GY Paraclinic new

A nervous 42-year-old woman presents herself to your antenatal clinic very worried that she has missed the right time to have her combined test for Down's syndrome screening. She is now 17 weeks pregnant and is very concerned about her ag You counsel her about the appropriate alternative, the quadruple test and arrange to have this don What assays make up the quadruple test?

2. A 29-year-old woman is seen at her booking visit and has blood taken for screening. Which of these is the most appropriate set of booking tests?

3. A 37-year-old woman in her fourth ongoing pregnancy presents to the labour ward at 34 weeks' gestation complaining of a sharp pain in her chest, worse on inspiration. An arterial blood gas shows: pH 7.51, P02 8.0 kPa, PC02 4.61 kPa, base excess 0.9. What is the most appropriate investigation?

4. A 32-year-old woman in her third pregnancy is 37 weeks pregnant and has an extended breech baby on ultrasound. After discussion in the antenatal clinic, which of the following is not an absolute contraindication to an external cephalic version (ECV)?

5. A 16-year-old girl attends accident and emergency complaining of mild vaginal spotting. Her serum beta hCG is 4016 miU/mL. She is complaining of severe left iliac fossa pain and stabbing sensations in her shoulder tip. What is the most appropriate definitive investigation?

6. A 25-year-old woman in her first pregnancy has a pathological CTG. Her cervix is 5 em dilatated. Which of the following might increase the risk to the fetus if the doctor performed a fetal blood sample?

7. A 49-year-old comes to the urogynaecology clinic with a history of leaking urine for the last year. There are associated stress symptoms and some urge symptoms. Interestingly she says that it seems to come from inside the vagina as well. She had a hysterectomy last year for endometrial cancer and had quite a prolonged recovery. She has a BMI of 30 kglm2, does not smoke and is otherwise fit and well. You are suspicious that she might have a vesicovaginal fistula secondary to her operation. What is the most appropriate first line investigation?

8. A 26-year-old woman is otherwise fit and well has been trying to conceive for over 2 years. On questioning she has regular periods and has been having regular intercourse. There are no abnormalities on clinical examination. What would be your first line investigations for her subfertility?

9. A 24-year-old woman is admitted to the gynaecology ward with a 4-day history of severe hyperemesis gravidarum. She has been unable to tolerate food or fluid orally for 2 days. On the second day of admission she develops signs of a severe pneumonia. This is presumed to be a hospital-acquired infection. She deteriorates rapidly. An arterial blood gas shows: pH 7.68; P02 10.0 kPa; PC02 4.26 kPa; HC03 32 mmol/L; K+ 1.9 mmol/L; Lactate 1.2 mmol/L. What is the most accurate description of the acid-base disorder?

10. A 21-year-old comes to the clinic with a history of intermenstrual bleeding for the last 6 weeks. She has regular periods and does not experience post-coital bleeding. She is not on the oral contraceptive pill and has no other past medical history. What is the most appropriate first line investigation?

11. A 57-year-old woman has been referred by her GP under the 2-week suspected cancer referral approach with vaginal bleeding. She has been post-menopausal for the last 4 years and she has been taking Ellested. Duet to treat her vasomotor symptoms. Two weeks ago, after reading about the risks associated with hormone replacement therapy (HRT) she stopped taking any medication. This is the first unscheduled bleeding she has ever ha She had a normal smear 2 years ago and is otherwise well. What would be your first line investigation?

12. A 13-year-old girl presents with menorrhagia and is found to have von Willebrand's disease. Which of the following coagulation parameters would be most expected to be abnormal?

13. A 22-year-old female presents with a one day history of lower abdominal pain. She has no past medical history of not On examination she has a temperature of 37.5°C, and is exquisitely tender in the left iliac fossa with guarding. Bowel sounds are audible. Which if the following is the most appropriate initial investigation for this patient?

14. A 60-year-old postmenopausal woman complains of recent onset of vaginal bleeding. She has a past history of diabetes mellitus for which she takes metformin 500 mg b She underwent the menopause 10years previously and took continuous combined HRT for two years. Digital vaginal examination is normal. What is the single most appropriate first line investigation for this woman?