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MRCOG PART 2 SBAs and EMQs

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Week 8 - Pre-term labour2

Week 8 - Pre-term labour2 Posted by PAUL A.

Question1

Prophylactic antibiotics are offered to women with pre-term prelabour rupture of the membranes. Erythromycin has advantages over other antibiotics because

A.    It is readily absorbed from the gastro-intestinal tract

B.    It crosses the placenta readily

C.    It has a short plasma half-life

D.    It is poorly absorbed from the gastro-intestinal tract              

E.     More than one option is correct 

 

Question2

In women with confirmed pre-term prelabour rupture of the membranes, the administration of prophylactic antibiotics is associated with

A.    A significant reduction in perinatal mortality

B.    A significant reduction in deaths before discharge

C.    A significant reduction in the risk of intraventricular haemorrhage                

D.    No significant difference in the risk of delivery within 7 days

E.     More than one of the above is correct

 

Question3

In women with confirmed pre-term prelabour rupture of the membranes, the administration of prophylactic antibiotics is associated with

A.    A significant reduction in the risk of cerebral palsy

 

B.    A significant reduction in the risk of functional impairment by the age of 7 years old

 

C.    A significant reduction in the risk of death after the first year of life

 

D.    A significant reduction in the risk of chronic lung disease

 

E.     None of the above                  

 

Question4

A healthy 23 year old woman presents with confirmed pre-term prelabour rupture of the membranes at 28 weeks gestation. P = 68 bpm, BP = 82/60 mmHg, Temp = 36.9C and her abdomen is soft and non-tender. There are no uterine contractions and the cervix is long and closed.

A.    Erythromycin 250 mg 4 times a day until delivery

B.    Erythromycin 250 mg 4 times a day for 10 days or until delivery

C.    Erythromycin 250 mg 4 times a day for 10 days or until active labour                       

D.    Erythromycin 250 mg 4 times a day for 10 days

E.     Erythromycin 250 mg 4 times a day for 14 days or until delivery

 

Question5

A healthy 23 year old woman presents with confirmed pre-term prelabour rupture of the membranes at 28 weeks gestation. P = 68 bpm, BP = 82/60 mmHg, Temp = 36.9C and her abdomen is soft and non-tender. There are no uterine contractions and the cervix is long and closed. The woman is allergic to erythromycin.

A.    Oral clindamycin

B.    Oral penicillin               

C.    Oral azithromycin

D.    Oral co-amoxiclav

E. Oral rifampicin

 

Question6

In women presenting with confirmed pre-term prelabour rupture of the membranes

A.    C-reactive protein above 5 mg/100 ml is a useful predictor of histological chorioamnionitis

B.    C-reactive protein above 5 mg/100 ml is a useful predictor of clinical but not histological chorioamnionitis

C.    C-reactive protein above 0.7 mg/100 ml is a useful predictor of both histological and clinical chorioamnionitis

D.    C-reactive protein above 0.7 mg/100 ml is a useful predictor of histological but not clinical chorioamnionitis

E.     C-reactive protein above 0.7 or 5 mg/100 ml is not a useful predictor of histological or clinical chorioamnionitis                 

 

Question7

In women presenting with confirmed pre-term prelabour rupture of the membranes

A.    A white blood cell count above 12,500 cells / ml is a useful predictor of clinical and histological chorioamnionitis

 

B.    A white blood cell count above 12,500 cells / ml is a useful predictor of histological but not clinical chorioamnionitis

 

C.    A fetal heart rate above 160 bpm is a useful predictor of histological chorioamnionitis

 

D.    An abnormal CTG is a useful predictor of clinical and histological chorioamnionitis

E.     A white blood cell count above 12,500 cells / ml or a fetal heart rate above 160 bpm is not a useful predictor of clinical or histological chorioamnionitis                      

 

Question8

In women presenting with confirmed pre-term prelabour rupture of the membranes, raised maternal temperature

A.    Has a very useful likelihood ratio for predicting histological chorioamnionitis

B.    Has a not useful negative likelihood ratio for predicting chorioamnionitis                   

C.    Has a low specificity for predicting histological chorioamnionitis

D.    Has a high sensitivity for predicting histological chorioamnionitis

E.     Should not be used in the diagnosis of chorioamnionitis

 

Question9

 

In women presenting with pre-term prelabour rupture of the membranes, a diagnosis of chorioamnionitis should be based on

 

A.    Clinical history

 

B.    Temperature and abdominal tenderness

 

C.    CRP

 

D.    White blood cell count

 

E.     All of the above                       

 

Question10

 

A healthy 26 year old woman has been admitted because of pre-term prelabour rupture of the membranes at 29 weeks gestation. On admission, T = 36.8C, P = 87 bpm, BP = 90/62 mmHg and her abdomen was soft and non-tender. White cell count = 9,600 / ml and CRP < 5 mg/100 ml. Corticosteroids and oral antibiotics are offered. Two days later, she remains clinically well with all observations within normal limits. Her white cell count = 13,500 / ml and CRP = 12 mg/100 ml.

 

A.    Recommend delivery

 

B.    Offer intravenous antibiotics

 

C.    Ultrasound scan for biophysical profile

 

D.    Continue monitoring                 

 

E.     Offer intravenous antibiotics and recommend delivery

 

Question11

 

A very useful positive likelihood ratio is

 

A.    Between 1 and 2

 

B.    Between 5 and 10

 

C.   Greater than 10                    

 

D.   Less than 0.05

 

E.    Less than 1

 

Question12

 

A very useful negative likelihood ratio is

 

A.    Less than 0.05

 

B.    Less than 0.1                                   

 

C.   Less than 1

 

D.   Between 5 and 10

 

E.    Less than 10

 

Question13

 

A new test is being developed to identify which women presenting with threatened pre-term labour are in pre-term labour. The test is found to have a negative likelihood ratio of about 1.0. This means that

 

A.    Women who have a positive test have a 1% chance of being in pre-term labour

 

B.    Women who have a negative test have a 1% chance of being in pre-term labour

 

C.   A negative test is equally likely in women in pre-term labour and those who are not                   

 

D.   1% of women in pre-term labour will have a negative test

 

E.    1% of women who are not in pre-term labour will have a negative test

 

Question14

 

A healthy 28 year old woman presents with uterine contractions every 2-3 minutes at 31 weeks gestation. She is feeling good fetal movements and there is no vaginal bleeding or discharge. On speculum examination, the cervix is long and closed. Which one should be used to determine the likelihood of pre-term delivery?

 

A.    Bishop score

B.    Fetal fibronectin test

 

C.   Phosphorylated insulin-like growth factor binding protein-1

 

D.   Cervical length by trans-vaginal ultrasound scan                     

 

E.    A combination of tests

 

Question15

 

Measurement of phosphorylated insulin-like growth factor binding protein-1

 

A.    Has a very useful positive likelihood ratio in diagnosing pre-term labour

 

B.    Has a very useful negative likelihood ratio in diagnosing pre-term labour

 

C.   Should be used in combination with fetal fibronectin to diagnose pre-term lablor

 

D.   Should be used in combination with cervical length measurement to diagnose pre-term labour

 

E.    Should not be offered to women presenting with threatened pre-term labour                   

 

Question16

 

The fetal fibronectin test

 

A.    Is more useful in ruling out pre-term labour than in diagnosing pre-term labour  

B.    A result of 50 nanograms/ml is positive

 

C.   Should be offered before cervical length measurement by transvaginal scanning in women presenting with threatened pre-term labour

 

D.   Should not be offered if testing for phosphorylated insulin-like growth factor binding protein-1 is available

 

E.    Should not be offered after 30 weeks gestation

 

 

Question17

 

In women presenting with threatened pre-term labour, trans-vaginal ultrasound measurement of cervical length is positive if cervical length is

 

A.    Less than 35 mm

 

B.    Less than 25 mm

 

C.   Less than 20 mm

 

D.   Less than 15 mm                

 

E.    Less than 10 mm

 

Question18

 

A healthy 24 year old woman presents with a 6 hours history of uterine contractions every 2-3 minutes at 30 weeks gestation. There is no vaginal bleeding or discharge and she is feeling good fetal movements. The vagina and vulva appear normal on speculum examination but the cervix is not visualized.

 

A.    Do not perform digital vaginal examination

 

B.    Perform fetal fibronectin test followed by digital vaginal examination

 

C.   Perform phosphorylated insulin-like growth factor binding protein-1 test followed by digital vaginal examination

 

D.   Perform transvaginal scan for cervical length followed by digital vaginal examination

 

E.    Perform digital vaginal examination                    

 

Question19

 

A healthy 24 year old woman with 3 previous vaginal births presents with a 6 hours history of uterine contractions every 2-3 minutes at 28 weeks gestation. There is no vaginal bleeding or discharge and she is feeling good fetal movements. The uterus is soft and non-tender with palpable contractions every 3 minutes lasting 30-40s. The vagina and vulva appear normal on speculum examination and the cervix is 1-2 cm long and 1-2 cm dilated.

 

A.    Offer fetal fibronectin test

B.    Offer corticosteroids and tocolytics                     

C.   Offer trans-vaginal ultrasound scan for cervical length

D.   Offer phosphorylated insulin-like growth factor binding protein-1 test

E.    Offer fetal fibronectin test and trans-vaginal scan for cervical length

 

 

Question20

 

A healthy 34 year old woman with one previous spontaneous pre-term birth at 28 weeks gestation presents with a 6 hours history of uterine contractions every 2-3 minutes at 32 weeks gestation. There is no vaginal bleeding or discharge and she is feeling good fetal movements. The uterus is soft and non-tender with palpable contractions every 3 minutes lasting 30-40s. The vagina and vulva appear normal on speculum examination and the cervix is 1-2 cm long and 1-2 cm dilated.

 

A.    Fetal fibronectin test

 

B.    Tocolytics and corticosteroids

 

C.   Trans-vaginal scan for cervical length                

D.   Phosphorylated insulin-like growth factor binding protein-1

 

E.    Fetal fibronectin test, FBC and CRP

preterm Posted by rasheeda B.

1B 2C 3a 4b 5b 6a 7e 8a 9e 10d 11c 12c 13c 14d 15e 16a 17d 18d 19b 20b

Posted by PAUL A.

Answers

 

1)   D

2)   C

3)   E

4)   C

5)   B

6)   E

7)   E

8)   B

9)   E

10)                  D

11)                  C

12)                  B

13)                  C

14)                  D

15)                  E

16)                  A

17)                  D

18)                  E

19)                  B

20)                  C