GY Diagnostic New

. A nulliparous woman is seen at the antenatal clinic 27 weeks into her first pregnancy. Routine screening with a 75 g oral glucose tolerance test for gestational diabetes mellitus (GDM) is performed .Which of the following would confirm a diagnosis of GDM?

2. A 34-year-old woman attends antenatal clinic for a routine ultrasound scan. Abnormalities of placentation are detected and a magnetic resonance imaging (MRI) scan is organized by the fetal medicine consultant. The MRI report shows: 'The placenta is in the lower anterior uterine wall with evidence of invasion to the posterior wall of the bladder '.What is the most likely diagnosis?

3. A 21-year-old woman attends the labour ward with per vaginal bleeding of 100 mL. She is 32 weeks pregnant and has had one normal delivery in the past. An important history to note is that of an antepartum haemorrhage in her last pregnancy and she smokes 10cigarettes a day. Her 20-week anomaly ultrasound revealed a posterior fundal placenta. She admits she and her partner had intercourse last night and is concerned by terrible abdominal pains. What is the most likely diagnosis?

4. A 38-year-old woman in her first pregnancy is 36 weeks pregnant. She presents to the labour ward feeling dizzy with a mild headache and flashing lights.Her past medical history includes systemic lupus erythematosus (SLE), renal stones and malaria.Her blood pressure is 158/99 mmHg with 2+ protein in her urine. Her platelets are 55 x 109/L, Hb 10.1 gldL, bilirubin 62 f!mol/L, ALT 359 IU/L, urea 2.3 mmol/L and creatinine 64 f!mol!L. What is the most likely diagnosis?

5. A 24-year-old woman who is 32 weeks pregnant presents to the labour ward with a terrible headache that has not improved despite analgesic. It started 2 days ago and came on suddenly. She has stayed in bed as it hurts to be in sunlight and she vomited twice this morning. Her past medical history includes a macroprolactinoma (which has been removed) and occasional migraines. She is haemodynamically stable with no focal neurology or papilledema. You arrange for her to have aCT of her head as an emergency, which adds no further information to aid your diagnosis. There are red cells on lumbar puncture but no organisms are isolate What is the most likely diagnosis?

6. A 44-year-old women who is 18 weeks pregnant presents to your clinic with a 2-day history of a viral illness. She is extremely anxious and is in floods of tears.She recently had some soft cheese in a restaurant and after an internet search she is convinced she has a particular infection. What infection is she concerned about?

7. A 26-year-old woman is 37 weeks pregnant and consults you about a rash that started on her abdomen and has now spread all over her body. Interestingly her umbilicus is spare The rash is very itchy and nothing is helping. The rash is her first problem in this pregnancy. Of interest, her mother has pemphigoid and her sister has psoriasis. What is the most likely cause of her rash?

8. A 42-year-old woman is in her first pregnancy. She conceived with in vitro fertilization (IVF) and has had a straightforward pregnancy so far. At 25 weeks' gestation she is seen in clinic with a blood pressure of 142/94 mmHg and protein + in her urine. A protein creatinine ratio (PCR) comes back as 19. She says that her blood pressure is often up at the doctor's. With the information you have to hand what is the most likely diagnosis?

9. A 24-year-old woman attends accident and emergency 4 weeks after having a positive urinary pregnancy test. She has had 3 days of painless vaginal bleeding and is passing clots. Over the past 2 days the bleeding has settle. An ultrasound scan shows an empty uterus. What is the correct diagnosis?

10. An 18-year-old woman presents to accident and emergency having fainted at work. She is complaining of pain in the lower abdomen. A serum beta hCG performed in the emergency department is 3020 miU/mL. The on-call gynaecologist performs transvaginal ultrasonography in the resuscitation area which shows free fluid in the Pouch of Douglas and no visible intrauterine pregnancy. Her pulse is 120 bpm and blood pressure 90/45 mmHg. What is the most likely diagnosis?

11. A 26-year-old woman presents to accident and emergency with left-sided lower abdominal pain and a single episode of vaginal spotting the day before. A urinary beta hCG is positive, and her last period was 6 weeks ago. A transvaginal ultrasound shows two gestational sacs. What is the most likely diagnosis?

12. A 59-year-old woman attends the gynaecology clinic complaining of worsening pain during penetrative sexual intercourse. She went through the menopause 9 years before, with very few problems, and did not require hormone replacement therapy (HRT). She has been with the same partner for 4 years since the death of her husband with whom she had four children. What is the most likely diagnosis?

13. A 19-year-old woman is referred to accident and emergency with a fluctuant lower right abdominal pain which started over the course of the morning, associated with vomiting. There is rebound tenderness on examination. She is afebrile. Serum beta human chorionic gonadotrophin (hCG) is negative. An ultrasound shows free fluid in the peritoneal cavity but no other pathology to account for the pain. White cells are 14 * 109/L and the C-reative protein (CRP) is 184 mg!L.What is the most likely diagnosis?

14. A 38-year-old nulliparous woman has had an uncomplicated pregnancy. She has laboured very quickly and is 10 em dilate The fetal heart falls to 60 for 4 minutes. She is pushing effectively and the head is 1em below the ischial spines. You prepare for forceps delivery in the room. She has had no analgesia so you quickly insert a pudendal nerve block and deliver the baby 4 minutes later in good condition. Which of the following is not a branch of the pudendal nerve?

15. A 39-year-old woman is 6 days post-partum and has come back to hospital with shortness of breath. She is struggling to breath at rest, has a respiratory rate of 28, pulse 115, BP 105/60 mmHg, temperature 37.4 On examination she has an audible wheeze and cough. Investigations reveal a P02 of 9.5 kPa on arterial blood gas and a PC02 3.7 kPa, pH 7.36, base excess -3.4. A chest x-ray shows some upper lobe diversion and bilateral diffuse shadowing with an enlarged heart. Her haemoglobin is 8.9 g/dL,white blood count 11.1x 109/L and C-reactive protein 21 mg/L. What is the most likely cause of her symptoms?

16. A 17-year-old girl is seen in accident and emergency 14 days after an emergency caesarean delivery of a healthy infant, her first. Her neighbours became concerned and called the polic She had been seen prostrate in the garden chanting verses from the Bible and shouted at them accusing them of being spies when they asked if she was ok. They say her problem has worsened over the past fortnight .What is the most likely diagnosis?

17. A 34-year-old woman develops a significant post-partum haemorrhage and hypotensive shock following vaginal delivery of a healthy infant at term. The labour was uncomplicated. She recovers well with volume replacement and oxytocin and returns to the post-natal war She is unable to breast feed on the ward and 2 months later has neither started breastfeeding nor resumed her periods and is increasingly fatigue What is the most likely diagnosis?

18. A 30-year-old French woman delivers a live female infant by spontaneous vaginal delivery at term. In the eleventh week of pregnancy she developed a flu-like illness which resolved spontaneously a week later. Her newborn child has severe hydrocephalus and chorioretinitis. Four days after birth, she develops severeconvulsions and efforts to revive her are unsuccessful. Which pathogen is most likely to be responsible?

19. A 32-year-old woman has a routine cervical smear at her GP practice The result returns as severe dyskaryosis. Following colposcopy and cervical biopsy, formal histological examination reveals cervical intraepithelial neoplasia 3 (CIN 3). Which of the following pathogens is the most likely to have caused this disease?

20. A 15-year-old girl attends the paediatric gynaecology clinic with primary amenorrhoea and features of secondary breast development. She has intermittent abdominal bloating and is extremely worried that she is 'not like other girls'. On speculum examination of the vagina, which is normal externally, a bulging red disc is seen 3 em proximal to the introitus. What is the most likely diagnosis?

21. A 19-year-old woman undergoes surgical evacuation of the retained products of conception (ERPC). Histological examination of the sample shows genetically abnormal placenta with a mixture of large and small villi with scalloped outlines, trophoblastic hyperplasia. What is the most likely diagnosis?

22. A 16-year-old girl attends the gynaecology clinic complaining of vaginal itching and lumpy labia. On examination the area is covered with vulval warts. Which is the causative pathogen for vulval warts?

23. An 18-year-old woman attends clinic seeking contraceptive advice. She is currently using condoms only and is keen to start taking the combined oral contraceptive pill (COCP). Her sister used to take it but told her there were lots of problems with it. Her aunt has bowel cancer and she has no other past medical history. Appropriate counselling should cover all of the following except:?

24. A 41-year-old woman is about to undergo her first cycle of IVF. As part of the consultation, she is counselled about the maternal and fetal risks involved with IVF-conceived pregnancies. All of the following occur in such pregnancies except:?

25. A 35-year-old woman is seen in the assisted conception unit. She has been trying to conceive for 4 years. In this period she has been having regular intercourse. Her periods have been irregular and recently she has had no periods at all. Her BMI is 19.5 kglm2, she has had an appendectomy and is otherwise well.Her biochemistry comes back as follows: luteinizing hormone (LH) 0.5 lUlL, follicle-stimulating hormone (FSH) 1.0 lUlL, prolactin 490 miUIL, thyroxine (T4) 12, thyroid stimulating hormone (TSH) 4.2 miUIL, oestradiol 60 pmol!L. What is the most likely cause of her subfertility?

26. An 18-year-old girl is seen in the colposcopy clinic after having had persistent post-coital bleeding. She has been sexually active since the age of 14 and has no past medical history. She is studying for her A-levels and has been doing a lot of reading.She is concerned that she might have cervical cancer. Which of the following is not a risk factor for cervical cancer?

27. In a busy gynaecology clinic you are assessing a 22-year-old woman who has not had a period for 18 months. She is not pregnant and previously had regular periods. She has had two surgical terminations of pregnancies (STOP), an underactive thyroid gland and an appendectomy. Clinical examination is unremarkable with a BMI kglm2 of 20. Biochemical investigations reveal a T4 of 17 pmol!L, TSH 4.6 kglm2, prolactin of 570 mUlL, and testosterone of 42 ngldL. LH and FSH are normal. Vaginal ultrasound shows a normal sized uterus and the left ovary contain four cysts. Which of the answers listed below is the most likely cause?

28. A 17-year-old girl comes to clinic with her mother as she has not started having periods yet and they are worried. On examination she is of short stature, with a slightly widened neck and has no secondary sexual characteristics and there is no obvious abnormality of the external genitale. What is the most likely diagnosis form this limited information?

29. A 22-year-old woman presents to the GUM clinic with an offensive smelling discharge. She is sexually active and is in a monogamous relationship. She describes no pain or soreness just an offensive smelling discharge. After examination and taking swabs for the second time she is diagnosed with bacterial vaginosis. Which of the following organisms is not likely to be the cause?

30. A 58-year-old woman presents to the clinic with post-menopausal bleeding. A pipelle biopsy confirms adenocarcinoma of the endometrium. Further imaging of the pelvis shows that there is spread of the tumour outside of the uterus into the left adnexa. There is no other spread. What is the most likely stage of the tumour?

31. A 62-year-old woman presents to accident and emergency with shortness of breath. Examination reveals reduced breath sounds and a swollen, distended abdomen.Chest x-ray demonstrates a left-sided pleural effusion. On further questioning the woman has had a poor appetite for the last 6 months and recently had some vaginal bleeding. An ultrasound revealed large quantities of ascites, which were drained. Analysis of the ascites shows a high protein content. What is the most likely diagnosis?

32. Following surgery to place a tension-free transobturator tape for stress incontinence, a 54-year­ old woman loses some sensation in part of her labia anterior to the anus. Damage has most likely been caused to which nerve?

33. Two days after undergoing posterior exenteration for recurrence of cervical adenocarcinoma a 53-year-old woman develops a tachypnoea, tachycardia of 125 bpm and a fever of 39° Blood cultures have grown methicillin-resistant Staphylococcus aureus (MRSA). She requires intravenous vasopressors. What is the most appropriate diagnosis?

34. A 39-year-old woman attends the gynaecology clinic complaining of long-standing pelvic pain. Routine bimanual examination and abdominal ultrasonography do not detect any abnormality. At diagnostic laparoscopy, multiple tiny dark brown nodular lesions are noted covering the surface of the uterus, tubes and left ovary, as well as in the Pouch of Douglas. Which finding is most likely from histological examination of the excised lesions?

35. A 29-year-old female presents with dysuria and vaginal discharge which has deteriorated over the past week .She is in a steady relationship and uses the oral contraceptive pill. Her partner is asymptomatic. She has a temperature of 37.5° Vaginal examination reveals tenderness with an inflamed cervix and a purulent discharge, culture of which reveals Gram negative diplococci. What is the likely diagnosis?

36. A 40-year-old female solicitor attends her general practitioner's surgery and complains of postcoital bleeding of two months duration. She does not experience pain during intercourse and has not had any vaginal discharge other than the post-coital bleeding. She is still having regular periods.Which of the following is the most likely diagnosis in this case?

37. A 19-year-old female presents with heavy irregular menstrual bleeding and has a BMI of 35. Which of the following is the most likely diagnosis?

38. A 14-year-old white British girl presents with heavy, irregular menstrual bleeding. Her periods began 6 months ago and have never been regular. She is not sexually active, takes no medication, and is otherwise well.What is the most likely cause for her menorrhagia?

39. An 18-year-old female presents with a four-month history of secondary amenorrhoea followed by a week of intermittent light vaginal bleeding. She has gained approximately one stone in weight over this time. Which of the following is the likely diagnosis?

40. An 18-year-old girl presents with heavy irregular periods, postcoital bleeding and deep dyspareunia for the last six months. Which of the following is the likely diagnosis?

41. A 19-year-old female presents with a four month history of secondary amenorrhoea. She has lost approximately 8 kg over this time and has a BMI of 17.4 kglm2. Which of the following is the most likely diagnosis?

42. A 36-year-old Afro-Caribbean woman presents having suffered her fourth miscarriage .She has a history of venous thrombosis. She is positive for the lupus anticoagulant. What is the likely diagnosis?

43. A 35-year-old woman has had four previous live births. Sixteen weeks into her fifth pregnancy she presents with diffuse lower abdominal pain. On examination she is tender in the suprapubic are She has a fundal height of 25 em and there is a firm mass related to the uterus. She has urinary frequency but no dysuria. Only one fetal heart is heared. What is the most likely diagnosis?