Obstetrics MCQs for AMC Part 1 Exam

ByAMC Wise

Question 3501-1


A 32-year-old breastfeeding woman presents to the obstetrics clinic with localized breast pain, redness, and swelling in her left breast. On examination, there is warmth and tenderness over the affected area, and she has a low-grade fever. There is no evidence of nipple abnormalities or breast masses. The patient denies any recent trauma to the breast but reports feeling generally unwell. What is the most likely diagnosis?

  • A) Ductal Ectasia
  • B) Breast Abscess
  • C) Fibrocystic Breast Changes
  • D) Inflammatory Breast Cancer
  • E) Bacterial Mastitis

Answer: E) Bacterial Mastitis

Bacterial mastitis is an infection of the breast tissue, commonly seen in breastfeeding women. It is characterized by localized breast pain, redness, swelling, warmth, and tenderness. The patient may also experience a low-grade fever. Unlike breast abscess, there is typically no fluctuant mass. Prompt recognition and treatment with antibiotics are essential to prevent complications and provide relief to the breastfeeding mother.

Question 3501-2

A 28-year-old breastfeeding woman complains of localized breast pain and redness in her right breast. On examination, there is warmth and tenderness over the affected area, and the patient has a low-grade fever. There are no nipple abnormalities, and she denies trauma to the breast. The patient is otherwise healthy, with no history of breast surgery. What is the most appropriate initial management for this condition?

  • A) Prescribe oral Flucloxacillin
  • B) Surgical drainage of the abscess
  • C) Cold compresses and pain relief
  • D) Discontinuation of breastfeeding
  • E) Topical antifungal cream

Answer: A) Prescribe oral Flucloxacillin

Flucloxacillin, administered orally at a dose of 500 mg four times a day for 7–10 days, is the recommended initial management for bacterial mastitis in breastfeeding women It is important to encourage continued breastfeeding to help drain the affected ducts and prevent the development of a breast abscess. If the patient does not respond to initial management or if there are signs of abscess formation, further interventions are required.

Question 3501-3

A 30-year-old breastfeeding woman presents with persistent localized breast pain and swelling in her left breast. Despite completing a course of antibiotics for bacterial mastitis, her symptoms have not improved. On examination, there is a palpable, tender, fluctuant mass in the upper outer quadrant of the left breast. The overlying skin is erythematous, and the patient has a low-grade fever. What is the most likely next step in management?

  • A) Adequate pain relief with analgesics
  • B) Switching to a different class of antibiotics
  • C) Discontinuation of breastfeeding
  • D) Needle aspiration of the lump
  • E) Cold compresses and pain relief

Answer: D) Needle aspiration of the lump

In the presence of a palpable, tender, fluctuant mass that persists despite antibiotic therapy, a breast abscess should be suspected. The most appropriate next step in management is Needle aspiration of the lump. Sometimes it may require surgical drainage under general anaesthesia.

Question 3501-4

A 29-year-old breastfeeding woman complains of persistent breast pain and nipple discomfort in both breasts. On examination, there is erythema, shiny or flaky skin on the nipples, and deep breast pain during feeding. The infant has a white coating on the tongue but is otherwise healthy. The mother reports no improvement with previous antibiotic courses. What is the most likely cause of her symptoms?

  • A) Bacterial Mastitis
  • B) Breast Abscess
  • C) Ductal Ectasia
  • D) Candida Mastitis
  • E) Inflammatory Breast Cancer

Answer: D) Candida Mastitis

Candida mastitis is characterized by deep breast pain during feeding, nipple discomfort, erythema, and shiny or flaky skin on the nipples. It is often associated with a white coating on the infant’s tongue (oral thrush). Unlike bacterial mastitis, Candida mastitis does not typically present with localized swelling, warmth, or tenderness. Treatment involves antifungal agents for both the mother and the infant, and improving breastfeeding technique can be beneficial in preventing recurrence.

Question 3501-5

A breastfeeding mother presents with deep breast pain, erythematous nipples, and her infant has oral thrush. Despite previous unsuccessful courses of antibiotics, you suspect Candida mastitis. What is the most appropriate initial pharmacological treatment the mother?

  • A) Cephalexin
  • B) Fluconazole
  • C) Amoxicillin-Clavulanate
  • D) Clindamycin
  • E) Azithromycin

Answer: B) Fluconazole

Fluconazole is the recommended antifungal agent for the treatment of Candida mastitis. It is given orally at a dose of 150 mg every second day for three doses for the mother followed by oral nystatin (PO) tds for 10 days. Miconazole gel (qid) to nipple after feeds is also given.

Question 3501-6

A breastfeeding woman is diagnosed with Candida mastitis. In addition to oral fluconazole for the mother, what topical treatment is recommended for the nipples to alleviate symptoms and aid in the resolution of Candida infection?

  • A) Hydrocortisone cream
  • B) Mupirocin ointment
  • C) Miconazole gel
  • D) Silver sulfadiazine cream
  • E) No topical treatments are recommended

Answer: C) Miconazole gel

In addition to oral fluconazole, the recommended topical treatment for the nipples in Candida mastitis is miconazole gel, to be applied four times daily after feeds.

Question 3501-7

A 3-month-old infant is diagnosed with oral thrush as a result of Candida mastitis in the breastfeeding mother. What is the appropriate pharmacological treatment for the infant to address the oral thrush?

  • A) Oral amoxicillin
  • B) Topical hydrocortisone gel
  • C) Oral nystatin drops
  • D) Oral fluconazole
  • No treatments is needed

Answer: C) Oral nystatin drops

The infant can be treated with oral nystatin drops or miconazole oral gel. It is important for both the mother and the infant to receive appropriate treatment concurrently to prevent reinfection and ensure a successful resolution of Candida mastitis.

Question 3502-1

A 28-year-old primigravida at 38 weeks of gestation is in the labor and delivery unit with prolonged, and obstructed labor. She has been in labor for 18 hours and has made minimal progress despite good contractions. On examination, her cervix is fully dilated, and the fetal head is engaged but remains high in the pelvis. The fetal heart rate tracing is reassuring. What is the next step in the management of this patient?

  • A) Immediate cesarean section
  • B) Trial of vacuum extraction
  • C) Augmentation with oxytocin
  • D) Continue conservative management
  • E) Forceps delivery

The correct answer is B) Trial of vacuum extraction

In cases of obstructed labor with a fully dilated cervix and a high fetal head, a trial of vacuum extraction is a reasonable next step in management. Vacuum extraction is a less invasive option compared to immediate cesarean section, and it can often help to facilitate delivery in such cases.

Immediate cesarean section (Option A) is typically reserved for situations where vacuum extraction or forceps delivery is contraindicated, such as when there is fetal distress, cephalopelvic disproportion, or other conditions that make vaginal delivery unsafe.

Augmentation with oxytocin (Option C) is not the best initial step in this scenario because the cervix is already fully dilated, and the primary issue appears to be the descent of the fetal head.

Continuing conservative management (Option D) is not appropriate in cases of severe, prolonged, and obstructed labor, as it may increase the risk of complications for both the mother and the baby.

Forceps delivery (Option E) may be considered in some cases, but vacuum extraction is typically attempted first in cases of high fetal head and obstructed labor, as it is associated with a lower risk of maternal trauma.

It’s important to note that the choice of intervention may vary depending on the specific clinical circumstances and the healthcare provider’s judgment, but in this scenario, a trial of vacuum extraction is a reasonable initial step.

Question 3503-1

A 28-year-old pregnant woman presents to her obstetrician at 8 weeks into her pregnancy. She has no significant past medical history and denies any symptoms. Screening tests reveal a positive VDRL test. The patient has no known history of syphilis or previous treatment for the infection. Which of the following is the most appropriate next step in managing this patient?

  • A) Initiate treatment with benzathine benzylpenicillin G
  • B) Termination of pregnancy
  • C) Monitor the VDRL titer throughout pregnancy
  • D) Administer benzathine benzylpenicillin G prophylaxis to the newborn
  • E) Educate the patient about safe sexual practices

Answer: A) Initiate treatment with benzathine benzylpenicillin G

The positive VDRL test in a pregnant woman indicates the need for treatment to prevent maternal and fetal complications. The most appropriate next step in managing this patient is to initiate treatment with penicillin, as recommended by current guidelines for the management of syphilis in pregnancy in Australia.

Question 3504-1

A 32-year-old pregnant woman at 38 weeks of gestation presents to the labor and delivery unit with ruptured membranes and is in labor. She has no known allergies and no significant medical history. Her prenatal care has been unremarkable. A prenatal culture at 36 weeks of gestation was positive for Group B Streptococcus (GBS). What is the most appropriate next step in the management of this patient?

  • A) Administer intravenous ceftriaxone
  • B) Administer intravenous ampicillin and gentamicin
  • C) Perform a cesarean section
  • D) Initiate intravenous penicillin G prophylaxis
  • E) No need to actively manage the GBS infection in this patient

The correct answer is D) Initiate intravenous penicillin G prophylaxis

In pregnant women who are colonized with Group B Streptococcus (GBS) and are at risk of preterm delivery or rupture of membranes, the recommended management is to initiate intravenous penicillin G prophylaxis during labor. This prophylactic antibiotic treatment is given to reduce the risk of early-onset GBS neonatal sepsis and other complications in the newborn.

Administering intravenous ceftriaxone (Option A) or ampicillin and gentamicin (Option B) are not the first-line treatment for GBS prophylaxis in laboring women. Penicillin G is the preferred antibiotic for this purpose.

Performing a cesarean section (Option C) is not the primary step in managing a pregnant woman with GBS colonization and ruptured membranes in labor. The first step is to initiate intravenous penicillin G prophylaxis, as it has been shown to be effective in reducing the risk of neonatal GBS infection.

Initiating intravenous penicillin G prophylaxis (Option D) is the correct management approach in this scenario, as it helps protect the newborn from GBS-related complications, including sepsis and pneumonia.

References

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