Practice Questions – Labour & Delivery EMQ

Option list:
A. TSH
B. Prolactin levels
C. Pregnancy test
D. FSH
E. Ultrasound
F. Karyotyping
G. MRI
H. CT scan
I. Serum DHEA -S levels
J.Testosterone
Choose the most appropriate investigation for the following questions once or more than once or not at all:

1. Ms Anne 15-year-old, has presented with primary amenorrhoea, on examination, her BMI was 29 and was found to have absent secondary sexual characteristics. The investigation of choice is

Option list:
A. Will continue treatment with tranexamic acid.
B. Counsel the patient directly for hysterectomy considering age, ET and BMI in mind.
C. Undertake outpatient hysteroscopy and endometrial biopsy
D. Undertake outpatient hysteroscopy and endometrial biopsy and discuss risk/benefits of insertion of Mirena LNG-IUS with the woman prior to hysteroscopy.
E. General anaesthetic day-case hysteroscopy and endometrial ablation
F. Request a full blood count, endocrine profile (FSH, LH, testosterone, prolactin, day 21 progesterone, estradiol, TFTs) and fasting glucose/HbA1c.
G. Hysteroscopic polypectomy
H. Undergo imaging, with biomarkers and MDT meeting before any treatment.
I. Laparotomy with hysterectomy
J. Staging Laparotomy with hysterectomy and bilateral salpingectomy
K. Hysteroscopic guided polypectomy with endometrial biopsy
L. Laparoscopic hysterectomy with bilateral salpingo-oopherectomy
M. LNG-IUS followed by EB after 3 months
For each patient described below choose the single most appropriate management option from the list. Each option may be used once, more than once, or not at all.

2. Mrs.X is a 48-year-old woman, para 3, BMI- 38, presenting to secondary care with a 3-year history of worsening HMB with irregularity of her menstrual cycle. She is unresponsive to a 4 month course of transexamic acid treatment. Her cervical smear 12 months ago was normal. The woman’s pelvic ultrasound shows endometrial thickness of 15 mm with no uterine structural abnormalities and normal ovaries. What is the further line of management?

3. A 54-year-old woman nulliparous, was operated for breast cancer 3 years back and is on Tamoxifen. She now complains of bleeding per vagina on and off for last 3 months. USG reveals multiple polys. What will be the next step in her management?

4. A 54-year-old woman nulliparous, was operated for breast cancer 3 years back and is on Tamoxifen. She now complains of bleeding per vagina on and off for last 3 months. USG reveals multiple polys. Polypectomy and EB done. Biopsy report reveals atypical hyperplasia. What is management for this patient?

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