MCCQE Common Obstetrical Complications 3

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?

Accepted Answer

Complete hydatidiform mole

Answer

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?

Accepted Answer

Placental abruption

Answer

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?

Accepted Answer

Surfactant deficiency causing alveolar collapse

Answer

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?

Accepted Answer

Cervical cerclage placement

Answer

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?

Accepted Answer

Abandon vacuum and proceed to caesarean delivery

Answer

Two cup detachments (pop-offs) are an indication to abandon vacuum delivery and proceed to caesarean to prevent fetal injury.

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

(MCCQE) Medical Council of Canada Qualifying Examination Practice Test

MCCQE Common Obstetrical Complications 3