Antenatal Care – EMQ

Option List :

A. Early ultrasound assessment for fetal anomalies
B. Uterine artery Doppler at 20-24 weeks of gestation
C. USG assessment for fetal echogenic bowel
D. Uterine artery Doppler at 24-28 weeks of gestation
E. Serial assessment of the fetal size from 26-28 weeks
F. Aspirin 150mg from now till birth of the baby
G. Assessment for SGA is not indicated for this women
H. Umbilical artery Doppler assessment in third trimester
I. Serial fetal growth and Doppler assessment from 26-28 weeks
J. Aspirin 75 mg daily from 16 weeks till 34 weeks of pregnancy
K. Umbilical artery Doppler assessment every 2 weeks
L. Monitor the SFH on a customised growth chart

1. Ms. Spencer 26 year old G2P1L1 attends the clinic for a booking visit at 12+5 weeks. Her previous pregnancy was 1 year back ended up in a normal vaginal delivery following induction of labour at 37 weeks for a small for gestational age and the weight of the baby was at the 9th centile. She is otherwise fit and fine with a BMI of 20, non-smoker and non alcoholic, and has good diet pattern. The most appropriate step in the management of this woman is

2. 36  year old G3P2L2 attends the booking clinic. She has had two previous normal vaginal deliveries. John and Jim are 8 years and 6 years respectively. Her first pregnancy was complicated by eclampsia 36 weeks and was induced at 36 weeks. At present, her BMI is 27, she is a non-smoker and non-alcoholic. The most appropriate step in the assessment of SGA for the woman is

3. 21 year old G2P1L1 presented to the booking clinic with 13 + weeks of pregnancy. Her previous pregnancy was complicated by severe Pre-eclampsia and had a preterm delivery by caesarean section at 35 weeks of gestation. Her BMI is 26 and her first trimester aneuploidy screen showed PAPPA 0.44. The most appropriate step that is clinically relevant for her now is

Option List

A.1 in 2
B.1in 12
C.1 in 3
D.1 in 4
E.1 in 8
F.2 in 3
G.2 in 7
H.3 in 4
I.100%
J.0%

A woman has a brother affected by haemophilia A and comes to see you to discuss the implications of this as she is planning a pregnancy. Which of the answers from the list is the most appropriate?
All the options can be chosen once or Moore than once

4. What is the chance of her having an unaffected son?

5. What is the chance of her having a daughter who is a carrier?

6. What is the chance of her being a carrier?

7. What is the chance of her brother having an affected son?

8. What is the chance of her having a son who is a carrier?

Option List:
A. Dexamethasone 12 mg, 2 doses, 12 hrs apart
B. Lower segment CS – category I
C. Fetal fibronectin assay
D. Insulin like growth factor binding Protein I test
E. Commence Magnesium sulphate infusion
F. High vaginal Swab for culture
G. In uterotransfer
H. Intravenous atosiban 6.75 mg bolus followed by infusion with dexamethasone
I. Urine microscopy and MSU for culture
J. Oral erythromycin 250 mg QID with betamethasone
K. Betamethasone 12 mg 24hrs apart
L. Oral Nifedepine 20mg followed by 10-20mg with betamethasone
M. Oral erythromycin 250mg TID with betamethasone
For each of the following questions, choose the single most appropriate options from the list given above. Each option may be used once or more than once or not at all

9. 35 year old Primi gravida with an uneventful Antenatal period presents at 28 weeks of gestation with complaints of draining P/V with no pain or bleeding. On examination, uterus was relaxed with no contractions and pooling of fluid was observed on speculum examination. The best management plan is

10. 30 year old Primigravida deemed to have low risk pregnancy presented with complaints of draining P/v at 33 weeks of gestation. On examination, uterus was relaxed and pooling of the liquor was not evident. The best management plan is

11. 35 year old second gravida presented with 33 weeks of gestation presented with leaking P/V. On examination, was found to have regular uterine contractions and pooling of vaginal fluid on speculum examination with a partially effaced cervix. The best management option is

12. 40 year old primigravida presented with complaints of pain abdomen at 31 weeks of gestation with complaints of leaking P/V with no pain or bleeding. She had been previously managed for a threatened preterm labour 3 days back. On examination, was found to have regular uterine contractions and pooling of vaginal fluid on speculum examination and cervix was 3-4 cms dilated. The best management option is

Option List
A. Low dose Aspirin
B. Serial Cervical length ultrasound scan
C. Prednisolone
D. HCG
E. Low molecular weight Heparin
F. Metformin
G. Hysteroscopic resection
H. Intravenous immunoglobulin
I. Cervical cerclage
J. Reassurance
K. Progesterone pessary
L. Low dose Aspirin & LMW Heparin
M. Weight reduction

Choose the single most appropriate management plan for the following statements:
Each option may be used once, more than once, or not at all.

13. A 28 year old lady presents at 10 weeks gestation with vaginal spotting. She gives history of one first trimester pregnancy loss and one second trimester pregnancy loss at 18 weeks suspected to be due to cervical weakness. Investigations were normal.

14. A 34 year old woman being investigated for recurrent 1st trimester Pregnancy losses. She is obese with a BMI of 33 and a family history of diabetes mellitus. She has been diagnosed to have PCOS. No other cause has been found.

Each of the following labelled images are different types of FGM.

Identify correct label corresponding to scenario explained in questions

. For each patient select the SINGLE most appropriate answer from the list above. Each option may be used once, more than once or not at all.

Option List :

A. Image C&D
B. Image A&B
C. Image D
D. Image A
E. Image A&D
F. Image B&C
G. Image B&D
H. Image B
I. ImageD&A
J. Image C&B
K. Image A&C
L. none of the above

15. Ms.Fuda , from Mali is here for booking visit,she gives history of FGM , on examination she has undergone total removal of the clitoris.

16. Ms, Adaego ,26 year old from Nigeria ,she is here for her first cervical smear .

She has undergone FGM as a child .on examination total removal of the clitoris and the labia minora,without excision of the labia majora .

17. Mrs. NasmaZahan, 18 year old has presented with Apareunia, recurrent urinary tract infections .on examination . seal is formed by cutting and sewing over the outer, labia, with removal of the clitoris &inner labia.

The above labelled images describe various ultrasound images related to Twin gestation . Please choose appropriate labelled image for the clinical scenarios Below .All options can be used once , many times or not at all

A.image B
B.image C
C.Image D
D.Image A
E.Image G
F.Image E
G,Image H
H.Image F
I.Image B& F
J.Image D&G
K.Image G&H
L.Image B&C
M.None of the above

18. Mrs, Ritu, an immigrant who is 25 year old has presented first visit ,late booker at 20 weeks for anomaly scan Looking at usg image , while counselling regarding her antenatal care , you advise her Combine appointments with scans at estimated gestations of 22, 24, 28, 32 and 34 weeks.Identify the usg image which best explains this type of condition .

19. Mrs. Rama , 42year old IVF pregnancy , twin gestation at 20 weeks has presented with symptoms of breathlessness and abdominal distension. Initially u thought these are exaggerated physiological changes . After discussing with consultant , you send her for scan . After looking at image your consultant advise her to undergo a procedure by Solomon technique .

20. Mrs, Meenu , is at 32 weeks of gestation as it’s identical twins , she is on regular follow up scans . Recent scan suggest TWIN A is 2000gm , Twin B is 1500 gm, and umbilical artery Doppler shows absent end diastolic flow in TWIN B

21. Mrs, Ruby , 30 year old asylum seeker her first visit at 32 weeks , When u  examined uterus is overdistended & multiple fetal parts felt . Ultrasound shows very rare form of mono chorionic monoamniotic twins ,The prevalence is one in 90 000 to 100 000 pregnancies

22. Mrs. Rama , 42year old IVF pregnancy , twin gestation follow up visit at 30 weeks . Her record shows  she has undergone laser procedure by Solomon technique  for twin to twin transfusion syndrome ,

Now Sonologist   is worried  by the presence of increased MCA PSV in the donor, suggestive of fetal anaemia (greater than 1.5 multiples of the normal median), and a decreased MCA PSV in the recipient twin, suggestive of polycythaemia (less than 1.0 multiples of the normal median), with the absence of significant oligohydramnios/polyhydramnios sequence. Twin B sonologist unable to locate baby’s heart .

23. Mrs.Amanda , 11week pregnant is at booking visit . After ultrasound ,  you advised  her least eight antenatal appointments with a healthcare professional from the core team. At least two of these appointments should be with the specialist obstetrician. Her estimated gestations of 20, 24, 28, 32 and 36 weeks .Offer additional appointments without scans at 16 and 34 weeks.which ultrasound  image  depicts  this type of pregnancy

Option List

A. VBAC is contraindicated
B. Refer to a tertiary centre
C. VBAC may be considered after consultant assessment
D. ERCS after 39+0 weeks
E. ERCS at 38 weeks with antenatal steroids
F. Epidural may be considered
G. Emergency LSCS
H. VBAC as it is successful
I. Epidural contraindicated
J. Blood transfusion

24. 31 year old with previous LSCS for breech presentation had consented for VBAC. Her previous pregnancy was uneventful except that during LSCS, there was an inadvertent extension of the left lateral angle with an associated PPH of about 900ml-1000ml. She underwent appropriate closure and postoperative period was uneventful. The most appropriate mode of delivery is?

25. 36 year old G5P4L4, with previous two LSCS for breech presentation. She has had two normal vaginal deliveries. What is the most appropriate option regarding the mode of delivery?

Option List
A. Serial amnioreduction
B. NT alone
C. Fetoscopic laser ablation
D. Quadruple marker
E. Elective delivery from 35 weeks after steroids
F. Elective delivery at by 37 weeks after steroids
G. Septostomy
H. Combined screening test
I. Elective delivery by 32 weeks after steroids
J. Elective delivery by 37 weeks

Choose the most appropriate treatment for the clinical scenario given. The option may be used once or more than once or not at all.

26. 31 year oldprimiparous presented to the emergency at 24 weeks of gestation with acute onset of breathlessness and difficulty in lying down. At 12 weeks, USG done showed the following features.

The USG at the presentation showed DVP 1.2cm in twin A and DVP in the Twin B with DVP of 10.6 and there is bladder discordances of the twin. The first line treatment is

27. 32 year oldwoman had underwent IVF done and detected to have monochorionic diamniotic twin pregnancy. Ultrasound examination at 30 weeks showed growth discordance of more than 20% with reversed end diastolic flow in umbilical artery and the ductus venosus showing normal flow pattern. The best time to deliver the babies is:

28. 27 year old woman undergoes ultrasound scan at 13 weeks and is found to have monochorionic diamniotic twin. What test should be offered to the woman to determine the risk of aneuploidy in this pregnancy?

Option List
A. Administer antenatal steroid prophylaxis
B. Administer prolonged release diazepam
C. Admit for observation
D. Assess fetal biometry
E. Commence i.v hydralazine
F. Commence labetalol 400 mg four times a day
G. Commence magnesium sulphate
H. Commence methyldopa 250mg three times a day
I. Emergency caesarean section
J. Perform 24 hrs urine collection
K. Start aspirin 75 -150 mg daily
L. Start enalapril
M. Uterine artery dopplers

The following clinical scenarios refer to a pregnant woman who is at risk of developing or has developed pre-eclampsia. For each scenario choose the single most likely management from the list of options. Each option may be used once, more than once or not at all.

29. You are the registrar on call. You receive an urgent call to the ward to review a woman who is at 32 weeks of gestation in her first pregnancy. She was admitted from an antenatal clinic earlier after complaining of a frontal headache. She was found to have a blood pressure of 150/94 mmHg and +++ protein. On examination, she is hyperreflexic and 4+ clonus and is complaining of blurred vision and severe headache.

30. You review a woman in the clinic who is 40 years old and has been referred to you with essential hypertension for pre-conceptual advice. She is currently taking lisinopril 40 mg once daily.

31. You are reviewing a woman in the clinic. She is in her second pregnancy. Her first pregnancy resulted in an emergency caesarean section at 28 weeks of gestation secondary to severe pre-eclampsia; she made a full recovery. She has a BMI of 35 and has a family history of cardiovascular disease. She is at 12 weeks of gestation and this pregnancy is with a new partner.

Option list:

A. Offer Magnesium sulphate infusion
B. Admission at 34 weeks, offer steroid and cesarean at 36 weeks if asymptomatic
C. Offer steroids
D. Admission at 36 weeks for elective cesarean if asymtomatic
E. incision type doesn’t affect outcome of baby
F. Do a vaginal exanination.
G. Admission at 32 weeks, offer course of steriods and deliver at 34-36 weeks if asymptomatic
H. Novasure endometrial ablation
I. verticals skin incision and or curvilinear uterine incision
J. Consultant led care unit
K. Pfannesteil skin and curvilinear uterine incision
L. Wait and watch
M. Vertical skin and or vertical uterine incision.

Each of the following Option describes various women presenting with Antepartum Haemorrhage for each patient select the single most appropriate management option from the list

32. A 24year old woman immigrant of Asian origin, in her second pregnancy. First delivery by cesarean section. This pregnancy she is diagnosed to have grade 2 placenta Previa, planned for elective CS at 37 weeks as she was asymptomatic. Now she is 35weeks 2days. Presented with spotting.

33.  A 32 year old woman , presented with heavy bleeding. She is now 27 weeks pregnant with transverse lie, she was resuscitated with 6units of packed red blood cells and 4units of FFP. She is immediately shifted to OT,what is the best surgical approach?

34. A 30 year old primigravida, conceived by IVF, anomaly scan shows vessel running between placenta and succenturiate lobe. What is the best plan for her delivery?

Option List
A. Inform Police
B. Inform child safeguarding services
C. Offer re-infibulation provided she understands the consequences
D. Clitoral reconstruction should not be performed
E. Treatment of UTI, testing for Hep B, HIV and syphilis and documentation of FGM
F. Re-infibulation can be done only during the repair of the perineum post delivery
G. De-infubulation, additional testing for Hep C along with Hep B, syphilis, and HIV, treat UTI and documentation
H. Deny re-infibulation under any circumstances
I. Refer to cosmetic gynaecologist to do clitoral reconstruction and document the referral

35. 28 year old woman presented to antenatal clinic with symptoms of UTI with 34 weeks of gestation. She was found to have type 3 FGM which was done during her childhood and it was found difficult to perform a vaginal examination and the urethral meatus was not visible. What would be the appropriate management?

36. 34 year old primigravida from Ethiopia has come in labour at 39+ weeks of gestation. On examination was found to have a type 3 FGM and after discussion with the woman was decided to go ahead with infibulation. She is requesting re-infibulation. What is the most appropriate action to be taken?

37. 20 year old woman from Somalia had undergone a type 2 FGM when she was a child. She wishes to get a clitoral reconstruction as she is getting married. The most appropriate management would be?

OPtion List:

A.  Bursitis of the knee joint

B.  Dislocation of the hip

C.  Fracture of sacral promontory

D.  Fracture of the pubic bone

E.  Lumbosacral disc prolapse

F.  Mechanical back pain

G.  Osteitis pubis

H.  Osteomyelitis of pubis

I.  Osteomyelitis of the hip

J.  Osteoma of the hip

K.  Pregnancy-induced osteomalacia

L.  Symphysis pubis dysfunction

M.  Sciatica

N.  Subluxation of the sacral promontory

O.  Transient osteoporosis of pregnancy affecting the hip joint

P.  Tuberculosis of the spine or Pott Disease

Instructions: For each clinical scenario described below, choose the single most appropriate diagnosis from the list of options above. Each option may be used once, more than once, or not at all.

38. Sushama (42-year-old woman) attends her antenatal appointment at 28 weeks of gestation. A waddling gait is seen on entering the examination room. Sushma complains of a burning pain in the pubic region during walking, standing on one leg and parting her legs. Clinical examination reveals tenderness on the sacroiliac joint and restriction of the abduction and lateral rotation of hip.?

39. A 42-year-old woman attends the obstetric day assessment unit at 28 weeks of gestation with low grade pyrexia and reduced hip movements due to severe pain. Clinical examination reveals tenderness over the pubic symphysis and pubic rami, painful abduction of the hip and pain on lateral compression of the pelvis. She gives a history of recurrent urinary tract infection in the past and recently had stenting of the ureters for ureteric stricture. X-ray of the pelvis shows widening as well as bony erosions of the symphysis pubis.

40. A 42-year-old woman attends the obstetric day assessment unit at 28 weeks of gestation. A waddling gait is seen on entering the examination room. She complains of pain in the pubic region which is radiating to the groin and thigh. She also explains that the pain is aggravated on climbing stairs and lying on one side in bed. The other aggravating factors for pain include coughing and sneezing. Examination of her hips reveals tenderness on compression of the right as well as left trochanters.

41. A 42-year-old Asian woman, para 5, attends her antenatal appointment at 28 weeks of gestation. She complains of non-specific pain in the lumbosacral and pubic regions. Blood tests reveal low serum calcium but raised alkaline phosphatase. Pseudofractures (Looser zones) are reported on the X-ray of the pubic bone.

Option List:

A. Multiple pregnancy
B. Gestational diabetes mellitus
C. Fetal macrosomia
D. Fibroid uterus with red degeneration
E. An adnexal mass complicating pregnancy
F. Gestational trophoblastic disease
G. Abruption with concealed haemorrhage
H. A cervical fibroid
I. Multiple uterine fibroids
J. Obesity
K. Full bladder
L. Fetal hydrops
M. Diabetes complicating pregnancy
N. Wrong dates
O. Polyhydramnios

Choose an appropriate option for each question from the list given above.

42. Sukumari 28-year-old presents in her first pregnancy at 16 weeks’ gestation with severe hyperemesis. Her blood pressure is 150/96 mmHg with 3_ of proteinuria. Her booking blood pressure is noted to be 115/70 mmHg. Abdominal examination demonstrates that the symphysis–fundus height is equivalent to 22 cm.

Option List

A. Image C
B. Image A
C. Image E
D. Image B
E. Image E&A
F. Image C&D
G. Image B&C
H. Image E &F
I. Image F
J. Image D

You have ultrasound images of the women visiting you for antenatal care .
The above Labelled images show various images of fetus
The following scenarios explain typical usg findings

Correlate images and choose appropriate option from image given.

43.Mrs.X, 12 weeks for dating scan. scan shows Lethal fetal anomaly. you also explain women that she can develop problems like polyhydramnios

44. Mrs, D , primi in her 23 Weeks of gestation got a late anomaly scan done,Scan shows Baby has a non lethal fetal anomaly -foot anomaly which can be corrected by simple physiotherapy or using proper footwear or if not corrected small surgery at later part of life

45. Mrs. G, primigravida is a Iate booker Scan at 30 weeks shows fetal anomaly where bowel loops exposed . U explain women she has Very low incidence of other abnormalities, No increase in the incidence of chromosomal abnormalities And associated with oligoamnios

46. Mrs. H, 32 year old shows a fetal anomaly. You explain mother that immediately after birth baby will have serious breathing difficulty which needs immediate ventilator support because of pulmonary hypoplasia.

47. Mrs. P , second gravida anomaly scan shows fetal anomaly which shows herniation of abdomen contents with covering , associated with Chromosomal anomalies , She can develop Polyhydramnios.

48. Mrs.W, 42 year old, IVF pregnancy got her anomaly scan done, After seeing her scan your reassure her as it’s within normal limits

Option List
A. 1 in 2
B. 1in 12
C. 1 in 3
D. 1 in 4
E. 1 in 8
F. 2 in 3
G. 2 in 7
H. 3 in 4
I. 100%
J. 0%
A pregnant woman attends the antenatal clinic with a family history of genetic tests have been performed on her and her partner, that has revealed they both are carriers of cystic fibrosis. Both are carriers of the most common mutation associated with cystic fibrosis the deltaF508 mutation. The women and her partner have some questions which they put you in clinic. Which of the answers from the list is the most appropriate?

49. If this child is unaffected, what is the chance of her having an affected child in her next pregnancy?

50. What is the chance of her having an affected son?