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MRCOG PART 2 SBAs and EMQs

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SBA 1

SBA 1 Posted by PAUL A.

Question 1

 

A healthy 34 year old woman attends the maternity assessment unit at 23 weeks gestation because of vague abdominal discomfort. Temp = 37.1C, BP = 132/67 mmHg and urine analysis is normal. Fetal heart rate could not be detected using a hand-held Doppler and fetal death is confirmed by ultrasound scan. Labour is induced and the woman gives birth 48 hours later. This death should be classified as

 

A.    A stillbirth

B.    An early stillbirth

C.   A miscarriage                       

D.   A stillbirth if the woman wishes to register the death

E.    A termination of pregnancy

 

Question2

A 23 year old woman presents with reduced fetal movements at 25 weeks gestation. Dating scan at 12 weeks and anomaly scan at 19 weeks were normal. Temp = 36.8C, BP = 138/82 mmHg and urine analysis is normal. Intrauterine fetal death is confirmed by ultrasound scan. Fetal biometry is consistent with 22-23 weeks gestation. Labour is induced and a severely macerated fetus is delivered 36 hours later. This death should be classified as

 

A.    A stillbirth                  

B.    An intra-uterine death

C.   A miscarriage

D.   A termination of pregnancy

E.    A stillbirth if the woman wishes to register the death

 

Question3

A 17 year old woman presents with frequent and painful contractions at 21 weeks gestation. Within 30 minutes of attending, her membranes rupture and the fetus is delivered. There is a heart rate and obvious movements for about 10 minutes before death is confirmed. This death should be classified as

A.    A miscarriage

B.    A stillbirth

C.   A neonatal death                 

D.   A stillbirth or neonatal death depending on the woman’s wishes

E.    A pre-neonatal death

 

Question4

A 34 year old woman presents with spontaneous rupture of the membranes and contractions at 24+3 weeks gestation. The fetal heart rate is 148 bpm. Following detailed counseling, intermittent auscultation is planned. Three hours later, the fetal heart could not be detected. A male infant is delivered 30 minutes later with no signs of life. This death should be classified as

A.    A neonatal death

B.    A stillbirth                  

C.   A miscarriage

D.   A stillbirth if the woman wishes to register the death

E.    An early neonatal death

 

Question5

The perinatal mortality rate is calculated

A.    Per 1,000 live births

B.    Per 1,000 maternities

C.   Per 10,000 total births

D.   Per 10,000 maternities

E.    Per 1,000 total births                      

 

Question6

In the UK, the perinatal mortality rate

 

A.    Includes babies born without signs of life after 22 weeks gestation

B.    Excludes babies born without signs of life after 25 weeks gestation

C.   Includes all neonatal deaths

D.   Includes all early neonatal deaths                       

E.    Excludes all babies born with signs of life

 

Question7

Early neonatal deaths refer to

A.    Death of a live-born infant within 24 hours of birth

B.    Death of a life-born infant born at 24-28 weeks gestation

C.   Death of a live-born infant within 7 days of birth                        

D.   Death of an infant born after 24 weeks gestation and within 7 days of birth

E.    Death of an infant born after 22 weeks gestation within 24 hours of birth

 

Question8

The neonatal death rate is reported

 

A.    Per 1000 maternities

B.    Per 1000 live births             

C.   Per 1000 total births (live births + stillbirths)

D.   Per 1000 births after 24 weeks gestation

E.    Per 1000 births after 28 weeks gestation

 

Question9

The infant mortality rate

A.    Includes stillbirths

B.    Excludes neonatal deaths

C.   Excludes early neonatal deaths

D.   Is calculated per 1000 total births

E.    Includes neonatal deaths and is calculated per 1000 live births      

 

Question10

The post-neonatal mortality rate

A.    Includes stillbirths

B.    Excludes births before 24 weeks gestation

C.   Excludes births before 28 weeks gestation

D.   Includes deaths between 28 days and 1 year of age              

E.    Includes deaths between 28 days and 6 weeks of age

 

Question11

With respect to mortality statistics in England & Wales

A.    The perinatal mortality rate is lower than the infant mortality rate

B.    The infant mortality rate for multiple births is not significantly different when compared to singleton births

C.   The neonatal mortality rate for multiple births is 2-3 times higher than for singleton births

D.   The post-neonatal mortality rate for multiple births is 2-3 times higher than for singleton births                      

E.    The post-neonatal mortality rate for multiple births is similar to that for singleton births

 

Question12

Multiple pregnancy is an important risk factor for low birth weight. The % of multiple births with birth weight below 2500 g in England & Wales is

A.    10-20%

B.    30-40%

C.   50-60%                      

D.   65-75%

E.    Over 75%

 

Question13

 

With respect to the rate of multiple birth following spontaneous conception and in-vitro fertilization (IVF)

 

A.    1 in 20 IVF pregnancies and 1 in 100 spontaneous pregnancies result in multiple births

 

B.    1 in 5 IVF pregnancies and 1 in 80 spontaneous pregnancies result in multiple births              

 

C.   1 in 10 IVF pregnancies and 1 in 100 spontaneous pregnancies result in multiple births

 

D.   1 in 5 IVF pregnancies and 1 in 150 spontaneous pregnancies result in multiple births

 

E.    1 in 20 IVF pregnancies and 1 in 80 spontaneous pregnancies result in multiple births

 

Question14

 

A 23 year old woman with type 1 diabetes attends the antenatal clinic at 10 weeks gestation. She was reviewed by the renal physician at 8 weeks gestation and found to have micro-albuminuria.

 

A.    Her urine PCR is over 300 mg/mmol

 

B.    Her urinary albumin : creatinine ratio is over 30 mg/mmol

 

C.   Her urinary albumin : creatinine ratio is over 3.5 mg/mmol                

 

D.   She has overt diabetic nephropathy

 

E.    Her serum creatinine concentration will be expected to be over 150 microM

 

Question15

 

With respect to the classification of diabetic nephropathy

 

A.    End-stage renal disease is serum creatinine over 120 microM

 

B.    Incipient nephropathy is serum creatinine over 100 microM

 

C.   End-stage renal disease is urine albumin : creatinine ratio over 30 mg/mmol

 

D.   Incipient nephropathy is characterised by micro-albuminuria                       

 

E.    Creatinine clearance increases as renal disease progresses

 

Question16

 

A 25 year old woman with type 1 diabetes attends the antenatal clinic at 8 weeks gestation. Which tests should be used for renal assessment?

 

A.    Serum creatinine

 

B.    Serum creatinine and 24 h urine protein

 

C.   Serum creatinine, urine albumin : creatinine ratio and estimated GFR

 

D.   Serum creatinine, urine albumin : creatinine ratio and renal ultrasound scan

 

E.    Serum creatinine and urine albumin : creatinine ratio                        

 

F.    Serum creatinine, urine PCR and estimated GFR

 

Question17

 

A 23 year old woman with type 1 diabetes attends the antenatal clinic at 10 weeks gestation. She was reviewed by the renal physician at 8 weeks gestation and found to have micro-albuminuria. She should be informed that

 

A.    Micro-albuminuria is not associated with adverse pregnancy outcome

 

B.    Pregnancy increases the risk of progression of diabetic retinopathy

 

C.   Micro-albuminuria is almost certainly pregnancy-induced and would resolve after delivery

 

D.   Estimated GFR is needed to assess the risks to her pregnancy

 

E.    She is at increased risk of having a small-for gestational age baby compared to diabetics without micro-albuminuria                  

 

Question18

 

A 24 year old woman with pre-existing diabetes attends the antenatal clinic at 10 weeks gestation. Her blood glucose levels are within the target range and HbA1c is 7.0%.  You are discussion the effect of diabetes on congenital anomalies.

 

A.    The risk of cardiac anomalies is 3-10 per 1000 births

 

B.    The risk of gastro-intestinal anomalies is not increased

 

C.   The risk of urinary tract anomalies is 4-8 per 1000 births

 

D.   The risk of congenital anomalies is increased in women with type 1 and type 2 diabetes                     

 

E.    Congenital anomalies are 10 times more common in women with type 1 diabetes

 

Question19

 

With respect to screening for chromosomal or congenital anomalies, which marker is reduced in women with pre-existing diabetes compared to women without diabetes?

 

A.    PAPP-A

 

B.    Nuchal translucency

 

C.   Weight-corrected total HCG

 

D.   Weight-corrected AFP                                 

 

E.    Weight-corrected beta-HCG

 

Question20

 

A 34 year old woman with type 2 diabetes attends for her anomaly scan at 20 weeks gestation. There are no other risk factors for congenital anomalies.

 

A.    A specialist fetal cardiac scan should be offered at 22 weeks

 

B.    A specialist fetal cardiac scan should be offered if diabetes is treated with insulin

 

C.   A specialist fetal cardiac scan should be offered if first trimester HbA1c was over 7.5%

 

D.   A specialist fetal cardiac scan should be offered if the woman is aged over 35 years

 

E.  A specialist fetal cardiac scan is not indicated             

 

Posted by koukab abdullah A.
Dr Fauzia. C C a b a d c b e d d a b d e e a e d e
ANSWERS Posted by PAUL A.

Answers

 

1)   C

2)   A

3)   C

4)   B

5)   E

6)   D

7)   C

8)   B

9)   E

10)                  D

11)                  D

12)                  C

13)                  B

14)                  C

15)                  D

16)                  E

17)                  E

18)                  D

19)                  D

20)                  E

20 answer ? should be cardiac scan (A) Posted by Jimmy N.

whether you have type 1 or 2 if its pre-existing which this question suggests then NICE says do a scan regardless of method of diabetes treatment or what the HBA1c level is.

20 weeks is preferable but 22 still useful

 

therefore by elimiation BCDE arent correct

Posted by PAUL A.
20 answer ? should be cardiac scan (A) Posted by Jimmy N.
Tue Jun 9, 2015 12:09 pm

whether you have type 1 or 2 if its pre-existing which this question suggests then NICE says do a scan regardless of method of diabetes treatment or what the HBA1c level is.

20 weeks is preferable but 22 still useful

 

therefore by elimiation BCDE arent correct

 

NO - NICE GUIDELINES 2015

  • Specialist cardiac scan should be offered at 22 weeks of gestation only if the results of the four chamber plus outflow tracts view are abnormal or if there is a relevant history of cardiac malformations.

 

cardiac scan Posted by farzana S.

Nice guidelines say ,Offer an ultrasound scan for detecting fetal structural abnormalities, including examination of the fetal heart (4 chambers, outflow tracts and 3vessels).

I could not find about scan at 22wks.

Question5 Posted by Shradha C.

TOG 45

Term perinatal mortality ( Combined no of still birth{Antipartum + Postpartum} + Neonatal death {28 days}

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10000 live birth & still birth at or beyond 37 completed weeks of gestation