Midwifery Exam Questions

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S. R. is a 51-year-old male patient who is being evaluated for fatigue. Over the last few months he has noticed a marked decrease in activity tolerance. Physical examination reveals a variety of ecchymoses of unknown origin. The CBC is significant for a Hgb of 10.1 gdL, an MCV of 72 fL and a platelet count of 65,000L the remainder of the CBC is normal. Coagulation studies are normal, but bleeding time is prolonged. The AGACNP recognizes that initial management of this patient will include

  • A. Avoidance of elective surgery and nonessential medications
  • B. Prednisone 60 mg daily until platelets normal
  • C. Monoclonal antibody therapy such as rituximab
  • D. Splenectomy
Correct Answer: A

Rationale: The correct answer is A: Avoidance of elective surgery and nonessential medications. This is the initial management for a patient with thrombocytopenia and abnormal bleeding time, possibly indicating immune thrombocytopenic purpura (ITP). Avoiding surgery and medications that can worsen thrombocytopenia is crucial to prevent bleeding complications. Prednisone (B) is not the first-line treatment for ITP, especially without confirming the diagnosis. Monoclonal antibody therapy (C) such as rituximab is usually reserved for refractory cases. Splenectomy (D) is considered only if other treatments fail as a last resort.

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Why is it important to monitor blood pressure regularly in pregnant women?

  • A. To prevent anemia
  • B. To detect preeclampsia
  • C. To avoid preterm labor
  • D. To prevent gestational diabetes
Correct Answer: B

Rationale: It is important to monitor blood pressure in pregnant women to detect preeclampsia, a serious condition that can lead to complications for both the mother and the baby. Preeclampsia is characterized by high blood pressure and protein in the urine, and early detection is crucial for timely intervention. Regular monitoring allows healthcare providers to identify and manage preeclampsia promptly, reducing the risk of severe complications such as eclampsia and organ damage. Anemia, preterm labor, and gestational diabetes are important aspects of prenatal care but are not directly related to the need for regular blood pressure monitoring in pregnant women.

Which of the following is an indication for forceps delivery?

  • A. Cephalopelvic disproportion
  • B. Occipito posterior position
  • C. Breech presentation
  • D. Placenta abruption
Correct Answer: B

Rationale: The correct answer is B: Occipito posterior position. Forceps delivery may be indicated in this situation to help rotate the baby's head and facilitate delivery. Occipito posterior position can lead to prolonged labor and fetal distress, making forceps delivery necessary for a safe delivery.

Incorrect choices:
A: Cephalopelvic disproportion is not an indication for forceps delivery as it refers to mismatch between the size of the baby's head and the mother's pelvis.
C: Breech presentation typically requires a different approach such as cesarean section rather than forceps delivery.
D: Placenta abruption, a medical emergency, would not be managed with forceps delivery but rather require immediate intervention to prevent harm to both the mother and baby.

Bruised and oedematous appearance of the uterus, associated with placenta abruption is collectively referred to as

  • A. Wernicke’s encephalopathy
  • B. Uterine prolapse
  • C. Couvelaire uterus
  • D. Asherman’s syndrome
Correct Answer: C

Rationale: The correct answer is C: Couvelaire uterus. This condition refers to the bruised and edematous appearance of the uterus associated with placental abruption. Placental abruption occurs when the placenta separates from the uterine wall prematurely, leading to bleeding and a compromised blood supply to the uterus. The bruised appearance is due to blood infiltrating the myometrium.

Explanation for other choices:
A: Wernicke’s encephalopathy - This is a neurological disorder caused by thiamine deficiency, not related to uterine issues.
B: Uterine prolapse - This is the descent or herniation of the uterus into or beyond the vaginal canal, not related to placental abruption.
D: Asherman’s syndrome - This is characterized by intrauterine adhesions or scar tissue, typically a result of uterine surgery, not associated with placental abruption.

Which one of the following fetal positions is associated with intense back pain during labor?

  • A. Occipito-anterior
  • B. Transverse position
  • C. Occipito-posterior
  • D. Occipito-lateral
Correct Answer: C

Rationale: The correct answer is C: Occipito-posterior. This position occurs when the baby's head is facing forward but towards the mother's spine. This position can cause intense back pain during labor because the baby's head puts pressure on the mother's lower back. Occipito-anterior (A) is the most common and ideal position for labor. Transverse position (B) is when the baby is lying sideways, which may cause prolonged labor but not necessarily intense back pain. Occipito-lateral (D) is a less common position where the baby's head is facing sideways, which may not specifically cause intense back pain.

While participating in sports, it is not uncommon for people to be subjected to sudden rotational injuries that result in the abrupt rotation of the cerebral cortex around the more fixed midbrain structures. This can interrupt input and outflow from the reticular activating system and result in what clinical phenomenon?

  • A. Epidural hematoma
  • B. Uncal herniation
  • C. Concussion
  • D. Contrecoup injury
Correct Answer: C

Rationale: Step 1: Sudden rotational injuries can disrupt brain function.
Step 2: Abrupt rotation of the cerebral cortex can affect the reticular activating system.
Step 3: Disruption of the reticular activating system can lead to altered consciousness.
Step 4: Altered consciousness is a hallmark of a concussion.
Therefore, the correct answer is C: Concussion. Other choices are incorrect because an epidural hematoma involves bleeding between the skull and dura (A), uncal herniation involves brain shifting through tentorium (B), and contrecoup injury occurs opposite the site of impact (D).

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