FCPS Part-2 Written -Maternal Medicine

1. Patient with altered GCT next test for confirmation of diabetic

2. Which of the following is not a contraindication to pregnancy?

3. Which of the following test is the most sensitive marker for detection of iron deficiency in pregnancy?

4. A 28years old patients has presented to you at gestational amenorrhea of 18weeks. she had previous 2 still births at home delivery because of good size baby. her 75gm oral glucose test show 1hr post p bsl 140mg. Most appropriate test to know her previous control of bsl?

5. You see a 31-year-old primigravida at 26 weeks’ gestation who presents with worsening fatigue, sweating, insomnia, loss of weight and palpitations. She reports good fetal movements. Physical examination shows exophthalmos, an enlarged nontender thyroid gland and fine hand tremors. Her thyroid function test results show a TSH less than 0.05 mU/L (normal range 0.4–5.0) and a 4 of 70 pmol/L (normal range 10–20). You counsel her regarding the risks of poorly controlled hyperthyroidism in pregnancy. Which of the following is not a recognized risk?

6. a 22-year-old G2P1, at gestational amenorrhea of 35 weeks has  presented to the labour ward complaining of headache,

abdominal pain, nausea, vomiting and widespread itching with no rash. On examination there is mild jaundice and bilateral pedal edema. Her BP is 150/95 mm Hg, urine albumin 1+ . FBC, LFT , U&E, clotting screen and serum urate awaited.What is the single most important test that could help to distinguish

AFLP from HELLP and severe pre.eclampsia?

7.  a 31-year-old primigravida at 37 weeks of gestaion presented with c/o  with headache and blurring of vision. Her BP is 160/110 mm Hg, urine albumin 3+,  urine protein : creatinine ratio is 90 mg/mmol . Her reflexes are brisk, and her abdomen is soft . SFH is 35 cm, the CTG is normal. What is the most appropriate action?

8. A 23-year-old woman, k/c of  beta thalassaemia major. She had splenectomy at the age of 9. presented for booking at 14 weeks of gestation. Her recent platelet count is 680 × 109/L . What antenatal thromboprophylaxis is recommended?

9. A 35-year-old G2P1 at 34 weeks of gestation presented with complain of pruritus, especially in the palms and soles. She also gives a history of induction of labour at 38 weeks for obstetric cholestasis in her first pregnancy. Inspection of the skin shows scratch marks but no rash. The SFH is 36 cm and a CTG is normal. Her liver function tests show an elevated alanine transaminase and bile acids. You suspect obstetric cholestasis. How would you counsel her regarding obstetric cholestasis?

10. a 30-year-old G3P2 previous SVD. She is found to have a platelet count of 80 × 109/L on routine screening at 30weeks’ gestation. Her first child was delivered at term by caesarean section for breech presentation. she doesnt have any history of bruising or bleeding. Which of the following conditions could not explain her thrombocytopenia?

11. a 36-year-old woman , G4P3 at 32 weeks of gestation. herBMI of 40 kg/m2 . presented with sudden onset shortness of breath with no cough or chest pain. She has right leg pain and swelling. vital signs show a pulse rate of 100 bpm, BP 110/70 mm Hg, temperature 37°C and respiratory rate 18/min. Chest examination is normal. You suspect pulmonary embolism and start LMWH. What is your next most appropriate test?

12. a 34-year-old primigravida at 32 weeks’ gestation, presented with c/o of nonspecific headaches, nausea, retrobulbar pain and blurring of vision from last 3 days. Her neurologic examination is normal, an ophthalmologic examination shows bilateral papilledema. A magnetic resonance venogram demonstrates no mass lesion or venous thrombosis. A lumbar puncture, however, shows a raised opening pressure, but normal otherwise. Her BMI is 36 kg/m2. Which of the following is the drug of choice?

13. A 30-year-old G2P1 at 31 weeks of  gestation presented with skin rash and itching. On
examination, there are erythematous papules and vesicles all over the abdomen (sparing the umbilicus) and , limbs, palms and soles. What is the most likely diagnosis?

14. In GDM, maternal hyperglycaemia is independently and significantly linked to all of the following adverse outcomes except:

15. Which of the following statements best describes the role of serum ferritin in pregnancy?

16. a 24 year old primigravida, 29 weeks pregnant and has been diagnosed with gestational diabetes on her 2 h OGTT. Her fasting plasma glucose on the OGTT was 7.3 mmol/L. Which of the following treatment options are best suited to her?

17. Respiratory depression at which serum level of mgso4?

18. Which of the following is not an indication to start aspirin prophylaxis in patients high risk for developing pre eclampsia?

19. G2P1 at 35 weeks of gestation, presented with bp 160/100 from last 3 days which of the following will prompt an indication for premature delivery ?

20. Most common cause of death in patients with eclampsia?

21. A 24years old G2P1 , at 30weeks of gestation,  k/c of hyperthyroidism 2 years, on antithyroid medication using with poor compliance, presented with fever , nausea vomiting from last 2 days, pt also complains of somnolence, and vaginal discharge from 2 days. on examination her blood pressure 160/100, pulse rate is 110/min, respiratory rate 22/min, temperature 102F, what is probable diagnosis?

22. Primigravida at 34 weeks of gestation, BMI 40g/m^{2 ,} had to travel by air due to some emergency, her air travel comprises of 5 hours, c/o sudden chest pain, shortness of breath and cyanosis, her vital signs include 150/100, pulse rate 88/min, respiratory rate 6/min, temp 101F, what is wrong with this patient?

23. A 28 years old woman, G6P1A4, at 35weeks of gestation, known case of APLS on low dose aspirin and LMWH , presented with preterm labour, vital signs stable, on abdominal examination, SFH 34cm, lie longitudnal with cephalic presentation, 4/5 palpable, CTG shows fetal distress, you plan an emergency LSCS, when the LMWH should have been stopped before abdominal delivery?

24. Most sensitive investigation for diagnosing pulmonary embolism in pregnancy?

25. 25 years old , primigravida at 33weeks of gestaion, presented with shortness of breath and palpitation. she is known case of moderate mitral stenosis resulting from rheumatic fever at 14years of age. on examination her blood pressure 110/70, pulse rate 120/min, respiratory rate 24 /min, chest examination shows bilateral basal crepts, how will you manage this patient?

26. A 22years old primigravida at 30weeks of gestation, with mechanical heart valve, presented to you for routine antenatal check up, which of the following is inadequate for thromboprophylaxis in prosthetic valves?

27. most common cause of paradoxical embolism?

28. Most specific investigation for diagnosing pulmonary embolism in pregnancy?

29. Obesity is associated with decrease incidence of which of the following?

30. 29years old G2P1 at 26weeks, presented with shortness of breath, she is known case of asthma, on examination B/L rhonci present, which is an effective treatment of acute asthma?

31.Which of the following is true regarding changes in respiratory physiology during pregnancy?

32.A 24years old primigravida presented to you for routine antenatal checkup at 22weeks of gestation. she had her renal transplant 2 years back for APKD . she is using cyclosporine since before pregnancy, which of the following is not true for cyclosporine usage in pregnancy?

33. which of following is true regarding diagnosis of gestational diabetes?

34. primigravida at 37weeks of gestation, k/c of GDM and PIH in this pregnancy, no previous history of diabetes or hypertension. she is using tab glucophage 500mg*tds for diabetes and tab aldomet 250mg*tds for hypertension both well controlled. now presented with complaint of labour pains from last 1 day . on examination she is 4cm dilated fully effaced. u decide trial of labour, what is true regarding post natal managment of GDM?

35. Which of following is true regarding babies of diabetic patients?

36. A 22years old G3P2 previous vaginal deliveries, at 33 weeks of gestaion. Presented wioth complaint of labour pains from last 2 hours, on examination patient is in labour with palpable contractions and cervical changes. Her current pregnancy is complicated woith GDM and using tab metformin 500mg *tds with controlled blood sugar levels. what is true regarding mangment of preterm labour in this patient?

38. A 32years old patient G5P1A3 at 6weeks of gestation for booking. she has previous history of recurrent miscarriges and was diagnosed as C/O AntiPhospholipid syndrome. her last pregnancy was successful but she had DVT in puerpurium. she is on long term anticoagulation with warfarin 5mg once a day. what is the protocol for anticoagulation in pregnancy in this patient?

38. which of the following is not a contraindication to vaginal delivery in cardiac patients?

39. A 30 year old patient has presented to you with c/o palpitation, tremors, diarhea from last 3 weeks. she is primigravida at 14weeks of gestation. her thyroid is slightly enlarged. serum TSH is 0.03mU/L, how would you manage this patient?

40. 36-year-old woman with known hypothyroidism has been taking levothyroxine 100 micrograms once a day. she is at 10weeks of gestation. Her most recent (TSH) is 2.5mU/L. She has come to the early pregnancy unit with abdominal pain and a positive pregnancy test. Transvaginal ultrasound confirmed an intrauterine pregnancy. How would you advise with regards to her levothyroxine dosage?

41. A 38 years old G6P5 at 34 weeks of gestation, presented in emergency deptt with c/o shortness of breath from last 2 weeks that has increased now. she has previous all vaginal deliveries with h/o primary PPH in last 2 pregnancies. she also has history of severe anemia in last pregnancy requiring antenatal blood transfusion as well. she doesnt have any complaint of chest pain, orthopnea or fever with cough. on examination she is very pale. her Hb% is 6.5gm/dl.how will you manage this patient?

42. A 25years old primigravida at 35week of gestation. presented with c/o easy fatigability and tiredness . she has history of hyperemesis in early pregnancy . PICA intake is also positive . she had been prescribed with oral iron previously for mild anemia but complains of nausea vomiting and abdominal pain with constipation . her recent Hb% is 8gm/dl. what is best option for this patient?

43. most common cause of anemia in pregnancy?

44. an 18years old primigravida, presented with easy fatigability and inability to do her house hold work. she was diagnosed as c/o iron defincy anemia. was advised oral iron that she tolerated well but her anemia was  not responding to oral therapy, what could be possible cause?

45. PG 32 weeks with BP of 160/100 alb 3+ pedal edema. What immediate treatment should be given?

46. What is the leading cause of mortality i9n patients with Beta Thalassaemia?

47. most common cause of thrombocytopenia in pregnancy?

48. which of the following obstetric complicatrion can occur in 50% of patient with von willibrand disease?

49. which of the following is not true for autoimmune hemolytic anemia in pregnancy?

50. which of following contraceptive may help in preventing painful crisis in patients with sickle cell disease?