EBCOG Part-1 High Yield questions – Post OP Care (S.B.A)

1.Which of the following statement best describes perinatal mortality?

A The number of stillbirths is included in the enumerator
B The total number of babies dying in the neonatal period is included in the Enumerator
C The total number of live birth is used as a denominator
D Babies dying as a result of lethal congenital abnormality are excluded
E Babies born dead before 28 weeks' gestation are not included

2. From the list of following drugs which one should be avoided during breastfeeding

A Heparin
B Warfarin
C Ondansetron
D Metronidazole
E Phenindione

3.Regarding maternal mortality, which of the following is incorrect?

A It includes deaths up to 42 days after the termination of pregnancy
B Direct deaths are those resulting from obstetric complications of the pregnant state
C Includes fortuitous deaths
D Cardiac diseases are the most common cause of indirect death
E It includes direct and indirect deaths

4. A patient is referred to the gynaecology clinic for consideration of hysterectomy following a failed endometrial ablation.At what point should enhanced recovery planning start?

A. Following discharge from hospital
B. On admission
C. Preoperative assessment clinic
D. Upon completion of the operation
E. With the initial referral

5. A woman has had a successful trial of forceps delivery under spinal anaesthetic. What is the minimum duration that the catheter should remain in situ to reduce the risk of asymptomatic bladder overfilling?

A. 3 hours
B. 6 hours
C. 9 hours
D. 12 hours
E. 24 hours

6.A 48-year-old woman has undergone a midurethral tape procedure for stress urinary incontinence and is ready to be discharged. Within what time frame should she be seen as an outpatient to exclude tape erosion?

A. 6 weeks
B. 2 months
C. 3 months
D. 6 months
E. 12 months

7.A patient is seen 2 weeks after a laparoscopic hysterectomy. An intraoperative bladder injury was noted and repaired laparoscopically by the urologist. A catheter has been left in situ for 2 weeks. A retrograde cystogram subsequently reports a leak from the bladder. The woman is clinically well. What is the most appropriate management?

A. Leave catheter in situ and repeat cystogram in 1 week
B. Perform cystoscopy to assess the defect
C. Repeat laparoscopy and secondary repair
D. Request a CT intravenous urogram to check ureters are not damaged
E. Urgent urological review

8. A 38-year-old woman is admitted with nausea, vomiting and confusion following a transcervical resection of the endometrium (TCRE) for heavy menstrual bleeding. It is noted that the fluid deficit at the time of the procedure was 1.6 l. What is the single most important investigation?

A. Chest X-ray
B. CT of abdomen and pelvis
C. Full blood count (FBC)
D. Serum urea and electrolytes
E. Ultrasound of the pelvis

9. A 49-year-old woman had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for irregular menstrual bleeding and pelvic pain, related to previous diagnosis of endometriosis. Her immediate postoperative recovery was uneventful. Seven days later, she is readmitted with a vaginal loss of watery fluid and blood- stained urine.What is the most likely diagnosis?

A. Detrusor overactivity
B. Urinary retention with overflow
C. Urinary tract infection
D. Vaginal candidiasis
E. Vesicovaginal fistula

10. Following surgery, how long should patients wait before they can shower?

A. 24 hours
B. 48 hours
C. 72 hours
D. 5 days
E. 7 days

11.What is the most common type of postoperative infection following an emergency caesarean section?

A. Endometritis
B. Lower respiratory tract infection
C. Upper respiratory tract infection
D. Urinary tract infection
E. Wound infection

12.Of women that develop pyrexia in the first 48 hours after gynaecological surgery,what proportion do not have an identifiable cause?

A. 5%
B. 10%
C. 20%
D. 40%
E. 80%

13. Following a general anaesthetic, what is the most common cause of pyrexia in the immediate postoperative period?

A. Lower respiratory tract infection
B. Pulmonary atelectasis
C. Upper respiratory tract infection
D. Urinary tract infection
E. Wound infection

14. A 27-year-old primigravida presents at 35+3 weeks’ gestation with a headache and 24 hours of no fetal movement. An IUFD and preeclampsia are diagnosed. Induction of labour is performed. Four days a er delivery her BP is still very labile, and she continues to require second-line oral therapy. She is troubled by lactation and breast pain. What would be the best management for her?

A. Cabergoline.
B. Bromocriptine.
C. Metoclopramide.
D. Ethinyl oestradiol.
E. Simple measures such as supportive bra, ice packs and analgesia.

15. A 23-year-old medical student has delivered a healthy male neonate weighing 2900 g at term 36 hours ago by SVD. T e mother is generally t and well and has been granted a year out of her studies, having found out she was pregnant shortly a er her elective in Papua New Guinea. She has noticed that, this morning, the neonate has rapidly developed severe bilateral conjunctivitis with a profuse purulent discharge. Last night the neonate’s eyes looked normal.What is the most likely causative organism in this case of neonatal conjunctivitis?

A. Chlamydia trachomatis.
B. Herpes simplex virus type 1.
C. HPV type 6.
D. Neisseria gonorrhoeae.
E. richomonas vaginalis.

16.A 32-year-old primigravida commences a planned delivery in a rural stand-alone midwifery unit. A er 8 hours of established labour, the second stage of labour is diagnosed. T e woman develops an urge to push 1 hour later and she commences pushing. A er 30 minutes late decelerations are heard on intermittent auscultation. On examination the fetus is cephalic, 2/5 palpable per abdomen, fully dilated, direct OP and at station spines −1. T ere is 3+ caput and 3+ moulding. A decision is made for transfer to hospital, although this is delayed because of treacherous snow-covered and ice-covered roads. On arrival at hospital 3 hours later the C G is severely abnormal, with examination ndings unchanged and a category 1 caesarean section is performed. en minutes a er delivery resuscitation is stopped for a few seconds while the neonate is reassessed. T e fetus is still extremely oppy, with no pulse, no response to stimulation and no spontaneous breathing. It is blue.What is the infant’s 10-minute Apgar score?

A. 0.
B. 1.
C. 2.
D. 3.
E. 4.

17. A 32-year-old obese primigravida has a forceps delivery at 39+2 weeks’ gestation for suspected fetal compromise. Because the baby is not spontaneously crying at delivery, the obstetrician clamps and cuts the cord immediately. Shortly a erwards, however, the baby spontaneously cries a er stimulation by the midwife. T e following day the baby feeds
poorly and is found to be anaemic. T e issue of cord clamping in term neonates is discussed and debated between the obstetricians and neonatologists at the next perinatal morbidity meeting. What is the best management regarding cord clamping in term neonates?

A. Cord clamping 1 to 5 minutes postdelivery unless infant heart rate is less than 60 bpm or there is concern about the integrity of the cord, followed by oxytocin 10 IU intramuscularly (IM).
B. Cord clamping 1 to 5 minutes postdelivery unless infant heart rate is less than 100 bpm or there is concern about the integrity of the cord, followed by oxytocin 10 IU IM.
C. Cord clamping 1 to 5 minutes postdelivery unless infant is not spontaneously crying or there is concern about the integrity of the cord, followed by oxytocin 10 IU IM.
D. Oxytocin 10 IU IM at delivery of neonate, cord clamping 1 to 5 minutes postdelivery unless infant heart rate is less than 60 bpm or there is concern about the integrity of the cord.
E. Oxytocin 10 IU IM at delivery of neonate, cord clamping 1 to 5 minutes postdelivery unless infant heart rate is less than 100 bpm or there is concern about the integrity of the cord.

18. A healthy 34-year-old low-risk primigravida is referred to the obstetric antenatal clinic by her midwife at the woman’s request to discuss the management of the third stage of labour. Her antenatal group has advised her to have physiological management of the third stage of labour to improve bonding with her baby. T ey suggest that, as long as
she delivers in a quiet room, her own endogenous oxytocin will work well and, as she is ‘low risk’; her chance of postpartum haemorrhage will be no higher than if she were to have an active management of the third stage. T e woman asks you for your advice and rationale for this regarding management of her third stage of labour.
Which is the best advice?

A. Advise her there is no di erence in outcome between active management and physiological management of third stage of labour. Because she is low risk, either are appropriate choices.
B. Recommend active management of third stage of labour, because it is associated with a slightly decreased risk of haemorrhage and blood transfusion compared with physiological third stage.
C. Recommend active management of third stage of labour, because it is associated with approximately half the risk of haemorrhage of more than 1 L and approximately a third of blood transfusion compared with physiological third stage.
D. Recommend controlled cord traction, because it is associated with shorter third stage and higher maternal satisfaction, but there is no need for oxytocin as she is low risk.
E. Recommend physiological management of third stage, converting to active management if there is a delay in the delivery of the placenta.

19. A 32-year-old low-risk primigravida presents with contractions at 26+0 weeks’ gestation. On examination the cervix is 5 cm dilated. She is admitted, steroids are given and a magnesium sulphate infusion is commenced. She is anxious and is keen to know a very approximate prognosis for her fetus. Approximately what percentage of live births at 26 weeks’ gestation will go on to survive without disability?

A. 10%
B. 15%.
C. 20%.
D. 60%.
E. 90%.

20. A 33-year-old primigravida with asthma delivers a live infant at term. T ere was no meconium. T e infant makes no spontaneous attempt at breathing and is oppy. It is dried, covered and assessed. Five in ation breaths are performed. T ere is good chest movement on in ation. T e neonate is then reassessed: there is a heart rate of around 50 bpm
although still no breathing. Senior assistance is summoned and en route. What is the next immediate step?

A. Chest compressions and ventilation breaths in ratio 1 : 1.
B. Chest compressions and ventilation breaths in ratio 3 : 1.
C. Chest compressions and ventilation breaths in ratio 5 : 1.
D. Chest compressions and ventilation breaths in ratio 15 : 1.
E. Chest compressions and ventilation breaths in ratio 30 : 2.