M24

Question 1

Answer 1

B

Question 2

Answer 2

C

Question 3

Answer 3

A

Question 4

Answer 4

A

Question 5

Answer 5

D

Question 6

Answer 6

A (abd circumference 5th percentile but preserved head growth (most important))

Question 7

Answer 7

C

Question 8

Answer 8

C (HBGM should be FG < 6 and PPG < 7)

Question 9

Answer 9

D

Question 10

Answer 10

B

Question 11

Answer 11

C

Question 12

Answer 12

C

Question 13

Answer 13

C

Question 14

Answer 14

B (overactive bladder –> antimuscarinics (oxybutynin)

Question 15

Answer 15

B (adequate hydration and pain relief with an epidural will minimize risks of seizures in labor and provide maximum safety in the event of a seizure)

MgSO4 is for managing seizure
Pethidine = opioid (can induce seizure)

Question 16

Answer 16

A

Doxycycline is 1st line but not used in prengnacy due to AE

Question 17

Answer 17

C (candida –> use an azole to manage)

Question 18

Answer 18

B

Question 19

Answer 19

D

Question 20

Answer 20

D

Question 21

Answer 21

D

Question 22

Answer 22

D

Question 23

Answer 23

D

Question 24

Answer 24

B

Question 25

Answer 25

C (if gonodotrophins are elevated into the menopausal range a repeat FSH measurement is indicated in 1 month. If the result indicates that FSH is elevated a diagnosis of primary ovarian insufficiency can be established)

Question 26

Answer 26

B

Question 27

Answer 27

C

Question 28

Answer 28

A

Question 29

Answer 29

A

Question 30

Answer 30

B

Question 31

Answer 31

A (as endometrial thickness >4mm requires biopsy)

Question 32

Answer 32

B (Benign looking endometrial cells --> investigate if postmenopausal or >45 and symptomatic (e.g. AUB), treat as normal if < 45yo

Question 33

Answer 33

A

Question 34

Answer 34

C

Question 35

Answer 35

A

Question 36

Answer 36

A

Question 37

Answer 37

B

Question 38

Answer 38

A

Question 39

Answer 39

A

Question 40

Answer 40

B

Question 41

Answer 41

B

Question 42

Answer 42

A

Question 43

Answer 43

A

Question 44

Answer 44

A

Question 45

Answer 45

A

Question 46

Answer 46

B

Question 47

Answer 47

A

Question 48

Answer 48

C (vault smear done at 6 and 18 months post total hysterectomy)

Question 49

Answer 49

A (always offer screening first before invasive diagnostic testing) can also do NIPT/ chromosomal microarray

Question 50

Answer 50

A

Question 51

Answer 51

A

Question 52

Answer 52

B

Question 53

1. HT on enalapril, 8 week pregnant 2. 20/F G1P0 20 weeks gestation with chlamydia, currently on clindamycin 3. alpha thal carrier on folic supplement. low MCV 4. Female with 2 miscarriage prviosuly, known carrier of balanced translocation chromosome disorder

Answer 53

1. A 2. G 3. B 4. I

Question 54

1. Recurrent miscarriage, anti cardiolipin ab+. Now 8 weeks of pregnancy 2. G2P1 lady, contact with son who has chickenpox; herself asymptomatic and told you that she is not immune 3. HBV+ mother with high viral load at 28w 4. caucasian BMI 40 complete C section after failed IOL. Cant leave bed for 2 days due to pani, now ha SOB and vague chest pain. DVT picture.

Answer 54

1. B 2. H (as asymptomatic so VZIG single dose effective. If has vesicles --> than give acyclovir) 3. F 4. C

Question 55

1. 54/f PMB. TVUS found endometrial thickness 2.4mm and no lesion 2. 52/F PMB. TVUS found endometrial thickness 8.2mm with cystic lesions 3. 32/F HMB and clots. TVUS found 3.5 x 3.5 x 3.2cm well circumscribed hypoechoic lesion in anterior wall of uterus abutting the endometrium 4. 32/F with heayv painful menstruation. TVUS show posterior uterine wall thickening of 3.5cm. Endometrial thickness 5.6mm

Answer 55

1. B 2. D (if with atypia --> requires total hysterectomy) 3. G 4. A

Question 56

1. lady 36wk breech presentation wish vaginal birth 2. 35yo GA37 week multiple pregnancy DCDA. 1st twin cepahlic delivered vaginally. 2nd twin breech now. CTG shows reactive 3. 30yo GA 38 week with poorly controlled DM presented with unstbale lie. Wish vaginal delivery 4. 25yo GA32wk admitted for leaking. Speculum shows clear liquor and cord prolapse. Fetus shows persistent bradycardia

Answer 56

1. ECV 2. Assisted breech vaginal delivery 3. Admission for monitoring from 37w 4. Classical CS (as preterm so lower section of uterus not well formed)

Question 57

1. previous open myomectomy which breached endometrial cavity. Now presented with irregular contraction. Cervix 3cm dilated 2. 39 weeks gestation, lady with preeeclampsia. Had an epileptic fit when her cervix was 9cm dilated and now stabilized. FHR normal, now in labor 3. Induction of labor with 6 contractions per 10 minutes 4. F/26 nulliparous, pushed for 90 minutes in 2nd stage. On epidural analgesics. Reactive FHR. Contractions good. Cervix fully dialted. fetal station +2, 2cm caput, 1+ moulding

Answer 57

1. F 2. B 3. I (hyperstimulation of uterus normally from augmentation by oxytocin) 4.F

Question 58

1. young couple tried for half a year still cant concieve. all test normal 2. 37yo previous surgery saw adhesions. HSG shows bilateral blocked duct 3. Husband premature ejaculation, seen counsellor for 1 year still not good. wife all normal 4. Newly married, PCOS. No clinical signs of hyperandrogenism, no hormonal abnormality. BMI 22, follicles 18/22 in L and R ovary.

Answer 58

1. A 2. G (as advanced maternal age) 3. C 4. D

Question 59

1. lady with 6 weeks missed period, pregnancy test 1 week ago was positive. today have 1st checkup and TUCS does not hv intrauterine sac. HCG is negative. 2. lady with 6 weeks missed period, pregnnacy test 1 week ago was positive. Today have abd pain and bleeding, BP 80/30, HR 120bpm. TVUS shows absent intrauterine sac and right adnexal mass with moderate free fluid amount free fluid in POD 3. Similar scenario as above but stable vitals and HCV2500. Patient prefers not to have surgery 4. Lady with 6 weeks missed period, PT test one week ago positive. Today bleeding. Previous spontaneous miscarriage 6 months ago

Answer 59

1. C 2. F 3. D 4. G (use progesterone in cases of threatened miscarriage in women who had history of miscarriage)

Question 60

1. 20yo unprotected sex after party within 24 hours 2. 45/F heavy smoker with menorrhagia and anemia has trypanophobia 3. 45/F G4P3 plan to have elective CS later at 39 weeks of gestation. Completed family 4. History of CA breaast treated 2y ago, wants contraception, dont want surgery

Answer 60

1. H 2. D 3. I 4. F (only option for CA breast --> cannot use hormonal contraceptives or LNG IUD)

Question 61

1. 40/F with suction evacuation for complete molar pregnancy 2 weeks ago. Pre op HCG 100,000. 1 week later drop to 20,000 than rise to 25,000 in 2 weeks 2. 28/F microinvasive SCC found on LLETZ, 1x1x2mm with margin involvement 3. 70/F with recurrent ovarian cancer despite multiple lineage of chemotherapy, admitted due to SOB. cachexic and wheelchair bound. CXR found progressive lung met. Daughter wished active cancer tx 4. 29/F early stage 1a1 endometrial CA due to fertility wish, given mirena. Endometrail biopsy later found non atypical endometrial hyperplasia

Answer 61

1. A 2. H 3. E 4. D

Question 62

1. 28yo 10 day post partum increase lochia, antepartum unremarkable, fever 38.5. Tender uterus, os closed 2. young lady has asthma, postpartum after elective. delivered placenta. profuse uterine bleeding, uterus soft 600ml blood loss. IV syntocinon full rate not responsive. BP 80/30 3. uterus 14w size os still open, no fever haemodynamically unstable 4. multiple STOP, controlled cord traction for 15min and still attached --> bleeding os open

Answer 62

1. K (to rule out RPOG with concomitant infection) 2. I 3. C 4. J