Archives: Medical Student Finals

MSFinals-3316

A 26-year-old woman presents to the Emergency Department with minimal vaginal bleeding. She reports her last menstrual period as having been 4 weeks ago. She denies pain but reports severe nausea and vomiting. She has no significant past medical history and her last check-up 6 months ago did not reveal any abnormalities. On examination, her blood pressure is 160/110 mmHg and her uterus measures 12 weeks’ size. A serum beta human chorionic gonadotropin (β-HCG) level is drawn and found to be in excess of 300 000 iu. An ultrasound does not identify any foetal parts. What is this patient at risk of developing?

MSFinals-3317

A 30-year-old woman with a previous macrosomic baby and a history of gestational diabetes presents in her second pregnancy. She is at eight weeks’ gestation and attends the midwife booking visit.
What is the most suitable test to diagnose gestational diabetes in this patient?

MSFinals-3318

A 29-year-old lady who is 30 weeks pregnant with her second child presents in a very anxious state. She has just been at a friend’s party and has discovered that one of the children there had just developed a rash suggesting chickenpox. She is terrified the disease is going to harm her unborn child. She cannot recall if she had chickenpox as a child. Her medical record does not shed any light on the situation, and it is unclear if she has had vaccination against varicella. She does not have a rash herself and feels well. Her pregnancy has been uncomplicated to date.
What is the most appropriate next course of action?

MSFinals-3301

A 26-year-old patient, who is 22 weeks pregnant, has been experiencing severe allergic rhinitis. She complains of bilateral eye puffiness and itching, rhinorrhoea, and chronic nasal congestion. She has tried nasal sprays before, but they were ineffective. Due to her pregnancy, she has refrained from taking any medication, but her symptoms are now affecting her work and sleep. What is the most suitable initial medication to recommend for this patient?

MSFinals-3290

A 29-year-old primigravida presents at ten weeks’ gestation with persistent nausea and vomiting. She reports this is mostly in the morning but has affected her a lot, as she is struggling to attend work. She can manage oral fluids, but she struggles mostly with eating. She has tried avoiding certain foods and has followed some conservative advice she found on the National Health Service (NHS) website, including ginger, and they have not helped. Her examination is unremarkable. Her documented pre-pregnancy weight is 60 kg, and today she weighs 65 kg. The patient is keen to try some medication.
Which of the following is the most appropriate management for this patient?

MSFinals-3291

A 20-year-old G3P2 woman presents to the Emergency Department with vaginal bleeding. She reports no pain or fever and has not received prenatal care for this pregnancy. Her last menstrual period was 8 weeks ago. Upon examination, her heart rate is 76 bpm, blood pressure is 112/68 mmHg, and temperature is 37.1 ºC. A serum β-human chorionic gonadotropin level is 10,000 iu. A pelvic exam reveals a closed cervical os. A bedside ultrasound confirms the presence of an intrauterine gestational sac with cardiac activity. What is the diagnosis?

MSFinals-3292

A 29-year-old woman on day one postpartum who is breastfeeding is concerned about the safety of her pain medication. When you arrive, you find that the patient was prescribed acetaminophen for pain relief, but when she was offered this, she told the midwife it cannot be used as it can have detrimental effects for her baby. She wants to know if there are any other options. You explain that acetaminophen is safe to use while breastfeeding.
Which of the following analgesics is another safe first line treatment to use in women who are breastfeeding?

MSFinals-3293

A 28-year-old woman with a history of back pain uses paracetamol and ibuprofen regularly for pain relief. She and her partner are planning to have a baby, and would like to know about the safety of analgesics during pregnancy.
What is the best statement regarding the safety of analgesics in pregnancy?

MSFinals-3294

A 35-year-old woman, who is exclusively breastfeeding, presents six months postpartum with burning pains and itching of the nipples. She has occasional sharp pains behind the areolae and reports that symptoms are worse after feeding.
On examination, both nipples appear erythematosus and inflamed, with small fissures. On further questioning, she reports no history of atopy. She also tells you that last night, she noticed some white patches in her infant’s mouth that she tried to wipe off but were stuck on the mucosa.
Which of the following is the most likely diagnosis?

MSFinals-3295

You are summoned to the Labour Ward to assess a 29-year-old woman who is receiving consultant-led care for gestational diabetes. She was induced at 38+5 weeks’ gestation and has been on oxytocin for augmentation for one hour. She is currently experiencing regular contractions, with six to seven every ten minutes, each lasting at least 45 s. The cervix is dilated to 5 cm. The cardiotocograph (CTG) displays a fetal heart rate baseline of 130 bpm, variability of 20 bpm, accelerations and variable decelerations lasting > 60 s, with a reduced baseline variability in up to 50% of contractions for 30 minutes or more.
What is the next appropriate step in managing this patient?