EBCOG Part1 – General Gyne – Day 5(E.M.Q)

A. Acute contact dermatitis
B. Benign mucous membrane pemphigoid
C. Contact dermatitis
D. Diabetic vulvitis
E. Dysaesthetic vulvodynia
F. Hydradenitis suppurativa
G. Lichen planus
H. Lichen sclerosus
I. Lichen simplex (eczema)
J. Malignant melanoma
K. Paget’s disease
L. Psoriasis
M. Vulval carcinoma
N. Vulval Crohn’s disease
O. Vulval intraepithelial neoplasia
P. Vulval vestibulitis syndrome
Q. Zoon’s vulvitis

Instructions: For each of the following clinical conditions, select the single most likely diagnosis from the option list above. Each option may be selected once, more than once or not at all.

1)  A32-year-oldwomanpresentswithextensiveulcersonthevulvaand a dirty brown vaginal discharge of 7 months’ duration. The discharge is intermittent. The ulcerations are widespread and are associated with significant scarring.

2. A 43 year old presents with troublesome itching of the vulva of 12 months’ duration. She was sterilized 7 years ago and her last cervical smear was 2 years ago. On examination, her vulva is found to have multiple, red, crusted plaques with sharp edges. No other pelvic abnormality is identified.

A) Infected sebaceous cyst
B) Genital herpes
C) Genital warts
D) Lichen sclerosus
E) Lichen planus
F) Psoriasis
G) Vulval intra-epithelial neoplasia
H) Squamous cell carcinoma of the vulva
I) Nabothian cyst
J) Paget’s disease of the vulva
K) Bechet’s disease
L) Condylomata acuminata
M) Vulval atrophy
N) Urethral caruncle

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

3.  A healthy 36 year old woman presents with s 48 hour history of painful swelling on the vulva. She had noticed a lump in the area 3 years ago and the lump has gradually increased in size. She had squeezed the lump three days earlier and expressed white cheesy material. Examination shows a 5cm red and tender lump on the mons pubis.

4) A 48 year old woman complains of distressing vulval pain and irritation that has not responded to medical therapy. Punch biopsy of the vulva shows thinned epidermis with hyperkeratosis. There is a wide band of homogenized collagen below the dermo-epidermal junction with a marked lymphocytic infiltrate beneath the homogenized area. There are no atypical cells.

A) Reassurance & counselling
B) Cyclical progestogens
C) Weight reduction
D) Gonadectomy
E) Gonadectomy + oestrogen replacement
F) Gonadectomy + oestrogen + progesterone replacement
G) Glucocorticoids
H) Mineralocorticoids
I) Testosterone
J) Combined oral contraceptive pill
K) Oestrogen + progesterone HRT
L) Genital re-construction

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

5) An 18 year old woman has been referred to the gynaecology clinic because she has not started menstruating. She is 162 cm tall with a BMI of 23 kg/m2. She has normal breast, axillary and pubic hair development and is sexually active. The uterus is absent on ultrasound scan and the karyotype is 46 XY

6) A healthy 16 year old woman has been referred to the gynaecology clinic because she has not started menstruating and is concerned about the appearance of her external genitalia. Her height is normal and her BMI is 28 kg/m2 with a male body habitus. She has moderate cliteromegaly. Endocrine profile shows moderately elevated serum testosterone levels and elevated 17-OH-progesterone levels. She has a 46XX karyotype

7) A 17 year old woman has been referred to the gynaecology clinic because she has not started menstruating. She is not sexually active and her weight and height are normal. There is no evidence of breast development. The external genitalia appears normal and pelvic ultrasound scan shows that the uterus is present. Serum androgen levels are within the normal female range and FSH levels are elevated. Karyotype is 46XX. Serum electrolytes, progesterone and 17-OH-progesterone levels are normal

8) A 17 year old woman has been referred to the gynaecology clinic because she has not started menstruating. She is not sexually active and her weight and height are normal. There is no evidence of breast development. The external genitalia appears normal and pelvic ultrasound scan shows that the uterus is present. Serum androgen levels are within the normal female range and FSH levels are elevated. Karyotype is 46XY. Serum electrolytes, progesterone and 17-OH-progesterone levels are normal

A) Ultrasound scan for ovarian morphology
B) CT scan of abdomen and pelvis
C) CT scan of brain
D) Skull X-ray
E) Visual fields
F) Pregnancy test
G) Mid-luteal phase progesterone
H) Karyotype
I) 17-OH-progesterone
J) Serum prolactin
K) Serum oestradiol
L) DHEA and DHEA-sulphate
M) Ovarian biopsy
N) Serum electrolytes

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

9) A 21 year old woman has been referred to the gynaecology clinic because she has not had any menstrual periods for 1 year. She is sexually active, not using any contraception and her pregnancy test is negative. Her height is 152 cm and her BMI is 30 kg/m2. She has normal secondary sexual characteristics. Trans-vaginal ultrasound scan identifies a small uterus with normal ovaries. FSH and LH levels are in the post-menopausal range and serum androgen levels are normal.

10) A healthy 16 year old woman has been referred to the gynaecology clinic because she has not started menstruating. Her height is 156 cm and her BMI is 24 kg/m2. She is sexually active and the pregnancy test is negative. Her breasts are infantile but the uterus is identified on trans-vaginal scanning. FSH and LH levels are low, serum prolactin is slightly elevated and serum androgens are within normal limits.