Welcome to your 🏥 Obstetric Emergencies, Puerperium, Maternal Mental Health & Neonatal Care with Pregnancy, Delivery & Puerperium Clinical Long Case Arena — 40 MCQs
1.
A newborn of a mother with gestational diabetes becomes jittery and feeds poorly two hours after birth. The baby is not cyanosed and has no respiratory distress. Which investigation should be prioritized?
2.
A 34-year-old woman with insulin-controlled gestational diabetes attends at 37 weeks. Glucose control is satisfactory, fetal surveillance is reassuring, and estimated fetal weight is not excessive. She asks whether Caesarean section is compulsory. Which management principle is most appropriate?
3.
A woman admitted with maternal sepsis initially improves after intravenous antibiotics and fluid resuscitation. Twelve hours later, fever persists, inflammatory markers remain elevated, and ultrasonography suggests infected retained intrauterine tissue. What is the most appropriate next step?
4.
A 33-year-old woman attends her postpartum review after a pregnancy complicated by gestational diabetes. Her 75-g oral glucose tolerance test at eight weeks postpartum is normal. She has obesity and a family history of Type 2 diabetes. Which long-term recommendation is most appropriate?
5.
A term newborn develops noticeable jaundice eight hours after delivery. The infant appears otherwise active and feeds normally. The mother asks whether treatment can wait until the routine newborn review. What is the most appropriate response?
6.
A 27-year-old woman undergoes a 75-g oral glucose tolerance test at 26 weeks of gestation. Her fasting plasma glucose is 96 mg/dL (5.3 mmol/L), and her 2-hour value is 158 mg/dL (8.8 mmol/L). Using WHO/IADPSG criteria, what is the most appropriate diagnosis?
7.
A 25-year-old woman develops persistent low mood and loss of interest six weeks after childbirth. She reports feelings of worthlessness and poor concentration. During assessment, she reveals occasional thoughts that her family would be better off without her. Which additional assessment is most important?
8.
A 31-year-old woman at 32 weeks with gestational diabetes receives insulin. During an antenatal visit, she becomes sweaty, tremulous and dizzy after missing lunch. Her capillary glucose is 54 mg/dL (3.0 mmol/L). She is conscious and able to swallow. What is the most appropriate immediate action?
9.
A 36-year-old woman with gestational diabetes has persistently poor glycaemic control and suspected fetal macrosomia at 38 weeks. She previously delivered a baby complicated by shoulder dystocia. What is the most appropriate management approach?
10.
A 29-year-old primigravida at 35 weeks of gestation presents with severe abdominal pain and reduced fetal movements. Her pulse is 118/min, blood pressure is 100/65 mmHg, and the uterus is tense and tender. Only a small amount of vaginal bleeding is visible. Ultrasound does not demonstrate a retroplacental haematoma. Which interpretation is most appropriate?
11.
A 31-year-old woman presents with renewed heavy vaginal bleeding 12 days after an apparently uncomplicated delivery. She has lower abdominal discomfort, and ultrasonography reveals echogenic material within the uterine cavity. Which diagnosis best explains this presentation?
12.
A patient has continuing major postpartum haemorrhage despite appropriate initial medical treatment. Coagulation studies reveal worsening coagulopathy, and the obstetric team is considering additional haemostatic measures. What is the most appropriate principle?
13.
A woman with poorly controlled gestational diabetes delivers a 4.2-kg infant at 39 weeks. Two hours after birth, the baby becomes jittery and feeds poorly. What is the most likely metabolic complication requiring immediate assessment?
14.
A 30-year-old breastfeeding mother is recovering from a treated postpartum infection. She is clinically stable but worries that she may develop another infection after discharge. Which discharge advice is most appropriate?
15.
A mother receiving treatment for postpartum depression wishes to continue breastfeeding. She is concerned about the possible effects of antidepressant medication on her baby. Which management principle is most appropriate?
16.
A woman receiving inpatient treatment for a severe postpartum psychiatric illness requests that her family be informed about her progress. Her husband also requests unrestricted access to all medical information. Which approach best respects patient-centred care?
17.
A 30-year-old woman with gestational diabetes has an ultrasound at 33 weeks showing estimated fetal weight at the 65th percentile, normal amniotic fluid volume and no structural abnormalities. She asks why further fetal surveillance is needed. Which explanation is most appropriate?
18.
A 32-year-old woman at 27 weeks of gestation reports increased thirst and urinary frequency. She has a family history of diabetes and gained considerable weight before pregnancy. She asks whether these symptoms are normal physiological changes. What is the most appropriate clinical interpretation?
19.
A 30-year-old woman at 30 weeks of gestation has gestational diabetes. On examination, her blood pressure is 152/98 mmHg, and urine dipstick shows 2+ protein. She reports a persistent headache. What is the most important interpretation of these findings?
20.
A newborn delivered at 39 weeks weighs 2.2 kg. The infant has good muscle tone and no immediate respiratory difficulty. During examination, the student labels the baby as preterm because of the low birth weight. Which interpretation is correct?
21.
A 35-year-old woman with newly diagnosed gestational diabetes attends her first specialist antenatal consultation. She had gestational diabetes in a previous pregnancy but did not undergo postpartum glucose testing. Which additional historical information is particularly important for her current risk assessment?
22.
A 29-year-old woman, G2P1, attends antenatal clinic at 25 weeks of gestation. Her previous baby weighed 4.3 kg at birth. Her BMI before pregnancy was 31 kg/m², and her mother has Type 2 diabetes mellitus. She has no symptoms. Which aspect of her history most strongly indicates the need for assessment for gestational diabetes?
23.
A 29-year-old woman with gestational diabetes is asked to monitor fasting and post-meal capillary glucose. Her fasting readings are usually 89–94 mg/dL, while 2-hour post-meal readings range from 145–165 mg/dL. What is the most appropriate interpretation?
24.
A 28-year-old woman is reviewed six weeks after delivery. She reports persistent exhaustion, poor sleep and difficulty coping with household responsibilities. Examination reveals pallor, and she had substantial blood loss during childbirth. What is the most appropriate clinical approach?
25.
A 32-year-old woman with insulin-treated gestational diabetes attends at 35 weeks. Serial ultrasound assessments show increasing fetal abdominal circumference, with estimated fetal weight above the 90th percentile. Amniotic fluid volume is also increased. What is the most appropriate clinical interpretation?
26.
A 34-year-old woman at her first antenatal visit at 11 weeks has a fasting plasma glucose of 132 mg/dL (7.3 mmol/L), confirmed on repeat laboratory testing. She has obesity and a strong family history of diabetes. How should this finding be classified?
27.
A woman develops heavy bleeding immediately after delivery. The placenta appears incomplete, and the uterus contracts poorly despite initial uterotonic treatment. Which mechanism most directly explains the ongoing haemorrhage?
28.
A 32-year-old woman with two previous Caesarean deliveries is found to have an anterior low-lying placenta during antenatal ultrasonography. Further imaging raises suspicion of abnormal placental adherence. Which management approach is most appropriate?
29.
A 31-year-old woman at 32 weeks of gestation has gestational diabetes managed with insulin. She reports reduced fetal movements since the previous evening. Her capillary glucose readings have remained within the agreed targets. What is the most appropriate next step?
30.
A 30-year-old woman at 29 weeks of gestation has newly diagnosed gestational diabetes. Her fasting glucose readings are 106–112 mg/dL, and postprandial readings are frequently elevated. Ultrasound shows fetal abdominal circumference above the 90th percentile. Which explanation best integrates these findings?
31.
A 34-year-old multiparous woman develops severe postpartum haemorrhage after vaginal delivery. Initial resuscitation, uterine massage and appropriate uterotonics have been started. Her haemoglobin result is only mildly reduced, but she remains pale, tachycardic and hypotensive. How should the haemoglobin result influence management?
32.
A woman at 30 weeks with gestational diabetes has followed an individualized meal plan and undertaken regular walking for two weeks. Her fasting glucose remains 108–116 mg/dL, and her 1-hour post-meal glucose frequently exceeds 150 mg/dL. What is the most appropriate next management step?
33.
A 33-year-old woman at 28 weeks has gestational diabetes. She is overweight and has no symptoms of hyperglycaemia. Her glucose readings are mildly elevated, and fetal assessment is reassuring. Which initial management approach is most appropriate?
34.
A neonate born at 33 weeks is stable after initial observation but has a weak suck and becomes tired before completing feeds. Blood glucose readings are borderline low, and weight gain is inadequate. What is the most appropriate explanation for the feeding problem?
35.
A 29-year-old woman with gestational diabetes delivers vaginally following an uncomplicated labour. Her insulin requirement falls rapidly after delivery. She asks whether diabetes care can now be discontinued permanently. What is the most appropriate advice?
36.
A woman with a previous history of bipolar disorder is admitted following childbirth. Her family reports progressively reduced sleep, unusually elevated mood, excessive activity and increasing irritability over several days. She has not yet developed clear hallucinations. Which approach is most appropriate?
37.
A 26-year-old woman develops fever, tachycardia and increasing lower abdominal tenderness four days after an emergency Caesarean section. She becomes confused, and her urine output falls. Blood cultures have been collected, but laboratory identification of the organism is pending. What is the most appropriate management principle?
38.
During routine neonatal examination, a student identifies weak femoral pulses compared with the upper limb pulses in a two-day-old infant. The baby is currently feeding adequately and has no respiratory distress. Which interpretation is most appropriate?
39.
A 28-year-old woman with gestational diabetes attends antenatal review at 34 weeks. Her symphysis-fundal height measures 39 cm. She reports normal fetal movements, and examination suggests a large fetus. What is the most appropriate interpretation?
40.
A stable low-birth-weight infant is receiving hospital care after premature delivery. The neonate maintains spontaneous breathing but requires assistance with feeding and temperature regulation. Which intervention provides important supportive benefits?
