EBCOG P1 – 3 Month – General gynecology – Day 2

Q1. What is the most common subtype of vulval lichen planus to cause vulval symptoms?

Q2. A 40-year-old woman complains of burning and stinging in the vulva. There is no clinically identifiable neurological condition and there are no relevant visible findings.

What is the most likely clinical diagnosis?

Q3. A women diagnosed with localised unprovoked vulvodynia has had no relief from her symptoms despite practising good vulval care and using topical treatments which included lidocaine oint- ment and gabapentin.

What is the next line of management?

Q4. Community-based surveys indicate that about one-fifth of women have significant vulval symptoms. Symptoms and signs of vulval skin disorders are common and include pruritus, pain and changes in skin colour and texture. What is the most common vulval disorder seen in a hospital set- ting?

Q5. Lichen sclerosus accounts for at least 25% of the women seen in dedicated vulval clinics, with estimates of incidence quoted as 1 in 300 to 1 in 1000 of all patients referred to dermatology departments. What is the pathognomonic histologic feature of lichen sclerosus?

Q6. A 60-year-old woman presents with vulval itching with no relief with scratching. On examination the skin appears fragile, with well demarcated white plaques. There is no involvement of the vagina or the oral mucosa. What is the most likely diagnosis?

Q7. A woman with biopsy-proven lichen sclerosus is not responding to topical ultra-potent steroids. What is the second line of treatment?

Q8. . Ms. XY is 64 years old, postmenopausal. Her recent TV ultrasound scan reveals the presence of a 4 cm right ovarian cyst. The cyst is multiloculated and shows the presence of a solid area. There is no free fluid. The left ovary is normal. Her CA125 is 70 u/ml. She has been explained of her RMI results. What is her RMI score based on the information provided?

Q9. You perform a transvaginal ultrasound scan on a 56-year-old woman who has a unilateral ovarian cyst. Which of the following is a suspicious feature?

Q10. Ms. XY is 64 years old and is postmenopausal. She has recently been diagnosed with a 4 cm ovarian cyst on a transabdominal scan. The scan could not identify the other ovary as the bowel obscured it. The scan was being undertaken for suspected gallstones with the cyst being an incidental finding. Ms. XY is very anxious that this may represent ovarian cancer. Which of the following investigations are best suited to her to further investigate the ovarian cyst?

Q11. Ms. XY is 64 years old, postmenopausal. Her recent TV ultrasound scan reveals the presence of a 4 cm right ovarian cyst. The cyst shows anechoic fluid with no solid areas. There is no free fluid. The left ovary is normal. Her CA125 is 5 u/ml. Which of the following treatment options are best suited to her?

Q12. Ms. XY is 64 years old, postmenopausal. Her recent TV ultrasound scan reveals the presence of a 4 cm right ovarian cyst. The cyst is multiloculated and shows the presence of a solid area. There is no free fluid. The left ovary is normal. Her CA125 is 50 u/ml. She has been explained of her RMI results (450). Which of the following treatment options are best suited to her?

Q13. What is the risk of cancer RMI scores of less than 25 ——, between 25 and 250 —–,and greater than 250 —— respectively, based on historical validation data.

Q14. The risk of malignancy in these studies of simple cysts that are less than 5 cm, unilateral, unilocular and echo-free with no solid parts or papillary formations is less than 1%.In addition, a study reported that more than 50% of these simple cysts might resolve spontaneously within —– months.