1 Maternal and perinatal mortality: the confidential enquiry
A Maternal death D Maternal mortality rate (tỉ lệ tử vong mẹ) G Stillbirth (thai lưu)
B Direct maternal death E Perinatal death (Tử vong chu sinh) H None of the above
C Indirect maternal death F Perinatal mortality rate
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 Death of a woman while pregnant, or within 42 days of termination (chấm dứt) of pregnancy, from any cause related to, or aggravated by bị trầm trọng hơn, the pregnancy or its management, but not from accidental or incidental death.
2 The number of stillbirths thai lưu and early neonatal deaths sơ sinh mất sớm per 1000 live births and stillbirths.
3 Fetal death occurring between 20 0 weeks and 23 6 weeks. If the gestation is not certain all births of at least 300 g are reported.
4 Death resulting from previous existing disease, or disease that developed during pregnancy and which was not due to direct obstetric cause, but which was aggravated by the effects of pregnancy that are due to direct or indirect maternal causes.
2 Conception, implantation and embryology
A Paramesonephric ducts D Anterior neuropore G Ectoderm
B Mesonephric ducts E Posterior neuropore H Endoderm
C Primitive streak F Mesoderm
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 The structure that give rise to the uterus.
2 The structure that give rise to the somites.
3 The structure that gives rise to the gastrointestinal tract.
4 The structure that defines caudal and cephalic poles.
3 Physiological changes in pregnancy: uterus and cervix
A Inhibin D Insulin-like growth G Corticotrophin-releasing factor
factors I and II
B Progesterone E Human chorionic H None of the above
gonadotrophin
C Oestradiol F Human placental lactogen
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 A peptide that is used within the triple test.
2 A substance that is produced by trophoblast from mid-pregnancy.
3 A peptide hormone produced within the myometrium.
4 A pregnancy-specific hormone that has thyrotrophic activity.
4 Normal fetal development: the fetal heart
A The ductus venous E Right atrium I Umbilical artery
B The ductus arteriosus F Mitral valve J Intra-atrial septum
C Foramen ovale G Tricuspid valve K Intraventricular septum
D Left atrium H Umbilical vein L None of the above
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 Location of the patent foramen ovale.
2 Vessel that carries oxygenated blood from the placenta and, in adult life, forms part of the falciform ligament.
3 Blood from the inferior and superior vena cava is directed across this structure in neonatal life.
4 Vessel that shunts blood away from the liver.
5 Antenatal care
A Triple test E Dating scan I Biophysical scan
B Ferritin F Syphilis J Anatomy scan
C Mid-stream specimen of G Protein dip stix K Nuchal translucency scan
urine (MSSU)
D Full blood count (FBC) H Urate
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 A second trimester test for Down’s syndrome.
2 A fetal viability test.
3 A screening test for pre-eclampsia.
6 Antenatal imaging and fetal assessment
A Variable decelerations E Fetal heart rate accelerations I Biophysical profile
B Late decelerations F Antenatal Doppler J None of the above
C Early decelerations G Doppler in labour
D Baseline variability H Diagnostic ultrasound
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 Reflection of the normal fetal autonomic nervous system.
2 Assessment of fetal breathing, gross body movements, fetal tone, reactive fetal heart rate and amniotic fluid.
3 Transient reduction in the fetal heart rate of 15 beats per minute or more, lasting for more than 15 seconds.
4 Transient increase in the fetal heart rate of 15 beats per minute or more, lasting for more than 15 seconds.
7 Prenatal diagnosis
A Spina bifida D Thalassemia G Turner’s syndrome
B Down’s syndrome E Cerebral palsy H Fragile X
C Duchenne muscular dystrophy F Klinefelter’s syndrome I None of the above
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 The diagnosis may be suspected on ultrasound by the observation of the lemon and banana signs.
2 Measurement of the maternal serum hormones during the second trimester offers an effective screening modality.
3 Prenatal diagnosis is available by the demonstration of multiple repeats (200) in a male fetus.
4 Affected individuals are infertile males with a slightly reduced intelligence, testicular dysgenesis and a tall stature.
8 Second trimester miscarriage
A Threatened miscarriage D Septic miscarriage G Urinary tract infection
B Inevitable miscarriage E Incompetent cervix H None of the above
C Missed miscarriage F Chorioamnionitis
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each
option may be used once, more than once, or not at all.
1 A 23-year-old woman presents at 13 weeks of amenorrhea. She is complaining of low backache and suprapubic discomfort. Routine examination of the patient’s abdomen reveals that there is suprapubic tenderness. Examination of her vital signs reveals pyrexia of 37.7°C and a tachycardia of 90 beats per minute. Internal examination reveals that the cervix is closed. Urine dipstix demonstrates leucocytes and nitrites.
2 A 23-year-old woman presents at 20 weeks of amenorrhea in her second pregnancy. The first pregnancy had unfortunately ended at 19 weeks with a miscarriage after premature rupture of the fetal membranes. She is complaining of low backache, feeling warm and a slight vaginal loss. She has pyrexia of 38°C and a pulse of 98 beats per minute. Routine examination of the patient’s abdomen reveals that there is tenderness suprapubically. Speculum examination reveals a slightly open cervix and fluid draining.
3 A 23-year-old woman presents at 13 weeks of amenorrhea. She is complaining of vaginal bleeding, low backache and suprapubic discomfort. Routine examination of the patient’s abdomen reveals that there is suprapubic tenderness. Examination of her vital signs demonstrates that she is apyrexial. Internal examination reveals that the cervix is closed. Urine dipstix is unremarkable.
4 A 32-year-old woman presents in her first pregnancy at 20 weeks of amenorrhea. She is complaining of minor discomfort in the lower abdomen. Her pulse and blood pressure are within the normal range and she is apyrexial. Abdominal examination is unremarkable. However, speculum examination reveals a slightly open cervix. A transvaginal ultrasound scan demonstrates the cervical canal to be 2 cm long and funnelling of the membranes is present.
9 Antenatal obstetric complications
Antepartum haemorrhage
A Placenta praevia D Threatened miscarriage G Vasa praevia
B Placenta abruption E Ectopic pregnancy H Vaginal infection
C Complete miscarriage F Cancer of the cervix I None of the above
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 A 32-year-old woman presented to the delivery suite. She was 28 weeks pregnant in her second pregnancy. An ultrasound scan at 12 weeks had confirmed a twin pregnancy. She was admitted complaining of bleeding per vaginum; this was bright red in nature and painless.
2 A 34-year-old woman presents to casualty. She has a history of pelvic inflammatory disease. She is 7 weeks pregnant by her dates. She is complaining of left-side abdominal pain and brown discharge. On examination, she is tender in the left iliac fossa and the cervix is closed.
3 A 26-year-old woman presents to casualty. She has a history of pelvic inflammatory disease. She is 7 weeks pregnant by her dates and is complaining of bright red bleeding per vaginum. She also complains of suprapubic tenderness. On examination, there is blood in the vagina and the cervix is closed.
4 A 32-year-old woman presented to the delivery suite. She was 34 weeks pregnant in her first pregnancy. She was admitted complaining of severe abdominal pain, and bright red bleeding and clots per vaginum. On examination, the uterus was painful and there were palpable contractions.6 Obstetrics
10 Twins and higher order multiple gestations
A Miscarriage E Preterm labour I Pre-eclampsia
B Diachorionic diamniotic twins F Nuchal translucency J Monozygotic twins
C Monochorionic monoamniotic G Triple test K None of the above
twins
D Twin–twin transfusion syndrome H Monochorionic diamniotic twins
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 The observation of the lambda sign on an early pregnancy scan confirms the diagnosis.
2 Death or handicap of the co-twin occurs in 25 per cent of cases.
3 The chance that at least one of the twin pair is affected by a chromosomal defect is twice as high as for a singleton pregnancy.
4 Placental vascular anastomoses allow communication between the two feto-placental circulations. In some twin pregnancies, imbalance in the blood flow across these arteriovenous communications occurs.
11 Disorders of placentation
The clinical management of hypertension in pregnancy
A Magnesium hydroxide F 24-hour urinary protein I Immediate Caesarean section
B Oral antihypertensive G Admission for observation and J Induction of labour
C Oral diuretic investigation. K Intravenous antihypertensive
D Monitor blood pressure. H Fetal ultrasound L None of the above
E Renal function tests
For each description below, choose the SINGLE most appropriate action from the above list of options. Each option may be used once, more than once, or not at all.
1 At 34 weeks, a 80 kg woman complains of persistent headaches and ‘flashing lights’. There is no hyper-reflexia and her blood pressure (BP) is 155/100 mmHg.
2 At 33 weeks, a 31-year-old primigravida is found to have BP of 145/95 mmHg. At her first visit at 12 weeks, the BP was 145/85 mmHg. She has no proteinuria but she is found to have oedema to her knees.
3 A 29-year-old woman has an uneventful first pregnancy to 31 weeks. She is then admitted as an emergency with epigastric pain. During the first 3 hours, her BP rises from 150/100 to 170/119 mmHg. A dipstick test reveals she has 3 proteinuria. The fetal cardiotocogram is normal.
4 A 32-year-old woman in her second pregnancy presents to her general practitioner (GP) at 12 weeks’ gestation. She was mildly hypertensive in both of her previous pregnancies. Her BP is 150/100 mmHg. Two weeks later, at the hospital antenatal clinic, her BP is 155/100 mmHg.Extended matching questions 7
12 Medical diseases of pregnancy
Drugs used in pregnancy
A Calcium supplements D Ritodrine G Oral labetolol
B Erythromycin E Ursodeoxycholic acid H Ferrous sulphate
C Nifedipine F Magnesium sulphate I None of the above
For each description below, choose the SINGLE most appropriate drug treatment from the above list of options. Each option may be used once, more than once, or not at all.
1 A 27-year-old woman presents at 33 weeks in her first pregnancy. She is complaining of generalized itching, worse on the palms of her hands and soles of her feet. Abdominal examination is unremarkable. Blood investigations reveal that she has increased bile acids.
2 A 23-year-old primigravid women presents at 31 weeks. At her 12 weeks booking visit she was normotensive and had no history of epilepsy. She is admitted as an emergency having had a seizure. On admission, her blood pressure is 150/110 mmHg and dipstick urine analysis reveals 3 proteinuria.
3 A 32-year-old woman presents in her second pregnancy at 29 weeks. Her first pregnancy had been uncomplicated, however, she had delivered at 36 weeks’ gestation. She is admitted with a history of sudden gush of fluid per vaginum. On examination her abdomen is consistent with a 29-week pregnancy. Speculum examination reveals copious amounts of clear fluid. Temperature and pulse are normal.
4 A 25-year-old Asian woman in her third pregnancy presents to clinic at 24 weeks of her pregnancy. She is complaining of tiredness and lethargy. Abdominal examination is unremarkable. Dipstix urine analysis demonstrates 3 glycosuria. A full blood count reveals haemoglobin of 11 g/dL. An oral glucose tolerance test shows a fasting blood glucose of 8.1 mmol/L.
13 Perinatal infections
A Toxoplasmosis E Listeria monocytogenes H Gonorrhoea
B Cytomegalovirus F Herpes simplex I Trichmoniasis
C Varicella zoster G Chlamydia trachomatis J None of the above
D Cocksackie B virus
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 A bacterium that is found in sewage, but can grow in refrigerated food, including meat, eggs, and dairy products.
2 A protozoan parasite that may be acquired from exposure to cat faeces or from eating uncooked meats.
3 In children it causes a viral exanthema know as ‘fifth disease’.
4 Primary infection usually presents within 7 days of exposure and may be accompanied by wide lesions around the vulva, vagina, and cervix.8 Obstetrics
14 Labour
Mechanism of labour
A Descent D Flexion G Internal rotation
B Extension E External rotation H None of the above
C Engagement F Restitution
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 After the head delivers through the vulva, it immediately aligns with the fetal shoulders.
2 The occiput escapes from underneath the symphysis pubis, which acts as fulcrum.
3 The anterior shoulder lies inferior to the symphysis pubis and delivers first, and the posterior shoulder delivers subsequently.
4 When the widest part of the presenting part has passed successfully through the pelvic inlet.
15 Obstetric emergencies
Collapse
A Simple faint D Pulmonary embolism G Hypoglycaemia
B Epileptic fit E Eclampsia H Ectopic pregnancy
C Subarachnoid haemorrhage F Haemorrhage I None of the above
For each description below, choose the SINGLE most appropriate diagnosis from the above list of options. Each option may be used once, more than once, or not at all.
1 A 37-year-old woman in her second pregnancy has delivered a live male infant. She has no past medical history of note. Ten minutes after delivery, she complains of a sudden onset severe occipital headache that is associated with vomiting. Shortly after this, she losses consciousness and is unresponsive to any stimuli.
2 A 23-year-old woman who is 32 weeks pregnant presents to delivery suite. She complains of feeling generally unwell. Clinical examination reveals a 28-week size fetus. Her blood pressure was noted to be 120/90 mmHg and on urine analysis 2 protein was present. During the clinical examination, she has a seizure.
3 A 32-year-old woman who has had an emergency Caesarean section is on the postnatal ward. She suddenly becomes breathless and complains of central chest pain. She subsequently loses consciousness.Extended matching questions 9
16 The puerperium
Postpartum pyrexia
A Pylelophritis E Meningitis I Breast abscess
B Mastitis F Endometritis J Chest infection
C Pneumonia G Wound infection K None of the above
D Deep vein thrombosis H Retained products of conception
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 A 30-year-old woman is admitted from home. She had an uncomplicated pregnancy and a normal vaginal delivery 4 days previously. She presented with feeling generally unwell associated with heavy, fresh, vaginal bleeding and clots. On examination, she has a temperature of 38.3°C. Abdominal examination reveals mild suprapubic tenderness. Vaginal examination revealed blood clots and the cervix admits a finger and is enlarged and bulky.
2 A 26-year-old woman is admitted 7 days after having a Caesarean section, which was performed for failure to progress after augmentation for prolonged rupture of the fetal membranes. She is generally unwell and complains of a foul-smelling vaginal discharge. On examination, she has a temperature of 39.0°C. Abdominal examination reveals suprapubic tenderness. Vaginal examination confirms the offensive discharge and uterine tenderness.
3 A 32-year-old woman is seen 3 days after having a Caesarean section. The Caesarean section was performed as an emergency for placental abruption and was carried out under general anaesthesia. She is complaining that she is generally unwell and has been coughing up green sputum. On examination, she has a temperature of 38.0°C and a pulse of 90 beats per minute. The respiratory rate is 30 inspirations per minute and she using her accessory respiratory muscles. Abdominal and pelvic examinations are unremarkable. Chest examination reveals purulent sputum and coarse crackles of auscultation.
17 Psychiatric disorders in pregnancy and the puerperium
A Baby blues D Schizophrenia G Depression
B Postnatal depression E Puerperal psychosis H None of the above
C Panic disorders F Bipolar affective disorder
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 A 40-year-old woman presents on the fifth day after a normal delivery. Her husband has brought her in to accident and emergency, after he noticed an abrupt change in her behaviour. He describes her as confused, restless and is expressing thoughts of self-harm.
2 A 23-year-old woman, who had a normal delivery 12 hours earlier, is noted by the ward staff to be having difficulties sleeping, is overactive and expresses feelings of excitement.
3 A 23-year-old woman presents at a booking clinic. She is 7 weeks pregnant in her first pregnancy and has been referred by the community midwife for consultant care. She is taking lithium and carbamazepine.
4 A 32-year-old woman who had an emergency Caesarean section 2 days earlier, is noted by the midwives on the ward to be having sleeping difficulties, and is tearful and short tempered.10 Obstetrics
18 Neonatology
A Erythema toxicum E Subgaleal haemorrhage I Milia
B Erb’s palsy F Transient tachypnoea of the J Port wine stain newborn
C Klumpke’s palsy G Respiratory distress K None of the above
syndrome
D Necrotizing entrocolitis H Cerebral palsy
For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.
1 A newborn baby of 36 weeks’ gestation, present with cyanosis, tachypnoea, grunting and recession.
2 In a newborn postnatal check of a term baby delivered by vaginal breech, the attending senior house officer notes that there is a claw hand with inability to extend the fingers.
3 The senior house officer is asked by the midwives to review a 3-day-old baby. The baby has an oval erythematous rash with white pinpoint heads.
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