SMLE Obstetrics and Gynaecology 6

Question 1

A 35-year-old woman with a BMI of 40 and PCOS has been trying to conceive for 2 years. She has irregular cycles and anovulation. What is the most appropriate first step?

Accepted Answer

Weight loss and lifestyle modification

Answer

In obese women with PCOS and anovulatory infertility, weight loss of even 5-10% of body weight can restore ovulation and improve fertility outcomes. Lifestyle modification is the recommended first step before pharmacological ovulation induction.

Question 2

A woman at 30 weeks gestation presents with severe pre-eclampsia. Corticosteroids have been administered. Despite antihypertensive therapy, her condition is deteriorating with HELLP syndrome. What is the definitive treatment?

Accepted Answer

Delivery of the fetus and placenta

Answer

The definitive treatment for pre-eclampsia/HELLP syndrome is delivery of the fetus and placenta, as the placenta is the source of the pathology. In severe deteriorating disease, delivery is indicated regardless of gestational age after stabilisation and corticosteroids.

Question 3

A 50-year-old woman presents with postmenopausal bleeding. Endometrial biopsy shows complex atypical hyperplasia. What is the recommended management?

Accepted Answer

Total hysterectomy with bilateral salpingo-oophorectomy

Answer

Complex atypical hyperplasia has a 25-30% risk of concurrent or progression to endometrial carcinoma. In a postmenopausal woman not desiring fertility, total hysterectomy with bilateral salpingo-oophorectomy is the definitive management.

Question 4

A primigravida at 37 weeks presents with a frank breech presentation confirmed by ultrasound. She desires vaginal delivery. What is the recommended approach?

Accepted Answer

External cephalic version (ECV) attempt

Answer

External cephalic version (ECV) is recommended at 37 weeks for breech presentation in a primigravida with no contraindications. It has a success rate of approximately 50% in nulliparous women and can allow for a subsequent vaginal cephalic delivery.

Question 5

A woman undergoes cervical screening. HPV testing is positive for high-risk HPV types 16 and 18, but cytology is normal. What is the recommended follow-up?

Accepted Answer

Immediate colposcopy

Answer

HPV 16 and 18 are the highest-risk types for cervical cancer. Even with normal cytology, guidelines recommend direct referral to colposcopy for HPV 16/18 positive results due to their high oncogenic potential.

SMLE Practice Test

SMLE Practice Test

SMLE Obstetrics and Gynaecology 6