EBCOG P1 High Yield ques – General Gyneacology-29 April(S.B.A)

1. An 18-year-old girl has presented with abnormal vaginal discharge. Cultures of the purulent discharge confirm Neisseria gonorrhoea and Chlamydia trachomatis coinfection. What is the most cost-effective treatment?

A Azithromycin 1 g per os one dose
B Ceftriaxone 500 mg intramuscular + azithromycin 1 g per os one dose
C Ceftriaxone 500 mg intramuscular + doxycycline 100 mg twice daily for 7 days
D Doxycycline 100 mg twice daily for 7 days
E Ofloxacin 200 mg twice daily or 400 mg once daily for 7 days

2.A 16-year-old girl presents to the gynaecology outpatient clinic with primary amenorrhoea. Her breast development is Tanner stage IV. She has a blind vaginal pouch and no cervix. Which of the following describes the most likely diagnosis?

A Gonadal dysgenesis
B Kallman's syndrome
C Late onset congenital adrenal hyperplasia
D Mayer-Rokitansky-Küster-Hauser syndrome
E Polycystic ovarian syndrome

3. A 48-year-old multiparous woman presents with heavy menstrual bleeding. Her ultrasound scan is normal. What should the next step in her management be?

A Hysteroscopy
B Hysterectomy
C Endometrial biopsy
D Reassure
E Gonadotropin-releasing hormone analogues

4. Tranexamic acid belongs to one of the following groups:

A COX inhibitor
B COX activator
C Antifibrinolytic
D Plasminogen activator
E Menstrual endometrium stabiliser

5.A 31-year-old woman had a large loop excision of the transformation zone (LLETZ) for high grade abnormality of her cervix 3 months ago. What is the most appropriate follow up?

A Colposcopy 6 months following LLETZ
B Colposcopy and treatment 6 months from LLETZ
C Human papilloma virus (HPV) blood test at 6 months
D Smear and HPV testing at a general practice 6-months post LLETZ
E Smear and HPV testing at a general practice 12 months following LLETZ

6.A 54-year-old woman presents to the general gynaecology clinic with an incidental finding of a 4 cm simple right ovarian cyst. Her CA-125 is 24 kU/L. What is the best option for her?

A Recommend an exploratory laparotomy
B Recommend a laparoscopic bilateral salpingo-oophorectomy
C Recommend an ovarian cystectomy
D Refer to a gynaecological oncologist
E Repeat the pelvic ultrasound and CA-125 in 4 months

7. Which of the following findings on transvaginal scan is a definitive of the diagnosis of missed miscarriage?

A Crown-rump length of 3.4 mm with no fetal heart
B Crown-rump length of 6.7 mm with no fetal heart
C Crown-rump length of 8.6 mm with no fetal heart
D Empty gestational sac with a mean sac diameter of 15 mm
E Gestational sac with mean sac diameter of 19 mm, with presence of yolk sac but no fetal pole

8.Methotrexate can be offered as the first line treatment for ectopic pregnancy in which of the following scenarios?

A Stable patient with B-human chorionic gonadotropin (B-hCG) of 348 IU/L with significant amount of echogenic fluid in the abdomen
B Stable patient with B-hCG of 6648 IU/L
C Stable patient with a live ectopic pregnancy (fetal heart seen)
D Stable patient with B-hCG of 1487 IU/L and minimal free fluid in the pouch of Douglas (POD)
E Stable patient with B-hCG of 4487 IU/L and minimal free fluid in the POD

9.A 32-year-old nulliparous woman presents with heavy menstrual bleeding. Ultrasound scan shows a grade 0 submucosal fibroid of 5 cm. The patient is keen to have children. What management option are you most likely to consider for her?

A levonorgestrel-releasing intrauterine system
B Hysteroscopic fibroid resection
C Uterine artery embolisation
D GnRH analogues
E Hysterectomy

10.A 40-year-old woman presents with cyclical mood swings and abdominal bloating in the premenstrual phase of the menstrual cycle. Which of these these modalities of treatment will you not consider?

A GnRH analogues
B Laparoscopic bilateral oophorectomy
C Cyclical progestogens
D Antidepressants

11. 24-year-old woman is diagnosed with an ectopic pregnancy on ultrasound. serum -hCG level measured on the day was 1100 mIU/mL and she was en 50 mg/m2 of methotrexate intramuscularly. Five days later, she complains of increased lower abdominal pain. Her blood pressure is 120/78 mmHg and ulse is 78 beats per minute. Her abdomen shows some tenderness in the left iliac fossa with no guarding or rebound. Which of the following is the best course of action?

A Laparoscopy +/- salpingectomy
B Laparotomy
C Repeat dose of methotrexate
D Repeat serum B-hCG level
E Repeat ultrasound scan

12.A 37-year-old woman presented with vaginal spotting at 7 weeks’ gestation. Transabdominal ultrasound scan suggests a mean sac diameter of 24 mm with no fetal pole seen. What is the most appropriate course of action?

A Repeat ultrasound scan in 2 weeks
B Transvaginal scan in 2 weeks
C Perform transvaginal scan at same setting
D Measure serum ß-hCG
E Offer medical management of miscarriage

13. Which of the following management options for a miscarriage are associated with reduced rate of fever and rigors, and improved patient satisfaction?

A Misoprostol 400 ug oral
B Misoprostol 400 ug rectal
C Misoprostol 400 ug vaginal
D Misoprostol 800 mg oral
E Misoprostol 800 ug vaginal

14. A 65-year-old woman presented with an episode of post-menopausal bleeding lasting one week. An outpatient hysteroscopy finds a 3 cm endometrial polyp. What would be your next line of management?

A Blind avulsion of the polyp in the outpatient clinic
B Endometrial biopsy
C Hysterectomy
D Hysteroscopic resection of polyp under general anaesthetic

15.Which clinical feature is diagnostic of the menopause?

A Amenorrhoea for longer than 12 months after the age of 45 years
B Follicle stimulating hormone level of > 30 IU/L
C Development of vasomotor symptoms
D Menstrual changes after the age of 52 years
E Sexual dysfunction and reduced libido after the age of 52 years

16.Which of the following conditions is not associated with an early menopause?

A Cardiovascular disease
B Osteoporosis
C Endometrial cancer
D Sexual dysfunction
E Subfertility

17.Which enzyme is responsible for the peripheral conversion of androgens to oestradiol in the menopausal patient?

A P450 aromatase
B 50. Reductase
C 17a-hydroxylase
D 17-20 desmolase
E 17-3 hydroxysteroid dehydrogenase

18. A 48-year-old patient with a body mass index of 24 is referred to the gynaecology department because her periods have become more unpredictable and are sometimes heavier than she is used to. Her cycle is now 4-8/28-38. Her last period, which lasted for 8 days and was associated with clots, was 3 weeks ago. Her follicle stimulating hormone level is 12 IU/L. What STRAW +10 criteria best fit her current menopausal status?

A -5
B -4
C -3b
D -2
E -1

19.A 48-year-old patient with a body mass index of 28 is referred to the gynaecology department because she is experiencing vasomotor symptoms. Her last period was 3 months ago and her general practitioner was uncertain whether cyclical hormone replacement therapy or the combined oral contraceptive pill would be most appropriate.What STRAW +10 criteria best fit her current menopausal status?

A -4
B -3b
C -2
D -1
E +1

20. A 66-year-old woman presents to the rapid-access gynaecology clinic with a small episode of postmenopausal bleeding. A pelvic ultrasound (transvaginal) scan shows an endometrial thickness of 12 mm but no polyps or fibroids, and her adnexa looks normal. A pelvic examination shows atrophic changes but is otherwise normal. A pipelle biopsy reveals scanty endometrial cells only but no neoplasia, hyperplasia or atypia. What is the single most appropriate management step?

A Discharge back to the general practitioner with topical hormone replacement therapy (HRT) and instruct her to return if bleeding persists
B Discharge back to the general practitioner with oral HRT and instruct her to return if bleeding persists
C Hysteroscopy +/- biopsy
D Hysterectomy
E Repeat ultrasound +/-pipelle biopsy in 3 months