M23 Flashcards
1
Q
A
A
2
Q
A
A
3
Q
A
C
4
Q
A
C (haemodilution wont cause low MCV, if thalassemia would have low MCV before pregnancy)
5
Q
A
A (kleihaur test)
6
Q
A
B
7
Q
A
C
8
Q
A
D
TORCH (toxoplasmosis, others (treponema, VSV), rubella, CMV, HSV)
9
Q
A
A
10
Q
A
C
11
Q
A
A
Lambda sign is DCDA (thicker)
12
Q
A
B
13
Q
A
C
14
Q
A
B
15
Q
A
D (placental abruption)
16
Q
A
C
17
Q
A
D
18
Q
A
D
Aim for platelet at >50x10^9 at time of delivery
Platelet >30 x 10^9 and no bleeding –> no treatment till 36w gestation
19
Q
A
A (pregnant and rash confirmed VZV –> isolation with airborne precaution, oral or IV acyclovir + delay IOL/elective delivery x 7d)
20
Q
A
A (HELLP is a complication from severe preeclampsia)
21
Q
A
C (labor is defined as regular contractions that bring about cervical chance, 5-1-1 rule means patient is already having regular contractions)
22
Q
A
B
23
Q
A
A as already S2
C if normal cephalic presentation (easy as low down. Cannot do Ventouse as preterm baby. Cannot do LSCS as baby is too low)
24
Q
A
A (buy time to mature the lung and reduce chance of ARDS)
25
Q
A
B
26
Q
A
A (primigravada should be 1-2cm/hour –> slow 1st stage labor)
27
Q
A
D
28
Q
A
B
29
Q
A
B
30
Q
A
A
31
Q
A
B
32
Q
A
B (1st line would normally be COCP to control menses but BMI >35 is contraindicated to COCP) –> can help regulate menstrual cycles
33
Q
A
B (Mullerian agenesis)
34
Q
A
B (tricohomoniasis vaginalis is flagellated)
35
Q
A
A (HSV –> multiple vesicles)
36
Q
A
C (surgical evacuation for inevitable miscarriage)
37
Q
A
A
38
Q
A
A
39
Q
A
B (antimuscarinic is 1st line)
40
Q
A
D (confirmed on urodynamic study)
41
Q
A
C
42
Q
A
A (luteal cyst hemorrhage in midluteal phase)
43
Q
A
B
(Breast cancer CI use of levonorgestrel IUCD and any hormonal contraception. Can only use copper IUD)
44
Q
A
B
45
Q
A
B (meigs syndrome: firboma + ascites + pleural effusion)
46
Q
A
0 (3 x 20 x 0)
47
Q
A
C
48
Q
A
A
49
Q
A
A (definitive tx is hysterectomy)
50
Q
A
A
51
Q
A
A
52
Q
A
B
53
Q
A
A
54
Q
A
D
55
Q
A
A
56
Q
- Gestation 30w decreased fetal movement
- 34w, SGA picture, USG in private shows all fetal parameters 2 weeks behind gestational age
- 12 weeks gestation, both parents beta thal carrier, keen to know if b have beta thal major
- 37/F, G3P2 came for 12wk antenatal checkup, found DS T21 risk 1 in 15. She was keen to know antenatally if her fetus has Downs
A
- D
- E
- A
- A (1st tiear screening by USG of fetal nuchal translucency and maternal serum markers in the 11th-13th week –> 2nd tier screening by NIPT (maternal plasma fetal DNA) –> chorionic villus sampling/amniocentesis/chromosomal micrarray (molecular karyotyping for microdeletions and microduplications)). Only CVS or amniocentesis is diagnostic.
57
Q
- 39/F G1P0 38wk present with backpain and vaginal bleeding. BP 190/105 with 3+ proteinuria. Uterus felt hard and fetal parts not palpable, CTG shows mild contracting uterus and recurrent late deceleration
- 39/F G1P0 38 week presented with vaginal bleeding and blood stained liquor. Fresh red blood ozzing from the os. CTG showed sinusoidal pattern followed by fetal bradycardia
- 34/F at 31wk, congested reddish cervix with contact bleeding. Soft and non tender uterus. Normal CTG
- Previous previs. This time 32w scan also shows low lying placenta. Came in for painless vaginal bleeding. USG shows placenta previa, placenta with multiple lacunae, loss of retroplacental sonolucent zone
A
- D
- G (as there is decreased blood flow to the baby causing bradycardia)
- F
- B (there is concomitant placenta accreta (but this will present after delivery)
58
Q
- 35/F antenatal checkup at 32 weeks of gestation, found to have breech presentation. antenatal uneventful
- 36/F G1P0 38 week of gestation admitted for active labor and rupture of membrane. Baby in transverse lie and with shoulder presentation. Cervix is 5cm dilated and liquor is leaking. CTG normal fetal heart pattern.
- 32/F G3P2 scheduled for ECV at 37 week of gestation for breech presentation. One day before admission for ECV, she presented with spontaneous onset of labor. Cervix is fully dilated but membrane is intact. Buttock was seen in introitus. CTG normal.
- 30/F G2P1 DCDA twin pregnancy presented with spontaneaous onset of labor at 37 week of gestation. Antenatal history uneventful. Growth parameters and HR are normal for both babies. Cervical 5cm dilated. CTG normal. Presenting baby in cephalic presentation and second baby in transvere presentation. Wanted vaginal delivery if possible
A
- D (rescan at 36 weeks/arrange ECV at 37 weeks)
- C
- J (as buttock already in introitus): too low to do ECV or LSCS
- J
59
Q
- F/22 G1P0 BP 130/85 proteinuria 1+, 7 weeks of gestation, complained of suprapubic pain after having sex 3 days ago
- F/32 G2P1 BP 140/90 proteinuria 2+, 6w gestation, complained of fever, joint pain and facial rash
- F/45 G1P0 BP 180/110 proteinuria 4+, 36 weeks, complained of headache and epigastric pain
- F/35 G1P0 BP 120/70 proteinuria 2+ complained of abundant foul smelling vaginal discharge and itchiness for 5 days
A
- G
- E
- A
- F
60
Q
- intrapartum, wants inhalation method
- cervical dilatation of 2cm, wants analgesia that does not affect her mobility
- ITP, plt count 65, planned for elective C/S
- G5P1, previous 4 STOP. Placenta in situ after delivery. Vaginal bleeding is not excessive. Vital signs are stable. Decided for manual removal of placenta
A
- E
- F
- A
- D
61
Q
- 23yo, 1 yr history of dysmenorrhea, missing 1-2d of work. PE show retroflex uterus, normal uterus, USG unremarkable
- 45yo premenopausal, with history of R salpingoophorectomy for benign ovarian tumor. Asymptomatic. Recent pelvic USG shows 6cm endometriotic cyst in left ovary
- 40yo with lap surgery done 3 months ago for endometrioma, injection after surgery. Now no menses, vaginal dryness and occasional hot flush. Come here for repeated injection and ask you what injection it is
- 32yo asymptomatic virgo intacta. CA125 81. Fammed ordered MRI show normal uterus and ovary. She is concerned about endometriosis, referred to you what to do?
A
- H (NSAIDs)
- J (premenopausal asymptomatic 5-7cm ovarian cyst –> rescan in 12 weeks than yearly –> if enlarging than excision)
- B (GnRH agonist –> decreases FSH and LH and than no estrogen –> vaginal dryness (similar to climacteric symptoms)
- J
62
Q
- 30 yo woman with IUCD installed 3 years ago. abd pain for 6 months
- 30 year old G1P1 woman complained of intermenstrual bleeding for 6 months. She has been taking OC pills for 3 years
- 30 yo women was given abx for UTI, developed vuval itchiness
- 30 yo women delivery a baby who developed meningitis. The lady is asymptomatic
A
- A
- C
- B
- G
63
Q
- 20 yo woman underwent suction evacuation 6 months ago. Pathology showed complete hydatidiform mole. She is followed up by weeky hCG, which is persistently elevated at 500IU/L for the past 3 weeks
- 60yo women complains of postmenopausal bleeding. Endometrial aspiration failed due to tight os. Diagnostic hysteroscopy showed generalized thickening of endometrium. Pathology showed atypical endometrial hyperplasia
- 45yo woman complains of lower abd pain and increasing abd distenison for 6 months. Physical examination shows grossly distended abd. CT shows gross ascites with a partily cystic and partly solid ovarian mass. CA125 is 1250U/ml
- 72yo women complains of PMB for 6 months. PE shows whole cervix being replaced by an 8cm tumor, involving the lower third of vaginal and parametrium on both sides. Biopsy reveals SCC.
A
- B
- H (if typical endometrial hyperplasia can just do LNG IUD)
- G
- J (invasion beyond parametrium requires chemo RT but RT more important (chemo is just to increase radiosensitivity of tumor)
64
Q
- 24/F G1P1, complain of heavy menstrual bleeding in the gyn clinic
- 28/F G1P1, asymptomatic. Now having 1st ever gyneocological check up in family planning association
- 50/F did total hysterectomy after diagnosed to have HSIL. Now is gynecology FU 6 months after operation
- 50/F diagnosed to have HSIL after a satisfactory colposcopy and cervical biopsy 1 week ago. Today, come back for follow up.
A
- C
- A
- G (vault cytology is upper part of vagina that remains after hysterectomy). QMH protocol: women who undergo hysterectomy and have completely excised CIN (or SIL) should have vaginal vault cytology at 6 and 18 months following hysterectomy)
- E
