AMC MCQ - Australian Medical Council Multiple Choice Questions Obstetrics and Gynaecology Questions and Answers 1 — Questions and Answers
Question 1: A 62-year-old woman, G2P2, who went through menopause 10 years ago, presents with a single episode of vaginal spotting. She is not on hormone replacement therapy and has a BMI of 32 kg/m². What is the most appropriate initial investigation to assess her risk of endometrial carcinoma?
- Cervical HPV test
- Transvaginal ultrasound to measure endometrial thickness (Correct answer)
- Diagnostic hysteroscopy with endometrial biopsy
- Serum CA-125 measurement
Correct answer: Transvaginal ultrasound to measure endometrial thickness
Postmenopausal bleeding (PMB) is a red flag for endometrial cancer, which must be excluded. A transvaginal ultrasound is the recommended initial investigation to measure endometrial thickness (ET). An ET of less than or equal to 4-5mm has a very high negative predictive value for endometrial cancer. If the endometrium is thickened, further investigation with an endometrial biopsy is warranted. While a cervical screening test is important, it doesn't assess the endometrium. Direct biopsy is usually a second-line investigation after imaging, and CA-125 is not a screening tool for endometrial cancer.
Question 2: A 28-year-old primigravida attends her first antenatal visit at 10 weeks' gestation. She is interested in screening for fetal chromosomal abnormalities like Down syndrome. According to Australian guidelines, which of the following is the most commonly offered and recommended initial screening test?
- Amniocentesis at 16 weeks
- Maternal serum alpha-fetoprotein (MSAFP) alone
- Combined first-trimester screening (nuchal translucency ultrasound and maternal serum markers) (Correct answer)
- Fetal morphology ultrasound at 20 weeks
Correct answer: Combined first-trimester screening (nuchal translucency ultrasound and maternal serum markers)
Combined first-trimester screening (cFTS) is the standard initial screening test for chromosomal abnormalities offered in Australia. It combines a maternal blood test (measuring PAPP-A and free β-hCG) between 9 and 13 weeks with a nuchal translucency (NT) ultrasound scan between 11 and 13 weeks. This combination provides a risk assessment for conditions like Down syndrome (Trisomy 21) and Edwards syndrome (Trisomy 18). Amniocentesis is a diagnostic test, not a screening test, and is offered if screening indicates a high risk. MSAFP alone is part of second-trimester screening, which is less accurate than cFTS. The 20-week morphology scan can detect structural anomalies but is not the primary screening tool for chromosomal aneuploidy.
Question 3: A 32-year-old woman at 34 weeks' gestation presents with a persistent headache and visual disturbances. Her booking blood pressure was 110/70 mmHg. Today, her blood pressure is 150/95 mmHg. A urine dipstick shows 2+ proteinuria. According to the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) guidelines, which of the following is the most likely diagnosis?
- Gestational hypertension
- Chronic hypertension
- Eclampsia
- Pre-eclampsia (Correct answer)
Correct answer: Pre-eclampsia
The patient meets the diagnostic criteria for pre-eclampsia, which is defined as new-onset hypertension (≥140/90 mmHg) after 20 weeks' gestation accompanied by evidence of maternal organ dysfunction or uteroplacental dysfunction. In this case, she has new-onset hypertension plus proteinuria and neurological symptoms (headache, visual disturbances). Gestational hypertension is high blood pressure without proteinuria or other signs of organ dysfunction. Chronic hypertension would have been present before 20 weeks. Eclampsia involves the development of seizures in a woman with pre-eclampsia.
Question 4: According to the National Cervical Screening Program in Australia, what is the recommended primary screening test and interval for an asymptomatic 30-year-old woman with no history of cervical abnormalities?
- Liquid-based cytology (Pap smear) every 2 years
- Co-testing with HPV and cytology every 3 years
- Human Papillomavirus (HPV) DNA test every 5 years (Correct answer)
- Visual inspection with acetic acid (VIA) annually
Correct answer: Human Papillomavirus (HPV) DNA test every 5 years
The current Australian National Cervical Screening Program recommends primary screening with a Human Papillomavirus (HPV) DNA test every 5 years for asymptomatic women and people with a cervix aged 25 to 74. This replaced the 2-yearly Pap smear (cytology) program. If the HPV test detects an oncogenic HPV type, reflex liquid-based cytology (LBC) is performed on the same sample to triage management.
Question 5: A 29-year-old G1P0 at 40 weeks' gestation is in active labour. The cardiotocograph (CTG) shows a baseline fetal heart rate of 130 bpm, moderate variability, and repetitive, shallow decelerations where the nadir occurs after the peak of each contraction. What is the most appropriate immediate action?
- Administer an intravenous fluid bolus and place the mother in a lateral position (Correct answer)
- Proceed immediately to an emergency caesarean section
- Continue routine monitoring as this is a normal pattern
- Start an oxytocin infusion to augment labour
Correct answer: Administer an intravenous fluid bolus and place the mother in a lateral position
The CTG describes recurrent late decelerations, which are a sign of uteroplacental insufficiency and potential fetal hypoxia. The initial management involves intrauterine resuscitation measures aimed at improving placental blood flow and fetal oxygenation. These steps include changing maternal position (to left or right lateral to relieve aortocaval compression), administering an IV fluid bolus, and potentially reducing uterine activity (e.g., by stopping oxytocin if it is running). Immediate delivery is only indicated if these measures fail to resolve the non-reassuring pattern. This is not a normal pattern, and augmenting labour would likely worsen the fetal compromise.
Question 6: A 24-year-old woman presents with a history of irregular menstrual cycles, occurring every 3 to 6 months, and significant acne. An ultrasound report notes that both ovaries have multiple small follicles. According to the Rotterdam criteria, which are widely used in Australia, what additional feature is required to diagnose Polycystic Ovary Syndrome (PCOS)?
- Insulin resistance on a glucose tolerance test
- A luteinising hormone (LH) to follicle-stimulating hormone (FSH) ratio greater than 2:1
- Evidence of clinical or biochemical hyperandrogenism (Correct answer)
- Body Mass Index (BMI) greater than 30 kg/m²
Correct answer: Evidence of clinical or biochemical hyperandrogenism
The Rotterdam criteria, which are standard for diagnosing PCOS in Australia, require the presence of two out of three of the following: 1) oligo- or anovulation (manifesting as irregular cycles), 2) clinical or biochemical signs of hyperandrogenism (e.g., hirsutism, severe acne, or elevated testosterone), and 3) polycystic ovaries on ultrasound. This patient already has oligo-ovulation (irregular cycles) and polycystic ovaries on ultrasound. Therefore, the third criterion, evidence of hyperandrogenism (in this case, her significant acne serves as a clinical sign), completes the diagnosis. While insulin resistance, an altered LH:FSH ratio, and obesity are common in PCOS, they are not part of the core diagnostic criteria.
AMC MCQ - Australian Medical Council Multiple Choice Questions Obstetrics and Gynaecology Questions and Answers 1
A 62-year-old woman, G2P2, who went through menopause 10 years ago, presents with a single episode of vaginal spotting.
She is not on hormone replacement therapy and has a BMI of 32 kg/m².
What is the most appropriate initial investigation to assess her risk of endometrial carcinoma?