EBCOG Part 1-Postnatal Care & Sexual Reproductive Health-Day 8 (SBA)

1.With regards to syphilis: All of the following are false except?

A It is caused by a virus
B The primary chancre is raised, round, indurated and painful
C The primary chancre resolves in 10–18 weeks
D Secondary syphilis is associated with painless lymphadenopathy
E Tertiary syphilis doesnot involve the cardiovascular system

2.A 21-year-old woman comes to the accident and emergency unit complaining of bilateral lower abdominal pain. On examination, her temperature is 38.5 C with bilateral adnexal tenderness. She tested negative for gonorrhoea and chlamydia the previous week.What is the management for this woman?

A. Reassure and discharge her.
B. Reassure, give pain killers and ask to repeat gonorrhoea and chlamydia testing in one week.
C. Repeat tests for gonorrhoea and chlamydia, and start treatment according to the results.
D. Start empirical IV antibiotic treatment.
E. Start empirical oral antibiotic treatment.

3.A 26-year-old woman comes to the accident and emergency unit complaining of abnormal vaginal bleeding, including post-coital and intermenstrual bleeding and menorrhagia. Her temperature is 38C. On bimanual vaginal examination, there is adnexal tenderness and cervical motion tenderness. A pregnancy test is negative. You diagnosed a pelvic inflammatory disease (PID). The patient tells you that she has been abroad and had unprotected sex. What is the recommended regimen for this patient?

A. . im ceftriaxone 1000mg single dose stat + Oral doxycycline 100mg BD + Oral metronidazole 400mg BD for 14 days.
B. Ciprofloxacin 200 mg twice a day (BD) plus oral doxycycline 100 mg BD for seven days.
C. Levoflaxacin 500 mg once daily (OD) plus oral metronidazole 400 mg BD for 14 days.
D. Moxifloxacin 400 mg OD oral for 14 days.
E. Ofloxacin 400 mg twice daily oral plus oral metronidazole 400 mg twice daily for 14 days.

4. A 25-year-old woman comes to the outpatient clinic for follow-up after a diagnosis of PID three weeks previously. Results of swabs were negative for chlamydia and gonorrhoea. You explained the significance of PID and its sequelae. She stated that the symptoms resolved and she had her antibiotics regularly. What else should you check at this visit?

A. Reassure and do nothing.
B. Review again in four to six weeks.
C. Repeat swaps for chlamydia and gonorrhoea.
D. Repeat bloods and C-reactive protein.
E. Screening and treatment of sexual contacts.

5.A 24-year-old woman comes to the genitourinary medicine clinic complaining of small multiple groups of painful vulval ulcers. On examination, the base of the ulcer was erythematous and inguinal lymph nodes were painful.What is the most likely diagnosis?

A. Chancroid.
B. Granuloma inguinale.
C. Herpes simplex virus (HSV).
D. Lymphogranuloma venereum.
E. Syphilis.

6.A 24-year-old woman comes to the genitourinary medicine clinic complaining of multiple painful ulcers on the vulval area. On examination, the ulcers are sharply circumscribed with a yellow exudate in the base. There are also painful inguinal lymph nodes on the left side.What is the most likely causative organism?

A. Calymmatobacterium granulomatis.
B. Chlamydia trachomatis.
C. Haemophilus ducreyi.
D. HSV-type 2.
E. Treponema pallidum.

7.A 23-year-old woman presents complaining of vaginal discharge. She has had recur- rent episodes of vulvovaginal candidiasis. You prescribe an induction and mainten- ance regimen for six months. She is worried about use of contraception as she had a copper intrauterine device (IUD) inserted two months earlier. What advice would you offer her?

A. Should remove the IUD.
B. Should remove the copper IUD and insert the Mirena coil.
C. Switch to a suitable oral contraceptive.
D. Should continue with this method.
E. Use the condom as an additional method to prevent recurrence of infection.

8.Which one of the following is correct in relation to syphilis?

A. Identified preferentially by culture of genital ulcer exudate in artificial media.
B. Dark field microscopy of genital ulcer (chancre) exudate is non-diagnostic.
C. Antibacterial treatment in early pregnancy does not prevent congenital syphilis.
D. Primary syphilis is associated with a mucocutaenous rash.
E. Secondary syphilis is associated with generalised lymphadenopathy.

9.A21-year-old woman presents to the emergency department because she has not been able to pass urine for the last 8 hours. She reports malaise, a temperature and myalgia a few days ago. When you examine her to insert a catheter, you see multiple blisters on the labia bilaterally. What is the diagnosis?

A.Chlamydia trachomatis
B.Herpes simplex virus
C.Human papillomavirus
D.Treponema pallidum
E.Varicella zoster Virus

10.Which one of the following is correct in relation to diagnosing and treating acute pelvic inflammatory disease (PID)?

A. All cases diagnosed with PID require transvaginal ultrasound scanning.
B. Long-term sequelae are unrelated to the severity of PID at presentation.
C. Outpatient antibiotic treatment should not be commenced prior to identification of organisms on swabs or knowing their sensitivities.
D. Over the long term, a copper IUD is associated with a lower rate of PID com- pared to Mirena LNGIUS.
E. The absence of endocervical or vaginal pus cells on a wet-mount vaginal smear reliably excludes PID.

11.A 21-year-old woman comes to the accident and emergency unit complaining of bilateral lower abdominal pain and fever. On examination, her temperature is 38.2 C with bilateral adnexal tenderness. What is your first line of investigation?

A. Endocervical swab for gonorrhoea and chlamydia.
B. HIV antibody test.
C. Pelvic ultrasound.
D. Pregnancy test.
E. Total leucocyte count.

12.A 21-year-old woman attends the emergency department with a genital ulcer. She is very anxious that this could be a sexually transmitted disease. A few weeks ago, she Visited friends in South-East Asia and had sexual Intercourse ‘with one of them. Examination reveals a single painless ulcer on the labia. What is the most likely infection?

A ChIamydJa trachomatis
B Herpes simplex virus
C Human papiIlomavirus
D Treponema pallidum
E Varicella zoster virus

13.You made a diagnosis of moderate PID in a young 24-year-old woman who presented to the accident and emergency unit with lower abdominal pain and pyrexia. You prescribe a combination of a single intramuscular injection of ceftriaxone and oral doxycycline and antipyretics. She is worried about her future fertility as a result of her PID. Where is she best treated to preserve her fertility?

A. As an inpatient.
B. As an outpatient.
C. In the accident and emergency unit until her temperature normalizes.
D. In a fever hospital.
E. In an isolation ward.

14.With regards to genital herpes simplex. All of the following are false except?

A It is the least common cause of reported vulval ulceration in the UK
B Most genital infections are caused by type 1 herpes simplex
C It typically causes multiple shallow painless ulcers on the vulval region
D Recurrent infections occur in 80% of the patients
E Recurrent infections tend to be more sever

15. 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 confirms 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 purulent.
E. Lower abdominal pain which is typically unilateral.

16. 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 five 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 five times a day for 5 days.
D. Oral aciclovir 400 mg five times a day for 7 to 10 days.
E. Oral aciclovir 800 mg five times a day for 5 days.

17.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.

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