Obstetrics

1. 12 week old pregnant lady was brought to the emergency department with vomiting,
abdominal pain and severe bleeding for the past 4 hours.She also had 2 fainting
attacks.Her blood pressure is 80/40.She was normal till before this episode and USG at
11 weeks showed normal nuchal translucency.Which is the most likely diagnosis?
Incomplete abortion(there will be bleeding & rpocs on usg)
Complete abortion(no bleeding, no rpocs)
Abruption placenta
Ectopic pregnancy rupture
Hydatidiform mole

Normal U/s finding exclude H.mole and ectopic pregnancy

Placental abruption occur in late pregnancy
So if she presented now At ER with severe vaginal bleeding its incomplete abortion
If at ER there is No vaginal bleeding and closed Os and No POC its complete abortion
In this case the answer is A

2. Women came with infertility.has irregular period of avg 48days. Sex 3 times
weekly. Asking cause –
1.Anovulation(irregular time ,dx pcod)
2.Endometriosis
3.Wrong time of intercourse
3. Female with history of CS with lower abdominal incision before, admitted at
32 weeks with labour pain by examination cervix was dilated and uterus level
was 32 and baby presentation was cephalic (not remembering the rest of
examination) she was admitted for observation , suddenly she passed 1 L of
fresh blood from the vagina( not mentioning tender uterus ), what is the cause:
Placenta previa
Placenta accreat
Rupture uterus
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 Coagulopathy
4. 35 year old pregnant woman presented at 15 weeks gestation asking you for a
diagnostic screening of down, what is the diagnostic screening test you should do for
this woman? 
A-nuchal translucency ultrasound 
B-maternal serum and ultrasound 
C-maternal serum 
D-amniocentesis 
E-chorionic villous sampling
5. patient came at 12 weeks labs showed rh antibodies in her blood.this is her
2nd pregnancy what to do?
a) do blood group of her spouse
b) monitor level of antibody
c) give her anti d now
d) do fetal usg
e) terminate pregnancy

6. PV bleeding 12 weeks pregnancy.BP decreased and pulse increased.USG before no

nuchal translucency,abdominal pain present.diagnosis
A)abruptio
B)incomplete miscarriage
C)ectopic
7. CTG showed reduced baseline variability and variable deceleration (CTG was not
given). The mother had 4 cm cervical dilation within 14 hours .Pethidine was
given to her 3 times .Fetal head was in the left occiput posterior. What is the
cause of the CTG abnormality?
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 a) prolonged labour
b) elevated resting uterine pressure due to incoordinate uterine action
c) molding of fetal head
d) sedative drugs

8. Old female on Anti ht past 10 days b/l pedal odema n groin odema..no inc jvp no
crackle..
Xray chest
Ct abdo
Doppler echo
The most common cause for pain or swelling in the groin. The area between the abdomen
and thigh – is a hernia. ...
Another common cause of swelling in the groin area are swollen lymph nodes. ...
Other causes include inflammation and cancers. ...
These are only some of the possible causes of pain and swelling in the groin.

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9. Pt 32year old woman, currently Gravida 2 Para1, at 15weeks of gestation. First
child was born premature at 32weeks. Pt concerned about Down Syndrome as a
Friend has a Down Syndrome kid. Now asking for most appropriate Ix to reassure
mother child does not have Down Syndrome.
A. Serum bloods.
B. Amniocentesis
C. CVS
D. Nuchal Translucency tests

10. H/O fibroids ? Week of pregnancy. USG earlier week was normal.came with
pain, uterus correlate to week or 2 cm larger. No bleeding.FHR normal.
A) abruptio (Non-tender)
B) red degeneration (Pain+Fever+Local Tenderness)
C) round ligament pain

A 32 or 37 week pregnant patient present with right iliac fossa pain.she vomited
twice.there was no abdominal tenderness or rigidity,.what is the cause of her pain
1.acute appendicitis
2.intraabodominal adhesion
3. red degeneration of unrecognized fibroid
4- Placental abruption

Pregnant patient presents with RLQ pain in 22 weeks.

She vomited twice. No abdominal tenderness or rigidity.
She has history of appendicectomy when she was 19 years
old. What is the cause of pain?
a) Intraabdominal adhesion
b)Red degeneration of unrecognised fibroid
c) Round ligament strain
d)Cholecystitis
e)Adnexal torsio

11. H/0 pain during pregnancy,USG normal before. Pain ,vomiting uterus ? Non
tender,no bleeding ,FHR 144.
A)abruptio

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 B)round ligament pain
C)round ligament pain
12. PV bleeding 12 weeks pregnancy.BP decreased and pulse increased.USG
before no nuchal translucency,abdominal pain present.diagnosis
A)abruptio
B)incomplete miscarriage
C)ectopic

13. 15weeks preg come for Down $ screening,after couselling for risk of abortion
1:200,and she agree to do,next?
A.CVS
B.amniocenthesis
C.nuchal fold thickness( 11-13 wk only)
D. serum AFP
E. Quadruple test including nuchal translucency (15-18 wk)
14. A 25 yr old woman no history of diabetes or history of previous
congenital malformed babies( spina bifida). She is not on any anti epileptic
drug or teratogenic drug. She asked for preconception advice on folic acid
therapy bcos a friend is taking them
1. Tell her its not important B. Give her 5mg folic acid daily
3. Give her multivitamins
4. Give her low dose folate therap
15. a pregnant woman in her first trimester is worried that her child may be
affected with trisomy 21 as her sister gave birth of a baby with down syndrome
what is the best to screen for down syndrome
a. ultrasound for nuchal translucency in week 10
b. amniocentesis in week 15
c. matenal alpha fetoprotein+estriol +hCG .

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 16. A 39-year-old woman (gravida 2, para 1) attends for her first antenatal visit
at eight weeks of gestation in her second pregnancy and is concerned about the
risk of Down syndrome in the fetus. Which one of the following is the safest test
(i.e. the one least likely to result in a pregnancy loss, but still enabling the
diagnosis to be made) to definitely exclude the presence of Trisomy 21 in the fetus
in this pregnancy?
A. Nuchal translucency at 11 - 12 weeks of gestation.
B. Chorion villus biopsy (CVB) at 10-12 weeks of gestation.
C. Amniocentesis at 16 weeks of gestation. (pg 582, Q3.324 HB)
D. Maternal serum screening for alpha-fetoprotein, beta-hCG and oestradiol levels.
E. Cordocentesis at 18 weeks of gestation

For the scenario about Down's Syndrom

There is screening test and diagnostic test.
Screening test in the first trimester and if positive the patient will do the diagnostic test.
Screening test:
1- HCG
2- Pregnancy-associated plasma protein
3- Nuchal translucency scan (should be done between 11-14 weeks) can not done
before this
2nd trimester
Screening:
HCG, alfafeto protein, Oestriol and inhibin A
HCG will be increased; Inhibin A will be increased BUT there will be decrease in Alfafeto
protein and decrease in Oestriol.
These four tests are called the quadruplet test.
Triplet test for screening in the 2nd trimester include hcg, alfafeto protein and oestriol
Diagnostic test in the 2nd trimester are CVS and amniocentesis
17. the question asked about a lady with an otherwise uncomplicated pregnany
but Clinical features suggestive of hyperemesis gravidarum. after initial fluid
rresuscitation, the q asked as to what shud be the next step. these were the
options i was confused about.
a. measure HCG
b. US pelvis (JM 1193)

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(Pelvic us to find out whether it is hydatid or multiple pregnancy as in both
cases hyperemesis present)
18. Primigravida with scenario of hyperemesis gravidarum mx- options were
about termination of pregnancy
treatment with ondansetron
fluid therapy

19. 55 yrs old patient with low folic acid, howel jolly body , stomatitis , normal
bowel, weight loss...Inv?? 
a. small bowel biopsy-caeliac disease
b. colonoscopy 
c. Vit B 12

20. 31-year-old woman G2P1 presents at 10 weeks’ gestation for antenatal visit.
She is found to have a twin pregnancy. Her previous pregnancy was complicated
with placental abruption at 34 weeks. Which one of the following is the next best
step in management in addition to standard antenatal care?�The options I have
seen for this question are:�•
a. Admit to the hospital for rest after 34 weeks.�•
b. Cervical suture.�•
c. Vitamin supplementation.�•
d. iron and folic acid supplementation. ... �•
e. serial CTGs from 34 wks�

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 21. 2nd trimester with nausea vomiting and heart burn sometimes epigastric
pain similar problems in first pregnancy
Metoclopramide
Omeprazole
Ranitidine
Milk

22. 28 weeks preg nausea vomiting and heart burn 2 weeksheart burn releived
by milk , no other pron in 1 st trimester all exam normal
1. metochlopramide(if vomiting is present choose this)
2. ranitidine
3. omeprazole

https://www.mayoclinic.org/drugs-supplements/metoclopramide-oral-route/description/
drg-20064784?
fbclid=IwAR0qP9Q_ulcSci3gYkjeEWimMvfQFOL0dJstI5vup4jBxLw0rVHK4tRQiZY

23. a pregnant lady 26 weeks comes with the complaints of vomiting and heart
burn,gastric upset sometimes ,occasional epigastric pain.She had similar problem
in her first pregnancy . What will next best treatment of this condition?
A. Mylanta(if no vomiting than choose this)
B. PPI
C. Ranitidine
D. Domperidone

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E. Metochlopromide (so if only heart burn, no vomiting -mylenta; if heart
burn+vomiting=meto)

24. Scenario of 2nd trimester lady come with C/o nausea vomiting ,heart
burn .What will be next ?
A. Metochlopromide
B. omeprazole
C. ranitidine
D. Milk
25. 24 weeks pregnant lady with condyloma alumianta treated with cryotherapy,
but the warts appeared again and increasing in size most appropriate next step in
mx-
termination of pregnancy,
surgical removal of warts - it will induce preterm labour
diathermy - CI in pg
Pap smear - not helpful
Operative cryao/repeat cryotherapy (other options are contraindicated in pg)
wait untill delivery -best answer

26. 24 weeks pregnant lady with condyloma alumianta treated with cryotherapy,
but the warts appeared again and increasing in size most appropriate next step in
mx?
a) termination of pregnancy
b) surgical removal of warts
c) diathermy
d) pap smear
e)Operative cryao/repeat cryotherapy

https://www.racgp.org.au/afpbackissues/2004/200409/20040901ooi.pdf?
fbclid=IwAR3ERBaRHEmja-05yXdcwhQU8-s6wP-OSJ2Qmj8wkT_UApypOVuCi9IWdFM

24 weeks pregnant lady with condyloma alumianta treated with cryotherapy, but the warts appeared again and
increasing in size most appropriate next step in mx?
a) termination of pregnancy

9
b) surgical removal of warts
c) diathermy
d) pap smear
e)repeat cryotherapy
24 weeks pregnant lady with condyloma alumianta treated with cryotherapy, but the warts appeared again and
increasing in size most appropriate next step in mx-
termination of pregnancy,
surgical removal of warts
diathermy,
Pap smear
Operative cryo/repeat cryotherapy
wait untill delivery

27. At 12 week pregnancy, urine culture positive for GBS(group B streptococcus).

Treated with AB for 7 days, whats your futureplan?(hb 3.306)
1. swab at 34-37 wks 
2. penicillin during labour 
3. fetal prophylactic treatment at birth

28. 52 y/o female has 1y amenorrhea, 2 years ago pap smear was normal but 4
years ago pap smear was cervical wart, she has had sexual contact after 1 year,
during sex, she had not any discomfort or pain. After that she developed 24 hour
vaginal bleeding. Cause?
a. vaginal atrophy
b. cancer cervix
c. cancer endometr
d. relapse of condyloma
e. menstrual cycle
29. A pregnant woman who is at 26 weeks of gestation. Has spot bleeding,
abdominal cramp, examination shows 2 contractions during the last 10 minutes,
the cervix dilated to 3cms, 80 effaced. Which of the following you can’t do?

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 a. Glucoccorticosteroid
b. Test foetal fibronection
c. USG
d. Cervix cerclage-if before 24wks dilatation less then 4 without contraction

Emergency cerclage may be considered in women

in whom the cervix has dilated to < 4 cm without
contractions before 24 weeks of gestation..

30. Pregnant lady with lower abdominal pain and mild tenderness, U/A: no
blood, no pr, no nitrite. (Bac/wbc were not mentioned), she has hx of
appendectomy, in Ultrasonography last antenatal visit all pelvic organs were
normal, placenta attached anteriorly to fondus.. what is the most probable
cause of pain to investigate for?
A.UTI(u/a NORMAL EXCLUDE THIS)
B.Red degeneration(usg normal exclude this)
C.Physiological cramps

Pregnant woman at 34 weeks gestation presented at 32 weeks for antenatal care where
her first USG was done. Everything was normal. She has returned today with complaint
that someone had told her she looks small. What will you do to confirm with her that her
progress is normal?
a) Repeat abdominal USG  (2.053 pg 133 hb, for 1st visit we can go for usg option)
b) symphysio-fundal height of 34cm at 35 weeks 
c) examine her on next visit
d) If fundal height has been shown continuous linear growth, not to worry

. pt at 36 weeks gestation asking her friends says that she has decrease fundal height
and that baby is not growing well. What of the following will show the normal growth of
the baby during pregnancy?MCQ 2.053
a)continuouslyincreasing fundal height in pregnancy
b) SFH of 35cm at 34 weel gestation
c)ctg
d) usg at 32 week showing baby at 50 percentile
https://www.familyeducation.com/pregnancy/fetal-growth-development/assessing-fetal-
growth-well-being

32..Pregnant woman at 34 weeks gestation presented at 32 weeks for antenatal care

where her first USG was done. Everything was normal. She has returned today with
complaint that someone had told her she looks small. What will you do say to assure her
that her progress is normal?
a) Repeat abdominal USG
b) symphysio-fundal height of 34cm at 35 weeks ***

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c) examine her on next visit
d) If fundal height has been shown continuous linear growth, not to worry

A 27 years old woman has just found out she is pregnant. There is no past medical
history of note and this is her first pregnancy. She asks for advice about vitamin D
supplementation. What is the most appropriate advice to give?
A) Offer vitamin D supplementation
B. Should be avoided-potential risk to developing fetus
C) Await booking bloods for confirmation of vitamin D levels
D) Advice to increase milk and soft-cheese consumption( cheese CI in preg)
E) Advise her she can take supplements if she wishes but is not part of routine NHS
antenatal advice#31

Pregnant lady comes to u for antenatal check up at 16 weeks , she never had pap smear
, and no abnormality now too.. what to do next:�a. repeat pap now(pg 1088 jm)�b.
pap after 6 weeks after delivery �c. no pap needed in pregnancy

mother proved to have cmv acute infs by having cmv igm + in her 28 th week of
gestation , what to do next :
a-terminate the pregnancy
b-check fetal blood for cmv igm
c-check if the mother has cmv igm in her first antenatal visists or not .

#GYNOBS #INFX Let's solve these CMV matters

Pregnant lady contacted with CMV affected person. Her blood results came are CMV
IgM. Next important step
1- terminate pregnancy
2- check her past history previous serology
3- repeat serology ( IgM and IgG) in the next 2 weeks.
4- give antiviral Tx
Q.A G2P1 came at 12 weeks of pregnancy for the second time. The first visit was at 4
weeks of pregnancy, now in her lab tests: CMV IgM (+). What is the appropriate
management?
a. Check her previous sample for Ig G and Ig M
b. Do amniocentesis
c. Do blood test again for Ig G
d. USG in 18 weeks
Q.Lady came with CMV IgM positive at 16 week pregnancy how will you manage?
1) Offer termination
2)Take foetal blood sample
3) Repeat serology test for mother after 3 weeks

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Q. Lady with symptoms of CMV infection and is also positive for IgM antibodies. Next
step:
A. Offer termination of pregnancy(depend on wk of gestation)
B. Vaccination
C. Immunoglobulin
D. Do nothing

https://www.sahealth.sa.gov.au/wps/wcm/connect/
931725804ee204ddb33fbfd150ce4f37/Cytomegalovirus_PPG_v4_1.pdf?
MOD=AJPERES&CACHEID=ROOTWORKSPACE-931725804ee204ddb33fbfd150ce4f37-
msqmJRV&fbclid=IwAR2ruIJW5vjwx_805X0yleOnJse9tMn2JZ3pQjfFZoG6UshYk_7zyBhJE
xk

Antenatal visit
Gestation. Uterine size BP
18 wks. 18cm. n
28wks. 28cm. n
30wks. 28cm. n
What is the next thing to do
CTG
US ( if > 2 )
CT
Do nothing and reassess after 1 wk
ECG

3.Pregnant woman, antenatal screening 2 month ago showed vzv serology(+), has
contact with chicken pox infected child, mx?
A) reassure that she is already immuned, she dosn't need vaccine
B) Give immunoglobulin
C) Give vaccine
https://www.sahealth.sa.gov.au/wps/wcm/connect/
a69e3d004eee7fab80d3a36a7ac0d6e4/
Varicella+Zoster+Chicken+Pox+in+Pregnancy_Sept2015.pdf?
MOD=AJPERES&CACHEID=ROOTWORKSPACE-a69e3d004eee7fab80d3a36a7ac0d6e4-
moBLdYU&fbclid=IwAR3lmL2C06ePrKbEKeP6V7wMfFgbqoaEF_ZfMZavi0M06ibnkVgDss7f
P90

Pregnant women at 34 week BP is 160/90 and +1 proteinurea...after 30 min her BP is

130/70 and no proteinurea..no edema or other physical finding..her BP at 1st antenatal
visit and untill now was normal...cause of hypertension
1-PIH

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2-pre eclampsia (bp cant go down so fast)
3-essential hypertension

2. 22 year old pregnant lady 20 weeks of gestation presents for her antenatal check up.
All the investigatons were normal except for Low platelet : 100 ( 150-300) N n other
symptoms. Asking for diagnosis?
Gestational thrombocytopenia (pg 1190 jm)
https://emedicine.medscape.com/article/272867-overview

https://www.cancertherapyadvisor.com/obstetrics-and-gynecology/thrombocytopenia-in-
pregnancy/article/617107/?
fbclid=IwAR019I3k830yNYAG3ikUrzEq0VixgH_MWuDMSGibtt9FqtpsFqag4S1WSEM

2. 22 year old pregnant lady 20 weeks of gestation presents for her antenatal check up.
All the investigatons were normal except for Low platelet : 100 ( 150-300) N n other
symptoms. Asking for diagnosis?
A. Gestational thrombycytopenia
B. Immune thrombocytopenia
C. ITP
D. Idiopathic thrombocytopenia

*8 week old Baby born at 32 week gestational remained in hospita for 6 week....now
come to you for immunisation....he got hep B immunisation at birth...what vill you do
1,gv all two month vaccinations
2,wait for Corrected 2 months age then vaccinate
https://www.mydr.com.au/kids-teens-health/vaccination-australian-standard-
vaccination-schedule?
fbclid=IwAR3QFAzvQVUu_NNLM7XGB8NtNJgtZQmbo4UbnWOIkctcPCTj-BhXsjGMi-E

Female,39 weeks of gestation,200 ml of painless bleeding(Abruption).On palpation

uterus is soft and non tender.On examination,cervix is normal and 3 cm dilated with
membranes clearly visible.USG was done and placenta was placed posteriorly in
fundus.What to do next?
Amniotomy
Admit in antenatal ward for observation
Urgent c section
Send her home

30 yr old primi @ 32 wks GA , presents cos of previous hx of small warts on her vulva
which has increased inside from last antenatal visit. Considering her current GA what do
we do next? (pg 1279 jm)

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A. Surgery after delivery
B. Surgery now
C. Podophyllin(contraindicated in pg)
D. Imiquimod

A baby is born by an emergency Caesarean section at 40 weeks, due to pathological

cardiotocography. She appears normal at birth, with Apgar scores of 9 and 10 (1 and 5
minutes respectively). Soon after delivery, the midwife notes that the baby's respiratory
rate is elevated (other observations are normal). Maternal antenatal history is
unremarkable and her observations were normal during labour.
What is the most likely diagnosis?
A) Pneumothorax
😎 Neonatal pneumonia
C) Tracheoesophageal fistula (TOF)
D) Transient tachypnoea of the newborn (TTN) (all of sudden only this happen)
E) Respiratory distress syndrome (RDS)

Pregnant lady comes at 34 weeks for first antenatal check up in hospital after her shared
gp
care check up.at 32 weeks had USG,all were normal.but her friend told her she looked
small.what below will assure her?
a-symphysio fundal height 34 cm at 35 weeks
b-do USG now

Patient at 8 weeks antenatal visit, asking about Influenza vaccine. What to tell her?
She should take it now(inactivated vaccine we can give in preg)
She should take it at 12 weeks and never before it
No vaccine during pregnancy

32 year old lady 20 weeks pregnant with underlying Hep C . Asking advice on
breastfeeding
A. Contraindicated as it is vertically transmitted
B. Can breastfeed after c section
C. No evidence of as it is not vertically transmitted(HIV,chemotherapy taker & Active tb t
breastfeeding kora jabe na)
D. Give pasteurised breast milk
E. Contraindicated because Hep c antigen pass through breast milk

A vegan pregnant woman (in early first trimester) came to you for antenatal care.She
takes folic acid pill regularly.What is your advice?
Zinc and Iron
Iron and Vitamin k
Iron and vit c (pg 1177 jm)

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8. 32 years old lady , 39 weeks pregnant presents wth complaint of did not feel fetal
movement for past 12 hours .She was seen 2 weeks ago and everything was normal.
what do you do?
A. CTG(1st)
B. USG
C. Reassure
D. Review in 24 hours
E. Admit and observe(than)

. Day 6 postpartum presents with severe mastitis. Which antibiotic to give?

A. Flucloxacilin(staph.aureus most common) (pg1204 jm)
B. Erythromycin
C. Gentamicin
D. Penicilin Procaine

At 12 week pregnancy, urine culture positive for GBS. Treated with AB for 7 days, whats
your future plan?
1. swab at 34-37 wks 
2. penicillin during labour 
3. fetal prophylactic treatment at birth

Q64 Woman with 2 previous miscarriages at 16wk and 18wk. stillbirth with no abnormal
appearance. Now third pregnancy miscarriage again. What could be the cause? 
• Antiphospholipid syndrome(most common cause ,we give aspirin to prevent miscarg)
• GBS infection
• Rubella
• SLE
• Chromosomal abnormality(occur earlier)
GBS case with limb paralysis and mild dyspnea. What is the most important next step :
A. LP
B. Spirometer  ( most imp Fvc)
C. MRI

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GBS screening is done in obs cases by many doctors aspg 1180 jm)
a. GBS if found can be treated with 4-6 weeks pencillin to eradicate risk
b. GBS if found can be treated by pencillin one dose during labour(3.306 pg 576 hb)
c. GBS if detected can be eradicated with pencillin and confirmed by endocervical swab 
d. GBS if detected then pregnancy should be terminated

Routine test for GBS has done at 36 weeks pt found to be GBS carrier
Prophylaxis of which antibiotic will be done if pencillin hypersensitivity is present
Cephalexin
Amoxicillin
Clindamycin /erythromycin(pg 1180 jm)
Vancomycin

Female with pain in vulva. On examination vulva tender, lower abdominal pain and fever
as well. Vulva red, has ulcers. Likely cause. Bv, 
streptococcus, 
herpes simplex, 
actinomycosis

child 15 months brought by his mom to clinic , this boy had a rash similar to rubella 1
month ago , last vaccine he took was at the age of 12 months
what should you do now ?
a- Check IGM for rubella
b- Give only measles mumps vaccine

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c- Give MMR
d- Delay his vaccines for a while ( next will b at 18 month )

A 7yr old is brought to your clinic, Her neck was tiltedand fixed to one side. On
examination, she had 2 palpable neck lymphnodes. Her chest xray had bilateral
pulmonary infiltrates (image not given). Her head circumference was small for age,
fundoscopy showed hyperpigmented retina. She had significant hepatomegaly of about
5cm from costal margin. What is your diagnosis?

A Congenital rubella
B Congenital CMV
C Cerebrohepatorenal (Zellweger's) syndrome
D Combined immunodeficiency
E Hypergammaglobulinemia

mother come with 12 month old infant with increase head size from 25
percentile at birth to 75 percentile now and on examination child hypotonic
what will you do next??
a.CT SCAN headb.check CMV infection

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c..TSH (congenital hypothyroidism)
D.head ultrasound
e.rubella test
https://emedicine.medscape.com/article/919758-overview

HYDROCEPHALUS:
• bulging fontanel, which is the soft spot on the surface of the skull
• a rapid increase in head circumference
• eyes that are fixed downward
• seizures
• extreme fussiness
• vomiting
• excessive sleepiness
• poor feeding
• low muscle tone and strength
in congenital hypothyroidism there is fontanalle bulging....whole circumference of head
will nt b increased...so its nt hypothyroidism....for hydrocephalus initially head USG
done...so...D
A mother comes with 10 months old baby whose growth is normal but head
circumference increased from 25 th percentile at birth to 75th percentile now baby is
feeding well but can't roll over or support himself hypotonic next investigation 
TSH(congenital hypothyroidism)
USG head
Ct scan (hydrocephalus)
MRI
16 month old boy is brought in to see you. He has had fever, rash and a mild runny
nose. These symptoms pass, then a few days later bight red rash appears in the face
and a lacy rash on the rest of the body. What is the most likely diagnosis? 
a) Measles 
b) Chicken pox 
c) Erythema infectiosum 
d) Rubella 
e) Roseola infantum.
14 month old Mark is brought in to see you. He has had high fevers and a mild runny
nose for three days but has still been quite active. Mark's temperature has returned to
normal today but he has now developed a red maculopapular rash on his trunk. The
MOST LIKELY diagnosis is: 
a) Measles 
b) Chicken pox 

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 c) Erythema infectiosum (age school going children)
d) Rubella 
e) Roseola infantum(age 6-18yrs)
30 year old female was exposed to rubella.Her rubella IgM titer is high.She is 10 weeks
pregnant.Next step?(pg 1180 jm)
Reassure and routine follow up(hb ques3.310, pg 573)
Give IvIg
Give mmr
Offer abortion
Hospitalize and monitor for any signs of infection

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Check if baby is positive too by CVS or amniocentesis. Then if positive, abort during first
trimester
https://sogc.org/wp-content/uploads/2013/01/guiJOGC203CPG0802.pdf?
fbclid=IwAR2OqIGmhDJTMrb1jZ41hWKEcWdxMIjfONN1WKGQSjw3qmdOtlTBxvW57IY

Q.Teacher exposed to rubella positive student. Came to you for consultation. After
reviewing her history, you find out that she is already vaccinated before this pregnancy
and IgG was positive after vaccination. She is still anxious. What to do?
Tell her that she is 100% immune and there is no need for further investigation ( it
should be 95 % )
Repeat IgG titre now
Do USG
Q.A mother brings her child for MMR vaccination at 12 months of age.Child has got flu-
like illness with temperature 38 ºC. What is the most appropriate next step?
a. Give MMR vaccine except rubella and give rubella vaccine once the child recover from
flu
b. Postpone vaccination and vaccinate after the child recovers from flu
c. Give MMR vaccine now(38.5 er upore gele dibo na)
d. Tell the mother that MMR is contraindicated
e.. Give MMR vaccine except rubella portion

21
mother come with 10 month old infant with increase head size from 25 percentile at
birth to 75 percentile now and on examination child hypotonic with open anterior
fontanelle what will you do next??
A- CT ScAN head
B- check CMV infection
C- Thyroid function test
D- head ultrasound
E- rubella test
Pregnant Women,Varicella serology positive at 8wks of gestation.Now 10wks of
gestation,exposed to chicken pox.What to do?
A.Reassure
B.VZIG
C.Varicella vaccine
D.Varicella Serology
E.Acyclovir

6-2 7-year-old boy with a history of atopic eczema is brought to the surgery. Overnight
he has developed a painful blistering rash affecting his face and neck. His temperature is
38.1deg.
Which one of the following is most likely to be responsible for this presentation?(pg 1345

22
jm)
a. Varicella zoster virus
b. Streptococcus pneumoniae
c. Pox virus
d. Staphylococcus aureus
e. Herpes simplex virus
69. chicken pox exposure at 12 weeks . no past h/o immunisation. serology at 8 weeks
shows
positive. what will u do ?
a. repeat serology
b. give Varicella Igg
c. reassure she's immunised

Child with varicella contact history, no history of vaccination. What is next?

a)Vaccine
b)School exclusion
c)Confirm varicella infection
https://www.rch.org.au/clinicalguide/guideline_index/Chickenpox_contact_flowchart/
Patient varicella zoster skin infection,ulcerated,some chronic features, Mx? 
a. oral antibiotics 
b. cover the wound 
c. topical cream (pg 1343 jm)
d. analgesic 
e. famicyclovir

Preg 10 wk contact with a child with fever & rash. She has no h/o of measles &
varicella previously. What will u do ?
Give measle vaccine
Serology
Immunoglobulin
Do nothing
Check fetus for infection

pregnant 10 weeks gestation presented with history of contact with child known to have
chicken pox, she has no hx of chicken pox infection nor and unvaccinated for VZV.
asking you if she might be affected, her tests showed that she is seropositive for VZV.
What is your most appropriate next step?
A-reassure her that she is immunized
B-give her VZV vaccine
C-give her VZV immunoglobulin within 5 days
D-wait for further 1 month to see if she was affected
E-give her acyclovir

23
https://www.sahealth.sa.gov.au/wps/wcm/connect/
a69e3d004eee7fab80d3a36a7ac0d6e4/
Varicella+Zoster+Chicken+Pox+in+Pregnancy_Sept2015.pdf?
MOD=AJPERES&CACHEID=ROOTWORKSPACE-a69e3d004eee7fab80d3a36a7ac0d6e4-
moBLdYU&fbclid=IwAR1FlNKJxYRdyuRUMyzEc7ZxxMYAaD862TACTcliQrXmYX4sI36rJdpA
5t4
Old 50 year lady her daughter is going to be pregnant. Vaccination for that old lady
a)Varicella
b)Pertussis tetanus diphtheria
c)Influenza
d)Pneumecocal
e)Hiv
https://beta.health.gov.au/health-topics/immunisation/immunisation-throughout-life/
immunisation-for-seniors?
fbclid=IwAR28Qk6bVBGR1LsVFcSt3doZ4GyDAwanta_iiroDqTXEq0b8QDC4JdWKJ_A

https://www.mydr.com.au/kids-teens-health/vaccination-australian-standard-
vaccination-schedule?fbclid=IwAR1n4ROc_xeIXlf7_JftKvyC-dsMgt8suJq7Exl1CXymiL-
gLAVS7vK2JFA

Indigenous Australian never travelled abroad, developed cough 3 weeks. He has a 3

month old infant, does not want him to get affected. What should be done now?
Nasopharyngeal PCR
Pertussis serology
Throat culture
Mycoplasma serology
Tuberculin skin test
https://www.rch.org.au/clinicalguide/guideline_index/Whooping_Cough_Pertussis/?
fbclid=IwAR3bzoLsdDW8wwyWfxzuibWiMB6Ixnu6WpASz_HQFLL4wAGifZo1tpr_zrw

https://www.aafp.org/afp/2011/1015/p887.html?
fbclid=IwAR3VVhBusphNO103Ag7C_5CsMQ0e9-e0V2tjsdtcm0iENR_htoP5ShZga1Y

https://www.aafp.org/afp/2007/0215/p567.html?
fbclid=IwAR0yvCc8C46AE4Heu4vhHP2UgLcmk_bS-SOZMmaWAKq0WWH-C1CqgfI94-c

https://www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html?
fbclid=IwAR28uIyvuykoIVQ916loaEyphixLH-s8bOGe0CA0qbu9P5OqS4UHqInHGkY
grand mom worried about vaccine as her daughter is pregnant options r
a DPT
b influenza
c rubella

24
30-year-old lady presents at your clinic at 26 weeks of gestation.She is worried as she
came in contact with a child having chicken pox 24 hours ago.You checked her pre-
pregnancy IgG level for chicken pox which was negative.She missed to get vaccinated
for chicken pox before pregnancy.She has no symptoms otherwise.
What is next best step in her management?( 2.087 hb pg 155)
a. Check IgM level
b. Give vaccine for chicken pox
c. Check IgG level
d. Give varicella zoster immunuglobulins
e. No action needed as she is asymptomatic

Mother 32 weeks pregnant, 8 year old child has Varicella Zoster. Mother never
vaccinated nor
had chicken pox. What to do:
a) Check igG of mother
b) Give IVIG
c) Give vaccine
d) Ultrasound

Female with burning face pain,redness???

a)trigeminal neuralgia
b)herpes simplex
c)varicella(pg 1342-1343 jm)

A recently vaccinated boy with varicella developed 2 rashes. He is living with pregnant
mother.
Appropriate next step?
Isolate boy
Pregnant lady must stay away
Cover the rashes and can stay in the same house
Give immunoglobulin to pregnant lady and vaccine
26. mother presented with child with hereditary spherocytosis. Becoming progressively
pale for last two month..blood picture of very low anaemia(42) and there low in
reticulocyte count. But wbc and platelet were normal. bilirubin normal ,What the cause?
a) aplasia 
b)unexplained haemolysis
c)folate deficiency
d) parvo 19 virus

25
A pregnant lady 15 weeks was exposed to parvovirus.serology test revealed positive
IgM,positiveIgG.WHAT TO DO?(pg 1181 jm)
1.repeat serology within weeks
2.viral culture of amniotic fluid
3.USG
4.fetal haem

14 weeks pg lady exposed to Parvo virus. IgG and IgM negative. Next step in Mx ?
a. Rpt levels after 2 weeks
b. gGive Immunoglobulin
c. Antibioti

26
P

27
26. mother presented with child with hereditary spherocytosis. Becoming progressively
pale for last two month..blood picture of very low anaemia(42) and there low in
reticulocyte count. But wbc and platelet were normal. bilirubin normal ,What the cause?
a) aplasia
b)unexplained haemolysis
c)folate deficiency
d) parvo 19 virus
#hematology

pregnant lady with regular check ups. her first trimester usg was normal at 24 weeks her
fundal height was small for gestation and on usg it was small (iugr) and also
asymmetric.w hat will u do to know the cause?

28
a. tsh
b. abort
c. parvo virus serology
d. blood transfusion

Patient at 8 week gestation , at first visit to clinic after pregnancy , mother have history
of gdm , then developed Dm ..when to do GDM testing

A) ogtt now
😎 fasting blood sugar now
C) ogtt at 26 week
D) ogtt at 2o week

U r a locum gp and found that one of ur collegue who is separated from wife recently is
taking mirijuana during tea breaks outside the ward between patients consultations.
A. Inform health board
B. Talk to head of the ward
C. Talk to him that if he didnt stop board will be informed

a woman came in labour, Cx dilatation was 3cm soft and fully effaced, fetal HR normal,
station at Ischial spine. After 4 hours, now 6cm dilated, station below ischial spine and
FHR normal.. what to do

a) Observe and review again(normal progression of labour)

b) Oxytocin infusion
c) Forcep delivery

pateint with hx of shellfish allergy.. and asthma. On multiple drugs. Also on ACE i ... got
swelling of tongue at 4 in the morning. He remembers eating food at asian restaurant
last night. Dx
A drug allergy
B e1 elastase def.(pg 121 master the board)
C shellfish allergy (Symptoms usually start as soon as a few minutes after eating a food and as long
as two hours after. In some cases, after the first symptoms go away, a second wave of symptoms
comes back one to four hours later (or sometimes even longer).

https://www.racgp.org.au/afp/2013/december/ace-inhibitor-angioedema/

Rx of acute attack of angioedema (hereditary ) management

a) PPI
b) Steroid/FFP
c) Epinephrine
d) Diphenylhydramine(anti histamine)
e) complement c1

29
https://www.racgp.org.au/afp/2013/december/ace-inhibitor-angioedema/

A photo about uveitis in a girl who her brother has spondylitis ancylosis:next inves:
Ana
HLA B27
Mri of limbo sacral

A 76-year-old man with heart disease is on diuretics. He complains of stiff, painful hands
and knees. On examination Heberden’s nodes are seen.
What is the most appropriate treatment?
a. Colchicine
b. Allopurinol
c. Oral NSAIDs with gastric protection (dx-osteoarthritis)
d. Knee replacement
e. Joint aspiration and microscopy

Young boy, accident with slipped fall during skiing. Very marked swollen elbow, very
painful. On examination, absent peripheral pulses, numbness cold and clammy. At
emergency department, what is your next step of management?
A. Ulnar nerve decompression
B. Reduction
C. Refer to OT
D. Simple analgesic
E. X ray

31- History of ST segment elevation (as I red it .. I’m totally ECG looser) .. with classic
history of coronary pain 24 hours ago .. after giving morphine .. what to give next
TPA
IV heparin
SC heparin
IV nitroglycerin

A case of a 18 yr old girl with no menstration. Oestrogen and progesterone challenge

test done with no response. What next?
fshf b. LH c. Ultrasound d. Prolactin

https://www.aafp.org/afp/2006/0415/p1374.html?
fbclid=IwAR10talWk6ee8QfX7MuJHvcHlrgtriE7JpBKqYujzqfJXPwUAcrLGlDRAm8

30
No withdrawal bleeding occurs Suggests uterine bleeding outflow obstruction
if no bleeding occurs after progesterone withdrawal, then the patient's amenorrhea is
likely to be due to either a) low serum estradiol, b) hypothalamic-pituitary axis
dysfunction, c) a nonreactive endometrium or d) a problem with the uterine outflow
tract, such as cervical stenosis or uterine synechiae

A 14 YRS OLD GIRL WITH MANY EVERY FEATURES OF DEVelopment NORMAL BUT ABS
OF MENSES, PRESENTS WITH MUM TO SEE GP, PHYSICAL EXAM IS NORMAL . GIRL
WANTS FURTHER EXAM TO BE DONE. WHAT TO DO? A) B-HCG, B) FSH AND LH, C)
PELVIC USS
If 2ndary sexual characteristics present->C, if absent-->B

15-52 year old woman to whom Pap test performed before 2 years and it was
normal on examination she is healthy woman with no evidence of family history.
Apart from Pap smear. which is the most important screening test to advise her
at this age?

A-mammography

B-glaucoma screening

C-colonoscopy

D-chlamydia test

E-other non-relevant

31
100-woman with amenorrhea for 12 months , she is divorced and had had no
sexual intercourse in the previous year , on examination they couldn’t find
anything abnormal. Which of the following test will lead you to her diagnosis?

A-FSH/LH-primary ovarian failure

B-estrogen/progesterone

C-BHCG

D-abdominal ultrasound

E-TSH

116-32 year old woman with her mother recently diagnosed as breast cancer at
60 year age, worried if she got breast cancer and asking advice , what is your
most appropriate action?

A-reassure her that no further action is required (not ans)

B-recommend and teach her the systematic ways of breast self-examination(ans)

C-annual mammography with 6 monthly clinical review

D-refer for genetic screening

E-ultrasound and mammography now (3.395 hb)

126-mother presented to you complaining of her baby is restless during breast

feeding and he doesn’t look feeding well , also she feel her breast full after
feeding . what is the most appropriate next step?

A-feeding observation

B-examine her breast

C-discard the milk

D-reassure nothing to do (not sure)

32
 a woman came in labour, Cx dilatation was 4cm soft and fully effaced, fetal HR
normal, station at 1cm above Ischial spine. After 4 hours, now 5cm dilated, station at
ischial spine and FHR normal.. what to do
a) Observe and review again
b) Oxytocin infusion
c) Forcep delivery

(dilation is 4 to 5 in 4 hours..means 1 cm in 4 hours here.So have to give synto if less

than 2 cmm in 4 hrs)
a woman came in labour, Cx dilatation was 3cm soft and fully effaced, fetal HR
normal, station at Ischial spine. After 4 hours, now 6cm dilated, station below ischial
spine and FHR normal.. what to do

a) Observe and review again

b) Oxytocin infusion
c) Forcep delivery

A woman in labor, cervix dilated 5 cm n fetal head in LOP at 1 cm above ischial spine.
After 4 hours cervix still 5cm n fetal head also at same place while she is having
contractions every 5 mins. Whats the mnagement:
A. Amniotomy
B. CS
C. Ventouse delivery
D. Epidural
E. Oxytocin

37. 30yrs woman, new partner, post coital bleeding, pap 3mth back done normal. Dx?
Chlamydia
28 yr female postcoital bleeding on two separate occasions... Pap smear normal 2
months ago...what next
Hpv serology
Chlamydia pcr
Pap smear
Thin film pap smear
Repeat pap smear
9. A 54 yrs old lady had menopause 2 years ago. Now she comes with vaginal bleeding
since 3 days. What is the best next investigation.
A. USG
B. Hysteroscopy (best)
C. Endometrial sampling
D. CT pelvis
E. Coagulation profile

33
A 25 year old comes to you to discuss about gardasil vaccine. She wants to get tested
for HPV and also wants to know if she has acquired the infection already. What do you
suggest? a. Tell her the test is not routinely offered
b. Tell her the test is not specific
c. Give her the vaccine
d. Perform PAP smear first

A teacher rings you for your child who has an asthma and your patient is going for
camping. His teacher tried to call the parents for asking about childs medication but not
able to contact them.What should u do?
a.tell her I cant tell
b.tell her about patient record and recent updated management for the childs asthma
c.advise child not to go fr trip
A woman comes at 30 weeks gastation , her fundal height at 33 cm . her ogtt at 24 weeks
was normal. her dates confirmed at 10 weeks. Her last usg at 19 weeks normal. Rest of
tests were normal. What is the reason of fundal height?
Polyhydramnios
Full bladder(3cm +- in full bladder)
Wrong dates
Fibroid

Pt 54 year on cyclic HRT since 4 years having regular scanty menses, now came to u and
said hv stop vaginal bleeding from 7 months .no other complain. So what ll u do
Stop HRT
Continue on same treatment
Increase progestogen
Decrease progestogen

24 . Woman with premenstrual symptoms affecting her marriage only, she complained of
decreased libido. She is v concerned to save her marriage. Her husband is also annoyed
but she can go out and enjoy with friends. What is the best treatment option available?
1. Psychoeducation
2.sexual therapy
3. relationship therapy
4. positive thinking
5.relaxation therapy/ssri

34
 a man works whole day in a kitchen cabinet , he complains of pain swelling in elbow
near lateral epicondyle . what the cause of this pain.
a. bursa inflammation(if near)
b. tendon rupture(if at)
c. fracture

12 year boy brought by his mother complaining that everyone is school called him fat ,
his weight is at 90th percentile and height 50 th percentile. She said its happening when
he was six years old. What is ur next investigation of choice
a. chromosomal analysis
b. early morning serum cortisol
c. plasma growth hormone
d. thyroid stimulating hor/blood sugar

45years old woman comes with hot flushes n insomnia. She has history of treated breast
CA at her 40years of age. What will u give?

A HRT
B paroxetine
C clonidine(BP bashi thakle clonidine)
D oestrogen only

Which one of the following is not correct about haemochromatosis?

A.The incidence of haemochromatosis in Australia is 1:200.

B.C282Y homozygous accounts for approximately 90% of haemochromatosis in

Australia.

C.The majority of patients with one copy of C282Y and H63D mutation never develop
haemochromatosis.

D.90% of those with homozygous C282Y will develop symptoms at some stage of their
lives.

E.Carriers of only one copy of the mutated HFE gene will not be affected clinically.

. Pregnant 40 weeks does not feel fetal movement for 36 hours, CTGnormal
fetal heart rate 140, the mother is still worried and not convinced with the CTG:

a) amniotomy

b ) repeat CTG

35
c) Come back in next routine followup

d) Come back in 24hr******

26. A 28 week pregnant with loss of small amount of blood, nearest level 2
hospital is 50 km away, and nearest tertiary is 150 km away, after speculum
exam you don’t see sign of cord prolapse and everything is normal. After giving
antibiotic, and betamethasone, what would be your next best action?

a. Send her home and ask her to come back if anything happens

b. Send her to the tertiary hospital 150 km away**

c. Send her to the level 2 hospital 50 km away

39.patient taking ocp for very long period (time not mention) now complain of
shoulder tip pain. What's the diagnosis?

a.polymyalgia rheumatica

b.frozen shoulder

c.migraine

D. Cholestasis ( not option mentioned here)***

Estrogens and oral contraceptives are both associated with several liver related complications
including intrahepatic cholestasis, sinusoidal dilatation, peliosis hepatis, hepatic adenomas,
hepatocellular carcinoma, hepatic venous thrombosis and an increase risk of gallstones

CTG showed reduced baseline variability and variable deceleration (CTG was not given).
The mother had 4 cm cervical dilation within 14 hours .Pethidine was given to her 3
times .Fetal head was in the left occiput posterior. What is the cause of the CTG
abnormality?
a) prolonged labour
b) elevated resting uterine pressure due to incoordinate uterine action
c) molding of fetal head
d) sedative drugs

36
 A couple came to you they r in relationship with each other from last 4 yrs now
they are planning for pregnancy what will you check in female partner a)
Rubella*** b) CMV c) Parvovirus d) Toxopalasmosis e) Varicalla
. pregnant lady came with husband.during examination you found bruises on
thigh, genitalia what next-

admit now***

refer to shelter

tell her to come alone without husband

confront husband

tell husband to be careful during sex

71. Child born by c/s,heart beat before c/s and afteris 60bpm. Wat inv in
mother?

Lupus anticoagulant,

laiden V,

anti Ro antibody***

37
Complete heart block (CHB) is the most serious manifestation of the
neonatal lupus syndrome (NLS), a congenital syndrome in which maternal
IgG anti-Ro/SS-A autoantibodies cross the placenta and injure an otherwise
normally developing heart
24 weeks pregnant lady with condyloma alumianta treated with
cryotherapy, but the warts appeared
again nd increasing in size most appropriate next step in mx-
termination of pregnancy, surgical removal
of warts diathermy,
pap amear

Women on paroxtine well controlled on it since 2 yrs now wants to

concieve but concerned about post partum depression due to
previous pregnancy what advice you will give

A. Cease paroxtine

B. Cease paroxtine replace it with escitalopram

C. Use both paroxtine and escitlopram

D. Use escitlopram

E. No medication (may be not sure)

No option of pros and cons of

medicine.if it's there,choose that.

breech delivery scenario---lady come on 35 wks for f/u,baby was
breech presentation in early pregnancy,now u hv done an usg &
found complete breech in presentation ,what will u do now ??

a. c/s now

B. c/s at 39 wks

38
C. external cephalic version at 36 wks****

d.othes r irrelevant

ans.C

A 32 year old woman has increasing white vaginal discharge. She is 7

weeks pregnant. Her Chlamydia swab is positive. All other tests are
normal. What is the single most appropriate treatment? a. Amoxicillin
b. Clindamycin c. Doxicycline d. Erythromycin e. Metronidazole
regnant mother in her 28th week of
gestation,diagnosed by Usg and hydrops fetalis was found.What
investigation will help you treat the hydrops?
Fetal blood sample for HB***
fetal anaermia
Fetal heart usg
Fetal blood sample for CMV IgM Maternal Coombs
test
Mother brought her daughter 15 years old unwillingly. Saying that
her daughter recently been always depressed, locks herself in the
room, decline school performance and fights with the father . What
do you do to obtain diagnosis?
A. Talk to the girl with presents of both parents B. Speak to her
alone***. Ask the girl to go out and speak to her mother and get
more information
D. Make an appointment to meet the father E,suisadal

Patient with a fracture managed on Fentanyl infusion for pain. He

complains of continuous nausea but the pain is well controlled on
Fentanlyl. Most appropriate next step :
a. Reduce dose of Fentanyl
b. Add IV Metoclopramide along with Fentanyl infusion****
c. Replace Fentanyl with Morphine
d. Something metioned about giving Tramadol e. Continue
same dose of Fentanyl

39
Patient underwent Conization for abnormal pap smear 2-3 days
back. Now presents with fever 39, pain lower abdomen and
tenderness. What’s the most appropriate place to take a swab?
a. Blood culture
b. Endocervical swab**** 90 percentage
pcr dx-PID c. High vaginal swab
d. Low vaginal swab
e. Endometrial
A woman whose partner has hep c virus and wants to get pregnant comes
for advice?
A. IVF
B. That vertical transmission is about 6%
C. That hcv is unlikely to be transmitted by sex (ans)
D. Don't breastfeedPregnant lady diagnosed with b hcg ...dnc done
after 6 weeks ..came again with amenorrhea. ..b hcg 900 now What
should be the possible cause ? A. New pregnancy
B. Endometriosis C. Recurrent hydatidiform mole (hcg should be
100000)
5.Uterus with thickening 8mm next investigation asked
jm 1124,1127

A normal endometrial thickness, as measured by ultrasound, is

between 6 and 12 mm.
If it is >12 mm for premenopausal women or >5 mm for
perimenopausal women, endometrial biopsy (with or without
hysteroscopy) is indicate

Jm 1127:
● Endometrial thickening >4 mm demands endometrial
sampling. If >7 mm, endometrial cancer
should be excluded. CT scan and plain X-ray of limited
value but MRI is accurate
106- woman with symptoms premenstrual so severe that she afraid it will
affect her marriage and relationship with her husband... Other wise she is
normal having friends having good job with frequent business travel. Now
what is the best psychotherapy for her
A-physchoeducation

40
B-ask her to do more activity socially with positive thought
C-relationship therapy (be careful not relaxation therapy)
D-distress tolerance
E- marriage counseling (something close to that)
SSRI>Relaxation therapy>distress management
A 34 years old primigravida in the 3rd trimester came to u in ur clinic
with headache and high BP 150/100mmhg dipstick shows protein++
+, during consultation she developed a tonic colonic seizure
and collapsed with loss of consciousness, next step immediately?
A) give iv mgso4
😎 intubate and ventilate
C) immediate cs with delivery of the baby
D) basic life support management and MgS04 Woman 34
years...grandmother had ca breast.... Now what to advise ?
A.BRCA1 study B. screens now
C. tell her watch carefully of the look and the feel of her breast
(breast awareness)
D. show her the systemic way of self- breast examination
E. tell her to come back again next year

. Women on paroxetine well controlled on it since 2 yrs now wants

to conceive but concerned about post partum depression due to
previous pregnancy what advice you will give
A. Cease paroxtine
B. Cease paroxtine replace it with escitalopram C. Use both
paroxtine and escitlopram
D. Use escitlopram
E. No medication (may be not sure) No option of pros
and cons of
Medicine(2 yrs stable, so should we stop)

70. Women with menopause since 2yrs has bleeding 2

episodes what investigation next? A. Uterine US
B. Hysteroscopy(best)C. Endometrial biopsy
. A 45 yr old lady smoker and HTN uses ocps for many years now
comes re prescription ,she says doesn't want to come off because it
has controlled her menorrhagia and also says doesn't want to
conceive. What to do now??
41
A. Tell her stop smoking then can give ocps B. Use implanon
C. Use copper iud
D. Use progestogen only pill****
E. Use condoms +ocps

8. Scenario of preclampsia complicated with eclampsia and

convulsions given magnesium sulphate and developed increased
patellar reflexes with other signs, what is the next step in
management ?
A. stop magnesium sulphate

. 34 week pregnant lady with genitalia wart, how to determine it is

primary or latent:
a. Get a swap of wart for culture
b. Sample of wart for PCR
c. Review her serology status in week 10
d. Send a sample for serology now
e.Igm
2. A 32 primi came at 28 weeks having contractions , her examination
3weeks ago was pretty normal so as the baby too , u did a CTG , What
is the best test to be done to reveal the problem of the baby and give
a clue about early intervention to save it
a. Fetal blood sampling
b. Mother serum for Ig anti D titration
c. B HCG
d. Ultrasound
e. Amniocentesis
1.pregnant women came as her friends told her take precautions in ur
usual diet.what she should not eat??
a..tinned salmon
b..coffee
c..soft cheese
d..fresh veg
e..Iodine
pregnant pt at 20 weeks with hsv infection on pcr. What is treatment
for this pt?
a) oral acyclovir
b)iv acyclovir
42
c)oral famciclovir
d)topical antiviral

pt at 36 weeks gestation asking her friends says that she has

decrease fundal height and that baby is not growing well. What of the
following will show the normal growth of the baby during pregnancy?

a)continuously increasing fundal height in pregnancy

b) SFH of 35cm at 34 weel gestation
c)ctg
d) usg at 32 week showing baby at 50 percentile
42yo woman who smokes 20 cigarettes/d presents with complains of
heavy bleeding and prolonged menstrual period. What is the most
appropriate tx for her?
a. Tranexemic acid
b. COCP
c. Mefenemic acid
d. IUCD
e. Norethisterone

26 yr old lady came at 18th week gestation with clear vaginal

discharge, however she told that the pregnancy was unplanned, fetal
movement normal heart rate 144/min, her last pap smear was one
year ago. she had no abd pain, what inv will you do
a.Fetal fibronectin test
b. Low vaginal swab
High cervical swab
Urine microscopy and culture
e.Repeat Pap
fibronectin test is the best predictor of PROM.we can do it after
22weeks.low vaginal swab is for GBS infection which can be done
@3rd trimester.so urine microscopy & culture to exclude
asymptomatic bacteriuria.

wone is 26wk pregnant she hasintercourse with her husband last night now
she came with the complain of fluid loss, on examination there is fluid in
vagina which is straw coloured whats is the diagnosis-PROM

43
primary gravida her bishop score is 2 long scenario with preeclampsia have
to induce the labour so what should we do, Ans-PGI2 then amniotomy
after 4-6 hrs

A pregnant lady from Vietnam is presenting with pallor, jaundice and

hypochromic microcytic anemia. The iron and the ferritin are decreased.
What do you do?
a.Hb electrophoresis
b.Iron studies
c.Detection of blood in faeces
d.Thick an thin blood film

A 32 year old woman who is 10 weeks pregnant presents to the Obstetrics

clinic for prenatal care. She has a history of treatment for syphilis 7 years
previously. The results of serologic tests for syphilis are as follows:
-Non-treponemal test RPR: Nonreactive
-Treponemal test (TP-PA) reactive
Which of the following statement is most correct?
a) The baby is at high risk for congenital syphilis
b) The mother needs a lumbar puncture and a VDRL test for her CSF for
Neurosyphilis
c) The mother needs to be treated again for syphilis
d) The mother’s previous treatment for syphilis was effective

A4th day Puerperium with bright red bleeding and treatment started with
cephalosporin class drug asking what to add next?
A. Gentamicin
B. Metronidazole
C. Flucloxacillin
D. oestrogen patch

#ethics
1) - A 13-year-old girl comes to your GP clinic asking for options regarding
abortion. She left home 12 months ago and is living with his 18-year-old
boy friend. She wants to know if she could have an abortion in case she
gets pregnant. Last evening she went to a party where she became drunk
and was forced to have unwanted sex with a man. On examination, there
is no evidence of trauma. Which one of the following should be notified
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A. Sexual assault services.

B. The police.
C. Her parents.
D. School.
E. No mandatory reporting is required.

2)A 13-year-old girl presents to your clinic asking for termination of

pregnancy. Three weeks ago she participates in a party where she is
coerced to have unwanted sex with a stranger. Yesterday, using a home
pregnancy test, she realised that she is pregnant. She is a school girl and
lives with her parents. Which one of the following is the most appropriate
next step in management?

A. Inform the Child Protection Service.

B. Inform her parents of the event.
C. Terminate the pregnancy.
D. Inform the police.
E. Inform the Sexual Assault Services.

3) A 13-year-old girl presents to your practice asking for an abortion. Eight

weeks ago, she is a raped in party. After missing her due period, she
performed a home pregnancy test which showed she is pregnant. The girl
had left home 2 years ago and lives by herself. Which one of the following
is the most appropriate next step in management?

A. Refer her for an abortion as she wishes.

B. Inform the police.
C. Inform the Child Protection Service.
D. Inform the Sexual Assault Services.
E. Inform her parents.

121.25 yrs old..12 months previously pap done which showed LSIL..now u
repeat pap smear(NOT HPV TEST)..what will u tell her for HPV VACCINE?

- it is indicted NOW..

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-it is not indicated now

-it depends in the result of today’s pap smear

-it depend on HPV serology

-it depend upon HPV A 65 years old man in on warfarin for 2 months. He is
on regular check-up for INR, which is within the required range of 2.5. He
travelled to Bali 2 weeks ago and came back with bloody diarrhoea
diagnosed with amebiasis. And he was treated with Metronidazole. You
checked his INR you found it to be 9.5. What will be your NEXT step in
management?
A- Reassure as his INR as there is no bleeding.
B- Admit and give vit. K and fresh frozen plasma
C- Skip today’s dose and measure INR tomorrow
D- Give vitamin K
E- Stop warfarin and give FFP #drug Mansurul Islam Fuad culture

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