EBCOG Part 1 2 Weeks Crash Course General Gynaecology,Urogynaecology,Reproductive Medicine Day 1

1.You are asked to see a 16 year old girl who has still not started menstruating. You request some basic investigations and an ultrasound shows that the uterus is present and bloods show high gonadotrophin levels. Which is the most likely cause?

2.A 19-year old girl presents with primary ammenorrhoea.During the course of  investigations, a diagnosis of idiopathic hypogonadotrophic hypogonadism is made. Which one of the following is likely to be true?

3.On prenatal genetic diagnosis, a female fetus is found to have Turner’s syndrome. The parents request counselling to understand the effect that this will have on their child later in life.Which of the following statements is not correct to include in the counselling?

4) A 17-year old girl who is generally fit and well presents with primary amenorrhoea. She has poorly developed secondary sexual characteristics, but normal female external genitalia. She underwent successful treatment for a Wilm’s tumour in infancy.

5. Ms. XY is 32 years old, otherwise fit and well and using the progesterone-only pill for contraception. She has recently been diagnosed (incidentally) with a 55 mm simple right ovarian cyst with anechoic fluid. Her CA-125 results are 5 u/ml. She is very anxious about the prospect of surgery. She has been risk assessed for VTE and is at low risk for using the COCP. Which of the following treatment options are best suited to her?

6.Oral HRT commenced in the peri-menopause:

7.Regarding oestrogen therapy and the post-menopausal bladder:

8.The following drugs have anti-catabolic actions on bone:EXCEPT:

9.With regard to causes of primary amenorrhoea:

10.Answer true or false.

Complete Müllerian agenesis, or Rokitansky syndrome, is

classically associated with:ALL EXCEPT:

11.Combined hormone replacement therapy (HRT) commenced more than 10 years after the menopause:

12. A 70-year-old woman undergoes a dual-energy X-ray absorptiometry (DXA) scan to assess her bone mineral density. What T score is diagnostic of osteoporosis?

13 .What is the mode of action of bisphosphonates?

14. A 55-year-old woman is due to come in for total abdominal hysterectomy and bilateral salpingo-oophorectomy for a large mucinous ovarian cyst. She takes sequential HRT for menopausal symptoms. You discuss with her the risk of venous thromboembolism. How long prior to surgery should she stop HRT?

15. A 38-year-old woman presents to the gynaecology clinic with a 6-month history of amenorrhoea and hot flushes. A pregnancy test is negative. Her serum follicle-stimulating hormone (FSH) is measured and found to be 45 IU/l. What further result would confirm a diagnosis of premature ovarian insufficiency (POI)?

16. A 44-year-old woman is referred to a menopausal clinic with severe vasomotor symptoms and low mood. She has a history of oestrogen-receptor-positive and progesterone-receptor-negative breast cancer which was treated with wide local excision and radiotherapy. She is currently on tamoxifen.What would you prescribe to treat her menopausal symptoms?

17. A 38-year-old woman is referred to gynaecology clinic by GP. She gives history of amenorrhoea for the past 6 months. She has two children delivered by caesarean section and regular periods prior to this. Her urine pregnancy test is negative. Her mother had premature menopause at the age of 30.The diagnosis in her case is based on

18. A 36-year-old woman is referred to the gynaecology clinic complaining of secondary amenorrhea for the last eight months since stopping COCP, which she has been taking for two years. She is a mother of two children. Her BMI is 24. Hormonal assessment five weeks previously showed her follicular stimulating hormone (FSH) of 26 IU/L and luteinizing hormone (LH) of 20 IU/L. What will be your next step for diagnosis?

19.An 18-year-old national gymnastic champion is referred to you. She experiences long periods of secondary amenorrhea and she only has two to three periods each year. She is training for the coming Olympics but her general practitioner advised her to visit you because she is worried about her. She suffers from backache. Her BMI is 16. What will you offer her?

20. A 53-year-old woman who is amenorrhoeic for the past 1 year complains of vaginal dryness, superficial dyspareunia and urinary urgency. She has been treated for urinary infection 2 months back, and there is no active urinary infection now although symptoms persist. She has been on HRT for the past 6 months due to severe palpitations, hot flushes and night sweats, and she is relieved of those symptoms.Which of the following statements is appropriate for her?

22. Women with premature ovarian insuffi ciency are not at increased risk of:

23.A 52-year-old woman is referred by her GP to the menopause clinic with hot flushes and night sweats. She is concerned about the risk of breast cancer following the use of HRT. Which of the following statements regarding HRT and breast cancer is true?

24.Mrs. Rebecca 32yearold with secondary amenorrhoea who intentionally lost 12kgs BMI;26

FHS:56Iu/L

LH: 43 IU/L

Estradiol ;25mmol

Cause  of amenorrhea

24.A 35-year old woman with a BMI of 32 is referred to the menstrual dysfunction clinic and, after investigation, receives a diagnosis of PCOS. She would like to know about the potential health benefits of weight loss. Which one of the following is not likely to be improved by a 5e10% weight loss?

25.A 51-year old university professor suffers from heavy regular periods and has opted to have a Mirena IUS fitted in an attempt to improve these. She has some detailed questions about how the Mirena will work and how it will treat her  menorrhagia. Which one of the following is not true regarding the Mirena IUS?