Archives: Medical Student Finals

MSFinals-1718

A prospective study is designed to compare the risks and benefits of combined oestrogen and progesterone replacement therapy versus oestrogen-only replacement therapy in patients aged < 55 years, who are within 10 years of their menopause. One group of women will receive systemic oestrogen and progesterone for 4 years (HRT group) and the second group will receive the same systemic dose of oestrogen (without progesterone) for the same period (ERT group). The levonorgestrel intrauterine system is placed in women of the second group to counterbalance the effect of systemic oestrogen on the endometrium. The study will only include women who have not undergone a hysterectomy.
Which one of the following outcomes is most likely to be observed at the end of this study?

MSFinals-1719

A 28-year-old dentist presents to the General Practitioner (GP) with symptoms of irregular menstrual bleeding associated with abdominal discomfort. She often does not have periods for months at a time. She is also overweight and has always had a history of hirsutism. The patient is concerned that she may have polycystic ovarian syndrome.
A pelvic ultrasound is ordered to confirm the diagnosis.
Which of the following is the most common site of referred ovarian pain?

MSFinals-1701

A 27-year-old woman is being consented for a diagnostic laparoscopy for endometriosis. Apart from dysmenorrhoea, menorrhagia and difficulty conceiving, she has no past medical history. She takes ibuprofen during menses, but does not take any other medication. She has never had surgery before, and appears nervous.
What common side-effect of laparoscopy should she be cautioned about prior to the procedure?

MSFinals-1702

A 38-year-old woman presents with a gradual masculinisation process, including deepening of her voice, increased body hair, and clitoral enlargement. Ultrasonography shows a tumour in the left ovarian hilus, and her 17-ketosteroid excretion is elevated. The histopathology confirms a diagnosis of hilus cell tumour, with large, lipid-laden tumour cells. Which cells in the male reproductive system are homologous to the affected cells?

MSFinals-1696

A 35-year-old woman presents with increasing abdominal distension and feeling bloated, which has been getting worse over the last six months. She has no other medical history of note. She has regular periods with a 30-day cycle without heavy or intermenstrual bleeding.
On examination, there is an abdominal mass in the region of the left iliac fossa which is tender to palpation. The doctor orders blood tests and arranges an urgent ultrasound scan of the abdomen to assess the mass further.
Which of the following is the most likely diagnosis in this patient?

MSFinals-1697

A 29-year-old woman, who previously had a negative HPV smear, has been requested to visit the General Practice Surgery to discuss the outcome of her recent smear. The results letter states that she is ‘human papillomavirus negative’. As per NICE guidelines, what is the most suitable course of action for managing this patient?

MSFinals-1698

A 25-year-old woman, presenting with a 4-month history of severe mood swings, breast tenderness and reduced cognitive ability to perform functions at work, comes for a review with her diary of symptoms corresponding to a period of three cycles. She attends work regularly during these episodes and goes out with friends, but does not enjoy it as much and is less productive.
Going through the diary, symptoms occur during the luteal phase and resolve 2–3 days into menstruation.
Blood tests, including thyroid function tests, are normal. She has tried the progesterone implant, which made her symptoms worse; therefore, she is not currently using any contraception.
A diagnosis of premenstrual syndrome (PMS) is made.
Which of the following is the next step in the management of this patient?

MSFinals-1699

A gynaecologist is performing a pelvic examination on a 30-year-old woman in the lithotomy position. To palpate the patient’s uterus, the index and middle fingers of the right hand are placed inside the vagina, while the fingers and palm of the left hand are used to palpate the abdomen suprapubically. While palpating the patient’s abdomen with her left hand, the doctor feels a bony structure in the lower midline.
Which one of the following bony structures is the doctor most likely to feel with the palm of her left hand?

MSFinals-1700

A 42-year-old woman, who had a hysterectomy to treat fibroids in the past, visits the Preoperative Gynaecology Clinic for sacrospinous fixation to address a vault prolapse. The surgeon discusses the potential risks and complications of the procedure before obtaining consent. What nerve is in danger of being harmed during sacrospinous fixation for vault prolapse treatment?

MSFinals-1684

A 23-year-old woman student presents to her general practitioner (GP) with menstrual irregularity. Her last menstrual period was 5 months ago. On examination, the GP notes an increased body mass index (BMI) and coarse dark hair over her stomach. There are no other relevant findings. The GP makes a referral to a gynaecologist.
What is the most probable reason for this patient’s menstrual irregularity?