FCPS Part 2- Written Mega Mock -Paper D

1. A 32-year-old nulliparous woman sees you in the antenatal clinic at 22 weeks’ gestation. She has just had a transvaginal scan that showed the cervix to be 22 mm in length. She has a past history of a cone biopsy of the cervix six years previously with normal follow-up smears. Which of the following options would you recommend for her?

2. A 29-year-old woman in her first pregnancy presents to the labour ward with some vaginal discharge at 27 weeks and two days. The pregnancy has been uneventful. Speculum examination reveals the cervix to be partially effaced and dilated 3 cm with bulging amniotic membranes. She is not in pain, and her observations are normal. The cardiotocograph (CTG) is reassuring. Which of the following options is the most appropriate in her management?

3.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?

4. A 35-year-old healthy woman in her second pregnancy at 27 weeks presents to the labour ward with abdominal pain. She had a normal vaginal delivery at term in her first pregnancy three years previously. All observations are within normal limits. A CTG shows one to two irregular contractions every 10 minutes. The fetal heart trace is normal. Vaginal examination reveals the cervix to be 50% effaced but closed. Which of the following is the most appropriate management option?

5. A 35-year-old healthy woman in her second pregnancy at 30+6 weeks presents to the labour ward with abdominal pain. She had a normal vaginal delivery at term in her first pregnancy three years previously. All observations are within normal limits. A CTG shows one to two irregular contractions every 10 minutes. The fetal heart trace is normal. Vaginal examination reveals the cervix to be 50% effaced but closed. What should you do next?

6. A 26-year-old woman in her first pregnancy presents to the labour ward at 28 weeks and four days gestation with abdominal pain. Maternal observations are all within normal limits. A CTG reveals she is contracting at a rate of three times in 10 minutes, with a normal fetal heart rate. Speculum examination shows the cervix is effaced and dilated 3 cm. The ST3 obstetric trainee wants to know the correct dose of magnesium sulfate for neuroprotection for the baby. Which of the following statements is the most appropriate answer?

7. What is the diagnostic tool of choice for tubal ectopic pregnancy?

8. A 56 year old P3 diabetic, postmenopausal lady underwent evaluation for PMB and was diagnosed to have endometrial hyperplasia without atypia. Her BMI was 40. She opted for continuous oral progesterone treatment and underwent 2 endometrial biopsies at 6 monthly intervals, both negative. What should her further plan be:

9.A 28-year-old primigravida presents to the antenatal clinic with headache. Which of the following headaches in pregnancy is classified as primary headache?

10. A 26-year-old woman in her first pregnancy presents to the labour ward at 28 weeks and four days gestation with abdominal pain. Maternal observations are all within normal limits. A CTG reveals she is contracting at a rate of three times in 10 minutes, with a normal fetal heart rate. Speculum examination shows the cervix is effaced and dilated 3 cm. The ST3 obstetric trainee wants to know the correct dose of magnesium sulfate for neuroprotection for the baby.Which of the following statements is the most appropriate answer?

11. A 32-year-old woman is seen for preconception counselling. She has a history of breast cancer and has just completed a course of tamoxifen.
How long should she wait before she can try to conceive?

12. A 38-year-old woman is seen in antenatal clinic at 12 weeks of gestation. She has a body mass index (BMI) of 37 kg/m2 and does not regularly undertake exercise. What would the recommendation be with regard to starting exercise in pregnancy in order to control her weight?

13.A 32-year-old nulliparous woman sees you in the antenatal clinic at 22 weeks’ gestation. She has just had a transvaginal scan that showed the cervix to be 22 mmin length. She has a past history of a cone biopsy of the cervix six years previously with normal follow-up smears.
Which of the following options would you recommend for her?

14. A 23-year-old woman has asked her general practitioner if it is appropriate for her to breastfeed. Which of the following maternal infections is a contraindication to breastfeeding?

15. You are explaining to your year one resident colleague the physiology of lactation. What will you tell him?

16. You review a 24-year-old woman with epilepsy controlled by lamotrigine who delivered spontaneously. She is keen to breastfeed her baby. Her last fitting episode was two months prior to pregnancy. What advice would you give her?

17. You have just examined Mrs X in the postpartum clinic. She is complaining of breast pain and discomfort. You have established a diagnosis of postpartum mastitis.

 All of the following are treatment options for her except:

 18. While on call on the labour ward, the midwife asks you to see a primigravida who has just delivered by a vacuum-assisted delivery after a long painful 16 hours’ labour. The woman feels exhausted and is reluctant to breastfeed. She seemed to understand the benefits of breastfeeding. When is the most appropriate time to start breastfeeding if she wishes to exclusively breastfeed?

19.The commonest urinary problem occurring in the postpartum period is:

20. Breastfeeding immediately after delivery of a baby can reduce the risk of bleeding by causing uterine contraction. Which hormone is released to cause this?

21. A healthy multiparous woman has just delivered. She suffered from mastitis with her previous child. What is your advice if she develops mastitis?

22. A 40-year-old woman, who has had three previous vaginal deliveries, experiences brisk vaginal bleeding immediately following vaginal delivery of 36-week gestation twins (birth weights 2.0 and 1.9 kg). An episiotomy was not required. The placenta was delivered without complication. 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?

 23. A 31-year-old nulliparous woman with breast cancer underwent a radical mastectomy of her right breast last year. She wishes to achieve pregnancy in the near future. She is worried that pregnancy may precipitate recurrence of the cancer. What advice you will you give her?

24. Postpartum anaemia is defi ned as a haemoglobin less than:

25.  A 25-year-old low-risk woman delivered a healthy baby at term by an emergency caesarean section for massive APH. Estimated blood loss was 1.5 L, uneventful recovery. What is the risk of abruption in her next pregnancy?

26.  Ms. XY is brought to the A + E department, unwell. She is a para 1, post-SVD 3 days ago with ragged membranes noted at delivery. Her observations include pulse 128 bpm, BP 80 systolic, RR 24 breaths/min and temp 39° C and she feels cold and clammy. She reports heavy offensive lochia. She has been fl uid resuscitated now and commenced on oxygen by mask. What is the next immediate step in her management?

27. During your postnatal ward round you are asked to review a baby with clinical jaundice. He was delivered two days ago and his unconjugated bilirubin blood levels are 320 mmol/L. What is your first-line management?

28. A woman who is nine weeks pregnant comes to the early pregnancy assessment unit complaining of severe nausea and occasional vomiting. She is not keen on drug therapy. What is your advice?

29.  A 33-year-old woman, gravida 3, para 2, comes to the emergency department complaining of excessive vomiting for the last three days. She is otherwise asymptomatic with a normal past medical history. She is admitted and her thyroid function tests showed a low thyroid stimulating hormone (TSH) level with raised free thyroxine (T4). What is the most important feature to differentiate transient hyperthyroidism of hyperemesis gravidarum (THHG) from hyperthyroidism?

30. A 20-year-old woman who was nine weeks into her first pregnancy has just had a complete miscarriage. She is distressed and very tearful. You have explained that miscarriage does not affect her future fertility. Her partner is worried her anxiety may persist and be a possible cause of a delayed pregnancy. What else will you tell them?

31.  A woman who is 11+3 weeks pregnant complained of abdominal colic and an attack of brisk vaginal bleeding. A repeat ultrasound confirmed fetal demise. You diagnosed inevitable miscarriage. She is considering expectant management. How will you counsel her?

32. Approximately what percentage of pregnant women are offered a choice of invasive prenatal testing?

33. The incidence of clinically recognised miscarriage in pregnancy is about:

34. A 20-year-old woman comes to the early pregnancy assessment unit with 7+6 weeks amenorrhea and mild to moderate vaginal bleeding with the occasional abdominal pain. She has a positive pregnancy test but refuses a transvaginal ultrasound scan. How will you handle the situation?

35. A woman who is eight weeks pregnant complains of vaginal bleeding. An ultrasound scan showed a crown rump length of 7 mm but no visible fetal heart. You advised her to come for a follow-up scan after seven days. She expressed her concern that waiting that long may harm the pregnancy or her health. How will you counter her concern?

36. The most common indication for women attending gynaecology emergency in the UK is:

37. The community midwife calls you about an eight-week pregnant woman who is complaining of vaginal bleeding and abdominal colic. A repeat scan confirmed fetal demise. She opted for expectant management. Her bleeding and abdominal pains have resolved. The woman wants to know how to confirm that miscarriage is complete. What is your advice?

38. Which of the following statements is correct about molar pregnancy:

39. A 23-year-old woman in her second pregnancy presents to you requesting surgical termination of the pregnancy. She is 11 weeks pregnant, verified by ultrasound scan. What is the risk of uterine perforation in this case?

40. What proportion of ectopic pregnancies occur in the interstitial portion of the fallopian tube?

41. A 22 years old woman attends the early pregnancy unit having experienced some discomfort and vaginal bleeding in early pregnancy. It is 6 weeks since her last menstrual period. She is actively trying to conceive. A transvaginal ultrasound scan is performed, but there is no evidence of an intrauterine gestation sac. Her serum β-hCG level is 1200 IU/l. The β-hCG is repeated after 48 hours and is 950 IU/l.What is the most appropriate management?

42. A woman attends the early pregnancy unit with a small amount of per vaginam spotting. It is 7 weeks since her last menstrual period, but her cycle is irregular. A transvaginal scan is performed, which shows an intrauterine gestation sac measuring 15 mm in diameter. A follow-up scan is arranged 14 days later, which shows a gestation sac with a diameter of 24 mm. There is now a yolk sac visible with a fetal pole with a crown–rump length of 7 mm, but no fetal heartbeat is visible.What is the diagnosis?

43. What proportion of miscarriages occur after the identification of fetal heart activity?

44. Which objective and validated index is typically used to classify the severity of nausea and vomiting in pregnancy (NVP)?

45.A woman presents at 36 weeks of gestation with a history of a pin ious caesarean section. Her previous baby Was led by early anise group B Striplaoo-us g: Lb). 9w is keen to &timer vagmally.tile has Awn ameyced by •osnsultant obstetnoa n and is suitable for a vaginal delivery. Ha vaginal swab at 36 work, is negative lee GUS.What mode of delivery S best suited for ha. considering lwr history?

46. A 34-yearold presented to the delivery suite with a history of a sudden gush of watery vaginal discharge_ she is 30 weeks pregnant in her first pregnancy, which is uncomplicated. A vaginal speculum examination confirmed ruptured membranes with clear liquor draining. A scan confirmed cephalic presonation. She was asked to attend the day assessment clinic twice weekly_ Which investigation is most likely to identify chorioamnionitis?

47. A woman at 28 weeks of gestation has been in contact with her neighbour who devekiped chickenpox two days ago. She Is unclear about a previous history of chickenpox In childhood and visit. her general practitioner. What Is the must appropriate next step?

48. A primigravida presents at 33 weeks of gestation with a history of itching involving the palms and soles of the feet for one week. On rumination, she has evidence of demutographia anetacta. Her liver functions show modest elevation of both aspar-tate transammase (AST) and alanine traroaminase (ALT). and a normal biliruhin. There is nif evidence of a rash. What is the most likely clinical diagnosis?

49. The consultant Is asked to review a woman at 22 weeks of gestation, as her ultra-sound scan suggests that the fetus has an echogenic bowel. The results CMV tests performed two weeks previously indicate that she seroconverted in the previous three months. The samples were tested in parallel at the regional laboratory. What Is the risk of vertical transmission of CMV

50. Basic neonatal resuscitatkon is life-saving. training is simple and feasible, and the cost is low. Neonatal immolation training packages for traditional birth attendants have been shown in both randomized and non-randomized trials to reduce perinatal and neo-natal deaths by