SMLE Obstetrics and Gynaecology 3 — Questions and Answers
Question 1: A woman at 41 weeks gestation presents for routine assessment. Non-stress test shows a reactive pattern. What does this indicate?
- Fetal compromise requiring immediate delivery
- Normal fetal well-being (Correct answer)
- Need for contraction stress test
- Fetal anaemia
Correct answer: Normal fetal well-being
A reactive non-stress test (NST) shows ≥2 accelerations of ≥15 bpm above baseline lasting ≥15 seconds within a 20-minute period, indicating normal fetal autonomic function and well-being. This is reassuring.
Question 2: A 26-year-old woman presents with cyclical pelvic pain, dysmenorrhoea, dyspareunia, and infertility. Laparoscopy reveals chocolate cysts on the ovaries and powder-burn lesions on the peritoneum. What is the diagnosis?
- Pelvic inflammatory disease
- Endometriosis (Correct answer)
- Ovarian carcinoma
- Dermoid cyst
Correct answer: Endometriosis
Endometriosis is characterised by the presence of endometrial tissue outside the uterus. Chocolate cysts (endometriomas) on the ovaries and powder-burn/gunshot lesions on the peritoneum are classic laparoscopic findings. It is a common cause of dysmenorrhoea and infertility.
Question 3: A pregnant woman at 12 weeks gestation undergoes first-trimester screening. Nuchal translucency is 4.5 mm. What is the most appropriate next step?
- Reassure and repeat ultrasound in 4 weeks
- Chorionic villus sampling (CVS) or cell-free fetal DNA testing (Correct answer)
- Amniocentesis at 16 weeks
- No further action needed
Correct answer: Chorionic villus sampling (CVS) or cell-free fetal DNA testing
An increased nuchal translucency (≥3.5 mm) is associated with chromosomal abnormalities (particularly trisomy 21), cardiac defects, and other structural anomalies. The next step is either non-invasive prenatal testing (cfDNA) or invasive testing (CVS at this gestation) for definitive diagnosis.
Question 4: A 60-year-old postmenopausal woman presents with vaginal bleeding. Endometrial thickness on ultrasound is 8 mm. What is the most appropriate next step?
- Reassure and observe
- Endometrial biopsy (Correct answer)
- Total abdominal hysterectomy
- Hormone replacement therapy
Correct answer: Endometrial biopsy
Postmenopausal bleeding with endometrial thickness >4-5 mm on transvaginal ultrasound requires endometrial biopsy to exclude endometrial carcinoma, which is the most important diagnosis to rule out in this setting.
Question 5: What is the Bishop score used for in obstetrics?
- Assessing fetal well-being
- Evaluating cervical favourability for induction of labour (Correct answer)
- Determining Apgar score
- Staging of cervical cancer
Correct answer: Evaluating cervical favourability for induction of labour
The Bishop score assesses cervical readiness for induction of labour based on five parameters: cervical dilation, effacement, station, consistency, and position. A score ≥8 indicates a favourable cervix with a high likelihood of successful induction.
Question 6: A woman presents with a grape-like vesicular mass expelled from the vagina, a markedly elevated beta-hCG level, and a 'snowstorm' appearance on ultrasound. What is the most likely diagnosis?
- Missed miscarriage
- Complete hydatidiform mole (Correct answer)
- Ectopic pregnancy
- Threatened miscarriage
Correct answer: Complete hydatidiform mole
A complete hydatidiform mole presents with vaginal bleeding, a uterus larger than dates, markedly elevated beta-hCG, and a classic 'snowstorm' or 'cluster of grapes' appearance on ultrasound. Suction evacuation followed by beta-hCG monitoring is the management.
SMLE Obstetrics and Gynaecology 3
A woman at 41 weeks gestation presents for routine assessment.
Non-stress test shows a reactive pattern.
What does this indicate?