Archives: Medical Student Finals

MSFinals-3321

A 32-year-old woman presents on day 28 postpartum with burning pain in the nipples bilaterally and itching. She reports symptoms are worse after feeds.
On examination, you notice that the nipples are erythematosus, swollen and fissured. The breasts are unremarkable. Her observations are stable, and she is apyrexial. She tells you she wants you to review her baby and that she noticed small white patches in his mouth.
Given the likely diagnosis, which of the following is the most appropriate management?

MSFinals-3322

A woman presents to the Emergency Department 45 days after giving birth by Caesarean section. She complains of persistent vaginal bleeding. Her temperature is 38.5 ºC, pulse 88 bpm and blood pressure 110/76.
What is the most likely diagnosis?

MSFinals-3323

A 23-year-old primigravida comes for her first midwifery appointment at nine weeks’ gestation. She was born in Romania and is uncertain if she has received the MMR vaccine.
What is the indicative outcome for rubella immunity resulting from vaccination?

MSFinals-3324

A 24-year-old primigravida is brought to the Emergency Department by her husband at 33 weeks of gestation after experiencing a generalised tonic–clonic seizure. Examination reveals blood pressure of 160/90 mmHg, temperature of 37 °C and 2+ pitting oedema in the lower extremities. She appears lethargic but responds to simple commands. What is the definitive treatment for this patient’s condition?

MSFinals-3325

A 30-year-old woman who is 26 weeks’ pregnant presents to the Emergency Department (ED) with some swelling of her ankles. She has had no other pregnancy problems and this is her first child. Her blood pressure is 150/95 mmHg and she has 2+ protein in her urine. After 4 hours, her blood pressure has decreased to 130/95 mmHg. Her booking bloods and previous bloods are not available. Her results are as follows:
Investigation Result Normal value
Blood pressure 130/95 mmHg < 120/< 80 mmHg
Haemoglobin (Hb) 85 g/l 115–155 g/l
Platelets (Plts) < 210 × 109/l 150-400 × 109/l
Alkaline phosphatase (ALP) 250 U/litre 25–250 U/litre (in pregnancy)

Which of the following statements is most likely to be true?

MSFinals-3326

A 35-year-old woman with hypertension is considering pregnancy and seeks pre-pregnancy planning. She is currently taking losartan 50 mg daily and her BP measures 130/88 mmHg. What guidance should be provided to this patient in this scenario?

MSFinals-3327

A 29-year-old primiparous woman presented to Labour Ward triage at 34+1/40 with upper back/chest pain and a headache. The pregnancy had been uncomplicated up to this point, with only some lower back pain over the past 2 weeks.
Obs: blood pressure 151/102, respiratory rate 18, sats 100% room air, heart rate 60 bpm, afebrile. On examination, she appeared well – PERL. Heart sounds were normal, chest was clear, and there was no shortness of breath (SOB). Her abdomen and uterus were soft and non-tender (SNT), and her calves were also SNT. Reflexes were normal. A urine dip showed nitrate +, leukocytes +, protein 1+. Electrocardiography (ECG) and cardiotocography (CTG) were both normal. Blood tests were taken, and results were pending.
Considering the likely diagnosis, what would be your first step in management?

MSFinals-3328

A 31-year-old woman with epilepsy, associated with generalised tonic–clonic seizures, attends her regular Epilepsy Clinic appointment with her partner. She is currently taking the combined oral contraceptive pill, but she wants to start trying for a baby. She is currently on sodium valproate and has been seizure-free for one year.
What is the most suitable antiepileptic medication for this patient to take during the preconception period and pregnancy?

MSFinals-3329

A 26-year-old epileptic woman presents to the clinic with her partner, reporting several instances of tonic-clonic seizures. They plan to start a family within the next year and seek advice. She is currently controlling her epilepsy with sodium valproate. What is the most appropriate recommendation for managing her condition?

MSFinals-3330

A 28-year-old woman is on day one postpartum, following a normal vaginal delivery. She has called the midwife, as she is struggling to establish breastfeeding and correct positioning of the baby to the breast. She reports pain when the baby is breastfeeding.
Which of the following is a feature of a poor latch?