Archives: Medical Student Finals

MSFinals-3226

A 29-year-old woman is admitted to the Intensive Therapy Unit. She presented with multiple seizures to the Emergency Department and is 8 months pregnant. She is intubated and ventilated; her blood pressure is 145/95 mmHg.
Investigations:
Investigation Result Normal value
Haemoglobin 108 g/dl 115–155 g/l
White cell count (WCC) 8.1 × 109/l 4–11 × 109/l
Platelets 30 × 109/l 150–400 × 109/l
Aspartate aminotransferase (AST) 134 U/l 10–40 IU/l
Urine analysis protein ++
Which of the following fits best with this clinical picture?

MSFinals-3227

A 28-year-old woman attends her regular antenatal check at 16 weeks gestation. It is her second pregnancy and she has had no complications.
The nurse is discussing the results of previous tests, checking her urine and measuring her blood pressure. The patient has no protein in her urine and her blood pressure is 102/70 mmHg.
Which of the following describes a normal physiological change in this patient?

MSFinals-3228

A 32-year-old woman who is at 10 weeks’ gestation in her second pregnancy sees her midwife to receive her Booking Clinic blood results. She feels a bit tired at present and appears pale. She denies any infective symptoms, and observations and examination are unremarkable.
Her full blood count is as follows:
Investigation Result Normal value
Haemoglobin 101 g/l 115–155 g/l
Mean corpuscular volume (MCV) 73 fl 76–98 fl
White cell count (WCC) 7 × 109/l 4–11 × 109/l
Platelets 323 × 109/l 150–400 × 109/l
Which of the following statements best describes the management of anaemia in pregnancy?

MSFinals-3229

A 32-year-old woman presents at 35 weeks’ gestation in clinic. She had a primary infection with genital herpes at 24 weeks’ gestation, which was treated with acyclovir. She has attended clinic to discuss birth and management options.
What is the recommended management plan for this patient?

MSFinals-3230

A 35-year-old woman is referred to hospital by her midwife 5 days after giving birth to a healthy baby boy by vaginal delivery. She has reported increasing lochia and has had an increase in lower abdominal cramping over the last few days. On examination, she is hot and sweaty with temperature 38 °C, heart rate 120 bpm and capillary refill time (CRT) 3 s, and her abdomen is firm and tender, with the uterus still palpable just below the umbilicus. There is mild perineal swelling but no tears, and lochia is offensive. The rest of the examination is normal. She is keen to get home to her baby as she is breastfeeding.
What would you do next?

MSFinals-3231

A 29-year-old woman presents with hypertension at 12 weeks into her pregnancy. She has no history of hypertension. She complains of headache and tenderness in the right lower quadrant. An ultrasound of her pelvis reveals multiple cysts in both ovaries. There are no signs of hirsutism or virilism. What is the most probable diagnosis?

MSFinals-3232

A 35-year-old primip is being evaluated on day six postpartum for unilateral breast discomfort. The discomfort began two days ago, and despite continuing to breastfeed, it has not improved. She feels generally fatigued, but she is currently eating and drinking well.
During the examination, you observe an erythematosus, firm, and swollen area in a wedge-shaped distribution on the right breast. There is a small crack in the nipple. The examination is painful.
Her vital signs are stable, and her temperature is 37.5 °C.
What is the most appropriate initial management, given the above information?

MSFinals-3233

A 32-year-old primiparous woman attends her first health visitor appointment. She is currently exclusively breastfeeding, but she complains of sore, cracked nipples. Despite using nipple shields, her symptoms have not improved. The woman is also concerned that her baby is not feeding enough, as she frequently has to stop the feed due to tenderness.
During nipple examination, you observe small surface cracks, but no exudate or erythema.
What is the initial step in managing this patient’s condition?

MSFinals-3234

A 32-year-old primiparous woman with type 1 diabetes mellitus is at 12 weeks’ gestation and attended for her nuchal scan. She is currently on insulin treatment. Her HbA1c at booking was 34 mmol/mol (recommended at pregnancy < 48 mmol/mol).
What is the most appropriate antenatal care for pregnant women with pre-existing diabetes?

MSFinals-3235

A 32-year-old woman comes for her first trimester scan at 12 weeks’ gestation. She reports no vaginal bleeding and is feeling well. The ultrasound shows an intrauterine gestational sac with a fetal pole that corresponds to nine weeks’ gestation, but no fetal heart rate is detected. The patient had a stillbirth in her previous pregnancy at 27 weeks, and she underwent an extended course of psychotherapy to cope with the aftermath. What is the most suitable initial management for this patient?