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?

A 33-year-old woman presents to hospital with a 2-day history of itching on the soles of her feet and the palms of her hands. Her pregnancy has been straightforward and she has good fetal movements. Liver function tests reveal an alanine transaminase (AL T) of 64 lUlL and bile acids of 30 Jtmol/L. You suspect that she might have developed obstetric cholestasis. Which of the following bits of advice is true?

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?

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?

A 24-year-old woman who is IDV 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?

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?

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?

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 em 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?

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?

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?

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?

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:?

A 19-year-old woman is giving birth to her first baby. She has been pushing for an hour and the fetal 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?

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?

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 obstetricianconfirms 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?

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?

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?

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?

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?

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?

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?

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?

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)?

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?

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?

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?

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?

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?

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?

A nulliparous woman is seen at the antenatal clinic 27 weeks into her first pregnancy. Routine screening with a 75 g oral glucose tolerance test for gestational diabetes mellitus (GDM) is performed. Which of the following would confirm a diagnosis of GDM?

A 34-year-old woman attends antenatal clinic for a routine ultrasound scan. Abnormalities of placentation are detected and a magnetic resonance imaging (MRI) scan is organized by the fetal medicine consultant. The MRI report shows: 'The placenta is in the lower anterior uterine wall with evidence of invasion to the posterior wall of the bladder'. What is the most likely diagnosis?

A 21-year-old woman attends the labour ward with per vaginal bleeding of 100 mL. She is 32 weeks pregnant and has had one normal delivery in the past. An important history to note is that of an antepartum haemorrhage in her last pregnancy and she smokes 10 cigarettes a day. Her 20-week anomaly ultrasound revealed a posterior fundal placenta. She admits she and her partner had intercourse last night and is concerned by terrible abdominal pains. What is the most likely diagnosis?

A 38-year-old woman in her first pregnancy is 36 weeks pregnant. She presents to the labour ward feeling dizzy with a mild headache and flashing lights. Her past medical history includes systemic lupus erythematosus (SLE), renal stones and malaria. Her blood pressure is 158/99 mmHg with 2+ protein in her urine. Her platelets are 55 x 109/L, Hb 10.1 gldL, bilirubin 62 f!mol/L, AL T 359 IU/L, urea 2.3 mmol/L and creatinine 64 f!mol!L. What is the most likely diagnosis?

A 24-year-old woman who is 32 weeks pregnant presents to the labour ward with a terrible headache that has not improved despite analgesic. It started 2 days ago and came on suddenly. She has stayed in bed as it hurts to be in sunlight and she vomited twice this morning. Her past medical history includes a macroprolactinoma (which has been removed) and occasional migraines. She is haemodynamically stable with no focal neurology or papilledema. You arrange for her to have aCT of her head as an emergency, which adds no further information to aid your diagnosis. There are red cells on lumbar puncture but no organisms are isolate What is the most likely diagnosis?

A 44-year-old women who is 18 weeks pregnant presents to your clinic with a 2-day history of a viral illness. She is extremely anxious and is in floods of tears. She recently had some soft cheese in a restaurant and after an internet search she is convinced she has a particular infection. What infection is she concerned about?

A 26-year-old woman is 37 weeks pregnant and consults you about a rash that started on her abdomen and has now spread all over her body. Interestingly her umbilicus is spare The rash is very itchy and nothing is helping. The rash is her first problem in this pregnancy. Of interest, her mother has pemphigoid and her sister has psoriasis. What is the most likely cause of her rash?

A 42-year-old woman is in her first pregnancy. She conceived with in vitro fertilization (IVF) and has had a straightforward pregnancy so far. At 25 weeks' gestation she is seen in clinic with a blood pressure of 142/94 mmHg and protein + in her urine. A protein creatinine ratio (PCR) comes back as 19. She says that her blood pressure is often up at the doctor's. With the information you have to hand what is the most likely diagnosis?

A 24-year-old woman attends accident and emergency 4 weeks after having a positive urinary pregnancy test. She has had 3 days of painless vaginal bleeding and is passing clots. Over the past 2 days the bleeding has settle. An ultrasound scan shows an empty uterus. What is the correct diagnosis?

An 18-year-old woman presents to accident and emergency having fainted at work. She is complaining of pain in the lower abdomen. A serum beta hCG performed in the emergency department is 3020 miU/mL. The on-call gynaecologist performs transvaginal ultrasonography in the resuscitation area which shows free fluid in the Pouch of Douglas and no visible intrauterine pregnancy. Her pulse is 120 bpm and blood pressure 90/45 mmHg. What is the most likely diagnosis?

A 26-year-old woman presents to accident and emergency with left-sided lower abdominal pain and a single episode of vaginal spotting the day before. A urinary beta hCG is positive, and her last period was 6 weeks ago. A transvaginal ultrasound shows two gestational sacs. What is the most likely diagnosis?

A 59-year-old woman attends the gynaecology clinic complaining of worsening pain during penetrative sexual intercourse. She went through the menopause 9 years before, with very few problems, and did not require hormone replacement therapy (HRT). She has been with the same partner for 4 years since the death of her husband with whom she had four children. What is the most likely diagnosis?

A 19-year-old woman is referred to accident and emergency with a fluctuant lower right abdominal pain which started over the course of the morning, associated with vomiting. There is rebound tenderness on examination. She is afebrile. Serum beta human chorionic gonadotrophin (hCG) is negative. An ultrasound shows free fluid in the peritoneal cavity but no other pathology to account for the pain. White cells are 14 * 109/L and the C-reative protein (CRP) is 184 mg!L. What is the most likely diagnosis?

A 38-year-old nulliparous woman has had an uncomplicated pregnancy. She has laboured very quickly and is 10 em dilate The fetal heart falls to 60 for 4 minutes. She is pushing effectively and the head is 1 em below the ischial spines. You prepare for forceps delivery in the room. She has had no analgesia so you quickly insert a pudendal nerve block and deliver the baby 4 minutes later in good condition. Which of the following is not a branch of the pudendal nerve?

A 39-year-old woman is 6 days post-partum and has come back to hospital with shortness of breath. She is struggling to breath at rest, has a respiratory rate of 28, pulse 115, BP 105/60 mmHg, temperature 37.4 On examination she has an audible wheeze and cough. Investigations reveal a P02 of 9.5 kPa on arterial blood gas and a PC02 3.7 kPa, pH 7.36, base excess -3.4. A chest x-ray shows some upper lobe diversion and bilateral diffuse shadowing with an enlarged heart. Her haemoglobin is 8.9 g/dL, white blood count 11.1 x 109/L and C-reactive protein 21 mg/L. What is the most likely cause of her symptoms?

A 17-year-old girl is seen in accident and emergency 14 days after an emergency caesarean delivery of a healthy infant, her first. Her neighbours became concerned and called the polic She had been seen prostrate in the garden chanting verses from the Bible and shouted at them accusing them of being spies when they asked if she was ok. They say her problem has worsened over the past fortnight. What is the most likely diagnosis?

A 34-year-old woman develops a significant post-partum haemorrhage and hypotensive shock following vaginal delivery of a healthy infant at term. The labour was uncomplicated. She recovers well with volume replacement and oxytocin and returns to the post-natal war She is unable to breast feed on the ward and 2 months later has neither started breastfeeding nor resumed her periods and is increasingly fatigue What is the most likely diagnosis?

A 30-year-old French woman delivers a live female infant by spontaneous vaginal delivery at term. In the eleventh week of pregnancy she developed a flu-like illness which resolved spontaneously a week later. Her newborn child has severe hydrocephalus and chorioretinitis. Four days after birth, she develops severeconvulsions and efforts to revive her are unsuccessful. Which pathogen is most likely to be responsible?

A 32-year-old woman has a routine cervical smear at her GP practice The result returns as severe dyskaryosis. Following colposcopy and cervical biopsy, formal histological examination reveals cervical intraepithelial neoplasia 3 (CIN 3). Which of the following pathogens is the most likely to have caused this disease?

A 32-year-old woman has a routine cervical smear at her GP practice The result returns as severe dyskaryosis. Following colposcopy and cervical biopsy, formal histological examination reveals cervical intraepithelial neoplasia 3 (CIN 3). Which of the following pathogens is the most likely to have caused this disease?