EBCOG Part-1 High Yield questions Sexual & Reproductive health

A. Advise to stop smoking
B. No need for follow up
C. Repeat smear in 1 year
D. Repeat smear in 2 years
E. Repeat smear in 3 years
F. Repeat smear in 5 years
G. Repeat smear in next couple of weeks
H. Refer to colposcopy
I. Refer to genitourinary medicine or sexual health clinic
J. Urgent referral for suspected cancer to colposcopy '2-week wait'

For each of the following cases, select the most appropriate next management step. Each option may be used once, more than once or not at all.

1. A 33-year-old woman was called for routine recall for her smear, however thesample was inadequate. She is a smoker.

2. A 40-year-old woman has a smear which is reported as borderline but is HPVpositive.

3. A 48-year-old woman has a smear showing possible glandular disease.

4. A 38-year-old woman has a smear test that shows severe dyskaryosis, suggestive ofhigh-grade cervical intraepithelial neoplasia.

A. Aciclovir 400 mg orally three times per day for 21 days
B. Azithromycin 1 g orally as a single dose
C. Ceftriaxone 500 mg intramuscularly plus azithromycin 1 g orally
D. Clindamycin orally 300 mg twice daily for 7 days
E. Clotrimazole vaginal pessary 1 g for 5 nights
F. Fluconazole 1 g orally
G. Fluconazole 150 mg every 72 hours for three doses
H. Metronidazole 2 g orally as a single dose
I. Metronidazole 500 mg orally twice daily for 14 days
J. Nevirapine intravenous stat dose
K. Ofloxacin 400 mg twice daily orally plus oral metronidazole 400 mg twice daily for 14 days
L. Valaciclovir 500 mg twice daily for 5 days
M. Zidovudine intravenous infusion

Each of the following clinical scenarios relates to a woman with a pelvic infection. For each woman, select the single most appropriate initial management from the list above. Each option may be used once, more than once or not at all.

5. A 26-year-old woman attends the gynaecology emergency services complaining of painful blisters and ulceration on her vulva for last 2 days. She has dysuria and vaginal discharge. On examination, there is bilateral tender inguinal lymphadenitis.

6. A 21-year-old woman who suffers with alcohol dependence attends the gynaecology clinic complaining of a persistent watery vaginal discharge. There is no history of irritation or pruritus. She smokes ten cigarettes a day. On vaginal examination, there is an offensive fishy- smelling vaginal discharge.

7. A 23-year-old university student complains of persistent purulent vaginal discharge. On vaginal examination, there is contact bleeding from the cervix. Microscopy of a Gram- stained endocervical swab specimen showed monomorphic Gram-negative diplococci within polymorphonuclear leucocytes.

8. A 49-year-old menopausal diabetic woman presents with vulval soreness and pruritus, and a non- offensive thick white vaginal discharge. She gives a history of at least three past similar episodes over the last 12 months and suffers from superficial dyspareunia. On examination, there is erythema and some fissuring of the vulval skin

A. Black cohosh
B. Clonidine
C. Cognitive behavioural therapy (CBT)
D. Oestradiol implant
E. Oestriol cream vaginally
F. Oral conjugated equine oestrogens
G. Oral continuous combined HRT
H. Oral cyclical HRT I. Oral oestradiol
J. Psychosexual counselling
K. St John’s wort
L. Testosterone gel
M. Testosterone implant
N. Tibolone
O. Transdermal continuous combined HRT
P.Transdermal cyclical HRT
Q.Transdermal oestrogen

For each of the following clinical scenarios, choose the single most appropriate treat-ment from the list of options above. Each option may be used once, more than once or not at all.

9. A 52-year-old woman with a BMI of 31 kg/m2 presents with vasomotor symptoms and vaginal dryness. She has no significant past medical history. Her last menstrual period was 12 months ago.

10. A 50-year-old woman who previously had a hysterectomy for uterine fibroids presents with severe menopausal symptoms. She is concerned about taking HRT as her elder sister recently had a stroke.

11. A 54-year-old woman who is taking continuous combined HRT presents with a lack of libido.

A. Candida albicans
B. Chlamydia trachomatis
C. Gardnerella vaginalis
D. Haemophilus ducreyi
E. Herpes simplex virus
F. Herpes zoster virus
G. Human papillomavirus
H. Molluscum contagiosum virus
I. Mycoplasma genitalium
J. Neisseria gonorrhoeae
K. Phthirus pubis
L. Sarcoptes scabiei
M. Treponema pallidum
N. Trichomonas vaginalis

In each of the following scenarios, what is the most likely organism that is being described? Each option may be used once, more than once or not at all.

12. A large DNA pox virus that causes a benign epidermal eruption of the skin. The lesions are usually characteristic, presenting as smooth- surfaced, firm, dome- shaped papules with central umbilication.

13. A sexually transmitted infection commonly presenting with vulval discharge and itching, dysuria and offensive odour. Overall, 10–50% of women are asymptomatic. Of women that are infected, the urethra is colonised in 90%, and 2% of women will have a ‘strawberry cervix’.

14. Permethrin is the first- line treatment for infection with this organism. Classic sites of infection include the interdigital folds, the wrists and elbows, and around the nipples in women

A. Autoimmune ovarian failure
B. Constitutional delay
C. Craniopharyngioma
D. Etoposide
E. Galactosaemia
F. Iatrogenic
G. Irradiation
H. Kallmann syndrome
I. Laurence–Moon–Bardet–Biedl syndrome
J. Langerhans cell histiocytosis
K. McCune–Albright syndrome
L. Noonan syndrome
M. Rubella
N. Turner syndrome
O. Tuberculosis

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

15. A 16-year-old girl attends her general practitioner centre with her mother as she has not attained menarche. Clinical examination reveals a short stature, cubitus valgus and coarctation of the aorta. Ultrasound scan shows streak gonads.

16. A 15-year-old girl attends the paediatric emergency department with a fall. Clinical examination reveals a short stature, hypertelorism, downward slanting of the eyes and a right-sided heart murmur.

17. A 14-year-old girl attends her general practitioner centre with her mother as she has not attained menarche. She has a history of an unknown cancer at the age of 10 years and had received chemotherapy in Pakistan.

18.A 7-year-old girl attends the paediatric emergency department with her mother as she started to have monthly vaginal bleeding. Clinical examination reveals incomplete sexual precocity and café-au-lait spots with irregular borders.

A. Angelman syndrome
B. Androgen insensitivity syndrome
C. Congenital adrenal hyperplasia
D. Gonadal dysgenesis
E. Hypothyroidism
F. Hyperprolactinaemia
G. Noonan syndrome
H. Klinefelter syndrome
I. Mayer–Rokitansky–Küster–Hauser syndrome
J.Fragile X syndrome
K. Pituitary tumour
L. Pituitary prolactinoma
M. Turner syndrome (45XO)
N. Turner mosaic (45XO/46XX)
O. von Hippel–Lindau disease

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

19. A 16-year-old tall girl presents with primary amenorrhoea. On clinical examination there is normal breast development, sparse axillary and pubic hair, blind vaginal pouch and an absent uterus.

20. A 16-year-old young girl is referred to the gynaecology clinic by her general practitioner with primary amenorrhoea. She gives a history of excessive weight gain and lethargy. Secondary sexual characters are normal on clinical examination. Investigations reveal raised serum thyroid-stimulating hormone (TSH) and prolactin levels.