PLAB 1 Obstetrics and Gynaecology 2

Question 1

A 22-year-old woman presents with heavy, regular periods (menorrhagia) but no structural abnormality on ultrasound. She does not wish to conceive. According to NICE, what is the first-line treatment?

Accepted Answer

Levonorgestrel intrauterine system (Mirena IUS)

Answer

Combined oral contraceptive pill

Answer

Tranexamic acid

Answer

Endometrial ablation

Question 2

A woman at 28 weeks' gestation has a routine blood test showing she is Rhesus D negative. What is the recommended prophylactic management?

Accepted Answer

Routine antenatal anti-D immunoglobulin prophylaxis at 28 weeks

Answer

No action needed until after delivery

Answer

Immediate delivery to prevent sensitisation

Answer

Weekly blood tests for antibodies until delivery

Question 3

A 40-year-old woman presents with a 3 cm complex ovarian cyst found incidentally on ultrasound. Her CA-125 is 85 U/mL (normal <35). Using the Risk of Malignancy Index (RMI), which factors are included in the calculation?

Accepted Answer

Ultrasound score, menopausal status, and CA-125 level

Answer

Age, BMI, and family history

Answer

Tumour size, blood pressure, and parity

Answer

Ethnicity, smoking status, and hormone use

Question 4

A primigravida at 41+3 weeks' gestation is offered a membrane sweep. She asks about the evidence. What should you tell her about the purpose of a membrane sweep?

Accepted Answer

It can help stimulate the onset of spontaneous labour by releasing prostaglandins, reducing the need for formal induction

Answer

It guarantees labour will start within 24 hours

Answer

It has no evidence base and is not recommended by NICE

Answer

It is a form of artificial rupture of membranes

Question 5

A 32-year-old woman in established labour has a cervical dilatation rate of 0.3 cm/hour after 4 hours despite adequate contractions. According to NICE intrapartum care guidelines, what is this called and what is the next step?

Accepted Answer

Delay in the first stage — consider amniotomy if membranes are intact, and/or oxytocin augmentation

Answer

Normal progress — continue observation

Answer

Failure to progress — immediate caesarean section

Answer

Precipitate labour — slow down contractions with tocolytics

Question 6

A woman has a primary postpartum haemorrhage (PPH) with estimated blood loss of 1,200 mL. According to UK guidelines, what are the four 'T' causes of PPH?

Accepted Answer

Tone, Trauma, Tissue, Thrombin

Answer

Temperature, Thrombosis, Trauma, Tissue

Answer

Tachycardia, Tension, Torsion, Toxins

Answer

Transfusion, Tocolysis, Traction, Tamponade