FCPS PART 2 – WRITTEN SELLABLES 500 MEGA MOCK – PAPER C

1..A 35 year old lady presented in collapsed state in labour room, urgent basic life support resuscitation has been provided by arrest team but patient is unable to revive, decision of perimortem cesarean section has been made for maternal interest as her fundal height is above 20 weeks. What is the gestation limit to involve neonatologist at the time of delivery

2.A primigravida has been brought to the Accident and Emergency department in a collapsed state following a eclamptic fit at 32 weeks gestation. The resuscitation team has been called What is the most appropriate initial action in her case ?

3.24 -year-old multigravida at 32 weeks is presented with pre-labour rupture of membrane. She is 6cm dilated fully effaced cervix. On abdominal examination the head is 0/5 palpable per abdomen. You are asked to assess her 30 minute CTG trace . What would be your first step

4.A 20 year old low risk primigravida presented with PROM , CTG is commenced on her request  On assessment she is 3 cm dilated with absent of membranes, she is draining clear liquor. Comment on the category of her 40 minute CTG trace

5 A 30 year old  G4P3 with prev -3 cesarean section at 35 weeks presented in spontaneous labour. On vaginal examination, she is 3 cm dilated. You are asked to assess the 25 minute CTG trace.  What would be the next step of management

6.A 28-year-old healthy woman in her  4^thpregnancy at 28 weeks presents to the labour ward with abdominal pain. She had previosuly normal vaginal deliveries at term. 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?

7 Ms. XY, A primigravida at 40 weeks of gestation was induced labour in view of GDM during pregnancy. She had progressed well. After the delivery of the head, there is a delay in the delivery of the shoulders. Following the diagnosis of Shoulder dystocia, first line manoeuvres were performed and failed. For performing the second line manoeuvres, you have now decided to give an episiotomy following the assessment. Which of the structure is divided while performing a mediolateral episiotomy?

8 The causes of SUI can be due to all the following except:

9.The most common symptom of presentation in a women with vault prolapse is

10. 60 year old multiparous woman presented with urinary frequency, dysuria and vaginal dryness. She was prescribed topical estrogen for the relief of symptoms. The estrogen provide relief from the urinary symptoms by

11 For a  long-term use of an indwelling urethral catheter, the choice of material used should be

12.48 year old woman had presented with complaints of urinary incontinence and on assessment was found to have a OAB. She was started on oral oxybutynin at standard dose. In what time frame should she be reassessed?

13 Pregnancy is associated with an increase in the following factors except

14. In the investigation that should be performed for a women presenting with stress urinary incontinence with urgency and voiding dysfunction that should be undertaken as a part of initial evaluation is

15. Choose the most significant regarding complications of laparoscopic surgery:

A.The internal iliac arteries are the most commonly injured vessels

B.Bowel injury with the Verees needle is usually significant

C.A quarter of all complications are missed at the time of the initial procedure

D.The Trendelenburg position limits the risk of injury during introduction of the Verres needle and trocars

E.The incidence is 1 in 1000 for diagnostic procedures

16.During TAH + BSO, The ureter:  (Choose the correct one from below)

17 A 61-year-old lady who also takes prednisolone complains of a dry mouth. Which medication is suitable to treat her overactive bladder symptoms?

18. All are true regarding Duloxetine, except

19.. A 60year old woman presents to the emergency department 5 days after vaginal hysterectomy for a stage 3 prolapse feeling unwell. Which of the following presentation would be least consistent with the diagnosis of vault haematoma?

20.Interpret the following urodynamic study testing:

21. which of the following statements regarding Caesarean section in not true

22. Which of the following condition is a contraindication to epidural anaesthesia?

23. 21 year old Primigravida is requesting for labour analgesia. The following statement regarding is true:

24. 15 year old girl presented with oophoritis following mumps. She was complaining of painful spasms of the muscles and numbness on the skin of the medial part of the thigh. Which of the following nerves is likely to be involved?

25.20 year old lady was brought to the Emergency Department in shock following incomplete miscarriage. She presented to the WMO, 3 hours back with complaints of passing clots and a very heavy bleeding soaking about 3 pads in 1hour following the intake of medical termination of pregnancy. She was diagnosed to have incomplete miscarriage and when explained about the options, she had refused surgical evacuation of the pregnancy. She is now in being managed to correct the shock. And would need a surgical evacuation. Following the refusal of the procedure, how would you go about the procedure?

26.  What is the maximum recommended dose of bupivacaine that can be used as a local anaesthetic?

27.Mrs. XX is a 54 year old multiparous women with heavy menstrual bleeding for which all medical management has failed. She is a known diabetic for the past 10years with a HbA1C of 5.4. she is being planned for a vaginal hysterectomy. All of the following are true about the perioperative planning for a good optimisation of the surgery except:

28. 48-year-old woman of Polish origin with a history of lower abdominal pain and a pelvic mass. A pelvic ultrasound scan showed a left-sided ovarian cyst, measuring 8.4 × 7.1 × 6.1 cm, with no complex features. Tumour markers were normal. At operation, the laparoscope was introduced through a 10-mm intraumbilical incision. Two additional 5-mm ports were inserted in the left and right iliac fossae under direct laparoscopic vision. A left oophorectomy was performed This was done under direct vision with a 5-mm laparoscope, inserted through the right iliac fossa port. At the end of the procedure, the ports were removed under direct vision, with release of carbon dioxide. Monofilament sutures were used for skin closure. She was initially observed in the recovery area and, subsequently, transferred to the day surgical ward. One hour postoperatively, nursing staff noted bleeding from the port site in the right iliac fossa. On review by the registrar, a subcutaneous haematoma was noted with blood ‘oozing’ from the port site. A pressure dressing was applied. Subsequent review by the team consultant noted that the haematoma was increasing in size. Which of the following vessel is injured ?

 29.Mrs X presented to the A&E with history of vaginal bleeding & lower abdominal pain.Pregnancy test was positive.An ultrasound was ordered & the sonologist called back saying ,she was suapecting a cervical pregnancy.All of the features below except one,when considered together would suggest a cervical ectopic,Which feature would not be suggestive of a cervical ectopic pregnancy?

30.A primi with 6 weeks amenorrhea presented to the A & E with mild vaginal bleeding.A pregnancy test done at home was positive.The lady was scared that she was having a miscarriage & wanted a scan to know how the pregnancy was progressing .The lady was clinically stable.A TVS was done which showed a normal size anteverted uterus with thickened endometrium .Both ovaries & tubes were normal & there was no free fluid in Pouch of Douglas.A BHCG was ordered which was 200.So she was called again after 48 hrs & repeat BHCG was 400.What will you explain to the lady regarding the prognosis for this pregnancy

31.What is the predominant cause of anovulatory infertility?

32.A 35 year old multiparous lady presents to the A & E with a one week history of brownish vaginal discharge.She is not sure of her last menstrual period & she is not on any contraception.A pregnancy test was positive.A TVS showed a complex right adnexal mass,measuring15x10x10 mm & no free fluid in POD.The uterus was empty.BHCG done measured 500iu/L.The patient was clinically stable.Taking into consideration the scan findings & a positive BHCG.she was diagnosed as a case of right ectopic pregnancy.What is the treatment of choice for her?

33. A 22 year old woman experiences mild bleeding at 7 weeks of gestation.She attends the EPAU ,where a TVS is done.It shows a gestational sac with a diameter of 20 mm & no fetal pole.What is the next step in your management?

34.A 40 year old woman had a complete hydatidiform mole evacuated uneventfully.Post evacuation the BHCG dropped to 1000 iu/L from a level of 50,000iu/L.It remained at 1000 iu/L for 8 weeks post evacuation.clinical exam & investigations showed no evidence of metastasis.A tvs showed a 2 cm lesion in the myometrium.What is the further management in this case?

35 A 35 years old lady was diagnosed with a partial molar pregnancy for which she underwent a suction evacuation of the uterus .The histology confirmed diagnosismof partial molar pregnancy.Which of the following features is characterictic of the condition?

36 A 40 year old woman underwent surgical evacuation of uterus for a missed miscarriage 8 weeks ago.The histology showed evidence of a molar pregnancy.She had a blood sample taken 2 days for evaluation of BHCG which turned out to be 500 IU.She presents to you for further follow up.What is the duration of follow up you will advise?

37 A 35 year old lady has suffered from 3 consecutive first trimester miscarriages.She was tested for anticardiolipin antibodies twice,12 weeks apart.The test was positive on both occasions.What advise will u give her regarding treatment in her next pregnancy?

38. A couple with 3 first trimester losses has come in for counselling .While counselling you tell them about risk factors associated with RPL.Which of the following is not associated with recurrent first trimester pregnancy loss?

39.For women with a confirmed diagnosis of miscarriage,expectant management is an option.other options should be explored if the woman has any of the following factors ,except

40.For using methotrexate as a treatment option for ectopic pregnancy,certain criteria are laid down. Which one of the following does not fit into this criteria?

41. Mrs Jane was diagnosed with a left tubal ectopic pregnancy.She underwent a laparoscopic salpingectomy as treatment for the ectopic pregnancy.What advise will you give her at discharge regarding a urine pregnancy test?

42.Combined Test for screening for aneuploidies in early pregnancy.At what gestational age is the Combined Test done?

43.The quadruple test is done from 15+0 to 20+0 weeks of gestation to screen for Down’s syndrome.The test measures maternal levels of 4 biochemical markers.Which of the following is not included in the quadruple test?

44.Whenever the risk of Down syndrome or Edward/Patau’s syndrome is reported as 1:150 or more the woman is offered a diagnostic test .This is usually a chorionic villus sampling or an amniocentesis.At what gestational age is chorionic villus sampling indicated?

45.A 29-year-old gravida 2 para 1 is admitted with history of preterm prelabour rupture of membranes at 31+5weeks gestation of 4 hours duration. She is a known HIV patient with a low viral load and had been commenced on HAART at 22 weeks. Her viral load at 28 weeks was <50 copies/ml. On admission, she is apyrexial, vital signs are within normal limits and the CTG is reassuring. What is the most appropriate immediate management with regard to delivery?

46. A 27-year-old Emmy is a newly married woman is HIV positive on Truvada regimen. She is receiving her anti-HIV medications and is using a 35-mcg oestrogen combined oral contraceptive pills (COCP). She finished a pill packet 10 days ago, forgot to restart again and had unprotected sexual intercourse 2 days ago. She also missed two pills in her last week of the previous pill packet, when she was on honeymoon with her husband. A chlamydia urine polymerase chain reaction test is negative. She has history of severe asthma controlled by oral glucocorticoids. She attends asking for emergency contraception. What is the most appropriate method of emergency contraception in this situation?

47. 28-year-old woman, who is 37 weeks pregnant, is seen in antenatal clinic. This is her second pregnancy. She is HIV positive + HBsAg positive only. She has been fully compliant with her HAART (highly active antiretroviral therapy) throughout her pregnancy. Her latest serum viral load is <50 copies/mL. Her pregnancy has been uncomplicated. She is not concerned about vertical transmission of HIV but keen to know in which of the conditions immunoglobin is given to neonate to reduce the risk of vertical transmission to neonate?Which of the following options is true?

48. As the registrar, you are seeing a 23-year-old woman and her partner in the clinic. They have known each other for 7 months but have not yet achieved vaginal penetration despite repeat attempts. The woman has never had sex before this and describes her vagina as a ‘brick wall: There is no significant past medical history and she is not taking any medication.On examination, she appears to be healthy, with a body mass index of 23 kg/m2. Vaginal examination reveals involuntary spasm of the pubococcygeal and other perineal muscles.What is the diagnosis?

49. A 28-year-old woman has come to your registrar-led clinic with vaginal discharge. This started 2 years ago after a surgical termination of pregnancy. The GP has repeatedly arranged investigations, including swabs and pelvic ultrasound, but no cause has been identified for the discharge. The woman does not believe the investigation results are normal. She feels that the discharge has been caused by an instrument left behind during the termination of pregnancy. How should she be managed?

50.A 38-year-old woman and her husband have come to the family planning clinic for advice on contraception. They have four children and do not want any more. As the registrar, you discuss with them permanent (vasectomy and sterilisation) and long-term reversible forms of contraception. They prefer permanent contraception and understand that permanent methods are irreversible. They would like to know the first-year failure rate for female (laparoscopic tubal occlusion) and male sterilisation procedures.Which of the following are the correct rates?