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1. A 25-year-old woman known to have hyperthyroidism is going for radioactive iodine therapy. She has been trying to conceive for the last 6 months. How long should she avoid pregnancy after this treatmentCorrectIncorrect
- A 38-year-old nulliparous woman with moderate chronic renal failure comes to the preconception clinic as she wishes to have a baby. She had renal transplantation 3 years ago and her recent creatinine is around 130 with estimated glomerular filtration rate (GFR) of approximately 45. She is currently taking prednisolone, mycophenolate, angiotensin-converting enzyme (ACE) inhibitors and aspirin. You have advised her to stop mycophenolate and to start another immunosuppressant. Which one of the immunosuppressant drugs would be contraindicated in pregnancy?
- A 25-year-old para 1 woman at 30 weeks’ gestation was brought in to the Obstetric day assessment unit with abdominal and back pains, vomiting and feeling unwell. Her observations are temperature 38.2°C, pulse 110 bpm, blood pressure (BP) 100/60 mm Hg, respiratory rate 18/min and oxygen saturations 98% on room air. On examination, she has suprapubic and right flank tenderness with 3+ leucocytes and positive nitrates on urine dipsticks. Foetal movements were good and cardiotocography was normal. You have admitted her and started broad spectrum intravenous antibiotics for acute pyelonephritis after doing the septic screen. What is the recurrence rate of pyelonephritis during the pregnancy?
- A 35-year-old nulliparous woman with chronic renal failure had a successful renal transplantation surgery recently. She wishes to have children in the future and her GP has referred for preconception advice. What is the recommended time interval for conception after an allograft transplantation?
- A 30-year-old primigravida at 35 weeks’ gestation with monochorionic diamniotic pregnancy presents with intense itching and rash on the abdomen. On examination there were erythematous papules and plaques in the striae gravidarum with umbilical sparing. The most likely diagnosis is which one of the following?
- A 38-year-old primigravida at 36 weeks’ gestation with dichorionic diamniotic twin pregnancy was diagnosed with acute fatty liver of pregnancy. She was stabilised and delivered by caesarean section. What is the risk of recurrence in subsequent pregnancies?
- A 26-year-old, nulliparous woman at 33 weeks’ gestation presented with severe generalised itching that was worse at night and also present on the palms and soles. She was diagnosed to have intrahepatic cholestasis of pregnancy (IHCP) and was started on ursodeoxycholic acid and chlorpheniramine. Which one of the statements is true with regards to counselling women with IHCP?
- A 30-year-old nulliparous woman with sickle cell disease (SCD) attends your clinic for preconception advice. You have requested the following tests to assess for the chronic disease complications prior to stopping contraception. Which one of these screening tests is not indicated yearly?
- A 26-year-old nulliparous woman at 36 weeks’ gestation was diagnosed as having idiopathic immune thrombocytopenia (ITP). Her recent platelet count was 70 × 109 /L. Which one of the following statements is true?
- A 28-year-old para 1 woman with systemic lupus erythematosus (SLE) presents for a growth scan at 28 weeks’ gestation. Foetal heart (FH) rate was 80–90 beats per minute and a foetal echocardiogram confirmed a seconddegree congenital heart block (CHB). Which one of the following autoantibodies is associated with CHB in women with SLE?
- A nulliparous woman had a thrombophilia screen requested by her GP because of the family history of VTE in her mother and sister. Which one of the thrombophilia defects is associated with the highest risk of VTE in pregnancy?
- A 25-year-old nulliparous woman with type 1 diabetes on insulin attends her first diabetic/antenatal clinic at 10 weeks’ gestation. You have discussed diet, exercise, blood glucose monitoring and target blood glucose levels. Which one of the options is correct with regards to her capillary plasma glucose target levels?
- A 30-year-old nulliparous woman with poorly controlled type 1 diabetes attends a preconception clinic for advice. You have reviewed her recent HbA1c test results. At what HbA1c level should you strongly advise her not to get pregnant?
- A 30-year-old para 1 woman with a body mass index (BMI) of 38 and family history of diabetes attends antenatal clinic at 28 weeks’ gestation. She was diagnosed with gestational diabetes 2 days ago when her glucose tolerance test was abnormal with a fasting glucose of 7.0 mmol/L and a 2-hour plasma glucose of 8.9 mmol/L. What is the most appropriate intervention in managing her gestational diabetes?
15. A primigravida is seen for booking. She is 40 years and has conceived through IVF. Ultrasound scan has confirmed a twin pregnancy. Her BMI is 36 kg/m2. What treatment would you advise to reduce the risk of pre-eclampsia?CorrectIncorrect
- A woman with chronic essential hypertension was converted from Lisinopril to methyldopa in a preconception counselling clinic. The pregnancy was uncomplicated and she delivered spontaneously at term. At what stage postnatally should the antihypertensive medication be switched back to Lisinopril?
17) A 34-year-old nulliparous woman in the second stage of labour has been pushing for the last two hours and is exhausted. The CTG is normal; the head is 1 cm above the ischial spines, in occipitoanterior position.
Which of the following would be the most appropriate action?CorrectIncorrect
18) Which type of episiotomy would be most appropriate to reduce the risk of severe perineal tear?CorrectIncorrect
19) A 33-year-old woman in her second pregnancy presents to the labour ward at 39 weeks with painful uterine contractions every three minutes. Vaginal examination shows the cervix to be dilated 6 cm and effaced. The head is 3 cm above the ischial spines. The membranes are ruptured. You could easily feel the anterior fontanel and the supraorbital ridges. Fetal heart rate is normal. Her first pregnancy ended in a normal uncomplicated vaginal delivery. Which of the following is the best management option?CorrectIncorrect
20) A patient in early labour enquires about the risk of accidental dural puncture if she has epidural analgesia.
What is the risk of dural puncture?CorrectIncorrect
21) A 34-year-old para 2 woman with two previous normal deliveries comes in spontaneous labour at 40 weeks’ gestation. She was low risk and was found to be in established labour at 6 cm cervical dilatation with intact membranes. A few hours after this examination, she had spontaneous rupture of membranes, fully dilated cervix and a brow presentation. What is the diameter of the presenting part?CorrectIncorrect
22) A 28-year-old woman with a past history of a third-degree tear was admitted in established labour and progressed well. She was in the second stage of labour and was actively pushing with good descent. Which one of the following would be most appropriate in preventing the obstetric anal sphincter injuries (OASIS)?CorrectIncorrect
23) What is the risk of umbilical cord prolapse in breech presentation?CorrectIncorrect
24) You were asked to see a 29-year-old nulliparous woman in the active second stage of labour, pushing for about an hour and exhausted, asking for a caesarean section. She was induced at 38 weeks for type 1 diabetes and suspected macrosomia. She is contracting 4 in 10 minutes and the CTG is normal. Per abdomen, 0/5th head was palpable and you have confirmed full dilatation, absent membranes, right occipito-posterior (ROP) position with the vertex at spines and descent to +1 during pushing. What is the most appropriate management plan?CorrectIncorrect
25) A nulliparous woman at 40 + 2 gestation was admitted in spontaneous labour and progressed satisfactorily to full dilatation 2 hours ago. On reassessment there is no change in the descent with the vertex at −1 station, the position is occipitoanterior with absent membranes, no caput or moulding. Epidural is effective, contractions are three in 10 minutes and the CTG is normal. What is the most appropriate management?CorrectIncorrect
26. A 23-year-old nulliparous woman has been pushing for two hours. The head is not palpable abdominally, the cervix is fully dilated, and on vaginal examination, the head is in right occipitoposterior position with minimal caput. The station is 1 cm below the ischial spine. The CTG is reassuring.
Which of the following management options would be the most appropriate?CorrectIncorrect
27. A patient comes to you at 20 weeks of gestation and she seeks advise as her son has developed chicken pox 1 day before.She is not sure that she has developed chicken pox or not. She is otherwise well .what will be most appropriate immediate management.CorrectIncorrect
28. A 38 weeks pregnant patient calls you and tells that her husband has been diagnosed with herpes zoster and she thinks that she has not had chicken pox.what is the most apropriate managementCorrectIncorrect
29. A 26 years old primigravida patient presents to you at 38 weeks of gestation and her induction of labour is planned.She is diagnosed with primary varicella zoster virus infection. what will be your recomendation to reduce the transmission of infection to babyCorrectIncorrect
30. A patient comes to you at 27 weeks of infection with chicken pox infection . What would be your further action ?CorrectIncorrect
31. A patient has received rubella vaccination.for how long you wil advise your patient to follow contraceptlionCorrectIncorrect
32. A woman who is 22 weeks pregnant is seen in the antenatal clinic. Her hepatitisscreening test shows IgM antibody to the hepatitis B core antigen (HBcAg ). What is your diagnosis?CorrectIncorrect
33. If a patient presents to you with primary herpes What are the risks of the baby developing neonatal herpes if she has a vaginal delivery?CorrectIncorrect
34. What is the percentage of all HIV-positive women in the UK, who are identified because of antenatal screening in their current pregnancy?CorrectIncorrect
35. A full-term primigravida pregnant woman presented in established labour at 6-cm dilatation. Her previous screening showed she is HIV screen positive but did not have any treatment. What is your immediate management?CorrectIncorrect
36. A woman who is 35 weeks pregnant is diagnosed with primary genital herpes. She received acyclovir treatment but was reluctant to accept Caesarean section delivery. What are the risks of the baby developing neonatal herpes if she has a vaginal delivery?CorrectIncorrect
37. Of the following, the most consistent finding in uterine rupture is:CorrectIncorrect
38. Which one of the following statements is correct in relation to the third stage of labour?CorrectIncorrect
39. Which ONE of the following statements represents the correct sequence of events in relation to the mechanism of labour for a vertex presentation?CorrectIncorrect
40. You are evaluating Mrs X who has been in fi rst stage of labour for the past 10 h. Which of the following information is least relevant to your further clinical management?CorrectIncorrect
41. Which type of female pelvis favours direct occipito-posterior position?CorrectIncorrect
42. Accepted maternal indications For operative vaginal delivery include all EXCEPT which of the following?CorrectIncorrect
43. Which of the following describes forceps that are applied to the fetal head with the scalp visible at the introitus without manual separation of the labia?CorrectIncorrect
44. An 18-year-old woman books into the antenatal clinic at 12 weeks of gestation. She is fit and well but is noted to have an increased body mass index (BMI) but no other risk factors for diabetes. What BMI and above should she be offered screening for diabetes?CorrectIncorrect
45. What is the main contraindication to the use of antenatal corticosteroids?CorrectIncorrect
46. A 39-year-old Type 2 diabetic of Asian origin presents with an acute onset of epigastric pain, chest pain and breathlessness at 30 weeks gestation. She is gravida 5 Para 4 (four normal vaginal deliveries), and has a BMI of 41 kg/m2. This was an unplanned pregnancy. Her diabetes is poorly controlled and her haemoglobin was 85 g/1 at 28 weeks. She is on oral iron and there is history of familial hyperlipidemia. What is the most likely working diagnosis for this mother?CorrectIncorrect
47. A 41-year-old woman has an oral glucose tolerance test (OGTT) at 28 weeks gestation in her fourth pregnancy. The results are as follows: Fasting plasma glucose: 5.8 mmol/l 2 hour plasma glucose: 7.4 mmol/l What is the correct diagnosis?CorrectIncorrect
48. A woman who is taking antipsychotic medication is contemplating pregnancy. Why is Lithium not the drug of choice?CorrectIncorrect
49. A woman who is a recent immigrant to the United Kingdom is admitted in labour and delivers rapidly. At delivery, the midwife had noted that the liquor was offensive and appropriate swabs were taken. The mother is also noted to have a low-grade pyrexia and mild tachycardia. Within minutes of antibiotic administration, the mother collapses and anaphylactic shock is diagnosed. An A, B, C, D, E approach has been initiated. What is the definitive treatment for anaphylaxis?CorrectIncorrect
50. A woman with a BMI of 40 whose epilepsy is well controlled on anti-epileptic drugs (AEDs) attends for a booking appointment with the community midwife at 10 weeks gestation. Which combination of vitamin supplements should she be advised to take?CorrectIncorrect