Archives: Medical Student Finals

MSFinals-3558

A 29-year-old woman who is 20-weeks pregnant comes to the emergency department after noticing a vesicular rash on her torso this morning. Upon further questioning, you discover that her 5-year-old daughter developed chickenpox last week and the patient cannot recall if she has had the condition before. She seems at ease while resting.

Serological testing for varicella zoster virus reveals the following results:
Varicella IgM Positive
Varicella IgG Negative

What is the most suitable course of action?

MSFinals-3559

Sarah, a 29-year-old pregnant woman (gravidity 1, parity 0) currently 33+0, visits her obstetrician with a new rash. Sarah attended her 6-year-old nephew’s birthday party 2 weeks ago. Today, she woke up feeling unwell with malaise and a loss of appetite. She also noticed a new itchy rash on her back and abdomen. Upon calling her sister, she found out that one of her nephew’s friends at the party was recently diagnosed with chickenpox. Sarah has never had chickenpox before. During the examination, Sarah has red papules on her back and abdomen. She is not running a fever. What is the most appropriate course of action?

MSFinals-3560

A 25 year old woman presents to her GP with breast pain. She gave birth 3 weeks ago and is exclusively breastfeeding. She reports a 4 day history of increasing pain in her left breast, which has not improved with continued feeding and expressing. During examination, she appears healthy, but her temperature is 38.5ºC. There is a small area of redness above the left nipple, which is sensitive to touch. She has no known allergies.
What is the best course of action for management?

MSFinals-3523

A 29-year-old woman presents to the clinic with a complaint of intense itching that has developed over the past few weeks. She is currently 32 weeks pregnant and has had an uncomplicated pregnancy thus far. The patient reports that the itch is particularly bothersome on her palms and soles. She denies any recent illness or fever and states that she otherwise feels well. On examination, there is no evidence of a rash. Blood tests reveal elevated levels of bilirubin, ALT, AST, and ALP. What should be discussed with the patient?

MSFinals-3524

A 32-year-old female who is 20 weeks pregnant has a raised serum alpha-fetoprotein (AFP) and is worried about the possible causes. What could be responsible for the elevated AFP levels in this patient?

MSFinals-3525

A 30-year-old, 16 week pregnant, female arrives at the emergency department complaining of abdominal pain that has been persistent for the last 2 hours. She denies any vaginal bleeding. What are the risk factors linked to an elevated chance of placental abruption?

MSFinals-3526

A 38-year-old G7P3 mother presents with a show and waters breaking at 34+1 weeks, following three days of fever and left flank pain. Despite hoping for a home birth, she eventually agrees to go to the hospital after three hours of convincing from the midwife. Upon arrival, continuous cardiotocography is initiated and a foetal doppler reveals foetal bradycardia. On abdominal exam, the baby is found to be in a footling breech position, but the uterus is non-tender and contracting. A speculum examination reveals an exposed cord, with a soft 8 cm cervix and an exposed left foot.

What is the most appropriate initial management plan for this patient and her baby?

MSFinals-3527

A 27-year-old woman presents to the GP clinic with complaints of abdominal pain. She missed her last menstrual period and had unprotected sexual intercourse 8 weeks ago. She denies any vaginal discharge or bleeding and has no urinary symptoms. On examination, her abdomen is soft with mild suprapubic tenderness. Her vital signs are stable with a heart rate of 72 beats per minute and blood pressure of 118/78 mmHg. A pregnancy test is performed and comes back positive. As per the current NICE CKS guidelines, what is the next appropriate step in management?

MSFinals-3528

A 28-year-old female presents to the Early Pregnancy Unit with vaginal bleeding and an unknown gestational age. She reports no pain and is stable. This is her first pregnancy. An ultrasound reveals a tubal pregnancy with a visible fetal heartbeat and an unruptured adnexal mass measuring 40mm. Her beta-hCG level is 5,200 IU/L. What is the initial management plan for this patient?

MSFinals-3529

A 29-year-old woman is admitted to the labour ward at 38+4 weeks gestation. This is her first pregnancy and she reports that contractions began approximately 12 hours ago. Upon examination, her cervix is positioned anteriorly, is soft, and is effaced at around 60-70%. Cervical dilation is estimated at around 3-4 cm and the fetal head is located at the level of the ischial spines. No interventions have been performed yet.
What is the recommended intervention at this point?