Obstetrics- OSCE June 2021

Question 1

You are a doctor obsterician gynecologist.
Today is 12 JUN2021

Mrs. R. K., 30 years old, primigravida, arrived to outpatient clinic for prenatal care. A woman complains for a morning nausea. Her period is late so she performed a pregnancy test. It was positive. Mrs. R.K. is worried, she wants to perform all laboratory tests as soon as possible. She thinks that she needs genetic testing for fetus chromosomal abnormalities, because she is 30 and read about such useful possibilities online.
LMP 5 APR 2021. Menstrual cycle was regular, 30 days in length, bleeding lasts for 5 days

From history: a woman has no chronic extragenital diseases, no surgery and allergies. Her grandmother had diabetes mellitus, and mother has hypertonic disease.

You made inspection, checked blood pressure – 130/84mmHg, recommended ultrasound scan of I trimester and performed laboratory tests:

Blood group – A, Rh factor – negative (blood group of husband – B, Rh factor – positive),
Tests for HIV, syphilis, hepatitis B – negative. Gliucose test – 4,4mmol/l.

CBC: hemoglobin – 132g/l, leucocytes – 11x10 /l, trombocytes – 220x10 /l.

Urinalysis - nitrites (1+), no leucocytes. Urine culture – bacterial colonisation ( >10 E.coli) was found.

Calculate estimated day of delivery using Naegeleʼs formula: Select one (1p)

Accepted Answer

14 JAN 2022

Answer

12 JAN 2022

Answer

30 DEC 2021

Answer

Naegeleʼs formula can not be used in this case because the length of cycle is not 28 days

Answer

5 JAN 2022

Question 2

Are there the indications for a screening for chromosomal
abnormalities in the I trimester:
Select one or more (2p)

Accepted Answer

No, they are not, because a woman is under 35 years old

Accepted Answer

No, they are not, because there are no data about the chromosomal pathology in womanʼs and her husbandʼs families

Answer

Yes, they are, because a woman is 30 years old

Answer

Yes, they are, a screening for chromosomal abnormalities in the I trimesteris a routine test for all women

Answer

Yes, they are, indication –womanʼs wish

Question 3

Please, evaluate womanʼs blood pressure (BP):
Select one (1p)

Accepted Answer

Normal

Answer

Such BP is too high in the I trimester

Answer

A woman needs consultation of the cardiologist for further detailed examination

Question 4

The blood groups and Rh factors of spouses do not match. The
correct decisions are:

Select one or more (4p)

Accepted Answer

If Rh prophylaxis was done at 28 week of gestation, so after delivery antibodies titre should be tested – after results a decision about second dose will be given

Accepted Answer

If no antibodies are present, Rh prophylaxis is administrated at 28-30 gestational week

Accepted Answer

After Rh prophylaxis there is no need for the antibody screen later in pregnancy

Accepted Answer

After delivery the second dose of Ig should be provided if a newborn was Rh D positive

Accepted Answer

After delivery the second dose of Ig should not be provided if a newborn was Rh D negative

Accepted Answer

Antibody testing should be performed and repeated at 20 and 27-28 week of gestation

Answer

After Rh prophylaxis is important to follow antibodies titre till the delivery

Question 5

Results of the urine analysis: the nitrites (1+) positive and
leucocytes negative. The bacterial colonisation (>10 E.coli) in
the urine culture was found.
Such results show:

Select one (1p)

Accepted Answer

Asymptomatic bacteriuria in pregnancy

Answer

A low quality of the test. There are not enough data for infection, because no leucocytes are in the urine sample. The tests must be repeated

Answer

An infection of the urine bladder – cistitis

Answer

Acute pyelonephritis in pregnancy

Question 6

Results of the urine analysis: the nitrites (1+) positive and
leucocytes negative. The bacterial colonisation (>10 E.coli) in
the urine culture was found.
Your decision is:

Select one (!p)

Accepted Answer

To start antibacterial therapy

Answer

To recommend a homeopathic treatment for urinary tract infection

Answer

To repeat the tests after 1 week and to start antibacterial therapy if the Abnormalities will persist

Question 7

You will perform a fetal ultrasound screening scan at:

Select one (1p)

Accepted Answer

18-20 week of gestation

Answer

16-17 week of gestation

Answer

30-32 week of gestation

Answer

I will not perform any ultrasound scan, because the scan at I trimester is already done and it was normal

Question 8

Should glucose tolerance test (GTT) be done in this case:

Select one (1p)

Accepted Answer

Yes (at 24-28 week of gestation)

Answer

Yes (at 30-32 week of gestation)

Answer

GTT must be done at I trimester, because womanʼs
grandmother has diabetes mellitus

Answer

No, because glucose at I trimester was normal

Answer

Yes (at 28-30 week of gestation)

Question 9

You will perform a Beta Hemolytic Streptococcus (GBS) Culture
test at 35 - 36 week of pregnancy. If it will be positive, then the
right statements are:

Select one or more (2p)

Accepted Answer

A woman is a carrier of GBS

Accepted Answer

A newborn is at risk of early neonatal sepsis

Accepted Answer

A woman does not need treatment before delivery but during delivery antibacterial therapy must be prescribed

Answer

A planned cesarean section must be recommend on purpose to reduce a risk for the newborn

Answer

A woman has GBS infection in the vagina, a treatment should be started before delivery on purpose to reduce a risk for the newborn

Question 10

2 weeks left before estimated date of delivery. A woman started
to be nervous with her decision when she supposed to leave to
the hospital. Your advices:

Select one or more (3p)

Accepted Answer

To go to the hospital if bloody spotting occurred

Accepted Answer

To go to the hospital if the rupture of the fetal membranes occurred

Accepted Answer

To go to the hospital if the contractions of uterus are every 10min and more often

Accepted Answer

To go to the hospital if fetal movements decreased

Answer

To go to the hospital if the uterus contractions started

Answer

To go to the hospital on the day which was calculated as estimated date of delivery

Question 11

You have to pay attention to fetal condition during pregnancy. Which methods are used to evaluate a fetal condition in III trimester: 
Select one or more: (5p)

Accepted Answer

All answers are correct

Answer

Leopald maneuvers

Answer

Cardiotocography

Answer

Ultrasound fetometry

Answer

Assessment of biophysical profile

Answer

Calculation of fetal movements

Answer

Ultrasound and doplerometry data of fetus

Answer

Asessment of placenta location at ultrasound scan

Answer

Auscultation of fetal heart rate

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Obstetrics- OSCE June 2021

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