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Obstetrics and Gynaecology Flashcards

6 cards from real PLAB 1 practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 28-year-old woman at 32 weeks' gestation presents with painless bright red vaginal bleeding. On examination, the uterus is soft and non-tender. What is the most likely diagnosis?

    Answer: Placenta praevia

    Painless, bright red vaginal bleeding in the third trimester is the hallmark presentation of placenta praevia. The soft, non-tender uterus distinguishes it from placental abruption, which typically presents with constant pain and a woody-hard uterus. Digital vaginal examination is contraindicated.

  2. A 30-year-old primigravida at 34 weeks' gestation has a blood pressure of 165/110 mmHg, proteinuria of 3+, and complains of a severe headache and visual disturbances. What is the most appropriate immediate management?

    Answer: Admit, commence IV magnesium sulphate and IV labetalol, and plan urgent delivery

    This presentation — severe hypertension, significant proteinuria, headache, and visual disturbances — constitutes severe pre-eclampsia with imminent risk of eclampsia. NICE guidelines (NG133) recommend IV magnesium sulphate for seizure prevention, IV labetalol for BP control, and planned delivery.

  3. A 25-year-old woman presents at 7 weeks' gestation with vaginal bleeding and left iliac fossa pain. Her serum beta-hCG is 1,500 IU/L and transvaginal ultrasound shows an empty uterus. What is the most likely diagnosis?

    Answer: Ectopic pregnancy

    An empty uterus on transvaginal ultrasound with a beta-hCG above the discriminatory level (usually 1,500-2,000 IU/L), combined with pain and bleeding, is highly suspicious for ectopic pregnancy until proven otherwise. This requires urgent gynaecological assessment.

  4. According to NICE guidelines, what is the recommended method of induction of labour when the cervix is unfavourable (Bishop score <6)?

    Answer: Vaginal prostaglandin E2 (dinoprostone) or oral misoprostol to ripen the cervix

    NICE recommends cervical ripening with vaginal prostaglandin E2 (dinoprostone) or oral misoprostol when the cervix is unfavourable (Bishop score <6). ARM and oxytocin are used once the cervix is favourable. Mechanical methods (balloon catheter) are also options.

  5. A 35-year-old woman presents with post-menopausal bleeding. She is on no hormone replacement therapy. What is the most appropriate initial investigation?

    Answer: Transvaginal ultrasound to assess endometrial thickness

    Post-menopausal bleeding requires investigation to exclude endometrial cancer. NICE recommends transvaginal ultrasound as the first-line investigation. If endometrial thickness is ≥4 mm, hysteroscopy with endometrial biopsy is indicated. All women with PMB should be referred via 2-week wait.

  6. During labour, a CTG shows late decelerations with reduced variability. What does this pattern most likely indicate?

    Answer: Uteroplacental insufficiency causing fetal hypoxia

    Late decelerations (decelerations that start after the peak of a contraction and return to baseline after the contraction ends) with reduced variability indicate uteroplacental insufficiency and fetal hypoxia. This is a pathological CTG pattern requiring urgent intervention.