O&G module I (2004-2005) Exam
MCQ
1. A woman with 10 wks gestation. Biochemical screening shown risk of Down's 1:5. What should you do?
A. redo the screening
B. redo the screening in 2nd trimester
C. perform CVS now
D. ….
E. Perform amniocentesis at 14-16wks
2. 17-year-old girl with primary amenorrhoea, virgin, with breash development at Tannar stage IV, axillary and pubic hair present.
Which of the following management is not appropriate?
A. pelvic USG
B. Estrogen and testosterone
C. Karyotype
D. LH/ FSH
E. endometrial sampling
3. A 50 year old women, with 6 cycles of menorragia. Which is NOT the appropriate
management?
A. Endometrial abalation
B. Hysterectomy
C . Mirena
D. Uterine artery embolisation
E. GnRHa until menopause
4. A 28 years old lady, G2P1, complained of repeated vomiting for the past 1 week. She is at 9 weeks gestation. There is blood streaks found in her vomitus today after repeated vomiting. She is unable to tolerate any food or drinks. Examination reveals dry mucous membrane and urine ketone is positive.
Which of the following management(s) is/are correct and relevant to her current condition?
1. Dextrose solution every 4 hours to replace fluid and energy loss
2. endoscopy to rule out oesophageal tear and peptic ulcer
3. Avoid metoclopromide becauseit is dangerous for early pregnancy
4. MSU for microscopy and culture
5. USG
A. 4 only
B. 1 and 4
C. 4 and 5
D. 1,2,3 and 4
E. All of the above
5. 34yo G4P3 3 x NSD. This pregnancy unstable lie since 36wk. Stabilising induction at 38wk: ECV + Syntocinon infusion + AROM at 0900. CTG normal till 1100: Fetal bradycardia down to 90bpm x 3 min. Uterine contractions: 3/10 min. What is the immediate action?
A. Vacuum delivery
B. EmCS because bradycardia
C. TAS because fear of return to transverse lie
D. Vaginal examination for cervical status & prolapse cord
E. Fetal blood sampling
7. A 30-year-old obesity woman, presented with secondary amenorrhoea for six months. She has no withdraw bleeding after taken the combined oral contraceptive drug for six days from private clinic.
Which of the following is not true?
A. Pregnancy test is required.
- The diagnosis is likely to be polycystic ovarian syndrome.
- If hormonal profile (FSH, LH) is normal, the diagnosis is probably turner syndrome.
- ??
- Clomiphene citrate can be used to treat the infertility.
8. A 36-year-old primigravida woman was diagnosed to have gestational diabetes
at 28 weeks of gestation. Physical examination showed the uterine size
larger than date. 1800 kcal diabetic diet failed to achieve optimal
diabetic control.
Which of the following action(s) is/are appropriate?
A. Start oral hypoglycemic agent such as metformin as the second-line
diabetic treatment.
B. Arrange ultrasonography for any evidence of macrosomia and/or
polyhydramnios.
C. Test urine for glucose regularly to monitor response to the diabetic
treatment.
D. 75 gm OGTT at postpartum day 2 to exclude impaired glucose tolerance.
E. B and D
9. A 28 year old woman, 38 weeks of gestation, with unremarkable past medical history, who was just recovered from generalized convulsion in the antenatal ward. Her BP now is ?? and proteinuria +++, Which is the most important immediate management?
- connect CTG to check for the fetal well being
- emergenct C/S
- Diazpam
- MgSO4
- ?
10. para0 lady, recurrent bleeding at 16, 20, 22 wk of gestation. admited for
bleeding again at 26 wk. otherwise normal. normal fetal morphology at 20 wk.
which statement is correct?
A. pv exam should be done to exclude local lesion
B. weekly corticosteroid should be commenced for fetal lung maturity
C. low-lying placenta is unlikely because bleeding from that is unlikely before
28 wk
D. minor placental abruption is a possible cause
E. serial afp should be taken because elevated afp is associated with bleeding
11. patient with BP 150/85, 0.8g/l proteinuria, what would you do?
A. perform emergency caesarian section
B. daily CTG of the fetus
C. Anti-HT cannot stop the progress of the disease and is not indicated
in this stage
D. discharge her
E. ?
12. 30 year old, G0P0, complain of on and off pelvic pain for 2 yrs. This is her
first visit to doctor. She has one sexual partner and her husband practised
coitus interruptus. She has normal flow and dysmenorrhea from day 1 to day 3
of the cycle.
Which of the following is NOT you initial management?
A. Diagnostic laparoscopy
B. Swab for STD
C. Ultrasound pelvis
D. Ponstan
E. Pictorial Chart
14. You are a GP in Sheung Shui. A 14 year-old girl comes with her boyfriend who is 15 years old. She is in 9 weeks of gestation and requests for termination of pregnancy.
What will you do?
1) Call the police immediately as you are legally responsible to report crime
2) Give Mifepristone for TOP
3) You must terminate pregnancy for her as she is < age 16
4) Ask for reasons of TOP
5) Counsel the couple on future contraception.
A. 1 only
B. 3 only
C. 1,2,3 only
D. 4,5 only
E. all are correct
16. A woman present with retention of urine for 12 hr after normal vaginal delivery with ventose extraction; Which of the following is the most possible reason for the retention of urine?
A. bladder injury;
B. UTI;
C. Wound pain;
D. 2&3
E. 1&2&3
17. 40 year old, 2 yr primary inferitily. Irregular long cycle since menarche.
Some episode of IMB. No withdrawal bleeding after progestogen.
LH : 10.9
FSH : 3.2
Progesterone : 1.4
Which of the following is incorrect:
A. Check testosterone
B. Checking serum prolactin is necessary
C. Endometrial accessment since she has increase risk of endometrial hyperplasia
D. she may have features of metabolic symdrome
E. Clomiphene is the treatment of choice
18. 36yo, para 3 lady with history of 3 induced abortions, is breastfeeding for 9
months. She has no menses yet. Her husband is found to have extramarital
relationship. She is planning to divorce. She recently has developed clamydial
infection and ask for reliable contraceptive method.
Which of the following is most appropriate for her?
A. injectable progestogen
B. progestogen-only pills
C. lactational amenorrhea
D. sterilization
E. IUCD
19. A Para 5 lady, 60 years old, had a physiological menopause at 50 years
old. She has not been put on HRT. She now complains of vaginal dryness and
worries about the risk of bone fracture as a recent examination showed that
she has mild osteoporosis. She now asks you for advice.
Which of the following statement is correct?
A. She should be offered Premelle cycle which contains both estrogen and
progestogen
B. Raloxifene should be offered to her as it solves both of her problems and
does not increase the risk of breast cancer.
C. Both HRT and SERM are the best medications for osteoporosis, so either
one of the two options could be chosen.
D......
E. None of the above is correct
21. Mrs Wong is 30 years old, para 0. Now at 8 weeks of gestation. USG shows a intrauterine sac with 2 fetal poles. Each has its own amniotic sac. Which of the following is incorrect?
A. There is risk of twin-twin transfusion in this pregnancy.
B. There is higher risk of structural defects in this pregnancy than a singleton.
C. Perinatal morbidity is higher if 2 fetus share one amniotic sac.
D. Repeating the scan at 18 weeks to determine the chorioamniocity would be more accurate.
E. 2nd twin in breech presentation is not an contraindication for vaginal delivery.
23. You are the on-call houseman called to see a woman who is having heavy bleeding after a vaginal delivery. Her BP:80/50 mmHg, Pulse:120bpm. The bed is full of blood and blood-clots. What is the most appropriate immediate action?
A. Insert a gauze to the vagina, inform senior as the condition is complicated.
B. Check the completeness of the placenta
C. Establish IV access, give IV Fluid, sent urgent cross match
D. Check episiotomy wound, repair if ther's active bleeding
E. give syntocinon infusion
24. You have just received the ultrasound scan of a 28 year-old, G1P0 lady at 30 weeks of gestation. The scan shows normal biparietal diameter (BPD) and femur length (FL). The abdominal circumference (AC) is increased. There is also scalp edema, cardiomegaly, ascites and pleural effusion. The other features are normal.
Which of the following if true?
A. ...
B. The lady is at risk of abruption placentae.
C. The most likely cause is Rhesus D iso-immunization.
D. Infection can be a cause.
E. Both B and D are correct.
25. A 38 years old nulliparous lady, secondary amenorrhea for 6 months, galactorrhea, no headache, no visual disturbance. 4 fold increase in serum prolactin, currentlyon combined oral contraceptive pills for contraception, her LMP was 2 months ago. Which of the following is most appropriate?
A.No need for pregnancy testing as she's on OC pills and hyperprolactinaemia
accounts for the amennorrheoa.
B. MRI not needed as no headache and no visual disturbance
C.Encourage to avoid future pregnancy
D.Stop OC pills immediately as it will cause further rise in prolactin levels
E. Bromocriptine is the correct treatment whether or not she has pituitary
adenoma
True or False
27. The fetus will develop abnormality, when there is poorly controlled maternal SLE
before or during pregnancy.
28. The VDRL titre can become zero after effective treatment of syphilis.
30. Both SLE and congenital syphilis increase the risk of preterm deliveries.
31. A woman with ovarian hyperstimulation syndrome with haemoconcentration.
Generous fluid replacement is mandatory.
32. Mirena is a device which is formed by the combination of a Copper-coil IUCD and a povera releasing device to treat menorrhagia.
33. Regarding hormone replacement therapy- estrogen only HRT has a smaller risk of breast cancer compared with estrogen and progestagen HRT.
34. Jane presented to your clinic because of hisutism causing severe psychological disturbances. You prescribe cyproterone acetate to her and advice her to have hair shaving and bleaching at the mean time as it can take up to 6 months for cyproterone acetate to act.
35. Candidiasis typically presents as greenish vaginal discharge with fishy odor and test +ve on KOH test
37. Mrs Yen has her endometrial sampling done for intermenstrual bleeding. The result was shown to be "complex hyperplasia with atypia". She should be regularly followed up every 6 months to repeat endometrial samplings because she may develop carcinoma of corpus in 8%.
38. Miss Green，has a result of LGSIL in her pap smear examination. Her chance of having cervical cancer is 20%. She should undergo colposcopy and LEEP.
39. MgSO4 is shown to be useful in preventing recurrent fit attacks in both pre-eclampsia and eclampsia.
40. For hyperstimulation of uterus due to syntocinon induction of labour for post-term pregnancy, tocolytics can be used
OSCE
Q1. CBC report: MCV 60, others normal
a) What do you suspect?
b) What will you investigate? Give 2.
c) What is the major problem that the fetus will likely be suffered from?
d) What are the risk during pregnancy?
Then complete report:
Hb normal
Hb A2 normal
Hb H inclusion bodies positive
e) What is the fetus suffer from?
Q2. Pic shows a vaginal ring pessary.
a) What is the device shown in the picture?
b) What condition is the device used in?
c) List 4 complications associated with the use of the device and 4 risk factors for the condition in b.
d) When will you offer the follow up and what will you do in the follow-up?
Q3. An AN assessment form showing a mother age=38, previous CS in year 2000, previous Graves’ disease, Hep B carrier.
a). What problems have you notice from the AN form of the patients? How
would these cause problems during pregnancy?
b). Briefly write your management plan for the above problems?
Q4. A picture showing a copper IUCD
a)What is pearl index?
b)What is the peral index of this device?
c)What are the complications of it? Name 4
d)What is the most important gynaecological problem that has to be rule out first? why?
Now the lady got pregnant. USG shows normal pregnancy. The lady wants to keep the pregnancy.
e)Counsel the lady. (5 marks)
Q6. 2 pictures of fetal scalp electrode
a) What is this?
b) Write 2 Indications (2 marks)
A picture of vaccum cups
c) 4 Indications (2 marks)
d) 4 Risks (2 marks)
e) 4 Contraindications (2 marks)
Q7. Age 36 G1P0 came for first visit at 12+6 wk today. She is sure of her LMP but with irregular cycle of 30-60days. Physical examination are all normal. USG showed CRL 1.9
Please plot it against the gestational age, what does it show?
--CRL far below 3rd percentile
What is the most probable reason?
--date problem
What should you do?
--correctthe EDC according to USG
What is the new EDC?
--check table to get corrected age to be 8+4 wk, thentell correctedEDC by using the gestational calender.
With a EDC corrected by USG at 8+4week, the lady is now in her 32 weeks of gestation. Fetal parameters by USG showed the followings:
BPD=____
AC=____
FL=____
AFI=5.5
Plot the following on the graphs
--result will show BPD and FL at mean, AC far below 3rd percentile.
What is the diagnosis?
--asymmetrical IUGR and oligohydramnios.
What would you do?
--detailed USG for fetal morphoogy, esp. renal system.
--Doppler study for fetal wellbeing.
--CTG
Whatwould youdo if they showed sign of fetal comprimise?
--consider Em C/S or early IOL or early IOL after 1 course of antenatal steroid.
What if there studies are all normal?
--? consider IOL at 34 week
Q8. Miss Lee, G1P0, 38 weeks of gestation. Present with IC.
(A CTG belongs to Miss Lee is shown)
(Baseline FHR ~145bpm, variability: below 5pm all along, flat, No acceleration, No deceleration, No FM, Regular uterine contractions: 2 per 10 mins)
a) Comment on the CTG
b) This CTG pattern persists for 2 hours. Is this a 1) Normal 2) Suspicious or 3) Abnormal CTG?
c) What will you do next? (the examiner may expect me to answer “PV exam”, but I answer I will perform fetal scalp blood sampling if the cervix is already 3 cm to 4 cm dilated.)
d) PV exam: OS closed, cervix tubular. What will you next?
e) How would your counsel the mother for emergency CS?
f) What will you tell the mother apart from Surgical risks, e.g. wound infection, UTI?
Q9. A girl with 9 wks of gestation, presented with painless vaginal bleeding. PT +ve 4 weeks ago.
a) What P/E will u do?
b) What are the ddx?
c) What investigation would you do?
d) Interpret this HCG results (with a paper given)
e) how do u counsel the patient?