FCPS Part 2 Written Sellables 500 Mega Mock – Paper A

1.Which of the following test is confirmatory test for the detection of fetal anomalies

2. A pregnant woman attends the antenatal clinic with a family history of Genetic tests have been performed on her and her partner that have revealed they are both carriers of gene which cause Congenital adrenal hyperplasia,  what is the chance of having an effected daughter?

3.A 18 year old lady with previous history of down syndrome baby presented at 12 weeks for booking visit, what is the risk of recurrence of down syndrome

4.What of the following anomaly is not associated with incease level of alpha feto-protein

5.A 30-year-old para 3 at 37+4 weeks’ gestation presents to the labour ward with heavy bleeding. While transferring onto her labour room bed, she collapses. Cardiopulmonary resuscitation (CPR) is commenced.What would be the best airway protection during CPR in this patient?

6.A 40-year-old para 3 at 38+4 weeks’ gestation presents to the labour ward with heavy bleeding  While transferring onto her labour room bed, she collapses,She is unresponsive, Cardiopulmonary resuscitation (CPR) is commenced, decision has been made to deliver her immediately for maternal interest .which of the following statement is correct about peri-mortum caesarean section

7. A 28-year-old healthy woman in her  4^thpregnancy at 28 weeks presents to the labour ward with abdominal pain. The fetal heart trace is normal. Vaginal examination reveals the cervix to be 50% effaced but closed. What should you do next?

8. Ms Sonia is 32/40 weeks pregnant with a cervical cerclage inserted at 14/40. She presents to the labour suite with a confirmed diagnosis of PPROM and with regular uterine contractions . Inflammatory markers are normal. Which of the following treatment options are best suited to her?

9. A 28-year-old para 1 presents to the maternity unit in spontaneous labour at term. On admission to the unit, she is 3 cm dilated. She is contracting 2 in 10 minutes and her contractions are assessed as moderate. Three hours later the vaginal examination is repeated and her cervix is 5 cm dilated.She is encouraged to mobilise and her membranes are left intact. Four hours later ,she is assessed again and the findings are unchanged (5 cm dilated) 3/10 contractions in 10 minutes.What would be your next step most approirate step of management

10.A 33-year-old primigravida presents to the maternity unit in spontaneous labour at term..On admission to the unit, she is 3 cm dilated.. Three hours later the vaginal examination is repeated and her cervix is 5 cm dilated.  She is encouraged to mobilise and her membranes are left intact. Four hours later ,she is assessed again and the findings are unchanged (5 cm dilated) 3/10 contractions in 10 minutes .Your Perform amniotomy examined after 2 hours .the finding are still be the sameWhat would be your next step

11.A 31-year-old woman, G3P2, undergoes induction of labour due to post maturity at 41+5 weeks of gestation. She had an artificial rupture of the fetal membranes. Four hours later, she is reassessed and found to be fully dilated with face presentation, which of statement is correct regarding mechanism of labour of mento-anterior presentation

12. A 31-year-old woman, G3P2, undergoes induction of labour due to post maturity at 40+5 weeks of gestation. She had an artificial rupture of the fetal, Four hours later, she is reassessed and found to be fully dilated with the fetal head at station 0 and a occipito-posterior presentation.Which of the following is the presenting diameter in her case?

13. A primigravida has been in the second stage of labour for 3 hours, and has been pushing for 2 hours. The head is zero/fifth palpable. Vaginal findings – vertex is at +3 station, Occipito-anteior presentation with caput +, moulding +. The CTG is reassuring.What would be the next step of management

14.gravida 2 para 1 (previous normal vaginal delivery) is in prolonged labour. No pole is palpable per abdomen. Vaginal findings – vertex at + 1 station, direct occipito posterior, caput + over occiput. CTG shows deep variable decelerations. There is poor pushing in spite of good contractions due to maternal exhaustion

15.A woman has a delayed second stage of labour and is tiring. You discuss the options for further management with her, and she consents to an assisted vaginal delivery.In which clinical situation would a ventouse delivery be absolutely contraindicated?

16.Which of the following statement is correct regarding aftercare following assisted vaginal birth

17. A 35-year-old woman, primigravida, underwent in spontaneous labour due to post maturity at 38+5 weeks of gestation. She had an artificial rupture of the fetal membranes and she was commenced on an intravenous infusion of synthetic oxytocin (Syntocinon). Four hours later, she is reassessed and found to be fully dilated with occipito-posterior presentation, which of statement is correct regarding mechanism of labour of occipito-posterior presentation

18. A 26 year old G3P2 with previous spontaneous vaginal delivers presented mild vaginal spotting, on speculum examination cervix is 2 cm dilated membranes are intact , at what gestation rescue cerclage can be considered

19. A 36 year old primigravida at 30 weeks presented to labor room with a history of sudden passage of gush of fluid from vagina, diagnosis of PPROM was made after speculum examination, her vital signs are stable and CTG is reassuring .what would be your plan of delivery for her ?

20. You are called to see a woman to assess her perineum after a normal delivery. You diagnose perineal tear involving full thickness  external anal sphincter.How will you repair the full thickness external anal sphincter tear (EAS )?

21. A 29 year old lady had a previous history of 3^rddegree perineal tear, now presented at 36 weeks of gestation, she enquires about the most likely factor to be associated with obstetric anal sphincter injury

22. A female infant is born vaginally at 36 weeks of gestation following spontaneous rupture of membranes 22 hours prior. Her mother developed a temperature of 38°C in the last hour of the labour. Six hours after delivery her mother notes that the baby is lethargic and not feeding well What is the most likely aetiology?

23. 28-year-old woman is found to have Group B Streptooccus on a high vaginal swab she had taken because of vaginal discharge. She is currently 30 weeks pregnant. She has had two previous elective caesarean sections and is planning a third. She has no allergies.
What would be your proposed treatment?

24. Mrs. C ,A 22-year-old G1 at 14 weeks gestation presents to your office with a history of recent exposure to her 3-year-old nephew who had a rubella viral infection. In which time period does maternal infection with rubella virus carry the greatest risk for congenital rubella syndrome in the fetus?

25.A 30-year-old primigravida attends the delivery suite at 40 weeks of gestation with pre-labour rupture of membranes. On reviewing the notes she has a positive result for GBS in her urine one week ago. She has no known drug allergies.According to the NICE guidelines which antibiotic should she receive?

26.Approximately what % of cases of placental abruption occur in low-risk pregnancies?

27.A 23-year-old P1 has undergone an induction of labour at 41 weeks + 6 days in her first pregnancy. The antenatal care was complicated with an admission to hospital with a small painful antepartum haemorrhage at 34 weeks of gestation and her abdomen is tense , her CTG showed sinusoidal pattern,What’s your definitive step in management

28. 22 year old Rachel has come for booking visit .Her ultrasound at 10 wks showed herniation of gut with umbilical cord on top of sac. What is the probable Diagnosis?

29. A woman is noted to have a low-lying placenta at her 20-week anomaly scan. At 32 she is diagnosed with placenta previa with no morbid adherence, at what gestation next scan you suggest

30.A 40 year old primigravida found to be high risk of down syndrome at 15 weeks after the report of CCFDNA, she is having monochorionic diamniotic twin pregnancy, the most appropriate test for her?

31. A 31 year old women delivers a healthy baby boy at term. You note the pregnancy prior to this  one was an aborted molar pregnancy. What would you advise regrading follow up in light of  this? 

32. A 33 year old women is referred to the recurrent miscarriage cliic along with her 31 year old  partner following a third consecutive miscarriage. The following results are noted:  Maternal lupus anticoagulant detected on 2 tests (taken 14 weeks apart)   thrombophilia screen negative   Cytogenetic analysis on products of conception reveals no chromosomal abnormality   Pelvic ultrasound normal What is the most appropriate next investigation or treatment in future pregnancy? 

33.A patient with beta thalassemia is seen in preconception clinic. She is known to be diabetic.  What is the optimum test for monitoring diabetes in patients with beta thalassaemia?   

34.A patient who is 37 weeks gestation. This is her first pregnancy. She has been admitted and given oral beta blocker. She smokes 15 cigarettes per day. Her BMI is 28.5 Kg/m2. Her blood  pressure is 165/115 

35. A 33-year-old woman with insulin dependent diabetes mellitus presents to the antenatal clinic at 7 weeks. She wants to know about the risks to her baby. Which of the following is not associated with diabetes?

36. A 24 year old women is taken to theatre following presentation with severe lower abdominal  pain and a positive pregnancy test. Laparoscopy shows healthy appearance of the left fallopian  tube but on the right side there is a tubal mass consistent with an ectopic pregnancy. What is  the most appropriate management?   

37.A 28 year old year patient with beta thalassemia presents to the EPU. She is 8 weeks pregnant. You note she has had a splenectomy. Her current platelet count is 450 x 10³/ml. What would  you advise regarding thromboprophylaxis?

38. A 32 year old patient who was seen at 9 weeks gestation with threatened miscarriage is seen  back in clinic for a follow up scan and advised her current pregnancy has miscarried. This is her  3rd miscarriage. The previous pregnancies miscarried at 7 weeks and 9 weeks respectively.  What is the appropriate management from the list below?

39. A 25 year old patient has been referred by her GP as she has SCD and is pregnant for the first  time. She is currently 6 weeks pregnant. Her Blood pressure is 110/70. Urinalysis is negative for  protein and there are no signs of infection. The following blood tests are sent to the lab:   Full blood count   Ferritin   Liver function tests   Urea and Electrolytes   Red cell antibodies  What additional test or treatment from the list above would be appropriate at this stage?  

40. A 24 year old patient with SCD is seen for pre‐conception counselling. She is told to stop one of  her medications 3 months prior to trying to conceive. Which medication should be stopped 3  months pre‐conception? 

41. A 25 year old woman presents at 9 weeks gestation with vaginal bleeding. She advises she has  had terrible morning sickness. Examination reveals a 14 week uterus. Bloods and pelvic  ultrasound show the following:   HCG 109,355 IU/ml   Hb 9.6 g/dl   Rhesus positive   TSH 0.9 U/ml T4 12.1 µg/dl   Pelvic USS: large for dates uterus with features suggestive of partial molar pregnancy

42. A 21 year old woman presents after being referred by her GP with vaginal bleeding and a  positive pregnancy test. Based on her LMP she is 16 weeks pregnant. She advises she has been  vomiting intermittently for the past few months. Examination reveals a 20 week uterus. Bloods  and pelvic ultrasound show the following:   HCG 179,685 IU/ml   Hb 8.9 g/dl   Rhesus positive   TSH 0.9 U/ml T4 12.1 µg/dl   Pelvic USS: large for dates uterus with features suggestive of partial molar pregnancy 

43. A 27 year old patient is 24 weeks pregnant. Her GP performs a routine blood pressure and urine  check that shows BP 150/100 and protein ++ on urine dip. What is the appropriate  management? 

44. A 29 year old patient, para 2 and smokes 5 cigarettes per day is referred to the early pregnancy  unit (EPU) by her GP. She has presented with lower abdominal pain and spotting following 2  months of amenorrhoea. Transvaginal ultrasound (TVS) shows crown‐rump length of 7.5mm  and no visible heartbeat

45. A 19 year old nulliparous patient is referred to the early pregnancy unit (EPU) by her GP. She  presented due to light irregular vaginal bleeding earlier in the week on a background of  irregular periods. Urine pregnancy test at the GP surgery was positive. The cervical OS is noted  to be closed. Transvaginal ultrasound (TVS) shows an intrauterine gesatational sac with mean  gestational sac diameter of 18mm. No fetal pole or heartbeat is visible

46. A 36 year old patient who is pregnant for the fourth time (3 live births). She is a non‐smoker.  Her BMI is 31.5 Kg/m2. There is no history of VTE or clotting disorder and she is fully mobile 

47 A 25 year old patient is pregnant for the first time. She is a non‐smoker, BMI is 26.7 kg/m2. She  is fully mobile. She had 3 months anticoagulation for an idiopathic DVT 3 years ago.  Thrombophilia studies were all normal

48. You are called to see a 69 year old patient on the ward who underwent total abdominal  hysterectomy for endometrial cancer 4 days earlier. She is struggling to complete sentences.  She complains of sharp bilateral chest pains. Examination reveals a clear chest to auscultation  but you note an audible murmur.   Her obs are as follows:   BP 90/60   Heart rate 120   Resp rate 23   Temp 36.9°C

49. A pregnant patient undergoes an oral glucose tolerance test. The results are shown below:  fasting plasma glucose 5.9 mmol/l  2-hour plasma glucose 7.0 mmol/l  What does this result show?       

 50. A 35 year old lady who has raised BMI of 35 kg/m2 and is Type 2 diabetic on Gliclizide, ramipril and simvastatin. She wants to get pregnant and has come to your clinic for pre-pregnancy counselling. Which of one of the following is the correct advice?