MCCQE Common Obstetrical Complications 3 — Questions and Answers
Question 1: A 24-year-old G1P0 at 12 weeks presents with severe nausea, vomiting, and weight loss of 5 kg. Her urine shows large ketones. Beta-hCG is markedly elevated and ultrasound shows a 'snowstorm' appearance without a fetal pole. What is the diagnosis?
- Hyperemesis gravidarum with normal twin pregnancy
- Complete hydatidiform mole (Correct answer)
- Partial hydatidiform mole
- Missed abortion with choriocarcinoma
Correct answer: Complete hydatidiform mole
A complete hydatidiform mole presents with markedly elevated hCG, hyperemesis, snowstorm ultrasound, and absence of fetal tissue.
Question 2: A 38-year-old G4P3 at 32 weeks presents with sudden onset severe abdominal pain and uterine rigidity. She denies bleeding. BP is 150/98. On CTG, late decelerations are noted. What is the most likely diagnosis?
- Placenta previa
- Placental abruption (Correct answer)
- Preterm labour
- Uterine rupture
Correct answer: Placental abruption
Placental abruption classically presents with painful uterine rigidity, may have concealed hemorrhage, and is associated with hypertension.
Question 3: A neonate born at 29 weeks develops respiratory distress, intercostal retractions, and nasal flaring within 2 hours of birth. CXR shows ground-glass opacification with air bronchograms. What is the pathophysiology?
- Meconium aspiration causing airway obstruction
- Surfactant deficiency causing alveolar collapse (Correct answer)
- Group B Streptococcal pneumonia
- Transient tachypnea of the newborn
Correct answer: Surfactant deficiency causing alveolar collapse
Respiratory distress syndrome (RDS) in premature neonates is caused by surfactant deficiency, leading to diffuse alveolar collapse and the characteristic ground-glass appearance.
Question 4: A 29-year-old woman at 20 weeks is found to have cervical length of 18 mm on transvaginal ultrasound during routine anatomy scan. She had a second-trimester loss last pregnancy. What is the most appropriate management?
- Bed rest and pelvic rest only
- Cervical cerclage placement (Correct answer)
- Immediate induction of labour
- Progesterone suppositories alone
Correct answer: Cervical cerclage placement
Women with prior second-trimester loss and short cervix benefit from cervical cerclage to reduce the risk of recurrent preterm birth.
Question 5: During a vacuum-assisted vaginal delivery, a pop is heard and the cup detaches. After reapplication, another pop occurs. What is the recommended course of action?
- Apply forceps immediately to complete delivery
- Allow up to 5 cup detachments if fetal descent is occurring
- Abandon vacuum and proceed to caesarean delivery (Correct answer)
- Increase vacuum pressure and continue
Correct answer: Abandon vacuum and proceed to caesarean delivery
Two cup detachments (pop-offs) are an indication to abandon vacuum delivery and proceed to caesarean to prevent fetal injury.
Question 6: A 33-year-old G2P1 at 37 weeks with known HIV on HAART has a viral load of 450 copies/mL at 36 weeks. What is the recommended mode of delivery?
- Vaginal delivery is safe as viral load is below 1000 copies/mL
- Elective caesarean section at 38 weeks
- Elective caesarean section at 37-38 weeks to reduce vertical transmission (Correct answer)
- Vaginal delivery with IV zidovudine intrapartum only
Correct answer: Elective caesarean section at 37-38 weeks to reduce vertical transmission
Elective caesarean section is recommended for HIV-positive women with viral load >400 copies/mL at 36 weeks to reduce vertical transmission risk.
Question 7: A 31-year-old G1P0 at 28 weeks presents with preterm prelabour rupture of membranes (PPROM). Speculum exam confirms rupture. She has no signs of chorioamnionitis. What antibiotic regimen is most appropriate?
- Amoxicillin-clavulanate for 10 days
- Erythromycin and ampicillin for 48 hours then oral erythromycin for 5 days (Correct answer)
- No antibiotics unless fever develops
- Metronidazole alone for 7 days
Correct answer: Erythromycin and ampicillin for 48 hours then oral erythromycin for 5 days
The standard regimen for PPROM without chorioamnionitis is IV ampicillin plus erythromycin for 48 hours followed by oral erythromycin for 5 days (avoiding amoxicillin-clavulanate due to NEC risk).
MCCQE Common Obstetrical Complications 3
A 24-year-old G1P0 at 12 weeks presents with severe nausea, vomiting, and weight loss of 5 kg.
Her urine shows large ketones.
Beta-hCG is markedly elevated and ultrasound shows a 'snowstorm' appearance without a fetal pole.
What is the diagnosis?