USMLE Gynecology2e/Basic (CH-HOO)

1. Maternal physiology changes throughout pregnancy to cope with the additional demands of carrying a foetus. Which of the following changes best represents a normal pregnancy?

At a booking visit a first time mother is told that she is rhesus negative. Which of these answers is the most appropriate advice for the mother?

A 19-year-old woman in her first pregnancy presents to the GUM clinic with an outbreak of primary herpes simplex infection on her labia. She is 33 weeks pregnant. What is the best advice regarding her herpes?

5. A 19-year-old woman is referred to your pre-conception clinic. She has SLE and wants to fall pregnant. She is currently not on any treatment and has no symptoms. As part of your general counselling you should talk about the risks associated with pregnancy. Which of the following is not a particular risk to a woman with SLE?

6. A 24-year-old woman attends the antenatal clinic. She has had a glucose tolerance test which is abnormal. A diagnosis of gestational diabetes is mad The primary purpose of this appointment is to explain to her what gestational diabetes means to her and her baby. You explain to her that sugar control is important and there are specific glucose ranges that she should try to adhere to. Which of the following would be correct advice for this woman?

7. A 24-year-old woman who is mv positive is in her first pregnancy. She is 39 weeks pregnant and is seen by you in the antenatal clinic. She has just transferred to your care, with no other previous antenatal car She reports that her pregnancy has been uncomplicate Her CD4 count is 180/mm3 and her viral load is 5500 copies/mL. She has come to find out what advice you have for her delivery?

8. A 19-year-old woman is referred to your early pregnancy unit as she is having some vaginal bleeding. This is her first pregnancy, she has regular menses and the date of her last menstrual period suggests she is 8 weeks gestation today. She is well apart from her bleeding and is naturally concerne A transvaginal ultrasound reveals an intrauterine gestational sac of 18 mm with a yolk sa What is the most likely explanation of these findings?

9. A 50-year-old woman comes to your clinic with a 2-year history of no periods. Her GP has confirmed that her luteinizing hormone and follicle-stimulating hormone levels are menopausal. Her night sweats and hot flushes are unbearable and are preventing her from going to work. She would like to start hormone replacement therapy (HRT) but is very worried about the side effects. Which of the following is incorrect?

10. A 24-year-old woman in her first pregnancy presents to the labour ward in labour. She and her partner express an overwhelming desire to avoid a caesarean section. Her labour does not progress and after 9 hours her cervix is still only 3 cm dilate Unfortunately, the fetal heart slows to 60 beats and does not recover after 5 minutes. Your senior registrar explains the situation to the woman and recommends an immediate caesarean section. She refuses and her partner tells you to stop harassing them. You explain that their unborn child will die if this continues. What options do you have?

11. A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. This is an accepted definition of what?

12. A 39-year-old woman is seen in the gynaecology clinic having been diagnosed with polycystic ovarian syndrome (PCOS). She has lots of questions in particular about the associated long-term risks. Which of the following is not a risk of PCOS?

13. A 54-year-old menopausal woman comes to your clinic desperate for hormone replacement therapy (HRT) as her vasomotor symptoms are very troubling. Her next door neighbour recently developed a deep vein thrombosis while on HRT. She is concerned about the risks of venous thromboembolism (VTE) and wants your advice. Which of the following would you not advise?

14. A 19-year-old biochemistry student is seen in your clinic worried about her hormone levels. She has been told by her GP that her progesterone is low. You enter into a long discussion about the effects of progesterone on the body. Progesterone:?

15. A 19-year-old woman is giving birth to her first baby. She has been pushing for an hour and the feta] head has been on the perineum for 6 minutes. There seems to be a restriction due to resistance of her tissues. Her midwife carries out a right mediolateral episiotomy. Which of the following structures should not be cut with the episiotomy?

16. A mother comes to labour ward who is low risk, in labour at term. The unit is short staffed and there are not enough midwives to provide intermittent auscultation of the fetal heart. You decide to start continuous electronic monitoring (CTG). She is an epidemiologist and asks you about the CTG and how it will help her labour and prevent her baby suffering harm. Which of the following would you tell her? Continuous monitoring has a?

17. A 24-year-old woman is seen after her normal vaginal birth. The midwife who delivered the baby is concerned that there is a third degree tear. Having examined the woman the obstetrician confirms a third degree tear. The woman is taken to theatre to repair the external anal sphincter. Which of the following is not a risk factor for third degree tear?

18. A woman on the labour ward has just had a normal birth. At birth there was a lot of meconium present. The newborn did not respond initially but did after subsequent resuscitation. The midwife records the Apgar score as 5. Which of the following best describes the categories an Apgar score is created from?

19. A 16-year-old presents to the termination of pregnancy service 6 weeks into her second pregnancy requesting surgical termination (STOP). What is not required as part of her work-up for the procedure?

20. A 19-year-old comes to you for some pre-conception advice. Some members of her family and her partner's family have a sickle cell anaemia. She reveals that her sister and his sister are both affecte Tests have shown that they are both carriers. What is the chance that if their child was a boy he would have sickle cell anaemia?

21. A 40-year-old woman comes to your clinic alone wanting an effective form of contraception. She has two children from a previous marriage and has recently started a new relationship. She says that she does not want any further children. She has regular heavy periods, no menopausal symptoms and she is otherwise well with no past medical history. A recent ultrasound showed a normal sized uterus and pipelle biopsy revealed normal secretory endometrial tissue. What is the most appropriate form of contraception?

22. A 42-year-old man undergoes semen analysis as part of the investigation of subfertility with his wife. What result would most likely contribute to their subfertility?

23. A woman is undergoing surgery to enhance the cosmetic appearance of her labia. A bleeding vessel is encountered at the labia majora which cannot be controlled through pressure alone. The surgeon believes it to be a branch of the posterior labial artery. The posterior labial artery is a branch of which artery?

24. A 54-year-old woman with a history of significant ischaemic heart disease undergoes vaginal hysterectomy for symptomatic uterine prolapse. She develops significant surgical site bleeding which is repaired at reoperation the same day. Her postoperative haemoglobin is 6.4 g/dL. Later the same day she develops chest pain. Her observations, blood gas and cardiac enzymes are within normal limits. An electrocardiogram (ECG) shows sinus rhythm without ST changes. She is charted for thromboprophylaxis. What is the most likely cause of the chest pain?

25. A 74-year-old woman has an annual health check up with her private insurer. They arrange an ultrasound scan that shows a cyst on her right ovary. It is multiloculated and has solid components. She is post-menopausal and otherwise well. A doctor has sent for a CA 125 which comes back as 120 U/mL. What is her risk of malignancy index score (RMI)?

26. A 60-year-old woman is undergoing abdominal hysterectomy for a fibroid uterus. During suture ligation of the right uterine pedicle, iatrogenic injury to the ureter is confirmed. Which of the following statements is correct?

27. A 21-year-old woman with dysmenorrhorea, dyspareunia and dyschezia has been scheduled for a laparoscopy to investigate possible endometriosis. You are asking for her consent and you describe the risks of laparoscopy, which include bleeding and damage to blood vessels, viscera and nerves. Which of the following is not at risk when inserting a lateral port?

28. A 32-year-old female has a 5-year-old child with cystic fibrosis by her ex-husband. She has remarried and wants more children. She wants to know the risk of her and the new (Caucasian) husband having an affected child. What is the risk?

29. A 3-day-old neonate is noted by ward staff to have had a seizure. Which of the following statements concerning neonatal convulsions is correct?

30. A 35-year-old female presents as she is eight weeks pregnant. She has read much about pregnancy at her age and is concerned about possible Down's syndrome. Her partner is 42. Which of the following would reflect the approximate risk of this woman having a baby with Down's syndrome?

31. A 30-year-old lady attends clinic for advice concerning her future cancer risk. She has been appropriately treated for CIN II. She is an ex-smoker and takes the combined oral contraceptive pill. Two of her paternal aunts died of ovarian carcinoma at the ages of 40 and 48. Which of the following is the most important predisposing factor to ovarian cancer in this patient?