Archives: Medical Student Finals

MSFinals-3361

A pregnant woman who is slightly older is admitted to the Emergency department with symptoms of nausea, vomiting, and lethargy. She is in her 38th week of pregnancy and has never been pregnant before. Upon examination, she appears to be clinically jaundiced and has a temperature of 37.7ºC. Her blood pressure and heart rate are normal.

The results of her blood tests are as follows:
– Bilirubin: 80 µmol/l
– ALP: 240 u/l
– ALT: 550 u/l
– AST: 430 u/l
– γGT: 30 u/l
– INR: 1.8
– Hb: 110 g/l
– Platelets: 331 * 109/l
– WBC: 12.5 * 109/l

An acute viral hepatitis screen comes back negative. An urgent US doppler liver shows steatosis with patent hepatic and portal vessels. What is the most likely diagnosis?

MSFinals-3362

A 35-year-old woman comes to the obstetric clinic during her 28th week of pregnancy. She has been diagnosed with gestational diabetes and has been taking metformin for the past two weeks. However, her blood glucose levels are still elevated despite following a strict diet and taking the maximum dose of metformin. What is the next best course of action to manage her blood glucose levels?

MSFinals-3363

A 28-year-old woman is diagnosed with hypertension during her first prenatal visit at 12 weeks with a blood pressure reading of 150/100 mmHg. Her urine test reveals +++ protein. What is the best course of action to manage her hypertension?

MSFinals-3364

A 28-year-old woman presents to the maternity unit 3 days after delivering a healthy baby at 39 weeks gestation. She had a normal third stage of labour and has been experiencing intermittent vaginal bleeding and brown discharge, with an estimated blood loss of 120 ml. The patient has a history of asthma.
On examination, her temperature is 37.2ºC, heart rate is 92 bpm, and blood pressure is 120/78 mmHg. There is no abdominal tenderness and a pelvic and vaginal exam are unremarkable.
What is the next appropriate step in managing this patient?

MSFinals-3365

A 26-year-old female arrives at the emergency department complaining of sporadic abdominal pain and vaginal bleeding. She believes her last menstrual cycle was 8 weeks ago but is uncertain. She has no prior gynecological history and has never been pregnant before. Her vital signs are stable, with a blood pressure of 130/85 mmHg and a pulse rate of 79 bpm. A pregnancy test conducted in the department is positive, and a transvaginal ultrasound confirms a pregnancy in the adnexa with a fetal heartbeat present. What is the most appropriate course of action in this scenario?

MSFinals-3366

A 26 year-old woman with type 1 diabetes arrives at the maternity department at 25+3 weeks gestation with tightness and a thin watery discharge. Her pregnancy has been uneventful thus far, with all scans showing normal results. She maintains good diabetes control by using an insulin pump.

During a speculum examination, no fluid is observed, and the cervical os is closed. A fetal fibronectin (fFN) test is conducted, which returns a positive result of 300.

What is the most appropriate course of action?

MSFinals-3367

A 31-year-old primiparous woman, who is 34 weeks pregnant, presents to the emergency department with abdominal pain and vaginal bleeding. She reports that the bleeding has stopped after about a teaspoon of blood. Her pregnancy has been uncomplicated, and she has been attending antenatal care regularly. She confirms that her waters have not broken.

Upon examination, her vital signs are stable, and the foetal heart rate is reassuring. However, she has a tense and tender abdomen. A transvaginal ultrasound reveals a small retroplacental haemorrhage and an apically located placenta.

What is the most appropriate next step in managing this patient?

MSFinals-3368

A woman who is 34 weeks pregnant is being assessed for her first pregnancy. Her baby is currently in a breech presentation. What is the best course of action for management?

MSFinals-3369

A 25-year-old woman who is 32 weeks pregnant presents to the Emergency Department with sudden onset abdominal pain and some very light vaginal bleeding which has subsequently stopped. On examination her abdomen is tense and tender. The mother says she has not noticed any reduction in foetal movements. Her vital signs are as follows:

HR 105 bpm
BP 120/80 mmHg
Temperature 37.1ºC
Respiratory Rate 20 min-1

Cardiotocography (CTG) was performed and showed a foetal heart rate of 140 bpm, with beat-beat variability of 5-30 bpm and 3 accelerations were seen in a 20 minute period.

Ultrasound demonstrates normal foetal biophysical profile and liquor volume. There is a small collection of retroplacental blood.

What is the most appropriate course of action for this patient?

MSFinals-3370

A 35-year-old primigravida woman at 30 weeks gestation arrives at the Emergency Department with premature rupture of membranes. She has had an uncomplicated pregnancy and is in good health. What is the optimal approach to managing her condition?