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MRCOG PART 2 SBAs and EMQs

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EMQs

EMQs Posted by PAUL A.

Instructions

For the scenario below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

 

Question 1

 

A 24 year old woman with type 1 diabetes attends the antenatal clinic at 10 weeks gestation. This is a planned pregnancy and she had received pre-conception care. Her blood glucose levels are within the target range. BP = 110/68 mmHg and urine analysis is normal. HbA1c = 7.0%. She had retinal and renal assessment 8 weeks ago.

 

A.    Repeat retinal assessment not indicated

 

B.    Repeat retinal and renal assessment at 10 weeks

 

C.   Repeat retinal assessment at 11-14 weeks

 

D.   Repeat retinal assessment at 10 weeks if retinopathy was present

 

E.    Repeat renal assessment if she had micro-albuminuria

 

F.    Repeat retinal assessment at 16-20 weeks if retinopathy was present     

 

G.   Repeat retinal and renal assessment at 16 - 20 weeks if there was no retinopathy

 

H.   Repeat retinal assessment at 28 weeks

 

I.      Repeat retinal assessment at 34 weeks

 

J.     Repeat retinal assessment 6 weeks after delivery

 

K.    Repeat retinal assessment 6 months after delivery

 

Instructions

 

For the scenario below, choose the single most appropriate timing of retinal assessment from the above list of options. Each option may be used once, more than once, or not at all.

 

Question 2

 

A 34 year old woman with type 2 diabetes attends the antenatal clinic at 16 weeks gestation. This is an unplanned pregnancy and she had not received pre-conception care. She is taking metformin and aspirin but no other medication. BP = 132/82 mmHg and urine analysis shows 1+ glucose. Her blood glucose levels 1 hour after eating are 5.8 – 7.2 mM. Retinal assessment undertaken earlier in pregnancy was normal.

 

A.    Repeat retinal assessment not indicated

 

B.    Repeat retinal assessment at 16 weeks

 

C.   Repeat retinal assessment at 18

 

D.   Repeat retinal assessment at 20 weeks

 

E.    Repeat retinal assessment at 28 weeks                       

 

F.    Repeat retinal assessment at 34 weeks

 

G.   Repeat retinal assessment at 36 weeks

 

H.   Repeat retinal assessment 6 weeks after delivery

 

I.      Repeat retinal assessment 6 months after delivery

 

J.     Repeat retinal assessment yearly

 

Instructions

For the scenario below, choose the single most appropriate timing of the next contact to assess glycaemic control from the above list of options. Each option may be used once, more than once, or not at all.

 

Question 3

 

A 20 year old woman with type 1 diabetes attends the antenatal clinic at 28 weeks gestation in her first pregnancy. She has no evidence of secondary diabetic complications. Her fasting blood glucose levels are 4.5 – 5.6 mM and 1 hour post-prandial blood glucose levels are 6.2 – 7.9 mM. BP = 126/82 mmHg and urine analysis is normal. Ultrasound scan shows the abdominal circumference on the 50th centile with normal amniotic fluid volume.

A.    After 2-3 days

B.    After 5-7 days

C.   After 1 week

D.   After 1-2 weeks                                

E.    After 2-3 weeks

F.    After 3-4 weeks

G.   At 31 weeks

H.   At 32 weeks

I.      Every day

J.     After 2 weeks

K.    After 3 weeks

 

Instructions

For the scenario below, choose the single most appropriate option from the above list of options. Each option may be used once, more than once, or not at all.

 

Question 4

 

A 20 year old woman with type 1 diabetes attends the antenatal clinic at 28 weeks gestation in her first pregnancy. She has no evidence of secondary diabetic complications. Her fasting blood glucose levels are 4.5 – 5.6 mM and 1 hour post-prandial blood glucose levels are 6.2 – 7.9 mM. BP = 126/82 mmHg and urine analysis is normal. Ultrasound scan shows the abdominal circumference on the 50th centile with normal amniotic fluid volume.

 

A.    Biophysical profile at 30 weeks

 

B.    Umbilical artery Doppler at 28 weeks

 

C.   Growth scan and biophysical profile at 30 weeks

 

D.   Growth scan and biophysical profile at 32 weeks

 

E.    Growth scan and umbilical artery Doppler and biophysical profile at 30 weeks

 

F.    Growth scan and umbilical artery Doppler at 32 weeks

 

G.   Growth scan and amniotic fluid volume at 32 weeks              

H.   Umbilical artery Doppler at 30 weeks

I.      Amniotic fluid volume and umbilical artery Doppler at 30 weeks

J.     Growth scan and umbilical artery Doppler at 31 weeks

K.    Growth scan and amniotic fluid volume at 34 weeks

L.    Growth scan and umbilical artery Doppler at 34 weeks

 

 

Instructions

 

For the scenario below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

 

Question 5

 

A 30 year old woman with gestational diabetes attends the antenatal clinic at 36 weeks gestation in her third pregnancy. She has two previous caesarean sections. She has been treated with insulin from 32 weeks. Fasting blood glucose is 3.9- 5.6 mM. Blood glucose levels 1 hour after meals are 5.8 – 7.9 mM. BP = 128/66 mmHg and urine analysis is normal. Growth scan shows fetal abdominal circumference just above the 50th centile.

 

A.    Increase dose of insulin

 

B.    Reduce dose of insulin

 

C.   Induction of labour at 37 weeks

 

D.   Caesarean section at 37-38 weeks

 

E.    Caesarean section at 38-39 weeks

 

F.    Weekly biophysical profile

 

G.   Weekly biophysical profile and twice weekly CTG

 

H.   Caesarean section at 39 weeks                          

 

I.      Induction of labour by 40+6 weeks

 

J.     Induction of labour at 39-40 weeks

 

K.    Growth scan and umbilical artery Doppler at 38 weeks

 

L.    Weekly ultrasound scan for maximum pool depth

 

M.   Corticosteroids and caesarean section at 37 weeks

 

N.   Corticosteroids and caesarean section at 38 weeks

 

Instructions

 

For the scenario below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

 

Question 6

 

A 36 year old woman with gestational diabetes attends the antenatal clinic at 36 weeks gestation in her first pregnancy. She has been managed with exercise and dietary modifications. BP = 124/68 mmHg and urine analysis is normal. Estimated fetal weight is on the 50th centile on a customised growth chart. Blood glucose levels 1 hour after meals are 5.8 – 7.9 mM.

 

A.    Recommend metformin

 

B.    Recommend insulin

 

C.   Induction of labour at 37 weeks

 

D.   Umbilical artery Doppler at 37 weeks

 

E.    Induction of labour at 37-38 weeks

 

F.    Weekly umbilical artery Dopplers from 37 weeks

 

G.   Induction of labour at 38-39 weeks

 

H.   Twice weekly CTG from 37 weeks

 

I.      Growth scan and umbilical artery Doppler at 38 weeks

 

J.     Induction of labour by 40+6 weeks                                  

 

K.    Induction of labour at 39-40 weeks

 

L.    Induction of labour at 41-42 weeks

 

Instructions

 

For the scenario below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

 

Question 7

 

A 36 year old woman with type 2 diabetes attends the antenatal clinic at 36 weeks gestation. She has no secondary diabetic complications and has been treated with insulin from 32 weeks. BP = 130/64 mmHg and urine analysis is normal. Blood glucose levels 1 hour after meals are 5.8 – 7.9 mM. Assessment of fetal wellbeing is reassuring.

 

A.    Growth scan and umbilical artery Doppler at 38 weeks

 

B.    Umbilical artery Doppler at 37 weeks

 

C.   Induction of labour at 37 weeks

 

D.   Weekly biophysical profile from 37 weeks

 

E.    Twice weekly CTG from 37 weeks

 

F.    Weekly biophysical profile and twice weekly CTG from 37 weeks

 

G.   Induction of labour at 37-38 weeks                     

 

H.   Induction of labour at 38-39 weeks

 

I.      Weekly biophysical profile from 38 weeks

 

J.     Twice weekly CTG from 38 weeks

 

K.    Weekly biophysical profile and twice weekly CTG from 39 weeks

 

L.    Induction of labour by 40+6 weeks                     

 

M.   Induction of labour at 39-40 weeks

 

Instructions

 

For the scenario below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

 

Question 8

 

A 20 year old woman with type 1 diabetes attends the antenatal clinic at 36 weeks gestation. She has no secondary diabetic complications. BP = 124/82 mmHg and urine analysis is normal. Blood glucose levels 1 hour after meals are 5.8 – 7.9 mM. Assessment of fetal wellbeing is reassuring.

 

 

A.    Growth scan and amniotic fluid volume at 38 weeks

 

B.    Induction of labour at 37 weeks

 

C.   Biophysical profile at 37 weeks

 

D.   Twice weekly CTG from 37 weeks

 

E.    Umbilical artery Dopplers at 37 weeks

 

F.    Induction of labour at 37-38 weeks                     

 

G.   Induction of labour at 38-39 weeks

 

H.   Twice weekly CTG from 38 weeks

 

I.      Biophysical profile from 39 weeks

 

J.     Biophysical profile from 40 weeks

 

K.    Induction of labour by 40+6 weeks                     

 

L.    Induction of labour at 39-40 weeks

 

 

Instructions

 

For the scenario below, choose the single most appropriate option from the above list of options. Each option may be used once, more than once, or not at all.

 

Question 9

 

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

 

F.     The glucose tolerance test should not have been done

 

G.    The glucose tolerance test should be repeated at 24 weeks

H.    The 1 hour blood glucose result is needed for accurate diagnosis

 

I.       The HbA1c test should have been done instead of the glucose tolerance test

 

J.     A random blood glucose should have been done instead of the glucose tolerance test

 

Instructions

 

For the scenario below, choose the single most appropriate option from the above list of options. Each option may be used once, more than once, or not at all.

 

Question 10

 

A 23 year old woman with type 1 diabetes attends the antenatal clinic at 8 weeks gestation. Which one is not a recognised consequence of fetal hyper-insulinaemia?

 

A.    Overgrowth of adipose tissue

 

B.    Neonatal hypoglycaemia

 

C.    Birth trauma

 

D.    Hypoxaemia

 

E.     Hyper-bilirubinaemia

 

F.     Renal vein thrombosis

 

G.    Polycythaemia

 

H.    Increased risk of long-term obesity

 

I.       Neonatal hyperglycaemia                                

 

J.     Neonatal jaundice

ANSWERS Posted by PAUL A.

Answers

 

1)   F: Repeat retinal assessment at 16-20 weeks if retinopathy was present

2)   E: Repeat retinal assessment at 28 weeks

3)   D: After 1-2 weeks

4)   G: Growth scan and amniotic fluid volume at 32 weeks

5)   H: Caesarean section at 39 weeks

6)   J: Induction of labour by 40+6 weeks

7)   G: Induction of labour at 37-38 weeks

8)   F: Induction of labour at 37-38 weeks

9)   D: She might have pre-existing type 2 diabetes        

10)                   I: Neonatal hyperglycaemia

Posted by Tehseen  C.
Hi, Paul Please explain Q7&8 . Why induction at 37-38 wks & not at 39-40 wks. Will these cases will require antenatal steroids?
Posted by PAUL A.
Posted by Tehseen  C.
Thu Jun 11, 2015 09:48 am

Hi, Paul Please explain Q7&8 . Why induction at 37-38 wks & not at 39-40 wks. Will these cases will require antenatal steroids?

 

See NICE diabetes in pregnancy guidelines.

RCOG guidelines on antenatal corticosteroids do not recommend use before IOL after 34+6 (or 35+6 for SGA).