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Palestine Medical Council Previous Part I Exam- MCQs 1- Regarding carbohydrate metabolism in normal pregnancy , the following is true except A. B. C. D. E. fasting hyperglycemia , postprandial hyperglycemia and hyperinsulinemia fasting hypoglycaemia , postprandial hypoglycaemia and hypoinsulinemia fasting hypoglycaemia , postprandial hyperglycemia and hyperinsulinemia fasting hypoglycaemia, postprandial hypoglycaemia and hyperinsulinemia fasting hyperglycemia, postprandial hypoglycaemia and hypoinsulinemia 2- Thrombocytopenia during pregnancy is defined as platelet number between ; A. B. C. D. E. 120.000- 150.000 100.000- 120.000 80.000- 100.000 50.000-80.000 20.000- 50.000 3- The following is true during pregnancy A. first heart sound shows decrease splitting B. cardiac output at term increase almost 10% when the pregnant woman was moved from her back to her left side C. the arteriovenous oxygen gradient increase in pregnancy D. left ventricular function increase during pregnancy E. the increase in read cell mass occurs steadly until tearm 4- The following are true in human cytogenetics EXCEPT: A. B. C. D. E. the Y chromosome is acrocentric pentasomy of sex chromosomes is compatible with life trisomy 16 is the commonest trisomy found in first trimester spontaneous abortions trisomy 1 is present in almost 10% of the first trimester spontaneous abortion a cause of trisomy is non-disjunction at meiosis 5- Testicular feminisation is characterized by: A. B. C. D. E. XY mosaicism A hypoplastic uterus Chromatine negative Poorly developed breasts Pure Gonadal dysgenisis 6- One of the following conditions is X linked: A. B. C. D. E. congenital adrenal hyperplasia Duchenne muscular dystrophy Classical achondroplasia Hurler’s syndrome Glactosaemia 7- All are true about standard deviation EXEPT: A. is a test of significance 1 B. C. D. E. gives an indication of the scatter of the observations can only apply to a normal distribution is calculated from the mean and the number of observation is not the same as the median 8- The following is falls during pregnancy A. B. C. D. E. functional residual capacity and the residual volume decrease respiratory acidosis occurs glomerular filtration rate and renal plasma flow increase hydroureter and hydronephrosis maximal intraurethral pressure increase from 70 to 90 cm H2O 9- The following is true in pregnancy except A. B. C. D. E. gastric empting time is not prolonged alkaline phosphates , double . the pituitary gland enlarges by approximately 135% plasma prolactine decrease during pregnancy the amniotic fluid has no prolactin . 10 – The following affect the Q- T interval in ECG in pregnancy except A. B. C. D. E. digoxin . quinidine. magnesium heart rate it is between 2.5 and 3.0 large squares 11- The following is true in pregnancy A. B. C. D. E. the thyroid volume is unchanged T3 decreased hyperparathyroidism aldosteron increase dehydroepiandrosterone sulphate decrease 12- Regarding nervous system which of the following is true A. B. C. D. E. pregangilionic sympathetic fibres are short cholinergic stimulation leads to decrease bronchial secreations pilcarpine decrease the activity of endings of parasympathetic neurons fibres from temperature receptore dose not cross the midline of spinal cord cortical lesions affect pain sensations 13- Regarding iron deficiency anemia the following is true A. B. C. D. 8.5mg/day is the daily requirement of iron in pregnancy normal plasma ferritin is 150-300micro grams/liter increase in MCHC occurs in severe forms of iron depletion ferritin is aglycoprotein affected by recent iron ingestion 14 – The following is true about urinary bladder A. residusl volume is 100 mg B. maximum flow rate is 80 mls/second C. voiding volume between 220 – 320 mml 2 D. bladder capacity is 300mml E. voiding pressure is 145-170 cm H2O 15-In human genetics A. B. C. D. E. the total number of chromosomes in both normal male and female is 23 in the female the sex chromosome are XY chromatin positive cells are characteristics of normal males the sexual differentiation of the fetal gonads occurs the seventh week the Y chromosome determines the development of the ovary 16-The following are true about fetal circulation EXCEPT: A. B. C. D. E. the foramen ovale permits blood to pass from right to left atrium the ductus arteriosus carries blood from the pulmonary artery to the aorta the ductus venosus carries blood to the inferior vena cava from the umbilical artery the ductus arteriosis is contractile the umbilical vein becomes the ligamentum teres of the adult 17- In the development of fetal sex organs: A. the pronephric duct degenerates as the mesonephros develops B. ova originates outside the developing gonads C. the presence of ovaries is necessary for the development of the paramesonephric ducts D. the vagina is formed entirely by invagination of the paramesonephric ducts E. sexual differentiation of the external genitalia is complete before the tenth week of life 18- The Mullerian ducts: A. B. C. D. E. are derived from intermediate cell mass appear between the eighth and ninth weeks of embryonic development develop lateral to the Wolffian ducts fuse throughout their length by the 12th week of fetal development become the sinovaginal bulbs in their lower part 19-Features of untreated Turner’s syndrome include: A. B. C. D. E. a low serum gonadotrophin levels high serum estrogen levels hot flushes lymphoedema increased incidence of gonadal malignant tumor 20- All are true about amniotic fluid EXCEPT: A. B. C. D. E. is more alkaline than blood has decreased bilirubin concentration with increased gestation contains glial cells in the presence of open neural tube defects does not contain fibrinogen has increased insulin concentrate with increased gestation 21- All are true about fetal circulation EXCEPT: 3 A. B. C. D. E. the foramen ovale permits blood to pass from the right to the left atrium the ductus arteriosus carries blood from the pulmonary artery to the aorta the ductus venosus carries blood to the inferior vena cava from the umbilical artery the ductus arteriosus is contractile the umbilical vein becomes the ligamentum teres of the adult 22- Select the antibiotic most frequently associated with the following fetal side effects. A. B. C. D. E. Tetracycline. Streptomycin. Nitrofurantoin. Chloramphenicol. Sulfonamides. 23-Which of the following statements about twinning is true? A. B. C. D. E. The frequencies of monozygosity and dizygosity are the same. Division after formation of the embryonic disk results in conjoined twins. The incidence of monozygotic twinning varies with race. A dichorionic twin pregnancy always denotes dizygosity. Twinning causes no appreciable increase in maternal morbidity and mortality over singleton pregnancies. 24-Velamentous insertion of the cord is associated with an increased risk for A. B. C. D. Premature rupture of the membranes. Fetal exsanguinations before labor. Torsion of the umbilical cord. Fetal malformations. E. Uterine malformations. 25-A pelvis characterized by an anteroposterior diameter of the inlet greater than the transverse diameter is classified as: A. B. C. D. Gynecoid. Android. Anthropoid. Platypelloid. 26-An abnormal attitude is illustrated by A. B. C. D. E. Breech presentation. Face presentation. Transverse position. Occiput posterior. Occiput anterior. 27-Which of the following statements concerning placenta previa is true? A. B. C. D. E. Its incidence decreases with maternal age. Its incidence is unaffected by parity. The initial hemorrhage is usually painless and rarely fatal. Management no longer includes a double setup. Vaginal examination should be done immediately on suspicion of placenta previa. 4 28- A patient at 17 weeks gestation is diagnosed as having an intrauterine fetal demise. She returns to your office 5 weeks later and has not had a miscarriage, although she has had some occasional spotting. This patient is at increased risk for A. B. C. D. E. Septic abortion. Recurrent abortion. Consumptive coagulopathy with hypofibrinogenemia. Future infertility. Ectopic pregnancies. 29-Indications for instituting single-agent chemotherapy following evacuation of a hydatidiform mole usually include A. B. C. D. E. A rise in hCG titers. A plateau of hCG titers for 1 week. Return of hCG titer to normal at 6 weeks after evacuation. Appearance of liver metastasis. Appearance of brain metastasis. 30- A 27-year-old has just had an ectopic pregnancy. Which of the following events would be most likely to predispose to ectopic pregnancy? A. B. C. D. E. Previous tubal surgery. Pelvic inflammatory disease (PID). Use of a contraceptive uterine device (IUD). Induction of ovulation. Exposure in utero to diethylstilbestrol (DES). 31-All of the following are appropriate tocolytics for this patient except A. B. C. D. E. Indocin. Nifedipine. Terbutaline. Ritodrine. Magnesium sulfate. 32-At 29 weeks gestational age, it becomes apparent that the fetus has developed hydrops. All of the following are characteristics of fetal hydrops except A. B. C. D. E. Polyhydramnios. Small placenta. Pericardial effusion. Ascites. Subcutaneous edema. 33- A pregnant woman is discovered to be an asymptomatic carrier of Neisseria gonorrhoeae. A year ago, she was treated with penicillin for a gonococcal infection and developed a severe allergic reaction. Treatment of choice at this time is A. Tetracycline. 5 B. C. D. E. Ampicillin. Spectinomycin. Chloramphenicol. Penicillin. 34-True statements concerning infants born to mothers with active tuberculosis include which of the following? A. The risk of active disease during the first year of life may approach 90% without prophylaxis. B. Bacille Calmette-Guerin (BCG) vaccination of the newborn infant without evidence of active disease is not appropriate. C. Future ability for tuberculin skin testing is lost after BCG administration to the newborn. D. Neonatal infection is most likely acquired by aspiration of infected amniotic fluid. E. Congenital infection is common despite therapy. 35-A 21-year-old has difficulty voiding 6 h postpartum. The least likely cause is which of the following? A. B. C. D. E. Preeclampsia. Infusion of oxytocin after delivery. Vulvar hematoma. Urethral trauma. Use of general anesthesia. 36- Breast-feeding can be encouraged despite which of the following conditions? A. B. C. D. E. Maternal hepatitis B. Maternal reduction mammoplasty with transplantation of the nipples. Maternal acute puerperal mastitis. Maternal treatment with lithium carbonate. Maternal treatment with tetracyclines. 37-A 50-year-old woman is diagnosed with cervical cancer. Which lymph node group would be the first involved in metastatic spread of this disease beyond the cervix and uterus? A. B. C. D. E. Common iliac nodes. Parametrial nodes. External iliac nodes. Paracervical or ureteral nodes. Paraaortic nodes. 38- Which of the following is consistent with a diagnosis of delayed puberty? A. B. C. D. Breast budding in a 10-year-old girl. Menarche delayed beyond 16 years of age. Menarche 1 year after breast budding. FSH values less than 20 mIU/mL. 39- Which of the following medications is used as first-line therapy in the treatment of endometriosis? A. Unopposed estrogens. 6 B. C. D. E. Dexamethasone. Danazol. Gonadotropins. Parlodel. 40- During the evaluation of secondary amenorrhea in a 24-year-old woman, hyperprolactinemia is diagnosed. Which of the following conditions could cause increased circulating prolactin concentration and amenorrhea in this patient? A. B. C. D. E. Stress. Primary hyperthyroidism. Anorexia nervosa. Congenital adrenal hyperplasia. Polycystic ovarian disease. 41-The presentation of Asherman syndrome typically involves A. B. C. D. E. Hypomenorrhea. Oligomenorrhea. Menorrhagia. Metrorrhagia. Dysmenorrhea. 42- Following a cesarean birth, contraindications for a trial of labor in a subsequent pregnancy include A. B. C. D. E. Breech presentation. Lack of prior vaginal delivery. The fact that the first section was for cephalopelvic disproportion (CPD). Unavailability of x-ray pelvimetry. Classic cesarean section scar. 43- A patient at 17 weeks gestation is diagnosed as having an intrauterine fetal demise. She returns to your office 5 weeks later and has not had a miscarriage, although she has had some occasional spotting. This patient is at increased risk for A. B. C. D. E. Septic abortion Recurrent abortion Consumptive coagulopathy with hypofibrinogenemia Future infertility Ectopic pregnancies 44-The following arteries are branches of the internal iliac artery , except A. B. C. D. E. internal pudendal ovarian iliolumber obturator middle rectal 45 – The pudendal nerve A. B. C. D. lies medial to the ischial spine arises from S3,4,5 . contains parasympathetic fibres to the anal canal receives sensory fibres from the cervix 7 46- The uterine cervix , except A. B. C. D. E. has a canal lined by columnar epithelium has an alkalin secreations loses the whole of its lining during menstruation undergoes cyclic changes during the menstrual cycle has a profuse watery discharge during ovulation 47- The gynaecoid pelvis , except A. B. C. D. is the commonest type of feemal pelvis has a wider aneroposterior than transvers diameter at the prim has a shallow , wide sacrosciatic notch has parallel pelvic side – walls 48- The primary source of progesterone during the reproductive cycle of a non-pregnant female is (are) the: A. B. C. D. E. granulosa cells. theca cells. corpus luteum. pituitary. hypothalamus 49-GnRH, all are false EXCEPT: A. B. C. D. E. is distinct from LH-RH is produced in the posterior pituitary is a decapeptide produced in pulses at ninety minute exerts its main effect directly on the ovary is used to induce ovulation in IVF programmes intervals 50- Life cycle of Corpus luteum is completed in: A. B. C. D. 6 - 12 days 12 - 14 days 14 - 18 days 18 - 22 days 51- During nonnal menstrual cycle. ovulation occurs as a result of A. excess Estrogen level B. low Estrogen level C. surge of leutenizing hormone D. low level of HCG 52- The intercellular chemical signal that is released by cells and has a local effect on the same cell type as that from which the chemical signal is released is: A. autocrine chemical signal B. pheromone 8 C. paracrine chemical signal D. hormone E. neurotransmitter 53-Estrogen,progesterone, testosterone, and glucocorticoids are all examples of: A. B. C. D. E. proteins. glycoproteins. polypeptides. amino acid derivatives. steroids 54- Which of the following is not associated with an increased risk for ovarian carcinoma ? A. B. C. D. Nulliparity Radiation exposure A diet low in fibre and Vit A. Familial tendency 55- Approximately 75 - 80% of ovarian tumors originate from: A. Epithelium B. Stroma C. Germ cells D. Mesoderm E. Unclassified tissue 56- A 26 year old nullipara presents with smooth , pedunculated ovarian mass anterior to the uterus. What is the most likely diagnosis? A. luteoma B. cystic teratoma C. theca lutein cyst D. serous cystadenoma E. brenner's tumor 57- Germ cell tumours, all are true EXCEPT: A. Are all malignant B. Progress in patients with endodermal sinus tumours can be monitored using alphafetoprotein (AFP) C. Etoposide is a useful agent for anaplastic tumours D. Lactate denydrogenase (LDH) may be raised in some of these tumours 58- The Brenner tumour of the ovary, all are false EXCEPT: A. B. C. D. Is not hormonally active Is classified as a germ cell tumour Usually measures 6-10 cm in diameter Contains nests of epithelial cells 59-Which one of the following statements is false? A. B. C. D. During sexual excitement, breasts swell due to vasocongestion. During sexual excitement, nipples become erect. During sexual excitement, vaginal smooth muscles constrict During orgasm, the vagina contracts. 9 E. Orgasm in women consists of 3-15 rhythmic contractions of the uterus 60- In which of the following is there an absent vagina? A. B. C. D. E. Androgen insensitivity Turner syndrome CAH in female adrenal hyperplasia Gonadal agenesis 61-A 55 year old woman has recurrent urinary retention after a hysterectomy done for huge fibroid. The most likely cause is: A. B. C. D. Atrophic and stenotic urethra. Lumbar disc prolapse. Injury to the bladder neck. Injury to the hypogastric plexi 62- Detrusor instability, all are false EXCEPT: A. B. C. D. May occur de novo after bladder neck surgery A pressure rise during filling of between 5-15 CmH2O Always symptomatic Implies a neurological disorder 63- Which one of the following is not associated with cervical carcinoma? A. B. C. D. Multiple sexual partners Human papilloma virus (HPV) Young age at first sexual intercourse Intrauterine contraceptive devices (IUCDs) 64- The age at which the peak incidence of cervical carcinoma develops. Choose the single most likely time or time-interval: A. B. C. D. E. 30 years 45 years 50 years 55 years 65 years 65- Intrauterine contraceptive devices (IUDs) except : A. B. C. D. E. Increase the risk of pelvic inflammatory disease. Are commonly used as a method of contraception in Egypt. May be used in a nulligravida. Act through prevention of implantation. Commonly cause an increase in menstrual flow. 66- Using a condom and spermicide concurrently has a method effectiveness rate of: A. B. C. D. 50 percent 75 percent 85 percent >90 percent 10 67- Vulval Dystrophy, all are true EXCEPT: A. Associated with pruritis B. Extends to perineum C. Premalignant condition D. Malignant condition E. Histological diagnosis 68- Melanoma of the vulva, all are false EXCEPT: A. B. C. D. E. constitutes 2 to 9 percent of most series of vulvar cancer occurs mostly in the fifth decade occurs mostly in premenopausal women has an overall survival rate of 70 percent is non aggressive 69- Female pseudohermaphrodites have a genetic karyotype with: A. B. C. D. E. xx xy xy/xo xxx xx/xy 70- Side effects of Gn RH agonists includes all of the following EXCEPT A. B. C. D. E. Hot flashes Vaginal dryness Bone resorption & osteoporosis Headache Decreased high density lipoproteins 71- According to Tanner, which developmental stage of pubic hair and breast development is characterized by downy pubic hair and breast buds? A. B. C. D. 1 2 3 4 72- The production of testosterone in the interstitial cells is stimulated by: A. B. C. D. inhibin. luteinizing hormone (LH). follicle-stimulating hormone (FSH). progesterone 73- Viability of sprmatozoa in Female genital tract is: A. 6 hrs B. 24 hrs C. 48 hrs D. 12 hrs 11 74- Characteristic features of choriocarcinoma include which of the following: A. B. C. D. Haematuria Gastritis Haemoptysis and vaginal bleeding Haematemesis 75-All of the following are features of good-prognosis metastatic gestational trophoblastic disease except: A. B. C. D. E. Serum beta-hCG of less than 40,000 mIU/mL. Disease duration of less than four months. Gestational trophoblastic disease following a normal term pregnancy. No metastases to the brain or liver. All of the above are features of good-prognosis gestational trophoblastic disease 76- Which of the following side effects is least common with cisplatin? A. B. C. D. E. Thrombocytopenia Hypomagnesimia Cardiac toxicity Neuropathy High frequency hearing loss 77- The most common sarcoma of the uterus is: A. B. C. D. E. endometrial stromal sarcoma carcinosarcoma leiomyosarcoma mixed mesodermal sarcoma rhabdomyosarcoma 78- Carcinoma of the ovary: A. B. C. D. E. Are the most common malignant tumor of the female genital tract. Is classified as stage II if it has spread to the pelvic peritoneum. Can be detected by tumor markers. The most important route of spread is by lymphatics. Occurs only in old females. 79- Mucin secreting tumors of the ovary,except A. B. C. D. Can reach huge sizes. Are usually bilateral. Are usually multilocular. Can be seen by ultrasound 12 80- A 21-year-old woman comes to the physician because of "bumps" on her vulva that she has just recently noticed. These bumps do not cause her symptoms, but she wants to know what they are and wants them removed. She has no medical problems, takes no medications, and has no allergies to medications. She smokes one-half pack of cigarettes per day. She is sexually active with 3 partners. Examination shows 3 cauliflower-like lesions on the right labia majora. Which of the following is the most appropriate next step in management? A. Acyclovir B. Penicillin C. Cone biopsy D. Cryotherapy E. Vulvectomy 81-A 29-year-old patient comes to the physician for an annual examination. She has normal menstrual periods every 30 days. She was 15 years old when she first began having intercourse. She uses condoms for contraception. Her past medical history is significant for multiple sclerosis. This condition has required her to use a wheelchair for the past 4 years, which makes pelvic examination somewhat difficult for her. She smokes one pack of cigarettes per day. Given her difficulty with the pelvic examination, she inquires as to how often she needs to have a Pap smear performed. Which of the following is the correct answer? A. A Pap smear should be performed every year B. A Pap smear should be performed every 3 years C. A Pap smear should be performed every 5 years D. A Pap smear should be performed only if there are symptoms E. A Pap smear is not necessary 82-A 32-year-old nulliparous woman at 38 weeks' gestation comes to the labor and delivery ward with regular painful contractions after a gush of fluid two hours ago. Her temperature is 98.6 F (37 C). She is found to have gross rupture of membranes and to have a cervix that is 6 centimeters dilated. The fetus is in breech position. The patient is then brought to the operating room for cesarean delivery. Which of the following represents the correct procedure for antibiotic administration? A. Administer intravenous antibiotics 30 minutes prior to the procedure B. Administer intravenous antibiotics after the cord is clamped C. Administer intravenous antibiotics immediately after the procedure D. Administer intravenous antibiotics for 24 hours after the procedure E. Administer oral antibiotics for 1 week following the procedure. 13 83- A 32-year-old woman, gravida 2, para 2, comes to the physician for followup of an abnormal Pap test. One month ago, her Pap test showed a high-grade squamous intraepithelial lesion (HGSIL). Colposcopy demonstrated acetowhite epithelium at 2 o'clock. A biopsy taken of this area demonstrated HGSIL. Endocervical curettage (ECC) was negative. The patient has no other medical problems, has never had cervical dysplasia, and takes no medications. Which of the following is the most appropriate next step in management? A. Repeat Pap test in 1 year B. Repeat Pap test in 6 months C. Repeat colposcopy in 6 months D. Loop electrode excision procedure (LEEP) E. Hysterectomy 84- A previously healthy 21-year-old woman has a profuse, malodorous vaginal discharge. Examination shows a greenish gray "frothy" discharge with a "fishy" odor and petechial lesions on the cervix. There is no cervical motion tenderness. Her temperature is 37.5 C (99.4 F), blood pressure is 120/80 mm Hg, pulse is 60/min, and respirations are 16/min. Microscopic evaluation of the discharge is most likely to show which of the following? A. "Clue cells" B. Gram-negative diplococci C. Gram-positive diplococci D. Motile, flagellated organisms E. Pseudohyphae or hyphae 85- A 24-year old woman comes to the physician because of burning with urination. She states that every time she urinates there is pain and that she has a feeling that she constantly needs to urinate even though only a little comes out. She has never had any similar symptoms before. She has no medical problems and no known drug allergies. Examination is unremarkable. Urinalysis demonstrates that the urine is positive for leukocyte esterase and nitrites. Which of the following is the most appropriate pharmacotherapy? A. Intramuscular ceftriaxone B. Intravenous levofloxacin C. Oral levofloxacin for 7 days D. Oral trimethoprim-sulfamethoxazole for 3 days E. Wait for the culture results to institute therapy 86- which of the following is most likely to be damaged during parturition A. B. C. D. ureter ovary urethra round ligament of the uterus 87- The ureter all true except A. B. C. D. are innervated by the renal nerve plexus obtain blood supply from the branches of the common iliac arteries pass above the lateral fornix of the vagina lie medial to the ampulla of the ductus deferenc 14 88- The ureter is lined by A. B. C. D. simple cuboidal epithelium transitional epithelium pseudostratified columnar epithelium mesothelium 89- The mucosa of the bladder is covered by A. B. C. D. endothelium transitional epithelium squamous non-keratinized epithelium ciliated columnar epithelium 90- A 75 year old woman presents with a 7cm adnexal mass . approximately what percentage of such masse in postmenopausal women are malignant ; A. B. C. D. 10% 30% c-50% 70% 91- the incidence of sarcomatous degeneration in uterine leiomyoma is A. B. C. D. <1% 3% 10% 15% 92- The risk of placenta accreta in women with a placenta previa with four or more previous CS is A. B. C. D. 1 to 5 percent, b-11 to 25 percent 35 to 47 percent 50 to 67 percent 93- Treatment of Asherman syndrome involve lysis of the adhesions and treat with : A. B. C. D. estrogen progesterone steroid oral contraceptive 94- the most common chromosomal abnormality in abortuses is A. B. C. D. trisomy 45, XO triploidy unbalanced translocation 15 95- The following risks apply to drug administration in first trimester in pregnancy A. B. C. D. sodium valproate and neural tube defects tetracycline and dental discoloration metronidazol and skeletal abnormalities azathioprine and cranio-facial abnormality 96- the most significant prognostic factor in cervical carcinoma is A. B. C. D. Histological type tumour volume smoking age 97- fetal blood is returned to the umbilical arteries and the lacenta through the : A. B. C. D. E. hypogastric arteries ductus venosus portal vein inferior vena cava foramen ovale 98- A 20 week anomaly scan will detecte the following percentage of anomalies A. B. C. D. 60% of trisomy 30% of cardiac anomaly 90% of cases of duodenal atresia 80% of cleft lip 99- in a pregnant woman whose first and only delivery was by cs for a breech presentation ; A. B. C. D. E. the chance of vaginal delivery are over 60% the risk of scar rupture or dehiscence is over 1% erec lateral pelvimetry should be performed to exclude CPD intrauterine pressure monitoring has been shown to reduce risk of uterin rupture continous electronic fetal heart rat monitoring should not be used in labour 100- epidurals are indicated in labour in the following cardiovascular condition A. B. C. D. E. previous myocardial infarction ( MI) aortic stenosis hypertrophic obstructive cardimyopathy eisenmengers syndrome pulmonary hypertention 16