Obstetrics and Gynaecology 🤰

A 29 year old woman who is 33 weeks gestation attends the antenatal clinic. Her full blood count was taken when she was 28 weeks as part of an antenatal screen for anaemia. The results show:

Haemoglobin 96 g/L (115-160 g/L)

Mean cell volume 75 fL (76-96)

She is asymptomatic. What is the SINGLE most appropriate management?

A 28 year old woman has been admitted at 38 weeks gestation. Her blood pressure is 190/120 mmHg and proteinuria is seen on urinalysis. Immediately following admission, she has a grand-mal seizure. What is the SINGLE most appropriate initial management?

A 24 year old lady presents to the Early Pregnancy Unit with vaginal spotting and mild left-sided abdominal pain. Her last menstrual period was 8 weeks ago. A pregnancy test done in the GP clinic was positive. She has a transvaginal ultrasound scan, which is reported as inconclusive’. Serum human chorionic gonadotropin (hCG) is 1400 IU/litre What is the SINGLE most likely diagnosis?

(A serum hCG above 25 IU/litre is considered positive for pregnancy)

A 35 year old woman at her 28th week gestation attends her antenatal clinic for a routine check-up. She feels well and has no complaints. Her blood pressure is 160/95 mmHg, and her urine dipstick shows 2+ protein. A protein creatinine ratio was performed in the maternity unit which results were inconclusive. A 24-hour urine protein was sent and was discovered to be 1.5 g. What is the SINGLE most likely diagnosis?

A 35 year old lady presents with urinary incontinence 4 months after having a normal vaginal delivery of her second child. She says that she urinates a little every time she sneezes or coughs. On a speculum examination, there are no anatomical abnormalities. What is the SINGLE most appropriate next step in management?

A 23 year old woman has had intermittent abdominal pain in the left iliac fossa for 6 week. Over the past 48 hours, she had had severe abdominal pain and fever of 39°C. Urine HCG is negative. She also has cervical motion tenderness. Pelvic ultrasound shows a 6.5 cm multilocular complex adnexal mass. Her WBC and CRP are raised. What is the SINGLE most likely diagnosis?

A 53 year old woman complains of dyspareunia and vaginal dryness. On a speculum examination, an atrophic vaginitis is seen. Her last menstrual period was one year ago. What is the SINGLE most appropriate management?

A 32 year old woman attends the GP surgery requesting for the combined oral contraceptive pill. She has used it when she was in her early twenties and had no side effects from it. She delivered her first child by vaginal delivery 8 months ago and is still breastfeeding. She and her partner have recently become sexually active and she would like to use contraception. She smokes 8 cigarettes a day. Her past medical history includes migraines with aura and varicose veins. She has a BMI of 31 kg/m2. What is the SINGLE absolute contraindication for combined oral contraceptive use?

A 34 year old woman presents to the infertility clinic with her husband. They have been trying to conceive for 3 years but have not been successful despite having regular intercourse. Her BMI is 31 kg/m2. She has dark pigmentation on her neck and severe acne on her face. She also complains of thinning of her hair. She was sent for an ultrasound scan which showed multiple follicles on both her ovaries. What is the SINGLE most appropriate initial management to treat her infertility?

A 40 year old woman develops hypertension during the 3rd trimester of her pregnancy. She was started on oral antihypertensives until she delivered at 39 weeks of gestation by vaginal delivery. Two days after her delivery, her blood pressure is taken and it is 155/95 mmHg. She has decided to breastfeed her baby. She is informed by the obstetric team to continue using the same antihypertensives as she was before she delivered. Her medical history includes well-controlled asthma which she uses inhaled corticosteroids for. What is the SINGLE most likely antihypertensive that this woman is taking?

A 33 year old woman with 2 healthy children comes to you to discuss contraceptive methods. She is fit and well. Her two children were born by vaginal deliveries. She has a stable partner and both of them do not want any further children. Which of the options below has the lowest contraceptive failure rate?

A 31 year old woman complains of increased urinary frequency and urinary urgency. She also describes painful voiding. She complains of dyschezia, dysmenorrhoea, sacral backache with menses and also deep dyspareunia which has been worsening over the last year. What is the SINGLE most likely diagnosis?

A 29 year old woman who is 18 weeks gestation attends the maternity unit with concerns about exposure to chickenpox. Her nephew visited her 8 days ago and spent the day with her. She has just been told that he developed a chickenpox rash last night. She is currently asymptomatic. She does not have a history of chickenpox. What is the SINGLE most appropriate management?

A 33 year old 39 week pregnant nulliparous woman with a history of gestational hypertension is in labour. Her membranes had ruptured earlier in the day. She was assessed by the midwife and her cervix was found to be soft, mid-position with an os 3 cm dilated. The fetus is in cephalic position. A vaginal examination was performed 4 hours later and the cervical os still remains at 3 cm dilated. Cardiotocography is reassuring and she is contracting less than three times in 10 minutes. What is the SINGLE most appropriate action?

A 28 year old woman at 34 weeks gestation attends the antenatal clinic. Her full blood count which was recently taken shows the following

Haemoglobin 111 g/L (115-160)

Mean cell volume 75 fL (76-96)

Mean cell haemoglobin concentration 298 g/L (300-360)

What is the SINGLE most appropriate management?

A 31 year old primigravida at 24 weeks’ gestation was admitted 24 hours ago to the maternity unit because of preterm premature rupture of membranes (PPROM). She is starting to have abdominal pains and uterine contractions. She has a pulse rate of 122 beats/minute and a temperature of 36.8°C. Routine examination of the patient’s abdomen reveals tenderness suprapubically. A speculum examination reveals a foul- smelling discharge originating from the cervix with the cervix slightly opened. What is the SINGLE most likely diagnosis?

A 33 year old woman who is 34 weeks gestation is worried as she has felt fewer fetal movements over the past 48 hours. She recently had an upper respiratory tract infection which her GP assessed her 2 days ago and informed her that it was likely a viral aetiology. She has a temperature of 37.5°C and a heart rate of 90 beats/minute. What is the SINGLE next most appropriate investigation to perform?

A 40 year old woman attends the pre-operative clinic as she is going to undergo a hysterectomy for the management of fibroids. Which of the following investigations are appropriate to be requested in the clinic?

A 26 year old woman complains of cyclical pelvic pain, dyspareunia and dyschezia for the past 2 years. She has regular 25-day menstrual cycles. Her lower abdominal pain is non- specific and often can go on for several days. A laparoscopy done for her symptoms shows small powder burn lesions which are red-brown at the pouch of Douglas. What is the SINGLE most likely diagnosis?

A 49 year old woman presents to Accident & Emergency (A&E) with the complaint of breathlessness. She gives a three-month history of dyspnoea, initially on exertion but now also at rest. She also complains of worsening fatigue and pelvic pain. The patient does not have any significant past medical history. She does not smoke but has an occasional drink. Her age of menarche was 13 years and she has had regular 28-day cycles up until a few months ago. She has two children in their late teens who are healthy and her obstetric history does not reveal any peculiarities. Examination reveals tachypnoea. Her heart rate is 112 beats per minute. Examination of the patient’s chest reveals dullness to percussion over the right lung base with decreased breath sounds and decreased tactile vocal fremitus. An abdominal examination reveals abdominal fullness and shifting dullness. A thoracentesis reveals the following:

Pleural fluid protein 42 g/L

Serum total protein 45 g/L (60-80 g/L)

What is the SINGLE most likely reason for this patient’s symptoms?

A 32 year old woman presents to the GP surgery with a burning sensation when she urinates. She also has suprapubic discomfort. She is 11 weeks pregnant. Urinalysis shows 1+ nitrates and 1+ leukocytes. Her temperature is 36.5°C and she has a heart rate of 70 beats/minute. A midstream urine sample is sent to microbiology for culture. She has no previous urine cultures. What is the SINGLE most appropriate action?

A 32 year old rhesus negative woman whose previous pregnancy was complicated by recurrent antepartum haemorrhage. At booking she was found to have anti-D antibodies and was referred for obstetric-led care. An ultrasound scan 1 weeks ago showed normal growth of the fetus. She now presents with reduced fetal movements 33 weeks gestation. A CTG is normal. What is the SINGLE most appropriate investigation?

A 24 year old lady has lower abdominal pain worsening over the last 7 days. She has vaginal discharge and also complains of deep dyspareunia. Her last menstrual period was 2 weeks ago. Cervical motion tenderness was noted when doing a pelvic examination. She has a temperature of 38.2°C. Her blood tests show:

White cell count 15 x 10^9/L

CRP 55 mg/L

She has no significant past medical history. What is the SINGLE most likely diagnosis?

A 41 year old woman who has epilepsy attends the GP surgery requesting long term contraception with the lowest risk of falling pregnant. She takes sodium valproate. She has a new partner and is sexually active. She is a non-smoker and her blood pressure is 120/80 mmHg. What is the SINGLE most appropriate action?

A 53 year old woman complains of unbearable hot flushes and night sweats for the past month. She gives a history of having had a laparoscopically assisted vaginal hysterectomy 3 years ago. She smokes around 10 cigarettes a day for the past 20 years. What is the SINGLE most appropriate treatment for her symptoms?

A 38 year old woman has had no menstrual periods for the last 11 months. Prior to that, she had regular menstrual cycles. FSH was found raised (more than 40 IU/L) on two separate occasions a month apart. Her Thyroid-stimulating hormone (TSH) and prolactin are within normal limits. Her pregnancy test was negative. What is the SINGLE most likely diagnosis?

A 30 year old female who has had 3 previous miscarriages, all before 10 weeks gestation. Antiphospholipid syndrome has been diagnosed. She now presents to the antenatal clinic asking if there is any treatment that she could have that could prevent another miscarriage. What is the SINGLE most appropriate management?

A 40 year old woman attends the Gynaecology outpatient clinic for painful periods. The pain is worse on the first day of her menstrual cycles and continues for 5 days. She has regular 28 cycles. She also suffers from menorrhagia. She has had a laparoscopic tubal sterilisation in the past. She takes ibuprofen and paracetamol for pain relief during the first few days of pelvic pain. She is currently sexually active with her stable partner of 10 years. She has no bowel or urinary symptoms. Endometriosis is suspected. What is the SINGLE most appropriate action?

A 28 year old woman is concerned about cervical cancer as her mother was recently diagnosed with cervical cancer. She smokes 20 cigarettes a day. She uses tampons during her menstruation. She is sexually active and uses the combined oral contraceptive pill as prescribed. When she is with a new partner, she uses condoms. Which is the best advice to give to reduce her risk of cervical cancer?

A 35 year old woman has just discovered that she is pregnant. Her last menstrual period was 7 weeks ago. She has been on anti-epileptic medication for the past 3 years. What is the SINGLE most important supplement for her to start to prevent teratogenic effects in her unborn child?

A 27 year old asian primiparous woman with type 1 diabetes mellitus has delivered a baby weighing 4.5 kg with the help of forceps. The placenta was removed with continuous cord traction and her uterus is well contracted however she continues to bleed heavily. What is the SINGLE most likely cause of her postpartum haemorrhage?

A 23 year old woman is followed up for 6 weeks after a surgical procedure to evacuate the products of conception in the uterus following a miscarriage. The histology shows changes consistent with a hydatidiform mole. What is the SINGLE most appropriate investigation to perform in this case?

A 38 year old woman attends the family planning clinic requesting long term contraception. She has 3 healthy children and does not wish to have any more children in the near future. She complains of menorrhagia. She has a history of venous thromboembolism 3 years ago. On examination, she has a palpable, irregular shaped uterus. What is the SINGLE best contraception for her?

A 25 year old lady has had an uncomplicated pregnancy so far. She is now 39 weeks gestation. She was admitted because she had of a show and has regular and painful uterine contractions. Her cervix is now 10 cm dilated and she has started pushing. What stage of labour is she in?

A 21 year old primiparous woman with no previous history of infection with varicella- zoster virus, is 24 week pregnant. She had significant contact with a young boy 8 days ago who developed a chicken pox rash the following day after he met her. There is no evidence of varicella-zoster antibodies in the pregnant women’s serum. She has no rash at present. What is the SINGLE most appropriate management?

A 28 year old woman has forgotten to take her oral combined oral contraceptive pill (Microgynon 306) for the past 3 days. She was on a business trip and forgot to bring her pills. She is currently on day 14 of the pill packet. She had unprotected intercourse 2 days ago. What is the SINGLE most appropriate advice?

A 31 year old primigravida at 32 weeks gestation is found to have a blood pressure of 170/115 mmHg on routine check-up. She is known to have pre-eclampsia and is on labetalol 4 times a day. Her booking blood pressure was 120/80 mmHg. She was brought to the abstetric unit where her blood pressure was repeated twice and was found to be 150/110 mmHg and 155/111 mmHg. A urinalysis shows 2+ protein. She is not experiencing any symptoms and feels well. Her CTG is seen to be normal. What is the SINGLE most appropriate next step?

A 33 year old woman who is 30 weeks pregnant attends the obstetric unit as she has developed severe itching all over her body over the past 3 weeks. It is worse on her palms and her feet. The pruritus disrupts her sleep at night. On examination, there are no rashes seen, however, excoriation marks are seen on her trunk. What is the SINGLE most appropriate investigation?

A 34 year old primigravid cocaine user who is 30 week pregnant presents to the labor ward with a history of constant abdominal pain for the last 8 hours. She gives a history of having lost a cupful of fresh blood per vagina before the pain started. She has not felt any movements since the pain started. She has a tender lower abdomen on examination. She has a pulse rate of 105 beats/minute. Fetal heart is unfortunately not seen on the ultrasound scan. What is the SINGLE most likely diagnosis?

A 31 year old female presents to the infertility clinic with her husband. They have been trying to conceive for 3 years. Her BMI is 31 kg/m2. She has dark pigmentation on her neck and severe acne on her face. There is also thinning of hair. Blood test reveals elevated insulin levels, elevated LH levels and moderately elevated testosterone levels. What is the SINGLE most appropriate diagnostic test to confirm the diagnosis?

A 31 year old woman has been having heavy menstrual periods over the past year. She has regular 30 day menstrual cycles. She has had one pregnancy before which resulted in a still birth that was delivered vaginally. Her last pelvic ultrasound scan done 3 months ago shows no evidence of fibroids. She does not smoke. She has a BMI of 28 kg/m2. She is single and not sexually active currently. What is the SINGLE most appropriate management?

A 27 year old lady has had an uncomplicated pregnancy so far. She is now 40 weeks gestation. She came to the hospital 2 hours ago after her waters broke. She has regular and painful uterine contractions. PV examination reveals a 4 cm dilated cervix. Her vital signs are normal. What stage of labour is she in?

A 39 year old woman attends the GP surgery for advice on contraception. Her medical history includes hypertension which is well controlled with ramipril. She is a non-smoker and has had 2 vaginal deliveries in the past. Which of the following contraception methods is LEAST appropriate?

A 65 year old female patient diagnosed with breast cancer was given tamoxifen. Which SINGLE symptoms would be the most alarming?

A 35 year old female presents to the gynaecology clinic for investigations of infertility. She has menstrual cycle which she counted as being 35 days. She is an no long term medications. She demonstrates enthusiasm about her job as a journalist and claims that she is experiencing no stress at home or at work. She drinks alcohol socially and smokes around ten cigarettes a day. A blood sample was taken from the patient and her results are as follows:

Follicle-stimulating hormone (FSH) 5 U/L

Luteinizing Hormone (LH) 3 U/L

Prolactin 300 mU/L

Oestradiol 800 pmol/L

21 day Progesterone 10 ng/dL

What is the SINGLE most likely reason for the results above?

A 23 year old lady with a BMI of 30 kg/m2 attends the GP surgery with complaints of facial hair growth and has a history of amenorrhoea for the past 6 months. Blood tests were requested and the results show:

Follicle-stimulating hormone (FSH) 22 IU/L (<25)

Luteinizing Hormone (LH) 78 IU/L (<84)

Prolactin 439 ng/mL (<440)

Oestradiol 117 pmol/L (<130)

Progesterone 100 ng/dL (70-280)

Sex hormone-binding globulin 11 nmol/L (18 to 144)

What is the SINGLE most likely diagnosis?

A 33 year old woman has been found to have high risk-HPV positive on a routine cervical screening test. Her cytology has come back as normal. She is sexually active and has a new partner recently. Her previous cervical smears were normal. What is the SINGLE most appropriate next step in action?

An 18 year old nulliparous girl who has mild learning difficulties attends the GP surgery seeking advice on contraception. She is sexually active and currently using candams, however, she would like to try a different contraceptive method that is more secure. She has no relevant past medical history. What is the SINGLE most appropriate contraception for her?

A 23 year old girl attends the GP surgery complaining of irregular menstrual cycles and menorrhagia. She can bleed for the first 5 days of every menstrual cycle. Her menstrual cycles are unpredictable and can occur from every 15 days to every 30 days. She is sexually active and uses candams for contraception. She does not want to get pregnant. What is the SINGLE most appropriate management?

A 38 year old female attends the clinic because of issues of infertility. She also says that her last period was 9 months. Lab results show.

Follicle-stimulating hormone (FSH) 59 IU/L (<25) Luteinizing Hormone (LH) 78 IU/L (<84)

Prolactin 12 ng/mL (<440)

Oestradiol 25 pmol/L (<130)

An FSH was repeated 4 weeks later which was still elevated.

What is the SINGLE most likely diagnosis?

49 year old woman attends the GP surgery with symptoms of hot flushes, night sweats and vaginal dryness for the past few months. Her last menstrual period was 10 months ago. Her blood pressure is 125/80 mmHg. She is no longer sexually active and does not need contraception. What is the SINGLE most appropriate medication to prescribe?

A 40 year old woman with a diagnosis of polycystic ovarian syndrome is seen in the gynaecology clinic for investigations of her infertility. She has not been able to conceive for the past 2 years despite regular sexual intercourse. Her menstrual period is regular at a 35-day interval. What is the most appropriate hormone to check to confirm ovulation?

A 28 year old primiparous woman, with no previous history of infection with varicella- zoster virus, is 18 week pregnant. She had significant contact with a young girl with widespread chicken pox 8 days ago. Serum stored from an antenatal booking blood sample was sent for serology and came back negative for VZV IgG. She has no rash at present. What is the SINGLE most appropriate management?

A 55 year old woman has hot flashes, night sweats and insomnia. She also complains of vaginal dryness and symptoms of urinary frequency. Her last menstrual period was 11 months ago. Her medical history includes having a myocardial infarction when she was 48 years old. What is the SINGLE most appropriate management for her?

A 33 year old pregnant woman presents to the Emergency Department with her husband. She was diagnosed with hyperemesis gravidarum a few weeks ago and has been unable to keep anything down for the past few days. She is 27 weeks pregnant and has been given intravenous 0.9% sodium chloride and anti-emetics. Her most recent blood results show a potassium level of 3.2 mmol/L (3.5-4.5) and her urine dipstick shows 3+ ketonuria. What is the single next most appropriate choice of management?

A 39 year old female was on combined oral contraceptive pills which she stopped 9 months ago. She has not had her periods since then. Lab results show:

Follicle-stimulating hormone (FSH) SS U/L

Luteinizing Hormone (LH) 75 U/L

Prolactin 14 ng/mL

Oestradiol 30 pmol/L

What is the SINGLE most likely diagnosis?

A 44 year old woman has a bilateral oophorectomy and total hysterectomy because of her high genetic risk of ovarian cancer. She has not had any fractures before. What is the SINGLE most appropriate medication to prescribe to prevent osteoporosis?

A 32 year old woman attends the GP clinic 16 days postpartum. She is worried that she may need emergency contraception. She delivered a healthy baby boy by C-section 16 days ago. She is both breastfeeding and formula feeding. She had intercourse with her partner 2 days ago without any barrier methods. Prior to her pregnancy, she was using combined oral contraceptive pills. She stopped it 6 months before she fell pregnant. She would like to know if she needs any emergency contraception. What is the most appropriate action?

A 23 year old clinically obese woman suffers from acne and hirsutism. She has suffered from irregular menstrual cycles for the past 3 years. Her menstrual cycles can range from 40 days to withdrawal bleeds for several months. Her recent blood results show an increase in levels of free testosterone. She is not sexually active. What is the SINGLE most appropriate medication?

A 24 year old woman who is 15 weeks pregnant presents with pain in her lower abdomen for the past couple of hours. She has some vaginal spotting. On examination, the abdomen is tender, and cervical os is closed. A transvaginal ultrasound scan shows no fetal heartbeat or fetal activity. What is the SINGLE most likely diagnosis?

A 31 year old woman who is 35 weeks gestation presents with a widespread maculopapular vesicular rash. She has a temperature of 38.8°C and a heart rate of 90 beats/minute. Her 2 year old son had chicken pox 2 weeks ago. What is the SINGLE most appropriate management?

A 43 year old woman who is currently 34 weeks pregnant presents to the maternal assessment unit with headache, mild epigastric pain and slight nausea. Her symptoms started in the morning. She complains of visual disturbance which include flashing lights. A dipstick shows 2+ protein. Her heart rate is 105 beats/minute. She has a blood pressure of 158/105 mmHg. The blood pressure was repeated twice more and readings were 155/102 mmHg and 150/90 mmHg. A CTG was connected and the trace is reassuring. What is the SINGLE most appropriate initial management?

A 24 year old woman attends the GP surgery requesting contraception. She has just started dating and has become sexually active. She suffers with severe mood swings, tension headaches, aggression and irritability a few days just before her periods. Her symptoms are severe enough that they affect her daily functioning. Her symptoms usually resolve within 3 days of starting her period. She has a regular 28-day menstrual cycle. Her medical history includes depression. She is nulliparous. She does not smoke and has a BMI of 20 kg/m2. What is the SINGLE most appropriate contraception for her?

A 35 year old woman who is 37 weeks pregnant attends the obstetric unit because she feels decreased fetal movements over the past 24 hours. She has no contractions at present and has no bleeding vaginally. The midwife puts her on a CTG and monitors her. For the last 20 minutes, the CTG has been showing good variability with a baseline of 130 bpm which is followed by a single 3 minute long fetal bradycardia. What is the SINGLE most appropriate initial action?

An 13 week pregnant woman with presents to the hospital with severe persistent vomiting and nausea over the past few weeks. She is unable to keep fluids down. A urinalysis shows 4+ ketones. Her blood pressure is 110/70 mmHg and a pulse rate of 115 beats/minute. Her blood test show the following:

Haemoglobin 121 g/L (115-160)

White cell count 8 x 10^9/L (4-11)

Platelets 380 x 10^9/L (150-400)

Sadium 136 mmol/L (135-145)

Potassium 3.5 mmol/L (3.5-5)

Urea 10 mmol/L (2.0-7)

Creatinine 80 μmol/L (70-150)

eGFR 90 mL/min (>90)

What is the SINGLE most appropriate fluid to administer?

A 32 year old woman, primigravida and now 39 weeks gestation attends the antenatal day unit with sudden onset of epigastric pain associated with nausea. On physical examination, there the presence of right upper quadrant and epigastric tenderness. Her temperature is 36.8°C, Blood pressure is 165/95, heart rate 90 beats/minute and respiratory rate 19 breaths/minute. Her booking blood pressure at 10 weeks was 110/70 mmHg. Her blood tests show:

Haemoglobin 87 g/L (115-160)

Platelets 90 x 10^9/L (150-400)

Alanine transferase 219 U/L (5-35)

Aspartate transaminase 180 U/L (5-35)

Lactate dehydrogenase 720 U/L (70-250)

What is the SINGLE most likely diagnosis?

A 26 year old woman with type 1 diabetes mellitus would like to know about prenatal vitamins and supplements. She is anxious about fetal abnormalities but would like to conceive. Which supplement should she take in a higher dose compared to the general population?

A 28 year old female who is four weeks pregnant presents to the antenatal clinic for a check-up. She expresses a concern about ectopic pregnancies and wants to know the risk of her having an ectopic pregnancy. The patient claims that she read a NHS leaflet about ectopic pregnancies a few days ago and that it had gotten her worried that she might have an ectopic pregnancy. Which of the following is the greatest risk factor for an ectopic pregnancy?

A 30 year old woman attends clinic asking for a reversible form of contraception. Her obstetric history is significant for a previous caesarean section one year ago. She is known to have menorrhagia and dysmenorrhoea. What is the SINGLE most appropriate contraceptive for her?

A 33 year old lady who is now 28 weeks pregnant comes to the antenatal clinic with pain and swelling on her left calf muscle. On physical examination, she has distension of superficial veins and increase skin temperature at affected area. What is the SINGLE most appropriate treatment?

A pregnant woman attends the early pregnancy unit with a history of PV bleeding earlier in the day. Her last menstrual period was 6 weeks ago. She is terrified that she is having a miscarriage. She has no abdominal pain and is no longer having any PV bleeding. A transvaginal ultrasound was performed which showed no fetal cardiac activity. The crown-rump length was measured to be 5 mm. What is the SINGLE most appropriate action?

A 22 year old woman at 28 weeks gestation attends the antenatal clinic. Her full blood count which was recently taken shows the following:

Haemoglobin 109 g/L (115-160)

Mean cell volume 72 fL (76-96)

Mean cell haemoglobin concentration 302 g/L (300-360)

Haematocrit 0.34 L/L (0.37-0.47)

What is the SINGLE most appropriate management?

A 32 year old woman was induced at 41+2 weeks gestation. She had a long labour which lasted 24 hours. The uterus is still palpable above the umbilicus after an hour from delivering the placenta. What is the SINGLE most likely cause for her postpartum haemorrhage?

A 20 year old girl has pelvic pain at the onset of her menstrual periods. The pain can last 48 to 72 hours. She has had these pains ever since she stopped her combined oral contraception 4 months ago. She is married and wishes to conceive. What is the most appropriate medication to prescribe?

A 24 year old woman is on Depo-Provera for contraception which was started 6 weeks ago. She has no unwanted side effects except for intermenstrual bleeding. She is sexually active with her partner of 3 years. She has no vaginal discharge and does not complain of dyspareunia. What is the SINGLE most appropriate management?

A 25 year old woman would like contraception that can be used for 6 months. After this period, she would like to try to conceive. She has a medical history of asthma and migraines with aura. Her regular medications include inhaled salbutamol and an inhaled corticosteroids. Her obstetric history includes having one vaginal delivery. She suffers from dysmenorrhoea. What is the SINGLE most appropriate contraception to use?

A 66 year old woman had two episodes of post-coital vaginal bleeding in the last week. She has not had any withdrawal bleeds for more than 12 years. Her last cervical smear was 3 years ago which showed no abnormalities. What is the SINGLE most appropriate initial action?

A 45 year old lady comes to the family planning clinic for contraception advice. She has two young children and does not want any more children. An incidental finding of multiple small submucosal fibroids was found recently on an ultrasound scan with the largest being 25 cm in diameter. She is asymptomatic and her medical history is otherwise insignificant. What is SINGLE most appropriate contraceptive for this lady?

22 year old woman is brought into the Emergency Department by her husband with severe abdominal cramping. Her abdomen is very tender. Serum beta human chorionic gonadotropin (hCG) was measured at 1400 IU/litre. A transvaginal ultrasound reveals an empty uterine cavity with a small right adnexal mass measuring 20mm and free fluid in the pelvis. No fetal heart activity was noted. Her systolic blood pressure was 110 mmhg on admission but has dropped to 80 mmHg an hour later. Intravenous fluids have been prescribed. What is the SINGLE most appropriate next course of action?

(A serum hCG above 25 IU/litre is considered positive for pregnancy)

A 36 year old woman suffers from heavy and irregular menstrual periods for the past 5 years. She does not complain of pelvic pain. She has 2 children and is not planning to have any more children in the future. Her medical history includes pulmonary embolism 6 years ago and breast cancer involving a left mastectomy 3 years ago. She suffers from a migraine with aura. A recent pelvic ultrasound scan reveals small submucosal fibroids. Her last haemoglobin was 95 g/L (115-160) and she is currently on iron supplements. What is the SINGLE most appropriate management?

52 year old woman attends the GP surgery with symptoms of hat flushes and insomnia for the past few months. She also has been feeling law in mood. She has been having infrequent periods every 3 to 4 months. Her last period was 4 months ago. Her blood pressure is 130/80 mmHg. She is no longer sexually active and does not need contraception. What is the SINGLE most appropriate medication to prescribe?

A 31 year old woman with 2 healthy children comes to discuss contraceptive methods. Her two children were born by vaginal deliveries. She has a stable partner and both of them do not want any further children. They are looking for contraception. She suffers from very heavy menstrual bleeds. Her menstrual bleeding can last for 4 days. She has a regular 28-day cycle. Her last blood test shows that she is anaemic with iron deficiency. Which of the options is the most appropriate contraception for this patient to manage her symptoms?

A 22 year old woman using Depo-Provera for 10 months attends her GP surgery with concerns that she has had no menstrual bleeding for the past 5 months. She initially had irregular bleeding when first she first started Depo-Provera which was followed by less frequent menstrual bleeding over the subsequent few months. What is the SINGLE most appropriate action?

A 41 year old pregnant woman at 18 weeks gestation is seen in her antenatal appointment with a blood pressure of 155/110 mmHg. She was seen at her booking appointment at 10 weeks with a blood pressure of 141/92 mmHg. She feels well herself and has no complaints. A urine dipstick shows evidence of 1+ protein. What is the SINGLE most accurate diagnostic term for this patient?

A 33 year old woman who is 8 weeks gestation has had 3 previous miscarriages, all in her first trimester. A blood test was performed and she is found to have the presence of anticardiolipin antibody in high titre. What is the SINGLE most appropriate management?

A 33 year old woman has just had an uncomplicated normal vaginal delivery. The third stage of labour was managed actively and the placenta and membranes were expelled completely soon after delivery of the baby however she continues to bleed vaginally. She has now a total estimated blood loss of 1 litre. Her uterus is relaxed and is felt to be boggy and above the umbilicus. What is the SINGLE most appropriate immediate step to manage this patient?

A 31 year old woman, gravida 5 para 4, present to the emergency department with vaginal bleeding. She has a history of amenorrhoea for 12 weeks. Pregnancy test was done in the emergency department and it was positive. Symphyseal-fundal height measurement corresponds to 22 weeks gestation. Ultrasound of the pelvis reveals bilateral cystic masses. No fetal parts are seen during the ultrasound examination. The cervix is closed. Which is the SINGLE most likely diagnosis?

A 25 year old woman had an emergency lower segment caesarean section after prolonged labour 4 days ago due to fetal distress. She complains of intermittent vaginal bleeding and foul-smelling discharge which started 24 hours ago. Her 02 saturation is 98% on air. She has a blood pressure of 124/88 mmHg, a pulse of 84 beats/minute and a temperature of 37.9°C. An ultrasound scan shows no evidence of echogenic or heterogeneous material within the endometrial cavity. The surgical notes reveal that the obstetric surgeons had difficulty in removing the placenta from the uterus. After removal of the placenta, the placenta and membranes were examined to be complete. What is the SINGLE most likely diagnosis?

A 29 year old woman experienced severe blood loss shortly after delivery of a still barn vaginally, following a major placental abruption. Given the risk factors, what is the SINGLE most likely predisposing factor for developing postpartum haemorrhage in this women?

A 60 year old woman complains of bleeding after having intercourse. In the past month, she has had 3 episodes of mild vaginal bleeding. She had regular withdrawal bleeds until 8 years ago and has not had a bleeding since. Her last cervical smear was 3 years ago which showed no abnormalities. A speculum examination shows a normal cervix and vagina. What is the SINGLE most important diagnosis to look for?

A 26 year old woman is now 21 days postpartum and would like contraception. She has a fear of needles and would like a contraception that is reversible as she wants to conceive again in 6 months. She is currently breastfeeding. What is the SINGLE most appropriate contraception?

A 37 year old woman has irregular menstrual cycles for the last 9 months accompanied by hot flashes and night sweats. She also complains of pain during sexual intercourse. What is the SINGLE most appropriate initial investigation?

A 34 year old primigravid who is 35 weeks gestation presents to the assessment unit with a sudden onset of abdominal pain at rest with bleeding per vagina. There is a history of perceived reduced fetal movements for the past 12 hours. The pain has reduced since attending the assessment unit. On examination, her abdomen is soft and non-tender. What is the SINGLE most appropriate next step?

A 32 year old primiparous woman attends the GP clinic for her routine antenatal check- up. She is 32 weeks gestation. She complains of mild swelling of her hands although she feels well. She has good fetal movements. She has no abdominal pain. She has no relevant past medical history. Her blood pressure in the clinic is 135/85 mmHg and a urine dipstick reveals she has 1+ of protein in her urine. Her symphysis-fundal height is 31 cm and the fetal heart is heard. Her booking blood pressure obtained at 12 weeks gestation was 130/79 mmHg. What is the most appropriate action?

A 24 year old lady presents with lower abdominal pain for the last 3 months, dysuria, dyspareunia and vaginal discharge. Urine HCG is negative. She has no significant past medical history. What is the SINGLE most appropriate next step in management?

A 26 year old woman presents to the Emergency Department with lower abdominal pain. Her last menstrual period was 7 weeks ago. Serum b-hCG level was done and reported as 850 IU/litre. A transvaginal ultrasound shows an empty uterus. During her stay in the Emergency Department, she becomes pallor with a blood pressure of 80/30 mmHg and a heart rate of 120 beats/minute. Initial resuscitation efforts are successful and her repeated blood pressure is 95/60 mmHg. What would be the most appropriate next step?

(A serum hCG above 25 IU/litre is considered positive for pregnancy)

A 38 year old female with lymphoma was treated with chemotherapy. She says she has been amenorrheic for the last 8 months. Lab results show.

Follicle-stimulating hormone (FSH) 60 IU/L

Luteinizing Hormone (LH) 77 IU/L

Prolactin 13 ng/mL

Oestradiol 26 pmol/L

An FSH was repeated 4 weeks later was still elevated.

What is the SINGLE most likely diagnosis?

47 year old woman attends the GP surgery with symptoms of vaginal dryness. Her last menstrual period was 13 months ago. She suffers from recurrent urinary tract infections where she has had 3 lower urinary tract infections over the past 12 months. She is sexually active with her husband. Her husband has had a vasectomy. What is the SINGLE most appropriate medication to prescribe?

A 33 year old woman has vaginal spotting 2 days ago that is painless. She is worried of cervical cancer. She is currently on combined oral contraceptives and had a cervical smear last year which was reported as normal. Her last menstrual period was 14 days ago. Cervical ectropion is diagnosed on examination. There was no bleeding from the cervix on touch. What is the SINGLE most appropriate next step?

A 33 year old woman, with 3 previous normal vaginal deliveries complains of urinary leakage when she plays tennis or coughs. What is the SINGLE most likely diagnosis?

A 30 year old woman with suspected pelvic inflammatory disease presents to the Emergency Department with worsening of her symptoms of lower abdominal pain despite being treated with oral metronidazole and ofloxacin for 14 days. She has a temperature of 38.6°C, heart rate of 89 beats/minute, and a blood pressure of 110/80 mmHg. Her blood tests show:

White cell count 18 x 10^9/L

CRP 160 mg/L

What is the SINGLE most appropriate next course of action?

An 17 year old girl with primary amenorrhoea complains of severe abdominal pain every 4 to 8 weeks which is now getting worse. On abdominal examination, a lower abdominal mass is felt. What is the SINGLE most likely diagnosis?

A 22 year old woman who was diagnosed with a missed miscarriage a week ago now presents to the hospital because of abdominal pain. She says she passed a small fetus and a number of clots this morning. On examination, abdomen is tender, and cervical os is opened. A transvaginal ultrasound scan shows products of conception still present in the uterus. What is the SINGLE most likely diagnosis?

An 11 week pregnant woman presents with severe persistent vomiting and nausea. She has been feeling nauseous for the past few days. A urinalysis shows 2+ ketones. She has a pulse rate of 100 beats/minute. What is the SINGLE most appropriate action?

A 23 year old woman comes to the Emergency Department with severe lower abdominal pain. Her blood pressure is 120/85 mmHg and her temperature is 38.9°C. Her abdomen is rigid. Cervical excitation is noticed during a vaginal examination. She gave a past history of pelvic inflammatory disease 3 years ago which was successfully treated with antibiotics. What is the SINGLE most appropriate investigation?

A 45 year old woman has vaginal spotting after every intercourse. She also complains of intermenstrual bleeding. She has had a cervical smear 1 year ago which was reported as normal. She has been taking combined oral contraception for the past 3 years. She has been with the same partner for the last 3 years. Her last sexual transmitted infection screen was normal. Her abdomen is soft and there are no palpable masses. A speculum examination shows a friable cervix which bleeds when prodded. What is the SINGLE most appropriate action?

A 32 year old female who has completed her family wants to know more about contraception and the risk of ectopic pregnancies. Which of the following contraceptive method increases the absolute risk of ectopic pregnancies?

A 25 year old woman attends the GP surgery concerned about missing her contraceptive pill. She has been taking the desogestrel progestogen-only pill regularly for the past few years. She usually takes them at 9 am in the morning but today she forgot to take it in the morning and it is now 1 pm. She had unprotected intercourse 2 days ago. What is the SINGLE most appropriate advice?

A 30 year old multiparous woman has just delivered a term male baby. She is group A(-) and her husband’s blood group is unknown. She does not remember having any intramuscular injections in her previous pregnancy. The infant boy develops severe jaundice within a few hours after being born. What is the SINGLE most likely diagnosis?

A 53 year old woman complains of vaginal dryness, hot flashes and night sweats for the past 6 months. Her last menstrual period was more than a year ago. She currently takes an ACE inhibitor as part of her management for her blood pressure. Her blood pressure recorded at home over the past week ranges between 125/70 mmHg to 138/85 mmHg. What is the SINGLE most appropriate management for her symptoms?

A 23 year old primigravid woman comes into the antenatal unit with painless vaginal bleeding at 37 weeks of pregnancy. She describes the bleeding amount as half a cup full She has no uterine contractions. The fetal heart tones are regular at 140 beats/minute. On examination, abdominal palpation identifies the fetus to be in a transverse lie and the uterus is non tender. A speculum examination reveals a closed cervix with no polyps or lacerations identified. She has a pulse rate of 90 beats/minute, a blood pressure of 110/60 mmHg and a respiratory rate of 19 breaths/minute. What is the SINGLE most appropriate next action?

A 33 year old woman who is 11 weeks gestation attends her booking appointment with questions regarding vaccinations in pregnancy. What vaccines are offered to women who are pregnant in the UK?

A 31 year old woman presents to the emergency department with a lower abdominal pain and per vaginal bleeding one day after having a hysterosalpingography as a part of her infertility treatment. Her blood pressure is 85/50 mmHg and pulse rate is 125 beats/minute. On examination, the abdomen is rigid and tender. What is the SINGLE most appropriate next step in investigation?

A 27 year old woman presents to the emergency department with a presenting complaint of lower abdominal pain. The pain started suddenly earlier in the day. She is sexually active and does not use any barrier methods. She has abdominal tenderness, temperature of 39.0°C, heart rate of 102 bpm, and a blood pressure of 130/85 mmHg. There is no vaginal discharge seen on speculum examination. What is the SINGLE most appropriate next course of action to make the diagnosis?

An 11 week pregnant woman with twins presents with severe persistent vomiting and nausea is admitted in the hospital under the care of the obstetricians. She has been feeling nauseous for the past few weeks. A urinalysis shows 4+ ketones. She has a pulse rate of 109 beats/minute. She has been given intravenous fluids and intravenous antiemetics but continues to vomit. She is not able to keep any fluid down orally over the past 24 hours. What is the SINGLE most appropriate action?

A 23 year old woman attends the GP surgery with a disabling headache lasting for 48 hours. It is accompanied by photophobia and nausea. She reports having similar episodes once a month. She usually has to find a dark place to lie down until her symptoms pass. Before the headache starts, she feels a tingling sensation of her left hand and left face. The tingling spreads proximally starting from the hand and moves towards the left face. During the headache, she also has difficulty finding the right words to use and mixing up words. She takes regular combined oral contraceptive pills and is sexually active with her male partner of 2 years. She smokes 2 cigarettes a day. Her blood pressure is 110/70 mmHg. What is the SINGLE most appropriate action?

A 33 year old woman presents to the GP surgery with a positive pregnancy test and concerns about this pregnancy. She has had 3 early miscarriage in the past with no live births. Based on her last menstrual period, she is now 6 weeks gestation. She was investigated for antiphospholipid syndrome in the past and her lupus anticoagulant antibodies were found to be positive. Her BMI is 22 kg/m2 and she is a non-smoker. What is the SINGLE most appropriate management?

A 64 year old woman has been on hormone replacement therapy for 5 years. She had regular withdrawal bleeds until 3 years ago and has not had a bleeding since. Recently she noticed a brown vaginal discharge on her underpants. Her last cervical smear was 3 years ago which showed no abnormalities. What is the SINGLE most appropriate initial investigation?

A 29 year old woman has chronic cyclical pelvic pain, and dysmenorrhoea over the last 9 months in which she takes NSAIDS for. She complains of pain during sexual intercourse. A trial of combined oral contraceptive pills was given but there was no reported benefit. She denies any urinary or bowel symptoms. What is the SINGLE most definitive diagnostic test?

A 32 year old woman presents at 39 weeks gestation of her third pregnancy. She reports having a vaginal loss of clear viscous fluids 4 days ago. She did not attend the delivery suite as she had planned for a home birth. Over the past 3 hours, she complains of feeling feverish and sweaty. Examination of the patient’s abdomen reveals tenderness suprapubically. The symphysis-fundal height is 35 cm. She has a temperature of 38.3°C. The CTG shows a baseline fetal tachycardia of 170 beats/minute for the past 30 minutes. Her blood test show:

Haemoglobin 105 g/L

White cell count 19 x 10^9/L

Platelets 250 x 10^9/L

CRP 219

What is the SINGLE most likely diagnosis?

A 19 year old lady with primary amenorrhoea has the following blood results:

Follicle-stimulating hormone (FSH) 11 IU/L (5-25)

Luteinizing Hormone (LH) 16 IU/L (16-84)

Prolactin 13 ng/mL (<25)

Oestradiol 280 pmol/L (275-1650)

What is the SINGLE most likely diagnosis?

A 33 year old lady presents with clear, watery discharge. On examination, a red ring is seen around the cervical os. The diagnosis of cervical ectropion is made. What is the SINGLE most accurate description to define cervical ectropion?

A 31 year old woman attends the GP clinic for a 6 week postpartum check up. She delivered a term baby and there were no complications during the birth or throughout her pregnancy. She is breastfeeding. She would like a form of contraception that could be reversed in 6 months as she plans to become pregnant then. She is afraid of needles and would prefer a contraception that does not involve cutting her skin. What is the SINGLE most appropriate contraception?

A 31 year old woman suffers from acne and infrequent periods. She has suffered from irregular menstrual cycles for the past 4 years. Her menstrual cycles can range from 4 to 8 months once. Her recent blood results show an increase in levels of free testosterone.

Her ultrasound pelvis shows evidence of polycystic ovarian syndrome. She has tried using combined oral contraceptives before but due to side effects which include nausea and vomiting, she does not want to use them. She is not sexually active. She has no past medical or surgical history of significance. She does not smoke. What is the SINGLE most appropriate medication to start?

A 28 year old woman presents to the fertility clinic for advice. She and her husband are trying to conceive. She had an etonogestrel implant removed 6 months ago. She has regular menstrual cycles every 28 to 31 days. Her body mass index is 20 kg/m2. She has no past medical history of note and is not taking any regular medications. She jogs around 10 km a day. She drinks 2 cups of coffee a day. She targets sexual intercourse only around the days that she ovulates. What is the most appropriate advice to give her?

A 43 year old female who is eight weeks pregnant presents to the antenatal clinic for a check-up. She expresses concern about ectopic pregnancies as her sister and her mother had ectopic pregnancies. This is her first pregnancy. She is a known smoker. She has been treated for a pelvic inflammatory disease over twenty years ago. Which of the following is the greatest risk factor for an ectopic pregnancy?

A 28 year old woman who is 10 weeks pregnant attends her GP clinic complaining of frequency and dysuria. A urine dipstick shows nitrates and leukocytes positive. Which is the SINGLE antibiotic which should be AVOIDED in the first trimester of pregnancy?

A 16 year old clinically obese girl has not started her menstrual periods yet. She has severe acne and facial hair growth. Among her investigations, a high level of insulin was found. She is not taking any medications. What is the SINGLE most likely diagnosis?

A 31 year old woman has vaginal spotting after her last intercourse which was a day ago. Her last menstrual period was 10 days ago and she usually has a regular 28 day menstrual cycle. A cervical smear performed 6 months ago was shown to be normal. A speculum examination shows cervical ectropion which does not bleed on touch. What is the SINGLE most appropriate action?

A 25 year old woman has been taking the progestogen-only pill regularly for the past few months. She missed one pill yesterday evening. She normally takes her pills in the evening at 8 pm. It is currently 10 am the following day. Her last menstrual period was 14 days ago. She had unprotected intercourse 5 days ago. What is SINGLE most appropriate advice?

A 22 year old woman who was diagnosed with a missed miscarriage a week ago presented to the hospital last night with abdominal pain and vaginal bleeding. Since then, she has passed a small fetus. A transvaginal ultrasound was repeated which showed an empty uterus. The pain is slowly easing off. Which term describes the most specific type of miscarriage to describe this?

A 36 year old woman goes to her local GP clinic with the complaint of heavy menstrual bleeding. She also complains of pain in her lower abdominal area during her menstrual periods. She describes the pain as being intermittent in nature with a cramping quality. The pain sometimes radiates to her lower back. She takes standard over-the-counter paracetamol for the pain but she says that they provide only minimal relief. She has a standard 28 day menstrual cycle and describes her menstrual bleeding as being regular in duration and onset, but extremely heavy in nature. She has had three children, and she claims that their births were all by elective caesarean section and that they were uncomplicated in nature. A urine pregnancy test comes up negative. Her past medical history is significant for her being diagnosed with a deep vein thrombosis five years ago. The patient was put on oral warfarin for three months after her diagnosis of a deep vein thrombosis. Now, she has no other medical problems and takes no chronic medications. A transvaginal ultrasound was done for the patient. The ultrasound revealed multiple small-sized fibroids measuring about 2cm x 2cm in diameter. The fibroids do not distort the uterine cavity. What is the SINGLE best contraceptive method to offer this patient?

A 32 year old woman presents to the clinic with a 11 week history of amenorrhoea. A home pregnancy test done that morning was shown to be positive. Today, she is complaining of painless vaginal bleeding. She has excessive morning sickness for the past 2 weeks. She has had two previous normal vaginal deliveries. Routine examination of the patient’s abdomen reveals a gravid uterus which extends to slightly past the umbilicus. The fundal height measures around 16 cm. On speculum examination, the cervical os is seen as closed. What is the SINGLE most likely diagnosis?

A 29 year old woman stopped taking combined oral contraceptive pills 6 months ago and she has been amenorrhoeic since then. Ultrasonography reveals normal ovaries with no signs of developing follicles.

Her blood results show:

Follicle-stimulating hormone (FSH) & IU/L

Luteinizing Hormone (LH) 9 IU/L

Prolactin 44 ng/mL

Oestradiol 53 pmol/L

What is the SINGLE most likely cause?

A 31 year old pregnant woman has her antenatal screening at her booking appointment for HIV and Hepatitis B status. What other routine investigations are ordered at booking?

A 27 year old woman had pre-eclampsia and was delivered by C-section. 3 days after she delivered, she starts complaining of right upper quadrant pain. She has been feeling generally unwell over the past 24 hours. She has a headache and notices visual changes including the sensation of flashing lights. She has a blood pressure of 140/90 mmHg and a heart rate of 95 beats/minute. On examination, her right upper quadrant is tender. The uterus is well contracted. What is the SINGLE most appropriate immediate investigation?

A 31 year old woman who is 40 weeks pregnant is in first stage labour. Her cervix is 5 cm dilated on the last vaginal examination. She is having 2 to 3 contractions every 10 minutes. For the last 30 minutes, the CTG has been showing a variability of less than 5 bpm. The baseline remains at 150 bpm. There are no accelerations or decelerations present. What is the SINGLE most appropriate action?

A 33 year old female presents with sudden severe colicky abdominal pain at her right iliac fossa. The pain is severe and has worsen intermittently over the last few hours. The pain radiates to her back and pelvis. She has also been vomiting and feeling nauseous since the pain started. A tender, mobile mass is felt at the right iliac fossa on examination. What is the SINGLE most likely diagnosis?

A 22 year old woman is brought into the Early Pregnancy Unit with per vaginal bleeding. She cannot remember the date of her last menstrual period. Serum beta human chorionic gonadotropin (hCG) was measured at 900 IU/litre. A transvaginal ultrasound reveals an empty uterine cavity with a small right adnexal mass measuring 20 mm. No fetal heart activity was noted. Her systolic blood pressure was 100 mmhg on admission. Her heart rate is 70 beats/minute. What is the SINGLE most appropriate next course of action?

(A serum hCG above 25 IU/litre is considered positive for pregnancy)

A 90 year old woman complains of urinary incontinence. She feels the compelling desire to pass urine which she finds impossible to defer. She would occasionally wet herself before she reaches the toilet. She has to pass urine several times at night. Her symptoms have been ongoing for more than a few years. A urinalysis shows no evidence of blood, nitrates or leukocytes. What is the SINGLE most appropriate treatment?

A 27 year old presents to the Emergency Department with left sided abdominal pain and vaginal spotting. Her last menstrual period was 7 weeks ago. Her abdomen was tender to palpate and cervical motion tenderness was noticed on examination. Transvaginal ultrasound scan was performed which showed an empty uterus. Serum human chorionic gonadotropin (hCG) is 4900 IU/litre. Her observations include a blood pressure of 105/65 mmHg, heart rate of 80 beats/minute and respiratory rate of 18 breaths/minute. Her pain is not resolving despite morphine sulphate administered orally. What is the SINGLE most appropriate next course of action?

(A serum hCG above 25 IU/litre is considered positive for pregnancy)

A 38 year old woman who is 32 weeks gestation attends her antenatal clinic for a routine check-up. She feels well and has no complaints. Her blood pressure in the clinic is 168/95 mmHg, and her urine dipstick shows 2+ protein. She was referred to the maternity unit and a protein creatinine ratio was performed which showed a result of 10 mg/mmol. Her blood pressure was repeated and it was 170/97 mmHg. Her booking blood pressure at 10 weeks gestation was 120/80 mmHg. What is the SINGLE most likely diagnosis?

A 28 year old female has had 3 consecutive miscarriages. All her miscarriages had occurred before she was 10 weeks gestation. Cytogenetic analysis performed on products of conception of the third miscarriage shows no abnormalities. She comes to the clinic inquiring if it is safe for another pregnancy. What is the SINGLE most appropriate investigation to perform?

A 26 year old woman is seen in the Emergency Department for severe lower abdominal pain and vaginal spotting. The pain started 12 hours ago and is associated with nausea. Her last menstrual period was 8 weeks ago. She has a positive pregnancy test. On examination, she looks pale. She is tender at the right iliac fossa. An ultrasound reveals large amounts of free fluid in the pouch of Douglas with an empty uterus and no adnexal mass. What is the SINGLE most likely diagnosis?

A 24 year old woman with multiple sexual partners complains of non cyclical intermittent lower abdominal pain, deep dyspareunia and menstrual irregularities that has been ongoing for 18 months. On vaginal examination, cervical excitation was noted and she is tender on both adnexae. She has no significant past medical history. Which is the SINGLE most likely cause of her symptoms?

A 28 year old lady presents with lower abdominal pain and increased vaginal discharge. pregnancy test was performed and it was negative. She has a temperature of 38.5°C and also complains of deep dyspareunia. She has a pulse rate of 90 beats/minute. What is the SINGLE most appropriate antibiotic regimen?

A 29 year old woman who is 32 weeks pregnant attends her general practice with complaints of constipation. She has already tried conservative managements like increased water intake and is on high fibre foods. She takes an estimate of 2 litres a day and her diet consist of a good amount of fruits and vegetables. She is also active and exercises twice a week. What is the SINGLE most appropriate medication to administer?

A 50 year old lady presents with complains of urinary incontinence which occurs daily.

She says that she urinates a little everytime she laughs or coughs. She has had 2 previous vaginal deliveries. She has been avoiding going out and has reduced her outdoor activities due to her urinary incontinence. On physical examination, the patient is found to have vaginal atrophy and a well supported uterus. A urinalysis was done and the results were found to be insignificant. What is the SINGLE most appropriate initial step in her management?

A 35 year old woman who is 32 weeks gestation is worried as she has felt fewer fetal movements over the past 48 hours. She has sat down and focused on her fetal movements over a few hours and perceives her fetal movements to be reduced. She has had a history of a stillbirth 2 years ago. A fetal hand-held doppler ultrasound confirms a fetal heart. What is the SINGLE next most appropriate investigation to perform?

A 33 year old woman with a background history of sickle cell disease complains of heavy menstrual blood loss over the past year. She is not sexually active and has no plans for children in the near future. She has 2 to 3 episodes of severe pain associated with sickle cell crisis a year. What is the SINGLE most appropriate management?

A 20 year old primiparous woman, 32 weeks gestation, presents to the maternity assessment unit with a history of painless vaginal bleeding after intercourse. She is not booked at your current hospital, but came to the closest hospital for assessment. She states that there have been no problems during her pregnancy and that she has been seeing her midwife in the community. On examination, a soft and relaxed uterus is noted with a fundal height of 32 cm. CTG is normal. Her pulse of 112 beats/minute, a blood pressure of 94/60 mmHg and a respiratory rate of 26 breaths/minute. What is the the SINGLE most likely diagnosis?

A 33 year old woman comes to the emergency department complaining of right sided abdominal pain for the last day. She vomited once earlier today. She gives a history of missing a period. A urine pregnancy test was found to be positive. A transvaginal ultrasound scan reveals an empty uterus. On examination, she is found to be tender at the right iliac fossa with no signs of peritonism. She is afebrile and observations are stable. What is the SINGLE most appropriate next step in management?

A 30 year old woman presents to the GP surgery with dysuria, increased urinary frequency and lower abdominal pain. A urine dipstick shows nitrates and leukocytes positive. A discharge letter from the Accidents and Emergency in the hospital 5 days ago states that she was having similar symptoms and was treated with a 3-day course of nitrofurantoin. Her urine pregnancy test was positive at the hospital and B-HCG results were 2000 mIU/ml.

A urine culture sent 5 days ago has grown Escherichia coli which is sensitive to cefalexin, trimethoprim, ciprofloxacin, amoxicillin. She has a history of developing a rash when using penicillin in the past. What is the SINGLE most appropriate antibiotic to prescribe?

A 35 year old woman has been having a very heavy menstrual bleed over the past 5 days. She has been passing clots. She has been having heavy menstrual cycles for the past 6 months. She has no history of vaginal discharge, pelvic pain or dysmenorrhoea. She is not sexually active. Her most recent smear was a year ago and was normal. She has regular 25-day menstrual cycles. She has a BMI of 28 kg/m2. She has no relevant obstetric history. There are no abnormal masses palpable on an abdominal examination. Her uterus is not palpable abdominally. Her bimanual pelvic examination and speculum examination are unremarkable. What is the SINGLE most appropriate initial investigation?

A 42 year old overweight smaker complains of heavy periods. An ultrasound scan reveals a normal uterus. She would like a long term treatment with minimal side effects that would offer treatment for the menorrhagia and provide contraception although she is still unsure if she would like children in the future. What is the SINGLE most appropriate management?

A 30 year old lady presents to the outpatient clinic with difficulty in conceiving for the past 2 years. She and her husband have been trying to achieve pregnancy for more than 2 years and have been unsuccessful. There is no previous history of pelvic inflammatory disease. She has a BMI of 23. She has a regular 32 day menstrual cycle. What is the SINGLE most appropriate test to perform to assess ovulation?

A 29 year old woman’s recent cervical smear results show inflammatory changes without any dyskaryosis. She has no pelvic or vaginal pain. There was no discharge on examination. Speculum examination had shown a normal cervix and vaginal mucosa. What is the SINGLE most appropriate action?

A 25 year old woman is concerned about cervical cancer as her mother was recently diagnosed with cervical cancer. She is sexually active and would like to know which method of contraception is most likely to decrease the risk of cervical cancer?

A 15 year old female presents to the abortion service requesting a surgical termination of pregnancy. She is 10 weeks of gestation and has hid the pregnancy thus far from her parents and her partner. Her parents, who accompany her, disapprove of her decision and wish for her to see the pregnancy to term and then give the baby up for adoption. A consult with the patient in private reveals that she understands all aspects and risks of a surgical termination of pregnancy. She is adamant that she wants to have a surgical termination of her pregnancy without involving her partner and all efforts to persuade her otherwise have failed. What is the SINGLE most appropriate conclusion?

A 35 year old woman presented with the complaint of lower abdominal pain to the gynaecology outpatient clinic. She had been experiencing mild abdominal pain since the insertion of an intrauterine contraceptive device (UCD) two months ago. Her last menstrual period was seven days ago. On speculum examination, the IUCD strings were not visualised. The patient says that she is in a long term sexual relationship with her boyfriend of three years. The patient was subsequently referred for a transvaginal ultrasound whereupon the IUCD was not found in the uterus. What is the SINGLE most appropriate next step in this case?

An 8 week pregnant woman presents with persistent nausea and vomiting and a history of weight loss. She has a pulse of 110 beats/minute. Her dehydration has been managed with sodium chloride 0.9% with added potassium chloride. She continues to vomit several times during the day despite being given intramuscular cyclizine. What is the SINGLE next most appropriate management?

A 30 year old 34 weeks of gestation primiparous woman attends the GP surgery for her routine antenatal clinic appointment. She feels well herself with no complaints other than slight swelling of her feet. She is happy with baby movements and the fetal heart is heard using a handheld doppler. She has a blood pressure of 148/95 mmHg and her urinalysis shows 3+ protein. Her blood pressure was repeated again in clinic and was 143/93. Her booking blood pressure was 130/80 mmHg. What is the SINGLE most appropriate action?

A 68 year old nulliparous woman presents to her general practitioner with a six month history of poorly-localised abdominal discomfort and a constant feeling of bloatedness. On pelvic examination you find a nontender, 7 cm, solid, irregular, fixed, left adnexal mass. Her last examination was 1 year ago, which was normal, and it included a normal pap smear. What is the SINGLE most appropriate initial investigation?

A 32 year old primigravida at 28 weeks gestation presents with a blood pressure of 152/105 mmHg. A second blood pressure reading was taken 10 minutes later which read 153/108 mmHg. She is asymptomatic and otherwise well. A urinalysis was negative for protein. She has no history of high blood pressure in the past. What is the SINGLE most likely management?

A 20 year old woman who is 38 weeks pregnant attends the maternity unit with a severe headache. Her blood pressure is 171/119 mmHg, and her urine dipstick shows 2+ protein. A protein creatinine ratio (PCR) was performed in the maternity unit which results show 340 mg/mmol. Her liver function test and renal function test are within normal limits. What is the SINGLE most likely diagnosis?

A 29 year old woman is referred to the general surgeons by the A&E doctors because of worsening right iliac fossa pain which started a few hours ago. She has been vomiting and has a fever. An ultrasound scan reveals a 6 cm right ovarian cyst with reduced vascularity. The appendix is not visualised. She has a temperature of 38.2°C, a heart rate of 102 beats/minute, a blood pressure of 100/68 mmHg and a respiratory rate of 23 breaths/minute. She is given pain relief. What is the SINGLE most appropriate action?

A 51 year old, nulliparous Professor comes to GP clinic with irregular heavy vaginal bleeding for the past 6 months. She complains of hot flushes and night sweats which began a few months ago. She feels tired most of the time and also having difficulty in sleeping. She states that her job is demanding and stressful at times. She has no significant past medical history. What is the SINGLE most appropriate initial investigation?

A 16 year old girl has complains of dysmenorrhoea, menorrhagia and irregular menstrual cycles. This complains started a few years ago and has gotten worse with time. Her period pain is so intense that she occasionally has to skip school to stay at home. She has not tried any medication to manage her symptoms. She is not sexually active. What is the SINGLE most likely management to treat her symptoms?

A 42 year old complains of heavy blood loss per vaginam. An ultrasound shows uterine thickness of more than 12mm. There was no polyps or benign lesions seen on hysteroscopy. Histology reveals the diagnosis of simple endometrial hyperplasia without atypia. She has two children and is not currently planning for another child. What is the SINGLE most appropriate management for her?

A 62 year old woman presents to the GP surgery complaining of abdominal distention and discomfort for the past 6 months. The distention can occur several times a month. She denies any bleeding rectally and has no weight loss. She has a normal appetite but feels early satiety. An abdominal and pelvic examination is found to be normal. A CA-125 was requested which has come back with the following result:

CA-125 88 IU/mL (<35)

What is the SINGLE most appropriate action?

A 36 year old woman is planning to undergo laparoscopic tubal sterilisation. What is the of pregnancy after sterilisation by tubal ligation? risk

A 39 year old woman has not had her period for 10 months. She feels well but is anxious as her mother had an early menopause. What is the SINGLE most appropriate initial investigation?

A 31 year old woman presents to the maternity unit as she has been having vaginal spotting over the past few days. Her last menstrual period was 7 weeks ago. She had a positive pregnancy test at home earlier in the day. She denies any abdominal pain. A beta-HCG was performed which is 1400 mIU/mL. Her blood pressure is 120/80 mmHg and pulse is 70 beats/minute. What is the SINGLE most appropriate investigation?

(A serum hCG above 25 IU/litre is considered positive for pregnancy)

A 31 year old woman who is currently 39 weeks gestation attends the antenatal day unit feeling very unwell with sudden onset of epigastric pain associated with nausea and vomiting. Her booking blood pressure at 9 weeks gestation was 120/70 mmHg. Her antenatal scans at 12 weeks and 20 weeks were normal. Her booking blood test was normal. She has a temperature of 36.7°C and her blood pressure is 155/100 mmHg. Her pulse rate is 100 beats/minute. On examination, she is tender at her right upper quadrant and her epigastrium. Her blood results are as follows:

Haemoglobin 82 g/L (115-160)

White cell count 5 x 10^9/L (4-11)

Platelets 90 x 10^9/L (150-400)

Alanine transferase 189 U/L (5-35)

Aspartate transaminase 185 U/L (5-35)

Alkaline phosphatase (ALP) 220 U/L (30-150)

Bilirubin 33 μmol/L (3-17)

Her urinalysis shows 1 + protein. What is the SINGLE most likely diagnosis?

A 27 year old waitress has pelvic pain, dysmenorrhoea and increasingly heavy periods over the last 9 months. The pain is worse when she is standing for long periods of time. She also complains of dyspareunia. A pelvic ultrasound was reported as normal. A diagnostic laparoscopy was performed which did not show any abnormalities. What is the SINGLE most likely diagnosis