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  • Question 1 - A 27-year-old G2P1 visits the gynaecologist with complaints of increased hair growth on...

    Correct

    • A 27-year-old G2P1 visits the gynaecologist with complaints of increased hair growth on her face, breast, and belly, but hair loss in the temporal regions of her head. She has also struggled with acne. On physical examination, the patient's face, chest, and belly are covered in coarse, dark hair. Her clitoris is swollen on pelvic examination. Her left adnexal mass is 7 cm in diameter. What is the most likely ovarian tumour to be associated with this clinical picture?

      Your Answer: Sertoli-Leydig cell tumour

      Explanation:

      Sertoli-Leydig cell tumours constitute less than 0.5 percent of ovarian neoplasms. They may behave in a benign or malignant fashion, which correlates with the degree of differentiation in an individual case. Approximately 75 percent occur in women under the age of 40 years (mean age at diagnosis is 25), but they occur in all age groups. The neoplasms are characterized by the presence of testicular structures that produce androgens. This can result in virilization, although not all of these neoplasms are functionally active.

      Pure Sertoli cell tumours are usually estrogenic and may also secrete renin, leading to refractory hypertension and hypokalaemia. In addition, these tumours may be associated with Peutz-Jeghers syndrome.

      Pure Leydig cell tumours are androgen secreting; only a few cases have been reported. Virtually all of these rare tumours are unilateral and confined to the ovary at diagnosis.

      Granulosa cell tumours typically present as large masses; the mean diameter is 12 cm. Women may present with an asymptomatic mass noted on abdominal or pelvic examination. Granulosa cell tumours often produce oestrogen and/or progesterone; consequently, symptoms related to hyperestrogenism are common at diagnosis.

      Krukenberg tumour, also known as carcinoma mucocellulare, refers to the signet ring subtype of metastatic tumour to the ovary. The stomach followed by colon are the two most common primary tumours to result in ovarian metastases, pursued by the breast, lung, and contralateral ovary.

      A rare tumour that is made up of more than one type of cell found in the gonads (testicles and ovaries), including germ cells, stromal cells, and granulosa cells. Gonadoblastomas are usually benign (not cancer), but they may sometimes become malignant (cancer) if not treated.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 2 - A 23 year old female patient with DVT on anticoagulant came to your...

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    • A 23 year old female patient with DVT on anticoagulant came to your clinic for advice. She is on combined OCPs. What would you advice her?

      Your Answer: Progesterone only pill

      Explanation:

      Women with medical conditions associated with increased risk for thrombosis generally should not use oestrogen-containing contraceptives.

      The majority of evidence identified does not suggest an increase in odds for venous or arterial events with use of most POCs. Limited evidence suggested increased odds of VTE with use of injectables (three studies) and use of POCs for therapeutic indications (two studies, one with POCs unspecified and the other with POPs).

      Discontinuing anticoagulants increases her risk of recurrent DVT.

    • This question is part of the following fields:

      • Gynaecology
      5.5
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  • Question 3 - A 35-year-old female went to a contraception clinic because she does not want...

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    • A 35-year-old female went to a contraception clinic because she does not want to conceive for the next 2 years. She also has a history of heavy menstrual bleeding and pelvic pain. Imaging revealed fibroids. What is the best method of contraception for the patient in this case?

      Your Answer: IUS

      Explanation:

      IUS or Intra Uterine System/Device releases progestin. The progestin thickens the cervix, preventing the sperm from penetrating the cervix, and it also causes the uterine lining to become thinner, preventing any implantation. IUS may also prevent excessive bleeding and can help women with fibroids.

    • This question is part of the following fields:

      • Gynaecology
      1.3
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  • Question 4 - An 18 year old and has yet to begin her period. She stands...

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    • An 18 year old and has yet to begin her period. She stands at 4'10. She shows no signs of breast development. She has no pubic hair on pelvic examination. The patient has a cervix and uterus, according to digital inspection. The ovaries cannot be felt. Serum FSH and LH levels are drawn as part of the workup, and both are elevated. Which of the following is the most likely cause of this patient's delayed puberty and sexual infantilism?

      Your Answer: Gonadal dysgenesis

      Explanation:

      In girls, delayed puberty and primary amenorrhea may be subdivided according to associated changes in stature. If the affected girl is short, the likely causes are gonadal dysgenesis (Turner syndrome) or hypopituitarism (with both gonadotropin and growth hormone deficiency). Gonadal dysgenesis results from the absence of a sex chromosome or other abnormality of a sex chromosome. In affected girls the gonads are streaks of fibrous tissue and contain no follicles, and these girls may have a variety of congenital anomalies, including a webbed neck, a shieldlike chest, or a small jaw.

      Kallmann syndrome presents with amenorrhea, infantile sexual development, low gonadotropins, normal female karyotype, and anosmia (the inability to perceive odours).

      In Müllerian agenesis, the Müllerian ducts either fail to develop or regress early in fetal life. These patients have normal ovarian development and normal secondary sexual characteristics. They present with a blind vaginal pouch and no upper vagina, cervix, or uterus, and primary amenorrhea.

      The McCune-Albright syndrome rather presents with precocious puberty.

    • This question is part of the following fields:

      • Gynaecology
      2.1
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  • Question 5 - A 62-year-old woman complains of urinary incontinence for the past 12 months after...

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    • A 62-year-old woman complains of urinary incontinence for the past 12 months after having four pregnancies before the age of 30. She has to wear a 'pad' inside her pants all of the time because of this condition. She isn't on any hormone replacement therapy at the moment. Which of the following signs indicates that the incontinence is most likely true stress incontinence?

      Your Answer: Only small quantities of urine ore lost each time she is incontinent.

      Explanation:

      Only little volumes of urine are lost when her intra-abdominal pressure is elevated during coughing, laughing, jumping, and straining, which is the only symptom associated with real stress incontinence.
      The other reactions are significantly more compatible with a detrusor instability diagnosis (also called urge incontinence).
      If she had incontinence throughout pregnancy, it would have been stress in nature, which is what her current incontinence is.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 6 - A 34-year-old woman presents to your clinic with a chief complaint of vague...

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    • A 34-year-old woman presents to your clinic with a chief complaint of vague stomach pain. A unilocular cyst (3.8 x 4.3 x 3.0 cm) was discovered in the left ovary during a trans-abdominal ultrasound. What is the best management strategy?

      Your Answer: Reassurance, no further action required

      Explanation:

      In premenopausal women, watchful waiting usually involves monitoring for symptoms (pelvic pain or pressure) and repeating the pelvic ultrasound after six to eight weeks. If the ovarian cyst does not enlarge or if it resolves during the period of watchful waiting, it does not usually require surgical removal. Some premenopausal women will be advised to take a birth control pill during this time to help prevent new ovarian cysts from developing.

      If a cyst decreases in size or does not change, the ultrasound is often repeated at regular intervals until your healthcare provider is certain that the cyst is not growing. If the cyst resolves, no further testing or follow-up is required.
      Surgery may be recommended in the following situations:
      – A cyst is causing persistent pain or pressure, or may rupture or twist.
      – A cyst appears on ultrasound to be caused by endometriosis and is removed for fertility reasons.
      – Large cysts (>5 to 10 cm) are more likely to require surgical removal compared to smaller cysts. However, a large size does not predict whether a cyst is cancerous.
      – If the cyst appears suspicious for cancer. If you have risk factors for ovarian cancer or the cyst looks potentially cancerous on imaging studies, your healthcare provider may recommend surgery.
      – If the suspicion for ovarian cancer is low but the cyst does not resolve after several ultrasounds, you may choose to have it removed after a discussion with your healthcare provider. However, surgical removal is not usually necessary in this case.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 7 - A 18-year-old girl arrives at the ER with severe abdominal pain. When it...

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    • A 18-year-old girl arrives at the ER with severe abdominal pain. When it started, she was in the school band. She says the pain began 30 minutes ago in the left lower region and didn't radiate. On a scale of 1 to 10, the discomfort is a 7 and is not accompanied by nausea, vomiting, or diarrhoea. Menarche began at the age of thirteen. Her menses were erratic at first, but she has had regular periods for the past six months. Her vital signs are stable, and she has no fever. She uses combination oral contraceptives and is sexually active. She denies taking any other drugs. A flat abdomen with regular peristalsis is revealed on physical examination. Pelvic examination indicates a regular vagina with a normal-appearing cervix. There is no mucopurulent cervical discharge. Bimanual examination is remarkable with a tender 5-cm mass in the left adnexa. A pregnancy test result is negative. A pelvic sonogram exhibits a normal intrauterine pregnancy and a 5 X 6 cm complex mass of the left ovary, with focal areas of calcification. Which of the following is the most likely diagnosis?

      Your Answer: Cystic teratoma

      Explanation:

      Mature cystic teratomas of the ovary are often discovered as incidental findings on physical examination, during radiographic studies, or during abdominal surgery performed for other indications.

      Most mature cystic teratomas can be diagnosed at ultrasonography (US) but may have a variety of appearances, characterized by echogenic sebaceous material and calcification.

      Follicular cysts are simple fluid-filled cysts and never have calcifications.

      Mucinous cystadenoma usually develop in the third to fifth decades of life and typically cause vague symptoms, such as increasing abdominal girth, abdominal or pelvic pain, emesis, fatigue, indigestion, constipation, and urinary incontinence However, calcifications are not usually seen.

      Brenner tumour is also a benign epithelial ovarian tumour but it is solid, occurring most often in women over 50 years of age.

      Serous cystadenoma also does not show calcifications.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 8 - A 51-year-old woman comes to your doctor's office for a breast cancer screening....

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    • A 51-year-old woman comes to your doctor's office for a breast cancer screening. For the past year, she has been on combination hormone replacement treatment (HRT). Mammography is the sole accessible form of breast cancer screening, and she is predicted to have dense breast tissue due to HRT. Which of the following is the best HRT and breast cancer screening suggestion for this patient?

      Your Answer: Continue HRT and perform mammography as recommended for other women

      Explanation:

      Among a variety of imaging modalities developed for breast cancer screening, mammography is the best-studied and the only imaging technique that has been shown to decrease mortality as demonstrated in multiple randomized trials. However, it is important to know that, even in the best circumstances, mammography may miss up to 20 percent of underlying breast cancers.

      Women on HRT are likely to have dense breast. Dense breasts are associated with an increased risk of breast cancer and can decrease the sensitivity of mammography for small lesions. Nevertheless, we do not alter our general approach to age- and risk-based screening based on breast density. However, for women with dense breasts, we do prefer digital mammography over film mammography, due to greater sensitivity; digital mammography is the modality typically used for mammography in most locations in the United States.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 9 - A 38-year-old lady appears with a 7-month history of secondary amenorrhea. She has...

    Correct

    • A 38-year-old lady appears with a 7-month history of secondary amenorrhea. She has a BMI of 24. Her FSH level is 55 U/L (2-8 U/L in luteal phase; >25 U/L in menopause), LH is 54 U/L, and oestradiol is low, according to laboratory tests. The level of serum prolactin is likewise normal. Her urine pregnancy test came out negative. Each ovary had 3-4 cysts on ultrasonography. She hopes to get pregnant in the near future. Which of the following would be the best treatment option for her condition?

      Your Answer: Menopausal hormone replacement therapy (HRT)

      Explanation:

      Ovarian insufficiency is a failure of the ovary to function adequately in a woman younger than 40 years, in its role either as an endocrine organ or as a reproductive organ. In women aged 40 years or older, the expected physiologic decline of ovarian function that takes place with aging is termed perimenopause or the menopausal transition.
      Medical treatment of patients with primary ovarian insufficiency should address the following aspects:

      Ovarian hormone replacement
      Restoration of fertility
      Psychological well-being of the patient

      It is not appropriate to give this patient contraceptive pills since she desires pregnancy.

      There is no evidence that Danazol or Metformin would improve ovarian follicle function.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 10 - A 48-year-old woman presented to you with a breast mass. On examination, it...

    Correct

    • A 48-year-old woman presented to you with a breast mass. On examination, it is hard, irregular and ill defined. The surface of the breast is slightly bruised however, there is no discharge. The most probable diagnosis is?

      Your Answer: Fat necrosis

      Explanation:

      Fat necrosis is often a result of a trauma or surgery. In fat necrosis the enzyme lipase releases fatty acids from triglycerides. The fatty acids combine with calcium to form soaps. These soaps appear as white chalky deposits which are firm lumps with no associated discharge. The given case has a bruise which indicates prior trauma.

    • This question is part of the following fields:

      • Gynaecology
      2.3
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