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Flashcards in More O&G SBAs Deck (50)
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1

A 23 year old multip is found to have a positive pregnancy test. This is a surprise as she has been using the copper coil for contraception. On examination the strings cannot be seen. The next best step in her management is to;

1. Use a coil retriever to find the coil
2. Organise an ultrasound scan
3. Perform a laparoscopy to make sure the coil is not in the abdominal cavity
4. Advise a termination of pregnancy because copper coils can lead to congenital anomaly.
5. Perform a hysteroscopy to identify where the coil is

Organise an ultrasound scan

2

A 14 year old girl who is a virgin has irregular and occasionally heavy menses. She attends your outpatients with her mother they are both very concerned. What is the next best step in her management:

1. Reassure and perhaps organise an ultrasound
2. Perform a speculum examination and take swabs because an STD can cause abnormal menstrual loss
3. Start her on an anxiolytic to help her deal with her anxiety
4. Insert the Mirena coil
5. Perform a smear to exclude cervical disease

Reassure and perhaps organise an ultrasound

3

A nulliparous woman presents to her antenatal appointment at 32 weeks in your general practice. She is asymptomatic and has a blood pressure of 148/ 90 there is no proteinurea, her baby is well grown and her booking blood pressure was 102/62. What should you do next?

1. Organise a further review of her blood pressure within the week.
2. Call the hospital and organise her admission
3. Start a 24 hour urine collection
4. Tell her to return on her 36 week appointment
5. Give her steroids to help mature the babies lungs

Organise a further review of her blood pressure within the week.

4

A patient in the antenatal clinic is found to have a baby which is a breech presentation. She is 29 weeks gestation. The next best step is to:

1. Ask her to sleep on her left side
2. Admit her to hospital in case she goes into preterm labour and has a cord prolapse
3. Arrange a review of the presentation at 36 weeks
4. Organise her delivery by Caesarean section
5. Arrange an ECV

Arrange a review of the presentation at 36 weeks

5

A couple present in their mid thirties with a history of primary infertility. They have regular intercourse and are both fit and well. What is the most important factor in the woman’s past medical history that is associated with infertility:

1. She has a retroverted womb
2. She has had two abortions one at 12 and one at 14 weeks
3. She has a pedunculated fibroid
4. She has a history of a chlamydial infection
5. She has a smear showing moderate dyskariosis.

She has a history of a chlamydial infection

6

A 32 year old woman is having a VBAC. She is 8 cm dilated, what feature would make worry that there was dehiscence of the uterine scar:

1. On abdominal examination the fetal head is still 2/5 palpable
2. Bloodstained liquor
3. A CTG showing persistent decelerations
4. The mother requesting an epidural
5. Painful contractions

A CTG showing persistent decelerations

7

Which one of the following is the most likely cause of death of a woman during her reproductive years, in the UK.

1. Suicide
2. Murder
3. Pregnancy
4. Smoking
5. Contraception

Pregnancy

8

A 22 year old nulliparous woman presents to A and E with a 2 week history of right sided abdominal pain which has progressively worsened. Over the last 24 hours she has had light vaginal bleeding. She has a past history of Chlamydia. She uses condoms for contraception but admits to having unprotected sex with her boyfriend on occasions. She does not know the date of her last menstrual period. On examination, her pulse rate is 104 beats per minute, blood pressure 74/50 and her abdomen is diffusely tender with rebound and guarding in the right iliac fossa. Vaginal examination reveals tenderness in the right adnexa. A full blood count and group and save has been requested and intravenous access established. The most important next step in her management is to:

1. Perform a pregnancy test
2. Arrange for a pelvic ultrasound scan
3. Arrange for transfer to the operating theatre immediately
4. Send an urgent swab for Chlamydia
5. Arrange for a surgical review

Perform a pregnancy test

9

A 53 year old lady presents with a 3 week history of postmenopausal bleeding. Which of the following is NOT associated with an increased risk of endometrial cancer

1. Nulliparity
2. A history of atypical endometrial hyperplasia
3. A history of oral contraceptive use
4. Diabetes
5. Obesity

A history of oral contraceptive use

10

A 32 year old black African woman requests the combined oral contraceptive pill. She has sickle cell trait but is currently in good health. She had a DVT in pregnancy 2 years ago. Her mother suffered a stroke at 59, and died of ovarian cancer the following year. Her father has hyperlipidaemia.

1. Sickle cell trait
2. History of DVT
3. Cerebrovascular vascular accident in a first degree relative
4. Family history of hyperlipidaemia
5. Family history of ovarian cancer

Family history of hyperlipidaemia

11

A 33 year old nulliparous lady has a cervical smear performed in accordance with the NHS Cervical Screening Programme and it is reported as inadequate. Her previous cervical smears have always been normal and she has no gynaecological complaints. She uses the combined oral contraceptive pill


1. She should be referred for colposcopy where she should be seen within 8 weeks
2. The smear should be repeated and she should be referred for colposcopy if 2 consecutive smears are reported as inadequate
3. She should be referred for colposcopy where she should be seen within 2 weeks
4. The smear should be repeated and she should be referred for colposcopy if 3 consecutive smears are reported as inadequate
5. She should be advised to discontinue the combined oral contraceptive pill and have the smear repeated in 4 weeks time

The smear should be repeated and she should be referred for colposcopy if 2 consecutive smears are reported as inadequate

12

A 22 year old nulliparous woman complains of longstanding irregular painful periods. Her periods are not particularly heavy. She has a regular sexual partner and uses condoms for contraception. She has no significant past medical or family history and is a non-smoker. Vaginal examination is normal and you take swabs to exclude genital infection. You recommend

1. Prescription of the combined oral contraceptive pill without further investigations
2. Outpatient endometrial biopsy
3. Prescription of the combined oral contraceptive pill provided endometrial biopsy is normal
4. Outpatient hysteroscopy and endometrial biopsy

Prescription of the combined oral contraceptive pill without further investigations

13

A 27 year old primagravida attends the Early Pregnancy Unit after slight vaginal bleeding following 9 weeks amenorrhoea. Transvaginal ultrasound shows an intrauterine pregnancy with a 10 mm fetus but no fetal heart pulsations. Which of the following is NOT appropriate management for this patient:

1. She has the option of surgical evacuation as a planned day-case procedure
2. She has the option of expectant management
3. She has the option of medical therapy with misoprostol followed by dinoprostone
4. It should be sensitively explained to the patient that the scan shows she has miscarried
5. She has the option of alternate day beta HCG monitoring with repeat pelvic ultrasound in one week

She has the option of alternate day beta HCG monitoring with repeat pelvic ultrasound in one week

14

A 40 year old lady who is 38 weeks pregnant is due to have a planned Caesarean section the following week because her baby is breech. She requests sterilisation by tubal occlusion at the time of the Caesarean. She already has 3 children and is certain that her family will be complete once this baby is born. She has no significant past medical or gynaecological history. Which of the following is NOT true?

1. The failure rate of vasectomy is lower than that of tubal occlusion
2. The failure rate of tubal occlusion is lower if performed at Caesarean section
3. If tubal occlusion is to be performed at the time of Caesarean section, counselling and consent should have been given at least one week prior to the procedure
4. The failure rate of the intrauterine system (IUS) is at least as low as that of tubal occlusion
5. The woman is more likely to regret her decision to be sterilised if performed at Caesarean section

The failure rate of tubal occlusion is lower if performed at Caesarean section

15

A 24 year old nulliparous woman complains of hot flushes and irritability. She had radiotherapy and chemotherapy for Hodgkins Disease 2 years previously. She reports that her menses were regular during chemotherapy, but then became irregular and stopped 3 months ago. Serum beta HCG is negative. The most important next step in her management is to

1. Reassure the patient and see her for follow-up in 6 months time
2. Prescribe a hormone replacement therapy regimen containing both oestrogen and progestogen
3. Arrange for serum FSH level
4. Arrange for serum oestradiol level
5. Arrange for a pelvic ultrasound

Arrange for serum FSH level

16

A 24 year old primagravida has HIV antibody testing as part of her antenatal booking investigations at 15 weeks gestation. The test is positive. Which of the following statements regarding mother to child transmission of HIV is NOT true

1. All neonates born to HIV-infected women should be given antiretroviral therapy to reduce the risk of transmission
2. Exclusive formula feeding reduces transmission by half
3. Transmission most commonly occurs at the time of delivery
4. Without intervention transmission occurs in approximately 60% of cases
5. All women, irrespective of their plasma viral load, should be advised to take antiretroviral therapy in pregnancy in order to reduce the risk of transmission

Without intervention transmission occurs in approximately 60% of cases

17

A 42 year old nulliparous woman presents with lower abdominal pain, fever and vaginal discharge. Pregnancy test is negative. Your clinical assessment suggests that the likely diagnosis is acute pelvic inflammatory disease (PID). Indication for hospital admission for patients with PID include all of the following EXCEPT:

1. Pregnancy
2. Tubo-ovarian abscess
3. Gastrointestinal symptoms
4. Age > 40
5. HIV infection

Age > 40

18

1. The number of weeks at which induction should be considered if maternal diabetic control has not been optimal.

A. 38
B. 1
C. 3
D. 2
E. 7
F. 8
G. 40
H. 6
I. 34
J. 36

Correct A. 38

19

2. For tight control a woman’s % HbA1c should be below this number.

A. 38
B. 1
C. 3
D. 2
E. 7
F. 8
G. 40
H. 6
I. 34
J. 36

Correct E. 7

20

4. A 21 year old woman presents to the accident and emergency department with a history of fainting while waiting for the bus. She has had left iliac fossa pain for the last two days, which has been constant in nature. In the last twelve hours the patient mentions that she also has right shoulder tip pain. She has had some brown vaginal discharge. Her last menstrual period was 8 weeks ago. She has been trying to get pregnant for a few months and had a positive pregnancy test 2 weeks ago at home. She has had Chlamydia in the past which was treated with doxycycline.

A. Inevitable miscarriage
B. Heterotopic pregnancy
C. Ectopic pregnancy
D. Ovarian torsion
E. Delayed miscarriage
F. Appendicitis
G. Pelvic inflammatory disease
H. Haemorrhagic corpus luteum
I. Complete miscarriage
J. Threatened miscarriage

Correct C. Ectopic pregnancy

21

3. Type of diabetes which is becoming more prevalent in the UK as the childbearing population changes.

A. 38
B. 1
C. 3
D. 2
E. 7
F. 8
G. 40
H. 6
I. 34
J. 36

Correct D. 2

22

4. Pre-delivery steroids need to be given if possible when delivering before this number of weeks to avoid neonatal respiratory distress syndrome.

A. 38
B. 1
C. 3
D. 2
E. 7
F. 8
G. 40
H. 6
I. 34
J. 36

Correct I. 34

23

5. For the mini GTT blood needs to be taken for glucose measurement this many hours after Lucozade dosing.
A. 38
B. 1
C. 3
D. 2
E. 7
F. 8
G. 40
H. 6
I. 34
J. 36

B. 1

24

1. A diabetic woman comes to her GP as she has just found out she is pregnant. Her GP advices that she must discontinue the medication she is currently taking for her high blood pressure.

A. 5%
B. Ca 2+ channel blocker
C. 3 & 4
D. 8 mmol/l
E. 5.5 mmol/l
F. 0.4mg
G. ACE
H. 5 & 6
I. 5mg
J. 7%

G. ACE

25

2. A woman who developed gestational diabetes in her pregnancy has just given birth. It was complicated and the baby has been damaged, which cervical nerves are likely to have been damaged.

A. 5%
B. Ca 2+ channel blocker
C. 3 & 4
D. 8 mmol/l
E. 5.5 mmol/l
F. 0.4mg
G. ACE
H. 5 & 6
I. 5mg
J. 7%

H. 5 & 6

26

3. A 30 year old woman with type 1 diabetes goes to see her diabetic nurse as she is hoping to get pregnant. What dose of folic acid should the nurse advise her to take?

A. 5%
B. Ca 2+ channel blocker
C. 3 & 4
D. 8 mmol/l
E. 5.5 mmol/l
F. 0.4mg
G. ACE
H. 5 & 6
I. 5mg
J. 7%

I. 5mg

27

4. A diabetic woman’s glycosylated haemoglobin should ideally be less than what in pregnancy.

A. 5%
B. Ca 2+ channel blocker
C. 3 & 4
D. 8 mmol/l
E. 5.5 mmol/l
F. 0.4mg
G. ACE
H. 5 & 6
I. 5mg
J. 7%

Correct J. 7%

28

5. A type 1 diabetic woman measures her blood glucose 1 hour after she has eaten lunch. She is hoping that her blood glucose should be less than what value.

A. 5%
B. Ca 2+ channel blocker
C. 3 & 4
D. 8 mmol/l
E. 5.5 mmol/l
F. 0.4mg
G. ACE
H. 5 & 6
I. 5mg
J. 7%

Correct D. 8 mmol/l

29

4. A 28 year old woman presents to the GP surgery with her baby, who is three weeks old. The delivery was by emergency caesarean section for failure to progress in labour. She was discharged on day three after the delivery. She had minimal bleeding for the first two weeks, but over the last few days, bleeding has increased. She is now passing clots vaginally and is feeling unwell. On palpation, the abdomen is tender suprapubically. Her temperature is 38ºC.

A. Deep venous thromboembolism
B. Endometritis
C. Incisional hernia
D. Urinary tract infection
E. Urinary retention
F. Retained products of conception
G. Wound haematoma
H. Wound infection
I. Atelectasis
J. Pulmonary embolism

Correct B. Endometritis

30

1. A 29 year old woman at 35 weeks in her first on-going pregnancy presents to the labour ward with a history of bright red vaginal bleeding following intercourse. The bleeding was several hours ago and has settled spontaneously. Her ultrasound scan at 20 weeks showed that the placenta is located at the fundus.

A. Increase syntocinon infusion
B. Perform caesarean section
C. Perform fetal blood sample
D. Cardiotocograph
E. Start syntocinon infusion
F. Speculum examination
G. Continue CTG and review later
H. Admit to antenatal ward for observation
I. Complete partogram

Correct F. Speculum examination