1
Q
How should levothyroxine dosage be managed in early pregnancy for a woman with known hypothyroidism?
A
Increase dose to 125 micrograms per day.
2
Q
How long should a woman avoid pregnancy after radioactive iodine therapy for hyperthyroidism?
A
6 months.
3
Q
Which anti-thyroid medication is associated with causing aplasia cutis congenita in the fetus?
A
Carbimazole.
4
Q
Which immunosuppressant drug is contraindicated in pregnancy for a renal transplant patient?
A
Sirolimus.
5
Q
What is the recurrence rate of acute pyelonephritis during pregnancy?
A
0.2
6
Q
What is the recommended time interval to wait before conceiving after a renal transplant?
A
24 months (2 years).
7
Q
Which statement is true about pemphigoid gestationis?
A
It is associated with other autoimmune diseases.
8
Q
What is the most likely diagnosis for an itchy rash on the abdomen with umbilical sparing in a primigravida with twins?
A
Polymorphic eruption of pregnancy (PEP).
9
Q
What is the most likely diagnosis for a woman at 36 weeks with RUQ pain
A
deranged LFTs
10
Q
What is the risk of recurrence for Acute Fatty Liver of Pregnancy (AFLP) in a subsequent pregnancy?
A
0.25
11
Q
Which statement is true when counselling a woman with Intrahepatic Cholestasis of Pregnancy (IHCP)?
A
The risk of recurrence in subsequent pregnancies is about 90%.
12
Q
Which vaccine should be recommended preconceptionally for a woman with Sickle Cell Disease?
A
Pneumococcal vaccine.
13
Q
Which yearly screening test is NOT indicated for a woman with Sickle Cell Disease?
A
Red cell antibody screening.
14
Q
Which statement is true regarding young women with Beta Thalassaemia Major?
A
Cardiac failure is the primary cause of death in more than 50% of cases.
15
Q
Which statement is true about Idiopathic Immune Thrombocytopenia (ITP) in pregnancy with a platelet count of 70?
A
Neonatal thrombocytopenia occurs in approximately 25% of cases.
16
Q
Which autoantibody is associated with congenital heart block in the fetuses of women with SLE?
A
Anti-Ro antibodies.
17
Q
What is the most appropriate thromboprophylaxis in pregnancy for a woman with APS and a previous VTE?
A
Higher dose LMWH antenatally and for 6 weeks postpartum.
18
Q
Which thrombophilia defect is associated with the highest risk of VTE in pregnancy?
A
Antithrombin deficiency.
19
Q
What is the correct one-hour post-meal capillary plasma glucose target for a pregnant woman with Type 1 diabetes?
A
7.8 mmol/L.
20
Q
At what HbA1c level should a woman with Type 1 diabetes be strongly advised not to get pregnant?
A
Above 86 mmol/mol (10%).
21
Q
What is the most appropriate initial management for gestational diabetes with a fasting glucose of 7.0 mmol/L at diagnosis?
A
Diet + exercise + insulin ± metformin.
22
Q
In which scenario should anti-D prophylaxis be given to an RhD-negative woman after postpartum hemorrhage?
A
After transfusion of RhD-positive platelets.
23
Q
Which initial mental health screening tool is recommended at the antenatal booking appointment?
A
Two depression identification questions.
24
Q
What is the risk of postpartum psychosis for a woman with bipolar disorder and a previous episode?
A
Greater than 1 in 2 (more than 50%).
25
What is the advice for a woman on tamoxifen (after breast cancer) who wishes to conceive?
Stop tamoxifen and wait for 3 months before trying.
26
What is the recommended management for early-stage breast cancer diagnosed at 12 weeks of gestation?
Proceed with surgical treatment.
27
For how long is a pregnant woman considered infectious after chickenpox exposure if she received VZIG?
From 8 to 28 days after exposure.
28
From what gestation should an HIV-positive woman with genital herpes start daily suppressive acyclovir to reduce transmission risk?
From 32 weeks onwards.
29
What is the approximate risk of neonatal HSV transmission with primary genital herpes occurring late in the third trimester?
0.4
30
What is the management for PPROM at 33 weeks in a woman with recurrent genital herpes lesions?
es be managed?
· A: Steroids + erythromycin + oral acyclovir + consider induction of labour at 34 weeks.
31
Which factor has the highest predictive value for placental abruption?
Abruption in a previous pregnancy.
32
How much does the risk of placenta praevia increase for a woman with three previous caesarean sections?
More than 20 times higher.
33
What is the recommended timing for cerclage suture removal in a woman with PPROM at 32 weeks?
Give steroids and consider delayed removal for 48 hours.
34
What is the management for a nulliparous woman with an incidentally found short cervix (18 mm) at 23 weeks?
Offer prophylactic vaginal progesterone.
35
What percentage of polyhydramnios cases are idiopathic?
50%–60%.
36
What is an important aspect of management for unexplained polyhydramnios?
A thorough neonatal survey should be performed after birth.
37
· Q: What stage of TTTS is defined by oligo/polyhydramnios with visible donor bladder and normal Dopplers?
·
Stage 1
38
What is the risk of recurrence for a 3rd or 4th degree perineal tear?
5%–7%.
39
Which aneuploidy is most commonly associated with the prenatal 'double bubble' sign?
Down syndrome (Trisomy 21).
40
What is the first step after finding an increased nuchal translucency (4.5 mm) at the 12-week scan?
Referral for ultrasound by a fetal medicine specialist.
41
Which aneuploidy is suggested by a first-trimester screen showing low PAPP-A and high free beta-hCG?
Trisomy 21 (Down syndrome).
42
What is the risk for the children of a female carrier of Duchenne muscular dystrophy?
A 50% (1 in 2) chance her sons will be affected.
43
What is the risk of intrauterine transmission with a primary maternal CMV infection?
30%–40%.
44
What is the recommended delivery plan for a preterm SGA fetus (<32 weeks) with absent end-diastolic flow on umbilical Doppler?
Delivery by caesarean section by 32 weeks.
45
What is the recommended delivery plan for an SGA fetus at 36 weeks with normal umbilical artery Doppler?
Induction of labour at 37 weeks.
46
Which statement about mastitis is correct?
Mastitis may occur in the absence of bacterial infection.
47
What is the immediate action for postnatal depression with suicidal ideation?
Ensure urgent assessment by the perinatal mental health team.
48
Which antidepressant is considered safer during breastfeeding?
Sertraline.
49
Which NSAID has the best safety profile for postpartum pain relief?
Ibuprofen.
50
When can LMWH be given after removal of an epidural catheter post-caesarean?
At least 4 hours after catheter removal.
51
What is the recommended cord clamping time for a stable preterm baby (33 weeks)?
Wait at least 30 seconds
52
What postnatal test is advised for a woman who had gestational diabetes?
Fasting blood glucose at 6–13 weeks postpartum.
53
What is the appropriate repair technique for a partial-thickness external anal sphincter tear?
End-to-end method.
54
What is the likely diagnosis for a well-defined parietal swelling after ventouse delivery?
Cephalhaematoma.
55
What is the immediate drug of choice for active management of the third stage of labour?
Syntocinon (oxytocin) 10 IU intramuscularly.
56
What is the first step for a stable woman with a retained placenta?
Perform a vaginal examination to assess the placenta.
57
By what proportion does active management reduce the risk of postpartum haemorrhage?
By about 60%.
58
Which statement about mastitis is correct?
Mastitis may occur in the absence of bacterial infection.
59
What is the immediate action for postnatal depression with suicidal ideation?
Ensure urgent assessment by the perinatal mental health team.
60
Which antidepressant is considered safer during breastfeeding?
Sertraline.
61
Which NSAID has the best safety profile for postpartum pain relief?
Ibuprofen.
62
When can LMWH be given after removal of an epidural catheter post-caesarean?
At least 4 hours after catheter removal.
63
What is the recommended cord clamping time for a stable preterm baby (33 weeks)?
Wait at least 30 seconds
64
What postnatal test is advised for a woman who had gestational diabetes?
Fasting blood glucose at 6–13 weeks postpartum.
65
What is the appropriate repair technique for a partial-thickness external anal sphincter tear?
End-to-end method.
66
What is the likely diagnosis for a well-defined parietal swelling after ventouse delivery?
Cephalhaematoma.
67
What is the immediate drug of choice for active management of the third stage of labour?
Syntocinon (oxytocin) 10 IU intramuscularly.
68
What is the first step for a stable woman with a retained placenta?
Perform a vaginal examination to assess the placenta.
69
By what proportion does active management reduce the risk of postpartum haemorrhage?
By about 60%.
70
What is the presenting diameter in a brow presentation?
13 cm (Mento-vertical diameter).
71
What are the temperature guidelines for a water birth?
Water temperature should not exceed 37.5°C and be checked hourly.
72
What is a proven effect of adopting an upright position during labour?
It reduces the duration of labour.
73
A: : Which statement about opioid analgesics (e.g., remifentanil PCA) is true?
· A: It requires continuous monitoring of maternal oxygen saturations.
74
What is the recommended drug and dose for treating local anaesthetic toxicity?
Intralipid 20% intravenous bolus at 1.5 mL/kg over 1 minute.
75
What is most appropriate for preventing obstetric anal sphincter injuries (OASIS) during delivery?
Perineal protection at crowning.
76
What is the risk of umbilical cord prolapse with a breech presentation?
0.01
77
: With the vertex at +1 station (head not palpable abdominally), how is the operative vaginal delivery classified?
· A: Mid-cavity delivery
78
What is the initial management for threatened preterm labour at 26+4 weeks with bulging membranes?
Betamethasone injection and oral nifedipine.
79
· Q: What is the plan for a woman with a previous C-section, now at term with PROM, 1cm dilated, and not in established labour?
· A: Await events (no immediate intervention; continuous monitoring will start when labour establishes
80
What is the plan for exhaustion in the second stage with a suspected big baby and mid-cavity ROP position?
Trial of instrumental delivery in theatre.
81
How does induction of labour affect uterine scar rupture risk in VBAC compared to spontaneous labour?
The risk is two- to threefold increased.
82
Which suture material should be used to repair a torn anorectal mucosa?
3-0 Polyglactin (Vicryl).
83
What is the future risk of shoulder dystocia for a woman who has had one before?
Ten times higher than the general population.
84
What is the management for a mento-anterior face presentation at full dilatation with good progress?
Allow an hour for passive second stage.
85
· Q: A woman with an effective epidural has been fully dilated for 2 hours with no descent (vertex at -1). Contractions are 3/10. What is the next step?
· A: Commence Syntocinon augmentat
86
What is the management for a second twin in breech with cord prolapse and feet at the introitus?
Deliver by breech extraction.
87
What is the next step for shoulder dystocia if McRoberts and suprapubic pressure fail in a woman with an effective epidural?
Attempt internal manoeuvres.
88
What is the recommended drug for active management of the third stage of labour?
Syntocinon (oxytocin) 10 IU intramuscularly.
89
Which is an absolute contraindication for uterine artery embolisation (UAE)?
Asymptomatic fibroids.
90
Which statement about UAE counselling is false?
98% of patients will be symptom-free following UAE (actual rate is 80-90%).
91
Which test helps differentiate an adrenal from an ovarian androgen-secreting tumour?
Increased serum dehydroepiandrosterone sulphate (DHEAS) levels.
92
Which statement about Danazol is NOT correct?
It can cause osteoporosis with long-term use.
93
Which syndrome is a recognised cause of gynaecomastia?
Klinefelter syndrome.
94
What is a patient with high-grade cervical glandular intraepithelial neoplasia (CGIN) at increased risk of?
Adenocarcinoma of the cervix.
95
Q: What is the likely diagnosis for an older woman with an ovarian mass, ascites, and a pleural effusion?
.
· A: Meigs syndrome
96
Which risk is NOT appropriate to discuss during consent for a diagnostic laparoscopy?
The risk of death is 100/100,000
97
What is the likely skin condition in an older woman with fluid-filled blisters and complete uterine prolapse?
Bullous pemphigoid.
98
Which component is NOT part of Intralipid?
Sodium.
99
Which risk has NOT been reported with Intralipid administration?
Allergic reaction.
100
For which condition has Intralipid been reported to be beneficial?
Local anaesthetic toxicity.
101
Which statement about counselling for endometrial ablation is incorrect?
Dysmenorrhoea will be relieved.
102
When managing endometrial hyperplasia
which factor does NOT need to be determined?
103
What should be prescribed for severe vasomotor symptoms in a breast cancer survivor on tamoxifen?
Clonidine.
104
How is premature ovarian insufficiency diagnosed?
Elevated FSH levels on two blood samples taken 4–6 weeks apart.
105
Which is NOT an absolute contraindication for uterine artery embolisation?
Pedunculated fibroid.
106
Which action will NOT increase pregnancy risk for a woman using the Lactational Amenorrhoea Method (LAM)?
Increase in breastfeeding frequency.
107
Which statement about starting contraception postpartum is correct?
Progesterone-only pills (POP) can be safely started prior to 21 days postpartum.
108
Which statement about contraception for women with cardiac disease is correct?
The intrauterine device should be fitted in hospital if the risk of vasovagal reaction is high.
109
Which statement about COC use for a BRCA1 carrier with hypertension is NOT correct?
Her risk of ovarian cancer increases by 30% with COC use.
110
For a 14-year-old having a confidential TOP
which action is NOT appropriate?
111
Which condition is NOT UKMEC Category 1 for using the LNG-IUS?
Infections including past PID without subsequent pregnancy.
112
Which condition falls into UKMEC Category 3 for LNG-IUS use?
Past history of breast cancer with no recurrence in the last 5 years.
113
In which scenario does a woman need extra protection for 7 days after LNG-IUS insertion?
If she is partially breastfeeding
114
Which sample is NOT routinely indicated for forensic exam after sexual assault with anal penetration?
Anal canal swab.
115
Which is NOT a basic principle for consenting a 15-year-old for a termination?
Consent cannot be revoked by the patient at any time before treatment.
116
What should a doctor do for an unstable 15-year-old if parents refuse a life-saving blood transfusion?
Give blood transfusion to save the girl.
117
Which condition is NOT commonly caused by gonorrhoea?
Endocarditis.
118
Which statement about chlamydia is NOT correct?
Abnormal menstrual bleeding is not a symptom.
119
Which statement about chlamydia pelvic infection is NOT correct?
Barrier contraception helps to prevent re-infection.
120
What is the appropriate treatment for early syphilis diagnosed at 29 weeks of pregnancy?
Two doses of benzathine penicillin G to be given 1 week apart.
121
Which is NOT an indication for cerebrospinal fluid (CSF) examination in late latent syphilis?
Cardiovascular signs and symptoms.
122
What is the likely diagnosis for multiple painful vulval ulcers with ragged edges and tender inguinal lymph nodes?
Chancroid.
123
How should vulval and vaginal warts be treated in a woman at 16 weeks of pregnancy?
Trichloroacetic acid.
124
· Q: What is the likely diagnosis for an older woman on HRT with vulval itching, erythema, fissuring, and satellite lesions on the thigh?
· A:.
Candidiasis
125
What is the likely diagnosis for a frothy
fishy vaginal discharge with a red
126
· Q: What is the diagnosis for a thin, fishy-smelling discharge that worsens before periods, with a normal-looking vulva/vagina?
· A: Bacterial vaginosis.
127
What is the likely cause of frothy yellow discharge and lower abdominal pain where the organism is seen moving in a saline wet mount?
Trichomonas vaginalis.
128
Q: What is the likely diagnosis for a thin, homogenous vaginal discharge where a wet mount smear shows 'clue cell
s'?
· A: Gardnerella vaginalis (the bacteria causing Bacterial Vaginosis).
129
For which condition can Pre-implantation Genetic Diagnosis (PGD) NOT be offered?
Down syndrome.
130
Which condition is NOT a risk associated with Down syndrome (Trisomy 21)?
Spina bifida.
131
Which feature is NOT associated with Down syndrome?
Congenital deafness.
132
What is the genetic makeup and origin of a complete molar pregnancy?
Diploid: two paternal sets.
133
Which genetic syndrome is incorrectly matched with its gene mutation?
Peutz-Jeghers syndrome: PMS2 (it is caused by STK11).
134
What chromosomal abnormality is most common with truncus arteriosus?
Chromosome 22q11 deletions (DiGeorge syndrome).
135
In which scenario is a male child NOT at risk for haemophilia A?
A male child whose father has the deficient gene.
136
Which statement about foetal isoimmune anaemia is true?
Middle cerebral artery Doppler waveforms accurately predict foetal anaemia.
137
Which statement about triploidy is NOT correct?
Three sets of diploid chromosomes (it is three sets of haploid chromosomes).
138
Which condition is NOT transmitted in an autosomal dominant manner?
Xeroderma pigmentosum (it is autosomal recessive).
139
Which condition is an exception
manifesting only when homozygous?
140
Which condition is an exception
manifesting in heterozygous individuals?
141
Which condition is NOT a cause of azoospermia?
Down syndrome.
142
Which condition is a recognised indication for ovum (egg) donation?
Turner syndrome.
143
What yields the best pregnancy rate for a woman with premature ovarian failure?
Ovum donation.
144
Which is NOT a risk factor for having a twin pregnancy?
Personal history of monochorionic twins.
145
Which factor will NOT reduce the success rate of an IVF pregnancy?
Consumption of less than one unit of alcohol twice a week.
146
Which statement about the success rate of artificial insemination is NOT true?
Fresh sperm gives a higher conception rate with intracervical insemination (ICI) than with intrauterine insemination (IUI).
147
Which semen analysis parameter is abnormal according to WHO reference values?
pH: 7.12 (should be ≥7.2).
148
Which result indicates a high ovarian response to gonadotrophin stimulation in IVF?
Anti-Müllerian Hormone (AMH) of 25.5 pmol/L.
149
How should a couple with unexplained subfertility (normal tests) be initially managed?
Advise regular unprotected intercourse at least three times a week.
150
What is the next step for a woman with subfertility and a BMI of 35?
Lifestyle modifications and advise weight loss.
151
How should a left unruptured tubal ectopic pregnancy be managed laparoscopically if the other tube is healthy?
Left salpingectomy.
152
What is the surgical management for a left ovarian torsion with a non-viable ovary?
Left-sided oophorectomy and peritoneal washings.
153
What is the risk of bladder injury during a caesarean section?
1 in 1000 women.
154
What is the approximate risk of maternal death from a planned caesarean section at 39 weeks?
13 per 100
155
What is the risk of uterine perforation during surgical evacuation for a missed miscarriage?
Up to 5 in 1000 women.
156
What is the recommended intra-abdominal pressure for inserting laparoscopic ports?
20 mm of Hg.
157
Which laparoscopic port sites require closure of the rectus sheath?
7 mm suprapubic port and 10 mm umbilical port.
158
Which statement about improving outcomes with abdominal incisions is NOT correct?
Closure of peritoneal surfaces decreases the risk of intestinal obstruction.
159
Which statement about the degree of perineal tears is incorrect?
First degree involves both skin and the transverse perineal muscle.
160
Which expectation might NOT be met after a NovaSure endometrial ablation?
Successful reduction in bleeding occurred in 98% of patients by 12 months.
161
What is the diagnosis for post-op straw-coloured drain fluid with creatinine similar to serum?
Lymphocele.
162
Which finding is NOT a sign of urinary tract injury post-op?
Only straw-coloured fluid in the peritoneal drain.
163
What is the most important initial investigation for suspected ureteric injury?
Intravenous urogram (IVU).
164
What is the recommended repair for a ureteric injury near the bladder edge?
Ureteric re-implantation into the bladder using a psoas hitch.
165
What is the immediate management for a symptomatic post-hysterectomy vault haematoma in a stable patient?
A: IV access, blood transfusion, antibiotics, withhold anticoagulants (Clexane), and close monitoring. (Conservative management is first-line for stable patients).
166
: Which condition is an exception, manifesting only when homozygous and NOT in heterozygous individuals?
· A: Fanconi anaemia. (It is autosomal recessive, requiring two copies of the mutant allele).
12. Condition NOT Requiring Homozygosity to Manifest
· Q: Which condition is an exception, manifesting in individuals who are heterozygous?
· A: Marfan syndrome. (It is autosomal dominant; one copy of the mutant allele is sufficient
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