MODULE 2 short answer questions.

Below are 5 SAQs to test the application of your obstetric and general surgical knowledge. You have 30 minutes. Good luck!

    Module 2 saQS

    SAQ 1.

    A 26 year old woman presents to your emergency department with cramping pain and significant vaginal bleeding. She is six weeks pregnant by dates, and this is her fourth pregnancy. Her blood pressure is 105/ 76 mmHg and heart rate is 100 bpm.
    Question 1. (3 marks)

    What risk factors for ectopic pregnancy will you inquire about on history?
    Question 2. (2 marks)

    What are the 2 most important blood tests you will order and why?
    Question 3. (2 marks)

    What are the bHCG cut offs for acceptable sensitivity in detecting ectopic pregnancy for each available mode of ultrasound?
    The patient’s investigations return and show:

    1) Quantitative bHCG 1900IU/L
    2) Transvaginal ultrasound: no products of conception seen in either the uterus, fallopian tubes or abdomen. No free fluid identified.
    3) G+H: AB-ve
    Question 4. (3 marks)

    The patient’s pain has completely settled and the bleeding has ceased. Interpret the results and outline your management including the disposition of the patient.

    SAQ 2.

    A 38 year old primigravida presents to your emergency department complaining of both upper and lower abdominal pain. She is 36 weeks pregnant by dates and has no medical history of note.

    Her vital signs are:

    BP              168/122    mmHg
    HR              120        /min
    RR              24        /min
    O2 Sats     99%        RA
    T                 37.2        oC
    A 38 year old primigravida presents to your emergency department complaining of both upper and lower abdominal pain. She is 36 weeks pregnant by dates and has no medical history of note.

    Her vital signs are:

    BP              168/122    mmHg
    HR              120        /min
    RR              24        /min
    O2 Sats     99%        RA
    T                 37.2        oC

    Question 1. (5 marks)

    Select pathology results from blood taken at time of triage are shown below. Describe and them and outline your diagnosis/(es).

    Hb        97    mg/dL
    Plt        42    x109/L
    AST        450    IU/L
    ALT        430    IU/L
    GGT        77    IU/L
    ALP        66    IU/L
    Question 2. (4 marks)

    Twenty minutes after arrival in the emergency department the patient has a generalized tonic clonic seizure. What drugs will you administer?
    Question 3. (1 mark)

    What is your disposition of this patient?

    SAQ 3

    A 29 year old primigravida presents with a headache. She states the headache has been building up over the last 3 weeks, and that she has some peripheral visual changes. This pregnancy is currently at 35/40 and has so far been uncomplicated.
    Question 1. (4 marks)

    List 4 pregnancy related differentials for this patient’s presentation.
    Question 2. (3 marks)

    List  3 non radiological investigations you will perform in this patient.
    Question 3. (3 marks)

    The patient has a normal blood pressure, and the investigations you have ordered are normal. An MRI scan of the patient’s brain is ordered, and a slice is shown below. What are the 2 major abnormalities and what is the diagnosis?

    SAQ 4

    A 19 year old female presents to your emergency department complaining of severe abdominal cramps. She admits to being 31 weeks pregnant with her second child.
    Question 1. (4 marks)

    Give three obstetric related features (not inclusive of vital signs) you will assess on clinical examination.
    Question 2. (4 marks)

    Give 4 indications for emergency delivery of this woman’s foetus.
    Question 3. (2 marks)

    There are no indications for urgent delivery, and the obstetric examination does not indicate an imminent delivery. However, she is clearly in labour. Give two medications you will administer to this patient.

    SAQ 5

    A 24 year old female presents to your department complaining of lower pelvic pain. The pain is severe, and localized to the right lower abdomen. She has no bowel symptoms, but does complain of some pain with urination without frequency. She also complains of some whitish vaginal discharge. Her last period was 4 weeks ago, and she says it is due in the next 2-3 days.

    Her vital signs are:
    HR        98    /min
    BP         115/78 mmHg
    RR        16    /min
    Sats        99%    RA
    T        37.9    oC
    Question 1.

    What is your differential diagnosis? (3 marks)
    Question 2.

    What investigations will you perform and why? (5 marks)
    Question 3.

    On vaginal examination the patient has significant right forniceal tenderness and cervical excitation tenderness. A pregnancy test is negative. There is also some pustulent discharge visible at the cervical Os. What treatment will you administer? (2 marks)