EBCOG PART 1 – 2 Months Subfertility – Day 2

1. A 30 year old woman has presented to subfertility clinic with primary subfertility.Semen analysis of partner is normal.She has regular cycles although there is severe dysmenorrhea & menorrhagia.Ultrasound done shows an endometriotic cyst 4 cm on right side.Rest of findings are normal.For tubal testing which is the most appropriate test for her?

A. HycoSy scan
B. Diagnostic laparoscopy
C. MRI scan to diagnose endometriosis
D. HSG
E. There is no need to test tubal function.

2. Which of the following is true of using chlamydia antibodies as a screening test?

A. The test is very expensive.
B.♦.A positive test is always indicative of C.trachomatis infection.
C. There is no link established between serum antivbodies & C.trachomatis infection& tubal factor infertility
D. In the absence of risk factors a negative Chlamydia antibody test indicates a <15% likelihood of tubal patency
E. The test is cycle specific in its application.

3. A 35 year old woman presents with secondary subfertility of 2 years.She had 2 miscarriages over a period of 6 months.A usg showed an enlarged uterus with multiple fibroids.Hsg done a year ago showed patent tubes.Semen analysis of her partner is normal.The couple want to start fertility treatment.What is the most appropriate initial assessment you would advise for her?

A. Hysteroscopy to look for any fibroids in the cavity.
B. Diagnostic laparoscopy & myomectomy
C. MRI to confirm fibroids
D. Sonohysterography for the evaluation of endometrial cavity.
E. Repeat USG in 6 months.

4. A 35 year ols woman with multiple uterine fibroids wishes to start her family now.What is the step in her treatment?

A. Hysteroscopic evaluation of cavity for submucosal resection
B. 6 month treatment with raloxifene
C. Treatment with uterine artery embolization
D. Laparoscopic myomectomy
E. Treatment with danazol for 1 year

5. While counselling a woman in the subfertility clinic about HSG,which of the following statement holds true?

A. Its a contrast study using Xrays that helps to visualise the uterine cavity,fallopian tubes & the ovaries.
B. It has a high degree of specificity & if it suggests tubal patency ,tubal blockage is unlikely.
C. The procedure can be done at nay of the menstrual cycle.
D. Its a non dynamic test that assess tubal function by a series of Xrays.
E. It is not necessary to exclude chlamydia infection prior to the test.

6. A 28 year old woman developed acute pelvic pain after undergoing an HSG.She has 3 years of secondary subfertility .She has a child with her previous partner.The recnt HSG showed blocked tubes.Which of the following statement is true with regards to tubal factor infertility?

A. PID is the major cause of tubal factor infertility.
B. Early diagnosis & treatment is futile.
C. There is no value in tubal surgery
D. Streotococcus B is the most common offender
E. This accounts for approximayely 80% of subfertility in women.

7. A 30 year old woman with infertility presented for treatment.Her HSG shows bilateral hydrosalpinges.Semen analysis of her partner is normal.What is the best treatment option for her?

A. IVF treatment
B. Consider salpingectomy prior to IVF
C. Consider tubal aspiration prior to IVF
D. Offer 6 cycles of IUI with gonadotropins
E. Offer 6 cycles of IUI with clomiphene

8. What is the most appropriate treatment for a woman seeking fertility with a moderate sized intracavitary fibroid measuring just less than 3 cm.

A. Uterine artery embolization
B. Hysteroscopic resection of fibroid
C. High intensity focussed ultrasound for destruction of the fibroid.
D. Myomectomy
E. Magnetic resonance guided focussed ultrasound surgery.

9. A 30 year old presents with primary subfertility for 2 years.HSG has confirmed tubal patency,but shows a filing defect in the uterine cavity suggestive of a fibroid.An ultrasound revals a bulky uterus with multiple fibroids.What would be the next step in her management?

A. Saline sonogram to visualise the cavity
B. 3D ultrasound
C. MRI to correctly delineate the number,size & site of fibroids
D. HyCoSy scan
E. Hysteroscopic exam

10. A couple is trying for a pregnancy for 3 years.The female partner is 37 yrs old & diagnosed with stage 3 endometriosis.What will be the most appropriate recommendation for her?

A. Laparoscopic surgery with ablation of endometriotic tissues
B. Laparoscopic surgery followed by 6 mth period of ovulation induction
C. Laparoscopic surgery followed by 3 trials of ovulation induction
D. Treatment with GnRH analogue for a period of 3-6 mths
E. Proceed to IVF as soon as possible

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EBCOG PART 1 – 2 Months Subfertility – Day 2

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