Antenatal Care(platinum)-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?