DRCOG – FREE Trial Questions

A 24-year old woman calls her GP for contraceptive advice.She uses the combined hormonal transdermal patch and has just noticed that the patch she applied yesterday has become detached. She is unsure when the patch came off and has had unprotected sexual intercourse in the last 24 hours.  What is the most appropriate advice?

A 20 year old woman presents to her local sexual health clinic with symptoms of profuse vaginal discharge which she describes as offensive. On examination, there is profuse frothy yellow offensive vaginal discharge and there is a strawberry cervix appearance with small punctate haemorrhages with ulceration. What is the most likely causative organism?

Which of the following statements about female sterilization is incorrect?

A 24 year old nulliparous woman attends her GP with nausea, abdominal distension and rapid weight gain.She is 6 weeks pregnant following successful IVF treatment for polycystic ovary syndrome and has recently had a scan that confirmed a viable singleton intrauterine pregnancy. What is the likely diagnosis?

A 30-year-old woman presents to fertility clinic with her partner with a history of secondary infertility. She had a miscarriage 5 years ago and has been trying to conceive since. She has oligomenorrhea. Early follicular gonadotrophin levels were normal. Given the irregularity of her cycles, ovulation could not be demonstrated biochemically. Her ultrasound scan had shown a normal size anteverted uterus and shown ovaries with over 20 follicles on the right ovary with an ovarian volume of 11ml. The left ovary could not be clearly seen. HyCosy examination has demonstrated patent fallopian tubes. Her BMI is 28. She has no other medical issues. The semen analysis of her partner was normal. What is the first line pharmacological treatment for her?

A 20 year old primigravida attends her GP at 7 weeks gestation with persistent nausea and vomiting for the last week. Clinically, she appears dehydrated but has not lost any weight.  She asks if there are any medications to alleviate her symptoms.  What is the most appropriate antiemetic regimen?

A recent randomised trial has demonstrated a benefit in progesterone therapy for women with early pregnancy bleeding and one or more previous miscarriages. What is the recommended regime to use for these women?

A 30 year old woman attends her GP at 28 weeks gestation as she is concerned because her husband has developed shingles around his left eye.  She does not recall having had chicken pox herself as a child.  What is the most appropriate management?

A GP is reviewing some blood results at the end of clinic.  A low risk primigravida has recently had a full blood count that shows a low haemoglobin of 80g/L with an MCV of 70.  The GP notes from her medical records that she is currently 30 weeks pregnant and has already been on oral iron for two months.  What is the most appropriate management?

A 38 year old black African woman has an induction of labour at 37 weeks for Type 2 diabetes and gestational hypertension medicated with oral nifedipine 10mg BD.  She has a spontaneous vaginal birth and her blood pressure on Day 1 and Day 2 postnatally is normal. She is reviewed in the community on Day 5 and noted to have a blood pressure of 155/98 mmHg.   She is otherwise clinically well and is asymptomatic. She is not breastfeeding and does not plan to start. What is the most appropriate treatment option?

A woman has a vaginal delivery and sustains a perineal tear. On examination, the injury affects the skin and perineal muscles and more than 50% of the external anal sphincter is torn.  What classification of perineal tear is this?

A woman has an emergency Caesarean section for presumed fetal compromise and the baby is born in poor condition.At  birth and one minute of age, the baby has a heart rate of 120bpm but makes no respiratory effort and is pale and does not move spontaneously or in response to stimulation.  At five minutes of age after successful resuscitation, the baby has a heart rate of 150bpm, is pink and moving and is crying weakly both spontaneously and in response to stimulation.  What Apgar scoring should be documented in the postnatal notes?

A 71 year old woman presents to her GP with a single episode of post-menopausal bleeding.She is very worried as her sister has recently died of endometrial cancer.  She is otherwise fit and well with a normal BMI and no significant past medical history.  Abdominal and speculum examination is unremarkable.  Her GP arranges a transvaginal pelvic ultrasound scan which shows a normal size anterverted uterus with a 12mm endometrial polyp arising at the fundus of the uterus with endometrial thickness of 3mm.  What is the next most appropriate management?

A 40 year old woman with known Lynch syndrome has a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy for risk reduction and subsequently develops debilitating menopausal symptoms.What is the most appropriate management option?

A 60 year old woman presents to her GP with severe vulval itching and soreness. On examination, there are pale white atrophic areas of the vulva and fusion of the labia minora in the midline but no involvement of the vaginal mucosa.  What is the most appropriate management?

A 28 year old attends her GP with secondary amenorrhoea for 6 months.  She is nulliparous with a BMI of 24 and her periods have always been regular previously. A urinary pregnancy test is negative but she reports that she has been experiencing some hot flushes in the last few months.  Her GP arranges blood tests and the results are shown below:

FSH – 45                      (1.0-11.0 IU/L)

LH – 30                        (0.5-14.5 IU/L)

Oestradiol – 80           (70-510 pmol/L)

Testosterone – 1.8      (0.8-3.1 nmol/L)

Prolactin – 401            (90-520 mu/L)

TSH – 2.1                     (0.5-7.0 mu/L)

Free T4 – 20                (11-23 pmol/L)

What is the next most appropriate investigation?