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MRCOG PART 2 SBAs and EMQs

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SBA questions

SBA questions Posted by Farrukh G.

WE ARE SORRY LAST WEEK'S QUESTIONS GOT DELETED FROM THE DATABASE

 

Question 1

 

A 24 year old woman has a glucose tolerance test at 16 weeks gestation because of persistent glycosuria. Fasting blood glucose = 5.4 mM and 2 hour blood glucose = 8.1 mM.

 

a)    She has impaired glucose tolerance

 

b)    She has type 1 diabetes

 

c)    She definitely has gestational diabetes

 

d)    She might have pre-existing type 2 diabetes                          

 

e)    The glucose tolerance test should be repeated at 28 weeks

 

Question 2

 

A 23 year old woman with type 1 diabetes attends the antenatal clinic at 8 weeks gestation. When discussing how diabetes affects the pregnancy, she should be informed that

 

a)    High blood glucose in the woman results in high blood glucose in the fetus 

 

b)    Low insulin levels in the woman results in low insulin levels in the fetus

 

c)    High blood glucose in the woman results in low insulin levels in the fetus

 

d)    Low blood glucose in the woman results in high insulin levels in the fetus

 

e)    High insulin levels in the woman result in high insulin levels in the fetus

 

Question 3

In women with pre-existing diabetes, maternal hyperglycaemia is associated with

 

A.    Fetal islet cell hypoplasia

 

B.    Fetal thrombocytopaenia

 

C.    Fetal hypoxaemia                                

 

D.    Fetal hypo-insulinaemia

 

E.     Fetal growth restriction

 

Question 4

 

With respect to the risk of gestational diabetes in the UK, women from which ethnic background have the greatest risk?

 

a)    Indian                           

 

b)    Black African

 

c)    Black Caribbean

 

d)    Chinese

 

e)    South-East Asian

 

Question 5

 

Recognised risk factors for gestational diabetes include

 

a)    Smoking, advanced maternal age and previous baby above the 90th centile on customised chart

 

b)    Smoking, previous baby over 4500g and advanced maternal age                 

 

c)    Previous gestational diabetes, advanced maternal age, previous caesarean section

 

d)    Indian ethnic origin, advanced maternal age, high maternal weight gain in pregnancy

 

e)    Smoking, Black ethnic origin, previous baby above 95th centile on customised chart

 

Question 6

 

Screening for gestational diabetes should be based on risk factors. Screening is not recommended in which group of women?

 

a)    Women aged over 35 years               

 

b)    Women with a previous baby weighing over 4500g

 

c)    Women with a family history of type 1 diabetes

 

d)    Women with BMI over 35 kg/m2

 

e)    Women of Indian ethnic origin

 

Question 7

 

Women should be supported to make informed decisions about screening in pregnancy. Before screening for gestational diabetes, women should be informed that

 

a)    The majority of women with gestational diabetes will be managed with diet and exercise only

 

b)    Diagnosing gestational diabetes will reduce the need for intervention during labour

 

c)    Diagnosing gestational diabetes will reduce the need for intervention during pregnancy

 

d)    The majority of women with gestational diabetes will be managed with tablets or insulin                           

 

e)    The majority of women with gestational diabetes will not have gestational diabetes in their next pregnancy

 

Question 8

 

With respect to the timing of screening for gestational diabetes

 

a)    Gestational diabetes does not occur in the first trimester

 

b)    Screening should not be done before 20 weeks gestation

 

c)    Screening in the first trimester should only be done using self-monitoring of blood glucose

 

d)    Screening should be done at 20-24 weeks in women with risk factors

 

e)    Screening should be offered in the first and / or second trimester depending on risk factors       

 

Question 9

 

A healthy 34 year old woman attends the antenatal clinic at 32 weeks gestation. She has no symptoms and is feeling good fetal movements. Her BP = 127/68 mmHg and urine dipstix shows 3+ glucose, 1+ protein, 2+ leucocytes and nitrites are negative.

 

a)    Reassure

 

b)    Recommend 24 hour urine collection

 

c)    Recommend random blood glucose

 

d)    Recommend glucose tolerance test                            

 

e)    Review in 1 week

 

Question 10

 

A healthy 34 year old woman attends the antenatal clinic at 32 weeks gestation. She has no symptoms and is feeling good fetal movements. Her BP = 127/68 mmHg and urine dipstix shows 1+ glucose, 2+ leucocytes and nitrites are negative. Urine dipstix has been normal at previous visits.

 

a)    Repeat urine dipstix in 1 week

 

b)    Repeat urine dipstix in 2 weeks

 

c)    Keep routine antenatal clinic visit in 4 weeks                         

 

d)    Offer random blood glucose test

 

e)    Offer fasting blood glucose test

 

Question 11

 

A 23 year old woman has a glucose tolerance test because of her BMI. Gestational diabetes should be diagnosed if

 

a)    Fasting blood glucose is over 5.0 mM

 

b)    1 hour blood glucose is over 7.8 mM

 

c)    Fasting blood glucose is 5.6 mM or more and 2 hour blood glucose is 7.8 mM or more

 

d)    2 hour blood glucose is 7.8 mM or more                     

 

e)    Fasting blood glucose is 5.6 mM or more and 1 hour blood glucose is 7.8 mM or more         

 

Question 12

 

A 23 year old woman has a glucose tolerance test because of her BMI. 2 hour blood glucose = 7.9 mM. Unfortunately her other blood samples were not received by the lab.

 

a)    Diagnose impaired glucose tolerance

 

b)    Diagnose gestational diabetes                        

 

c)    Repeat glucose tolerance test within 1 week

 

d)    Offer random blood glucose

 

e)    Offer HbA1c

 

Question 13

 

A 23 year old woman has a glucose tolerance test at 26 weeks gestation because of her BMI. Fasting blood glucose = 4.0 mM and 2 hour blood glucose = 7.9 mM.

 

a)    Reassure

 

b)    Refer to joint diabetes antenatal clinic within 1 week                         

 

c)    Repeat glucose tolerance test at 28-32 weeks

 

d)    Recommend home blood glucose monitoring

 

e)    Offer treatment with metformin

              

 

Question 14

 

A 23 year old woman has a glucose tolerance test at 26 weeks gestation because of her BMI. Fasting blood glucose = 4.0 mM and 2 hour blood glucose = 7.9 mM. Which one is the most appropriate treatment option?

 

a)    Metformin

 

b)    Metformin or insulin

 

c)    Diet and exercise                                

 

d)    Diet, exercise and metformin

 

e)    Exercise

 

Question 15

 

A 35 year old woman attends the joint diabetic-antenatal clinic at 27 weeks gestation in her second pregnancy. Glucose tolerance test was performed at 26 weeks because her previous baby weighed 4678 g. The results showed fasting blood glucose = 7.2 mM and 2 hour blood glucose = 9.2 mM.

 

a)    Recommend diet and exercise

 

b)    Recommend insulin or metformin

 

c)    Recommend diet, exercise and insulin                        

 

d)    Recommend metformin or glibenclamide

 

e)    Recommend insulin or glibenclamide

 

Question 16

 

A 35 year old woman attends the joint diabetes-antenatal clinic at 30 weeks gestation. She was diagnosed with gestational diabetes at 27 weeks and offered a regimen of diet and exercise. After 2 weeks, her 1 hour post-prandial blood glucose levels are 8.5 – 10.3 mM, which is higher than the 7.8 mM target.

 

a)    Reduce calorie intake and increase exercise

 

b)    Offer metformin in addition to diet and exercise                     

 

c)    Offer metformin in place of diet and exercise

 

d)    Offer insulin

 

e)    Offer glibenclamide

 

Question 17

 

A 32 year old woman attends the joint diabetes-antenatal clinic at 32 weeks gestation. She was diagnosed with gestational diabetes at 28 weeks gestation following a glucose tolerance test. She has been treated with a diet and exercise regimen plus metformin. Over the last week, her 1 hour post-prandial blood glucose levels are 8.2 – 9.8 mM. The target set for her was below 7.8 mM. She declines insulin because she has a needle phobia.

 

a)    Check HbA1c to confirm glycaemic control

 

b)    Increase dose of metformin and review in 2 weeks

 

c)    Offer glibenclamide                             

 

d)    Restrict calorie intake and increase exercise

 

e)    Continue current therapy and review in 1 week

 

Question 18

 

A healthy 34 year old woman is referred for growth scan at 32 weeks gestation because the fundal height la large for dates. Ultrasound scan shows the fetal abdominal circumference above the 95th centile on the customised chart and there is polyhydramnios. Glucose tolerance test is requested and it shows a fasting blood glucose of 6.5 mM and 2 hour blood glucose of 9.2 mM.

 

a)    Low glycaemic diet and exercise

 

b)    Metformin

 

c)    Glibenclamide

 

d)    Low glycaemic diet and exercise + metformin

 

e)    Low glycaemic diet and exercise + insulin                             

 
Answers Posted by PAUL A.

Answers

 

1)   D

2)   A

3)   C

4)   A

5)   B

6)   A

7)   D

8)   E

9)   D

10)                  D

11)                  D

12)                  B

13)                  B

14)                  C

15)                  C

16)                  B

17)                  C

18)                  E

Posted by tmalar@yahoo.com C.

Question 1

 

A 24 year old woman has a glucose tolerance test at 16 weeks gestation because of persistent glycosuria. Fasting blood glucose = 5.4 mM and 2 hour blood glucose = 8.1 mM.

 

a)    She has impaired glucose tolerance

 

b)    She has type 1 diabetes

 

c)    She definitely has gestational diabetes

 

d)    She might have pre-existing type 2 diabetes                          

 

e)    The glucose tolerance test should be repeated at 28 weeks

 

Dear Paul.

 

The new guideline says Diagnose gestational diabetes if the woman has either:

  • a fasting plasma glucose level of 5.6 mmol/litre or above or

  • a 2‑hour plasma glucose level of 7.8 mmol/litre or above. [new 2015]   

 
Hence why is the answer D is correct instead of C
Posted by tmalar@yahoo.com C.

Dear Paul could you reply to the doubts put forward on 21 st may 2015 by me.

Posted by tmalar@yahoo.com C.

Question 1

 

A 24 year old woman has a glucose tolerance test at 16 weeks gestation because of persistent glycosuria. Fasting blood glucose = 5.4 mM and 2 hour blood glucose = 8.1 mM.

 

a)    She has impaired glucose tolerance

 

b)    She has type 1 diabetes

 

c)    She definitely has gestational diabetes

 

d)    She might have pre-existing type 2 diabetes                          

 

e)    The glucose tolerance test should be repeated at 28 weeks

 

Dear Paul.

 

The new guideline says Diagnose gestational diabetes if the woman has either:

  • a fasting plasma glucose level of 5.6 mmol/litre or above or

  • a 2‑hour plasma glucose level of 7.8 mmol/litre or above. [new 2015]   

 
Hence why is the answer D is correct instead of C
Posted by PAUL A.

All women diagnosed with gestational diabetes might have pre-existing type 2 diabetes. This is especially so if GDM is diagnosed in early pregnancy.

 

You have 2 options - definitely has GDM or might have type 2 diabetes. The clinician must recognise that this could be pre-existing type 2 diabetes.