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Flashcards in O&G Deck (61)
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1

1. A 27 year old woman attends the early pregnancy unit with a history of heavy vaginal bleeding with blood clots and cramping pains which lasted for 12 hours and settled spontaneously. Last menstrual period was 6 weeks previously and her cycle is normally four weeks long. She had a positive urinary pregnancy test 1 week ago at home. On examination the cervix is closed. Transvaginal ultrasound shows no intrauterine sac and an endometrial thickness of 8mm.

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 I. Complete miscarriage

2

2. An 18 year old woman presents to the accident and emergency (A&E) department with right sided abdominal pain. Her last menstrual period was ten weeks ago. She has a regular sexual partner but is not using any contraception. A trans-abdominal ultrasound in A&E shows an intra-uterine sac and a fetus with a heart beat present. The crown rump length is 20mm. On examination she has right iliac fossa pain, rebound tenderness and guarding. Her temperature is 38C and white blood cell count is 18.5 with a predominant neutrophilia.

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 F. Appendicitis

3

3. A 28 year old woman presents to the GP surgery with a history of painless PV bleeding, similar in amount to her normal period. Her last period was 7 weeks ago. A urinary hCG test is positive. On examination, the abdomen is soft and non-tender. Speculum examination reveals a closed cervix with a small amount of fresh bleeding at the external cervical os.

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 J. Threatened miscarriage

4

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

5

5. You are asked to see a 32 year old woman in the antenatal clinic after her routine dating scan. She is in her first pregnancy and her last menstrual period was 12 weeks ago. She felt very sick when she first got pregnant but more recently these symptoms have subsided. The ultrasonographer shows you the scan report which documents an intrauterine gestation sac measuring 30mm in diameter. A small fetal pole is seen measuring 10mm but no fetal heart was present. The patient does not report any vaginal bleeding.

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 E. Delayed miscarriage

6

1. An 18 year old woman presents to the GP surgery complaining of post-coital bleeding for 3 months. She is sexually active and uses the combined oral contraceptive pill. She does not complain of any vaginal discharge. On speculum examination, a cervical ectropion is seen.

A. Endometrial carcinoma
B. Uterine fibroids
C. Polycystic ovarian syndrome
D. Atrophic vaginitis
E. Endometrial polyp
F. Dysfunctional Uterine Bleeding
G. Fallopian tube carcinoma
H. Chlamydia trachomatis
I. Imperforate hymen
J. Cervical carcinoma

Correct H. Chlamydia trachomatis

7

2. A 65 year old woman is referred by her GP to the gynaecology clinic with a history vaginal bleeding like a period on three separate occasions in the last 4 months. The bleeding has been painless, and her last period was aged 56 years old. She has a BMI of 35kg/m2 and has no children. An ultrasound scan organised by the GP shows an endometrial thickness of 11mm.

A. Endometrial carcinoma
B. Uterine fibroids
C. Polycystic ovarian syndrome
D. Atrophic vaginitis
E. Endometrial polyp
F. Dysfunctional Uterine Bleeding
G. Fallopian tube carcinoma
H. Chlamydia trachomatis
I. Imperforate hymen
J. Cervical carcinoma

Correct A. Endometrial carcinoma

8

3. A 40 year old woman is referred to the gynaecology clinic with a history of irregular vaginal bleeding for 6 months. There is no pattern to the bleeding. She did not attend for her last smear but she informs you that she has attended for colposcopy a few years ago, though she cannot remember why. She has a history of genital warts which were treated a few years ago. Abdominal examination is unremarkable. Speculum examination reveals an irregular lesion on the cervix, which is 3cm in diameter and bleeds on contact.

A. Endometrial carcinoma
B. Uterine fibroids
C. Polycystic ovarian syndrome
D. Atrophic vaginitis
E. Endometrial polyp
F. Dysfunctional Uterine Bleeding
G. Fallopian tube carcinoma
H. Chlamydia trachomatis
I. Imperforate hymen
J. Cervical carcinoma

Correct J. Cervical carcinoma

9

4. A 41 year old Afro-Caribbean woman attends her GP with a history of increasingly heavy periods over the last couple of years. They now last 8 days, with flooding through her pads, such that she has to use ‘double protection.’ She notes blood clots in the bleeding. She also reports that her ‘tummy feels swollen’. Abdominal examination is remarkable for a large, firm, non-tender mass arising from the pelvis and reaching the umbilicus.

A. Endometrial carcinoma
B. Uterine fibroids
C. Polycystic ovarian syndrome
D. Atrophic vaginitis
E. Endometrial polyp
F. Dysfunctional Uterine Bleeding
G. Fallopian tube carcinoma
H. Chlamydia trachomatis
I. Imperforate hymen
J. Cervical carcinoma

Correct B. Uterine fibroids

10

5. You are seeing a 36 year old woman for a follow up appointment in the gynaecology clinic with a history of heavy, frequent periods for the last 12 months. Your colleague who saw her previously arranged an ultrasound scan, which showed a normal uterus, tubes and ovaries. You also note that her LH and FSH levels are normal, as are her thyroid function tests.

A. Endometrial carcinoma
B. Uterine fibroids
C. Polycystic ovarian syndrome
D. Atrophic vaginitis
E. Endometrial polyp
F. Dysfunctional Uterine Bleeding
G. Fallopian tube carcinoma
H. Chlamydia trachomatis
I. Imperforate hymen
J. Cervical carcinoma

Correct F. Dysfunctional Uterine Bleeding

11

1. A 30 year old woman attends the GP surgery saying she has received a letter saying that her last routine smear (which was 3 months ago) showed moderate dyskaryosis. She has also noticed some intermenstrual bleeding since that smear. She is requesting advice about what should be done next.

A. Pipelle biopsy
B. Pelvic ultrasound scan
C. Hysteroscopy
D. CA12-5 test
E. Repeat smear test
F. Abdominal CT scan
G. Thyroid function tests
H. Colposcopy
I. Abdominal X Ray
J. Swab for Chlamydia trachomatis

Correct H. Colposcopy

12

2. A 66 year old woman is referred by her GP to the gynaecology clinic with a history vaginal bleeding like a period on three separate occasions in the last 4 months. The bleeding has been painless, and her last period was aged 56 years old. She has a BMI of 35kg/m2 and has no children. An ultrasound scan organised by the GP shows an endometrial thickness of 11mm.

A. Pipelle biopsy
B. Pelvic ultrasound scan
C. Hysteroscopy
D. CA12-5 test
E. Repeat smear test
F. Abdominal CT scan
G. Thyroid function tests
H. Colposcopy
I. Abdominal X Ray
J. Swab for Chlamydia trachomatis

Correct A. Pipelle biopsy

13

3. A 40 year old woman is referred to the gynaecology clinic by the GP with intermenstrual bleeding for 3 months. The GP has organised an ultrasound scan – the report describes a 10 mm intra-uterine polyp.

A. Pipelle biopsy
B. Pelvic ultrasound scan
C. Hysteroscopy
D. CA12-5 test
E. Repeat smear test
F. Abdominal CT scan
G. Thyroid function tests
H. Colposcopy
I. Abdominal X Ray
J. Swab for Chlamydia trachomatis

Correct C. Hysteroscopy

14

4. A 19 year old woman presents to the GP surgery complaining of post-coital bleeding for 3 months. She is sexually active and uses the combined oral contraceptive pill. She has had 3 sexual partners in the last three months. She does not complain of any vaginal discharge. On speculum examination, a cervical ectropion is seen.

A. Pipelle biopsy
B. Pelvic ultrasound scan
C. Hysteroscopy
D. CA12-5 test
E. Repeat smear test
F. Abdominal CT scan
G. Thyroid function tests
H. Colposcopy
I. Abdominal X Ray
J. Swab for Chlamydia trachomatis

Correct J. Swab for Chlamydia trachomatis

15

5. A 33 year old woman attends the GP surgery complaining that her periods are irregular. On further questioning, she states that her cycle ranges from 30 to 36 days with her periods lasting anything from 3 up to 7 days. In passing she mentions that she had a smear at the family planning clinic 3 months ago and the result was ‘insufficient’.

A. Pipelle biopsy
B. Pelvic ultrasound scan
C. Hysteroscopy
D. CA12-5 test
E. Repeat smear test
F. Abdominal CT scan
G. Thyroid function tests
H. Colposcopy
I. Abdominal X Ray
J. Swab for Chlamydia trachomatis

Correct E. Repeat smear test

16

1. You are asked to see a 24 year old woman at 34 weeks’ gestation in her second on-going pregnancy. She has presented to the labour ward complaining of reduced fetal movements for the past 24 hours and is very anxious about this. The symphysio-fundal height is 35 cm.

A. Kleihauer test
B. Chest X Ray
C. Abdominal ultrasound for fetal growth
D. HIV ELISA assay
E. Fetal blood sample
F. Echocardiogram
G. Glucose tolerance test
H. Ventilation-perfusion (VQ) scan
I. Bile acid level
J. Cardiotocograph

Correct J. Cardiotocograph

17

2. A 27 year old woman is sent to the maternity day assessment unit by her GP with a history of painless vaginal bleeding which has settled spontaneously. She is 28 weeks pregnant and the pregnancy has previously been uneventful. On examination, there is no active bleeding and her abdomen is soft and non-tender.

A. Kleihauer test
B. Chest X Ray
C. Abdominal ultrasound for fetal growth
D. HIV ELISA assay
E. Fetal blood sample
F. Echocardiogram
G. Glucose tolerance test
H. Ventilation-perfusion (VQ) scan
I. Bile acid level
J. Cardiotocograph

Correct A. Kleihauer test

18

3. A 35 year old woman in her first pregnancy presents to the maternity day assessment unit. She is 32 weeks pregnant and complains of itching for the last few days, especially on the palms of her hands and the soles of her feet. She has no visible rash and her sclerae are not icteric.

A. Kleihauer test
B. Chest X Ray
C. Abdominal ultrasound for fetal growth
D. HIV ELISA assay
E. Fetal blood sample
F. Echocardiogram
G. Glucose tolerance test
H. Ventilation-perfusion (VQ) scan
I. Bile acid level
J. Cardiotocograph

Correct I. Bile acid level

19

4. A 27 year old woman is in spontaneous labour. She is progressing well and you are informed that she was 9cm dilated at the last vaginal assessment. There have been persistent late decelerations on the cardiotocograph with reduced baseline variability.

A. Kleihauer test
B. Chest X Ray
C. Abdominal ultrasound for fetal growth
D. HIV ELISA assay
E. Fetal blood sample
F. Echocardiogram
G. Glucose tolerance test
H. Ventilation-perfusion (VQ) scan
I. Bile acid level
J. Cardiotocograph

Correct E. Fetal blood sample

20

5. A 20 year old woman presents for a routine 28 week appointment to the antenatal clinic. She mentions that she has had episodes where she ‘feels her heart racing’ and this has made her feel dizzy twice. This has never happened before pregnancy. On auscultation there is a grade 2 ejection systolic murmur.

A. Kleihauer test
B. Chest X Ray
C. Abdominal ultrasound for fetal growth
D. HIV ELISA assay
E. Fetal blood sample
F. Echocardiogram
G. Glucose tolerance test
H. Ventilation-perfusion (VQ) scan
I. Bile acid level
J. Cardiotocograph

Correct F. Echocardiogram

21

1. You are asked to see a 25 year old woman who is complaining of sudden onset of shortness of breath and chest pain 24 hours after an emergency caesarean section. The midwife informs you that the oxygen saturation probe is showing a reading of 91% on room air. On examination the respiratory rate is 25/min and the pulse is 110/min.

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 J. Pulmonary embolism

22

2. A 30 year old diabetic woman presents to the accident and emergency department 5 weeks after an emergency caesarean section for fetal distress in labour. She is complaining of a ‘lump’ in her abdomen. She now has three children, all delivered by caesarean section. Her BMI is 36 kg/m2. On examination, there is a non tender lump under the right hand portion of the caesarean scar. The lump is more prominent when she stands up and a cough impulse can be felt.

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 C. Incisional hernia

23

3. You are called to assess a 37 year old woman on the post-natal ward. She had an elective caesarean section yesterday for a breech presentation. The foley catheter was removed after 24 hours. She complains of urinary frequency and dysuria. The urine shows leucocytes, nitrates and ketones on dipstix.

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 D. Urinary tract infection

24

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

25

5. You are reviewing a 25 year old woman on the post-natal ward. She had a caesarean section two days ago electively for maternal request. There is a soft, boggy swelling beneath the left hand end of the abdominal wound. The swelling is tender and non-reducible, with no cough impulse. The skin over the swelling is dark blue-black.

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 G. Wound haematoma

26

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

27

2. You are called to see a 35 year old woman who is in labour. She was last examined 4 hours ago when the cervix was 6cm dilated. The cardiotogograph indicates a fetal heart rate of 70bpm for the last 10 minutes. There is meconium staining of the liquor. You perform a vaginal examination which shows the cervix to be 8cm dilated.

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 B. Perform caesarean section

28

3. A 38 year old woman is being induced at 41+5 weeks’ gestation in her first pregnancy. She has had an uneventful pregnancy so far. She has been given 2 doses of prostaglandin by the midwives on the antenatal ward and had an amniotomy (artificial rupture of membranes) 4 hours ago. She is not contracting. The cardiotocograph is reassuring.

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 E. Start syntocinon infusion

29

4. At 10pm you are called to see a 25 year old woman who is in labour at 41 weeks’ gestation. At 6pm cervical assessment showed a dilatation of 6cm. The cardiotocograph shows the fetal heart rate to have a baseline of 150bpm, with reduced variability for 1 hour. There are also variable decelerations present for the last hour. Vaginal examination reveals the cervix to be 9cm dilated and the head is at the level of the ischial spines. The liquor is clear.

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 C. Perform fetal blood sample

30

5. A 28 year old woman is brought to the labour ward by ambulance with heavy vaginal bleeding. She is 37 weeks pregnant and the bleeding began 30 minutes ago and is running down her legs. She is complaining of constant abdominal pain. The midwife is listening to the fetal heart and the rate is around 60bpm. Vaginal examination reveals a closed cervix with fresh bleeding from the external os.

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 B. Perform caesarean section