Archives: Medical Student Finals

MSFinals-1643

A 58-year-old woman, with a history of fibromyalgia, presents to her General Practitioner with a 6-month history of a constant soreness in the pelvic and perineal area. She reports it is there most of the time, and she struggles to carry on with her daily activities and sleep. She is tearful and fatigued. She tried paracetamol and ibuprofen, but these have not worked. She denies any postmenopausal bleeding or vaginal discharge.
Examination is unremarkable. She had a recent abdominal computed tomography (CT) scan for investigation of acute diverticulitis that revealed no abnormality in the uterus and ovaries.
Which of the following is the next step in the patient’s management?

MSFinals-1644

A 65-year-old woman presents to the Gynaecology clinic with complaints of vaginal bleeding. She reports that she underwent menopause at age 63 and has never engaged in sexual activity. Her height is 5 ft and she weighs 136 kg. Upon further investigation, malignancy is detected in the suspected organ. What is the typical histologic appearance of the epithelial lining of this organ?

MSFinals-1623

A 30-year-old obese woman presents with a gradual onset of hirsutism and abnormal menses. Her menses are irregular and vary in duration, timing and amount of bleeding. She had an impaired glucose tolerance diagnosis 2 years ago, using an oral glucose tolerance test. Luteinising hormone concentration is elevated. Serum androstenedione and testosterone concentrations are mildly elevated. Serum sex hormone-binding globulin is decreased. The concentration of 17-hydroxyprogesterone is normal. Ultrasound shows bilaterally enlarged ovaries with multiple cysts.
Which one of the following is the most likely diagnosis?

MSFinals-1624

A 25-year-old female graduate student presents to her primary care physician with complaints of weight gain and excessive hair growth on her face and upper chest. She reports having irregular periods, with only one occurring every 2-3 months. Upon examination, the patient is found to have elevated levels of testosterone at 3.5 nmol/l and an elevated LH:FSH ratio. Additionally, she is overweight with a BMI of 28 and has acne. What is the most probable diagnosis?

MSFinals-1625

A 32-year-old woman and her 34-year-old partner visit the general practice clinic as they have been unsuccessful in conceiving after 14 months of trying. She reports having regular menstrual cycles every 28 days.
What is the most appropriate test to determine if she is ovulating?

MSFinals-1626

A 32-year-old women with her 34-year-old partner have come to see you regarding the inability to conceive over the last year. She has regular cycles over 28 days.
Which test will best see if she is ovulating?

MSFinals-1627

You are seeing a 67-year-old woman who has recently been diagnosed with urge incontinence. She has tried conservative measures, such as optimizing fluid and caffeine intake and completing six weeks of bladder training, which have helped to some extent. However, her main symptom of nocturia continues to affect her sleep and well-being. She has no other medical history and currently takes no regular medication. What is the next most appropriate treatment?

MSFinals-1628

A 32-year-old woman, who was recently diagnosed with polycystic ovary syndrome (PCOS), has been struggling with persistent hirsutism and acne since her teenage years. She expresses that this is now impacting her self-confidence and she has not seen any improvement with over-the-counter acne treatments. When asked about her menstrual cycles, she reports that they are still irregular and she has no plans to conceive at the moment. What is the most suitable next step in managing this patient?

MSFinals-1629

A 56-year-old postmenopausal woman visits her GP complaining of increased urinary frequency and urgency for the past 4 days, along with two instances of urinary incontinence. She has a medical history of type 2 diabetes mellitus (managed with metformin) and diverticular disease. She does not smoke but admits to consuming one bottle of wine every night. During the examination, her heart rate is 106 bpm, and she experiences non-specific lower abdominal discomfort. Perineal sensation and anal tone are normal. What is the most probable cause of this patient’s incontinence?

MSFinals-1630

A 30-year-old woman presents with a history of heavy menses since she started menstruating at the age of 13. She has regular periods every 28 days, which last for seven days, during which time she works from home as she needs to change pads every 1–2 hours.
She is in a relationship and does not wish to conceive at present. A full blood count and a pelvic ultrasound are abnormal.
You offer her the levonorgestrel intrauterine system (IUS), as per the National Institute for Health and Care Excellence (NICE) guidelines.
Which of the following is a contraindication to the insertion of levonorgestrel IUS?