Treatment

Question 1

A 46 year old woman presents with a 3 month history of painless post coital bleeding. She did not have other symptoms. She had her last smear test 10 years ago and that was normal

Answer 1

Cervical carcinoma

Question 2

A 48 year old Afro-Caribbean woman presents with lower abdominal pain and heavy periods. On examination, she is found to have a bulky uterus. She is otherwise normal and healthy.

Answer 2

Fibroids

Question 3

A 21 year old woman presents with bleeding and vaginal discharge. She also has a 3 month history of intermittent fever and abdominal pain. On examination, cervical excitation is found and there is purulent vaginal discharge.

Answer 3

Chlamydia trachomatis

Question 4

A 62 year old postmenopausal woman has a 2 month history of weight loss and vaginal bleeding. She is obese and she lives with her husband. They have no children. Ultrasound scan shows a 9mm thick endometrium.

Answer 4

Endometrial carcinoma

Question 5

A 24 year old woman has increasing pain during her menstruation for 3 months, She has heavy periods and the pain increases throughout menstruation.

Answer 5

Endometriosis

Question 6

A 22 year old woman is a sex worker. She had a history of 2 abortions and she wanted to stop getting pregnant. She asked for female sterilization as she thought that would be the best way to stop getting pregnant.

Answer 6

Barrier method

Question 7

A 45 year old woman had 3 children and feels she has completed her family. She wants a permanent method of contraception, and her husband will not consider vasectomy. What would you recommend?

Answer 7

Female sterelization

Question 8

A 19 year old woman complained of heavy periods and dysmenorrhoea. She has a new boy friend and has recently become sexually active. She wants treatment for her periods as well as contraception.

Answer 8

IUCD

Question 9

A 23 year old woman had unprotected sex at a party yesterday and would like to emergency contraception.

Answer 9

Morning after pill

Question 10

A 26 year old comes to the clinic with her husband. She would like to have contraception. She is a busy person and often forgets to take her pills. She does not like the idea of a coil and does not like condoms.

Answer 10

Injectable progestrogens

Question 11

A 25 year old woman presented to Emergency Department with a history of 2 hour lower left pelvic pain. She felt nauseous. On examination, she had a tender lower left abdomen with guarding and rebound. No bleeding was observed and her pregnancy test was negative.

Answer 11

Ovarian torsion

Question 12

A 22 year old university student presented with fever and lower abdominal discomfort. She complained of vaginal discharge. She had a history of unprotected sex with multiple partners. On examination, she had cervical excitation.

Answer 12

Chlamydia trachomatis

Question 13

A 27 year old woman was brought into the emergency department by her husband. She was complaining of severe lower left abdominal pain before she was found collapsed on the floor by her husband. Her last menstrual period was 2 months ago. She was tachycardic with BP 80/50.

Answer 13

Ectopic pregnancy

Question 14

A 31 year old woman presented with a 5 year history of lower abdominal pain. She had episodes of pain nearly once every month before her menstruation. She also mentioned that she had problems in conceiving a child with her husband. On examination, tenderness was found on bimanual palpitation with a retroverted uterus.

Answer 14

Endometriosis

Question 15

A 25 year old woman presented with an abdominal pain associated with heavy bleeding. She had a positive pregnancy test a week ago. On examination, there was no cervical excitation. Ultrasound showed an empty uterus.

Answer 15

Early miscarriage

Question 16

A 36 year old lady presented with menorrhagia. It started 2 months ago and this is the first time that she suffered from heavy periods. She would like to have less blood loss. She has had 3 children and would like reliable contraception too.

Answer 16

Intrauterine system

Question 17

A 24 year old non-smoking female presents with increasingly heavy periods for 3 months. She tried tranexamic acid for 3 cycles but that did not help. She currently has no children but would like to consider contraception for a short time as she is keen to try for a family over the next year or two. She would like to try another medication.

Answer 17

Combined oral contraceptive pill

Question 18

A 44 year old African-Caribbean woman presented with pain and very heavy periods. On examination, she had a bulky uterus or about 16 week size. Her symptoms have a severe impact on her quality of life and would like to stop her periods. She has 4 children and has finished her family. Multiple fibroids were found on ultrasound scan of her pelvis (2 of them >4cm).

Answer 18

Hysterectomy

Question 19

A 30 year old woman was complaining of heavy periods and abdominal pain. She has tried all medical management but it was not successful. A large fibroid protruding into the uterine cavity has been seen on ultrasound scan. She would like to retain her fertility and prefers not to have open surgery.

Answer 19

Hysteroscopic myomectomy

Question 20

A 21 year old woman complains of heavy periods. They have been getting worse over the past 5 months. She has not had any treatment for her menorrhagia and is not keen on ‘hormones’ treatment.

Answer 20

Tranexamic acid

Question 21

A 33 year old Afro-Caribbean woman is at term and in spontaneous labour. She has a history of heavy periods and a bulky uterus. Her pregnancy has been uneventful until spontaneous labour at term. During labour the head has failed to engage in the pelvis and can still be palpated abdominally and a smooth round mass can be felt abdominally and on cervical examination.

Answer 21

Cervical fibroids

Question 22

A 28 year old multiparous woman was brought to the hospital after signs showing that she is in spontaneous labour. The fetus backbone could be felt uppermost in the uterus on abdominal examination. On vaginal examination, the pelvis is empty.

Answer 22

Transverse lie

Question 23

A 23 year old woman primigravida is in spontaneous labour. Her labour is prolonged. Her contractions are fewer than 2 in ten minutes and last less than 60s.

Answer 23

Inefficient uterine action

Question 24

A 26 year old woman is an insulin dependent diabetic, she admitted to the hospital after spontaneous rupture of membranes.. She was examined initially and found to be 6cm dilated, four hours later she is still 6cm dilated with excellent contractions. The fetal head has not descended.

Answer 24

Fetal macrosomia

Question 25

A 32 year old primiparous woman has had a prolonged labour, with no change in dilatation of her cervix or descent of the fetal head. In her teens she has a history of serious trauma to her pelvis necessitating internal fixation.

Answer 25

Pelvic fractures

Question 26

A 32 year-old woman is 23 weeks pregnant. She has had minor painless bleeds. She has had a 20-week anomaly scan which shows a low lying placenta.

Answer 26

Placenta praevia

Question 27

A 24 year-old woman is 26 weeks pregnant. She has had a heavy bleed after she tripped and fell on to the ground in the morning. She has had severe pain in her abdomen and is admitted to the hospital by ambulance. On examination, she had a firm and tender uterus.

Answer 27

Placenta abruption

Question 28

A 28 year-old woman is 20 weeks pregnant. She is complaining about vaginal spotting. She has had a fever and dysuria for 2 days. On examination, there are no signs of blood in the vagina.

Answer 28

Urinary tract infection

Question 29

A 19 year-old woman has a history of 9 weeks amenorrhoea. She has had a positive home pregnancy test. 2 days later, she has had fresh vaginal bleeding. Ultrasound scan shows an empty uterus and on examination, she has a tender right adenexa with cervical excitation.

Answer 29

Ectopic pregnancy

Question 30

A 21 year-old woman has a history of 10 weeks amenorrhoea. Since this morning she has had vaginal bleeding and has passed clots and tissue. On examination, no abnormality was found. Ultrasound scan shows an empty uterus.

Answer 30

Miscarriage

Question 31

An 86 year old woman complains of urinary incontinence for several years. She mainly has incontinence when she coughs. She has had 5 children by vaginal delivery.

Answer 31

Genuine stress incontinence

Question 32

A 74 year old woman presents with incontinence for over a month. She finds it difficult to hold on to go to the toilet and feels like she needs to go to the toilet all the time. She often wets her bed at night. She denies any problems of incontinence with coughing. On examination there was no abnormality found.

Answer 32

Detrusor overactivity

Question 33

A 33 year old African woman delivered her third child last month in Africa. She had prolonged labour but both the baby and mother were fine in the end. For the past few days, she noticed that she is incontinent without any urge sensation. On examination, urine does not leak out when coughing. A small opening is observed in the upper part of her vagina. She said it was not painful and there was no abnormal bleeding.

Answer 33

Fistula formation

Question 34

A 70 year old diabetic woman was presents with a 2 month history of urinary incontinence. She reports it as a gradual loss of sensation of fullness of her bladder and the situation has been getting worse over the past 2 months.

Answer 34

Neurological deficit

Question 35

A 67 year old woman was presents with a 2 day history of fever and feeling generally unwell. She complains of episodes of irresistible sensation to pass urine in the past 2 days and haematuria.

Answer 35

Urinary tract infection

Question 36

A 25 year old woman went for her first smear test and the result was normal.

Answer 36

Repeat smear test in 3 years

Question 37

A 28 year old woman went for her smear test and the result showed that she had mild dyskaryosis. The sample tests negative for human pipilloma virus (HPV).

Answer 37

Repeat smear test in 3 years

Question 38

A 64 year old lady had just had her smear test. Her previous result and this result were both negative.

Answer 38

Remove from the screening programme

Question 39

A 32 year old woman had her LLETZ 6 months ago. Her smear is HPV positive.

Answer 39

Refer to colposcopy

Question 40

A 42 year old woman had moderate dyskaryosis on her smear test result, her previous test was normal.

Answer 40

Refer to colposcopy