Formative

Question 1

What are women offered as routine screening for Down’s syndrome?

a) amniocentesis
b) CUB (combined ultrasound/biochemical) screening
c) AFP test
d) foetal blood sampling
e) nuchal translucency scan

Answer 1

b) CUB (combined ultrasound/biochemical) screening

Question 2

A 40 year old Para 4 with a BMI of 40 presents with leakage of urine on laughing and coughing. All of the following are appropriate management steps except:

a) anti-cholinergic medication
b) decrease caffeine intake
c) physiotherapy
d) transvaginal tape
e) weight loss

Answer 2

a) anti-cholinergic medication

Question 3

A woman attends for induction of labour. Certain conditions need to be met before proceeding with induction. Which of the following is a contraindication to the induction of labour?

a) cephalic presentation
b) obesity
c) oblique lie
d) previous caesarean section
e) rupture of membranes

Answer 3

c) oblique lie

Question 4

Which of the following drugs is contraindicated in pregnancy?

a) ramipril
b) labetalol
c) methyldopa
d) magnesium sulphate
e) nifedipine

Answer 4

a) ramipril

Question 5

In order to prevent rhesus disease in the baby, which women are recommended to receive anti-D in their pregnancy?

a) all rhesus negative women
b) all rhesus positive women
c) all women
d) rhesus negative women with rhesus positive partner
e) rhesus positive women with rhesus negative partner

Answer 5

a) all rhesus negative women

Question 6

A 22 year old woman is referred to the gynaecology clinic with cyclical pain and dyspareunia. The consultant is concerned that she has endometriosis. What is the best investigation to confirm the diagnosis?

a) barium enema
b) CT scan
c) diagnostic laparoscopy
d) MRI scan
e) transvaginal ultrasound

Answer 6

c) diagnostic laparoscopy

Question 7

During the menstrual cycle the levels of hormones change. Which hormone has sudden rise in level just before ovulation?

a) 17 (OH) progesterone
b) oestrogen
c) LH
d) progesterone
e) testosterone

Answer 7

c) LH

Question 8

A 31 year old woman presents with severe right sided upper abdominal pain at 34 weeks gestation. She reported normal foetal movements up until now. She has no vaginal bleeding but pain is getting worse. Abdomen is tense and tender. High blood pressure was recorded at her midwife visit. Urine dipstick is normal. What is the most likely diagnosis?

a) cholecystitis
b) placental abruption
c) pre-eclampsia
d) pre-term labour
e) urine infection

Answer 8

b) placental abruption

Question 9

A 73 year old nulliparous lady presented to the general practitioner with 3 episodes of unprovoked vaginal bleeding. She is menopausal, obese and diabetic. Her smears were up to date til 60 years of age, the limit for the National Screening programme at that time. She was referred to the hospital by the GP. What is the most probable diagnosis?

a) cervical cancer
b) endometrial cancer
c) ovarian cancer
d) pelvic inflammatory disease
e) rectal cancer

Answer 9

b) endometrial cancer

Question 10

A 27 year old primagravid patient has been admitted at 37 weeks with a 6 hour history of contractions. She is having 2 contractions in 10 minutes and each is lasting 50 seconds. She has had no show and her membranes are intact but she thinks she is in labour. Which one of the following is the best clinical sign to assess if she is in established labour?

a) abdominal examination to assess the descent of the foetal head
b) abdominal examination to assess the strength of the contractions
c) speculum examination to assess cervical dilation
d) vaginal examination to assess cervical dilation
e) vaginal examination to assess if the membranes are intact

Answer 10

d) vaginal examination to assess cervical dilation

Question 11

A parous patient is in established labour and the head is just visible at the introitus. She has had no analgesia. She is pushing well but is screaming for pain relief. What method of pain relief is best for her?

a) epidural anaesthetic
b) entonox
c) morphine
d) spinal anaesthetic
e) supportive care

Answer 11

e) supportive care

just kidding don’t be an idiot it’s entonox

Question 12

A 26 year old woman is pregnant with her first baby. She has remained very well during her pregnancy but her haemoglobin has dropped from 13g/dl at 12 weeks to 11g/dl at 28 weeks pregnant. What is the most likely explanation for this?

a) concealed haemorrhage
b) iron deficiency anaemia
c) normal physiological change in pregnancy
d) pernicious anaemia
e) sickle cell disease

Answer 12

c) normal physiological change in pregnancy

Question 13

Considering secondary prevention of cervical cancer in the UK, CIN is diagnosed by:

a) colposcopy
b) cytology
c) HPV testing
d) histology
e) MRI scan

Answer 13

d) histology

Question 14

What is true about pregnant women who are diabetics?

a) they do not suffer from a higher rate of still brith
b) they have babies who are at risk from neonatal hyperglycaemia
c) they need good diabetic control before conception to help prevent anomalies in the baby
d) they only suffer complications in the mother as glucose does not cross the placenta and therefore does not harm the baby
e) they typically have babies which are smaller than non-diabetic mothers

Answer 14

c) they need good diabetic control before conception to help prevent anomalies in the baby

Question 15

A 50 year old woman has irregular periods and suffering from mood swings and night sweats. She is perimenopausal and wishing to commence on HRT to help her symptoms. Which hormone’s reducing level results in such menopausal symptoms?

a) FSH
b) LH
c) oestrogen
d) progestogen
e) thyroxine

Answer 15

c) oestrogen

Question 16

The primary prevention of cervical cancer in the UK is performed by:

a) HPV 6 and 11 immunisation
b) high risk HPV testing
c) HPV 16 and 18 immunisation
d) HIV immunisation
e) cervical screening

Answer 16

c) HPV 16 and 18 immunisation

Question 17

In the UK National Breast Screening programme:

a) the screening target population are women aged between 40 and 70 years of age
b) the screening target population are offered primary screening by clinical examination of the breasts
c) the screening target population are offered a mammogram every five years
d) the screening target population are registered with a GP practice and aged 50-70 years
e) the screening target population is anyone with a family history of a first degree relative with breast cancer

Answer 17

d) the screening target population are registered with a GP practice and aged 50-70 years

Question 18

The pregnant patient should always be nursed in a left lateral position because:

a) in the supine position the umbilical cord is compressed by the overlying foetus
b) in the supine position the pressure of the gravid uterus on the inferior vena cava causes a reduction in venous return to the heart with a possible 25% reduction in cardiac output
c) in the left lateral position there is an increase in functional residual capacity of the lungs
d) in the supine position the pressure of the gravid uterus on the aorta reduces blood flow to vital organs by 10%
e) nursing in the left lateral position ensures that blood flow to a posterior placenta is not compromised

Answer 18

b) in the supine position the pressure of the gravid uterus on the inferior vena cava causes a reduction in venous return to the heart with a possible 25% reduction in cardiac output

Question 19

Iron deficiency anaemia is by far the commonest cause of anaemia and iron deficiency anaemia is the commonest haematological problem in pregnancy.
In pregnancy the following is true -
a) a pregnancy causes a 10 fold increase in the requirement for iron not only for haemoglobin synthesis but also for certain enzymes and the foetus
b) because the expansion in plasma volume is greater than the increase in red cell mass there is a fall in haemoglobin concentration, haematocrit and red cell count
c) changes in the coagulation system during pregnancy produce a physiological hypercoaguable state – clotting factors VIII, IX, X decrease and fibrinogen increases
d) a woman will not be iron deficient if she has a normal haemoglobin and MCV (mean cell volume)
e) all women planning a pregnancy should be advised to take 400mcg folate periconceptually and up until 12 weeks gestation to prevent megaloblastic anaemia

Answer 19

b) because the expansion in plasma volume is greater than the increase in red cell mass there is a fall in haemoglobin concentration, haematocrit and red cell count

Question 20

A 33 year old para 1+2 presents to the antenatal clinic at 9+ weeks gestation. From this, what do we know about this woman’s obstetric history?

a) this is her 2nd pregnancy
b) this is her 4th pregnancy and she has one child who is alive and well
c) this is her 4th pregnancy and she has had 2 miscarriages
d) this is her first pregnancy
e) this is her 4th pregnancy and she had 2 previous early pregnancy losses

Answer 20

e) this is her 4th pregnancy and she had 2 previous early pregnancy losses

Question 21

Women are seen by a midwife for a booking appointment when they are offered screening for certain infections.
Which of the following infections are women NOT routinely offered at booking?
a) hepatitis B
b) human immunodeficiency virus (HIV)
c) sickle cell
d) thalassaemia
e) varicella (chicken pox)

Answer 21

e) varicella (chicken pox)

Question 22

A 22 year old woman attends her GP requesting emergency contraception. She has a regular 28 day menstrual cycle and this is day 15. She reports unprotected intercourse 78 hrs ago.
Which is the most effective option for this woman?
a) emergency copper intrauterine device
b) levonelle
c) mifepristone
d) mirena levonorgestrel intrauterine system
e) ulipristil acetate

Answer 22

a) emergency copper intrauterine device

Question 23

A 35 year primigravid patient at 36 weeks gestation is noted to have a blood pressure of 160/98 at a routine community antenatal check. Which of the following additional findings would be diagnostic of pre eclampsia?

a) excessive weight gain
b) oedema
c) parasthesia
d) proteinuria
e) visual disturbance

Answer 23

d) proteinuria

Question 24

A women presents with vaginal bleeding and lower crampy abdominal pain at approximately 9 weeks gestation. Her observations are stable. Speculum examination reveals blood and small clots coming through the open cervical os.
Which of the following is the most likely diagnosis? a) complete miscarriage
b) ectopic pregnancy
c) inevitable miscarriage
d) pelvic infection
e) threatened miscarriage

Answer 24

c) inevitable miscarriage

Question 25

A 28 year old woman is seen at the infertility clinic. She has irregular periods and a diagnosis of polycystic ovarian syndrome (PCOS). Her partner’s semen analysis is normal. The decision is made to commence on ovulation stimulation.
Which one of the following drugs would be the best option?
a) clomiphene
b) danazol
c) decapeptyl SR
d) dianette
e) follicle stimulating hormones (FSH)

Answer 25

a) clomiphene