SMLE Obstetrics and Gynaecology 1 — Questions and Answers
Question 1: A 30-year-old primigravida at 34 weeks gestation presents with severe headache, visual disturbances, and blood pressure of 170/110 mmHg. Urinalysis shows 3+ proteinuria. What is the diagnosis?
- Gestational hypertension
- Chronic hypertension
- Pre-eclampsia with severe features (Correct answer)
- Eclampsia
Correct answer: Pre-eclampsia with severe features
Pre-eclampsia with severe features is diagnosed when hypertension (≥160/110 mmHg) occurs after 20 weeks gestation with proteinuria and severe symptoms (headache, visual disturbances, epigastric pain). This requires urgent management including magnesium sulphate and delivery planning.
Question 2: A woman in active labour has a cervical dilation of 4 cm that remains unchanged after 4 hours despite adequate contractions. What is this called?
- Prolonged latent phase
- Active phase arrest (Correct answer)
- Second stage arrest
- Precipitous labour
Correct answer: Active phase arrest
Active phase arrest is defined as no cervical change for ≥4 hours with adequate contractions (or ≥6 hours with inadequate contractions) in a patient who has entered active labour (≥6 cm historically, though 4 cm was the older threshold).
Question 3: A 25-year-old woman presents with secondary amenorrhoea, galactorrhoea, and a positive pregnancy test is negative. Prolactin level is markedly elevated. What is the most likely cause?
- Hypothyroidism
- Prolactinoma (Correct answer)
- Polycystic ovary syndrome
- Sheehan syndrome
Correct answer: Prolactinoma
A markedly elevated prolactin level with secondary amenorrhoea and galactorrhoea in a non-pregnant woman is most commonly caused by a prolactinoma (pituitary prolactin-secreting adenoma). MRI of the pituitary should be performed to confirm the diagnosis.
Question 4: What is the drug of choice for prevention and treatment of eclamptic seizures?
- Diazepam
- Phenytoin
- Magnesium sulphate (Correct answer)
- Labetalol
Correct answer: Magnesium sulphate
Magnesium sulphate is the gold standard for prevention and treatment of eclamptic seizures, as demonstrated by the Magpie Trial and BEAM Trial. It is superior to diazepam and phenytoin in both preventing recurrent seizures and improving maternal and neonatal outcomes.
Question 5: A 28-year-old woman with a previous caesarean section presents in labour with sudden severe abdominal pain, loss of fetal station, and vaginal bleeding. CTG shows fetal bradycardia. What is the most likely diagnosis?
- Placenta praevia
- Placental abruption
- Uterine rupture (Correct answer)
- Cord prolapse
Correct answer: Uterine rupture
Uterine rupture in a patient with a previous caesarean scar presents with sudden severe abdominal pain, cessation of contractions, loss of fetal station (fetus palpable in abdomen), vaginal bleeding, and fetal distress. Emergency laparotomy is required.
Question 6: A Rh-negative mother delivers a Rh-positive baby. When should anti-D immunoglobulin be administered?
- Within 72 hours of delivery (Correct answer)
- Within 7 days of delivery
- Only during the next pregnancy
- Only if Kleihauer test is positive
Correct answer: Within 72 hours of delivery
Anti-D immunoglobulin should be administered within 72 hours of delivery of a Rh-positive baby to a Rh-negative mother to prevent Rh isoimmunisation. A Kleihauer test determines if additional doses are needed for large fetomaternal haemorrhage.
SMLE Obstetrics and Gynaecology 1
A 30-year-old primigravida at 34 weeks gestation presents with severe headache, visual disturbances, and blood pressure of 170/110 mmHg.
Urinalysis shows 3+ proteinuria.
What is the diagnosis?