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EFOG-EBCOG Part 2 - independent subject foundations study materials
EFOG-EBCOG Part 2 - independent subject foundations study resources

EFOG-EBCOG Part 2 - independent subject foundations practice questions

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Question 1Maternal physiology, antenatal assessment and fetal complications

A pregnant patient with preeclampsia asks why magnesium sulfate is being recommended. Which counselling statement is most accurate?

  1. It is given to prevent or treat seizures and requires monitoring of respiratory rate, reflexes, urine output, and toxicity signs Correct answer.
  2. It lowers blood pressure faster than intravenous labetalol and is used as the main antihypertensive
  3. It improves fetal growth by increasing placental blood flow over several days
  4. It eliminates the need for delivery if blood tests remain abnormal

Explanation

Magnesium sulfate is an anticonvulsant for seizure prevention or treatment in severe preeclampsia/eclampsia. It is not the primary antihypertensive and does not reverse the disease.

Question 2Maternal physiology, antenatal assessment and fetal complications

A 36-week pregnant patient with a singleton frank breech presentation asks about birth options. Which counselling approach is most appropriate?

  1. Discuss external cephalic version if suitable, planned caesarean birth, and carefully selected vaginal breech birth with local expertise Correct answer.
  2. State that vaginal birth is always safer than caesarean birth for breech presentation
  3. Offer induction of labour solely to convert the fetus to cephalic presentation
  4. Avoid discussing external cephalic version because it is only offered before 28 weeks

Explanation

Counselling should cover suitability for external cephalic version near term, planned caesarean birth, and selected vaginal breech birth where skilled staff and criteria are available.

Question 3Maternal physiology, antenatal assessment and fetal complications

A 30-week pregnant patient presents with acute pleuritic chest pain, breathlessness, and oxygen saturation of 92%. Pulmonary embolism is suspected. What is the best immediate management?

  1. Delay anticoagulation until imaging is completed in every case
  2. Assess ABCDE, give oxygen as needed, call senior help, start therapeutic low molecular weight heparin unless contraindicated, and arrange diagnostic imaging Correct answer.
  3. Use warfarin as first-line treatment because it does not cross the placenta
  4. Reassure her that pregnancy-related dyspnea does not require investigation

Explanation

Suspected pulmonary embolism in pregnancy requires urgent assessment, oxygen if hypoxic, senior involvement, therapeutic LMWH unless contraindicated, and objective imaging.

Question 4Maternal physiology, antenatal assessment and fetal complications

A 39-week pregnant patient reports reduced fetal movements since yesterday. What is the most appropriate initial assessment?

  1. Advise her to wait until the next scheduled appointment if movements improve after a meal
  2. Tell her reduced movements are normal at term because the fetus has less space
  3. Arrange induction immediately without checking fetal wellbeing
  4. Prompt maternal assessment and fetal assessment with cardiotocography, followed by ultrasound evaluation if indicated Correct answer.

Explanation

Reduced fetal movements at term require prompt assessment, usually including CTG and consideration of ultrasound for growth, liquor, and Doppler depending on findings and history.

Question 5Maternal physiology, antenatal assessment and fetal complications

In a fetal growth restriction counselling station, which explanation best describes why umbilical artery Doppler is used?

  1. It assesses placental resistance and helps guide surveillance frequency and timing of birth Correct answer.
  2. It directly measures fetal oxygen saturation continuously during pregnancy
  3. It confirms fetal chromosomal status without invasive testing
  4. It predicts the exact birthweight at delivery

Explanation

Umbilical artery Doppler reflects placental vascular resistance. Abnormal flow patterns increase concern and influence monitoring intensity and timing of delivery.

Question 6Maternal physiology, antenatal assessment and fetal complications

A patient at 29 weeks with threatened preterm labour asks what treatments may help the baby before birth. Which answer is most appropriate?

  1. Immediate induction because fetal outcomes are better once contractions begin
  2. Avoid corticosteroids because they are only useful after 37 weeks
  3. Antenatal corticosteroids, magnesium sulfate for fetal neuroprotection when indicated, and short-term tocolysis if appropriate to allow treatment or transfer Correct answer.
  4. Give magnesium sulfate only to mature the fetal lungs

Explanation

At 29 weeks, corticosteroids reduce neonatal respiratory morbidity, magnesium sulfate may provide neuroprotection, and tocolysis can buy time for steroids or in utero transfer when suitable.

Question 7Maternal physiology, antenatal assessment and fetal complications

A 32-week pregnant patient has confirmed preterm prelabour rupture of membranes, is afebrile, and has a reassuring fetal assessment. What is the most appropriate management plan?

  1. Perform digital vaginal examinations every 4 hours to monitor cervical change
  2. Discharge without safety-net advice because rupture has been confirmed
  3. Admit or closely monitor, give antibiotics and antenatal corticosteroids as indicated, watch for infection or labour, and plan timing of birth based on gestation and clinical status Correct answer.
  4. Start oxytocin immediately in all cases of PPROM at 32 weeks

Explanation

Stable PPROM before term is usually managed expectantly with infection surveillance, antibiotics, corticosteroids when indicated, avoidance of unnecessary digital exams, and individualized delivery planning.

Question 8Maternal physiology, antenatal assessment and fetal complications

A pregnant patient with known mechanical mitral valve attends an OSCE counselling station about birth planning. Which principle is most important?

  1. Manage as low risk if she is asymptomatic at the booking visit
  2. Stop anticoagulation permanently at 34 weeks to reduce postpartum bleeding
  3. Recommend home birth because hospital admission increases thrombotic risk
  4. Plan care with a multidisciplinary team, including cardiology, obstetrics, anaesthesia, haematology, and neonatology, with an agreed anticoagulation and delivery plan Correct answer.

Explanation

Mechanical heart valves in pregnancy are high risk. Safe care requires multidisciplinary planning, anticoagulation management, anaesthetic planning, and clear escalation arrangements.

Question 9Maternal physiology, antenatal assessment and fetal complications

A 34-week patient with preeclampsia has blood pressure 172/116 mmHg but no seizure. What is the most appropriate acute management?

  1. Observe for 24 hours before treating because symptoms are absent
  2. Restrict all oral and IV fluids without monitoring urine output
  3. Discharge with home blood pressure monitoring only
  4. Treat severe hypertension promptly with an appropriate antihypertensive, assess maternal and fetal status, check bloods and urine, and consider magnesium sulfate based on severity Correct answer.

Explanation

Severe-range blood pressure in pregnancy is an emergency. Prompt antihypertensive therapy, maternal and fetal assessment, laboratory evaluation, and seizure prophylaxis assessment are required.

Question 10Maternal physiology, antenatal assessment and fetal complications

A patient at 30 weeks with suspected fetal growth restriction asks whether immediate delivery is necessary. Which response is best?

  1. Recommend delivery within 24 hours for all fetal growth restriction after 28 weeks
  2. Reassure her that growth restriction never requires preterm birth
  3. Explain that timing balances prematurity against the risk of ongoing placental insufficiency and depends on growth pattern, Dopplers, CTG, amniotic fluid, and maternal condition Correct answer.
  4. Base timing only on fundal height measurement

Explanation

FGR management balances fetal compromise against prematurity. Dopplers, surveillance findings, gestation, growth trajectory, liquor, CTG, and maternal disease guide timing.

Question 11Maternal physiology, antenatal assessment and fetal complications

A woman with gestational diabetes asks why her baby may need glucose checks after birth. What is the best explanation?

  1. Neonatal glucose checks are done because insulin crosses the placenta in high concentrations
  2. Babies exposed to maternal hyperglycaemia can produce extra insulin and may become hypoglycaemic after the cord is cut Correct answer.
  3. Gestational diabetes prevents newborns from taking milk orally for the first 24 hours
  4. Hypoglycaemia occurs only if the mother had type 1 diabetes, not gestational diabetes

Explanation

Maternal hyperglycaemia can cause fetal hyperinsulinaemia. After delivery, maternal glucose supply stops, but neonatal insulin remains high, increasing hypoglycaemia risk.

Question 12Maternal physiology, antenatal assessment and fetal complications

A 36-week patient with congenital heart disease becomes acutely breathless in labour with oxygen saturation 88%, tachycardia, and pulmonary crackles. What is the best immediate OSCE response?

  1. Give a rapid large crystalloid bolus before assessment because all labouring patients are dehydrated
  2. Use an ABCDE approach, sit her up, give oxygen, call obstetric, anaesthetic, cardiology, and critical care help, and avoid fluid overload while identifying the cause Correct answer.
  3. Continue pushing without escalation because breathlessness is normal in second stage
  4. Delay treatment until a postnatal echocardiogram is available

Explanation

Acute cardiopulmonary compromise in pregnancy needs immediate ABCDE assessment, oxygen, senior multidisciplinary escalation, careful fluid management, and cause-directed treatment.

Question 13Maternal physiology, antenatal assessment and fetal complications

A station stem describes a 32-week pregnant patient with severe headache, visual symptoms, blood pressure 170/112 mmHg, and epigastric pain. Which action should take priority?

  1. Send her home with oral analgesia and ask her to return if symptoms worsen.
  2. Call for senior and multidisciplinary help, begin maternal stabilisation including antihypertensive treatment and magnesium sulfate according to protocol, and assess fetus after immediate maternal safety steps. Correct answer.
  3. Perform a detailed ultrasound before treating the blood pressure because fetal assessment comes first.
  4. Wait for proteinuria results before escalating because pre-eclampsia cannot be suspected without them.

Explanation

This presentation suggests severe pre-eclampsia with risk of eclampsia or stroke. Maternal stabilisation and escalation are immediate priorities.

Question 14Labor, operative assessment and postpartum emergencies

In an obstetric OSCE station, a 31-year-old at 38 weeks suddenly collapses on the labour ward with seizure activity and severe-range blood pressure. What is the best immediate priority while calling for help?

  1. Arrange urgent CT brain before giving anticonvulsant treatment
  2. Give oral labetalol and observe whether the seizure terminates spontaneously
  3. Prepare immediate caesarean birth before stabilising the mother
  4. Place her in the left lateral position, protect the airway, give high-flow oxygen, and prepare magnesium sulfate Correct answer.

Explanation

Eclampsia is managed first with maternal stabilisation: call for senior help, lateral positioning, airway support, oxygen, and magnesium sulfate. Birth planning follows once the mother is stabilised.

Question 15Labor, operative assessment and postpartum emergencies

During a postpartum hemorrhage station, a patient has heavy bleeding immediately after vaginal birth and a soft, enlarged uterus. After calling for help, what should the candidate do first?

  1. Take the patient to theatre for hysterectomy without attempting uterine contraction
  2. Wait for a full blood count result before starting treatment
  3. Start uterine massage and administer a uterotonic while assessing blood loss and maternal observations Correct answer.
  4. Perform manual removal of placenta without analgesia or uterotonic treatment

Explanation

A boggy uterus indicates uterine atony, the commonest cause of primary postpartum hemorrhage. Immediate uterine massage, uterotonics, resuscitation, and escalation are required.

Question 16Labor, operative assessment and postpartum emergencies

In a shoulder dystocia OSCE station, the fetal head has delivered but restitution fails and gentle traction is unsuccessful. Which action is most appropriate as the first manoeuvre after calling for help?

  1. Fundal pressure to push the shoulders through the pelvis
  2. Forceful downward traction on the fetal head
  3. McRoberts manoeuvre with suprapubic pressure Correct answer.
  4. Immediate Zavanelli manoeuvre before any external manoeuvres

Explanation

Initial management is to call for help, stop traction, announce shoulder dystocia, use McRoberts manoeuvre, and apply suprapubic pressure. Fundal pressure and forceful traction increase injury risk.

Question 17Labor, operative assessment and postpartum emergencies

In labour, the fetal heart tracing shows recurrent late decelerations with reduced variability despite maternal repositioning and correction of hypotension. Cervix is 5 cm dilated. What is the best next step?

  1. Continue routine observation because late decelerations are expected at 5 cm
  2. Increase oxytocin to shorten labour regardless of the fetal heart pattern
  3. Ask the patient to push to speed delivery despite incomplete cervical dilatation
  4. Escalate urgently for senior review and prepare for expedited birth if the pathological pattern persists Correct answer.

Explanation

Persistent late decelerations with reduced variability suggest fetal compromise. Initial reversible causes should be addressed, then urgent senior review and expedited birth are considered.

Question 18Labor, operative assessment and postpartum emergencies

A labouring patient has fever, maternal tachycardia, uterine tenderness, and fetal tachycardia. Sepsis is suspected. Which OSCE management bundle is most appropriate?

  1. Give oral antibiotics and defer observations until the next routine review
  2. Call for senior and anaesthetic help, take cultures, start broad-spectrum intravenous antibiotics, give IV fluids, monitor lactate and urine output, and plan birth according to maternal and fetal status Correct answer.
  3. Perform immediate operative birth before starting antibiotics or resuscitation
  4. Withhold fluids in all pregnant patients because pulmonary edema is inevitable

Explanation

Maternal sepsis requires early recognition, escalation, cultures, prompt IV antibiotics, fluid resuscitation with monitoring, lactate assessment, source control, and individualized birth planning.

Question 19Labor, operative assessment and postpartum emergencies

A patient with insulin-treated diabetes in pregnancy is in labour. Which intrapartum management principle is most appropriate?

  1. Monitor maternal glucose regularly and use local insulin-dextrose protocols to maintain target glucose while monitoring fetal wellbeing Correct answer.
  2. Stop all glucose monitoring once active labour begins
  3. Aim for maternal hyperglycaemia to prevent neonatal hypoglycaemia
  4. Avoid continuous fetal monitoring regardless of treatment or risk factors

Explanation

Intrapartum diabetes care includes regular glucose monitoring, protocol-based insulin and dextrose when needed, and fetal monitoring according to local risk-based guidance.

Question 20Labor, operative assessment and postpartum emergencies

A patient has severe postpartum hemorrhage with ongoing bleeding despite uterine massage and first-line uterotonics. Which leadership action is most appropriate?

  1. Continue alone to avoid alarming the patient
  2. Declare a major obstetric hemorrhage, allocate roles, activate the transfusion protocol, request senior obstetric and anaesthetic help, and continue cause-directed management Correct answer.
  3. Wait until estimated blood loss exceeds 3000 mL before involving the blood bank
  4. Ask the most junior team member to decide whether escalation is needed

Explanation

Major hemorrhage requires early declaration, role allocation, senior help, anaesthetic support, blood bank activation, resuscitation, and treatment of the underlying cause.

Question 21Labor, operative assessment and postpartum emergencies

During shoulder dystocia management, McRoberts and suprapubic pressure fail. Which next approach is appropriate for a trained operator?

  1. Proceed to internal rotational manoeuvres or delivery of the posterior arm while maintaining clear communication and timing Correct answer.
  2. Apply fundal pressure more forcefully
  3. Pull continuously on the fetal head until the shoulders deliver
  4. Abandon documentation until the end of the shift

Explanation

If initial manoeuvres fail, trained staff should progress to internal rotational manoeuvres and/or posterior arm delivery. Timing, communication, neonatal readiness, and documentation are essential.

Question 22Labor, operative assessment and postpartum emergencies

A CTG shows fetal tachycardia, reduced variability, and recurrent variable decelerations while oxytocin is running. Uterine contractions are 6 in 10 minutes. What should the candidate do?

  1. Increase oxytocin because reduced variability means labour is too slow
  2. Ignore contraction frequency if the cervix is dilating
  3. Stop or reduce oxytocin, manage uterine tachysystole, reposition the mother, assess for reversible causes, and escalate for urgent review Correct answer.
  4. Ask the patient to avoid changing position because this worsens variable decelerations

Explanation

Tachysystole with a concerning CTG requires reducing uterine stimulation, intrauterine resuscitation, assessment of reversible causes, and senior review for possible expedited birth.

Question 23Labor, operative assessment and postpartum emergencies

In a vacuum birth technical skills station, which prerequisite must be confirmed before applying the cup?

  1. Fully dilated cervix, ruptured membranes, known fetal head position and station, adequate pelvis, empty bladder, consent, analgesia, and a backup plan Correct answer.
  2. Unconfirmed fetal head position if the CTG is abnormal
  3. Intact membranes to cushion the fetal scalp
  4. No need for consent because instrumental birth is always an emergency

Explanation

Safe operative vaginal birth requires full dilation, ruptured membranes, known position and station, suitability assessment, consent, analgesia, bladder emptying, and readiness to abandon if unsafe.

Question 24Labor, operative assessment and postpartum emergencies

A 28-week patient with PPROM develops fever, uterine tenderness, foul-smelling liquor, and fetal tachycardia. What is the most appropriate management?

  1. Continue expectant management until 37 weeks regardless of infection signs
  2. Give tocolysis to suppress labour until antibiotics have been completed for 7 days
  3. Avoid fetal monitoring because infection makes CTG interpretation impossible
  4. Treat as intrauterine infection with senior escalation, IV antibiotics, sepsis assessment, and planning for birth after maternal stabilisation Correct answer.

Explanation

Chorioamnionitis after PPROM requires prompt antibiotics, sepsis care, senior involvement, and delivery planning once the mother is stabilised. Prolonged expectant management is unsafe.

Question 25Labor, operative assessment and postpartum emergencies

A patient with sepsis after miscarriage is hypotensive, febrile, and awaiting ultrasound confirmation of retained products. What is the best prioritisation?

  1. Wait for ultrasound before giving antibiotics so the diagnosis is certain.
  2. Start sepsis management immediately with escalation, cultures, IV antibiotics, fluids, monitoring, and source control planning without waiting for imaging. Correct answer.
  3. Give oral antibiotics and discharge if pain improves.
  4. Focus first on arranging outpatient follow-up because retained products are usually self-limiting.

Explanation

Suspected sepsis requires immediate treatment and escalation. Diagnostic confirmation should not delay resuscitation or antibiotics.

Question 26Bleeding, pain, adnexal and vulvovaginal disease

In an OSCE counselling station, a 43-year-old with heavy regular periods asks why she needs investigation before starting treatment. Which explanation is most appropriate?

  1. Most heavy bleeding is benign, but the assessment checks for anaemia, pregnancy-related causes, structural pathology, and endometrial risk factors before choosing treatment. Correct answer.
  2. Heavy regular bleeding is almost always caused by endometrial cancer, so treatment should wait for hysterectomy planning.
  3. Investigation is unnecessary if cycles are regular because ovulation excludes important pathology.
  4. The main purpose of assessment is to decide whether oral antibiotics are required.

Explanation

AUB counselling should normalise common benign causes while explaining targeted assessment: pregnancy exclusion, FBC, risk factors, examination, imaging or biopsy when indicated.

Question 27Bleeding, pain, adnexal and vulvovaginal disease

A 39-year-old with heavy menstrual bleeding wants a treatment that also provides contraception. She has no contraindication to intrauterine contraception. Which option is usually the most suitable first-line discussion?

  1. Endometrial ablation as the first treatment
  2. Cyclical norethisterone only from day 19 to day 26
  3. Levonorgestrel-releasing intrauterine system Correct answer.
  4. Immediate total hysterectomy

Explanation

The LNG-IUS reduces menstrual blood loss and provides contraception. Ablation and hysterectomy are later options after assessment and shared decision-making.

Question 28Bleeding, pain, adnexal and vulvovaginal disease

During consent for outpatient endometrial biopsy, which statement should be included?

  1. A normal biopsy fully excludes all endometrial and cervical disease.
  2. The procedure requires general anaesthesia in most patients.
  3. The sample may be insufficient or miss focal pathology, so further assessment such as hysteroscopy may still be needed. Correct answer.
  4. There is no need to discuss pain because the biopsy is painless.

Explanation

Consent should cover pain, bleeding, infection, rare perforation or failed sampling, and the possibility of further investigation if symptoms persist or the sample is inadequate.

Question 29Bleeding, pain, adnexal and vulvovaginal disease

In a pelvic pain station, which history point most specifically supports endometriosis?

  1. Sudden unilateral pain with syncope and shoulder-tip pain
  2. Constant suprapubic pain with dysuria and fever after intercourse
  3. Painless intermenstrual spotting after cervical screening
  4. Cyclical pelvic pain with deep dyspareunia, dyschezia during menses, and subfertility Correct answer.

Explanation

Endometriosis classically causes cyclical pain, deep dyspareunia, bowel or bladder symptoms linked to menses, and may be associated with infertility.

Question 30Bleeding, pain, adnexal and vulvovaginal disease

A patient with suspected endometriosis asks whether a normal ultrasound excludes the diagnosis. What is the best answer?

  1. Yes; a normal pelvic ultrasound definitively rules out all endometriosis.
  2. No; ultrasound can detect endometriomas and some deep disease, but superficial peritoneal disease may not be seen. Correct answer.
  3. Yes, provided the scan was performed transabdominally rather than transvaginally.
  4. No; the diagnosis can only be considered if CA-125 is markedly elevated.

Explanation

Imaging is useful for ovarian endometriomas and deep infiltrating disease, but a normal scan does not exclude superficial endometriosis.

Question 31Bleeding, pain, adnexal and vulvovaginal disease

A 45-year-old with pressure symptoms has a 12-week-size fibroid uterus. She wants to preserve her uterus. Which counselling approach is best?

  1. Recommend hysterectomy as the only effective treatment for all symptomatic fibroids.
  2. Advise that fibroids always shrink quickly before menopause and need no follow-up.
  3. Discuss medical symptom control, myomectomy, uterine artery embolisation, and the effect of fibroid size, location, fertility wishes, and recurrence risk. Correct answer.
  4. Offer endometrial ablation without imaging because it treats all fibroid-related symptoms.

Explanation

Fibroid management is individualised. Uterus-sparing options exist, but suitability depends on symptoms, location, size, fertility priorities, and malignancy red flags.

Question 32Bleeding, pain, adnexal and vulvovaginal disease

In a sexual health station, a patient reports postcoital bleeding and a new partner. Which approach is best?

  1. Assume the cause is cervical ectropion and avoid questions about partners.
  2. Give empirical antifungal treatment without examination or testing.
  3. Take a non-judgemental sexual history, assess pregnancy risk and safeguarding, offer STI testing, and examine the cervix if appropriate. Correct answer.
  4. Defer all discussion because sexual history is not relevant to gynaecology.

Explanation

Postcoital bleeding needs cervical assessment and STI consideration. A structured, non-judgemental history also screens for pregnancy risk and safeguarding concerns.

Question 33Bleeding, pain, adnexal and vulvovaginal disease

A patient with suspected pelvic inflammatory disease has lower abdominal pain, cervical motion tenderness, fever, and a positive chlamydia test. What is the best management principle?

  1. Start prompt broad-spectrum antibiotics, arrange partner notification and STI testing, and advise abstinence until treatment is completed. Correct answer.
  2. Wait for laparoscopy confirmation before starting antibiotics.
  3. Treat only with simple analgesia because PID is usually self-limiting.
  4. Treat the patient only; partners do not need assessment if asymptomatic.

Explanation

PID is a clinical diagnosis and treatment should not be delayed. Partner management and sexual health follow-up reduce reinfection and complications.

Question 34Bleeding, pain, adnexal and vulvovaginal disease

A 58-year-old has intense vulval itch and white plaques with fissuring. Which counselling point is most appropriate if lichen sclerosus is suspected?

  1. It is a sexually transmitted infection and her partner must be treated before she can start therapy.
  2. Topical oestrogen alone cures the condition in most cases.
  3. Biopsy and follow-up are never needed if itching improves.
  4. A vulval examination is needed, potent topical steroid treatment is commonly used, and follow-up is important because of scarring and small cancer risk. Correct answer.

Explanation

Lichen sclerosus is inflammatory, not an STI. Treatment often uses potent topical corticosteroid, with follow-up for symptom control, architecture changes, and malignancy surveillance.

Question 35Bleeding, pain, adnexal and vulvovaginal disease

During a basic hysteroscopy technical skills station, what is the safest initial response if visibility suddenly becomes poor and fluid deficit is rising quickly?

  1. Increase pressure indefinitely until the cavity is visible again.
  2. Continue resection because poor visibility is expected and fluid deficit is irrelevant.
  3. Switch to blind curettage without telling the patient or team.
  4. Stop the procedure, maintain patient safety, check inflow and outflow, assess the fluid deficit, and call for senior help according to local thresholds. Correct answer.

Explanation

Poor visibility with rising fluid deficit raises risk of perforation, bleeding, or fluid overload. The safe response is to stop, assess, communicate, and escalate.

Question 36Bleeding, pain, adnexal and vulvovaginal disease

After diagnostic laparoscopy, the team suspects a small bowel injury may have occurred. Which action best demonstrates appropriate disclosure and escalation?

  1. Stabilise the patient, inform the consultant and relevant surgical team, document events clearly, and give the patient an honest explanation with an apology when clinically appropriate. Correct answer.
  2. Delay escalation until the next day if the observations are currently normal.
  3. Avoid documenting uncertainty to reduce medicolegal risk.
  4. Tell the patient only that the procedure was difficult and omit the suspected injury.

Explanation

Suspected visceral injury requires immediate escalation, multidisciplinary management, clear documentation, and open duty-of-candour communication when the patient is safe to discuss it.

Question 37Bleeding, pain, adnexal and vulvovaginal disease

A patient presents with acute pelvic pain, positive pregnancy test, shoulder-tip pain, and syncope. What is the safest integrated management approach?

  1. Book a routine early pregnancy scan because pain is common in early pregnancy.
  2. Treat as possible ruptured ectopic pregnancy, assess ABCs, obtain IV access and bloods including group and screen, call senior gynaecology and anaesthesia, and arrange urgent imaging or theatre depending on stability. Correct answer.
  3. Give oral antibiotics for presumed pelvic inflammatory disease and review in one week.
  4. Reassure her because a positive pregnancy test excludes gynaecological emergencies.

Explanation

Syncope and shoulder-tip pain with a positive pregnancy test are red flags for intra-abdominal bleeding from ectopic pregnancy.

Question 38Gynecologic oncology, precursor lesions and inherited risk

A 62-year-old reports one episode of vaginal bleeding 8 years after menopause. Which response best demonstrates safe OSCE management?

  1. Explain that postmenopausal bleeding needs prompt assessment to exclude endometrial cancer, while reassuring that benign causes are common. Correct answer.
  2. Reassure her that a single episode can be ignored if there is no pain.
  3. Start combined HRT immediately because bleeding proves oestrogen deficiency.
  4. Treat empirically with antibiotics and review only if bleeding becomes heavy.

Explanation

Any postmenopausal bleeding warrants timely evaluation, commonly with pelvic examination and transvaginal ultrasound, with biopsy or hysteroscopy depending on findings and risk.

Question 39Gynecologic oncology, precursor lesions and inherited risk

When counselling a premenopausal patient about a newly found complex ovarian cyst, which phrase is most appropriate for risk communication?

  1. A complex cyst always means ovarian cancer, so fertility cannot be preserved.
  2. We will combine symptoms, examination, ultrasound features, and tumour markers to estimate risk and decide whether specialist referral is needed. Correct answer.
  3. Tumour markers alone are accurate enough to decide management without imaging details.
  4. If the cyst is painless, malignancy does not need to be considered.

Explanation

Ovarian mass risk assessment integrates clinical features, ultrasound morphology, menopausal status, and markers; risk should be communicated without false reassurance or alarm.

Question 40Gynecologic oncology, precursor lesions and inherited risk

A 67-year-old with bloating, early satiety, and a complex adnexal mass has raised CA-125. What is the most appropriate next step?

  1. Reassure that CA-125 is non-specific and repeat it in 12 months.
  2. Start a combined oral contraceptive pill to suppress the cyst.
  3. Arrange cyst aspiration in primary care to relieve symptoms.
  4. Refer urgently to a gynaecological oncology service or multidisciplinary pathway. Correct answer.

Explanation

Postmenopausal symptoms, complex morphology, and raised CA-125 are concerning for malignancy and require urgent specialist assessment rather than aspiration or delayed review.

Question 41Gynecologic oncology, precursor lesions and inherited risk

A patient referred for colposcopy after abnormal cervical screening is anxious that she has cancer. Which counselling statement is best?

  1. Most referrals are for abnormal cells or HPV-related changes rather than cancer, and colposcopy allows magnified assessment and biopsy if needed. Correct answer.
  2. Colposcopy is a treatment that removes the cervix if HPV is found.
  3. Abnormal screening means cervical cancer is already present until proved otherwise.
  4. She should avoid attending until symptoms develop because screening changes often settle.

Explanation

Colposcopy evaluates the transformation zone after abnormal screening; it is diagnostic and may include biopsy or treatment depending on findings.

Question 42Gynecologic oncology, precursor lesions and inherited risk

Before loop excision of the transformation zone, which risk is important to discuss during consent?

  1. Permanent infertility in almost all patients
  2. Immediate menopause because the ovaries are removed
  3. Bleeding, infection, discharge, incomplete excision, and a small increased risk of future preterm birth depending on excision depth Correct answer.
  4. Loss of need for any future cervical screening

Explanation

LLETZ consent includes common short-term effects, incomplete treatment or recurrence, and reproductive implications, especially with deeper or repeated excisions.

Question 43Gynecologic oncology, precursor lesions and inherited risk

Which fibroid feature most strongly suggests a need for urgent senior or specialist assessment rather than routine counselling?

  1. Rapid enlargement after menopause with new pain or bleeding Correct answer.
  2. Stable small intramural fibroid in a menstruating patient
  3. Mild dysmenorrhoea with normal haemoglobin
  4. Fibroid discovered incidentally during fertility work-up

Explanation

Growth after menopause or new postmenopausal symptoms are red flags for malignancy or other serious pathology and should prompt urgent assessment.

Question 44Gynecologic oncology, precursor lesions and inherited risk

A 45-year-old has heavy menstrual bleeding, intermenstrual bleeding, obesity, and a family history of endometrial cancer. What is the best OSCE differential and next step?

  1. Diagnose dysfunctional uterine bleeding and prescribe tranexamic acid without further assessment.
  2. Assume perimenopause is the cause because she is over 40.
  3. Start combined hormonal contraception immediately and defer examination for six months.
  4. Consider structural causes and endometrial hyperplasia or malignancy, arrange appropriate pelvic assessment and endometrial sampling according to local pathways. Correct answer.

Explanation

Intermenstrual bleeding and risk factors require assessment for endometrial pathology, while still considering benign structural causes.

Question 45Reproductive endocrinology, fertility and contraception

A 28-year-old asks for contraception and has migraine with aura. Which method should generally be avoided?

  1. Copper intrauterine device
  2. Levonorgestrel intrauterine system
  3. Progestogen-only implant
  4. Combined hormonal contraception Correct answer.

Explanation

Migraine with aura is a contraindication to combined hormonal contraception because of increased stroke risk. Progestogen-only and non-hormonal methods are alternatives.

Question 46Reproductive endocrinology, fertility and contraception

In contraceptive counselling, which statement about long-acting reversible contraception is most accurate?

  1. LARC should be offered only to patients who have completed their families.
  2. LARC methods are highly effective because they do not rely on daily adherence, but choice should reflect preferences, bleeding pattern, risks, and reversibility. Correct answer.
  3. Implants and intrauterine methods protect against sexually transmitted infections.
  4. The copper IUD is ineffective if used by someone who has never been pregnant.

Explanation

LARC is suitable for many reproductive plans, including nulliparity. It is highly effective but does not protect against STIs, so condoms may still be needed.

Question 47Reproductive endocrinology, fertility and contraception

A patient presents 4 days after unprotected intercourse and wants the most effective emergency contraception. What should be discussed first if eligible?

  1. Starting combined oral contraception and waiting for withdrawal bleeding
  2. Copper intrauterine device insertion Correct answer.
  3. Taking a pregnancy test immediately and giving no contraception if it is negative
  4. Depot medroxyprogesterone acetate as emergency contraception

Explanation

The copper IUD is the most effective emergency contraception and can provide ongoing contraception. Oral options may be considered if IUD is declined or unsuitable.

Question 48Reproductive endocrinology, fertility and contraception

When counselling about oral emergency contraception, which point is important?

  1. It reliably terminates an established pregnancy.
  2. It provides contraception for the rest of the cycle without additional precautions.
  3. It is unnecessary to discuss regular contraception at the same visit.
  4. It does not protect against sexually transmitted infections, and follow-up pregnancy testing is needed if the next period is late or abnormal. Correct answer.

Explanation

Emergency pills delay or inhibit ovulation and do not treat STIs. Ongoing contraception and pregnancy testing advice are essential.

Question 49Reproductive endocrinology, fertility and contraception

A 52-year-old with troublesome vasomotor symptoms asks about systemic menopausal hormone therapy. She has an intact uterus and is otherwise eligible after assessment. Which prescription principle is correct?

  1. Oestrogen should be combined with adequate progestogen for endometrial protection. Correct answer.
  2. Oestrogen-only HRT is safest for the endometrium when the uterus is present.
  3. Progestogen is needed only if she has a family history of breast cancer.
  4. HRT should be refused because vasomotor symptoms are not treatable.

Explanation

Unopposed systemic oestrogen increases endometrial hyperplasia and cancer risk in patients with a uterus, so progestogen is required unless contraindicated.

Question 50Reproductive endocrinology, fertility and contraception

Which counselling point is most appropriate for vaginal oestrogen used for genitourinary syndrome of menopause?

  1. It is the same as high-dose systemic HRT and always requires full-dose oral progestogen.
  2. It is used only for hot flushes and has no effect on vaginal symptoms.
  3. Low-dose vaginal oestrogen can improve dryness, dyspareunia, and urinary symptoms with minimal systemic absorption for most patients. Correct answer.
  4. It provides reliable contraception in the perimenopause.

Explanation

Local vaginal oestrogen is effective for urogenital atrophy symptoms and usually has low systemic exposure; contraception and systemic vasomotor treatment require separate discussion.