Self Assessment in Obstetrics and Gynaecology by Ten

Teachers 2E EMQs, MCQs, SBAs, SAQs & OSCEs 2nd Edition

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 Acknowledgements

The Editor (LCK) would like to acknowledge the help of Mr Fred English, BSc (Hons) with the preparation of
this text.
This book is dedicated to my sons, Conor and Eamon (LCK)
To my Father and to Oscar (CA)

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 Commonly used abbreviations
ABO ABO blood group IVP intravenous pyelogram
AC abdominal circumference LDL low-density lipoprotein
ACTH adrenocorticotrophin horome LFT liver function test
ADH antidiuretic hormone LH luteinizing hormone
AFP alpha-fetoprotein LLETZ large loop excision of the transformation
AIDS acquired immunodeficiency syndrome zone
ALT alanine aminotransferase LMP last menstrual period
AMH anti-Müllerian hormone LNG-IUS levonorgestrel intrauterine system
AP anterior–posterior MCV mean corpuscular volume
BMI body mass index MSU mid-stream specimen of urine
BP blood pressure NHS National Health Service
BPD biparietal diameter NICE National Institute for Health and Clinical
BSO bilateral salpingo-oophorectomy Excellence
BV bacterial vaginosis NIDDM non-insulin dependent diabetes mellitus
CAH congenital adrenal hyperplasia NSAID non-steroidal anti-inflammatory drug
CGIN cervical glandular intraepithelial neoplasia NTD neural tube defect
CIN cervical intraepithelial neoplasia OAB over active bladder
CMV congenital cytomegalovirus PCOS polycystic ovarian syndrome
COCP combined oral contraceptive pill PE pulmonary embolism
CPD cephalopelvic disproportion PID pelvic inflammatory disease
CT computed tomography PR per rectum
CTG cardiotocography PROM preterm rupture of the membranes
CVS chorionic villus sampling REM rapid eye movement
DFA direct fluorescent antibody RMI relative malignancy index
DVT deep vein thrombosis RCOG Royal College of Obstetricians and
ECG electrocardiogram Gynaecologists
ECV external cephalic version sb-hCG serum beta-human chorionic
EDD expected date of delivery gonadotrophin
ELISA enzyme-linked immunosorbent assay SSRIs selective serotonin reuptake inhibitors
FBC full blood count TAH total abdominal hysterectomy
FL femur length TCRE transcervical resection of the
FSH follicle-stimulating hormone endometrium
FTA fluorescent treponemal antibody TDF testicular development factor
GFR glomerular filtration rate TFT thyroid function test
GnRH gonadotrophin-releasing hormone TPHA Treponema pallidum haemagglutination
GP general practitioner assay
HbF haemoglobin F TPPA Treponema pallidum particle
HC head circumference agglutination
HCG human chorionic gonadotrophin TSH thyroid-stimulating hormone
HDL high-density lipoprotein TTTS twin-to-twin transfusion syndrome
HELLP haemolysis, elevated liver enzymes and TVT tension-free vaginal tape
low platelets U&Es urea and electrolytes
HIV human immunodeficiency virus USI urodynamic-proven stress incontinence
HPV human papillomavirus USS ultrasound scan
HRT hormone replacement therapy UTI urinary tract infection
HVS high vaginal swab VDRL Venereal Disease Research Laboratory
IUCD intrauterine contraceptive device VKDB vitamin K deficiency bleeding
IUGR intrauterine growth restriction VMA vanillylmandelic acid
IUS intrauterine system V/Q ventilation/perfusion
IV intravenous VTE venous thromboembolism
IVF in-vitro fertilization

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 SE C TI O N 1
OBSTETRICS

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 C H AP T E R 1
EXTENDED MATCHING
QUESTIONS
Questions...................................................................... 3 The clinical management of hypertension in
Pre-existing maternal conditions...................................... 3 pregnancy............................................................... 10
Gravidity/parity................................................................ 4 Features of abnormal placentation................................. 10
Maternal and perinatal mortality: the confidential Late miscarriage............................................................ 10
enquiry...................................................................... 4 Risk factors for preterm labour...................................... 11
Standards in maternity care............................................. 4 Diagnosis and management of preterm delivery............. 11
Physiological changes in pregnancy: uterus and Drugs used in pregnancy............................................... 12
cervix........................................................................ 5 Shortness of breath in pregnancy................................... 12
Haematological changes in pregnancy............................. 5 Perinatal infection (1)..................................................... 12
Normal fetal development: the fetal heart........................ 5 Perinatal infection (2)..................................................... 13
Normal fetal development: the urinary tract..................... 5 Mechanism of labour..................................................... 13
Antenatal care................................................................. 6 Stages of labour............................................................. 13
NICE guidelines on routine antenatal care........................ 6 Interventions in the second stage................................... 14
Antenatal imaging and assessment of fetal well-being..... 6 Complications of Caesarean section............................... 14
Ultrasound measurements............................................... 7 Obstetric emergencies (1).............................................. 14
Prenatal diagnosis........................................................... 7 Obstetric emergencies (2).............................................. 15
Modes of prenatal testing................................................ 7 Postpartum pyrexia........................................................ 15
Antepartum haemorrhage................................................ 7 Postpartum contraception.............................................. 16
Fetal malpresentations..................................................... 8 Psychiatric disorders in pregnancy and the
Thromboprophylaxis........................................................ 8 puerperium............................................................. 16
Common problems of pregnancy..................................... 9 Neonatology................................................................... 16
Twins and higher order multiple gestations...................... 9 Neonatal care................................................................ 17
Management of multiple pregnancy................................. 9 Neonatal screening........................................................ 17
Answers...................................................................... 18

QUESTIONS

1 Pre-existing maternal conditions

A Diabetes E Factor V Leiden deficiency I Crohn’s disease
B Hypertension F HIV J Mitral valve stenosis
C Epilepsy G Asthma K Myasthenia gravis
D Vitiligo H Smoking L Glomerulonephritis
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 Reduces intrauterine growth in a dose-dependent manner.
2 Increases risk of venous thromboembolism (VTE) in the puerperium.
3 Increased frequency of episodes during pregnancy.
4 Risk of fetal macrosomia if condition not well controlled.
5 Maternal muscle fatigue in labour.
6 Requires prophylactic antibiotics for instrumental delivery.

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 4 Obstetrics

2 Gravidity/parity
A G1 P0 E G2 P1 I G1 P1
B G4 P2 F G1 P2 J G3 P1
C G0 P0 G G6 P0 K G4 P3
D G3 P3 H G5 P2 L G2 P0

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 woman currently pregnant who has had a previous term delivery.
2 A woman not currently pregnant who has had one previous termination, one early miscarriage and one still-
birth at 36/40.
3 A woman who attends for pre-conception counselling, never having been pregnant.
4 A woman currently pregnant with twins who has had one previous early miscarriage.
5 A woman not currently pregnant who previously had a twin delivery at 28/40.

3 Maternal and perinatal mortality: the confidential enquiry

A Maternal death D Maternal mortality rate G Stillbirth
B Direct maternal death E Perinatal death 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 of pregnancy, from any cause related to,
or aggravated by, the pregnancy or its management, but not from accidental or incidental death.
2 The number of stillbirths and early neonatal deaths 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.

4 Standards in maternity care

A 
Royal College of Obstetricians E 
National Childbirth I 
Maternity Services Liaison
and Gynaecologists Trust Committee
B 
Clinical Negligence Scheme for F 
National Institute for Health J 
Confidential Enquiry into
Trusts and Clinical Excellence Maternal and Child Health
C The Cochrane Library G World Health Organization K National Screening Committee
D Maternity Matters H National Library for Health L National Health Service

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 Publishes national guidelines on all aspects of clinical care, including obstetric practice.
2 National consumer group representing the views of women on maternity care.
3 Sets standards for provision of care, training and revalidation of obstetric doctors in the UK.
4 An insurance scheme to help hospital Trusts fund ligation claims and manage risk.
5 Unifies and progresses standards for screening across the UK.

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 Extended matching questions 5

5 Physiological changes in pregnancy: uterus and cervix

A Oestradiol E Collagenase H 
Adrenocorticotrophic hormone
B Prostaglandins F Prolactin (ACTH)
C Progesterone G Human chorionic I Oxytocin
D Cortisol gonadotrophin (HCG)

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 
Levels approximately x15 higher in third trimester than in non-pregnant state.
2 
Induces the process of cervical remodelling.
3 
Regulates local uterine blood flow through endothelial effects.
4 
Utilized in triple test.
5 
Released from posterior pituitary gland.

6 Haematological changes in pregnancy

A Haematocrit D Plasma folate concentration G Fibrinogen
B Bilirubin E White blood cells H Alkaline phosphatase
C Triglycerides F Tissue plasminogen activator I Lactate dehydrogenase

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 
Levels rise through pregnancy due to increased production of placental isoform.
2 
Falls in pregnancy due to dilutional effect.
3 
Increased by 50 per cent in pregnancy, contributing to hypercoagulable state.
4 
Routine supplementation advised during pregnancy due to fall in level.

7 Normal fetal development: the fetal heart

A The ductus venosus E Right atrium I Umbilical artery
B The ductus arteriosus F Mitral valve J 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 
Connects the pulmonary artery to the descending aorta.
4 
Vessel that shunts blood away from the liver.

8 Normal fetal development: the urinary tract

A Mesonephric duct D Collecting duct system G Nephronic units
B Glomeruli E Ectoderm H Renal agenesis
C Ureteric bud F Mesoderm I Pronephros

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 6 Obstetrics

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 
Originates on either side of the embryonic midline on the nephrogenic ridge.
2 
Branches to form the collecting duct system.
3 
Associated with anhydramnios and neonatal death.
4 
Embryonic layer from which the renal parenchyma is derived.

9 Antenatal care
A Triple test E Dating scan I Biophysical profile
B Ferritin F Syphilis J Anatomy scan
C Mid-stream urine specimen G Protein dip stick K Nuchal translucency
D Full blood count (FBC) H Serum 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 
Second trimester screening for Down’s syndrome.
2 
A fetal viability test.
3 
A screening test for pre-eclampsia.
4 
Should routinely be performed at booking and repeated at 28/40.

10 NICE guidelines on routine antenatal care

A Booking visit E 25/40 I 36/40
B 10–14/40 F 28/40 J 38/40
C 16/40 G 31/40 K 40/40
D 18–20/40 H 34/40 L 41/40

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 
Attend for ultrasound to detect structural abnormalities.
2 
Folic acid and lifestyle issues discussed.
3 
Offer membrane sweep.
4 
First dose of anti-D prophylaxis for Rhesus –ve women.

11 Antenatal imaging and assessment of fetal well-being

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.

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 Extended matching questions 7

12 Ultrasound measurements
A Crown–rump length D Head circumference (HC) G Abdominal circumference (AC)
B Biparietal diameter (BPD) E Femur length (FL) H Placental site
C Estimated fetal weight F HC/AC ratio I Nuchal translucency

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 
Used to date pregnancies when booked between 14 and 20/40.
2 
Marker of asymmetrical intrauterine growth restriction (IUGR).
3 
Increased in infants of poorly controlled diabetic mothers.
4 
Can be calculated by combining HC/AC/FL(femur length)/BPD measurements.

13 Prenatal diagnosis
A Spina bifida D Thalassaemia 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 where enlargement of the ventricles is observed.
2 
Ultrasound between 11 and 14 weeks in combination with blood tests is a reliable method of screening.
3 
Prenatal diagnosis is available by the demonstration of multiple repeats (>200) in a male fetus.
4 
Affected individuals are infertile males, some of whom have reduced intelligence, testicular dysgenesis and
tall stature.

14 Modes of prenatal testing

A Amniocentesis D Ultrasound scan G Chorionic villus sampling (CVS)
B Viral serology E Cordocentesis H Free fetal DNA
C Nuchal translucency F Fetal RNA profile 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 Most suitable diagnostic test where a woman wishes to know fetal karyotype as early in the pregnancy as
possible.
2 Most suitable diagnostic test where fetal alloimmune thrombocytopaenia is suspected.
3 Most suitable non-invasive test when an X-linked disorder is suspected.
4 Non-invasive test which will give a reliable diagnosis of a fetal single gene defect.

15 Antepartum haemorrhage
A Placenta praevia D Threatened preterm labour G Vaginal infection
B Placental abruption E Vasa praevia H Cervical trauma
C Rectal bleeding 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.

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 8 Obstetrics

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 36-year-old woman presented to the delivery with a small amount of fresh red vaginal bleeding. She was
36 weeks pregnant with her third child. She was in no pain and speculum examination revealed a trace of
bright red blood in the vagina. She had a history of sexual intercourse 4 hours earlier.
3 
A 19-year-old woman presented to the emergency department with a small amount of blood-stained dis-
charge. She was 30 weeks into her first pregnancy. Speculum examination revealed thick off-white discharge
mixed with a little brownish blood in the vagina.
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.

16 Fetal malpresentations
A Transverse D Footling breech G Unstable lie
B Frank breech E Cephalic H Complete breech
C Extended breech F Oblique 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 
Longitudinal lie where the presenting part is a foot.
2 
The fetal long axis runs perpendicular to the maternal long axis.
3 
Women should routinely be admitted to the antenatal ward at term.
4 
The position intended to be achieved by external cephalic version.

17 Thromboprophylaxis
A No intervention required E 
Discussion with haematologist H 
Antenatal prophylaxis with low
B Lifelong anticoagulation for expert advice molecular weight heparin
C 
Intravenous (IV) unfractionated F 
1 week post-natal low I None of the above
heparin for 24 hours molecular weight heparin
D 
6 weeks post-natal low molecu- G 
Early mobilization and
lar weight heparin hydration

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 woman attends for booking at 6 weeks of pregnancy. She has had a previous metallic mitral valve
replacement.
2 
A 28-year-old woman who has had an emergency Caesarean section in labour for fetal distress. She had a
DVT in a previous pregnancy.
3 
A healthy 30-year-old woman had a normal vaginal delivery of her fourth child 4 hours ago.
4 
A healthy 36-year-old woman had a normal vaginal delivery of her fourth child 4 hours ago.

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 Extended matching questions 9

18 Common problems of pregnancy

A Constipation E Leg cramps I Striae gravidarum
B Oedema F Hyperemesis gravidarum J Carpal tunnel syndrome
C Leg cramps G Breast soreness K Tiredness
D Fainting H Symphysis pubis dysfunction L Gastro-oesophageal reflux

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 
Best treated with simple analgesia and low stability belt.
2 
Due to hormonal effects in relaxing the lower oesophageal sphincter.
3 
Hydration and use of compression stockings may help to prevent.
4 
May be exacerbated by administration of iron tablets.

19 Twins and higher order multiple gestations

A Miscarriage E Preterm labour J Monozygotic twins
B Dichorionic diamniotic twins F Nuchal translucency K None of the above
C 
Monochorionic monoamniotic G Triple test
twins H Monochorionic diamniotic twins
D 
Twin–twin transfusion syndrome I Pre-eclampsia

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 early ultrasound confirms the diagnosis.
2 
Death or handicap of the co-twin occurs in 25 per cent of cases.
3 
Result of single embryo splitting between 4 and 8 days post-fertilization.
4 
Imbalance in blood flow across placental vascular anastomoses.

20 Management of multiple pregnancy

A Fortnightly ultrasound scans D Lambda sign G Maternal steroid therapy
B 
Ultrasound measurement of E 
Elective Caesarean section at H 4–6-weekly ultrasound scans
cervical length 36–37 weeks I 
Elective Caesarean section at
C Internal podalic version F Multi-fetal reduction 32–34 weeks

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 
Recommended surveillance for monozygotic twins in the third trimester.
2 
May be considered in higher order multiple pregnancies to reduce the possibility of preterm birth.
3 
Helpful in predicting preterm labour in multiple pregnancies.
4 
Most common delivery strategy for monozygotic monoamniotic twins.

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 10 Obstetrics

21 The clinical management of hypertension in pregnancy

A Magnesium hydroxide E Renal function tests I Immediate Caesarean section
B Oral antihypertensive F 24-hour urine protein collection J Induction of labour
C Oral diuretic G 
Admission for observation and K Intravenous antihypertensives
D 
Outpatient monitoring of blood investigation L None of the above
pressure H Fetal 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 
At 34 weeks, an 80 kg woman complains of persistent headaches and ‘flashing lights’. There is no hyper-
reflexia and her blood pressure (BP) is 155/90 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. Her renal
function tests are normal.
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’ gesta-
tion. She was mildly hypertensive in her previous pregnancy. Her BP is 150/100 mmHg; 2 weeks later, at the
hospital antenatal clinic, her BP is 155/100 mmHg.

22 Features of abnormal placentation

A HELLP syndrome D 
Disseminated intravascular G Chronic hypertension
B Pre-eclampsia coagulation H Placental abruption
C Eclampsia E Glomeruloendotheliosis I None of the above
F Gestational hypertension

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 in her first pregnancy presents in labour. Her blood pressure is 145/90. Shortly after
beginning regular contractions she has a tonic-clonic seizure.
2 
A 32-year-old woman presents at 38/40 in her second pregnancy, her first having been complicated by pre-
eclampsia. Her blood pressure is 130/85 and her alanine amino transferase (ALT) is 70.
3 
A 24-year-old woman in her first pregnancy presents at 32/40 with sudden onset severe abdominal pain and
vaginal bleeding. Her blood pressure is 160/95.
4 
A 36-year-old woman in her first pregnancy is noted to have a blood pressure of 140/85 at 32/40. There is no
protein in her urine and she is asymptomatic.

23 Late miscarriage
A Threatened miscarriage D Stillbirth G Urinary tract infection
B Inevitable miscarriage E Complete miscarriage 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.

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 Extended matching questions 11

1 A 23-year-old woman presents at 21/40. 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 dipstick demonstrates leukocytes and nitrites.
2 A 23-year-old woman presents at 23/40 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 hot 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 21/40. She is complaining of vaginal bleeding, low backache and supra-
pubic 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 dipstick is unremarkable.
4 A 32-year-old woman presents in her first pregnancy at 20 weeks of amenorrhoea. 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.

24 Risk factors for preterm labour

A Smoking F Intrauterine bleeding J Afro-Caribbean origin
B Uterine abnormality G Cervical fibroids K Multiple pregnancy
C Appendicitis H 
Poor socioeconomic L Previous cervical cone biopsy
D Parity >5 background
E Previous preterm delivery I Interpregnancy interval <one year

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 
Risk of preterm labour is primarily due to uterine over-distension.
2 
Linked to recurrent episodes of threatened miscarriage early in pregnancy.
3 
May require surgery during pregnancy with associated risk of preterm labour.
4 
Modifiable risk factor for which help and advice can be given in antenatal clinic.

25 Diagnosis and management of preterm delivery

A Fetal fibronectin testing D Cervical length measurement H Tocolysis
B Maternal steroids E Nitrazine test I High vaginal swabs
C 
Cardiotocography (CTG) F Cervical cerclage
monitoring G Amniocentesis

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 
High negative predictive value for detecting preterm pre-labour rupture of the membranes.
2 
May allow a window of opportunity for antenatal steroid administration or intrauterine transfer.
3 
Contraindicated in the presence of vaginal bleeding, contractions or infection.
4 
Invasive test for chorioamnionitis.

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 12 Obstetrics

26 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 inves-
tigations reveal that she has increased bile acids.
2 A 23-year-old primigravid woman 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 un-
complicated; 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. Dipstick 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.

27 Shortness of breath in pregnancy

A Pneumonia D Cystic fibrosis G Mitral stenosis
B Ischaemic heart disease E Pulmonary embolism H Pulmonary hypertension
C Asthma F Ventricular septal defect 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 
At least 30 per cent of women show an improvement in the condition during pregnancy and there is no
increased risk of exacerbation postpartum.
2 
Requires close attention to nutritional status, physiotherapy and treatment of infections in pregnancy.
3 
Patients should be strongly advised against pregnancy, due to high risk of maternal mortality.
4 
40 per cent experience worsening symptoms in pregnancy, with a risk of pulmonary oedema in the third
trimester.

28 Perinatal infection (1)

A Toxoplasmosis E Listeria monocytogenes I Neisseria gonorrhoeae
B Cytomegalovirus F Parvovirus J Trichomoniasis
C Varicella zoster G Chlamydia trachomatis K Yersinia pestis
D Cocksackie B virus H Group B streptococcus 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.

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 Extended matching questions 13

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 known 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.

29 Perinatal infection (2)

A HIV E Treponema pallidum H Hepatitis B
B Hepatitis C F 
Recurrent genital herpes I None of the above
C Plasmodium falciparum infection
D Varicella zoster G Rubella

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 
Delivery by elective Caesarean section may decrease transmission rate.
2 
Immunity is 90 per cent in the UK adult population.
3 
Treatment may provoke a Jarisch–Herxheimer reaction.
4 
Vaccination during pregnancy is contraindicated, but should be given after pregnancy if non-immune.

30 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 a fulcrum.
3 The anterior shoulder lies inferior to the symphysis pubis and delivers first, and the posterior shoulder deliv-
ers subsequently.
4 When the widest part of the presenting part has passed successfully through the pelvic inlet.

31 Stages of labour
A Latent phase D Passive descent G Effacement
B Third stage E First stage H Active second stage
C Transition F 
Braxton-Hicks contractions 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 
Should be considered abnormal if lasting more than 30 minutes.
2 
The cervix shortens in length until it becomes included in the lower segment of the uterus.
3 
Conventionally should last no longer than 2 hours in a primiparous woman.
4 
Time between onset of labour and 3–4 cm cervical dilatation.

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 14 Obstetrics

32 Interventions in the second stage

A Episiotomy D Syntocinon post-delivery G Kiwi Omnicup
B Metal cup ventouse E Kielland’s forceps H Neville Barnes forceps
C Emergency Caesarean F Silicone rubber ventouse cup 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 primigravida in spontaneous labour at 34+3/40 has a pathological trace in the second stage. The fetal head
is at +2 station and is occipito-anterior.
2 
A multigravida has been induced at 42/40. She has been diagnosed with a brow presentation in the second
stage.
3 
A primigravida in spontaneous labour at 39+2/40 has been actively pushing for 30 minutes. The fetal head is
at 0 station, occipito-transverse.
4 
A primigravida in spontaneous labour at 39+2/40 has been actively pushing for 2 hours and is exhausted. The
fetal head is at +2 station, occipito-transverse.

33 Complications of Caesarean section

A Pulmonary embolus D Bladder trauma G Bowel injury
B Wound infection E Endometritis H Ileus
C Caesarean hysterectomy F Uterine atony 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 34-year-old woman who underwent Caesarean section 24 hours ago complains of abdominal pain and
distension. Her vital signs are all stable.
2 
A 34-year-old woman who underwent Caesarean section 3 days ago complains of severe abdominal pain and
distension. She is tachycardic and febrile.
3 
A 38-year-old woman who underwent Caesarean section 24 hours ago complains of sharp pain in the shoul-
der tip and pain on deep inspiration. Her vital signs are stable.
4 
A 42-year-old woman who underwent Caesarean section 48 hours ago is diagnosed with the condition that is
the leading cause of maternal mortality.

34 Obstetric emergencies (1)

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 medical history of
note. 10 minutes after delivery, she complains of a sudden onset severe occipital headache that is associated
with vomiting. Shortly after this, she loses 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.

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 Extended matching questions 15

3 
A 32-year-old woman who has had an emergency Caesarean section is on the post-natal ward. She suddenly
becomes breathless and complains of central chest pain. She subsequently loses consciousness.

35 Obstetric emergencies (2)

A Cord prolapse D Uterine atony G Uterine rupture
B Amniotic fluid embolus E Pulmonary embolus H Eclamptic seizure
C HELLP syndrome F Uterine inversion I Shoulder dystocia

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 38-year-old gestational diabetic with a BMI of 35 is induced at 42/40. After a long labour, the obstetric
registrar plans to deliver with forceps.
2 
A 27-year-old woman is admitted with spontaneous rupture of the membranes and mild contractions at
30/40. An ultrasound examination reveals the fetus to be in a footling breech position.
3 
A 34-year-old woman is fully dilated and pushing during her second labour. Her contractions have been
augmented with syntocinon. Her first child was born by emergency Caesarean.
4 
After delivery, a 36-year-old woman has failed to complete the third stage. The obstetrician is anxious to
avoid taking her to theatre.

36 Postpartum pyrexia
A Pyelonephritis 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 reveals 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 tempera-
ture of 38.0°C and a pulse of 90 beats per minute. The respiratory rate is 30 inspirations per minute and she
is using her accessory respiratory muscles. Abdominal and pelvic examinations are unremarkable. Chest
examination reveals purulent sputum and coarse crackles of auscultation.

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