Q1. In a THREATENED miscarriage the cervical os is: A. Open, with tissue passing B. CLOSED, with a viable pregnancy C. Open, with all tissue passed D. Closed, with a dead fetus and no symptoms ANSWER: B. Why: threatened miscarriage means bleeding with a closed os and a still-viable pregnancy, and most continue. An open os indicates inevitable or incomplete miscarriage. LEARNING POINT: bed rest does not change the outcome and may imply the woman caused the bleeding.

Q2. In hyperemesis gravidarum, thiamine should be given: A. After the vomiting settles B. BEFORE OR ALONGSIDE glucose-containing fluids C. Only if the patient drinks alcohol D. Never in pregnancy ANSWER: B. Why: prolonged vomiting depletes thiamine, and glucose metabolism consumes what remains — precipitating Wernicke's encephalopathy, which may be irreversible. LEARNING POINT: this is the same rule as in alcohol dependence.

Q3. A woman has fever, offensive discharge, a tender uterus and heavy bleeding days after a pregnancy ended. Staff question her about the circumstances before treating. The correct approach is: A. Complete the history first B. TREAT IMMEDIATELY — resuscitate, antibiotics, and EVACUATE the uterus C. Antibiotics alone and review tomorrow D. Discharge with oral antibiotics ANSWER: B. Why: this is septic miscarriage, which is life-threatening. Retained infected tissue is the source, so antibiotics alone will not control it — the same source control principle as an abscess. LEARNING POINT: never delay care to establish how a pregnancy ended.

Q4. A woman has severe vomiting, a uterus larger than dates, very high hCG and no fetal heart. The likely diagnosis is: A. Hyperemesis alone B. MOLAR PREGNANCY C. Twin pregnancy with a viable fetus D. Ectopic pregnancy ANSWER: B — molar pregnancy. Why: a uterus large for dates with disproportionate vomiting, very high hCG and no fetal heart is characteristic. Severe hyperemesis should itself prompt the thought. LEARNING POINT: serial hCG follow-up after evacuation is essential — some progress to choriocarcinoma.

Q5. A woman with two weeks of vomiting is given intravenous glucose and becomes confused and ataxic with abnormal eye movements. The cause is: A. Hypoglycaemia B. WERNICKE'S ENCEPHALOPATHY from thiamine depletion C. Eclampsia D. Anxiety ANSWER: B. Why: prolonged vomiting depletes thiamine, and a glucose load consumes what remains. The triad of confusion, ataxia and ocular signs is characteristic and may become irreversible. LEARNING POINT: give thiamine before or alongside glucose-containing fluid in anyone with prolonged poor intake.

Q6. Why is serial hCG monitoring essential after evacuation of a molar pregnancy? A. To confirm the uterus is empty B. Because a proportion progress to PERSISTENT TROPHOBLASTIC DISEASE or CHORIOCARCINOMA C. To time the next pregnancy D. It is not necessary ANSWER: B. Why: persistent disease is detected by a failure of hCG to fall or by a rise, and it is highly treatable when caught early. LEARNING POINT: pregnancy is avoided until follow-up is complete, because it makes the hCG uninterpretable.

Q7. What should a woman with a miscarriage be told about the cause? A. That she should have rested more B. That most result from CHROMOSOMAL abnormality and are NOT caused by anything she did C. That working caused it D. Nothing — it is better not to discuss it ANSWER: B. Why: many women assume they caused the loss through working, lifting, travel, arguments or sex, and are never told otherwise because nobody asks what they believe. LEARNING POINT: saying this explicitly is part of the clinical care, not an optional kindness.