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?

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?

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?

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:?

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:?

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?

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?

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?

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?

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?

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?

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?

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

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

A nervous 42-year-old woman presents herself to your antenatal clinic very worried that she has missed the right time to have her combined test for Down's syndrome screening. She is now 17 weeks pregnant and is very concerned about her ag You counsel her about the appropriate alternative, the quadruple test and arrange to have this don What assays make up the quadruple test?

A 29-year-old woman is seen at her booking visit and has blood taken for screening. Which of these is the most appropriate set of booking tests?

A 37-year-old woman in her fourth ongoing pregnancy presents to the labour ward at 34 weeks' gestation complaining of a sharp pain in her chest, worse on inspiration. An arterial blood gas shows: pH 7.51, P02 8.0 kPa, PC02 4.61 kPa, base excess 0.9. What is the most appropriate investigation?

A 32-year-old woman in her third pregnancy is 37 weeks pregnant and has an extended breech baby on ultrasound. After discussion in the antenatal clinic, which of the following is not an absolute contraindication to an external cephalic version (ECV)?

A 16-year-old girl attends accident and emergency complaining of mild vaginal spotting. Her serum beta hCG is 4016 miU/mL. She is complaining of severe left iliac fossa pain and stabbing sensations in her shoulder tip. What is the most appropriate definitive investigation?

A 25-year-old woman in her first pregnancy has a pathological CTG. Her cervix is 5 em dilatated. Which of the following might increase the risk to the fetus if the doctor performed a fetal blood sample?

A 49-year-old comes to the urogynaecology clinic with a history of leaking urine for the last year. There are associated stress symptoms and some urge symptoms. Interestingly she says that it seems to come from inside the vagina as well. She had a hysterectomy last year for endometrial cancer and had quite a prolonged recovery. She has a BMI of 30 kglm2, does not smoke and is otherwise fit and well. You are suspicious that she might have a vesicovaginal fistula secondary to her operation. What is the most appropriate first line investigation?

A 26-year-old woman is otherwise fit and well has been trying to conceive for over 2 years. On questioning she has regular periods and has been having regular intercourse. There are no abnormalities on clinical examination. What would be your first line investigations for her subfertility?

A 24-year-old woman is admitted to the gynaecology ward with a 4-day history of severe hyperemesis gravidarum. She has been unable to tolerate food or fluid orally for 2 days. On the second day of admission she develops signs of a severe pneumonia. This is presumed to be ahospital-acquired infection. She deteriorates rapidly. An arterial blood gas shows: pH 7.68; P02 10.0 kPa; PC02 4.26 kPa; HC03 32 mmol/L; K+ 1.9 mmol/L; Lactate 1.2 mmol/L. What is the most accurate description of the acid-base disorder?

A 21-year-old comes to the clinic with a history of intermenstrual bleeding for the last 6 weeks. She has regular periods and does not experience post-coital bleeding. She is not on the oral contraceptive pill and has no other past medical history. What is the most appropriate first line investigation?

A 57-year-old woman has been referred by her GP under the 2-week suspected cancer referral approach with vaginal bleeding. She has been post-menopausal for the last 4 years and she has been taking Ellested. Duet to treat her vasomotor symptoms. Two weeks ago, after reading about the risks associated with hormone replacement therapy (HRT) she stopped taking any medication. This is the first unscheduled bleeding she has ever ha She had a normal smear 2 years ago and is otherwise well. What would be your first line investigation?

A 13-year-old girl presents with menorrhagia and is found to have von Willebrand's disease. Which of the following coagulation parameters would be most expected to be abnormal?

A 22-year-old female presents with a one day history of lower abdominal pain. She has no past medical history of not On examination she has a temperature of 37 .5°C, and is exquisitely tender in the left iliac fossa with guarding. Bowel sounds are audible. Which if the following is the most appropriate initial investigation for this patient?

A 60-year-old postmenopausal woman complains of recent onset of vaginal bleeding. She has a past history of diabetes mellitus for which she takes metformin 500 mg b She underwent the menopause 10 years previously and took continuous combined HRT for two years. Digital vaginal examination is normal. What is the single most appropriate first line investigation for this woman?

A 24-year-old Jehovah's Witness is brought to accident and emergency with a Glasgow coma scale (GCS) score of 3, BP 90/30 mmHg and pulse 110 bpm. Her husband reports that her last menstrual period was 8 weeks ago and she complained this morning of lower abdominal pain and vaginal spotting. Ultrasonography suggests a ruptured ectopic pregnancy. As part of the resuscitative measures employed before emergency laparotomy, a transfusion of group 0- negative blood is prepared. Her husband interrupts and says that as a Jehovah's Witness she would absolutely refuse all blood products even at risk of death, and has previously signed an advance directive stating this. What is the most appropriate option?

An unhooked 26-week pregnant woman sees you at the hospital to request a termination of pregnancy. She says that if she leaves here today without a termination she will try and do it herself by stabbing her abdomen. Your consultant arranges an urgent psychiatric review which finds no grounds under which to detain this woman in regards to her mental health. Under these circumstances, if a termination was performed, which part of the Abortion Act would it fall under?

A 46-year-old women in her fifth IVF cycle is admitted to the emergency department 4 days after egg collection. She is complaining of a swollen abdomen and shortness of breath. She is reviewed and a diagnosis of ovarian hyperstimulation syndrome (OHSS) is made. Which of the following is not a clinical feature/complication of OHSS?

A 19-year-old girl presents at the antenatal clinic. She is approximately six weeks pregnant and the pregnancy was unplanned. She has a two-year history of grand mal epilepsy for which she takes carbamazepine. She has had no fits for approximately six months. She wants to continue with her pregnancy if it is safe to do so. She is worried about the anticonvulsant therapy and its effects on the baby. She asks how she should be managed. Which of the following management plans is the most appropriate in this case?

A 33-year-old nulliparous woman is 29 weeks pregnant. She was referred to the rapid access breast clinic for investigation of a solitary breast lump. Sadly, a biopsy of this lump revealed a carcinoma. After much counselling from the oncologists and her obstetricians a decision is reached on her further treatment. What option below may be available to her?

A 38-year-old woman with type 2 diabetes attends the maternal medicine clinic. She has a body mass index (BMI) of 48 and is currently controlling her sugars with insulin. You have a long discussion about her weight. What should not be routinely offered to this woman?

A 30-year-old nulliparous woman is 29 weeks pregnant. She presented to hospital with a history of a minor, unprovoked painless vaginal bleed of about a teaspoonful. Her anomaly scan at 20 weeks showed a low-lying placenta. Her fetus is moving well and continuous cardiotocography (CTG) is reassuring. What is the most appropriate management?

A 28-year-old pregnant woman attends accident and emergency with a history of clear vaginal loss. She is 18 weeks pregnant and so far has had no problems. Her past medical history includes a large cone biopsy of the cervix and she is allergic to penicillin. She is worried because the fluid continues to come and there is now some blood. On examination it is apparent that her membranes have rupture What is the most appropriate initial management?

A 32-year-old woman in her second pregnancy presents at 36 weeks gestation with a history of a passing gush of blood stained fluid from the vagina an hour ago, followed by a constant trickle since. The admitting obstetrician reviews her history and weekly antenatal ultrasound scans have shown a placenta praevia. What is the most appropriate management? She has a firm, posterior cervix and has not been experiencing any contractions?

A 30-year-old woman attends the antenatal clinic asking to be sterilized at the time of her elective caesarean. She is 34 weeks into her second pregnancy having had her first child 2 years ago via an emergency caesarean section. She is not sure that she wants any more children. Furthermore, she does not wish to try for a vaginal birth. She has tried the contraceptive pill in the past but does not like the side effects. You talk to her about other options, including the sterilization she is requesting. What is the best management option for this woman?

A 41-year-old multipara attends the antenatal clinic at 36 weeks gestation complaining oflower abdominal cramps and fatigue when mobilizing. Clinical examination is unremarkable save for a grade I pansystolic murmur, loudest over the fourth intercostal space in the midaxillary line. What is the most appropriate management?

A 32-year-old HIV positive woman who booked for antenatal care at 28 weeks gestation arrives on the delivery suite at 37 weeks with painful regular contractions and a cervix dilated to 4 em. Ultrasonography confirms a breech singleton pregnancy with a reactive fetal heart rat What is the most appropriate management option?