OG35.{1-14,19},OG36.1-2,OG38.4 | Core Clinical Skills — Practice Quiz

Correct. Naegele's rule (LMP + 1 year + 7 days – 3 months) assumes a 28-day cycle. This woman has a 35-day cycle — 7 days longer than the standard. Ovulation occurs approximately 7 days later, so the EDD is shifted forward by 7 days: 12th December + 7 days = 19th December.

Always ask cycle length before applying Naegele's rule. For every extra day beyond 28, shift the EDD forward by one day.

Remember that Naegele's rule is calibrated for a 28-day cycle. For a 35-day cycle (7 days longer), add 7 extra days to the standard EDD. Standard EDD = 12th December; corrected EDD = 19th December.

Correct. The OG history follows the same logical sequence as any clinical history: chief complaint → history of present illness → menstrual history → obstetric history → gynaecological history → contraceptive history → personal/social history. Starting with the chief complaint establishes the context for all subsequent questions.

A complete OG history follows: chief complaint → HPI → menstrual → obstetric → gynaecological → contraceptive → personal/social/family history.

The correct sequence begins with chief complaint and its duration — the patient's presenting problem — before moving to menstrual, obstetric, and other specialised components. This mirrors the universal clinical history structure.

Correct. The obstetric formula (gravida, para, living, abortion — G/P/L/A), gestational age, EDD, and fetal presentation are discipline-specific essentials unique to the obstetric case record. Demographic details, medications, and clinical history are standard across all specialties.

The obstetric case record must always include the obstetric formula (G/P/L/A), gestational age in weeks, EDD by Naegele's rule (adjusted for cycle), and fetal lie/presentation/position.

While demographic details, medications, and clinical history are required in any case record, the OBSTETRIC-SPECIFIC essentials are: obstetric formula (G/P/L/A), gestational age, EDD, and fetal presentation. These are unique to OG documentation.

Correct. GDM resolves in most women after delivery, but approximately 50% develop type 2 diabetes within 10 years. The discharge summary MUST include a recommendation for OGTT at 6–12 weeks postpartum (WHO 75 g 2-hour OGTT). Without this instruction in the discharge summary, the primary care physician may not know to arrange this follow-up.

A discharge summary ensures continuity of care. For GDM, the key follow-up instruction is OGTT at 6–12 weeks postpartum — approximately 50% of GDM women develop type 2 diabetes within 10 years.

The critical actionable item in a GDM discharge summary is the recommendation for postpartum OGTT at 6–12 weeks to screen for persistent glucose intolerance or type 2 diabetes. This is a follow-up instruction that enables continuity of care.

Correct. Informed consent is a process, not a paper. A signed form without comprehension is legally and ethically vulnerable. The doctor performing or supervising the procedure must re-explain the specific risk the patient has raised, confirm comprehension (ask her to repeat back what bleeding means for this surgery), and document this additional discussion in the notes.

Consent is a process, not a paper. A signature without comprehension is invalid. Always explain, confirm understanding (ask the patient to repeat back), and document additional discussions.

A signed consent form without patient comprehension does not constitute valid informed consent. The operating doctor must personally explain the misunderstood risk, confirm comprehension, and document the conversation. Delegating to a nurse or simply proceeding is inappropriate.

Correct. The SPIKES protocol (Setting → Perception → Invitation → Knowledge → Empathy → Summary/Strategy) is the structured framework for breaking bad news in obstetrics and gynaecology. It ensures privacy, gauges the patient's existing understanding before adding new information, uses plain language, and provides an empathic response before outlining next steps.

SPIKES is the standard bad-news protocol in OG: Set the scene (privacy, sitting) → gauge Perception → get Invitation to proceed → share Knowledge in plain language → respond with Empathy → give Summary/Strategy.

Breaking bad news requires a structured approach. The SPIKES protocol (Setting, Perception, Invitation, Knowledge, Empathy, Summary/Strategy) is the standard framework. Speed, medical jargon, and third-party disclosure without patient consent are all inappropriate.

Correct. Before investigating any pelvic mass, always catheterise the bladder — a distended bladder is the most common masquerading 'pelvic mass' in a busy OPD. After catheterisation, pelvic ultrasound is the first-line imaging investigation for a pelvic mass. CA-125, MRI, and laparoscopy are ordered after ultrasound characterises the mass.

Bedside rule: always catheterise before diagnosing a pelvic mass. A full bladder is the most common 'pelvic mass' in OPD. Pelvic ultrasound is the first-line imaging investigation.

The bedside rule for any pelvic mass: catheterise first. A full bladder is the most common false 'pelvic mass.' After catheterisation, pelvic ultrasound is the first-line investigation — it characterises the mass (origin, echogenicity, vascularity) before more expensive or invasive tests.

Correct. Standard (universal) precautions assume EVERY patient is potentially infectious. They are applied universally — not selectively based on known diagnosis or serostatus. This prevents both under-protection (thinking a 'clean' patient is safe) and stigmatisation of patients with known infections.

Universal precautions are applied to every patient, regardless of serostatus. Selective precautions only for known infections violate the universal principle and may stigmatise patients.

Universal precautions mean exactly that — universal, not selective. They apply to every patient, regardless of known infection status. The principle is that all blood and body fluids are treated as potentially infectious.

Correct. The ABCDE framework guides initial management of PPH. A shock index >1.0 (pulse/SBP) indicates significant haemodynamic compromise. The immediate priority is: call for help (two-call rule) → establish IV access (two large-bore cannulae, 16G or above) → commence fluid resuscitation → simultaneously assess uterine tone. Ergometrine is contraindicated in hypertension; treatment of the cause (atony, trauma, retained tissue) follows assessment.

Shock index = pulse/SBP. A value >1.0 indicates significant haemorrhage. Initial PPH management: call for help → two large-bore IVs → rapid crystalloid → assess uterine tone. Ergometrine is contraindicated in hypertension/pre-eclampsia; carboprost is contraindicated in asthma.

In PPH with haemodynamic compromise (shock index >1.0), the immediate priority is Circulation: call for help, secure two large-bore IV lines, and begin rapid crystalloid while assessing the cause. Ergometrine is contraindicated in hypertension. Surgical transfer comes after initial stabilisation.

Correct. A referral note for a high-risk obstetric emergency must specify: current haemodynamic and clinical status, treatment already administered (critically — the loading and maintenance dose of MgSO4, with timing, so the receiving team knows the last dose and can prevent toxicity), reason for referral, and urgency grading. This enables the receiving team to continue care without dangerous duplication or gap.

For severe pre-eclampsia referrals, the most critical referral note element is MgSO4 dose and timing already given — the receiving team must know this to avoid re-dosing toxicity. Always include current BP, proteinuria, and treatment given before transfer.

The essential components of an emergency referral note are: current clinical status → treatments already given (especially MgSO4 dose and timing, to prevent double-dosing toxicity) → reason for referral → urgency grading. Nursing details and social information are secondary.