Progress Test Flashcards
A 36-year-old woman presents for a routine antenatal review. She is now 15 weeks pregnant. Her blood pressure in clinic is 154/94 mmHg. This is confirmed with ambulatory blood pressure monitoring. On reviewing the notes it appears her blood pressure four weeks ago was 146/88 mmHg. A urine dipstick is normal. There is no significant past medical history of note. What is the most likely diagnosis?
pre-existing hypertension
Which one of the following statements regarding endometrial cancer is incorrect?
Trans-vaginal ultrasound is the first-line investigation
Has a poor prognosis
Progestogen treatment may be used in frail elderly patients not fit for surgery
Treatment of early disease is with total abdominal hysterectomy with bilateral salpingo-oophorectomy
Pelvic pain is rarely a presenting feature
Has a poor prognosis
A 29-year-old lady is in labour with her first child. However, during the second stage, fetal distress is identified and instrumental delivery considered. Which of the following would be a contraindication to this procedure?
Head palpable abdominally
You review the blood results taken from a pregnant woman at her booking visit. In addition to the standard antenatal bloods she also had her rubella status checked as she didn’t have the MMR vaccine as a child. She is now 11 weeks pregnant and currently well.
Advise the risks of rubella and keep away from anyone with it
Which one of the following drugs is not contra-indicated whilst breast feeding?
Tetracycline Ciprofloxacin Chloramphenicol Doxycycline Ceftriaxone
Ceftriaxone- Cephalosporins in breastfeeding is considered safe to use
A 21-year-old student attends your general practice clinic to discuss a recent positive pregnancy test result. Following lengthy discussion with her partner and family has decided that she wants an abortion. You find the consultation particularly difficult, as you do not personally agree with abortion and are currently caring for several patients who have been struggling to conceive. What should you do?
Discuss her options and explain that due to your personal beliefs, you will arrange for her to see another doctor in this instance who will make necessary arrangements
A 22-year-old woman has just had an artificial rupture of membranes in order to augment a slowly progressing labour. Her partner is helping her move into a more comfortable position when she suddenly becomes breathless and collapses from the bed. She is unconscious and unresponsive with a blood pressure of 82/50 mmHg and a heart rate of 134 beats per minute. What is the most likely diagnosis?
Amniotic fluid embolus
A woman complains of severe itching at 34 weeks gestation. The itching started 2 weeks previously and has been preventing her from sleeping. She is itchy all over her body, especially in her hands and feet. She has not noticed any rashes. Her mother reports similar symptoms when she was pregnant with her 2nd child. She is otherwise well. What is the most appropriate action?
Check LFTs (obstetric cholestasis)
A 37-year-old woman presents for review. She is 26 weeks pregnant and has had no problems with her pregnancy to date. Blood pressure is 144/92 mmHg, a rise from her booking reading of 110/80 mmHg. Urine dipstick reveals the following:
Protein negative
Leucocytes negative
Blood negative
What is the most appropriate description of her condition?
Gestational hypertension
A 34-year-old, G2P1, is referred to the obstetrics assessment unit by her general practitioner for mild abdominal pain and vaginal bleed. She is 15 weeks pregnant.
Which one of the following in her history might make you worry about a miscarriage?
Large cervical cone biopsy
A 25-year-old female comes to see her GP with a positive pregnancy test following a missed period. Given her last menstrual period it is estimated that she is 4-5 weeks pregnant. Although the news is unexpected, she is happy to continue with the pregnancy, however she is a known epileptic and is concerned about her medication.
Which of the following medications are recommended for epileptics in pregnancy?
Lamotrigine
A 24-year-old woman presents to her GP with lower abdominal pains that have been getting worse over the past two days. The pain is in the suprapubic area and slightly to the right. She had some vaginal bleeding this morning which she describes as being like a light period. The patient also describes some shoulder pain which she thinks came on following a game of squash. Her last period was eight weeks ago and was described as normal. In the past, she has been treated for Chlamydia infection and admits to not practicing safer sex.
On examination, she is tender in the right iliac fossa. Blood pressure is 100/60mmHg and the pulse is 102/min.
What is the most likely diagnosis?
Ruptured ectopic pregnancy
An 18-year-old woman visits a family planning clinic to discuss methods of contraception. She has suffered from migraine with aura for the last eighteen months. Which one of the following methods is classified as by the UK Medical Eligibility Criteria as having no caution or contraindication to use in this condition?
Copper intrauterine device
A 34-year-old old woman who is 34 weeks pregnant is investigated following vaginal blood loss. She is found to have placenta accreta. Which one of the following is the most important risk factor for this condition?
Previous C-sections (scarring- placenta accreta is when the placenta detaches)
A 27-year-old female presents to her GP as she missed her desogestrel contraceptive pill (progestogen only) this morning and is unsure what to do. She normally takes the pill at around 0900 and it is now 1430. What advice should be given?
Take missed pill now and no further action needed
A 22-year-old woman who is an immigrant from Malawi presents for review as she thinks she is pregnant. This is confirmed with a positive pregnancy test. She is known to be HIV positive. Which one of the following should NOT be part of the management plan to ensure an optimal outcome?
Encourage breast feeding
A 25-year-old comes to see you exceedingly anxious that her routine smear result has shown ‘borderline changes’. She asks you what will happen next. What is the most appropriate advice to give her?
Her smear cells will be tested for Human Papilloma Virus, and if positive she will be referred to the colposcopy clinic
Which one of the following contraceptives do the Faculty of Sexual and Reproductive Healthcare (FSRH) recommend should be discontinued after the age of 50 years?
Injectable contraceptives (e.g. Depo-Provera)
Which of the following is a potentially sensitising event in pregnancy and requires administration of anti-D in a RhD-negative woman?
Previously non-sensitised 16 weeks pregnant woman undergoing amniocentesis
A 38-year-old woman presents to the GP requesting contraception. She has a history of migraine with aura and a family history of deep vein thrombosis (DVT). She smokes 20 cigarettes per day. Which of the following forms of contraception is inappropriate for her?
Contraceptive vaginal ring
A 25-year-old woman who is 7 weeks into her pregnancy, presents to the emergency department with a one-week history of severe vomiting. She feels tired and unwell. She has dry skin and complains of a headache. Her B-hCG is raised however the uterus is of normal size for dates. What is the most likely diagnosis?
Hyperemesis Gravidarum
You are a male FY1 working in obstetrics. A 33-year-old female is on the ward in labour, 10 minutes ago she suffered a placental abruption and is in need of emergency care. Her midwife comes to see you, informing you that she is requesting to only be seen and cared for by females. What do you say?
Ask the midwife to immediately summon senior medical support, regardless of gender
A 33-year-old woman is reviewed regarding her asthma control. You notice from her records that she has never had a cervical smear and raise this with her. She responds that she is a lesbian and has never had sex with a man. What is the most appropriate advice to give?
She should have cervical screening as per normal
A 36-year-old multiparous patient has an uncomplicated delivery at 39 weeks gestation. One hour following delivery, the patient develops severe post partum haemorrhage which is acutely managed in the labour ward. Seven weeks later, the patient presents with difficulty breastfeeding due to a lack of milk production. Which of the following conditions is most likely to explain this history?
Sheehan’s syndrome
A 20-year-old woman presents to her GP complaining of painful periods. She currently uses an implant (Nexplanon) for contraception which she is very happy with.
What is the most suitable initial treatment?
Mefenamic acid
A 28-year-old woman is 30 weeks into her first pregnancy. She is found to have a blood pressure of 162/110 mmHg and a urine dipstick shows protein +++. She also has marked oedema of her ankles but feels well in herself. What is the first line therapy to manage her high blood pressure?
Labetalol
A 32-year-old pregnant woman presents to the GP with jaundice and itchy skin for the past 2 weeks. She claims that is a lot worse during this pregnancy compared to her last one. History reveals that she is currently 30 weeks pregnant with no complications up until presentation. On examination, the only notable findings are mild jaundice seen in the sclerae, as well as excoriations around the umbilicus and flanks. She denies any tenderness in her abdomen during the examination. Blood tests show the following:
ALT 206 U/L AST 159 U/L ALP 796 umol/l GGT 397 U/L Bilirubin (direct) 56 umol/L Bile salts 34 umol/L
Bile salts reference range 0 - 14 umol/L
What is the most likely diagnosis?
Obstetric cholestasis
A 27-year-old female comes to see her GP in order to discuss her fertility and the prospect of getting pregnant. She is particularly concerned about spina bifida as a friend of hers recently gave birth to a child with the condition. She is otherwise well with no significant medical history and no family history of any birth defects.
What dose of the supplement used to prevent neural tube defects should be given in the first 12 weeks of pregnancy?
400micrograms
A 36-year-old woman suffers from a major postpartum haemorrhage after delivering twins. The obstetric consultant examines her and suspects uterine atony to be the cause. The protocol for major PPH is initiated. Bimanual uterine compression fails to control the haemorrhage. Which drug is an appropriate next step in the management of uterine atony?
IV oxytocin
A 40-year-old pregnant woman is seen for her 41 week check. Her blood pressure has consistently been 140/90 mmHg for the last 2 weeks. Her booking blood pressure was 110/70 mmHg. You administer labetalol to treat the high blood pressure. What should be the next step in the management?
Induce labour
A 30-year-old female presents to her GP seeking contraception. She has three children and states she has completed her family. She is open to long-acting reversible contraception. After receiving advice about all options available, she opts for the copper IUD. Besides pregnancy, which of the following is it important to exclude?
Pelvic inflammatory disease
A 28-year-old woman presents the Emergency Department at 35-weeks gestation with lower abdominal pain and vaginal bleeding. She is alert and responsive. Physical examination revealed a heart rate of 115 bpm, blood pressure of 90/60 mmHg and O2 saturation of 99%. On neurological exam, her pupils were dilated and her reflexes were brisk.
Hb 115 g/l Platelets 250 * 109/l WBC 5 * 109/l PT 12 seconds APTT 30 seconds
Which of the following underlying conditions would most likely explain the findings on physical exam?
Cocaine abuse
A 25-year-old woman presents for her first cervical smear. What is the most important aetiological factor causing cervical cancer?
HPV 16 and 18
A 31-year-old female presents 5 weeks postpartum. She asks about methods of contraception that would be safe for her baby as she is exclusively breastfeeding. Which of these methods of contraception would not be recommended for this patient?
COCP
A 30-year-old woman who is 26 weeks pregnant is admitted to the maternity unit with heavy vaginal bleeding. She is Rhesus negative.
What is the most appropriate management for prophylaxis of Rhesus sensitisation?
One dose of Anti-D immunoglobulin followed by a Kleihauer test
A 27-year-old woman with a BMI of 18 is referred to a fertility clinic after failing to become pregnant after 2 years of trying with her partner. Male factor infertility has been ruled out and you suspect the patient’s low BMI may mean she is not ovulating. Which hormone could you measure on day 21 of her menstrual cycle to test for ovulation?
Progesterone
You are reviewing a 37-year-old gravida 3 para 2 woman who has come in for her booking visit. She is now 10 weeks gestation.
She had gestational hypertension during her first pregnancy which was treated with labetalol but her blood pressure is currently normal. She is currently taking 400 µcg folic acid supplements but no other medications.
A full set of blood and urine samples are taken during this clinic visit.
Which of the following changes would you expect to see in a healthy pregnant patient as compared to before pregnancy?
Decreased serum urea
A 27-year-old woman attends colposcopy as she had moderate dyskaryosis on her recent cervical smear. On colposcopy she has aceto-white changes and a punch biopsy followed by cold coagulation. Histology of the biopsy shows CIN II. When should she next be offered cervical screening?
6 months
A 32-year-old female presents at 28 weeks gestation in her third pregnancy. An ultrasound scan at 12 weeks had confirmed a dichorionic diamniotic twin pregnancy. She was admitted complaining of bleeding per vaginum. The bleeding was bright red in nature and painless. She has a history of two previous caesarian sections. What is the most likely diagnosis?
placenta praevia
A 24-year-old woman presents to the emergency department with a 1 day history of nausea and severe constant pain localised since onset to the left iliac fossa. She had vomited once but has no other symptoms. She has a 28 day menstrual cycle, her last menstrual period started 7 days ago. She is sexually active and has always used condoms for contraception. There is no vaginal bleeding. What is the most likely diagnosis?
Ovarian torsion
A 24-year-old woman who has just returned from holiday presents to your clinic 6 days after unprotected sexual intercourse. She reports having a regular 28-day cycle with ovulation around day 14. She is currently on day 16 of her cycle.
What would be the most appropriate method of emergency contraception for this patient?
Copper IUD
A woman who is taking the combined oral contraceptive pill comes to see you in clinic. She is worried about the risk of cancer from taking the pill after hearing something on the news. You sit down with her and talk about evidence-based medicine. The combined oral contraceptive pill is thought to reduce the risk of which of the following types of cancer?
Ovarian
A 34-year-old pregnant woman comes to see you in clinic today concerned as her brother’s son has just been diagnosed with rubella. She is 9 weeks pregnant and is unsure of her rubella status.
What is the most appropriate first step to take at this stage?
Discuss immediately with the local Health Protection Unit
A 78-year-old woman presents with post-menopausal bleeding. She has had multiple episodes over the past 8 months. She has to wear sanitary pads due to the bleeding, and says it can be quite heavy but denies any clots. She does not have any bowel or urinary symptoms. She denies weight loss and is otherwise well. She went through the menopause at the age of 49 years and took hormone replacement therapy to reduce symptoms of hot flushes and mood swings for 3 years. She has 1 child who was born by spontaneous vaginal delivery 50 years ago. There is no family history of any gynaecological problems. What is the most likely diagnosis?
Endometrial cancer
A young woman of 28 weeks gestation presents to the emergency department with painless vaginal bleeding, she appears well and is haemodynamically stable.
Which investigation is most likely to help confirm the diagnosis?
Abdominal ultrasound with colour flow doppler
A 66-year-old woman presents to her general practitioner with a six month history of poorly-localised abdominal discomfort and a constant feeling of bloatedness. Abdominal and pelvic examination is normal. The GP was initially concerned about bowel malignancy and referred her for colonoscopy, which ruled this out. The consultant gastroenterologist who performed the colonoscopy suggested that her symptoms might indicate irritable bowel syndrome. The patient has no history of digestive disorders. What should the GP’s next step be?
Measure serum CA125 levels
A 38-year-old female develops hypertension in the third trimester of her first pregnancy. A 24 hour urine collection shows 0.5g protein. Which one of the following complications is least associated with this condition?
Transverse myelitis
A 26-year-old woman is found to be hypertensive with a blood pressure of 155/110 mmHg during labour for her first baby at 39 weeks. Urinalysis shows +++ protein. Which of these is the most appropriate way to manage her hypertension?
Administer intravenous labetalol with target diastolic blood pressure 80-100 mmHg
A 48-year-old female smoker attends the GP for information regarding contraception. Her last menstrual period was 9 months ago and she is convinced that she has ‘gone through the menopause’. The most suitable form of contraception is:
IUS
A 22-year-old woman presents to the Emergency Department with rapid onset abdominal pain. The pain comes and goes in waves, is located in the right iliac fossa and is rated at 7/10 severity. The patient feels nauseous and has vomited twice. Her last menstrual period was 3 weeks ago. Ultrasound imaging of the abdomen reveals a whirlpool pattern in the right iliac fossa. What is the most likely diagnosis?
Ovarian torsion
