267893536-EMQs-busyspr-pdf.pdf

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Options for Questions 1-2 Options for Questions 1-2

A Prolactinoma B Pre-mature ovarian failure

C Turner’s syndrome D Ovarian hyper-stimulation syndrome E Polycystic ovary syndrome F Hypothyroidism

G Cushing’s syndrome H Congenital adrenal hyperplasia I Hypothalamic amenorrhoea J Hyperthyroidism

K Androgen insensitivity syndrome L Pure gonadal dysgenesis

Instructions:

Instructions: For each of the case histories described below, choose the singlesinglemost likely cause of menstrual abnormalities from the above list. Each option may be used once, more than once, or not at all.

Question 1 Question 1

A 35 year old woman and her 40 year old partner have been referred to the fertility clinic because of a failure to conceive after 3 years of unprotected intercourse. The semen analysis is normal. The woman has irregular periods every 3-6 months but no other symptoms and her BMI is 27. The woman’s results are as follows: FSH (day 3) = 20mIU/ml, LH (day 3) = 8mIU/ml, prolactin = 110 ng/ml, progesterone (day 21) = 1.5ng/ml, testosterone = 2.0pg/ml, DHEA, DHEA-sulphate and thyroid function tests were normal.

Your answer: AA Correct answer: BB

A 35 year old woman with one previous normal pregnancy 3 years earlier attends the gynaecology clinic because of irregular periods every 4-6 months. On direct questioning, she complains of persistent headaches in the last 9 months which are worse first thing in the morning and a milky discharge from her right breast. Her BMI is 27 and there is a bi-temporal hemi-anopia on clinical examination.

Your answer: AA Correct answer: AA

| EXPLANATION | Options for Questions 3-4 Options for Questions 3-4

A Routine recall in 3 years B Routine recall in 5 years

C Hysteroscopy + D&C D Laser vapourisation

E Refer for colposcopy F Cold knife cone biopsy

G Repeat cervical smear as soon as possible H Cryotherapy

I No further cervical smears required J Repeat cervical smear in 6 months Instructions:

Instructions: For each scenario described below, choose the singlesinglemost appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

Question 3

Question 3 A 30 year old woman with previously normal cervical smears hasa smear which is reported as inadequate because the specimen was poorly fixed.

Your answer: AA Correct answer: GG

A 35 year old woman had a cervical smear 3 years ago which showed border-line nuclear abnormalities. She has since had two consecutive smears 12 months apart which have been reported as negative

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A Continue iv oxytocin B Deliver by caesarean section C Evacuation of retained products of conception D No additional intervention at this stage E Bimanual compression of the uterus F Venous access and resuscitation G Examination under spinal anaesthesia H Lovset’s manoeuvre

I Intravenous ritodrine J Manual replacement of the uterus K Sub-cutaneous terbutalline L Administer uterotonic agent Instructions:

Instructions: For each of the case histories described below, choose the singlesinglemost appropriate initial management from the above list. Each option may be used once, more than once, or not at all.

A 16 year old primigravida attends for induction of labour following intra-uterine fetal death at 36 weeks gestation. Maternal BP is 120/80 with no proteinuria and all blood tests are normal. The fetus is in a breech presentation. Prostaglandin is administered and oxytocin commenced at 12:00 according to the unit protocol. At 00:00, the cervix remains 1cm long and the os is closed. There are 3 uterine contractions every 10 minutes.

A 34 year old woman is bleeding heavily and collapses during the third stage of labour. Her pulse is 40bpm and systolic BP is 70mmHg. There is a mass at the introitus consistent with uterine inversion

Your answer: AA Correct answer: FF

A Failure to relieve symptoms B Damage to bowel

C Removal of ovaries D Irregular bleeding for 3-4 months E Failure to identify disease F Failure to visualise uterine cavity G Shoulder-tip pain H Haemorrhage requiring return to theatre

I Laparotomy J Failure rate 1 in 200

Instructions:

Instructions: For each of the case histories described below, choose the singlesinglemost relevant complication that you must discuss with the patient when taking consent prior to surgery from the above list of options. Each option may be used once, more than once, or not at all.

A 35 year old nulliparous woman with menorrhagia is having the levonorgestrel releasing intra-uterine system inserted under general anaesthesia

Your answer: AA Correct answer: DD

Question 8

Question 8 A 40 year old woman with a previous failed TVT for genuine stress incontinence is having a Burch colposuspension

A Stress incontinence B Urinary retention with overflow

C Urinary retention D Detrusor instability

E Detrusor hyper-reflexia F Interstitial cystitis G Genuine stress incontinence H Mixed urinary incontinence

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K Diabetes mellitus Instructions:

Instructions: For each of the case histories described below, choose the singlesinglemost likely diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

A 35 year old woman complains of urinary frequency, urgency, urge incontinence and bladder pain. Urine dipstix showed haematruria. Her symptoms have not responded to conservative and medical treatment. Cystoscopy showed petechial haemorrhages in the bladder mucosa

A 40 year old woman has been investigated extensively for persistent microscopic haematuria which was initially detected during pregnancy. Over the last year, she has developed urinary urgency with bladder pain. Bladder biopsy showed a chronic inflammatory infiltrate in the detrusor muscle

| EXPLANATION |

A Counsel and offer evacuation of retained products of

conception B Counsel and offer support group

C Counsel and offer laparoscopy & salpingectomy D Counsel and offer investigation for recurrent miscarriage

E Counsel and offer treatment with methotrexate F Counsel and offer laparotomy & salpingectomy G Counsel and offer termination of pregnancy H Perform salpingectomy

I Proceed to laparotomy J Serial HCG assay

K Counsel and refer to early pregnancy assessment

unit L Repeat trans-vaginal scan 7 days later

Instructions:

Instructions: For each patient described below choose the singlesinglemost appropriate initial management option from the list. Each option may be used once, more than once, or not at all.

A 25 year old woman had a transvaginal scan following IVF treatment during which 2 embryos were replaced and was found to have a 6 week singleton intra-uterine pregnancy. She presents 2 weeks later with abdominal pain and vaginal bleeding and is found to have an empty uterus with a small amount of free fluid in the pouch of Douglas.

A 25 year old woman had a transvaginal scan following IVF treatment during which 2 embryos were replaced and is found to have a 6 week singleton intra-uterine pregnancy with a 5cm cystic structure adjacent to the right ovary with internal echoes consistent with an ectopic pregnancy.

Your answer: AA Correct answer: CC

| EXPLANATION |

A Stop heparin on the evening before induction B Commence oral warfarin C Await results of V/Q scan then commence

treatment D

Await results of venogram then commence treatment

E Await results of D-dimers assay F Commence therapeutic dose of heparin G Commence prophylactic dose of heparin

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I Antenatal prophylactic treatment with heparin J Antenatal treatment with warfarin K Prophylactic heparin for 6 weeks post-partum L Stop heparin therapy

Instructions:

A 30 year old woman with a previous DVT presents for antenatal care at 15 weeks gestation. There is no family history of VTE and her BMI is 25. She is otherwise fit and well with a negative thrombophilia screen

Your answer: AA Correct answer: KK

A 30 year old woman with recurrent first trimester miscarriages is known to have the anti-phospholipid antibody syndrome and has had a spontaneous vaginal delivery at 39 weeks gestation. Her BMI is 27 and she is otherwise fit and well with no family history of VTE.

| EXPLANATION |

A 85% 5 year survival B 70% 5 year survival

C 60% 5 year survival D 40% 5 year survival

E 25% 5 year survival F Virtually 0% 5 year survival G Almost 100% 5 year survival H Overall life-time risk ~1%

I Overall life-time risk ~2% J Overall life-time risk _1.5% K Overall life-time risk ~3% L Overall life-time risk of 0.1% Instructions:

Instructions: For each scenario described below, choose the singlesinglemost appropriate information that should be given to the woman from the above list of options. Each option may be used once, more than once, or not at all.

A 68 year old woman attends the gynaecology clinic 4 weeks after TAH + BSO for endometrial carcinoma. The histology shows that the tumour had extended to involve the cervix and she has been advised to have radiotherapy. She enquires about the survival rate for women with similar tumours.

A 32 year old teacher has been referred to the gynaecology clinic because of marked anxiety since her friend died suddenly from ovarian cancer at the age of 35 years. She has no family history of ovarian cancer and enquires about the likelihood of any woman developing the disease.

Your answer: AA Correct answer: II

| EXPLANATION |

A Endocervical and urethral swabs for culture B EUA + cystoscopy

C MRI scan D Out-patient hysteroscopy and biopsy

E Hysteroscopy D&C F Vulval biopsy

G Cervical smear H Peritoneal fluid for cytology

I Serum CA-125 J Colposcopy

Instructions:

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above list of options. Each option may be used once, more than once, or not at all.

A 56 year old woman with a 3 year history of vulval lichen sclerosis complains of a firm lump on the labia majora which has increased in size over the last 3 months and is bleeding intermittently

A 34 year old woman complains of a 3 months history of post-coital bleeding. The cervix appears normal and microbiology swabs are negative. Cervical smear shows atypical glandular cells

Your answer: AA Correct answer: JJ

| EXPLANATION |

A Congenital syphilis B Congenital varicella syndrome

C Parvovirus B19 infection D Turner’s syndrome

E Parder-Willy syndrome F Fetal hydantoin syndrome

G Group B streptococcal infection H Congenital rubella syndrome

I Cri-du-chat syndrome J Edward’s syndrome

K Patau’s syndrome L Down’s syndrome

Instructions:

Instructions: For each of the case histories described below, choose the singlesinglemost likely cause of fetal abnormality from the above list of options. Each option may be used once, more than once, or not at all.

Question 19

Question 19 A 42 year old woman is late booking for antenatal care. Theestimated gestation age by ultrasound scan is 22 weeks and the fetus is found to have an atrio-ventricular septal defect and a double bubble sign in the upper abdomen

Your answer: AA Correct answer: LL

A 42 year old woman had bleeding in early pregnancy and was found to have an 8 week viable pregnancy. Anomaly scan at 22 weeks showed a head and abdominal circumferences below the third centile , bilateral choroids plexus cysts and rockerbottom feet

| EXPLANATION |

A No additional intervention at this stage B Deliver by caesarean section C Evacuation of retained products of conception D Artificial rupture of membranes E Oxytocin induction of labour F Venous access and resuscitation G Controlled artificial rupture of membranes in theatre H Intra-muscular analgesia

I Prostaglandin induction of labour J Manual replacement of the uterus K Sub-cutaneous terbutalline L Delay induction of labour Instructions:

Instructions: For each of the case histories described below, choose the singlesinglemost appropriate management from the above list. Each option may be used once, more than once, or not at all.

A 34 year old nulliparous woman presents in spontaneous labour at 37 weeks gestation with the cervix 3cm dilated. Four hours later, the cervix is 8cm dilated and a frank breech presentation is diagnosed.

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A 24 year old primigravida has been admitted for induction at 38 weeks gestation with a dichorionic twin pregnancy because of maternal discomfort. The pregnancy has otherwise been uncomplicated and twin 1 is cephalic. The cervix is 2cm long, posterior, soft and the os is closed. The presenting part is 3cm above the spines. CTG is reactive.

| EXPLANATION |

A Cystoscopy B MRI scan

C Urodynamic studies D Bladder re-training

E Urine for cytology F Cystoscopy and biopsy

G Examination under anaesthesia H MSU for culture and sensitivity

I Urine electrolytes J Renal function tests

Instructions:

Instructions: For each of the case histories described below, choose the singlesinglemost important investigation from the above list of options. Each option may be used once, more than once, or not at all.

A 60 year old woman developed cervical cancer 12 months earlier and was treated with combined chemotherapy and radiotherapy. She now complains of blood in her urine which occurs all the time

A 45 year old woman complained initially of urinary frequency urgency and urge incontinence and also leaked urine on coughing or straining. She was treated medically initially and her symptoms of urinary frequency and urgency have largely resolved. Over the last 6 months, she is finding that urinary leakage on coughing and straining is increasingly affecting her social life.

| EXPLANATION |

A In-vitro fertilisation B Intra-uterine insemination C Laparoscopy and dye test D Intra-cytoplasmic sperm injection E Clomephene citrate F Gonadotrophin induction of ovulation

G Metformin H Oocyte donation

I Surrogacy J Weight reduction

K Weight gain L Measure serum androgen concentrations Instructions:

Instructions: For each of the case histories described below, choose the singlesinglemost appropriate initial management from the above list. Each option may be used once, more than once, or not at all.

A 24 year old woman with her 35 year old partner has been referred to the infertility clinic because of 2 years of primary infertility. The woman has an irregular menstrual cycle every 2-4 months and her partner’s semen analysis is normal. The woman’s BMI is 26 and there is no significant past medical history. Investigations have confirmed a diagnosis of polycystic ovary. The couple have not achieved a pregnancy despite a 6 months course of clomephene citrate with evidence of ovulation based on day 21 progesterone concentration and ultrasound

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scanning.

A 34 year old woman with her 35 year old partner has been referred to the infertility clinic because of 2 years of primary infertility. The woman has a regular 28 day cycle and her periods are heavy with severe dysmenorrhoea. She also complains of deep dyspareunia and intermittent lower abdominal and pelvic pain. Her BMI is 27. Investigations have shown normal LH, FHS, Thyroid function tests, prolactin and day 21 progesterone concentration confirms ovulatory cycles. Laparoscopy and dye test shows evidence of chronic pelvic inflammatory disease with bilateral tubal occlusion. Her partner’s semen analysis is normal.

| EXPLANATION |

A Counsel and recommend appropriate contraception B Counsel and offer termination of pregnancy C Commence folic acid 0.4mg/day D Commence folic acid 4mg/day

E Change anti-hypertensive drug to captopril F Stop anti-hypertensive medication

G Stop propylthiouracil H Change therapy to carbimazole

I Reassure J Commence block and replace therapy

K Explain risk of neonatal thyrotoxicosis L Change therapy to propylthiouracil M Increase dose of thyroxine N Explain 20% risk of neonatal hypothyroidism Instructions:

A 30 year old woman with Graves disease is adequately controlled on carbimazole is planning a pregnancy. She attends the pre-conception clinic enquiring about the risks to her fetus

A 25 year old insulin dependent diabetic with well controlled disease is planning a pregnancy and attends the pre-conception clinic. All observations and investigations are within normal limits.

| EXPLANATION |

A TAH + BSO B Vaginal hysterectomy

C Radical abdominal hysterectomy D Laparoscopic assisted vaginal hysterectomy

E TAH + BSO + omentectomy F BSO

G TAH H Chemotherapy

I Radiotherapy J Combined chemo-radiotherapy

K Endometrial biopsy Instructions:

A 65 year old woman presents with a 6 months history of post-menopausal bleeding. Endometrial biopsy showed an endometrial adenocarcinoma and MRI scan shows that the tumour has infiltrated the outer 50% of the myometrium but does not involve the cervix or adnexal structures

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An asymptomatic 56 years old woman is referred to the gynaecology clinic because of a cervical smear showing atypical glandular cells. The trans-vaginal scan requested by the general practitioner shows a normal size uterus with a regular 8mm endometrium with normal ovaries.

| EXPLANATION |

A Maternal treatment with antibiotics B Detailed fetal anomaly scan C Deliver by caesarean section D Active immunisation of neonate

E Avoid breast-feeding F Counsel and offer termination of pregnancy G Delay delivery by 5-7 days H Administer corticosteroids

I Administer tocolytics J Reassurance

K Screen for maternal syphilis infection Instructions:

A 20 year old woman presents with intermittent abdominal pain and a febrile illness at 20 weeks gestation. Blood cultures are positive for Listeria monocytogenes

A 30 year old woman has the following results following routine antenatal screening at 15 weeks gestation: VDRL positive, FTA-abs positive

| EXPLANATION |

A Cancel IVF cycle B Freeze embryos

C Admit for iv fluids and thromboprophylaxis D Termination of pregnancy

E Transfer to ITU F Fluid restriction

G Drain pleural effusion H Drain ascites

I Drain ovarian cysts J Proceed with embryo replacement

K Avoid unprotected sexual intercourse L Diuretics Instructions:

A 35 year old woman with PCOS is undergoing IVF treatment. She attends for embryo replacement 6 days after HCG administration and complains of abdominal distension and pain with nausea and vomiting 2-3 times per day over the previous 48h. Clinical examination showed a mildly distended abdomen and ultrasound scan confirmed bilateral ovarian enlargement 8-10cm. All her blood tests were normal.

A 35 year old woman with primary infertility is undergoing IVF treatment. She attends 10 days after embryo replacement and complains of abdominal distension and pain with nausea and persistent severe vomiting over the previous 48h. Clinical

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examination showed a markedly distended abdomen with ascites and pleural effusion. Abdominal and pelvic ultrasound scan confirmed 12cm diameter bilateral cystic ovaries. All her blood tests were normal.

| EXPLANATION |

A Damage to bladder / ureter B Damage to bowel

C Failure rate 1 in 200 D Failure to gain entry into abdominal cavity E Failure to identify disease F Failure to visualise uterine cavity G Haemorrhage requiring blood transfusion H Haemorrhage requiring return to theatre

I Laparotomy J Uterine perforation

Instructions:

Instructions: For each of the case histories described below, choose the singlesinglemost relevant complication that you must discuss with the patient when taking consent prior to surgery from the above list of options. Each option may be used once, more than once, or not at all.

A 48-year-old nulliparous woman is scheduled for vaginal hysterectomy because of menorrhagia. Her uterus is enlarged equivalent to 14 weeks' gestation.

A 30 year old woman with a 3 year history of abdominal and pelvic pain that has failed to respond to medical treatment. Her pain is unrelated to menses and she has no bowel symptoms. She is otherwise fit and well with a BMI of 25 and is listed for diagnostic laparoscopy.

Your answer: AA

Correct answer: EE

| EXPLANATION |

A Oestrogen cream B Testosterone cream

C Oral HRT D Topical anti-histamines

E Vaginoplasty F Radical vulvectomy

G Skinning vulvectomy H Topical anti-fungal cream

I Clobetasol cream J Excision biopsy

Instructions:

Instructions: For each clinical scenario below choose the singlesinglemost appropriate treatment from the list above. Each diagnosis may be used once, more than once, or not at all.

A 23-year-old woman presents with a two-year history of vulval,_{perineal and perianal irritation. The vulva is red, excoriated and} there areas of white, thickened skin. Application of 3% Acetic acid shows areas of mosaic and coarse punctuation.

A 47 year old woman complains of a 3 months history of vulval irritation and superficial dyapareunia. The vulval skin is thin and white with fissures and narrowing of the introitus and fusion of the labia minora over the clitoris

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A Tranexamic acid B Danazol

C GnRH analogues D Laparoscopy and ablation of endometriosis E Diagnostic laparoscopy F Mefenamic acid

G Pelvic ultrasound scan H MRI scan of the pelvis I Dilatation and curettage J Endocervical and urethral swabs K Combined oral contraceptive pill L Depo-medroxyprogesterone acetate M Refer to pain clinic N Refer to psychiatrist

Instructions:

A 35 year old woman attends the gynaecology clinic with her 14 year old daughter who is complaining of severe period pains since the onset of menstruation at the age of 13 years. Menstrual loss is not heavy and she has no bowel symptoms. Her symptoms are now interfering with her education as she takes several days off school every month. She does not require contraception and clinical examination is normal.

A 33 year old mother of 3 children complains of progressively painful periods over 5 years. There is occasional deep dyspareunia but she has no bowel symptoms. Her symptoms have not responded to simple analgesia and non-steroidal anti-inflammatory drugs. Clinical examination is normal.

Options for Questions 1-2

A Raloxifene B Oral sequential oestrogen + progestogen

C Oral continuous oestrogen + progestogen D Oestrogen patches

E Vaginal oestrogen tablets F Levonorgestrel IUS + oral oestrogens

G Levonorgestrel IUS H Refer to special oncology clinic

I Counsel and recommend discontinuation of HRT J HRT not recommended

Instructions: For each scenario described below, choose the single most appropriate

management from the above list of options. Each option may be used once, more than

once, or not at all.

A 60 year old woman complains of vaginal dryness and superficial / deep dyspareunia since discontinuing oral HRT because of media reports. She has used lubricants without improvement

Your answer: AA Correct answer: EE

A 40 year old woman has TAH + BSO for stage Ia endometroid adenocarcinoma of the ovary and complains of debilitating hot flushes.

| EXPLANATION |

Options for Questions 3-4

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A Administer VZIG as soon as possible to mother B Administer VZIG to mother if maternal serology -ve

C Administer VZIG to neonate D Detailed ultrasound examination E Immediate caesarean section and transfer baby to

the neonatal unit F

Advise avoid contact with other pregnant women and neonates

G Induction of labour H Reassurance

I Separate mother and baby after delivery J Serum for VZV IgM antibodies K Give intravenous Aciclovir L Treat with oral Aciclovir

Instructions: For each scenario described below, choose the single most appropriate

management from the above list of options. Each option may be used once, more than

once, or not at all.

A 26-year-old Para 1+ 0 at 38 weeks gestation contacts her GP immediately after hearing that a child in her son's nursery has developed chickenpox. On direct questioning, she admits to having had chicken pox as a child.

Your answer: AA Correct answer: HH

A 26-year-old Para 1+ 0 at 38 weeks gestation contacts her GP immediately after discovering that her husband has shingles. She has no memory of having chicken-pox in the past.

| EXPLANATION |

Options for Questions 5-6

A Genital swabs for viral culture B Immediate induction of labour C Delay delivery by 5-7 days if possible D Offer prophylactic oral acyclovir E Treat with intra-venous acyclovir F Deliver by caesarean section G Treat neonate with intravenous acyclovir H Reassurance

I Avoid breast-feeding J Avoid contact with other pregnant women and neonates K Refer to genito-urinary medicine clinic L Screen for other sexually transmitted infections

Instructions: For each scenario described below, choose the single most appropriate

management from the above list of options. Each option may be used once, more than

once, or not at all.

A 17 year old woman complains of vulval soreness at 18 weeks gestation. She is found to have vulval herpetic vesicles on examination. There is no history of previous genital herpes.

Your answer: AA

Correct answer: KK

A 20 year old woman presents in spontaneous labour at 37 weeks gestation. She developed primary genital herpes at 34 weeks gestation but is now symptom-free.

| EXPLANATION |

Options for Questions 7-8

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C CVS and karyotype D CVS and PCR

E Amniocentesis and enzyme assay F Fetal blood sampling and karyotype G Fetal blood sampling and measurement of PO2 H Fetal blood sampling and haemoglobin

electrophoresis I Fetal blood sampling and haemoglobin

concentration J Fetal blood sampling and viral culture K Reassurance

Instructions: For each of the case histories described below, choose the single most

appropriate management from the above list of options. Each option may be used once,

more than once, or not at all.

A 30 year old woman with myotonic dystrophy is 11 weeks pregnant and would like to know whether or not her fetus has inherited the condition

A 21 year old woman with 3 previous consecutive first trimester miscarriages is found to be a t(14:21) balanced translocation carrier. She is 10 weeks pregnant and would like to know whether or not her fetus has inherited an unbalanced translocation.

| EXPLANATION |

Options for Questions 9-10

A Commence iv oxytocin B Deliver by caesarean section C Fetal blood sampling D No additional intervention at this stage E Umbilical artery Doppler F Reduce oxytocin dose

G Uterine artery Doppler H Forceps delivery

I Intravenous ritodrine J Administer maternal facial oxygen K Sub-cutaneous terbutalline L Administer uterotonic agent

Instructions: For each of the case histories described below, choose the single most

appropriate initial management from the above list. Each option may be used once, more

than once, or not at all.

You have been asked to review a 35 year old woman half an hour after spontaneous vaginal delivery of her first child because the membranes are ragged although the placenta appears complete. The uterus is well contracted, the lochia are normal and all maternal observations are satisfactory.

A 35 year old mother of two children presents in spontaneous labour at 39 weeks gestation. She has one previous caesarean section for breech presentation followed by a spontaneous vaginal delivery. At 12:00, the cervix is 7cm dilated with a direct occipito-anterior position with 3:10 strong contractions. At 16:00, the cervix is 7cm dilated and the contractions are inco-ordinate occurring 2-3:10. The CTG is normal

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Options for Questions 11-12

A Oestrogen cream B Testosterone cream

C Oral HRT D Topical anti-histamines

E Vaginoplasty F Radical vulvectomy

G Skinning vulvectomy H Topical anti-fungal cream

I Clobetasol cream J Excision biopsy

Instructions: For each clinical scenario below choose the single most appropriate treatment

from the list above. Each diagnosis may be used once, more than once, or not at all.

A 23-year-old woman presents with a two-year history of vulval, perineal and perianal irritation. The vulva is red, excoriated and there areas of white, thickened skin. Application of 3% Acetic acid shows areas of mosaic and coarse punctuation.

A 47 year old woman complains of a 3 months history of vulval irritation and superficial dyapareunia. The vulval skin is thin and white with fissures and narrowing of the introitus and fusion of the labia minora over the clitoris

| EXPLANATION |

Options for Questions 13-14

A Administer regional analgesia if APTT is

normal B

Administer regional analgesia if APTT and PT are normal

C Administer protamine sulphate then regional

analgesia D Advice that regional analgesia is contra-indicated E Administer regional analgesia F Administer prophylactic dose of heparin

G Remove epidural catheter H Check APTT then remove epidural catheter if result is normal

I Advise against removal of epidural catheter J Check anti-Xa levels then administer regional analgesia if normal

K Wait for 12h then administer heparin

Instructions: For each scenario described below, choose the single most appropriate

management from the above list of options. Each option may be used once, more than

once, or not at all.

A 40 year old woman with a BMI of 39 has had an emergency caesarean section for failure to progress at 6cm dilatation under combined spinal epidural (CSE) analgesia. The procedure was uncomplicated with a blood loss of 700ml. A prophylactic does of LMWH was administered at noon, 6h after insertion of CSE. She requests removal of the epidural catheter at 18:00h.

A 25 year old woman with a BMI of 38 has an emergency caesarean section at full dilatation under spinal anaesthesia because of fetal distress. The procedure was uncomplicated with blood loss of 700ml. She is now 8h post-surgery and your attention is drawn to instructions on post-partum

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thromboprophylaxis.

| EXPLANATION |

Options for Questions 15-16

A Quadruple test B Integrated test

C Nuchal transluscency D Serum integrated test

E Triple test F Anomaly scan

G Fluorescent in-situ hybridisation H Amniocentesis

I Chorionic villus sampling J PCR

K No investigation L Fetal blood sampling

Instructions: For each of the case histories described below, choose the single most

important investigation from the above list of options. Each option may be used once, more

than once, or not at all.

A 30 year old woman has one previous termination of pregnancy at 22 weeks gestation for Edward’s syndrome now presents at 10 weeks gestation.

Question 16

Question 16 A 30 year old woman is found to have a fetus with duodenal atresia on anomaly scan at 20 weeks gestation

Your answer: AA

Correct answer: HH

| EXPLANATION |

Options for Questions 17-18

A In-vitro fertilisation B Intra-uterine insemination C Laparoscopy and dye test D Laparoscopic ovarian drilling E Clomephene citrate F Gonadotrophin induction of ovulation

G Metformin H Carbegolline

I Hystero-salpingogram J Weight reduction

K Weight gain L Measure serum androgen concentrations

Instructions: For each of the case histories described below, choose the single most

appropriate initial management from the above list. Each option may be used once, more

than once, or not at all.

A 34 year old woman with her 35 year old partner has been referred to the infertility clinic because of 2 years of primary infertility. The woman has a regular and normal 28 day cycle, her BMI is 26 and she has no other symptoms. Investigations have shown normal LH, FHS, Thyroid function tests, prolactin and day 21 progesterone concentration confirms ovulatory cycles. Her partner’s semen analysis is normal.

Question 18

Question 18 A 36 year old woman with her 35 year old partner has been referred to the infertility clinic because of 2 years of primary

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infertility. The woman has a regular and normal 28 day cycle, her BMI is 26 and she has no other symptoms. Investigations have shown normal LH = 7.5mIU/ml, FHS = 17mIU/ml, Thyroid function tests, prolactin and day 21 progesterone concentration confirms ovulatory cycles. Her partner’s semen analysis is normal. Hystero-salpingogram confirms bilateral patent fallopian tubes.

Correct answer: BB

| EXPLANATION |

Options for Questions 19-20

A Avoid breast-feeding B Administer VZIG to neonate and avoid breast-feeding

C Administer VZIG to neonate but breast-feeding

encouraged D Immediate induction of labour

E Delay delivery with tocolytics F Offer termination of pregnancy G Treat neonate with oral acyclovir H Treat neonate with intravenous acyclovir

I Examine neonate for evidence of congenital

anomalies J Reassurance

K Delay delivery for 5-7 days if possible L Detailed ultrasound examination

Instructions: For each scenario described below, choose the single most appropriate

management from the above list of options. Each option may be used once, more than

once, or not at all.

A 20 year old woman is in hospital 2 days after vaginal delivery of her first baby and is informed that her 8 year old step-daughter has chicken-pox. She does not remember having chicken pox in the past and is worried about taking her new baby home. Investigations show that she is varicella zoster IgG positive and IgM negative

A 20 year old woman is being treated in the infectious diseases unit for chicken pox and reports having missed a period with a positive pregnancy test. Dating scan shows that she has a viable 11 week pregnancy and she is discharged following resolution of her symptoms

| EXPLANATION |

Options for Questions 21-22

A Serial beta-HCG assay B Laparoscopy

C Repeat trans-vaginal scan in 24h D Repeat trans-vaginal scan in 7 days

E Counsel and discharge F Offer surgical evacuation of products of conception G Offer medical treatment with methotrexate H Laparotomy

I Serum progesterone assay J Serum AFP assay K Refer to molar pregnancy centre L Refer to other specialty

Instructions: Instructions: For each patient described below choose the single most

appropriate initial management option from the list. Each option may be used once, more

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than once, or not at all.

An asymptomatic 30 year old woman with a previous ectopic pregnancy presents at 6 weeks amenorrhoea for trans-vaginal scan to exclude a repeat ectopic pregnancy. The scan is reported to show a 14mm endometrium with no gestation sac. There are no adnexal masses and no free fluid in the pouch of Douglas. HCG concentration is 500IU and 1600IU 48h later

An asymptomatic 30 year old woman with a previous ectopic pregnancy presents at 6 weeks amenorrhoea for trans-vaginal scan to exclude a repeat ectopic pregnancy. Her pregnancy test had been positive 2 weeks earlier. The scan is reported to show a 14mm endometrium with no gestation sac. There is a 4cm cystic structure in the right adnexum suggestive of an ectopic pregnancy but no free fluid in the pouch of Douglas

| EXPLANATION |

Options for Questions 23-24

A Bilateral oophrectomy B CA-125 assays every 6-12 months

C TAH + BSO D Cyst aspiration for cytology

E Refer to cancer centre F Refer to palliative care team

G Reassure H Measure serum CA-125

I Yearly pelvic ultrasound scans J Repeat pelvic ultrasound scan in 4-6 months

Instructions: For each scenario described below, choose the single most appropriate

management from the above list of options. Each option may be used once, more than

once, or not at all.

A 40 year old woman presents with a 12 months history of vague abdominal discomfort that did not respond to simple analgesia. Ultrasound scan shows bilateral complex ovarian cysts with right sided hydronephrosis and ascites. Her CA-125 is 1500iu

Your answer: AA Correct answer: EE

A 20 year old woman is admitted with sudden onset left sided pelvic pain 23 days after her LMP. Her pregnancy test is negative and her symptoms are improving with simple analgesia. Pelvic ultrasound scan shows a 5cm left ovarian cyst with internal echoes consistent with a haemorrhagic cyst.

| EXPLANATION |

Options for Questions 25-26

A Closure of visceral peritoneum B Closure of parietal peritoneum C Closure of Scarpa’s fascia D Non-closure of the rectus sheath E Instillation of local anaesthetic into pelvis F Supra-pubic catheterisation G Mass closure of abdominal incision H Prophylactic heparin 2h pre-op

I Application of methylene blue to vagina J Closure of vaginal vault

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Instructions: For each of the case histories described below, choose the single most

appropriate intervention that would reduce peri-operative morbidity and mortality from the

above list. Each option may be used once, more than once, or not at all.

Question 25

Question 25 A 25 year old woman is undergoing an emergency caesarean section at 9cm dilatation for failure to progress

Question 26

Question 26 A 42 year old woman is to undergo TAH for dysfunctional uterine bleeding. She is otherwise fit and well with a BMI of 35.

| EXPLANATION |

Options for Questions 27-28

A Atrophic vulvovaginitis B Human papilloma virus infection C Benign mucous membrane pemphigoid D Candida infection

E Lichen sclerosus F Contact dermatitis

G Lichen simplex et chronicus H Herpes simplex infection I Vulval intraepithelial neoplasia J Vulvodynia

Instructions: For each clinical scenario below choose the single most likely diagnosis from

the list above. Each diagnosis may be used once, more than once, or not at all.

A 23-year-old woman presents with a two-year history of vulval, perineal and perianal irritation. The vulva is red, excoriated and there areas of white, thickened skin. Application of 3% Acetic acid shows areas of mosaic and coarse punctuation.

A 78-year-old woman presents with vulval irritation and soreness. On examination the vulva is red in colour, slightly oedematous and there are small, red papules scattered randomly beyond the perimeter of the vulva. She also complains of soreness and irritation under the breasts.

| EXPLANATION |

Options for Questions 29-30

A No additional intervention at this stage B Deliver by caesarean section

C Increase dose of oxytocin D Lovset’s manoeuvre

E Decrease dose of oxytocin F Fetal blood sampling

G Forceps delivery H Delivery of the posterior arm

I Episiotomy J Inhaled salbutamol

K McRobert’s manoeuvre L Administer maternal facial oxygen

Instructions: For each of the case histories described below, choose the single most

appropriate management from the above list. Each option may be used once, more than

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once, or not at all.

A 34 year old woman with 3 previous vaginal deliveries presents in spontaneous labour at 39 weeks gestation. The cervix is fully dilated with thick meconium stained liquor. The CTG shows a base-line fetal heart rate of 135bpm with variability of 3-4bpm with variable decelerations. There are 3-4 uterine contractions every 10 minutes. The fetus is in a direct occipito-anterior position 1cm below the ischial spines.

You have been called into a delivery room by the senior midwife because of difficulties delivering the fetal shoulders. On your arrival, the woman is in lithotomy and the head had been delivered 2 minutes earlier but moderate traction has thus far failed to deliver the shoulders.

| EXPLANATION |

Options for Questions 31-32

A Fetal blood sampling B Triple test

C Quadruple test D Integrated test

E Chorionic villus sampling F Serum integrated test G Amniocentesis H Nuchal transluscency

I Anomaly scan J Fluorescent in-situ hybridisation

K PCR L Restriction fragment length polymorphisms

M Karyotype

Instructions: For each of the conditions described below, choose the single most

appropriate diagnostic tests from the above list of options. Each option may be used once,

more than once, or not at all.

Question 31

Question 31 Fetal anaemia

Question 32

Question 32 Fetal gastroschisis

| EXPLANATION |

Options for Questions 33-34

A Emergency caesarean section B Ultrasound scan for placental site C Induction of labour with prostaglandins D Induction of labour by amniotomy E Oxytocin augmentation of labour F Fetal scalp blood sampling G Vaginal operative delivery H Maternal blood transfusion

I Transfer to high dependency unit J Expectant management K Arrange antenatal clinic follow-up L Treatment with tocolytics M Umbilical artery Doppler N Perform Kleihauer test

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Instructions: For each of the case histories described below, choose the single most

appropriate management from the above list of options. Each option may be used once,

more than once, or not at all.

A 42 year old woman had an elective caesarean section at 37 weeks gestation for major placenta previa. She returned to theatre 6h later because of suspected intra-abdominal bleeding and has undergone a total abdominal hysterectomy

A 35 year old Rhesus positive woman presented with fresh vaginal bleeding and intermittent abdominal pain at 30 weeks gestation. Maternal pulse on admission was 90bpm with BP 120/80. The fetal heart rate was normal. She has been in hospital for 48h and complains of a slight brown discharge but no other symptoms and has had no further bleeding.

| EXPLANATION |

Options for Questions 35-36

A Increase iv fluids B Insert central venous pressure line C Intravenous magnesium sulphate D Measure serum aspartate transaminase

immediately

E Measure serum magnesium F Blood transfusion

G Monitor patellar reflex every 15 minutes H Provide a fluid challenge with colloids I Provide intravenous Hartmann J Decrease iv fluids

K Immediate dose of 10ml 10% calcium gluconate

intravenously L Carry out visual field assessment

Instructions: For each patient described below choose the single most appropriate

management option from the list. Each option may be used once, more than once, or not at

all.

A 20-year-old primigravida is 30 weeks' pregnant and has been transferred to the delivery suite with severe gestational proteinuric hypertension. She complains of severe frontal headache but has no other symptoms. She has a normal respiratory rate and her urine output has been satisfactory. Her blood pressure is 140/100mmHg. There are five beats of bilateral ankle clonus.

A 20-year-old primigravida delivered a live infant 5 hours previously by emergency caesarean section. She has developed severe gestational proteinuric hypertension. Blood loss at caesarean section was estimated at 1,000 ml. BP = 160/100mmHg on oral anti-hypertensive treatment and pulse = 95bpm. She has been given one litre of Hartmann's solution intravenously since her delivery but has passed 40ml of urine since delivery. Her clotting, liver enzymes and serum creatinine are normal.

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Options for Questions 37-38

A Uterine perforation B Laparotomy

C Bladder injury D Bleeding requiring transfusion

E Continuing pregnancy F Infertility

G Wound infection H Failure to identify any pathology

I Failure to gain access to abdominal cavity J Risk of failure of the procedure

Instructions: For each of the case histories described below, choose the single most

relevant complication that you must discuss with the patient when taking consent prior to

surgery from the above list of options. Each option may be used once, more than once, or

not at all.

A 34 year old woman with a previous left salpingectomy for ectopic pregnancy presents with abdominal pain and vaginal bleeding and is found to have an empty uterus with a right adnexal mass consistent with an ectopic pregnancy.

A 35 year old woman with a 10 week missed miscarriage is undergoing evacuation of retained products of conception under general anaesthesia

| EXPLANATION |

Options for Questions 39-40

A Rocker bottom feet B Exomphalos

C Holoprosencephaly D Cystic hygroma

E Gastroschisis F atrio-ventricular septal defect G Intra-cranial calcification H Duodenal atresia

I Spina bifida J Polyhydramnios

K Echogenic bowel

Instructions: For each of the conditions described below, choose the single most

characteristic abnormality from the above list of options. Each option may be used once,

more than once, or not at all.

Question 39

Question 39 Turner’s syndrome

Your answer: AA Correct answer: DD Question 40 Question 40 Trisomy 13 Your answer: AA Correct answer: CC

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Your score is 8%

8% for this EMQ Exam

You answered 3 out of 40 questions correctly.

40 random questions for EMQ Mock Exam 40 random questions for EMQ Mock Exam

A No additional intervention at this stage B Deliver by caesarean section

C Evacuation of retained products of

conception D

Artificial rupture of membranes E Bimanual compression of the uterus F Venous access and

resuscitation G Controlled artificial rupture of membranes

in theatre H Intra-muscular analgesia

I Prostaglandin induction of labour J Manual replacement of the uterus

K Sub-cutaneous terbutalline L Commence iv oxytocin Instructions:

Instructions: For each of the case histories described below, choose the singlesingle most appropriate management from the above list. Each option may be used once, more than once, or not at all.

You have been asked to review a 25 year old woman half an hour after spontaneous vaginal delivery of her first child because a placental cotyledon is retained. The uterus is well contracted, the lochia are normal and all maternal observations are satisfactory.

A 23 year old woman with two previous vaginal deliveries is admitted for induction of labour at 42 weeks gestation. The pregnancy has been uncomplicated and the fetal head is three fifths palpable. The cervix is 1cm long, central, 2cm dilated with bulging membranes and the fetal head is 2cm above the ischial spines.

| EXPLANATION |

C GnRH analogues D TAH + BSO

E Diagnostic laparoscopy F Medroxyprogesterone acetate G Pelvic ultrasound scan H MRI scan of the pelvis

I Dilatation and curettage J Endocervical and urethral swabs K Combined oral contraceptive

pill L

Levonorgestrel releasing intra-uterine system

M Refer to pain clinic N Refer to gastroenterologist Instructions:

Instructions: For each of the case histories described below, choose the singlesingle

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most appropriate management from the above list. Each option may be used once, more than once, or not at all.

A 22 year old woman is known to have endometriosis diagnosed at laparoscopy. She is referred to the gynaecology clinic because of progressively severe pelvic pain,

dysmenorrhoea and deep dyspareunia. There is a past medical history of focal migraine. Clinical examination showed a tender pelvis with a normal size anteverted uterus and no adnexal masses. Your answer: AA Correct answer: FF Question 4 Question 4

A 22 year old woman is referred to the gynaecology clinic because of a 2 year history of persistent pelvic pain which is worse during and after intercourse and during menstruation. She also complains of intermittent abdominal bloating with alternating constipation and diarrhoea and urgency of defecation. There is occasional rectal bleeding which is unrelated to her menses and usually occurs during episodes of constipation. Clinical examination is normal and there is no significant past medical history.

Your answer: AA Correct answer: NN

A Raloxifene B Oral sequential oestrogen +

progestogen C Oral continuous oestrogen +

progestogen D Oestrogen patches

E Vaginal oestrogen tablets F Tamoxifen

G Levonorgestrel IUS H Refer to special oncology clinic I Counsel and recommend

discontinuation of HRT J HRT not recommended Instructions:

A 40 year old woman has TAH + BSO for stage Ia ovarian cancer and complains of distressing hot flushes and vaginal dryness

A 52 year old woman with a previous PE complains of infrequent periods and distressing hot flushes. Her sister died from PE while on the COCP at the age of 38 years.

A Urinary retention B Damage to bowel

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cavity

E Failure to identify disease F Failure to visualise uterine cavity G Haemorrhage requiring blood

transfusion H

Haemorrhage requiring return to theatre

I Laparotomy J Uterine perforation

Instructions:

Instructions: For each of the case histories described below, choose the singlesingle most relevant complication that you must discuss with the patient when taking consent prior to surgery from the above list of options. Each option may be used once, more than once, or not at all.

A 30 year old woman with genuine stress incontinence who is due to have a tension-free vaginal tape Your answer: AA Correct answer: AA Question 8 Question 8

A 30 year old woman with primary infertility who is due to undergo IVF treatment and is scheduled to have laparoscopy and ovarian cystectomies for severe endometriosis with bilateral ovarian endometriomas.

A Abdominal pressure due to mass

B Bladder neck weakness C Pelvic floor muscle damage D Congenital weakness of the pelvic

floor

E Obstetric trauma F Oestrogen deficiency G Neurological disease H Drug side-effects

I Tumour infiltration into bladder J Bacterial urinary tract infection K Schistosomiasis L Radiation injury

Instructions:

Instructions: For each of the case histories described below, choose the singlesingle most likely cause of urinary tract symptoms from the above list of options. Each option may be used once, more than once, or not at all.

A 35 year old woman complains of a 2 month history of urinary frequency, urgency and haematuria. She had an abdominal X-ray 2 weeks earlier for an unrelated complaint which showed evidence of bladder calcification. Cystoscopy showed numerous polypoid lesions in the bladder Your answer: AA Correct answer: KK Question 10 Question 10

A 52 year old woman complains of

progressively worsening urinary frequency and urgency 3 years after radical abdominal hysterectomy and radiotherapy for cervical cancer. There is no haematuria and all investigations including cystoscopy are normal

(24)

A Commence oral warfarin B Await results of D-dimers assay C Commence therapeutic dose of

heparin D

Prophylactic dose of heparin for 3-5 days post-partum

E Antenatal prophylactic treatment

with heparin F Antenatal treatment with warfarin G Prophylactic heparin for 6 weeks

post-partum H Continue s/c heparin for 6 weeks I Stop heparin therapy J Continue heparin therapy for 6

months

K No treatment required L Continue heparin prophylaxis during labour

Instructions:

A 20 year old woman is known to be a carrier of the factor V Leiden mutation following screening because of a DVT in her sister. She attends the antenatal clinic at 15 weeks in her first pregnancy. Her BMI is 22 and she is otherwise fir and well.

A 30 year old woman complains of a painful swollen left lower limb at 32 weeks gestation and is treated with heparin. Subsequent Doppler studies have shown a left popliteal vein thrombosis.

Your answer: AA

Correct answer: JJ

| EXPLANATION |

A Stop heparin on the evening before

induction B Commence oral warfarin

C Await results of V/Q scan then

commence treatment D

Await results of venogram then commence treatment E Await results of D-dimers assay F Commence therapeutic dose of

heparin G Commence prophylactic dose of

heparin post-partum H Oral aspirin therapy I Antenatal prophylactic treatment

with heparin

J Antenatal treatment with warfarin K Prophylactic heparin for 6 weeks

post-partum L Stop heparin therapy

Instructions:

A 30 year old woman with a previous DVT presents for antenatal care at 15 weeks gestation. There is no family history of VTE and her BMI is 25. She is otherwise fit and well with a negative thrombophilia screen

(25)

A 30 year old woman with recurrent first trimester miscarriages is known to have the anti-phospholipid antibody syndrome and has had a spontaneous vaginal delivery at 39 weeks gestation. Her BMI is 27 and she is otherwise fit and well with no family history of VTE.

| EXPLANATION |

A Take pill as soon as possible B Take pill as soon as possible + barrier contraception for 7 days C Take pill as soon as possible and

omit pill-free week D

Administer emergency contraceptive pill

E Insert copper IUCD F Await results of pregnancy test G Replace detached patch with a

new patch H

Replace with a new patch and use barrier contraception for 7 days I Apply new patch and use barrier

contraception for 7 days J

Apply new patch but keep the same change date

K Apply new patch and delay

change day by 24h L

Apply new patch and delay change day by 36h

Instructions:

Instructions: For each of the case histories described below, choose the singlesingle most appropriate advice from the above list. Each option may be used once, more than once, or not at all.

A 30 year old nulliparous woman is using the combined contraceptive patch. She placed her second patch at 10pm before going to bed and having sexual intercourse and realised at 10am that the patch had detached.

A 29 year old mother of 3 children is using the combined contraceptive patch. She placed her second patch at 10pm on a Wednesday and realised 3 days later that the patch had detached. She had sexual intercourse on several occasions.

| EXPLANATION |

A Chorionic villus sampling B Amniocentesis C Fetal blood sampling D Triple test

E Karyotype F Integrated test

G Western blotting H Northern blotting

I Anomaly scan J Southern blotting

K PCR Instructions:

Instructions: For each of the case histories described below, choose the singlesingle most relevant investigation from the above list of options. Each option may be used once, more than once, or not at all.

(26)

A 35 year old woman with myotonic dystrophy is undergoing IVF treatment in order to ensure that the disease is not passed on to her child

A 35 year old woman is found to have raised maternal serum AFP at 16 weeks gestation. Anomaly scan is equivocal because of high body mass index and she has opted to have amniocentesis

| EXPLANATION |

C GnRH analogues D Laparoscopy and ablation of endometriosis

E Diagnostic laparoscopy F Mefenamic acid G Pelvic ultrasound scan H MRI scan of the pelvis

I Dilatation and curettage J Endocervical and urethral swabs K Combined oral contraceptive

pill L Depo-medroxyprogesterone acetate

M Refer to pain clinic N Refer to psychiatrist Instructions:

A 35 year old woman attends the gynaecology clinic with her 14 year old daughter who is complaining of severe period pains since the onset of menstruation at the age of 13 years. Menstrual loss is not heavy and she has no bowel symptoms. Her symptoms are now interfering with her education as she takes several days off school every month. She does not require contraception and clinical examination is normal. Your answer: AA Correct answer: FF Question 20 Question 20

A 33 year old mother of 3 children complains of progressively painful periods over 5 years. There is occasional deep dyspareunia but she has no bowel symptoms. Her symptoms have not responded to simple analgesia and non-steroidal anti-inflammatory drugs. Clinical examination is normal.

| EXPLANATION |

A Counsel and offer evacuation of

retained products of conception B Counsel and offer support group C Counsel and offer laparoscopy &

salpingectomy D

Counsel and offer investigation for recurrent miscarriage E Counsel and offer treatment with F Counsel and offer laparotomy &

(27)

methotrexate salpingectomy G Counsel and offer termination of

pregnancy H Perform salpingectomy

I Proceed to laparotomy J Serial HCG assay K Counsel and refer to early pregnancy

assessment unit L

Repeat trans-vaginal scan 7 days later

Instructions:

Instructions: For each patient described below choose the singlesinglemost appropriate initial management option from the list. Each option may be used once, more than once, or not at all.

A 25 year old woman has a transvaginal scan following IVF treatment during which 2 embryos were replaced and is found to have a 6 week singleton intra-uterine pregnancy with no fetal heart activity. Your answer: AA Correct answer: AA Question 22 Question 22

A 25 year old nulliparous woman has had 2 previous first trimester miscarriages presents at 8 weeks gestation for an early pregnancy scan. She is found to have a 7 week missed miscarriage.

| EXPLANATION |

A Congenital adrenal hyperplasia B Maternal androgen therapy C Down’s syndrome D Turner’s syndrome E Maternal diabetes mellitus F Maternal lithium therapy G Maternal warfarin therapy H Maternal heparin therapy

I Group B streptococcus infection J Maternal anti-epileptic drug therapy K Maternal smoking L Maternal cocaine abuse

Instructions:

Instructions: For each of the case histories described below, choose the singlesingle most likely cause of neonatal collapse from the above list of options. Each option may be used once, more than once, or not at all.

A 6 hour old neonate delivered at 35 weeks gestation following prolonged pre-term rupture of the membranes Your answer: AA Correct answer: II Question 24 Question 24

A 6 hour old neonate delivered by rotational forceps delivery for prolonged second stage of labour. Initial examination showed epicanthic folds with up-slanting palpebral fissures and a loud systolic murmur

| EXPLANATION |

A Endometriosis B Acute PID

C Chronic PID D Irritable bowel syndrome

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G Diverticular disease H Interstitial cystitis I Primary dysmenorrhoea J Adenomyosis

K Uterine fibroids L Polycystic ovary syndrome M Inflammatory bowel disease N Chronic constipation Instructions:

Instructions: For each of the case histories described below, choose the singlesingle most likely cause of chronic pelvic pain from the above list. Each option may be used once, more than once, or not at all.

A 23 year old woman has been referred to the gynaecology clinic with a 6 months history of lower abdominal and pelvic pain and deep dyspareunia. Her symptoms are particularly worse during menstruation. Over the last 4 months, she has experienced episodes of bloody diarrhoea and has lost about 5kg in weight. Her Hb = 10.0g/dl, white cell count = 15 x 10E9/l and platelet count = 450 x 10E9/l.

Your answer: AA Correct answer: MM

A 35 year old woman complains of a 2 year history of progressively painful periods with occasional deep pain during intercourse. She denies any bowel or urinary symptoms. Clinical examination showed a bulky smooth and tender uterus with no adnexal masses and no adnexal tenderness. Her symptoms have not responded to non-steroidal anti-inflammatory agents and diagnostic laparoscopy was normal.

| EXPLANATION |

A Commence iv oxytocin B Deliver by caesarean section C Evacuation of retained products of

conception D

Artificial rupture of membranes E Bimanual compression of the uterus F Venous access and

resuscitation

G Examination under spinal anaesthesia H Intra-muscular analgesia I Intravenous ritodrine J Manual replacement of the

uterus

K Sub-cutaneous terbutalline L Administer uterotonic agent Instructions:

A 34 year old woman is bleeding heavily during the third stage of labour. Her pulse is 60bpm and systolic BP is 100/40mmHg. There is a mass at the introitus consistent with uterine inversion. She has venous access with adequate fluid resuscitation

A 23 year old primigravida is admitted for induction of labour at 39 weeks gestation because of symphysis pubis diastasis. Three hours after vaginal prostaglandin