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MCQ revision > High risk Obstetrics > Flashcards

High risk Obstetrics Flashcards

1
Q

Which one of the following is FALSE regarding nitric oxide (NO)?

a. Nitric oxide contracts vascular and uterine smooth muscle
b. Nitric oxide acts via cGMP
c. Nitric oxide synthetase (NOS) inhibitors do NOT increase uterine contractile activity in animal studies, suggesting no role for nitric oxide in maintaining uterine quiescence
d. Nitric oxide is released by immune cells in response to inflammatory stimuli

A

a. Nitric oxide contracts vascular and uterine smooth muscle

O

Causes smooth muscle RELAXATION so dilation

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2
Q

Thyroid hormone

a. Must be present for the fetus to grow normally
b. Is active in the fetus as rT3
c. Is necessary for shivering thermogenesis, but not non-shivering
d. Has increased concentrations after birth because of a TSH surge

A

d. Has increased concentrations after birth because of a TSH surge

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3
Q

Which of the following is NOT a feature of placenta sulphatase deficiency?

a. Abnormal serum screening for Down Syndrome
b. Low bishop score at term
c. Icthyosis
d. Autosomal recessive inheritance
e. Prolonged pregnancy

A

d. Autosomal recessive inheritance

O

X-linked ichthyosis = scaly baby
X-linked inborn error of metabolism
placental SSD is associated with pregnancies progressing beyond 40 weeks gestation, with less than a third of the pregnancies affected by placental SSD laboring spontaneously.
The majority of reported cases ended in induction of labor and/or cesarean delivery.
increased rate of failure to respond to endogenous or intravenous oxytocin and failure of cervical dilatation.

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4
Q

During placental development

a. Complete fetoplacental circulation is developed by 5-6 weeks post conception
b. Endovascular migration by cytotrophoblasts proceeds in two waves that are complete by 8-10 weeks gestation
c. Uteroplacental blood flow is 200-250mL/min at term
d. Fetal blood flows to the placenta through paired umbilical arteries and a vein, and reaches 350-400mL/min average

A

a. Complete fetoplacental circulation is developed by 5-6 weeks post conception

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5
Q

Which of the following statements concerning monozygotic twins is NOT TRUE?

A. Approximately 30% of monozygotic twins are diamniotic dichorionic

B. Approximately 25% of twins are monozygotic

C. Placental vascular anastamoses are present in approximately 95% of monochorionic twins

D. Splitting of the embryo before day 8 post-conception will result in dichorionic twins, splitting after day 8 results in monochorionic twins

E. Monochorionic twins occur approximately 1 in 400 births.

A

D. Splitting of the embryo before day 8 post-conception will result in dichorionic twins, splitting after day 8 results in monochorionic twins

O

DCDA by day 3
MCDA between days 4-7
MCMA between days 8-12
Conjoined after day 13

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6
Q

Which is autosomal recessive?

a. Huntingtons
b. Marfans
c. Cystic fibrosis
d. Adult onset PCKD

A

c. Cystic fibrosis

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7
Q

A man with an X linked recessive condition has a child to a normal homozygous woman. They have two children. The chance that BOTH children have the disease is

a. 0
b. 1/8
c. 1/4
d. ½

A

a. 0

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8
Q

Amniocentesis reveals a karyotype 47XXY. Which of the following descriptions is INACCURATE for an adult with this condition?

a. Serious intellectual disability
b. Tall stature
c. Elevated FSH
d. Female fat distribution

A

a. Serious intellectual disability

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9
Q

Which is FALSE regarding the hormone relaxin in pregnancy?

a. It is structurally related to growth hormone
b. The corpus luteum is the most important source of circulating relaxin
c. The absence of relaxin doesn’t seem to have clinical sequelae
d. Recombinant human relaxin is not an effective cervical ripening agent

A

a. It is structurally related to growth hormone

O

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10
Q

Crossing over of chromosomes occurs during

a. Metaphase 1
b. Mitotic prophase
c. Meiotic prophase 1
d. Meiotic prophase 2

A

c. Meiotic prophase 1

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11
Q

During gestation, amniotic fluid

a. Osmolality increases to become isosmotic with plasma at term
b. Becomes progressively hyposmolar, with lower concentrations of sodium and potassium chloride than in maternal plasma
c. Is formed in late gestation, with almost equal contribution from fetal urine and lung liquid
d. Volume is regulated by fetal swallowing which commences after keratinisation of fetal skin
e. Volume progressively increases, reaching a maximum volume of 750mL at 40weeks

A

b. Becomes progressively hyposmolar, with lower concentrations of sodium and potassium chloride than in maternal plasma

O

Max volume ~800mL usually and peaks at ~34weeks
Main determinant is fetal UO

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12
Q

Alpha feto protein concentration in the amniotic fluid will be elevated in each condition EXCEPT

a. A dead fetus
b. A fetus with spina bifida occulta
c. A fetus with a myelomeningocele
d. Contamination of amniotic fluid with fetal red cells
e. A fetus with exomphalos

A

b. A fetus with spina bifida occulta

O

  • no increase in occulta, all other forms it will. Amniotic fluid will be elevated as well as maternal serum.
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13
Q

Which is FALSE?

a. Base deficit is defined as the bicarbonate ion concentration below normal
b. After bicarbonate, Hb is the next most important acid base buffer for the fetus
c. Increase in the anion gap is commonly seen in Diabetic Ketoacidosis
d. The fetal oxygen haemoglobin dissociation curve is shifted to the right compared to an adult

A

d. The fetal oxygen haemoglobin dissociation curve is shifted to the right compared to an adult

LEFT shift
Higher affinity due to HbF

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14
Q

The mode on inheritance of cystic fibrosis is

a. Autosomal recessive
b. Autosomal dominant
c. Sex linked recessive
d. Sex linked dominant
e. Polygenic

A

a. Autosomal recessive

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15
Q

Which one of the following statements concerning TTTS is LEAST CORRECT

a. In stage 1 TTTS there is polyhydramnios, stage 2 empty bladder of the donor twin, stage 3 absent/reversed umbilical arterial doppler waveform, stage 4 fetal hydrops, stage 5 fetal death of one or both twins
b. The presence of increased arterial-arterial anastomoses on the surface of the placenta is associated with an increased risk of TTTS
c. Survival in TTTS is approximately 30% untreated, 50% if treatment is available
d. Serious disability still occurs in approximately 10% of TTTS survivors treated with laser coagulation (where both twins are survivors)
e. Increased nuchal translucency at 11-14 weeks gestation is associated with an approximately 30% sensitivity and 30% PPV in detecting subsequent TTS
f. The incidence of TTS in monochorionic twin pregnancies is approximately 15%

A

b. The presence of increased arterial-arterial anastomoses on the surface of the placenta is associated with an increased risk of TTTS

O

Assoc with LOWER risk TTTS - thought to be protective. MCMA higher rates of A-A anastomosis and lower rates TTTS

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16
Q

A 28yo G2P1 is referred at 36+2 weeks gestation with BP 150/100, proteinuria, headache, and upper abdominal discomfort. The AST is 100. She has no history of pre-eclampsia in the previous pregnancy. Your NEXT step is:

a. Induction of labour as soon as possible
b. Discharge patient home and ask the LMC to check the blood pressure next week
c. Arrange a growth scan
d. Arrange BP in 48 hours along with CTG and repeat bloods.

A

a. Induction of labour as soon as possible

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17
Q

In advising a woman on whether she should continue the pregnancy to 42 weeks or be induced at 41 weeks, which of the following is FALSE?

a. The Canadian randomised trial (Hannah et al) showed that induction of labour increases the likelihood of Caesarean section
b. Waiting is likely to be associated with a higher perinatal mortality
c. If the Bishop score is <5, intravaginal prostaglandins will be recommended
d. An ultrasound will be indicated if she elects to wait

A

a. The Canadian randomised trial (Hannah et al) showed that induction of labour increases the likelihood of Caesarean section

O

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18
Q

Each of the following statements concerning Multifetal Reduction is true EXCEPT

a. Reducing triplets to twins at 10-14 weeks gestation is associated with a subsequent rate of miscarriage of both twins of approximately 8%
b. Reducing triplets to twins at 10-14 weeks gestation is associated with an increase in mean gestation at delivery
c. Reducing triplets to twins at 10-14 weeks gestation is not associated with a reduction in perinatal mortality
d. Reducing triplets to twins at 10-14 weeks gestation is associated with a reduction in the likelihood of having a handicapped survivor
e. KCl and xylocaine are alternative agents to use for Selective Feticide

A

c. Reducing triplets to twins at 10-14 weeks gestation is not associated with a reduction in perinatal mortality

Correct answer in official MCQ Feb 2011 and RANZCOG online questions

2008 answer:
b. Reducing triplets to twins at 10-14 weeks gestation is associated with a reduced likelihood of taking home one live baby

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19
Q

A 20yo G1P0 has DCDA twins diagnosed at 18 weeks. All of the following should normally form part of the subsequent management of this pregnancy EXCEPT:

a. Ultrasound at 26-30 weeks, and again at 34-35 weeks
b. Iron and folic acid supplementation
c. Prophylactic corticosteroids with betamethasone due to the risk of preterm labour
d. The need to present early if painful uterine contractions occur prior to 34 weeks

A

c. Prophylactic corticosteroids with betamethasone due to the risk of preterm labour

O

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20
Q

Which is false regarding atosiban?

a. RCT’s show similar efficacy to beta sympathomimetics in delaying delivery by 48 hours
b. RCT’s show better maternal tolerance of side effects in comparison to beta sympathomimetics
c. RCT’s suggest that atosiban has a higher perinatal mortality than salbutamol when used at extremely premature gestations
d. RCT’s suggest that atosiban has similar efficacy to beta sympathomimetics in the prevention of preterm birth
e. Atosiban is an inhibitor of oxytocin secretion by the neurohypophysis

A

e. Atosiban is an inhibitor of oxytocin secretion by the neurohypophysis

O

Tocolytic agent

The oxytocin receptor antagonist, atosiban, may be used for the inhibition of uncomplicated premature labour between 24 and 33 weeks of gestation. Atosiban may be preferable to a beta2 agonist because it has fewer adverse effects.

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21
Q

Factors that are associated with an incompetent cervix include all of the following EXCEPT

a. In utero exposure to DES
b. Cervical laceration
c. Cervical infection
d. Cervical cone biopsy

A

c. Cervical infection

O

DES causes reproductive tract abnormalities to women exposed in utero
- miscarriages, PTB, ectopic pregnancy

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22
Q

A 22yo woman at 32 weeks presents with painful uterine contractions and 200mL APH. Fundus is smaller than dates, she has pain between contractions. If this is due to drug exposure in utero, the likely culprit is

a. Heroin
b. Cocaine
c. Caffeine
d. Cannabis
e. Alcohol

A

b. Cocaine

O

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23
Q

Which of the following congenital malformations below is MOST LIKELY to be associated with oligohydramnios?

a. Duodenal atresia
b. Unilateral ureteropelvic junction obstruction
c. Gastroschisis
d. Posterior urethral valves

A

d. Posterior urethral valves

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24
Q

In placebo-controlled RCT’s, beta sympathomimetics have been shown most convincingly to:

a. Lower risk of preterm birth
b. Lower risk of birth within 48 hours
c. Lower perinatal mortality
d. Cause higher birthweight

A

b. Lower risk of birth within 48 hours

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25
Q

Which of the following statements about GBS infection is FALSE?

a. The major reservoir of organisms is the gastrointestinal tract
b. 5-10% of women who are negative at 28 weeks will be positive at term
c. A serious neonatal infection will occur in 5% of GBS carriers
d. It causes 5-10% of maternal asymptomatic bacteriuria

A

c. A serious neonatal infection will occur in 5% of GBS carriers

O

  • actually less 1:200 to 1:400

17-25% of women who screen positive for GBS at 35-37 weeks will be negative for GBS at delivery

Many women carry the bacteria, and in the majority of cases, babies born safely and without developing infection

26
Q

The MOST FREQUENT site of colonisation with GBS is

a. Lower vagina
b. Cervix
c. Pharynx
d. Lower intestinal tract

A

d. Lower intestinal tract

O

27
Q

An 18yo 63kg G3P0 presents at 21/40 with pain and bleeding. She has had 2x previous terminations. She is found to be 8cm dilated, fetus in transverse lie, back uppermost, arms and legs presenting in the lower segment. Which is the MOST APPROPRIATE management:

a. Internal podalic version, breech extraction
b. ECV under beta-mimetic infusions
c. Destructive embryotomy
d. Take no specific action

A

d. Take no specific action

O

28
Q

A multipara presents at 38 weeks with spontaneous rupture of membranes 20 hours ago and early labour. She has had no antenatal care. She is afebrile with a normal CTG. The MOST APPROPRIATE Group B Streptococcus (GBS) prophylaxis is:

a. 1 gram IM ampicillin stat
b. 500mg po erythromycin every 6 hours
c. 1.2 grams IV benzylpenicillin stat
d. GBS prophylaxis is not required

A

c. 1.2 grams IV benzylpenicillin stat

O

RANZCOG says >18hours SROM is a risk factor so treat.

29
Q

Which is most likely to occur within the next week in a woman with PPROM at 30 weeks

a. Sealing of the leak
b. Chorioamnionitis
c. Labour
d. Malpresentation
e. Cord prolapse

A

c. Labour

O

30
Q

Which of the following is related to a preventable increased risk of preterm delivery?

a. Periodontal disease
b. Endodontal disease
c. Dental caries
d. Impacted wisdom teeth

A

a. Periodontal disease

O

But if treated doesn’t reduce the risk for that pregnancy

31
Q

All of the following increase the risk of preterm birth EXCEPT:

a. Hyperemesis gravidarum
b. Bleeding in the first trimester
c. Oligohydramnios
d. Placenta praevia
e. Multiple gestation

A

a. Hyperemesis gravidarum

O

32
Q

In a low risk population undergoing routine ultrasound screening, the LOWEST rate of detection of abnormalities is usually found for abnormalities of which system?

a. Gastrointestinal
b. Cardiac
c. CNS
d. Genitourinary
e. Skeletal

A

b. Cardiac

O

33
Q

A 35yo G1P0 is referred by a GP at around 30 weeks gestation. USS is performed to check fetal growth. AFI is 35, deepest vertical pocket 15cm. Which congenital anomaly is the LEAST LIKELY to be associated with this finding?

a. Duchenne muscular dystrophy
b. Myotonic dystrophy
c. Congenital diaphragmatic hernia
d. Hydrocephaly
e. Arthrogryposis
f. Pena-Shockier syndrome

A

a. Duchenne muscular dystrophy

O

Shoulder and pelvic girdle muscles affected so no concern with fetal swallow.

Arthrogryposis - fetal limb contractures, commonly assoc with polyhydramnios
PSS - lethal, fetal akinesia syndrome

34
Q

Which of the following statements about stillbirth is INCORRECT

a. The rate of stillbirth is increased with a true knot in the cord
b. In the 41st week, the rate of stillbirth is approximately the same as in the 38th week
c. Approximately 1/500 women will have a stillbirth at or beyond 38 weeks gestation
d. In each week of pregnancy between 26 and 40 weeks, the rate of stillbirth is around 0.03%

A

b. In the 41st week, the rate of stillbirth is approximately the same as in the 38th week

O

NZ neonatal death rate 2017 - 2.9/1000 live births
NZ perinatal mortality rate 2017 - 9.2

Stillbirth rate

  • The number of stillbirths per 1000 livebirths and stillbirths (total births)
  • 4.8 /1000 live births
35
Q

A 33-year-old woman, G3P2 who has had two previous LUSCS is diagnosed on a 20 week US with a low lying anterior placenta that is invading the myometrium. There has been no bleeding and the fetus is morphologically normal. You recommend that:

A. the pregnancy should be terminated immediately and a hysterectomy should be arranged.
B. she should be admitted to hospital for close observation until delivery at 34 weeks.
C. she should be transferred to a tertiary hospital for further management and level III US.
D. an elective USCS at 37 weeks should be arranged followed by a hysterectomy.

A

C. she should be transferred to a tertiary hospital for further management and level III US.

O

36
Q

What is the prevalence of PLA-1 (HPA-1a) negative women in the population?

A. 0.005%
B. 0.02%
C. 0.1%
D. 0.5%
E. 2%
A

E. 2%

O

I.e. 98% of women are antigen positive
Anti-Human platelet antigen is implicated in neonatal alloimmune thrombocytopaenia.

37
Q

Chromosome mosaicism is detected at CVS performed for advanced maternal age. As a NEXT STEP you would recommend:

A. a repeat of the CVS.
B. an amniocentesis.
C. consideration of termination of pregnancy.
D. no further action.

A

B. an amniocentesis.

Could be confined placental mosaicism (occurs in 2% of pregnancies)

O

38
Q

A 30 year old patient, gravida 3, para 2, at 14 weeks gestation asks you for information about second trimester maternal serum screening. Select the MOST APPROPRIATE response.

A. Using a risk cut-off of 1 in 250, the triple test will identify 90% of all fetuses with trisomy 21
B. 1 in 100 women will have a “positive test” (risk greater than 1: 250)
C. The test performs best in patients with a high risk of trisomy 21
D. The test should not be offered to women with a high (>1/250) age-related risk of trisomy 21
E. The test is of no use when screening for neural tube defects

A

C. The test performs best in patients with a high risk of trisomy 21

O

39
Q

In a first trimester (12 weeks gestation) twin pregnancy, where there is discordancy of the nuchal translucency measurements, the next most important information needed is:

A. the chorionicity of the twins.
B. the zygosity of the twins.
C. the karyotypes of the twins.
D. the amniotic indices for the twins.

A

A. the chorionicity of the twins.

O

This is a non-specific marker for TTTS

40
Q

A 22-year-old woman is seen at 10 weeks gestation in her second pregnancy, her first child being born with a closed spina bifida.
Which of the following statements is TRUE?

A. The risk of a neural tube defect in this pregnancy is 10%
B. Amniocentesis is indicated at 15-16 weeks
C. She should start on a folate supplement now
D. An ultrasound examination is indicated at 11-12 weeks

A

D. An ultrasound examination is indicated at 11-12 weeks

41
Q

Which of the following statements is true regarding third trimester idiopathic oligohydramnios confirmed on ultrasound?

a. Amnioinfusion should be performed regularly until term.
b. Isolated oligohydramnios is associated with worse perinatal outcomes.
c. The use of amniotic fluid index (AFI) of less than 5cm rather than a single deepest pocket (SDP) of less than 2cm for diagnosis improves perinatal outcome.
d. The earlier the diagnosis in the 3rd trimester the worse the perinatal outcomes.

A

d. The earlier the diagnosis in the 3rd trimester the worse the perinatal outcomes.

Compared to SDVP of <2cm, an AFI <5cm is associated with increased:

  • Diagnosis of oligohydramnios
  • Induction of labour
  • CS delivery for fetal distress

But with no difference in Apgar score, umbilical artery pH <7.1 or improvement in perinatal outcome
Therefore interpretation of amniotic fluid volume should be based on SDVP
- To reduce the diagnosis of oligohydramnios and need for obstetric intervention

42
Q

A 40-year-old nulligravid woman has attended your clinic for booking at 10 weeks in her first pregnancy.
Which of the following statements concerning risks in this pregnancy is most correct?

a. She has a 1% risk of an infant with a neural tube defect.
b. She has a 2% adjusted risk of miscarriage following amniocentesis at 15 weeks gestation.
c. She has a 3% chance of an infant with Down Syndrome.
d. She has a 4% risk of any chromosomal abnormality detected at CVS at 11 weeks.

A

d. She has a 4% risk of any chromosomal abnormality detected at CVS at 11 weeks.

O

43
Q

A 36-year-old, primigravid woman at 16 weeks of gestation, has received genetic counselling and has chosen to proceed with prenatal diagnosis as there has been unusually slow growth of the fetus since the 12 week scan.
Which of the following is most correct?

a. Amniocentesis is indicated because it is too late for chorionic villus sampling (CVS).
b. CVS may indicate a cause for the growth restriction, not apparent with amniocentesis as placenta mosaicism is a potential cause.
c. The risk of miscarriage associated with amniocentesis is 1:600 if performed by a maternal fetal medicine subspecialist.
d. CVS is unhelpful in this situation because of potential karyotypic disparity between fetus and trophoblast.

A

b. CVS may indicate a cause for the growth restriction, not apparent with amniocentesis as placenta mosaicism is a potential cause.

O

Confined placental mosaicism has been shown to be a clinically significant cause of FGR

Amnio - From 15/40
Optimal timing 15+0 to 17+6

CVS - From 11/40 (11 to 14 weeks)
Although CVS can be performed >14/40, amniocentesis is preferred from 15/40 as technically easier, more comfortable for patient and avoids placental mosaicism

44
Q

A 36 year old, primigravid woman, at 16 weeks of gestation, has received genetic counselling and has chosen to proceed with prenatal diagnosis. She has read about chorionic villus sampling (CVS) and now consults you about the relative risks and benefits of CVS versus amniocentesis.
In counselling the patient, you emphasise,

A. the proven increased safety of CVS over amniocentesis
B. the improved accuracy of prenatal diagnosis from CVS
C. that she is beyond the appropriate gestational age for CVS
D. the risk of miscarriage associated with amniocentesis performed at 16 weeks gestation is 1/600

A

C. that she is beyond the appropriate gestational age for CVS

O

45
Q

The genetic abnormality MOST COMMONLY associated with fetal or infantile cystic hygroma is

A. Turner's Syndrome (45 X0)
B. Down Syndrome (Trisomy 21)
D. Triploidy
D. Trisomy 18
E. Trisomy 13
A

A. Turner’s Syndrome (45 X0)

O

46
Q

The following statements regarding intrauterine fetal death at 34 weeks gestation are true EXCEPT

A. 80% of women will labour spontaneously within 2 weeks of fetal death
B. early IOL is indicated in the presence of a dead fetus and coagulopathy
C. the earliest indication of a coagulopathy is usually a prolonged prothrombin time
D. the diagnosis can be made on radiographic examination which shows an overlapping skull
E. the probability of intrauterine death occurring in a subsequent pregnancy is <8%

A

C. the earliest indication of a coagulopathy is usually a prolonged prothrombin time

O

May be normal. D dimer elevated

47
Q

Based on evidence from RCTs, which of the following should NOT be done in pregnancy?

A. ECV at 33weeks to prevent breech at term
B. Smoking cessation programme during pregnancy
C. Antibiotic treatment of asymptomatic bacteruria
D. Local imidazoles for treatment of vaginal candidiasis

A

A. ECV at 33weeks to prevent breech at term

O

48
Q

Which of the following conditions has a recognised association with a low maternal serum alpha- fetoprotein?

a) IUGR
b) Fetal cystic fibrosis
c) Fetal nesidioblastosis
d) Closed spina bifida
e) Rh isoimmunisation
f) PET

A

a) IUGR

As per MRANZCOG MCQs August 2009 and August 2008

?Correct
On researching have found that high levels are assoc with IUGR

Is recognised to be low with T21 and T18.
Is recognised to be high with: Rh isoimmunisation, PET, Fetal CF
Unable to find level assoc with nesidioblastosis (hyperinsulinaemia)

49
Q

A mother has two children, one with open spina bifida and the other with a myelomenigiocoele. What is the likelihood of recurrence?

A. 1% 
B. 5% 
C. 10% 
D. 15% 
E. 20%
A

C. 10%

The risk is approximately 5% with one affected sibling and 10% with two affected siblings (UTD)

M

50
Q

Regarding the triple test, which is true?

A. 1% of women undergoing the test will be placed at increased risk category
B. Most accurate at 15-16w
C. Indicated for women at increased risk of Down’s syndrome
D. Will pick up 90% of affected infants

5% at least in high-risk group.

A

B. Most accurate at 15-16w

M

Triple test is AFP, BhCG, oestradiol. If add inhibin- A makes quadruple test.

MSS2 = quadruple
Sensitivity 75%
PPV 3%

51
Q

Risk of Down’s syndrome at age 40

A. 1 in 50 
B. 1 in 100 
C. 1 in 250 
D. 1 in 20 
E. 1 in 5
A

B. 1 in 100

M

52
Q

Woman’s daughter has just had VSD successfully repaired age 18 months and asks what chance next baby has cardiac lesion?

A. 1% 
B. 2-5% 
C. 10% 
D. 15% 
E. 50%
A

B. 2-5%

M

*Haven’t seen where this stat comes from

53
Q

Regarding cocaine use in pregnancy, all true except?

a. IUGR caused by excessive movements on coming off drug
b. Constriction of uterine artery with cocaine
c. Increased sympathetic tone in baby
d. Decreased blood flow around baby

A

a. IUGR caused by excessive movements on coming off drug

M

54
Q

Considering Doppler flow studies. The S/D ratio is inversely proportional to:

a. Maternal weight
b. Gestational age
c. Placental mass
d. Size of infant
e. None of the above

A

b. Gestational age

M

55
Q

A woman at 32/40 with a known fibroid uterus presents with sudden onset of abdominal pain. O/E afebrile, FH 140, general uterine tenderness, BP 95/-, PR 110. Most likely diagnosis?

a. Appendicitis
b. Concealed abruption
c. Degeneration of fibroid
d. Chorioamnionitis
e. Splenic rupture

A

b. Concealed abruption

M

56
Q

Which of the following is most accurate in predicting IUGR?

a. Serial assessment of fundal height
b. Serial assessment of BPD with US
c. US detection of oligohydramnios
d. Serial assessment of abdominal circumference with US
e. US assessment of femur length

A

d. Serial assessment of abdominal circumference with US

M

57
Q

Risk of fetal demise within 1/52 of BPP 0/10?

a. 100%
b. 80%
c. 70%
d. 60%
e. 50%

A

d. 60%

M

UTD says 0-4 risk of fetal asphyxia within 1 week is 91-600/1000

58
Q

Which of the following is the best predictor of fetal outcome at 42w?

a. non stress CTG
b. stress CTG
c. liquor volume
d. kick chart
e. fetal breathing movements

A

c. liquor volume

M

*Review this

59
Q

A G1 P0 is seen in ANC. Her recent scan show that the baby is LGA on 95% at 36 weeks. She does not have diabetes. Which of the following is not appropriate?

a. LSCS at 39 weeks
b. IOL at 38 weeks
c. Send back to MW clinic
d. Obstetrician around at delivery

A

b. IOL at 38 weeks

NB RANZOCG guideline update 2022
Weight unsure so cannot comment on suitability for ElCS.
Research has looked at IOL BEFORE 39weeks but concerns re neonatal consequences. At this point research does not support IOL before 39weeks on that basis.

60
Q

Which Doppler finding is most predictive of acidosis at 28 weeks. UA, DV, MCA all used

a. AFI 5, UA absent flow, positive a wave, MCA N
b. AFI 5, UA reversed flow, positive a wave, MCA abnormal
c. AFI 2, UA reversed flow, positive a wave and MCA abnormal
d. AFI 5, UA absent flow, DV with absent a wave, MCA normal

A

d. AFI 5, UA absent flow, DV with absent a wave, MCA normal

E agrees

MCQ revision (21 decks)

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