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3,531 questions
A 24-year-old woman with gestational diabetes has been progressing normally through an uncomplicated labour. The midwife delivers the head but it retracts and does not descend any further. What should the midwife do next?
A 29-year-old multiparous woman is in established labour contracting strongly. She is 4 cm dilated and had been having regular painful contractions for 6 hours before they stopped abruptly, heralded by a sudden onset of severe, continuous lower abdominal pain. The fetal heart trace is difficult to identify, and the tocometer does not register a signal. What is the most appropriate management?
A 23-year-old woman is in her first labour. Her cervix is 6 cm dilated and she is in distress. She is asking for an epidural. Before you call the anaesthetist you check her history. Which of the following would be an absolute contraindication to an epidural?
The obstetric team is alerted to a blue-light trauma call expected in accident and emergency. A 28-year-old woman who is 37 weeks pregnant has been involved in a high-speed road traffic collision. On arrival, where the obstetric team is on standby, her Glasgow Coma Scale score is 5 and she has a tachycardic hypotension. What is the most appropriate management sequence?
A 31-year-old undergoes a planned caesarean section for a breech presentation. After delivery of her healthy baby there is difficulty in delivering the placenta, as it is adhered to the uterus. She has lost 5 L of blood as a result of the placenta accrete. The placenta has been removed but she is still bleeding and is cardiovascularly unstable despite blood product replacement. What would be the most management to definitively arrest haemorrhage?
An 18-year-old woman has been successfully delivered of a healthy female infant by elective caesarean section for maternal request. Estimated blood loss was 1120 mL. Forty minutes after return to the recovery area, she has a brisk vaginal bleed of around a litre. Her pulse rate is 120 bpm and blood pressure is 95/55 mmHg. What should the immediate management process be?
An 89-year-old woman attends the gynaecology clinic with a long history of a dragging sensation in the vagina. Apart from severe aortic stenosis, she has no significant medical history. She leaks fluid when she sneezes or coughs. On examination with a Sims' speculum in the left lateral position, a grade 1 uterine prolapse is seen, with an additional cystocoele. What is the most appropriate management?
A 46-year-old woman presents to your clinic with a 6-year history of Incontinence. She has had four children by vaginal deliveries, has a body mass index (BMI) of 35 kg/m2 and suffers from hayfever. Initial examination reveals a very small cystocele. A mid-stream urine culture is negative and urodynamic studies show a weakened urethral sphincter. What is the most appropriate first line management?
A 25-year-old woman attends accident and emergency with an exquisitely sore, large swelling of her vagina which she noticed only a couple of days before. It has steadily got much bigger. On examination there is a soft fluctuant mass on the right labia minora which is very tender. What is the most appropriate management?
A 49-year-old woman presents to a private clinic expressing her desire to become pregnant. She has no past medical history. Initial investigations show that she still has ovarian function, is ovulating and is having regular periods. An ultrasound of her pelvis shows no structural abnormality and an hysterosalpingography demonstrates patent fallopian tubes. Analysis of her partner's semen is normal. Which would not be an appropriate first line management option?
A 42-year-old woman presents to the urogynaecology clinic with a 3-year history of urge incontinence. She has features of an overactive bladder and is desperate to start treatment for her problem as it is affecting her quality of life. She opts for medical treatment. What is the most appropriate first line pharmacological therapeutic?
A 16-year-old girl presents to your surgery with a history of unprotected sexual intercourse (UPSI) 70 hours ago. Her last menstrual period was 8 days ago. Her only past medical history of note is that of epilepsy which is well controlled by carbamazepine. She is worried about becoming pregnant, does not want her mother to find out and is in a hurry to get home before suspicions are raise Which of the following options are available to her?
A 28-year-old woman attends her GP clinic for routine cervical screening. Liquid based cytology (LBC) shows mild dyskaryosis. A repeat sample again shows mild dyskaryosis. What is the most appropriate management?
A 26-year-old undergoes potassium-titanyl-phosphate (KTP) laser laparoscopic excision of endometriosis. Her postoperative haemoglobin is 8.1 g/dL. Six hours postoperatively she complains of increased umbilical swelling, abdominal pain and shortness of breath and she appears pal A repeat full blood count now shows a haemoglobin count of 6.5 g/dL. What are the most appropriate steps you should take next?
A 54-year-old woman presents to her GP with a 1-year history of bloating, early satiety and occasional crampy pelvic pain. She was diagnosed a year ago with irritable bowel syndrome (JBS). A serum CA 125 is 62 IU/mL (normal range <36 IU/mL). What is the most appropriate management?
circumscribed nodular lesions in the liver and on the omentum which are highly suspicious for metastatic ovarian cancer. What is the most appropriate treatment regimen?
A 28-year-old woman attends accident and emergency unable to walk because she is so faint. She has had heavy vaginal bleeding for 4 hours since she engaged in sexual intercourse with a new partner, which she described as 'rough and very painful'. She is still bleeding and cannot tolerate vaginal examination due to the pain. A point-of-care haemoglobin estimation is 6.4 g/dL and she is haemodynamically unstable. What is the most appropriate management?
A 64-year-old woman with asthma is admitted to the ward prior to an elective vaginal hysterectomy for symptomatic uterine prolapse. Her medications include Seretide (fluticasone/salmeterol 500/50) four times daily and oral prednisolone 20 mg twice daily. What is the most important peri-operative consideration?
A 46-year-old woman is returned to the ward from the recovery room following a routine vaginal hysterectomy for heavy periods and prolapse. The estimated blood loss at operation was 200 mL. Two hours later the ward sister becomes concerned that her urine output is low and calls the doctor. Her observations show: pulse 115 bpm, BP 90/62 mmHg, temperature 37.1Β° What are the most appropriate next steps in her management?
A 20-year-old female attends clinic requesting advice on appropriate contraception. She has a steady relationship and has no desire to start a family. There are no risk factors for venous thrombosis in her family history and she drinks approximately 12 units of alcohol each week. Apart from acne, she is otherwise fit and well. She has a body mass index of 35.5 kg/m2 and a blood pressure of 122/70 mmHg. Which of the following contraceptives would be most appropriate for this patient?