EBCOG Part-1 High Yield Questions – Sexual & Reproductive health

1. A 25-year-old sexually active woman presents with pelvic pain and vaginal discharge. A urine pregnancy test is negative. On examination, cervical excitation is noted. Vaginal swabs are taken.
What is the most appropriate next course of action while waiting for the swab results?

A. Await results and do nothing
B. Reassure patient and discharge
C. Start empirical antibiotics
D. Provide pain relief and reassure the patient that non-steroidal anti-inflammatory drugs should resolve the symptoms
E. Arrange laparoscopy

2. A 22-year-old woman attends the consultant antenatal clinic at 8 weeks of pregnancy. She has a history of syphilis which was treated 5 years ago. The results of serologic tests for syphilis are as follows:
Non-treponemal test (rapid plasma reagin assay): non-reactive Treponemal test (Treponema pallidum particle agglutination assay): reactive
Which of the following statements is correct?

A. The baby is at high risk for congenital syphilis
B. No further action is required
C. Oral prophylactic erythromycin should be given during pregnancy
D. The patient needs a lumbar puncture and a venereal disease research laboratory test for her cerebrospinal fluid for neurosyphilis
E. The patient needs to be checked for syphilis serology IgG

3. A 24-year-old presents to the A&E department with pelvic pain and vaginal discharge. On examination she is found to be pyrexial (38°C) with moderate lower abdominal tenderness. Vaginal examination con rms bilateral adnexal tenderness and cervical motion tenderness.
Which of the following clinical features are not suggestive of PID?

A. Lower abdominal pain which is typically bilateral.
B. Deep dyspareunia.
C. Abnormal vaginal bleeding, including post coital, intermenstrual and menorrhagia.
D. Abnormal vaginal or cervical discharge which is o en purulent.
E. Lower abdominal pain which is typically unilateral.

4. A 34-year-old woman with a BMI of 29, who has been taking enalapril for essential hypertension, requests the combined oral contraceptive pill. Her BP is well controlled on this treatment and today is 134/88 mm Hg.
To which UK Medical Eligibility Criteria would well-controlled hypertension be considered?

A. 1
B. 2
C. 3
D. 4
E. 5

5. A 36-year-old para 2 who is HIV positive with a CD4 count of 73 has been recently started on antiretrovirals. She has attended for her routine cervical smear and mentions that she has developed an ulcer on her labia. Clinically this is vulval herpes simplex virus.
What is the best treatment regime?

A. Oral aciclovir 200 mg 5 times a day for 5 days.
B. Oral aciclovir 200 mg 7 to 10 times a day for 5 days.
C. Oral aciclovir 400 mg 5 times a day for 5 days.
D. Oral aciclovir 500 mg 5 times a day for 7 to 10 days.
E. Oral aciclovir 800 mg 5 times a day for 5 days.

6. A 28-year-old nulliparous patient attended for routine cervical screening which has shown borderline changes and HPV inadequate results. She is not currently sexually active and has had normal smear results before this test.
What is the next appropriate step in management?

A. Refer to colposcopy.
B. Repeat cytology only in 3 months.
C. Repeat cytology and HPV in 3 months.
D. Repeat cytology and HPV in 6 months.
E. Repeat cytology and HPV in 12 months.

7. An 18-year-old nulliparous patient attends the gynaecology clinic for heavy painful menstrual bleeding. She is in a sexual relationship with a new partner and both have tested negative for STIs, though she has had a previously treated chlamydia infection. She does not want any children in the near future. She takes lamotrigine for epilepsy control and has not su ered any seizures for 3 years. General and pelvic examinations are normal, and her BMI is 30.
What is the best appropriate method of contraception in her situation?

A. Combined oral contraceptive pill.
B. Depot medroxyprogesterone acetate.
C. Evra patch.
D. Levonorgestrel-releasing intrauterine system.
E. NuvaRing

8. A 35-year-old nulliparous patient is HIV positive and takes efavirenz and nevirapine. She is using a 30-mcg oestrogen combined oral contraceptive preparation as well as barrier contraception. She nished a pill packet 10 days ago, forgot to restart again and had unprotected sexual intercourse 2 days ago. She also missed two pills in her rst week of the previous pill packet. A chlamydia urine polymerase chain reaction test is positive. She attends asking for emergency contraception.
What is the most appropriate method of emergency contraception in this situation?

A. 1.5 mg levonorgestrel as soon as possible.
B. 3 mg levonorgestrel as soon as possible.
C. LNG-IUS as soon as possible.
D. e copper IUD as soon as possible.
E. Ulipristal acetate single 30 mg tablet as soon as possible.

9. A 50-year-old para 2 attends the outpatient gynaecology clinic for HRT advice. She has not had a period for 2 years and has been su ering with increasing hot ushes and sweating. She also reports decreased sexual desire. Detailed history, general and pelvic examinations are unremarkable.
What is the most appropriate HRT regime?

A. Low-dose vaginal oestrogen
B. Topical oestrogen preparation.
C. Combined oestrogen progesterone preparation orally.
D. Cyclic oestrogen progesterone preparation orally.
E. Tibolone.

10. A 28-year-old patient is referred from the A&E department with lower abdominal pain and vaginal discharge. On examination she has a temperature of 37.3°C, a pulse of 86 bpm and a BP of 120/83 mm Hg.
Her abdomen is slightly tender in the LIF region. On vaginal examination there is a mild corresponding adnexal tenderness, the IUCD threads are seen and a swab of mucopurulent discharge is taken. She mentions that she has a new sexual partner and has not used barrier contraception.
What is the most appropriate next step in her management?

A. Intravenous PID-targeted antibiotics + IUCD removal immediately.
B. Oral PID-targeted antibiotics + IUCD removal immediately.
C. Oral PID-targeted antibiotics and, if no improvement in symptoms, remove IUCD in 24 hours.
D. Oral PID-targeted antibiotics and, if no improvement in symptoms, remove IUCD in 48 hours.
E. Oral PID-targeted antibiotics and, if no improvement in symptoms, remove IUCD in 72 hours.

11. A hysteroscopic tubal sterilization using exible microinserts (Essure) is performed. e procedure time is about 30 minutes (from insertion to removal of hysteroscope), and there was a concern regarding possible perforation due to a sudden loss of resistance at insertion.
What is the suggested method of con rming that the procedure has been
successful?

A. Hysterosalpingogram.
B. Magnetic resonance imaging.
C. Transvaginal ultrasound scan.
D. Pelvic x-ray.
E. Diagnostic laparoscopy.

12. Gonorrhoea most commonly causes the following except for which one?

A. Urethritis
B. Proctitis
C. Conjunctivitis
D. Pharyngitis
E. Endocarditis

13. The following facts about chlamydia are true except for which one?

A. It is the most common sexually transmitted infection (STI) in the United Kingdom
B. 3%–7% of sexually active women under 24 years of age have this condition
C. 70% of women can be asymptomatic
D. Abnormal menstrual bleeding is not a symptom
E. If untreated, it can cause sexually acquired reactive arthritis (SARA)

14. Chlamydia is the most common STI in the United Kingdom. With regards to chlamydia pelvic infection, the following facts are true except for which one?

A. It is effectively treated with doxycycline
B. PID occurs in 10%–15% of untreated women attending GUM with chlamydia
C. It is treated with erythromycin if diagnosed during pregnancy
D. Eradication should be checked 4–6 weeks after treatment
E. Barrier contraception helps to prevent re-infection

15. A 28-year-old woman attends antenatal clinic at 29 weeks of gestation. She recently had visited a sexual health clinic for investigation of her painless vulval ulcer and inguinal lymphadenopathy.
What treatment would be appropriate for her from the following options?

A. Benzathine penicillin G single dose as first-line therapy
B. Azithromycin single dose as first-line therapy
C. Two doses of benzathine penicillin G to be given 1 week apart
D. Benzathine penicillin G three weekly doses as first-line therapy
E. Tetracycline 100 mg three times a day for 14 days

16. A 29-year-old woman attends antenatal clinic at 28 weeks of gestation. She gives a history of syphilis 2 years ago. She has recently been diagnosed with late syphilis and now advised to have a cerebrospinal fluid (CSF) examination test.
The indications for CSF examination include all of the following except for which one?

A. Ophthalmic signs and symptoms
B. Syphilis treatment failure
C. Neurological signs and symptoms
D. Cardiovascular signs and symptoms
E. HIV infection with late latent syphilis

17. A 25-year-old woman presents to A&E with painful vulva. Examination reveals multiple ulcers (around the fourchette) with ragged undermined edges with necrotic base and purulent exudate. There was contact bleeding. Also noted were enlarged tender left inguinal lymph modes.
The like diagnosis in her case is which of the following?

A. Lymphogranuloma venerum
B. Syphillis gummata
C. Chancroid
D. Donovanosis
E. Type 2 herpes simplex infection

18. A 23-year-old woman presents to the sexual health clinic with warty lesions on her vulva. Examination reveals warts on the vulva and the lower part of vagina but not obstructing the vagina. She is currently 16 weeks by dates and is booked for an anomaly scan at 20 weeks.
How would you treat her at this stage?

A. Podophylline
B. Trichloroacetic acid
C. 5-Fluorouracil
D. Excision of all lesions under general anaesthesia
E. Interferons

19. A 66-year-old woman is referred to the vulval clinic as a 2-week wait. She is para 2 with premature menopause. She has been taking hormone replacement therapy (HRT) for the last 27 years. She gives history of vulval itching, soreness and superficial dyspareunia. Clinical examination reveals erythematous changes within the vulval skin with fissuring, excoriation and oedema. Satellite lesions are seen on the inner thigh and lower abdomen.
A probable diagnosis in her case is which of the following?

A. Lichen sclerosis
B. Lichen planus
C. Candidiasis
D. Donovanosis
E. Lichen simplex

20. A 35-year-old woman presented with a frothy vaginal discharge that is fishy in

odour. On speculum examination, the cervix was red, punctate and inflamed.

The wet mount shows the mobile organism.

What is a likely diagnosis in her case?

A. Trichomoniasis
B. Candidiasis
C. Bacterial vaginosis
D. Chlamydia
E. Donovanosis