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MBBS V - Senior Clerkship - Block C CCT > O&G CCT > Flashcards

O&G CCT Flashcards

1
Q

32 yo primigravida female suffer from massive obstetric haemorrhage, received blood and clotting factors transfusion, then developed disseminated intravascular coagulation (DIC). Which of the following is compatible with DIC?
A. Decreased APTT
B. Increased Factor VII
C. Increased fibrinogen
D. Thrombocytopenia

A

Ans: D

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2
Q

35 yo female is admitted for severe abdominal pain. She has a history of ovarian cystectomy for endometriotic cyst 2 years ago. She is known to have recurrence, and is admitted for abdominal pain, pulse 100, BP 90/40. Urine pregnancy test is negative. Which of the following is the cause of her problem:
A. Acute appendicitis
B. Ovarian cyst complication
C. Ruptured ectopic pregnancy
D. Urinary tract infection

A

Ans: B

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3
Q

35 yo female has a vulval swelling after delivery. Cause?
A. Cellulitis
B. Vulval oedema
C. Vulval haematoma
D. ?

A

Ans: C

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4
Q

Lady with history of gestational DM, 35? weeks gestation. The head was delivered without any issues, but the midwife cannot deliver with gentle traction with a turtle sign present. What is the most likely problem?
A. CPD
B. Shoulder dystocia
C. Malpresentation
D. Prolonged phase 2 labor

A

B. Shoulder dystocia

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5
Q

A 36 years old Gravida 1 Para 0 woman was admitted at 29th week of gestation for a gush of fluid from her vagina 2 hours ago. She had no other associated symptoms. Fetal movement was active. Speculum examination confirmed leaking with clear pool of liquor seen. She stayed in the hospital for monitoring. She suddenly complains of a mass protruding from her vagina while straining for bowel opening 5 days later. A loop of cord without pulsation is found. Fetal heart pulsation is absent.

A. Early neonatal death
B. Neonatal death
C. Silent miscarriage
D. Stillbirth

A

D. Stillbirth

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6
Q

A 32-year-old woman is readmitted to the postnatal ward 10 days after an emergency C-section with a swollen painful calf. Her observations are normal. She is obese with a BMI of 40. What is the most likely diagnosis?
A. Cellulitis
B. Deep vein thrombosis
C. Muscle strain
D. Phlebitis

A

B. Deep vein thrombosis

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7
Q

PPH. which of the following can manage uterine atony?
A. blood transfusion
B. transamin
C. pethidine injection
D. uterotonic agent

A

D. uterotonic agent

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8
Q

young female multiple sexual partner. 1 day hx of lower abdominal pain with no radiation. BP stable, tachycardic, body temperature at 39, lower abdominal tenderness with no peritoneal sign. PV exam shows cervical excitation. diagnosis?
A. acute appendicitis
B. acute PID
C. ovarian cyst torsion
D. ruptured ectopic pregnancy

A

B. acute PID

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9
Q

pregnant woman admitted at 38w gestation for headache. epigastric discomfort. BP 180/100, PR 80, proteinuria 3+. sudden onset of twitching at ward and LOC?? dx?
A. Seizure
B. Eclampsia
C. Aortic dissection

A

B. Eclampsia

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10
Q

35/F, G1P0, gestational week 35, admitted for high blood pressure monitoring 150/100. Oral methyldopa was prescribed. Protein dipstick albumin 2+, witnessed generalized tonic clonic seizure with regain of consciousness after 30s. The patient now experiences of epigastric pain and headache, what drug should be given first?
A. Famotidine
B. Labetalol
C. Methyldopa
D. Magnesium sulphate

A

D. Magnesium sulphate

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11
Q

32w of gestation? Leakage, cervical exam shows clear liquor. No pain. Fetal movement is present. After admission, sudden onset of persistent left lower quadrant pain with torrential bleed. What is the MOST likely diagnosis?
A. APH of unknown origin
B. Placenta abruption
C. Threatened early labour
D. Uterine rupture

A

B. Placenta abruption

leakage of liquor signifies preterm premature membrane rupture, which causes rapid uterine decompression and predisposes to placental abruption

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12
Q

A 24 year old lady G1P0 referred from Family Planning Association had an unplanned and unwanted pregnancy. She underwent suction evacuation. During operation, a ‘give-way’ sensation was felt by the surgeon. The patient complained of mild vaginal bleeding, otherwise well. BP 120/80, pulse 80 beats per minute. What is the MOST LIKELY diagnosis?
A. Bowel injury
B. Bladder injury
C. Hemoperitoneum
D. Uterine perforation

A

D. Uterine perforation (suspected when loss of resistance)

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13
Q

32/F postpartum haemorrhage of 1500mL in 15mins due to uterine atony. Treated with multiple drugs. After 1 hour, BP 172/110. Which agent is the possible cause?
A. Carboprost
B. Misoprostol
C. Oxytocin
D. Syntometrine

A

B. Misoprostol

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14
Q

A 25-year-old woman with a history of pelvic inflammatory disease presents to the Emergency Department with severe abdominal pain. She has mild vaginal bleeding and her last menstrual period was 7 weeks ago. She is afebrile. Her pulse is 120 beats per minute, her blood pressure is 60/40mmHg, and she has a distended tender abdomen. What is the MOST LIKELY diagnosis?

A. Acute pelvic inflammatory disease
B. Threatened miscarriage
C. Inevitable miscarriage
D. Ruptured ectopic pregnancy

A

D. Ruptured ectopic pregnancy

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15
Q

35 weeks gestation, found to have severe vaginal bleeding. PE shows the uterus is irritable and painful, HR 120, BP 150/100, fetal bradycardia, what is the most likely diagnosis?
A. Placental abruption
B. Placenta previa
C. Vasa previa
D. Preterm labour

A

A. Placental abruption

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16
Q

A 17 year old girl who was never sexually active presented to the Accident and Emergency Department with severe abdominal pain. Physical examination revealed left lower quadrant tenderness and rigidity. Most likely diagnosis.

A. ovarian cyst complication
B. acute appendicitis
C. acute PID
D. Urinary tract infection

A

A. ovarian cyst complication

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17
Q

A pregnant woman giving birth to a baby was given intramuscular syntometrine as prophylaxis during Stage 3 of labour. After delivery of the baby and the placenta, there was heavy bleeding from the vagina due to uterine atony. You have established IV access, and you are now performing uterine massage. Which is the most appropriate drug to give to this patient?

A. IV syntocinon
B. IM carboprost
C. Per rectal misoprostol
D. IV Tranexamic acid

A

A. IV syntocinon

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18
Q

A 29 year old female patient, G1P0, comes in with abdominal pain, 110/60mmHg, HR 100, ultrasound shows a left adnexal mass with fetal heart sound present and moderate amounts of free fluid in Pouch of Douglas. What is the most APPROPRIATE management? (details missing)

A. Expectant management
B. IM Methotrexate
C. Laparoscopic salpingectomy
D. Laparoscopic salpingotomy

A

D. Laparoscopic salpingtomy (signs indicate that not ruptured yet: collected blood from ruptured ectopic pregnancy would present with ground glass appearance)

All tubal pregnancies can be treated by partial or total salpingectomy

Salpingostomy is only indicated when
1. The patient desires to conserve her fertility
2. Patient is haemodynamically stable
3. Tubal pregnancy is accessible
4. Unruptured and <5cm in size
5. Contralateral tube is absent or damaged

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19
Q

A woman with dermoid cyst underwent ovarian cystectomy. Most APPROPRIATE counselling advice for her would be:

A. Does not affect fertility
B. Need long term follow up
C. Pregnancy is contraindicated
D. Increase risk of recurrence in future pregnancy

A

A. Does not affect fertility

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20
Q

68 y/o vaginal vaginal spotting 2 weeks ago, menopause 15 years ago, good past health, regular og checkup normal, what is the management?

A. CT abdomen pelvis
B. CBC
C. Cervical smear
D. Pelvic ultrasound
E. Endometrial aspirate

A

E. Endometrial aspirate

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21
Q

40 y/o Cervical smear 2 weeks ago Dx: LSIL, what management?

A. Observe
B. Colposcopy
C. Cervical smear today
D. Cervical smear 4 months later
E. Cervical smear 6 months later

A

B. Colposcopy

22
Q

22 y/o irregular menses 90-180 days, polycystic ovaries, what condition can be prevented by progesterone prescription for cyclic withdrawal bleeding?

A. Ca breast
B. Ca endometrium
C. Ca ovary
D. Infertility

A

B. Ca endometrium

High progesterone: Protective against CA Endomedtium; BUT increases risk of CA Breast
High oestrogen: Increase endometrial cancers

23
Q

35 year old clerk, G4P3 just gave birth to a 4.2kg baby by vaginal delivery, immediate severe vaginal bleeding after smooth delivery of placenta. most likely cause

A. coagulopathy
B. genital tract trauma
C. retained placenta
D. uterine atony
E. uterine inversion

A

D. uterine atony

24
Q

A 30 year old woman attended gynaecological outpatient clinic with an incidental ultrasound finding of a 5cm dermoid ovarian cyst. She was asymptomatic. What is the MOST appropriate
plan of management?
A. Arrange an Elective laparoscopic ovarian cystectomy B. Arrange an emergency laparoscopic ovarian cystectomy
C. MRI
D. CA125
D. Urinepregnancytest

A

A. Arrange an Elective laparoscopic ovarian cystectomy

25
Q

a 20 y/o admitted to gynecological ward for mild vaginal bleeding. LMP 6 weeks ago +ve urine pregnancy test abdomen soft and non tender. speculum examination cervical closed + mild vaginal bleeding. what is the management plan.
A. Diagnosticlaparoscopy
B. Suction
C. Pelvic ultrasound to check vitality and position of fetus
D. Discharge and refer to antenatal care
E. Repeat pregnancy test

A

C. Pelvic ultrasound to check vitality and position of fetus

26
Q

A 38-year-old woman who is 36 weeks pregnant complains of severe painless vaginal bleeding. There is no leaking. Her blood pressure is 100/60, pulse 110 per minute. Her abdomen is soft and nontender. The foetus is cephalic in presentation and its level is totally above the brim. What is the most likely diagnosis?
A. Placentaabruption
B. Placentapraevia
C. Prematurelabour
D. Pretermprelabourruptureofmembrane E. Primarypostpartumhaemorrhage

A

B. Placentapraevia

27
Q
  1. G1P0. Elective C-section for twin pregnancy. Intraop 2.6L blood loss requiring blood transfusion. Twin 1: 2.4kg. Twin 2: 2.3 kg. Placenta checked and complete. After delivery, profuse vaginal bleeding. Uterine contracting well. What is the cause?
    A. Coagulopathy
    B. Uterineatony
    C. Retainedplacenta
    D. Uterineinversion
    E. Lowergenitaltracttrauma
A

A. Coagulopathy

28
Q

A 35-year-old Gravida 1 Para 0 woman with history of poorly controlled asthma, has delivered by vacuum extraction for prolonged second stage and maternal exhaustion. A baby boy of 4.5 kg was born. There was primary postpartum hemorrhage due to uterine atony. She was already given IV syntocinon but there was continuous heavy vaginal bleeding. Placenta was checked complete. What is the MOST APPROPRIATE management?
A. Examination under anaesthesia
B. Expectant management
C. Intramuscular. Carboprost
D. Oral tranexamic acid
E. Rectal misoprostol

A

D. Oral tranexamic acid (1g administered over 10 mins)

Should be given as soon as possible (within 3 hour window) in conjunction with uterotonic medication if suspicious of uterine atony

29
Q

F/30. G4P0 had 3 termination of pregnancy. Had normal vaginal delivery. Continuous vaginal bleeding. BP 90/45, PR 110. Placenta was checked and had missing cotyledons. Uterus was well contracted. What is the most appropriate management?
A. Examination under anaesthesia
B. Intravenous Hartmann’ssolution
C. Intravenous syntocinon
D. Intravenous tranexamic acid
E. Observation

A

A. Examination under anaesthesia

RPOG suspected when placenta found to be incomplete, or uterine atony is refractory to medical treatment

Exploration of uterus should be done ine the OT under GA
When 3rd stage >=30 mins, and in the absence of active bleeding, intraumbilical venous injection of 20IU oxytocin in 20ml normal saline can be considered.
Manual removal of placenta could be considered without trial of intraumbilical oxytocin.

30
Q

F/34 : suspected of ruptured ectopic, BP 90/40, HR 110 bpm, +ve peritoneal signs, +ve urine pregnancy test, what is the most APPROPRIATE management plan for this patient ?
a. Laparotomy
b. Pain relief
c. Observation
d. Check B hCG level
e. TA US pelvis

A

a. Laparotomy

31
Q

19 year old bartender, G3P0, with 3 terminal of pregnancies, admitted for severe lower abdominal pain with fever. She has multiple Sex partners and irregular use of condoms. On examination, she has blood pressure of 90/45 mmHg, pulse rate of 124 bpm, temperature of 39C. Abdominal examination showed lower abdominal tenderness with guarding and no rebound tenderness. Pelvic examination shows cervical excitation. Pregnancy test was negative. What is the most APPROPRIATE management plan for this patient?
A. CT abdomen and pelvis
B. Laparotomy
C. USG pelvis
D. Resuscitations and IV antibiotics
E. Emergency contraception

A

D. Resuscitations and IV antibiotics (likely PID)

32
Q

Which of the following is NOT recorded in the partogram?
A. Cervical length
B. Descent of fetal head
C. Maternal temperature
D. Uterine contraction
E. Fetal heart rate

A

A. Cervical length

33
Q

A 26 year old para 2 woman develops very heavy bleeding after delivery of a 4 kg baby and placenta. The uterus was found to be soft. What is the most likely cause of the bleeding?
A. Vaginal laceration
B. Cervical laceration
C. Coagulopathy
D. Uterine rupture
E. Uterine atony

A

E. Uterine atony (most common cause of PPH)

34
Q

Which of the following can decrease the incidence of postpartum hemorrhage?
A. Routine epistiotomy
B. Routine oxytocin given at first stage of labor
C. Routine oxytocin given at second stage of labor
D. Routine oxytocin given at third stage of labor
E. Routine prophylactic antibiotics given before delivery

A

D. Routine oxytocin given at third stage of labor

35
Q

A 32 year old woman presented with complications of pregnancy.
Ultrasound pelvis revealed an empty uterus. Emergency laparoscopy was done and found to have hemoperitoneum. Which of the following is the cause of the hemoperitoneum?
A. Tubal abortion
B. Tubal pregnancy from ampulla
C. Tubal pregnancy from cornua
D. Tubal pregnancy from fimbria
E. Tubal pregnancy from isthmus

A

B. Tubal pregnancy from ampulla

Distribution of ectopic pregnancies are as follows: 70% ampullary, 12% isthmic, 11.1% fimbrial, 3.2% ovarian, 2.4% interstitial, 1.3% abdominal.

36
Q

A 29-year-old woman, G1P0, 14-week gestation, comes to antenatal clinic for check-up, the test results are as follows:
hemoglobin: normal
MCV: normal
platelet: normal
VDRL: non-reactive
HIV antibody: negative
rubella IgG: positive
HBsAg: positive
blood group B: positive
which is the MOST appropriate action?
A. check patient’s hemoglobin profile
B. check partner’s blood for CBC
C. give folic acid
D. give hep B vaccine & hep B immunoglobulin at birth
E. give rubella vaccine to mother after delivery

A

D. give hep B vaccine & hep B immunoglobulin at birth

37
Q

A 35-year old woman died of ACS 5 days after the birth of her first child. This is also known as:
A. direct maternal death
B. indirect maternal death
C. co-incidental maternal death
D. accidental maternal death
E. late maternal death

A

B. indirect maternal death

Maternal death: during pregnancy or within 42 days of termination of pregnancy, miscarriage, delivery
Direct: death from obstetric complications
Indirect: Pregnancy related death that was not the result of obstetrical complications but aggravated by the physiological effects of pregnancy.
Late death: occuring from 42 days-1 year that is the result of direct or indirect cause.
Coindental death: death that happens to occur during pregnancy or puerperium

38
Q

A 24-year-old woman admitted for spontaneous onset of labor at term. She had history of thrombocytopenia with platelet level of 60 x 10^9/L. The antepartum period was uneventful. What is the best pharmacological pain relief method for her?
A. Entonox gas
B. Epidural analgesic
C. Intramuscular pethidine
D. Non-steroidal anti-inflammatory drugs (NSAIDs)
E. Oral paracetamol

A

A. Entonox gas

39
Q

A 24-year-old woman was admitted for abdominal pain. She had a 2-year history of a 4 cm adnexal mass managed conservatively. The last menstrual period was two weeks ago. Examination showed right lower quadrant tenderness, with guarding and rigidity. Her blood pressure was 140/90 mmHg, pulse was 120 per minute. She was afebrile. Which is the most likely diagnosis of this patient?
A Acute appendicitis
B Acute pyelonephritis
C Pelvic inflammatory disease
D Ruptured ectopic pregnancy
E Torsion of ovarian cyst

A

E Torsion of ovarian cyst

40
Q

G4P0 women, 3 previous surgical terminations. presented with contractions 20 minutes ago and rupture of membrane. Traction on the cord was needed for placental expulsion. During placental delivery there was a red vaginal mass attached to placenta. The patient BP is now 80/40mmHg, 90bpm. What is the like cause for her condition.
A. Coagulopathy
B. Placental abruption
C. Uterine atony
D. uterine inversion
E. vaginal hematoma

A

D. uterine inversion

41
Q

39/F G2P1 with previous vaginal delivery. Onset of delivery at 39 wk, complains of severe headache bp 230/128, given MgSO4 and labetalol. Later delivered 3.2 kg baby. 2 hrs later had persistent severe headache, drowsiness and disorientation. What is the most appropriate management?
A. Continue MgSO4 for 24 hours
B. Give labetalol for 24 hours
C. Give Valium
D. Keep observation
E. Order urgent CT

A

A. Continue MgSO4 for 24 hours

42
Q

delivery at 40 weeks previous c section uncomplicated
want vaginal delivery
contraction 3 to 4 in 10 minutes
Occipital sth 2cm
Cervix remain tubular
Cardiotocogram deceleration
Slowing of uterine contraction
What to do?
A. Emergency C section
B. Monitoring of fetal heart rate
C. Give oxytocin to augment labor
D. Observation

A

A. Emergency C section

Abnormal CTG warrants immediate delivery by C-section if cervix is not fully dilated (i.e. in 1st stage) or by instrumental delivery if cervix is fully dilated (i.e. in 2nd stage)

Avoid hypoxia –> cerebral palsy

43
Q

24 year old nulliparous women, undergoing surgical management of ectopic tubal pregnancy. On laparoscopy, contralateral tube was noted to be damaged. Patient expressed concerns over future fertility and wish of natural conception. Which would be the most appropriate management?
A. Bilateral salpingectomy
B. Bilateral salpingotomy
C. Medical management
D. Salpingotomy with conservation of contralateral tube
E. Salpingectomy with conservation of contralateral tube

A

D. Salpingotomy with conservation of contralateral tube

44
Q

32 y/o lady, G3P0, came for an early scan.
History of miscarriage with expectant management and ectopic pregnancy with lap salpingectomy. Scan shows ectopic pregnancy in left adnexa with fetal activity.
A. Expectant with serial bBCA
B. Laparoscopic Salpingectomy
C. Laparoscopic Salpingotomy
D. Laparotomy with salpingectomy
E. Methotrexate regimen

A

D. Laparotomy with salpingectomy

(1) Expectant with serial hCG – only when hCG is <1000, minimal symptoms and no fetal heartbeat;
(2) Medical Mx (MTX) – only when hCG ≤1500 or when size is small (<35mm) without visible heartbeat, and has no significant pain;
(3) Lapaoroscopic salpingotomy/salpingectomy if otherwise.

45
Q

A 32 year-old woman attended A&E for feeling unwell. Her body temperature is 38.9C, Pulse 140 bpm, respiratory rate 38. She had undergone termination of pregnancy 3 days ago. What is the IMMEDIATE next step of management?
A. Blood culture, White cell count, IV broad spectrum antibiotics, fluid resuscitation
B. Surgical management to remove retained products
C. Paracetamol
D. Pelvic scan for retained products
E. Transfer to HDU

A

B. Surgical management to remove retained products

46
Q

In managing post partum hemorrhage due to uterine atony, which of the following is a correct drug prescription:
A. carboprost 250mcg IM injection, maximum dose 2g, 15min apart
B. ergometrine 500mcg IV bolus
C. misoprostol 50mcg per rectal
D. syntocinon 5 units IM injection
E. syntometrine 1mL in 500mL saline IV infusion

A

A. carboprost 250mcg IM injection, maximum dose 2g, 15min apart

Oxytocin 10 units IVI followed by infusion 10 units per hour
Misoprostol 800-1000mg per rectal/sublingual

47
Q

Mother uneventful previous vaginal delivery. Current vaginal delivery lost 400mL, readmitted 2 days after due to 500mL of vaginal blood loss, no cervical tenderness, what is the diagnosis?
A. Antepartum haemorrhage
B. Primary PPH
C. Primary + Secondary PPH
D. Secondary PPH
E. Return of menses

A

D. Secondary PPH

significant vaginal bleeding that occurs between 24 hours after placental delivery and during the following 6 weeks

48
Q

G2P2 pregnant mother with unremarkable antenatal history. Vaginal delivery, baby’s birth weight was 3000g. How would you manage postpartum haemorrhage due to uterine atony in this lady?
A.
B.
C. Prostaglandin E2
D. Tranexamic acid
E. IV Syntocinon

A

E. IV Syntocinon

Oxytocis: syntimetrine (combination of ergometrine and oxytocin), syntocinon (synthetic oxytocin)

49
Q

38 yo nulliparous lady, E lower segment C section for PPROM at 35 week. 1 hour ago blood loss 1L. You are the on call MO, informed that now PR 130bpm, BP 80/40 mmHg, T 37.1 C. On assessment, you found a floppy uterus with on going vaginal bleeding. Besides fluid resuscitation, which of the following drugs should not be considered?
A. Mifepristone
B. Misoprostol
C. Syntocinon
D. Syntometrine
E. Tranexamic acid

A

A. Mifepristone

Mifepristone is an antiprogestogen and should only be used for abortion.

50
Q

Woman after delivery in shock and cannot deliver placenta, you are house officer. Nurse calls u at 3am. What should you do immediately?
A. Attempt controlled cord traction
B. Call anaes
C. Call MO, establish 16 gauge IV cannula, take CBC, type and screen
D. call MO, establish 20 gauge IV cannula, take CBC, type and screen
E. Take CBC, type and screen, take the blood to lab by yourself to ensure no delay

A

C. Call MO, establish 16 gauge IV cannula, take CBC, type and screen

51
Q

A 30-year-old lady gravida 3 para 2, the 2 previous vaginal delivery were both complicated with postpartum hemorrhage and retained placenta which required manual removal. You are the house officer and you admitted her at 3:00 am, what is the MOST APPROPRIATE management?
A. Allow the patient to have diet as tolerated, take blood for complete blood count, clotting profile and type and screen. Give IV syntocinon at third stage of labour.
B. Allow the patient to have diet as tolerated, take blood for complete blood count, clotting profile and type and screen. Give IV syntometrine at third stage of labour
C. Allow the patient to have diet as tolerated, delay blood taking till the second stage of labour. Give IV syntocinon at at third stage labour
D. Keep the patient fasted, take blood for complete blood count, clotting profile and type and screen. Give IV syntocinon at third stage of labour.
E. Keep the patient fasted, take blood for complete blood count, clotting profile and type and screen. Give IV syntometrine at third stage of labour.

A

B. Allow the patient to have diet as tolerated, take blood for complete blood count, clotting profile and type and screen. Give IV syntometrine at third stage of labour

MBBS V - Senior Clerkship - Block C CCT (52 decks)

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