EFOG Part 1 – 2 Days Pre Exam Course – Mock Exams – Day 2

A. Ovarian hyperthecosis
B. Premature ovarian failure
C. Prolactin secreting adenoma
D. Drug-induced hyperprolactinaemia
E. Post-pill amenorrhoea
F. Depo-medroxyprogesterone acetate induced amenorrhoea
G. Unexplained infertility
H. Late onset congenital adrenal hyperplasia
I. Androgen secreting tumour
J. Cushing’s syndrome
K. Asherman’s syndrome
L. Sheehan’s syndrome


The following clinical scenarios show various causes of amenorrhea . Chose the appropriate diagnosis for the situation.

1. A healthy 32 yr old with secondary amenorrhoea. She had been using depo-inj for contraception, last injection was 2 yrs ago. Her BMI is 24 kg/m2. Pelvic ultrasound shows increased ovarian volume. Serum prolactin = 50 ng/ml, testosterone = 3.6 nmol/L, FSH = 2.2 IU/L, LH = 2.0 IU/L, TSH = 1.5 mIU/L, SHBG = 12 nmol/L. All other investigations normal

2.A healthy 35 yr old with secondary infertility. Her only child was delivered by CS for placenta previa 3 years ago. She has period every 32– 50 days & has not used contraception for 3 yrs. Pelvic ultrasound and her partner’s semen analysis are normal. Follicular phase FSH = 25 IU/L, LH = 18 IU/L, day 21 progesterone = 3 ng/ml, prolactin = 15 ng/ml.

3.A healthy 35 yr old with rapidly progressive hirsutism & male pattern baldness. She has period every 22-65 days, her BMI is 34 kg/m2. Pelvic ultrasound: bilateral complex ovarian cysts of 5.6cm and 6.4cm. Follicular phase FSH = 5.5 IU/L, total serum testosterone = 6.5 nmol/L, prolactin = 15ng/ml.

A.Replace IUS now

B.Remove IUS now

C.Remove IUS in 12 months

D.Replace IUS in 12 months

E.Replace IUS in 2 years

F.Remove IUS in 2 years

G.Remove IUS at age 54 years

H.Remove IUS at age 55 years 

I.Replace IUS at age 55 years

J.Check serum progesterone levels

K.Check serum FSH levels

L.Check serum anti-Mullerian hormone levels

Which is correct answer for the following questions given below. Each of the above options can be used once, more than once or not at all.

4.A general practitioner telephones for advice about a 51 year old woman who had MIRENA IUS inserted at the age of 47 years for contraception and heavy menstrual bleeding. The woman has not had any menstrual periods for 3 years and is considering removal of the intra-uterine device.   

5.A general practitioner telephones for advice about a 51 year old woman who had the MIRENA IUS inserted 5 years ago for contraception and heavy menstrual bleeding. The woman has not had any menstrual periods for 3 years but started oestrogen-only HRT 6 months ago.

A.Open labelled RCT

B.Double blind RCT

C.Single blind RCT

D.Case control

E.Cohort prospective

F.Cohort retrospective

G.Systematic review

H.Meta analysis

I.Longitudinal

J.Cross section

K.Case series

L.Expert opinion

M.Ecological studies

The above options show the various research studies .Choose the most appropriate one for each of the questions. Each option can be chosen once more than once

6.To study the impact of smoking on serum FSH, The aim was to compare the FSH level between women who smoke and women who don’t smoke, which type of study design suits the best?

7.To study the impact of smoking on serum FSH, The aim was to observe the changes in FSH levels over a long period of time from present, in smokers and non smokers, which type of study design suits the best?

8.Level 4 recommendation grade is applicable to which study

9.The process through which application of statistical methods are used on the published data to draw firm conclusions is applicable to which study design?

10.A study was done to find the association between average exposure levels of gamma radiation and incidence of leukemia and solid tumors. This is which type of study design?

A.Chemotherapy
B.Examination under anaesthesia and biopsy
C.Modified Radical hysterectomy with pelvic lymphadenectomy
D.To insert bilateral nephrostomies ± ureteric stents
E.Urgent radiotherapy
F.No further treatment
G.Large loop excision of the transformation zone
H.Cone biopsy
I.Total abdominal hysterectomy
J.Total abdominal hysterectomy and bilateral salpingo-oophorectomy
K.Radical hysterectomy (+/-BSO) and pelvic lymphadenectomy
L.Radical trachelectomy and pelvic lymphadenectomy
M.Anterior pelvic exenteration
N.Posterior pelvic exenteration
O.Total pelvic exenteration
P.Palliative care

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

11. The patient is a 25-year-old Primigravida patient who presents with a severely  dyskaryotic invasive smear. She is found to have a 3 mm depth invasive tumour which found to be a well-differentiated squamous cell carcinoma of the cervix on punch biopsy with no LVSI. MRI shows the tumour to be confined to the cervix with no lymphadenopathy. She is keen to maintain her pregnancy. Her all pre-op investigations are done.

12.A 38-year-old G2P1 woman has been trying for a pregnancy for long and is finally is pregnant now. She is 12 weeks pregnant. She complained of spotting P/v for which Per speculum examination was done. It was suspicious looking cervix with growth so she was referred for colposcopy immediately. Colposcopy and biopsy reveals a lesion 4.7 X 5.9 cm in size. MRI shows the tumour to be confined to the cervix with no lymphadenopathy. She is keen to maintain her pregnancy. Her all pre-op investigations are done.

A.Interstitial cystitis
B.Hunner ulcer
C.Bladder tuberculosis
D.Glomerulations
E.Cancer of the bladder
F.Bladder pain syndrome
G.Nodular lesions

Each of the following Options describes various clinical diagnosis in woman
presenting for cystoscopy.
For each patient select the single most appropriate diagnosis from the list above.Each option may be used once, more than once or not at all

13.

14.

15.

A.Anovualtion
B.PMS
C.Endometriosis
D.gonorrheal salpingitis
E.Genital tuberculosis
F.Asherman syndrome
G.salpingitis isthmica nodosa
H.Sub mucous fibroid
I.Bilateral Hydrosalphynx
J.Ovulation
K.Sub serous fibroid
L.Endometrial polyp
M.sub-mucous fibroid

Following scenarios Show various women presenting to infertility clinic.choose the single most appropriate diagnosis from above list for these women


16. Tracking Basal body temperature (BBT) is an easy way to get an idea of if and when you're ovulating.By looking at At BBT Curve , the image shows the basal temperature graph made by the couple Mr&Mrs.Adams , the previous month.What thisBBT chart implies ?

17.ms. Kenchamma, 33-year-old  Asian  woman has been trying for pregnancy for 1    Year , now she complains  of  pelvic  pain  and  amenorrhea   For 3 months associated  with  low-grade fever  and  weight  loss. Physical  examination  demonstrates  a  tender  pelvic  mass. Surgical  findings include  dense  pelvic  adhesions,  segmental  dilatation  of  the  fallopian  tubes,  and  everted  fimbria.Microscopic  examination  of  the  right  fallopian  tube  shows  proliferation  of  tubal  folds  with  giant  cells within  the  tube. Which   Is probable diagnosis  ?

18.Mrs. A.Is 25year old , she is known case of infertility .she has undergone surgical evacuation 6 weeks back for a missed miscarriage her partners semen analysis normal , .Diagnostic Laprosocpy  bilateral tubes are  normal .serum progesterone is 40 .She  also complains of light periods .Her HSG is as follows

19.MrsX, 42 year old nulliparous from Ghana has presented with dysmenorrhoea ,  and infertility . her partners semen analysis normal , .Diagnostic  Laprosocpy  bilateral tubes are  normal .serum progesterone is 38 on day 15 .Her Hysterosocpy Image is attached ,what is the cause of her infertility ?

A.Colposcopy
B.Local silver nitrate application
C.Change dose of pill
D.Insert Mirena
E.Endometrial biopsy
F.GnRHAnalogue
G.Tranexamic acid
H.Novasure endometrial ablation
I.Add to waiting list of lap hysterectomy
J.Insert mirena and follow up in 6months
K.Perform Endometrial sampling with Hysteroscopy
L.Reinsert Mirena coil
M.Tranexamic acid with mirena
N.Total abdominal hysterectomy with bilateral salpingo-oophrectomy.
Each of the following Options describes various woman presenting with abnormal uterine bleeding
For each patient select the single most appropriate management option from the list
20.Ms Lucy is a 27-year-old nulliparous presents with a history of post-coital bleeding for 6 months. Bleeding is often unpredictable and is affecting her relationship. She is otherwise fit and well. She is using a COCP over the last year for contraception. BMI is 21kg/m2.Gynaecological examination is within normal limits with the exception of a cervical ectropion. Swabs for Chlamydia and an HVS are negative. Pelvic USS shows an endometrial thickness of 10 mm with a normal uterus, rest of the pelvic anatomy being normal. What treatment is most suited to her?

21.Mrs, Brown 46-year-old mutiparous , who has completed her family presents with a history of painful heavy menstrual bleeding with infrequent cycles (every 2–3 months) for 1 year. Her BMI is 44. She is currently on iron supplements for anaemia and is prescribed proton pump inhibitors for GORD. She is otherwise fit and well. Abdominopelvic examination is unremarkable. Pelvic ultrasound shows an endometrial thickness of 12 mm with a bulky uterus and normal ovaries with no pelvic pathology. A pipelle biopsy suggests a proliferative endometrium.

22.You review a 48-year-old woman in the menstrual disorders clinic who complains of a 3-year history of heavy menstrual bleeding. She is a mother of four children, all born by normal vaginal deliveries. Her menstrual cycle is every 30 days and the bleeding lasts for 6 days. However, recently it has become associated with clots.       Cervical smears are up-to-date and her BMI is 39. You perform a   transvaginal scan which reveals a bulky uterus of 8 mm endometrial thickness and three intramural fibroids of 1, 3and 5 cm size respectively. On vaginal examination you find stage I cystocele, stage I rectocele and stage II uterine descent.The current waiting list for benign gynaecological surgery in your hospital is 4 months.

23.Mrs. Leslie , 50-year-old woman had a Mirena IUS inserted 2 years ago for heavy menstrual periods. She was initially amenorrhoeic but has now developed heavy menstrual bleeding again. Endometrial biopsy shows complex endometrial hyperplasia with atypia.

A.Lichen sclerosis
B.Lichen simplex chronicus
C.psoriasis
D.Eczema
E.VIN
F.vulval cancer
G.Pages diseases
H.Vulval endometriosis
I.Gartners cyst
J.vulval wart
K.none of the above
L.Lichen planus

Each of the above Options describes Various vulval conditions .
For each patient select the single most appropriate causes from the list above. Each option may be used once, more than once or not at all.

24. A 32 year old presented with vulval itching and soreness .It’s aggravated during her periods. It’s relieved during summer. On examination
Pitted nails noted
Skin lesions on scratching shows minute Haemorrhages
Thick red plaques with silvery scales seen over vulva
Same lesions seen under breast
Pitted nails noted
Skin lesions on scratching shows minute Haemorrhages

25.32 year old  Penny, presents with vulval itching and soreness .

She s noticed these symptoms  with stress when her PHD exams were nearing 
On examination

Polygonal purple topped lesions present  over hand

Wickham striae noted in buccal mucosa as well as well

On vulvlal examination 

plain topped polygonal lesions seen .

26.You are seeing 56 year old  postmenopusal Amy ,  in clinic ,has been referred for uncontrollable vulval itch & soreness which is worse at night .she has visited her GP and He has given her some lubricants which was of no benefit .

On examination  thinning of skin , labial adhesions seen Skin looks like cigarette paper vulval  biopsy showed thinned  epidermis  with  sub-epidermal hyalinization and  deeper  inflammatory  infiltrate.

A.Arterial blood gas analyses
B.Blood Culture. Blood sugar
C.C-reactive protein
D.CT scan of abdomen
E.CA125
F.cervical swab for microscopy and Gram stain
G.chest x-ray
H.erect abdominal x-ray
I.full blood count
J.liver function tests
K.Mid stream urine for microscopy
L.pelvic ultrasound scan
M.serum amylase and lipase.
N.serum lactate
O.Trans abdominal ultrasound scan
P.USG scan of kidneys, ureters and bladder
Q.urea, , electrolytes and creatinine
R.Urine pregnancy test

27.healthy 32-year-old P3 has a 12-hour history of increasingly severe bouts of central abdominal pain with vomiting during the height of the pain, which slowly passes off, with loss of appetite. She gave birth to a healthy male infant – birthweight 3456 g – 4 days ago and is breastfeeding. The lochia and uterine involution have been recorded by the midwife as being normal. The pregnancy was uncomplicated throughout. The anomaly ultrasound scan at 20 weeks of gestation was normal apart from a simple right ovarian cyst that measured 8–9 cm in diameter. She is a non-smoker and was well prior to the onset of the pain and has never experienced anything like this pain in the past.
On examination she looks distressed, pale and dehydrated; the abdomen is very tender in the lower half with no peritonism, and the uterus is just palpable; no other masses. Vaginal examination is normal.
Observations are as follows:
* pulse rate = 110 beats per minute
* blood pressure = 140/90 mmHg
* respiratory rate = 12 breaths per minute
* temperature = 37.2°C
* urine analysis = blood ++, ketones +++, protein trace
* O2 saturation on air = 98%

28.A healthy 22-year-old, P0+1, has a 48-hour history of increasing lower abdominal pain localising to the right side. She has lost her appetite and generally feels unwell; she was well prior to the onset of the pain. She smokes 10–15 cigarettes a day and suffers with mild asthma and uses inhalers when necessary; she has noticed a more productive cough and some breathlessness. Her last mestrual period was 3 weeks ago; periods are regular: 3–4/28 days. She uses the progesterone implant for contraception, which was inserted after an uncomplicated termination of pregnancy.

On examination: she looks pale and dehydrated; the abdomen is very tender in the lower half particularly on the right side with no peritonism; no masses. Vaginal examination: there is some vague tenderness otherwise unremarkable.

Observations are as follows:

* pulse rate = 120 beats per minute

* blood pressure = 120/70 mmHg

* respiratory rate = 19 breaths/minute

* temperature = 38.4°C

* urine analysis = protein trace, nitrites trace, ketones +

* O2 saturation on air = 90%

29.A 19-year-old, P0+1, has a 72-hour history of increasingly severe lower abdominal pain localising to the right side. She has lost her appetite and generally feels unwell; she was well prior to the onset of the pain. She smokes ten cigarettes per day. Her last menstrual period was 3 weeks ago; periods are regular: 3–4/28 days with some breakthrough bleeding from time to time. She has used the progesterone implant for contraception for 2 years, which was inserted after a termination of pregnancy that was complicated by a postoperative uterine infection.

On examination she looks pale and dehydrated; the abdomen is very tender in the lower half, particularly on the right side with a suggestion of some peritonism; no masses. Vaginal examination shows there is some dark brown vaginal discharge; no masses; a normal-sized uterus and cervical excitation tenderness.

Observations are as follows:

* pulse rate = 105 beats per minute

* blood pressure = 120/70 mmHg

* respiratory rate = 12 breaths per minute

* temperature = 37.9°C

* urine analysis = protein trace, blood +, ketones ++

* O2 saturation on air = 99%

30.A healthy 38-year-old P3 presents at midnight with a 5-hour history of sudden-onset severe right-sided lower abdominal pain that came on after sexual intercourse. Her last menstrual perios was 24 days ago; periods are regular: 3–4/28 days; she has been sterilised. She has a past history of recurrent urinary tract infections, which is under investigation by a urologist.

On examinatio: she looks pale and distressed; the abdomen is very tender in the lower half, particularly over the bladder and on the right side with rebound peritonism; no masses. Vaginal examination shows a normal-sized uterus, no masses and cervical excitation tenderness is elicited.

Observations are as follows:

* pulse rate = 115 beats ber minute

* blood pressure = 140/60 mmHg

* respiratory rate = 18 breaths/minute

* temperature = 36.0°C

* urine analysis = protein trace, blood trace

* O2 saturation on air = 96%