Obstetric MCQ pool Flashcards by Steph Peterson

Which structures do you incise during a episiotomy?
a. Ischiocavernosus and bulbocavernosus
b. Bulbocavernosus and superficial transversus perineii
c. Ischiocavernosus and superficial transversus perineii
d. Iliococcygeus and pubococcygeus
e. Iliococcygeus and ischiococcygeus

B
Ischiocavernosus – crura of clitoris → inferior pubic ramus; Bulbocavernosus – cover vestibular bulbs,
perineal body → clitoris; Superficial transverse perineal muscle – perineal body → ischial tuberosity

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Which are the muscles that are cut by a midline episiotomy
f. Iliococcygeus
g. Transverse superficial peronei
h. Bulbocavernosus
i. Pubocavernosus

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What structures would you not meet when repairing a 3rd degree tear?
a. Bulbocavernosus
b. Ischiocavernosus
c. External anal sphincter
d. Superficial transverse perinei
e. Deep transverse perinei

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Crossing over of chromosomes occurs in:
a. Both prophase of mitosis and meiosis
b. Meiotic prophase 1
c. Metaphase 1
d. After ovulation

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Relaxin is produced from:
a. endometrium
b. myometrium
c. chorioamniotic membranes
d. corpus luteum
e. syncytiotrophoblast

D
Relaxin is produced by the corpus luteum, decidua and placenta (UTD). Speroff states that the major
source of relaxin is the corpus luteum although it is produced at other sites

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Relaxin, incorrect option
a. Main production from corpus luteum
b. Not associated with adverse outcome if not present
c. Similar to growth hormone
d. RCT has not shown that it is useful for ripening the cervix

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All of the following hormones have a similar structure EXCEPT:
a. inhibin A
b. inhibin B
c. TSH
d. AMF
e. Activin

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EGF – endothelial growth factor
a. Was first isolated from frog skin
b. Reaches high levels in the fetal circulation
c. Causes respiratory distress by inducing epithelial overgrowth in neonatal lungs
d. In high doses induces excessive growth of hair or wool
e. Its receptors are stimulated by TGF- alpha

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In pregnancy compared to the non-pregnant state:
a. Thyroxine remains the same
b. Free T3 increases
c. Total T3 increases
d. Thyroid binding globulin decreases

Thyroxine increases, T3 increases, thyroid binding globulin increases (Nelson-Piercy)
Answer C?

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Which of the following is not produced by the fetus?
a. oestrogen
b. insulin
c. ACTH
d. TSH

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What compound is at the greatest concentration in blood in physiological conditions?
a. Carbon dioxide
b. Bicarbonate
c. Carbonic acid
d. All are at equal concentrations

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Maternal blood gases in late pregnancy, all except?
a. alkalosis
b. low bicarbonate
c. base excess greater

C
Alkalosis and low bicarbonate are normal

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Respiratory function in pregnancy – all except?
a. Increased tidal volume
b. Decreased functional reserve capacity

B - decrease in functional residual capacity

Respiratory function in pregnancy changes with an increase in tidal volume and reduced functional
residual capacity

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In pregnancy all of the following increase except
a. Tidal volume
b. Respiratory rate
c. Minute ventilation
d. Residual volume
e. Oxygen consumption

Tidal volume, minute ventilation and oxygen consumption increase; respiratory rate remains stable;
residual volume (do they mean functional residual capacity?) falls

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. Which hormone increased near labour, all except?
a. oxytocin
b. oestrogen
c. progesterone
d. CRH

C
Labour may be precipitated by progesterone withdrawal (C&R)

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With advancing gestation the uterus gets more receptors for, or increased sensitivity to, incorrect option
a. CRH
b. Oxytocin
c. Beta agonists

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Which is wrong in late pregnancy?
a. increase LH
b. increase oxytocin
c. increase aldosterone
d. increase CRH

A
Progressive increase in CRH, oxytocin and aldosterone

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24 hr uterine activity monitoring show peak in 3rd trimester:
a. midnight
b. early am
c. ~ 5pm

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Oxytocin : all are true except**
a. It is a nanopeptide
b. Oxytocin receptors are found in decidua
c. Stimulates influx of Ca2+ across the plasma membrane in smooth muscle
d. all are true

D
Oxytocin is made up of nine amino acids (therefore is a nanopeptide); receptors are found in the decidua;
increases the intracellular calcium concentration both from entry into the cell and release from the
sarcoplasmic reticulum

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Regarding syntocinon, which is true?
e. Causes hypernatraemia
f. May cause hypotension in mother
g. Water intoxication is seen because it is given in 5% dextrose
h. Should be given in 5% dextrose to reduce risk of electrolyte incompatibility

B
May cause water intoxication due to its ADH type actions.

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Regarding AVP, which is true?
a. The main determinant of fetal heart rate variability
b. Causes increased fetal urine output to protect umbilical cord with amniotic fluid
c. Is produced in the right atrium under the influence of stretch receptors
d. Causes fetal tachycardia secondary to peripheral vasoconstriction
e. Is released in response to haemorrhage

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Which change is considered normal/physiological in preg (correct option)
a. Raised Alk phos
b. Decreased albumin
c. Increased urea

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Placental sulphatase deficiency associated with
a. X linked
b. Premature labour
c. Psoriasis
d. All the above
e. None of the above

A
Placental sulphatase deficiency can be otherwise known as X-linked ichthyosis and usually manifests as
scaling of the skin. Can be associated with an inability to labour rather than preterm birth.

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Regarding nitric oxide: which is wrong
a. Contracts smooth muscle
b. Equally effective at 48 hrs as Ventolin
c. Acts via cyclic GMP

A
Potent vasodilator; is as equally effective as a tocolytic as salbutamol at 48 hours in prolonging delivery.

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Regarding smooth muscle contraction, which is wrong: a. Voltage dependent Ca channels b. Receptor mediated calcium channels c. Smooth endoplasmic reticulum uptake of calcium (?release)

C The sarcoplasmic reticulum releases calcium; the sacrolemma has both potential dependant calcium channels and receptor mediated channels (B&L

Regarding stimulation of myometrial muscle contraction which is wrong? a. Voltage dependant Ca channels b. Receptor dependant Ca channels c. Smooth endoplastic reticulum uptake of calcium d. Myosin related calmodulin receptor kinase

Placentation. Which is true? a. Complete feto-placental circulation established by 5-6 weeks post conception b. Two waves of endothelial cytotrophoblast invasion is finished by 10/40 c. Of uterine blood flow 55% is to placenta, rest to myometrium/endometrium/deciduas d. Blood leaves fetus to go to placenta via 2 arteries and 1 vein and flow is 350 ml/min e. Flow in cord is 150 ml/min

A The flow through the cord is 350ml/min; placentation is complete by 14 weeks; 85% of uterine blood perfuses the intervillous space Two waves of endothelial cytotrophoblast invasion is finished by 14/40 Of uterine blood flow 80% is to placenta, rest to myometrium/endometrium/deciduas

. Fetal vessels with highest p02 in utero a. IVC at heart b. SVC at heart c. Umbilical artery d. Ductus arteriosis e. Pulmonary artery

A Oxygenated blood flows from the umbilical vein into the IVC either via the ductus venosus or the hepatic veins. The IVC enters the right atrium and goes through the foramen ovale into the left atrium and into the ascending aorta. The order would be – IVC at heart, SVC at heart, ductus arteriosus, pulmonary artery, umbilical artery.

What is the fetal scalp PaO2 at term? a. 22 mmHg b. 32 mmHg c. 42 mmHg d. 52 mmHg e. 62 mmHg

What is the cord pH at term immediately after a normal labour and delivery?** a. Vein 7.3, artery 7.27 b. Vein 7.27, artery 7.3 c. Vein 7.5, artery 7.2 d. Vein 7.2, artery 7.5

. The vessel which carries the most oxygenated blood in the fetus is the a. IVC as it enters the heart b. SVC as it enters the heart c. Pulmonary artery d. Umbilical artery e. Renal vein

. Streaming of blood in the fetal IVC result in: a. More oxygenated blood being directed through the foramen ovale to the left atrium b. Deoxygenated blood from the coronary sinuses being directed to the aorta c. Deoxygenated blood being directed to the left lobe of the liver d. Oxygenated blood travelling in the right ventral portion of the IVC

. Regarding fetal cardiac output: a. Half the output of the right ventricle is directed to the ductus arteriosus b. 40% is directed to the placenta c. 1/3 is directed to the brain via the carotids d. The right and left ventricles have equal outputs e. Half the right ventricular output is directed to the pulmonary artery

B 3% goes to the heart; right 65%; left 35%: 10% to lungs Brain gets 26%

Cardiovascular changes at birth? a. Brain is organ which receives most dramatic increase in blood flow b. Foramen ovale is a flap valve which becomes functionally closed when LA pressure > RA pressure c. Prostaglandins have minor role in physiological closure of ductus arteriosus d. Pulmonary vascular resistance and pulmonary blood flow decrease

. In newborn, normal circulatory changes include all except: a. Increased flow in pulmonary vein b. Increase in left arterial pressure (?atrial) c. Increase in pulmonary vascular resistance d. Increase renal blood flow e. Decrease ductus venosus flow

Circulatory transition from foetal to extrauterine life, which is true?** a. Gas expansion leading to dramatic increase in pulmonary vascular resistance and increase pulmonary blood flow b. Doubling of previous return c. Occlusion of the cord leads to a large flood of blood to the placenta is interrupted causing decrease in systemic BP d. PGE1 causes closure of ductus arteriosis e. Ductus venosus oxygen tension decreases

E PGs keep the DA open (NSAIDS inhibit PG synthesis and therefore close DA)

. How many weeks post conception does NT close? a. 4 b. 6 c. 8 d. 10 e. 12

A Closure occurs between the 25th and 27th day post-conception

Fetal lungs: a. Are 80% of the volume that they will be immediately after birth b. Lung movement is required for the production of surfactant c. The pressure in the trachea is less than that in amniotic fluid d. None of the above

D Pressure is slightly higher at the trachea to prevent collapse

The fetal auditory system: a. Is fully myelinated by term b. Can detect sounds by the end of the first trimester c. The basal portion of the cochlea matures before the apical portion d. Can detect high frequency sounds better than low frequency e. Sound is transmitted via the ossicles through the air filled middle ear

C Fetal ear is well developed by mid-pregnancy and the fetus can hear some sounds in utero as early as 24- 26 weeks. Myelination of the spinal cord continues to occur throughout the first year of life. (Williams)

With respect to the fetal auditory system, which statement is correct? a. High pitched sounds are heard best b. Depends on movement of ossicles in the air-filled middle ear c. Has completed myelination by the time of birth d. The cochlear membrane develops from the basilar end to the apical end

Average weight of a 28-week neonate with no adverse factors? a. 400 g b. 850 g c. 1100 g d. 1350 g e. 1600g

C The average fetal weight at 28 weeks is 1196gm with 5th to 95th centiles being 670 – 1977gm. 28 1.1 32 2.2 36 3.3

. Blood volume of term neonate? a. 200 ml b. 400 ml c. 600 ml d. 800 ml e. 1000 ml

B 78ml/kg = 234-273ml for 3-3.5kg neonate (Williams); 110-115ml/kg if you include placenta

What is the blood volume of a newborn baby weighing 3500g? a. 150 ml b. 250 ml c. 300 ml d. 350 ml e. 400 ml

Blood volume of normal 3.5kg neonate: a. 100ml b. 150 ml c. 400 ml d. 500 ml e. 1000 ml

A multiparous woman at 36 weeks has haemoglobin of 6.8. The fetus will have haemoglobin of? a. 8 b. 10 c. 12 d. 16 e. 20

D Fetal haemoglobin is 106 at 16 weeks gestation and 144 at forty weeks gestation (50th centile). At 36 weeks the fetal haemoglobin should be around 138. It should be largely unaffected by maternal haemoglobin levels. The average term cord Hb is 160 (140-200). Normal fetal Hb is 7.8 + (0.19 x gestation).

Predominant Hb type in neonate? a. HbA b. HbA2 c. HbF d. HbH

What contributes most to AFI in late gestation? a. fetal swallowing b. fetal urination c. transudation across membranes

Re amniotic fluid. Which is correct?** a. Volume increase to a maximum of 750-1000ml at 40 weeks b. It becomes iso-osmotic with maternal plasma by term c. It is increasingly hypo-osmotic to maternal plasma with decreased Na, Cl and K towards term d. Urination and lung fluid contribute equally to production near term e. Volume is regulated by fetal swallowing which begins when skin is keratinised

Amniotic fluid during gestation a. Osmolality increases throughout gestation to become iso-osmolar with maternal serum at term b. Has a low chloride and low protein content c. Reaches a maximum volume of 750-1000 mls at 40 weeks

The fetal kidney: a. Is just as responsive to aldosterone as the adult kidney b. Produces hyperosmolar urine c. Responds to hyperosmolar mannitol by increasing GFR to excrete the osmotic load

A Fetal urine osmolality decreases towards term.

. Fetal urine amount related to? a. fetal weight 30% of body weight b. gestational age

B 30% of body weight

Thyroid hormone: a. Increase immediately after birth in pre-term but not term infants b. Increases at birth due to a surge of TSH c. Cause shivering but not non-shivering thermogenesis d. Is essential for normal fetal development e. The active form in the fetus is reverse T3

B T4 is stimulated by a surge in TSH at birth, in response to temperature and clamping the cord. Preterm infants undergo similar changes but at a smaller magnitude. There is an reverse T3 in the fetus but it is not active.

Behavioural state 2F is characterised by: ** a. Eye movements, fetal breathing movements and frequent heart rate accelerations b. Absent gross body movements but frequent eye and breathing movements c. Absent eye, breathing and gross body movements associated with decreased heart rate variability d. Occurs most of the time at term e. High voltage, slow wave EEG pattern

A Behavioural state 2F (active sleep) is characterised by frequent gross body movements, eye movement continually present, fetal heart rate with a wide oscillation bandwidth and frequent accelerations during body movements. Predominates at term - 40% of the time at term

The “D” antigen first appears on RBCs at a. 5w b. 8w c. 12w d. 16w e. 22w

A According to UTD the D antigen is expressed by 30 days gestation

Which is not true? a. Normal non-pregnant, non-menstruating iron requirement is 1mg/day b. Normal non-pregnant, menstruating iron requirement is 2mg/day c. Normal pregnant requirement 8mg/day d. 10% of iron from diet is absorbed in non-pregnant e. Cord ferritin is higher than maternal ferritin

C Menstruating iron requirement is between 1-2mg per day absorbed dose, male iron requirement is 1mg. Iron requirements during pregnancy are 6-7mg/day. Iron absorption is 30% if haem and 10% in nonhaem. (UTD and Williams). Recommended intake is 30mg /day (CONSUMPTION). If deficient increase to 60mg/day ABSORPTION requirement in preg is 4-5mg day 18% of iron is absorbed from a mixed diet (10% from a vegetarian diet) Heme iron = iron from meat – absorption = 30% Non heme = from iron rich foods – absorption = 10%

Which is true of iron metabolism a. Only 5% of her daily intake of iron is absorbed b. A pregnant woman requires 9mg/day c. A menstruating non-pregnant woman requires 2mg/day

C 30% of haem iron is absorbed whilst less than 10% of non-haem iron is absorbed Iron requirements during pregnancy are 6-7mg/day.

Which of these are true in pregnancy? a. Normal pregnant requirement of iron in 9mg/day b. Normal non-pregnant requirement of iron is 4 mg/day c. Cord ferritin is higher than maternal ferritin d. 10% of iron is absorbed from non-haem sources

With respect to iron requirements which is NOT CORRECT a. 1mg/day in non-menstruating women is adequate b. 2mg/day in menstruating women is adequate c. 9mg/day is required in pregnancy d. There is 5% absorption of iron in the GIT

C (vs D)

At routine CS the patient is noted to have pink/red excresences on the surface of the ovary. Most likely diagnosis: a. Decidual reaction b. Endometriosis c. Walthard’s nests d. Corpus luteum of pregnancy

A Walthard’s nests are an accumulation of epithelial cells found on the peritoneum of the tubes, ovarian hilum, mesosalpinx and mesovarium. They appear as white-yellow nodules reaching 2mm.

What is the average weight of the term placenta? a. 100g b. 450g c. 720g d. 1000g e. 1200g

B Placental weight is approximately one sixth fetal weight. It is probably about 500gm (Williams). Placental weight changes with gestation 1:4 at 27 weeks to 1:7 at term. 10th centile - 420gm; 90th centile – 632gm (UTD).

Which is category A drug? a. ondansetron b. Maxalon c. Augmentin d. phenytoin e. betamethasone

B and E

What is the criteria of calling a drug class B3 a. Animals study show a defect, the significance of which is unclear in humans b. Animal studies are lacking, but no evidence of defects c. Harmful effects in human suspected, but those effects are reversible d. Animal studies showed reversible defect

Before starting isotretinoin in a 16 year old check a. LFTs b. Full blood count c. Urine BHCG

. Which drug should not be used in lactation a. Amiodarone b. Warfarin c. Digoxin d. Propylthiouracil

Which is associated with increased miscarriage a. Isotretanoin b. Heroin c. Marijuana d. Heparin e. Cocaine

. Which is associated with IUGR a. Isotretanoin b. Heroin c. Marijuana d. Heparin e. Cocaine

Which is associated with placental abruption? a. Isotretanoin b. Heroin c. Marijuana d. Heparin e. Cocaine

Unbooked at 30/40. Fundal ht consistent with 34/40, abdominal pain, on examination uterus is firm and tender. Her friend says that she has been experimenting with street drugs recently. Most likely drug used: a. Heroin b. Marijuana c. LSD d. Cocaine

Side effects to fetus of indomethacin? a. prem closure of PDA b. polyhydramnios

Antenatal administration of indomethacin has all the following effects? a. Premature closure of ductus arteriosus b. Fetal kidney problems c. Reduced liquor problems d. All of the above e. None of the above

. Which drug is most likely to cause oligohydramnios? a. Captopril b. Verapamil c. Prazosin

Propranolol: actions? a. alpha, beta blockade b. beta blockade c. vasodilator d. none of the above

Labetolol: actions? a. alpha, beta blockade b. beta blockade c. vasodilator d. none of the above

Alpha methyl dopa: actions? a. alpha, beta blockade b. beta blockade c. vasodilator d. none of the above

D (alpha 2 adrenergic antagonist)

Regarding warfarin which of the following is correct? a. IV vitamin K reverse side effects in 15 seconds b. Can’t breast feed c. Can give epidural d. Normal dose paracetamol no serious side effects

Regarding warfarin anticoagulation in pregnancy: a. Reversed within 10 min of IV injection of vitamin K b. Paracetamol in therapeutic dosage has no adverse effect c. Monitored by whole blood clotting time d. Associated with NTD’s e. Breast feeding is contraindicated

Regarding warfarin. Which is true? a. It is only safe in second trimester b. It can be interfered with by therapeutic dose of paracetamol c. It is monitored with use of APTT d. Can be used in breast feeding

Side effects of oxytocin-receptor antagonist (ag atosiban) a. headache b. N+V c. Arthralgia d. None of the above e. All of the above

D Hypersensitivity and injection reactions only according to UTD

Most important diagnosis to know before giving PGF2a? a. PDA b. HT c. Asthma d. AV fistula

. All of the following patterns of inheritance are correct except: a. von Recklinghausen’s AD b. Huntington’s chorea AD c. Fibrocystic disease of the newborn AR d. Tay Sachs disease AD

D Autosomal dominant – von Recklinghausen’s (neurofibromatosis type I), Huntington’s chorea. Autosomal recessive – Tay Sachs disease,

Which type of inheritance is wrong? a. Duchenne muscular dystrophy – autosomal recessive b. Tuberous sclerosis – autosomal dominant c. Myotonic dystrophy – autosomal dominant d. Tay Sach’s disease – autosomal recessive

. Which disease is the wrong inheritance: a. Tay Sachs – AD b. Huntington’s – AD c. Achondroplasia – AD d. CF – AD

A and D

Which of the following conditions is autosomal recessive? a. Haemophilia A b. Cystic fibrosis c. Tuberous sclerosis d. Huntington’s chorea e. Adult polycystic kidney disease

B Haemophilia A is X-linked; Huntington’s, tuberous sclerosis and aPCKD are AD

. Which of the following is an autosomal recessive condition? a. Cystic fibrosis b. Huntington’s chorea c. Duchenne muscular dystrophy

Which genetic condition is NOT associated with an ethnic group a. Tay Sachs b. Von Willebrands c. Sickle cell d. Alpha-thalassaemia

Adopted girl whose natural mother dies of Huntington’s disease. The risk of her baby having the disease is: a. 50% b. 25% c. <1% d. none if it is a girl e. only if a boy

Fragile X syndrome a. occurs only in men b. Mendelian inheritance c. associated with premature menopause d. no phenotypic features e. none of the above

Pregnant woman’s brother has schizophrenia. Risk of schizophrenia in child? a. nil b. 1-2% c. 2-4% d. 5-10% e. 25% f. 50% g. 100%

Pregnant woman’s husband has schizophrenia. Risk of schizophrenia in child? a. nil b. 1-2% c. 2-4% d. 5-10% e. 25% f. 50% g. 100%

D Lifetime risk = 0.2-0.7% increased 10 fold if a parent affected

Your patient attends for menopausal advice, mentions her son has schizophrenia as has his partner and they are thinking of starting a family. Risk for child? a. nil b. 1-2% c. 2-4% d. 5-10% e. 25% f. 50% g. 100%

Commonest inherited condition a. Tay Sachs disease b. Hurler’s syndrome c. PKU d. Cystic fibrosis e. Congenital hypothyroidism

D CF – 1:2500, ChT – 1:5000, PKU – 1:14000; TSD – 1:36,000

. The husband of a normal female has Christmas disease. She gave birth to a son. What is the probability that he is affected? a. none b. 10% c. 20% d. 30% e. 50%

A Christmas disease is haemophilia B and is an X-linked recessive disorder. Therefore if the husband has the disorder there is no chance a son will have it given that the Y is inherited from the father. A daughter would be a carrier.

A woman’s previous son has Duchenne muscular dystrophy. What is the chance her current fetus is affected? a. 50% b. 25% c. 0% d. 10% e. 33%

Male with an X linked disease is married to a normal homozygous female. What chance do their children have of getting the disease?** a. 0% b. 6.25% c. 12.5% d. 25% e. 50%

A man has an X-linked disorder and his wife is homozygous normal. What is the chance that their two children will both be affected? a. 0 b. 1/2 c. 1/4 d. 1/16 e. 1/32

Meningomyelocoele is associated with: a. trisomy 21 b. Turner’s syndrome c. Trisomy 18 d. Arnold Chiari malformation e. Noonan syndrome

. A mother has two children, one with open spina bifida and the other with a myelomenigiocoele. What is the likelihood of recurrence? a. 1% b. 5% c. 10% d. 15% e. 20%

C The risk is approximately 5% (C&R) with one affected sibling and 10% with two affected siblings (UTD).

A patient has a termination of pregnancy at 18 weeks for an open neural tube defect. What is the risk of recurrent NTD in her next pregnancy? a. 1% b. 2% c. 5% d. 10% e. 50%

A woman who has a prior child with Spina bifida comes to see you 10w. What do you recommend? a. US 11w b. Start folate now c. CVS now d. Amnio 16w e. Reassure

.What is the recurrence rate of anencephaly after one affected child? a. 3% b. 5% c. 10% d. 20% e. 25%

US (picture given) at 17/40 shows ‘frog’s eyes’ (anencephaly) and maternal serum AFP 4 times above normal range. Following options in counselling parents? a. Defect unclear as not often seen at 17/40 b. Neonatal survival is poor (<48hrs) c. Prompt termination required to avoid serious maternal complications d. Fetus will survive, but with significant morbidity

.The recurrence risk of NTD after one affected pregnancy is a. <0.5% b. 1 in 1000 c. 1 in 400 d. 1 in 20 e. 1 in 5

.Incorrect karyotype for the stated condition is a. Klinefelters 47 XYY b. Turners 46 XO c. Superfemale 47 XXX d. CAH 46 XX

A or B

FDIU at term. Most likely abnormality statistically? a. Triploidy b. Trisomy 21 c. Trisomy 18 d. Trisomy 13 e. Turners’ syndrome

Which chromosomal abnormality doesn’t increase in frequency with increased maternal age? a. trisomy 21 b. trisomy 18 c. Turners XO d. XXY

You are counselling a 40 yo lady 10/40 for prenatal diagnosis. What do you say about the triple test? a. 1:250 is high risk, detecting 85% of Downs b. she has a 5% risk of Downs c. she has 4x risk of abnormal chromosomes on amniocentesis d. best done at 15-16/40

D The triple test has 69%-77% accuracy rate at 5%FPR. The background age risk is 1:90.

.Woman 16 weeks pregnant, requesting tests for genetic diagnosis, correct option: a. Perform amnio as too late for CVS b. 1/600 risk miscarriage with amnio c. Results with CVS more reliable than amnio

Regarding the triple test, which is true? a. 1% of women undergoing the test will be placed at increased risk category b. Most accurate at 15-16w c. Indicated for women at increased risk of Down’s syndrome d. Will pick up 90% of affected infants

B 5% at least in high-risk group.

.A woman has decided she wants prenatal diagnosis for Down’s syndrome and comes to see you at 16/40. In your discussion you should emphasise? a. Increased safety of CVS over amnio b. Increased accuracy of CVS over amnio c. Miscarriage rate with amnio at 16/40 is 1/600 d. CVS not generally performed as late as 16/40

Spontaneous mid-trimester abortion with amniocentesis? a. 1:100 b. 1:200 c. 1:350 d. 1:500 e. 1:1000

Triple screen is also useful to detect all except: a. Multiple pregnancy b. T13 c. T18 d. XO

Low serum AFP, oestrogen, HCG seen in? a. Downs syndrome b. Trisomy 18 c. Trisomy 13 d. Triploidy

B T21 - decreased AFP, UE3, increased BhCG; T 18 - decreased AFP, UE3 BhCG; T 13 – no significant pattern; Triploidy – AFP not relevant, decreased UE3 and BhCG

40yo woman in first pregnancy a. 3% chance of T21 b. 4% chance of chromosomal abnormality on amnio c. 2% chance of miscarriage after amnio d. 10% chance of miscarriage after CVS e. 1% chance NTD

B Risk of T21 is 1 in 90. Background risk of NTD is 1 in 1000. Risk of miscarriage after CVS is 6-7%, the rate after amnio is about 1 in 100. The rate of chromosomal abnormality is 1 in 40.

Risk of Down’s syndrome at age 40 a. 1 in 50 b. 1 in 100 c. 1 in 250 d. 1 in 20 e. 1 in 5

A couple presented for genetic counselling because her first child has trisomy 21. On karyotype testing, she was found to have a balanced translocation of 14/21. What is her risk of recurrence? a. 100% b. 50% c. 25% d. 10% e. 0%

D 10-15% according to UTD

Down’s syndrome is associated with all except a. long femur and humerus b. duodenal atresia c. increased nuchal thickness d. VSD e. ear abnormalities

Which of the following conditions is most likely associated with chromosomal abnormalities? a. PUJ obstruction b. VSD c. Gastroschisis d. Duodenal atresia e. Pulmonary stenosis

D Renal pyelectasis occurs in 10-25% of fetuses with Trisomy 21 and 1-3% of normal fetuses. PUJ obstruction has a weak association with trisomy 21. VSD has an overall rate of 46% and pulmonary stenosis 5%. Gastroschisis is not associated with an increased prevalence of chromosomal abnormalities (if isolated). 30% of infants with duodenal atresia have trisomy 21. (UTD).

Which of the following cannot be detected on routine US scanning? a. Hydrocephalus b. Exomphalos c. Cystic fibrosis d. Cleft palate

Which is not associated with aneuploidy? a. omphalocele b. gastroschisis c. CVS defect

Which of the following is least likely to be associated with aneuploidy? a. Duodenal atresia b. Omphalocoele c. Gastroschisis d. Mental retardation e. Congenital heart disease

The risk of omphalocoele being associated with a chromosomal abnormality is: a. <20% b. 30% c. 60% d. 80% e. >80%

C Chromosomal abnormalities are commonly associated with omphalocele, especially if there are associated abnormalities, intracorporeal liver or abnormal liquor volumes (50-70%). Fetal medicine foundation book states that 50%, 30% and 15% of fetuses with omphalocele at 12 weeks, 20 weeks and birth respectively have a chromosomal defect. Gastroschisis is rarely associated with chromosomal defects.

Exomphalos (omphalocele) is associated with: a. trisomy 21 b. Turner’s syndrome c. Trisomy 18 d. Arnold Chiari malformation e. Noonan syndrome

C Associated with trisomy 18 and 13 (C&R)

.An ultrasound examination reveals that your patient has a fetus with gastroschisis. You advise her that: a. The fetus has >30% chance of an associated chromosomal abnormality b. Surgical repair is successful in <20% of cases c. It is uncertain whether LUSCS confers any advantages over NVD d. The infant is likely to have severe mental retardation

A CVS for advanced maternal age reveals mosaicism. Do you counsel for? a. TOP b. Explain what likely phenotype is and allow patient to request a TOP c. Repeat the CVS d. Offer amniocentesis e. Ignore it as it is likely to be confined to the placenta

.USS at 28/40 shows ventriculomegaly with a cortical mantle thickness of 8mm. You advise: a. Prognosis bleak – TOP advised b. Prognosis is uncertain and await spontaneous labour c. Ventriculocentesis will cause brain damage d. Could be prevented by pre-conceptual folate

A 3cm unilateral choroid plexus cyst was found on routine antenatal US at 24 weeks. Which of the following is correct? a. reassure mother and no follow up required b. perform serial US and reassure mother is cyst remains the same c. cephalocentesis is indicated d. choroid plexus cyst is most commonly found in 3rd ventricle e. perform an amniocentesis to obtain fetal karyotype

A Choroid plexus cysts are a common finding (0.18-3.6%) with an association with trisomy 18 and other chromosomal abnormalities. It occurs in the lateral ventricles growing in the first trimester and have usually disappeared by the third trimester.

On 18 weeks US see bilateral choroid plexus cysts but otherwise fetus normal. Do you? a. Disregard as inconsequential b. Do immediate amnio c. Repeat scan in 4 weeks d. Recommend TOP

Babe with choroid plexus cysts, missing 2 fingers on each hand and cystic hygroma? a. Trisomy 21 b. Trisomy 18 c. Trisomy 13 d. Triploidy

A Cystic hygromas are associated with T21 and Turner’s syndrome

.What is this syndrome – choroid plexus cysts, cystic hygroma, absent 3rd and 4th digits? a. CMV b. Rubella c. T21 d. T18 e. T13 f. Turners syndrome

.Anechoic masses are seen in the fetal abdomen on US. Dx: a. Intestinal obstruction b. Cardiac abnormality c. Downs syndrome d. Renal aplasia e. Oesophageal atresia

None of the above

.Fetal cystic hygroma is most commonly associated with a. Trisomy 21 b. Trisomy 18 c. 45, X d. mosaicism e. 47, XXX

A Cystic hygroma is associated with Turner’s syndrome but statistically more often found in Down’s syndrome. To be picky – if diagnosed in 1st T the most common aneuploidy is T21 but if diagnosed in 2nd T 75% of cases are 45XO.

Which is wrong? a. 47XXY – Klinefelters b. 46 XO – Turners

A low AFP is associated with: a. trisomy 21 b. Turner’s syndrome c. Trisomy 18 d. Arnold Chiari malformation e. Noonan syndrome

A Low AFP is associated with trisomy 21, trisomy 18 and Turner’s syndrome

.Decreased AFP is seen in a. IUGR b. Fetal cystic fibrosis c. Closed spina bifida d. Rhesus isoimmunisation e. Pre-eclampsia

.Lady with past Hx of baby with NTD. Now has low AFP in this pregnancy. Normal 16/40 US. Repeat sample low AFP. Advise? a. reassure no NTD b. recommend amnio to check for trisomy c. repeat US

.A woman found to have an AFP level 0.2-0.3 multiples of the median at 16 weeks. This level is associated with? a. 47 XXY b. XXX c. Turners d. Trisomy 21 e. Mosaicism

.High AFP likely due to the following except: a. spina bifida occulta b. omphalocoele c. anencephaly d. FDIU e. Myelomeningocoele

A AFP does not detect closed NTDs

.Which of the following is a recognised cause of elevated serum AFP? a. Retro-placental bleed b. Duodenal atresia c. Closed NTD d. CF

16 weeks, AFP 4 times MoM, next step in management a. repeat the AFP b. amniography c. ultrasonography d. amniocentesis e. intra-amniotic installation of PGF 2 alpha

Lady with sister who has spina bifida. Amniotic fluid AFP 4.5 MOM after 16 weeks amniocentesis. US appeared normal and agreed with dates. Mx a. reassure all normal on US/no risk of fetal anomalies b. repeat blood AFP c. repeat US at 18 weeks d. advise TOP due to high risk of NTD

Which one does NOT elevate AFP in amniotic fluid? a. dead fetus b. myelomenigocele c. spina bifida occulta d. multiple pregnancy e. fetal blood mixed in sample

In a primigravida with congenital heart disease the fetus is at risk of: a. cardiac abnormality b. venous abnormality c. arterial abnormality such as coarctation d. cardiac, venous or arterial anomalies e. all abnormalities incl arterial, venous or cardiac

A Babies of mothers with CHD (or a family history) are at significantly greater risk of cardiac abnormalities (5% approxiamately compared to background risk of 5-8/1000 newborns). One third are the same as the maternal lesion with outflow tract lesions being more common to be inherited. No comment is made on arterial or venous abnormality. (UTD)

.Woman’s daughter has just had VSD successfully repaired age 18 months and asks what chance next baby has cardiac lesion? a. 1% b. 2-5% c. 10% d. 15% e. 50%

.A primigravida completed in a running marathon. On the day, the weather was very hot and she suffered from heat stroke. She was admitted to the hospital, diagnosed with hyperthermia. She was treated successfully with rehydration. Her last normal menstrual period was 4 weeks ago and her pregnancy test was positive. She came to you to obtain advice about the effect of this episode on her fetus. Which of the following is the fetus at risk of? a. VSD b. Gastroschisis c. Phocomelia d. Spina bifida e. Anencephaly

D Increased maternal core temperature during embryogenesis is associated with major abnormalities in animals. These include neural tube defects, micropthalmia, arthrogryposis, abdominal wall defects and limb deficiencies. Phocomelia is the absence of long bones with flipper like hands and feet. Four weeks gestation is a period where the CNS is highly sensitive. (UTD)

Exercise in pregnancy – 3km running, 3x /week in woman who has been doing it for years? a. not likely to cause fetal hypoxia b. not likely to cause adverse neonatal outcome

.A woman has a CXR at 16 weeks gestation. You tell her a. There is no proven adverse effect on the fetus b. She is at increased risk of miscarriage

.Which gives the most radiation exposure in the first trimester? a. IVP b. CXR c. Barium enema d. Cholecystogram

C Barium enema > Cholecytogram > IVP > CXR

.Which investigation delivers the greatest dose of radiation to an 8 weeks fetus? a. IVP b. CXR c. Cholecystogram d. Barium enema e. Lumbar spine series

D IVP – 400-900 mrad; CXR - <1 mrad; cholecystogram - ?; barium enema – 700-1600 mrad; 400-600

.What is worst advice re ETOH in pregnancy? a. nil is safest b. 1 drink per week is probably OK c. 1 drink per day is probably OK d. 2 drinks per day, 5x per week is probably OK e. isolated occasion < or = 1x per month of < or = to 10 drinks is OK after first trimester

Advice re alcohol in pregnancy? a) Only safe thing is not to have any b) Better to have none but no increase in FAS with one standard drink per day c) 3 standard drinks per day safe as long as there is no binge drinking d) A constant low intake best so the fetus is exposed to constant low levels

.Microcephaly, flat nose, thin upper lip, large distance between nose and lip. Which drug is culprit? a. ETOH b. Marijuana c. Cocaine d. Amphetamines e. Heroin

Regarding cocaine use in pregnancy, all true except? a. IUGR caused by excessive movements on coming off drug b. Constriction of uterine artery with cocaine c. Increased sympathetic tone in baby d. Decreased blood flow around baby

.An IV drug user on heroin first presents at 28/40 and is commenced on methadone 40mg daily. She is seeing you at 31/40. What should ongoing Mx plan be? a. Continue methadone at current dose until delivery b. Wean from now on, using promethazine to treat withdrawal symptoms c. Continue methadone but introduce low dose naloxone at 38/40 d. Continue methadone until labour then cease and use promethazine in labour e. Continue methadone but give IV naloxone infusion in labour

.Regarding substance abuse in pregnancy a. Dangerous to withhold narcotic drugs from heroin addicts b. Do not permit alcohol in the puerperium because it is transmitted in the breast milk c. Cocaine has less serious side effects than heroin d. Up to 50% incidence of prem labour and IUGR in women with heroin addiction

.At 30 weeks with clinical abruption and FDIU. Aggressive behaviour, increase BP, PR 110: a. Cocaine b. LSD c. Alcohol d. Heroin

.Which substance has a dose related effect on fetus? a. Heroin b. Cocaine c. Marijuana d. Alcohol e. Cigarettes

Which substance is known to cause placental abruption? a. Heroin b. Cocaine c. Marijuana d. Alcohol e. Cigarettes

Which substance is considered dangerous to use during pregnancy even in small amounts? a. Heroin b. Cocaine c. Marijuana d. Alcohol e. Cigarettes

Which substance decreases overall risk of preeclampsia? a. Heroin b. Cocaine c. Marijuana d. Alcohol e. Cigarettes

Smoking doesn’t cause? a. increase PET b. unemployment c. low attendance at ANC

A Smoking is protective against PET

A patient has bipolar affective disorder and is on lithium 900mg/day. Risks to fetus include: a. CNS anomalies b. Cardiac anomalies c. Renal anomalies d. Post maturity

B Lithium causes an increased risk of cardiac abnormalities (RR 1.2-7.7), no increased risk of NTDs and goitre.

A woman with bipolar affective disorder on lithium presents at 11/40. Serum lithium is 1.0 (therapeutic 0.9-1.4). She should be told? a. Lithium is suspected of causing heart defects b. To cease lithium now will decrease risk to baby c. To decrease dose will decrease risk to baby d. Should have CVS now e. Should have amniocentesis at 16/40

.Which drug has been shown to be harmful to the fetus during pregnancy? a. Metronidazole b. Heparin c. Azathioprine d. Thiazide diuretics

D Azathioprine is safe (fetal liver does not have the enzyme to convert to active form); thiazides can cause thrombocytopaenia, jaundice and electrolyte abnormalities.

Phenytoin is associated with all of the following except: a. IUGR b. Mental retardation c. Spina bifida d. Cardiac anomalies e. Cleft palate

C Phenytoin is associated with orofacial clefts, cardiac abnormalities and genitourinary defects (UTD). Some evidence exists that children taking anti-epileptic medications have lower IQ. Fetal hydantoin syndrome may cause IUGR. The least likely association is NTDs.

.What is phenytoin not associated with? a. mental retardation b. cleft palate c. spina bifida d. CVS defects

.A primigravida who is 3 months pregnant had in utero exposure to DES (herself). Advise: a. 3 monthly Pap smears to screen for clear cell Ca vagina b. 3 monthly Pap smears to screen for clear cell Ca cervix c. biweekly vaginal examinations because of high risk PTL d. elective CS at term because of high risk of cervical stenosis e. HSG

C Exposure to DES in-utero confers a 40 fold increased risk (1 in 1000-2000) of clear cell adenocarcinoma of the vagina and cervix and annual screening is recommended. There is an increased risk of preterm labour (RR 2.93), 2nd T miscarriage (RR 4.25) and 1st T miscarriage (RR 1.31) and surveillance is recommended. They are at increased likelihood of having an abnormal HSG. No comment on needing elective CS. (UTD)

Lady at 23/40 by dates and confirmed by early US, fundus > dates. Measurements on US c/w 23 weeks but polyhydramnios. What is the most likely diagnosis? a. omphalocoele b. meconium ileus c. polycystic kidneys d. duodenal atresia

D Duodenal atresia is the most likely diagnosis to cause polyhydramnios but omphalocele could plausibly create a gastrointestinal obstruction, as could polycystic kidneys if they were large enough.

.A fetus was terminated due to multiple fetal abnormalities. The body was shown to the parents. a. This will increase marital discordance b. Increase anger towards the obstetrician c. Promotes the process of grief reaction d. Increase fear of future pregnancy

Polyhydramnios will not be seen with? a. Congenital myasthenia gravis b. Myotonic dystrophy c. Duchenne muscular dystrophy d. Hydrocephalus e. Arthrogryposis

Intra-uterine fetal death at 18/40. Safest option? a. prostaglandins b. D&C c. Intra-amniotic saline/PG

.If you were discussing the safety aspects of ultrasound with a pregnant lawyer what would you emphasise? a. pulsed US b. angle of rays in = angle of rays out c. continuous US beam d. acoustic impedance

.Which of the following is true about Doppler waveform studies? a. It can be used as a screening test to identify pregnancies at risk b. A normal result excludes fetus compromised by hypertension and IUGR c. Growth retarded fetus may have reduced renal systolic flow d. It is only an indirect test for fetoplacental vascular bed e. A single result of high resistance flow indicates the need for delivery

A or C

Use of Dopplers in pregnancy a. assess blood flow in umbilical vein b. assess fetoplacental resistance c. assess blood flow in uterine artery

Strictly speaking the use of Doppler in pregnancy is used to assess blood flow in MCA, uterine artery, umbilical artery and ductus venosus. It is used indirectly to assess fetoplacental resistance.

.Considering Doppler flow studies. The S/D ratio is inversely proportional to: a. Maternal weight b. Gestational age c. Placental mass d. Size of infant e. None of the above

.Error of EFW on US at term: a. 5% b. 10% c. 15% d. 20% e. 25%

Which ultrasound features are the least accurate assessment of gestational age? a. BPD b. FL c. AC d. BPD/FL ratio

.In a low risk population undergoing US at 18/40 which type of abnormality will have the lowest pickup (highest false negative results)?** a. CVS b. Skeletal c. Gastrointestinal d. CNS e. Genitourinary

A CNS > cardiac > clefts

In a low risk population undergoing a routine 18 weeks US, which type of abnormality will have the lowest pickup rate? a. Cardiovascular system b. Musculoskeletal c. Gastrointestinal d. Central nervous system e. Dermatologica

E then A

.A US is performed at 28/40 and a hydrocephalic fetus with ventriculomegaly is diagnosed. The cortical thickness is 1 cm. Which of the following is correct? a. Ventriculoamniotic shunt b. Cervagem termination of pregnancy now c. Wait till 36/40 then LUSCS d. Commence on folic acid before conceiving next time e. Second weekly cephalocentesis to prevent further cerebral damage

The most commonly reported treatment of twin-twin transfusions are: a. observation alone b. NSAIDS c. Amnioreduction d. Ligation of connecting placental vessels

18 weeks gestation with IUGR a. Too late for CVS b. Risk of fetal loss with an amnio is 1/600 c. One benefit of a CVS is it may detect placental mosaicisms that may assist with the diagnosis

.A G4P3 with 3 NVD at term with BW approximately 3500g presents at 36w with fundal height of 31cm. US showed single fetus with BPD and AC consistent with 31w size. Liquor volume and BPS normal. What is the most appropriate management? a. LUSCS b. Cordocentesis for karyotype c. BPP and CTG weekly d. Reassure patient and change EDC e. BPP and CTG weekly and repeat US in 2 weeks

E This describes a symmetrically small baby with no history of previous placental insufficiency therefore high likelihood of aneuploidy. Amniocentesis may be indicated (? would change Rx) but not cordocentesis

.Para 3, all SVD at term weighing > 3600g. Now 36 weeks gestation with a 31 cm fundus. US BPD = 7.9 cm, BPP normal. Mx? a. Delivery by CS b. Karyotype the fetus c. Biweekly US to assess fetal growth d. Amniocentesis for L:S ratio

.A woman developed increasing pressure symptoms at 30 weeks. Known to have an O+ve blood group. On examination, fundus 35cm, fetal parts difficult to identify. The CTG has a baseline FHR of 200 bpm with no evidence of decelerations. No clinical evidence of chorioamnionitis. USS showed fetal pleural and pericardial effusions. What is your next step in management? a. Fetal pericardiocentesis b. Commence on oral digoxin c. Amniocentesis for fetal karyotype d. Delivery e. Observe and repeat US 2w

B The clinical picture is consistent with hydrops fetalis. The likely cause of the hydrops is a fetal tachyarrhythmia given that the FH is 200. The management of this would maternal administration of digoxin.

.What level of fetal Hb is associated with fetal hydrops a. 2 b. 4 c. 6 d. 8 e. 10

C Difficult question as depends on gestation! – a deficit of 7 gives hydrops Normal fetal Hb level = 7.8 + (0.19 x K) - which is roughly 0.19 x gestation in weeks – about 4 at 24 weeks, but 7.6 at term!.

.Fetal tachycardia, confirmed as SVT. Evidence of pericardial effusion and ascites on scan. Incorrect option: a. Steroids b. Digoxin c. Amiodarone d. Flecanide e. Delivery

E All are appropriate medications for treatment; Generally hydropic infants do poorly if delivered so aim for an intra-uterine fix

Suspected fetal hypothyroidism is best managed by? a. High dose of thyroid hormone to pregnant mother b. Intra amniotic injection of thyroid hormone c. Nothing until delivery then thyroid hormone to neonate

Management in suspected fetal hypothyroidism? a. give mother thyroxine b. intraamniotic thyroxine c. do nothing in utero but give thyroxine to neonate d. none of the above

A woman has SLE diagnosed during her pregnancy. Which of the following maternal antibody is most likely associated with fetal heart block? a. Anti SSA b. Anti SSB c. LA d. ACA e. Anti Ro

E Anti Ro (SSA) , Anti La (SSB) both cause CHB

.Which antibody is associated with congenital heart block? a. SSA b. Anti mitochondrial c. Anti smooth muscle d. Anti cardiolipin

.A woman with SLE consults you regarding the risk of congenital heart block if she has anti-Ro antibodies. An estimate of this risk is? a. <10% b. 20% c. 40% d. 50% e. >90%

Which of the following conditions is not associated with non-immune hydrops? a. fetal lupus b. trisomy 21 c. anti-c d. parvovirus B19 e. congenital toxoplasmosis

C Aneuploidy (10%), infections (including toxoplasmosis; 8%), and anaemia (including parvovirus; 10-27%) all cause NIHF. Fetal lupus can cause congenital heart block which would cause NIHF. Anti-c is not associated with NIHF (does cause immune hydrops)

There is a result of 40mL of fetal cells on Kleihauer at delivery of a negative woman. How much anti-D should be given? a. 1 vial b. 2 vials c. 5 vials d. 7 vials e. 10 vials

D One vial = 625 IU = 125mcg = 6ml fetal blood

What is the most correct response for a woman who is positive for Kell antibodies?** a. If intrauterine transfusion is required, it is okay to use the mother’s blood b. Amniocentesis with monitoring of the delta-OD 450 is an acceptable means of monitoring disease activity c. The commonest phenotype is Kk d. Kell antibodies affects erythroblasts as well as causing haemolysis

D The most common phenotype is kk (75%)

.A woman has positive Kell antibodies. Which is true? a. Amniotic fluid levels of bilirubin are not as reliable a marker of fetal anaemia with anti Kell as opposed to anti Duffy b. The commonest genotype in the community is Kk c. The baby can be given a transfusion with maternal blood d. Fetal anaemia is due to suppression of erythropoiesis as well as haemolysis

A or D

Kell antibodies are found in a primip at 12 weeks. The first step is to: a. Check husbands blood group b. Repeat level at 34 weeks c. Amniocentesis d. Ignore as this is the first pregnancy

With a Kell titre of 1:2056 at 19 weeks and husband karyotype KK all true except: a. Next step is fetal blood sampling b. Most Kell in population is found in heterozygotes c. Exchange transfusions have a lower mortality than intra amniotic transfusions

B 9% of whites and 2% of blacks have the kell antigen and almost all are heterozygotes

.A primigravida with a positive antibody screen shows anti-S Ab in the first trimester. Should you? a. Obtain paternal genotype b. Tell her not to worry as anti’s doesn’t cause haemolysis c. Quantify the titre d. Do US at 18/40 looking for early hydrops fetalis e. Repeat titre at 16/40

A Anti-S can be associated with haemolytic disease

.If woman has a titre of 1:16 at 12 weeks of anti-Fya, next step in management is a. US at 18/40 looking for hydrops b. Repeat titre at 16 weeks c. Check husbands karyotype d. Reassure that Fya is not associated with isoimmunization

C Titres as low as 1:8 are associated with disease (C&R)

.Question about Anti D antibody receptors a. Phagocytosis of the antibody into the cell b. IgG 1, sometimes IgG 1 and 3 c. FuC (?) receptors

B Anti-D IgG antibodies that are responsible for severe cases of HDN belong chiefly to IgG1 and IgG3 subclasses

With Rhesus incompatibility which is the most reflective of the fetal condition? a. Amniocentesis to detect the concentrations of bilirubin products b. Amniocentesis to detect anti-D antibody levels c. An USS to detect fetal well being d. Maternal antibody levels e. A detailed history of past pregnancies

Probably irrelevant now Answer: C – assuming MCA Doppler (otherwise A)

Most useful investigation of fetal condition in sensitised female who is RH negative? a. Maternal antibodies b. US c. Amniocentesis antibody titre d. Amniocentesis to measure bilirubin like compounds

Probably irrelevant now Answer: B

You have been referred a patient who has anti-D titres of 1 in 32 at 35 weeks gestation. What would be the most appropriate treatment? a. Do nothing b. Deliver at 35 weeks c. Intrauterine transfusion d. Amniocentesis

D C&R states that once the critical titre is reached (usually 32) MCA-PSV should be measured weekly. If there has been a previously affected pregnancy maternal titres are not predictive of the degree of fetal anaemia. Optimal options not present (again)

4.Your patient has an anti-D titre of 1:256 at 6w. The OD 450 at 28w is 0.08 (zone 1). The father is heterozygous for RhD. All of the following are correct except: a. Decreased OD 450 may mean the fetus is RhD negative b. Decreased OD 450 may mean the fetus is mild to moderately affected c. OD 450 is as good as US for predicting fetal erythroblastosis d. OD 450 levels are altered by polyhydramnios e. OD 450 levels are altered by bloody tap

No longer relevant Answer: C apparently

.A lady who is Rh negative has an anti-D level of 1:256 at 30 weeks. Amniocentesis was performed and sent for OD 450 studies. A level of 0.07 was noted. What is the next appropriate step? a. Repeat amniocentesis in 2 weeks b. Repeat anti-D level in 2 weeks c. Cordocentesis d. Commence on intraperitoneal transfusion e. Perform serial ultrasound

A OD 450 < 0.09 suggests mild or no disease; OD 450 > 0.15 suggests severe disease; Need to plot on graph to calculate next option

Last pregnancy complicated by Rhesus isoimmunisation and was delivered at 36 weeks. Baby required several exchange transfusions. In her current pregnancy, FBS should be commenced at: a. 18 weeks b. 26 weeks c. 28 weeks d. 30 weeks e. 32 weeks

B Now irrelevant but 10 weeks prior to last affected pregnancy

.A 32 year-old woman, G2P1 with one term delivery of a live infant. Her blood group is O neg. She is in her second pregnancy with an anti-D level of 1:32. At 30 weeks gestation. US exam is normal. What is your next step of management? a. Repeat anti-D level at 36 weeks b. Amniocentesis c. Cordocentesis d. Check the husband’s blood group e. Repeat the US at 36/40

A 32/40 multi is referred to you with an anti-D titre 1:4, last pregnancy uneventful. USS today displays a live fetus, no hydrops and anterior placenta. Do you order? a. CTG b. Cordocentesis c. Amniocentesis d. Repeat titre in 2/52 e. Elective LUSCS at 35-36/40

32 yo woman G2P1 with 1 term delivery of a live infant. Her blood group is O neg and she is at her 2nd pregnancy with an anti-D level of 1:4. At 30/40, US is normal. What is your next step? a. Repeat anti-D level at 36/40 b. Amniocentesis c. Cordocentesis d. Check the husbands blood group e. Repeat US at 36/40

.Which of the following antibodies is not associated with isoimmunisation? a. anti-C b. anti-Kell c. anti-Lewis d. anti-Kidd e. anti-p

All a cause of haemolytic disease of newborn except: a. Kell b. Duffy c. Lewis d. ABO

Which Ab does not cause haemolytic disease of the newborn? a. Anti FYa b. Anti P c. Anti K

Which of the following blood antigens are associated with fetal erythroblastosis EXCEPT: a. Lewis b. I c. Kell d. Kidd e. Duffy

A or B Lewis and I antibodies do not cross the placenta

4.Which is most incorrect statement regarding the accepted management of ITP? a. LUSCS of no benefit to fetus with known severe thrombocytopenia b. Fetal risk can be determined by maternal anti-platelet antibody titre c. Fetal risks increased if mother has Phx of splenectomy d. Fetal scalp sampling shouldn’t be used because of risk of bleeding e. Maternal steroids should be given if the maternal count drops below 100

B or E

.ITP, correct option: a. Caesarean section is not helpful in known severe fetal thrombocytopenia b. FBS should not be attempted due to risk of bleeding from puncture site c. Splenectomy decreases the likelihood of correlation between maternal and fetal platelet counts d. Maternal antiplatelet ab levels correlate with incidence of neonatal platelet levels

MG presents unbooked in early labour. Platelet count is incidentally noted to be 90000. Management? a. Allow to labour and anticipate vaginal delivery b. LUSCS c. Assess fetal platelet count (scalp or cordocentesis) d. Plasmapheresis

32 yo G4P3 with 3 previous uneventful pregnancies and deliveries arrives in labour at term and if found to have platelet count of 85. Otherwise NAD. Most acceptable management is: a. Normal delivery and neonatal platelet count b. LUSCS c. LUSCS to avoid mid-cavity forceps d. Fetal blood sampling

Mainstay of treatment for neonatal allo-immune thrombocytopenia is? a. Steroids b. Intrauterine platelet transfusion c. Maternal immunoglobulin

.Alloimmune thrombocytopenia, management, correct option: a. IV immunoglobulin b. Plasmapheresis c. Prednisolone d. Betamethasone e. Fetal platelet transfusion

What is the frequency of PLA1 negative in women? a. 0.0005% b. 0.0002% c. 0.002% d. 0.02% e. 2% f. 20%

E Otherwise known as HPA-1a antigen, involve in NAIT. UTD

.The common cause of non-bacterial fetal infection is? a. Toxoplasmosis gondii b. Rubella c. CMV d. Syphilis e. HSV

Which state has the greatest clinical infection of Candida? a. 1 st trimester b. 2 nd trimester c. 3rd trimester d. Post partum e. Post menopause

.Asymptomatic bacteruria in pregnancy – which is wrong? a. common association with urinary tract abnormality b. PTL c. 5-10% incidence d. with no treatment 20-30% acute pyelonephritis

Acyclovir may be used with what infection in pregnancy? a. Rubella b. CMV c. Varicella d. Toxoplasmosis

.A primigravida at 16 weeks develops primary genital herpes. Most important management is: a. analgesia b. acyclovir c. Herpes antibodies detection d. Serial obstetric US e. Counselling about recurrence in pregnancy

B Antiviral therapy will reduce pain, length of symptoms and duration of viral shedding. If primary herpes is already diagnosed serology will not add to diagnosis (analgesia would be second-line). Serial USS are probably unnecessary as although congenital infection occurs it is rare. Counselling is important but probably not as important that treatment.

A 21 yo primigravida at 30 weeks gestation presents with an acute primary episode of HSV2 of the vulva. Which is the most important? a. Treat with acyclovir b. Treat with tetracycline c. Local symptomatic treatment d. Counselling regarding the long term risks of recurrence e. Plan for CS for delivery

A patient has a secondary attack of herpes at 38w. She is not in labour and the membranes are intact. Which is correct? a. expectant management b. perform CS now c. perform CS when in labour d. commence acyclovir e. expect vaginal delivery and prophylactic acyclovir to the newborn

You have been looking after a pregnant patient who has a past history of recurrent genital herpes. She presents to you at 38 weeks with a herpes lesion which has been confirmed with viral culture. Your management is? a. Immediate CS b. Await spontaneous labour or ROM and perform a CS then c. Culture the cervix weekly and allow vaginal delivery when culture are negative d. Await SROM or spontaneous labour and assess the lesion then and decide on mode of delivery based on the lesion at the time

.A 20yo woman has an attack of genital herpes at 20 weeks. She is now 38w pregnant and has developed another attack. Management: a. CS immediately b. Wait until 40 weeks and then do CS c. Wait for SROM then do CS d. Wait until 40 weeks and decide on clinical picture of eruptions e. Expectant vaginal delivery

Which of the following is correct about genital herpes in pregnancy? a. topical acyclovir is significantly shortened the duration of viral shedding in recurrent episodes of genital herpes b. prophylactic acyclovir is advisable to the neonate if the mother has a recurrent attack of herpes infection in labour c. serologic studies are effective in predicting neonatal transmission d. those infants who develop neonatal herpes infection have documented maternal infection e. all patients should have an amniocentesis at term if positive genital cultures in order to determine the mode of delivery

HSV. Which is wrong? a. Anti-HSV1 gives partial protection against HSV2 b. HSV2 is usually genital infection c. HSV is more common among women with CIN d. If pt has lesion at 38/40, not in labour, warrants CS now e. In event of recurrent HSV, decide at time of ROM or labour on mode of delivery

The best indicator for the management of labour in a patient with a past history of genital herpes is currently? a. Culture results b. Pap smear c. Serological testing d. Clinical assessment early in labour e. Patient preference

?TPHA 1:8 in early pregnancy. History of treated syphilis What do you do? a. Obtain RPR/VDRL b. Treat with penicillin c. Contact tracing d. Obtain records of prior titre levels

A TPHA once positive – always positive

A woman attends antenatal clinic in early pregnancy. She has a positive RPR/VDRL 1:8 with a history of syphilis treatment. What do you do? a. Obtain TPHA/FTA b. Treat with penicillin c. Contact tracing d. Obtain records of prior titre levels

Secondary syphilis treatment a. Procaine penicillin 5million units IV b. Benzathine Penicillin 2.4million units IM c. Ampicillin 500mg QID for 7 days d. Doxycycline 100mg QID for 7 days e. Ofloxacin 400mg BD for 7 days

Hepatitis serology is positive for Hep B core Ab but negative for Hep B surface antigen and antibody. This indicates? a. Chronic carriage b. She will become Hep B surface Ab positive in the near future c. Never had hepatitis B d. Cross reaction with hepatitis A e. She is highly infectious

A woman presents at 10 weeks gestation. Her partner has recently been diagnosed with acute hepatitis B. She is negative for HBsAb, HBsAg, HBcAb, HBeAb. What do you do? a. Commence vaccination for Hep B b. Give Hep B IV Ig c. Give Hep B IV Ig and commence vaccination d. Vaccinate post partum e. Can’t remember

C Vaccine and Iv Ig if high risk exposure (sex, IVDU, mucosal)

.With respect to needle stick injury what is the LEAST likely? a. Risk of transmission of Hepatitis C if the patient is positive is 2% b. Risk of HIV infection if the patient is HIV positive is 0.3% c. Risk of infection with Hepatitis B if the patient is sAgen positive is 30% d. Risk of contracting hepatitis C from a blood transfusion is one in a million per unit e. None of the above

What is the transmission rate to the fetus if the mother is HTLV3 (HIV) positive a. 0 % b. 10% c. 30% d. 50% e. 100%

C First world ?15-20%; third world 25-40%

All true of HIV except? a. More risk from intercourse with an infected female than with an infected male b. May develop symptoms in pregnancy in HIV positive women c. Shown that virus carried in breast milk d. First presentation may be with Pneumocystic carinii

Parvovirus B19 is associated with? a. Rapid progression of cervical dysplasia to invasion b. Fetal anaemia and hydrops c. Maternal pneumonia d. Benign condylomata e. Hepatitis C

.Regarding CMV: a. Commonest intrauterine viral infection b. Most infected infants are symptomatic c. Contracted from eating undercooked meat

A 5-15% of infants are symptomatic at birth (C&R). CMV is the most common intrauterine viral infection (UTD).

CMV, fetal infection rate if the mother seroconverts in pregnancy, correct option: a. 100% b. 80% c. 50% d. 20% e. <5%

.Five days after a busy obstetric clinic one of the patients develops rubella. Should all of the rest of the patients who attended the clinic? a. Have rubella vaccine b. Be tested for IgM Rubella antibodies c. Be tested for IgG Rubella antibodies d. Be given immune globulin e. None of the above

Your patient is 8w and has been exposed to Rubella. Your management should include all of the following except: a. Perform IgG and IgM levels b. If IgG negative then repeat IgM in 10 days c. Administer IgM immunoglobulin if IgM positive d. Counsel regarding the high risk of abnormality e. Counsel regarding the risks of hearing, eye and ear defects

Regarding rubella? a. Has 100% teratogenic effect if infected <10 weeks b. First discovered in Australia c. Can cause PDA

C At < 8 weeks the risk of fetal damage is 90-100%, at 8-12 weeks it is 50%. The features of congenital rubella include PDA

.All of the following occur in congenital rubella except: a. Cataracts b. Deafness c. IUGR d. Cardiac defects e. Renal dysplasia

Rubella infection a. 1% risk of fetal syndrome in 2nd trimester b. is a killed virus c. viraemia precedes rash d. attenuated by blood transfusion

C 20-50% risk of congenital rubella syndrome in second trimester; vaccine is a modified live virus; not affected by blood transfusion; viraemia precedes rash

.Rubella vaccine? a. Seroconversion in 85% of individuals b. Causes a viral infection which is communicable c. Can be transmitted in breast milk d. A killed vaccine e. Effectiveness reduced by blood transfusion

E 95% effectiveness, not generally communicable, live vaccine

Toxoplasmosis all true except: a. A bacteria b. Can cause fetal loss c. Causes cerebral calcifications d. Causes chorioretinitis e. Hydrocephalus

Toxoplasmosis in pregnancy – all except a. IgM = acute infection b. Spread by cats c. Incidence in Australia in pregnancy 10/1000 d. Treat with spiramycin e. Chrorioretinitis is most common manifestation of latent infection

A vs C Not quite as straight forward as doing an IgM; 1-8 per 1000 pregnancies; spiramycin is appropriate and choriretinitis is the most common manifestation of latent infection (14%) Incidence in Australia in pregnancy 10/1000 = (probably a touch high) 0.23/1000

Toxoplasmosis, incorrect option: a. Keep away from cats b. Important cause of cerebral calcification c. 25-50% are immune to toxo in Australia d. Usually asymptomatic e. Spiramycin is the treatment of choice

A 30% immune in Australia (MJA article -2002, 176)

Which of the following is true regarding malaria? a. Pyrimethamine-sulfadiazine causes kernicterus in neonate b. Chloroquine is antimalarial of choice in pregnancy

Which does not cause intrauterine infection? a. CMV b. Polio c. Mumps d. Toxoplasmosis e. Malaria

Pregnant woman with history of 4 month chronic cough, fever, night sweats, loss of weight. Has apical lesion on CXR. Treatment would include: a. streptomycin b. erythromycin c. isoniazid d. penicillin

.Your 16 week patient has a mantoux reaction of 16mm. She is asymptomatic and has a normal CXR. What is the best management? a. Vaccinate with BCG b. Reassure and review postnatally c. Isoniazid 300mg daily for 6 months d. Isoniazid 300mg daily for 12 months e. Rifampicin 100 mg daily for 12 months

.A 38 year old woman with no history of high risk exposure and no other risk factors has a Mantoux and it is measured as a response of 16mm. CXR normal. Would your further management be? a. No further treatment b. Treatment with Rifampicin (gave dosage) c. Treatment with Isoniazid (gave dosage) d. Treatment with Isoniazid (different dosage) e. Give BCG

Patient at her first antenatal visit had MSU with mixed contamination, including GBS. Options. a. Treat with antibiotics and swab vagina at 28/40 b. Vaginal swab at 28/40 c. Vaginal swab and MSU at 28/40 then treat with oral antibiotics d. Swab at 28/40 and treat intrapartum if positive e. Treat in labour

? treat UTI and then prophylactic abx in labour

.Regarding GBS: a. Maternal carriage is 50% b. Neonatal sepsis is rare if the mother is clinically well c. 10% of babies born of carrier mothers are sick d. If isolated from amniotic fluid with PPROM should give antibiotics and deliver e. Treat and wait

.Referred 34/40 with GBS on swab? a. give course of ampicillin now b. give course at 38 weeks c. IV ampicillin in labour d. Treat neonate with penicillin e. None of the above

C ?but also repeat swab within 5wks of expected delivery

.GBS – most common location? a. low vagina b. urethra c. GIT

Which of the following is least likely to have normal pregnancy outcome? a. booking BP 140/90 b. maternal age 40 yrs c. serum urea of 12

Which of the following conditions in pregnancy, when treated, would cause thrombocytopenia and/or osteoporosis? a. asthma b. hypertension c. pneumonia d. pulmonary TB e. pulmonary embolus

E Treatment with steroids and heparin will cause both osteoporosis and thrombocytopenia.

.Obesity is not related to? a. PET b. Eclampsia c. GDM d. Chronic HT

Appropriate management of anaphylactic reaction to penicillin? a. adrenaline 0.3-0.5mL of 1 in 1000 sc b. adrenaline 0.3-0.5mL of 1 in 10,000 sc c. hydrocortisone

A 0.3-0.5mg is the appropriate dose of adrenalin. 1:1000 is 1mg/ml.

Which of the following is appropriate management for an anaphylactic reaction to penicillin with BP 80/40? a. Adrenaline 0.3-0.5 ml of 1:1000 sc b. Adrenaline 0.3-0.5 ml of 1:10000 sc c. Phenergan 25mg IV d. Hydrocortisone 100 mg IV

A 0.3-0.5mg is the appropriate dose of adrenalin. 1:1000 is 1mg/ml

Patient in septic shock, hypotension, poor urine output, peripherally shutdown despite adequate fluid resuscitation. Which of the following is likely to improve urine output? a. Dopamine b. Noradrenaline c. Nitroprusside d. The anaesthetic reg

Which of the following can be considered normal in pregnancy? a. Diastolic murmur b. Midsystolic click c. Third heart sound d. Ejection click

Which of the following cardiac anomalies is most likely to be associated with maternal mortality? a. VSD b. Aortic stenosis c. Marfan’s syndrome d. Primary pulmonary hypertension e. Mitral valve prolapse

D The order from greatest to least likely to be associated with maternal mortality is primary pulmonary hypertension, aortic stenosis / Marfan’s syndrome, VSD, mitral valve prolapse.

Most likely to cause maternal mortality a. Mitral stenosis b. Diabetes c. PIH d. Pulmonary stenosis

Pulmonary hypertension most likely to be associated with? a. Mitral stenosis b. Eisenmenger’s c. Preeclampsia d. Aortic stenosis

Regarding mitral valve prolapse in pregnancy? a. Requires prophylactic antibiotics for prevention of bacterial endocarditis b. Most suffer palpitations c. Is a cause of sudden death

Regarding mitral stenosis? a. It is the worst cardiac lesion to have in pregnancy b. It is unusual to cause any problems if it is grade 1 or 2 at conception c. If it produces cardiac failure before 32 weeks valvotomy will often be required despite medical treatment d. The most common cause of death is cerebral emboli from atrial thrombus e. Bacterial endocarditis is more common in pregnancy

B AS is the worst lesions to have during pregnancy; no cut off for valvotomy; heart failure is the cause of death.

.Which is most likely to cause pulmonary HT? a. Eisenmenger’s syndrome b. MS

Which of the following is associated with maternal mortality? a. cholestasis of pregnancy b. eclampsia c. fatty liver of pregnancy d. Chronic active hepatitis e. Hepatitis A

PG presented at 14 weeks with booking BP 160/110 at rest. Which of the following is most lethal? a. acute glomeruonephritis b. PIH c. Eclampsia d. Hydatidiform mole e. Phaeochromocytoma

Phaeochromocytoma in pregnancy is associated with? a. Paroxysmal episodes of HT b. High urinary levels of hydroxy indole acetic acid, HIAA c. Obstetric collapse d. Tumour in adrenal cortex medulla e. Glucose intolerance

A High urinary levels of hydroxy indole acetic acid, HIAA (breakdown product of serotonin – screen for carcinoid tumours = metabolically actove GIT tumour) Tumour in adrenal medulla

10 weeks pregnant, essential HT, which drug contra-indicated? a. Aldomet b. Hydralazine c. Labetolol d. Oxprenolol e. Captopril

.Which of the following is not associated with thrombosis? a. activated protein C deficiency b. protein S deficiency c. thrombin 3 deficiency d. factor V leiden mutation e. antiphospholipid syndrome

A patient who is 26 weeks pregnant presents with a cold, swollen right leg. You suspect a DVT and doppler ultra sound is done which shows no DVT. Her leg feels cold and has sluggish venous return. Your next investigation would be?** a. CT venogram b. Duplex doppler of the pelvic veins c. MRI pelvis d. Pelvic ultra sound e. Discharge home

Iliofemoral thrombosis is best diagnosed in pregnancy by a. duplex Doppler studies b. impedance plethyebogram c. contrast venogram d. fibrinogen uptake test

A Impedence plethyesmogram is a complicated test for DVT now rendered obsolete by USS; likewise for contrast venogram. Fibrinogen uptake test, similar to D-dimer is not specific enough during pregnancy.

Pulmonary Embolus – all are correct except? a. Classical presentation in < 5% b. Most large PE’s have clinical DVT’s c. Symptoms depend on site, size and number d. 60% obstruction of pulmonary vessels leads to raised right atrial P and CVP e. Most are clinically unrecognised

All of the following are typical of a massive pulmonary embolism except: a. pulmonary vascular congestion on CXR b. retrosternal chest pain c. evidence of right ventricular strain d. tachypnoea

39 yo woman had elective rpt GA LUSCS and developed pleuritic chest pain and tachypnoea 3 days postop. WCC 11.000, CXR showed R lower lobe atelectasis. ABG showed pO2 65mmHg. Next most appropriate step: a. Pulmonary angiogram b. Ventilation perfusion lung scan c. Chest physio and deep breathing exercises d. IV antibiotics e. Pulmonary CT scan

A woman at 32w developed sudden onset of dyspnoea and lung scan showed VQ inequality. The starting dose of heparin would be a. 10,000 to 15,000 U/24 hours b. 30,000 to 35,000 U/24 hours c. 5000U stat + a) d. 5000U stat + b)

D Initial dosing of IV UFH consists of an IV UFH bolus of 80 units/kg, followed a continuous infusion of 18 units/kg per hour. (UTD)

Which one crosses the placenta? a. Heparin only b. Warfarin only c. Heparin and warfarin d. None of the above

Which of the following is monitored by bleeding time? a. Heparin only b. Warfarin only c. Heparin and warfarin d. None of the above

.Which one causes stippling of the epiphysis? a. Heparin only b. Warfarin only c. Heparin and warfarin d. None of the above

Which one causes lysis of the thromboses? a. Heparin only b. Warfarin only c. Heparin and warfarin d. None of the above

.A G2P1 whose last pregnancy was 8 months ago is now 12 weeks pregnant. Her Hb is 90 and Hct 28 with a microcytic anaemia on film. She feels tired and has had no treatment. What is the best explanation? a. iron deficiency anaemia

A Given the short inter-pregnancy interval

Which of the following are rich sources of Fe and Zn? a. Meat b. Green vegetables c. Bread and cereals d. Milk e. Rice

Zinc deficiency causes: a. Anaemia b. IUGR c. Prem labour

Which of the following is considered normal in the second half of pregnancy? a. MCV 105 fl b. WCC 12x10 (9) /l c. Platelets 100,000 d. Reticulocytes 15% of red blood cell count

.In a woman who is found to have Hb 9 g/dl, MCV 70fl, MCHC 28, serum iron 6 and TIBC 109, which is most likely? a. A microcytic picture on blood film b. Target cells c. Reticulocyte count of 10% d. She should be treated with folic acid e. High urea levels

A This picture is consistent with iron deficiency anaemia. Target cells occur with haemoglobinopathies

.A patient has an FBE with HB 10.4, MCV 70 and MCHC 28 (30-36). Which is true? a. Her film will show microcytosis b. She should have a trial of folate c. She will have target cells on film d. Reticulocyte count will be 10%

.Which of the following tests is most useful in diagnosing haemoglobinopathy? a. HbEPG b. Bone marrow c. DNA analysis d. Red cell index e. Blood film

Which of the following is most normal in a normal pregnancy? a. MCV 105 b. WCC 12 c. Platelets 100,000 d. Reticulocytes 15%

22yo nulliparous patient has a mother with IDDM. At first visit in 1st T, her urinalysis is normal. Advise the patient a. no chance she will develop diabetes b. needs a formal GTT in 2nd T c. start prophylactic insulin d. if does not develop glycosuria, no risk of developing DM e. monitor her by doing fasting BSL in pregnancy

B This patient has a substantial risk of developing GDM and as such should be screened in 2nd T.

In a RCT the proven benefits of screening for GDM are a. Decreased PNM b. Decreased shoulder dystocia c. Decreased neonatal jaundice d. All of the above e. None of the above

D No RCT on screening, several RCTs on treatment - Probably referring to ACHOIS

22 year-old primigravida presents in first trimester. Mother has NIDDM, urinalysis –ve glucose, no ketones. Which is true? a. She has 2% chance of developing GDM this pregnancy b. She should have a GTT 6/52 post partum c. If urinalysis shows no glycosuria the chance of GDM adversely affecting pregnancy is minimal d. She should have a GCT now

All of the above incorrect; The risk of GDM would be >3% Answer: none

1st ANC visit, 22yo primip, mother is NIDDM. No glycosuria. You advise the patient: a. No chance that she will get diabetes b. Need GTT in 2nd trimester c. Start prophylactic insulin d. If doesn’t get glycosuria in pregnancy, no risk of diabetes e. Monitor her by doing fasting BSL in pregnancy

G6P5 with 5 NVD’s of 4-4.5kg babies, presented to ANC for 1st time at 32w. Obstetric US at 18w which showed singleton fetus consistent with gestation and no abnormalities. On palpation fundus 40cm, gained 5 kg in last 4 weeks and GTT 7.8 mmol/l at 1 hr and 12 mmol/l at 2 hrs. What is next appropriate step? a. general advice on diet and rpt GTT b. low carbohydrate diet c. diet modification to limit her caloric intake to 2100kcal/dy d. commence on insulin e. admit to hospital

Pregnant lady in first trimester with the following GTT. Fasting BSL 6.8, 2 hrs post 100g load 12.6. Mx? a. admit for stabilisation b. commence on oral hypoglycaemic agent c. commence on insulin as an outpatient d. repeat the test in the second trimester e. counsel on dietary measures

Which is not common in diabetic pregnancy? a. hyperemesis b. PET c. PTL

A multiparous woman presents 8 weeks post partum complaining of tiredness, palpitations and tremor. She has been losing weight and is unable to sleep. Pulse is 100 bpm, BP 160/90. The most likely diagnosis is: a. HIV b. Anxiety c. Drug abuse d. Thyrotoxicosis

Most common cause of hyperthyroidism in pregnancy? a. toxic multinodular goitre b. Grave’s disease c. Toxic single adenoma d. Iatrogenic

The most common cause of hypothyroidism in pregnancy is? a. Congenital b. Autoimmune thyroiditis c. Previous surgery d. Previous ablation with radioiodine e. Drug related

In first trimester, a PG presents with N & V, tachycardia. TFT show slight increase in free T4, decrease in TSH, and normal RT3. This is associated with: a. Normal b. hyperemesis gravidarum c. Graves disease d. Hashimoto’s thyroiditis e. Non-toxic goitre

A woman at 16 weeks at ANC, OE: small nodular goitre. TFT showed increase in total T3 and free T4 and T3. TSH normal. Which is correct? a. Normal b. Hyperemesis c. Grave’s disease d. Hashimoto’s thyroiditis e. Non toxic goitre

E Normal changes in pregnancy are increased TBG with small increased total T4 and T3 to compensate. Hyperemesis and Grave’s would have a decreased TSH whilst Hashimoto’s would be hypothyroid. A goitre is not normal.

Usually found in trophoblast associated hyperthyroidism? a. increase free T3 and T4 b. increase total T3 and T4 c. low measurable TSH d. all of the above

Which of these crosses the placenta the least? a. TSH b. T4 c. TRH d. Propylthiouracil

What has the least effect on the fetus when given to the mother? a. TSH b. TRH c. Thyroxine

A TRH can cross the placenta and will effect the fetus whilst little TSH crosses the placenta. The effect of thyroxine is controversial and may effect the fetus.

.Post partum thyroiditis typically begins with transient? a. Hyperthyroidism b. Hypothyroidism c. Goitre d. Exophthalmos

The normal outcome of post-partum thyroiditis at 12 months is? a. Hyperthyroidism b. Hypothyroidism c. Euthyroidism

Pregnant women with thyroid nodule. Mx? a. Observe for 3/12 then biopsy b. Immediate FNA c. Immediate excision biopsy d. Suppressive therapy if persists e. Radioactive iodine localisation

A woman is pregnant after bromocriptine treatment of a pituitary macroademoma. Management during pregnancy should include: a. Continue bromocriptine b. Visual field assessment c. X-ray sella turcica d. Neurosurgery

Regarding inflammatory bowel disease in pregnancy? a. Ulcerative colitis is associated with reduced fertility compared to Crohn’s disease . b. It gets worse in pregnancy and the puerperium c. Surgery should not be delayed due to pregnancy d. Sulfasalazine is C/I in pregnancy

C fertility may be decreased in active crohns

A woman with stable Crohns Disease presents in her first trimester. Her MCV is 86 and her B12 level 115 (N=>127). Your management would be: a. No treatment b. Give IMI B12 c. Commence on Fefol d. Repeat the test

.Which dermatologic sign is not physiologic in pregnancy? a. chloasma b. linea nigra c. vitiligo

Which of the following dermatological conditions is not associated with pruritus and papules? a. Pruritus gravidarum b. Herpes gestationis c. PUPPP d. Prurigo gestationis e. Prurigo anularis

A Pruritus gravidarum is the old term for obstetric cholestasis. Herpes gestationis is otherwise known as gestational pemphigoid, a blistering, painful rash occurring typically in the 2nd or 3rd trimester of pregnancy. PUPPP is pruritic urticarial papules and plaques of pregnancy. Prurigo gestationis is prurigo of pregnancy consisting of erythematous, excoriated nodules or papules on the extensor surfaces of the limbs and trunk. Unsure what prurigo anularis is.

.Herpes gestationis can be diagnosed if? a. Similar skin lesions are noted in subsequent pregnancies b. Similar skin lesions are noted in association with the OCP or menstruation c. There is peripheral eosinophilia d. Herpes serology is positive e. On histologic examination complement and IgG is seen adjacent to the basement membrane between the dermis and epidermis

E Herpes gestationis is pemphigoid gestationis; it recurs with subsequent pregnancies and has 25% chance of flare with menses and OCP. There is a peripheral eosinophilia but herpes serology is normal. Complement and IgG is present adjacent to the basement membrane.

Which of the following dermatological conditions is associated with pruritis and bullae? a. pruritis gravidarum b. herpes gestationis c. PUPPP d. Prurigo gestationis e. Prurigo anularis

.Which neurologic disorder is specific for pregnancy? a. Bell’s palsy b. Nystagmus c. Meralgia paraesthetica (LFCN entrapment)

Answer: A and C occur more often in pregnancy

Regarding Bell’s palsy a. It is caused by compression of the pterygo-pallatine fossa b. It responds to anti-inflammatory drugs c. It causes a sensory nerve deficit d. It is most common in late pregnancy

Regarding Bell’s palsy: a. Results from compression b. Increased in T3 c. Is permanent

A 32 year-old presents at 35/40 with recent onset malaise. BP 130/84, AST + ALT elevated, bilirubin 80, platelets 60. O/E cervix long and closed. Management? a. IOL b. LUSCS c. Upper abdominal US for gallstones d. Bed rest

.A woman is 31w pregnant and presented with RUQ pain for 2 days. BP 140/90. No proteinuria. Normal reflexes. Abdominal examination revealed mild tenderness over the right hypochondrium. BSL 2.5. Plt 150. UA 0.31. Hb 11. LFT: AST 100, ALT 30, ALP 160. CTG normal. Which of the following is correct? a. perform an USS to exclude gall stones b. Acute fatty liver of pregnancy c. Consistent with PET, give steroids and deliver d. Obstetric cholestasis e. Hepatitis

32 weeks gestation twins. Unwell for 2 days. Coffee ground vomitus. Appears drowsy and unwell. BP 130/85. Slightly jaundiced, tender in RUQ and epigastrium. Blood BR 30, GGT 455, AP 180, creat 100 UA 450. The most likely diagnosis is? a. PET b. Gallstones c. Obstetric cholestasis d. Acute FLP e. Hepatitis

.Regarding acute fatty liver of pregnancy? a. Prompt delivery improves prognosis b. Avoid subsequent pregnancy due to high risk of recurrence c. Related to a previous diagnosis of viral hepatitis

.PG at 32w presents with vomiting, epigastric pain. LFT’s abnormal, platelets 60. Cervix long and closed. BP normal, no proteinuria. What do you do? a. USS liver b. Induction c. Caesarean d. Watch and wait

Most common cause of jaundice in pregnancy? a. hepatitis b. cirrhosis c. PET

The disease most likely to cause jaundice when it occurs in pregnancy is? a. Pancreatitis b. Cholecystitis c. Hepatitis d. Severe pre-eclampsia e. Cirrhosis

Cholestasis of pregnancy is associated with the following except: a. neonatal jaundice b. prematurity c. pruritis and jaundice in T3 d. PPH e. Stillbirth

A Vit K is given to prevent haemorrhage not jaundice

.Cholestasis of pregnancy is associated with a. Prematurity/??placental insuff b. RUQ tenderness c. Palmar rash d. Vomiting in late pregnancy

Intrahepatic cholestasis associated with all except: a. Neonatal jaundice b. Pruritis with onset of jaundice c. 3rd trimester d. Increase premature delivery

.Which of the following is associated with intrahepatic cholestasis of pregnancy? a. RUQ pain b. High risk of recurrence in future pregnancies c. Bilirubin levels >10 d. Excessive use of antacids

What is the mainstay of treatment for thrombotic thrombocytopenia purpura a. plasmaphoresis b. deliver the baby c. steroids

A Aggressive treatment with FFP and plasmapheresis limits vascular injury and improves prognosis. Corticosteroids may be of benefit. Delivery does not affect course of TTP

Mainstay of treatment for TTP a. Steroids b. Plasmapheresis c. Ig infusion

.In comparing HELLP with TTP. Which is not true? a. Liver dysfunction more common in HELLP b. DIC more common in HELLP c. Delivery of fetus mandatory in TTP

.TTP and HELLP, incorrect option a. TTP more correlated with DIC b. HELLP more associated with neurological abnormality c. HELLP more associated with haemolysis

.Ruptured liver haematoma: a. Pack b. Hepaticetomy c. Hepatic artery embolisation d. Hepatic artery ligation

Which one does not indicate activation of clotting system in PET? a. increase FDP b. increase D-dimer c. increase antithrombin 3 d. thrombocytopenia

C Antithrombin is decreased (UTD)

.The best treatment for raised intra-cranial pressure in eclampsia is: a. Hydralazine b. Beta blockers c. Calcium channel blockers d. Mannitol

What is the kidney lesion with PET? a. increase mesangial cells b. fibrinoid necrosis c. glomerular endotheliosis

Proteinuria in PET. All true except: a. It is non-selective b. It contains IgG c. It is tubular in origin d. Associated with fibrin damage in the glomerulus

C Proteinuria is due, in part, to impaired integrity of the glomerular barrier and altered tubular handling of filtered proteins (hypofiltration) leading to increased protein excretion. Both size and charge selectivity of the glomerular barrier are affected.

Which of the following is considered normal in pregnancy? a. increased renal blood flow, increased serum urea, increased serum creatinine b. increased renal blood flow, decreased urea, increased creatinine c. increased, decreased, decreased d. increased, increased, decreased e. decreased, decreased, decreased

.The commonest cause of pulmonary oedema in severe PET is: a. Iatrogenic fluid overload b. Left ventricular failure c. Leaky capillaries d. Hypoalbuminaemia

PG at 32/40 with BP 130/90, headache and epigastric pain. VE cervix long and closed. LFT’s reveal elevation of transmainases and a plt count of 70 000. MX? a. Observe b. IOL c. Platelet transfusion d. LUSCS

.Patient presents at 31/40 with BP 160/100. Serum biochemisty is normal, platelet count is 90000 and CTG is reactive. VE cervix is 1 cm dilated, 50% effaced and vertex presents at sp-2. The following day BP 150/100, serum biochemistry and CTG are unchanged but platelets are now 70000, Repeat plt after 6 hrs is 60000. Mx? a. Platelet transfusion b. LUSCS c. Observe d. IOL

A black multigravida who underwent a LUSCS for FTP after induction for PET, complicated by endometritis comes to see you with fatigue / dyspnoea / orthopnoea. O/E HR 110, BP 140/95, pre-tibial oedema, RUQ tenderness. Fine crackles in both lung bases. CXR cardiomegaly. Temp 36.7. Diagnosis is? a. Post-partum cardiomyopathy b. Mitral stenosis c. Pulmonary hypertension d. Bacterial endocarditis e. Essential hypertension

The CLASP trial showed that 60 mg aspirin is useful in? a. Preventing IUGR in women with chronic hypertension b. Preventing recurrent early onset severe PET c. Preventing recurrent IUGR

B CLASP enrolled patients for both prevention of recurrent IUGR and PET, but more patients for PET

The CLASP trial demonstrated that aspirin 60mg daily could: a. Reduce severe early onset IUGR associated with PET b. Reduce IUGR c. Both d. Neither

Prognosis for future pregnancy is best for: a. Primip – eclampsia and DIC at 6 weeks postpartum normal BP b. Multi with HT controlled in pregnancy, still hypertensive c. Multi with severe PE with normal BP at 6/52 d. Congenital cardiac disease, stable but past history of CCF e. Stable chronic renal failure

What woman has the best reproductive future? a. PG, eclamptic fit with DIC, BP normal at 6/52 b. MG with severe preeclampsia, BP normal at 3 months c. Preeclampsia with diastolic BP 100mmHg at 3 months d. Woman with essential hypertension e. Woman with chronic renal failure, currently stable

36 year-old G3 P2 with a 3cm x 3 cm breast lump at 34 weeks gestation. To investigate for carcinoma which is the best investigation? a. Mammogram b. Thermogram c. FNAB d. Excision biopsy

.A patient who is 28 year-old who is at 14 weeks has a 2cm intra-ductal carcinoma of the breast, has a mastectomy and nodes. The next appropriate management is: a. Termination there and then b. Termination at 16/40 c. CS at 36/40 d. IOL at 36 weeks e. Leave until term and manage expectantly

30yo primigravida with PPROM at 32 weeks. The best management is: a. expectant management b. take HVS and manage expectantly c. steroid and expectant mx d. oral ABx and await spont labour e. immediate delivery

D Most appropriate management would be HVS, steroids, antibiotics and manage expectantly (maybe deliver).

.The lowest morbidity from PPROM at 32 weeks occurs with the following management? a. HVS and await labour b. Steroids and CS in 24-36 hrs c. Steroids and induce in 24-36 hrs d. Delivery immediately

PPROM at 30 weeks. What is the most likely outcome? a. cord prolapse b. chorioamnionitis c. labour d. malpresentation e. placental abruption

C The majority of pregnancies deliver preterm within 7 days of membrane rupture (UTD & Williams).

PPROM at 30 weeks, what is the most likely outcome? a. cord prolapse b. chorioamnionitis c. labour d. malpresentation

.From the Oracle trial which antibiotic is the best first choice for PROM? a. Amoxyl b. Augmentin c. erythromycin d. None of the above

.Which organism is most likely to be associated with PROM at 32 weeks? a. Gonococcus, T. pallidum, Trichomonas b. Chlamydia, ureaplasma, Mycoplasma c. GBS, Gardnerella, E.coli

Chorioamnionitis – commonest pathogen in newborn? a. E.Coli b. Enterococcus c. Peptostreptococcus

C Peptostreptococcus (9.4%), E.coli (8.2%), Enterococcus (5.4%) – for intra-mniotic infections – UTD GBS more common than all of these, ueraplasma most common

All are risk factors for preterm delivery except: a. Smoking b. Low socio-economic group c. Previous pre-term delivery d. Previous 2nd trimester spontaneous miscarriage e. Previous unexplained stillbirth

.An incompetent cervix can be due to the following except a. DES b. Uterine anomaly c. Cone biopsy d. Cervical laceration e. Cervical infection

.Which is not related to PTL? a. Hyperemesis b. 1 st T bleeding c. Oligohydramnios

A 30yo woman presented to a country hospital with PTL at 32 weeks. The cervix was 2cm dilated and 1cm long with a normal CTG. IV salbutamol was commenced and a dose of steroid given. Within 4 hours she was transferred to a tertiary hospital where an amniocentesis was performed on each fetus. The amniotic fluid was blood stained. The L:S (lecithin : sphingomyelin ratio) were both 3.5 with positive phosphatidylglycerol. Which of the following is correct? a. traumatic tap lead to contamination of liquor with blood giving a falsely (?im)matured L:S b. matured L:S due to asphyxia, hence delivery required immediately c. matured L:S due to use of steroid d. matured L:S due to use of salbutamol.

A A L:S ratio over 2.0 and positive phosphatidylglycerol is associated with fetal lung maturity. Blood interferes with the L:S ratio but not phosphatidylglycerol but it lowers the ratio rather than raise it giving a falsely immature result. Too soon for steroids to have an effect (UTD, C&R). Probably irrelevant now

The dose of IV salbutamol for sudden tonic uterine contraction causing fetal distress is? a. 500 mcg b. 100 mcg c. 25 mcg

Tocolysis. Which is true? a. IV GTN gives a short lived significant tocolytic effect b. Halothane is more effective than enflurane or isofluorane at equipotent doses in causing uterine relaxation c. Syntocinon has no effect on maternal BP

.All of the following are complications of beta-mimetics for tocolysis except: a. Hypokalaemia b. Hyperglycaemia c. Chest pain d. Hyponatraemia

.Why is MgSO4 preferred in USA for tocolysis (cf ritodrine/salbutamol) a. Easily monitored toxicity b. Ease of administration c. Decreased maternal SE d. Decreased fetal SE e. Increased efficacy

Atosiban all are true except: a. RCT show better than salbutamol for prevention of preterm labour <28/40 b. RCT shows well tolerated, no more side effects than salbutamol c. RCT show equal tocolytic effect to salbutamol

A Equal in efficacy to salbutamol with fewer side effects but seems to have an increased risk of delivery at less than 28 weeks when compared to placebo. (UTD)

Ca Channel blockers as tocolytic, all are true except: a. Nifedipine and niparidine are equivalent calcium channel blockers b. Nifedipine becomes less effective tocolytic over time relative to ritodrine c. Nifedipine has been shown in trials to improve neonatal outcome relative to ritodrine d. Nifedipine has been shown in RCT’s to be better tocolytic than ritodrine

B CCBs did not reduce the risk of birth within 48 hours but did reduce the risk of birth within seven days and prior to 34 weeks when compared to other tocolytics. Also reduced. When compared to beta agonists nifedipine is more effective and improves neonatal outcomes.

.Multi presented to LW at 30 weeks, breech, labour. You arrived to see her immediately but she commenced pushing involuntarily but her cervix was 7 cm on VE. Next contraction body delivered, head trapped. Which of the following pharmaceutical agents is most appropriate?** a. Ritodrine b. Valium c. Pethidine d. Halothane e. Ether

.A primigravid comes in at 30 weeks gestation with a frank breech presentation. She labours too quickly and there is nothing done. The head gets stuck in an incompletely dilated cervix. What is the most appropriate drug to give next?** a. Nitrous oxide and oxygen b. Sentinel c. Salbutamol d. GTN

Not true with regard to mode of delivery for breech at term a. LSCS 39/40 decreases risk of cord prolapse at time of spontaneous labour b. Mortality and morbidity for head entrapment is decreased with EL LSCS then vaginal breech delivery c. All should have LSCS d. Continuous monitoring in labour e. Caesarian best >39/40 but before onset of labour f. RCT showed lower mortality with EL LSCS Vs attempted vaginal breech delivery

.A 29 yo Rh+ woman has been a poor ANC attender presents at 30w in labour and delivers a hydropic fresh stillborn infant. All of the following investigations are indicated except: a. Maternal urinary drug screen b. Placental histology c. Fetal karyotype d. Maternal serum screen for Kell antibodies e. Hb electrophoresis of baby’s blood

4 weeks FDIU macerated fetus and placenta. Plt 150, FDP increased: a. Observe loss b. Plt transfusion c. FFP d. Heparin

IUFD at 34/40 all true EXCEPT a. 80% labour spontaneously within two weeks b. Early IOL is indicated to decrease coagulopathy c. Earliest indication is prolonged PT d. Radiologic diagnosis by overlapping skull e. Recurrent IUFD <8%

B or C The risk of recurrence if unexplained is 8-11 per 1000 births; 80-90% labour spontaneously within two weeks; decreased fibrinogen and platelets is the first sign of coagulopathy

.Which of the following is INCORRECT with regards to stillbirth?** a. Rate increased with true knot in the cord b. Each week, from 26 weeks to 40 weeks, the risk of still birth is 0.03% c. 41 – 41+6 weeks gestation has the same risk as 38 - 38+6 weeks gestation d. 1/500 women have a stillbirth beyond 38 weeks

C Cord knots probably do increase risk of stillbirth; risk of stillbirth is less than 0.5 per 1000 from 26 to 40 weeks; can’t find the incidence of stillbirth after 38 weeks

A woman at 32/40 with a known fibroid uterus presents with sudden onset of abdominal pain. O/E afebrile, FH 140, general uterine tenderness, BP 95/-, PR 110. Most likely diagnosis? a. Appendicitis b. Concealed abruption c. Degeneration of fibroid d. Chorioamnionitis e. Splenic rupture

Regarding monozygous twins, all right except? a. Increased mortality compared to dizygous twins b. IUGR is asymmetric c. Increased incidence of vascular anastamoses cf DZ d. Most cleave before day 8 e. Increased incidence with Clomid

.MZ twins, which is NOT TRUE a. Vascular anastomoses in 95% (true) b. MZ represent 25% of all twins (20%) c. DC occurs in 1/3 (true) d. MZ twins 1:400 (0.5%) e. Splitting embryo < 8days = DC, > 8 days = MC (false – Day 3)

.Twin pregnancy uneventful. Which is not necessary? a. US for growth 28 and 34 weeks b. Iron and folate and calcium supplement c. Increased visits in T3 to pick PE d. Warn to present early in labour < 34/40 e. Prophylactic steroids

.In locking of twins the most likely presentation is: a. cephalic-cephalic b. cephalic-breech c. cephalic-transverse d. breech-cephalic e. breech-breech

Multipara with mono-amniotic twins at 37 weeks with PE that need delivery. Twin 1 is breech, twin 2 is vertex. Best Mx? a. Expectant b. IOL with prostin c. IOL with ARM & syntocinon d. CS

.A multi has an epidural in and just had a low forceps delivery of twin 1 for prolonged second stage. On abdominal palpation twin 2 is oblique with head in RIF, FHR = 80, moderate PV bleeding. Best management is? a. LUSCS b. ECV, ARM ventouse to deliver twin 2 c. Internal podalic version, ARM, breech extraction d. Internal cephalic version, ARM, breech (?!) extraction e. ECV, ARM, encourage mother to push hard

E (C if E is not available)

IVF triplets at 19 weeks presents with vaginal bleeding and low back ache. Irritable uterus, cervix 5 cm dilated with bulging membranes. Live fetuses. a. LUSCS b. Classical CS c. Do nothing active d. IV Ventolin e. Cervical suture f. Vaginal delivery g. Internal version and breech extraction

Natural twins. Monoamniotic in a multip. Normal growth. Premature labour at 35 weeks, twin 1 frank breech, twin 2 cephalic a. LUSCS b. Classical CS c. Do nothing active d. IV Ventolin e. Cervical suture f. Vaginal delivery g. Internal version and breech extraction

.Multip with twins. Twin 1 cephalic delivers with epidural, twin 2 transverse with back up. Unsuccessful external version. Membranes intact, FHR 56 and irregular a. LUSCS b. Classical CS c. Do nothing active d. IV Ventolin e. Cervical suture f. Vaginal delivery g. Internal version and breech extraction

uccess of vaginal delivery following LUSCS for fetal distress? a. 40% b. 50% c. 60% d. 75% e. 90%

D William’s states the success rate is 84% if fetal distress was the indication for intial caesarean section

What is the percentage of uterine rupture after classical CS with subsequent pregnancy? a. 5% b. 10% c. 20% d. 30% e. 50%

A RCOG greentop gives a risk of 2-9% of rupture.

.Which is most reliable to detect uterine rupture during a vaginal delivery with previous CS** a. fetal monitoring b. vaginal bleeding c. haematuria

CS at term for transverse lie, back down, membranes ruptured, appropriate incision? a. extraperitoneal LUS incision b. low transverse incision c. J incision in lower segment d. Classical incision e. Fundal transverse incision

D UTD suggests that delivery can be achieved through a low transverse incision but may be difficult. Other incisions include a fundal transverse incision and the authors use a classical incision. Williams agrees and suggests a classical incision particularly if large fetus (term), ROM and in labour

A woman diagnosed to have an anterior grade 3 placenta praevia on US exam. You are performing an elective CS at 38 weeks. The fetus is cephalic and was found to be mobile in the lower uterine segment. How would you deliver the baby? a. transverse LUSCS, cut through placenta and deliver head with fundal pressure b. perform a LUSCS, head with forceps after cutting though placenta c. perform a LUSCS, above placenta and deliver fetus as breech extraction d. perform a LUSCS, below placenta and deliver head with forceps e. classical CS

Placenta accreta is diagnosed at CS, bleeding continuous from placental bed. What is your management? a. ligating of placental bed vessels b. ligating of internal iliac arteries c. subtotal hysterectomy d. total hysterectomy e. uterine packing

Placenta praevia accreta diagnosed on CS associated with massive haemorrhage. Management: a. oversewing blood vessels b. ligate IIA c. TAH d. Subtotal hysterectomy e. Uterine packing

.Elective repeat LUSCS and placenta doesn’t separate. You pick off most of it piecemeal. Anaesthetist reports that he is starting a transfusion as pt is hypotensive and EBL~ 2L. Mx? a. Hysterectomy b. Curette placental bed and tie off any bleeders c. Ligate internal iliacs d. PGF2a e. Syntocinon/ergometrine

Most common complication of CS / hysterectomy: a. Haemorrhage b. Ureteric damage c. Infection d. Bladder damage e. Pelvic thrombosis

You perform a repeat caesarean section on a woman who has had three prior caesareans. The bladder was adherent high up the uterus and a bladder injury was sustained. It was repaired in three layers. When do you remove the IDC? a. The next day b. When the haematuria resolves c. When the course of antibiotics is completed d. 10 days e. 48 hours

Which of the following is most accurate in predicting IUGR? a. Serial assessment of fundal height b. Serial assessment of BPD with US c. US detection of oligohydramnios d. Serial assessment of abdominal circumference with US e. US assessment of femur length

.Placental causes of IUGR a. Battledore b. Praevia c. Bilobe d. Circumvallate e. Succenturiate

.In assessing fetal welfare, which of the following tests is most reassuring in a growth retarded fetus if the test was normal? a. CTG b. Fetal tone c. Fetal breathing movement d. US for amniotic index e. Fetal hiccough

Which is not characteristic of a variable deceleration? a. Response to hypoxia b. Activation of baroreceptors c. Result of head compression d. Stimulation of the carotid sinus

C ?

28/40 reduced movements for several days so CTG performed. CTG show baseline 140 and persistent late decelerations. Mx should be? a. Immediate LUSCS b. Biophysical profile c. Fetal blood sampling d. Repeat CTG in 12 hrs

.A woman at 28/40 complained of reduced movements for several days, so a CTG was performed. CTG shows baseline 140, with persistent late decelerations. The least helpful thing you could do is: a. Immediate LUSCS b. Reassessed via CTG in 12/24 c. Biophysical profile d. Fetal blood sampling e. Discharge home

.35/40 gestation, complaining of several days of reduced fetal movements. CTG show flat trace, persistent shallow decelerations. The least helpful thing you could do is: a. Immediate LUSCS b. IOL c. Repeat CTG in 12/24 d. Fetal blood sampling

Single variable deceleration, decreased reactivity, 35 weeks, otherwise uncomplicated pregnancy: a. IOL b. CS c. Rpt in 12-24 hrs d. Fetal blood sampling

CTG abnormality, incorrect option: a. Decreased variability with pethidine b. Tachycardia with hydralazine c. Non-reactive with beta blocker d. Absent variability with methyl dopa e. Sinusoidal trace with parvovirus

A patient presented with contractions at 34 weeks gestation. A 20-minute CTG was performed on admission. This showed a baseline of 140 bpm, with reduced beat to beat variability and there was no evidence of acceleration or decelerations. What is the next appropriate management? a. Amniocentesis b. US for biophysical profile c. CS delivery d. Induction if cervix is favourable e. Continue the CTG for further 20 mins

41 weeks uncomplicated pregnancy, just reactive trace: a. IOL b. CS c. Rpt CTG in 12-24 hrs

Answer: Either A or C depending on maternal preference

.A woman at 41 weeks has reduced variability on CTG (CTG shown). Least appropriate management is a. IOL b. Repeat CTG in 12-24 hours c. LSCS d. Fetal scalp sampling e. Vibroacoustic stimulation test

41w essential HT on meds, otherwise uncomplicated, nonreactive trace for 23 minutes a. Continue for further 30mins b. Contraction stress test c. VAST d. IOL e. Send home or CS

.Risk of fetal demise within 1/52 of BPP 0/10? a. 100% b. 80% c. 70% d. 60% e. 50%

.Risk of fetal demise within 1/52 of reactive NST? a. 0.1/1000 b. 0.5/1000 c. 1/1000 d. 5/1000 e. 10/1000

Which of the following is the best predictor of fetal outcome at 42w? a. non stress CTG b. stress CTG c. liquor volume d. kick chart e. fetal breathing movements

The most accurate predictor of outcome in post dates pregnancies: a. AFI b. Doppler c. CTG d. Contraction stress test

The management of a pregnancy at 42+ weeks? a. CTG daily and expectant management b. Amniocentesis to exclude meconium c. Second daily biophysical profile d. IOL if cervix favourable e. Routine induction regardless of cervical score

42+ weeks uncertain LMP. US BPP normal, CTG reactive. Cervix is unfavourable for IOL. Mx? a. delivery by CS b. weekly NST c. twice weekly NST and weekly US d. review in 1 week e. perform amniocentesis looking for meconium

?induce Answer: C

Which of the following does not increase risk of LUSCS for 41/40 primip? a. IOL due to prelabour ROM b. ARM as part of active management of labour c. Thick meconium liquor d. CTG monitoring e. Syntocinon for secondary arrest at 8 cm

The average difference in diameter between obstetric conjugate and the diagonal conjugate are: a. 0.5 cm b. 1.5 cm c. 2.5 cm d. 3.5 cm e. none – they are both the same thing

B The obstetrical conjugate is measured by subtracting 1.5-2cm from the diagonal conjugate (Williams)

.Stretching the cervix - a. Shortens the labour b. Increase hyperstimulation c. Both d. Neither

High dose oxytocin protocol - a. shortens the labour b. increase hyperstimulation c. both d. neither

.Which element of Bishop score most relates to decreased length of labour? a. Dilation b. Effacement c. Station d. Consistency

Which is the predictor of success of IOL? a. Bishop’s score b. Gestational age c. Maternal age

Bishop score <4. What is best way to ripen cervix? a. PGE1 vaginally b. PGE2 vaginally c. Laminaria tents d. Intra-amniotic PG

Which of the following CTG patterns is most ominous? a. late decelerations b. variable decelerations c. early decelerations d. decreased variability with shallow late decelerations

.Dublin trial, incorrect option a. One to one care, FH every 15 mins then after every contraction b. Low risk patients were predefined and there was no statistically significant difference in outcomes c. ARM and clear liquor were part of inclusion criteria d. More seizures in IA versus EFM group e. Results can’t be extrapolated if colour of liquor unknown f. Don’t use EFM for low risk pregnancy

.In Dublin trial of electronic fetal monitoring all are true except: a. More convulsions in IA group b. Can recommend that EFM not be used in low risk group c. Meconium liquor excluded d. Cannot extrapolate to conduct of labour where membranes intact and liquor colour unknown

.A 26yo G4P2 at 36 weeks is in early labour. Cephalic presentation, green brown liquor, cervix 2-3cm dilated but not effaced. What is the most appropriate management? a. test liquor for lamellar bodies b. test for Listeria c. attempt fetal scalp pH d. US to exclude oesophageal atresia e. Steroids

B Lamellar bodies signify fetal lung maturation. USS would not change any management and is unlikely to be +ve in the absence of polyhydramnios. Corticosteroids are not indicated at this gestation and given the liquor it is not prudent to wait for them to be effective. Listeria is a cause of meconium stained liquor at preterm gestations and should be tested.

A 20 year old G3P2, with no antenatal care, presents with a painful PV bleed and tense abdomen at 36 weeks gestation. On USS there is a large retroplacental clot and the fetal heartbeat was not detected. VE shows 2cm dilated and fully effaced cervix, ARM performed with blood stained liquor. No active bleeding, BP – 130/85, PR – 90. Which of the following is correct. a. LUSCS to prevent further bleeding b. Take drug history to exclude cocaine addiction c. Avoid syntocinon in case of uterine rupture d. Most likely due to preeclampsia

A 32 yo G4P3 with 3 uneventful previous pregnancies and deliveries arrives in labour at term. FBE on admission has platelet count of 85, otherwise NAD. Most accepted Mx of this labour? a. Normal delivery then neonatal platelet count b. LUSCS c. LUSCS to avoid mid-forceps delivery d. Fetal blood sampling

.Woman at 41/40 being induced, SROM, station -3, clear liquor. Pinnard hears what sounds like a decel to 80 for first contraction? a. immediate CS b. VE c. Put on external CTG d. Stop synt

PG labour 5cm. CTG variable decel to 80 bpm and lasting 20 seconds. Management? a. scalp pH b. LUSCS c. Augment labour d. Reposition mother and observe closely e. Arrange for epidural block

.CTG 41 weeks, complaining of reduced FMF 4 days, CTG FH110, one episode of reactivity in 20 minutes, appears to have reduced variability, no decels. No apparent uterine contractions. Action: a. repeat CTG 12-24 hours b. IOL c. Immediate CS d. Reassure e. Fetal scalp pH

41 weeks gestation, reduced FMF, CTG: FH 140, no reactivity, persistent shallow late decels. Some uterine activity. Least useful action: a. immediate CS b. repeat CTG 12-24h c. IOL d. FBS

Primigravida at 5cm dilation. Vulva oedema is most commonly associated with: a. Obstructed labour b. Pre-eclampsia c. Allergy to hibitane obstetric cream d. Renal insufficiency

.PG in labour ward with 5 minutely contractions at term. The cervix was 3 cm dilated, 50% effaced and –2 station. 4 hours later, CTG was reactive, cervix became 4 cm dilated 75% effaced. 3 hrs later cervix still 4 cm dilated and CTG was normal. What is your management? a. Amniotomy and syntocinon b. R/V in 4 hrs c. Emerg CS d. Epidural block e. Buscopan and Phenergan

This question provided a partogram and a brief history, in summary it showed a primip with secondary arrest in labour at 6cm. Management? a. epidural b. Syntocinon infusion c. LSCS d. Repeat assessment in 4 hours

.What is the earliest sign of uterine rupture?** a. Abnormal fetal heart rate pattern b. Pain c. Bleeding d. Loss of station e. Cessation of contractions

G3P2 in labour at 38 weeks with a hydrocephalic fetus. On admission to labour ward the cervix was 3cm dilated. She appears to have been in active labour now for 6 hours and on repeat examination the cervix is still 3cm. Your management should be: a. IV Syntocinon and drain the head near full dilatation b. Per abdominal drainage of the head now c. Per vaginum drainage of the head now d. Caesarean delivery

B or C depends if it can be drained PV or not at 3cm. Given that she is a multiparous woman syntocinon should probably be withheld. Probably would need drainage for delivery by c/section as well

Woman with a gross hydrocephalic baby. She is 3 cm dilated and hasn’t progressed past that in the last 3 hrs. She is a multigravid patient. Management: a. CS b. Syntocinon then transvaginal ventriculocentesis when fully dilated c. Ventriculocentesis d. Abdominocentesis

C (or D under USS)

.Regarding 2nd stage? a. Primigravidas shouldn’t push till head visible at introitus b. Should not be > 60min c. Caput is CI to Keillands d. Liberal episiotomy use decreases complications

.Twins, 37/40. First delivered NVD, 2nd transverse lie with back up and FHR 32 a. ECV b. ECV under tocolysis c. LUSCS d. Classical CS e. Do nothing f. Duhrssen incision in cervix g. Stretch cervix to fully h. Stabilising induction i. Reductive embryotomy j. Internal version and breech extraction

Woman refusing to give any history with mature looking breech at introitus, delivered to umbilicus. Cord pulsating but 6 cm dilated cervix a. ECV b. ECV under tocolysis c. LUSCS d. Classical CS e. Do nothing f. Duhrssen incision in cervix g. Stretch cervix to fully h. Stabilising induction i. Reductive embryotomy j. Internal version and breech extraction

37 week IDDM woman, 87 kg, breech. Previous vaginal breech delivery of macrosomic baby with Erb’s palsy a. ECV b. ECV under tocolysis c. LUSCS d. Classical CS e. Do nothing f. Duhrssen incision in cervix g. Stretch cervix to fully h. Stabilising induction i. Reductive embryotomy j. Internal version and breech extraction

23 week fetus in primip, 8cm dilated with legs and arms dangling, membranes intact a. ECV b. ECV under tocolysis c. LUSCS d. Classical CS e. Do nothing f. Duhrssen incision in cervix g. Stretch cervix to fully h. Stabilising induction i. Reductive embryotomy j. Internal version and breech extraction

31 weeks lady with 26 week fundus and shoulder and back felt through dilating cervix with contractions a. ECV b. ECV under tocolysis c. LUSCS d. Classical CS e. Do nothing f. Duhrssen incision in cervix g. Stretch cervix to fully h. Stabilising induction i. Reductive embryotomy j. Internal version and breech extraction

.A 20yo primigravida presented in established labour, cervical dilation 7.5cm, ROM 10h, FH 144, contracting 2-3minutely lasting 45sec. The cervix was fully dilated after one hour and pushing actively the vertex descended from at spines to +2. Most likely dx? a. arrested labour b. pelvic dystocia c. normal labour d. requires augmentation e. anticipate shoulder dystocia

20 yo PG fully dilated for 2 hours. VE: vertex is spines +2 OA. a. ventouse extraction b. mid cavity forceps delivery c. both forceps and ventouse d. neither forceps or ventouse

A (they think C)

A 20 yo primip has been fully dilated for 2 hrs. On VE the vertex is at sp+2 in an OA position. Options for next 4 questions: a) ventouse extraction b) midcavity forceps delivery c) both forceps and ventouse d) neither forceps nor ventouse .Which is associated with a significant risk of substantial fetal trauma?

A 20 yo primip has been fully dilated for 2 hrs. On VE the vertex is at sp+2 in an OA position. Options for next 4 questions: a) ventouse extraction b) midcavity forceps delivery c) both forceps and ventouse d) neither forceps nor ventouse Which may be safely used at a higher fetal station?

Term primigravida, second stage of 90 minutes. VE: anterior fontanelle felt below pubic arch and orbital ridges posterior to it with station at spines. Which of the following is correct? a. Await NVD b. Mid-cavity forceps delivery c. Manual rotation followed by forceps delivery d. Vacuum extraction e. Caesarean section

E The presentation described is a brow presentation (mento-parietal diameter). Given the late stage of labour and diagnosis augmentation and instrumental delivery are contraindicated. NVD is unlikely to occur spontaneously (20% will revert to vertex, 30% to face).

Primigravida with face presentation at term in labour. Fully dilated for two hours, pushing for two hours, station at +2. ? Mento posterior a. EDB (epidural block?) and increase expulsion force with syntocinon b. Manual rotation to mento-anterior and NBF c. Keilland’s rotational forceps d. LUSCS e. Manual conversion to vertex and forceps delivery

Answer: A if M-A; D if M-P Conversion manually or with forceps to a mento-anterior position is dangerous and should not be done. In the absence of a contracted pelvis and in the presence of good labour deliver will usually occur (Williams). In mento-posterior position 30-50% will rotate spontaneously; 2/10 delivered vaginally (UTD).

.A patient you are seeing in labour ward is discovered to have a face presentation – mento-anterior. The presenting part is on view with pushing. All of the following apply except: a. the head is engaged b. Neville Barnes forceps may be applied to an infant with this presentation c. If mento-transverse the head will usually rotate to mento-anterior d. The diameter of presentation is submentobregmatic and is approximately 9.5 cm diameter e. May be caused by disproportion

?C I think D is wrong

PG, fully for 2 hrs, last 90 mins 2-3 minutely contractions and pushing. Term, spontaneous labour. O/E Left mento-transverse at spines Mx: a. Manually rotate to mentoanterior then NBF b. Ventouse c. Keillands d. Syntocinon e. LUSCS

E If M-T, probably rotating to M-A and would therefore be deliverable vaginally (Williams)

.A MG at term with face presentation, S2 45 minutes. O/E face, mentoanterior +1 cm, Normal CTG. Most appropriate management? a. Encourage to push b. Keillands rotation forceps c. CS d. NBF delivery e. Syntocinon infusion

.Which of the following is incorrect about Keilland’s forceps rotation? a. The posterior blade is applied first b. Barton’s forceps are best for a platypoid pelvis c. Wandering method involve sliding across the occiput d. Should be attempted only when the head is engaged

A Barton’s forceps are used for a high transverse head in a flat (platypoid) pelvis (google). Wandering application: slide anterior blade over occiput if head flexed, over face if extended head.

Pick the correct response regarding the episiotomy: a. Essential management of the primigravida patient b. Episiotomy rate should be 10% c. To avoid excessive blood loss the episiotomy should be made after locking the blades during a Keilland’s forceps d. May avoid the use of forceps in cases of deep transverse arrest e. None of the above

What is NOT a risk for shoulder dystocia? a. maternal obesity b. rotational forceps c. gestation > 42/40 d. syntocinon for secondary arrest at 8 cm

.A primip, short 1st stage, slow but steady 2nd stage. After delivery of the head, shoulders do not follow with strong downward traction or movement into the oblique (Wood screw manoevre). What should you do next? a. Fundal pressure and increased maternal effort b. Push head back in and do LUSCS c. Fracture the clavicle d. Deliver the posterior arm

466.Shoulder dystocia – most likely injury? a. Nerve b. Fractured clavicle c. Fractured humerus

All of the following are true regarding vaginal breech delivery at term except? a. Elective LUSCS at 39 weeks prevents cord prolapse at 40 weeks b. Elective LUSCS reduces the morbidity and mortality from head entrapment c. Infants delivered by LUSCS and vaginally have the same neonatal outcomes d. Elective LUSCS should be done prior to onset of labour

.Regarding term primigravid breech. Which is true? a. Elective LUSCS will improve neonatal outcome b. Elective LUSCS at 38/40 will prevent cord prolapse and death at 40/40 c. LUSCS will reduce morbidity and mortality related to head entrapment d. A randomised trial of planned vaginal breech delivery vs elective LUSCS should be started e. Retrospective data will provide helpful information

A (vs C?)

Breech delivery, incorrect option: a. LUSCS at 30/40 will prevent cord prolapse at 40/40 b. All women should be told to have LUSCS c. RCT showed decreased perinatal mortality with LUSCS d. LUSCS should be performed after 39/40 but before the onset of labour

.You are performing a vaginal breech delivery, the breech and scapula were delivered. The left was delivered spontaneously and (illustration provided showing right arm behind head with flexion at elbow, shoulder extended). What is the next appropriate step? a. insertion of your fingers and perform a manual extraction of the arm b. clockwise rotation of the fetal body c. anticlockwise rotation of the fetal body d. insertion of a hook to extract the arm e. allow the breech to hang and wait for spontaneous delivery

Which of the following manoeuvres will avoid injury to the liver? a. perform Prague manoeuvre b. apply both hands across the fetal trunk to splint the abdomen c. employ Pinards manoeuvre d. apply the thumbs overlying the lumbosacral spine and the index fingers on the iliac crests e. apply gentle traction on the legs

D Pinard’s maneuver is the delivery of extended legs by flexion of the knees. ? Prague manuever.

Regarding 3rd stage? a. IV ergometrine acts in 40 secs b. IM syntometrine acts in 7 mins c. Crede’s method should be routine d. Fundal dimpling indicates placental separation

A Crede’s maneuver is cord traction and fundal pressure (results in uterine inversion). The half life of IV syntocinon is approximately 3 mintues, ergometrine acts almost immediately IV and after several minutes if IM

.A woman with severe idiopathic cardiomyopathy is having an atonic PPH. EB: 800-1000ml. You have given 10 units syntocinon but she is still bleeding. Next agent should be?** a. Further 10 units synto b. 40 units synto infusion in 1000ml c. Intramyometrial PGF2 alpha d. IV ergometrine

D Can’t find anything that suggests heart failure is a contr-indication to ergometrine

.A grand multi had a rapid labour and delivered 20 minutes ago. She developed sudden onset of dyspnoea and collapsed on the floor. Which of the following is the most likely diagnosis? a. AMI b. Amniotic fluid embolism c. Pulmonary embolism d. Splenic rupture e. Cerebral haemorrhage

B Risk factors for AFE include rapid labour and grand multiparity. Can occur in the immediate post-partum setting

.Grand multipara delivered at home. Admitted, small tear sutured, well contracted uterus. No lower genital tract trauma. Still trickling a little blood. a. insert catheter b. FFP c. Tie off internal iliacs d. Protamine sulphate e. IM ergometrine f. Hysterectomy g. Bimanual compression h. PGF 2 alpha i. EUA and D&C j. Antibiotics

.Fulminating PET, minimal coagulation dysfunction. Delivered by LUSCS under GA. Placenta removed and now bleeding very heavily despite bimanual compression. a. insert catheter b. FFP c. Tie off internal iliacs d. Protamine sulphate e. IM ergometrine f. Hysterectomy g. Bimanual compression h. PGF 2 alpha i. EUA and D&C j. Antibiotics

.Woman presents 1 week after uncomplicated NVD. Normal BP, temp etc but heavy bleeding. US -> echoes in uterine cavity a. insert catheter b. FFP c. Tie off internal iliacs d. Protamine sulphate e. IM ergometrine f. Hysterectomy g. Bimanual compression h. PGF 2 alpha i. EUA and D&C j. Antibiotics

23 yo primip, previous DVT and fully heparinized. Bleeding ++ despite syntometrine and IV syntocinon a. insert catheter b. FFP c. Tie off internal iliacs d. Protamine sulphate e. IM ergometrine f. Hysterectomy g. Bimanual compression h. PGF 2 alpha i. EUA and D&C j. Antibiotics

.Which of the situations is least likely to result in PPH? a. 4600g macrosomic infant – vaginal delivery b. 4 h labour G3P2 c. G6P6- 2 hr labour d. Midcavity forceps delivery 3.6 kg 16 hr labour e. Para 0, 8 hrs labour fetus weights 3.4 kg

.A woman delivers a severely macerated fetus and placenta. Bleeding PV within normal limits. Platelets 50,000. Haemotocrit 38%. Mx? a. Observe for bleeding b. Fibrinogen c. Platelets d. Fresh whole blood e. Heparin

Contraindications to prostaglandin F2alpa for PPH secondary to uterine atony a. Asthma b. Chorioamnionitis c. Pre-eclampsia d. Previous CS

You are practising in a country hospital. A 20yo primigravida presents with ROM in established labour at term. The cervix was 3cm dilated. After 6 hours of augmentation the cervix remains 3cm dilated and the station -1. There was no FD. You have decided on CS for FTP due to CPD under GA (for some reason). The patient was paralysed but the anaesthetist is unable to intubate. The next step will be to: a. perform a tracheostomy b. continue with hand bagging and proceed with CS c. continue with hand bagging and transfer her to a teaching hospital d. roll her to her side and insert a spinal anaesthetic and do CS e. roll her to her side and insert an epidural

Answer: Apparently wake up and do regional

.Which of the following is the most effective way to avoid aspiration in a GA CS? a. fasting during labour b. use of antacids c. rapid-sequence induction techniques with cricoid pressure d. premedication with sedatives and antiemetics e. premedication with atropine

C The use of rapid sequence induction and cricoid pressure reduces the risk of aspiration whilst the use of antacids reduces the acidity of the stomach contents and the subsequent damage done by aspiration.

.Regarding a spinal tap with continuous epidural infusion? a. Must abandon procedure b. Reduce chance of vaginal delivery c. Increases PPH d. Can cause resp arrest

A PG woman in established labour requested epidural analgesia at 4 cm cervical dilation. She developed sudden onset of hypotension 10 minutes after insertion of an epidural analgesia. Your first reaction is: a. IV epinephrine b. IV adrenaline c. IV ephedrine d. Sit the patient up to avoid the anaesthestic agent ascending up the epidural space e. If there is any evidence of fetal distress, perform an emergency CS

.MG is labour, top up of 15ml rupivicaine 0.5% for instrumental delivery. Suddenly, seizure and cardiac arrest. Likely cause: a. Local anaesthetic toxicity b. Spinal block c. Eclampsia d. Idiopathic epilepsy

patient has an epidural top up with Marcaine for an operative delivery. She immediately has a tonicclonic seizure then cardiac arrest. What is the LEAST helpful thing you can do? a. Intubate b. Ventilate with mask/100% O2 c. Deliver baby urgently d. Ephedrine IV e. CPR with patient in left lateral tilt

.A primiparous patient has a normal vaginal delivery including 4h of continuous lumbar epidural anaesthesia. She was catheterised twice in labour with in-out catheter. 6 hrs after delivery she was unable to void. An indwelling catheter was inserted and drained 1500mls. The IDC was left in overnight and removed the next day. She voided small amounts during the day 50-100mls at a time. A second IDC was inserted and drained 700 ml. The cause of the urinary retention was: a. Urethral spasm b. Urethral trauma c. Detrusor failure d. Parasympathetic blockade caused by the epidural anaesthesia

.A pregnant woman who has an epidural in situ. She has intermittent catheterisation twice throughout labour and six hours after her labour she can’t void and has a catheter put in and has 1200 mL drained. This is due to: a. Urethral swelling b. Inflammation of the trigone c. Non-functioning of the detrusor d. Parasympathetic paralysis secondary to the epidural

3 hrs after a NVD a woman is noted to have a temperature of 40C and a tender uterus. Provisional diagnosis of endometritis. Which of the following is the most likely to be isolated from her HVS? a. Bacteroides b. GBS c. E. coli d. Chlamydia e. Anaerobic strep

.Called to see a patient with T2DM 72 hours following a NVD, with midline episiotomy that extended to 3rd degree tear. Pt unwell, flushed, febrile 38.9, HR 100, BP 90/50, uterus well contracted, 2cm below umbilicus, slightly tender, lochia like a period and slightly malodorous. Vagina and vulva appear grey, reduced sensation to pinprick:** a. rectovaginal fistula b. perirectal abscess c. endometritis d. necrotising fasciitis e. pelvic haematoma

D Given time period it is too early for RVF. Pararectal abscess and pelvic haematoma are uncommon and necrotising fasciitis is very rare. Most likely answer is endometritis. However T2DM is a risk factor; also comments on vaginal appearance and the unwell appearance of patient may suggest necrotising fasciitis (typically pain out of keeping with appearance).

.You are called to see a White’s Class D GDM who had a normal vaginal delivery complicated by an episiotomy 12 hours ago. She has malodourous discharge, tender uterus 2cm below umbilicus, a temperature of 38.7, BP 90/60 and a HR of 120. a. paravaginal haematoma b. perirectal abscess c. rectovaginal fistula d. endometritis e. necrotising fasciitis

D White’s classification is an outdated classification for GDM. D means onset of diabetes before 10 years of age, duration over 20 years, benign retinopathy OR hypertension. Given the short time following delivery pararectal abscess, rectovaginal fistula, endometritis and necrotising fasciitis would all be unikely. Paravaginal haematoma is most likely but unrelated to malodourous discharge and GDM.

You are asked to see patient with NVD, midline episiotomy. Examination: BP 110/60, left lateral vaginal wall mass, enlarging, now 6cm. a. pack vagina b. undo episiotomy c. drain mass d. blood transfusion e. commence iv Abs

C Likely diagnosis is a vaginal haematoma, likely from the descending branch of the uterine artery. Both UTD and Williams agree that masses over 4cm should by opened in OT, drained and the bleeding point ligated. If it stems from a repair – it needs to be reopened. Follow-up care is with vaginal pack, IV antibiotics +/- blood transfusion.

Which of the following factors are associated with the highest risk of postnatal depression? a. Delivery of stillborn b. Elderly patient c. History of PMS d. Multiparous e. Previous 2 uneventful pregnancies

.Severe post-partum depression is most likely with? a. Low SES status b. A poor emotional relationship of the patient with her mother c. Past history of depression d. First pregnancy e. Loss of weight during the pregnancy

.The percentage of women who will complain of post partum blues, transient depressive symptoms that resolve completely is? a. 5% b. 10% c. 25% d. 40% e. >50%

The psychiatric diagnosis that is most likely to have a familial component is? a. Post-partum depression b. Post-menopausal depression c. Anxiety d. Bipolar disorder e. None of the above

Regarding breastfeeding, which of the following is true? a. High circulating prolactin levels are required to maintain lactation b. Prolactin secretion increases during pregnancy due to an increase in size of pituitary lactotrophs c. Following delivery the oestrogen and progesterone levels fall and the inhibitory effects on prolactin receptors ceases

.Mastitis, most common causative organism? a. GBS b. Something else c. Something else forgotten d. Coagulase positive Staph e. Coagulase negative Staph

Lactating mother develops mastitis. Least correct option? a. most likely to occur 3-4 weeks post partum b. caused by Staph aureus c. treatment with flucloxicillin d. should not feed for 7-10 days e. tends to recur

.A woman had a NVD and developed a temperature of 39 12 hours after. A presumptive diagnosis of endometritis was made. Which of the following is the most likely causative organism? a. E. coli b. Bacteroides c. GBS d. S. aureus e. Clostridium

B vs C GBS – most common within 24 hours

The least useful antibiotic in post-partum endometritis? a. Cephalothin b. Erythromycin c. Metronidazole d. Clindamycin e. Chloramphenicol

.Most common organism causing endometritis at 6 weeks a. GBS b. Chlamydia c. Enterobacter d. Peptostreptococcus e. Bacteroides

D vs B The most common cause of acute endometritis unrelated to pregnancy is chlamydia. Pathogens isolated at time of delivery were peptostreptococcus (45%), bacteroides (9%), clostridium (3%), GBS (8%), E.coli (9%), enterococcus (14%) and these are implicated in postpartum endometritis. If the question was postpartum peptostreptococcus would be correct, if unrelated to pregnancy chlamydia would be correct. Given time frame, chlamydia is the more likely answer.

.Endometritis at 6 weeks post partum, what is the most likely organism? a. GBS b. E.coli c. Chlamydia d. Anaerobic Strep e. Gonococci

C The most common cause of acute endometritis unrelated to pregnancy is chlamydia. Pathogens isolated at time of delivery were peptostreptococcus (45%), bacteroides (9%), clostridium (3%), GBS (8%), E.coli (9%), enterococcus (14%) and these are implicated in postpartum endometritis. If the question was postpartum peptostreptococcus would be correct, if unrelated to pregnancy chlamydia would be correct.

.Endometritis at 6 weeks postpartum. Which is the least likely organism? a. Chlamydia b. Enterobacter c. Klebsiella d. Proteus e. Peptostreptococcus

.Multiparous woman 8 weeks post partum. Well antenatally and NVD. Now feels anxious and sweaty, feels heart racing. Diarrhoea several times a day. Insomnic and sweating at night. BP 160/110. HR 100. What is going on? a. anxiety disorder b. Addison’s disease c. HIV infection d. Manic depressive psychosis (have these people seen the latest DSM?!) e. Thyrotoxicosis

Most common cause of term infant mortality? a. congenital abnormalities b. infection c. NEC d. Bronchopulmonary dysplasia e. Intraventricular haemorrhage

Most likely cause of perinatal mortality with diabetes? a. Fetal hypoglycaemia b. Congenital abnormality c. APH d. Fetal hyperinsulinaemia e. PIH

Primip with no antenatal care delivers 1000 g baby at 28/40. What is most likely cause of death? a. Sepsis b. Temp instability c. Intracranial haemorrhage d. RDS

Which is true re: neonates? a. Apgar at 5 mins of 3 -> 50% CP b. Commonest cause of death in first year of life=cot death c. ABO incompatibility does not need phototherapy d. Seizures are the best predictor of poor outcome

B A high incidence of death, neurodevelopmental delay and neurologic impairment occurs in neonates with seizures. The cause of the seizures is more important in predicting outcome rather than seizures themselves. Apgars of 3 at 5 mins has CP rates of 4-7% in old studies. ABO incompatibility sometimes requires photoherapy. SIDs is the leading cause of mortality in the US between the age of 1 month and 1 year of age.

Steroids in a preterm baby will a. Reduce RDS b. Reduce IVH c. Reduce NEC d. All of the above e. A and B but not C

.Regarding cerebral palsy and birth asphyxia a. 50% of affected infants will have Apgars less than 3 at 5 minutes b. Most affected infants will have normal Apgars c. Early neonatal fitting does not indicate a poor prognosis

B 4% of infants with CP had evidence of asphyxia or abnormal apgars

Cerebral palsy, incorrect option: a. 20 times more likely if Apgars <4 at 5 mins b. 5% will develop CP if Apgars <4 at 5 mins c. Triplets 45 per 1000 develop CP d. Twins 15 per 1000 develop CP e. Singleton 2 per 1000 develop CP f. 25% infants with grade 3 IVH develop CP

C Background rate – 3.6 per 1000; if apgar less than 3 at five minutes the risk was 4.7%; 25 times the background rate; singletons – 1.6 / 1000 survivors; twins – 7.3 / 1000 (CI 5-10); triplets 28 per 1000 (CI 11- 63). (UTD). C&R state that 35% of infants with grade III IVH have adverse neurologic outcomes. C&R also states that risk is 4-5 times greater for twins and 12-13 times greater for triplets

Which statement is NOT true a. Perinatal mortality rate in singletons 8 per 1000 b. Perinatal mortality rate in twins 40 per 1000 c. Perinatal mortality rate in triplets 70 per 1000 d. Cerebral palsy rate in singletons 2 per 1000 e. Cerebral palsy rate in twins 10 per 1000 f. Cerebral palsy rate in triplets 50 per 1000

C Australian PNM – singletons – 7.5, twins – 30.2, higher order – 54

.Regarding apgars: Which of the following is correct? a. 75% of CP have normal Apgars

A Lol.

A term infant has just been delivered with Apgar 1 at 1. Airway cleared. What is the next most appropriate step? a. IM Konakion b. Intraumbilical glucose and bicarb c. Continue to bag and mask d. Intubate

C The logarithm is to provide warmth, position, clear airway followed by giving supplemental oxygen or positive pressure ventilation. Intubation can be considered to clear airway or provide positive pressure ventilation but is not necessary. (Neonatal resuscitation handbook)

A male baby has just been delivered by elective LUSCS weighing 3000g. Apgars 7, 9. After a couple of hours, he develops grunting and intercostal recession and RR 80. Resolved by 18 hours. Mechanism? a. surfactant deficiency b. delayed resorption of lung fluid c. acidosis d. neonatal pneumonia

An elective CS was performed at 38/40 for grade 4 placenta praevia under GA. Infant was delivered with Apgars of 9 and 9. The infant develops increasing respiratory effort 1 hr after birth. What is the most likely diagnosis? a. Hyaline membrane disease b. Pneumonitis c. Transient tachypnoea of newborn d. Prolonged effects of newborn e. Birth asphyxia

Vaginal swab from mother delivered at term, the most important information for the neonatologists is: a. haemolysis on blood Agar b. group (A, B, D etc) c. antibiotic sensitivities

Commonest cause of neonatal hypothyroidism? a. previous Graves treated with surgery b. patient on PTU c. iodine deficiency induced goitre d. radioiodine therapy for hyperthyroidism in pregnancy e. patient received thyroid releasing factor (TRH) during pregnancy

Most likely cause of neonatal hyperthyroidism is: a. Maternal toxic nodular goitre b. Treated maternal Grave’s disease c. Excess thyroxine d. Excess maternal ingestion of mercapto-imadazole

The best screen for neonatal hypothyroidism is? a. T4 with subsequent TSH in low T4 cases b. TSH with subsequent T4 if TSH high c. Simultaneous TSH and T4

Signs suggestive of neonatal hypothroidism? a. Hypotonia b. Dry skin c. Open posterior fontanelle d. Typical facies e. All of the above

Regarding fetal thyroid function a. Serum TSH levels rise rapidly in the first minutes after birth and peak at 30 minutes of postnatal life

Neonatal thyroid function which are true: a. Increase in thyroxine after birth in preterm but not term infants b. Neonatal rise in T4 due to TSH increase c. Thyroxine is involved in shivering but not non-shivering thermogenesis

.Advantages of rooming in. All except: a. baby is colonised with mother’s bugs, not others b. reduction in SIDS later c. facilitates 4 hourly feeds d. increases uterine involution e. improves letdown reflex

Breast feeding and rooming in promote all of the following except? a. Decreased infant infection b. Decreased maternal infection from other sources c. Decreased child abuse d. A 4 hr feeding regime e. Bonding

All of the following promote breastfeeding except? a. rooming in b. demand feeding c. regular feeding

C Rooming in enhances early initiation and establishment of breastfeeding. Demand feeding is also encouraged for healthy babies because the babe will be awake, eager to seek food and empties breast better. The stronger stimulation also helps to establish lactation. Regular 3-4 hr feeds tend to bear no relationship to baby’s hunger and therefore the sucking process is less satisfactory

Evidence from RCT, what should you not do in pregnancy a. ECV at 33/40 to avoid breech at term b. Stop smoking programs c. Antibiotics for asymptomatic bacteruria d. Local imadazoles for thrush

.What is the commonest cause of indirect maternal death in Australia? a. MCA b. Congenital heart disease c. Rheumatic heart disease d. Renal diseases e. Infections

B In the 2003 - 2005 triennium the leading causes of indirect maternal death were cardiac (10), psychiatric (6), non-obstetric haemorrhage (5), infection (4), hypertension (1) and other (10). Further breakdown of cardiac causes was congenital (6). MCA is classified as an incidental maternal death.

.Which is an example of an indirect obstetric death: a. Cerebral haemorrhage during eclamptic fit b. 28/40, fatal pulmonary oedema secondary to mitral stenosis c. Renal shutdown following abruption d. Septicaemia after pPROM resulting in caesarian delivery

In Australia the neonatal mortality rate is defined as: a. The number of deaths within 28 days per 1000 total births b. The number of deaths within 28 days per 100000 live births c. The number of deaths within 28 days per 1000 live births d. The number of deaths within 7 days per 1000 live births

Perinatal mortality rate is** a. Sum of still birth rate + NND rate b. Number of still births / total number of babies born c. Number of babies born alive who died within 28 days / total number live births d. Sum of number of still births and number of NND / total number of births

.Which is most correct a. PNG perinatal mortality 20/1000 b. Australian maternal mortality 10/10,000 c. PNG maternal mortality 1/250 d. Worldwide 1500 women die every day due to pregnancy

D PNG MMR – 700-900/100 000 = 1:137; Australia MMR – 7-8/100 000;

Choose the most incorrect option:** a. The maternal mortality rate in Australia and New Zealand is 1:10,000 b. The maternal mortality rate in PNG is 1:250 c. 1500 women die daily from child birth d. The perinatal mortality rate in Australia and New Zealand is 8:1000 e. The PNM rate in PNG is 20:1000

.Which is the closest to Australian perinatal mortality rate:** a. 5 per 1000 live births b. 10 per 1000 live births c. 10 per 1000 total births d. 20 per 1000 live births e. 20 per 1000 total births

.The purpose of a screening test is to: a. Identify individuals at risk of developing a condition b. It identifies high risk patients c. Identify individuals with disease early in order to reduce costs of treatment d. Identify individuals early in disease process to improve outcomes e. To find those with no symptoms in a low risk population

Evidence based medicine based on? a. cohort study b. RCT

Which is the best test for a rare slowly progressive disease? a. case control b. cohort c. RCT d. Case series

.The requirements for reporting an RCT are stated in a. COCHRANE database b. NICE guideline c. CONSORT d. QUORUM

.The difference between a case-control and a cohort study is: a. In a case-control study the subjects are allocated by disease status and in a cohort study by exposure status b. In a case-control study the subjects are allocated by exposure status and in a cohort study by disease status c. A case-control study is retrospective whereas a cohort study is prospective d. A case-control study is prospective whereas a cohort study is retrospective

A cohort study starts with an exposure and moves forward towards a disease whereas a case control = retrospective study starts with a disease and works backwards to the exposure Answer: A and C are true; A probably more so

Which is true? a. Risk estimate from case control is more reliable then cohort b. Risk estimate from case control equal to cohort c. Risk estimate from case control and cohort not comparable d. Risk estimate from case control more reliable then from cohort

The ability of a test to detect persons with a condition? a. Sensitivity b. Specificity c. Odds ratio d. PPV

100 females undergo CST (contraction stress testing). 10 are positive and there are 2 still births both whom had +ve CST. What is sensitivity?** a. 10% b. 20% c. 80% d. 90% e. 100%

Diagnostic test for Chlamydia is 95% sensitive and 95% specific. What is PPV of test when prevalence is 5% a. 90% b. 50% c. 30% d. 5%

B In a population of 2000 with 5% prevalence 100 will have Chlamydia and 1900 will not. If 95% sensitivity then 95 that have disease will have positive test and 5 that have disease will be negative. If 95% specificity then 1805 that are negative will have negative test and 95 that are negative will have positive test

.If test for Chlamydia has sensitivity 95% and specificity 95% and prevalence is 30% then positive predictive value is approx 90%. If prevalence is now 5% then PPV is: a. 10% b. 30% c. 50% d. 70% e. 90%

Which is correct regarding sensitivity and specificity? a. Sensitivity is proportional to specificity b. For a given sensitivity and specificity positive predictive value increases with increasing prevalence c. For a given sensitivity and specificity positive predictive value increases with decreasing prevalence d. The specificity is the reciprocal of the NPV e. Sensitivity is equivalent to PPV

Regarding the positive predictive value? a. The PPV may increase or decrease with increasing prevalence, depending on the sensitivity and specificity b. For a given sensitivity, PPV alters with increasing prevalence

.Which of the following is true? a. The specificity is the inverse of the negative predictive value b. The PPV may increase or decrease with increasing prevalence and static specificity and sensitivity depending on other factors c. For a given specificity and sensitivity the PPV will increase with increasing prevalence

.If the sensitivity and specificity of a test stay the same with increasing prevalence the positive predictive value will: a. increase b. decrease c. stay the same

.What does random allocation achieve? a. Equal numbers in each arm b. Equal distribution of suspected confounding factors c. Equal distribution of possible unknown factors d. Greater interest in your article

What sample size would be required to have 80% power to detect a 25% decrease in poor birth outcome that is currently 4 per 1000 with an alpha error of 0.05? a. 200 b. 2000 c. 20000 d. 200,000

What will increase power of a research paper? a. Decrease bias b. Increase sample size c. Refer to statistician

Bias is: a. Reduced by increasing sample size b. Systematic error c. Not affected by blinding

.In doing a trial on a new method of rectocele posterior repair, the best way to assess the repair technique would be a. Speculum examination by surgeon at 3/12 b. Bimanual examination by the surgeon at 3/12 c. Speculum examination by independent, blinded examiner at 3/12 d. Standardized questionnaire at 3/12 e. POP-Q by surgeon at 3/12 f. POP-Q by independent, blinded assessor external observer at 3/12

.Number of women who will live to their 90’s if alive at 50? a. 75% b. 50% c. 10% d. 5%

.32 year-old with 2 children sees you requesting sterilisation. You decide not to. This decision is an example of a: a. Clinical decision b. Ethical decision c. Moral decision d. Collaborative decision

The purpose of ethics is to: a. Resolve moral dilemmas b. Provide ultimate judgement c. Guide us in uncertainty d. Replace clinical decisions

The decision to allocate funds towards the purchase of new laparoscopic equipment for the department of O&G is an example of the ethical principle of: a. Beneficence b. Non-maleficence c. Paternalism d. Distributive justice

What is unethical? a. Reanastomoses of tubes 41 yo female b. IVF if unmarried female c. Surrogate motherhood as 30 yo professional with mild endo doesn’t want to stop her Provera d. IVF if female with father with Huntingtons

.You administer anti-D to a Rh-ve woman at 28 weeks. After you have given the injection the midwife informs you that she is a JW. What do you do? a. Remove the medication sheet from the chart and destroy it b. Contact your medical defence organisation c. Explain to the woman and apologise d. Report the midwife for failing to tell you sooner e. Nothing

The application of ethics in O&G is: a. Free of moral and religious beliefs b. Influenced by personal opinion c. Different to ethics of everyday life

In the literature, what is said by patients to be a contributing factor as to why they were unhappy with the way their doctor informed them of their diagnosis? a. Doctor not confident in their skills at breaking bad news b. Patient not given time to say question they want to ask c. Doctor thinks telling them the diagnosis will cause long term harm d. Patient doesn’t want to know the diagnosis

According to recent literature the reasons stated for patient non compliance include all except a. Complex medication regimens b. Poor communication with the prescribing doctor c. Doctor gender d. Dissatisfaction with level of care e. The age of the patient

A quality assurance program should include all the following features EXCEPT: a. Identify who is your customer (patient) b. Identify what services are required by the customer (patient) c. Identify how services are provided to the customer (patient) d. Identify the cost of the services to the customer (patient) compared to other institutions e. Identify processes by which services to the customer (patient) may be improved

How many women die every day world wide because of a pregnancy related problem? a. 100 b. 700 c. 1400 d. 3600

C (536,000 per year)

.A markedly increasing population growth in some third world countries is chiefly related to a. Reduced death rate b. Social and cultural changes c. Increase in birth rate d. Failure of contraception e. Improvements in obstetric care

A patient is suspected of Hepatitis B. Serology demonstrates Hep B core antibody positive but surface antibody and antigen negative. This means: a) the patient is a chronic carrier b) the surface antibody will rise soon c) the patient probably did not have Hep B d) cross reaction with Hep A e) the patient is highly infectious

Which structures do you incise during a episiotomy? a. Ischiocavernosus and bulbocavernosus b. Bulbocavernosus and superficial transversus perineii c. Ischiocavernosus and superficial transversus perineii d. Iliococcygeus and pubococcygeus e. Iliococcygeus and ischiococcygeus

B Ischiocavernosus – crura of clitoris → inferior pubic ramus; Bulbocavernosus – cover vestibular bulbs, perineal body → clitoris; Superficial transverse perineal muscle – perineal body → ischial tuberosity

Which are the muscles that are cut by a midline episiotomy j. Iliococcygeus k. Transverse superficial peronei l. Bulbocavernosus m. Pubocavernosus

What structures would you not meet when repairing a 3rd degree tear? a. Bulbocavernosus b. Ischiocavernosus c. External anal sphincter d. Superficial transverse perinei e. Deep transverse perinei

.Crossing over of chromosomes occurs in: a. Both prophase of mitosis and meiosis b. Meiotic prophase 1 c. Metaphase 1 d. After ovulation

.Relaxin is produced from: a. endometrium b. myometrium c. chorioamniotic membranes d. corpus luteum e. syncytiotrophoblast

D Relaxin is produced by the corpus luteum, decidua and placenta (UTD). Speroff states that the major source of relaxin is the corpus luteum although it is produced at other sites

Relaxin, incorrect option a. Main production from corpus luteum b. Not associated with adverse outcome if not present c. Similar to growth hormone d. RCT has not shown that it is useful for ripening the cervix

All of the following hormones have a similar structure EXCEPT: a. inhibin A b. inhibin B c. TSH d. AMF e. Activin

EGF – endothelial growth factor a. Was first isolated from frog skin b. Reaches high levels in the fetal circulation c. Causes respiratory distress by inducing epithelial overgrowth in neonatal lungs d. In high doses induces excessive growth of hair or wool e. Its receptors are stimulated by TGF- alpha

In pregnancy compared to the non-pregnant state: a. Thyroxine remains the same b. Free T3 increases c.Total T3 increases d. Thyroid binding globulin decreases

? Thyroxine increases, T3 increases, thyroid binding globulin increases (Nelson-Piercy)

.Which of the following is not produced by the fetus? a. oestrogen b. insulin c. ACTH d. TSH

What compound is at the greatest concentration in blood in physiological conditions? a. Carbon dioxide b. Bicarbonate c. Carbonic acid d. All are at equal concentrations

Maternal blood gases in late pregnancy, all except? a. alkalosis b. low bicarbonate c. base excess greater

Respiratory function in pregnancy – all except? a. Increased tidal volume b. Decreased functional residual capacity

.In pregnancy all of the following increase except a. Tidal volume b. Respiratory rate c. Minute ventilation d. Residual volume e. Oxygen consumption

.Which hormone increased near labour, all except? a. oxytocin b. oestrogen c. progesterone d. CRH

C Labour may be precipitated by progesterone withdrawal (C&R)

With advancing gestation the uterus gets more receptors for, or increased sensitivity to, incorrect option a. CRH b. Oxytocin c. Beta agonists

Which is wrong in late pregnancy? a. increase LH b. increase oxytocin c. increase aldosterone d. increase CRH

A Progressive increase in CRH, oxytocin and aldosterone

24 hr uterine activity monitoring show peak in 3rd trimester: a. midnight b. early am c. ~ 5pm

Oxytocin : all are true except** a. It is a nanopeptide b. Oxytocin receptors are found in decidua c. Stimulates influx of Ca2+ across the plasma membrane in smooth muscle:

? Oxytocin is made up of nine amino acids (therefore is a nanopeptide); receptors are found in the decidua; increases the intracellular calcium concentration both from entry into the cell and release from the sarcoplasmic reticulum

.Regarding syntocinon, which is true? i. Causes hypernatraemia j. May cause hypotension in mother k. Water intoxication is seen because it is given in 5% dextrose l. Should be given in 5% dextrose to reduce risk of electrolyte incompatibility

B May cause water intoxication due to its ADH type actions.

Regarding AVP, which is true? a. The main determinant of fetal heart rate variability b. Causes increased fetal urine output to protect umbilical cord with amniotic fluid c. Is produced in the right atrium under the influence of stretch receptors d. Causes fetal tachycardia secondary to peripheral vasoconstriction e. Is released in response to haemorrhage

.Which change is considered normal/physiological in preg (correct option) a. Raised Alk phos b. Decreased albumin c. Increased urea

Placental sulphatase deficiency associated with a. X linked b. Premature labour c. Psoriasis d. All the above e. None of the above

A Placental sulphatase deficiency can be otherwise known as X-linked ichthyosis and usually manifests as scaling of the skin. Can be associated with an inability to labour rather than preterm birth.

Regarding nitric oxide: which is wrong a. Contracts smooth muscle b. Equally effective at 48 hrs as Ventolin c. Acts via cyclic GMP

A Potent vasodilator; is as equally effective as a tocolytic as salbutamol at 48 hours in prolonging delivery.

Regarding smooth muscle contraction, which is wrong: a. Voltage dependent Ca channels b. Receptor mediated calcium channels c. Smooth endoplasmic reticulum uptake of calcium (?release)

C The sarcoplasmic reticulum releases calcium; the sacrolemma has both potential dependant calcium channels and receptor mediated channels (B&L)

.Regarding stimulation of myometrial muscle contraction which is wrong? a. Voltage dependant Ca channels b. Receptor dependant Ca channels c. Smooth endoplastic reticulum uptake of calcium d. Myosin related calmodulin receptor kinase

Placentation. Which is true? f. Complete feto-placental circulation established by 5-6 weeks post conception g. Two waves of endothelial cytotrophoblast invasion is finished by 10/40 h. Of uterine blood flow 55% is to placenta, rest to myometrium/endometrium/deciduas i. Blood leaves fetus to go to placenta via 2 arteries and 1 vein and flow is 350 ml/min j. Flow in cord is 150 ml/min

A The flow through the cord is 350ml/min; placentation is complete by 14 weeks; 85% of uterine blood perfuses the intervillous space

.Fetal vessels with highest p02 in utero a. IVC at heart b. SVC at heart c. Umbilical artery d. Ductus arteriosis e. Pulmonary artery

What is the fetal scalp PaO2 at term? a. 22 mmHg b. 32 mmHg c. 42 mmHg d. 52 mmHg e. 62 mmHg

What is the cord pH at term immediately after a normal labour and delivery?** a. Vein 7.3, artery 7.27 b. Vein 7.27, artery 7.3 c. Vein 7.5, artery 7.2 d. Vein 7.2, artery 7.5

.The vessel which carries the most oxygenated blood in the fetus is the a. IVC as it enters the heart b. SVC as it enters the heart c. Pulmonary artery d. Umbilical artery e. Renal vein

Streaming of blood in the fetal IVC result in: e. More oxygenated blood being directed through the foramen ovale to the left atrium f. Deoxygenated blood from the coronary sinuses being directed to the aorta g. Deoxygenated blood being directed to the left lobe of the liver h. Oxygenated blood travelling in the right ventral portion of the IVC

Regarding fetal cardiac output: f. Half the output of the right ventricle is directed to the ductus arteriosus g. 40% is directed to the placenta h. 1/3 is directed to the brain via the carotids i. The right and left ventricles have equal outputs j. Half the right ventricular output is directed to the pulmonary artery

B 3% goes to the heart; right 65%; left 35%: 10% to lungs

Cardiovascular changes at birth? e. Brain is organ which receives most dramatic increase in blood flow f. Foramen ovale is a flap valve which becomes functionally closed when LA pressure > RA pressure g. Prostaglandins have minor role in physiological closure of ductus arteriosus h. Pulmonary vascular resistance and pulmonary blood flow decrease

.In newborn, normal circulatory changes include all except: a. Increased flow in pulmonary vein b. Increase in left arterial pressure (?atrial) c. Increase in pulmonary vascular resistance d. Increase renal blood flow e. Decrease ductus venosus flow

.Circulatory transition from foetal to extrauterine life, which is true?** a. Gas expansion leading to dramatic increase in pulmonary vascular resistance and increase pulmonary blood flow b. Doubling of previous return c. Occlusion of the cord leads to a large flood of blood to the placenta is interrupted causing decrease in systemic BP d. PGE1 causes closure of ductus arteriosis e. Ductus venosus oxygen tension decreases

E PGs keep the DA open (NSAIDS inhibit PG synthesis and therefore close DA)

How many weeks post conception does NT close? a. 4 b. 6 c. 8 d. 10 e. 12

A Closure occurs between the 25th and 27th day post-conception

D Pressure is slightly higher at the trachea to prevent collapse

.The fetal auditory system: a. Is fully myelinated by term b. Can detect sounds by the end of the first trimester h. The basal portion of the cochlea matures before the apical portion c. Can detect high frequency sounds better than low frequency d. Sound is transmitted via the ossicles through the air filled middle ear

.Average weight of a 28-week neonate with no adverse factors? a. 400 g b. 850 g c. 1100 g d. 1350 g e. 1600g

.Blood volume of term neonate? a. 200 ml b. 400 ml c. 600 ml d. 800 ml e. 1000 ml

B 78ml/kg = 234-273ml for 3-3.5kg neonate (Williams); 110-115ml/kg if you include placenta

.What is the blood volume of a newborn baby weighing 3500g? a. 150 ml b. 250 ml c. 300 ml d. 350 ml e. 400 ml

Blood volume of normal 3.5kg neonate: a. 100ml b. 150 ml c. 400 ml d. 500 ml e. 1000 ml

A multiparous woman at 36 weeks has haemoglobin of 6.8. The fetus will have haemoglobin of? a. 8 b. 10 c. 12 d. 16 e. 20

Predominant Hb type in neonate? a. HbA b. HbA2 c. HbF d. HbH

What contributes most to AFI in late gestation? a. fetal swallowing b. fetal urination c. transudation across membranes

Amniotic fluid during gestation d. Osmolality increases throughout gestation to become iso-osmolar with maternal serum at term e. Has a low chloride and low protein content f. Reaches a maximum volume of 750-1000 mls at 40 weeks

.The fetal kidney: d. Is just as responsive to aldosterone as the adult kidney e. Produces hyperosmolar urine f. Responds to hyperosmolar mannitol by increasing GFR to excrete the osmotic load

A Fetal urine osmolality decreases towards term.

Fetal urine amount related to? a. fetal weight b. gestational age

B (30% of body weight)

Behavioural state 2F is characterised by: ** f. Eye movements, fetal breathing movements and frequent heart rate accelerations g. Absent gross body movements but frequent eye and breathing movements h. Absent eye, breathing and gross body movements associated with decreased heart rate variability i. Occurs most of the time at term j. High voltage, slow wave EEG pattern

.The “D” antigen first appears on RBCs at a. 5w b. 8w c. 12w d. 16w e. 22w

.Which is not true of iron metabolism a. Only 5% of her daily intake of iron is absorbed b. A pregnant woman requires 9mg/day c.A menstruating non-pregnant woman requires 2mg/day d. ?

All are wrong

Which of these are true in pregnancy? a. Normal pregnant requirement of iron in 9mg/day b. Normal non-pregnant requirement of iron is 4 mg/day c.Cord ferritin is higher than maternal ferritin d. 10% of iron is absorbed from non-haem sources

C, D also correct

C or D

.What is the average weight of the term placenta? a. 100g b. 450g c. 720g d. 1000g e. 1200g

Which is category A drug? a. ondansetron b. Maxalon c. Augmentin d. phenytoin e. betamethasone

B and E

.What is the criteria of calling a drug class B3 a. Animals study show a defect, the significance of which is unclear in humans b. Animal studies are lacking, but no evidence of defects c. Harmful effects in human suspected, but those effects are reversible d. Animal studies showed reversible defect

Before starting isotretinoin in a 16 year old check a. LFTs b. Full blood count c. Urine BHCG

Which drug should not be used in lactation a. Amiodarone b. Warfarin c. Digoxin d. Propylthiouracil

.Which is associated with increased miscarriage a. Isotretanoin b. Heroin c. Marijuana d. Heparin e. Cocaine

.Which is associated with IUGR a. Isotretanoin b. Heroin c. Marijuana d. Heparin e. Cocaine

Which is associated with placental abruption? a. Isotretanoin b. Heroin c. Marijuana d. Heparin e. Cocaine

Side effects to fetus of indomethacin? a. prem closure of PDA b. polyhydramnios

.Which drug is most likely to cause oligohydramnios? a. Captopril b. Verapamil c. Prazosin d. ?

Propranolol: actions? a. alpha, beta blockade b. beta blockade c. vasodilator d. none of the above

.Labetolol: actions? a. alpha, beta blockade b. beta blockade c. vasodilator d. none of the above

.Alpha methyl dopa: actions? a. alpha, beta blockade b. beta blockade c. vasodilator d. none of the above

D (alpha 2 adrenergic antagonist)

.Regarding warfarin which of the following is correct? a. IV vitamin K reverse side effects in 15 seconds b. Can’t breast feed c. Can give epidural d. Normal dose paracetamol no serious side effects

Regarding warfarin. Which is true? e. It is only safe in second trimester f. It can be interfered with by therapeutic dose of paracetamol g. It is monitored with use of APTT h. Can be used in breast feeding

Side effects of oxytocin-receptor antagonist (ag atosiban) a. headache b. N+V c. Arthralgia d. None of the above e. All of the above

.Most important diagnosis to know before giving PGF2a? a. PDA b. HT c. Asthma d. AV fistula

All of the following patterns of inheritance are correct except: a. von Recklinghausen’s AD b. Huntington’s chorea AD c. Fibrocystic disease of the newborn AR d. Tay Sachs disease AD

D Autosomal dominant – von Recklinghausen’s (neurofibromatosis type I), Huntington’s chorea. Autosomal recessive – Tay Sachs disease, fibrocystic disease of the newborn (?)

.Which type of inheritance is wrong? a. Duchenne muscular dystrophy – autosomal recessive b. Tuberous sclerosis – autosomal dominant c. Myotonic dystrophy – autosomal dominant d. Tay Sach’s disease – autosomal recessive

Which disease is the wrong inheritance: a. Tay Sachs – AD b. Huntington’s – AD c. Achondroplasia – AD d. CF – AD

A and D

Which of the following conditions is autosomal recessive? a. Haemophilia A b. Cystic fibrosis c. Tuberous sclerosis d. Huntington’s chorea e. Adult polycystic kidney disease

B Haemophilia A is X-linked; Huntington’s, tuberous sclerosis and aPCKD are AD

.Which of the following is an autosomal recessive condition? d. Cystic fibrosis e. Huntington’s chorea f. Duchenne muscular dystrophy

Which genetic condition is NOT associated with an ethnic group a. Tay Sachs b. Von Willebrands c. Sickle cell d. Alpha-thalassaemia

Adopted girl whose natural mother dies of Huntington’s disease. The risk of her baby having the disease is: a. 50% b. 25% c. <1% d. none if it is a girl e. only if a boy

Fragile X syndrome a. occurs only in men b. Mendelian inheritance c. associated with premature menopause d. no phenotypic features e. none of the above

.Pregnant woman’s brother has schizophrenia. Risk of schizophrenia in child? a. nil b. 1-2% c. 2-4% d. 5-10% e. 25% f. 50% g. 100%

.Pregnant woman’s husband has schizophrenia. Risk of schizophrenia in child? a. nil b. 1-2% c. 2-4% d. 5-10% e. 25% f. 50% g. 100%

D Lifetiem risk = 0.2-0.7% increased 10 fold if a parent affected

.Your patient attends for menopausal advice, mentions her son has schizophrenia as has his partner and they are thinking of starting a family. Risk for child? a. nil b. 1-2% c. 2-4% d. 5-10% e. 25% f. 50% g. 100%

.Commonest inherited condition a. Tay Sachs disease b. Hurler’s syndrome c. PKU d. Cystic fibrosis e. Congenital hypothyroidism

D CF – 1:2500, ChT – 1:5000, PKU – 1:14000; TSD – 1:36,000

.The husband of a normal female has Christmas disease. She gave birth to a son. What is the probability that he is affected? a. none b. 10% c. 20% d. 30% e. 50%

.A woman’s previous son has Duchenne muscular dystrophy. What is the chance her current fetus is affected? a. 50% b. 25% c. 0% d. 10% e. 33%

.Male with an X linked disease is married to a normal homozygous female. What chance do their children have of getting the disease?** a. 0% b. 6.25% c. 12.5% d. 25% e. 50%

.A man has an X-linked disorder and his wife is homozygous normal. What is the chance that their two children will both be affected? a. 0 b. 1/2 c.1/4 d. 1/16 e. 1/32

Meningomyelocoele is associated with: a. trisomy 21 b. Turner’s syndrome c. Trisomy 18 d. Arnold Chiari malformation e. Noonan syndrome

A mother has two children, one with open spina bifida and the other with a myelomenigiocoele. What is the likelihood of recurrence? a. 1% b. 5% c. 10% d. 15% e. 20%

C The risk is approximately 5% (C&R) with one affected sibling and 10% with two affected siblings (UTD).

.A patient has a termination of pregnancy at 18 weeks for an open neural tube defect. What is the risk of recurrent NTD in her next pregnancy? a. 1% b. 2% c. 5% d. 10% e. 50%

.A woman who has a prior child with Spina bifida comes to see you 10w. What do you recommend? a. US 11w b. Start folate now c. CVS now d. Amnio 16w e. Reassure

.What is the recurrence rate of anencephaly after one affected child? a. 3% b. 5% c. 10% d. 20% e. 25%

.US (picture given) at 17/40 shows ‘frog’s eyes’ (anencephaly) and maternal serum AFP 4 times above normal range. Following options in counselling parents? a. Defect unclear as not often seen at 17/40 b. Neonatal survival is poor (<48hrs) c. Prompt termination required to avoid serious maternal complications d. Fetus will survive, but with significant morbidity

.The recurrence risk of NTD after one affected pregnancy is a. <0.5% b. 1 in 1000 c. 1 in 400 d. 1 in 20 e. 1 in 5

.Incorrect karyotype for the stated condition is a. Klinefelters 47 XYY b. Turners 45 XO c. Superfemale 47 XXX d. CAH 46 XX

FDIU at term. Most likely abnormality statistically? a. Triploidy b. Trisomy 21 c. Trisomy 18 d. Trisomy 13 e. Turners’ syndrome

.Which chromosomal abnormality doesn’t increase in frequency with increased maternal age? e. trisomy 21 f. trisomy 18 g. Turners XO h. XXY

D The triple test has 69%-77% accuracy rate at 5%FPR. The background age risk is 1:90

Woman 16 weeks pregnant, requesting tests for genetic diagnosis, correct option: a. Perform amnio as too late for CVS b. 1/600 risk miscarriage with amnio c. Results with CVS more reliable than amnio

Regarding the triple test, which is true? e. 1% of women undergoing the test will be placed at increased risk category f. Most accurate at 15-16w g. Indicated for women at increased risk of Down’s syndrome h. Will pick up 90% of affected infants

.A woman has decided she wants prenatal diagnosis for Down’s syndrome and comes to see you at 16/40. In your discussion you should emphasise? e. Increased safety of CVS over amnio f. Increased accuracy of CVS over amnio g. Miscarriage rate with amnio at 16/40 is 1/600 h. CVS not generally performed as late as 16/40

.Spontaneous mid-trimester abortion with amniocentesis? a. 1:100 b. 1:200 c. 1:350 d. 1:500 e. 1:1000

.Triple screen is also useful to detect all except: a. Multiple pregnancy b. T13 c. T18 d. XO

.Low serum AFP, oestrogen, HCG seen in? a. Downs syndrome b. Trisomy 18 c. Trisomy 13 d. Triploidy

.40yo woman in first pregnancy a. 3% chance of T21 b. 4% chance of chromosomal abnormality on amnio c. 2% chance of miscarriage after amnio d. 10% chance of miscarriage after CVS e. 1% chance NTD

B Risk of T21 is 1 in 90. Background risk of NTD is 1 in 1000. Risk of miscarriage after CVS is 6-7%, the rate after amnio is about 1 in 100. The rate of chromosomal abnormality is 1 in 40.

Risk of Down’s syndrome at age 40 a. 1 in 50 b. 1 in 100 c. 1 in 250 d. 1 in 20 e. 1 in 5

.A couple presented for genetic counselling because her first child has trisomy 21. On karyotype testing, she was found to have a balanced translocation of 14/21. What is her risk of recurrence? a. 100% b. 50% c. 25% d. 10% e. 0%

D (10-15%)

Down’s syndrome is associated with all except a. long femur and humerus b. duodenal atresia c. increased nuchal thickness d. VSD e. ear abnormalities

.Which of the following conditions is most likely associated with chromosomal abnormalities? a. PUJ obstruction b. VSD c. Gastroschisis d. Duodenal atresia e. Pulmonary stenosis

.Which of the following cannot be detected on routine US scanning? a. Hydrocephalus b. Exomphalos c. Cystic fibrosis d. Cleft palate

Which is not associated with aneuploidy? a. omphalocele b. gastroschisis c. CVS defect

.Which of the following is least likely to be associated with aneuploidy? a. Duodenal atresia b. Omphalocoele c.Gastroschisis d. Mental retardation e. Congenital heart disease

The risk of omphalocoele being associated with a chromosomal abnormality is: a. <20% b. 30% c. 60% d. 80% e. >80%

Exomphalos (omphalocele) is associated with: a. trisomy 21 b. Turner’s syndrome c. Trisomy 18 d. Arnold Chiari malformation e. Noonan syndrome

C Associated with trisomy 18 and 13 (C&R)

An ultrasound examination reveals that your patient has a fetus with gastroschisis. You advise her that: a. The fetus has >30% chance of an associated chromosomal abnormality b. Surgical repair is successful in <20% of cases c. It is uncertain whether LUSCS confers any advantages over NVD d. The infant is likely to have severe mental retardation

.A CVS for advanced maternal age reveals mosaicism. Do you counsel for? a. TOP b. Explain what likely phenotype is and allow patient to request a TOP c. Repeat the CVS d. Offer amniocentesis e. Ignore it as it is likely to be confined to the placenta

USS at 28/40 shows ventriculomegaly with a cortical mantle thickness of 8mm. You advise: a. Prognosis bleak – TOP advised b. Prognosis is uncertain and await spontaneous labour c. Ventriculocentesis will cause brain damage d. Could be prevented by pre-conceptual folate

.A 3cm unilateral choroid plexus cyst was found on routine antenatal US at 24 weeks. Which of the following is correct? a. reassure mother and no follow up required b. perform serial US and reassure mother is cyst remains the same c. cephalocentesis is indicated d. choroid plexus cyst is most commonly found in 3rd ventricle e. perform an amniocentesis to obtain fetal karyotype

On 18 weeks US see bilateral choroid plexus cysts but otherwise fetus normal. Do you? a. Disregard as inconsequential b. Do immediate amnio c. Repeat scan in 4 weeks d. Recommend TOP

Babe with choroid plexus cysts, missing 2 fingers on each hand and cystic hygroma? a. Trisomy 21 b. Trisomy 18 c. Trisomy 13 d. Triploidy

A Cystic hygromas are associated with T21 and Turner’s syndrome

What is this syndrome – choroid plexus cysts, cystic hygroma, absent 3rd and 4th digits? a. CMV b. Rubella c. T21 d. T18 e. T13 f. Turners syndrome

.Anechoic masses are seen in the fetal abdomen on US. Dx: a. Intestinal obstruction b. Cardiac abnormality c. Downs syndrome d. Renal aplasia e. Oesophageal atresia

None of the above

.Fetal cystic hygroma is most commonly associated with a. Trisomy 21 b. Trisomy 18 c. 45, X d. mosaicism e. 47, XXX

.Which is wrong? a. 47XXY – Klinefelters b. 46 XO – Turners

A low AFP is associated with: a. trisomy 21 b. Turner’s syndrome c. Trisomy 18 d. Arnold Chiari malformation e. Noonan syndrome

A Low AFP is associated with trisomy 21, trisomy 18 and Turner’s syndrome

Decreased AFP is seen in a. IUGR b. Fetal cystic fibrosis c. Closed spina bifida d. Rhesus isoimmunisation e. Pre-eclampsia

Lady with past Hx of baby with NTD. Now has low AFP in this pregnancy. Normal 16/40 US. Repeat sample low AFP. Advise? a. reassure no NTD b. recommend amnio to check for trisomy c. repeat US

.A woman found to have an AFP level 0.2-0.3 multiples of the median at 16 weeks. This level is associated with? a. 47 XXY b. XXX c. Turners d. Trisomy 21 e. Mosaicism

.High AFP likely due to the following except: a. spina bifida occulta b. omphalocoele c. anencephaly d. FDIU e. Myelomeningocoele

A AFP does not detect closed NTDs

.Which of the following is a recognised cause of elevated serum AFP? e. Retro-placental bleed f. Duodenal atresia g. Closed NTD h. CF

16 weeks, AFP 4 times MoM, next step in management a. repeat the AFP b. amniography c. ultrasonography d. amniocentesis e. intra-amniotic installation of PGF 2 alpha

.Lady with sister who has spina bifida. Amniotic fluid AFP 4.5 MOM after 16 weeks amniocentesis. US appeared normal and agreed with dates. Mx a. reassure all normal on US/no risk of fetal anomalies b. repeat blood AFP c. repeat US at 18 weeks d. advise TOP due to high risk of NTD

Which one does NOT elevate AFP in amniotic fluid? a. dead fetus b. myelomenigocele c. spina bifida occulta d. multiple pregnancy e. fetal blood mixed in sample

.In a primigravida with congenital heart disease the fetus is at risk of: a. cardiac abnormality b. venous abnormality c. arterial abnormality such as coarctation d. cardiac, venous or arterial anomalies e. all abnormalities incl arterial, venous or cardiac

Woman’s daughter has just had VSD successfully repaired age 18 months and asks what chance next baby has cardiac lesion? a. 1% b. 2-5% c. 10% d. 15% e. 50%

A primigravida completed in a running marathon. On the day, the weather was very hot and she suffered from heat stroke. She was admitted to the hospital, diagnosed with hyperthermia. She was treated successfully with rehydration. Her last normal menstrual period was 4 weeks ago and her pregnancy test was positive. She came to you to obtain advice about the effect of this episode on her fetus. Which of the following is the fetus at risk of? a. VSD b. Gastroschisis c. Phocomelia d. Spina bifida e. Anencephaly

Exercise in pregnancy – 3km running, 3x /week in woman who has been doing it for years? a. not likely to cause fetal hypoxia b. not likely to cause adverse neonatal outcome

A woman has a CXR at 16 weeks gestation. You tell her a. There is no proven adverse effect on the fetus b. She is at increased risk of miscarriage

.Which gives the most radiation exposure in the first trimester? a. IVP b. CXR c. Barium enema d. Cholecystogram

Which investigation delivers the greatest dose of radiation to an 8 weeks fetus? a. IVP b. CXR c. Cholecystogram d. Barium enema e. Lumbar spine series

What is worst advice re ETOH in pregnancy? a. nil is safest b. 1 drink per week is probably OK c. 1 drink per day is probably OK d. 2 drinks per day, 5x per week is probably OK e. isolated occasion < or = 1x per month of < or = to 10 drinks is OK after first trimester

.Advice re alcohol in pregnancy? e) Only safe thing is not to have any f) Better to have none but no increase in FAS with one standard drink per day g) 3 standard drinks per day safe as long as there is no binge drinking h) A constant low intake best so the fetus is exposed to constant low levels

.Microcephaly, flat nose, thin upper lip, large distance between nose and lip. Which drug is culprit? a. ETOH b. Marijuana c. Cocaine d. Amphetamines e. Heroin

.An IV drug user on heroin first presents at 28/40 and is commenced on methadone 40mg daily. She is seeing you at 31/40. What should ongoing Mx plan be? f. Continue methadone at current dose until delivery g. Wean from now on, using promethazine to treat withdrawal symptoms h. Continue methadone but introduce low dose naloxone at 38/40 i. Continue methadone until labour then cease and use promethazine in labour j. Continue methadone but give IV naloxone infusion in labour

Regarding substance abuse in pregnancy a. Dangerous to withhold narcotic drugs from heroin addicts b. Do not permit alcohol in the puerperium because it is transmitted in the breast milk c. Cocaine has less serious side effects than heroin d. Up to 50% incidence of prem labour and IUGR in women with heroin addiction

At 30 weeks with clinical abruption and FDIU. Aggressive behaviour, increase BP, PR 110: a. Cocaine b. LSD c. Alcohol d. Heroin

Which substance has a dose related effect on fetus? a. Heroin b. Cocaine c. Marijuana d. Alcohol e. Cigarettes

.Which substance is known to cause placental abruption? a. Heroin b. Cocaine c. Marijuana d. Alcohol e. Cigarettes

.Which substance is considered dangerous to use during pregnancy even in small amounts? a. Heroin b. Cocaine c. Marijuana d. Alcohol e. Cigarettes

.Which substance decreases overall risk of preeclampsia? a. Heroin b. Cocaine c. Marijuana d. Alcohol e. Cigarettes

.Smoking doesn’t cause? a. increase PET b. unemployment c. low attendance at ANC

A patient has bipolar affective disorder and is on lithium 900mg/day. Risks to fetus include: a. CNS anomalies b. Cardiac anomalies c. Renal anomalies d. Post maturity

B Lithium causes an increased risk of cardiac abnormalities (RR 1.2-7.7), no increased risk of NTDs and goitre

A woman with bipolar affective disorder on lithium presents at 11/40. Serum lithium is 1.0 (therapeutic 0.9-1.4). She should be told? f. Lithium is suspected of causing heart defects g. To cease lithium now will decrease risk to baby h. To decrease dose will decrease risk to baby i. Should have CVS now j. Should have amniocentesis at 16/40

Which drug has been shown to be harmful to the fetus during pregnancy? e. Metronidazole f. Heparin g. Azathioprine h. Thiazide diuretics

D Azathioprine is safe (fetal liver does not have the enzyme to convert to active form); thiazides can cause thrombocytopaenia, jaundice and electrolyte abnormalities.

Phenytoin is associated with all of the following except: a. IUGR b. Mental retardation c. Spina bifida d. Cardiac anomalies e. Cleft palate

What is phenytoin not associated with? a. mental retardation b. cleft palate c. spina bifida d. CVS defects

D Duodenal atresia is the most likely diagnosis to cause polyhydramnios but omphalocele could plausibly create a gastrointestinal obstruction, as could polycystic kidneys if they were large enough.

A fetus was terminated due to multiple fetal abnormalities. The body was shown to the parents. a. This will increase marital discordance b. Increase anger towards the obstetrician c. Promotes the process of grief reaction d. Increase fear of future pregnancy

Polyhydramnios will not be seen with? a. Congenital myasthenia gravis b. Myotonic dystrophy c. Duchenne muscular dystrophy d. Hydrocephalus e. Arthrogryposis

Intra-uterine fetal death at 18/40. Safest option? a. prostaglandins b. D&C c. Intra-amniotic saline/PG

If you were discussing the safety aspects of ultrasound with a pregnant lawyer what would you emphasise? a. pulsed US b. angle of rays in = angle of rays out c. continuous US beam d. acoustic impedance

A or C

Use of Dopplers in pregnancy a. assess blood flow in umbilical vein b. assess fetoplacental resistance c. assess blood flow in uterine artery

Strictly speaking the use of Doppler in pregnancy is used to assess blood flow in MCA, uterine artery, umbilical artery and ductus venosus. It is used indirectly to assess fetoplacental resistance.

Considering Doppler flow studies. The S/D ratio is inversely proportional to: a. Maternal weight b. Gestational age c. Placental mass d. Size of infant e. None of the above

Error of EFW on US at term: a. 5% b. 10% c. 15% d. 20% e. 25%

.Which ultrasound features are the least accurate assessment of gestational age? a. BPD b. FL c. AC d. BPD/FL ratio

In a low risk population undergoing US at 18/40 which type of abnormality will have the lowest pickup (highest false negative results)?** a. CVS b. Skeletal c. Gastrointestinal d. CNS e. Genitourinary

A US is performed at 28/40 and a hydrocephalic fetus with ventriculomegaly is diagnosed. The cortical thickness is 1 cm. Which of the following is correct? a. Ventriculoamniotic shunt b. Cervagem termination of pregnancy now c. Wait till 36/40 then LUSCS d. Commence on folic acid before conceiving next time e. Second weekly cephalocentesis to prevent further cerebral damage

The most commonly reported treatment of twin-twin transfusions are: a. observation alone b. NSAIDS c. Amnioreduction d. Ligation of connecting placental vessels

18 weeks gestation with IUGR a. Too late for CVS b. Risk of fetal loss with an amnio is 1/600 c. One benefit of a CVS is it may detect placental mosaicisms that may assist with the diagnosis

.What level of fetal Hb is associated with fetal hydrops a. 2 b. 4 c. 6 d. 8 e. 10

.Fetal tachycardia, confirmed as SVT. Evidence of pericardial effusion and ascites on scan. Incorrect option: a. Steroids b. Digoxin c. Amiodarone d. Flecanide e. Delivery

.Suspected fetal hypothyroidism is best managed by? a. High dose of thyroid hormone to pregnant mother b. Intra amniotic injection of thyroid hormone c. Nothing until delivery then thyroid hormone to neonate

Management in suspected fetal hypothyroidism? a. give mother thyroxine b. intraamniotic thyroxine c. do nothing in utero but give thyroxine to neonate d. none of the above

C Need to confirm diagnosis with FBS

A woman has SLE diagnosed during her pregnancy. Which of the following maternal antibody is most likely associated with fetal heart block? a. Anti SSA b. Anti SSB c. LA d. ACA e. Anti Ro

E Anti Ro (SSA) , Anti La (SSB) both cause CHB

Which antibody is associated with congenital heart block? a. SSA b. Anti mitochondrial c. Anti smooth muscle d. Anti cardiolipin

A woman with SLE consults you regarding the risk of congenital heart block if she has anti-Ro antibodies. An estimate of this risk is? a. <10% b. 20% c. 40% d. 50% e. >90%

Which of the following conditions is not associated with non-immune hydrops? a. fetal lupus b. trisomy 21 c. anti-c d. parvovirus B19 e. congenital toxoplasmosis

There is a result of 40mL of fetal cells on Kleihauer at delivery of a negative woman. How much anti-D should be given? a. 1 vial b. 2 vials c. 5 vials d. 7 vials e. 10 vials

D The most common phenotype is kk (75%)

A or D

Kell antibodies are found in a primip at 12 weeks. The first step is to: a. Check husbands blood group b. Repeat level at 34 weeks c. Amniocentesis d. Ignore as this is the first pregnancy

B 9% of whites and 2% of blacks have the kell antigen and almost all are heterozygotes

A primigravida with a positive antibody screen shows anti-S Ab in the first trimester. Should you? a. Obtain paternal genotype b. Tell her not to worry as anti’s doesn’t cause haemolysis c. Quantify the titre d. Do US at 18/40 looking for early hydrops fetalis e. Repeat titre at 16/40

A Anti-S can be associated with haemolytic disease

If woman has a titre of 1:16 at 12 weeks of anti-Fya, next step in management is a. US at 18/40 looking for hydrops b. Repeat titre at 16 weeks c. Check husbands karyotype d. Reassure that Fya is not associated with isoimmunization

C Titres as low as 1:8 are associated with disease (C&R)

Question about Anti D antibody receptors a. Phagocytosis of the antibody into the cell b. IgG 1, sometimes IgG 1 and 3 c. FuC (?) receptors d. etc

B Anti-D IgG antibodies that are responsible for severe cases of HDN belong chiefly to IgG1 and IgG3 subclasses

With Rhesus incompatibility which is the most reflective of the fetal condition? f. Amniocentesis to detect the concentrations of bilirubin products g. Amniocentesis to detect anti-D antibody levels h. An USS to detect fetal well being i. Maternal antibody levels j. A detailed history of past pregnancies

C – assuming MCA Doppler (otherwise A)

Most useful investigation of fetal condition in sensitised female who is RH negative? a. Maternal antibodies b. US c. Amniocentesis antibody titre d. Amniocentesis to measure bilirubin like compounds

B Probably irrelevant now

You have been referred a patient who has anti-D titres of 1 in 32 at 35 weeks gestation. What would be the most appropriate treatment? e. Do nothing f. Deliver at 35 weeks g. Intrauterine transfusion h. Amniocentesis

6.Your patient has an anti-D titre of 1:256 at 6w. The OD 450 at 28w is 0.08 (zone 1). The father is heterozygous for RhD. All of the following are correct except: a. Decreased OD 450 may mean the fetus is RhD negative b. Decreased OD 450 may mean the fetus is mild to moderately affected c. OD 450 is as good as US for predicting fetal erythroblastosis d. OD 450 levels are altered by polyhydramnios e. OD 450 levels are altered by bloody tap

C apparently - no longer relevant

A lady who is Rh negative has an anti-D level of 1:256 at 30 weeks. Amniocentesis was performed and sent for OD 450 studies. A level of 0.07 was noted. What is the next appropriate step? a. Repeat amniocentesis in 2 weeks b. Repeat anti-D level in 2 weeks c. Cordocentesis d. Commence on intraperitoneal transfusion e. Perform serial ultrasound

A OD 450 < 0.09 suggests mild or no disease; OD 450 > 0.15 suggests severe disease; Need to plot on graph to calculate next option

B Now irrelevant but 10 weeks prior to last affected pregnancy

.32 yo woman G2P1 with 1 term delivery of a live infant. Her blood group is O neg and she is at her 2nd pregnancy with an anti-D level of 1:4. At 30/40, US is normal. What is your next step? a. Repeat anti-D level at 36/40 b. Amniocentesis c. Cordocentesis d. Check the husbands blood group e. Repeat US at 36/40

.Which of the following antibodies is not associated with isoimmunisation? a. anti-C b. anti-Kell c. anti-Lewis d. anti-Kidd e. anti-p

.All a cause of haemolytic disease of newborn except: a. Kell b. Duffy c. Lewis d. ABO

Which Ab does not cause haemolytic disease of the newborn? d. Anti FYa e. Anti P f. Anti K

Which of the following blood antigens are associated with fetal erythroblastosis EXCEPT: f. Lewis g. I h. Kell i. Kidd j. Duffy

Lewis and I antibodies do not cross the placenta

Which is most incorrect statement regarding the accepted management of ITP? f. LUSCS of no benefit to fetus with known severe thrombocytopenia g. Fetal risk can be determined by maternal anti-platelet antibody titre h. Fetal risks increased if mother has Phx of splenectomy i. Fetal scalp sampling shouldn’t be used because of risk of bleeding j. Maternal steroids should be given if the maternal count drops below 100 (false)

Answer: B is probably the most incorrect

ITP, correct option: a. Caesarean section is not helpful in known severe fetal thrombocytopenia b. FBS should not be attempted due to risk of bleeding from puncture site c. Splenectomy decreases the likelihood of correlation between maternal and fetal platelet counts d. Maternal antiplatelet ab levels correlate with incidence of neonatal platelet levels

.32 yo G4P3 with 3 previous uneventful pregnancies and deliveries arrives in labour at term and if found to have platelet count of 85. Otherwise NAD. Most acceptable management is: a. Normal delivery and neonatal platelet count b. LUSCS c. LUSCS to avoid mid-cavity forceps d. Fetal blood sampling

Mainstay of treatment for neonatal allo-immune thrombocytopenia is? d. Steroids e. Intrauterine platelet transfusion f. Maternal immunoglobulin

Alloimmune thrombocytopenia, management, correct option: a. IV immunoglobulin b. Plasmapheresis c. Prednisolone d. Betamethasone e. Fetal platelet transfusion

What is the frequency of PLA1 negative in women? a. 0.0005% b. 0.0002% c. 0.002% d. 0.02% e. 2% f. 20%

E Otherwise known as HPA-1a antigen, involve in NAIT. UTD

.The common cause of non-bacterial fetal infection is? a. Toxoplasmosis gondii b. Rubella c. CMV d. Syphilis e. HSV

.Which state has the greatest clinical infection of Candida? a. 1 st trimester b. 2 nd trimester c. 3 rd trimester d. Post partum e. Post menopause

Asymptomatic bacteruria in pregnancy – which is wrong? a. common association with urinary tract abnormality b. PTL c. 5-10% incidence d. with no treatment 20-30% acute pyelonephritis

Acyclovir may be used with what infection in pregnancy? a. Rubella b. CMV c. Varicella d. Toxoplasmosis

A primigravida at 16 weeks develops primary genital herpes. Most important management is: a. analgesia b. acyclovir c. Herpes antibodies detection d. Serial obstetric US e. Counselling about recurrence in pregnancy

.A 21 yo primigravida at 30 weeks gestation presents with an acute primary episode of HSV2 of the vulva. Which is the most important? a. Treat with acyclovir b. Treat with tetracycline c. Local symptomatic treatment d. Counselling regarding the long term risks of recurrence e. Plan for CS for delivery

A 20yo woman has an attack of genital herpes at 20 weeks. She is now 38w pregnant and has developed another attack. Management: a. CS immediately b. Wait until 40 weeks and then do CS c. Wait for SROM then do CS d. Wait until 40 weeks and decide on clinical picture of eruptions e. Expectant vaginal delivery

.The best indicator for the management of labour in a patient with a past history of genital herpes is currently? a. Culture results b. Pap smear c. Serological testing d. Clinical assessment early in labour e. Patient preference

?TPHA 1:8 in early pregnancy. History of treated syphilis What do you do? a. Obtain RPR/VDRL b. Treat with penicillin c. Contact tracing d. Obtain records of prior titre levels

Answer: A (perinatal infections book) TPHA once positive – always positive

?(not sure which of these is remembered correctly. )A woman attends antenatal clinic in early pregnancy. She has a positive RPR/VDRL 1:8 with a history of syphilis treatment. What do you do? a. Obtain TPHA/FTA b. Treat with penicillin c. Contact tracing d. Obtain records of prior titre levels

.Hepatitis serology is positive for Hep B core Ab but negative for Hep B surface antigen and antibody. This indicates? a. Chronic carriage b. She will become Hep B surface Ab positive in the near future c. Never had hepatitis B d. Cross reaction with hepatitis A e. She is highly infectious

Answer: C – Vaccine and Iv Ig if high risk exposure (sex, IVDU, mucosal)

A (as per previous marking schedule)

.What is the transmission rate to the fetus if the mother is HTLV3 (HIV) positive a. 0 % b. 10% c. 30% d. 50% e. 100%

C First world 15-20%; third world 25-40% (my notes)

.All true of HIV except? a. More risk from intercourse with an infected female than with an infected male b. May develop symptoms in pregnancy in HIV positive women c. Shown that virus carried in breast milk d. First presentation may be with Pneumocystic carinii

.Parvovirus B19 is associated with? a. Rapid progression of cervical dysplasia to invasion b. Fetal anaemia and hydrops c. Maternal pneumonia d. Benign condylomata e. Hepatitis C

Regarding CMV: a. Commonest intrauterine viral infection b. Most infected infants are symptomatic c. Contracted from eating undercooked meat

A 5-15% of infants are symptomatic at birth (C&R). CMV is the most common intrauterine viral infection (UTD)

CMV, fetal infection rate if the mother seroconverts in pregnancy, correct option: a. 100% b. 80% c. 50% d. 20% e. <5%

?C Risk of transmission with primary infection 30%

Five days after a busy obstetric clinic one of the patients develops rubella. Should all of the rest of the patients who attended the clinic? a. Have rubella vaccine b. Be tested for IgM Rubella antibodies c. Be tested for IgG Rubella antibodies d. Be given immune globulin e. None of the above

.Your patient is 8w and has been exposed to Rubella. Your management should include all of the following except: a. Perform IgG and IgM levels b. If IgG negative then repeat IgM in 10 days c.Administer IgM immunoglobulin if IgM positive d. ounsel regarding the high risk of abnormality e. Counsel regarding the risks of hearing, eye and ear defects

Regarding rubella? a. Has 100% teratogenic effect if infected <10 weeks b. First discovered in Australia c. Can cause PDA

C At < 8 weeks the risk of fetal damage is 90-100%, at 8-12 weeks it is 50%. The features of congenital rubella include PDA

All of the following occur in congenital rubella except: a. Cataracts b. Deafness c. IUGR d. Cardiac defects e. Renal dysplasia

.Rubella infection a. 1% risk of fetal syndrome in 2nd trimester b. is a killed virus c. viraemia precedes rash d. attenuated by blood transfusion

C 20-50% risk of congenital rubella syndrome in second trimester; vaccine is a modified live virus; not affected by blood transfusion; viraemia precedes rash

Rubella vaccine? a. Seroconversion in 85% of individuals b. Causes a viral infection which is communicable c. Can be transmitted in breast milk d. A killed vaccine e. Effectiveness reduced by blood transfusion

E 95% effectiveness, not generally communicable, live vaccine

Toxoplasmosis all true except: a. A bacteria b. Can cause fetal loss c. Causes cerebral calcifications d. Causes chorioretinitis e. Hydrocephalus

B - not spread by cats technically, but is from cat excrement

Which of the following is true regarding malaria? a. Pyrimethamine-sulfadiazine causes kernicterus in neonate b. Chloroquine is antimalarial of choice in pregnancy

.Which does not cause intrauterine infection? a. CMV b. Polio c. Mumps d. Toxoplasmosis e. Malaria

A 38 year old woman with no history of high risk exposure and no other risk factors has a Mantoux and it is measured as a response of 16mm. CXR normal. Would your further management be? a. No further treatment b. Treatment with Rifampicin (gave dosage) c. Treatment with Isoniazid (gave dosage) d. Treatment with Isoniazid (different dosage) e. Give BCG

.Patient at her first antenatal visit had MSU with mixed contamination, including GBS. Options. a. Treat with antibiotics and swab vagina at 28/40 b. Vaginal swab at 28/40 c. Vaginal swab and MSU at 28/40 then treat with oral antibiotics d. Swab at 28/40 and treat intrapartum if positive e. Treat in labour

Referred 34/40 with GBS on swab? a. give course of ampicillin now b. give course at 38 weeks c. IV ampicillin in labour d. Treat neonate with penicillin e. None of the above

.GBS – most common location? a. low vagina b. urethra c. GIT

Obstetric MCQ pool Flashcards

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