Free SMLE Obstetrics & Gynecology questions

A 45-year-old woman presents with continuous vaginal bleeding for 15 days, soaking six pads daily. She feels lightheaded on standing and has fainted twice. Pulse is 108 beats/min and supine blood pressure is 100/62 mm Hg. She is sexually active and uses no contraception. Which of the following is the most appropriate initial investigation?

A 31-year-old woman at 7 weeks of gestation has had three consecutive unexplained first-trimester miscarriages and one unprovoked deep vein thrombosis 2 years ago, after which warfarin was started. Lupus anticoagulant and anticardiolipin IgG were positive on two occasions 12 weeks apart, confirming antiphospholipid syndrome. She stopped warfarin 10 days ago when her pregnancy test became positive. What is the most appropriate antithrombotic regimen for this pregnancy?

A 26-year-old woman presents with 2 weeks of thin, greyish-white vaginal discharge with a fishy odour that is worse after intercourse. She has no itching, dysuria, or dyspareunia. Speculum examination shows discharge coating the vaginal walls with no vulval or vaginal erythema and no cervical motion tenderness. Vaginal pH is 5.0, and potassium hydroxide releases a pungent amine odour. Which of the following is the most likely diagnosis?

A 29-year-old woman delivers vaginally at 41 weeks. The placenta fails to separate, and manual removal fails because it is densely adherent. She declines hysterectomy and wishes to preserve fertility. The cord is ligated high, the placenta is left in situ, and methotrexate is started. Which of the following is the most likely complication of this management?

A 30-year-old woman has been unable to conceive for six years despite regular unprotected intercourse. She has severe cramping pelvic pain beginning two days before each period, no longer relieved by naproxen, with deep dyspareunia and pain on defecation during menstruation. Cycles are regular at 29 days. Bimanual examination reveals a fixed retroverted uterus and tender nodularity along the uterosacral ligaments. Which of the following is the most likely diagnosis?

A 33-year-old nulliparous woman reports cyclic pelvic pain, painful defecation during menses and deep dyspareunia for 3 years. Examination shows a fixed retroverted uterus with tender nodules in the posterior fornix. Diagnostic laparoscopy reveals bluish-black powder-burn lesions over the pelvic peritoneum with dense adhesions. Which of the following is the most likely diagnosis?

A 26-year-old woman underwent suction evacuation of a complete hydatidiform mole 6 weeks ago. Weekly serum beta-hCG values over the past month are 3,100, 3,050, 3,200, and 3,100 IU/L. She has light vaginal bleeding, and ultrasound shows no retained tissue. Chest radiograph is clear. Which of the following is the most appropriate management?

A 34-year-old woman at 38 weeks gestation reports severe headache. Blood pressure is 168/108 mm Hg with 2+ lower limb edema; no petechiae are seen and neurologic examination is normal. Platelets are 68 × 10⁹/L, AST 210 U/L, LDH 820 U/L, creatinine 88 µmol/L, urine protein 2+. Smear shows fragmented erythrocytes. Which of the following is the most appropriate management?

A 37-year-old woman, gravida 3 para 1, at 28 weeks' gestation reports vaginal spotting 2 weeks ago and no fetal movement since. She has had no cramping and has passed no tissue. Fundal height measures 18 cm. Ultrasound shows no fetal cardiac activity and no fetal movement. Which of the following is the most likely diagnosis?

A 30-year-old woman with laparoscopically confirmed endometriosis has persistent dysmenorrhea and deep dyspareunia despite 3 months of regular naproxen. Pelvic examination shows tender uterosacral nodularity without an adnexal mass. She is not seeking pregnancy in the near term and has no contraindication to hormonal therapy. Which of the following is the most appropriate next step in management?

A 30-year-old nulligravid woman underwent laparoscopic myomectomy for multiple symptomatic intramural fibroids. The operative note documents inadvertent entry into the endometrial cavity, which was closed in layers. She has no prior cesarean delivery or uterine curettage and now asks about future pregnancy. Which of the following best describes her risk of placenta accreta spectrum?

A 35-year-old woman with three previous cesarean sections is admitted at 37 weeks for elective repeat cesarean section. Antenatal ultrasound showed an anterior low-lying placenta with multiple lacunae and loss of the clear zone. At surgery the placenta is densely adherent to the uterine wall without invading the myometrium or bladder. Which of the following is the most likely diagnosis?

A 41-year-old woman has three months of bleeding after intercourse. Her cycles have become irregular over the past year and she has never attended cervical screening. Speculum examination shows a friable area on the anterior cervical lip that bleeds on contact. The uterus is normal-sized and mobile with no adnexal masses, and a urine pregnancy test is negative. Which of the following is the most appropriate next step in management?

A 28-year-old woman is 2 weeks postpartum after an uncomplicated vaginal delivery and is exclusively breastfeeding her infant. She wants to start contraception today. She has no vaginal bleeding, no fever, and no history of venous thromboembolism. Blood pressure is 118/74 mm Hg. Which of the following is the most appropriate contraceptive method for her now?

A 23-year-old nulliparous woman has crampy pelvic pain starting the day before menses and lasting 2 days, severe enough to miss work each cycle. Symptoms began at menarche. Pelvic examination and transvaginal ultrasound are normal. She is sexually active and wants both reliable ongoing pain control and contraception. Which of the following is the most appropriate long-term treatment?

A 26-year-old woman, gravida 1 para 0, at 40 weeks of gestation is admitted in spontaneous labour with painful contractions. The cervix is 3 cm dilated and 60% effaced with intact membranes. Fourteen hours later she is 5 cm dilated, the fetal heart tracing is category I, and she is afebrile. Beyond how many hours is her latent phase considered prolonged?

A 32-year-old primigravida at 36 weeks of gestation reports that fetal movements have been noticeably reduced for the past 24 hours. Blood pressure is 118/72 mm Hg, symphysis-fundal height is 34 cm, and the fetus is cephalic. She has no bleeding, contractions, or leaking fluid. Which of the following is the most appropriate initial investigation?

A 19-year-old primigravida at 32 weeks is referred from the antenatal clinic with a blood pressure of 164/112 mm Hg on two readings 20 minutes apart. She has no headache or visual symptoms, urine dipstick shows 2+ protein, and the fetal heart rate is 145 beats/min. Which of the following is the most appropriate immediate next step in management?

A 27-year-old primigravida with homozygous sickle cell disease attends antenatal clinic at 16 weeks gestation. She takes folic acid, penicillin prophylaxis, and low-dose aspirin begun at 12 weeks, and had two vaso-occlusive crises last year. Hemoglobin is 82 g/L, blood pressure is 108/64 mm Hg, and urinalysis shows no protein. Apart from acute painful crisis, which complication is she most likely to develop?

A 54-year-old woman, para 4 with all vaginal deliveries, reports involuntary urine loss whenever she coughs, laughs or lifts her grandchild. She has no urgency, nocturia or dysuria. She has completed 6 months of supervised pelvic floor muscle training without improvement. The cough stress test is positive with urethral hypermobility and no prolapse beyond the hymen. Post-void residual volume is 25 mL. What is the most effective definitive treatment?

A 27-year-old primigravida has 900 mL of postpartum bleeding after vaginal delivery. The uterus stays atonic despite oxytocin, misoprostol, carboprost and bimanual compression, and she is taken to theatre. She strongly wishes to preserve fertility. Blood pressure is 92/56 mm Hg with pulse 118 beats/min. Which structure is most appropriate to ligate to control the bleeding?

A 40-year-old woman, gravida 4 para 2, at 41 weeks is 6 hours into induction with vaginal prostaglandin. She develops sudden severe abdominal pain, contractions cease, and heavy vaginal bleeding occurs. Blood pressure is 78/40 mm Hg, pulse 132 beats/min, the presenting part has receded, and fetal heart tones are absent. Which of the following is the most likely diagnosis?