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3,531 questions
A 28-year-old woman with a history of pelvic inflammatory disease is 6 weeks into her third pregnancy. She previously had two terminations. She presents with lower abdominal pain and per virginal bleeding. Her beta hCG is 1650 mIU/mL, progesterone 11 nmol/1. An ultrasound reveals a small mass in her left fallopian tube with no intrauterine pregnancy seen. There is no free fluid in the Pouch of Douglas. She is diagnosed with an ectopic pregnancy and is clinically stable but scared of surgery. How would you manage this case?
A 24-year-old woman attends her GP complaining of deep dyspareunia and post-coital bleeding. She has crampy lower abdominal pain. Of note, she has been treated in the past for gonorrhoea on more than one occasion. On speculum examination there is no visible discharge, but the cervix bleeds easily on contact. What is the most appropriate management?
A 24-year-old woman who is 9 weeks pregnant is brought to accident and emergency by ambulance with left iliac fossa pain and a small vaginal bleed. An abdominal ultrasound scan performed at the bedside demonstrates a corneal pregnancy and free fluid in the pelvis. Her observations are: pulse 119 bpm, blood pressure 74/40 mmHg, respiratory rate 24/minute. What is the most appropriate definitive management?
A 32-year-old woman with paranoid schizophrenia is admitted for antenatal assessment at 36 weeks' gestation with twins. Her pregnancy is complicated by intrauterine growth restriction and impaired placental flow. She has had no psychotic symptoms in this pregnancy. Her obstetricians recommend an early caesarean section and argue it is in the best interests of the mother and her babies and to prevent further fetal insult. She has repeatedly said that despite the significant risks, which she understands, she refuses caesarean delivery. What is the most appropriate action?
A 16-year-old Muslim woman attends accident and emergency department with her father. She complains of a 1-day history of left iliac fossa pain and mild vaginal spotting. A urinary beta hCG test is positive. As part of your assessment the patient consents to a vaginal examination. She insists you do not tell her father that she is pregnant, and you consider her to be competent in her judgement. Her father becomes angry and says you must not perform a vaginal examination. How should you proceed?
A 32-year-old woman is rushed to accident and emergency as the viction of a high speed vehicle collision. She is 35 weeks pregnant and unconscious. There is evidence of blunt abdominal trauma and she is showing signs of grade 3 hypovolaemic shock. The consultant obstetrician on call immediately attends the resus call and recommends immediate perimortem caesarean delivery in a resuscitative effort to improve the management of her shock. Her husband has been brought into resus by the police, and insists that she would refuse caesarean section under any circumstances. What is the most appropriate management?
A 59-year-old woman has been admitted for a hysterectomy for endometrial cancer. She has not yet given her consent and the rest of the team is in theatre. You have performed a hysterectomy before so feel confident in taking her through what will happen and the risks involve The General Medical Council (GMC) says that you should tailor your discussion to all of the options except which of the following?
A 15-year-old girl attends the gynaecology clinic with her boyfriend, also 15, requesting the morning after pill 4 months after being circumcised during a family trip to Somali She understands your advice and the implications of her decisions to engage in sexual activity, is using condoms regularly and refuses to inform her parents. What is the most appropriate management?
A 34-year-old woman with long-standing menorrhagia attends accident and emergency having fainted at home. She is on the third day of her period, which has been unusually heavy this month. She insists she cannot be pregnant as she has not had sexual intercourse for a year. She is haemodynamically stable. A point-of care test venous full blood count in the emergency department shows: Hb 5.2 g/dL, WCC 8.9 .109/L, Hct 0.41% L, MCV 80 fL. What should the initial management be?
A 66-year-old post-menopausal woman is referred to you urgently by her general practioner (GP). She had been complaining of some lower abdominal pain. An ultrasound arranged by the GP shows a 4 cm simple left ovarian cyst. A CA 125 comes back as 29 U/ml (normal 0-35 U/ml). What is the most appropriate management?
A 79-year-old woman attends your clinic with some vaginal bleeding. Her last period was 16 years ago. She has had two children both via caesarean section, has a normal smear history and is currently sexually active. On examination the vagina appears mildly atrophic with some raw areas near the cervix. What is the most important next step in her management?
At laparoscopy a 21-year-old woman is found to have severe endometriosis. There are multiple adhesions and both ovaries are adherent to the pelvic side wall. The sigmoid colon is adherent to a large rectovaginal nodule. The nodule is excised and the bowel and ovaries free Which of the following medications would be appropriate to help treat her endometriosis?
A 54-year-old woman comes to your clinic complaing of hot flushes and night sweats that are unbearable. Her last mentrual period was 14 months ago. She has had a levonorgestrel releasing intrauterine system (Mirena) in situ for 2 years as treatment for extremely heavy periods. What treatment would you consider for her symptoms?
A 41-year-old mother of two presents to the GP with long-standing heavy menstrual bleeding which has become worse over the past year. She is otherwise well and has no significant medical history. She requests treatment to alleviate the impact of her heavy bleeding on her social lif Pelvic examination reveals a normal sized uterus. What is the most appropriate first line treatment?
A 42-year-old woman is seen in the gynaecology clinic. She has been suffering from severe premenstrual symptoms all her life. They have now significantly affected her relationship and her husband is filing for divorce. She comes to your clinic in tears regarding the future of her children. She demands a hysterectomy and bilateral salpingoophrectomy. After taking her history you talk about other less radical treatments. Which management option is inappropriate?
A 22-year-old woman is seen in accident and emergency with lower abdominal pain and some vaginal discharge. She has had PID once in the past and was treated for it. She is otherwise well. Her temperature is 36.9°c, pulse 90, blood pressure 105/66 mmHg. She is passing good volumes of urine. On clinical examination she has diffuse lower abdominal tenderness. There are no signs of peritonism on examing her abdomen. On vaginal examination she has adnexal tenderness and an offensive discharge. Her CRP is 28 mg/L and her white blood count is 12.2 x109/L. Her pregnancy test is negative. She is reviewed by your senior and is diagnosed with PI What would be an appropriate antibiotic regime?
been 155, with variability of 2 beats per minute, for the past 60 minutes. There are no accelerations and no decelerations. What is the most appropriate management?
A multiparous woman is admitted to the labour ward with regular painful contractions. On examination she is 9 cm dilated with intact membranes and is coping well with labour pains. Forty minutes later her membranes rupture while she is being examined and you see the umbilical cord hanging from her vagina. You inform the woman what has happened. She is now fully dilated, the fetal position is Direct occipitoanterior, and the presenting part is below the ischial spines. What do you do next?
A 34-year-old para O has been admitted for a post-dates induction of labour at 42 weeks. She has received 4 mg PGE2 (prostaglandin) vaginally. After 72 hours her cervix is 5 cm dilate Four hours later she is still 5 cm dilate On abdominal examination the fetus appears to be a normal size. The fetal head position is left occipito-transverse, and the station is -1. There is no moulding but a mild caput. She is contracting two times in every 10 minutes and has an epidural in situ. You are asked to review and make a management plan. What would be the most appropriate plan?
A 29-year-old woman comes to the labour ward complaining that her baby has not been moving for 72 hours. She is 36 weeks pregnant. Otherwise her pregnancy has been complicated with gestational diabetes for which she is taking insulin. On examination you fail to pick up the fetal heart. You confirm the diagnosis of an intrauterine death. The scan shows no liquor and the baby is transvers After a long discussion you explain that she unfortunately needs to deliver her baby. What is the best way for her to deliver her baby?