Antenatal Care Platinum Extra Questions EMQ

Option List

A. Amniotic fluid volume and umbilical artery Doppler in 1 week
B. Amniotic fluid volume and umbilical artery Doppler in 2 weeks
C. Amniotic fluid volume and umbilical artery Doppler twice per week
D. Biophysical profile
E. Continue low- risk pathway
F. Ductus venosus Doppler
G. Growth scan in 3–4 weeks
H. Growth scan, amniotic fluid volume
I. Growth scan, amniotic fluid volume and umbilical artery Doppler
J. Growth scan, amniotic fluid volume and umbilical artery Doppler in 2 weeks
K. Middle cerebral artery (MCA) Doppler
L. Serial growth scans from 28 weeks
M. Umbilical vein Doppler
N. Uterine artery Doppler at 18 weeks
For the following clinical scenarios, choose the most important ultrasound scan investigation or action to take next. Assume that you are in a hospital where fetal medicine scanning is available. Each option may be used once, more than once or not at all.

1. A 28-year-old woman has a growth scan as her previous baby was born with a weight below the 5th centile. She is now at 28 weeks of gestation. The growth scan for obstetric history shows that the estimated fetal weight (EFW) is on the 50th centile. Amniotic fluid volume and umbilical artery Doppler are normal.

2. A 32-year-old woman in her first pregnancy is seen at 28 weeks of gestation. She has had a growth scan due to a symphysis fundal height measurement below the 10th centile. The growth scan shows an EFW of <5th centile with normal amniotic fluid volume and umbilical artery Doppler.

3. A 26-year-old patient is seen in the antenatal clinic. She is at 29 + 5 weeks of gestation and has a symphysis fundal height below the 10th centile. She has an ultrasound scan that shows EFW below the 5th centile and a normal amniotic fluid volume with absent end- diastolic flow in the umbilical artery. The CTG is normal.

4. An 18-year-old woman in her first pregnancy has a growth scan at 28 weeks of gestation due to her high BMI of 37 kg/m2. The growth scan shows an EFW 2 standard deviations with end diastolic flow positive.

Option List

A. Arterial blood gas
B. Compression duplex ultrasound
C. Continue treatment and repeat scan in 7 days
D. Computed tomography pulmonary angiography (CTPA)
E. D-dimer
F. ECG and chest X- ray (CXR)
G. Full blood count (FBC), urea and electrolytes (U&E), liver function test (LFT), coagulation test
H. Magnetic resonance venography
I. Refer back to midwife- led care
J. Start prophylactic low-molecular-weight heparin (LMWH)
K. Start therapeutic dose LMWH
L. Start unfractionated heparin
M. Stop treatment and repeat scan in 3 days
N. Stop treatment and repeat scan in 7 days
O. Thrombophilia screening
P. Ventilation/perfusion (V/Q) scan
For each of the following clinical scenarios, select the most appropriate next step in management from the list of options above. Each option may be used once, more than once or not at all.

5. A 34-year-old patient is seen in the obstetric triage unit out of hours at 26 weeks of gestation with acute pain, tenderness and swelling of her left leg. She is otherwise well with no chest pain or shortness of breath

6. A 38-year-old patient is seen at 22 weeks of gestation with acute swelling and pain in her right calf. She was started on a therapeutic dose of LMWH and has had a Doppler ultrasound scan that is negative for deep vein thrombosis (DVT). She remains symptomatic.

7. An 18-year-old patient at 35 weeks of gestation has presented with chest pain and shortness of breath. She has a sinus tachycardia and CXR is normal. Laboratory investigations are normal and she has been started on LMWH.

8. A 42-year-old patient is seen at 18 weeks of gestation with chest pain, mild shortness of breath and a swollen left leg. Baseline investigations including bloods, CXR and ECG are normal. She has a duplex ultrasound the same day that confirms left-sided femoral DVT.

9. A 23-year-old patient is referred by the midwife at 38 weeks of gestation with chest pain and shortness of breath. The symptoms resolve but the CTPA scan report states: ‘No evidence of embolus in the segmental or subsegmental pulmonary tree, unable to exclude smaller peripheral emboli on CTPA.’

Option List

A. Alternate days
B. At least four times per day
C. Daily
D. Fortnightly
E. Hourly
F. More than four times per day
G. Once only
H. Three times per week
I. Twice per day
J. Twice per week
K. Weekly
For each of the following clinical scenarios, select the single most appropriate frequency to monitor the requested parameter. Each option may be used once, more than once or not at all.

10. A 33-year-old woman is in her first pregnancy at 34 weeks of gestation. She has a blood pressure of 164/108 mmHg that is treated with oral labetalol as an inpatient. Her urinary protein : creatinine ratio is 26 mg/mmol. How often should urinary protein quantification be repeated?

11. A 28-year-old woman is in her first pregnancy at 32 weeks of gestation with a blood pressure of 154/103 mmHg with urinary protein : creatinine ratio of 22 mg/mmol. Treatment with labetalol is commenced. How often should her blood pressure be checked?

12. A 36-year-old woman is in her second pregnancy with dichorionic diamniotic (DCDA) twins at 30 weeks of gestation. Her blood pressure is 153/98 mmHg on two occasions. Her urinary protein : creatinine ratio is 89 mg/mmol. Initial blood tests for FBC, U&E and LFT are normal. How often should these blood tests be repeated?

13. A 29-year-old woman in her first pregnancy has been diagnosed with severe gestational hypertension at 30 weeks of gestation. She has an ultrasound scan that shows a normal growth, amniotic fluid volume and umbilical artery Doppler. How often should the scan be repeated, assuming the growth remains normal and stable?

Option List

A. 10 + 0 weeks
B. 12 + 0 weeks
C. 14 + 0 weeks
D. 16 + 0 weeks
E. 18 + 0 weeks
F. 20 + 0 weeks
G. 24 + 0 weeks
H. 28 + 0 weeks
I. 32 + 0 weeks
J. 34 + 0 weeks
K. 35 + 0 weeks
L. 36 + 0 weeks
M. 37 + 0 weeks
N. 38 + 0 weeks
O. 39 + 0 weeks
For each of the following clinical scenarios pertaining to multiple pregnancy, choose the single most appropriate gestational age from the list above. Each option may be used more than once, more than once or not at all.

14. A 24-year-old woman is referred to the antenatal clinic. She is uncertain of her last menstrual period and is thought to be in the second trimester. An ultrasound scan shows a twin pregnancy. Ideally, by what gestational age should chorionicity have been determined?

15. A 34-year-old woman is found in the first trimester to have an MCDA twin pregnancy. From what gestational age should serial ultrasound scans commence?

16. A 30-year-old woman is found in the first trimester to have a DCDA twin pregnancy. From what gestational age should serial assessment of fetal weight commence?

17. A 25-year-old woman is seen in the antenatal clinic with a DCDA twin pregnancy. It has so far been uncomplicated. From what gestational age should delivery be offered if it remains uncomplicated?

18. A 38-year-old woman is known to have an uncomplicated triplet pregnancy following IVF. From what gestational age should delivery be offered?

Option List

A. Antenatal booking blood tests including hepatitis C screen
B. Antenatal care by consultant obstetrician
C. Clitoral reconstruction
D. Immediate deinfibulation procedure
E. Immediate risk assessment about child safeguarding
F. Inform the police or social services
G. Intrapartum deinfibulation
H. Midwife-led antenatal care
I. Refer to mental health services
J. Refer to safeguarding midwife
K. Review in the presence of a professional interpreter
L. Thorough examination of the genitalia
Each of the following clinical scenarios relates to a woman with FGM in pregnancy. For each patient, select the single most appropriate advice about the next step in management from the list above. Each option may be used once, more than once or not at all.

19. A 22-year-old married British woman of Somali origin attends the consultant antenatal clinic following her routine fetal anomaly scan. She gives a history of having undergone FGM as a young girl at the age of 12 years and suffers from lack of sensation during sexual intercourse. Her 5-year-old son was born via uncomplicated vaginal birth and lives with the woman and her husband.

20. A 19-year-old woman in her first pregnancy is a new arrival in the UK. She attends the early pregnancy unit complaining of lower abdominal pain and vaginal spotting during the past week. There is no bleeding at present. Her home pregnancy test was positive a few weeks ago. She has not yet registered with a GP and does not have a community midwife. A female friend is accompanying her and reveals that the woman had undergone a procedure suggestive of FGM in her early childhood in Africa.

21. A 29-year-old woman in her first pregnancy at 40 weeks of gestation attends the obstetric day assessment unit following a fall onto her abdomen. She has been booked in another hospital and is currently a visitor on holiday in the locality. She gives a history of FGM for which she was to undergo a deinfibulation procedure at 38 weeks of gestation in the hospital where she is booked but was unable to attend. She is not keen on undergoing an examination of her genitalia and wishes to deliver in her own hospital. An abdominal examination and CTG are normal.

22. An obstetric registrar is asked to review a woman in the hospital accident and emergency department with a history of amenorrhoea for 2 months complaining of acute-onset lower abdominal pain. On questioning, she reveals that she was forced to undergo FGM a week ago. Examination reveals a remarkably distended bladder and evidence of freshly healing vulval wounds.

Option List

A. Combined spinal epidural analgesia
B. Inpatient treatment with oral labetalol
C. Intravenous diazepam
D. Intravenous hydralazine
E. Intravenous labetalol infusion
F. Intravenous magnesium sulfate 2–4 g
G. Intravenous magnesium sulfate 2 g loading dose, followed by infusion of 2 g/hour for 24 hours
H. Intravenous magnesium sulfate 4 g loading dose, followed by infusion of 1 g/hour for 24 hours
I. Intravenous phenytoin
J. Oral nifedipine
K. Preload with intravenous 500 ml crystalloid, followed by epidural analgesia
L. Preload with intravenous 500 ml crystalloid, followed by intravenous hydralazine
Each of the following clinical scenarios relates to severe hypertension in pregnancy. For each patient, select the single most appropriate option of management from the list above. Each option may be used once, more than once or not at all.

23. A 32-year-old woman at 37 weeks of gestation has had an eclamptic seizure and is currently receiving treatment with intravenous labetalol. A magnesium sulfate infusion has been running for the last 6 hours. Her blood pressure is 150/100 mmHg, urine output is 200 ml in the last 4 hours and her blood test results are within normal limits. She now has a second eclamptic seizure.

24. A 42-year-old woman has been admitted at 33 weeks of gestation with vomiting and is subsequently found to have severe pre- eclampsia. She is a known asthmatic on treatment with inhaled salbutamol and steroids. Her blood pressure is 170/110 mmHg and urine output is 140 ml in the last 4 hours. Her platelet count is 100 × 109/l. She appears well and her deep tendon reflexes are normal.

25. A 24-year-old woman at 32 weeks of gestation attends the midwife- led antenatal clinic and is found to have a blood pressure of 156/106 mmHg. Urine testing with an automated reagent- strip reader shows proteinuria of 2+ and a spot urinary protein : creatinine ratio of 30 mg/mmol.

Option List

A. Abdominal examination
B. Abdominal ultrasound scan
C. Bimanual vaginal examination
D. CT scan
E. Imaging at 28 weeks of gestation
F. Imaging at 32 weeks of gestation
G. Imaging at 36 weeks of gestation
H. MRI scan
I. Positron emission tomography (PET) scan
J. Speculum examination
K. Transvaginal ultrasound scan
L. Ultrasound scan with colour Doppler
M. Ultrasound scan with power Doppler
For each of the following clinical scenarios, select the single most appropriate management option from the list above. Each option may be used once, more than once or not at all.

26. A 32-year-old woman has her detailed anatomy scan at 20 weeks of gestation. The placenta is situated posteriorly, and it is suspected that the placental edge covers the internal os of the cervix.

27. A 32-year-old woman with a BMI of 35 kg/m2 who has had two previous caesarean sections is found to have an anterior placenta at her 20 - week scan and further imaging is arranged at 32 weeks of gestation. The findings are similar but the quality of the ultrasound image is poor.

28. A 28-year-old woman in her first pregnancy has a detailed scan at 20 weeks of gestation. This suggests that the placental edge is 1 cm from the internal cervical os. These findings are confirmed by a transvaginal scan. The pregnancy is otherwise uncomplicated.

Option List
A. Chlamydia trachomatis
B. Cytomegalovirus
C. Group A Streptococcus
D. Group B Streptococcus
E. Hepatitis B virus
F. Hepatitis C virus
G. Herpes simplex virus type 1
H. Herpes simplex virus type 2
I. Human immunodeficiency virus (HIV)
J. Human parvovirus B19
K. Listeria monocytogenes
L. Neisseria gonorrhoeae
M. Rubella virus
N. Toxoplasma gondii
O. Treponema pallidum
P. Varicella-zoster virus
Q. Zika virus
For each of the following clinical scenarios, select the organism that is the most likely cause of infection from the list above. Each option may be used once, more than once or not at all.

29. A woman experiences low- grade fever in the first trimester of pregnancy but does not seek medical advice. Later during her antenatal care, the fetus is noted to be SGA and is delivered at 38 weeks of gestation following induction of labour. At birth, the infant is noted to be jaundiced with a petechial rash. There is hepatosplenomegaly and microcephaly.

30. A woman who is an asylum seeker in the UK first presents for antenatal care at 36 weeks of gestation. Although it is difficult to determine the precise gestational age, the fetus appears to be small for dates. The woman delivers vaginally at 39 weeks of gestation. The fetus has congenital cataracts and microphthalmia. An echocardiogram shows pulmonary artery stenosis with a patent ductus arteriosus.

31. A British couple visit Cuba for their honeymoon and shortly afterwards the woman finds she is pregnant. For religious beliefs, the couple decline all screening tests. The woman delivers at term. The baby is found to have microcephaly and ventriculomegaly.

Option List
A. Autosomal dominant
B. Autosomal recessive
C. Balanced translocation
D. Maternal non-disjunction
E. Mitochondrial inheritance
F. Mosaicism
G. Paternal non-disjunction
H. Robertsonian translocation
I. Sporadic mutation
J. Triploidy
K. Unbalanced translocation
L. X-linked dominant
M. X-linked recessive
N. Y-linked
For each of the following conditions, give the most common genetic aetiology from the list above. Each option may be used once, more than once or not at all.

32. Down’s syndrome

33. Haemophilia A

34. β-Thalassaemia

35. Huntington’s disease

36. Duchenne muscular dystrophy

Option List
A. 1
B. 2
C. 3
D. 4
E. 5
F. 6
G. 7
H. 8
I. 10
J. 20
K. 25
L. 30
M. 65
N. 70
O. 100
P. 105
Q. 110
R. 120
For the following patients with antenatal haematological problems, choose the correct value from the list above to answer the question. The required unit is indicated in the question. Each option may be used once, more than once or not at all.

37. A 21-year-old woman is readmitted with an antepartum haemorrhage with a low placenta. She had a recent blood sample sent to the laboratory for group and screen during her last admission. Within how many days should this sample have been sent to be used for the provision of blood?

38. A 22-year-old woman has been found to be anaemic at 28 weeks of gestation. Below what threshold of haemoglobin (in g/l) should supplementation with oral iron be commenced?

39. A 38-year-old woman with β- thalassaemia trait has a haemoglobin level of 95 g/l. Haematinic studies are requested on a sample of her blood. Below what threshold of ferritin (in μg/l) should iron supplementation be commenced?

40. A 28-year-old woman is seen in the antenatal clinic. Her booking blood tests show a normal haemoglobin, but she is found to be iron deficient with a ferritin level of 5 μg /l. What daily dose (in mg) of elemental iron should be prescribed?