For those who are writing the SPI- Ultrasound physics exam. I have notes for sale it is about 1500 multiple choices sets for ARDMS -spi exam = 50 USA DOLLARS. I study those notes and passed my exam 670/700 . If you want to buy i can copy the notes and send them to you in e mail or by mail you can reach me atdrsteveramsey@gmail.com . I will also include some of the ideas about the 12 simulation questions. The payment with PayPal to drsteveramsey@gmail.com , fetal gender , Saad Ismail
————————————————————-
Obstetrics quiz;
When screening for Down’s syndrome which 3 of the following does the “Combined Test” involve?
Question 1 Explanation: All women presenting before 20 weeks of pregnancy should be offered screening tests for Down’s syndrome regardless of their age. The “Combined Test” is usually carried out between 11 weeks to 13 weeks + 6 days gestation. If the women has not presented to late to have the combined test they can have “Serum Screening” carried out between 15-20 weeks. There are a number of different types of “Serum Screening” such as Double, Triple & Quadruple tests. The Quadruple test measures free Beta hCG, AFP, Inhibin-A & uE3.
Which of the following are complications of induction?
Question 2 Explanation: Induction of labour increases the risk of a number of complications which are seen in vaginal delivery. The uterus can become over stimulated causing prolonged contractions which can starve the baby of oxygen. It can also cause contractions to be so powerful they cause rupture of the uterus. Finally if a women is induced to early it can result in prolonged labour & eventually emergency C-section or an instrumental delivery.
Which 2 of the following are drugs which can be used to induce labour?
Question 3 Explanation: Syntocinon is a synthetic form of Oxytocin. Oxytocin causes uterine contractions & cervical dilatation. Misoprostol is a prostaglandin which causes thinning of the cervix and uterine contraction. Usually women are given a prostaglandin first to induce labour, however if prostaglandins fail they can then be given Oxytocin. However you cannot give Oxytocin if you have had any prostaglandins within 6 hours previous.
What does symmetrical Intra-uterine Growth Restriction (both the head circumference & abdominal circumference are lower than normal) suggest?
Question 4 Explanation: Symmetrical IUGR usually suggests a baby has a chromosomal disorder. This is because in a healthy baby the head circumference should remain normal, even if there is significant placental insufficiency, as the body makes sure the brain receives the necessary fuel at the expense of the rest of the body. That’s why in placental insufficiency the abdominal circumference is reduced but the head circumference is normal (asymmetrical IUGR)
What is a mothers risk of having a child with Down’s syndrome at the age of 40?
Question 5 Explanation: The risk of having a child with Down’s syndrome increases with age. It’s important to know the chances a mother will have a child with Down’s syndrome so you can communicate this to your patient allowing them to make a more informed decision about pregnancy.
Which of the following need to be present for a women to be diagnosed as having Pre-eclampsia?
Question 6 Explanation: Pre-eclampsia is defined as the presence of both hypertension & proteinurea during pregnancy. Hypertension alone would be considered Pregnancy Induced Hypertension.
What is a mothers risk of having a child with Down’s syndrome at age 46?
Which of the following statements describe the first stage of labour correctly?
Which of the following are drugs used to reduce the high blood pressure associated with Pre-eclampsia?
Question 9 Explanation: In Pre-eclampsia the aim is to control the mothers blood pressure until the pregnancy reaches a gestation at which it would be safe to deliver. However there is a fine balance between ensuring a pregnancy reaches a viable gestation & ensuring the mothers health isn’t compromised. The aim is to keep the diastolic BP <110mmHg. Labetalol, Nifedipine & Hydralazine can allow the BP to remain at a safe level for a while longer giving a few more weeks for a foetus to mature before delivery.
Which of the following symptoms are experienced by women suffering with severe pre-eclampsia?
Question 10 Explanation: In severe pre-eclampsia the symptoms are widespread & affect many different body systems. The high blood pressure leads to increased intracranial pressure causing headache & papilloedema which causes visual disturbances. If a women presents with these symptoms immediate action must be taken as their is a significant risk of death for both the mother and foetus.
What period of gestation does the 1st trimester represent?
Question 11 Explanation: The first trimester refers to the first 12 weeks of pregnancy.
What is a mothers risk of having a child with Down’s syndrome at the age of 20?
Question 12 Explanation: Down’s syndrome is rarely seen in younger mothers & as a result many opt to not have screening for Down’s syndrome during pregnancy.
At 36 weeks gestation where would you expect to find the uterine fundus?
Which of the following are causes of Intra-Uterine Growth Restriction (IUGR)?
Question 14 Explanation: IUGR can be caused by many different factors. One very important one is smoking which accounts for around 30-40% of cases of IUGR. Alcohol abuse also causes IUGR and foetal alcohol syndrome. It’s essential to communicate to mothers the risks of smoking & alcohol in pregnancy to allow them to make a more informed decision about their lifestyle choices during pregnancy.
Which of the following statements are true about Magnesium Sulphate in relation to Pre-eclampsia & Eclampsia?
Question 15 Explanation: Eclampsia is a life threatening complication of pregnancy which can occur if pre-eclampsia is not controlled & becomes severe. It is characterised by the appearance of tonic clonic seizures. Eclampsia can cause coma & death in a very short period of time, therefore immediate action should be taken. Magnesium Sulphate is given to those at significant risk of developing Eclampsia.
At 28 weeks gestation where would you expect to feel the uterine fundus?
What is the most common cause of Post Partum Haemorrhage?
Question 17 Explanation: The most common cause of PPH is Uterine Atony however retained placenta & vaginal lacerations also account for a significant number of instances of PPH. Uterine atony described a state in which the uterus can no longer effectively contract. Because the uterus cannot contract all the blood vessels which were supplying the placenta are not clamped off & therefore can bleed profusely. A uterus can become atonic for a number of reasons such as prolonged labour, large baby, multiple pregnancy & retained placenta. If a women is found experiencing PPH its important to apply firm pressure to uterus immediately to reduce blood loss.
Which of the following methods are the correct way to calculate the Estimated Date of Delivery (EDD)?
Question 18 Explanation: The correct way to calculate the EDD is to add 9 months & 1 week onto the first day of the last normal menstrual period. This method may not be reliable if a women is unsure about when her last menstrual period was. As a result ultrasound is now used to date pregnancies.
Which of the following statements describes the 3rd stage of labour correctly?
Which of the following is a prostaglandin commonly used in induction of labour
Question 20 Explanation: Misoprostol is inserted vaginally & causes effacement of the cervix & uterine contractions.
Which 2 of the following does a membrane sweep” involve?
Question 21 Explanation: A midwife usually performs an internal examination on the mother & uses their finger to separate the amniotic membranes from the walls of the cervix. This causes release of prostaglandins which can kickstart the labour process.
Which of the following statements about Pre-eclampsia are correct?
Women with mild pre-eclampsia usually present to their doctor due to significant symptoms
Question 23 Explanation: Women with mild pre-eclampsia often do not have any symptoms at all. As a result they are usually picked up as a result of blood pressure screening by their midwife.
What is the definition of Post Partum Haemorrhage?
Question 24 Explanation: Primary postpartum haemorrhage is defined as a loss of blood >500ml from the genital tract within 24 hours of delivery. If the blood loss is between 500-1000ml it is defined as a Minor PPH. If the blood loss is more than 1000ml it is defined as a Major PPH & can result in death if not managed quickly & effectively.
In severe Pre-eclampsia women can develop HELLP syndrome which is very serious & life threatening. Which of the following are characteristic findings in the HELLP syndrome?
Question 25 Explanation: HELLP syndrome is a serious complication of severe pre-eclampsia & involves derangement of liver function & the clotting system. If not treated quickly it can result in massive haemorrhage as well as liver & renal failure.
At 22 weeks gestation where would you expect to find the uterine fundus?
At what stage of gestation would you expect a nulliparous women to begin to feel foetal movements?
Question 27 Explanation: Most women will become aware of foetal movements around 18-20 weeks. However if a women has had previous pregnancies they tend to notice movements earlier around 15-18 weeks.
Which of the following are causes of Post Partum Haemorrhage?
Question 28 Explanation: All of the above are causes of PPH with uterine atony been the most common. Coagulapathy accounts for only around 1% of PPH however it’s important to keep it in mind so you don’t miss it.
Which of the following are indications for induction of labour?
What does asymmetrical Intra-uterine Growth Restriction (Normal head circumference with reduced abdominal circumference) suggest?
Question 30 Explanation: If the placenta is not supplying adequate blood to the foetus there will be reduced amounts of energy for the baby to use. As a result the body directs the remaining fuel to allow normal brain development at the expense of the abdomen (glycogen stores in the liver) As a result the abdominal circumference decreases however the head circumference remains normal.
Which 3 of the following statements about Chorionic Villus Sampling are correct?
Question 31 Explanation: Chorionic Villus Sampling involves the sampling of developing placental tissue. It is the procedure of choice at earlier gestations (before 12 weeks) as it carries a lower risk of pregnancy loss compared to Amniocentesis. However in the second trimester Amniocentesis is favoured as it carries a lower risk of pregnancy loss.
Which sign is present on this pregnant abdomen?
Question 32 Explanation: This images shows a linea nigra. This occurs in around 3/4 of pregnancies. It’s described as a vertical line of increased pigmentation running down the centre of the pregnant abdomen. The increased pigmentation occurs over the linea alba which is stretched during pregnancy to accommodate the developing foetus.
Which of the following are risk factors for Post Partum Haemorrhage?
Question 33 Explanation: There are many significant risk factors for PPH. The amount each increases risk is as follows; – Placenta praevia (15x) – Multiple pregnancy (5x) – Pre-eclampsia (4x) – Nulliparity (3x) – Previous PPH (3x) – Asian Ethnicity (2x) – Obesity (2x)
The “Serum Screening” test for Down’s syndrome is carried out between 15-20 weeks for those women who presented too late to have the “Combined Test”. In the “Quadruple Serum Screening Test” which 4 of the following are measured?
Which of the following are risk factors for Pre-eclampsia?
Question 35 Explanation: The risk of Pre-eclampsia is influenced by many different factors. One which isn’t immediately obvious is the increased risk after changing partner. This is thought to be due to the fact that the mothers immune system is less tolerant of the new antigens from the new partner.
Which 3 of the following statements are true about Amniocentesis?
Question 36 Explanation: Amniocentesis involves sampling the amniotic fluid around the foetus during pregnancy. It can be carried out from 12 weeks gestation (early amniocentesis) however it can also be carried out later (16-18 weeks gestation) which reduces the risk of pregnancy loss. Chorionic Villus Sampling carries a lower risk of pregnancy loss compared to early amniocentesis, however a greater risk when compared to later amniocentesis. As a result Chorionic Villus Sampling is preferred at earlier gestations & is the investigation of choice before 12 weeks gestation.
Which of the following statements describes the 2nd stage of labour correctly?
At 12 weeks gestation where would you expect to feel the uterine fundus?
What period of gestation does the 2nd trimester represent?
Question 39 Explanation: The second trimester begins at 13 weeks and ends at 28 weeks.
What period of gestation does the 3rd trimester represent?
Question 40 Explanation: The third trimester starts at 29 weeks & ends at 40 weeks.
If a baby is found to have Intra-uterine Growth Restriction, what might be the next steps of management?
Question 41 Explanation: Umbilical artery doppler would be a logical next step to look at the blood flow of the placenta. If there was very poor blood flow, or reverse end diastolic flow it may suggest the need for prompt delivery. However if blood flow is normal an USS may be carried out to rule of chromosomal causes of IUGR such as Down’s syndrome. The women would also require regular follow up & serial growth scans to allow the growth trends to be monitored closely for signs of deterioration. If a women is already >37 weeks delivery may be suggested as it may be more dangerous to wait a few weeks more.
Which of the following is thought to be a cause of Hyperemesis Gravidarum?
Question 42 Explanation: Hyperemesis Gravidarum is a severe form of morning sickness in which women suffer with excessive nausea & vomiting which prevents them taking in adequate amounts of food & water. It is thought to be caused by high levels of circulating HCG. This is supported by the fact that it’s more common in multiple pregnancies & also tends to only affect women during the first 12 weeks of pregnancy.
When screening for Down’s syndrome which 3 of the following does the “Combined Test” involve?
Question 1 Explanation:
All women presenting before 20 weeks of pregnancy should be offered screening tests for Down’s syndrome regardless of their age. The “Combined Test” is usually carried out between 11 weeks to 13 weeks + 6 days gestation. If the women has not presented to late to have the combined test they can have “Serum Screening” carried out between 15-20 weeks. There are a number of different types of “Serum Screening” such as Double, Triple & Quadruple tests. The Quadruple test measures free Beta hCG, AFP, Inhibin-A & uE3.
Which of the following are complications of induction?
Question 2 Explanation:
Induction of labour increases the risk of a number of complications which are seen in vaginal delivery. The uterus can become over stimulated causing prolonged contractions which can starve the baby of oxygen. It can also cause contractions to be so powerful they cause rupture of the uterus. Finally if a women is induced to early it can result in prolonged labour & eventually emergency C-section or an instrumental delivery.
Which 2 of the following are drugs which can be used to induce labour?
Question 3 Explanation:
Syntocinon is a synthetic form of Oxytocin. Oxytocin causes uterine contractions & cervical dilatation. Misoprostol is a prostaglandin which causes thinning of the cervix and uterine contraction. Usually women are given a prostaglandin first to induce labour, however if prostaglandins fail they can then be given Oxytocin. However you cannot give Oxytocin if you have had any prostaglandins within 6 hours previous.
What does symmetrical Intra-uterine Growth Restriction (both the head circumference & abdominal circumference are lower than normal) suggest?
Question 4 Explanation:
Symmetrical IUGR usually suggests a baby has a chromosomal disorder. This is because in a healthy baby the head circumference should remain normal, even if there is significant placental insufficiency, as the body makes sure the brain receives the necessary fuel at the expense of the rest of the body. That’s why in placental insufficiency the abdominal circumference is reduced but the head circumference is normal (asymmetrical IUGR)
What is a mothers risk of having a child with Down’s syndrome at the age of 40?
Question 5 Explanation:
The risk of having a child with Down’s syndrome increases with age. It’s important to know the chances a mother will have a child with Down’s syndrome so you can communicate this to your patient allowing them to make a more informed decision about pregnancy.
Which of the following need to be present for a women to be diagnosed as having Pre-eclampsia?
Question 6 Explanation:
Pre-eclampsia is defined as the presence of both hypertension & proteinurea during pregnancy. Hypertension alone would be considered Pregnancy Induced Hypertension.
What is a mothers risk of having a child with Down’s syndrome at age 46?
Which of the following statements describe the first stage of labour correctly?
Which of the following are drugs used to reduce the high blood pressure associated with Pre-eclampsia?
Question 9 Explanation:
In Pre-eclampsia the aim is to control the mothers blood pressure until the pregnancy reaches a gestation at which it would be safe to deliver. However there is a fine balance between ensuring a pregnancy reaches a viable gestation & ensuring the mothers health isn’t compromised. The aim is to keep the diastolic BP <110mmHg. Labetalol, Nifedipine & Hydralazine can allow the BP to remain at a safe level for a while longer giving a few more weeks for a foetus to mature before delivery.
Which of the following symptoms are experienced by women suffering with severe pre-eclampsia?
Question 10 Explanation:
In severe pre-eclampsia the symptoms are widespread & affect many different body systems. The high blood pressure leads to increased intracranial pressure causing headache & papilloedema which causes visual disturbances. If a women presents with these symptoms immediate action must be taken as their is a significant risk of death for both the mother and foetus.
What period of gestation does the 1st trimester represent?
Question 11 Explanation:
The first trimester refers to the first 12 weeks of pregnancy.
What is a mothers risk of having a child with Down’s syndrome at the age of 20?
Question 12 Explanation:
Down’s syndrome is rarely seen in younger mothers & as a result many opt to not have screening for Down’s syndrome during pregnancy.
At 36 weeks gestation where would you expect to find the uterine fundus?
Which of the following are causes of Intra-Uterine Growth Restriction (IUGR)?
Question 14 Explanation:
IUGR can be caused by many different factors. One very important one is smoking which accounts for around 30-40% of cases of IUGR. Alcohol abuse also causes IUGR and foetal alcohol syndrome. It’s essential to communicate to mothers the risks of smoking & alcohol in pregnancy to allow them to make a more informed decision about their lifestyle choices during pregnancy.
Which of the following statements are true about Magnesium Sulphate in relation to Pre-eclampsia & Eclampsia?
Question 15 Explanation:
Eclampsia is a life threatening complication of pregnancy which can occur if pre-eclampsia is not controlled & becomes severe. It is characterised by the appearance of tonic clonic seizures. Eclampsia can cause coma & death in a very short period of time, therefore immediate action should be taken. Magnesium Sulphate is given to those at significant risk of developing Eclampsia.
At 28 weeks gestation where would you expect to feel the uterine fundus?
What is the most common cause of Post Partum Haemorrhage?
Question 17 Explanation:
The most common cause of PPH is Uterine Atony however retained placenta & vaginal lacerations also account for a significant number of instances of PPH. Uterine atony described a state in which the uterus can no longer effectively contract. Because the uterus cannot contract all the blood vessels which were supplying the placenta are not clamped off & therefore can bleed profusely. A uterus can become atonic for a number of reasons such as prolonged labour, large baby, multiple pregnancy & retained placenta. If a women is found experiencing PPH its important to apply firm pressure to uterus immediately to reduce blood loss.
Which of the following methods are the correct way to calculate the Estimated Date of Delivery (EDD)?
Question 18 Explanation:
The correct way to calculate the EDD is to add 9 months & 1 week onto the first day of the last normal menstrual period. This method may not be reliable if a women is unsure about when her last menstrual period was. As a result ultrasound is now used to date pregnancies.
Which of the following statements describes the 3rd stage of labour correctly?
Which of the following is a prostaglandin commonly used in induction of labour
Question 20 Explanation:
Misoprostol is inserted vaginally & causes effacement of the cervix & uterine contractions.
Which 2 of the following does a membrane sweep” involve?
Question 21 Explanation:
A midwife usually performs an internal examination on the mother & uses their finger to separate the amniotic membranes from the walls of the cervix. This causes release of prostaglandins which can kickstart the labour process.
Which of the following statements about Pre-eclampsia are correct?
Women with mild pre-eclampsia usually present to their doctor due to significant symptoms
Question 23 Explanation:
Women with mild pre-eclampsia often do not have any symptoms at all. As a result they are usually picked up as a result of blood pressure screening by their midwife.
What is the definition of Post Partum Haemorrhage?
Question 24 Explanation:
Primary postpartum haemorrhage is defined as a loss of blood >500ml from the genital tract within 24 hours of delivery. If the blood loss is between 500-1000ml it is defined as a Minor PPH. If the blood loss is more than 1000ml it is defined as a Major PPH & can result in death if not managed quickly & effectively.
In severe Pre-eclampsia women can develop HELLP syndrome which is very serious & life threatening. Which of the following are characteristic findings in the HELLP syndrome?
Question 25 Explanation:
HELLP syndrome is a serious complication of severe pre-eclampsia & involves derangement of liver function & the clotting system. If not treated quickly it can result in massive haemorrhage as well as liver & renal failure.
At 22 weeks gestation where would you expect to find the uterine fundus?
At what stage of gestation would you expect a nulliparous women to begin to feel foetal movements?
Question 27 Explanation:
Most women will become aware of foetal movements around 18-20 weeks. However if a women has had previous pregnancies they tend to notice movements earlier around 15-18 weeks.
Which of the following are causes of Post Partum Haemorrhage?
Question 28 Explanation:
All of the above are causes of PPH with uterine atony been the most common. Coagulapathy accounts for only around 1% of PPH however it’s important to keep it in mind so you don’t miss it.
Which of the following are indications for induction of labour?
What does asymmetrical Intra-uterine Growth Restriction (Normal head circumference with reduced abdominal circumference) suggest?
Question 30 Explanation:
If the placenta is not supplying adequate blood to the foetus there will be reduced amounts of energy for the baby to use. As a result the body directs the remaining fuel to allow normal brain development at the expense of the abdomen (glycogen stores in the liver) As a result the abdominal circumference decreases however the head circumference remains normal.
Which 3 of the following statements about Chorionic Villus Sampling are correct?
Question 31 Explanation:
Chorionic Villus Sampling involves the sampling of developing placental tissue. It is the procedure of choice at earlier gestations (before 12 weeks) as it carries a lower risk of pregnancy loss compared to Amniocentesis. However in the second trimester Amniocentesis is favoured as it carries a lower risk of pregnancy loss.
Which sign is present on this pregnant abdomen?
Question 32 Explanation:
This images shows a linea nigra. This occurs in around 3/4 of pregnancies. It’s described as a vertical line of increased pigmentation running down the centre of the pregnant abdomen. The increased pigmentation occurs over the linea alba which is stretched during pregnancy to accommodate the developing foetus.
Which of the following are risk factors for Post Partum Haemorrhage?
Question 33 Explanation:
There are many significant risk factors for PPH. The amount each increases risk is as follows; – Placenta praevia (15x) – Multiple pregnancy (5x) – Pre-eclampsia (4x) – Nulliparity (3x) – Previous PPH (3x) – Asian Ethnicity (2x) – Obesity (2x)
The “Serum Screening” test for Down’s syndrome is carried out between 15-20 weeks for those women who presented too late to have the “Combined Test”. In the “Quadruple Serum Screening Test” which 4 of the following are measured?
Which of the following are risk factors for Pre-eclampsia?
Question 35 Explanation:
The risk of Pre-eclampsia is influenced by many different factors. One which isn’t immediately obvious is the increased risk after changing partner. This is thought to be due to the fact that the mothers immune system is less tolerant of the new antigens from the new partner.
Which 3 of the following statements are true about Amniocentesis?
Question 36 Explanation:
Amniocentesis involves sampling the amniotic fluid around the foetus during pregnancy. It can be carried out from 12 weeks gestation (early amniocentesis) however it can also be carried out later (16-18 weeks gestation) which reduces the risk of pregnancy loss. Chorionic Villus Sampling carries a lower risk of pregnancy loss compared to early amniocentesis, however a greater risk when compared to later amniocentesis. As a result Chorionic Villus Sampling is preferred at earlier gestations & is the investigation of choice before 12 weeks gestation.
Which of the following statements describes the 2nd stage of labour correctly?
At 12 weeks gestation where would you expect to feel the uterine fundus?
What period of gestation does the 2nd trimester represent?
Question 39 Explanation:
The second trimester begins at 13 weeks and ends at 28 weeks.
What period of gestation does the 3rd trimester represent?
Question 40 Explanation:
The third trimester starts at 29 weeks & ends at 40 weeks.
If a baby is found to have Intra-uterine Growth Restriction, what might be the next steps of management?
Question 41 Explanation:
Umbilical artery doppler would be a logical next step to look at the blood flow of the placenta. If there was very poor blood flow, or reverse end diastolic flow it may suggest the need for prompt delivery. However if blood flow is normal an USS may be carried out to rule of chromosomal causes of IUGR such as Down’s syndrome. The women would also require regular follow up & serial growth scans to allow the growth trends to be monitored closely for signs of deterioration. If a women is already >37 weeks delivery may be suggested as it may be more dangerous to wait a few weeks more.
Which of the following is thought to be a cause of Hyperemesis Gravidarum?
Question 42 Explanation:
Hyperemesis Gravidarum is a severe form of morning sickness in which women suffer with excessive nausea & vomiting which prevents them taking in adequate amounts of food & water. It is thought to be caused by high levels of circulating HCG. This is supported by the fact that it’s more common in multiple pregnancies & also tends to only affect women during the first 12 weeks of pregnancy.
Thank you for reading; Share your knowledge and exam questions with others to learn. If you know and have SPI PHYSICS QUESTION share it with us.
Steve Ramsey -Calgary
For those who are writing the SPI- Ultrasound physics exam. I have notes for sale it is about 1500 multiple choices sets for ARDMS -spi exam = 50 USA DOLLARS. I study those notes and passed my exam 670/700 . If you want to buy i can copy the notes and send them to you in e mail or by mail you can reach me at drsteveramsey@gmail.com . I will also include some of the ideas about the 12 simulation questions. The payment with PayPal to drsteveramsey@gmail.com , fetal gender , Saad Ismail