Amref virtual training school krchn upgrading programme



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AMREF VIRTUAL TRAINING SCHOOL

KRCHN UPGRADING PROGRAMME

SEPTEMBER 2013 CLASS MID MODULE 2 EXAMINATION

DATE: FRIDAY, 4TH July, 2014.

TIME ALLOWED: 3 Hours TIME: 2:00PM- 5.00 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 I: MCQS (20 MARKS)

  1. Corpus luteum secretes;

  1. Follicle stimulating hormone and oestrogen

  2. Oestrogen and progesterone

  3. Luteinising hormone and estradiol

  4. Estradiol and progesterone

2. The main substance excreted from the fetus in utero is;



  1. Bilirubin

  2. Uric acid

  3. Meconium

  4. Carbon dioxide

3. Infant risk factors for mother to child transmission of HIV include;



  1. Low birth weight, high viral load, breastfeeding

  2. Prematurity, APH, vacuum delivery

  3. Mixed feeding, birth injuries, low birth weight

  4. High viral load, birth injuries, prematurity

4. The hormones that facilitate the mobility of pelvic joints during pregnancy and labour are;



  1. Relaxin and oestrogen

  2. Relaxin and progesterone

  3. Oxytocin and progesterone

  4. Oestrogen and progesterone

5. During the first examination of a newborn, the midwife noted a vertebral defect located at the 5th lumbar vertebrae and characterised by a small dimple. The defect is likely to be;



  1. Chiari malformation

  2. Spina Bifida Occulta

  3. Meningocele

  4. Meningo myelocele

6. The followings were the clinical findings of a client seen at the gynaecological clinic: moderate vaginal bleeding, dilated cervix, uterine size less than the gestational dates and abdominal cramping. These are features of;

  1. Threatened abortion

  2. Missed abortion

  3. Complete abortion

  4. Inevitable abortion

7. Causes of hyperthermia in newborns include;



  1. Hypoglycaemia,sepsis,delayed drying

  2. Respiratory distress, sepsis,delayed feeding

  3. Sepsis, brain injury,overheating

  4. Prematurity,hyperglycaemia,sepsis

8. Partograph is started in labour when:



  1. Cervical OS is 2 cm and above dilated

  2. Cervical OS is 4 cm and above dilated

  3. There is true labour irrespective of dilatation

  4. The contractions are moderate or severe

9. Non invasive procedures in the management of shoulder dystocia include;



  1. All fours, episiotomy, woods manouvre

  2. McRoberts, episiotomy, Rubin’s manouvre

  3. Zavanelli manoeuvre,all fours,suprapubic pressure

  4. All fours,suprapubic pressure,McRoberts

10. Signs of impeding eclampsia include;



  1. Vomiting, convulsions, nausea

  2. Oedema, proteinuria, hypertension

  3. Blurred vision, epigastric pain, severe frontal headache

  4. Hypertension, blurred vision, coma

11. The indications of vaginal examination when admitting a mother in labour are;



  1. Assessing pelvic adequacy, assessing progress of labour, checking if membranes are intact

  2. Checking presentation, assessing stage of labour, assessing pelvic adequacy

  3. Assessing progress of labour, assessing descent, assessing pelvic adequacy

  4. Confirming presentation, checking if membranes are intact, assessing progress of labour

12. Indicate whether the following statements are true (T) or false (F)



  1. In pre-eclampsia, there is depletion of intravascular fluid

  2. Eclampsia may occur without proteinuria

13. During labour, retraction of the uterine muscle facilitates;

  1. Good blood flow to the placental site

  2. Rupture of membranes

  3. Formation of the upper and lower uterine segments

  4. Descent of the fetus

14. Pelvic abdominal palpation on a pregnant woman is done to:



  1. Locate foetal pole to determine presentation

  2. Locate foetal back to determine position

  3. Ascertain the level of engagement

  4. Rule out speenomegally in case of jaundice

15. Polarity in the first stage of labour means:



  1. Neuro muscular harmony that prevails between the two uterine segments

  2. Formation of the upper and lower uterine segments

  3. Painless uterine contractions felt by the woman

  4. Contractions that starts from the cornua and spread towards the lower uterine segment

16. The processes that bring about involution of the uterus include;



  1. Autolysis and hypertrophy

  2. Haemolysis and ischaemia

  3. Hypertrophy and haemolysis

  4. Ischaemia and haemolysis

17. The characteristics of caput succedaneum include



  1. Present at birth, pits on pressure, may cross a suture

  2. Appears after 12 hours, always unilateral, tends to grow less

  3. Persists for weeks, never crosses a suture, usually bilateral

  4. Disappears within 36 hours, pits on pressure, tends to grow larger

18. During a vaginal exam, a midwife felt the foetal sutures apposed but reducible. This is indicated on the partograph as:



  1. +

  2. +++

  3. ++

  4. 0

19. The characteristics of a post- term infant include;

  1. Worried look, firm skull bones, wrinkled skin

  2. Soft flat pinnae, overgrown nails, dry loose skin

  3. Loose dry skin, small fontanelles, and narrow sutures

  4. Wide fontanelles, soft skull bones, narrow sutures

20. A diagnosis of occipital posterior position during labour is made vaginally by feeling;



  1. Anterior fontanelle on the anterior part of the pelvis

  2. Posterior fontanelle on the anterior part of the pelvis

  3. Anterior fontanelle on the posterior part of the pelvis

  4. Posterior fontanelle on the posterior part of the pelvis

Part II: Short answer questions (40 marks)

  1. Draw a labelled diagram of the sagittal section of the female pelvis (5 marks)

  2. Outline two (2) millennium development goals related to maternal and newborn health (2 marks)

  3. State five(5) areas of emphasis you would share with a client during pre-conception care (5 marks)

  4. List four (4) features of placenta praevia (2 marks)

  5. State five (5) possible risk factors for ectopic pregnancy (5 marks)

  6. Explain five (5) changes that occur to the gastro- intestinal system during pregnancy (5 marks)

  7. Outline six (6) neonatal danger signs (6 marks)

  8. State five (5) non contraceptive benefits of combined oral contraceptives (5 marks)

  9. State five (5) causes of physiological jaundice (5 marks)

Part III: Long answer questions (40 marks)

  1. Baby X is admitted in neonatal unit with a diagnosis of prematurity.

  1. Define prematurity (1 mark)

  2. Describe the management of baby X for the first 48 hours. (14 marks)

  3. State five (5) advantages of kangaroo mother care to a baby (5 marks)

  1. Ms. B para 0+0 is brought to the labour ward with complaints of lower abdominal pains and backache. On examination, she is found to be in second stage of labour.

  1. State three (3) probable signs of second stage of labour (3 marks)

  2. Explain the specific management of Ms. B during labour (12 marks)

  3. Explain five (5) possible complications during second stage of labour (5 marks)



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