Question bank

A 60-year-old postmenopausal woman complains of recent onset of vaginal bleeding. She has a past history of diabetes mellitus for which she takes metformin 500 mg b She underwent the menopause 10 years previously and took continuous combined HRT for two years. Digital vaginal examination is normal. What is the single most appropriate first line investigation for this woman?

A 24-year-old Jehovah's Witness is brought to accident and emergency with a Glasgow coma scale (GCS) score of 3, BP 90/30 mmHg and pulse 110 bpm. Her husband reports that her last menstrual period was 8 weeks ago and she complained this morning of lower abdominal pain and vaginal spotting. Ultrasonography suggests a ruptured ectopic pregnancy. As part of the resuscitative measures employed before emergency laparotomy, a transfusion of group 0-negative blood is prepared. Her husband interrupts and says that as a Jehovah's Witness she would absolutely refuse all blood products even at risk of death, and has previously signed an advance directive stating this. What is the most appropriate option?

An unbooked 26-week pregnant woman sees you at the hospital to request a termination of pregnancy. She says that if she leaves here today without a termination she will try and do it herself by stabbing her abdomen. Your consultant arranges an urgent psychiatric review which finds no grounds under which to detain this woman in regards to her mental health. Under these circumstances, if a termination was performed, which part of the Abortion Act would it fall under?

A 46-year-old women in her fifth IVF cycle is admitted to the emergency department 4 days after egg collection. She is complaining of a swollen abdomen and shortness of breath. She is reviewed and a diagnosis of ovarian hyperstimulation syndrome (OHSS) is made. Which of the following is not a clinical feature/complication of OHSS?

takes carbamazepine. She has had no fits for approximately six months. She wants to continue with her pregnancy if it is safe to do so. She is worried about the anticonvulsant therapy and its effects on the baby. She asks how she should be managed. Which of the following management plans is the most appropriate in this case?

A 33-year-old nulliparous woman is 29 weeks pregnant. She was referred to the rapid access breast clinic for investigation of a solitary breast lump. Sadly, a biopsy of this lump revealed a carcinoma. After much counselling from the oncologists and her obstetricians a decision is reached on her further treatment. What option below may be available to her?

A 30-year-old nulliparous woman is 29 weeks pregnant. She presented to hospital with a history of a minor, unprovoked painless vaginal bleed of about a teaspoonful. Her anomaly scan at 20 weeks showed a low-lying placenta. Her fetus is moving well and continuous cardiotocography (CTG) is reassuring. What is the most appropriate management?

A 28-year-old pregnant woman attends accident and emergency with a history of clear vaginal loss. She is 18 weeks pregnant and so far has had no problems. Her past medical history includes a large cone biopsy of the cervix and she is allergic to penicillin. She is worried because the fluid continues to come and there is now some blood. On examination it is apparent that her membranes have rupture What is the most appropriate initial management?

A 32-year-old woman in her second pregnancy presents at 36 weeks gestation with a history of a passing gush of blood stained fluid from the vagina an hour ago, followed by a constant trickle since. The admitting obstetrician reviews her history and weekly antenatal ultrasound scans have shown a placenta praevia. What is the most appropriate management? She has a firm, posterior cervix and has not been experiencing any contractions?

A 30-year-old woman attends the antenatal clinic asking to be sterilized at the time of her elective caesarean. She is 34 weeks into her second pregnancy having had her first child 2 years ago via an emergency caesarean section. She is not sure that she wants any more children. Furthermore, she does not wish to try for a vaginal birth. She has tried the contraceptive pill in the past but does not like the side effects. You talk to her about other options, including the sterilization she is requesting. What is the best management option for this woman?

A 41-year-old multipara attends the antenatal clinic at 36 weeks gestation complaining of lower abdominal cramps and fatigue when mobilizing. Clinical examination is unremarkable save for a grade I pansystolic murmur, loudest over the fourth intercostal space in the midaxillary line. What is the most appropriate management?

A 32-year-old HIV positive woman who booked for antenatal care at 28 weeks gestation arrives on the delivery suite at 37 weeks with painful regular contractions and a cervix dilated to 4 cm. Ultrasonography confirms a breech singleton pregnancy with a reactive fetal heart rat What is the most appropriate management option?

A 41-year-old multiparous woman attends accident and emergency at 32 weeks gestation complaining of sudden onset shortness of breath. A CTPA demonstrates a large saddle embolus. What is the most appropriate treatment regimen?

A 42-year-old para 4 with a dichorionic-diamniotic (DCDA) twin pregnancy at 31 weeks gestation presents to hospital with a painful per virginal bleed of 400 mL. The bleeding seems to be slowing. She is cardiovascularly stable, although having abdominal pains every 10 minutes. There is still a small active bleed on speculum and the cervix appears close Both fetuses have reactive CTGs. She has had no problems antenatally and her 28-week ultrasound revealed both placentas to be well away from the cervix. What is your preferred management plan?

You are the FYl covering the antenatal war A 27-year-old nulliparous woman who is 36 weeks and S days pregnant has been admitted to your ward with suspected pre-eclampsia The emergency buzzer goes off in her room. You are the first to attend and find your patient flat on the bed having a generalized seizure what do you do?

A 19-year-old woman in her first pregnancy is admitted to the labour ward with a 4-hour history of lower abdominal pain - she is 22 weeks pregnant. She has not had any vaginal bleeding but describes a possible history of rupture of her membranes. Her past medical history includes an appendectomy and a large cone biopsy of her cervix. On examination she has palpable lower abdominal tenderness, her cervix is 2 cm dilated, she has an offensive vaginal discharge and her temperature is 38.9° Her white cell count is 19.0 * 109/L and her C-reactive protein is 188 mg/L. There are no signs of cardiovascular compromise. How would you manage this woman?

A 24-year-old multiparous woman is 23 weeks pregnant. She has not had chicken pox before. She goes to a collect her 3-year-old son from a birthday party and comes into contact with a child with an infective chicken pox infection. She is naturally very anxious. What is the best course of management?

A 24-year-old type 1 diabetic woman has just had her first baby delivered by caesarean section at 35 weeks due to fetal macrosomia and poor blood sugar control. The operation is straightforward with no complications. She has an insulin sliding scale running when you review her on the ward 12 hours postoperatively. She has begun to eat and drink. How would you manage her insulin requirements?

A 51-year-old woman in her 12th week of an assisted-conception triplet pregnancy presents to accident and emergency with severe nausea and vomiting. She has mild lower abdominal and back pains. Urine dipstick shows blood -ve, protein -ve, ketones ++++,glucose+. What is the most appropriate management plan?

A 31-year-old woman is seen in the termination of pregnancy (TOP) clinic requesting a termination. She is 5 weeks pregnant in her first pregnancy. She is otherwise well but does have some lower abdominal pain on the right hand side. On examination her abdomen is soft and non-tender. An ultrasound reveals a small sac in the uterus which might be a pseudosac. What would be your next management step?