Archives: Medical Student Finals

MSFinals-3639

A 30-year-old woman who gave birth a week ago presents to the emergency department with concerns about vaginal bleeding. She reports that the bleeding started as bright red but has now turned brown. She is changing her pads every 3 hours and is worried about possible damage to her uterus from her recent caesarean section. On examination, she appears distressed but has no fever. Her vital signs are stable with a heart rate of 95 beats per minute and a respiratory rate of 19 breaths per minute. Abdominal examination is unremarkable except for a pink, non-tender caesarean section scar. What is the most appropriate management plan for this patient?

MSFinals-3640

A 28-year-old pregnant woman is undergoing screening for gestational diabetes. She has no significant medical history and this is her first pregnancy. During the screening, her fasting blood glucose level is measured at 7.2 mmol/L. What is the best course of action for management?

MSFinals-3641

Samantha is a 28-year-old woman who has been diagnosed with epilepsy and is currently taking carbamazepine. She has just given birth to a baby boy and is uncertain about breastfeeding. Samantha is worried that her medication may harm her baby if she continues to breastfeed. What guidance would you offer Samantha regarding her antiepileptic medication and breastfeeding?

MSFinals-3642

A 30-year-old Caucasian woman who is 26 weeks pregnant with her first child presents to antenatal clinic. She had been invited to attend screening for gestational diabetes on account of her booking BMI, which was 32kg/m². Prior to her pregnancy, she had been healthy and had no personal or family history of diabetes mellitus. She takes no regular medications and has no known allergies.

During her antenatal visit, she undergoes an oral glucose tolerance test (OGTT), which reveals the following results:
– Fasting glucose 6.9mmol/L
– 2-hour glucose 7.8 mmol/L

An ultrasound scan shows no fetal abnormalities or hydramnios. She is advised on diet and exercise and undergoes a repeat OGTT two weeks later. Due to persistent impaired fasting glucose, she is started on metformin.

After taking metformin for two weeks, she undergoes another OGTT, with the following results:
– Fasting glucose 5.8 mmol/L
– 2-hour glucose 7.2mmol/L

What is the most appropriate next step in managing her glycaemic control?

MSFinals-3643

A 36-year-old pregnant woman has a vaginal swab taken at 34 weeks gestation despite being asymptomatic. She informs you that during her previous pregnancy a bacteria which can cause sepsis in babies was detected on one of her swabs, which is why she needs to be tested again.

The microbiology report reads as follows:
Sample: Positive (awaiting sensitivities)
Gram stain: Positive
Morphology: Cocci in chains
Growth requirements: Facultative anaerobe

What is the most likely organism present based on this report?

MSFinals-3644

As a newly graduated doctor in obstetrics and gynaecology, you are attending to an emergency call for a midwife-led delivery. The delivery has been stalled for some time, and the midwife informs you that it is a case of shoulder dystocia. You determine that performing McRobert’s manoeuvre is necessary.

What is the appropriate position for the woman to be in to carry out this manoeuvre?

MSFinals-3615

A woman who is 32 weeks pregnant attends her antenatal appointment for her combined screening test. She gives her consent and undergoes the standard screening test, which includes blood tests and an ultrasound scan. After the test, she is informed that her results suggest the possibility of Down’s syndrome and is offered further discussion. What are the expected results in this scenario?

MSFinals-3616

A 28-year-old woman presents to the antenatal clinic for a routine visit and is found to have a blood pressure of 165/111 mmHg and ++proteinuria on urinalysis. Her doctor suspects pre-eclampsia and admits her to the obstetrics assessment unit. She has recently moved to the area and her medical records are not available. She is otherwise healthy and only uses blue and brown inhalers for her asthma, for which she recently completed a 5-day course of steroids after being hospitalized for a severe exacerbation. What medication should be used to manage her hypertension?

MSFinals-3617

A 28-year-old woman comes to the clinic with her worried partner. She has been exhibiting unpredictable mood swings since giving birth to their daughter 10 days ago. During the appointment, she seems restless and agitated. Her partner shares that she has been avoiding sleep due to her fear that something terrible will happen to their baby. The patient has a history of depression but has not taken her fluoxetine medication for 4 months because of concerns about potential complications. What is the best course of action for managing her symptoms?

MSFinals-3618

A 32-year-old woman, 3 weeks postpartum, is brought in by her sister after claiming her baby is possessed by demons. She has been experiencing insomnia and conversing with imaginary individuals. Her sister reports that she has been exhibiting extreme mood changes over the past few weeks and is worried about the safety of the baby. The patient has no significant medical or psychiatric history, and there is no family history of mental illness. What is the recommended course of action for managing this condition?