SMLE Obstetrics and Gynaecology 3

Question 1

A woman at 41 weeks gestation presents for routine assessment. Non-stress test shows a reactive pattern. What does this indicate?

Accepted Answer

Normal fetal well-being

Answer

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?

Accepted Answer

Endometriosis

Answer

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?

Accepted Answer

Chorionic villus sampling (CVS) or cell-free fetal DNA testing

Answer

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?

Accepted Answer

Endometrial biopsy

Answer

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?

Accepted Answer

Evaluating cervical favourability for induction of labour

Answer

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.

SMLE Practice Test

SMLE Practice Test

SMLE Obstetrics and Gynaecology 3