Antenatal-Care-One-File.pdf

5/27/2017 Single best answer question 1


Single best answer question 1

Assessment Results:

Score
Your score for this attempt: 1 (100%)
Maximum possible score: 1
Total attempts: 2
Average score: 50%

A nervous 42­year­old woman presents to your antenatal clinic. She is anxious that she has missed the right time to have her
combined test for Down syndrome screening. She is now 17 weeks pregnant and is very concerned about her age.


What assays would she be tested for at this gestation?

αFP, PAPP­A, inhibin B and hCG
αFP, inhibin B, hCG and estriol
hCG, PAPP­A, nuchal translucency and inhibin A
Unconjugated estriol, PAPP­A, hCG and inhibin A
Unconjugated estriol, hCG, αFP and inhibin A
Correct
The correct answer is unconjugated estriol, hCG, AFP and inhibin A.
Women who present after 14+1 weeks of gestation are offered the
quadruple test (maternal serum AFP, intact or free βhCG, inhibin A and
unconjugated estriol). The quadruple test window is 14+2 weeks of
gestation to 20+0 weeks of gestation. A maternal blood sample is required
for the analysis of hCG, αFP, unconjugated estriol (uE3) and inhibin­A.
See: NHS Fetal Anomaly Screening Programme. Screening for Down’s
syndrome: UK NSC Policy recommendations 2011–2014 Model of Best
Practice. Exeter: UK National Screening Committee. 2015.




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,5/27/2017 Single best answer question 2


Single best answer question 2

Assessment Results:

Score
Your score for this attempt: 1 (100%)
Maximum possible score: 1
Total attempts: 2
Average score: 50%

A 30­year­old woman is pregnant with her third baby. She has had two previous normal vaginal deliveries with no complications. She
is seen at her booking visit with her midwife and has bloods taken for antenatal screening.


Which of these is the most appropriate set of blood investigations
for her?

Hepatitis C, HIV, syphilis and toxoplasmosis
HIV, cytomegalovirus, rubella and hepatitis B
HIV, syphilis, rubella and group B streptococcus
Rubella, hepatitis B, hepatitis C and syphilis
Syphilis, hepatitis B and HIV
Correct
The correct answer is syphilis, hepatitis B and HIV. Note that women in
England are no longer routinely screened for rubella.




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,5/27/2017 Single best answer question 3


Single best answer question 3

Assessment Results:

Score
Your score for this attempt: 1 (100%)
Maximum possible score: 1
Total attempts: 2
Average score: 50%

A 34­year­old woman attends antenatal clinic at 41+0 weeks of gestation. She is pregnant with her third baby and has no
complications. She had two previous normal vaginal deliveries, both of which were induced. She is adamant that she does not want
induction of labour.


What is the most appropriate form of monitoring for her from 42
weeks of gestation?

Daily assessment with CTG and umbilical artery Doppler
Daily CTG, umbilical artery Doppler and ultrasound estimation of
maximum amniotic pool depth
Twice­weekly CTG and ultrasound estimation of maximum amniotic
pool depth
Twice­weekly CTG and ultrasound estimation of amniotic fluid index
Twice­weekly CTG and umbilical artery Doppler
Correct
The answer is twice­weekly CTG and ultrasound estimation of maximum
amniotic pool depth. This answer is based on guidance from NICE (2008;
updated 2016) Antenatal Care for Uncomplicated Pregnancies, section
1.11.1.3. Women with uncomplicated pregnancies should be offered
induction of labour after 41 weeks of gestation. From 42 weeks of
gestation, women who decline induction of labour should be offered
increased antenatal monitoring consisting of at least twice­weekly
cardiotocography and ultrasound estimation of maximum amniotic pool
depth.




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, 5/27/2017 Single best answer question 1


Single best answer question 1

Assessment Results:

Score
Your score for this attempt: 1 (100%)
Maximum possible score: 1
Total attempts: 2
Average score: 50%

You have been asked to review the notes of a 31­year­old nulliparous woman who is now 12 weeks pregnant. She is fit and healthy
with a BMI of 24. In the past she had surgical management for a missed miscarriage at 10 weeks of gestation.

The results of her booking bloods have been phoned through to the clinic and are as follows:

Blood group: A Rhesus negative
Antibody screen: Anti­D antibodies present at 3 IU/ml.


From the options below please select the most appropriate action.

Administer Anti­D 250 IU IM
Administer Anti­D 500 IU IM
Continue midwifery­led care
Measure serum Anti­D levels every 4 weeks
Refer patient to tertiary fetal medicine unit
Correct
The correct answer is measure serum anti­D levels every 4 weeks and
review in a consultant­led antenatal clinic.




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