Med Student Finals Category: Gynaecology

MSFinals-1687

A 29-year-old woman presents to her GP with a recent history of dyspareunia, occasional post-coital spotting and lower abdominal pain since having sexual intercourse with a new partner without using barrier methods. Her menstrual cycle is regular, and a pregnancy test is negative.
A pelvic examination reveals a blood stained purulent discharge, and cervical excitation is elicited on bimanual examination. Her blood pressure is 110/70 mmHg, heart rate 90 bpm and temperature 37.3 °C. Cervical and high-vaginal swabs are sent for analysis.
The patient reports she had two previous episodes of gonorrhoeal infection.
Which of the following is the most appropriate management?

MSFinals-1688

A 42-year-old woman has had a hysterectomy for a fibroid uterus two days ago. She will soon be ready for discharge, and your consultant has asked you to start the patient on hormone replacement therapy (HRT).
She has a body mass index (BMI) of 28 kg/m2, a history of type 2 diabetes mellitus on metformin and no personal or family history of venous thromboembolism.
Which of the following is the most appropriate management?

MSFinals-1673

A 29-year-old woman, with a history of ulcerative colitis, presents with a history of heavy, painful periods. She reports regular periods, lasting seven days.
During the first three days, she has to wear both a tampon and sanitary pads and has to take time off work due to the embarrassment of flooding and dizziness. She declined contraception, as she is trying for a baby.
A pelvic ultrasound revealed two small fibroids (< 3 cm in size) in the uterus, and a full blood count was as follows:
Investigation Result Normal value
Haemoglobin 95 g/l 115–155 g/l
Mean corpuscular volume (MCV) 73 fl 76–98 fl
White cell count (WCC) 7 × 109/l 4–11 × 109/l
Platelets (PLT) 390 × 109/l 150–400 × 109/l
Iron 12 μg/dl 50 to 170 µg/dl
Ferritin 5 μg/l 10–120 μg/l
What is the best first-line treatment for this patient’s menorrhagia if she is 29 years old?

MSFinals-1674

A 50-year-old multiparous woman presents to a specialist clinic with menorrhagia. She has multiple fibroids that distort the uterine cavity and has already completed a 3-month trial of tranexamic acid, which did not improve her symptoms. On examination, you notice that she appears pale and her uterus is equivalent to 16 weeks of pregnancy. The patient expresses her frustration and desire for a definitive treatment. A negative urinary pregnancy test is obtained. What would be the most appropriate definitive treatment for this patient’s menorrhagia?

MSFinals-1675

A 20-year-old woman visits her General Practitioner complaining of dysmenorrhoea. She has a history of asthma and cannot take ibuprofen due to a previous severe asthma attack triggered by the medication. An ultrasound scan reveals no pelvic pathology. What would be an appropriate treatment for her dysmenorrhoea?

MSFinals-1676

A 47-year-old woman presents to her General Practitioner (GP) with a 1-month history of post-coital bleeding, vaginal discomfort and intermittent vaginal discharge. She feels lethargic and reports unintentional weight loss. She is a single mother of two children and lives in shared accommodation with one other family. She is a smoker of 30 cigarettes a day. She has not engaged with the cervical screening programme.
Examination reveals a white lump on the cervix, associated with surface ulceration.
Cervical carcinoma is suspected.
Which of the following is a risk factor for developing cervical carcinoma?

MSFinals-1677

A 50-year-old woman visits her GP with a complaint of hot flashes that have been bothering her for the past 2 months, particularly at night, causing sleep and work disturbances. She expresses feeling exhausted and embarrassed at work, sweating profusely during the attacks, and carrying extra clothes to change. She is emotional and shares that she has been avoiding sexual intercourse due to pain. She has no medical history and is not on any medication. Her menstrual cycle is still ongoing but has become irregular, occurring once every 2-3 months. After a thorough discussion, she decides to start HRT. What would be the most suitable HRT regimen for this patient?

MSFinals-1678

A 32-year-old woman is considering artificial insemination. What is the most reliable blood hormone marker for predicting ovulation?

MSFinals-1679

A 35-year-old woman visits her GP and reports experiencing postcoital bleeding for the past three months. She denies any pain during intercourse and has not noticed any abnormal vaginal discharge except for the bleeding. She continues to have regular menstrual cycles. What is the most probable diagnosis in this scenario?

MSFinals-1680

A 32-year-old woman is admitted to hospital for a hysterectomy for treatment of fibroids.
What are the standard preventive measures for all women undergoing a complete abdominal hysterectomy?