FCPS OBG PART 2 WRITTEN – PAPER A1

1 Which statement is correct regarding calculating expected date of delivery (EDD)?

2. Which best describes the reproductive history of a woman at 12/40 with a previous twin delivery and a stillbirth at 27/40?

3. Which statement is correct regarding general examination in pregnancy?

4 A woman is found to have oligohydramnios at 30/40. Which of the following is the most likely cause?

5 A woman contacts her midwife with concerns regarding fetal well-being at 32/40 in a previously normal

pregnancy. Which is the best management?

6. A woman attends her first ultrasound scan in pregnancy. What is the maximum crown rump length (CRL) that is accurate for dating before you measure gestational age by head circumference (HC)

7. A 30-year-old woman visits her GP at 8 weeks gestation in her second pregnancy with mild symptoms of nausea and vomiting of pregnancy (NVP). She had severe NVP in her first pregnancy requiring hospital admission and is concerned that her symptoms will worsen. What is the most appropriate advice from her GP?

8. What percentage of pregnant women with hyperemesis gravidarum in early pregnancy experience transient hyperthyroidism?

9. A woman underwent medical management of miscarriage but no specimen was sent for histological analysis. What would be the advice to the patient following this procedure?

10. During a routine surgical evacuation of miscarriage when should oxytocic agents be used?

11. A woman has been diagnosed with high-risk gestational trophoblastic neoplasia (GTN) and is about to receive multiagent chemotherapy. What is the expected cure rate?

12. A woman has attended the gynaecology clinic to discuss a diagnosis of a molar pregnancy. What is the definitive method of diagnosis?

13. A 26-year-old patient presents with left iliac fossa pain and has a 6 week period of amenorrhoea. The patient is clinically stable. An ultrasound confirms the presence of a left-sided ectopic pregnancy. There is a 2x2x2 cm pool of free fluid in the pouch of Douglas and the serum βHCG level is 3500 IU/l. What is the recommended management?

14. A woman has had surgical management of miscarriage and a molar pregnancy has been confirmed. Which immunohistochemistry marker is useful for distinguishing between partial and complete molar pregnancies?

15. A woman attends the early pregnancy unit having experienced her second successive miscarriage. She has been researching miscarriage on the internet and has read that most miscarriages are due to genetic problems. What percentage of first-trimester miscarriages are due to chromosomal abnormalities?

16. A 40-year-old woman, who has been trying to conceive for 3 years, is offered IVF (in vitro fertilisation) as a treatment option by her fertility specialist. Which ONE of the following is an appropriate discussion issue during her clinic counselling?

17.  A 40-year-old woman, who has been trying to conceive for 3 years, is offered IVF (in vitro fertilisation) as a treatment option by her fertility specialist. Which ONE of the following is an appropriate discussion issue during her clinic counselling?

18. Which ONE of the following clinical scenarios is considered diagnostic of polycystic ovarian syndrome?

19. A 30-year-old woman has been trying to conceive for 3 years. She has infrequent menstrual cycles. Ultrasound confi rms a normal uterus and polycystic ovaries. X-ray hysterosalpingogram has confirmed bilateral patent fallopian tubes. Her partner’s semen analysis is reported as within normal limits. Her BMI is 25 kg/m 2 . She has normal prolactin, FSH, oestradiol and testosterone. Of the options listed, which one of the following therapies is considered the most appropriate initial therapy?

20. the WHO classification of ovulation disorders describes three classes. Which one of the following is characteristically associated with high FSH and low oestrogen (WHO Class III)?

21. A 29 yrs old female  and her male partner (26 years) have been trying to conceive naturally for the last 3 years. They have had infertility investigations over the last year. These include a normal semen analysis, normal USS pelvis, normal HSG, normal TSH, prolactin, D3 FSH, LH and normal AMH.  Her day 21 progesterone suggest ovulation. Ms XY is rubella immune and has negative swabs for an STI. Her recent cervical smear is normal. Which of the following treatment options are best suited to her?

22. A 23-year-old primiparous woman has been diagnosed with pulmonary tuberculosis at 33

weeks gestation. What is the impact on the pregnancy?

23. A 32-year-old woman contemplating her first pregnancy comes to see you in the pre-pregnancy clinic. She has had epilepsy since the age of 10. The following are true about anticonvulsants in pregnancy, except:

24. A woman who is Rhesus-negative undergoes a laparoscopic salpingectomy for an ectopic

pregnancy at eight weeks gestation. What dose of anti-D immunoglobulin should she

receive immediately after the operation?

25. The cardiovascular system undergoes numerous changes in pregnancy in order to adapt to

the demands of the developing fetus and labour. Which of the following parameters does

not change?

26. A 30 years old woman presents at 28 weeks gestation in her second pregnancy. She is

known to have anti-C antibodies. On reviewing her latest blood results, you notice that

her anti-C titre is 27 IU/ml. How would you manage her?

27. A 25-year-old woman who is known to have beta thalssaemia trait is due to marry

someone form the same ethnic background. Which of the following is correct?

28. Whilst performing your antenatal morning ward round, you come across a 22-year-old

woman in her first pregnancy at 37 weeks gestation who has been admitted with sickle

cell crisis. She describes severe pain in her right arm, which is persistent. Which of the

following is the most appropriate first-line management?

 29. A 24-year-old woman at 25 weeks gestation presents for advice following exposure to a

child one week ago who developed chickenpox two days ago. Which of the following is

true regarding varicella zoster virus (VZV)?

 30.A 30-year-old woman presents with a worsening cough, night sweats, and feeling unwell

at 24 weeks gestation. She is found to be sputum positive for gram-positive, acid-fast

bacilli, and a chest X-ray shows patch shadows in the upper zones with some fibrosis and

areas of cavitation. Which of the following medication should be considered for

treatment?

 31. A 25-year-old woman presents in her second pregnancy at eight weeks gestation. She has

previously had a painless preterm delivery at 26 weeks gestation, with no cause found.

Which of the following is correct?

33. A 32-year-old para 1+0 attends antenatal clinic for booking in her second pregnancy at 14 weeks gestation. She underwent uncomplicated emergency caesarean section in her last delivery due to presenting in labour with a breech presentation at 6cm cervical dilatation. She wishes to discuss her options for delivery in this pregnancy.

Choose the statement that best describes the risks and benefits of VBAC vs ERCS for her.

34. A G1P0 is admitted to labour ward with uterine activity at 39+3 weeks gestation. She has had a low risk pregnancy to date. She is found to be contracting 2 in 10, and these contractions are mild and in-coordinate. Abdominal examination reveals a fetus in the cephalic position, with 4/5 of the fetal head palpable abdominally. An initial vaginal examination reveals an effaced cervix, 5cm dilated with intact membranes and -3 station. A repeat examination after 4hrs reveals no change. The next most appropriate step in management is:

35. A 26-year-old G1P0 at 40+5 weeks of gestation presents to the labour ward with regular painful contractions for the past 3 hours. On examination, she is contracting 4 in every 10 minutes and the contractions are strong. Abdominal examination reveals that the fetus is in a cephalic presentation with the fetal head 3/5 palpable. Initial vaginal examination reveals an effaced cervix, which is 4 cm dilated. The fetal membranes are intact and the head is at station -1 to the spines with no caput or moulding. The position is not defined. At 4 hours later, a second examination reveals that the head remains at station –1 and the cervix is still 4 cm dilated despite ongoing adequate contractions.

Which is the most appropriate management intervention?

A 26-year-old woman – G1P0 at 38+5 weeks of gestation – presents to the labour ward with regular painful contractions for the past 3 hours, preceded by a gush of clear fluid. On examination, she is contracting twice in every 10 minutes. Abdominal examination reveals that the fetus is in cephalic presentation with the fetal head 3/5 palpable. Initial vaginal examination reveals an effaced cervix, which is 5 cm dilated. The head is at station –1 to the spines with no caput or moulding. The position is not defined and there is clear liquor draining. At 4 hours later, a second examination reveals that the head remains at station –1 and the cervix is still 5 cm dilated. The frequency of contractions has increased to five in every 10 minutes for the past 30 minutes.

Which is the most appropriate action?

37. A 26-year-old G2P1 woman with a low risk pregnancy presents at 41 weeks of gestation in spontaneous labour. She was transferred to the labour ward from the birth unit as she has been pushing for 2 hours and not yet delivered.

She has had a normal progress in labour to date and no CTG concerns on arrival. Findings were:

• vital signs normal
• per abdominal examination – less than one-fifth palpable
• vaginal examination – os fully dilated, presenting part vertex at spines, ROP, caput + and
  moulding +.

What would be your preferred line of management?

38.A 32-year-old primigravida with no antenatal risk factors attends the antenatal clinic for discussion of management of prolonged pregnancy. She is at 40 weeks of gestation and has had a membrane sweep in the past 7 days. You have discussed the risk associated with prolonged pregnancy.

39. A 32-year-old primigravida with no antenatal risk factors attends the antenatal clinic for discussion of management of prolonged pregnancy. She is at 42 weeks of gestation and had a membrane sweep 2 days ago. You have discussed the risk associated with prolonged pregnancyand placental insufficiency and she has declined induction of labour.

What is the most appropriate fetal monitoring options to offer?

40. A 33-year-old woman who is nulliparous with an uncomplicated antenatal history attends for a routine induction of labour at 41 weeks and 5 days of gestation.

Which is an appropriate vaginal induction agent and dose?

41. A 25-year-old primigravida with a small-for-gestational-age fetus is undergoing induction of labour at 38 weeks of gestation. She has a routine CTG 6 hours after prostaglandin E2 administration by vaginal delivery system. The fetal cardiotocograph shows uterine hypercontractility and frequent fetal heart rate variable decelerations for 20 minutes.

What is the most appropriate immediate action?

42. A 34-year-old primigravida at 39 weeks of gestation presents to the labour ward. She describes a gush of clear fluid per vagina associated with Braxton Hicks contractions. There have been no antenatal complications and she has been under low-risk midwifery care.

On examination her temperature is 37.2°C, heart rate is 85 beats per minute and she is normotensive. Abdominal palpation reveals a non-tender, soft uterus and cephalic presentation. Speculum examination confirms ruptured fetal membranes with clear liquor. The cardiotocograph is reassuring.

What is the most appropriate course of action?

43. A 20-year-old woman, a known epileptic, attends the medical antenatal clinic for

preconceptual counselling. She has been seizure free for two years.

Which of the following medications would you advise her against because of the risk

of congenital malformation?

44. A 34-year-old woman presents to the obstetric unit via ambulance after collapsing in

the supermarket. She has previously suffered two miscarriages and is 28 weeks

pregnant. On examination, she appears confused and complains she is dizzy. You

elicit a right-sided hemiparesis. She is apyrexial and all observations are stable.

What would be your first investigation of choice?

45.  A 39-year-old woman presents with right upper quadrant pain and polydipsia in her

third trimester. She appears jaundiced and tells you that she has been vomiting for

two days. On examination, she has a BMI of 35 kg/m2 and blood tests show a raised

alanine transaminase with hyperuricemia. Her creatinine is normal and she shows a

mild leucocytosis. Her BP is 149/100 mmHg and she has 3+ proteinuria.

Which of the following is most likely the cause of her clinical picture?

46. A 32-year-old diabetic woman had an instrumental delivery two hours previously.

Antenatally she complained of severe lethargy but is found to have normal haemoglobin.

You are called to see her as she has become confused and bradycardic. Her

observations record a temperature of 35_C, heart rate of 45 bpm and oxygen saturations

of 80% on air. Blood glucose level is 4 mmol/L, she is hyponatraemic and has

decreased reflexes.

What will the patient need following initial supportive treatment?

47. Sickle cell disease (SCD) is the most common inherited condition worldwide.

The recommended daily dose of folic acid for pregnant women with SCD is:

48. A 27-year-old primigravida presents at 35+3 weeks’ gestation with a headache and 24 hours of no fetal movement. An IUFD and preeclampsia are diagnosed. Induction of labour is performed. Four days after delivery her BP is still very labile, and she continues to require second-line oral therapy. She is troubled by lactation and breast pain.

What would be the best management for her?

50. Breastfeeding is absolutely contraindicated in women taking

51. You are asked to see a woman on the fifth day following an uncomplicated spontaneous vertex delivery at 39 weeks of gestation. The woman complains of unilateral breast pain. She is breastfeeding.Which of the following statements is correct?

52. A woman with postnatal blues…

53. You see a multiparous woman in the antenatal clinic at 37 weeks of gestation who has been diagnosed with pelvic girdle pain. The woman is requesting induction of labour. She is unable to weight bear and hip abduction is <20°. The woman is very concerned about vaginal delivery and the postpartum period.

What do you advise her?