EMQ

EMQ — Extended Matching Question · Review

Question 228

Delivery suite → Haemorrhage

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Classification

Speciality

Obstetrics and Gynaecology

Group

Clinical

Title

Delivery suite

Topic

Haemorrhage

Subtopic 1

Antepartum haemorrhage

Subtopic 2

Local

Subtopic 3

Assessment

Question Type

EMQ

Question

EEMQ

Question Header

Question Stem

A 30-year-old primigravida at 31+5 weeks presents after noticing a small amount of fresh blood on wiping following intercourse. She has no abdominal pain or contractions and reports normal fetal movements. Blood pressure is 112/68 mmHg, pulse 78/min and the uterus is soft and non-tender. Fetal assessment is reassuring. Her 20-week scan reported a posterior placenta clear of the internal cervical os. She reports several smaller episodes of postcoital spotting earlier in pregnancy. There is no ongoing heavy bleeding.

Answer Bank

A Digital vaginal examination as the first genital examination

B Rectal examination

C Examination under general anaesthesia

D No genital examination because all APH must be assumed placental

E Bimanual pelvic examination

F Speculum examination

G Immediate cervical biopsy during the bleeding episode

H Manual exploration of the cervical canal

Correct Answer

F. Speculum examination

Explanation

The recurrent small-volume postcoital bleeding, absence of pain or uterine tenderness and previously documented placental position make a local genital-tract source clinically important. Speculum examination can identify cervical or vaginal causes of bleeding. If the cervix appears suspicious, appropriate colposcopic evaluation should follow. The question requires discrimination between investigation of a local source and unnecessary or potentially hazardous digital manipulation.

Option Validity

A) Digital examination is not the preferred method for identifying a cervical or vaginal source of bleeding.

B) Rectal examination does not appropriately evaluate the likely genital-tract source.

C) Examination under anaesthesia is disproportionate as the initial assessment in this stable patient.

D) Local genital-tract causes remain part of the differential diagnosis of APH.

E) Bimanual examination is less appropriate than direct visualisation for identifying a cervical or vaginal lesion.

G) A suspicious cervical appearance requires appropriate specialist evaluation; immediate routine biopsy is not the initial examination requested here.

H) Manual cervical exploration is unnecessary and potentially traumatic.

Source & metrics

Authored Difficulty

4.00

Evaluation Score

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Destination

eBook

Source

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Updated

2026-10-06 01:57:35

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