SHORT ANSWER QUESTIONS – SECTION C

1. Mrs. Sarah Smith, a 29-year-old G2P2 +0 patient is 6 weeks postpartum and is breastfeeding. She visits her
GP requesting contraceptive advice.

(i) Which contraceptive methods would be suitable for her? (2 marks)

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(ii) She opts for an injectable method. Give 2 examples of these and the frequency of administration.
(2 marks)

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(iii) What is the pearl index with this method?

(1/2 mark)

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(iv) List 3 non-contraceptive uses of this injectable

(1 ½ marks)

(v) She returns to her GP three weeks later complaining of prolonged vaginal bleeding. Discuss her
subsequent management. (4 marks)

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2. A 26-year-old G2P1 +0 is seen in the ANC complaining of epigastric pain. On clinical examination, a
breech presentation at 36 weeks gestation is suspected,

(i) What two clinical findings will support the above diagnosis? (2 marks)

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(ii) What investigation will you request? (1 mark)

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(iii) List 4 useful bits of information that can be obtained from this investigation. (2 marks)

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(iv) The patient does not wish to have a Caesarean section. What are two options for delivery? (1 mark)

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(v) When should this be performed and give one reason for your answer. (2 marks)

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(vi) List 4 possible complications for one of the above options stated in (iv). (2 marks)

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3. A 25-year-old primigravida at 39 weeks gestation was admitted in labour 12 hours ago. CTG training of the
fetal heart now shows a baseline rate of 180 bpm and persistent late decelerations.
She is now scheduled to undergo an emergency Caesarean section under general anaesthesia.

(i) List 4 indications for emergency Caesarean section. (2 marks)

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(ii) List 4 key steps in preparing this patient for surgery. (2 marks)

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(iii) Post-operatively, she complains of shortness of breath. List 4 conditions which may be present giving
rise to this complaint. (2 marks)

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(iv) What 2 simple investigations might you perform? (2 marks)

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(v) What treatment measures might be instituted? (2 marks)

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4. A 22-year-old nulliparous patient with a BMI of 33 presents to the gynaecology clinic complaining of
excessive facial hair and irregular menses.

(i) What is the likely diagnosis? (1/2 mark)

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(ii) List 4 differential diagnoses. (2 marks)

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(iii) What criteria must be fulfilled to support the above diagnosis in (i)? (11/2 marks)

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(iv) What three investigations will you perform? (11/2 marks)

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(v) What are the long-term health implications of this condition? (11/2 marks)

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(vi) How will you manage this patient? (3 marks)

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SAQ Answers:
1)
i. Condoms 
Mini pill 
Injectables / implant (implanon) 
IUCD 
 
ii. Depo Provera every  12 weeks 
Noristerat every 8 weeks 
 
iii. 0 ‐1 
 
iv. Treatment of endometriosis 
Regression of endometrial hyperplasia in female wanting to preserve fertility 
Treatment of advanced/ recurrent endometrial Carcinoma 
 
v. Bleeding most likely as a result of the Depo‐Provera, however still need to exclude other causes 
– cervical pathology etc. 
 
Counselling / reassurance 
 
MXA 
 
May consider COCP x 3/12 
 
 
2)
i. Firm round, ballotable mass in upper pole / soft indentable mass in lower pole of uterus 
Fetal heart ascultated above umbilicus 

ii.  Ultrasound scan 
 
iii. Type of breech 
Liquor volume 
Placental site 
EFW 
Placental site 
Congenital abnormalities 
Pelvic tumours e.g fibroids 
Hc: Ac ratio 
 
iv. ECV 
Vaginal breech delivery 
 
v. After lung maturity achieved in case emergency delivery needed ECV at 37‐38 w 
Before engagement of breech 
Before onset of labour 
 
vi.  Complications of ECV 
Fetal bradycardia / distress
Placental abruption
Uterine rupture
Cord entanglement
Ruptured membranes
Feto-matrernal transfusion

OR
Complications of vaginal breech delivery
Cord prolapse
Trauma to viscera – liver
‐ Spleen 
Brachial plexus injury
Fracture of limbs
Dislocation of hips
Intra-cranial haemorrhage
3)

i. Fetal distress 
Cord prolapse
Antepartum haemorrhage 
Failure to progress in 1st or 2nd stages of labour 
Malpresentation in labour e.g. brow / face – mento posterior  

ii. Consent  
IV access / blood investigation 
Antacid prophylaxis – sodium citrate / vanitidine 
Catheterize bladder 
Contact relevant personnel – Paediatrician 
             Anaesthetist 
              Theatre etc. 
iii. Atelectasis 
Pulmonary oedema 
Pneumonia 
Pulmonary embolism 

iv. Arterial blood gases 
CXR
ECG
WBC

v. Px depends on likely cause 
‐ O2 
‐ diuretics 
‐ LMWH 
‐ physiotherapy 
‐ Antibiotics 
4)

i.     PCOS 
 
ii.     congenital adrenal hyperplasia 
Cushings syndrome
    Adrenal tumour 
    Hypothyroidism 
    Ovarian tumours (arrhenoblastoma) 

iii.     Androgen excess (biochemically – increase testerone / clinically …. Hirsutism / acne) 
    Menstrual irregularity (oligomenonhoea / omenorrhoea) 
    USS 12 – 15 follicles in peripheral distribution / ovarian volume > 10 cm 3   

iv.    Hormonal assay – testosterone 
Prolactin
LH FSH
Ultrasound scan
Dexamethasone suppression test

v.    Diabetes Mellitus 
   Ischemic heart disease 
   Endometrial Carcinoma 

vi.    Cosmetic procedures – electrolysis 
                                             Waxing / depilators etc. 
    Lifestyle changes – diet / exercise 
    Methformin 
    Diane‐35 / COCP