AMREF VIRTUAL TRAINING SCHOOL
SEPTEMBER 2012 CLASS
END MODULE 2 EXAMINATION
DATE: FRIDAY 30TH AUGUST, 2013.
TIME ALLOWED: 3 Hours TIME: 9:00AM- 12.00 PM
INSTRUCTIONS TO CANDIDATES:
1. Read the questions carefully and answer only what is asked.
2. ENTER YOUR ADMISSION NUMBER on each sheet of paper used.
3. All questions are compulsory.
4. For part I MCQs, answers to these questions MUST be written in the capital form e.g. A not “ a”
5. For Part II (SHORT ANSWER QUESTIONS)
Answers to these questions should follow each other on the provided sheets of paper.
6. For part III, essay Questions, answer to each question must be on separate sheet of paper.
7. Omission of or wrong numbering of examination papers, questions or parts of the question will result in 10% deduction of the marks scored from the relevant part.
PART A: MCQS (20 MARKS)
1. The layer of the blastocyst that erodes the walls of the blood vessels of the deciduas is the:
a) Mesoderm
b) Cytotrophoblast
c) Mesoderm
d) Ectoderm
2. The indirect causes of maternal mortality include:
a) Haemorrhage , anaemia
b) Tuberculosis ,malaria
c) Sepsis, haemorrhage
d) Disseminated intravascular coagulation(DIC), haemorrhage
3. The temporary structure in foetal circulation that connects the umbilical vein to the inferior venacava is the:
a) Ductus arteriosus
b) Ductus venosus
c) Foramen ovale
d) Hypogastric arteries
4. Breast engorgement during purperium occurs:
a) 3rd-4th day
b) 5th- 6th day
c) 10th-14th day
d) 1st -2nd day
5. Probable signs of pregnancy include;
a) Amenorrhoea, pregnancy test positive, frequency of micturition
b) Ballottement of the fetus, Braxton hicks contractions, positive pregnancy sign
c) Amenorrhoea, breast changes, quickening
d) Foetal heart tones, visualization of the foetus, foetal parts palpated
6. Polarity in the first stage of labour means:
a) Neuro muscular harmony that prevails between the two uterine segments
b) Formation of the upper and lower uterine segments
c) Painless uterine contractions felt by the woman
d) Contractions that starts from the cornua and spread towards the lower uterine segment
7. Perinatal mortality rate is defined as:
a) Number of infants dying under one week per 1000 life births per year
b) Number of still births and neonatal deaths during the first weeks of life per 1000 life and still births per year
c) Number of infants dying under one year per 1, 000 live births per year
d) Number of still births and neonatal deaths during the first year of life per 1000 live and still births per year
8. The prevention of mastitis during the purperium includes:
a) Proper attachment of the baby to the nipple
b) Application of hot compresses on the breast
c) Washing breasts with warm water after breast feeding
d) Wearing a firm and supportive brassire
9. The presenting diameter in occipitoposterior position is the:
a) Subocccipitofrontal diameter
b) Occipitofrontal diameter
c) Biparietal diameter
d) Bitemporal diameter
10. Pelvic abdominal palpation on a pregnant woman is done to:
a) Locate foetal pole to determine presentation
b) Locate foetal back to determine position
c) Ascertain the level of engagement
d) Rule out spleenomegally in case of jaundice
11. Hegars sign is a probable sign of pregnancy characterised by
a) Softening of the cervix
b) Periodic uterine tightening
c) Colour change of the vagina from pink to violet
d) Softening of the lower uterine segment
12. The term presentation means that:
a) The presenting part has sunk into the lower uterine segment
b) The largest diameter of the foetal skull has passed through the pelvic brim
c) Part of the fetus which lies in the lower pole of the uterus
d) The part of the fetus which lies over the cervical os during labour and on which the caput succedaneum forms
13. The phases of the ovarian cycle are;
a. menstrual, follicular and luteal
b. Menstrual, proliferative and secretory
c. Follicular, luteal and proliferative
d. Secretory, luteal and follicular
14. The impeding signs of the rupture of the uterus include:
a) Rise in pulse rate, hypertonic uterine contractions, excruciating pain
b) Band’s ring, vaginal bleeding, cessation of uterine contractions
c) Cessation of uterine contractions, tenderness in the lower uterine segment, rise in pulse rate
d) Hypertonic uterine contractions, bandl’s ring, vaginal bleeding
15. The reflex responses that protect the infant from airway obstruction are the:
a) Gag, cough, sneeze
b) Rooting, asymmetrical tonic neck, gag
c) Swallowing, sucking, asymmetrical tonic neck
d) Sucking, rooting, cough
16. Second degree tear involves;
a) The fourchette and the anal sphincter
b) Bulbo cavernosus and pubococygeous muscles only
c) Damage to the anal sphincter and rectal mucosa
d) Fourchette and superficial perineal muscles
17. The management of physiological jaundice in a newborn includes;
a) Early feeding, phototherapy, observing for the degree of jaundice
b) Intravenous fluids, observing for the degree of jaundice, early feeding
c) Increasing the frequency of feeding, observing for the degree of jaundice, checking the serum bilirubin level
d) Phototherapy, nasogastric tube feeding, observing the degree of jaundice
18. The predisposing factors to shoulder presentation include;
a) Extended legs, uterine abnormality, prematurity
b) Macerated fetus, uterine abnormality, contracted pelvis
c) Polyhydramnious, hydrocephalus, prematurity
d) Multiple pregnancy, contracted pelvis, placenta praevia
19. Match the terms in column A with correct description in column B.
COLUMN A
a) Schultze mechanism
b) Vasa praevia
COLUMN B
i. Turgid veins burst, a small amount of blood seeps between the thin septa of the spongy layer and the placental surface
ii. Placental separation begins centrally, a retro placental clot is formed, which becomes enclosed in a membranous bag as placenta descends, fetal surface first
iii. Fetal blood vessels lie over the os in front of the presenting part
iv. Placenta begins to detach asymmetrically at one of its lateral borders, blood escapes and separation is aided by the formation of retro-placental clot
20. Indicate whether the following statements are TRUE or FALSE.
a) Streptomycin causes deafness to the unborn baby
b) Pregnant women infected with HIV Virus should receive three doses of SP drugs during pregnancy
PART II: SHORT ANSWER QUESTIONS (40 MARKS)
1. Draw and label a diagram of female pelvic inlet showing its landmarks (5 marks)
2. State five (5) possible gastrointestinal malformations in a newborn (5 marks)
3. Describe four (4) non-pharmacological methods of pain control during labour (4 marks)
4. State three (3) symptoms of post-partum blues (3 marks)
5. Outline six (6) interventions for a woman with diabetes mellitus during the intra-partum period (6 marks)
6. State four (4) signs of early breast cancer (4 marks)
7. Explain four (4 ) modes of heat loss in a newborn (4 marks)
8. Outline four (4) effects of pregnancy on the digestive tract (4 marks)
9. State five (5) indications for emergency contraceptive pills (5 marks)
PART III: LONG ANSWER QUESTIONS (40 MARKS)
1. Mrs.Pedi 20 years old para 0+0 is admitted to the labour ward in active phase of labour.
a) Outline the stages of labour (4 marks)
b) Describe the management of mrs. Pedi till the baby is born (10 marks)
c) State four (4) advantages of oxytocinon as a uterotonic drug (4 marks)
d) List four (4 ) maternal factors that may affect the progress of labour (2 marks)
2. Baby X is born at term with a weight of 3.8 Kgs and an APGAR score of 10 in 5 minutes.
a) State four (4) features in the respiratory system of a normal newborn (5 marks)
b) Explain the management of baby X for the first 24 hours (10 marks)
c) State five (5 ) signs that a newborn baby is receiving adequate amount of breast milk (5 marks)
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