FCPS PART 2 WRITTEN MEGA MOCK – PAPER A

1. A 30-year-old woman had a vaginal deliveryand also required manual removal of the placenta under spinal anaesthesia. She is known to be rhesus negative and her baby is confirmed to be rhesus positive. The Kleihauer test shows fetomaternal haemorrhage (FMH) of 5 mL. How much anti-D should this woman receive?

2. A 35-year-old woman who has had two previous vaginal deliveries at 40 weeks has tested positive for HIV on antenatal screening. At booking, her viral load is reported as 150 copies/mL. She is otherwise well and is commenced on HAART (highly active antiretmviral therapy). At 36 weeks, her viral load is 75 copies/mL and there are no other obstetric complications. What is the most appropriate delivery plan?

3. A 25-year-old para 1 woman sustained a 3a perineal tear following an instrumental delivery. She attends her postnatal follow-up appointment. She has no faecal incon-tinence, has no incontinence of flatus and the perineum has healed well. What advice would you offer this woman with regard to subsequent delivery?

4. A woman with a body mass index (BMI) of 63 has a complicated labour and delivery and nearly dies. Which of the following causes of maternal mortality is independent of her BMI?

5. A 32-year-old woman is brought into the emergency department with a one-day history of fever, rigors, abdominal pain and heavy lochia. She had an uncomplicated spontaneous vaginal delivery two days ago. On arrival, she has a temperature of 39 °C, a heart rate of 143 bpm, a blood pressure of 82/50 mmHg and a respiratory rate of 40/min.
Following initial resuscitation, what is the most appropriate immediate management?

6. A primiparous woman presents two days after a normal vaginal delivery complain-ing of feeling unwell. On examination, she has a temperature of 38 °C, pulse rate of 110 bpm and blood pressure of 90/50 mmHg. There are no localizing signs of infection. Blood tests are performed. What test result would indicate a severe sepsis?

7. A 25-year-old woman has been having persistently high blood pressure of > 150/100 mmHg for three days following delivery with no biochemical or hae-matological abnormalities. She has no underlying medical problems and was not on any antihypertensive drugs during the pregnancy. She is breastfeeding. Which is the most appropriate antihypertensive agent that can be prescribed for her?

8. You are about to repair a second-degree tear under local anaesthetic in a woman with no previous analgesia. Her most recent weight in pregnancy was 50 kg. What is the maximum volume of 1% lidocaine (when not mixed with adrenaline) that can be used?

9. The cardiovascular system undergoes immense physiological changes in pregnancy. Which of the following parameters does not change in pregnancy?

10. A 30-year-old woman is delivered at 27 weeks of gestation due to severe pre-ecla mpsi a. What is the risk of recurrence of severe pre-eclampsia in the subsequent pregnancy?

11. A primigravida was delivered by Neville Barnes forceps for a pathological cardio-tocogram (CTG). Following delivery, a 3b perineal tear was diagnosed. What is a 3b injury?

12. You are writing a guideline about prevention of venous thromboembolism (VTE) in pregnancy and you need to include information on background epidemiology. What is the overall incidence of VTE in pregnancy and the puerperium? 

13. A 19-year-old primigravida presents to the delivery suite in early labour. Her preg-nancy has been low risk throughout. She is concerned about her delivery and would be very reluctant to consent to an operative vaginal delivery if she needed one. Which of the following is most likely to increase her chances of achieving a spont-aneous vaginal delivery?

14. You are called to obstetric theatre to see a woman who has a retained placenta. On examining her, you recognize that in addition to the retained placenta she has a partial uterine inversion. Your initial attempt to manually reduce the inversion is not successful. What can the anaesthetist administer to assist you in reducing the inversion?

15. You examine a 28-year-old primigravid woman in the antenatal ward at 36 weeks of gestation with polymorphic eruption of pregnancy, associated with generalized urticarial papules and increasingly severe pruritus. It has not responded to emollient creams, systemic antihistamines or topical steroids. What further treatment is most likely to be effective? 

16. During the labour ward handover, the coordinator informs you that there is a 35-year-old para 1 woman in labour with a face presentation. A junior doctor, who wants to do postgraduate training in obstetrics and gynaecology, is keen to learn more about this presentation. What is the engaging diameter in a face presentation? 

17. A 30-year-old primigravida presents in spontaneous labour at 41 weeks of gestation. On vaginal examination, the cervix is 8 cm dilated and the position of the vertex is left occipi to-posterior. What is the presenting diameter?

18. A woman is readmitted 48 hours after a normal vaginal delivery. Symptoms and signs suggest profound septic shock. What is the most appropriate first-line antibiotic regime to use?

19. A 29-year-old woman is brought in to the emergency department by paramedics with a suspected pelvic fracture at 34 weeks of gestation after being hit by a car. She is hypotensive and tachycardic. She is being fluid resuscitated, and bloods including crossmatch have been sent. What is the priority in the management of this woman?

20. A 38-week pregnant para 0 + 0 calls the maternity assessment department for advice. Her husband has been diagnosed with herpes zoster and she thinks she has not had chickenpox in the past. What is the most appropriate management for this woman?

21. Highly active antiretroviral therapy (HAART) in now routine in the management of HIV-positive women in pregnancy and is very effective in reducing mother-to-child transmission (MTCT) of HIV. What is the incidence of transmission reduced to?

22. A 28-year-old woman had a caesarean section for failure to progress. She visits her general practitioner four months postpartum with paraesthesia and sharp burning pains radiating from the incision site to the left labia and thigh. Which nerve is most likely to have been involved?

23. A 41-year-old woman presents at 36 weeks of gestation in active labour. She has had a previous caesarean section and a subsequent precipitate vaginal delivery. An ultrasound scan at 20 weeks showed a bilobed low-lying placenta. A repeat ultrasound scan at 32 weeks revealed a normally located placenta with polyhydram-nios. Immediately after rupture of membranes, she started bleeding vaginally with associated cardiotocography (CTG) abnormalities. What is the most likely diagnosis?

24. You are asked to review a woman eight hours after a vaginal delivery. She has an Obstetric Modified Early Warning Score of 6, which four hours previously was 0. She is tachycardic, tachypnoeic, hypotensive and pyrexial. She has abdominal tenderness and a sore throat.
What is the most likely causative organism?

25. A 30-year-old woman had a 3c perineal tear at her first vaginal delivery. She attends the postnatal perineal trauma clinic at six weeks. She is concerned about her persistent symptom of faecal urgency. What percentage of women are asymptomatic at 12 months after sustaining a third-degree tear?

26. A low-risk primigravida is admitted in spontaneous labour at term with intact membranes. She is contracting strongly, four in 10 minutes. The cervix is effaced and 5 cm dilated, cephalic presentation, occipito-anterior position with no caput or moulding and 1 cm above the ischial spines. Four hours later, she is 6 cm dilated. All other findings are unchanged. Intermittent auscultation is normal. According to National Institute for Health and Care Excellence (NICE) guidance, what is the diagnosis and recommended management?

27. A primigravid woman has been having serial ultrasound scans for a small-for-gestationa 1-age fetus. The fetal biometry is below the 10th centile, with normal liquor volumes and umbilical artery Doppler. She reports good fetal movements. She is currently 37 weeks pregnant and has declined induction of labour. After appropriate counselling regarding risks to her baby, what is the most appro-priate management for this woman?

28. A 25-year-old woman attends the postnatal clinic. She delivered her son eight weeks ago at 27 weeks of gestation following an eclamptic seizure. She is keen to have further children.
What is her risk of pre-eclampsia in her next pregnancy? 

29. A 27-year-old woman with epilepsy attends antenatal clinic in the third trimester of pregnancy. She is well controlled on lamotrigine. In women with treated epilepsy, what is the risk of having a tonic-clonic seizure in the peripartum period? 

30. A 22-year-old woman is on the postnatal ward having had a normal delivery. The midwife notices that the baby has sticky eyes on the morning after delivery. What is the most common causative organism of infective neonatal conjunctivitis? 

31. Following instrumental vaginal delivery, vaginal and rectal examination shows a perineal tear involving less than 50% of the external anal sphincter. The internal anal sphincter and rectal mucosa are intact. What is the dassification of this perineal injury?

32. Shakeela , A 16 year-old woman attended the gynaecology outpatient clinic with primary amenorrhoea. After investigation she was diagnosed as having uterus and ovaries .She was noted to be 150 cm tall and have a low hairline. What is the most likely karyotype?

33. A , multiparous lady is postpartum clinic She has delivered 8months back with history of major post partum hemorrhage ( 4500ml) now she complains of amenorrhoea. she stopped breastfeeding , also complains of difficulty in lactation . She complains of weight loss , dry skin and breast atrophy .what is the probable cause of diagnosis ?

34. A 16-year-old girl presents to the gynaecology outpatient clinic with primary She is 148 cm tall and weighs 54 kg (BMI 24.7). Breast development is assessed as Tanner stage 2 and her pubic hair is noted to be sparse. Further examination identifies cubitus valgus. She has no other dysmorphic features. What is the most likely diagnosis?

35. Kenchamma, a 33-year-old Asian woman has been trying for pregnancy for 1 Year , now she complains of pelvic pain and amenorrhea For 3 months associated with low- grade fever and weight loss. Physical examination demonstrates a tender pelvic mass. Surgical findings include dense pelvic adhesions, segmental dilatation of the fallopian tubes, and everted fimbria. Microscopic examination of the right fallopian tube shows proliferation of tubal folds with giant cells within the tube. Which is the probable diagnosis ?

36. Rebecca 32yearold with secondary amenorrhoea who intentionally FHS:56Iu/L LH: 43 IU/L Estradiol ;25mmol Cause of amenorrhea

37. Julies, 18year old with history of Amenorrhoea for 6months she gives history of tough exercise routine.She has lost suddenly 5kgs . what is the likely cause of Amenorrhoea 

38. An 18-year-old tall girl with a BMI of 19 presents with primary amenorrhoea at your clinic. On examination, her breast development is Tanner 5, pubic and axillary hair development is Tanner 2 and her external genitalia appears normal. A small inguinal swelling is detected on her right What is your most likely diagnosis?

39. Lucy Has brought her 8year child with premature sexual hair development.on X-ray she has advanced bone age and rapid growth velocity .on further evaluation her 17 hydroxy progesterone Levels are increased with normal DHEAs. What is the probable diagnosis 

40. A 24-year-old woman presents in clinic at 12weeks gestation with monochorionic Upon discussing the risks associated with monochorionic twins, she asks you how common twin-to-twin transfusion syndrome is. What is your answer?

41. A 42-year-old woman presents in her first pregnancy with monochorionic twins at ten week She is worried about the increased risk of congenital anomaly. Of which one congenital anomaly are her babies at higher risk of developing?

42. A 24-year-old primigravida woman is diagnosed to have a twin Which of the following is correct?

43. A 30-year-old nulliparous woman with a monochorionic diamniotic (MCDA) pregnancy was diagnosed to have twin-to-twin transfusion syndrome (TTTS) at 18 weeks ’gestation. There was significant discrepancy in the amniotic fluid volume with a maximum vertical pool of 8 cm in twin A and polyhydramnios with maximum vertical pool of 10 cm in twin B. Both the bladders are seen and the Doppler studies are normal. Which one of the options below represents the TTTS staging based on the Quintero classification system?

44. A 32-year-old para 0 undergoes IVF outside the UK and has a trichorionic triamniotic triplet pregnancy. She is concerned about how she will cope with her pregnancy towards her due date and asks the latest she is likely to be delivered by. When should women with trichorionic triamniotic triplets be offered elective delivery, in the absence of prior complications or labour? Options,

45. A primigravida at 20 weeks ’gestation attends obstetric triage feeling short of breath. She has a monochorionic diamniotic twin She has not attended for antenatal care since her dating scan at 14 weeks ’gestation where chorionicity was confirmed, after which she separated from her partner. Chest examination is unremarkable, but her SFH is 32 cm. An ultrasound scan is performed, revealing that both twins are alive. win 1 has polyhydramnios with a DVP of liquor measuring 9.5 cm and bladder visible. win 2 has oligohydramnios with a DVP of liquor measuring 0.5 cm. Despite an hour of scanning, it is not possible to identify a bladder in twin 2. Both twins have end diastolic ow present on UA Doppler. A diagnosis of suspect twin–twin transfusion syndrome is made. What Quintero stage would this be classified as?

46. A 28-year-old primigravida with monochorionic diamniotic twins comes for her regular ultrasound and antenatal clinic appointment at 24 weeks. win 2 has no fetal heart present and Spalding’s sign is present. win 1 has a fundal height with normal size, liquor volume, UA Doppler and a visible bladder with plenty of fetal movement. An ultrasound 2 weeks ago had been normal. Her BP is normal and there is no proteinuria. After a single fetal death in a monochorionic diamniotic twin pregnancy, what is the overall rate of survival for the co-twin?

47. A para 1 with treated hypothyroidism is seen for a scan at 19 weeks ’gestation, and Figure below is taken. The pregnancy is complicated by impaired glucose tolerance at 22 weeks and a small painless PV bleed 1 week When seen for review at 29 weeks, one of the twins is on the 10th centile and the other above the 50th, with an estimated 25% difference in estimated fetal weight. The liquor seems reasonably normal. What is your next step?

48. All of the following ultrasound signs help in the diagnosis of chorionicity in twin pregnancies except 

49. Severe twin to twin transfusion syndrome (TTTS) diagnosed before 26 weeks is best treated by:

50. You are attending a teaching session on labour management. You have been asked a series of questions regarding the mechanism by which the head is spontaneously born in a face presentation. By what mechanism is the head delivered in a face presentation?