Archives: Medical Student Finals

MSFinals-3385

A 25-year-old primigravida presents for her 36-week gestation check-up with her midwife in the community. She has had an uneventful pregnancy and is feeling well. Her birth plan is for a water birth at her local midwife-led birth center. During her assessment, her vital signs are as follows: temperature of 36.7ºC, heart rate of 90 beats/min, blood pressure of 161/112 mmHg, oxygen saturation of 98% in room air with a respiratory rate of 21/min. Urinalysis reveals nitrites + and a pH of 6.0, but negative for leucocytes, protein, and blood. What is the most appropriate management plan for this patient?

MSFinals-3386

A 35-year-old para 1+0 has arrived at term in labor. During a vaginal examination, the occiput is palpable posteriorly (near the sacrum). What is the appropriate course of action for managing this patient?

MSFinals-3387

As a young doctor in obstetrics and gynaecology, you are assisting in the delivery of a patient when suddenly, shoulder dystocia occurs. You quickly call for senior assistance and decide to perform McRobert’s manoeuvre by hyper flexing and abducting the mother’s hips, moving her onto her back and bringing her thighs towards her abdomen.

What other action can be taken to enhance the effectiveness of the manoeuvre?

MSFinals-3354

A 28-year-old G2P1 woman is admitted to the maternity ward after experiencing regular contractions. During a vaginal examination, the midwife confirms that the mother is currently in the first stage of labor. When does this stage of labor typically end?

MSFinals-3355

A woman who is 28 weeks pregnant arrives at the emergency department after experiencing painless leakage of fluid from her vagina. She reports an initial gush two hours ago, followed by a steady drip. During examination with a sterile speculum, the fluid is confirmed as amniotic fluid. The woman also discloses a severe allergy to penicillin. What is the optimal approach to minimize the risk of infection?

MSFinals-3356

A 26-year-old para 1+0 comes to the clinic at 36 weeks complaining of painless vaginal bleeding. She mentions having occasional spotting for the past 4 weeks, but it has become more frequent and heavier. Her blood pressure is 125/80 mmHg, and her heart rate is 85 bpm. During the examination, her abdomen is soft and non-tender, and the fetal head is not engaged and high. What further examination should you conduct to confirm your initial suspected diagnosis?

MSFinals-3357

A 36-year-old overweight gravida 3 para 2 presents with a tender and swollen left leg at 32 weeks of gestation. The clinician initiates appropriate treatment and decides to monitor it with a specific blood test. What is the name of this blood test?

MSFinals-3358

A 29-year-old woman who is 39-weeks pregnant presents to the labour suite with sporadic contractions. She had noticed a mucous plug in her underwear earlier in the day. Upon examination, she appears to be breathing heavily and experiencing some discomfort. The cardiotocography is normal and progressing smoothly. During a vaginal examination, her cervix is estimated to be dilated at 2 cm. What phase of labour is she currently in?

MSFinals-3359

A 28-year-old primigravida at 37 weeks presents to the antenatal unit with complaints of right-sided abdominal pain and vomiting. She denies any abnormal discharge and reports normal fetal movements. Her blood pressure is 148/97 mmHg and her blood results show Hb of 93 g/l, platelets of 89 * 109/l, WBC of 9.0 * 109/l, urate of 0.49 mmol/l, bilirubin of 32 µmol/l, ALP of 203 u/l, ALT of 190 u/l, and AST of 233 u/l. What is the most likely diagnosis?

MSFinals-3360

A 35-year-old pregnant woman presents to the Emergency department with complaints of severe itching, nausea, and lethargy. She is currently 38 weeks pregnant and this is her second pregnancy. Upon examination, she appears to be clinically jaundiced, but her vital signs are within normal limits. Laboratory tests reveal the following results: Hb 121 g/l, Platelets 189 * 109/l, WBC 8.7 * 109/l, Bilirubin 90 µmol/l, ALP 540 u/l, ALT 120 u/l, γGT 130 u/l, Albumin 35 g/l, and INR 1.0. The acute viral hepatitis screen is negative. Based on these findings, what is the most likely diagnosis?