Postpartum Hemorrhage and Coagulation disorder

 Postpartum Hemorrhage and Coagulation disorder:

1. Regarding Postpartum haemorrhage:

A. May occur as a consequence of Antepartum haemorrhage.

B. Ends with Hypercoagulable state

C. Hysterectomy is the first the first line of treatment

D. Always complicate intrauterine fetal death (IUFD)

E. Diagnosed only when the placenta is still undelivered

2. Regarding Secondary postpartum haemorrhage:

A. Is diagnosed when bleeding occurs 72 hours after delivery

B. Contra indicate breast feeding

C. The commonest cause is the cervical tears

D. Very common when the patient delivers a congenitally abnormal baby

E. Choriocarcinoma could be a cause.

3. In Abruptio placenta: Which is true?

A. It is bleeding from abnormally situated placenta

B. Has minimum effect on the fetus

C. Causes painless bleeding

D. Can be a cause of post partum hemorrhage

E. All should deliver by caesarean section

4. Atonic Post partum hemorrhage is best managed with :

A. Intra-venous progesterone

B. 0.5 mg oral ergometrine and uterine massage

C. 5 units oral syntocinon and uterine massage

D. Uterine massage

E. Uterine massage with 40 units syntocinon in 500 ml D5 % NS to be given

Intravenously

5. Postpartum hemorrhage can occur due to all the followings EXCEPT:

A. Fetal macrosomia.

B. Polyhydramnios.

C. Placenta brevia.

D. Abruptio placenta.

E. Postdate pregnancy.

6. Disseminated intravascular coagulation (DIC) :

A. Can be managed by leukocyte transfusion

B. Can cause decrease fibrinogen degeneration products

C. Can cause decrease PT , PTT

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D. Is characterized by increase platelet count

E. Can be encountered in case of IUFD

7. All of the following circumstances should alert an obstetrician to an increased

likelihood of postpartum hemorrhage EXCEPT:

A. Prolonged labor

B. Rapid labor

C. Postdate pregnancy

D. Oxytocin stimulation

E. Twin pregnancy

8. In DIC: Disseminating intravascular coagulation

A. The level of FDP (Fibrinogen degeneration products) is low

B. Platelet count is high

C. Bleeding time is prolonged

D. PT and PTT are normal

E. The Fibrinogen level is high

9. Clinical Presentation of DIC include the following EXCEPT:

A. Bleeding from IV sites

B. Hematuria

C. Failure active surgical hemostasis

D. Increase temperature (fever)

E. Epistaxis

10. Clinical causes of DIC ( disseminating intravascular coagulation ) include the

following EXCEPT :

A. Ectopic pregnancy

B. Septic abortion

C. Mild pre-eclampsia

D. The use of tampons

E. IUFD

11. The treatment of DIC may include the following EXCEPT:

A. Heparin

B. Packed RBCs

C. Platelet transfusion

D. Leukocyte transfusion

E. Cryoprecipitate

12. Ergometrine to control post-partum hemorrhage :

A. Is contraindicated in patient with high blood pressure

B. It will not act on the smooth muscle of the blood vessels

C. Intravenous root is the only way to be given

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D. It can be used for induction of labor

E. Is safe in cardiac patient

13. A 28 years old patient complains of the amenorrhea after D & C for postpartum

bleeding. The most likely diagnosis:

A. Gonadal dysgenesis

B. Sheehan's syndrome

C. Kallman's syndrome

D. Mayer-Rokitansky- Kuster-Hauser syndrome

E. Asherman's syndrome

14. Post-partum hemorrhage may have higher incidence in all the following

conditions EXCEPT:

A. Multiple pregnancies

B. Polyhydramnios

C. Macrosomic baby

D. Placenta previa

E. Pregnancy induced hypertension

15. All the following are causes of DIC in pregnancy, EXCEPT :

A. Fetal demise.

B. Abortion.

C. Placental abruption.

D. Placenta previa.

E. Sepsis.

16. Regarding postpartum hemorrhage the following are true EXCEPT:

A. blood loss of 500 ml or more after vaginal delivery.

B. Blood loss of 1000 ml or more after C-section.

C. Atonic hemorrhage is less common than traumatic one.

D. Multiple pregnancy may predispose to postpartum hemorrhage.

E. Patient with previous history of postpartum hemorrhage are at high risk

for postpartum hemorrhage after next delivery.

17. The following statements are correct EXCPT:

A. Syntometrine is composed of syntocinon & Ergometrine.

B. Ergometrine is contraindicated in cardiac patient.

C. Syntometrine is used prophylcatically in the management of 3RD stage of

labor.

D. Syntometrine is contraindicated in cardiac patients.

E. Syntometrine affects the smooth muscles of blood vessels.