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Bushra's EXAM Question > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Pregnancies after UAE are at higher risk of

A
  • miscarriage compared to pregnancies post laparoscopic myomectomy.
  • Increase CS
  • inc risk of PPH,
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2
Q
  • 36 year,
  • nulliparous
  • 2nd stae
  • Pushing 30 minutes
  • CTG: baseline 170 bpm, reduced variability, late decels 25 minutes
  • VE: head ischial spine, in OP

MX options:

  • continue pushin 30 minutes
  • FBS
  • Cat 1 CS
  • Start syntocinon
  • Trial of instrument in theatre
A

before trial of instrument in theter fbs must

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3
Q
  • low risk
  • 27 year old
  • IOL 41 weeks
  • 2nd pregnancy
  • hx of ventouse for fetal distress
  • Epidural
  • Full dilataion 1 hour, passive 2nd stae
  • Pushin 90 minutes
  • No signs of birth
  • she is well, contractions strong 4/10 minutes
  • FHR normal
  • Most appropriate step
    A- commence IV oxytocin
    B- Operative vaginal delivery after 30 minutes if no change
    C- Operative vaginal delivery after 60 minutes if no change
    D- discuss operative vainal delivery immediately
    E- encourage direct pushing in lithotomy
A

B
She is a G2
Time allowed -3 hours
Including passive stage, time elapsed is 2 and a half hours
So remaining time is 30 min.
For Primi it would be four hours so 60 min option would be right

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4
Q
  • Pregnant 12 weeks
  • vaginal bleeding
  • ERPC 4 days back
    Rh D negative
  • How many days Anti D can be given
A

10 days

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5
Q
  • pregnant
  • Severe chest pain
  • X ray abnoormal
Next investigation
A- CtPA
B- duplex US
C- Doppler
D- V/Q scan
E- No other
A

A- CtPA

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6
Q
  • Hx migraine & essential HTN
  • Delivered
  • Post operative headache, started suddenly for 1 day
  • not responding to simple analgesia
  • diplopia & edema
  • now altered conciousness
    CAUSE
  • Sagittal vein thrombosis
  • Aneurysm
  • Eclampsia
  • Cerebral infarction
  • SAH
A

SAH

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7
Q
  • 30 weeks
  • h/o prv SVD
  • A+E with unprovoked PV bleeding (50ml).
  • 20 wk scan: low lying placenta.
  • Exam: cervical ectropion with minimal fresh bleeding
  • wishes to go home as her FHR & CTG reassuring.
    which treatment option best suits her ?
    A. admission in the maternity unit until bleeding stops
    B. allow home as APH was minior
    C. CS
    D. tocolytocs + steroids
    E. USG to check for presistant low lying placenta
A

E looks better but rcog ……told rpt scan at 32 wks …so follow that

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8
Q 
Likelihood of spontaneous vaginal delivery after previous ovd?
a 60%
b70%
c80%
d 90%
A

Key-80%

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9
Q
  • 35 year old
  • undergoes forceps delivery in theatre.
  • Following delivery, perineal trauma that extends
    into external anal sphincter complex. Less 1/2
    thickness of external anal sphincter complex is torn.

What is most appropriate classification for the medical records?
A -Right mediolateral episiotomy
B -Second degree vaginal tear
C -Third degree perineal tear, sub group 3a
D -Third degree perineal tear, subgroup 3b
E -Third degree perineal tear, subgroup 3c

A

C -Third degree perineal tear, sub group 3a

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10
Q 
1. You are asked to see a pregnant woman, who has been referred for chest xray for suspected pneumonia at 24 wks . She is woried about the impact of exposure of ionizing radiations on her pregnancy. What is the accepted accumulative dose of ionizing radiation in pregnancy?
A. 50 m Gy
B. 100
C. 150
D. 250
E. 500
A

A. 50mGy

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11
Q
  • Nulliparous
  • progressed well in labour
  • now fully dilated
  • Pain releif: NItrous
  • head high
  • 1 hour passive finished
  • pushed 2 hours
  • fully , OA, ischial spine, no moulding or caput
    MX:
    A- allow to push 1 hour
    B- Em CS
    C- FBS
    D- Instrumental delivery in abour ward
    E- Instrument trial in theatre
A

E- Instrument trial in theatre

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12
Q
  • Nulliparous
  • progressed well in labour
  • now fully dilated
  • Pain releif: Epidural
  • head high
  • 2 hour passive finished
  • pushed 1 hours
  • fully , OA, ischial spine, no moulding or caput
    MX:
    A- allow to push 1 hour
    B- Em CS
    C- FBS
    D- Instrumental delivery in abour ward
    E- Instrument trial in theatre
A

E- Instrument trial in theatre

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13
Q
  • Nulliparous
  • progressed well in labour
  • now fully dilated
  • Pain releif: NItrous
  • head high
  • 1 hour passive finished
  • pushed 2 hours
  • fully , OA, ischial spine, no moulding or caput
    MX:
    A- allow to push 1 hour
    B- Em CS
    C- FBS
    D- Instrumental delivery in abour ward
    E- Instrument trial in theatre
A

A- allow to push 1 hour

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14
Q 
What's the incidence of fecal urgency after an OASIS?
A.26/100
B.16/100
C.06/100
D.01/100
E.01/1000
A

Key-A

Consent advice 2010 for OVD
answer is A (Frequent risk)
26/100 -- fecal urgency
9/100 -- dyspareunia & pain
8/100 -- wound infection
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15
Q

Face presentation
diameter
length

A

sub-mento brematic

9.5 cm

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16
Q
  • Multiple shallow ulcers first time
  • Labouring
  • HSV transmission to baby
A

40 -50 %

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17
Q
  • Nulliparous
  • Low risk
  • Folllowed consultant
  • Serial scan: 70 th centile
    A- Initial CEFM for 30 minutes then intermittent auscultation
    B- intermittent auscultation using hand held doppler
    C- intermittent auscultation using CTG machine
    D- CEFM
    E- US to see fetal heart
A

B- intermittent auscultation using hand held doppler

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18
Q
  • 27+1 weeks
    signifant APH & stopped now by symptom
    Per speculum: pool of blood in posterior FX
    -Os 3 cm dilated
    US : cephalic
    CTG: normal
NEXT STEP
 A- give 1 dose of dexa 12 mg IM & arrange IOL
B- Steroids , Arrange IOL in 48 hours.
C- Steroids , do CS in 24 hours.
D- expectant MX
E- CS cat 1
F- rescue cerclage
G- MG SO4+ dexamethasone & IOL now
H- antibiotics & conservative MX
I- Blood TX with conservative MX
J- antibiotics & MG SO4+ dexamethasone & IOL
A

B- Steroids , Arrange IOL in 48 hours.

or
G- MG SO4+ dexamethasone & IOL now

  • First question Pt has significant APH & still pool in posterior FX. We cannot wait 24 hr. She already 3 cm

final is B

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19
Q
  • 28 weeks
    -significant APH, now settle bleeding.
  • AFI: 15cm
    US: breech
    CTG normal
NEXT STEP
 A- give 1 dose of dexa 12 mg IM & arrange IOL
B- Steroids , Arrange IOL in 48 hours.
C- Steroids , do CS in 24 hours.
D- expectant MX
E- CS cat 1
F- rescue cerclage
G- MG SO4+ dexamethasone & IOL now
H- antibiotics & conservative MX
I- Blood TX with conservative MX
J- antibiotics & MG SO4+ dexamethasone & IOL
A

C- Steroids , do CS in 24 hours.

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20
Q
  • 24 years
  • 27 weeks
  • lower abdominal pain
  • Palpable tightening every 10 minutes
First line tocolysis
A- Beta-anatogonist
B- Calcium channel blocker
C- Magnesium sulphate
D- Nitric oxide donors
E- Oxytocin receptor antagonist
A

B- Calcium channel blocker

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21
Q 
- Patient for elective CS at 38wks need to know how much in 37 wk steroid will reduce respiratory
\:morbidity at this GA 
A.4-6%
B.40% 
C.50%
D.60% 
E.70%
A

B.40%

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22
Q 
Patient with previous abruption need to know recurrence in :current pregnancy
A.3%
B.4-6%
C.10%
D.19%
E.25%
A

B.4-6%

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23
Q 
Previous shoulder dystocia want to know recurrence :compared to general population
A. 2fold 
B. 3 fold 
C 5 fold 
D 10 fold
A

D 10 fold

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24
Q
  • 42 y/o
  • lost 2 litres blood, Em CS for fetal distress(DCDA) twins.

When considering the administration of blood and blood products which is correct?
A. FFPs contain more fibrinogen than cryoprecipitate
B. FFP is derived from whole blood and doesn’t contain clotting factors
C. FFP is stored at -30”c and needs to be defrosted thoroughly prior to administration
D. A PT & APTT ratio: below 1.5 associated with increased risk of a clinical coagulopathy
E. A unit of concentrated red cells increases hematocrit by 8%

A

Key is C
- PT/APTT ratio above 1.5 is ass with inc risk of coagulopathy.

  • Cryoprecipitate contain more fibrinogen than ffp and is used to correct hypo fibrinogenemia
  • FFP is derived from whole blood and contains Clotting factors.
  • PRBCs raises Hb by 1 g/dl and Hct by 3%
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25
Q 
What is the incidence of shoulder dystocia in vaginal deliveries?
A) 0.1%
B) 0.6%
C) 1.5%
D) 2.5%
E) 3.5%
A

Key -B

0.58 to 0.7 %

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26
Q

35 years

  • bowel resection for Crohn’S disease
  • now pregnant
  • Advice: vitamin D & calcium

Main mech of actio of Vit D on calcium metabolism.
A- stimulates parathyroid gland & promotes bone formation
B- decreases renal excretion of calcium from tubules
C- Increases calcium absorption from small intestine
D- Increases calcium absorption from large intestine
E- stimulates osteoclast formation

A

C- Increases calciumC- Increases calcium absorption from small intestine absorption from small intestine

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27
Q
  • Asthmatic
  • pregnant
  • received short acting betal blocker & 800 steroid
  • but asthma not controlled
NEXT STEP
A- steroid
B- LABA
C- theophyline
D- leukotriene
E- refer to specialist
A

B- LABA

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28
Q 
Perimortem CS time
A- 3 min
B- 4 min
C- 6 min
D 10 min
A

B- 4 min

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29
Q

where to implement decision of OVD is taken

A
  • if implemented in labour room it took 15 min and if implemented in OT it took 30 min .
  • If delivery in labour room fails shifted for Cs more time wasted as compare to shift to OT and try and if failed immediately CS.
  • though it’s less time in LR delivery, studies found no significant differences in outcome of delivering in LR/OT.
    And the risk of injury during shifting can be outweigh by a failed attempt in LR ‘
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30
Q

3rd and 4th degree tear in forceps & vaccuum

A

12 %

7 %

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31
Q
  • 24 years
  • pelvic pain last 8 months
  • booked for diagnostic laparascopy
  • risk of serious complication in consent
Most likely quoted risk
A- up to 1 woman in 10
B- up to 1 woman in 100
C- up to 5 woman in 100
D- up to 1 woman in 1000
E- up to 2 woman in 1000
F- up to 5 woman in 1000
G- up to 4-8 woman in 1000
H- up to 7-8 woman in 1000
I- up to 1 woman in 12,000
J- up to 1 woman in 100,000
K- up to 3-8 woman in 100,000
L- up to 10 woman in 100,000
M- up to 100 woman in 100,000
N- up to 1000 woman in 100,000
O- up to 10,000 woman in 100,000
A

E- up to 2 woman in 1000

frequent risks: 
1- wound bruising, 
2- shoulder tip pain, 
3- wound gaping & 
4- wound infection

serious risks:

  • bowel, bladder,ureter or major vessel injury:
  • require immediate repair by laparoscopy or laparotomy,
  • failure to gain entry to abdominal cavity and to complete intended procedure, hernia at site of entry.

Death: 3-8 /100, 000

Additional procedure needed:
laparotomy, repair of damage bowel, bladder ureter or blood vessel and blood transfusion.

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32
Q
  • 40 years
  • booked elective CS for breech
  • Labour 38 weeks
  • Cesarean hysterectomy risk
- Most likely quoted risk
A- up to 1 woman in 10
B- up to 1 woman in 100
C- up to 5 woman in 100
D- up to 1 woman in 1000
E- up to 2 woman in 1000
F- up to 5 woman in 1000
G- up to 4-8 woman in 1000
H- up to 7-8 woman in 1000
I- up to 1 woman in 12,000
J- up to 1 woman in 100,000
K- up to 3-8 woman in 100,000
L- up to 10 woman in 100,000
M- up to 100 woman in 100,000
N- up to 1000 woman in 100,000
O- up to 10,000 woman in 100,000
A

H- up to 7-8 woman in 1000

  • Em hysterectomy: 7-8/1000
  • need of further surgery at later date including cureettage: 5/1000
  • Admission to ICU(dependant on reason for CS 9/1000
  • TED d/s 4-16/10,000
  • bladder injury: 1/1000
  • ureteric injury: 3/10,000
  • Death: 1/12000
Frequent risks: maternal
- persistent wound & abdominal discomfort in first few months, 9/100
- repeat CS: 1/4
- readmission to hospita: 5 /100
Infection: 6/100

frequent risks, fetal:
- laceration:1-2/100

Risks for future pregnancies
uterine rupture in susequent pregnancies, deliveries: 2-7/1000
- increased risk of antepartum still birth: 2-4/1000
- subsequent pregnancies of placenta previa & placenta accreta : 4-8/1000

Additional procedure , may necessary during CS: hysterectomy, repair of injured organs & blood transfusion.

33
Q
  • 34 years
  • primi
  • labour pain at 40 weeks, regular contractions every 3 minutes
  • abdomen: ballotable head
  • VE: early labour
  • 30 minutes later SROM and cord prolapse
  • Crash CS
  • Risk of bladder injury
- Most likely quoted risk
A- up to 1 woman in 10
B- up to 1 woman in 100
C- up to 5 woman in 100
D- up to 1 woman in 1000
E- up to 2 woman in 1000
F- up to 5 woman in 1000
G- up to 4-8 woman in 1000
H- up to 7-8 woman in 1000
I- up to 1 woman in 12,000
J- up to 1 woman in 100,000
K- up to 3-8 woman in 100,000
L- up to 10 woman in 100,000
M- up to 100 woman in 100,000
N- up to 1000 woman in 100,000
O- up to 10,000 woman in 100,000
A

D- up to 1 woman in 1000

  • Em hysterectomy: 7-8/1000
  • need of further surgery at later date including cureettage: 5/1000
  • Admission to ICU(dependant on reason for CS 9/1000
  • TED d/s 4-16/10,000
  • bladder injury: 1/1000
  • ureteric injury: 3/10,000
  • Death: 1/12000
34
Q
  • 20 year
  • EAU 9 weeks , with mild vaginal bleeding
  • US: Missed miscarriage
  • Doctor discussed her options
    1- conservative
    2- medical
    3- surgical MX
  • woman wants surgical but risk of uterine perforation
- Most likely quoted risk
A- up to 1 woman in 10
B- up to 1 woman in 100
C- up to 5 woman in 100
D- up to 1 woman in 1000
E- up to 2 woman in 1000
F- up to 5 woman in 1000
G- up to 4-8 woman in 1000
H- up to 7-8 woman in 1000
I- up to 1 woman in 12,000
J- up to 1 woman in 100,000
K- up to 3-8 woman in 100,000
L- up to 10 woman in 100,000
M- up to 100 woman in 100,000
N- up to 1000 woman in 100,000
O- up to 10,000 woman in 100,000
A

F- up to 5 woman in 1000 in rekha

new advice
E- up to 2 woman in 1000

Seroius risk:

  • uterine perforation 5/1000
  • Significant trauma to cervix
  • no evidence of impact on future fertility

frequent risks
bleeding that lasts upto 2 weeks very coommon, but blood transfusion is uncommon (1-2 /1000)
- Need for repeat surgical evacuation, upto 5/100
- localized pelvic infection: 3/100

Additional procedure may be necessary during the procedure include laparoscopy or laparotomy to diagnose and repair organ injury or uterine perforation.

35
Q
  • 28 years
  • admitted day surgery for diagnostic laparoscopy
  • Dysmenorrhea: 2 years
  • US: ovaries normal, endometrial polyp
  • Die during sleep
  • Most likely quoted risk
    A- up to 1 woman in 10
    B- up to 1 woman in 100
    C- up to 5 woman in 100
    D- up to 1 woman in 1000
    E- up to 2 woman in 1000
    F- up to 5 woman in 1000
    G- up to 4-8 woman in 1000
    H- up to 7-8 woman in 1000
    I- up to 1 woman in 12,000
    J- up to 1 woman in 100,000
    K- up to 3-8 woman in 100,000
    L- up to 10 woman in 100,000
    M- up to 100 woman in 100,000
    N- up to 1000 woman in 100,000
    O- up to 10,000 woman in 100,000
A

K- up to 3-8 woman in 100,000, undergoing laparoscopy die as result of complication

36
Q

For recurrent hsv in pprom at term,
A - Immediate IOL
B- IOL after 24 hrs

For recurrent hsv in pprom < 34 weeks,
A - Immediate IOL
B- IOL after 24 hrs
C - oral acyclovir 400m TID + steroids

A

B -

risk of neonatal transmission id small, may be outweighed by morbidity & mortality associated with premature delivery.

<34 weeks: according to RCOG relevant guidline

37
Q

DKA more commonly with
Type 2
Type 1
GDM

A

type 1

38
Q 
The commonest pathogen to cause a sending genital tract infections following delivery 
Anaerobes
Chlamydia
Group A step
Group B step
A

GAS

39
Q

Breech primi uncomplicated Singleton offered ECV and not getting appointment at 37 weeks should be do@

38 weeks
35 weeks
36 weeks
No need to do

A

36 weeks

40
Q

Women with preexisting dm fundoscopy test for retinal examination done at booking unless women has been assessed in the last 3 months or 12 months?

A

it’s 3 months acc to nice …do at booking then at 28 weeks if it was normal and if there were changes at 16 weeks we repeat…..women with pre exist DM should have annual fundoscopy otherwise that is 12 monthly

41
Q

Massive PE with hemodynamic compromise.

MX is IV UFH or thrombolysis

A
  • for haemo unstable its thrombolysis
  • UFH is given as loading dose then maintainance dose. If she is thrombolysed then we omit loading dose of infractions heparin and give maintainance dose
42
Q

Q 30-32. choose most appropriate management

A. Admit to control glucose
B. IOL 37 - 40wks
C. Increase pre lunch insulin
D. US for umbilical artery Doppler
E. CS at 38 wks
F. Reassurance and to be seen in 2 wks
G. Many others options
  1. Known type 1 daibeties at 36wks GA controlled in insulin HBA1C 6.5% came after lunch to diabetic
    .joint clinic urine++ glucose US baby ok in 40th centile otherwise patient stable
  2. Known diabetic at 33 wks variable control HBA1C 7.4% urine++ glucose US baby in 10th centile. otherwise ok.
  3. Type 2 diabeties para 2 with 1 previous CS HBA1C 7.4% US baby in 70th centile keen for vaginal delivery
A

FDA

Q1 I agree with F
Q2 UAD
Q3 A admit to adjust the insulin dose then discharge as you can’t increase prelaunch dose blindly

43
Q

Patient pregnant for 8 wk with severe abdominal pain plus guarding. She has ovarian cyst measuring 8 cms. Management?

A. Doppler
B. CT
C. MRI
D. Laparoscopy
E. Analgesia and Observe
A

Laparoscopy

44
Q

If crl at 84
Hc
Crl

A

After 84 hc

45
Q 
Recommended vitamin D supplementation in pregnancy &amp; lactation
2.5 mcg / day
5 
7.5 
10
A

10

46
Q

A 30-year-old had an em CS in second stage for persistent bradycardia 6 days ago. She now presents with progressive abdominal distension, which was initially painless but has become increasingly painful. The pain is localised mainly to the right side. She is tachycardiac on examination and also pyrexial. What is the most likely diagnosis?

Bowel obstruction from adhesions
Bowel perforation
Faeculent peritonitis
Infected haematoma
Ogilvie syndrome
A

caecal obstruction and then rupture

47
Q

Lactate cut off for sepsis
A - 2
B - 4

A

More than 2 not 2 for severe sepsis
For septic shock more than 4 not 4

0-2: Normal
>2- <4: severe sepsis unless BP low
> 4: septic shock, If BP not low then cryptic shock

48
Q 
#PPH 
A 28-year old woman is pregnant with her second child.Following the spontaneous vaginal delivery of her first baby,she had a 2-litre PPH from atonic uterus. She attends for antenatal care with aim of preventing similar outcome for this delivery. Which of the following has been demonstrated to reduce PPH risk?
A) Controlled cord traction
B) Syntocinon infusion
C) Expectant management of third stage
D) Early cord clamping
E) Delivery on high-risk delivery unit
A

Active management of the third stage involves three components: 1) giving a drug (a uterotonic) to contract the uterus; 2) clamping the cord early (usually before, alongside, or immediately after giving the uterotonic), and this is before cord pulsation stops; 3) traction is applied to the cord with counter-pressure on the uterus to deliver the placenta (controlled cord traction)

49
Q

Highest odds ratio for PPH in a grand multiparous lady who underwent emergency section due to polyhydrominos for cord prolapse after ARM ?

Emergency section 
PHA 
Grand multiparity 
Macrosomia 
ARM 
IOL
A

Emergency section

50
Q 
After vaginal delivery pph not controlled with balloon 
What next
A. Brace suture
B. Step wise devascularisation
C. Internal illiac ligation 
4. Interventional radiology
A

Brace suture

51
Q

A 30-year-old woman presents 7 days after an emergency caesarean section with abdominal pain and a fever of 37.7°C . This is associated with nausea, vomiting and mild abdominal distension. She is started on antibiotics and sent home but 3 days later she re-presents with no improvements in her symptoms and features of paralytic ileus. She is examined and found to have a tube-like mass in her abdomen on deep palpation. A request is made for an ultrasound scan of the abdomen and pelvis. What is the most likely cause of this woman’s symptoms?

Infected haematoma
Postpartum ovarian vein thrombosis (POVT)
Pyelonephritis
Torted ovarian cyst
Tubo-ovarian absces
A

POVT

52
Q

What of the following conditions has more association with a male fetus

Options included
AFLP
obstetric cholestasis
pre-eclampsia

A

AFLP

53
Q

Risk of PPH maximum in

Operative vaginal delivery
Ist stage Lscs
2nd stage lscs
Multiple pregnancy
Shoulder dystocia
Prolonged 2nd stage
A

2nd stage CS

54
Q 
The most common time for presentation of post partum psychosis:
A. 1-3 days
B.1-3wks
C.4wks
D.6wks
E.8wks
A

B

55
Q

21 yrs old pregnant women with previous baby down syndrome, worried about this baby non invasive prenatal testing done positive and followed by amniocentesis done, results came as negative for down. What is the reason for positive NIPT result?

a) Placental mosaicism
b) Maternal DNA contamination
c) Presence of fetal cells of previous baby

A

a) Placental mosaicism

56
Q

Clinicians should consider the use of intravenous tranexamic acid in addition to oxytocin, at caesarean section to reduce blood loss in women at increased risk of PPH.

Dose is

0.5–1.0 g
0.5-1.0mg
2.0-2.5mg
2-5 g

A

0.5–1.0 g

57
Q

40 yrs lady, dating scan shows MCDA twins with one twin non viable, wants
to know the down syndrome risk. What is the most appropriate one?
a) Maternal age +NT
b) Mat age + NT + PAPP A+ b hcg
c) cffDNA
d) Anomaly scan

A

b) Mat age + NT + PAPP A+ b hcg

58
Q

LSCS rate in twin pregnancy

  • 40 %
  • 50 %
  • 60 %
A

60 %

59
Q 
Bl transfusion is almost always required if HB level is less than;
A,60g/l
B,70
C,80
D,90
E,100g/l
A

A,60g/l or 7

60
Q

If no haemostatic tests are available, early FFP should be considered for conditions with a suspected coagulopathy, such as placental abruption or amniotic fluid embolism, or where detection of PPH has been delayed

A

true
4 ffps and 10 units cryoprecipitate should be started regardless of coagulation status in emergency conditions with massive obs hemorhage

61
Q

Carbetocin what is false @

Short acting oxytocin

Used in case of elective cesarian section as prophylactic

Long acting oxytocin

It causes Significant reduction of further uterotonics requirement

A

Short acting oxytocin

62
Q 
Features of atrial fibrillation (AF) include which of the following?
A. Discordant apical and radial rate
B. Pulsus paradoxus
C. Radio-femoral pulse delay
D. Regularly irregular pulse
E. Water hammer pulse
A

A

63
Q

urgent venepuncture for PPH :what is the amount of blood is collected for following test for -blood group and screen
–&full blood count&
coagulation screen, including fibrinogen

10ml
20ml
5ml
15ml

A

20 ml

64
Q
  1. A pregnant, on citalopram for depression. Citalopram stopped by her GP. For the past 12 wks she started to develop low mood, poor sleep/appetite& can’t cope with her 2 yrs old boy. You decided to restart citalopram. Restarting citalopram was mainly for:
A. To help her cope with pregnancy.
B. To help her cope with her baby.?
C. To help with sleep/appetite.
D. To prevent postpartum depression.
E. To prevent postpartum suicide [? some said psychosis].
A

D

65
Q

puerperal psychosis, true / false
1} a woman who has experienced an episode
should be advised about both the risk of
postpartum and non-postpartum recurrence.

2} only women with psychiatric symptoms at
their antenatal booking visit should be
screened for risk factors.

3} women at high risk, even if they are well,
should be referred in pregnancy for psychiatric
assessment and management.

A

TFT

66
Q

T/f
In case of severe PPH
If prothrombin time/activated partial thromboplastin time is more than 1.5 times normal and haemorrhage is ongoing, volumes of FFP in excess of 15 ml/kg are must needed to correct coagulopathy.

A

True

67
Q

Labouring women, midwifery noticed multiple shallow ulcers, women has noticed first time. What is the risk of Herpes simplex transmission to newborn

a) 5-10%
b) 10- 20%
c) 20-30%
d) 30 -40%
e) 40 50%.

A

41 %

68
Q 
Most comman indication for cs in UK
A. Fetal distress ctg abnormal
B. Prolonged Labour
Failure to progress 
C. Something else
A

A. Fetal distress ctg abnormal

69
Q

sickle cell screening uk

A

sickle cell disease screening is based on prevalence in areas .Questionaire is given and risk calculated.If high risk then screening

70
Q

hemoglobinopathy screening in UK

A

Not routine it’s recommended for high risk women ( middle Eastern or African)

71
Q

Patient is collapsed in antenatal ward and you are the in charge…you immediately reach the site…what is the immediate action you should do?

A. Bag mask ventilation
B. ETT
C. Check Carotid
D. Cesarean
E. Chest Compression
A

E

72
Q

When to diagnose fe deficiency anemia in pregnant women
A. Ferritin less than 15
B. Ferritin less than 30

A

A

73
Q

21 yrs old lady with 28 weeks Pregnant women having symptomatic and anogenital warts which is extensive and rapidly enlarging.
intrapartum acquisition of HPV occurs in baby 1:80 , which of the following associated with baby from mother

genital warts 
laryngeal warts 
recurrent respiratory papillomatosis
None 
All of the above
A

E

74
Q 
Primigravida in labour from Somalia, cervical os -2cm with type 2 FGM...what next option?
A deinfibulate
B cesarean section
C refer to health services for the child
D augment with oxytocin
E do ARM
A

A

If she has infibulation so deinfibulation is a must then child protection society if baby is a girl

75
Q

GBS bacteriuria & Urinary tract complications
Pregnant women with previous history of pretem labour is having UTI symptoms, diagnosed to have GBS bacteriuria at 14 weeks which treated. During antenatal period follow up at 31 wks On Day 0 : 0700 hrs. C/o Abdominal discomfort & mild vaginal discharge. on examination there was white discharge os closed. No uterine contractions. CTG normal. Dipstick urine showed protein 1+,nitrites 1+,leukocytes1+. Blood investigations shows WBC 14 & CRP 10mg/dl .What is the appropriate management. Patient become unwell, tachycardic, tachypenic and c/o pain in loin ,O/E irritable uterus, 2 cm dilated os. ? USG shows pelvicalycealdilatation.What is the next appropriate management?

a) ReferforrenalUSG
b) Refer to urologist
c) Admit,analgesicsandInjGentamycinIV8thhrly
d) Tab Cefazolin 250 mg stat and repeat
e) Reassure
f) Admit, analgesics and Inj Ciprofloxacin IV 8 thhrly
g) Deliverimmediately
H) Tocolytics& Antibiotics
L) FASP

A

f you tried exclusion method all options are not suitable ( gentamicin cipeofloxacin not used in pregnancy)
So my answer is H
And if question giving information that there’s confirmed ROM then answer will be G
No place for referral or consultation in emergency situation

76
Q

obstetric cholestasis most prevalent country

A

Chile 2.4 then Pakistan 1.4

77
Q

Chlamydia trachomatis how much percentage asymtomatic and it’s not altered in pregnancy

90%
70%
55%
80%

A

b
70 % symptomatic
30 % asymtomatic
same figure symptomatic after perineal repair

78
Q

In patients receiving therapeutic doses of LMWH, for Caesarian section skin incision should be closed with which suture( way)

A

Keep subcutaneous drain and interrupted skin sutures

Vicryl 2/0

79
Q

Stratog questions regards antenatal care plz attempt

The booking appointment should ideally be completed by 10 weeks of gestation

The woman’s BMI must be calculated

A vaginal swab is taken to screen for Group B streptococcus

Iron supplementation is offered to all women along with folic acid

The booking appointment is usually done at the hospital by the consultant in charge of the woman’s care

A

TTFFF

Bushra's EXAM Question (2 decks)

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