LearnWithTest

1 A 32-year-old G3P2 woman at 39+4 weeks presents in active labor. On abdominal examination, the head is palpable in the right hypochondrium, the back is anterior, and fetal heart sounds are best heard above the umbilicus. Vaginal examination reveals a fully dilated cervix with a soft mass and irregular bony landmarks. What is the MOST likely malpresentation and the MOST appropriate immediate management?

Complete breech – allow vaginal delivery Frank breech – proceed with assisted breech delivery Transverse lie with shoulder presentation – emergency cesarean section Face presentation mentoanterior – trial of vaginal delivery

2 A primigravida at term is in second stage of labor. Vaginal examination shows facial features with the mouth and nose palpable. The chin is directed posteriorly. What is the MOST likely outcome if labor is allowed to continue?

Spontaneous vaginal delivery Rotation to mentoanterior and vaginal delivery Obstructed labor requiring cesarean section Instrumental delivery with forceps

3 A multiparous woman with polyhydramnios presents at 38 weeks. Ultrasound shows unstable lie. What is the MOST important complication she is at risk of during spontaneous rupture of membranes?

Uterine rupture Cord prolapse Placenta previa bleeding Amniotic fluid embolism

4 During labor, vaginal examination reveals the anterior fontanelle easily palpable, sagittal suture in transverse diameter, and head not well flexed. What malpresentation is this?

Occipitoposterior position Brow presentation Deflexed vertex Face presentation

5 A woman in labor has brow presentation diagnosed early in first stage. What is the MOST likely course of events?

Spontaneous vaginal delivery Persistent brow leading to obstructed labor Conversion to face or vertex presentation Immediate uterine rupture

6 A term fetus in breech presentation is being assessed for mode of delivery. Which finding ABSOLUTELY contraindicates vaginal breech delivery?

Estimated fetal weight 3.2 kg Frank breech Extended fetal head Multiparity

7 A 28-year-old primigravida presents with footling breech in early labor. Cervix is 4 cm dilated. What is the BEST management?

Allow spontaneous vaginal delivery External cephalic version in labor Emergency cesarean section Oxytocin augmentation

8 A fetus in occipitoposterior position fails to rotate during labor. What is the MOST likely complication?

Precipitate labor Deep transverse arrest Cord prolapse Uterine inversion

9 Which pelvic type MOST commonly predisposes to persistent occipitoposterior position?

Gynecoid Android Anthropoid Platypelloid

10 A fetus presents as complete breech. Which diameter of the fetal head must pass through the pelvis during delivery of the after-coming head?

Suboccipitobregmatic Occipitofrontal Mentovertical Biparietal

11 A transverse lie is diagnosed at 36 weeks. The patient is not in labor. What is the MOST appropriate management?

Immediate cesarean section External cephalic version Induction of labor Expectant management until labor

12 Which factor MOST strongly predisposes to face presentation?

Cephalopelvic disproportion Fetal anencephaly Short umbilical cord Oligohydramnios

13 A woman in labor has compound presentation with a hand alongside the head. What is the MOST appropriate management if labor is progressing normally?

Immediate cesarean section Manual replacement of the hand Allow vaginal delivery Forceps application

14 In shoulder presentation, which fetal landmark is MOST commonly felt on vaginal examination?

Scapula Elbow Clavicle Acromion

15 A multiparous woman presents late in labor with a dead fetus in transverse lie. Cervix is fully dilated. What is the MOST appropriate management?

Cesarean section Internal podalic version and breech extraction External cephalic version Destructive operation on the head

16 Which malpresentation is MOST associated with cord prolapse?

Frank breech Complete breech Footling breech Occipitoposterior

17 A fetus in face presentation is mentoanterior. Pelvis is adequate and contractions are good. What is the BEST plan?

Elective cesarean section Trial of vaginal delivery Forceps delivery in first stage Vacuum extraction

18 Which diameter engages in brow presentation?

Suboccipitobregmatic Occipitofrontal Mentovertical Biparietal

19 A woman with a previous cesarean section presents with persistent transverse lie at term. What is the BEST mode of delivery?

Trial of labor External cephalic version in labor Elective repeat cesarean section Induction with oxytocin

20 In breech delivery, which maneuver is used to deliver the after-coming head while maintaining flexion?

Lovset maneuver Mauriceau-Smellie-Veit maneuver Burns-Marshall technique Pinard maneuver

21 A fetus presents in persistent occipitoposterior position. Which maternal symptom is MOST characteristic?

Painless labor Severe back pain Sudden hypotension Early urge to push

22 Which uterine abnormality MOST predisposes to malpresentation?

Adenomyosis Bicornuate uterus Fibroid uterus with submucous fibroid Endometrial polyp

23 A fetus is in transverse lie with prolapsed arm and cord. Fetus is alive and cervix is fully dilated. What is the BEST management?

Internal podalic version Immediate cesarean section Allow spontaneous delivery External cephalic version

24 Which malpresentation is MOST likely to cause obstructed labor if persistent?

Occipitoposterior Face mentoanterior Brow presentation Frank breech