ABSTRACT
In these questions candidates must select one answer only.
In which circumstance is rhesus immunization NOT required in a rhesus-negative mother?
Following amniocentesis
After delivery of a rhesus-negative baby
After a threatened miscarriage at 10 weeks’ gestation
After termination of pregnancy at 8 weeks’ gestation
After a spontaneous miscarriage at 12 weeks’ gestation
Endometrial cancer is associated with all of the following EXCEPT:
Combined oral contraceptive pills
Premarin (HRT) use in postmenopausal women with a uterus
Early menopause
Hypothyroidism
Multiple pregnancy
Routine blood tests offered at a booking antenatal clinic include all of the following EXCEPT:
HIV antibody test
Serology for hepatitis B
Haemoglobin electrophoresis in a pregnant woman from India
FBC
Clotting studies
Increased serum human chorionic gonadotrophin (hCG) is associated with each of the following EXCEPT:
Choriocarcinoma
Hyperemesis gravidarum
Pregnancy
Ovarian carcinoma
Hydatidiform mole
Cervical smear may suggest the diagnosis of all of the following EXCEPT:
Adenomyosis
Bacterial vaginosis
Trichomonas vaginalis
CIN
Invasive carcinoma of the cervix
290The following statements regarding the Mirena coil are correct EXCEPT:
It contains levonorgestrel
It controls menorrhagia
It needs to be changed every 5 years
It is not advisable in women with a past history of PID
It increases the absolute risk of ectopic pregnancy
Postcoital bleeding can occur with each of the following EXCEPT:
Cervical polyp
CIN
Trichomonas vaginalis infection
Cervical ectropion
Endometrial carcinoma
Deep dyspareunia can occur with each of the following EXCEPT:
Pelvic inflammatory disease
Ovarian neoplasm
Ectopic pregnancy
Bartholin’s abscess
Endometriosis
Intermenstrual bleeding may be associated with each of the following EXCEPT:
Subserous fibroids
Polycystic ovarian syndrome
Carcinoma of the cervix
Combined oral contraceptives
Intrauterine contraceptive device
Appropriate investigations for a 32-year-old woman 5 days after an emergency caesarean section who now presents with per vagina bleeding and passage of blood clots include all of the following EXCEPT:
Transvaginal ultrasound scan
FBC
Vaginal swab for microscopy and culture
LFTs
Clotting studies
Causes of preterm labour include all of the following EXCEPT:
Chorioamnionitis
Polyhydramnios
Cervical incompetence
Human papillomavirus
Pyelonephritis
291Complications of pre-eclampsia include all of the following EXCEPT:
IUGR
Renal failure
Thrombocytopenia
Cerebrovascular accident
Hypoglycaemia
A 20-year-old woman is diagnosed with polycystic ovarian syndrome. She does not plan to conceive in the near future. Which treatment would you offer this patient?
Cyproterone acetate (Dianette)
Clomiphene citrate
Wedge resection of the ovaries
Microgynon (combined oral contraceptive pill)
Zoladex
Causes of dysmenorrhoea include all of the following EXCEPT:
Endometriosis
IUCD (intrauterine contraceptive device)
Pelvic inflammatory disease
Subserosal fibroids
Polycystic ovarian disease
The following statements regarding ectopic pregnancy are correct EXCEPT:
Risk factor includes the IUCD
It occurs in 1 in 200 pregnancies
It may present with shoulder-tip pain
It never presents with bilateral lower abdominal pain
It may be treated with injection of methotrexate into the unruptured ectopic
Appropriate forms of contraception after delivery for a mother who plans to breastfeed include all of the following EXCEPT:
Implanon
Progestogen-only pill
Depo-Provera
IUCD
Combined oral contraceptive pill
The differential diagnosis for postmenopausal bleeding includes all of the following EXCEPT:
Carcinoma of the cervix
Adenomyosis
Endometrial polyp
Atrophic vaginitis
Endometrial carcinoma
292A 14-year-old girl complains of dysmenorrhoea. She states that she is not sexually active. The most appropriate medication would be:
Tranexamic acid
Mefenamic acid
Paracetamol
Microgynon
Fluoxetine
Management of menorrhagia may include all of the following EXCEPT:
Norethisterone tablets 5 mg three times daily for 10 days
Tranexamic acid 1 g three times daily for 3 days
Placement on the combined oral contraceptive pill
Insertion of the Mirena intrauterine system
Zoladex
A 20-year-old woman requests emergency contraception. She had unprotected sexual intercourse 48 hours ago and has not been using any form of contraception. She has never been pregnant. Her LMP was 16 days ago. What would you offer her?
Combined oral contraceptive pill
Levonelle
Mirena coil
Depo-Provera
Implanon
You are summoned by the midwife to see Mrs Elliot who has just had a spontaneous vaginal delivery. She is lying in a pool of blood. The following steps in management are correct EXCEPT:
Insert two large-bore Venflons and take blood for FBC, clotting, and type and cross-match (T + C) 2 units
Alert the obstetric registrar, senior midwife and anaesthetist
Rub the uterus and check the placenta for tears
Commence Syntocinon infusion
Consent the patient for examination under anaesthesia
A 50-year-old woman presents with worsening urinary incontinence over the past 2 years. She has had three spontaneous vaginal deliveries (SVDs) and is now menopausal. She is not taking any medication. She states that the symptoms are worse when she coughs or sneezes. No prolapse is noted on pelvic examination. The following investigations are appropriate EXCEPT:
Urine dipstick for glucose and MSU for microscopy and culture
FBC and U&Es
Pelvic ultrasonography
Uroflowmetry
Cystometry
293A 28-year-old obese woman presents with difficulty in conceiving. She also complains of deep pelvic pain, dysmenorrhoea and deep dyspareunia. Her cycles come every 21 days and last for 10 days. The most likely diagnosis is:
Polycystic ovarian disease
Endometriosis
Ovarian remnant syndrome
Chronic PID
Fibroid uterus
A 27-year-old woman complains of amenorrhoea for 6 months and weight gain since she quit smoking. Her urine pregnancy test (UPT) is negative. Her serum hormonal levels are as follows:
Serum estradiol
350 pmol/L
FSH
5 IU/L
LH
15 IU/L
The most likely diagnosis is:
Polycystic ovarian disease
Premature menopause
Endometriosis
Ovarian neoplasm
Hydatidiform mole
Postcoital bleeding may be caused by each of the following EXCEPT:
Adenomyosis
Atrophic vaginitis
Cervical ectropion
Cervical polyp
Carcinoma of the cervix
The most important initial investigation for a sexually active 17-year-old woman complaining of lower abdominal pain and irregular vaginal bleeding is:
Transvaginal ultrasonography
Urine pregnancy test
FBC
High vaginal and endometrial swab
Serum βhCG and progesterone
A 35-year-old woman of 39 weeks’ gestation is found to have a fetus in transverse lie presentation confirmed by ultrasonography. The most appropriate management is:
Episiotomy
Syntocinon i.v.
Midforceps rotation
Admit and perform external cephalic version (ECV)
Hysterectomy
294A 26-year-old woman complains of dyspareunia. On examination she is found to have a fixed, retroverted uterus and has a tender old laparotomy scar. Treatment for endometriosis may include each of the following EXCEPT:
Danazol
Norethisterone
Total hysterectomy with bilateral salpingo-ophorectomy
Diathermy
Clomiphene citrate
A 19-year-old woman who is a primigravida presents at 22 weeks’ gestation. She is noted to have ++ proteinuria and a BP of 170/110. She complains of frontal headache and nausea. You decide to admit her. Appropriate steps in management aside from taking blood include all of the following EXCEPT:
24-hour urine collection for protein
Fetal cardiotocogram
Consent for emergency caesarean section
Transabdominal ultrasonography
Intravenous hydralazine or labetalol
Appropriate investigations for recurrent miscarriages include the following EXCEPT:
Chromosomal karyotyping of both parents
Screening for antiphospholipid antibody and lupus anticoagulant
Transvaginal ultrasonography
Semen analysis
Hysterosalpingogram
Pelvic inflammatory disease is associated with all of the following EXCEPT:
Infertility
Ectopic pregnancies
Chlamydia trachomatis infection
Tubo-ovarian abscess
Endometriosis
A 22-year-old woman presents with frothy grey vaginal discharge. She states that she last had unprotected sexual intercourse 2 weeks ago. The vaginal discharge emits a fishy odour on alkalinization with potassium hydroxide and is noted to have a pH of 5. The most likely organism is:
Neisseria gonorrhoeae
Trichomonas vaginalis
Candidiasis
Chlamydia trachomatis
Gardnerella vaginalis
295A 50-year-old woman presents with an abdominal mass and back pain. She denies abdominal pain or abnormal vaginal bleeding, having had her last period 9 months ago. Cervical smears have never been abnormal. On examination there is a central mass palpable to above the level of the umbilicus. On pelvic examination there is a palpable right adnexal mass. Urine hCG is negative. The most useful initial investigation is:
Plain abdominal and lumbar spine radiographs
CT scan of the abdomen and pelvis
Serum progesterone and βhCG
Pelvic ultrasonography
CEA-125 tumour marker
A 30-year-old woman who is a primigravida has prolonged labour lasting 18 hours. The cervix is dilated to 8 cm. Fetal monitoring now shows late decelerations and a scalp pH of 7.2. The next course of action is:
Episiotomy
Syntocinon i.v.
Midforceps rotation
Vacuum suction delivery
Emergency C-section
A 20-year-old woman presents with galactorrhoea and amenorrhoea. Her urine pregnancy test is negative. The most likely diagnosis is:
Ovarian failure
Anorexia
Hypothyroidism
Prolactinoma
Cushing’s syndrome
A 30-year-old, obese, hirsute woman presents with amenorrhea. Her blood pressure is 170/90 and her urine dipstick is positive for glucose. The most likely diagnosis is:
Ovarian failure
Anorexia
Hypothyroidism
Prolactinoma
Cushing’s syndrome
296A married, 38-year-old, obese woman of three with varicose veins and a 20 cigarette per day smoking habit would like a form of contraception. The most suitable choice would be:
Female condom
Contraceptive sponge
Combined oral contraceptive
Progesterone-only pill
Douching
A 28-year-old primigravida woman presents with lower abdominal pain and a spiking fever 24 hours after delivery of her baby. The most likely diagnosis is:
Mittelschmerz
Endometriosis
Appendicitis
Endometritis
Postpartum haemorrhage
A 30-year-old multiparous woman presents with scant vaginal bleeding, severe hypotension and a tender uterus. Fetal heart sounds, present previously, are not detected. The most likely diagnosis is:
Endometritis
Placental abruption
Postpartum haemorrhage
Placenta praevia
Ruptured ectopic pregnancy
A 50-year-old woman reports night sweats and hot flushes. What blood test would you order to confirm menopause?
FSH
LH
Progesterone
Prolactin
Testosterone
Candidal infection is associated with the following EXCEPT:
Pruritis
Glycosuria
Increase during pregnancy
Immune suppression
Is characteristically a frothy yellow – green discharge
297An increased risk of osteoporosis occurs with the following, EXCEPT:
Heparin
PCOs
Anorexia
Turner’s syndrome
Athletic amenorrhoea
A 20-year-old primigravida of 36 weeks’ gestation presents with a blood pressure of 160/110. What is the next step in management?
Rupture membranes
Emergency C-section
Intravenous Syntocinon
Epidural anaesthesia
Control blood pressure
Increased prolactin levels are associated with the following EXCEPT:
Methyldopa
Increased gonadotrophin-releasing hormones
Oligomenorrhoea
Acromegaly
Menorrhagia
The following drugs cross the placenta EXCEPT:
Pyrimethamine
Heparin
Warfarin
Tetracycline
Carbimazole
A 25-year-old woman with type 1 diabetes mellitus wants to start a family. One of the most important points to discuss is:
Commence a statin
Commence an ACE inhibitor
Start an oral hypoglycaemic drug
Commence folic acid
Reduce dose of insulin
Women taking the COC are more susceptible to which ONE of the following:
Ovarian cancer
Cancer of the uterus
Venous thrombosis
Pancreatitis
Benign breast disease
298Which statement concerning the emergency contraceptive pill is FALSE?
Should be used within 48 hours of unprotected sex
Contains progestogens only
Should be repeated if vomiting occurs
Follow-up should be arranged if there is a delay in the next expected menstrual cycle
Higher doses are required for women with epilepsy
The most common malignant tumour that affects women is:
Ovarian cancer
Bowel cancer
Endometrial cancer
Breast cancer
Cervical cancer
The most common cause of hirsutism in women is:
Polycystic ovarian syndrome
Idiopathic
Anabolic steroids
Congenital adrenal hyperplasia
Phenytoin
