EBCOG Part-1 General Gynaecology- Day 4(E.M.Q)

A) Refer to gastro-enterologist
B) Request ultrasound scan of the abdomen & pelvis
C) Request CT scan of the abdomen & pelvis
D) Refer to gynaecology clinic
E) Refer to cancer centre
F) Measure CA-125
G) Measure CA-125 and HE4
H) Measure AFP & HCG
I) Measure CEA and HE4
J) Review after 6 months if symptoms persist
K) Treat for irritable bowel syndrome and review after 6 weeks
L) Discharge from the clinic

For each of the scenarios below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all

1. A 42 year old woman has seen her general practitioner because of vague abdominal discomfort and bloating. She is worried about a diagnosis of cancer so a series of blood tests were performed. Her CA- 125 is 452 IU/ml. The general practitioner has phoned you for advise about subsequent management

A) MRI scan of the abdomen and pelvis
B) Ultrasound scan of the pelvis
C) Ultrasound scan of the abdomen and pelvis
D) CT scan of the abdomen and pelvis
E) Chest X-ray
F) Isotope bone scan
G) Diagnostic laparoscopy
H) MRI scan of the pelvis
I) CT scan of the pelvis
J) X-ray of the abdomen
K) Bronchoscopy
L) CT scan of the pelvis, abdomen and thorax

For each of the scenarios below, choose the single most appropriate investigation from the above list of options. Each option may be used once, more than once, or not at all

2.  A 49 year old woman has been referred to the oncology clinic with a history of intermittent abdominal pain, CA-125 of 654 IU/ml and an ultrasound showing a complex 7cm right ovarian cyst with a normal left ovary. Examination in clinic identifies a right pleural effusion.

A) High risk
B) Moderate risk
C) Low risk
D) Very high risk
E) 277
F) 283
G) 2493
H) 249.3
I) 1662
J) 116.2
K) 282
L) 831

3.A 42 year old woman has been referred to the gynaecology clinic with the following results: CA-125 = 277 IU/ml. Ultrasound scan: 8cm multilocular ovarian cyst in the right ovary with solid and cystic areas. There is no ascites and the left ovary is normal. There is no ultrasound evidence of metastases. The woman’s LMP was 2 months ago. Determine the risk of malignancy index.

A  CA 125
B  Chemotherapy
C  Computed tomography (CT) scan
D  Magnetic resonance imaging (MRI)
E  Ovarian cyst aspiration
F  Ovarian cystectomy
G  Oophorectomy
H  Ovarian transposition
I Repeat scan not necessary
J Repeat the transabdominal ultrasound
K Repeat the transvaginal scan (TVS)
L Refer to the colposcopy clinic
M Refer to the cancer centre
N Refer to the gynaecology clinic
O Staging laparotomy

Instructions: For each scenario described below, choose the single most appropriate management from the list of options above. Each option may be used once, more than once, or not at all.

4. A 20-year-old woman attends the emergency department with acute abdominal pain. The surgeon suspects appendicitis and performs a diagnostic laparoscopy. You are the on-call registrar for that night and the surgeon calls you to give an opinion on an incidentally found large solid ovarian mass in the right adnexa with papillary projections on the surface. There is some free fluid in the pelvis and the other ovary appears normal.

5.  A 58-year-old woman presents to her general practitioner with gradual distension of the abdomen for the last 6 months. She is then referred to the gynaecology clinic for suspected ovarian cancer. An ultrasound scan of the pelvis reveals a large multilocular ovarian cyst on the right side. Her tumour markers are reported as: (a) CA 125 2000 U/mL, (b) CEA 1.2 ng/mL, and (c) CA 19.9 1 U/mL.

6. A 39-year-old woman is reviewed in the gynaecology clinic with symptoms of pelvic pain for the last 2 years. She was treated for endometriosis 5 years ago with laparoscopic laser ablation. Her ultrasound scan 2 months ago revealed a left-sided ovarian cyst (5.8 cm) with diffuse low-level internal echoes with one thin internal septae. Her CA 125 level is raised (61 U/mL).

7. A 28-year-old woman is referred to the gynaecology clinic with symptoms of menorrhagia with no intermenstrual and postcoital bleeding. Her pelvic examination is normal. However, an ultrasound scan of the pelvis shows an incidental finding of a simple ovarian cyst (size 3 × 3 × 3 cm) on the right side. A serum CA 125 level is 15 U/mL. Her recent cervical smear was normal.

 8.A 50-year-old woman is referred to the gynaecology clinic with two ultrasound scan reports: (a) a current one showing a simple left ovarian cyst of 3 × 4 cm in size, and (b) the previous one performed 4 months ago showing a simple left ovarian cyst of 5 × 4 cm in size. Her CA 125 is 6 U/mL. She is otherwise asymptomatic and well.