MRCPI Part 2 Written – Mega Mock

1.30-year-old woman who is 2 weeks postnatal following a normal vaginal delivery at term presents with a 5-day history of offensive vaginal discharge and general malaise. She complains of a sore throat. Her temperature is 38°C.

What is the most likely infective aetiology in this case?

2.A woman had an emergency caesarean section for a pathological CTG and pyrexia in labour. She was discharged on postoperative day 4 but re-admitted on day 6 with pyrexia, tachypnoea, tachycardia and hypotension. Haemoglobin is 105 g/l. Septic shock is the main differential diagnosis. Following the Sepsis 6 bundle, along with antibiotics and blood cultures, which other important blood test needs to be taken?

3.The  postpartum nurse  calls  about  a  patient  who  had  an  uncomplicated  vaginal  delivery  12  hours  ago. She  is  concerned  that  the  patient  has  the  following  findings.  Which  of  them should  be  of  most  concern to  you?

4.Mrs KM is a 39 year old P2.Had elective caesarean section 12 days ago for previous caesarean section & fibroid uterus.During second operation she had massive PPH which needed B-Lynch suture,uterine artery embolization & 12 units blood.She is febrile since the operation & having profuse purulent discharge from the wound.She is on parenteral antibiotics & her most recent blood culture was positive for E.coli.What is the most likely complication she has had?

5.A 32 year old woman is brought into the A & E with a 1 day H/O fever,rigors,abdominal pain &heavy lochia.She had an uncomplicated spontaneous vaginal delivery 2 days ago.on arrival ,she has a temperature of 39֯ C,a heart rate of 143 bpm ,a BP of 82/59 mmHg & a RR of 40/min.Following initial resuscitation ,what is the most appropriate immediate management?

6.mrs.X delivered 7days back and come with mastitis she was started on coamoxiclav. Now she complains of  bilateral shooting pain .

What is the causative organism for this ?

7.Mrs. Rosy , A 30-year-old woman presents with abdominal pain, a high fever and has been feeling generally unwell for 10 days since her caesarean section. On examination, Image is enclosed a red, warm and swollen area is noted on her abdominal wall around the scar. She reports that the area of redness has rapidly increased in size. Blisters have developed around the margins. What is the likely diagnosis?

8.You review a 34-year-old woman with pyrexia 48 hours following an emergency caesarean section. Which of the following antibiotics is correctly matched to its corresponding infection?

9.A 27-year-old woman in her first pregnancy gives a 36-hour history of leaking clear fluid continuously. She is 31 weeks gestation with no abdominal pain or vaginal bleeding. What initial investigation would you request in the management of suspected infection with preterm pre-labour rupture of membranes (PPROM)?

10.Mrs,Angelina ,26year-old woman is referred by her GP 48hours following a second stage cesarean section for  fetal distress.She had an uncomplicated pregnancy apart from a history of prolonged rupture of membranes for which she was induced. She required epidural analgesia in labour. There were no concerns in the immediate postpartum period and she was discharged home the following morning.

 On admission her temperature is 38.6°C. She has tachycardia 130 beats/minute and feeling generally unwell.

What is the most important initial investigation?

11.Mrs.X , 32 year old primigravida is now 26weeks of pregnancy she has been lrensetd to A&E as she is feeling unwell.on examination pulse is  108bpm .Her blood pressure is  100/70mm Of Hg . Her temperature is 37.6 c .respiratory rate is 24 per min .per abdomen -soft, 26 weeks with active fetus.what is your management

12.Mrs, x , A primiparous woman became hypertensive after a caesarean birth at term for fetal distress. Over the following few days she had severe abdominal pain, a numb foot, diarrhoea and an ongoing need for analgesia including opiates. Staff were aware of her pain but interpreted it as normal post caesarean discomfort and she was not seen by a consultant. She was discharged but was in too much pain to interact with her baby and family. 40 hrs later, she was seen by the community midwife, her pain was worse, her abdomen was bruised and her foot numb. After a phone call to the GP, more analgesia was prescribed but the GP did not review her. Later that day she had copious bloody diarrhoea and collapsed.

She was taken to labour ward, where she was in extremis with rectal bleeding, a grossly distended and bruised abdomen, hypotension and acidosis.

She was taken straight to theatre for emergency surgery but unfortunately she died choose the most appropriate cause of  their death

13.20 year-old woman is brought in by ambulance to A&E who collapsed on the street . Before collapsing she complained of acute pelvic pain. On admission, her urine pregnancy test is positive  and a bedside ultrasound scan in A&E demonstrates  Free intro abdominal  fluid . You, as the gynaecology registrar, are fast bleeped to review her as she is unconscious with a BP of 70/40 mmHg and pulse of 120  bpm.

What is the most appropriate option of obtaining consent for proceeding to theatre?

14.Mrs.Sweetie , A 30 year-old woman underwent an uncomplicated  Diagnostic laparoscopy and dye test to investigate primary sub Fertility.  Uterus is normal and the fallopian tubes were patent. 6  hours after the operation the woman is experiencing a lot of pain requiring increased PCA.The abdomen is very tender around the secondary port site in the right  iliac fossa is slightly distended; oozing blood-stain fluid, despite a pressure dressing. Observations: pulse rate is 110 bpm; BP is 140/75 mmHg; temperature is 36.5°C; respiratory rate is 18 breaths/min

15.A 25-year-old primigravida woman is admitted to the labour ward with regular contractions and draining clear liquor. She is a known carrier for Streptococcus B in this pregnancy. Shortly after being given a loading dose of benzylpenicillin, she becomes wheezy, develops a rash and has difficulty breathing.

What is the most appropriate initial dose of intramuscular adrenaline?

16.A 23 year old woman presented to A&E  diagnosis of a ruptured ectopic pregnancy with hypovolemic shock  at 10 weeks’ gestation. Resuscitation was not successful. It is classified as

17.A 25-year-old nulliparous woman at 41 + 5 weeks’ gestation was induced for postdates with Prostin followed by artificial rupture of membranes and Syntocinon infusion. She collapsed 5 minutes after epidural insertion with bradycardia and hypotension. Immediate cardiopulmonary resuscitation measures were started after stopping the epidural infusion. The collapse was believed to be secondary to inadvertent intravenous administration of the local anaesthetic causing toxicity.

What is the recommended drug of choice for the treatment of local anaesthetic toxicity?

18.A primigravida at term, in first stage of labour had uterine hyperstimulation following oxytocin augmentation. The oxytocin drip was stopped, but after a few minutes, she had hypotension, tachycardia and a feeble pulse showing signs of collapse. Resuscitative efforts could not restore any cardiac output for 4 min, and a decision for perimortem caesarean section was taken. Which of the following is the correct approach in conducting the perimortem caesarean section?

19.A 40-year-old woman gave birth to her fifth child 15 minutes ago. She suddenly complains of shortness of breath, and in the next few minutes after delivery she collapses. The blood pressure is 70/30 mmHg, oxygen saturation is 88% on air and pulse is 75 bpm. Her arms have started to twitch, and there is heavy bleeding vaginally.

What is the likely cause of the collapse?

20.She has undergone in vitro fertilisation treatment and is now 8 weeks’ pregnant. It is 3a.m.andshehasbeenbrougbtto hospitalbyambulance.Shehadcollapsedathome, was found to be bleeding heavilyan was not responding to verbal commands. In the emergency department, you see that she is bleeding heavily and is hypotensive and tachyaudic. Youperform an abdominal ultrasound scan and find a viable intrauterine pregnancy with a fetal heartbeat. The haemoglobin concentration derived from a venous gas sample is 50 gIL. She requires an urgent evacuation of retained products of conception to stop the bleeding.

What is best practice for obtaining consent?

21.Mrs KM is a 39 year old P2.Had elective caesarean section 12 days ago for previous caesarean section & fibroid uterus.During second operation she had massive PPH which needed B-Lynch suture,uterine artery embolization & 12 units blood.She is febrile since the operation & having profuse purulent discharge from the wound.She is on parenteral antibiotics & her most recent blood culture was positive for E.coli.What is the most likely complication she has had?

22.A primi presents 2 days after a normal vaginal delivery c/o feeling unwell.On exam ,she has a temperature of 38֯ C,pulse rate of 110bpm & BP of 90/50 mmHg.Thre are no localising signs of infection.Blood tests are performed.What test result would indicate a severe sepsis?

23.A 42-year-old primigravid woman presents in spontaneous labour at 37 weeks of gestation. She develops central crushing chest pain which radiates to her left jaw.

Which of the following cardiac biomarkers is most reliable for diagnosing acute myocardial infarction during labour and delivery?

24.A 30yearold woman presents at 38 weeks of gestation with fever, myalgia, arthralgia, cough and dyspnoea which began yesterday evening. She also has symptoms of vomiting. She was previously fit and well. On examination, she has a respiratory rate of 28, oxygen saturations of 90% on air, and a pulse of 110 bpm. Blood pressure is 120/70 mmHG. Her chest has widespread wheeze and reduced air entry. A chest Xray shows patchy consolidation throughout both lungs.

What is the most appropriate initial treatment?

25.Dr.Xx ,doctor in early pregnancy unit is reviewing a patient  at 1800hrs.

Consultant has gone out he will take 60minutesto reach I’m case of any emergency .

Ms.Melanie, 18year old, who has come with excessive bleeding p/v .She was 8weeks pregnant and had taken mifepristone followed by misoprostol  for medical termination of pregnancy.  She is very pale with pulse 120 bpm Blood pressure off 80/50mm of Hg .on examination -products of conception seen at vital os Dr.xx  is the only doctor available at that shift & she has  has religious constraints to do abortion, What is the correct thing to do now

26.A 23 year old woman presented to A&E  diagnosis of a ruptured ectopic pregnancy with hypovolemic shock  at 10 weeks’ gestation. Resuscitation was not successful .

It is classified as

27. Ms.Rachel , primigravida in her first pregnancy admitted in labour room , 4cm dilated. On spontaneous rupture of membranes , prolonged fetlal bradycardia Is noted, on vaginal examination she is 5 cm dilated with cord prolapse, decoded for cesarean section

What is the category of cesarean section in this scenario

28.Ms. x , A 32-year-old woman is in labour in her second pregnancy. Her previous delivery was by caesarean section. What is the most consistent indicator of uterine rupture for this woman?

29.A 35-year-old primigravida with an unremarkable past medical and obstetric history was admitted to the antenatal ward for investigation of a suspected lower limb DVT at 32 weeks of gestation. She is found collapsed and unresponsive in the corridor. The midwife who found her has called for the emergency team. You are the next person to arrive on the scene.

What is the first most appropriate step in her care?

30.A 35-year-old primigravida with an unremarkable past medical and obstetric history was admitted to the antenatal ward for investigation of a suspected lower limb DVT at 32 weeks of gestation. She is found collapsed and unresponsive in the corridor. The midwife who found her has called for the emergency team. You are the next person to arrive on the scene.

You have established that the airway is clear but breathing is absent. There are no signs of life and you cannot palpate a carotid pulse.

Which is the most appropriate initial management option?

31.A 35-year-old primigravida with an unremarkable past medical and obstetric history was admitted to the antenatal ward for investigation of a suspected lower limb DVT at 32 weeks of gestation. She is found collapsed and unresponsive in the corridor.

The obstetric emergency team has arrived and cardiopulmonary resuscitation (CPR) according to Resuscitation Council (UK) guidelines have been ongoing for 4 minutes.

What is the most appropriate course of action?

32.You are called to see a woman to assess her perineum after a normal delivery. You diagnose a fourth degree perineal tear.

How will you repair the internal anal sphincter (IAS)?

33.26 year old primi underwent a vacuum extraction for a prolonged second stage. On assessment she required an episiotomy, and a mediolateral episiotomy. What is the recommended technique to repair the perineal muscles?

34.24-year-old nulliparous woman undergoes surgical management of a tubal ectopic pregnancy. At laparoscopy, the contralateral tube is examined and noted to be damaged. The woman has strongly expressed her concern about future fertility.

Which is the single best management option?

35.A 22year old woman presented with 6 weeks gestation, complains of mild pain abdomen with moderate  vaginal bleeding.

Hemodynamically stable ,

Abdomen and vagina examination is insignificant

Urine pregnancy test positive .

TVs scan- no intrauterine  sac , both tubes &ovaries -Normal

No free fluid

What’s an appropriate management plan?

36.After  a  significant  period  of  hypovolemic  shock,  the  bleeding  was  controlled  and  the  vascular  volume replaced.  Estimates  of  blood  loss  were  over  2,500  cc.  The  patient  apparently  recovered  well. However,  she  was  unable  to  breast-feed  and  gradually  noted  breast  atrophy  and  no  resumption  of menses.  Later,  she  developed  constipation,  slurred  speech,  and  moderate  nonpitting  edema.  Which  of the  following  is  the  most  likely  diagnosis?

37.A 7 week pregnant women with history of previous two miscarriage. Ultrasound showed.

What is the most likely karyotype ?

38.Mrs. Tina , 22 year old has presented to accident  and Emergency with excessive vomiting . She is 12weeks  pregnant  in her first pregnancy. She has got her ultrasound done. looking at the image ,

The genetic karyotyping of this pregnancy would be

39.Mrs. Leslie, 32 -year-old primiparous woman presents to the emergency department with sudden onset of lower abdominal pain, mainly localised in the left  iliac fossa. The pain is sharp in nature and is radiating to the left  flank.

Her last menstrual period was 7 weeks ago.

 History of recurrent PID noted.

Vital signs on arrival are:

blood pressure = 90/60 mmHg & pulse = 100 beats/min, temperature = 36.5°C, respiratory rate = 16/min

Vaginal examination is positive for cervical excitation.

Investigations : A urine pregnancy test is positive. , hCG level = 5000 iu/l.

On transvaginal scan – left adnexa was seen to contain an ectopic pregnancy measuring 22 mm x 18 mm x 15 mm with  noted cardiac activity and presence of  haemoperitoneum noted.

What is the treatment of choice for this woman?

40.Mrs. sweetie , A 20 -year-old nulliparous woman undergoes surgical management of a tubal ectopic pregnancy.  She has been treated for pelvic inflammatory disease three times in past . She also gives history of multiple sexual partners ,At laparoscopy, the contralateral tube is examined and noted to be damaged. The woman has strongly expressed her concern about future fertility.

Which is the single best management option?

41. Mrs.X. 29-year-old woman, P2L2 ,  has  had a rotational forceps delivery of  a  healthy  male infant  at  term  with  suspected extended    perineaL tear.in   theatre,  third degree  tear   (3b) is diagnosed . What suture material you would use to suture their tear ?

42.Sarah / 24 year old P1L1 who is about to be discharged She deliverd 48hrs ago male baby weighing 3.2kg, She had a forceps delivery for maternal exhaustion.She suffered a perineal tear, She has sustained a perineal tear in which 50% of the EAS was involved.

In perineal tear proforma What degree of tear you have to document ?

43.Mrs.Tina, is in her early pregnancy  clinic with 6weeks of pregnancy .she had 3 Miscarriages at6,8&9weeks of pregnancy previously .what is the advise u offer her

44.Mrs. A multiparous lady is a postpartum  clinic. She has delivered 8months back with a history of major postpartum hemorrhage ( 4500ml) now she complains of amenorrhoea. She stopped breastfeeding , and also complains of  difficulty in lactation . She complains of weight loss , dry skin and breast atrophy .What is the probable cause of diagnosis ?

45. Ms. A , 15 weeks pregnant with no symptoms but urine shows plenty of pus cells , her notes shows she is allergic to penicillin for which she was admitted to ICU, what is the best management for her?

46.Ms. Briganza, 34year old, multigravida had a forceps delivery followed by which she had massive PPH. She receives a transfusion of 18 units of both O negative and cross matches red blood cells, 12 units of fresh frozen plasma, 5 units of platelets and 3 units of cryoprecipitate. All are complications of massive blood transfusion except

47.Mrs.x , 24 year old had prolonged second stage , postnatal period she developed This problem As shown in image A.

Which nerve  is injured

48.You are reviewing a patient who delivered via ventouse 2 hours earlier. You note a bulge developed around her vagina. You suspect it’s a vulval hematoma. Which of the following vessels is responsible for a vulval haematoma?

49.Ms.suzi, 35year old presented with  secondary amenorrhea  .she complains of tiredness and vague complaints.

Her blood test shows Hemoglobin 9 gm/dL, FSH-1Iu/ml LH- 0.7Iu /ml . Prolactin is 300Iu/ml what  is the probable cause of her amenorrhea ?

50.Mrs.Rubaa , A 29-year-old patient presents with abdominal distension and vaginal bleeding at 12 weeks’ gestation. A transvaginal ultrasound scan suggests a molar pregnancy with bilateral ovarian cysts as enclosed in usg image .No free fluid in the pelvis .

What is the most likely diagnosis?

51.These hemodynamically forceps are used to hold the cut edges of transverse incision of the uterus &  the angles of the uterus .

52.A 45 year old Lisa presented to you with  Heavy menstrual bleeding . It is affecting her quality of life .she is requesting for conservative mangement .After  counseling , she chooses Tranexamic acid .  What is the mechanism of action of Tranexamic acid ?

53.Mrs. X , has undergone surgical evacuation for missed miscarriage 3months back . She has presented with breathing difficulty , and hemoptysis.

Chest X-ray is enclosed .

Which tumour marker is elevated in this woman ?

54.A woman presents to the antenatal clinic at 30 weeks of gestation she is presenting with some vulval lump.

What is the most likely cause?

55.You see a patient with the skin lesion below:

What is the diagnosis

56.patient with two previous caesarean sections presents at 35 weeks of gestation with a painless vaginal blood loss of 400 ml. She is ‘unbooked,’ that is, she has not presented for any previous antenatal appointments so far in this pregnancy. Clinical finding are as follows:

What is the most likely cause of the blood loss ?

57. A newborn baby develops sticky eyes 5 days after a vaginal delivery. His mother did not have any vaginal discharge although she had experienced dysuria and frequency a few months before pregnancy. She was having regular sexual intercourse during pregnancy with her partner of 2 years’ duration. On examination, both the baby’s eyes are sticky and have a yellowish discharge. The conjunctiva is inflamed.

58.Mrs. X is now 31 weeks Preterm  labour  with  evidence of  cervical  dilatation .so she was offered magnesium sulphate infusion of 4gm of bolus and 1gm/hr maintenance dose ,midwife suddenly calls you  as Mrs.X respiratory rate is 10beat super minutes , she has absent  knee reflex as well as her urine out out is only 50ml for last4hours ,what is the best recommendation for her ?

59. Mrs.X is in now 24 weeks pregnant .she is her third pregnancy  with low lying . It has been complicated by recurrent antepartum haemorrhage . She is B negative   Non sensitized woman ,she has presented with bleeding  .This is her third  episode  in last 6 weeks . What is the advise  you would  offer regrading  ANTI-D

60.Mrs. X is 32 year old primigravida 7 pregnant.she is here  for dating scan Trans abdominal scan shows gestational sac   pole measuring 26 mm and no cardiac activity noted. The sonography  is sure of findings .

What advice you would give her ?

61.Mrs.Tina is 32 year old lady who gives history of 3 miscarriages  at 20 , 22 and 24 weeks of gestation. She gives history of painful contraction followed by miscarriages. What could be the possible cause  of miscarriage ?

62. Ms. X, 44year old , chronic smoker complains of shortness of birth  .on examination  respiratory rate is 26, spo2-85% , abdomen examination shows mass corresponding to 14weeks gestation . Pelvic  ultrasound shows unilateral mass -solid mass with ascites .CA-125is 60mIu/m.X Ray shows pleural effusion

What is the probable diagnosis

63.Ms.X , 54 year old postmenopausal  woman has incidental finding on ultrasound scan –  right ovarian cyst – Multi locular    cyst measuring, 4cm   . No solid lesions noted, mild ascites  noted .Her CA-125-32 IU /ml .What is her RMI score ?

64.Systemic  Methotrexate is  a  safe  and  effective  treatment  for Ectopic pregnancy , what is the mechanism of action of Methotrexate ?

65.GP has referred ,Mr.Alan Dewhurst , 28year in to subfertility clinic

 He and his partner Jane Ellis , 24 has been investigated for 2year history of primary subfertility ,He is a physical trainer by profession . He takes testosterone injections for muscles for last 6months .he is not a smoker not a alcoholic

His  partners reports are all normal

His semen analysis  On two occasions are similar and as follows

Blood reports

 Total testosterone ;50 n mol /L(normal range ;8.4 -35.7)

FSH ; <0.5IU/L(normal range ;2.5-10.2 IU/L)

LH:<0.5 IU/L (normal range ; 1.9-12.5 )

Cystic fibrosis is negative for common mutations.

Karyotype is 46XY

Probable cause for his condition is

66.A 28-year-old woman with 3 years of secondary subfertility .she is a smoker, alcoholic . She has been treated for PID twice  at the age of 16 .She has had a child with a previous partner and a recent hysterosalpingogram s image is enclosed

What is correct regarding cause for tubal factor infertility?

67.Mrs. Roja, A 32-year-old Asian woman presents at 36 weeks of gestation with abdominal discomfort, 2+ proteinuria and a blood pressure of 140/90 mmHg. She has blood tests in accordance with the NICE guideline for the

management of hypertension in pregnancy. The midwife asks you to review the following blood results. What do these results suggest?

68.A 26 year old lady with twin pregnancy presented at 33 weeks of gestation, with intrauterine death of one foetus at the time of admission and was taken up for emergency caesarean under subarachnoid block. On examination she was drowsy, pulse 120 per minute, blood pressure 170/96 mm Hg, had pedal and sacral oedema. Hand held record investigations showed haemoglobin of 11.2gm %, platelet count 2,10,000/mm3, blood urea 24 mg %, serum creatinine 0.8 mg %, serum bilirubin 3.0 mg%, ALT 184 units per litre, AST 158 units per litre.immediate category 1cesarean did Both the babies delivered were still born and the intraoperative course was uneventful. In the postoperative period renal function deteriorated with blood urea of 36 mg % and serum creatinine 1.8mg %. There was evidence of haemolysis on peripheral blood smear and LDH was raised to 1110 units per litre. Coagulation profile was deranged with PT 12 secs and PTT 23 secs more than the control values and platelets count fell to 75,000/mm3. Urine is blood stained .

What’s your diagnosis ?

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

What’s the diagnosis ?

70.Fetus having this anomaly is commonly associated with which of the following?

71.A 15-year-old girl attends sexual health clinic requesting termination of pregnancy. She is 7 weeks pregnant. Her boyfriend is also 15-years-old and studies in the same school. She has not informed anyone of this pregnancy. What is your most likely immediate action?

72.Mrs, Susan, A 35 year old woman at 22 weeks of gestation presents with abdominal pain, nausea and vomiting. She reports that a sharp pain began the night before, starting at the umbilicus and radiating toward her right side. She has felt no contractions and has had no vaginal bleeding, fluid leaking or dysuria.

She had heartburn at times and chills the day before, but no fever. A similar pain 1 month before had resolved spontaneously, and no cause was determined.

On examination, she was afebrile, normotensive and in no apparent distress. Her heart and lungs were normal. Her abdomen was soft and gravid with a fundal height of 22 cm. Bowel sounds were present in all four quadrants. Fetal heart tones were normal, and there was no indication of contractions. Her abdomen was diffusely tender, with significant tenderness to deep palpation in the right flank. There was no rebound or guarding.

What’s your diagnosis ?

73.Mrs. Tina , 22 year old has presented to accident  and Emergency with excessive vomiting . She is 12weeks  pregnant  in her first pregnancy .

She has got her ultrasound done. looking at the image ,

The genetic karyotyping of this pregnancy would be

74.A 30-year-old woman who is 2 weeks postnatal following a normal vaginal delivery at term presents with a 5-day history of offensive vaginal discharge and general malaise. She complains of a sore throat. Her temperature is 38°C.

What is the most likely infective aetiology in this case?

75.Mrs, X , A 25-year-old woman  primigarvida is  referred by midwife as she is found to have a platelet count of 90 x 10*9/l  at  a routine check up at 28 weeks of gestation. Her platelet count at 12 weeks of gestation was 400 x 10*9/l. She has no history of travel, fever or any chronic conditions, She is now at 34 weeks with platelet count of 85 x 10*9/l   ,while discussing labour plan she  requests epidural analgesia ?

What’s the minimum platelet count for epidural analgesia ?

76.Mrs. X, 31-year-old patient is preparing to start in vitro fertilization (IVF) because of obstructed fallopian tubes. On hysterosalpin-gogram (HSG),image is enclosed

 What should be your next step?

77.38. Mrs.X , 32 year old primigravida is now 26weeks of pregnancy she has been  brought to A&E as she is feeling unwell.on examination pulse is  108bpm .Her blood pressure is  100/70mm Of Hg . Her temperature is 37.6 c .respiratory rate is 24 per min .per abdomen -soft, 26 weeks with active fetus.what is your management

78.Ms. X  32 year-old woman presents with chronic pelvic pain . She is requesting for diagnostic laparoscopy as all conservative measures failed. She has previous history of multiple surgeries like appendicectomy , myoemctomy , cystectomy Your consultant decides Palmer point of entry is best suitable for her ,Where is Palmer’s point?

79.Mrs. Lovely , 4o year old, is in her first pregnancy  late booker.now she is 16 weeks pregnant . She is recently diagnosed as HIV positive not any medications as her Downs syndrome risk is high 1in 100. She is advised to get invasive prenatal tests .

Her prenatal tests suggestive of Downs  syndrome.

80.Ms. Tina, 21-year-old athletic woman with diabetes on a low-dose oral contraceptive comes to your clinic with irregular menses and bilateral breast discharge. On examination, Breast examination is enclosed with fat globules seen microscopically. She currently takes metoclopramide for delayed gastric emptying. A random serum prolactin level is 65 ng/mL.

Which of the following is most likely responsible for her hyperprolactinemia?

81. All are true regarding The McRoberts’ manoeuvre except

82.Mrs,Sami ,undergoing primary Cesarean  section, Haemorrhage is an uncommon complication.

How do you explain uncommon ?

83.Mrs.x. 19  year old, presenting with 2 episode of nausea  and vomiting , she is not dehydrated , able to tolerate orally,.requesting for antiemetics

84.30 year old lady presenting with excessive vaginal discharge white in colour  with fishy  odour .dClue cells on microscopy of wet mount .pH of vaginal fluid 4.8.Which  organism is causing this ?

85.Ms. Tina 16 year old  girl presented with absence of periods .she has a BMI of 19.with normal secondary sexual characteristics shows normal development .Her karyotype is 46XX.ultrasound -Absence  Of uterus , presence of ovaries .

Cause is

86.Mrs. A ,  28 year old woman in her third planned pregnancy was referred to the Early Pregnancy Assessment Unit. She has had two previous caesarean sections and is now 6-7 weeks gestation with a two day history of left iliac fossa pain and dark vaginal bleeding. An ultrasound scan showed an empty uterus, left adnexal mass and the serum BhCG level was 3,500 iu. She agrees to a laparoscopy. The findings are: normal uterus, both ovaries and right tube,.left tube distended by an unruptured ectopic pregnancy 4x5cm in diameter. There is blood trickling from the fimbrial end and approximately 200 ml of blood in the pouch of Douglas. What is your management ?

87.A 28-year-old woman dies at 47 days postpartum following aspiration during an epileptic seizure. She had a 10 year history of epilepsy.

What is the classification of this maternal death?

88.The engaging diameter in Brow presentation is

89.Mrs. Mishra, 67 year old complaining of frequency , urgency , nocturnal and urinary incontinence  referred by her GP who treated her with immediate release oxybutinin Tablets . She developed side effects and stopped treatment . She is smoker ,smokes  10cigarettes per day Urodynamic  study performed . Drinks glass of wine and 2 cups of coffee every  day , Filling cystometry is enclosed .whats your diagnosis ?

90.Mrs, Briganza , A 58 year old, sexually active, woman complains of a “ballooning” of tissue through the vaginal opening when she stands for long periods of time.  She had a vaginal hysterectomy 15 years previously for dysfunctional uterine bleeding.she is sexually active and she complains of mild Dysparuenia . On examination, she has a vault prolapse.

What is the  best definitive management for her ?

91.29. Mrs.X.  29-year-old woman,  P2L2 ,  has  had a rotational forceps delivery of  a  healthy  male infant  at  term  with  suspected extended    perineaL tear.in   theatre,  third degree  tear   (3b) is diagnosed . What suture material you would use to suture their tear ?

92.Mrs, suzy , A 48 year woman approaches you in the clinic as she has been having regular, troublesome hot flushes for past 5 months. Her last period was 2 weeks ago and they are regular.

Which is the most suitable type of HRT to start her on?

93.A 53-year-old Asian woman presents to her GP with PMB. She had a left mastectomy and axillary node dissection for breast cancer 4 years ago. She is currently on two medications: tamoxifen and anastrozole. She has been up to date with her smears and all her previous smears, including the current one, are normal. A TVS performed in the clinic reveals 5 mm endometrial thickness and normal ovaries. A recent breast appointment shows no clinical evidence of recurrence of breast cancer. Which is single most important next step in her management?

94. Ms.Tina, 20 yr old  presents with irritability , mood swings before periods affecting relationships .its affecting her quality of life and putting strain on her relationship with her boyfriend.

What is the best management ?

95. Your consultant is doing a diagnostic laparoscopy for a 30 year old woman who has presented to you with chronic pelvic vein. Your consultant has asked you to identify the marked structure. Identify the structure.

96. Mrs.Braganza , 24year old , 9 weeks of gestation presented with nausea and vomiting , she is a known case of  migraine  on Propranolol . She is mildly  dehydrated , able to tolerate orally well. urine ketone is negative, she is looking for conservative management 

What is the first line of management ?

97.Mrs.Rebecca , is in her first pregnancy now she is 9 weeks  pregnant .has presented with excessive nausea and vomiting .

What’s her diagnosis ?

98.Mrs.Tina.  34 year-old woman is admitted with  recurrent hyperemesis .she is  into her 8 weeks pregnancy . Her thyroid function tests are abnormal with a raised Free T3&T4  and low TSH. Select the most likely cause of her deranged thyroid function:

99.Ms. Suzy ,22 year old women present to the A&E with episodes of nausea and vomiting , she is unable to tolerate oral fluids .she is dehydrated . All of the following

 metabolic disturbances can be seen  except

100.Ms. Shahbana ,22 year old Rachel has come for a booking visit .Her ultrasound at    10 weeks  showed  herniation  of  gut  with  umbilical  cord  on  top  of  sac.   What is the probable Diagnosis?

101.Mrs. Xavier ,  is 32 year old primigravida 7 pregnant.she is here  for dating scan Trans abdominal scan shows CRL of 8.2mm and no cardiac activity noted. The sonographer   is sure of findings .

What advice would you give her ?

102.You are teaching your junior  about ultrasound features of early pregnancy . The  yolk  sac  is  the  first  structure  often  seen  within  the  gestational  sac  and  it  confirms  an  intrauterine pregnancy.Junior asks transvaginal  scan ,yolk sac  should  always  be  visualised  when  the  mean  gestational  sac  diameter  is

103.Mrs.Braganza , 24year old ,  9 weeks of gestation presented with  nausea and vomiting , she is a known case of  migraine  on Propranolol .

She is mildly  dehydrated , able to tolerate orally well.

urine ketone is negative ,

she is looking for conservative management 

You prescribe her Cariban  

Cariban is

104.Ms.Tanvi , 24year old ,  early pregnancy presented with  nausea and vomiting , she is a known case of  migraine  on Propranolol .She is mildly  dehydrated , able to tolerate orally well.urine ketone is negative ,she is looking for conservative management .what gestational age beyond which ondansetron can be used ?

105.Pregnancy-Unique  Quantification  of  Emesis  (PUQE)  index  score

106.Which infection is reported to be risk factor for second trimester miscarriage .

107.Mrs. Tina, is 30 year old , has presented with recurrent miscarriages . At22,24&26weeks .Painless dilation followed by expulsion of fetus.

What is the Cause of her miscarriages ?

108.Which infection is reported to be risk factor for second trimester miscarriage .

109.Mrs. Tina, is 30 year old , has presented with recurrent miscarriages . At22,24&26weeks .Painless dilation followed by expulsion of fetus.

What is the Cause of her miscarriages ?

110.All are true regarding  termination of pregnancy in Ireland except

111.Mrs, Roma , A 21 year old patient presents to the emergency department with sudden onset of severe lower abdominal and pelvic pain. History reveals she missed her last 2 periods. She normally has regular 28 day cycles. She smokes 5 cigarettes per day.

On examination – she has lower abdominal tenderness and on vaginal exam there is cervical tenderness.

Observations are as follows:

Temperature: 37.2 oC

Blood pressure: 90/54

Heart rate: 115 bpm

Respiration rate: 18 /min

Pregnancy test positive

What would be the most appropriate management of this patient?

112.1A 24-year-old nulliparous woman undergoes surgical management of a tubal ectopic pregnancy. At laparoscopy, the contralateral tube is examined and noted to be damaged. The woman has strongly expressed her concern about future fertility.

Which is the single best management option?

113.A 32-year-old primiparous woman presents to the emergency department with sudden onset of lower abdominal pain, mainly localised in the right iliac fossa. The pain is sharp in nature and is radiating to the right flank. Her last menstrual period was 8 weeks ago. A urine pregnancy test is positive. On transvaginal scan the right adnexa was seen to contain an ectopic pregnancy measuring 22 mm x 18 mm x 15 mm with cardiac activity and an absent haemoperitoneum. Vital signs on arrival are:

blood pressure = 128/68 mmHg

pulse = 72 beats/min

temperature = 36.5°C

respiratory rate = 16

hCG level = 5000 iu/l.

What is the treatment of choice for this woman?

114.A 24-year-old P0 woman at 6 weeks of gestation presents to the emergency department with a 2 week history of brown vaginal discharge. On transvaginal scan, the left adnexa is seen to contain an ectopic pregnancy measuring 20 mm x 14 mm x 10 mm with absent fluid in the pouch of Douglas. Vital signs on arrival were:

blood pressure = 118/68 mmHg

pulse = 72 beats/min

temperature = 36.5°C

respiratory rate = 18.

Vaginal examination is negative for cervical excitation.

On her recent blood tests serum βHCG was 527 ui/l.

What is the treatment of choice for this woman?

115.A 24  year old with 7 weeks pregnancy presented  with abdominal pain and spotting. She has previous history of surgical termination of pregnancy complicated by infection in post op period.her Beta Hcg is 1750IU /L

USG Shows gestational  measuring  25x24mm  present below internal os, with absent sliding sign with vascularity around Gestational sac in Doppler

116.The general practitioner calls you out of hours to ask what to do because she has an eight-week pregnant woman who is complaining of moderate right abdominal pain and slight vaginal bleeding. What is your advice?

117.All of the following Factors that increase Perinatal Fisk transmission risk except

118.Mrs.x is a primigravida with 34 weeks of pregnancy . She is HIV positive as well as Hepatitis B positive .her CD4count is 400×106/ml.What is the appropriate management ?

119.Mrs.X is HIV positive who is Elite controller , is presenting at 34 weeks of gestation . HerCD4 count is 400×10^6/ml . Viral load is 40copies/ml. what is the best treatment for perinatal transmission ?

120.Mrs.X, in 38Weeks pregnancy is HIV Positive woman who presented with labour pain .she is 4cm dilated with regular contractions .her viral load is 1002 copies/ml.

What is the best route of delivery to decrease perinatal transmission ?