FCPS Part-2 Written-Antenatal Care & Postnatal Problems

1. A 28years old primigravida with a dichorionic diamniotic twin pregnancy presents at 30 weeks gestation with severe pruritis and an erythematous papular rash on her abdomen with periumbilical sparing. The most likely diagnosis is:

2. A 24 years old woman presents at 35 weeks gestation with a sudden onset of severe headache and altered consciousness. She also had an episode of vomiting and diarrhea at home . What is the most appropriate imaging technique to reach the diagnosis?

3. A 25years old woman presents to have a dating ultrasound scan at 12 weeks gestation. Doppler ultrasound identifies tricuspid regurgitation and a reversed A-wave in the ductus venosus (DV). She is at increased risk of which condition?

4. A 30 years old woman admitted with suspected small for dates pregnancy at 33 weeks gestation. Ultrasound assessment has confirmed a small for gestation (SGA) fetus with

reduced liquor volume and reversed end diastolic flow on umbilical artery (UA) Doppler. Cardiotocograph (CTG) is normal. What is the most appropriate management?

5. In high risk woman if aspirin is used to reduce risk of pre-eclampsia, at what gestation should it be started for maximum efficacy?

6. In high risk woman When calcium supplementation is used to reduce the risk of pre-eclampsia, at what gestation should it be started?

7. What is the incidence of red cell antibodies in pregnancy?

8. Which of following red cell antibody increases the risk of fetal anaemia in the presence of anti-c red cell antibodies in pregnancy?

9. A 23 year old primigravida is admitted at 24 weeks gestation in her with suspected appendicitis. She has a low grade fever with a leucocytosis and a mildly elevated C reactive protein level. Abdominal ultrasound is inconclusive. What imaging technique is the most appropriate subsequent investigation?

10.  A 82 year old women presents with vaginal candidiasis at 23 week pregnancy. What treatment should you offer her?

11. Women suffer from various anxieties in pregnancy. What is tokophobia?

12. What vitamin should women be advised to be taken throughout pregnancy and also while breastfeeding?

13. An 22 year old woman came for booking at 12 weeks of gestation. She is otherwise well except for an increased (BMI). What BMI and above should she be offered screening for diabetes?

14. A 28 years old G2P1 at 36 weeks of gestation presents with an uncomplicated breech presentation and decides to have ECV after consultation. What other management is most appropriate if she could not have an ECV at 37 weeks with persistent breech presentation?

15. A 27years old G3P2 at 34 weeks gestation is complaining of severe chronic sleep problem. What would be the most appropriate pharmacological intervention?

16. Which tocolytic agent has been proven to increase the success of an ECV?

17. A G3P2 (both full term normal deliveries) is diagnosed with breech presentation at 34 weeks of gestation and wants to have an external cephalic version. At what gestation is external cephalic version recommended for this mother?

18. A 28 years old primigravida is admitted with threatened preterm labour at 30 weeks. She wants to know about antenatal corticosteroids. What are the three recognised fetal benefits associated with antenatal corticosteroid administration in her case?

19. A 24 year old woman with H/O previous second trimester miscarriage is currently
undergoing a serial ultrasound assessment of cervical length. What is minimum cervical length on ultrasound at which cervical cerclage be recommended?

20. A 24 years old woman presented at 32 weeks gestation with severe falciparum malaria. What is the drug  of choice?

21. A 24 years old woman at 27weeks of gestation is planning to travel to her hometown that is endemic for chloroquine-resistant malaria. What would you recommend as the drug of choice for prophylaxis?

22. The velocimetry measurement of which blood vessel can be used to improve perinatal outcomes in high-risk pregnancies?

23. A G2P0+1 (molar pregnancy) is diagnosed with Rhesus isoimmunisation. Doppler assessment of which vessel is used to monitor fetal anaemia during pregnancy?

24. A 23 years old primigravida presents at 27 weeks of gestation with c/o reduced fetal movements. What is the most appropriate initial investigation to carry out?

25. A 24 years old G2P1 at 25 weeks of gestation with a monchorionic diamniotic twin pregnancy is being assessed by you. She is found to have severe TTTS (Quintero stage III). What is the optimal treatment?

26. A 30 year old primagravida with a BMI of 28 presented at 36 weeks gestation. She is suspected to have a ‘large-for dates’ baby. An ultrasound scan confirms the fetus to be large for gestational age. Her OGTT is normal. what will you do next ?

27. A 26 year old primagravida with a singleton pregnancy at 24 weeks gestation presented with c/o mild per vaginal bleeding. on ultrasound cervical length is 21mm. What is the next best management?

28. A 35 year old G7P6 has had a major PPH following a vaginal delivery. Mechanical and pharmacological measures have failed to control the bleeding. Examination is normal with no tears or rpocs. What is the most appropriate first-line surgical management?

29. A 32 year old P5 who was taking therapeuticdose of LMWH from 33 weeks gestation for confirmed pulmonary embolism. She has an uncomplicated spontaneous vaginal delivery at 38 weeks gestation. What is the most appropriate postnatal management?

30. A 37 year old primigravida with BMI of 40 kg/m2 has presented for booking. She has conceived after 7 years of subfertility through assisted conception. Ultrasound scan had confirmed a DADC twin pregnancy of 12 weeks gestation. Prophylactic LMWH had been given throughout pregnancy. A category 3 caesarean section had been performed at 37 weeks. What is recommended as the best practice with regard to reducing maternal risk of VTE in the puerperium?

31. A 22 years old primigravida is diagnosed to have Chlamydia infection at 28week sof gestation. She has been treated with antibiotics. When should the test of cure be done after initial treatment in pregnancy?

32. A 22 years old PG with confirmed obstetric cholestatis has a normal vaginal delivery.  How long after delivery should repeat liver function tests be performed?

33. A 22 years old woman presents with mood swings, irritability, anxiety and decreased Concentration 10 days post partum. Care of the baby is not impaired and the woman does not feel suicidal. What is the most likely diagnosis?

34. A 29 years old woman with a history of severe depression presents with mild depression in pregnancy. What is the best plan of care?

35. What is the incidence of postpartum psychosis in the general population?

36. A 25years old P1 is complaining of breast pain and discomfort 11th day post partum. She is diagnosed to have postpartum mastitis. All of the following are treatment options for her except:

37. Which of the following is commonest urinary problem occurring in the postpartum period :

38. A 38 years old woman with previous one caesarean delivery, presented with c/o sudden vaginal bleeding immediately following vaginal delivery of a 36-week gestation baby (birth weight 3.8 kg).  she had acute onset fetal bradycardia and cessation of uterine contractile activity 10 min prior to the delivery. The urinary catheter shows haematuria. The placenta was delivered without complication.
Bimanual compression of the uterus is extremely painful for the woman. Despite an estimated blood loss of 500 ml, she appears pale and clammy with BP 90/30 and pulse 120 bpm. Which one of the following is the most likely cause for the excessive genital tract bleeding?

39. A 32 years old woman, G4P3 with all svds, presents at term with twin pregnancy at 36+ weeks of gestation. 20 mintues after her uneventful vaginal delivery She complains of sudden onset of heavy bleeding. She received an epidural top-up 30 min before delivery. The estimated blood loss is 700 ml. Which one of the following is the most likely cause for the excessive genital tract bleeding?

40. A 32 years old P4, 6 days postnatal, presented with a 2 days history of worsening pelvic pain and vaginal bleeding with clots. She ahs history of vaccum cup application for poor pushing effort. Her BMI is 32g/m2. Her vital signs are with normal range. She has pelvic tenderness on examination. What is the SINGLE most likely diagnosis?

41. Which one of the following statements is correct in relation to postpartum depression?

42. In a breastfeeding population, what is the risk of mother to child transmission of HIV due to breastfeeding?

43. A 23 years old para 1 who delivered 1 week back. She was diagnosed to have diet controlled GDM, and her plasma glucose levels have now returned to normal. What follow-up should she have postpartum?

44. A 27years old para 1, 3 days postnatal. presented with c/o fever with rigors and foul smelling lochia. Her observations include pulse 128 bpm, BP 80 systolic, RR 24 breaths/min and temp 39° C. She has been fluid resuscitated now and commenced on oxygen by mask. Which of the following antibiotics are best suited to her?

45. A 22 years old para2, 1 day back delivered at home, presented with 1 postpartum with history of a fever and sore throat leading up to the delivery. What is the most likely organism responsible for her condition?

46. A 25years old P3, had a 3B perineal tear during delivery. You come to debrief her about the procedure. What percentage of women are asymptomatic after EAS repair at 12 months ?

47. A pregnant woman undergoes a routine anomaly ultrasound scan at 18 weeks of gestation. No ultrasound soft markers are present. At what nuchal translucency measurement is it recommended to refer the woman to fetal medicine services?

48. A woman is noted to have a low-lying placenta at her 20-week anomaly scan. At what gestational age should you arrange the next  scan to assess placental localisation?

49. What is the primary reason that serological screening for hepatitis B is routinely offered to all pregnant women?