KFP – Pregnancy and reproductive health (Obstetrics and Gynaecology)

Rina Mavrakis, aged 31, presents at 9 weeks gestation with persistent nausea and vomiting over the last two weeks. She reports vomiting at least four times daily and has been unable to keep most food or fluids down. She has lost approximately 4 kg since conception. She feels lightheaded on standing and reports dry mouth and reduced urination. She is otherwise fit and well and this is her first pregnancy.

Medications: Elevit, ginger tablets

Allergies: Nil known

Past history: Unremarkable

Family history: Mother with type 2 diabetes

Social history: Works as a teacher, non-smoker, no alcohol use

Obstetric/sexual history: First pregnancy, spontaneous conception

Examination findings: HR 105 bpm, BP 92/58 mmHg, dry mucous membranes, no abdominal tenderness or guarding, fundus not yet palpable

Investigations: Point-of-care urine shows ++ ketones. Serum electrolytes pending.

What are the most appropriate next steps in management? Select three (3) from the following list:

Emily Donoghue, aged 38, presents for a routine antenatal visit at 28 weeks gestation. This is her second pregnancy. Her first pregnancy ended in an emergency caesarean section at 36 weeks due to severe pre-eclampsia. She is feeling well currently and reports normal fetal movements. Her BMI is 35 kg/m². She has had a normal morphology scan at 20 weeks and her blood pressure has remained below 130/80 mmHg at all previous visits.

Medications: Elevit, aspirin 150 mg nocte (commenced at 12 weeks)

Allergies: Nil known

Past history: Pre-eclampsia in prior pregnancy

Obstetric/sexual history: G2P1, previous pre-eclampsia with emergency caesarean at 36 weeks

Examination findings: BP 144/92 mmHg, HR 82 bpm, SFH = 26 cm, no oedema, no proteinuria on dipstick

Investigations: 28-week bloods show Hb 114 g/L, Platelets 152 x10⁹/L, ALT 42 U/L (NR <40), AST 39 U/L (NR <35), serum urate 0.38 mmol/L (NR <0.36), urine PCR pending

What are the most appropriate next steps in management? Select four (4) from the following list:

Hannah Leung, aged 24, presents for contraceptive advice. She is in a stable relationship and is not planning a pregnancy for at least five years. She has a history of menorrhagia and iron-deficiency anaemia, which has improved with oral iron supplementation. She has never been pregnant. Her periods are regular every 28 days, lasting 6–7 days with heavy flow. She has tried the combined oral contraceptive pill (COCP) previously but stopped due to nausea and headaches.

Medications: Ferrograd C daily

Allergies: Nil known

Past history: Iron deficiency anaemia; intolerance to COCP

Family history: Mother with hypertension and migraine

Social history: Non-smoker, no alcohol, in a monogamous relationship, sexually active

Examination findings: BMI 24.8 kg/m², BP 116/74 mmHg, no pelvic tenderness on bimanual exam

What are the most appropriate contraceptive options to offer Hannah? Select three (3) from the following list:

Natalie Green, aged 33, presents at 6 weeks postpartum with a 3-day history of fever, malaise, and pain in her left breast. She reports the breast is red, swollen, and tender to touch. She has also noticed reduced milk output on that side and is finding it painful to breastfeed. Natalie delivered vaginally without complications and is breastfeeding her first child. She is otherwise healthy, with no significant past medical history.

Medications: None

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P1, delivered 6 weeks ago, exclusively breastfeeding

Examination findings: T 38.6°C, HR 96 bpm, BP 112/74 mmHg. Left breast is swollen, erythematous over upper outer quadrant, tender, firm. No fluctuance. No nipple discharge or abscess evident on clinical exam. No axillary lymphadenopathy.

What are the most appropriate next steps in management? Select three (3) from the following list:

Layla Osman, aged 19, presents to your general practice requesting a pregnancy test. Her last menstrual period was 7 weeks ago. She reports occasional nausea but no vomiting or breast tenderness. She had unprotected sex around the time of ovulation and has not used any contraception since. A urine pregnancy test performed in your clinic is positive.

Medications: Nil

Allergies: Nil known

Past history: Nil significant medical history

Family history: Mother with type 2 diabetes

Social history: Lives with her parents, recently finished high school, currently unemployed. She is unsure if she wants to continue the pregnancy.

Examination findings: BP 108/72 mmHg, HR 78 bpm, BMI 22.1 kg/m². Abdomen soft, non-tender. No palpable mass. No vaginal bleeding reported.

What are the most appropriate next steps in management? Select four (4) from the following list:

Sarah Macintyre, aged 41, presents at 10 weeks gestation for her first antenatal visit. This is her third pregnancy. Her last pregnancy ended in a miscarriage at 9 weeks, and her first was a normal vaginal delivery 15 years ago. She is concerned about her age and the risk of genetic abnormalities in the baby. She has not had any bleeding or cramping and feels well overall, though tired.

Medications: Elevit

Allergies: Nil known

Past history: Miscarriage at 9 weeks (G2P1)

Family history: Sister had Down syndrome pregnancy; no other relevant history

Social history: Works as a midwife, non-smoker, no alcohol, supportive partner

Examination findings: BP 118/72 mmHg, HR 74 bpm, BMI 23.5 kg/m². Uterus palpable just above symphysis pubis.

What are the most appropriate investigations and assessments at this stage? Select four (4) from the following list:

Priya Mehta, aged 30, presents at 36 weeks gestation with a new-onset generalised pruritus, particularly affecting her palms and soles. She denies any rash. She reports difficulty sleeping due to the itch. There are no other systemic symptoms. Fetal movements are normal. This is her second pregnancy. Her first pregnancy was uncomplicated, resulting in a vaginal delivery at term.

Medications: Elevit, iron supplement

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G2P1, previous term vaginal delivery

Examination findings: BP 120/76 mmHg, HR 78 bpm. No oedema. No rash. Abdomen consistent with 36 weeks gestation. Fetal heart 140 bpm, cephalic, not engaged.

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

Maryam Habib, aged 34, presents to your rural clinic at 14 weeks gestation for routine antenatal care. She has been well, though recently moved to your area and has not yet booked in with a hospital or midwife. She is unsure which investigations have already been done but recalls having bloods taken at 8 weeks. She is eager to continue shared care through your clinic. She does not have her previous medical records with her.

Medications: Elevit

Allergies: Nil known

Past history: Mild asthma, no hospitalisations

Family history: Father has type 2 diabetes

Social history: Recently arrived from regional Pakistan, lives with husband and extended family, speaks limited English

Obstetric/sexual history: G2P1 — first pregnancy was a vaginal delivery in Pakistan, no complications reported

Examination findings: BP 110/70 mmHg, HR 80 bpm, BMI 28.4 kg/m². Abdomen consistent with gestation. Fetal heart audible with Doppler.

What are the most appropriate next steps in her antenatal care at this visit? Select four (4) from the following list:

Gemma Rutherford, aged 26, presents to your clinic at 9 weeks gestation complaining of vaginal spotting for two days. She reports mild lower abdominal cramping but no passage of clots or tissue. She is still experiencing nausea and breast tenderness. This is her first pregnancy. She is understandably anxious and asks if she is having a miscarriage.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Family history: Mother had 3 children, no history of miscarriage

Social history: Lives with her partner, works full-time, no smoking or alcohol use

Examination findings: BP 114/70 mmHg, HR 76 bpm. Afebrile. Abdomen soft with mild suprapubic tenderness. Speculum exam shows closed cervical os and minimal old blood in the vagina. No active bleeding noted.

What are the most appropriate next steps in assessment and management? Select three (3) from the following list:

Julia Phan, aged 37, presents at 6 weeks gestation following IVF conception. She has a known history of hypothyroidism diagnosed two years ago, well-managed with thyroxine. She is concerned because she read online that thyroid levels can affect the pregnancy. She is otherwise well and has no symptoms of hyper- or hypothyroidism.

Medications: Thyroxine 100 mcg daily, Elevit

Allergies: Nil known

Past history: Primary infertility, hypothyroidism

Family history: Mother with Hashimoto’s thyroiditis

Social history: Works as an accountant, non-smoker, no alcohol, lives with husband

Examination findings: BP 110/76 mmHg, HR 72 bpm, BMI 24.1 kg/m². No goitre or clinical signs of thyroid dysfunction

What are the most appropriate next steps in managing Julia’s thyroid function in early pregnancy? Select three (3) from the following list:

Alisha Rahman, aged 29, presents at 20 weeks gestation with vulvar irritation, increased vaginal discharge, and external itching for the past five days. She denies dysuria, fever, or systemic symptoms. She has had one prior uncomplicated pregnancy. She has no new sexual partners and reports good hygiene practices. She is worried about a possible infection and asks if it will affect the baby.

Medications: Elevit

Allergies: Nil known

Past history: Recurrent vulvovaginal candidiasis (pre-pregnancy)

Obstetric/sexual history: G2P1, current pregnancy progressing well, no antenatal complications

Examination findings: Vitals normal. External vulva mildly erythematous with white discharge adherent to mucosa. No ulcers or vesicles. Speculum exam confirms thick white curd-like discharge. Cervix appears normal, closed, and non-friable.

What are the most appropriate next steps in diagnosis and management? Select three (3) from the following list:

Tamika Lewis, aged 40, presents for a preconception consultation. She and her partner have been trying to conceive for six months. This would be her first pregnancy. She is concerned about her age and risk factors, and wants to know what she should do to prepare for a healthy pregnancy. Her menstrual cycles are regular every 28–30 days. She has no chronic health conditions and takes no regular medications.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Family history: Mother with osteoporosis, father with hypertension

Social history: Works full-time, non-smoker, drinks 1–2 glasses of wine on weekends, exercises regularly

Examination findings: BP 118/72 mmHg, BMI 26.5 kg/m², no clinical abnormalities

What are the most appropriate next steps in preconception care? Select four (4) from the following list:

Laura Bains, aged 35, presents at 39 weeks gestation for a routine antenatal review. She is G2P1. Her first pregnancy ended in an emergency caesarean at 38 weeks for fetal distress. She is planning a trial of labour after caesarean (TOLAC) for this pregnancy. She reports regular fetal movements and no contractions. There is no vaginal bleeding or fluid loss. She is concerned about going past her due date and asks what the plan will be if she doesn’t go into labour spontaneously.

Medications: Elevit, ferrous sulfate

Allergies: Nil known

Past history: Emergency LSCS at term for fetal distress, no uterine rupture or complications

Obstetric/sexual history: G2P1, planning vaginal birth after caesarean (VBAC)

Examination findings: BP 120/74 mmHg, HR 80 bpm, SFH = 39 cm, cephalic, 4/5 palpable. Fetal heart 140 bpm. No uterine tenderness. Cervix closed on VE.

What are the most appropriate next steps in managing this patient’s care at 39 weeks gestation? Select three (3) from the following list:

Nikita Samuels, aged 22, presents with lower abdominal pain and vaginal bleeding. She reports the onset of bleeding one day ago, initially spotting but now heavier, with some clots. She has mild cramping and denies fevers or gastrointestinal symptoms. She had unprotected sex three weeks ago and has not had a period in over six weeks. She has not taken a pregnancy test.

Medications: None

Allergies: Nil known

Past history: Chlamydia infection one year ago, treated

Social history: University student, non-smoker, sexually active with one partner, no contraception

Examination findings: BP 108/68 mmHg, HR 90 bpm, Temp 36.9°C. Abdomen soft, mild suprapubic tenderness. Speculum shows moderate bleeding from the cervix, no visible products of conception. Cervix is closed. Bimanual exam: uterus normal size, cervical motion tenderness present.

What are the most appropriate next steps in the assessment and management of this patient? Select four (4) from the following list:

Angela Kerr, aged 25, presents at 30 weeks gestation with complaints of increased urinary frequency, dysuria, and lower abdominal discomfort for the past two days. She denies vaginal discharge, bleeding, or contractions. She is otherwise well and reports normal fetal movements. This is her first pregnancy, which has been uncomplicated to date.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0, low-risk pregnancy

Examination findings: BP 112/70 mmHg, HR 84 bpm, Temp 37.4°C. Abdomen soft and non-tender, uterine fundus at 30 cm. No suprapubic tenderness. No CVA tenderness. No uterine activity. Fetal heart 140 bpm, cephalic.

What are the most appropriate next steps in management? Select three (3) from the following list:

Eliza D’Souza, aged 32, presents at 12 weeks gestation with concerns about persistent nausea and early morning vomiting. She has recently noticed mild pain when passing urine, increased urinary frequency, and a low-grade fever. She has not yet had her first antenatal bloods and scan. This is her first pregnancy, conceived naturally. She has taken time off work due to fatigue and poor oral intake.

Medications: Elevit, ginger tablets

Allergies: Nil known

Past history: Migraine (infrequent), no regular medication

Social history: Non-smoker, no alcohol, supportive partner

Examination findings: Temp 37.9°C, HR 94 bpm, BP 108/68 mmHg. Abdomen soft, suprapubic tenderness on palpation. No costovertebral angle tenderness. Uterus palpable just above pubic symphysis.

What are the most appropriate next steps in the assessment and management of Eliza’s symptoms? Select four (4) from the following list:

Melissa Nguyen, aged 23, presents at 35 weeks gestation after noticing reduced fetal movements over the past 24 hours. She describes normally feeling the baby move regularly throughout the day but reports a significant decrease. She has tried drinking cold water and lying on her side with minimal effect. She denies any abdominal pain, bleeding, or leaking fluid. This is her first pregnancy and has been uncomplicated until now.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0, routine low-risk antenatal care

Examination findings: BP 118/72 mmHg, HR 78 bpm, fundal height = 34 cm. Abdomen soft, non-tender. Fetal heart not audible with Doppler after 1 minute of searching. No uterine contractions.

What are the most appropriate next steps in assessment and management? Select three (3) from the following list:

Amina Yusuf, aged 36, presents at 18 weeks gestation for routine antenatal care. She has a known history of Type 2 diabetes diagnosed three years ago and managed with metformin. Her HbA1c three months ago was 6.8%. She is concerned about the impact of diabetes on her pregnancy and asks if her baby is at risk.

Medications: Metformin 1000 mg BD, Elevit

Allergies: Nil known

Past history: Type 2 diabetes, BMI 32

Family history: Mother had gestational diabetes; father has Type 2 diabetes

Obstetric/sexual history: G2P1, previous SVD at term with macrosomic infant (birth weight 4.2 kg)

Examination findings: BP 124/78 mmHg, HR 82 bpm. SFH = 18 cm. No oedema. Fundus just below umbilicus. Fetal heart auscultated at 150 bpm.

What are the most appropriate next steps in management of her pregnancy? Select four (4) from the following list:

Isabelle Thorne, aged 29, presents to your clinic at 6 weeks postpartum complaining of feeling persistently low in mood. She says she has difficulty sleeping even when the baby sleeps, feels overwhelmed and tearful most days, and has little interest in activities she used to enjoy. She is breastfeeding and has good family support, but feels guilty for not enjoying motherhood as she expected. She denies thoughts of self-harm or harm to the baby.

Medications: Elevit, iron tablets

Allergies: Nil known

Past history: Generalised anxiety disorder (mild, managed without medication)

Obstetric/sexual history: G1P1, spontaneous vaginal delivery at term, no complications

Examination findings: BP 110/70 mmHg, HR 82 bpm. Appears flat in affect but cooperative. Baby present and well, feeding adequately.

What are the most appropriate next steps in assessment and management? Select four (4) from the following list:

Hannah Alford, aged 27, presents at 11 weeks gestation after returning from a two-week trip to Fiji. She reports feeling well overall but mentions she had an episode of fever, muscle aches, and a mild rash about five days ago while overseas. These symptoms resolved spontaneously. She is concerned after hearing about Zika virus risks in pregnancy and wants to know what to do next.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0, unremarkable early antenatal care so far

Social history: Non-smoker, no alcohol, lives with partner, both recently returned from Fiji

Examination findings: BP 110/68 mmHg, HR 76 bpm, Temp 36.8°C. No rash or lymphadenopathy. Abdomen soft. Uterus palpable at the symphysis pubis.

What are the most appropriate next steps in her assessment and management? Select three (3) from the following list:

Monique Taylor, aged 31, presents at 28 weeks gestation with persistent vulvar irritation and a white, clumpy vaginal discharge. She is otherwise well and reports normal fetal movements. This is her second pregnancy. She experienced similar symptoms during her first pregnancy, which resolved with treatment. She is worried this might harm the baby.

Medications: Elevit

Allergies: Nil known

Past history: Vulvovaginal candidiasis in previous pregnancy

Obstetric/sexual history: G2P1, previous term spontaneous vaginal delivery

Examination findings: BP 116/74 mmHg, HR 84 bpm. External vulva mildly erythematous with white adherent discharge. No ulcers or vesicles. Speculum confirms thick white curd-like discharge. Cervix closed and non-friable.

What are the most appropriate next steps in management? Select three (3) from the following list:

Georgia Mason, aged 42, presents at 8 weeks gestation following spontaneous conception. She is concerned about her age and the risk of chromosomal abnormalities. She has no current symptoms and this is her first pregnancy. She is otherwise healthy and has a BMI of 24. She has not had any early pregnancy testing yet and would like advice on how best to assess her baby’s health.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0, IVF considered previously but not pursued

Social history: Works as a teacher, non-smoker, no alcohol, lives with partner

Examination findings: BP 118/72 mmHg, HR 80 bpm. No abnormalities noted. Uterus not yet palpable.

What are the most appropriate next steps in prenatal screening and assessment? Select three (3) from the following list:

Jade Li, aged 34, presents at 33 weeks gestation with new-onset swelling in her hands and feet, headaches, and visual disturbances. She has no previous history of hypertension. Fetal movements are normal. This is her second pregnancy; her first pregnancy was uncomplicated. She appears anxious about the possibility of pre-eclampsia.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G2P1, previous term spontaneous vaginal delivery

Examination findings: BP 152/96 mmHg, HR 88 bpm, Temp 36.7°C. 2+ oedema in hands and lower limbs. Visual field testing reveals slight blurring. Urinalysis: 2+ protein. Fundal height 33 cm, fetal heart rate 145 bpm.

What are the most appropriate next steps in the management of this patient? Select four (4) from the following list:

Sophie Brennan, aged 21, presents at 16 weeks gestation with a two-day history of dysuria, urgency, and suprapubic discomfort. She denies fever, loin pain, or vaginal discharge. This is her first pregnancy and has otherwise been progressing well. She is worried about whether a urinary tract infection might affect the baby.

Medications: Elevit

Allergies: Nil known

Past history: Recurrent UTIs in adolescence

Obstetric/sexual history: G1P0, uncomplicated pregnancy to date

Examination findings: Temp 36.8°C, BP 112/70 mmHg, HR 80 bpm. Abdomen soft with mild suprapubic tenderness. No flank tenderness. Fundal height consistent with gestation. Fetal heart heard at 150 bpm with Doppler.

What are the most appropriate next steps in managing Sophie’s presentation? Select four (4) from the following list:

Natasha Mikhail, aged 39, presents at 24 weeks gestation for review following a routine morphology scan. The report shows a low-lying posterior placenta reaching the internal cervical os. She has not experienced any bleeding or pain. This is her second pregnancy; her first was a spontaneous vaginal delivery without complications. She is concerned about whether she will be able to have a vaginal birth again.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G2P1, previous uncomplicated SVD at term

Examination findings: BP 118/70 mmHg, HR 78 bpm. Abdomen consistent with gestation. Fetal heart rate 140 bpm. No uterine tenderness. No bleeding or discharge noted.

What are the most appropriate next steps in managing this patient’s placental finding? Select three (3) from the following list:

Zahra Malik, aged 26, presents at 13 weeks gestation with concerns about ongoing vomiting several times daily. She has been unable to tolerate food or fluids consistently, has lost 4 kg since conception, and feels lightheaded when standing. She reports passing small amounts of dark urine. She was previously managed in the emergency department with IV fluids five days ago and discharged with oral antiemetics, which she has struggled to keep down.

Medications: Ondansetron 4 mg PRN, Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0

Examination findings: BP 98/60 mmHg lying, 82/56 mmHg standing, HR 106 bpm. Appears dehydrated. Abdomen soft, no tenderness or guarding. Uterus not yet palpable. No vaginal bleeding.

Investigations: Bedside urine: 3+ ketones, 1+ blood. Serum results pending.

What are the most appropriate next steps in management? Select four (4) from the following list:

Amara Singh, aged 35, presents at 19 weeks gestation after routine morphology scan revealed a single umbilical artery (SUA). She is otherwise well and reports normal fetal movements. This is her first pregnancy, conceived naturally. Her early pregnancy screening and nuchal translucency results were low risk. She is concerned about what this means for her baby.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0

Examination findings: BP 116/76 mmHg, HR 76 bpm. SFH = 19 cm. No abnormalities on abdominal examination. Fetal heart rate 150 bpm.

What are the most appropriate next steps in managing this pregnancy? Select three (3) from the following list:

Yasmin Farouk, aged 33, presents at 7 weeks postpartum with complaints of persistent perineal pain, difficulty sitting, and occasional faecal incontinence. She had a spontaneous vaginal delivery with a prolonged second stage and a known third-degree perineal tear. She was discharged with laxatives and simple analgesia. The pain has not improved, and she feels embarrassed discussing her symptoms.

Medications: Paracetamol, Coloxyl with senna

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P1, third-degree tear, term SVD

Examination findings: BP 112/70 mmHg, HR 74 bpm. Mild perineal tenderness on inspection, healed scar visible, no obvious dehiscence. Anal tone appears reduced on digital rectal exam.

What are the most appropriate next steps in assessment and management? Select four (4) from the following list:

Leanne Brooks, aged 40, presents at 6 weeks gestation following spontaneous conception. She has a history of chronic hypertension diagnosed two years ago, currently well controlled with labetalol. This is her second pregnancy. Her first pregnancy was complicated by gestational hypertension at 36 weeks but no pre-eclampsia. She is concerned about recurrence and wants to know what she can do to reduce the risks this time.

Medications: Labetalol 100 mg BD, Elevit

Allergies: Nil known

Past history: Chronic hypertension

Obstetric/sexual history: G2P1, term SVD

Social history: Works in admin, non-smoker, BMI 31

Examination findings: BP 126/78 mmHg, HR 84 bpm. No oedema. Clinically well.

What are the most appropriate next steps in management to reduce obstetric risk? Select four (4) from the following list:

Katie Nolan, aged 28, presents at 30 weeks gestation complaining of intermittent lower abdominal cramping and a sensation of pelvic pressure. She denies vaginal bleeding or leaking of fluid. Fetal movements are normal. This is her first pregnancy. She has no known risk factors for preterm labour.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0

Examination findings: BP 110/68 mmHg, HR 82 bpm. Uterus soft between tightenings. Fundal height = 30 cm. No uterine tenderness. Speculum examination: closed cervix, no bleeding or liquor seen. CTG reassuring.

What are the most appropriate next steps in managing this patient? Select three (3) from the following list:

Nadine Chowdhury, aged 36, presents at 8 weeks gestation for a routine antenatal appointment. She has a history of epilepsy diagnosed in adolescence and is currently managed on sodium valproate. This is her first pregnancy. She is concerned about the effects of her medication on the baby and asks whether it is safe to continue.

Medications: Sodium valproate 500 mg BD, Elevit

Allergies: Nil known

Past history: Generalised epilepsy

Obstetric/sexual history: G1P0

Social history: Works as a software engineer, non-smoker, no alcohol

Examination findings: BP 110/70 mmHg, HR 76 bpm. Neurological exam normal. No focal deficits or tremors. No seizures reported in the last 6 months.

What are the most appropriate next steps in managing this patient’s care? Select four (4) from the following list:

Bianca Rossi, aged 30, presents at 28 weeks gestation for a routine antenatal check. She mentions feeling increasingly short of breath over the past two weeks. Initially, it was on exertion (e.g. climbing stairs), but now she feels breathless while resting. She also reports palpitations and general fatigue. She denies cough, chest pain, or leg swelling. Her pregnancy has been low-risk to date, and her iron studies at 16 weeks were borderline low.

Medications: Elevit

Allergies: Nil known

Past history: Mild asthma (childhood, resolved), no cardiac history

Obstetric/sexual history: G1P0

Examination findings: BP 104/68 mmHg, HR 106 bpm, RR 22 bpm, Temp 36.9°C. Pale conjunctivae. No wheeze or crackles. Mild systolic flow murmur. SFH = 27 cm. Fetal heart 145 bpm. No pedal oedema.

What are the most appropriate next steps in assessment and management? Select four (4) from the following list:

Aisha Rahimi, aged 29, presents at 20 weeks gestation for a routine antenatal visit. She mentions recent international travel to her home country, Afghanistan, two months ago. She reports feeling generally well but has not yet completed all her early antenatal investigations. She received childhood vaccinations overseas but is unsure of her current immunisation status.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0, spontaneous conception, uncomplicated pregnancy to date

Social history: Recently arrived in Australia, lives with extended family, speaks Dari, interpreter present

Examination findings: BP 110/68 mmHg, HR 76 bpm, SFH = 20 cm. No abnormalities noted. Fetal heart heard at 148 bpm.

What are the most appropriate next steps in this patient’s antenatal care? Select four (4) from the following list:

Rachel Mendes, aged 25, presents at 18 weeks gestation with vulval irritation and a new onset of grouped painful vesicles on the right labia majora. She reports a tingling sensation prior to the appearance of the lesions and has associated dysuria. This is her first pregnancy. She has a new sexual partner in the last two months. She is distressed and concerned about the impact on the baby.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0, routine antenatal care

Examination findings: Multiple grouped vesicles with erythematous base on the right labia. Inguinal lymphadenopathy present. No systemic symptoms. Speculum exam deferred due to pain.

What are the most appropriate next steps in management of this presentation? Select four (4) from the following list:

Charlotte Dean, aged 37, presents at 21 weeks gestation for review of her morphology ultrasound results. The report identifies a marginal placenta previa, with the placental edge located within 10 mm of the internal cervical os. She has had no bleeding, pain, or contractions. This is her third pregnancy. Her previous two pregnancies were uncomplicated vaginal deliveries.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G3P2, two previous term SVDs

Examination findings: BP 114/70 mmHg, HR 80 bpm. SFH = 21 cm. Fetal heart 148 bpm. No abdominal tenderness. No bleeding.

What are the most appropriate next steps in management? Select three (3) from the following list:

Erin Walker, aged 24, presents at 15 weeks gestation for a routine antenatal check. She reports a history of mild vaginal spotting over the past 3 days without pain or cramping. She denies any fevers, foul-smelling discharge, or urinary symptoms. This is her first pregnancy, conceived spontaneously. She is anxious about the possibility of miscarriage.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0

Examination findings: BP 110/72 mmHg, HR 76 bpm, afebrile. Abdomen soft, non-tender. Speculum exam: closed cervical os, no active bleeding, small amount of old blood in the vault. No discharge or cervical lesions seen.

What are the most appropriate next steps in managing this patient’s presentation? Select three (3) from the following list:

Lucinda Green, aged 38, presents at 10 weeks gestation following a routine early antenatal appointment. She is G3P1, with one prior elective termination at age 21 and one vaginal delivery at term four years ago. She has a BMI of 32 and a strong family history of type 2 diabetes. She is otherwise well and asks if she needs any additional testing or precautions this early in pregnancy.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Family history: Mother and sister with type 2 diabetes

Obstetric/sexual history: G3P1, previous term SVD

Examination findings: BP 122/76 mmHg, HR 78 bpm, BMI 32.3 kg/m². No abnormalities noted.

What are the most appropriate next steps in antenatal care for Lucinda at this visit? Select four (4) from the following list:

Emily Tran, aged 23, presents at 34 weeks gestation with intense pruritus that started on her palms and soles and has gradually spread to her abdomen and limbs. She reports no associated rash, bleeding, or fever. Fetal movements are normal. This is her first pregnancy. She is visibly distressed and says the itch is worst at night, disrupting her sleep.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0, uncomplicated pregnancy to date

Examination findings: BP 116/74 mmHg, HR 80 bpm. No rash. Scratch marks on arms and abdomen. No oedema. Fetal heart 142 bpm. Uterus consistent with gestation.

What are the most appropriate next steps in assessment and management? Select four (4) from the following list:

Samantha Liew, aged 31, presents at 18 weeks gestation after moving from interstate. She has had minimal antenatal care to date and has not yet had her morphology scan or first trimester screening. She has no current symptoms and reports feeling well. This is her second pregnancy — her first was a term spontaneous vaginal delivery. She is unsure what investigations she has previously had and has no records with her.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G2P1, previous uncomplicated SVD

Social history: Recently relocated, lives with partner and toddler

Examination findings: BP 112/68 mmHg, HR 78 bpm, SFH = 18 cm. Fetal heart rate heard at 150 bpm with Doppler.

What are the most appropriate next steps in her antenatal care? Select four (4) from the following list:

Fatima El-Sayed, aged 35, presents at 38 weeks gestation with complaints of intermittent lower abdominal cramping and increased vaginal discharge. She denies vaginal bleeding, ruptured membranes, or decreased fetal movements. She is anxious and unsure whether labour has begun. This is her second pregnancy — her first labour was induced at 40+5 weeks and resulted in a spontaneous vaginal delivery.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G2P1, previous term SVD

Social history: Lives with husband, supportive environment

Examination findings: BP 118/72 mmHg, HR 84 bpm. Abdomen soft between tightenings, cephalic presentation, 3/5 palpable. Fetal heart 144 bpm. No contractions observed during exam. Speculum: increased clear mucous discharge, cervix closed, no bleeding or liquor seen.

What are the most appropriate next steps in assessment and management? Select three (3) from the following list:

Nina Patel, aged 29, presents at 26 weeks gestation for a routine antenatal review. She reports no current symptoms. This is her first pregnancy, and she has been receiving shared antenatal care. Her early pregnancy screening and 20-week morphology scan were normal. She is unsure if she had gestational diabetes testing done yet and asks whether she still needs it.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0, low-risk pregnancy to date

Examination findings: BP 108/72 mmHg, HR 76 bpm, SFH = 26 cm. Fetal heart rate 146 bpm. No oedema or abnormal findings.

What are the most appropriate next steps in antenatal care for Nina? Select three (3) from the following list:

Jessie Carmichael, aged 30, presents at 9 weeks gestation following a positive home pregnancy test. She is unsure when her last menstrual period was, as she has irregular cycles. She has no abdominal pain or bleeding but is concerned about whether the pregnancy is viable and how far along she actually is. This is her first pregnancy.

Medications: Elevit

Allergies: Nil known

Past history: Polycystic ovarian syndrome (PCOS)

Obstetric/sexual history: G1P0, spontaneous conception

Social history: Works full time, lives with partner, non-smoker, no alcohol

Examination findings: BP 112/74 mmHg, HR 76 bpm. Abdomen soft, non-tender. No vaginal bleeding.

What are the most appropriate next steps in confirming pregnancy viability and gestational age? Select three (3) from the following list:

Layla Ahmed, aged 34, presents at 32 weeks gestation for review after returning from overseas travel to visit family in Pakistan. She reports feeling well but mentions that she developed a mild diarrhoeal illness two weeks ago that resolved spontaneously. She is concerned about infections she may have been exposed to overseas and whether any further screening is needed. Her pregnancy has otherwise been low-risk, and antenatal investigations have been up to date prior to travel.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G2P1, previous term SVD

Social history: Recently returned from 6 weeks in Pakistan, no known exposures or animal contact, no new sexual partners

Examination findings: BP 116/72 mmHg, HR 82 bpm, SFH = 32 cm. Fetal heart 145 bpm. No abdominal tenderness. No oedema.

What are the most appropriate next steps in her care? Select three (3) from the following list:

Alana Cooper, aged 22, presents at 36 weeks gestation reporting vulval discomfort and thick white vaginal discharge. She describes itchiness and irritation that worsens after exercise or wearing tight clothing. She denies dysuria, bleeding, or contractions. This is her first pregnancy and has otherwise been progressing well. She is concerned about the impact of this on her baby.

Medications: Elevit

Allergies: Nil known

Past history: Recurrent vulvovaginal candidiasis pre-pregnancy

Obstetric/sexual history: G1P0, low-risk pregnancy

Examination findings: Vitals normal. External vulva erythematous with adherent white discharge. No ulceration. Speculum confirms thick white curd-like discharge. Cervix appears closed and healthy.

What are the most appropriate next steps in managing this condition? Select three (3) from the following list:

Sophia McIntyre, aged 39, presents at 11 weeks gestation for her first antenatal visit. She conceived naturally and this is her first pregnancy. She is concerned about the risks of chromosomal abnormalities due to her age and would like to understand what testing options are available. She has read about different tests online but is confused about which are best and when they should be done.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0

Social history: Lives with partner, non-smoker, no alcohol

Examination findings: BP 120/70 mmHg, HR 80 bpm. No abnormalities on clinical examination. Uterus just palpable above the symphysis.

What are the most appropriate next steps in counselling and investigation? Select three (3) from the following list:

Harriet Lin, aged 28, presents at 14 weeks gestation with persistent nausea and occasional vomiting that has been ongoing since early pregnancy. She is managing to keep some food and fluids down but finds the nausea is interfering with her work and sleep. She has lost 2 kg since her first visit but appears well-hydrated. She is concerned about the impact on her baby and is unsure whether medication is safe at this stage.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0, dating scan confirmed viability at 8 weeks

Social history: Office worker, lives with partner, non-smoker

Examination findings: BP 110/68 mmHg, HR 78 bpm. Mild epigastric tenderness, no guarding. Urinalysis: negative for ketones.

What are the most appropriate next steps in management of Harriet’s symptoms? Select three (3) from the following list:

Tamara Bishop, aged 33, presents at 28 weeks gestation with concerns about feeling unusually tired and increasingly breathless on exertion. She has no chest pain, cough, or signs of infection. Her fetal movements are normal. She is otherwise healthy. This is her second pregnancy; the first was uncomplicated. Her iron levels were borderline at 12 weeks, and she was advised to take oral supplementation, which she stopped due to constipation.

Medications: Elevit (inconsistently), previously stopped iron tablets

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G2P1, previous term SVD

Examination findings: BP 108/68 mmHg, HR 96 bpm, RR 20. Conjunctivae pale. No oedema or murmurs. Fundal height = 28 cm. Fetal heart 144 bpm. No respiratory findings.

What are the most appropriate next steps in assessment and management? Select four (4) from the following list:

Megan Fitzgerald, aged 27, presents at 40 weeks and 3 days gestation for routine review. She reports feeling well with good fetal movements. She is G1P0 and has had an uncomplicated pregnancy. She is keen to avoid induction and asks how long she can safely continue with the pregnancy. She has not yet had a vaginal examination. She is open to discussing options for spontaneous labour stimulation.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0, low-risk pregnancy

Social history: Non-smoker, active, supportive partner

Examination findings: BP 118/74 mmHg, HR 82 bpm, SFH = 40 cm. Cephalic, 2/5 palpable. Fetal heart 144 bpm. No contractions. CTG reassuring if performed. VE not yet done.

What are the most appropriate next steps in managing this patient at this stage of pregnancy? Select four (4) from the following list:

Elena Petrova, aged 19, presents at 7 weeks gestation requesting a medical termination of pregnancy. She is emotionally well and reports that the pregnancy was unplanned. She is not in a stable relationship and feels unprepared to continue the pregnancy. She has no significant past medical history and is otherwise healthy. She has not had any antenatal investigations yet and is unsure of her exact dates. She seeks advice about her options and the next steps.

Medications: None

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0, sexually active, inconsistent contraception use

Social history: Lives with family, studying full-time, supportive friend network

Examination findings: BP 112/70 mmHg, HR 74 bpm. Abdomen soft, non-tender. No bleeding or pain. No signs of anaemia or systemic illness.

What are the most appropriate next steps in supporting Elena’s request? Select four (4) from the following list:

Chloe Whitman, aged 26, presents at 35 weeks gestation reporting intermittent vaginal leakage over the past 12 hours. She is otherwise well and reports ongoing fetal movements. There is no pain or bleeding. She describes the fluid as clear and odourless, and is unsure whether she has passed urine. This is her first pregnancy, and she is worried her waters may have broken.

Medications: Elevit

Allergies: Nil known

Past history: Nil significant

Obstetric/sexual history: G1P0

Social history: Lives with partner, non-smoker

Examination findings: BP 114/70 mmHg, HR 80 bpm, SFH = 35 cm. Cephalic, 3/5 palpable. No contractions noted. External genitalia healthy. Speculum: small amount of clear fluid seen in the vaginal vault. No active bleeding. Cervix appears closed.

What are the most appropriate next steps in management? Select four (4) from the following list: