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O&G Questions

Obstetrics and Gynaecology Questions

Written December 2012 by Felicity Arthur and Calum Johnston

INTR-UTERINE GROWTH RESTRICTION MEQ – 2005,

You are attached to a general practice antenatal clinic. You review a 19 year old woman who smokes 25
cigarettes per day attending at 32 weeks gestation. You have palpated her abdomen and the symphysio-
fundal height measured 26cm. Her blood pressure is 120/70mmHg and there is no protein in her urine.
She reports that foetal movements are good and you find the foetal heart rate is normal on auscultation.
You diagnose intra-uterine growth restriction (IUGR) and refer her for hospital consultation.

a. The patient attends and her consultant decides to regard this as a high-risk pregnancy and to
monitor the foetus closely. Apart from foetal heart monitoring, give 2 methods by which foetal
wellbeing might be assessed. (2)
- USS → 1. Measure abdo circumference and BPD to confirm IUGR
2. Assess liquor volume
3. Doppler umbilical arterial MCA
4. Ductus venous Doppler
- NOT Cordocentesis (used if a congenital infection is suspected) as it’s too invasive

b. On review of the hx, what advice would you give this patient to reduce the impact of IUGR? (1)
- Smoking Cessation

c. The patient continues with monitoring to 37 weeks when she goes into spontaneous labour.
Because the pregnancy is regarded as high-risk, the condition of the foetus during labour is
monitored with a foetal heart monitor (cardiotocograph/CTG). Give 2 examples of abnormalities
you would look for on the foetal heart monitor trace which would indicate a foetal problem. (2)
- Reduced Variability (<5bpm changes for >40mins)
- Baseline Tachycardia
- Late Decelerations
- NOT Loss of Accelerations as can occur in normal pregnancy

d. What short-term (i.e. pregnancy and peri-natal period) consequences are there of IUGR? (3)
- Respiratory Distress Syndrome
- Low Birth Weight → ↑risk of perinatal mortality, still birth and Necrotising Enterocolitis
- Hypoglycaemia
- Hypothermia

e. What 2 potential long-term medical complications may this baby be exposed to when it becomes
an adult? (2)
- Type II DM
- Coronary Artery Disease
- Cerebral Palsy
- Mental Retardation
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O&G Questions

ENDOMETRIOSIS– 2005 (Resit)

A 36 year old woman presents to her GP as she is worried about her failure to become pregnant. She
and her husband have been trying for a baby for approximately 18 months with no success. Your initial
history, examination and investigations lead you to suspect endometriosis in the woman as a cause of
the infertility.

a. Suggest 2 other symptoms that might be suggestive of endometriosis (2)

DDDD:
- Dysmenorrhoea (Secondary)
- Dyspareunia
- Dyschezia (difficulty defecating)
- DAMN THAT HURTS – Chronic Pelvic Pain

b. Name 1 treatment option available for mild/moderate endometriosis, which will increase
increase the chances of conception. (1)
- Controlled Ovarian Hyper-stimulation e.g. Clomiphene Therapy
- Surgical treatment of endometrial lesions (coagulation, diathermy, laser ablation) and removal of
endometriomas
- This is most likely to the be the second point, but both are likely to get the mark apparently.

c. List 2 features you would find on biopsy of endometriosis. (2)

- Endometrial Glands
- Endometrial Stroma
- Evidence of Haemorrhage
- Scarring or Fibrosis
- Haemosiderin-Laden Macrophages

d. List 2 other causes of blockages of the Fallopian tubes apart from Endometriosis. (3)
- Hydrosalpinx (fluid blockage secondary to chlamydia)
- PID or Previous Ectopic causing adhesion

e. In vitro fertilisation is proposed for the patient. List 3 issues that should be discussed
with the couple before a decision is made. (3)
- Success Rate
- Alternatives e.g. Adoption
- Consent to use fertilised ovum if relationship breaks up
- Decision subject to psychological assessement and age
- Limited attempts on NHS (2005 NICE guidelines state “up to 3 cycles” if couple is deemed suitable)
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O&G Questions

RUPTURED MEMBRANE MEQ – 2005 (Resit), 2006, 2012

A 27year old woman in her second pregnancy presents at 32 weeks gestation with a sudden gush of
clear fluid from her vagina. She has no contractions and has had no show. You suspect she has
ruptured her membranes.

a. List 2 complications of ruptured membranes. (2)

- Preterm Labour
- Infection → Chorioamnionitis
- Foetal Distress/Death
- Placental Abruption
- Cord Prolapse

b. You arrange for her admission and perform a sterile speculum examination. What observations
would you make and/or what investigations would you perform during the speculum exam?
List 3. (3)
Observations:
- Visualise Amniotic fluid draining through cervix
- Degree of dilation of Cervix
- Check for pooling of fluid in post fornix
- Look for offensive yellow/brown discharge

Investigations:
- High vaginal swab for infective agents (e.g. Chlamydia Trachomatis)
- Choriamniocentesis

c. List 3 variables that you would wish to monitor to try and identify the early onset of possible
complications. (3)
- Pre-term Labour → dilation of cervix, uterine contractions and foetal heart rate
- Chorioamnionitis → maternal temperature, WCC/cRP levels (↑), uterine tenderness
- Foetal Distress on CTG

d. The baby is delivered. In the first 4 hours after delivery what respiratory signs in the infant
would suggest Respiratory Distress Syndrome? List 2. (2)
- Cyanosis
- Nasal Flaring
- Intercostal Indrawing
- Subcostal Recession
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O&G Questions

CERVICAL CANCER – 2007

A 30 year old woman is sent by her GP to gynaecological outpatients complaining of postcoital

bleeding. She has never had a cervical smear. She is unmarried and has had several different sexual
partners.

a. You suspect cervical carcinoma. List 3 clinical signs you would look for on your initial clinical
examination. (3)
- Friable, red, raised area of cervix
- Blood stained vaginal discharge
- Pelvic mass
- Lymphadenopathy

b. Colposcopic examination and biopsy are arranged and the histopathology confirms a malignant
tumour. List the 2 most common types of malignant tumour of the cervix. (2)
- SCC
- Adenocarcinoma

c. The most common type of malignant tumour is often preceded by a premalignant condition.
Name the 3 stages of this premalignant condition in the order in which they occur. (3)
- CIN I, II, III – ridiculous; we know.

d. What agent is important in causing the above premalignant condition? (1)

- HPV (16 and 18 = higher risk; 6 and 11 = lower risk)

e. Name 2 ways in which this agent can cause abnormal cell proliferation. (3)
- Integration of viral DNA into epithelial cell DNA encouraging abnormal proliferation
- Viral antigens/proteins bind to host cell tumour suppressor genes inactivating them
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O&G Questions

PRE-ECLAMPSIA – 2010, 2011, 2011 (Resit)

A 24-year old primigravida presents at thirty-two weeks in a previously uneventful pregnancy. She is
symptom-free apart from marked facial oedema, but her blood pressure is sustained at 145/105 and
there is proteinuria (+) on testing. You arrange her admission for further investigation and management.

a. List 4 investigations that would help you assess the maternal condition. (4)
- FBC → Platelets (may be decreased, which may suggest HELLP – a subtype of severe pre-Eclampsia
characterised by Haemolysis (H), elevated liver enzymes (EL) and low platelets (P))
- LFTs → Transaminases (part of HELLP)
- U&Es → Creatinine (elevation may indicate underlying renal disease or (rarely) development of failure)
- Urate

Abdominal examination shows a fundal height of 26cm with apparently reduced liquor volume.

b. List 3 ways ultrasound can be used to help assess the foetal condition? (3)
- Estimated fetal weight
- Biophysical profile
- USS Doppler of Umbilical Artery (for waveform)
- Check movements of foetus
- Liquor volume is another answer here, but given that it is mentioned directly before this we’re not
certain it counts as an answer - particularly when there are other options available. Also, note that
although Biophysical Profile is on the mark scheme apparently but O&G don’t actually do it anymore.

c. What other investigation would help reassure you about foetal wellbeing? (1)
- CTG (Cardiotocography) → measure variability of heart rate

d. Delivery of the baby by caesarean section is planned, in the foetal and maternal interest.
How can the administration of steroids help the survival of the pre-term infant? (1)
- Reduces the risk of neonate developing RDS by stimulating production of pulmonary surfactant

e. What is the most likely diagnosis in this mother’s instance? (1)

- Pre-Eclampsia
N.B. some years this question is the first one asked
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O&G Questions

PRE-ECLAMPSIA 2 – 2012

A 36 year old primigravida is admitted with a raised blood pressure of 160/100 mmHg at 32 weeks
gestation. Her pregnancy had been uncomplicated until two days ago. She attended her midwife
today and was referred to the hospital on account of her blood pressure.

a. What is the most important diagnosis to consider? (1)

- Pre Eclampsia

b. List 4 important symptoms you must enquire about. (2)

- Headache
- Visual disturbance
- Discomfort in upper abdomen
- Peripheral oedema

c. Give 2 pieces of information which will be relevant from her booking attendance. (2)
- Baseline BP
- FH pre-eclampsia
- Dipstick Result
- PMH of hypertension

d. What single important bedside (or ward) investigation would you arrange to be performed? (1)
- Urine → proteinuria

e. Give 3 blood investigations that would indicate disease activity. (3)

- Haematocrit
- Platelets
- Urate
- LFTs

The blood pressure increases to 160/110 over the next 24 hours and biochemical abnormalities
persist.

f. What is the best treatment for this condition? (1)

- Delivery of placenta and baby
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O&G Questions

ECTOPIC PREGNANCY – Pre-2005, 2008

A 25-year old is seen in the A&E department with a history of right iliac fossa pain and slight
vaginal bleeding after 7 weeks of amenorrhoea.

a. What is the differential diagnosis? Give 2 conditions. (2)

- Ectopic Pregnancy
- Miscarriage

b. Give 2 important points in the history which you would wish to elicit. (2)
- Onset and duration of pain i.e. acute or insidious
- Has she had a positive pregnancy test?
- Dyspareunia over previous few days (common in ectopic)
- Any change in bowel habit? (diarrhoea can be present in ectopic or acute appendicitis)
- Does she know if she is pregnant or not? (i.e. has she had a urine or blood hCG test?)
- Previous pregnancies – any history of ectopic or recurrent miscarriages?

d. Give 2 investigations you would carry out. (3)

- Urinary pregnancy test
- Bloods → FBC, Clotting, hCG, Group and Save
- Imaging → Transvaginal USS

e. Name 1 treatment option for each of your possible diagnoses. (2)

- Ectopic → Surgical e.g. salpingectomy/salpingotomy or Medical e.g. Methotrexate
- Miscarriage → surgical management of miscarriage (SMM – new name for ERPC)

f. What injection must be given to a Rh -ve pregnant woman who bleeds during pregnancy? (1)
- Anti-D immunoglobulin (normally given at 28-32wks once or twice and 72hrs after birth)
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O&G Questions

TREATMENT FOR GYNAECOLOGICAL DISEASE EMQ – 2005, 2008, 2010 (Resit)

For each of the patients described in Section 1 select the most appropriate treatment from the options
listed in Section 2

Section 1:

Q1 An infertile nullipara with chronic anovulation due to polycystic ovarian syndrome which has failed to
respond to either Clomiphene or to ovarian diathermy – 2005/2008
Answer = G

Q1 A 29 year old nulliparous woman with anovulation due to polycystic ovarian syndrome presents with failure
to conceive. – 2010
Answer = B

Q2 A 30 year old para 2 who bleeds heavily for eight days every four weeks and whose only abnormality on
ultrasound appears to be a 1cm fundal fibroid.
Answer = J

Q3 A 54 year old who has been taking combined sequential hormone replacement therapy but who wishes to
have no withdrawal bleeds.
Answer = I/G

Q4 An 18 year old presenting for medical pregnancy termination for psycho social reaons, whose chlamydial
swab is positive. – 2005/2008
Answer = D

Q4 A 63 year old woman with atrophic vaginitis. – 2010 (Resit)

Answer = I

Q5 A 25 year old with troublesome hirsutes of the face and trunk, and with ↑serum androgen levels. – 05/08
Answer = B

Q5 A 26 year old with dysmenorrhoea who also requires contraception. – 2010

Answer = C

Section 2 (2005/08) Section 2 (2010 Resit)

A Bromocryptine A Bromocriptine
B Cyproterone Acetate (Dianette) B Clomiphene
C Danazol C Combnined Oral Contraceptive Pill
D Doxycycline D Danazol
E Ethinyl Oestradiol E Doxazocin
F Gentamycin F Medroxyprogesterone
G Gonadatrophin Therapy G Tibolone
H Medroxyprogesterone H Tolterodine
I Tibolone (Livial) I Topical Oestradiol
J Tranexamic Acid J Tranexamic Acid
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O&G Questions

MENSTRUAL DISORDERS EMQ – 2005 (Resit), 2012

For each of the patients described in Section 1 select the most likely diagnosis from the options listed
in Section 2

Section 1:

Q1 A 30 year old woman complains of pain during intercourse and painful periods. There are red vesicles in the
Pouch of Douglas as well as black lesions on the uterosacral ligaments at the time of laparoscopy.
Answer = E

Q2 A 17 year old university student complains of abdominal swelling, some non-specific discomfort and six
months amenorrhoea.
Answer = I

Q3 A 50 year old teacher complains of erratic periods and night sweats

Answer = H

Q4 A 35 year old shop assistant complains of painless bright red bleeding occurring after intercourse.
Answer = B

Q5 A primigravida 30 year old with an 8 weeks gestation presents with painless uterine bleeding. The human
chorionic gonadotrophin levels are 4 times the upper limit of normal for her gestation with echoluscent
spaces on ultrasound scan.
Answer = G

Section 2

A Adenomyosis
B Carcinoma of the Cervix
C Carcinoma of the Uterus
D Carcinoma of the Vagina
E Endometriosis
F Fibroids
G Hydatidiform Mole
H Peri-Menopause
I Pregnancy
J Prolactinoma
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O&G Questions

MENSTRUAL DISORDERD 2 EMQ – 2005 (Resit)

For each of the patients described in Section 1 select the most likely diagnosis from the options listed
in Section 2

Section 1:

Q1 A 17 year old long distance athlete presents with amenorrhoea and a stress fracture of a bone in her right
foot. She has a low BMI (13.5) and has lanugo hair growing on her back.
Answer = B

Q2 A 28 year old lady presents with amonorrhoea for the last 12 months. She has galactorrhoea, dyspepsia
and has had a non-specific headache for some time.
Answer = G

Q3 A 17 year old girl presented with abdominal swelling, a feeling of nausea and 5 months amenorrhoea.
Answer = F

Q4 A 17 year old university student complains of never having had any periods and underdeveloped breasts.
Her BMI is 18.5. Otherwise her secondary sexual characteristics are normal.
Answer = D

Q5 An 18 year old girl with learning difficulties is brought to hospital with amenorrhoea by her mother.
Examination shows a web neck, wide spaced nipples and limited secondary sexual characteristics.
Answer = J

Section 2

A Cushing Syndrome
B Hypoestrogenism
C Hypothyroidism
D Late Menarche
E Ovarian Failure Post-Chemotherapy
F Pregnancy
G Prolactinoma
H Polycystic Ovary Syndrome
I Sheehan’s Syndrome
J Turner’s Sydrome
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O&G Questions

COMPLICATIONS OF PREGNANCY – 2005 (Resit), 2006, 2007, 2010 (x2), 2011 (Resit)

For each of the patients described in Section 1 select the most likely diagnosis from the options listed
in Section 2

Section 1:

Q1 A 30 year old multiparous woman presents with scant vaginal bleeding, severe hypotension and a tender
uterus at 36 weeks gestation. Foetal heart sounds are not detected.
Answer = A

Q2 A 26 year old multiparous woman presents with irregular contractions causing discomfort only in the third
trimester of pregnancy
Answer = B

Q3 A 20 year old primigravid woman is brought into casualty following a fit in her 36th week of pregnancy. She
is noted to have a blood pressure of 170/110mmHg and 2+ proteinuria.
Answer = E

Q4 A 22 year old primigravid woman is seen in clinic at 28 weeks. She is noted to have ankle oedema and a
blood pressure of 160/110mmHg of Hg. Her urine demonstrates the presence of protein.
Answer = I

Q5 A 28 year old primigravid woman presents with lower abdominal pain and a spiking fever 24 hours after
delivery of her baby.
Answer = G

Section 2

A Abruptio Placentae
B Braxton-Hicks Contractions
C Endometriosis
D Early Pregnancy
E Eclampsia
F Ectopic Pregnancy
G Endometritis
H Placenta Praevia
I Pre-Eclampsia
J Quickening (first time of feeling the baby move – primi = 18-20wks; mutli = 17-19 weeks)
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O&G Questions

GYNAECOLOGICAL SYMPTOMS EMQ – Pre-2005

For each of the patients described in Section 1 select the most likely diagnosis from the options listed
in Section 2

Section 1:

Q1 A 23-year old para 0+1 presents with lower abdominal pain, hypotension and light vaginal bleeding after 7
weeks amenorrhoea. She has also noticed some shoulder tip pain.
Answer = I

Q2 A 49-year old para 2 has become significantly anaemic. She describes increasingly heavy and irregular
periods for the past four months. Pelvic examination reveals a normal uterus.
Answer = A

Q3 A 45-year old para 4, who has never had a smear, report post-coital and intermenstrual bleeding for the
past 6 months.
Answer = C

Q4 An 18-year old, who five days ago had casual unprotected intercourse, presents with acute lower abdominal
pain, pelvic tenderness and pyrexia.
Answer = H

Q5 A 70-year old obese nulliparus lady, who has diabetes and hypertension, presents with an abdominal
swelling and ascites.
Answer = G

Section 2

A Anovulatory dysfunctional uterine bleeding

B Atrophic vaginitis
C Cervical cancer
D Complete miscarriage
E Endometrial cancer
F Endometriosis
G Ovarian cancer
H Pelvic inflammatory disease
I Ruptured ectopic pregnancy
J Uterine fibroids
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O&G Questions

MANAGEMENT OF DYSFUNCTIONAL UTERINE BLEEDING EMQ – Pre-2005

For each of the patients described in Section 1 select the SINGLE most appropriate answer from the
options listed in Section 2

Section 1:

Q1 A 25-year old married woman who presents with irregular menstrual cycles and menorrhagia. She would not
like to start a family yet
Answer = I

Q2 A 50-year old woman present with irregular uterine bleeding.

Answer = D

Q3 A 14-year old female complains of heavy periods and pain. She is not sexually active.
Answer = F (or I but F is better as not sexually active unlike Q1)

Q4 A 40-year old woman presents with heavy, regular periods

Answer = H (though both I and F could be used, H is better)

Q5 A 33-year old woman presents with intermenstrual bleeding that is not controlled with oral contraceptives.
Answer = G
(Need to ensure it’s just a hormonal blip and not something more sinister)

P.S. This question is atrocious.

Section 2

A Clomiphene citrate
B Ethinylestradiol
C Hysterectomy
D Hysteroscopy
E Measure progesterone levels at day 21
F Mefenamic acid
G Pipelle endometrial sampling
H Provera
I Oral contraceptives
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O&G Questions

PROBLEMS IN PREGNANCY EMQ – Pre-2005

For each of the patients described in Section 1 select the most likely diagnosis from the options listed
in Section 2

Section 1:

Q1 A 16-year old unbooked nullipara presents at 33 weeks’ gestation (by her dates). Abdominal examination
shows a fundal height measurement of 37cm with a cephalic presentation.
Answer = J

Q2 A 26-year old para 3 presents with a light painless bleed at 30 weeks’ gestation. Examination reveals her to
be undistressed, with no signs of shock, and a non-tender abdomen. The fetal lie is transverse.
Answer = G

Q3 A 40-year old primigravida, with a twin pregnancy at 36 weeks’ gestation, gives a two-day history
of troublesome itch of the palms and soles. There is no obvious rash and no jaundice, although her
transaminases levels and serum bilirubin are elevated.
Answer = C

Q4 An 18-year old primigravida, estimated to be 30 weeks’ gestation, is admitted with acute onset of lower
abdominal pain and slight vaginal bleeding. Her blood pressure 100/60 and she has a tense, tender
abdomen and the fetal heart cannot be heard.
Answer = A

Q5 A 28-year old para 1 has has an uneventful pregnancy and a normal detailed US scan at 18 weeks’
gestation. At 35 weeks, the fundal height measures 28cm and the liquor volume is clinically reduced.
Answer = H

Section 2

A Abruptio placentae
B Cervical cancer in pregnancy
C Cholestasis of pregnancy
D Fatty liver of pregnancy
E Hepatitis C in pregnancy
F Hydatidiform mole
G Placenta praevia
H Placental insufficiency
I “Twin-to-Twin” transfusion syndrome
J “Wrong Dates”
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O&G Questions

PHARMACOLOGY IN PREGNANCY EMQ – Pre-2005

For each of the patients described in Section 1 select the most appropriate drug from the options listed
in Section 2

Section 1:

Q1 A woman diagnosed with a deep vein thrombosis at 32 weeks gestation

Answer = H

Q2 A woman diagnosed with a urinary tract infection at 12 week gestation

Answer = C

Q3 A woman at 34 weeks gestation with blood pressure persistently around 140/100 mmHg
Answer = I

Q4 A woman admitted with regular contractions at 28 weeks gestation

Answer = B

Q5 A woman at 25 weeks gestation with persistent backache not relieved by regular paracetamol
Answer = E

Section 2

A Bendrofluazide
B Betamethasone
C Cefalexin
D Diclofenac
E Dihydrocodeine
F Doxycylcine
G Enalapril
H Heparin
I Labetalol
J Warfarin