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MRCOG PART 2 SBAs and EMQs

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SBA 2

SBA 2 Posted by PAUL A.

Question1

 

A 34 year old woman with gestational diabetes attends the antenatal clinic at 36 weeks gestation. Gestational diabetes is managed with diet, exercise and metformin. Blood glucose levels are within the target range. BP = 120/68 mmHg and urine analysis is normal. Growth scan has shown estimated fetal weight above the 95th centile on the customised growth chart.

 

A.    Offer induction of labour at 37 weeks

 

B.    Offer caesarean section at 38 weeks

 

C.    Discuss risks and benefits of induction of labour and planned caesarean section               

 

D.    Recommend caesarean section if estimated fetal weight is over 4000 g at 40 weeks

 

E.     Recommend induction of labour at 38-39 weeks

 

Question2

 

A 26 year old woman with type 1 diabetes attends the antenatal clinic at 36 weeks gestation in her third pregnancy. She has no secondary diabetic complications. She has two previous caesarean sections and wishes to give birth by elective caesarean section. Her blood glucose levels are within the target range and fetal growth is on the 85th centile on a customised chart. BP = 124/76 mmHg and urine analysis is normal.

 

(a)   Caesarean section at 38+0 – 38+6 weeks

 

(b)   Caesarean section at 37+0 – 37+6 weeks

 

(c)   Caesarean section at 37+0 – 38+6 weeks                                  

 

(d)   Caesarean section at 37+0 – 39+6 weeks

 

(e)   Caesarean section at 38+0 – 39+6 weeks

 

Question3

 

A 36 year old woman with type 2 diabetes attends the antenatal clinic at 36 weeks gestation in her third pregnancy. She has no secondary diabetic complications. She has two previous caesarean sections and wishes to give birth by elective caesarean section. Her blood glucose levels are within the target range with metformin therapy. Fetal growth is on the 20th centile on a customised chart. BP = 114/56 mmHg and urine analysis is normal.

 

(a)   Induction of labour at 37+0 – 37+6 weeks

 

(b)  Caesarean section at 37+0 – 38+6 weeks                   

 

(c)   Induction of labour at 37+0 – 38+6 weeks

 

(d)  Caesarean section at 38+0 – 38+6 weeks

 

(e)   Caesarean section at 39+0 – 39+6 weeks

 

 

Question4

 

A 34 year old woman with gestational diabetes attends the antenatal clinic at 36 weeks gestation in her third pregnancy. She has two previous caesarean sections and wishes to give birth by elective caesarean section. Her blood glucose levels are within the target range with diet and exercise.  Fetal growth is on the 85th centile on a customised chart. BP = 124/76 mmHg and urine analysis is normal.

 

(a)   Caesarean section at 39+0 – 39+6 weeks                    

 

(b)  Caesarean section by 40+6 weeks

 

(c)   Induction of labour by 40+6 weeks

 

(d)  Induction of labour at 38+0 – 39+6 weeks

 

(e)   Caesarean section at 38+0 – 39+6 weeks

 

 

 

Question5

 

A 34 year old woman with gestational diabetes attends the antenatal clinic at 36 weeks gestation in her first pregnancy. Her blood glucose levels are within the target range with diet and exercise.  Fetal growth is on the 85th centile on a customised chart. BP = 124/76 mmHg and urine analysis is normal.

 

(a)   Induction of labour at 38+0 – 39+0 weeks

 

(b)  Induction of labour at 39+0 – 40+6 weeks

 

(c)   Induction of labour by 40+6 weeks                

(d)  Induction of labour by 39+6 weeks

 

(e)   Repeat growth scan at 38 weeks and then plan delivery

 

 

 

 

Question6

 

A 36 year old woman with type 2 diabetes attends the antenatal clinic at 36 weeks gestation in her third pregnancy. She has no secondary diabetic complications. She has two previous caesarean sections and wishes to give birth by elective caesarean section. Her blood glucose levels are within the target range with metformin therapy. Fetal growth is on the 20th centile on a customised chart. BP = 148/96 mmHg and urine analysis shows 2+ proteinuria. Urine protein : creatinine ratio = 90 mg/mmol. Blood tests are within normal limits.

 

(a)   Admit and plan caesarean section within 24 hours

 

(b)   Admit and plan caesarean section after 37+0 weeks

 

(c)   Daily reviews in day unit with caesarean section at 37+0 – 38+6 weeks

 

(d)   Admit and plan caesarean section before 37+0 weeks               

 

(e)   Review 3 times a week in day unit with caesarean section before 37+0 weeks

 

 

Question7

 

A 36 year old woman with gestational diabetes attends the antenatal clinic at 36 weeks gestation in her third pregnancy. She has two previous caesarean sections and wishes to give birth by elective caesarean section. Her blood glucose levels are within the target range with metformin therapy. Fetal growth is on the 50th centile on a customised chart. BP = 148/96 mmHg and urine analysis shows 2+ proteinuria. Urine protein : creatinine ratio = 90 mg/mmol. Blood tests are within normal limits.

 

(a)   Admit and plan caesarean section within 24 hours

 

(b)   Admit and plan caesarean section after 37+0 weeks                 

 

(c)   Daily reviews in day unit with caesarean section at 37+0 – 38+6 weeks

 

(d)   Admit and plan caesarean section before 37+0 weeks              

 

(e)   Review 3 times a week in day unit with caesarean section before 37+0 weeks

 

 

Question 8

 

A 23 year old woman with type 1 diabetes is admitted for elective caesarean section at 38+0 weeks gestation because of breech presentation. Following discussion, she wishes to have a general anaesthetic.

 

(a)   The risk of hyperglycaemia should be discussed

 

(b)  A glucose-insulin infusion should not be used during general anaesthesia

 

(c)   Blood glucose should be monitored hourly until recovery from anaesthesia

 

(d)  Blood glucose should be monitored every 30 minutes until recovery from anaesthesia                    

(e)   6U short-acting insulin should be administered at the time of induction of anaesthesia

 

 

Question9

 

(a)  With respect to the effect of glycaemic control during labour / birth and birth outcomes

 

(b)   Maternal blood glucose below 4.5 mM is associated with fetal distress

 

(c)   Maternal hyperglycaemia is associated with fetal distress                     

 

(d)   There is a positive correlation between maternal blood glucose concentration at birth and neonatal blood glucose concentration 2 hours after birth

 

(e)   There is a negative correlation between maternal blood glucose concentration at birth and neonatal blood glucose concentration at birth

 

 

 

Question10

 

A 22 year old woman with type 1 diabetes presents in spontaneous labour at 37 weeks gestation. She has no secondary diabetic complications and antenatal glycaemic control has been good. Fetal growth is on the 60th centile on a customised chart. A continuous insulin infusion is commenced. Blood glucose levels should be maintained between

 

(a)   4.0 – 7.0 mM               

 

(b)   5.0 – 7.0 mM

 

(c)   4.0 – 8.5 mM

 

(d)   5.5 – 7.9 mM

 

(e)   3.5 – 8.5 mM

 

 

 

 

Question11

 

A 23 year old woman with type 1 diabetes attends for induction of labour at 37+4 weeks gestation. Blood glucose levels have been within the target range and fetal growth is between the 50th and the 90th centile on a customised chart. Her Bishop score is 3 and vaginal prostaglandins are administered.  Intravenous dextrose and insulin infusion should be started

 

(a)   Once the woman is contracting 3 in 10 or more

 

(b)   Once the membranes have ruptured

 

(c)   Following prostaglandin administration

 

(d)   Once the woman is in established labour                                   

 

(e)   If the woman is requesting pain relief

 

 

 

Question 12

 

A 34 year old woman with gestational diabetes attends for induction of labour at 40 weeks gestation. Blood glucose levels have been within the target range with diet and exercise. Fetal growth is on the 60th centile on a customised growth chart. In intravenous glucose insulin infusion should be started

 

(a)   Once the woman is in established labour

 

(b)  If the woman has epidural analgesia

 

(c)   If blood glucose level is above 6.8 mM

 

(d)  If blood glucose is below 5.5 mM

 

(e)   If blood glucose is above 7.0 mM                               

 

 

 

 

 

Question 13

 

A 24 year old woman attends the antenatal clinic at 10 weeks gestation in her second pregnancy. In her first pregnancy, the baby was found to have a 47XY+21 karyotype following combined testing and chorionic villus biopsy. She underwent termination of pregnancy. The recurrence risk of Down’s syndrome in this woman is

 

(a)   1% above her age-related risk             

 

(b)  5% above her age-related risk

 

(c)   4 – 5%

 

(d)  Depends on maternal and paternal karyotype

 

(e)   About 1 in 180

 

 

.

 

Question 14

 

A 24 year old woman attends the antenatal clinic at 10 weeks gestation in her second pregnancy. In her first pregnancy, the baby was found to have Down’s syndrome associated with a t(14;21) following combined testing and chorionic villus biopsy. She underwent termination of pregnancy. Maternal and paternal karyotype were normal. The recurrence risk of Down’s syndrome in this woman is

 

(a)   10%

 

(b)  10% above maternal age-related risk

 

(c)   Same as maternal age-related risk

 

(d)  2-3 %                                      

 

(e)   15-20%

 

 

 

 

Question 15

 

A 19 year old woman attends the antenatal clinic at 10 weeks gestation. She was born with isolated tetralogy of Fallot that was repaired successfully. The chance of her baby being born with a congenital heart defect is

 

(a)   1 – 4 per 1000

 

(b)  5 – 10 per 1000

 

(c)   2 – 5 per 100                           

 

(d)  7 – 12 per 100

 

(e)   15 – 20 per 100

 

 

 

 

 

Question16

 

The prevalence of congenital heart disease is

 

(a)    0.5 – 1 per 1000 pregnancies

 

(b)   0.5 – 1.5 per 1000 live births

 

(c)    5 – 10 per 1000 pregnancies

 

(d)   5 – 10 per 1000 live births                              

 

(e)    0.1– 0.3 per 100 pregnancies

 

 

 

Question17

 

A 23 year old woman attends the antenatal clinic at 16 weeks gestation. There is a family history of congenital heart disease. The risk of her baby having a congenital heart defect is

 

(a)    5 times higher if the baby’s father is affected compared to an affected mother

 

(b)   10 times higher if the woman is affected compared to an affected father

 

(c)    2 – 5 % if there is an affected first degree relative                    

 

(d)   15-20% if there is an affected sibling

 

(e)    0– 5 per 1000 if there is an affected first degree relative

 

 

 

 

Question18

 

A healthy 33 year old woman attends the antenatal clinic at 10 weeks gestation in her first pregnancy. Her first pregnancy resulted in a termination of pregnancy at 21 weeks gestation because the fetus had a congenital cardiac defect. In her second pregnancy, fetal cardiac ECHO was normal but the baby was found to have a ventricular septal defect that was successfully repaired. The risk of this pregnancy being affected by a congenital cardiac defect is

 

(a)    5 – 10 per 1000

 

(b)   0– 3% above background risk

 

(c)    5 – 10%

 

(d)   10 – 15%                                  

 

(e)    30 – 40%

Posted by maryam R.
c,c,b,a,a,b,b,d,d,a,d,e,a,c,d,c,b,d
Posted by PAUL A.

Answers

 

1)   C

2)   C

3)   B

4)   A

5)   C

6)   D

7)   B

8)   D

9)   C

10)                  A

11)                  D

12)                  E

13)                  A

14)                  D

15)                  C

16)                  D

17)                  C

18)                  D