SMLE Obstetrics and Gynaecology 2 — Questions and Answers
Question 1: A 32-year-old woman at 28 weeks gestation presents with painless vaginal bleeding. Ultrasound shows the placenta completely covering the internal cervical os. What is the diagnosis?
- Placental abruption
- Placenta praevia (major/complete) (Correct answer)
- Vasa praevia
- Cervical ectropion
Correct answer: Placenta praevia (major/complete)
Placenta praevia (major/complete) is diagnosed when the placenta completely covers the internal cervical os. It presents with painless, bright red vaginal bleeding in the third trimester. Digital vaginal examination is contraindicated.
Question 2: A woman presents with a positive pregnancy test, vaginal bleeding, and an adnexal mass. Serum beta-hCG is 2,500 mIU/mL but transvaginal ultrasound shows an empty uterus. What is the most likely diagnosis?
- Threatened miscarriage
- Ectopic pregnancy (Correct answer)
- Complete miscarriage
- Gestational trophoblastic disease
Correct answer: Ectopic pregnancy
An empty uterus on transvaginal ultrasound with a beta-hCG above the discriminatory zone (1,500-2,000 mIU/mL) and an adnexal mass is highly suggestive of ectopic pregnancy. This requires urgent management (surgical or medical with methotrexate).
Question 3: What is the recommended screening test for gestational diabetes mellitus (GDM) according to SCFHS and Saudi guidelines?
- Random blood glucose at booking
- 75g OGTT at 24-28 weeks gestation (Correct answer)
- HbA1c at 24-28 weeks gestation
- Fasting glucose at 12 weeks gestation
Correct answer: 75g OGTT at 24-28 weeks gestation
The 75g oral glucose tolerance test (OGTT) at 24-28 weeks gestation is the recommended screening test for GDM per Saudi national guidelines, aligned with IADPSG criteria. High-risk women may be screened earlier at the booking visit.
Question 4: A 35-year-old multiparous woman has an atonic uterus after delivery with estimated blood loss of 1,500 mL. Uterine massage and oxytocin have been administered. What is the next pharmacological step?
- Methylergonovine (Methergine) (Correct answer)
- Tranexamic acid
- Factor VIIa
- Repeat oxytocin only
Correct answer: Methylergonovine (Methergine)
After initial oxytocin and uterine massage fail to control postpartum haemorrhage from uterine atony, second-line uterotonics include methylergonovine (ergometrine), carboprost (15-methyl PGF2α), and misoprostol. Methylergonovine is contraindicated in hypertension.
Question 5: A 22-year-old woman presents with lower abdominal pain, fever, purulent vaginal discharge, and cervical motion tenderness. What is the most likely diagnosis?
- Appendicitis
- Pelvic inflammatory disease (PID) (Correct answer)
- Ovarian torsion
- Endometriosis
Correct answer: Pelvic inflammatory disease (PID)
The triad of lower abdominal pain, fever, and cervical motion tenderness (chandelier sign) is classic for pelvic inflammatory disease. PID is usually caused by ascending infection from Neisseria gonorrhoeae or Chlamydia trachomatis.
Question 6: A 40-year-old woman presents with heavy menstrual bleeding, pelvic pressure, and an enlarged, irregular uterus. Ultrasound shows multiple well-circumscribed, hypoechoic masses within the myometrium. What is the most likely diagnosis?
- Endometrial carcinoma
- Uterine leiomyomas (fibroids) (Correct answer)
- Adenomyosis
- Endometrial polyps
Correct answer: Uterine leiomyomas (fibroids)
Uterine leiomyomas (fibroids) are the most common benign tumours of the uterus. They present with menorrhagia, pelvic pressure, and an enlarged irregular uterus. Ultrasound shows well-circumscribed, hypoechoic myometrial masses.
SMLE Obstetrics and Gynaecology 2
A 32-year-old woman at 28 weeks gestation presents with painless vaginal bleeding.
Ultrasound shows the placenta completely covering the internal cervical os.
What is the diagnosis?