Women’s Health Interest Society Monash (WHISM)

2021

Women’s Health Practice Paper

30 multiple-choice questions

Written and reviewed by WHISM 2021 5D Committee Members:

Sophie Gilbert, Sarah Butler, Zoe Lysaght, Nithya Thennakoon, Lachlan Douglass, Suwandi
Dewapura

1
MCQ 1
1 mark

A 30-year-old G2P1 at 38 weeks gestation has come into hospital in labour. She has had
spontaneous rupture of membranes whilst at home. She has progressed from 4cm to 8cm
over the last 3 hours and is experiencing regular contractions.

Select the MOST APPROPRIATE management:

A. Oxytocin infusion
B. Continue regular monitoring of foetal and maternal observations
C. Emergency caesarean section
D. Artificial rupture of membranes
E. Apply fetal electrode

MCQ 2
1 mark

What kind of decelerations are present on this CTG?

A. Variable decelerations
B. Late decelerations
C. Early decelerations
D. Prolonged decelerations
E. Sinusoidal decelerations

2
MCQ 3
1 mark

Which of the following is NOT a potential indication for an operative vaginal birth?
A. Fetal compromise
B. Maternal spinal cord injury
C. Inadequate uterine contractions
D. Maternal exhaustion
E. Prolonged second stage of labour

MCQ 4
1 mark

Jessica is a 28-year-old G3P2 woman who would like to have a normal vaginal birth and
mentions this at her first antenatal appointment. She has had three births, two which were
normal vaginal deliveries (the first and third) and one which was an emergency caesarean
for obstructed labour. She is medically well and takes no regular medications.

Which of these factors does NOT favour a successful vaginal birth after caesarean?
A. Previous normal vaginal delivery
B. Spontaneous onset of labour
C. Previous successful vaginal birth after a caesarean section
D. Uncomplicated pregnancy
E. Previous LUSCS for obstructed labour

MCQ 5
1 mark

Induction of labour does NOT increase the risk of which of the following?
A. Uterine hypertonia
B. Uterine rupture
C. Infection
D. Cord prolapse
E. Pre-eclampsia

3
MCQ 6
1 mark

A 28-year-old G2P1 with asthma has just birthed a healthy baby girl via vaginal delivery. She
was given oxytocin at delivery of the anterior shoulder but continues to bleed even after
complete delivery of the placenta. The midwife is performing fundal massage as the O&G
registrar prepares to administer appropriate medications.

Which of the following is the most appropriate first-line therapy for this patient?
A. Ergometrine 250mcg IM
B. Oxytocin 5 units IM
C. Oxytocin 5 units IV
D. Misoprostol 500mcg PR
E. Syntometrine 1mL IM

MCQ 7
1 mark

A 26-year-old primigravida presents to her General Practitioner for advice as her mother
developed pre-eclampsia in her first pregnancy. She is currently 8 weeks gestation without
complication and has no significant past medical history. Blood pressure, urine dipstick and
clinical examination is normal.

What would be the recommended advice?

A. Advise her that she is at high risk of pre-eclampsia so will need to commence aspirin
75mg daily immediately until birth
B. Advise her that she is at high risk of pre-eclampsia so will need to commence aspirin
150mg daily at 12 weeks until 36 weeks gestation
C. Advise her that she is at moderate risk of pre-eclampsia so will need to commence
aspirin 150mg daily at 12 weeks until 36 weeks gestation
D. Refer urgently for obstetrician care
E. Reassure her that she is at low risk of pre-eclampsia

4
MCQ 8
1 mark

A 31-year-old G1P0 at 41+5 weeks gestation presents to the birth unit for induction of
labour. Besides a diagnosis of polyhydramnios in her second trimester, her pregnancy has
been uncomplicated. After insertion of a cervical balloon catheter, she was connected to
cardiotocography (CTG) to monitor contractions and fetal heart rate - which remained
stable overnight. The next morning, her membranes were artificially ruptured. Immediately
afterwards, fetal bradycardia and variable decelerations were observed on CTG. On
speculum examination a pulsating cord was visible below the presenting part of the foetus.

What is NOT an appropriate immediate response to a cord prolapse?

A. Administer tocolysis
B. Emergency caesarean section
C. Knee-chest position
D. Lifting the presenting pole of the fetus
E. Manual replacement of the presenting umbilical cord

MCQ 9
1 mark

A 31-year-old G1P0 at 41 weeks presents to the birth unit with contractions following
spontaneous rupture of membranes at home. She has been actively pushing for a little
under 2.5 hours. The obstetrics registrar is called to attend after the midwife noticed the
fetal head retracting back into the perineum moments after crowning.

Which is the most appropriate management option?

A. Apply fundal pressure
B. Bakri balloon
C. Encourage maternal pushing
D. McRoberts’ manoeuvre
E. Misoprostol 800-1000mcg

5
MCQ 10
1 mark

A 27-year-old woman presents to the emergency department at 29 weeks gestation with

sudden onset abdominal pain and vaginal bleeding. The pain has been severe and constant
for the past hour. She has had no previous antenatal care but tells you this is her first
pregnancy and that her blood type is B(+). She is an ex-smoker and has a history of cocaine
use. Her uterus is rigid and tender on palpation. Vital signs are stable.

Which of the following is NOT going to be part of your management?

A. Administer 2 doses betamethasone 11.4mg IM, 24 hours apart
B. Administer 20mg oral nifedipine for tocolysis
C. Administer magnesium sulphate intravenous infusion
D. CTG monitoring
E. Order FBE, group & hold and crossmatch

MCQ 11
1 mark

Josie is a 29-year-old female who presents to the emergency department with unilateral
pelvic pain and vaginal bleeding. Her last normal menstrual period was 10 weeks ago. On
examination her blood pressure is 85/60 and her pulse rate is 120 beats per minute. Her
serum beta HCG is 6280IU/L and a pelvic ultrasound indicates that there is a 3cm right
adnexal mass.

From the following options, select the most appropriate management

A. Expectant management
B. Methotrexate
C. Suction D+C
D. Laparoscopic Salpingectomy
E. Mifepristone +/- Misoprostol

6
MCQ 12
1 mark

You are an O&G Resident in a clinic at a major metropolitan hospital. Your patient Linda is a
29-year-old female who has accidentally become pregnant, having forgotten to take her
COCP. She didn’t take a pregnancy test for a long-time as it slipped her mind, and she is now
at 12 weeks’ gestation. She would like to terminate the pregnancy as she doesn’t feel able
to support the baby at this time. She has no other co-morbidities.

From the following options, select the most appropriate management

A. Admit for medical management with mifepristone and misoprostol
B. Discharge home with instructions & medications for medical management for with
mifepristone and misoprostol
C. Surgical management with Suction D&C
D. Surgical management with D&E with feticide
E. Surgical management with D&E without feticide

MCQ 13
1 mark

Betty, a 24-year-old presents to her GP requesting emergency contraception 4 days

following unprotected intercourse.

Which of the following is appropriate to prescribe?

A. Ulipristal acetate 30mg.
B. Mirena intrauterine system 52mg.
C. Norethisterone 30microg.
D. Levonorgestrel 1.5mg.
E. Mifepristone 200mg.

7
MCQ 14
1 mark

A 23-year-old woman is presenting to the Emergency department with a one-day history of

vaginal spotting and mild cramping pain in the lower abdomen. She explains that she did a
urine pregnancy test at home a week ago which was positive, and her last menstrual period
was 5 weeks ago. On examination, her vital signs are within normal limits and her abdomen
is soft. A pelvic ultrasound finds a long and closed cervix with a crown-rump length
measuring 5.8mm, however there is no fetal cardiac activity detected.

Select the most appropriate management:

A. Expectant Management
B. Repeat Ultrasound in a week
C. Mifepristone +/- Misoprostol
D. Suction Curettage
E. Laparoscopic Salpingectomy

MCQ 15
1 mark

A 24-year-old woman presents with abdominal pain and vaginal bleeding after six weeks of
amenorrhoea.

Which one of the following combinations of physical signs is most likely if she has a tubal
ectopic pregnancy?
A. Board-like abdominal rigidity with both rebound tenderness and guarding.
B. Little guarding but marked rebound tenderness in the suprapubic region.
C. Profound shock with a rapid pulse and low BP.
D. Rapid pulse and upper abdominal rebound tenderness.
E. Tenderness in the pouch of Douglas and a tender adnexal mass.

8
MCQ 16
1 mark

A 30-year-old nulliparous woman presents anxious as she has been unable to conceive over
the last 3 years. On further history, she reports that she is still menstruating, however, has
struggled with irregular periods. She also complains of excessive hair growth. On
examination she is overweight.

Select the most likely diagnosis.

A. Polycystic ovary syndrome
B. Peri-menopause
C. Premature ovarian insufficiency
D. Sheehan’s syndrome
E. Prolactinoma

MCQ 17
1 mark

Tami is a 56-year-old lady, G0P0, BMI 33, who presents complaining of PV bleeding over the
last few months associated with mild fatigue. She went through menopause at age 53 and
has a past medical history of PCOS. Examination is unremarkable. A transvaginal ultrasound
reveals an endometrial thickness of 7mm. The endometrial biopsy does not show atypia.

Which is the most appropriate next step?

A. Repeat CST
B. Repeat transvaginal ultrasound in 6 months
C. Endometrial biopsy
D. Colposcopy
E. Mirena

9
MCQ 18
1 mark

A 21-year-old female has experienced significant issues with acne, weight gain and excessive
facial hair since her teenage years. She also mentions that she doesn’t seem to get her
periods as often as her friends. She has recently entered a new relationship and wishes to
be sexually active. She is seeking a form of contraception, and wonders if you, her doctor,
can prescribe a contraceptive which may also help with controlling her other issues with
acne, weight gain and excessive facial hair.

What will you prescribe?

A. COCP
B. Mirena
C. Domperidone
D. Implanon
E. Progesterone only pill

MCQ 19
1 mark

Eugenie is a 27-year-old sexually active female who presents complaining of a 4 week

history of “funny” vaginal discharge, post-coital bleeding and dysuria. She is not currently in
a stable relationship and has multiple sexual partners. An endocervical swab is performed
and the results come back as Chlamydia trachomatis positive.

How should this be managed?

A. Ceftriaxone 500mg IMI, stat in 2mL 1% lignocaine, with azithromycin 1g PO, stat
B. Benzathine penicillin 1.8g IMI, stat
C. Doxycycline 100mg PO, BD 7 days, OR azithromycin 1g PO, stat (correct - treatment
of uncomplicated genital or pharyngeal chlamydia infection)
D. Permethrin cream 5% topical (treatment of genital and pubic scabies infection)
E. No treatment required; advise to abstain from sexual intercourse for 7 days.

10
MCQ 20
1 mark

Mandy is a 31-year-old female smoker who presents with her husband Tom. They are both
distraught as they have been trying for a baby for 3 years and have been unsuccessful. On
history, Mandy reports recent issues with suddenly feeling very warm at times. She has also
been experiencing low mood and decreased libido. She states that she has also been “quite
dry down there” lately. Tom, on the other hand, appears to have no issues which could be
contributing to the difficulty conceiving. What is the most likely diagnosis?

Please select the best answer:

A. Polycystic ovary syndrome
B. Anorexia nervosa
C. Premature ovarian insufficiency
D. Sheehan’s syndrome
E. Peri-menopause

MCQ 21
1 mark

A 48-year-old woman presents with severe hot flushes, night sweats and sleep disturbances.
Past medical history includes diet-controlled Type 2 Diabetes Mellitus and hysterectomy for
endometriosis. Nil allergies. She mentions that she has a family history of endometrial and
colorectal cancer.

Select the most appropriate treatment option from the list for the clinical situation below.
A. Cyclical estrogen-based HRT and progesterone treatment
B. Combined estrogen-based HRT with progesterone treatment
C. Oestrogen replacement therapy alone
D. Combined oral contraceptive pill
E. Topical oestrogen cream

11
MCQ 22
1 mark

Last week you conducted a repeat CST on a 31-year-old asymptomatic woman, Mrs Timmel.
The CST result from 12 months ago showed HPV not 16/ 18, with reflex liquid-based
cytology showing low-grade squamous intraepithelial lesion. The current CST result shows
HPV infection still present.

Select the most appropriate management option from the list for the clinical situation
below.
A. Recommend CST today and every 5 years until age 70
B. Refer for colposcopy and biopsy
C. Repeat CST in 12 months
D. Repeat the CST in 6-12 weeks
E. Repeat the CST in 5 years

MCQ 23
1 mark

A 53-year-old lady, BMI 31, presents to her GP with twelve days of heavy, continuous
vaginal bleeding. Her periods have been irregular for the past few months. Her last period
was five months ago. She is also complaining of frequent hot flushes. She has a past history
of a bilateral mastectomy for breast cancer and is currently taking tamoxifen.

Select the diagnosis which best matches this clinical scenario.

A. Fibroids
B. Adenomyosis
C. Vaginal atrophy
D. Endometrial cancer
E. Cervical cancer

12
MCQ 24
1 mark

A 68-year-old woman re-presents to the GP clinic due to the continued experience of an

uncomfortable dragging sensation and a bulge in the vagina, worsened during straining. She
also has voiding difficulty, with increased urinary frequency, nocturia and weak stream. As
per her GP’s advice, she has limited her fluid intake to 1.5L a day with no fluid after 5pm to
reduce urinary frequency and nocturia with minimal improvement with these measures.

From the following options, please select the next most appropriate step in management
A. Hysterectomy +/- anterior or posterior repair
B. Sacrocolpopexy
C. Total laparoscopic hysterectomy +/- bilateral salphingo-oophorectomy
D. Lefort colpoclesis
E. Vaginal ring pessary and pelvic floor strengthening exercises

MCQ 25
1 mark

A 57-year-old woman has been referred by her GP to your outpatient Obstetrics and
Gynaecology clinic. Over the last 8 months she describes needing to urinate more than 10
times a day. She feels as though “she needs to go all the time”, despite maintaining the
same level of fluid intake and only voiding small amounts each time. Sometimes she reports
rushing to the bathroom as she feels she might have an accident. She has 2 children, both of
whom were delivered via C-section. As per her GP’s advice, she has limited her fluid intake
to 1.5L a day with no fluid after 5pm and stopped drinking her morning coffee but
experienced little improvement with these measures. Her GP also recommended that she
see a pelvic floor physiotherapist for the last 3 months, but she did not find the exercises
helpful. She does not consume alcohol and has never smoked. She was very worried about
coming into hospital today as she cannot forget a traumatic and painful catheterisation, she
had done during the birth of her second child.

From the following options, please select the next most appropriate step in management
A. Botulinum infections to the bladder neck
B. Tension free vaginal tape
C. Oxybutynin
D. Urethral bulking agents
E. Burch colposuspension

13
MCQ 26
1 mark

Sally presents at antenatal clinic. She had a 26-week OGTT yesterday as she has a BMI of 35,
the result was abnormal.

What is the next appropriate step?

A. Referral to diabetic educator and monitor BSL before and after meals
B. Prescribe metformin until euglycaemic
C. SC insulin with measurement of BSL pre/post prandial
D. Refer for urgent ultrasound because GDM can cause foetal abnormalities
E. Consider elective Caesarean due to risk of shoulder dystocia

MCQ 27
1 mark

A 33-year-old T1DM mother is planning for induction of labour at 38 weeks.

What is the most appropriate BSL management for her?

A. Prescribe metformin until euglycaemic
B. SC insulin with measurement of BSL pre/post prandial
C. Consider elective Caesarean due to risk of shoulder dystocia
D. Commence IV insulin or sliding scale with monitoring of BSL 3-4 hours
E. Perform biophysical profile

MCQ 28
1 mark

A 38-year-old primigravida with gestational hypertension on labetalol presents at 36 weeks

with headache, peripheral oedema and epigastric pain. Her BP is 170/110 and she has
generalised oedema, hyperreflexia, and protein in her urine. You arrange admission but in
the interim she begins to have a seizure.

What is the most appropriate immediate management?

A. Commence IV antihypertensive and target 140/90
B. Commence oral antihypertensive and target 110/80
C. Prepare for emergency Caesarean
D. Magnesium Sulphate
E. Urgent ultrasound to check baby

14
MCQ 29
1 mark

All of the following are risk factors for IUGR EXCEPT:

A. SLE with renal damage
B. Anorexia
C. Congenital infection
D. Chromosomal abnormalities
E. BMI 25-30

MCQ 30
1 mark

This condition usually abates in the second trimester but can continue the entire pregnancy.
It is more common in multiple gestations and molar pregnancies.

Select the best option from the following options:

A. Constipation
B. Hyperemesis Gravidarum
C. Gastrointestinal reflux
A. Gestational Diabetes Mellitus
B. E: Pre-eclampsia

15