is a known HIV positive patient, the midwife
should:
a) use clean and safe delivery practices
b) provide counseling about breast feeding options
c) ensure that the woman does not breast feed her baby
d) isolate the woman from other women in labour
In normal labour the uterine contractions are said to be strong when they last:
a) 20-25 seconds
b) 30-35 seconds
c) 40-60 seconds
d) 65-70 seconds

Progress of labour is said to be normal when plotting of cervical dilatation on the

partogram remains:
a) to the left of the alert line
b) on or to the left of the alert line
c) to the left of the action line
d) on or to the left of the action line

The following are signs of placental separation EXCEPT:

a) the uterus becomes firmer and globular
b) the cord pulsates
c) the umbilical cord descends further out of the vagina
d) there is often a sudden gush of blood

Cervical and vaginal tears should be:

a) repaired without delay
b) repaired when the bleeding has stopped and tears are easily seen
c) packed with gauze
d) a doctor’s decision whether to suture or not

Immediately after delivery of the placenta and membranes, the midwifes first priority
must be to:
a) give the baby to the mother
b) inspect the perineum for lacerations
c) check that the uterus is well contracted
d) examine the placenta

The most active part of the uterus during labour is:

a) cornua
b) upper uterine segment
c) lower uterine segment
d) internal uterine os

The stage of labour in which cervical dilatation occurs is:

a) First stage
b) Second stage
c) Third stage
d) Fourth stage

During uterine contraction, the blood flow to the utero-placental circulation is:
a) Unchanged
b) Increased
c) Decreased
d) Doubled
The intensity of a contraction is measured by:
a) vital signs of the patient
b) degree of firmness felt at the height of a contraction
c) patients expression of pain
d) subjective symptoms of pain

Braxton hicks contractions are:

a) Painful and regular
b) Painless and irregular
c) Painful and regular
d) Painless and regular

Which of the following is a physiological change in the 2nd stage of labour:

a) Displacement of the pelvic floor
b) Formation of the bag of waters
c) Effacement
d) There are regular uterine contractions

Effacement of the cervix refers to:

a) external cervical os dilating
b) taking up of the cervix
c) dilatation and thinning of the internal and external cervix
d) the thickening of the cervix so that it is incorporated in the lower segment.

During labour solid food is withheld:

a) because absorption of food is retarded
b) to avoid constipation
c) to avoid Mendelson syndrome
d) metabolism of food is fast and leads to hypoglycaemia

During delivery the pressure on the head will promote:

a) Descent
b) Crowning
c) Flexion
d) Extension

Which one of the following is a reason for performing an episiotomy?

a) control the birth of the head
b) enlarge the perineal body
c) as a routine procedure
d) shorten the second stage of labour

As soon as the baby’s head is born the first thing the midwife does is to:
a) clamp, tie and cut the cord
b) wrap the baby in a warm towel
c) the midwife should identify the baby with a wristlet
d) clear the airway

The observations of the colour of the amniotic fluid in labour is important because:
 a) Certain colour variations may signify fetal problems
b) Colour is determined by the amount of lipo protein
c) Colour changes occur as pregnancy advances
d) Colour indicates progression of fetal development

If profuse bleeding per vaginum occurs during the third stage of labour in the
presence of a well contracted uterus, the cause is likely to be:
a) Uterine atony
b) Cervical lacerations
c) Placental site bleeding
d) Cervical Polyp

Damage to the perineal body is more common with:

a) A well flexed head
b) Rigid perineum
c) Grande mulitparity
d) Elderly primigravida

The importance of examining the placenta is to:

a) Ascertain its completeness to rule out PPH
b) To ably plan for the management of the third stage of labour
c) To ensure that there is no retained lobe
d) To plan for third stage management

Pethidine is preferred to morphine in labour because it:

a) Does not effect the bowel
b) Causes less respiratory depression on the fetus
c) Acts more quickly
d) Is a more powerful analgesic

A full bladder in labour:

a) predisposes to infection
b) interferes with normal uterine action
c) causes dilatation of the cervix
d) causes pain on bearing down

In all stages if labour, the primary power is provided by:

a) Pelvic floor
b) Maternal effort
c) Abdominal muscles
d) Contractions of the uterus

A vaginal examination in labour will be performed to:

a) Determine the progress of labour
b) Stretch the vaginal orifice
c) Perform an episiotomy
d) Enlarge the introitus

Normal labour occurs:

a) After 28 weeks
 b) At 20 weeks
c) At 32 weeks
d) After 37 weeks

Normal uterine contractions are:

a) Painless and intermittent
b) Regular and rhythmic
c) Painful and unproductive
d) Strong and irregular
Complications In Labour

One of the following manoeuvres may be undertaken by a midwife during an

emergency breech delivery.
a) jaw flexion and shoulder traction
b) internal podalic version
c) Pagets manoeuvres
d) Credes manoeuvre

During the delivery of twins

a) two hours delay between delivery of the twins is normal
b) internal podalic version may be used if the second twin is breech
c) a syntocinon drip should be used after delivery of the first twin
d) the leading pole is cephalic in 50% of cases.

In assisting the delivery of the head at or below the ischial spines, one of the
following forceps can be used:-
a) Neville-barnes
b) Haig Fergusons
c) Wrigleys
d) Andersons

When positioning a pregnant woman in the lithotomy position on the delivery bed,
both legs should be placed in the stirrups at the same time to prevent:-
a) excessive pull on the fascia
b) pressure on the perineum
c) trauma to the uterine ligaments
d) venous stasis in the legs

In occipito posterior position the patient experiences severe backache because of:-
a) long rotation
b) posterior rotation
c) deep transverse arrest
d) pressure of the presenting part on the sacral plexus

In surgical induction the intravenous pitocin is discontinued:-

a) one hour after commencement of uterine contractions
b) as soon as the patient is in the second stage of labour
c) one hour after the third stage of labour
d) one hour after the forth stage of labour

The acceptable method to augment labour in a woman at term with ruptured

membranes would be:-
a) An intravenous infusion
b) Artificial rupture of the membranes
c) Administration of prostaglandins
d) A tap water enema

One of the following may cause retained placenta

 a) Bandls Ring
b) Multiple pregnancy
c) Polarity
d) Constriction ring

The following are the factors on which successful trial of labour depends EXCEPT:-
a) The strength of uterine contractions
b) The ‘give’ of the pelvic joints
c) Early rupture of membranes
d) The degree of moulding of the fetal head

Frank breech refers to:

a) breech with flexed legs
b) footling breech
c) breech with extended legs
d) Knee position

Caesarian Section should be performed on all patients who have:

a) Diabetes mellitus
b) Cardiac disease
c) Had two or more previous caesarian sections
d) Had a history of pre-eclampsia

In which of the following types of caesarean section is there a greater risk of uterine
rupture with subsequent pregnancy:-
a) lower segment
b) classical
c) pfannestiel
d) McBurney’s incision

The dominant function of obstetric forceps is:

a) Compression
b) Traction
c) Rotation
d) Protection

Acute inversion of the uterus is usually associated with all of the following EXCEPT:
a) Antepartum haemorrhage
b) Lax uterine muscles
c) Uncontrolled cord traction
d) Grand mulitparity

Prolonged labour is comparatively rare in multiparous women and may be due to:
a) mobility of the pelvic joints
b) obstructed labour
c) previous labour experience
d) moulding of the fetal head

Mode of delivery of a persistent mento posterior position is:

 a) manual rotation of the fetal head
b) Wriggles forceps to rotate the fetal head
c) Caesarian section
d) Vacuum (ventouse) extraction

The acceptable method to augment labour in a woman who has observed show, no
contractions yet and head is at station +1 on her expected date of delivery would be:
a) intravenous infusion of oxytocin
b) Artificial rupture of membranes
c) Administration of prostaglandins
d) A tap water enema

In order to prevent cardiac decompensation in a cardiac patient during labour, the

nurse should:
a) Position the woman on her side with her shoulders elevated.
b) Maintain an IV infusion of potassium chloride
c) Administer sodium IV infusion
d) Administer oxytocin to strengthen contractions.

One of the most common causes of hypotonic uterine dysfunction is:

a) Pre-eclampsia
b) Anaemia
c) Contracted pelvis
d) Multiple pregnancy

A constriction ring is:

a) Inco-ordinate uterine action
b) A retraction ring
c) Localised tonic spasm of the uterine muscle
d) Bandl’s ring

Acute inversion of the uterus is usually associated with:

a) prolonged labour
b) uncontrolled cord traction
c) elderly primigravidae
d) multiple pregnancy

In face presentation the denominator is:

a) sinciput
b) mentum
c) bregma
d) glabella

Premature labour is associated with all the following EXCEPT:

a) small for dates
b) diabetes mellitus
c) multiple pregnancy
d) malaria

Fresh meconium staining of amniotic fluid in labour is an indication of:

 a) fetal distress
b) fetal maturity
c) caesarian section
d) preterm labour

If the fetal head is delivered but remains tightly applied to the vulva, the midwife
should suspect:
a) occipito posterior position
b) occipito anterior position
c) shoulder dystocia
d) malpresentation

The following can be used to induce labour EXCEPT:

a) artificial rupture of membranes
b) prostaglandins
c) oxytocin
d) pudendal block

In management of a severely shocked woman, the midwife would first:

a) shout or call for help
b) greet the woman respectfully
c) introduce hem/herself
d) mobilise available personnel

Management of a woman in labour with active pulmonary tuberculosis (PTB)

Include:
a) acceleration of labout at 37 weeks gestation
b) possibility not to breast feed the baby
c) strict attention to infection prevention
d) administration of inhalation analgesia

The following are late signs of maternal distress EXCEPT:

a) restless and sweating
b) vomiting
c) scanty and concentrated urine
d) dry tongue

In breech presentation, when the hands are around the chest, the hips are flexed and
legs extended over them, the condition is known as:
complete breech
knee breech
footling breech
frank breech

Which of the following is a contra-indication for induction of labour?

a) prolonged pregnancy
b) pre-eclampsia
c) diabetes in pregnancy
d) frank breech
The use of oxytocin after spontaneous onset of labour is described as:
a) surgical induction of labour
b) medical induction of labour
c) induction of labour
d) acceleration of labour

An oedematous placenta is associated with:

a) Hydrops fetalis
b) Anancephaly
c) Hydrocephalus
d) Siamese twins
Eclampsia – Pre-eclampsia.
In eclampsia, cerebral oedema may occur causing:
a) Dehydration
b) Purpura
c) Tetany
d) Vomiting

In eclampsia cerebral oedema may occur and can cause the following except:
a) convulsions
b) purpura
c) frontal headache
d) vomiting

Mrs Peggy Chipili comes to your clinic for antenatal care today. She is 20 weeks
pregnant and on testing her urine, you find proteinuria. The likely cause for this is:
a) Essential hypertension
b) Urinary Tract Infection
c) Pre-eclampsia
d) Phenlyketonuria

The signs of fulminating pre-eclampsia include the following except:

a) Epigstric pain
b) Visual disturbance
c) Loss of weight
d) Generalised oedema

The first sign of an eminent convulsion in a patient with pre-eclampsia is frequently:

a) rolling of the eyes to one side with a fixed stare
b) spots of flashes before the eyes
c) Persistent headache and blurred vision.
d) Epigastric pain and vomiting

Which of the following is NOT a symptom of pre-eclampsia?

a) heart palpitations
b) frontal headaches
c) visual disturbances
d) epigastric pain

The first sign of pre-eclampsia is frequently:-

a) rolling of the eyes to one side with a fixed stare
b) spots or flashes of light before the eyes.
c) persistant headache and blurred vision
d) epigastric pain

A woman who is about to have an eclamptic fit will experience the following except:
a) blood pressure continues to rise
b) Diplopia
c) Frontal headache
d) The pupils dilate for at least 30 minutes
Proteinuria may be an indication of:
a) Diabetes mellitus
b) Adrenal tumors
c) Pre-eclampsia
d) Hyperemesis gravidarum

The difference between Eclampsia and pre-eclampsia is the fact that in the latter
condition the patient exhibits:
a) Visual disturbances
b) headache
c) Convulsions
d) Oliguria

Following a convulsion an eclamptic patient has an elevated temperature of 39°C.

This may be caused by:-
a) development of systematic infection
b) dehydration caused by rapid fluid loss
c) disturbances of the cerebral thermal centre
d) excessive muscular activity
 e) Cardiac disease.
A woman with moderate or severe cardiac lesion is most at risk during:
a) 12th-16th week of pregnancy
b) 28th-34th week of pregnancy ?
c) First stage of labour
d) Second stage of labour

Diabetes
The excessive size of infants born to diabetic mothers is due to:
Hyperglycaemia in the mother and hyperinsulinism in the fetus
Hyperinsulinism in the mother and hyperglycaemia in the fetus
Hyperinsulinism in the fetus and hypoglycaemia in the mother
Hypoglycaemia in the fetus and hyperinsulinimia in the mother

The effects of diabetes mellitus on pregnancy include:

a) Reduced insulin requirement during pregnancy
b) Risk of shoulder dystocia in vaginal delivery
c) Increased insulin requirement during puerperium
d) Reduced incidence of perinatal death

Hypoglycaemia occurs in the diabetic mother MOST frequently during:

The early months of pregnancy
The middle months of pregnancy
The later months of pregnancy
Any month during pregnancy

Diabetes mellitus has a deleterious effect in pregnancy in the following ways

EXCEPT:
a) increased fetal size with a greater risk of difficult vaginal delivery
b) an increased incidence of hydramnios
c) increased incidence of pre-eclampsia
d) increased incidence of small for dates babies

A diabetic mother’s metabolism is significantly altered during pregnancy as a result

of:
a) The increased effect of insulin during pregnancy.
b) The effect of hormones produced in pregnancy on carbohydrate and lipid
metabolism.
c) An increase in the glucose tolerance level of the blood
d) The lower renal threshold for glucose
Complications in pregnancy.
Oligohydramnios is associated with one of the following conditions:
a) Placenta abruption
b) Renal agenesis
c) Diabetes mellitus
d) Severe pre-eclampsia

External cephalic version can only be attempted in one of the following:-

a) Severe pre-eclampsia
b) Iron deficiency anaemia
c) Oligohydramnios
d) Rhesus iso-immunisation

The commonest cause of disseminated intravascular coagulation disorder (DIC) in

obstetrics is:-
a) abruptio placenta
b) placenta praevia
c) placenta accrete
d) vasa praevia

In which type of caersarian section would there be greater possibility of uterine

rupture in a subsequent pregnancy
a) Classical
b) Lower segment
c) Extra peritoneal
d) Retroperitoneal

Placenta praevia can be best defined as:

Thrombotic occlusion of the placental blood vessels before the fetus is developed
to full maturity
Separtion of the placenta from its attachment in the uterine walls before the 40 th
week of gestation
Implantation of the placenta in the lower uterine segment so as to cover the
internal cervical os
Proliferation of placental tissue at a rate exceeding that required for optimal fetal
nourishment.

The presence of a multiple pregnancy should be detected as early as possible and the
pregnancy managed as high risk because:
Perinatal mortality is 2 to 3 times higher than in single births.
Maternal mortality is much higher in multiple births.
The mother needs time to adjust psychologically and physiologically
Post-partum haemorrhage is likely to occur.

Although the causative factors are not clear, 40% to 50% of all patients with abruption
placenta also have:
Polyhydramnios
Hypertension
Diabetes
Cardiac arrthymia
A woman with pyelitis is encouraged to continue medical supervision throughout
pregnancy because:
antibiotic therapy is given until the urine is sterile
Pre-eclampsia frequently occurs following pyelitis
Pelvic inflammatory disease occurs with untreated pyelitis
A low protein diet is given until pregnancy is terminated

If anaemia is present with a haemoglobin level of 8 grams or lower, a pregnant

woman with cardiac disease will probably go into;
a) Cardiac failure
b) Heart block
c) Atrial fibrulation
d) Cardiac compensation

Which of the following is TRUE about placenta praevia?

a) More common in multipara
b) Incidences increase with age
c) Bleeding due to lowly situated placenta
d) Bleeding due to rupture of fetal blood vessels in membranes

In the management of hypertensive disorders of pregnancy, the following symptoms

should be reported to the physician promptly:
a) epigastric pain
b) dimness of vision
c) headache
d) all the above

In the management of hypertensive disorders of pregnancy, all of the following

symptoms should be reported to the obstetrician promptly EXCEPT:-
a) Epigastric pain
b) dimness of vision
c) headache
d) polyuria

The following are clinical features of placental abruption except:

a) unchanged contour
b) usually no fetal heart heard
c) continuous torrential, slight or no bleeding
d) contractions present with no relaxation

During pregnancy the severity of rhesus disease can be assessed by:

a) Number of fetal cells in the maternal blood
b) The maternal haemoglobin level
c) Urinary oestrial secretions
d) The maternal blood antibody titre

Rh incompatibility is most likely to occur if parents have:

a) Mother Rh positive, father Rh positive
b) Mother Rh negative, father Rh positive
 c) Mother Rh positive, father Rh negative
d) Mother Rh negative, father Rh negative

Polyhydramnious may be associated with:

a) Maternal physical build
b) Multiple pregnancy
c) Abnormal fetal heart sounds
d) Abruptio placenta

Coitus during pregnancy could be contra indicated in the presence of:-

a) leuchorrhoea
b) gestation of 30 weeks or more
c) premature rupture of membranes
d) increased foetal heart rate
Ante-natal

In taking the medical and family history of a pregnant woman which of the following
could be omitted as of no significance:
a) Rheumatic fever in childhool
b) Tuberculosis in the family
c) Gastroenteritis as a child
d) Malaria before this pregnancy

Pregnancy and birth are called crises because:

They are periods of change and adjustment to change
There are hormonal and physiological changes in the mother
There are mood changes during pregnancy
Narcissism in the mother affects the husband-wife relationship

Saucer-shaped depression just below the umbilicus is usually due to:

a) Full bladder
b) Transverse lie
c) Occipito posterior position
d) Occipito anterior position

For engagement to take place in a normal vertex presentation one of the following
fetal diameters passes through the pelvic brim:
a) occipito frontal
b) bi-parietal
c) mento vertical
d) submento bregmatic

In a normal presentation when the fetal head is one fifth palpable it indicates that:-
a) one fifth of the head is below the pelvic brim
b) the head is deeply engaged
c) one fifth of the head is above the ischial spines
d) the head is visible at the vulva

Mrs Cheelo para 0 gravida 1 comes to your clinic for antenatal care. Her LMP was
on ?(add). What is the gestational age by dates today?
a) 38 weeks
b) 38 weeks 5 days
c) 38 weeks 3 days
d) 39 weeks 3 days

Mrs Banda comes to your on 25/6/09, her LMP is 20/3/09 what gestation is she?
a) 12 weeks + 5 days
b) 13 weeks + 5 days
c) 13 weeks + 6 days
d) 14 weeks + 6 days

Mrs Silanda comes for booking her LMP is 29/4/09, what is her EDD?
a) 6/12/2009
b) 7/12/2009
 c) 6/1/2010
d) 7/1/2010

History of the present pregnancy is vital obstetrical data because it:

a) Helps the midwife explore the private life of the mother
b) Determines the genetic predisposition to certain diseases
c) Helps the midwife to determine the expected date of delivery
d) Allows the mother to express her feelings.

In normal pregnancy the presentation of the fetus at 36 weeks is:-

a) vertex
b) breech
c) shoulder
d) face

The normal total weight gain in pregnancy should not exceed:-

a) 5kg
b) 13kg
c) 17kg
d) 9kg

A client who is gaining weight during pregnancy should be informed that most of the
weight gain during pregnancy is due to:-
a) metabolic alterations
b) the foetus
c) increased blood volume
d) fluid retention

Mrs Mulenga had four living children, one died and one stillbirth and one abortion.
Her parity in the present pregnancy is:-
a) 4
b) 6
c) 7
d) 8

The lie of the fetus in utero is the relationship of the:-

a) Long axis of the fetus to the mother’s pelvis
b) Attitude of the fetus to the uterus
c) Long axis of the fetus to the long axis of the uterus
d) Denominator to the mother’s pelvis

Organisms commonly associated with infection of the female urinary tract include:-
a) Doderleins bacilli
b) Treponema pallidum
c) Salmonella
d) Escherichia coli

Nystatin pessaries are used in the treatment of:-

a) trichomoniasis
b) moniliasis
c) gonorrhoea
d) leuchorrhoea

Haemorrhoids may be prevented or minimised during pregnancy by:

a) taking adequate roughage to avoid constipation
b) regular bowel habits to avoid constipation
c) avoiding long periods of standing or sitting
d) all the above

Pyelonephritis is common in pregnancy women due to the effect of:

a) progesterone on the smooth muscles
b) oestrogen on the smooth muscles
c) oxytocin on the muscles
d) lacto placenta hormones on the smooth muscle

When examining a woman on the couch, she tells you that she feels dizzy, which
action would you take first?
a) Check her pulse and blood pressure
b) Give her oxygen 2 litres per minute
c) Encourage her to breath deeply
d) Turn her on her side

During pregnancy a polypeptide, melanocyte stimulating hormone, similar to the

adrenal steroids is responsible for:
a) symptoms of morning sickness
b) urinary frequency
c) Linea nigra and chloasma
d) Softening of the cervix

The most accurate estimation of duration of pregnancy can be achieved by:

a) Ultrasound scanning in the first trimester
b) Serial human placental lactogen levels
c) Estimation of human chorionic gonadotrophin levels
d) Abdominal examination.

When counseling a mother who wants to know something on nutrition during

pregnancy, the midwife should:
a) Give her a list of foods so she can better plan her meals
b) Assess what she eats by taking a diet history
c) Emphasise the importance of limiting salt and highly seasoned foods
d) Instruct her to continue eating a normal diet.

In order to exclude chepalo-pelvic disproportion, head fitting test is done at:

a) 30 weeks
b) 32 weeks
c) 34 weeks
d) 36 weeks
One of the following is a presumptive sign of pregnancy:
uterine soufflé
quickening
changes in the uterus
softening of the cervix

Poor weight gain during the 1st 20 weeks of pregnancy could be due to:
a) excessive exercise
b) lack of adequate rest
c) poor nutrition and smoking
d) poor antenatal attendance

The exchange of nutrients and wastes between the mother and fetus is by:
a) Mechanical pull
b) Diffusion
c) Gravitation
d) Osmosis and Diffusion

When the fetus lies diagonally across the long axis of the uterus the lie is said to be:
a) longitundinal
b) transverse
c) vertex
d) oblique

Which one of the following assessments is only done once during the antenatal
period?
a) height
b) weight
c) VDRL
d) Hb estimation

One of the following is a sign that a woman was pregnant before:

a) the abdominal muscles are rigid
b) the uterine wall is lax
c) pinkish or brownish striae gravidarum are present
d) the nipples are flat

During pregnancy one purpose of breast examination is to:

a) measure the size of the breast
b) express milk
c) diagnose pregnancy
d) remove crusts on the nipples

Which of the following examination would a midwife carry out at every antenatal
visit:
a) pelvic assessment
b) height
c) weight
d) haemoglobin estimation
What advice would you give to a pregnant woman who complains of backache?
a) use a soft bed
b) use of sedation
c) use of analgesia
d) resting and maintaining posture

Anterior obliquity of the uterus is also known as:

a) pendulous abdomen
b) Asynclitism
c) Cystocele
d) Bicornuate uterus

Which of the following predisposes to anaemia in pregnancy?

a) high risk behaviour
b) frequency of pregnancy
c) non-attendance of ante natal clinic
d) Dietary problems

Frequency of micturition in late pregnancy is usually associated with:

a) Urinary Tract infection
b) Relaxation of the ureters
c) Head engagement
d) Growing uterus
 e) Post-natal
Which one of the following should a midwife check for when receiving a postnatal
mother on the ward?
a) The breasts are lactating
b) That the uterus is well contracted
c) That the patient has opened bowels
d) Haemoglobin level is normal

Renal action is increased in the early stage of puerperium because of:

a) the effect of progesterone on the kidney pelvis
b) Reduction in blood volume
c) The action of oxytocin
d) Increase in blood volume

Deep vein thrombosis in the post-natal period is a dangerous condition because it may
lead to:
a) Pulmonary embolism
b) Thrombophlebitis
c) Septicaemia
d) Supression of lactation

One of the following pre-disposes the woman to puerperal infection:-

a) full bladder
b) numerous vaginal examinations
c) perineal care especially immediately after delivery of the baby
d) precipitate labour especially when the membranes rupture just before the
second stage of labour.

Insomnia with hyperactivity in the post-natal period may indicate:-

a) Sore perineum
b) Puerperal psychosis or emotional disorder
c) A retroverted uterus
d) Over full breast

The midwife would best explain the concept of exclusive breast feeding as an
arrangement where the:-
a) baby and mother are cared for in the same unit
b) mother does not deny breast milk to the baby
c) infant is fed with breast milk only from birth until six months old
d) mother is free to express breat milk and feed the baby on demand.

Which of the following is NOT a normal physiological change of puerperium?

a) The blood volume returns to pre-gravid state and there is a reduction of blood
flow to the heart and kidneys.
b) There is increased blood supply to the breast
c) The patient is thirsty in the early puerperium
d) The abdominal wall and perineal muscles regain their tone within the first
week of puerperium.
During the postnatal period the daily measuring of the height of fundus is done to find
out:
a) If the bladder is distended
b) The rate of involution
c) If there is profuse bleeding
d) If there is infection

The most common infecting organism in breast infection of the mother during the
puerperium is:
a) staphylococcus aureus
b) mycobacterium tuberculosis
c) clostridium welchii
d) treponema pallidum

On examination the post partum mother, the midwife identifies the presence of lochia
serosa and a fundus 4 finger breadths below the umbilicus. This indicates that the time
elapsed is:
a) 1 to 3 days post partum
b) 4-5 days post partum
c) 6-7 days post partum
d) 8-9 days post partum

Intake and output are important in the early post partum period since passing frequent
small amounts of urine
a) is common and should cause no alarm
b) Maybe indicative of beginning of glomerulonephritis
c) May indicate retention of urine with over flow
d) Is common because less fluid is excreted following delivery.

Care of a woman following repair of third degree tear of the perineum includes:
a) daily routine perineal care and administration of stool softeners
b) limiting activities on regard to early ambulation
c) encouraging the mother to sit erect until the wound has healed
d) examining the introitus every day.

One of the most important assessment of ongoing healing of the uterus at the placental
site is:
a) the type, amount and consistency of the lochia
b) uterine size
c) blood pressure
d) all the above

In the puerperium deep vein thrombosis should be managed:

a) embolectomy
b) with heparin
c) by resting the patient in bed
d) with vigorous leg exercises

Which of the following is not usually associated with breast infection?

a) Staphlococcus aureaus
 b) Cracked nipples
c) Inverted nipples
d) A flushed breast

Sub-involution is the term used to describe the condition which exists when:
a) Autolysis occurs leading to atrophy of the myometial fibres
b) Normal involution of the puerperal uterus is arrested or retarded
c) Tone in the uterine musculature exists
d) Normal exfoliation of the deciduas occurs

Insomnia in the postnatal period may indicate:

a) Sore perineum
b) Retroverted psychosis
c) Puerperal psychosis
d) Painfull episiotomy wound

The average time for the first menstruation after delivery in the non-lactating woman
is:-
a) 6-7 weeks
b) 7-9 weeks
c) 9-12 weeks
d) 12-14 weeks

Over stretching of perineal supporting tissue as a result of childbirth can bring about
cystocele. The most common is:-
a) protrusion of the bladder into the vagina
b) crampy abdominal pain
c) urinary stress incontinence
d) recurrent urinary tract infections

What is the cause of postpartum after pains?

a) tonic uterine contractions
b) intermittent uterine contraction
c) irritation of the placental site
d) inflammation of the uterine cavity
Post-partum Haemorrhage / Retained Placenta
Secondary post-partum hemorrhage:
a) Is often caused by infected retained products of conception
b) Is often caused by trauma
c) Occurs mainly in primigravida women
d) Usually occurs within the first 24 hours post delivery.

What immediate action should a midwife take in case of retained placenta?

a) Give an oxytocic drug
b) Give enema
c) Empty bladder
d) Pull it out

A predisposing factor in determining whether a woman will have post partum

haemorrhage is the knowledge that:
a) Her uterus is over distended
b) She has had more than 2 pregnancies
c) Her duration of labour is 8 hours
d) She is over 40 years of age

What is the danger of a boggy uterus:-

a) urinary retention
b) haemorrhage
c) severe after pains
d) haematomas
Neonate
When examining a neonate a neurological test is done in which the baby’s head is
allowed to drop back 1 or 2 cm and the baby throws out his arms with extension of
elbows and fingers is called:
a) Grasp reflex
b) Moro reflex
c) Rooting reflex
d) Traction

Startle reflex refers to:-

a) moro reflex
b) movement of the baby’s head towards the stimulated cheek
c) extension of the elbows and fingers in an embracing movement
d) rooting response

The cheapest means of keeping the baby warm is by:

a) Mother baby contact
b) Central heating
c) Keeping a heater in the room
d) Providing heavy clothing

Which of the following is a major neonatal disorder?

a) Sore buttocks
b) Pseudo menstruation
c) Hypoglycaemia
d) Physiological jaundice

The average length of a neonate at birth is

a) 30-32cm
b) 40-42cm
c) 50-52cm
d) 60-62cm

The first adjustment to be established in a normal neonate at birth is:-

a) breathing
b) hearing
c) sucking
d) regulation of body temperature

Nursery infections caused by staphyloccus aureus are reduced in frequency by:-

a) use of prophylactic antibiotics after prolonged rupture of membranes
b) isolation of affected babies
c) rooming out of babies with mothers
d) use of protective clothing

The frequent cause of neonatal morbidity and mortality in Zambia is:

a) infections
b) diabetes
c) pulmonary disorders
d) cardiac failure
On admission to the nursery the nurse should routinely do all the following on a
premature baby except:
a) Evaluate the newborn status
b) Support the body temperature
c) Administer oxygen
d) Record vital signs

The normal neonate has:

a) a birth weight of 2.4kgs
b) a head circumference of 30cms
c) A body temperature of below 35°C
d) An apex beat of 100 beats per minute

When does physiological weight loss occur in the newborn?

a) During the first 3 days after birth
b) On the fourth day after birth
c) A week after birth
d) A fortnight after birth

When the mother receives pethidine two hours before delivery, baby’s respiratory
centre may be depressed. In order to alleviate this a narcotic antagonist narcan can be
used in the dose of:
a) 0.01mg/kg body weight
b) 0.1 mg/kg body weight
c) 0.02 mg/kg body weight
d) 0.2 mg/kg body weight

Which of the following will predispose a newborn infant to intracranial haemorrhage?

a) hyperbilirubin
b) hypoxia
c) kernicterus
d) hypernatraemia

The neonate’s mouth DOES NOT need to be cleaned, but should be examined daily
for:
a) tongue tie
b) polyps
c) thrush
d) milk teeth

Which of the following conditions is responsible for a premature baby’s temperature

instability?
a) the surface area of a premature baby is smaller than that of the normal
newborn
b) A premature baby lacks subcutaneous fat, which would furnish some
insulation
c) A premature baby perspires a great deal, thus losing heat almost constantly
d) A premature baby has a limited ability to produce anti-bodies against
infections.
A baby who has muscle twitching, convulsions, cyanosis, abnormal respirations and a
short shrill cry must make the midwife suspect:
a) Tetany
b) Intracranial haemorrhage
c) Spina bifida
d) Hyperkalaemia

When observing a baby for signs of pathological jaundice the midwife should be alert
for:
a) Appearance of jaundice during the first 24 hours
b) Jaundice developing between 24 and 72 hours in full term infant
c) Neurological signs during the first 24 hours
d) Muscular irritability at birth

A newborn baby with asymmetric gluteal folds could be having :

a) A dislocated hip
b) Peripheral nervous system damage
c) An inguinal hernia
d) Central nervous system damage

Closure of the foramen ovale after birth is caused by:

a) A decrease in the aortic blood flow
b) An increase in the pulmonary blood flow
c) A decrease in the pressure of the left atrium
d) An increase in the pressure in the right atrium

When a baby of a diabetic mother shows symptoms of tremors, apnoea, cyanosis and
poor sucking reflex this could indicate:
a) Congenital depression of the Islets of langerhans
b) Hypoglycaemia
c) Central nervous system oedema
d) Hyperglycaemia

Which one of the following vaccines should NOT be frozen?

Polio
BCG
Tetanus toxoid
Measles

When giving a bitter syrup medicine to a baby the midwife should:

Taste the bitterness
Dilute with water
Add sugar
Give it in its formal preparation

The main aim of prophylactic eye care in the newborn is:

a) to enhace and protect the infant’s vision in the immediate period after birth.
b) To prevent candidiasis neonatorum
c) To prevent opthalmia neonatorum
 d) To prevent staphylococcal infection

A young woman asks how she will know when her baby is hungry, which of the
following would be the most appropriate response for a midwife to give?
a) all crying indicates hunger
b) feed the baby when ever awake
c) the baby will cry, fret and suck on anything that comes in contact with the lips
d) offer water first, if the baby refuses then feed the baby.

Which of the following clinical problems are possible in the infant of a diabetic
mother?
a) small for gestational age
b) respiratory distress syndrome
c) hyperglycaemia
d) hypoglycaemia

Which of the following reflexes is NOT fully developed at birth:

a) grasp
b) swallowing
c) walking
d) sucking

Rooting reflex is when a baby:

a) Throws out his arms with extension of the elbows
b) Turns his head to the side searching for his mother’s nipple
c) Grasps firmly a finger plaved in his palm
d) Makes stepping movements in standing position

A white greasy substance usually found on the skin of the newborn is called:
a) Lanugo
b) Milia
c) Petechiae
d) Vernix caseosa

Meconium is:
a) green black stools passed by the newborn
b) yellow, straw coloured stools passed by the infant
c) green, yellow stools passed by the infant
d) yellow, black stools passed by the infant

In fetal circulation, a blood vessel which carries oxygenated blood from the placenta
to the undersurface of the liver is:
a) ductus venosus
b) umbilical vein
c) ductus arteriosus
d) hypogastric arteries

Which of the following in not a temporary structure in the fetal circulation:

a) Ductus venosus
b) Ductus arteriosus
 c) Foramen ovale
d) Pulmonary artery

Excessive oxygen therapy can cause:

a) untraventricular haemorrhage
b) pulmonary stenosis
c) retrolental fibroplasias
d) achlorhydria

Naso gastric tube feeding is indicated in premature infants because:

a) The feeding can be given quickly, so handling is minimised
b) Vomiting is prevented
c) It conserves the baby’s strength and does not depend on the swallowing
reflex
d) The amount of food given can be more accurately regulated

A heart rate of 160 beats per minute in a baby who has been crying would probably
indicate:
a) normal apex beat
b) infection
c) heart disease
d) respiratory distress syndrome

A defect in the abdominal wall through which the bowel protrudes is known as:
a) Myelocele
b) Exomphalos
c) Meningiocele
d) Hydrocele

The baby’s normal respiratory rate is:

a) 20 breaths per minute
b) 40 breaths per minute
c) 30 breaths per minute
d) 60 breaths per minute

After birth the baby should pass urine within:

a) 24 hours
b) 36 hours
c) 12 hours
d) 48 hours

The recommended first feed for the neonate is:

a) plain water
b) ½ strength milk
c) Colostrum
d) Glucose water

Excessive traction during a difficult forceps delivery can result in the following birth
injuries except:
a) Erb’s palsy
 b) Facial palsy
c) Depressed fractures of the skull
d) Talipes equinovarus

In the neonate a hairy mole at the base of the spine may indicate:
a) Imperforate anus
b) Pilonidal sinus
c) Hirsch Sprungs disease
d) Occult spina bifida

Hypospadiasis is:
a) A form of polycystic kidney disease
b) When the testicals are undescended
c) When the urethra opens on the under side of the penis
d) Part of the epididymis

The premature has all the characteristics EXCEPT:

a) The CNS is fully developed
b) They are prone to infection
c) They usually have a delayed milestone
d) All the centres in the brain are not fully developed.

The most common complication in the preterm infant, which the midwife must
continuously monitor is:-
a) brain damage
b) respiratory distress
c) aspiration of mucus
d) haemorrhage

Which of the following conditions is responsible for a premature baby’s temperature

instability?
a) The surface area of a premature baby is smaller than that of a normal neonate
b) A premature baby lacks subcutaneous fat, which would furnish some
insulation
c) A premature baby perspires a great deal, thus losing heat almost instantly
d) A premature baby has limited ablility to produce antibodies against infection.

The destructive operation in which the clavicles are cut to reduce the shoulder girdle
is:-
a) decapitation
b) eviscerion
c) cleidotomy
d) craniotomy

The earliest sign in idiopathic respiratory distress syndrome in the newborn is

usually:-
a) sternal and sub-costal retractions
b) cyanosis
c) rapid respirations
d) grunting
In which of the fetal blood vessels is the oxygen content higher?
a) umbilical artery
b) ductus arterosus
c) ductus venousus
d) pulmonary artery
General

The best motivator to learning is:

a) interest
b) teacher
c) past experience
d) environment

The standards of behaviour that are socially accepted are called:

a) beliefs
b) norms
c) laws
d) taboos
Infertility

In dealing with a couple that has an infertility problem, the midwife should know that:
a) One partner has a problem that makes them unable to have children
b) The couple has been unable to have children after trying for a year
c) Infertility is usually psychological in origin
d) Infertility and sterility are essentially the same problem

A diagnostic test used to evaluate fertility is the post coital test. It is best timed:
a) Immediately after menses
b) Within 1 to 2 ddays of presumed ovulation
c) One week after ovulation
d) Just prior to the next menstrual period

Infertility due to a defect in the tube is usually related to:

a) Past infection
b) Fibroid tumour
c) Congenital anomaly
d) Previous injury to the tube
Family Planning
When using natural family planning method, the woman should be instructed to begin
counting the first day of her cycle as:
a) the day her menstrual period ceases
b) the first day after her menstrual period ceases
c) the first day of her menstrual period
d) the day of ovulation

When teaching the woman about the use of a diaphragm, it is important to instruct her
that the diaphragm should be re-checked for size:
a) every 5 years
b) after every menstruation
c) after each birth?
d) only after significant weight loss

Coitus interruptus is a term used to describe:

a) premature ejaculation
b) withdrawal before ejaculation
c) male impotence
d) male dominated method of family planning

Counselling of family planning clients should be done in:

a) an open space
b) privacy
c) group of hundred
d) the presence of two health providers

Vasectomy is effective:
a) Immediately
b) After three months?
c) After two clear sperm counts
d) After thirty ejaculations

Exclusive breast feeding is said to have contraceptive effect because:

a) It stimulates the shedding of the endometrium
b) It prevents the function of the hypothalamus
c) Raised levels of prolactin inhibit ovulation
d) The mother is relaxed at the time

Intrauterine contraceptive device provides contraception by:-

a) blocking the cervical os
b) increasing the mobility of the uterus
c) setting up a non specific inflammatory cell reaction on the endometrium
d) preventing the sperm from reaching the fallopian tube
Early Pregnancy Problems
Incomplete abortion can be distinguished from threatened abortion by:
a) pain
b) dilatation of the cervix
c) bleeding
d) passage of placental tissue

In hyperemesis gravidarum the urine will be:

Dilute and contain protein
Dilute and contain ketones
Concentrated and contain protein
Concentrated and contain ketones

The following are minor disorders of pregnancy EXCEPT:

a) Breast discomfort
b) Heartburn
c) Insomnia
d) Hyperemesis gravidarum

Slight vaginal bleeding in early pregnancy could be due to:

a) Inevitable abortion
b) Threatened abortion
c) Antepartum haemorrhage
d) Complete abortion

Vaginal bleeding before 28 weeks of gestation is commonly due to:

a) threatened abortion
b) Carneous mole
c) Antepartum haemorrhage
d) Hydatidiform mole

Hyperemesis gravidarum is common in:

a) Primigravida
b) Mulitpara
c) Obese women
d) Highly sensitive women

Most spontaneous abortions are caused by:

a) Physical trauma
b) Germ plasma defects
c) Unresolved stress
d) Congenital defects

Which symptoms would the midwife be alert for when caring for a patient with a
tentative diagnosis of hydatidaform mole?
a) Painless heavy vaginal bleeding
b) Unusually rapid uterine enlargement
c) Hypertension
d) Decreased fetal heart rate.
When there is 4-8 weeks amenorrhoea and the signs and symptoms of pregnancy
disappear after slight vaginal bleeding the condition is referred to as:
a) Threatened abortion
b) Missed abortion
c) Habitual abortion
d) Complete abortion

The benign neoplasm (tumour) of the trophoblast is known as:

a) amniotic tumour
b) missed abortion
c) vesicular mole
d) blood mole

Hyperemesis gravidarum may lead to:

a) abortion
b) ketosis
c) obesity
d) pre-eclampsia

Which of the following factors is NOT related to hyperemesis gravidarum?

a) high levels of chorionic gonadotrophin
b) decreased secretion of free hydrochloric acid
c) increased incidence of hydatidiform mole
d) increased incidence of polyhydramnious

Congenital cateract may be due to maternal infection such as:

a) chicken pox
b) rubella
c) influenza
d) tuberculosis
Screening Test
For purposes of chromosomal studies, amniocentesis is most commonly performed:
a) any time in early pregnancy
b) usually not until after the 12th week of pregnancy
c) usually not until after the 16th week of pregnancy
d) anytime during pregnancy

A common method of locating the precise position of a fetus prior to an amniocentesis

is:-
a) x-ray examination
b) histogram
c) fluoroscopy
d) ultrasonography
Unplaced questions.