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Question 1
Incorrect
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A 27-year-old woman presented to the clinic for advice because she is planning to conceive and has never been pregnant before. Upon history taking, it was noted that she has no history of diabetes, mental health issues, and is not taking any regular medication.
Which of the following is considered the best recommendation to give to the patient for the prevention of neural tube defects?Your Answer:
Correct Answer: Folic acid 0.4 mg daily for a minimum of one month before conception to first 12 weeks of pregnancy
Explanation:CDC urges all women of reproductive age to take 400 micrograms (mcg) of folic acid each day, in addition to consuming food with folate from a varied diet, to help prevent some major birth defects of the baby’s brain (anencephaly) and spine (spina bifida).
Women who are at high risk of having babies with neural tube defects and who would benefit from higher doses of folic acid include those with certain folate-enzyme genotypes, previous pregnancies with neural tube defects, diabetes, malabsorption disorders, or obesity, or those who take antifolate medications or smoke. Such women should take 5 mg/d of folic acid for the 2 months before conception and during the first trimester.
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This question is part of the following fields:
- Obstetrics
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Question 2
Incorrect
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A 32-year-old gravida 3 para 2 presents for routine prenatal care. The patient is at 14 weeks estimated gestational age by last menstrual period, and ultrasonography at 8 weeks gestation was consistent with these dates. Fetal heart tones are not heard by handheld Doppler. Transvaginal ultrasonography reveals an intrauterine foetus without evidence of fetal cardiac activity. The patient has not had any bleeding or cramping, and otherwise feels fine. A pelvic examination reveals a closed cervix without any signs of bleeding or products of conception.
Which one of the following is the most likely cause of this presentation?Your Answer:
Correct Answer: A missed abortion
Explanation:In this case, the patient has a missed abortion, which is defined as a dead foetus or embryo without passage of tissue and with a closed cervix. This condition often presents with failure to detect fetal heart tones or a lack of growth in uterine size.
– By 14 weeks estimated gestational age, fetal heart tones should be detected by both handheld Doppler and ultrasonography.
– An inevitable abortion presents with a dilated cervix, but no passage of fetal tissue.
– A blighted ovum involves failure of the embryo to develop, despite the presence of a gestational sac and placental tissue. -
This question is part of the following fields:
- Obstetrics
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Question 3
Incorrect
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A 50-year-old woman presents with moderately severe pain in her left groin and thigh. She had recently travelled by airplane from overseas and is at 18 weeks of gestation of her second pregnancy. The only incidence of trauma she can think of is when she hit her left knee on a table yesterday.
On physical examination, it is found that she has some swelling of her left ankle that is not present on the right side. Her first pregnancy was unremarkable except for development of some symptoms that were believed to be related to pelvic symphyseal separation around 28 weeks of gestation.
Which one of the following is the mostly cause for this patient's pain?Your Answer:
Correct Answer: deep venous Thrombosis (DVT) in her left leg
Explanation:For this pregnant patient who recently travelled overseas most likely has a deep venous thrombosis (DVT). It would also be expected that the patient would have oedema in the symptomatic leg and account for the swelling described.
Though they could cause unilateral leg pain, neither symphyseal separation nor sciatica due to a prolapsed intervertebral disc usually occur as early as 18 weeks of gestation. This patient’s symptoms also do not suggest either diagnosis.
Pain due to trauma would usually be maximal at the site where the trauma took place, which would be in the knee for this patient. Traumatic pain and house cleaning also would not cause the pain described or result in ankle swelling.
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This question is part of the following fields:
- Obstetrics
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Question 4
Incorrect
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A 32-year-old woman at 33 weeks of gestation presents with vaginal bleeding.
A pelvic ultrasound was done, which confirms the diagnosis of placenta praevia and you are planning a cesarean section as it is the most appropriate mode of delivery.
Which among the following is considered a possible outcome of cesarean section delivery?Your Answer:
Correct Answer: Increase risk of adhesions
Explanation:Obstetric complications during or following a cesarean section delivery include:
-Increased risk of maternal mortality.
-Increased need for cesarean sections in the subsequent pregnancies.
-Increased risk for damage to adjacent visceral organs especially bowels and bladder.
-Increased risk of infections.Increased risk for formation of adhesions is a complication after cesarean section and this is the correct response for the given question.
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This question is part of the following fields:
- Obstetrics
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Question 5
Incorrect
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Among the following presentations during pregnancy, which is not associated with maternal vitamin D deficiency?
Your Answer:
Correct Answer: Large for gestational age
Explanation:Retarded skeletal growth resulting in small for gestational age babies are the usual outcomes of an untreated vitamin D deficiency in pregnancy.
Symptoms associated with maternal vitamin D deficiency during pregnancy are:
– Hypocalcemia in newborn.
– Development of Rickets later in life.
– Defective tooth enamel.
– Small for gestational age due to its effect on skeletal growth
– Fetal convulsions or seizures due to hypocalcemia. -
This question is part of the following fields:
- Obstetrics
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Question 6
Incorrect
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Which one of the following is true regarding routine prenatal screening ultrasonography before 24 weeks gestation?
Your Answer:
Correct Answer: It has not been proven to have any significant benefits
Explanation:Routine ultrasonography at around 18-22 weeks gestation has become the standard of care in many communities. Acceptance is based on many factors, including patient preference, medical-legal pressure, and the perceived benefit by physicians. However, rigorous testing has found little scientific benefit for, or harm from, routine screening ultrasonography.
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This question is part of the following fields:
- Obstetrics
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Question 7
Incorrect
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A 26-year -old woman, who underwent an episiotomy during labour, presented with severe vaginal pain 4 days after the procedure.
At the site of the episiotomy, an 8-cm hematoma is noted on examination. Also the woman is found to be hemodynamically stable.
Among the following, which is considered the most appropriate next step in management?Your Answer:
Correct Answer: Explore the hematoma
Explanation:In most cases reported, puerperal hematomas arise due to bleeding lacerations related to operative deliveries or episiotomy, and in rare cases from spontaneous injury to a blood vessel in the absence of any laceration/incision of the surrounding tissue. Vulval, vaginal/paravaginal area and retroperitoneum are considered the most common locations for puerperal hematomas.
Most puerperal hematomas are diagnosed based on the presence of characteristic symptoms and physical examination findings:
VuIvar hematoma usually presents as a rapidly developing, severely painful, tense and compressible mass which is covered by skin of purplish discoloration. A vulvar hematoma can also be an extension of a vaginal hematoma which was dissected through a loose subcutaneous tissue into the vulva.
Vaginal hematomas often present with rectal pressure, were hemodynamic instability caused due to bleeding into the ischiorectal fossa and paravaginal space are the first signs and can result in hypovolemic shock. In these cases a large mass protruding into the vagina is often found on physical examination.
Retroperitoneal hematomas are asymptomatic initially and extend between the folds of broad ligament. Patients suffering will often present with tachycardia, hypotension or shock due to the significant accumulated of blood in the retroperitoneal space. Unless the hematoma is associated with trauma, patients will not present with pain, only signs will be a palpable abdominal mass or fever.Treatment of hematoma depends mostly on the size and location:
Non-expanding hematomas which are <3cm in size can be managed conservatively with analgesics and application of ice packs. An expanding hematoma or those greater than 3cm is managed effectively with surgical exploration under anesthesia, were an incision is made to evacuate the hematoma. The surgical site should not be sutured and vagina is often packed for 12-24 hours, an indwelling urinary catheter also may be indicated. In the given case, patient presents with a large haematoma (>3cm) which needs surgical excision and evacuation.Aspiration of the hematoma is not an appropriate treatment. If surgical intervention is indicated excision and evacuation is the preferred option, followed by vaginal packing for 12-24 hours.
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This question is part of the following fields:
- Obstetrics
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Question 8
Incorrect
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A 20-year-old primigravida at her 16 weeks of gestation, presented with the history of lower vaginal pressure, vaginal spotting and lower back pain.
Transvaginal ultrasound shows cervical shortening to 2 cm, cervical dilation, and protrusion of fetal membranes into the cervical canal. Findings confirms the woman has developed non-specific symptoms of cervical insufficiency which may lead to premature delivery.
Which among the following is the most appropriate management in this case?Your Answer:
Correct Answer: Reinforcement of the cervical ring with nonabsorbable suture material
Explanation:Patient mentioned in the given case has developed clinical features of cervical insufficiency and the possible treatment options include:
1- Cerclage, which is the technique used for the reinforcement of cervical ring with nonabsorbable suture material and is indicated based on ultrasonographic findings. It is the treatment of choice when cervical shortening is detected by ultrasonography before 22 to 24 weeks of gestation.2- Vaginal progesterone is used to reduce the risk of preterm delivery in women who have a prior history of idiopathic preterm delivery or cervical shortening, which is confirmed in the current pregnancy also by ultrasonography.This method is applicable only to those women who do not meet the criteria for Cerclage.
All the other options of management are incorrect in the given case.
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This question is part of the following fields:
- Obstetrics
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Question 9
Incorrect
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Among the statements given below which one is correct regarding shoulder dystocia?
Your Answer:
Correct Answer: Erb palsy is common fetal injury
Explanation:Shoulder dystocia occurs when the bisacromial diameter, which is the breadth of the shoulders, exceed the diameter of pelvic inlet. This typically results in a bony impaction of the anterior shoulder against the maternal symphysis pubis, instead of an arrest at the pelvic inlet. Brachial plexus palsies including Erb’s palsy is the most common foetal injury associated with shoulder dystocia.
It is not hyper-extension but the hyper-flexion of maternal legs tightly on her abdomen, called as McRoberts manoeuvre, which facilitates delivery during shoulder dystocia. This technique is effective as it increases the mobility of sacroiliac joint during pregnancy, which allows the rotation of pelvis and thereby facilitating the release of fetal shoulder.
If this manoeuvre does not succeed, another technique called suprapubic pressure is done where an assistant applies pressure on the lower abdomen and gently pulls the delivered head. This technique is useful in about 42% of cases with shoulder dystocia.Maternal diabetes mellitus and foetal macrosomia both are a risk factor for shoulder dystocia.
Administration of epidural anaesthesia during labour increases the possibility of shoulder dystocia.
Risk of shoulder dystocia may increase with Oxytocin augmentation also.
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This question is part of the following fields:
- Obstetrics
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Question 10
Incorrect
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An 19-year old female came in at the clinic for her first prenatal visit. She claims to have had regular menstrual cycles even while she was on oral contraceptives (OCP). 20 weeks ago, she stopped taking her OCPs and had a menstrual period few days after. No vaginal bleeding or fluid loss were noted since then. On physical examination, the uterus is palpated right above pubic symphysis. Fetal heartbeats are evident on handheld Doppler ultrasound. Which of the statements can mostly explain the difference between the dates and uterine size?
Your Answer:
Correct Answer: Ovulation did not occur until 6-8 weeks after her last period.
Explanation:When the palpated uterine size is in discrepancy with the expected size based on the duration of amenorrhoea, it can have several causes including reduced fluid volume or fetal growth (both of which are more common when there is fetal malformation), or miscalculated age of gestation as a result of wrong dates or actual ovulation occurring at a later date than expected. Reduced fluid volume and fetal growth are the most likely aetiologies during the third trimester of pregnancy, unlike in this patient at 20 weeks age of gestation.
Premature rupture of membranes is less likely the cause when there is negative vaginal fluid loss like this patient.
The most likely cause in this case is that ovulation did not occur as expected, especially when the patient ceased her OCPs during this period. In some instances, ovulation can occur 2 weeks later in about 50% of women, 6 weeks later in 90%, and may still not occur 12 months later in 1% of women.
The other listed statements are unlikely to explain the discrepancies in dates and the observed uterine size in this patient.
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This question is part of the following fields:
- Obstetrics
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Question 11
Incorrect
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A 25-year old woman presented to the medical clinic for her first prenatal check-up. Upon interview, the patient revealed that she has been smoking one pack of cigarettes per day for the past five years.
All of the following are considered correct regarding the disadvantages of smoking during pregnancy, except:Your Answer:
Correct Answer: Increased risk of developing small teeth with faulty enamel
Explanation:Small teeth with faulty enamel is more associated with fetal alcohol syndrome (FAS).
In FAS, the most common orofacial changes are small eyelid fissures , flat facies, maxillary hypoplasia, short nose, long and hypoplastic nasal filter, and thin upper lip. The unique facial appearance of FAS patients is the result of changes in 4 areas: short palpebral fissures, flat nasal bridge with an upturned nasal tip, hypoplastic philtrum with a thin upper vermillion border, and a flat midface. Other facial anomalies include micrognathia, occasional cleft lip and/or palate and small teeth with defective enamel.
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This question is part of the following fields:
- Obstetrics
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Question 12
Incorrect
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Etiological factors in spontaneous abortion include:
Your Answer:
Correct Answer: All of the options given
Explanation:Spontaneous abortion is the loss of pregnancy naturally before twenty weeks of gestation. Colloquially, spontaneous abortion is referred to as a ‘miscarriage’ to avoid association with induced abortion. Early pregnancy loss refers only to spontaneous abortion in the first trimester. In 50% of cases, early pregnancy loss is believed to be due to fetal chromosomal abnormalities. Advanced maternal age and previous early pregnancy loss are the most common risk factors. For example, the incidence of early pregnancy loss in women 20-30 years of age is only 9 to 17%, while the incidence at 45 years of maternal age is 80%. Other risk factors include alcohol consumption, smoking, and cocaine use.
Several chronic diseases can precipitate spontaneous abortion, including diabetes, celiac disease, and autoimmune conditions, particularly anti-phospholipid antibody syndrome. Rapid conception after delivery and infections, such as cervicitis, vaginitis, HIV infection, syphilis, and malaria, are also common risk factors. Another important risk factor is exposure to environmental contaminants, including arsenic, lead, and organic solvents. Finally, structural uterine abnormalities, such as congenital anomalies, leiomyoma, and intrauterine adhesions, have been shown to increase the risk of spontaneous abortion.
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This question is part of the following fields:
- Obstetrics
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Question 13
Incorrect
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A 34 year old female presents to the ob-gyn for a regular antenatal visit. Her previous pregnancy was complicated by pre-eclampsia and later eclampsia. What are the chances of her pre-eclampsia recurring in a later pregnancy?
Your Answer:
Correct Answer:
Explanation:Research suggests the risk of having preeclampsia again is approximately 20%, however experts cite a range from 5% to 80% depending on when you had it in a prior pregnancy, how severe it was, and additional risk factors you may have. If you had preeclampsia during your first pregnancy, you may get it again. HELLP is related to preeclampsia and about 4 to 12 percent of women diagnosed with preeclampsia develop HELLP. HELLP syndrome can also cause complications in pregnancy, and if you had HELLP in a previous pregnancy, regardless of the time of onset, you have a greater risk for developing it in future pregnancies.
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This question is part of the following fields:
- Obstetrics
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Question 14
Incorrect
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The relation of different fetal parts to each other determines?
Your Answer:
Correct Answer: Position of the foetus
Explanation:Fetal attitude is defined as the relation of the various parts of the foetus to each other. In the normal attitude, the foetus is in universal flexion. The anatomic explanation for this posture is that it enables the foetus to occupy the least amount of space in the intrauterine cavity. The fetal attitude is extremely difficult, if not impossible, to assess without the help of an ultrasound examination.
Fetal lie refers to the relationship between the long axis of the foetus relative to the long axis of the mother. If the foetus and maternal column are parallel (on the same long axis), the lie is termed vertical or longitudinal lie.
Fetal presentation means, the part of the foetus which is overlying the maternal pelvic inlet.
Position is the positioning of the body of a prenatal foetus in the uterus. It will change as the foetus develops. This is a description of the relation of the presenting part of the foetus to the maternal pelvis. In the case of a longitudinal lie with a vertex presentation, the occiput of the fetal calvarium is the landmark used to describe the position. When the occiput is facing the maternal pubic symphysis, the position is termed direct occiput anterior.
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This question is part of the following fields:
- Obstetrics
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Question 15
Incorrect
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A 32-year-old lady is two weeks postpartum and in good health. She has painful defecation that is accompanied by some new blood on the toilet paper. Which of the following diagnoses is the most likely?
Your Answer:
Correct Answer: Acute anal fissure.
Explanation:The history of acutely painful defecation associated with spotting of bright blood is very suggestive of an acute anal fissure. Typically, the patient reports severe pain during a bowel movement, with the pain lasting several minutes to hours afterward. The pain recurs with every bowel movement, and the patient commonly becomes afraid or unwilling to have a bowel movement, leading to a cycle of worsening constipation, harder stools, and more anal pain. Approximately 70% of patients note bright-red blood on the toilet paper or stool. Occasionally, a few drops may fall in the toilet bowl, but significant bleeding does not usually occur with an anal fissure.. After gently spreading the buttocks, a close check of the anal verge can typically confirm the diagnosis.
Rectal inspection is excruciatingly painful and opposed by sphincter spasm; however, if the fissure can be seen, it is not necessary to make the diagnosis at first.A perianal abscess, which presents as a sore indurated area lateral to the anus, or local trauma linked with anal intercourse or a foreign body, are two more painful anorectal disorders to rule out.
Anal fistulae do not appear in this way, but rather with perianal discharge, and the diagnosis is based on determining the external orifice of the fistula.
Although first-degree haemorrhoids bleed, they do not cause defecation to be unpleasant.
Although carcinoma of the anus or rectum can cause painful defecation, it would be exceptional in this situation.
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This question is part of the following fields:
- Obstetrics
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Question 16
Incorrect
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A 30-year-old pregnant woman, at her 29th week of gestation, presents to physician with flu-like symptoms for the past 3 days along with runny nose, mild headache and she feels achy. She also has mild fever and diffuse rash all over her body. She is concerned about the health of her baby and wants to know if there are any safe medications which will make her feel better in a short time. She has received tetanus vaccination as part of antenatal care program since she immigrated at the end of her first trimester from Romania. Patient is otherwise healthy.
Considering the symptoms and travel history of this patient, she is at higher risk of giving birth to a newborn with which of the following options?Your Answer:
Correct Answer: Wide pulse pressure
Explanation:This pregnant woman likely has an infection with the rubella virus, which increases the risk of congenital rubella syndrome in her newborn. congenital heart diseases, particularly patent ductus arteriosus (PDA) is a part of this syndrome. Persistence of a patent vessel between the left pulmonary artery and aorta which is supposed to closes in the first 18 hours functionally and in the first 2–3 days of life anatomically is called as PDA.
Normally there is right to left shunting in utero, but in case of PDA blood is shunted from the left (aorta) to the right (pulmonary artery) due to the decrease in pulmonary vascular resistance after birth. This causes right ventricular hypertrophy, if left untreated it can lead to left ventricular hypertrophy and heart failure. There will be a continuous machine-like murmur, heard over the left upper sternal border, as the blood is shunted throughout cardiac cycle. Diastolic BP becomes lower than normal, leading to a higher pulse pressure which is felt as a bounding pulse due to the lost volume from aorta. Though PDA is a non-cyanotic condition, it may lead to Eisenmenger’s syndrome in which R to L shunting persists, resulting in cyanosis, clubbing and polycythemia. Treatment with nonsteroidal anti-inflammatory drugs like indomethacin can close patent PDA. Other symptoms in infants born with rubella syndrome are microcephaly and cataract.
The characteristic feature of an atrial septal defect or ASD, which is a congenital heart disease presenting as an opening in the septa between right and left atria, is a single fixed S2. There will be a delay in closure of the pulmonic valve, due to the excess amount of blood diverted to the right side.
Brachial-femoral delay is a finding in coarctation of aorta, which presents as hypertension in the upper extremities and hypotension in the lower extremities.
A double split S2 is a physiological finding caused by the closure of pulmonary and aortic valves on inspiration.
PDA and pulmonary artery stenosis are the most common cardiac defects reported along with congenital rubella syndrome (CRS), whereas tricuspid valve regurgitation is never reported along with it.
Learning objective: is associated with a continuous machine-like murmur heard over the left upper sternal border, bounding pulse and an increased pulse pressure are the usual symptoms associated with patent ductus arteriosus (PDA), which is mostly seen along with congenital rubella syndrome.
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This question is part of the following fields:
- Obstetrics
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Question 17
Incorrect
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A 40-year-old woman who is at 34 weeks of pregnancy presented to the medical clinic for advice since her other two children were diagnosed with whooping cough just 8 weeks ago, she is worried for her newborn about the risk of developing whooping cough.
Which of the following is considered the most appropriate advice to give to the patient?Your Answer:
Correct Answer: Give Pertussis vaccine booster DPTa now
Explanation:To help protect babies during this time when they are most vulnerable, women should get the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) during each pregnancy.
Pregnant women should receive Tdap anytime during pregnancy if it is indicated for wound care or during a community pertussis outbreak.
If Tdap is administered earlier in pregnancy, it should not be repeated between 27 and 36 weeks gestation; only one dose is recommended during each pregnancy.Optimal timing is between 27 and 36 weeks gestation (preferably during the earlier part of this period) to maximize the maternal antibody response and passive antibody transfer to the infant.
Fewer babies will be hospitalized for and die from pertussis when Tdap is given during pregnancy rather than during the postpartum period. -
This question is part of the following fields:
- Obstetrics
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Question 18
Incorrect
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A 27-year-old female G1P1 presents with her husband because she has not been breastfeeding her baby 24 hours though she had previously stated she intended exclusive breastfeeding for the first 3 months. She feels sad most of the time and her mood has been very low for the past 2 weeks, she has trouble sleeping at night and feels tired all day. She complains that her husband doesn’t seem to know how to help. For the past 24 hours she feels like she is not fit to be a mother and doesn’t want to feed the baby anymore. She has been frightened by thoughts to harm herself and the baby. Her baby is 7 weeks old.
In addition to antidepressant medication, which of the following treatment is most appropriate for this patient?Your Answer:
Correct Answer: Electroconvulsive therapy
Explanation:This patient presents because of significant mood changes since she gave birth to her child: she is sad most of times and she is having guilt feelings about her adequacy for motherhood- She is also complaining of insomnia, tiredness, and even some suicidal ideation. These symptoms are highly suggestive postpartum depression. This should be differentiated from postpartum blues, which usually present within the first 2 weeks and last for few days. This patient’s symptoms started 5 weeks postpartum. Postpartum depression usually presents within the first 6 weeks to the first year postpartum.
Postpartum depression is the most common complication of childbearing and affects the mother, the child, and relationship with the partner. It is diagnosed the same way as major depressive disorder in other patients. Since untreated postpartum depression can have long-term effects on the mother and the child, appropriate therapy should be undertaken as soon as possible- Antidepressant medications such as sertraline can be used to treat postpartum depression. In a patient who has suicidal ideation, electroconvulsive therapy has a more rapid and effective action than medication and should be considered in these patients.
→ Cognitive behavioural therapy is effective in women with mild to moderate postpartum depression; it would not be a good choice in this patient with suicidal ideation and at risk of harming the baby.
→ Estrogen therapy used alone or in combination with antidepressant, has been shown to significantly reduce the symptoms of postpartum depression; however, it would not be the most appropriate choice in a patient with suicidal ideation.
→ Peer support has shown equivocal results in various studies even though most postpartum patients report that lacking an intimate friend or confidant or facing social isolation are factors leading to depression.
→ Non-directive counselling also known as ”listening visits“ has been found to be effective in postpartum patients, though the studies that were conducted are deemed to be of small sample and larger studies still need to be done to validate these findings. It would not be an appropriate choice for this patient with suicidal ideation. -
This question is part of the following fields:
- Obstetrics
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Question 19
Incorrect
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A 33-year-old 'grand multiparous' woman, who has previously delivered seven children by normal vaginal delivery, spontaneously delivers a live baby weighing 4750gm one hour ago after a three-hour long labour period. Shortly after, an uncomplicated third stage of labour, she goes into shock (pulse 140/min, BP 80/50 mmHg). At the time of delivery, total blood loss was noted at 500mL, and has not been excessive since then. What is the most probable diagnosis of this patient?
Your Answer:
Correct Answer: Uterine rupture.
Explanation:The patient most likely suffered a uterine rupture. It occurs most often in multiparous women and is less often associated with external haemorrhage. Shock develops shortly after rupture due to the extent of concealed bleeding.
Uterine inversion rarely occurs when after a spontaneous and normal third stage of labour. Although it can lead to shock, it is usually associated with a history of controlled cord traction or Dublin method of placenta delivery before the uterus has contracted. This diagnosis is also strongly considered when shock is out of proportion to the amount of blood loss.
An overwhelming infection is unlikely in this case when labour occurred for a short period of time. Uterine atony and amniotic fluid embolism are more associated with excessive vaginal bleeding, which is not evident in this case.
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This question is part of the following fields:
- Obstetrics
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Question 20
Incorrect
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A 28-year-old woman who is at the 18th week of gestation presented to the medical clinic due to a vaginal discharge. Upon history taking, it was revealed that she had a history of preterm labour at 24 weeks of gestation during her last pregnancy. Upon examination, the presence of a clear fluid coming out of the vagina was noted.
Which of the following is considered to be the best in predicting pre-term labour?Your Answer:
Correct Answer: Cervical length of 15mm
Explanation:Preterm birth is the leading cause of neonatal morbidity and mortality not attributable to congenital anomalies or aneuploidy. It has been shown that a shortened cervix is a powerful indicator of preterm births in women with singleton and twin gestations – the shorter the cervical length, the higher the risk of spontaneous preterm birth. Ultrasound measurements of the cervix are a more accurate way of determining cervical length (CL) than using a digital method.
25 mm has been chosen as the ‘cut off’ at above which a cervix can be regarded as normal, and below which can be called short. A cervix that is less than 25 mm may be indicative of preterm birth.
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This question is part of the following fields:
- Obstetrics
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Question 21
Incorrect
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A 39-year-old woman who is 8 weeks pregnant presented to the medical clinic for consultation regarding the chance of her baby having Down syndrome. She mentioned that she has read somewhere that one of the risk factors for Down syndrome is advanced maternal age. She is concerned and asks if there are ways in which she can know whether her baby will be affected.
Which of the following is considered as both the safest and the most accurate diagnostic tool for the exclusion of Down syndrome?Your Answer:
Correct Answer: Amniocentesis at 16 weeks gestation
Explanation:Amniocentesis is a prenatal procedure performed on a pregnant woman to withdraw a small amount of amniotic fluid from the sac surrounding the foetus.
The goal of amniocentesis is to examine a small amount of this fluid to obtain information about the baby, including its sex, and to detect physical abnormalities such as Down syndrome or spina bifida.
Amniocentesis is only performed on women thought to be at higher risk of delivering a child with a birth defect.Amniocentesis is performed between 16 and 20 weeks into the pregnancy. By around this time, the developing baby is suspended in about 130ml of amniotic fluid, which the baby constantly swallows and excretes. A thin needle is used to withdraw a small amount of this fluid from the sac surrounding the foetus.
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This question is part of the following fields:
- Obstetrics
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Question 22
Incorrect
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A 33-year-old nulliparous pregnant female at the 21st week of pregnancy came to the gynaecological clinic for evaluation of vulval ulcer. A swab was taken revealing the herpes simplex type 2 virus. There is no prior history of such lesions and her partners of the last decade had no history of the infection. She's anxious about how she got the condition and the potential consequences for her and her unborn kid. Which of the following suggestions is the most appropriate?
Your Answer:
Correct Answer: The primary infection is commonly asymptomatic.
Explanation:Despite the fact that this question includes many true-false options, the knowledge examined is particularly essential in the treatment of women who have genital herpes.
It answers many of the questions that such women have regarding the disease, how it spreads, how it may be controlled, and how it affects an unborn or recently born child.
All of these issues must be addressed in a counselling question.
Currently, the most prevalent type of genital herpes is type 1, while in the past, type 2 was more common, as confirmed by serology testing.
Type 2 illness is nearly always contracted through sexual contact, but it can go undetected for years.
Acyclovir can be taken during pregnancy, and there are particular reasons for its usage.
Neonatal herpes is most usually diagnosed when the newborn has no cutaneous lesions, and past genital herpes in the mother is protective against neonatal infection, although not always.
Where the genital infection is the initial sign of the disease rather than a relapse of earlier disease, neonatal herpes is far more frequent.
Many patients and doctors are unaware that, while the original infection might be deadly, it is usually asymptomatic.
This explains how the illness spreads between sexual partners when neither has had any previous symptoms of the disease. -
This question is part of the following fields:
- Obstetrics
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Question 23
Incorrect
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A 22-year-old pregnant woman attends clinic for a fetal scan at 31 weeks. She complains of difficulty breathing and a distended belly. U/S scan was done showing polyhydramnios and an absent gastric bubble. What is the most likely diagnosis?
Your Answer:
Correct Answer: Oesophageal atresia
Explanation:Oesophageal atresia of the foetus interrupts the normal circulation of the amniotic fluid. This causes polyhydramnios and subsequent distension of the uterus impacting proper expansion of the lungs. This would explain the difficulty breathing.
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This question is part of the following fields:
- Obstetrics
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Question 24
Incorrect
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A 30 year old female with a history of two first trimester miscarriages presented at 9 weeks of gestation with per vaginal bleeding. Which of the following is the most appropriate management?
Your Answer:
Correct Answer: Aspirin
Explanation:Antiphospholipid syndrome is the most important treatable cause of recurrent miscarriage. The mechanisms by which antiphospholipid antibodies cause pregnancy morbidity include inhibition of trophoblastic function and differentiation, activation of complement pathways at the maternal–fetal interface, resulting in a local inflammatory response and, in later pregnancy, thrombosis of the uteroplacental vasculature. This patient should be offered referral to a specialist clinic as she has had recurrent miscarriages. Low dose aspirin is one of the treatment options to prevent further miscarriage for patients with antiphospholipid syndrome.
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This question is part of the following fields:
- Obstetrics
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Question 25
Incorrect
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Consider you are looking after a male baby in neonatal unit. Case chart shows that his mother has been abusing intravenous drugs until late this pregnancy.
You will not discharge this baby home after delivery in all of the following conditions except?Your Answer:
Correct Answer: Weight loss greater than two percent of birth weight
Explanation:If a mother has been abusing drugs during antenatal period, there are some contraindications to discharge her baby home. These conditions includes:
– excessive weight loss, which is greater than ten percent of birth weigh
– suspected baby neglect or abuse
– suspected domestic violence
– a court order preventing baby from being discharged home or if there is requirement for further assessment of withdrawal symptoms.A 2-3 percentages weight loss during the early neonatal period is considered to be a normal finding and is therefore not considered as a contraindication to discharge the baby home.
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This question is part of the following fields:
- Obstetrics
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Question 26
Incorrect
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The following measures are usually performed during a routine antenatal visit for a healthy uncomplicated pregnancy at 36 weeks gestation, EXCEPT:
Your Answer:
Correct Answer: Mid-steam urine specimen (MSU) for culture & sensitivity
Explanation:At the 36‑week appointment, all pregnant women should be seen again. At this appointment: measure blood pressure and test urine for proteinuria; measure and plot symphysis–fundal height; check position of baby; for women whose babies are in the breech presentation, offer external cephalic version (ECV)
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This question is part of the following fields:
- Obstetrics
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Question 27
Incorrect
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A 25-year-old Aboriginal lady presents to antenatal clinic at 19 weeks of her gestation.
This is considered as the best time for which one of the following?Your Answer:
Correct Answer: Ultrasound
Explanation:Between 18-20 weeks of gestation is the best time to perform an ultrasound for the identification of any physical or anatomical abnormalities including neural tube defects.
Maternal serum screening for Down syndrome is best performed between 15-17 weeks of pregnancy and this screening includes analysis of alpha fetoprotein, estriol, and beta-HCG in maternal blood. Conducting tests on accurate dates is necessary to obtain reliable results.
Amniocentesis which is very accurate for the diagnosis of chromosomal anomalies including Down syndrome, is best performed between 16-18 weeks of gestation and it carries a risk of 1 in 200 for miscarriage. Rh negative women will need Rh D immunoglobulin (anti-D).
Chorionic villus sampling is best performed between 10-12 weeks of gestation and carries a 1 in 100 risk of miscarriage, this test is also very much accurate for diagnosis of chromosomal anomalies. Rh negative women need Rh D immunoglobulin (anti-D).
It is best to perform rubella screen before conception than during pregnancy, this is because rubella vaccine is not recommended to be given to a pregnant mother as its a live vaccine.
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This question is part of the following fields:
- Obstetrics
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Question 28
Incorrect
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A 35-year-old lady with a 4-year history of hypertension is planning to conceive. She has never been pregnant before and has stopped using contraception recently. She has a past medical history of asthma and the only medication she is on is ramipril 10 mg daily.
On examination her blood pressure is found to be 130/85 mm/Hg.
From the following which is the most appropriate initial management of her hypertension?Your Answer:
Correct Answer: Cease ramipril and start methyldopa
Explanation:In the given case pre-pregnancy counselling and management of chronic hypertension is very much essential.
Some commonly prescribed antihypertensive drugs like ACE inhibitors, angiotensin receptor antagonists, diuretics and most beta blockers are contraindicated or is best to be avoided before conception and during pregnancy.
Methyldopa is considered as the first line drug for the management of mild to moderate hypertension in pregnancy and is the most commonly prescribed antihypertensive for this indication.
Hydralazine can be used during any hypertensive emergencies in pregnancy.
Intake of Angiotensin receptor blockers and ACE inhibitors during the first trimester can lead to complications as they are both teratogenic; use of these drugs during second and third trimesters can result in foetal renal dysfunction, oligohydramnios and skull hypoplasia.
Diuretics can cause foetal electrolyte disturbances and significant reduction in maternal blood volume.
All beta blockers, except labetalol, can result in foetal bradycardia, and growth restriction in case its long-term use.
Calcium channel antagonists, except nifedipine, are avoided during pregnancy due to its high risk for maternal hypotension and foetal hypoxia. -
This question is part of the following fields:
- Obstetrics
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Question 29
Incorrect
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A lady who is 29-weeks pregnant, comes to a general practice, complaining of a sudden gush of clear fluid.
On Speculum examination, premature rupture of membranes is confirmed with closed cervix.
In addition to transferring patient to a tertiary care, what is the most appropriate in the management of this case?Your Answer:
Correct Answer: Betamethasone
Explanation:This patient who is at her 29 weeks of pregnancy, presented with sudden gush of clear fluid and Speculum examination has confirmed premature rupture of membrane (PROM).
Approximately, 50% of PROM progress to labour within 24 hours and in the remaining, 80% within seven days. The most important next step of management in this case is transferring this patient to tertiary care hospital as soon as possible. It is equally important to give corticosteroid therapy, like Betamethasone, if delivery prior to 34 weeks is likely to occur, as it will help in fetal lung maturity.
Cardiotocography (CTG) is usually not available in general practice settings and it can be done only while in the hospital. If CTG shows any abnormality or if there is any presence of infection it is better to induce labor.
Salbutamol and nifedipine are of no use in this case, as the patient is not in labour and does not require tocolytics.
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This question is part of the following fields:
- Obstetrics
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Question 30
Incorrect
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A 23-year-old woman at 36 weeks of gestation in her first pregnancy presents for headache and right upper quadrant abdominal pain for three days. The pregnancy has been normal and unremarkable until now.
Her blood pressure is 145/90 mmHg and urinalysis shows protein ++. On physical exam, her ankles are slightly swollen. There is slight tenderness to palpation under the right costal margin.
Which one of the following is the most likely diagnosis?Your Answer:
Correct Answer: Pre-eclampsia.
Explanation:There are a few differential diagnoses to think of in a patient that presents such as this one. Pre-eclampsia, cholecystitis, and fatty liver could all cause pain and tenderness, but cholecystitis would not normally cause the hypertension and proteinuria seen in this patient and neither would acute fatty liver of pregnancy. The more likely explanation is pre-eclampsia which must always be considered in the presence of these symptoms and signs. This process is particularly severe in the presence of pain and tenderness under the right costal margin due to liver capsule distension.
Chronic renal disease could cause the hypertension and mild proteinuria seen, but it would not usually produce the pain and tenderness that this patient has unless it was complicated by severe pre-eclampsia.
Biliary cholestasis does not usually produce pain.
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This question is part of the following fields:
- Obstetrics
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