MCCQE Common Obstetrical Complications 2

Question 1

A 32-year-old G2P1 at 36 weeks presents with sudden onset severe epigastric pain, vomiting, and jaundice. Labs show AST 850 U/L, ALT 920 U/L, bilirubin 6.2 mg/dL, platelets 48,000, and PT prolonged. What is the most likely diagnosis?

Accepted Answer

Acute fatty liver of pregnancy

Answer

Acute fatty liver of pregnancy (AFLP) presents with jaundice, coagulopathy, and markedly elevated transaminases in late pregnancy, distinguishable from HELLP by the degree of liver failure.

Question 2

A 28-year-old primigravida at 39 weeks in active labour has fetal bradycardia to 80 bpm lasting 3 minutes after a strong contraction, with slow return to baseline. On exam, the cervix is 7 cm dilated and you palpate the umbilical cord. What is the immediate management?

Accepted Answer

Manually elevate the presenting part and proceed to emergency caesarean section

Answer

Cord prolapse requires immediate digital elevation of the presenting part to relieve cord compression while preparing for emergency caesarean delivery.

Question 3

A 26-year-old G1P0 at 34 weeks presents with painless, bright red vaginal bleeding. She denies contractions. Ultrasound shows placenta previa. What is the most appropriate next step?

Accepted Answer

Admit for observation, IV access, crossmatch, and corticosteroids

Answer

Stable placenta previa at 34 weeks warrants expectant management with hospitalization, corticosteroids for fetal lung maturity, and avoidance of digital exam to prevent further hemorrhage.

Question 4

Which of the following is the most common cause of postpartum hemorrhage?

Accepted Answer

Uterine atony

Answer

Uterine atony accounts for approximately 70-80% of postpartum hemorrhage cases.

Question 5

A 35-year-old G3P2 at 38 weeks with no prenatal care presents with BP 165/110, headache, and 3+ proteinuria. Labs show platelets 95,000, LDH 650, and creatinine 1.3. She seizes on the ward. What medication should be given first?

Accepted Answer

Magnesium sulfate 4-6 g IV bolus

Answer

Magnesium sulfate is the drug of choice for both treatment and prevention of eclamptic seizures in obstetric patients.

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

MCCQE Common Obstetrical Complications 2