Obs+gynae past papers 16-21 Flashcards by Fran Scott

A 39 year old woman, gravidity 2 parity 0 at 39 + 3 weeks’ gestation is on the labour ward. She presented in spontaneous labour with a history of regular contractions every 4-5 minutes, lasting 30 seconds. Her MEWS (maternity early warning score) is 0. The foetal heart rate is reassuring. At 09:00 she was 2 centimetres dilated on vaginal examination. At 13:00 she was 5 centimetres dilated and at 17:00 she was 6 centimetres dilated. What is the most appropriate next step in management?

a. Artificial rupture of membranes
b. Commence oxytocin
c. Perform a caesarian section
d. Perform a membrane sweep
e. Wait for 2 hours and reassess

a. Artificial rupture of membranes

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A 35 year old woman and her male partner have been trying to conceive for 5 months. They have no underlying medical conditions and do not smoke. They have regular sexual intercourse. The woman has regular 31 day menstrual cycles. Which is the most appropriate next step in management?

a. Perform a female hormone profile
b. Perform a pelvic ultrasound scan
c. Perform a semen analysis
d. Reassure and advise to return in 7 months if not pregnant
e. Reassure and advise to return in 19 months if not pregnant

d. Reassure and advise to return in 7 months if not pregnant

1 year of unprotected sex

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A 24 year old woman in her first pregnancy, is in spontaneous labour on the labour ward. She is using Entonox for analgesia and has now been in the second stage for 3 hours. She has been in good descent from pushing for 2 hours. The baby is in the cephalic presentation in an occipito-anterior position, vertex below the ischial spines. The foetal heart rate has been suspicious for 30 minutes. Which is the most appropriate management in this scenario?

a. Caesarean section
b. Epidural analgesia
c. Episiotomy
d. Forceps delivery
e. Ventouse delivery

d. Forceps delivery

episiotomy beforehand

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A 27 year old woman is seen in the antenatal clinic for a routine appointment. She has a black eye which has been covered with makeup. When asked, she does not provide a clear cause for her injury. Which is the most appropriate initial course of action.

a. Refer to safeguarding midwife
b. Refer to the Caldicott guardian
c. Refer to the Emergency Department
d. Refer to the police
e. Refer to women’s aid

a. Refer to safeguarding midwife

+ Womens aid

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A 39 year old woman has a transvaginal ultrasound scan at 6 weeks of pregnancy, in which an intrauterine gestational sac was seen. She attends the Emergency Department 2 weeks later with 2 days of heavy vaginal bleeding. A transvaginal scan shows a normal endometrium. Both ovaries appear normal. There is no adnexal mass but there is a small amount of free fluid in the Pouch of Douglas. Which is the most likely diagnosis?

a. Complete miscarriage
b. Ectopic pregnancy
c. Incomplete miscarriage
d. Molar pregnancy
e. Pregnancy of unknown viability

e. Pregnancy of unknown viability

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A 42 year old woman is 12 weeks into her third pregnancy. She would like to have screening for Trisomy 21. Which is the most sensitive screening test?

a. Amniocentesis
b. Chorionic villous sampling
c. Non-invasive pre-natal testing (cell free DNA)
d. Nuchal translucency
e. Quadruple test

c. Non-invasive pre-natal testing (cell free DNA)

(becoming more common in the NHS)

(amniocentesis and CVS are diagnostic tests, not screening)

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A 27 year old woman in the early pregnancy unit has light vaginal bleeding, 6 weeks after her last menstrual period. Transvaginal ultrasound scan (USS) shows an intrauterine gestation sac. There was no visible yolk sac or foetal pole. Which is the recommended management?

a. Arrange a repeat USS in 10-14 days
b. Arrange a repeat USS in 48 hours
c. Offer management for miscarriage
d. Reassure and discharge
e. Take beta-HCG and repeat in 48 hours

a. Arrange a repeat USS in 10-14 days
(6 weeks is quite early and a foetal pole may not develop until 9 weeks)
(pregnancy of unknown viability)

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A 38 year old woman has a total abdominal hysterectomy for dysmenorrhoea. Histology shows that there were CIN 1 changes in the cervix, which were completely excised. Which is the most appropriate follow-up?

a. Back to routine smear recall
b. Colposcopy in 6 months
c. No follow up required
d. Vault smear in 6 months
e. Vault smear in 12 months

d. Vault smear in 6 months
(in total the cervix is also removed)
(CIN 1 is local and 1/3of lower epithelium)
Smears… if total or radical AND done due to cancer / CIN, smears are still done at 6 and 18m

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A 35 year old woman has a severe headache 24 hours following an elective cesarean section for placenta praevia under regional anaesthesia. It is worse on sitting up and better when she is lying down. Her temperature is 37.3C, heart rate 90 bpm, blood pressure 124/64 mmHg, respiratory rate 12 breaths per minute, oxygen saturation 98% breathing room air. Which is the most likely cause of her headache?

a. Cerebral venous sinus thrombosis
b. Meningitis
c. Migraine
d. Post-dural tap headache
e. Pre-eclampsia

d. Post-dural tap headache

process of elimination

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A woman sees her GP at 12 weeks gestation. Which vaccines should she be recommended?

a. BCG and pertussis
b. Influenza and pertussis
c. Influenza and rubella
d. Pertussis and varicella zoster
e. Rubella and varicella zoster

b. Influenza and pertussis

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A 32 year old woman is mixed feeding her 3 week old baby and complains of a tender left breast, which is more swollen than the right. She does not have a fever and is otherwise well, but reports some redness to the skin. Which advice should she be given as regards to infant feeding?

a. Continue feeding from both breasts
b. Express milk from the left breast and discard
c. Feed only from the left breast
d. Feed only from the right breast
e. Switch to formula feeding

a. Continue feeding from both breasts

(If breastfeeding is too painful, or the infant refuses to breastfeed from the affected breast, advise the woman to express the milk (by hand or with a breast pump) until she is able to resume breastfeeding from that breast.)

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A 37 year old woman on the Maternity Assessment Unit is 28 weeks pregnant. She has a sudden onset of chest pain. She reports some shortness of breath on minimal exertion. She smokes 2 cigarettes per day and has a BMI of 30 kg/m2. She has known hypercholesterolaemia. She needs to use 3 pillows to sleep comfortably at night. She works long hours at her desk from home. Which is the most likely diagnosis?

a. Cardiomyopathy
b. MI
c. Musculoskeletal pain
d. Oesophageal reflux
e. PE

e. PE

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A 22 year old woman with cystic fibrosis attends the obstetric medicine clinic for preconception counselling. Development of which obstetric complication is she at greatest risk, given her pre-existing disease?

a. Foetal congenital malformation
b. Gestational diabetes
c. Obstetric cholestasis
d. Pregnancy induced hypertension
e. Spontaneous miscarriage

b. Gestational diabetes

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A 24 year old vegan woman with alpha thalassemia trait has a booking haemoglobin of 115 g/L (115 - 150), WCC 7.9 x 10^9/L (3.8 - 10), platelets 230 x 10^9/L (150 - 400). At her 28 week appointment her Hb is 106 g/L, WCC 8.9 x 10^9/L, platelets 195 x 10^9/L. Which is the most likely cause for these test results?

a. Alpha thalassaemia
b. Diet
c. Myeloproliferative disorder
d. Physiological change
e. Retroplacental bleeding

d. Physiological change

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A 20 year old woman has abdominal discomfort for 3 months. A pregnancy test is negative. An ultrasound scan shows a complex cystic pelvic mass with solid components. Which is the most likely diagnosis?

a. Endometriosis
b. Epithelial ovarian cancer
c. Fibroids
d. Germ cell tumour of the ovary
e. Uterine sarcoma

d. Germ cell tumour of the ovary

most common benign growth under 30

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A 10 year old girl with BMI 28 kg/m2 is seen in adolescent gynaecology outpatients. She has breast bud development and some axillary hair. There are no other features of secondary sexual characteristics or galactorrhoea. Which is the most appropriate next step in management?

a. Follow-up in 2 years
b. Hormone profile
c. MRI brain
d. Pelvic ultrasound scan
e. Reassure and discharge

e. Reassure and discharge

not precocious or disturbing, expected of her BMI

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A 48 year old woman has a progesterone IUS in place. She complains of a 1 year history of palpitations, night sweats, fatigue, irritability and vaginal dryness. What is the most appropriate treatment?

a. Oral oestrogen
b. SSRIs
c. Tibolone
d. Transdermal oestrogen
e. Vaginal oestrogen

d. Transdermal oestrogen

not unopposed due to IUS

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A 40 year old woman with uterine fibroids require the active management of the third stage of labour. At which point in labour should IM syntocinon (oxytocin) be administered?

a. When the anterior shoulder has been delivered
b. When the head has been delivered
c. When the neonate has been delivered
d. When the trunk has been delivered
e. When the vertex is crowning

a. When the anterior shoulder has been delivered

not sure if this changes with fibroids

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A 55 year old woman in gynaecology outpatients has a BMI of 23.5 kg/m2 and a history of stress incontinence. Pelvic floor exercises have not improved her symptoms. Which is the most appropriate next step in management?

a. Hysterectomy
b. Intra urethral bulking
c. Ring pessary
d. Surgical repair
e. Weight loss

b. Intra urethral bulking
(surgery)

or ring pessary, they are both second line

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A 34 year old woman has an evacuation of retained products of conception, which are sent for cytogenetics. She is told she had a molar pregnancy. Which is the most appropriate follow up?

a. Chest x-ray
b. CT pelvis
c. Serial pipelle endometrial biopsy
d. Serial quantitative beta-HCG
e. Serial ultrasound scans

d. Serial quantitative beta-HCG

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A 23 year old woman has superficial dyspareunia and type 3 female genital mutilation. Which is the most appropriate next step in management?

a. Make a safeguarding risk assessment
b. Offer reversal surgery
c. Refer for psychosexual counselling
d. Refer to police
e. Refer to social services

b. Offer reversal surgery

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A 56 year old woman has a 6 month history of urinary incontinence and urgency, which is affecting her personal life. Urine microscopy is negative. Which is the most appropriate first investigation?

a. Bladder diary
b. Cystoscopy
c. Pad tests
d. Pelvic ultrasound
e. Urodynamics

a. Bladder diary

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A 23 year old woman complains of severe dysmenorrhoea every month for the last 6 months, lasting 3-4 days after her period ends. It is not relieved by regular paracetamol and a hot water bottle. Which is the most appropriate next step in management?

a. List for laparoscopy
b. Organise a pelvic CT scan
c. Organise a pelvic ultrasound scan
d. Perform a hormone profile
e. Perform a sexual health screen

c. Organise a pelvic ultrasound scan

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A 19 year old woman presents with an acutely painful large swelling near the opening of the vagina. She is unable to sit and passing urine is uncomfortable. Her last menstrual period started 2 days ago. Which is the most likely diagnosis?

a. Bartholin’s abscess
b. Bartholin’s cyst
c. Congenital urethral cyst
d. Urinary tract infection
e. Vaginal endometriosis

a. Bartholin’s abscess

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A 57 year old woman in General Practice has vulval itching and passes urine more frequently. She denies any vaginal discharge. The vulval area looks dry with evidence of excoriation marks. There is an area of paler skin near the introitus. Urinalysis showed 1+ leukocytes only. Which is the most likely diagnosis? a. Atrophic vaginitis b. Lichen sclerosus c. Urinary tract infection d. Vaginal candida e. Vaginal malignancy

b. Lichen sclerosus

A 34 year old woman attends her GP for her 32 week antenatal appointment. She feels well in herself and has regular foetal movements. She has had normal scans to date and an uncomplicated pregnancy. Her temperature is 36.8C, pulse 93 bpm, blood pressure 113/72 mmHg, and oxygen saturation 98% breathing air. Her booking blood pressure was 110/68 mmHg. Urinalysis - negative Ketones - negative Blood - negative Protein - 2+ Nitrites - negative Leukocytes - negative Which is the most appropriate next step in management? a. Ask midwife to review in 2 weeks b. Reassure and review at 36 week antenatal appointment c. Refer for antenatal same day assessment d. Send a mid-stream urine for microscopy, culture and sensitivity e. Send a protein creatinine ratio

e. Send a protein creatinine ratio ??? c. Refer for antenatal same day assessment ??/

A 30 year old woman presents to General Practice 2 weeks after delivery of her first baby. She has low mood, exhaustion, difficulty sleeping, and is very tearful for the last week. She felt well during her pregnancy. She is bonding well with her baby and has good support at home. She has a history of depression but has been stable for the last 2 years. She has no thoughts of self-harm or suicide. Which is the most likely diagnosis? a. Adjustment disorder b. Baby blues c. Dysthymia d. Postnatal depression e. Recurrent depression

b. Baby blues

A 35 year old woman in General Practice is 10 weeks pregnant and has worsening nausea and vomiting daily for 3 weeks. She is now struggling to keep down fluids but still passing urine. ``` Urinalysis: Glucose - negative Protein - negative Ketone - negative Blood - negative Nitrites - negative Leukocyte - negative Which is the most suitable management option? a. Admit to hospital b. Advise ginger tea c. Avoid heavy meals d. Offer cyclizine e. Offer ondansetron ```

d. Offer cyclizine

A 21 year old woman in General Practice has a 6 month history of irregular periods. She has gained 3 kg in weight over the last 4 months. Her BMI is 28 kg/m2 and she has cystic acne on her back. Which blood tests could support the most likely diagnosis? a. Cortisol, fasting glucose b. HbA1C, fasting lipids c. LH, FSH, SHBG, testosterone d. Prolactin, growth hormone e. TSH, free T4

c. LH, FSH, SHBG, testosterone | PCOS

A 42 year old woman in General Practice has 6 weeks of intermenstrual and post-coital bleeding. She is married with two children. She has no vaginal discharge. She has not previously taken hormonal contraception. Her last smear was normal 2 years ago. Which is the most likely diagnosis? a. Cervical cancer b. Endometrial cancer c. Endometrial polyp d. Ovarian cancer e. Sexually transmitted infection

cervical cancer or polyp

A 35 year old woman in General Practice has epilepsy and is currently taking sodium valproate and desogestrel. She has not had a seizure for 13 months. She and her boyfriend would like to conceive a child. Which is the most appropriate management option? a. Perform blood tests to check sodium valproate levels b. Reduce sodium valproate dose c. Refer to epilepsy clinic, continue current medication in the meantime d. Refer to epilepsy clinic, meanwhile switch to a different anti-epileptic e. Stop all medication now and refer to epilepsy clinic

c. Refer to epilepsy clinic, continue current medication in the meantime

A 60 year old woman in General Practice has 4 months of urinary frequency, nocturia, and urgency with occasional leaking of urine. She has no abdominal or back pain. Her temperature is 36.8C. Which is the most appropriate initial investigation? a. HbA1C b. Renal USS c. Urea and electrolytes d. Urinalysis e. Urodynamics

d. Urinalysis

A 28 year old woman with a twin IVF pregnancy has a scan at 18 weeks gestation. This shows a marked difference in foetal size with oligohydramnios in one twin and polyhydramnios in the other twin. What is the most likely diagnosis?

twin to twin tranfusion syndrome

A 36 year old woman presents with spontaneous rupture of membranes at 33 weeks’ gestation. She has no abdominal pain. Speculum examination confirms a <1cm dilated cervix. She has no allergies. Her temperature is 36.6C, pulse 88 bpm, BP 110/55 mmHg, respiratory rate 16 breaths per minute, oxygen saturation 99% breathing air. What antibiotic should be prescribed in this scenario?

erythromycin

An active 50 year old who has no medical problems has a total abdominal hysterectomy for large multiple fibroids. She loses 300mls of blood. The procedure is uncomplicated. For how long should she be advised to take bed rest following discharge home?

off work for 4 weeks, bed rest for 1 weeks

A 36 year old woman with a long history of dysmenorrhoea and cyclical rectal bleeding presents with worsening abdominal pain. Regular paracetamol has not eased her symptoms. She has been trying to conceive for 8 months. Her LMP was 3 weeks ago. What is the most likely diagnosis?

endometriosis

A woman is admitted at 12 weeks with severe nausea and vomiting. She requires three different anti-emetic treatments and IV fluids. What supplement must also be prescribed in this scenario?

pabrinex

A 27 year old woman who is low risk at booking has her booking blood tests taken by her midwife. Her results show she is HIV negative and syphilis negative. For what other virus must she be tested?

Hep b

A 33 year old woman is seen at 7 weeks of pregnancy for booking. She has a history of ectopic pregnancy and salpingectomy, two first trimester miscarriages, a miscarriage at 23+5 weeks’ gestation, two failed IVF cycles and a premature delivery at 27 weeks’ gestation. The infant died of complications related to prematurity four weeks later. What is her gravidity and parity? (Your answer should be expressed in the format: GX PX)

G6P1

A woman is due to have an elective caesarean section for breech presentation at 39 weeks’ gestation. For how many hours should she be fasted for solids prior to the operation? Your answer should be expressed numerically in the form: X hours

6 hours

A 20 year old woman with epilepsy presents with an unplanned pregnancy at 12 weeks’ gestation. She takes sodium valproate for seizure control. Which congenital abnormality is she most at risk of developing?

neural tube defects | cleft palate

A 27 year old woman has a non-viable pregnancy at 6 weeks with a beta-HCG of 28,000 IU/L. What malignancy is she at greatest risk of developing?

choriocarcinoma

A midwife is on her own with a patient on the labour ward. She states that the head has been delivered for 4 minutes but the body is not coming. The woman is lying flat on her back at the end of the bed. Name the first manoeuvre that should be performed in this scenario?

mcroberts

A 19 year old woman complains of irritability, aggression and low mood every month. She has no other medical conditions, takes no regular medication and is sexually active. The symptom diary shows that her work and social life are being affected in a cyclical way. What, specifically, is the aim of the hormonal management in this scenario?

to stop ovulation and therefore the luteal phase

A 27 year old woman has a complete molar pregnancy and only receives surgical management. She subsequently has regular serum beta-HCG monitoring. For how long should she be told to avoid pregnancy after the beta-HCG has returned to normal? (Your answer should be expressed numerically in the form: X months)

6 months

A 65 year old woman presents with a lump in her vagina, which has been getting worse over many years. She finds it difficult to evacuate her bowels and now needs to digitate her vagina to do so. What is the most likely diagnosis?

anal prolapse | rectocele

A 24 year old woman with a BMI of 22 kg/m2, has an elective, uncomplicated laparoscopic procedure for removal of a 6 cm simple ovarian cyst. Assuming good postoperative recovery, after how long would she be appropriate to be discharged? (Your answer should be expressed numerically in the form: X hours)

12 hours

A 30 year old woman in the third trimester of her first pregnancy develops an itchy, bumpy rash on her abdomen, with sparing of the periumbilical area. She is usually fit and well and has had an uneventful pregnancy so far. What is the most likely diagnosis?

polymorphic eruption of pregnancy

A baby girl is seen for her 6 week baby check in General Practice, with resolving yellow discolouration of the skin. She was born at term and is following the 25th centile for height and weight. She is breastfeeding well and stools are normal. What is the most likely diagnosis?

breast feeding jaundice

A 36 year old woman presents with a 4 day history of lower abdominal pain, dyspareunia and offensive vaginal discharge. She denies any bowel or urinary symptoms. She takes the combined oral contraceptive pill only and denies any missed pills. Her temperature is 38.2C. Her lower abdomen is mildly tender on palpation. Vaginal and speculum examinations are normal and pelvic swabs are taken. Her urine dipstick is normal. What is the most likely diagnosis?

PID

A 9 week pregnant woman has a routine urine dipstick during an antenatal check. The urine is positive for leukocytes and nitrites. She is asymptomatic. She has no previous past medical history. She is allergic to penicillin. What medication should be prescribed in this scenario?

nitrofurantoin

A 25 year old woman is having her first smear in General Practice. The nurse notices an absent clitoris and labia minora with surrounding scarring. What is the most likely diagnosis?

female genital mutilation type 2

1. Woman with sickle cell trait, wants to know the risk of the baby getting it, what would you do?

test father with Hb electrophoresis - if he is carrier then 1 in 4 of disease 75% of being carrier

2. Woman left a tampon in for 4d and has now taken it out but systemically well, what would you do?

safety net for toxic shock

3. Woman (19 years old) on COCP who smokes a bit starts developing migraines w/o aura, what would you do?

leave her alone to live her life

4. Rh negative, minor bleed at 9 weeks, resolves in 48 hours. What do you do?

nothing as before 12 weeks

5. 23yo with hx of FGM 6 years ago and now urge incontinence which is causing low mood, has two younger brothers, what do you do?

offer reconstructive surgery

6. Pregnant woman with chickenpox exposure, unsure of hx, what do u do?

varicella antibody levels

7. Preg woman w history of cocaine and cannabis use, hasn’t done drugs for the last 3 years, what would midwife do in addition to booking bloods?

Hep C test if IVDU drug use

8. What would NSAID use in the last trimester lead to?

PDA closure | renal issues

9. Preg woman at like 32w, OGTT at 28w was normal but now had glycosuria twice in preg, foetal parts difficult to palpate what would you do?

repeat OGTT

10. 6w post birth, feels sad, most likely dx?

depression as after 4 weeks

11. Woman after diagnostic laparoscopy had acute urinary retention which was treated and then had the catheter removed, when can she safely go home?

when she passes urine on her own and no retention on bladder scan

12. Woman planning to mix feed her baby after birth. When can she expect period to return?

6-8 weeks | But cannot give definite time

13. Lady with ectopic wants to know how long after methotrexate tx you can/should wait to get pregnant?

3 months as one off dose

14. Epileptic on sodium valproate with copper IUD wants to get pregnant, what do you do?

change to another medication - monotherapy | refer to specialist for changing medication

15. Woman with low lying placenta on 20w scan, which has moved up but succenturiate lobe seen, what dx must you exclude?

vasa praevia

16. Husband comes in with his wife as one week post birth she has started thinking her baby is an alien. What is the most likely diagnosis?

puerperal psychosis

17. 61 year old smoker, 6 month history of itchy vulva. 8mm raised and tender lesion on the vulva. What would you do next?

biopsy

18. Tender nodule on uterosacral ligaments found in woman with painful periods (?). What is the most likely diagnosis?

endometriosis

19. Woman with severe pain due to fibroids in pregnancy. Opiate does not help. 32 weeks pregnant. Management?

continue opiates

20. Antenatal scan at 18-20 weeks? See echogenic bowel on ultrasound. What is the significance of this?

trisomy 21

21. Woman with cord prolapse during labour. What is the definitive management?

lift the presenting part then c section DELIVERY (if quickest)

22. Lady in first trimester, vomiting lots, tried having cyclizine 50 mg once a day but it did not work. What should she try next?

prochlorperazine

23. Woman with irregular bleeding, 6 weeks ago LNG-IUS fitted in. Ix?

nothing as expected could check strings pregnancy test

24. Woman had a dating scan at 12 weeks, foetal CRL equivalent to 9 weeks foetus but no heart beat. Mx?

expectant, medical or surgical if mother wants

25. Photo of white lesion on labia, painful urination. Tx?

lichen scleorsus

26. 17 year old, amenorrhoea and something else. What investigation would confirm the diagnosis?

ultrasound of ovaries

27. Woman with menorrhagia and fibroids on USS. Tried tranexamic acid but unsuccessful. Next mx?

COCP

28. Pregnant woman has dysuria, frequency and urgency. Otherwise well. Mx plan?

abx - nitrofurantoin | depends on gestation

29. Woman with 1+ protein on urine dipstick but normal blood pressure at 32 weeks. Mx?

reassess in one week monitor closely and quantify proteinuria with something else lol???

30. 19 year old with post-coital bleeding for 3 weeks, had an implant inserted 18 months ago. Vaginal and speculum exam are normal. Pregnancy test negative. Next mx?

STI screen with swabs

31. Woman with dyspareunia, low mood, sweating, amenorrhoea for over a year. Previously breast cancer which was treated with chemo. Ix?

hormone Profile to see if menopause | Lh and FSH

38 weeks pregnant woman has irregular painful contractions for 6 hours, took paracetamol 6 hours ago. Cervix 2cm dilated. Which analgesia?

entonox

33. Large ovarian cyst removed at cystectomy found to be complex with solid components. Dirty fluid, fat, grease, hair shafts. Histological dx?

mature teratoma

34. 60 year old woman with PMB. Biopsy of a suspicious lesion taken from endometrium. Mx?

TAH

35. Woman with PMB and BMI of 40. USS scan shows thickened endometrial lining. Endometrial sampling in clinic not feasible due to cervical stenosis. Next mx?

hysteroscopy and biopsy under anaesthetic

36. Woman with dragging sensation in vagina when exercising. Weakened anterior vaginal wall but no descent to introitus on straining. Next mx?

lifestyle measures, lose weight if BMI over 30 can try pessary, such as ring or pelvis floor exercises

37. 60 year old woman with dyspareunia and vaginal dryness. Best mx?

lubricants or oestrogen cream

38. Woman with SOB, abdo pain, nausea, bloating, feeling faint. Having IVF cycle and embryo transfer 3 days ago. Dx?

ovarian hyperstimulation syndrome

39. Woman with excessive vomiting, 10 weeks pregnant and BP 180/110 mmHg. Fundal height consistent with 16-week pregnancy. Dx?

molar pregnancy

40. 17 year old girl with delayed menarche, short stature. High FSH and LH. Most definitive ix?

karyotyping

2. Woman with itch and picture of belly (this exact picture) with striae, what is most likely dx?

polymorphic eruption of pregnancy

3. 7 year old with foul smelling vaginal discharge, most likely cause?

foreign body

4. 47-year-old woman has a thickened endometrium with cystic spaces on TVUSS. What investigation is most diagnostic?

hysteroscopy with biopsy

5. Yellow frothy offensive PV discharge. She is afebrile, had sex 3 weeks ago. Has dysuria for the past few days and an itchy vulva. Most likely dx?

6. A woman has regular menstrual cycles of 35 days. LMP was 27/11/2019. What is her EDD (write answer in DD/MM/YYYY format)?

9th September 2020

7. After a stillbirth, a woman is distressed, what drug would you give to stop breast milk production?

cabergoline

8. Woman is planning waterbirth. She is low risk with no increased complications. What complication of normal delivery is increased by water birth?

infections

9. 8 days post birth, woman is confused and thinks police will take away her baby. Most likely diagnosis?

puerperal psychosis

10. A woman during labour (37 weeks gestation) is 5cm dilated and contracting 4:10 minutes. Becomes agitated and behaving oddly. She has extreme SOB, suddenly collapses. Begins to bleed from IV cannula site. She is hypotensive and sats are 78%. Afebrile and tachycardic. Most likely dx?

amniotic fluid embolism

11. A woman has had three miscarriages (week 7, 8 and 11), one ectopic (which was treated with lap salpingectomy). She also had stillbirth at 24 weeks. She has a daughter and is now again pregnant (6 weeks gestation). Calculate gravidity and parity

G7 p2

12. Woman is 5 weeks (?12 weeks - i think it was 5 weeks) pregnant with abdo pain. U/S shows no intrauterine pregnancy, corpus luteum on left ovary, normal adnexae. hCG is 700. How should this pregnancy be classified?

pregnancy of unknown location

13. 80 year old woman with BMI of 25, and COPD and angina. She has back pain and dragging sensation. She has a uterine prolapse, normal pelvic U/S. What is the most appropriate treatment?

surgery should be avoided due to comorbidities | pessary, e.g. ring

14. Woman had two vaginal deliveries in the past. Has urodynamics for urinary dysfunction. Report shows unprovoked pressure peaks with urinary leakage. What is the diagnosis?

urge

15. Which strains of HPV are targeted by quadrivalent vaccine?

6, 11, 16, 18

16. A woman has a 2 year history of subfertility with oligomenorrhoea and PCOS. BMI is 32. Husband has normal semen analysis. She has tried a 6 month course of metformin. What is the most appropriate medication to treat subfertility?

clomifene

17. A woman wants emergency contraception - 5 days after unprotected sex. Most effective option for her?

copper coil

18. Pregnant woman at 28 weeks in GP. Normal antenatal scans. Has had influenza vaccine. What other vaccine does she need?

pertussis

19. Woman with IUD goes to GP with lower abdo pain and spotting. Obs are normal. Most appropriate Ix?

pregnancy test

20. Woman in GP wants contraception. She has severe menorrhagia and gastric sleeve bypass 12 months ago. What is 1st line contraceptive management?

intrauterine - IUS as menorrhagia

1. Woman with a little bit of pink post-coital bleeding on wiping. Smear is fine, ultrasound is clear. What is the next |investigation?

hysteroscopy with biopsy

2. Secondary amenorrhoea. Table shows high prolactin and low LH

prolactinoma

3. Woman with secondary amenorrhoea for 6 months. High FSH and LH. Diagnosis?

POI

4. Girl with acanthosis nigricans and amenorrhoea.

PCOS

5. Twins, presenting twin is breech, other cephalic. How to deliver?

c-section

6. Woman had abdo trauma 32 week. Had her anti-D at 28 weeks - what to do next?

kleihauer test and give anit D

7. HIV positive woman - what is the most important factor deciding her mode of delivery?

viral load

8. Total abdo Hysterectomy yesterday. Woman goes upstairs and faints. Normal BP. DX.

pain???

9. Gravidity and Parity Q - currently pregnant woman with hx of 1 x 37 week stillbirth, 1 x current 7 week pregnancy, 1 x premature baby, 1 x miscarriage

G4 P2

10. Lady who had a tear after delivering baby, a few days later has offensive discharge, no fever or other symptoms

infection

11. Girl with dyskaryosis has colposcopy and biopsy showing CIN1. When should next colposcopy be?

smear in 12 months

1. Itching in third trimester, what is the most important investigation?

bile acids / LFTs

2. 23yr old woman with dyspareunia and FGM. What do you do?

offer deinfibulation and psychosexual counselling

3. 30 yr woman with last menstrual period on 25th August, 31 days cycles. What is the EDD?

June 4th (as longer cycle)

4. Pregnant woman has scan which shows anencephaly, until when can she have a TOP?

some people say at any point???

5. Woman wants to terminate her 8 week pregnancy because she already has 3 children - which clause of the abortion act does this fall under?

D or A depending on what guidelines you use lol

6. Hysterectomy yesterday. How long to stay off work for:

4 weeks

7. 45F. Wertheim’s hysterectomy. Last cervical smear 2 years ago. When next smear?

6 months

8. Post-LLETZ, when is her next smear?

6 months??? proof or cure smear?

9. Girl has regular sex for 3 months but no kid yet. How much longer she should try before further investigations should be done?

9 months

10. Lambda sign on USS - DCDA? When do you deliver?

37weeks (dichorioinc twins)

11. 38 weeks pregnant, acute onset pain -

placental abruption

12. Woman in stage 2 of labour, pushing for 30 minutes, head pressing against perineum, when CTG becomes pathological - what do you do next?

pudendal block, episiotomy and forceps

13. Woman with fever, deep dyspareunia

PID

14. Woman who is going away for 4 months or 3 weeks with heavy, irregular periods, wants something that will regulate her periods + make them lighter (possibly repeat)?

COCP

15. 32 year old with raised LH/FSH and amenorrhoea

premature ovarian insufficiency

16. 16 year old girl suffering from PMS - what is the next step?

lifestyle advice then COCP +/- CBT

17. LH raised more than FSH (3:1) -

PCOS

18. Woman has come for a sterilisation, has had protected sex (definitely protected) since her last menstruation one week ago, just post-ovulation - immediate tx?

pregnancy test?? should be fine

19. Woman has menopausal symptoms and wants to start HRT, last period 6m ago

cyclical

20. Woman with dribbling all the time and had to wear a pad

overflow incontinence

21. Woman with stress incontinence, with prolapse + leakage on coughing and standing, 1st line treatment -

pelvic floor exercises

22. Bloating, raised CA125, next step?

ultrasound of ovaries

23. Which test for Down syndrome screening at 15 weeks?

quadruple

24. Smoker, which extra tests does she require in pregnancy

doppler and extra growth scans

25. Protein 1+ in urine, BP normal, what does she have?

transient proteinuria or PET

26. Previous baby 5.1Kg and mother has diabetes, fasting glucose and OGTT normal - what extra tests should be arranged for her?

OGTT at 28 weeks again

27. Woman had a 3B tear previously, what mode of delivery for current pregnancy?

c-section if she chooses

28. Lady with pain on (left?) breast,mastitis, given antibiotics by GP - what other breastfeeding advice do you give her?

keep breast-feeding

29. Complex mass with solid components on ovary on USS 23y female

dermoid cyst

30. PMB, 5mm endometrial thickness, what do you do next?

pipelle biopsy or hysteroscopy

31. Young girl, no sexual hx, white discharge, vulval itching

thrush

32. Creamy white discharge, sexually active

thrush most likely due to colour

33. Treatment for candidiasis?

fluconazole orally | topical clotrimazole

34. Woman with sodium valproate wants to get pregnant but has relapsed when coming off it before. What do?

refer to specialist, change medication

35. Something about carbamazepine and pregnancy

is allowed at lowest possible dose and increased folic acid, 5mg

36. 16 year old girl with secondary characteristics only and no periods.

imperforate hymen

37. Girl has kid but has large tear a few years ago and is worried about this pregnant. What do you do different in this pregnancy?

monitor closely counsel - more likely in first labour c section if chosen

38. Something about women who delivered a baby, had a tear and wants 3 more children. What to plan for current pregnancy?

vaginal delivery | also depends on the tear, if grade 3 and above can offer c-section

39. Dishevelled woman come to antenatal clinic, baby is low weight, but everytime admitted to hospital, gains weight easily

neglect - refer to safeguarding midwife

40. Mother who has normal fasting glucose and normal OGTT (ranges given)?

not diabetic

41. Treatment for menorrhagia

TXA or hormonal IUS

42. Woman gets headache 24hrs after delivery??

post tap headache (epidural)

43. Woman who has just given birth to 2 day old baby. Her 2 year old son gets chicken pox, women has antibodies. Goes to GP, what should be done?

baby should have got abs from mother | not sure on action though - IVIG to baby

44. Best test for predicting preterm labour?

foetal fibronectin??

HIV with undetectable viral load. what is contraindicated in labour? Forceps, ventouse, foetal blood sampling, c section and some other stuff.

foetal blood sampling

Standard chicken pox question. Doesn’t remember she had it. What do you do?

varicella ab levels

Woman with BMI 40, abdo distension, urinary symptoms, bowel symptoms and weight loss. What could be it?

cancer - ovarian???

72 year old woman with PMB and endometrial thickness seen on USS, what’s the diagnosis?

endometrial cancer

60 year old woman with PMB and superficial dyspareunia, what is the MOST LIKELY diagnosis?

atrophic vaginitis

A 47 year old woman with a 2 cm simple ovarian cyst seen on USS, as well as 12mm endometrium. What do you do next?

biopsy, pipelle | not sure if they are trying to lean towards granulose theca ovarian cyst ---> stimulating endometrium

Woman with rupture of membranes, painless bleeding and something along those lines. What was the likely diagnosis?

vasa praevia

Woman had an implant inserted but she’s getting it removed. What is the most likely reason why?

irregular bleeding

What cancer are you at increased risk at with HRT?

breast

Cervical os is open in a young woman early pregnancy. What is it?

inevitable miscarriage

Woman with pre-eclampsia, what drug do you give her first-line?

labetalol

Mother had rupture of membranes at like 32 weeks. What do you give her?

``` steroids and abx (erythromycin) if not active labour ```

17yr old girl wanting Emergency contraception more than 5 days after unprotected sex.

copper coil | can give after 5 days if calculated that she probably has not ovulated

Woman wants contraception basically 6 hours (I thought 6 weeks) after giving birth. What is good?

can have coil if 6 hours

Second post-partum contraception question, exclusively breastfeeding

doesn't need as lactational | but POP

Babies head comes out but it kinda goes back in. What is the cause?

shoulder dystocia

Bloods shown with raised LH and FSH and all else normal in couple trying to get pregnant. What is the first question you want to ask the woman?

period regularity?

Woman had some intrauterine growth and endometrial thickness. What was the diagnosis

fibroids

Pregnant woman with gram negative bacilli in urine microscopy. Number was a bit low and on repeat was still low. What do you do?

treat as UTI

Some girl with painful periods in the first 2 days of her period ever since menarche, she has heavy bleeding. What is it?

primary dysmenorrhea

Some woman with BP of 120/80 or so, smokes like 5 a day, what contraception for her?

COCP is fine

Woman with painful breast after giving birth. She’s breast-feeding - think she had abscess secondary to mastitis. Tx

aspirate and culture

Pregnant woman in early pregnancy with depression and anxiety on sertraline. What do you do?

stay on it if well managed

What do you do for a woman in labour after 4 hours of checking, she’s like 4cm or something

depends on contraction frequency and progression after 4cm | can ARM or give synto if already ruptured to help progression

Post partum haemorrhage with high BP

syntocinon (is given as ergometrine is contraindicated in hypertensives)

Foreign woman has come in and is pregnant. What vaccine should she be offered?

pertussis and influenza as standard

Woman with really heavy periods. What’s the first line management?

LNG - IUS

Foetus with transverse lie, recent SROM, CTG (?decel/ fetal distress). Most likely cause?

cord prolapse

HRT question for a menopausal woman with flushes and stuff, last period ?10m ago (less than a year). What do you give her?

less than a year so cyclical

What’s the management for DVT risk in a pregnant woman or something like that who’s coming in for a planned cesarean?

LMWH and ted stockings....>>?????????.... if surgery LMWH would be stopped beforehand  If on LMWH maintenance treatment  NOT inject any more if they go into labour • If delivery is planned, LMWH should be discontinued 24 hours before  Anaesthetics: • Epidural not given until at ≥24 hours after last dose of LMWH • LMWH not be given until 4 hours after the epidural catheter has been removed

Woman with raised testosterone, and other blood tests were more or less normal. LH and FSH were a bit low I think. What is the cause for her infertility?

PCOS??

Some pregnant woman with some itch. What tests do you do?

bile acids

Woman with blocked tubes, blocked tubes on hysterosalpingogram, what treatment should you do for fertility?

tubal surgery if amenable or IVF

Some smear question she is 47 y/o. It was borderline HPV negative, what do you do?

return to normal recall, 3 years

Down’s syndrome person gets pregnant. Mum is like allow that and wants termination for her and Down’s person wants to keep it. What should you do?

assess capacity

Heavy periods in a girl not sexually active. What do you give her?

TXA?????

Woman 38/40 has come in for her elective c/s, ECV failed, what do you do now?

go ahead with the elective CS

Woman previously had a abortion cos of severe spina bifida. No other clinical information given. What do you advice her on folic acid doses for her next pregnancy

5mg

Old woman with itching, some white patchy stuff

lichen sclerosus

Woman with high BMI (28) who basically had stress incontinence. What’s the first line management?

lose weight | then pelvic floor exercises

Poorly controlled diabetic mother, her newborn has an abnormal asymmetric Moro reflex - what’s wrong?

brachial plexus injury

What do you measure at booking for hepatitis b?

HB surface antigen

What procedure is contra-indicated in HIV pregnant woman?

foetal blood sampling

Man with azospermia - what is the most common cause?

mumps orchitis | or hydrocele

Woman on COCP, has missed 6th and 7th day pill, had unprotected sex two days ago, her urine pregnancy is clear. What to do?

emergency contraception

Woman with endometriosis, had laparoscopic adhesiolysis - had a whole range of sx - high CRP, low Hb, constipation, bowel sounds absents etc - what’s happened?

perforation

Woman with offensive smelly lochia d2 post-partum, had had some high vaginal swabs?

endometritis - broad spectrum abx

Woman at term has just SROM’d, transverse lie clear liquid but fetal distress, why?

cord prolapse

Large mum (BMI >40), head comes out then goes back in, chin not visible.

shoulder dystocia

70yo w/ 2 pmbs, TVUS shows 6mm endometrium and 3 cm simple ovarian cyst. Next step?

pipelle biopsy or hysteroscopy

Woman who is exclusively breastfeeding for 6 weeks? and wants contraception-

inform of lactational contraception | but can give POP

Pregnant Woman has pain and bleeding and her abdomen feels hard

placental abruption, revealed

The very last question was a bunch of tests for a woman who couldn’t conceive- all test normal and prolactin raised by like 2 points above normal value what’s most likely cause?

no cause

40 year old premature ovarian failure and wanted medication to deal with the symptoms of menopause. What would you prescribe her?

hormone replacement therapy

Woman is pregnant and HIV negative at booking but her partner is HIV positive - what do you do?

PrEP

What signifies onset of active labour?

regular and painful contractions

Woman with white discharge and itch. Which treatment?

fluconazole (pessary or tablet)

Pregnant woman with itchy feet, what investigation?

bile acids, LFTs

Gardasil. What 4 does it protect against.

6,11,16,18

UTI in the first trimester of pregnancy. What would be the safest and most effective treatment?

nitrofurantoin or cefalexin

Amenorrhoea for 4 months - what do u do?

pregnancy test

19 year old abdo swelling, weight gain, irregular periods usually, can’t remember when last period was, denies being sexually active. What is the first test you would do?

LH FSH levels

Girl with cystic ovaries on US and something else. What other symptom would be the best indicator of her having polycystic ovaries?

hirsutism

Woman with PCOS. Best medication to increase fertility

clomifene

Woman with signs of premature ovarian failure. What test would be best to confirm this diagnosis:

LH and FSH levels

Man with azoospermia. What would be the most likely cause?

mumps orchitis | or hydrocele

Post-menopausal woman with a PV bleed. What ix should you do?

transvaginal USS, pipelle biopsy

Asymptomatic woman, nulliparous, found to have a 5.4cm unilocular ovarian cyst on US, no fhx. Mgmt/Ix?

Ca 125 level

lady with cyclic pain 1 week before her period starts, trying for a baby for one year Diagnosis?

endometriosis

Woman 8 weeks after normal vaginal delivery and second degree tear, still bleeding and mild lower pelvic pain. Diagnosis?

infection of wound

What is a 23 week USS useful for?

foetal anomaly scan and placental location

What causes increased urinary volume and frequency in the first trimester?

hormonal changes, progesterone increased and beta hcg

Effect of taking paroxetine during pregnancy on baby?

1st trimester = congenital heart defects

Woman with Nexplanon. Most likely reason for wanting to change contraceptive

irregular bleeding

14 year old girl wants TOP, can’t/will not inform parents. What do you do?

assess gillick competence and find out who the father is

Pregnant lady being domestically abused by husband and scared to go home. What do you do in GP?

find emergency housing

Woman with a slow growing painless lesion on labia.

vulval carcinoma

Woman with tender lump inside her vagina.

bartholins

Young woman, pain during sex, ‘Strawberry cervix’ on examination

trichomoniasis vaginalis

Woman with cheesy white discharge

candidiasis, thrush

Old woman complaining of superficial dyspareunia

atrophic vagnitis

Womren who has gone through menopause, had a hysterectomy. Wants HRT mainly to prevent osteoporosis and treat her hot flushes. Doesn’t want to take tablets.

oestrogen patch - transdermal

Swimmer wants to treat hot flushes, doesn’t want a patch.

not cream because she's a swimmer? so pill

Woman with premature ovarian failure, wants to have periods.

cyclical HRT??????

Woman who just wants to treat osteoporosis, 62.

bisphosphonates

Lady high White cell count, fever, lump in breast

breast abscess

General breast tenderness - left sided, breastfeeding

mastitis

Small slow growing lesion on labia, pregnant lady

vulval carcinoma

Small painful lump inside vagina of sexually active lady woman

bartholins cyst

Woman has cervical cancer, is a smoker, hasnt not had a smear for 8 years - what is the most likely contibuting factor?, ?

being a smoker

Obs+gynae past papers 16-21 Flashcards

(256 cards)