O&G Flashcards by Amy Dawson-Kavanagh

29 y/o woman visits GP with heavy sensation in her vagina when exercising. She is aware of a bulge in her vagina, sometimes associated with a desire to urinate. She had a vaginal delivery 2 years ago. O/E there is some laxity of the anterior vaginal wall but this does not descend to the introitus on straining. Urine culture is negative. What is the most appropriate management plan?

a. Oxybutynin hydrochloride
b. Pelvic floor exercises
c. Refer for urodynamic testing
d. Refer to urogynaecology clinic
e. USS of pelvis

b. Pelvic floor exercises

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42 y/o woman is 34 weeks pregnant and has had repeat admissions for severe abdominal pain. She currently needs opiate analgesia but is still struggling with the pain. USS shows a sub-serosal fibroid measuring 7cm x 9cm. What is the best management option for her pain?

a. Continuous regular opiates
b. Epidural anaesthesia
c. NSAIDs
d. Remifentanyl patient-controlled analgesia
e. Uterine artery embolisation

a. Continuous regular opiates

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60 y/o woman has hysteroscopy for post-menopausal bleeding. Biopsy shows suspicious endometrial lesion. What is the most appropriate management plan?

a. Admit to gynaecology ward
b. Follow up with GP
c. Gynaecology appointment within 6 weeks
d. Gynaecology telephone clinic appointment in 1 week
e. See in gynaecology clinic within 2 weeks

e. See in gynaecology clinic within 2 weeks

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33 y/o woman 32 weeks pregnant has glycosuria for the second time. Fundal height is 36cm and the fetal parts are difficult to palpate. Her routine glucose testing at 27 weeks was normal. What is the most appropriate next step in her management?

a. Advise low glycaemic index diet
b. Perform 75g glucose tolerance test
c. Send HbA1c
d. Start Insulin
e. Start Metformin

b. Perform 75g glucose tolerance test

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37 y/o woman is 16 weeks pregnant and had close contact with neighbour 4 days ago who now has chicken pox. She doesn’t think she’s had it before. What is the best course of action?

a. Ask her to attend antenatal clinic for urgent assessment
b. Check booking bloods for presence of VZV IgG
c. Fetal USS in 2 weeks
d. Give IVIg Infusion
e. Give VZV vaccine

b. Check booking bloods for presence of VZV IgG

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34 y/o nulliparous woman presents with chronic pelvic pain. Bimanual exam reveals a fixed retroverted uterus with tender nodules on the utero-sacral ligaments. What is the most likely diagnosis?

a. Adenomyosis
b. Endometriosis
c. Inflammatory bowel disease
d. Ovarian carcinoma
e. Pelvic inflammatory disease

b. Endometriosis

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40 y/o woman is successfully treated for ectopic pregnancy with methotrexate. After what interval may she safely conceive again?

a. 1 year
b. 3 months
c. 6 months
d. Her next menses
e. Immediately

b. 3 months

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26 y/o woman has oophorectomy for a 20cm ovarian cyst which was found on USS and described as “complex with solid areas”. Serum Ca125 was normal and on pathological examination the cyst contained dirty fluid, fat, hair shafts, and greasy material. What is the most likely diagnosis?

a. Mature cystic teratoma
b. Mucinous cystadenocarcinoma
c. Mucinous cystadenoma
d. Serous cystadenocarcinoma
e. Serous cystadenoma

a. Mature cystic teratoma

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A woman is having a repeat USS at 32 weeks gestation for a previously low-lying placenta. The USS shows the placenta is clear of the cervical os and an additional succenturiate lobe is seen. Which condition needs to be excluded in the USS?

a. Cervical shortening
b. Fetal growth restriction
c. Placenta praevia
d. Vasa praevia
e. Velamentous cord insertion

d. Vasa praevia

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Which of the following is a complication of 3rd trimester Ibuprofen use?

a. Acute kidney injury
b. Closure of ductus arteriosus
c. Liver failure
d. Preterm labour
e. Reye’s syndrome

b. Closure of ductus arteriosus

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32 y/o woman who is 30 weeks pregnant presents to A&E with abdo pain and small amount of vaginal bleeding. Temperature 37.2, HR 108, BP 90/62. Fetal heart rate is 220, and the uterus is tender and feels hard on palpation. What is the most likely diagnosis?

a. Acute appendicitis
b. Chorioamnionitis
c. Placenta praevia
d. Placental abruption
e. Pyelonephritis

d. Placental abruption

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63 y/o woman presents with a 2 week history of post-menopausal vaginal bleeding. BMI is 39.2. Pelvic USS shows irregular endometrial thickening (14mm). Outpatient endometrial sampling fails because of cervical stenosis. What is the most appropriate management?

a. CT abdomen and pelvis
b. Hysteroscopy with dilatation and curettage
c. Repeat USS in 2 weeks
d. Total abdominal hysterectomy + bilateral salpingo-oopherectomy
e. Total laparoscopic hysterectomy + bilateral salpingo-oopherectomy

b. Hysteroscopy with dilatation and curettage

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32 y/o nulliparous woman is 8 weeks pregnant and experiencing severe nausea and vomiting that makes it impossible for her to work. She is taking 50mg cyclizine OD (once daily) with no effect. What is the best next management option?

a. Admit for I.V. fluids
b. Change to prochlorperazine
c. Increase frequency of cyclizine to TDS (three times daily)
d. Add a PPI
e. Add Prochlorperazine

b. Change to prochlorperazine

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29 y/o woman with past history of cocaine and cannabis use denies using for the past 3 years. Which additional test should be done for this patient at booking?

a. Hair toxicology screen
b. Hepatitis C
c. Hepatitis E
d. Serum toxicology screen
e. Urine toxicology screen

b. Hepatitis C

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33 y/o woman has Ventouse delivery at 39 weeks gestation and requires manual removal of placenta. The removal is uncomplicated with an EBL of 600ml. She plans to mix feed her baby for the first 6 months. When can she expect her menstrual cycle to return?

a. Cannot be predicted
b. When she is more than 50% bottle feeding
c. When she stops breastfeeding
d. Within 6 months
e. Within 6 weeks

a. Cannot be predicted

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29 y/o attends A&E with SOB, abdo pain, nausea, bloating, and feeling faint. She is having her first cycle of IVF and had her embryo transfer 3 days ago. What is the most likely diagnosis?

a. Ectopic pregnancy
b. Miscarriage
c. Ovarian hyperstimulation syndrome
d. Pulmonary embolism
e. Ruptured ovarian cyst

c. Ovarian hyperstimulation syndrome

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20 y/o woman attends A&E. She realised 4 days after her menses finished that she had forgotten to remove her tampon. She has now removed it and is asymptomatic but concerned about the possible consequences. What is the most appropriate management?

a. Advise vaginal douching
b. Arrange USS pelvis
c. Perform high vaginal swabs
d. Prescribe prophylactic antibiotics
e. Reassure and discharge

e. Reassure and discharge

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60 y/o woman presents with discomfort during sex and vaginal dryness. What is the best management option?

a. Commence oral HRT
b. Commence SSRI
c. Commence topical vaginal oestrogen
d. Commence transdermal HRT
e. Commence vaginal lubricants

c. Commence topical vaginal oestrogen

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61 y/o sexually active woman smoker referred to gynaecology clinic with 6 month history of vulval itch. There is an 8mm raised and tender lesion on the right labium majorum. What is the most appropriate next step?

a. Perform a cervical smear
b. Perform a high vaginal swab
c. Perform a VDRL test
d. Perform a vulval biopsy
e. Perform viral swabs

d. Perform a vulval biopsy

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17 y/o girl has delayed menarche and short stature. Investigations:
FSH 70 (very high)
LH 40 (very high)
Which investigation is likely to produce a definitive diagnosis?
a.	Karyotyping
b.	MRI scan of pituitary fossa
c.	Serum oestradiol
d.	Thyroid function tests
e.	Pelvic USS

a. Karyotyping

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40 y/o woman is having a normal vaginal delivery with planned active management of third stage. She has a history of essential hypertension. Which is the most appropriate drug to reduce risk of post-partum haemorrhage?

a. Dinoprostone (prostaglandin E2)
b. Ergometrine maleate
c. Labetalol hydrochloride
d. Magnesium sulphate
e. Oxytocin (Syntocinon)

e. Oxytocin (Syntocinon)

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32 y/o woman has diagnostic laparoscopy to investigate pelvic pain, and has a catheter inserted in recovery for urinary retention. The catheter is removed the next morning. When can she be safely discharged home?

a. When she has voided more than 200ml
b. Straight away with advice to return if she has problems voiding
c. When her post-void residual volume is 0ml
d. When her post-void residual volume is 100ml
e. When her post-void residual volume is 300ml

d. When her post-void residual volume is 100ml

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36 y/o woman who is known to have a baby in breech position has ruptured her membranes on labour ward and is found to have cord prolapse. What is the definitive management of this scenario?

a. Category 1 C-section
b. Category 4 C-section
c. Fill bladder with 500mls normal saline
d. Knee-chest position
e. Replace cord in vagina and elevate presenting part

a. Category 1 C-section

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25 y/o woman who is 38 weeks pregnant is seen in triage for irregular painful contractions lasting 6 hours. She took paracetamol 6 hours ago. She is examined and found to be 2cm dilated. Which analgesia is most appropriate?

a. Co-dydramol
b. Epidural analgesia
c. Nitrous oxide
d. NSAID
e. Warm bath

a. Co-dydramol

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41 y/o women attends her dating scan. LMP dates make her 12 weeks pregnant. An intrauterine pregnancy is seen with no fetal heartbeat. CRL is equivalent to a fetus of 9 weeks gestation. What is the best next step? a. Admit her for laparoscopy b. Counsel her on management options for miscarriage c. Offer her a repeat USS in 1 week d. Offer treatment with methotrexate e. Serum beta-hCG now and repeat in 48 hours

c. Offer her a repeat USS in 1 week

37 y/o woman has her anomaly scan at 20+3 weeks of pregnancy, and it reveals echogenic bowel. What is the most likely cause? a. Duodenal atresia b. Incidental finding c. Male gender d. Trisomy 18 e. Trisomy 21

e. Trisomy 21

29 y/o woman had had intermittent vaginal bleeding since insertion of the Mirena coil 6 weeks ago. What is the most appropriate investigation? a. Cervical smear b. Colposcopy c. High vaginal swab d. No investigation required e. Transvaginal pelvic USS

d. No investigation required

A woman with sickle cell trait is 8 weeks into an unplanned pregnancy. Which investigation should be offered first? a. Chorionic villus sampling b. Free fetal DNA testing c. Partner FBC d. Partner haemoglobin electrophoresis e. Partner karyotyping

d. Partner haemoglobin electrophoresis

A Rh negative woman has light vaginal bleeding and pain at 9 weeks gestation. USS shows a viable 9 week intrauterine pregnancy. The bleeding resolves 48 hours later. What further treatment does she require? a. 250IU Anti-D prophylaxis immediately b. Kleihauer test c. No further action d. Progesterone pessaries e. Repeat scan in 2 weeks

c. No further action

37 y/o woman who is 10 weeks pregnant presents with 1 week of excessive vomiting. The fundal height is consistent with a 16 week gestation pregnancy. Temperature 37.2, HR 100, BP 180/110. What is the primary pathology? a. Gastroenteritis b. Hyperemesis gravidarum c. Molar pregnancy d. Pre-eclampsia e. Pregnancy-induced hypertension

c. Molar pregnancy

42 y/o Afro-Caribbean woman presents with ongoing menorrhagia. A uterine fibroid is identified on TVUSS, and a trial of tranexamic acid has not helped. Which is the next most appropriate management step? a. COCP b. Intrauterine coil device c. IUS d. Mefenamic acid e. Refer to gynaecology

c. IUS

24 y/o woman has urge incontinence causing low mood. She previously had a clitoridectomy aged 7 years old in Somalia. She is nulliparous. She has two younger brothers. What is the most appropriate next step in her management? a. Referral to FGM clinic b. Referral to mental health team c. Referral to police d. Referral to social services e. Referral to uro-gynaecology

a. Referral to FGM clinic

55 y/o woman in GP describes sudden need to urinate throughout the day with occasional leaks when she can’t make it to the bathroom in time. There is no dysuria and a urine dipstick is normal. What is the most appropriate management option? a. Bladder training b. Incontinence pads c. Pelvic floor exercises d. Tolterodine e. Trimethoprim

a. Bladder training

36 y/o woman sees GP for routine appointment at 32 weeks pregnancy. This is her first pregnancy and has so far been uncomplicated. She has normal fetal movements and is generally well with temperature 36.3, HR 90, BP 128/82, RR 13, O2 sats 96% on room air. Fundal height is 32cm and fetal HR is normal. Urine dipstick shows ++ protein but no other abnormalities. What is the most appropriate management? a. Immediate referral to obstetrics b. Repeat urinanalysis in 1 day c. Repeat urinanalysis in 1 week d. Send urine for MC&S and start Nitrofurantoin e. Send urine for MC&S and start Trimethoprim

a. Immediate referral to obstetrics

19 y/o woman in GP has a 3 week history of post-coital vaginal bleeding. She had a Nexplanon (Progesterone-only subdermal implant) inserted 18 months ago and has been amenorrhoeic for the last 12 months. Vaginal and speculum exams are normal and urine pregnancy test is normal. What is the most appropriate next investigation? a. Blood test for clotting screen b. Cervical cytology c. Endocervical, chlamydial, and high vaginal swabs d. Transvaginal USS e. Urine for microscopy, culture, and sensitivities

c. Endocervical, chlamydial, and high vaginal swabs

19 y/o woman attends GP for contraception review. She started Microgynon-30 14 months ago and reports a recent migraine without aura which lasted 2 days (which she has never experienced before). She is currently a smoker but has no other CVS disease or VTE risk factors. Her temperature is 36.5, HR 70, BP 115/63, RR 14, O2 sats 97% on room air, and her BMI is 21. What is the most appropriate next step in management? a. Continue Microgynon-30 and offer smoking cessation b. Continue Microgynon-30 and start Sumitriptan c. Stop Microgynon-30 and offer Microgynon-20 d. Stop Microgynon-30 and offer progesterone-only contraception e. Stop Microgynon-30 and start NuvaRing

d. Stop Microgynon-30 and offer progesterone-only contraception

26 y/o woman has 24 hours of vulval rash and painful urination. What is the most appropriate treatment? a. Oral aciclovir b. Oral flucloxacillin c. Topical aciclovir d. Topical clotrimazole e. Topical fusidic acid

a. Oral aciclovir

29 y/o seen in GP wanting to conceive. She has epilepsy and her last seizure was 18 months ago. She currently has a copper IUD in situ and is taking sodium valproate 1000mg BD. What is the most appropriate management? a. Leave IUD in situ, continue sodium valproate, and refer her for specialist advice b. Remove IUD, continue sodium valproate 1000mg BD and start folic acid 5mg OD c. Remove IUD, stop sodium valproate 1000mg and start carbamazepine 600mg BD and folic acid 5mg OD d. Remove ID, stop sodium valproate, and start folic acid 400mcg OD

a. Leave IUD in situ, continue sodium valproate, and refer her for specialist advice

31 y/o woman in GP is 34 weeks pregnant and presents with dysuria, frequency, and urgency. Temperature 37.2, HR 80, BP 126/78, RR 18, O2 sats 99% on room air. She has mild suprapubic pain with no rebound or tenderness. What is the most appropriate initial management plan? a. Arrange clinical review in 24 hours b. No investigation required, treat empirically with antibiotics c. Reassure, no treatment needed d. Send urine for MC&S and treat empirically with antibiotics without waiting for results e. Send urine for MC&S and treat with antibiotics based on the results

d. Send urine for MC&S and treat empirically with antibiotics without waiting for results

32 y/o woman presents to GP with dyspareunia, sweating, and low mood. She has not had a period in over a year, and has previously been treated with chemotherapy for breast cancer. What is the most appropriate investigation? a. LH and FSH b. Oestradiol level c. Pelvic USS d. Prolactin e. Testosterone

a. LH and FSH

45 y/o woman who has had 2 vaginal deliveries undergoes urodynamic testing for urinary dysfunction. The report reveals unprovoked pressure peaks with urinary leakage. What is the most likely diagnosis?

Urge incontinence

22 y/o woman is planning a water birth. She is low risk with no medical problems. What complication of normal delivery is increased by a water birth?

Infection?

Woman visited by community midwife 8 days after a vaginal delivery. Her partner reports she seems confused and believes police want to take her baby away. What is the most likely diagnosis?

Post-partum psychosis

30 y/o woman is in labour at 37 weeks. She is 5cm dilated with intact membranes and is contracting at 4 in 10 minutes. She becomes agitated and starts behaving oddly. She complains of extreme SOB and suddenly collapses, then begins to bleed from her I.V. cannula site. Temperature 36.8, HR 108, BP 82/44, RR 22, O2 sats 78%. What is the most likely diagnosis?

Amniotic fluid embolism

35 y/o woman has frothy and thin offensive yellow vaginal discharge. She is afebrile and last has sexual intercourse 3 weeks ago. She describes dysuria for the last few days and soreness and itchiness of her vulva. What is the most likely diagnosis?

Trichomonas vaginalis infection

Which 4 strains of HPV are targeted by the current UK quadrivalent vaccination program?

6, 11, 16, 18

80 y/o woman with a BMI of 25, COPD, and angina complains of back pain and a dragging sensation in her vagina. She has a uterine prolapse and a normal pelvic USS. What is the most appropriate treatment option?

Pelvic floor muscle training

8 y/o girl brought to gynaecology clinic with offensive vaginal discharge, but is otherwise well. What is the most likely cause?

Vaginal foreign body

40 y/o woman has had miscarriages at 8 weeks, 11 weeks, and 22 weeks. She has also had one ectopic pregnancy for which she had a laparoscopic salpingectomy. Last year she has a stillbirth at 24 weeks gestation. She has one 4 year old daughter delivered at 39 weeks by C-section, and is currently 6 weeks pregnant. What is her gravidity and parity (express as GxPx)?

G7P2 + 4

28 y/o woman has a regular 35 day cycle. The first day of her LMP is 27/11/2019. What is her estimated delivery date?

10/09/2020 Naegele's Rule = LMP - 3mths + 1yr + 7 days If longer/shorter cycle add (cycle length - 28)

49 y/o woman has heavy, irregular menstrual bleeding. TVUSS shows a thickened endometrium with cystic spaces. What investigation would be diagnostic in this scenario?

Biopsy

32 y/o with mild asthma has unexplained intra-uterine death at 37 weeks gestation. She is induced and has epidural analgesia and a spontaneous vaginal delivery. She is very distressed and would like to go home. What should be given to prevent her from expressing breast milk in this scenario?

Cabergoline

21 y/o woman is 5 weeks pregnant with abdominal pain. USS shows no evidence of an intrauterine pregnancy, a corpus luteum in the left ovary, and otherwise normal adenexae. Her serum b-hCG is 700 (<18 normal range). How should this pregnancy be classified?

Pregnancy of unknown location

A low risk woman would like to have epidural anaesthesia but is concerned about the risks. What is the risk of permanent paralysis (give as 1:X)

~1:140,000 it is so rare it is difficult to put a number on it

28 y/o woman has a 2 year history of subfertility with oligomenorrhea and PCOS. Her BMI is 32. Her husband’s semen analysis is normal. She has tried a 6 month course of Metformin. What is the most appropriate medication for the treatment of her subfertility?

Clomiphene

31 y/o woman is 37 weeks pregnant and attends GP with itchy rash, though she is systemically well. Temperature 36.8, HR 80, BP 116/78, RR 18, O2 sats 99% on room air. She has the rash depicted below. https://pic.glowing.com/forum/cc2c63454a6b6cb21d489cbda0bb495e.jpg What is the most likely diagnosis?

Pruritic uriticarial papules and plaques of pregnancy

19 y/o woman with intra uterine device in situ presents to GP with new onset low abdominal pain and spotting. Temperature 36.3, HR 83, BP 110/90, RR 18, O2 sats 98% on room air. What is the most appropriate initial investigation?

Urinary beta-hCG

34 y/o woman in GP is 28 weeks pregnant. She had normal antenatal screening and scans, and her pregnancy is uncomplicated. She has already had the influenza vaccination. Which other immunisation does she require?

Whooping cough

59. GP requesting emergency contraception 5 days after unprotected intercourse. What is the most effective option available to her?

Copper intrauterine device

38 y/o woman in GP requests contraception. She has severe menorrhagia and had a gastric sleeve bypass 12 months ago. What is the first line contraceptive management in this scenario?

Progestogen-only intrauterine system

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

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

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

e. Ventouse delivery

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

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

a. Complete miscarriage

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)

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

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

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

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

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

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

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

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

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

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

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

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

c. When the neonate has been delivered

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

d. Surgical repair

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

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

a. Make a safeguarding risk assessment

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

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

a. List for laparoscopy

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

b. Bartholin’s cyst

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

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

d. Postnatal depression

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

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 transfusion 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?

Two 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?

Thiamine

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?

Hepatitis 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)

G6 P1

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?

Spina bifida

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?

Gestational trophoblastic disease

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?

McRobert’s manoeuvre

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?

Regulate emotional effects of oestrogen

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 - 1 year

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?

Rectocoele

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?

Pruritic urticarial papules and plaques of pregnancy (PUPPP)

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?

Breastfeeding 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?

Pelvic inflammatory disease

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 mutation

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

Secondary amenorrhoea. Negative pregnancy test. Low LH: - Prolactin = 1500. Diagnosis? - Prolactin = 6500. Diagnosis?

- Non-functioning macroadenoma | - Prolactinoma

48 year old woman with secondary amenorrhoea for 6 months. High FSH and LH. Diagnosis?

Ovarian failure/ menopause

23 year old woman with acanthosis nigricans and amenorrhoea. Diagnosis?

PCOS

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

Caesarean section

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

Kleihauer-Betke test then give anti-D

HIV positive woman – what is the most important factor deciding her mode of delivery?

Viral load If viral load <1000, can advise vaginal delivery Wash baby after vaginal or Caesarean delivery

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

G4p2+1 ``` Gravidity = number of times pregnant Parity = number of times >24wks (stillborn or live baby) Abortus = miscarriages or terminations ```

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

Perineal wound breakdown/infection

Girl with dyskaryosis has colposcopy and biopsy showing CIN1 – no treatment is given. When should next colposcopy be?

12 months

HIV with undetectable viral load. what is contraindicated in labour? - Forceps - Ventouse - Foetal blood sampling - C-section

- Foetal blood sampling | though BHIVA say there is no real evidence to support this in undetectable women

Standard chicken pox question. Doesn’t remember whether she had it as a child. What do you do? - Check IgG antibodies - Check IgM antibodies - Give her varicella Ig - Give her aciclovir

- Check IgG antibodies

52 y/o woman with BMI 40, abdo distension, urinary symptoms, bowel symptoms and weight loss. What could be it? - Ovarian cancer - Endometrial cancer - Cervical cancer - Colorectal cancer

- Ovarian cancer

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? - Repeat US - Ca 125 levels, hysteroscopy - Pipelle biopsy - Reassure & discharge

- Pipelle biopsy

Woman with rupture of membranes, painless bleeding, and fetal distress on CTG. What was the likely diagnosis? - Placenta praevia - Vasa praevia - Placental abruption - Chorioamnionitis

- Vasa praevia

Woman had an implant inserted but she’s getting it removed. What is the most likely reason why? - Weight gain, - Irregular bleeding - Hirsutism

- Irregular bleeding

What cancer are you at increased risk at with combined HRT? - Ovarian - Endometrial - Cervical - Bowel - Breast What about oestrogen-only HRT?

- Combined: Breast | - Oestrogen: Breast & endometrial (endometrial > breast)

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

Inevitable miscarriage

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

Labetalol Nifedipine is 2nd then Methyldopa is 3rd – remember labetalol is contraindicated in asthma

Mother had rupture of membranes at 32 weeks but is not in labour. What do you give her?

Steroids + erythromycin

17yr old girl wanting Emergency contraception more than 5 days after unprotected sex, but ovulated within 5 days. - Copper IUD, - Levonorgestrel, - IUS, - COCP

- Copper IUD,

35 year old first-time mum, gave birth 6 weeks ago. Is exclusively breastfeeding. Wants to know if she needs contraception?

No contraception needed (Lactation Amenorrhea Method)

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? - Has the father ever had children? - When was your last period? - Do you have hot flushes? - How heavy are your periods? - What contraception have you used in the past?

- When was your last period?

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

Fibroids

Pregnant woman with Gram negative bacilli in urine microscopy. What do you do? - Watch and wait - Give Amoxicillin - Urgent referral - Some scans

- Give Amoxicillin

Girl with painful periods in the first 2 days of her period ever since menarche, she has heavy bleeding. What is it? - Primary dysmenorrhoea, - Endometriosis, - Endometrial cyst

Primary dysmenorrhoea

Woman with BP of 120/80, smokes 5 a day, what contraception for her?

Can use any but ideally avoid COCP which is UKMEC2 for smoking

Woman with painful breast after giving birth. She’s breast-feeding and has an abscess secondary to mastitis. - Surgical excision, - Aspirate and culture, - Ciprofloxacin

- Aspirate and culture,

Pregnant woman in early pregnancy with depression and anxiety on sertraline. What do you do? - Stop sertraline, - Carry it on, - Prescribe high-dose folic acid, - Reduce the dose, - Amitriptyline

Carry it on (benefits probably outweigh risks)

What do you do in a woman in labour after 4 hours of checking, she’s 4cm. - Vaginal prostaglandin, - Cervical sweep, - Oxytocin, - Ergometrine, - ARM

- ARM

Postpartum haemorrhage with high BP. Which agent to use? - Carboprost, - Misoprostol, - Ergometrine, - Syntocinon

- Syntocinon Ergometrine contraindicated in HTN

Foreign woman has come in and is pregnant. What vaccine should she be offered? - Hepatitis A, - Hepatitis B, - Whooping cough

- Whooping cough Vaccinations in pregnancy: Bordatella pertussis, influenza, COVID

Woman with really heavy periods. What’s the first line management? She doesn’t want to get pregnant. - COCP, - Implant, - IUS, - IUD, - Tranexamic Acid, - Mefenamic Acid

- IUS,

Foetus with transverse lie, recent SROM, CTG shows fetal distress. Most likely cause?

Cord prolapse

HRT question for a menopausal woman with flushes, last period 10m ago. What do you give her? - Cyclical combined HRT - Oestrogen only HRT - Topical HRT - Continuous HRT

- Cyclical combined HRT

What’s the management for DVT risk in a pregnant woman after an elective Caesarean? - LMWH, - LMWH and Ted stockings, - Ted stockings, - Warfarin, - Aspirin, - Aspirin and Ted stockings

- LMWH and Ted stockings

Woman with raised testosterone, LH and FSH were both elevated, with LH being 2.5 times higher than FSH on day 3 of her cycle. What is the cause for her infertility?

PCOS

A pregnant woman with an itch. What tests do you do? - Bile acids, - Uric acid, - FBC - USS - None needed

- Bile acids,

Woman with blocked tubes on hysterosalpingogram, what treatment should you do for fertility? - IVF, - IUI, - ICSI

- IVF ``` IVF = in-vitro fertilisation IUI = in-utero fertilisation ICSI = Intra-Cytoplasmic Sperm Injection ```

Smear question she is 47 y/o. It was borderline dyskaryosis, HPV negative, what do you do? - Repeat in 6w - Repeat 6m, - Repeat 1y, - Discharge to routine (2y), - Discharge to routine (3y)

- Discharge to routine (3y)

Down’s syndrome person gets pregnant. Mum wants termination and Down’s person wants to keep it. What should you do?

Assess her mental capacity without mum present

Heavy periods in a girl not yet sexually active. What do you give her? - COCP, - Mefenamic acid, - Tranexamic acid

- Tranexamic acid

Woman 38/40 has come in for her elective C-section, ECV was attempted and failed, what do you do now?

Carry on with C/S as planned

Woman previously had an 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 folic acid from before conception (1-3 months) until 12 weeks pregnant

Old woman with itchy white vulval patches: - VIN, - Vulvar cancer, - Lichen sclerosus

- Lichen sclerosus

Woman with high BMI (28) who basically had stress incontinence. What’s the first line management? - Pelvic floor exercises - Oxybutinin, - Bladder training, - Weight loss and lifestyle change

- Pelvic floor exercises | weight loss only recommended if BMI >30

Poorly controlled diabetic mother, her newborn has an abnormal asymmetric Moro reflex - what’s wrong? - HIE, - Fracture of humerus, - Brachial plexus injury

- Brachial plexus injury | secondary to probably shoulder dystocia because of diabetes

What do you measure at booking for hepatitis b?

Hep B surface antigen

Man with azoospermia – what is the most likely cause?

Varicocoele

Woman on COCP, has missed 6th and 7th day pill, had unprotected sex two days ago, her urine pregnancy test is clear. What to do? - Repeat in a week, - Reassure and discharge, - Emergency contraception

- Emergency contraception

Woman with endometriosis, had laparoscopic adhesiolysis – developed a whole range of sx - high CRP, low Hb, constipation, bowel sounds absents etc – what’s happened? - Bowel obstruction, - Bowel perforation, - Urinary retention, - Intrabdominal bleeding

- Bowel perforation,

Woman with offensive smelly lochia day 2 post-partum, had had some high vaginal swabs. What do you do next? - Reassure and discharge, - Await swab results, - Give broad-spectrum antibiotics, - Abdo USS

- Give broad-spectrum antibiotics,

Large mum (BMI >40), head comes out then goes back in, chin not visible. - Rupture, - Short cord, - Shoulder dystocia, - Normal mechanism of labour

- Shoulder dystocia,

70 year old with a 2 week history of vaginal bleeding, TVUSS shows 6mm endometrium and 3 cm simple ovarian cyst. Next step? - Ca125, - Diagnostic laparoscopy, - Pipelle biopsy

- Pipelle biopsy

Woman who is exclusively breastfeeding for 6 weeks and wants contraception. What do you tell her?

She can rely on breastfeeding as long as it is frequent, she is breastfeeding exclusively, and she will need other contraception by the 6 month mark

Pregnant Woman has pain and bleeding and her abdomen feels ‘woody’ Diagnosis?

Placental abruption

Woman wanting to get pregnant. All test normal and prolactin raised by like 2 points above normal value what’s most likely cause? - Unknown - Prolactinoma - PCOS

Unknown (accounts for 30% of subfertility)

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

LFTs

23yr old woman with dyspareunia and FGM. What do you do? Refer to police, Refer to FGM safeguarding, offer surgical reversal, psychosexual counselling

Refer to FGM safeguarding

30 yr woman with first day of last menstrual period on 25th August, 31 day cycles. What is the estimated delivery date?

June 4

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

Any point during this pregnancy

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

Clause A Subject to the provisions of this section, a person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith— (a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or (b) that the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or (c) that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated; or (d) that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

Hysterectomy yesterday. How long to stay off work for?

4 weeks

7. 45F has a radical hysterectomy (Wertheim’s hysterectomy) for CIN. Last cervical smear 2 years ago. When next smear? - 1 year - 6 months - vaginal vault smear - 6 months - 1 year - vaginal vault smear - No smear need ed

- 6 months - vaginal vault smear

Post-LLETZ, when is her next smear?

6 months

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

9 months

Lambda sign on USS – DCDA twin pregnancy. When do you aim to deliver these twins?

37 weeks

38 weeks pregnant, acute onset abdominal pain – diagnosis?

Placental abruption

Woman in stage 2 of labour, pushing for 30 minutes, head pressing against perineum, when CTG becomes pathological – what do you do next? - Emergency C section, - Forceps delivery, - Episiotomy

- Forceps delivery,

Woman with fever of 39, deep dyspareunia (PID) – do you send them for IV Abx or send home with oral Abx?

Send for IV abx

Woman who is going away for 4 months with heavy, irregular periods, wants something that will regulate her periods + make them lighter? - COCP, - POP, - Depot progesterone, - IUS

- COCP,

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

Ask her to complete a menstrual diary

LH raised more than FSH (3:1)

PCOS

Woman has come for a sterilisation, has had protected sex since her last menstruation one week ago, just post-ovulation – Immediate tx? - Insert IUD, - Cancel surgery, - Continue with surgery (so long as sex protected)

- Continue with surgery (so long as sex protected)

Woman has menopausal symptoms and wants to start HRT, last period 6m ago - which HRT?

Cyclical HRT

Woman with dribbling all the time and had to wear a pad – diagnosis?

Vesicovaginal fistula

Woman with stress incontinence, with prolapse + leakage on coughing and standing, 1st line treatment - Pelvic floor exercises, - Oestrogen pessary, - Tension-free tape, - B3 adrenergic antagonist

- Pelvic floor exercises,

Bloating, raised CA125, next step?

Pelvic USS

Which test is used to screen for Down syndrome at 15 weeks? - Amniocentesis, - Non-invasive pre-natal testing, - Chorionic villus sampling, - Quad test

- Quad test Quadruple test: - alpha-fetoprotein (AFP) - human chorionic gonadotropin (hCG) or free bhCG - inhibin-A - unconjugated oestriol (uE3) Only tests for Down's

Smoker, which extra tests does she require in pregnancy?

Serial growth scans - if smokes >10 per day

A g2p1 woman whose previous baby weighed 5.1Kg and who developed gestational diabetes in her previous pregnancy, is tested by the GP, but her fasting glucose and OGTT are normal – what extra tests should be arranged for her?

OGTT at 24-28wks

Lady with pain on left breast – mastitis, given antibiotics by GP - what other breastfeeding advice do you give her? - Continue breastfeeding from both breasts, - Continue from affected breast, - Continue from unaffected breast, - Express breast milk and discard, - Stop breastfeeding

- Continue breastfeeding from both breasts

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

Mature teratoma

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

Pipelle biopsy

Treatment for candidiasis?

Normal: Oral fluconazole, topical clotrimazole | In pregnancy: Topical clotrimazole only

16 year old girl with secondary sexual characteristics and no periods. Diagnosis?

Imperforate hymen

G2p1 woman is worried about delivery of current baby as she had a grade 3 tear in her last. What do you do different in this pregnancy? - Prophylactic episiotomy, - Elective C-section, - Episiotomy on the day

- Elective C-section, Depends on consultation with her Can have vaginal birth after tear but would never do prophylactic episiotomy - only do when indicated e.g. instrumental

Dishevelled woman come to antenatal clinic, baby is low weight, but every time admitted to hospital, gains weight easily - who to refer to?

Safeguarding midwife

Treatment for menorrhagia?

1st line: IUS | 2nd line: Tranexamic acid

Woman gets headache 24hrs after delivery? - Post-dural puncture headache, - Pre-eclampsia, - Migraines, - Cerebral vein thrombosis

- Post-dural puncture headache,

Woman who has just given birth to 2 day old baby. Her 2 year old son gets chicken pox, women has IgG antibodies. Goes to GP, what should be done? - Nothing, - Test foetal antibodies, - Give IVIG to baby, - Give aciclovir to baby

- Nothing,