Ministry of Health

Ethiopian Health Professionals’ Licensure Examination

MIDWIFERY
Ginbot 2015/May 2023

Full Name______________________________
PART: ONE TIME ALLOWED: 2:30 HOURS

GENERAL DIRECTIONS

IN THIS EXAMINATION, THERE ARE A TOTAL OF 100 MULTIPLE

CHOICE QUESTIONS. SELECT THE BEST ANSWER AND BLACKEN
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INSTRUCTIONS.

ANY FORM OF CHEATING OR AN ATTEMPT TO CHEAT IN THE

EXAMINATION WILL RESULT IN AN AUTOMATIC DISMISSAL FROM
THE EXAMINATION HALL AND CANCELLATION OF YOUR SCORE(S).
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 Ethiopian Health Professionals’ Licensure Examination

Midwifery Exam
Ginbot 2015/May 2023
PART ONE
Number of Items: 100 Time Allowed: 2:30 hours

DIRECTTIONS: Each of the following questions is followed by four possible

alternative answers. Read each question carefully and blacken the letter of your
best choice on the separate answer sheet provided.
1. A 28-year-old woman who is planning to conceive came to a clinic for preconception care
service. Previously she has lost a baby because of neural-tube defects and is worried about
her future pregnancy outcome.

What is the most effective preconception intervention for this woman?

(A) Folic acid supplementation (C) Iodine supplementation
(B) Hepatitis B vaccination (D) Iron supplementation

2. A 29-year-old woman came to a family planning clinic before the date of appointment being
upset. On assessment, she explained that, her partner is belittling, humiliating and
undermining her in front of others. In addition, he has restricted her from socializing with her
family and friends.

Based on her history, for what condition is the woman at greatest risk?
(A) Sexual violence (C) Physical violence
(B) Economic abuse (D) Psychological violence

3. A midwife is providing care for a 22-year-old woman who is planning to get pregnant. On
assessment, she had history of heavy alcohol dependence since two years.

For what fetal complication is this woman at greatest risk?

(A) Spinal bifida (B) Microcephaly (C) Macrosomia (D) Cleft palate

4. A 30-year-old woman came to a clinic for counseling service. On assessment, she was
diagnosed for severe anemia. She was managed accordingly and appointed after a month.

What is the most important laboratory investigation that would help to assess her progress
during revisit?
(A) Urinalysis (C) Blood group and RH
(B) Hemoglobin (D) Random glucose level

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5. A 32-year-old woman came to an OPD complaining of lacerations and bleeding from vagina
due to sexual abuse one hour back. On assessment, she stated that three men hanged her from
behind while she was returning from work, and forced her into having sex. On physical
examination, there are tears, bruises, scratches and abrasions to the posterior couchette. In
addition, there are bite and punch marks on her face and marks of restraints on the wrists.

What is the main purpose of doing physical examination for this woman?
(A) To understand the level of injury
(B) To identify those involved in sexual abuse
(C) To help the legal process forensic evidence
(D) To determine what medical care should be provided

6. A 23-year-old commercial sex worker came to a family planning clinic in pursuit of getting
advice on contraceptive methods.

What is the most recommended contraceptive method for this woman?

(A) Dual method (C) Long term contraceptive method
(B) Withdrawal method (D) Permanent contraceptive method

7. A 31-year-old woman who is planning to conceive came to a preconception service. On

assessment, her HIV result was positive and her hemoglobin level was 10 g/dl.

What is the ideal time to start ART for this woman?

(A) After her hemoglobin level reaches the normal range
(B) She can start the treatment immediately
(C) When she is WHO clinical Stage-IV
(D) 14 weeks after she gets pregnant

8. A 30-year-old mother brought her 15-day-old neonate complaining purulent discharge from
eye. After assessment, the midwife made a diagnosis of neonatal conjunctivitis.

What is the most appropriate management for this neonate?

(A) Amoxicillin plus Doxycycline (C) Ceftriaxone plus Erythromycin
(B) Wiping eyes with warm water (D) Applying 1 percent tetracycline eye ointment

9. A 26-year-old Para-III mother came for a family planning service after two weeks of
delivery. After detailed counseling, she decided to use lactation amenorrhea method.

What appropriate maternal history should the provider ask to confirm eligibility?
(A) Weight status (C) Immunization status
(B) Nutritional status (D) Breast feeding status
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10. A 28-year-old Para-VI mother came to a family planning service to space her pregnancy. She
has regular vaginal bleeding. On examination, she is febrile. During counseling she stated
that she does not want to use modern contraception because of the adverse effects she
experienced. At the end, she decided to use natural family planning method.
Which natural family planning method is NOT recommended for this mother?
(A) Basal body temperature (C) Standard day's method
(B) Cervical mucus method (D) Rhythm method

11. A 36-year-old Para-VI mother came to a family planning service to refill her contraceptive
on appointment date. She is breastfeeding and has regular menstrual cycle. On assessment,
she is HIV/AIDS sero -positive.
What should the health care provider do for this mother?
(A) Changing the previous method (C) Couple dual protection
(B) Managing method side effects (D) Counseling her future fertility

12. A 39-year-old Para-VIII mother came to a family planning service to utilize contraception.
During counseling, she decided to use progestin only pill.
What is the most appropriate physical examination the health provider needs to perform?
(A) Cervical examination (C) Pelvic examination
(B) Abdominal examination (D) Breast examination

13. A 22-year-old woman came with her classmates to a reproductive adolescent and youth
service room for consulting about condom breaks. On history, she has been using condom as
a family planning method for two years; but before two days, she faced breakage of condom
during sexual intercourse.
What is the most appropriate care needed for the client?
(A) Providing emergency contraceptives
(B) Counseling about pregnancy terminations
(C) Counseling about the disadvantage of condom use
(D) Counseling her to avoid condom as a contraceptive

14. A 27-year-old Para-II mother came to a family planning service after three months of
injection of depo provera. She stated that her bleeding is irregular and she wanted a method
change. The midwife made an assessment and concluded that her complaint is normal in
relation to the method she used.
What is the most important counseling component the provider needs to address?
(A) Reproductive health issues
(B) Problem of narrow birth interval
(C) The need to change to other methods
(D) The side effects of injectable contraceptive

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15. A 30-year-old Para-II mother came to a gynecology OPD with a complaint of inability to
conceive for the last three months. On assessment, she reported that she was using injection
of depo provera for five years. Her pregnancy test result was negative.
What is the most essential counseling component the provider needs to address?
(A) Counsel her that her condition might be due to menopause
(B) Reassure her since it is due to contraceptive side effect
(C) Send her for further gynecologic investigation
(D) Counsel her to repeat pregnancy test

16. A 26-year-old Para-III mother came to a gynecologic OPD for family planning service. She
is exclusively breastfeeding her four-month-old baby and her monthly bleeding has not
returned. She claimed that she does not want to use long acting methods.
What is the most appropriate method for the mother?
(A) Progestin only pills (C) Emergency contraceptive pill
(B) Combined oral contraceptive (D) Estrogen contained injectable

17. A 36-year-old woman came to a family planning unit for contraceptive use. She has mild
headache but no other complaints. After counseling the woman about the available methods,
she decided to use LNG-IUD. Finally, the provider wanted to check her vital signs to ensure
safe use of LNG IUD.
Which vital sign is most important input for making wise decision?
(A) Pulse rate (B) Temperature (C) Blood pressure (D) Respiratory rate

18. A 20-year-old woman came to a family planning unit with complaint of itchy skin around the
area where implant was inserted a week before. She admitted that she removed the plaster
and gauze applied immediately when she left the facility to hide the procedure from her
families. On inspection, the insertion site is reddened and there is slight pus surrounding the
area.

What is the most likely diagnosis?

(A) Missing of implant (C) Insertion site infection
(B) Expulsion of implant (D) Insertion site muscle injury

19. A 38-year-old woman came to a health center with a complaint of lower abdominal pain. She
claimed that she has started to use IUCD since two weeks back, and started to feel pain after
the fifth days of insertion. Currently, she has lower abdominal pain, nausea and feeling of
pain during intercourse. She is febrile to touch. On laboratory investigation, her pregnancy
test is negative.
What is the most likely complication this woman is suffering from?
(A) Perforated uterus (C) Local trauma of cervix
(B) Ectopic pregnancy (D) Pelvic inflammatory disease
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20. A midwife is preparing for IUCD insertion to his client. Before insertion, the midwife intends
to grasp the cervix with tenaculum.

What is the recommended site that the midwife has to use?

(A) At the 5 and 7 o'clock positions (C) At the 2 and 10 o'clock positions
(B) At the 4 and 8 o'clock positions (D) At the 9 and 12 o'clock positions

21. A 37-year-old woman who has been using implant for five years came to a family planning
unit for removal when it is due time for protection. She is satisfied with the contraception and
wants to continue the method. The site where the rods located is clean and has no scar. The
provider advised her about removal and re-insertion procedures, and selection of the
recommended area for re-insertion.

What is the recommended area for re-insertion?

(A) Insert the new rod at the same site where the rods are removed
(B) Change site of insertion at least 5 mm away from the previous
(C) Re-insert the rod opposite to the previous site at same arm
(D) Insert the new rod in the other arm

22. A 35-year-old Para-III woman came to a family planning unit to stop next chance of
pregnancy. The provider advised her about the available options of contraception. After the
counseling, she preferred to use tubal ligation. However, the provider told the woman that the
time of her visit is not ideal for the procedure; hence, it has to be postponed.

What is the optimum time to get such service?

(A) Within seven days of delivery (C) From 7 to 42 days of delivery
(B) Immediately after delivery (D) After 42 days of delivery

23. A 39-year-old woman is in a postnatal ward after she gave birth six hours back. A duty
midwife is preparing to counsel the woman about postpartum family planning prior to
discharge and identified important areas and components to be addressed during counseling.

Which information should NOT be included in the counseling?

(A) Counsel her about methods, their effectiveness rates, and side effects
(B) Reassure her that all methods are safe and does not interfere with breast feeding
(C) Provide her with the information on contraceptive resupply and access to follow-up care
(D) Advise her on contraceptives taking into account reproductive goal and protection against
STIs

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24. A 30-year-old woman on her third postpartum day came to a family planning unit for
contraceptive service. On history, she had prolonged labor and her baby died at birth. She
planned to delay pregnancy for the next two years and wants to use implant.

What is the most appropriate response from the provider?

(A) Allow to use implant and provide the service on same day
(B) Tell her she is not candidate as she needs to delay for two years
(C) Appoint her to come after six weeks of postpartum for insertion
(D) Appoint her to come after six months of postpartum for insertion

25. A 27-year-old Gravid-II, Para-I mother came to a health center for routine ANC service
utilization on day 05-07-2013E.C. During the course of the assessment, the midwife asked
her LNMP. Her menstrual bleeding was regular for the last one year; and the last one started
on 21-01-2013E.C and ended on 26-01- 2013E.C.

What is the gestational age of this pregnancy?

(A) 23 weeks + 3 days (C) 24 weeks + 3 days
(B) 23 weeks + 4 days (D) 24 weeks + 4 days

26. A 27-year-old Gravid-II, Para-I HIV positive mother came to an ANC unit on appointment.
Based on her LNMP and early first trimester ultrasound evaluation, the gestational age is 37
weeks. Laboratory investigation showed that her hemoglobin level is 12 mg/dl, WBC count
is 8000/mm3, platelet count is 150,000/mm3, viral load is 1500 copies/ml, and CD4 + count
is 200 cells/mm3 (Normal value hemoglobin is 12-16mg/dl, WBC is 4000-10,000/mm3,
platelet 100,000-450,000/mm3)

What measure should be taken to decrease the risk of MTCT of HIV for this mother?
(A) Elective cesarean delivery at 40 weeks (C) Elective cesarean delivery at 38 weeks
(B) Elective cesarean delivery at 39 weeks (D) Elective cesarean delivery at 41 weeks

27. A midwife screened a woman for HIV during ANC service. Prior to giving clear and accurate
information about the screening, the midwife reported the result to the woman.

What principle of HIV testing and counseling did the provider breach?
(A) Confidentiality (B) Connection (C) Comfort (D) Consent

28. A 26-year-old primigravida mother came to an ANC unit for antenatal care service.
According to her LNMP, the gestational age is 38 weeks. On the third Leopold maneuver
examination, the lower part of the abdomen was occupied by large, irregular and non-
ballotable mass.

What is the most likely presentation of the fetus?

(A) Face (B) Breech (C) Cephalic (D) Shoulder

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29. A 27-year-old Gravid-II, Para-I mother at 14-week gestation came for ANC follow-up. She
had no antenatal care during previous pregnancy and it ended up with intrauterine fetal death.
On review of the obstetrics history from chart, the inspection of the dead body of her baby
showed mummified, hydrocephalus and enlarged body organs. On physical examination, she
is well looking. She and her husband were also investigated for VDRL and they were
reactive.

What is the most appropriate interpretation for the above findings?

(A) Poor suggestive for syphilis infection
(B) Highly suggestive for syphilis infection
(C) Poor suggestive for Gonorrheal infection
(D) Highly suggestive for Gonorrheal infection

30. An 18-year-old primigravida woman with nine weeks of gestation came to a hospital with
complaints of nausea and vomiting for three days duration. Physical examination showed a
dry tongue and inelastic skin. Laboratory findings showed no hemoparasite on blood films,
Urine analysis is ketone + 3 and albumin trace, LFT and RFT results are in normal range.

What is the most likely diagnosis of this woman?

(A) Cholecystitis (C) Hyperemesis gravidrum
(B) Gastroenteritis (D) Gastro esophageal reflux disease

31. A 23-year-old multigravida woman at 32 weeks of gestation came to an ANC unit with
complaint of difficulty of breathing. She was diagnosed for diabetes mellitus and she is on
insulin. On assessment, inspection of abdomen showed tense and shiny skin with large striae,
fundal height larger for date, girth of the abdomen is round and the fetal parts were difficult
to clearly define. Moreover, on auscultation of fetal heart sound is difficult to hear.

What is the most likely diagnosis of this pregnancy?

(A) IUGR (B) IUFD (C) Polyhydramnios (D) Oligohydraminos

32. A 25-years-old Gravida-II Para-I woman was presented to an ANC clinic with complaint of
cessation of fetal body movement for seven days duration. According to her LNMP and first
trimester ultrasound result, the gestational age of the pregnancy was 32 weeks. On ultrasound
evaluation the fetal cranial bones were overlapped.

What is the most likely diagnosis of this pregnancy?

(A) IUFD (B) IUGR (C) Polyhydramnios (D) Oligohydraminos

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33. A 30-year-old multigravida mother came to an ANC unit with complaint of passing of the
due date for pregnancy. Based on LNMP and first trimester ultrasound, gestational age is 41
weeks and four days. Abdominal palpation findings showed that Fundal height is smaller for
the gestational age and the fetal parts are easily palpable. Moreover, auscultation revealed
normal fetal heart sound. On ultrasound evaluation, gestational age 40 weeks, AFI is 2 cm
and placenta anterior and fundal.

What is the most appropriate management for this case?

(A) Induction (C) Cesarean delivery
(B) Amnioinfusion (D) Wait until labor starts spontaneously

34. A 20-year-old primigravida woman at 34 weeks of gestation came to a hospital with referral
paper from a health center for further management. Her history showed that fetal movement
ceased before seven days. She has no known medical or surgical problems. On abdominal
assessment, she has abdominal tenderness, fundal height is 32 weeks, cephalic presentation
and FHB is absent. Her laboratory investigation result showed a hemoglobin level of 13
mg/dl, platelet count of 90,000/mm3, WBC count of 10,000/mm3, Blood group is B+, and
urine analysis, liver and renal function tests are within normal range. The ultrasound
evaluation shows absent FHB, gestational age 32 weeks, average fetal weight is 1.8 kg, AFI
is 4 cm and placenta fundal. (Normal value Hemoglobin is 12 up to 16mg per dl, WBC is
4000-10,000 and Platelet 100,000-450,000).

What is the most appropriate management for this case?

(A) Cesarean delivery (C) Augmentation of labor
(B) Induction of labor (D) Wait for spontaneous labor

35. A 32-year-old Gravida-III, Para-II woman at 33 weeks of gestation was presented to an ANC
clinic with a complaint of leakage of fluid through vagina of six hours duration. However,
she denied vaginal bleeding and abdominal pain. On examination, she is healthy looking and
her blood pressure is 120/75mmHg, respiration rate is 16/min, pulse rate is 76/min and
temperature is 36.6 degree centigrade. On abdominal examination, no tenderness, 30 weeks
gravid uterus and normal heart rate tracing were noted. On speculum examination, there is
accumulation of fluid in posterior fornix. When the woman is asked to cough, there is
leakage of fluid through the cervix. Laboratory investigation showed normal findings.
Ultrasound evaluation showed, GBM, FBM and FHB are seen, BPD is 30 weeks, AFI is 5
cm, and placenta is fundal and no gross congenital malformation seen.

What is the most appropriate management for this woman?

(A) Admit to ward, steroid, antibiotic and induction of labor
(B) Admit to ward, antibiotic and follow the feto-maternal conditions
(C) Admit to ward, antibiotic, steroid and prepare for cesarean delivery
(D) Admit to ward, antibiotic, steroid and follow the feto-maternal conditions
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36. A 25-year-old primigravida woman at 38 weeks of gestation (reliable for date) came to an
ANC unit with complaint of vaginal bleeding. She is known hypertensive mother and on
methyldopa 250 mg PO twice per day. On examination, she is healthy looking and her blood
pressure is135/85mmHg, respiration rate is 16/min and pulse rate is 80/min. On abdominal
examination, fundal height is 37 weeks, cephalic presentation and FHB is 140/min.
Laboratory investigation showed normal findings. On ultrasound evaluation, GBM, FBM and
FHB were seen, gestational age was 37 weeks, AFI was 10 cm and placenta was fundal and
anterior.

What is the most appropriate management for this case?

(A) Admit to ward and prepare for induction of labor
(B) Admit to ward and follow feto-maternal conditions
(C) Admit to ward, antibiotic and follow the feto-maternal conditions
(D) Admit to ward, glucocorticoids and follow the feto-maternal conditions

37. A 32-year-old pregnant woman visited an ANC clinic for the first time. She had a regular
menstrual cycle and gestational age is 12 weeks. Physical examination result showed that she
is well and comfortable with no other abnormalities detected. All routine laboratory
investigations were done and the results were within the normal range.

What is the appropriate intervention for this woman?

(A) Provide iron and folic acid supplements
(B) Instruct her to take caffeine just after meal
(C) Avoid consuming fruits while taking iron and folic acid
(D) Advice her to take tea at the same time when taking iron

38. A mother came to a health center for her third antenatal follow-up. She complains drowsiness
and malaise of three days duration. On examination, her blood pressure is 110/60 mmHg and
pulse rate is 95/min. Three weeks back she was given Iron-folate supplement. The midwife
needs to evaluate her adherence to the supplement.

What is the most appropriate evidence for evaluating the adherence?

(A) Slower refilling of the nail bed (C) Regular daily intake of Iron-folate
(B) Hemoglobin of less than 11 g/dl (D) Pallor conjunctiva and mucus membrane

39. A pregnant mother at a gestational age of six weeks came for antenatal check-up for the first
time. Her body mass index before pregnancy was 22kg/m2. All her histories, physical
findings and investigations are normal. She needs an advice on well balanced diet to maintain
a normal weight gain according to her BMI.

What is the appropriate advice regarding the daily intake of food for this mother?
(A) Low fiber diet intake (C) High saturated fatty foods
(B) Drink plenty of fluids (D) Low intake of protein rich foods
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40. A pregnant university student came to a health facility for antenatal follow-up before her date
of appointment. The pregnancy is wanted but unplanned. She has taken the first dose of
tetanus toxiod (TT-1) one a week before.

When is the second dose of TT appointment?

(A) Two weeks after today (C) One week after the first dose
(B) Three weeks after today (D) Five weeks after the first dose

41. A 25-year-old Gravida-II, Para-I woman at 36 weeks of gestation confirmed by first trimester
ultrasound was presented to an ANC clinic with complaint of leakage of fluid through vagina
of 24 hours duration. However, she denied vaginal bleeding and abdominal pain. On
speculum examination, there is accumulation of fluid in posterior fornix and leakage of fluid
from the cervix. On abdominal examination, fetal parts are easily palpable, cephalic
presentation and positive fetal heart beat. On ultrasound evaluation, expected fetal weight is
2.9 kg, positive fetal heart beat, AFI is 4 cm and placenta is fundal and anterior.

What is the most likely diagnosis of this woman?

(A) Term PROM (C) Preterm PROM
(B) Prolonged term PROM (D) Prolonged preterm PROM

42. A reproductive age woman came to a clinic with a complaint of genital ulcer of two weeks
duration. The ulcer is painful, vesicular and irritant. She also reported that she has fever,
headache, malaise and muscular pain. On physical examination, a midwife observed a
shallow and non-indurated tender ulcer on the perineum.

What is the most likely diagnosis of this woman?

(A) Neisseria gonorrhea (C) Trichomonas vaginalis
(B) Herpes simplex virus (D) Lymphogranuloma Venereum

43. A pregnant woman came to an antenatal clinic with a complaint of thick, profuse,
malodorous, yellow-green, frothy secretion from the vagina of two months duration. She has
also pruritis, itching, vulval irritation, dyspareunia, dysuria, and frequent of urination. She
also said that her husband has a penile discharge.

Which syndromatic approach is appropriate to treat this woman?

(A) Genital ulcer (C) Urethral discharge
(B) Genital bubo (D) Vaginal discharge

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44. A 40-year-old mother came to an emergency OPD complaining of severe dizziness and
drowsiness of week duration. She often drinks coffee or tea just after every meal. She
dislikes eating fruits, vegetables, meat and grains. Her blood pressure is 90/60 mmHg, pulse
rate is 100/min, temperature is 36.5 degree centigrade and respiratory rate is 24/min, and she
is pale. On investigation, hemoglobin is 9.5 g/dl. However, laboratory results of CBC, stool
exam and urine analysis are normal.

What is the diagnosis of this patient?

(A) Iron deficiency anemia (C) Physiologic anemia
(B) Megaloblastic Anemia (D) Sickle cell anemia

45. A 22-year-old primigravid woman came for an antenatal care follow-up for the first time.
She lives in malaria endemic area but has no history of malarial attack. Her vital signs are
within normal range and she has pink conjunctiva and mucous membranes. The hemoglobin
level is 12g/dl.

What is the most appropriate measure to minimize the risk of malaria infection for this
woman?
(A) Intermittent preventive treatment
(B) Prescribing Iron supplementation
(C) Use of long lasting insecticidal bed net
(D) Provision of personal protective equipments

46. A 38-year-old Gravida-VII Para-VI mother came for antenatal care follow-up at 32 weeks of
gestation from known hookworm endemic area. Her vital signs are withn the normal range,
conjunctiva and mucus membranes are pink, and hemoglobin is 13 gm/dl.

What prophylactic drug should be provided to this mother?

(A) Mebendazole 500 mg PO stat (C) MgSo4 4 g IV for 24 hours after birth
(B) Ampicillin 2 g IV for two days (D) Amoxicillin 500 mg BID for five days

47. A pregnant woman at 34 weeks of gestation was presented to a hospital with a compliant of
absence of fetal movement for 24 hours. She has no other danger signs of pregnancy. On
physical examination the vital signs were in the normal range, but fetal heart beat was not
heard and after counseling she was appointed to return back after 2 weeks.

What is the most appropriate issue that has to be addressed while counseling the woman?
(A) Danger signs of pregnancy (C) Neonatal danger signs
(B) Exclusive breast feeding (D) Additional nutrition

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48. A 35-year-old Gravid-V, Para-II, Abortion-II mother at 20 weeks gestation as estimated by

first trimester ultrasound came to a health center for ANC service utilization. She is known
diabetic mother on insulin. Physical examination and laboratory investigation showed normal
findings. Finally, the midwife sent her for ultrasound evaluation.

What is the importance of ultrasound evaluation for this mother?

(A) To identify gross congenital anomaly (C) To calculate amniotic fluid volume
(B) To determine expected fetal weight (D) To estimate the gestational age

49. On date 25/05/2015 E.C a 28-year-old primigravida mother was presented to a labor triage
with a complaint of pushing down sensation for the past three days. Upon history, her first
day of LNMP was on 29/8/2014 E.C.

What is the calculated gestational age for this mother?

(A) 37 weeks and 3 days (C) 39 weeks and 6 days
(B) 38 weeks and 5 days (D) 40 weeks and 4 days

50. A Gravida-IV, Para-II woman came to a hospital with a complaint of pushing down pain.
Abdominal examination revealed, longitudinal lie, cephalic presentation, FHB 140/min, and
descent 3/5 palpable above symphysis pubis.

What is the most appropriate physical examination to identify fetal lie?

(A) Fundal palpation (C) Lateral palpation
(B) Fundal grip palpation (D) Deep pelvic palpation

51. A 25-year-old Gravida-II, Para-I labouring woman came to a labour ward with a complaint
of pushing down pain. On abdominal examination, fetal lie is longitudinal, cephalic
presentation, descent 0/5, FHR is 140/min, has three strong contractions. Pelvic examination
revealed 9cm dilated cervix with ruptured membrane three hours back.

What is the stage of labour?

(A) Active first stage labour (C) Second stage labour
(B) Latent first stage labour (D) Third stage labour

52. A midwife at a labour ward is following a woman in labour. As the woman had ante partum
hemorrhage secondary to placental abruption, the fetal condition is thoroughly monitored
with CTG. The midwife is ordered to trace fetal heart and notify the doctor if things are
going abnormal.

What finding is most reassuring in tracing fetal heart rate?

(A) Fetal heart rate of 140 with absent variability
(B) Fetal heart rate of 160 with marked variability
(C) Fetal heart rate of 120 with minimal variability
(D) Fetal heart rate of 150 with moderate variability
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53. A midwife on duty follows the progress of a labor by plotting on the partograph. The day
duty midwife handed over to the next night duty shift. When the new midwife evaluates the
partograph, he noticed that the letter 'I' is plotted for the amniotic fluid assessment.

What interpretation of the partograph indicates the status of amniotic fluid?

(A) Blood-stained fluid (C) Meconium-stained fluid
(B) Membranes ruptured (D) Membranes not ruptured

54. A 36-year-old Gravida-I, Para-0 pregnant woman came to a health facility complaining of
pushing down pain for three hours duration. She also has headache and lower extremity
swelling. On evaluation, her blood pressure is 140/90mmHg and she is in active first stage
labor. For further investigation, she was sent for urine analysis to check the presence of
protein, glucose, blood, and leukocyte esterase.

What is the most revealing laboratory finding for the above case?
(A) 4+ protein (C) Negative glucose
(B) Trace blood (D) Absent leukocyte esterase

55. In a remote health center where there is no electricity supply, the refrigerator is not
functioning. For that reason, the health center made injectable uterotonic drugs unavailable.
A midwife tries to manage third stage by physiological approach.

What is the most likely course the midwife has to observe to deliver the placenta?
(A) Uterus becomes soft (C) Umbilical cord protrudes further
(B) Until brisk bleeding (D) Remove the placenta manually

56. A laboring woman was admitted in labor ward with first stage labor. On examination, all
findings are normal. A midwife told the woman to ambulate in the room. However, the
woman prefers to stay on the bed.

What appropriate position is preferable for this woman?

(A) Dorsal supine position (C) Right lateral position
(B) Any comfortable position (D) Prone supine Position

57. A 26-year-old laboring woman is in the second stage labour and transferred to delivery room.
The midwife is to begin assisting birth of the fetal head.

What is the most effective management plan to deliver the head?

(A) Wait for the movements of restitution and external rotation
(B) Maintain flexion to prevent its early extension and to regulate its slow escape
(C) Insert fore finger of each hand under the axillae and deliver gently by lateral flexion
(D) Traction made on bisacromial diameter to place in anteroposterior diameter of the pelvis
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58. A multigravid woman came to a labour ward with second stage labor. A midwife transferred
her to a delivery room and started to conduct birth by preparing a uterotonic drug for active
management of third stage labor.

What most important precaution should be applied before the drug administration?
(A) Massage the uterus to facilitate the birth of placenta
(B) Apply controlled cord traction to deliver the placenta
(C) Palpate the abdomen to rule out presence of additional fetus
(D) Instruct the woman to push down when she feels contraction

59. A primiparous woman is in active first stage of labour and cervix is 6 cm dilated. She failed
to make progress on two subsequent examinations. The labour ward team has planned to
evaluate the adequacy of contractions through direct measurement.

What is the most precise method to evaluate uterine activity in this woman?
(A) Manual palpation (C) External tocodynamometry
(B) Serum oxytocin levels (D) Intrauterine pressure catheter

60. A 28-year-old laboring woman is admitted to a labour ward with a diagnosis of active first
stage of labour. Reassessment was done after four hours, and she had irregular and infrequent
contractions, rate of cervical dilatation slower than 1 cm per hour and presenting part poorly
applied to the cervix. The midwife noticed about the progress.

What is the most appropriate explanation of this labor progress?

(A) Unsatisfactory progress (C) Precipitated labor
(B) Satisfactory progress (D) Prolonged labor

61. A 32-year-old primigravida woman was admitted to a labor ward with the diagnosis of
prolonged second stage labor due to poor uterine contraction. On abdominal examination,
there is term size uterus with longitudinal lie and the fetal heartbeat is 110/min. During
vaginal examination, there is vertex presentation lie on ischial spine.

What is the most important parameter that describes a prerequisite for vacuum delivery?
(A) Station -1 (C) Bradycardic FHR
(B) Station 0 (D) Poor uterine contraction

62. A 36-year-old Gravida-VII Para-VI mother came to a hospital after two days duration of
pushing down pain. On history, she had frequent and strong uterine contraction. Upon
abdominal examination, no contraction and negative fetal heart rate identified. Then a
midwife diagnoses the case as uterine rupture.

What is the most likely sign of uterine rupture that describes this case?
(A) Constriction ring (C) Titanic uterine contraction
(B) Ceased fetal movement (D) Sudden cessation of contraction
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63. A 36-year-old multipara mother came with referral for the diagnosis of shock after having a
profuse vaginal bleeding following delivery of a 3800gm alive male neonate with
spontaneous vaginal delivery.

What most likely sign and symptoms of shock would help the midwife to diagnose the case?
(A) Urine output 40ml/hr
(B) Slow respiration rate
(C) Pulse rate greater than 110/min
(D) Systolic blood pressure greater than 90 mmHg

64. A 38-year-old multi para mothers delivered a 4000 gm alive female neonate an hour ago.
During her immediate post partum period, she bleeds profusely. On examination, her blood
pressure is 90/30 mmHg, pulse rate is 112/min and temperature 35 degree centigrade. She
had no history of medical disorder.

What is the most likely type of shock?

(A) Septic shock (C) Anaphylactic shock
(B) Cardiogenic shock (D) Hypovolemic shock

65. A 34-year-old Gravida-III Para-II mother came to a hospital with complaint of vaginal
bleeding and abdominal pain. On history, she had no difficult delivery and her LNMP was
not known .On ultrasound scan, gestational age was 32weeks, breech presentation and the
placenta is in upper uterine segment.

What is the most likely diagnosis for this case?

(A) Ruptured uterus (C) Local lesion of the cervix
(B) Antepartum hemorrhage (D) Second triminister abortion

66. A 35-year-old Gravida-III Para-II mother came to a hospital on 26-05-2013E.C.On history,

she did not remember her LMP. Her first trimester ultrasound scan on 12/10/2012E.C
showed, single intrauterine viable fetus and gestational age from CRL is 9+3weeks. On
abdominal examination, there is term sized uterus longitudinal lie, cephalic presentation and
FHB is 124/min.

What is the most likely diagnosis?

(A) Normal third trimester pregnancy (C) Post term pregnancy
(B) Intra uterine fetal death (D) Twin pregnancy

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67. A 35-year-old Gravida-V Para-IV woman visits the hospital complaining gush of fluid per
vagina. She has no history of foul smelling vaginal discharge, dysurea and urgency. The
gestational age makes 39weeks from LNMP. Her blood pressure is 110/60mmHg, pulse rate
is 110/min and temperature is 38 degree centigrade. She has tenderness on abdominal
examination. The FHR is 182/min. On inspection, there is leakage of fluid per vagina. There
is no costo-vertebral angle tenderness.

What is the most likely diagnosis?

(A) Chorio-amnionitis (C) Vaginitis
(B) Pylonephritis (D) Cystitis

68. A 34-year-old Gravida-II Para-I woman was admitted to a labor ward with the diagnosis of
active first stage labor .Gestational age makes 39weeks from her LNMP. On abdominal
examination, there is longitudinal lie breech presentation, FHB 112/min and Vaginal
examination after two hours the cervix is fully dilated and station is 0, with spontaneous
rupture of membrane cord will be visible though the vulva.

What is the most likely management plan for the case?

(A) Cesearan section (C) Breech extraction delivery
(B) Vacuum delivery (D) Spontaneous vaginal delivery

69. A 35-year-old Gravida-III para-II mother came to a hospital with pushing down pain of
labor. Up on assessment, her gestational age is 38 weeks .On abdominal examination, there is
term sized uterus with longitudinal lie, breech presentation and FHR 124/min. On vaginal
examination, the cervix is fully dilated and station is 0. Frank breech is diagnosed, with
progressive pushing the lower extremities is delivered spontaneously but the upper
extremities and the shoulders fail to be delivered spontaneously.

What maneuver is needed for this delivery?

(A) Burns–Marshall (C) Wigand Maneuver
(B) Lovset maneuver (D) Mauriceau Smellie Veit maneuver

70. A 35-year-old primigravida mother was referred from a health center for difficult labor. On
physical examination, she is dehydrated, tachycardic, having low blood pressure and febrile.
On abdominal examination, there is titanic uterine contraction, bandl ring, three tumor
abdomen and FHB is negative .The cervix if fully dilated with excessive molding and high
station.

What is the appropriate management plan?

(A) Forceps delivery (C) Cesarean section delivery
(B) Destructive delivery (D) Spontaneous vaginal delivery

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71. A 36-year-old Gravida-VI Para-V mother came to a hospital with complaint of absent fetal
movement. She has no history of medical disease. The calculated gestational age from
LNMP is 38weeks. On physical examination, her vital sign is in the normal range. On
abdominal examination, there is 34weeks sized uterus, longitudinal lie, cephalic presentation
and FHB is negative. An ultrasound confirms absence of cardiac activity and all laboratory
investigations are normal.
What is the most likely management plan?
(A) Immediately ripe the cervix (C) Cesarean section
(B) Give time for spontaneous labor (D) Induction upon diagnosis

72. A 34-year-old Gravida-III, Para-II woman was admitted to a labor ward with a diagnosis of
active first stage of labor. She has no history of medical disease and a midwife started to
follow with a parthograph. The midwife detected and reported the presence of NRFHR as a
result emergency cesarean section was done. On the third postoperative day she developed
pain and edema of the leg and thigh.
What is the most appropriate post operative care to be given to the patient?
(A) Initiate Early ambulation
(B) Administration of antibiotics
(C) Initiate breast feeding within one hour
(D) Remove the catheter after eight hours of operation

73. A midwife working in labor ward is following a laboring woman in active first stage labor
with partograph. Plotting started at 9:00am and all findings were non-revealing. After one
hour, the membrane ruptured spontaneously and the midwife noticed that amniotic fluid is
meconium stained and FHR became tachycardic.
What is the most appropriate next step to evaluate fetal condition?
(A) Oxygen via tightly fitting face mask (6-8 liters /min)
(B) Correct maternal hypotension and dehydration
(C) Vaginal examination to exclude cord accident
(D) Decrease uterine activity by using tocolytics

74. A 28-year-old Gravida-II, Para-I laboring woman is admitted to a health center with a
diagnosis of active first stage labour with 6cm cervical dilatation, intact membrane and zero
station. When the midwife reassessed her progress after four hours, she has 3 moderate
contractions in 10 minutes, rate of cervical dilatation slower than 1 cm per hour which is 8cm
and bulged membrane. The midwife decided to take an action for the poor progress.
What is the most appropriate management plan based on the reassessment findings?
(A) Rupture the membrane after excluding cord presentation
(B) Put the woman on IV fluid and augment with oxytocin
(C) Inform the family to arrange for referral to hospital
(D) Re-check the cervix to ensure cervical dilatation

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75. A 34-year-old multiparous mother reported moderate fever associated with shortness of
breath and chest pain. Her respiratory rate is 22/min and pulse rate revealed 110/min. At the
time of examination she has hemoptysis and temperature of 38.5 degree centigrade. She has
history of venous thrombosis.

What lab investigation is highly suggestive in excluding the diagnosis of this case?
(A) Whole blood count (C) Arterial blood gas investigation
(B) Determine clotting factors (D) Investigate the level of D-Dimer

76. A 27-year-old woman living with HIV came with a complaint of pushing down pain of 10
hours duration. She is on HAART. On physical examination, cervix is fully dilated and the
presenting part is protruded through vaginal opening. The midwife is giving care for this high
risk mother.

What is the most appropriate newborn care based on the above scenario?
(A) Slap back of the newborn (C) Give care in separate room
(B) Cut cord under cover of light gauze (D) Routine suction of nose and mouth

77. A 22-year-old primipara woman came for a follow up after she gave birth through cesarean
section under spinal anesthesia with an indication of obstructed labor secondary to cephalo-
pelvic disproportion. She complains occasional headache located in the forehead and deep
behind the eyes. Vital signs are in the normal range.

What is the most likely factors that gave rise to this condition?
(A) Puerperal pyrexia (C) Post puncture headache
(B) Puerperal psychosis (D) Postpartum preeclampsia

78. A 32-year-old laboring mother who has no history of antenatal care follow up is diagnosed
for HIV during labor. She gave birth for a baby girl within three hours of ART initiation. The
mother has decided to practice exclusive breastfeeding for the first six months.

What is the recommended ARV prophylaxis to be initiated for the baby girl?
(A) NVP daily for 6 weeks (C) NVP daily for 18 months
(B) NVP daily for 12 weeks (D) NVP twice daily for 4 weeks

79. A 39-year-old woman is admitted in a maternity ward after being treated for postpartum
hemorrhage. The midwife wants to provide counseling on different components of
postpartum care.

What most important component has to be emphasized depending on her case?

(A) Immunization (C) Nutrition, including iron-rich foods
(B) Family planning method (D) Danger signs of the mother and newborn
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80. A 35-year-old Para-I woman on the 12th day after delivery came to a clinic for postnatal
follow up. She has yellow-white color vaginal discharge.

What is the most likely lochia type that can be identified from this case?
(A) Lochia (B) Lochia alba (C) Lochia rubra (D) Lochia serosa

81. A 22-year-old primipara woman was presented by her family to a health facility on the third
day of delivery. She had a sudden onset of fear, restlessness, mania and depression followed
by hallucinations. Her family reported that she had suicidal attempt.

What is the most likely psychiatric disorder of the woman?

(A) Postpartum blue (C) Postpartum psychosis
(B) Postpartum depression (D) Postpartum personality disorder

82. On the seventh postpartum day, a woman came to a postnatal clinic with a compliant of
lower abdominal pain for the last three days. On physical examination, she has maternal
tachycardia, uterine tenderness and foul smelling vaginal discharge. Additionally, the mother
is febrile but all other vital signs are with the normal range.

What laboratory investigation is highly essential for this woman?

(A) Blood group and cross-match (C) Stool microscopy
(B) Whole blood count (D) Urine protein

83. A 19 year-old Para-I woman came with complaints of urinary urgency, frequency and
dysuria on the 4th week of postpartum period. She had vaginal discharge. Her blood pressure
is 110/70 mmHg, pulse rate is 90/min, temperature is 37.8 degree centigrade, respiration rate
is 22/min. On examination, there is costo-vertebral angle and supra pubic tenderness on
palpation.

What diagnosis is most appropriate in this case?

(A) Malaria (C) Urinary tract infection
(B) Uterine infection (D) Very severe febrile disease

84. A 37-year-old mother who gave birth at home came to a hospital immediately on postpartum
period with a compliant of excessive bleeding for six hours. On physical examination, her
pulse rate is 100/min, blood pressure is 80/60 mmHg and her skin feels cold. Furthermore,
she is not oriented to time, place and person.

What is the most likely diagnosis for the above case?

(A) Hemorrhagic shock (C) Neurogenic shock
(B) Cardiogenic shock (D) Septic shock

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85. A 19-year-old primipara woman came to a clinic with a complaint of painful breast that
lasted for seven days duration. She gave birth at home a week ago. On physical examination,
her temperature was 40.5 degree centigrade, blood pressure was 110/90mmHg, pulse rate
was 84/min, her breast is painful, tender, red, tense and hot, and axillary lymph nodes are
enlarged.

What is the most likely complication that this woman has developed?
(A) Galactocele (C) Acute mastitis
(B) Breast abscess (D) Breast engorgement

86. A 19-year-old Para-II woman came to a hospital with complaints of high-grade fever and
chills of one day duration. On history, she was on active labour for about 24 hours and she
was catheterized because obstructed labor was anticipated. Meanwhile, the delivery was
assisted with vacuum.

What is the most likely diagnosis of the above scenario?

(A) Puerperal UTI (C) Normal puerperium
(B) Puerperal pyrexia (D) Puerperal psychosis

87. A 39-year-old woman came to a clinic at the 7th day of post partum period complaining of
lower abdominal pain for the last three days. On physical examination, she is febrile with
chills, rigor and has generalized abdominal tenderness. She has also abdominal distention and
uterine tenderness. Finally, she was diagnosed with postpartum endometiritis.

What was the most likely clinical feature that helped to reach the diagnosis?
(A) Lower abdominal pain and fever (C) Abdominal guarding
(B) Abdominal distention (D) Chills and rigor

88. A laboring mother with a diagnosis of preeclampsia with severity signs is referred from a
health center after she took loading dose of magnesium sulfate. The mother spontaneously
delivered on her way. She arrived after eight hours of magnesium loading dose. Her current
blood pressure is 130/90 mmHg and there was no severity sign.

What is the most appropriate management regarding the maintenance dose of MgSO4?
(A) Interrupt magnesium as she has already delivered
(B) Double dose of magnesium as she missed
(C) Continue for 24 hours after loading dose
(D) Continue until 24 hours after delivery

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89. A 40-year-old Para-VI, Abortion-I mother came with referral from a nearby health center
following her delivery. On physical examination, a blood pressure of 85/45mmHg, pulse rate
of 115/min, pallor, cold clammy sweats, cyanosis of the fingers were observed. She is not
oriented to person, place and time.

What is the most appropriate initial step in the management of this patient?
(A) Establishing two or more intravenous ways for blood
(B) Transfusion of blood of the same group if not available group O-ve
(C) Establishing an airway and giving oxygen by mask or endotrachial tube
(D) Administer Crystalloid solution as ringer lactate, normal saline or glucose 5 percent

90. A health center head invited a midwife to provide morning health education for clients and
attendants regarding postpartum hemorrhage (PPH) prevention.

What is the most appropriate education component that would help to address the attendants?
(A) Skilled birth delivery (C) Deworming intestinal parasites
(B) Controlled cord traction (D) Uterotonic drug administration

91. On the seventh postpartum day a woman came with a complaint of involuntary leakage of
urine for the last three days and was diagnosed with mild stress incontinence. She associated
the leakage with sneezing and laughing. The mother also said that she has experienced the
leakage recently after delivery. She has no history of chronic chough and constipation.

What is the most appropriate initial management for this woman?

(A) Pessaries (B) Urethropexy (C) Kegel exercise (D) Midurethral sling

92. A midwife received a phone call from one of a female client who is on ART at PMTCT
clinic. She disclosed that she missed taking the drug for more than 15 hours due to some
family ceremony at her home.

What is the best measure the midwife shall respond for the adherence?
(A) Skip the missed dose and continue the next dose as usual
(B) Take the missed dose and continue the next dose as usual
(C) Skip the missed dose and double up the next dose
(D) Take the missed dose and the next dose together

93. A newborn baby immediately after birth showed the following signs and symptoms. Weak
respiratory effort, well flexed and blue extremities, grimace, and pulse rate of 90/min.

What is the calculated APGAR score of the newborn?

(A) 7 (B) 6 (C) 4 (D) 5

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94. A newborn baby at the fifth minute of birth was assessed for APGAR score. The findings
showed good cry, coughing and sneezing, pulse rate of 105/min, and some flexed and blue
extremities.

What is the most likely interpretation for the baby's APGAR score?
(A) Normal (B) Moderate (C) Very low (D) Low

95. A postnatal mother is counseled on kangaroo mother care; but, she is not willing to carryout
it. A provider kept on counseling the mother to convince her on the importance of kangaroo
mother care. The provider mentioned that kangaroo mother care facilitates breastfeeding,
keeps bonding, maintains temperature, and reduces frequency of apnea.

What is the primary importance of kangaroo mother care?

(A) Reduces frequency of apnea (C) Keeps the baby warm
(B) Establishes breast feeding (D) Keeps bonding

96. A 25-year-old mother whose gestational age was 33 weeks was presented to a hospital with
pushing down pain. On physical examination, her vital signs are in the normal range, 33
weeks sized abdomen, contraction 3/10'/45", and full cervical dilatation. The delivery team
ordered an assistant to prepare vitamin K for the newborn care.

How much dose shall the assistant prepare for this case?
(A) 0.25 mg (B) 0.5 mg (C) 1 mg (D) 2.5 mg

97. A midwife examined a term male newborn baby to identify the presence of primitive
reflexes. After supporting the neonate in semi-erect position, the midwife allows the
neonate's head to fall backwards onto her hand. She noticed a symmetric extension and
abduction of the fingers and upper extremities followed by flexion of the upper extremities
and an audible cry.

What is the primitive reflex demonstrated by the baby's response?

(A) A normal moro reflex (C) A moderate tonic neck reflex
(B) An absence rooting reflex (D) Presence of palmar grasp reflex

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98. A midwife evaluated whether or not a mother is practicing optimal breastfeeding for a one-
week-old HIV exposed infant. The midwife found out that the baby is taking Nevirapin,
feeding the breast exclusively in two to three hours interval day and night and about half of
both breasts milk in one feeding. From this evaluation, the midwife realized that the feeding
practice is not optimal.

Which breastfeeding practice makes it not optimal?

(A) The feeding is less frequent
(B) Breasts are not completely fed
(C) The baby is taking medication
(D) The feeding is optimal but the midwife evaluated it incorrectly

99. A five-day-old neonate who was born at home is presented with eye redness and
discharge.The baby's mother was healthy throughout pregnancy and followed four antenatal
visits. The midwife at neonatal clinic assessed the neonate and reached at the diagnosis of
ophthalmia neonatorum and ordered Ceftriaxone 50mg/kg and Erythromycin 50mg/kg orally
in four divided doses for 14 days.

What is the most likely history component that supports the diagnosis?
(A) Unattended birth
(B) Eye exposure to the sunlight
(C) Possible maternal infection with STIs
(D) Frequent eye touching nature of neonates

100. A term newborn baby fails to initiate and sustain breathing at birth. Five minutes after
resuscitation, the neonate's re-evaluation result shows a weak respiratory effort, some flexed
and blue extremities, no response to stimuli, and a pulse rate of 90/min.

What is the most likely diagnosis of the neonate?

(A) Hypoglycemia (C) Perinatal asphyxia
(B) Neonatal sepsis (D) Hyaline membrane disease

THE END

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