SMLE Obstetrics and Gynaecology 2

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?

Accepted Answer

Placenta praevia (major/complete)

Answer

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?

Accepted Answer

Ectopic pregnancy

Answer

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?

Accepted Answer

75g OGTT at 24-28 weeks gestation

Answer

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?

Accepted Answer

Methylergonovine (Methergine)

Answer

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?

Accepted Answer

Pelvic inflammatory disease (PID)

Answer

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.

SMLE Practice Test

SMLE Practice Test

SMLE Obstetrics and Gynaecology 2