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Question 1
Correct
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A 27-year-old woman admitted with per vaginal bleeding and left sided pelvic pain for 2 days. There was no history of fever. She gave a history of absent periods for past 8 weeks. Abdominal examination revealed guarding and rebound tenderness in left iliac region. There was left sided cervical excitation on vaginal examination. What is the most probable diagnosis?
Your Answer: Ectopic Pregnancy
Explanation:History of amenorrhoea, abdominal and vaginal examination are more favour of ectopic pregnancy. Endometriosis usually has a chronic cause and dysmenorrhoea. Salpingitis usually presents with fever. Ovarian torsion and ovarian tumours have different clinical presentations.
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This question is part of the following fields:
- Gynaecology
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Question 2
Correct
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A 24-year-old pregnant female presented with severe pain in the lower abdomen and excessive vaginal bleeding at 35 weeks gestation. Which of the following investigations should be done?
Your Answer: US abdomen
Explanation:Ultrasound of abdomen should be done to rule out the cause of the excessive bleeding in this patient, this could confirm the very high suspicion of rupture of the placenta in this case.
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This question is part of the following fields:
- Gynaecology
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Question 3
Incorrect
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A 25 year old female who was on sodium valproate for epilepsy came for the advice about contraception. Which of the following is accurate?
Your Answer: She can use COCP if anticonvulsant is changed to carbamazepine.
Correct Answer: She can use COCP
Explanation:There are no interactions between the combined oral contraceptive pill, progesterone-only pill, medroxyprogesterone injections or levonorgestrel implants and the AEDs valproic acid (sodium valproate), vigabatrin, lamotrigine, gabapentin, tiagabine, levetiracetam, zonisamide, ethosuximide and the benzodiazepines. So she can use COCP along with Sodium valproate.
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This question is part of the following fields:
- Gynaecology
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Question 4
Incorrect
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An 18 year old girl presented with dysmenorrhea and irregular cycles. The most appropriate management in this case would be?
Your Answer: Mini pill
Correct Answer: Combined pill
Explanation:Combined oral contraceptive pills have an anti ovulatory function and also reduce the pain of menstruation.
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This question is part of the following fields:
- Gynaecology
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Question 5
Incorrect
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A 30-year-old woman living in England had a cervical smear test one month ago. There were no cervical abnormalities visualised at the time of the smear. She has no symptoms of unusual vaginal bleeding and her previous smear results have always been negative. She received the following report: 'Your recent smear was negative with no evidence of nuclear abnormalities.' When will she be routinely recalled for her next smear?
Your Answer: 1 year
Correct Answer: 3 years
Explanation:Women aged 25-49 years living in England are routinely recalled for screening every three years. Women receive their first invitation for cervical screening at 25 years of age. They are not invited earlier as changes in the young cervix can be normal and result in unnecessary treatment. Provided the smears remain negative and there are no symptoms to suggest cervical cancer, the routine recall is three years for women aged 25-49 years. Women aged 50-64 years old are routinely recalled for a smear every five years. After the age of 65 years, women are only screened if they have not had a smear since the age of 50 years (including those who have never had a smear) or those who have had recent abnormal smears. This is because due to the natural history and progression of cervical cancer, it is highly unlikely that women over 65 years old will go on to develop the disease.Â
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This question is part of the following fields:
- Gynaecology
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Question 6
Incorrect
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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:
Correct 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.
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This question is part of the following fields:
- Gynaecology
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Question 7
Incorrect
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An 8-year-old girl presents with a history of a bright red bloodstain in her underpants one day prior to consultation. Her mother reports that the girl started cycling lessons one week ago. How will you proceed with the investigation in this case?
Your Answer:
Correct Answer: Examination under Anaesthesia
Explanation:A local exam might not help in locating the cause of the bleeding because it might be underneath the superficial structures. A thorough examination should be done under GA to accurately locate the source of bleeding.
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This question is part of the following fields:
- Gynaecology
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Question 8
Incorrect
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A 38 year old woman has had amenorrhea for a year now. She admits she stopped her COCP treatment 18 months ago. Her blood exams reveal the following: FSH=8, LH=7, Prolactin=400, Oestradiol=500. What is the most likely diagnosis?
Your Answer:
Correct Answer: Hypothalamic amenorrhea
Explanation:Functional Hypothalamic Amenorrhea (FHA) is a form of chronic anovulation, due to non-identifiable organic causes and often associated with stress, weight loss, excessive exercise, or a combination thereof. Investigations should include assessment of systemic and endocrinologic etiologies, as FHA is a diagnosis of exclusion. A multidisciplinary treatment approach is necessary, including medical, dietary, and mental health support. Medical complications include, among others, bone density loss and infertility.
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This question is part of the following fields:
- Gynaecology
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Question 9
Incorrect
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A 33 year old lady presented with complaints of heavy menstrual bleeding. She is otherwise well and her US abdomen is normal. What is the best treatment option?
Your Answer:
Correct Answer: Mirena coil
Explanation:Mirena coil is used for contraception and for long term birth control. It causes stoppage of menstrual bleeding however, in a few cases there may be inter-menstrual spotting.
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This question is part of the following fields:
- Gynaecology
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Question 10
Incorrect
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A 33 year old lady in her first trimester of pregnancy presented with loss of weight, abdominal pain and frequent episodes of vomiting. Her vital signs are normal. She has been given a cyclizine injection but without any significant improvement. The next step would be?
Your Answer:
Correct Answer: IV steroids
Explanation:In hyperemesis gravidarum, IV corticosteroids can be given to reduce vomiting, if the patient is not responding to standard anti emetics.
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This question is part of the following fields:
- Gynaecology
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Question 11
Incorrect
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A 35-year-old African female presents with a history of heavy menstrual bleeding and dysmenorrhoea for 4 months. Which of the following could be the most likely cause for this presentation?
Your Answer:
Correct Answer: Fibroid
Explanation:History of heavy menstrual bleeding and amenorrhoea favour the diagnosis of a fibroid uterus. All the given responses are causes for subfertility. Ectopic pregnancy presents with abdominal pain has an acute presentation. Endometriosis and adenomyosis usually don’t present with amenorrhoea or heavy bleeding respectively. PID presents with chronic pelvic pain and is not related to menstruation.
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This question is part of the following fields:
- Gynaecology
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Question 12
Incorrect
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A 13-year-old woman is complaining of a lot of acne in her face. Her BMI is 37. She does not have her period yet. She has high insulin levels in her labs. What is the most likely diagnosis?
Your Answer:
Correct Answer: Polycystic Ovarian Syndrome (PCOS)
Explanation:The best answer is Polycystic Ovarian Syndrome (PCOS), supported by amenorrhea, obesity and acne. High insulin levels are indicative of PCOS and exclude Cushing syndrome (as this is associated with low insulin levels).
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This question is part of the following fields:
- Gynaecology
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Question 13
Incorrect
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A 30-year-old female is being investigated for subfertility. At what day of her menstrual cycle should blood be collected for progesterone, if she has a regular 28-day menstrual cycle?
Your Answer:
Correct Answer: Day 21
Explanation:Maximum levels of progesterone are detected at day 21 of 28 days in the menstrual cycle, assuming that ovulation has occurred at day 14. A value of >30nmol/l indicates an ovulatory cycle.
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This question is part of the following fields:
- Gynaecology
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Question 14
Incorrect
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What is the failure rate of tubal sterilization?
Your Answer:
Correct Answer: 1 in 200
Explanation:Tubal sterilization is a safe and effective surgical procedure that permanently prevents pregnancy. However, pregnancy can occur in 1 in 200 cases, according to international sources. In the 1st year after tubal sterilization, the estimated failure rate is 0.1-0.8% respectively.
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This question is part of the following fields:
- Gynaecology
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Question 15
Incorrect
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48 hours after having unprotected intercourse, a 16-year-old female requested a pregnancy test from her GP. What advice can you give her regarding the reliability of pregnancy testing at this time?
Your Answer:
Correct Answer: Even if conception has already occurred, beta hCG is likely to be normal
Explanation:Even if conception has already occurred, beta hCG is likely to be normal. Beta hCG is made by syncytiotrophoblast cells following conception. It then activates the corpus luteum to continuously produce progesterone for implantation to happen. In week 10/40, levels of HCG peak and the placenta can produce adequate progesterone by itself. As a general rule, a beta HCG concentration >25 U/I or a doubling of levels of HCG within two days is required to diagnose pregnancy. A urine pregnancy test would only likely prove positive around 8 days to 2 weeks following conception.
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This question is part of the following fields:
- Gynaecology
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Question 16
Incorrect
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A 30-year-old woman has a vaginal discharge with pH <4.5 and a very foul smell. What is the single most likely diagnosis?
Your Answer:
Correct Answer: Trichomoniasis
Explanation:Trichomoniasis is a common sexually transmitted infection caused by a parasite. In women, trichomoniasis can cause a foul-smelling vaginal discharge which might be white, grey, yellow or green, genital itching and painful urination.
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This question is part of the following fields:
- Gynaecology
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Question 17
Incorrect
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Which of the following can be considered as a major contraindication for the use of medroxyprogesterone acetate (Provera)?
Your Answer:
Correct Answer: History of breast cancer
Explanation:Contraindications of PROVERA (medroxyprogesterone acetate) include: undiagnosed abnormal genital bleeding, known, suspected, or history of breast cancer, known or suspected oestrogen- or progesterone-dependent neoplasia, active DVT, pulmonary embolism, or a history of these conditions, active arterial thromboembolic disease (for example, stroke and MI), or a history of these conditions, known anaphylactic reaction or angioedema, known liver impairment or disease, known or suspected pregnancy.
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This question is part of the following fields:
- Gynaecology
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Question 18
Incorrect
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A woman presents with pain and oedema of one leg, 3 days after an obstructed labour. Upon examination the leg is cold and pale. What is the most likely diagnosis?
Your Answer:
Correct Answer: Embolus
Explanation:Venous thromboembolism (VTE) during pregnancy and the postpartum window occurs at a 6-10-fold higher rate compared with age-matched peers and is a major cause of morbidity and mortality. Hypercoagulability persists for 6-8 weeks after delivery with the highest risk of PE being during the postpartum period. The lack of randomized trials in pregnant women leads to variability in practice, which are largely based on expert consensus or extrapolation from non-pregnant cohorts. The standard treatment of VTE in pregnancy is anticoagulation with low molecular weight heparin (LMWH), which like unfractionated heparin does not cross the placenta and is not teratogenic.
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This question is part of the following fields:
- Gynaecology
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Question 19
Incorrect
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A 53 year old female presents with hot flushes and night sweats. Her last menstrual period was last year. She had MI recently. Choose the most appropriate management for this patient.
Your Answer:
Correct Answer: Clonidine
Explanation:With a history of MI, oestrogen and COCP should be avoided. Evening primrose is also not suitable for post-menopausal symptoms. Raloxifene is a SERM – these make hot flushes worse. Clonidine will help improve the hot flushes and the vasomotor symptoms.
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This question is part of the following fields:
- Gynaecology
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Question 20
Incorrect
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A 22 year old woman is being followed up 6 weeks after a surgical procedure to evacuate the uterus following a miscarriage. The histology has shown changes consistent with a hydatidiform mole. What is the single most appropriate investigation in this case?
Your Answer:
Correct Answer: Serum B-HCG
Explanation:The most appropriate test for a hydatiform mole is serum beta hCG levels, which are consistently raised in these patients. The levels return to normal when the pregnancy is terminated.
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This question is part of the following fields:
- Gynaecology
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Question 21
Incorrect
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A 33 year old pregnant lady was brought into the emergency department with per vaginal bleeding. She has been having labour pains for the last 2 hours. O/E: her cervix was 2cm dilated. Which stage of labour is she in now?
Your Answer:
Correct Answer: First stage
Explanation:There are 3 stages of labour. The 1st stage of labour starts from labour contractions till the time the cervix is fully dilated. Stage 2 is from complete cervical dilatation until the baby is born. The 3rd stage is from the birth of the baby, until the time the placenta is expelled.
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This question is part of the following fields:
- Gynaecology
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Question 22
Incorrect
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A 25 year old female with her LRMP 8 weeks ago, presented with severe abdominal pain and per vaginal bleeding. On examination there was tenderness over her left iliac region. Her pulse rate was 110 bpm and blood pressure was 90/65mmHg. Which of the following is the most appropriate management?
Your Answer:
Correct Answer: Immediate laparotomy
Explanation:A ruptured ectopic pregnancy is the most probable diagnosis. As she is in shock (tachycardia and hypotension) immediate laparotomy is needed.
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This question is part of the following fields:
- Gynaecology
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Question 23
Incorrect
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A 34-year-old woman presents with pelvic pain and complains of dysmenorrhea and menorrhagia. She has been using an IUCD for one year now and wants to know the cause of her current condition. What is the most likely cause?
Your Answer:
Correct Answer: PID
Explanation:IUCD is a risk factor for PID and PID has the clinical picture already described. However, fibroids should also be excluded since they may present in the same way.
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This question is part of the following fields:
- Gynaecology
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Question 24
Incorrect
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A 25 year old unmarried female presented with dizziness, nausea and vomiting for 1 week. According to her, she has been stressed recently and her usual menstrual period has been delayed by 4 weeks. Examination findings were normal. Which of the following is the most appropriate next step?
Your Answer:
Correct Answer: Dipstick for B-hCG
Explanation:There is high possibility of her being pregnant. Urine B-hCG has to be checked to exclude pregnancy.
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This question is part of the following fields:
- Gynaecology
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Question 25
Incorrect
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A 25-year-old female presents to a gynaecologist with a complaint of abnormal vaginal bleeding, usually postcoital. On pelvic examination, the cervix of was found to be of an unusually bright red colour and its texture was rougher than normal. Which of the following will you choose as the next step in the management of this condition?
Your Answer:
Correct Answer: Cervical smear (2nd line)
Explanation:Before considering invasive procedures, a cervical smear must first be performed. Antibiotics can only be given when inflammation has been confirmed and culture results have identified the organism causing the inflammation. Endometrial ablation, colposcopy and vaginal US are all invasive procedures that are not relevant in the immediate management of this patient.
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This question is part of the following fields:
- Gynaecology
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Question 26
Incorrect
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A woman visited the OPD with complaints of severe abdominal pain and light-headedness. There is history of fainting three days prior to consultation. She also has vaginal bleeding. In this case, which of the following investigations should be ordered to reach the diagnosis?
Your Answer:
Correct Answer: Beta HCG
Explanation:Testing for beta hCG should be the first test in this case. It will rule out any pregnancy that is strongly suspected based on the patient’s history and physical examination.
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This question is part of the following fields:
- Gynaecology
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Question 27
Incorrect
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A 31-year-old woman's blood results after having secondary amenorrhoea that lasted for 6 months are: Testosterone = 3.4 nmol/L (<1.6), Oestradiol = 144 pmol/L (100-500), LH = 12 U/L and FSH = 4 U/L. What sign or symptom is she likely to have?
Your Answer:
Correct Answer: Hirsutism
Explanation:Biochemical features suggest that this patient has polycystic ovary syndrome (PCOS). It is associated with signs and symptoms of hyperandrogenism (oligomenorrhea, irregular menstruation, hirsutism, hair loss, and acne) and elevated testosterone. PCOS patients are often overweight or obese, have insulin resistance (treated with Metformin) and an adverse risk profile for cardiovascular disease.
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This question is part of the following fields:
- Gynaecology
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Question 28
Incorrect
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A 25-year-old female, expecting twins, complains of decreased fetal movements in her 40th week of gestation. An hour ago, she experienced constant abdominal pain for an hour and passed blood in her urine. What is the next best investigation in this case?
Your Answer:
Correct Answer: Cardiotocograph
Explanation:Cardiotocography (CTG) helps to record the heartbeat of the foetus in parallel to measuring the contractions of the mother’s uterus, this is the most appropriate tool to assess this patient’s condition.
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This question is part of the following fields:
- Gynaecology
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Question 29
Incorrect
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Which is the most useful tumour marker for monitoring of ovarian cancer patients?
Your Answer:
Correct Answer: CA 125
Explanation:CA-125 has found application as a tumour marker or biomarker that may be elevated in the blood of some patients with specific types of cancers, or other conditions that are benign. Increased level of CA125 appears in fifty percent of stage 1 ovarian cancer patients and more than 90% with stages 2-4 ovarian cancer. CA-125 is therefore a useful tool for detecting ovarian cancer after the onset of symptoms as well as monitoring response to treatment and for predicting a patient’s prognosis after treatment.
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This question is part of the following fields:
- Gynaecology
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Question 30
Incorrect
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A 50-year-old female presents with a complaint of bloating and abdominal distension. History reveals she underwent hysterectomy 3 months ago. Which investigation should be carried out in this case?
Your Answer:
Correct Answer: Plain X-ray abdomen
Explanation:A complication of bilateral salpingo-oophorectomy and hysterectomy is the formation of adhesions in the GIT that can cause intestinal obstruction. Abdominal X-ray is sufficient to visualize any obstruction in the GIT.
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This question is part of the following fields:
- Gynaecology
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SESSION STATS - PERFORMANCE PER SPECIALTY
