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Gine > Crash course > Flashcards

Crash course Flashcards

1
Q

Which of the following statements is incorrect?
A. Premature menopause is defined as the last period
before the age of 45 (but after 40 years) of age
B. The average age of menopause is 51
C. All patients should receive HRT
D. Where there is a uterus both oestrogen and
progesterone should be given as HRT
E. Endometrial cancer is a contraindication to HRT

A

C. Patients should only take HRT if clinically indicated.

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2
Q 
Transdermal HRT is becoming increasingly popular. Which statement regarding transdermal HRT is incorrect?
A. Avoids first-pass metabolism
B. Reduced risk of VTE
C. Continuous administration
D. Only contain oestrogen
E. Can cause skin reactions
A

D. Transdermal patches provide both oestrogen and progesterone.

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3
Q 
Clonidine is a centrally acting alpha-2 agonist used in the menopause, which of the following symptoms has it been shown to be useful in treating?
A. Hair loss
B. Loss of libido
C. Osteoporosis
D. Hot flushes
E. Mood swings
A

D. Clonidine is a useful second line agent for hot flushes.

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4
Q

Which of the following statistics reflects the success rate of conception for a couple trying for 1 year?
A. 60% will conceive within 1 year with regular
unprotected sexual intercourse
B. 84% will conceive within 1 year with regular
unprotected sexual intercourse
C. 15% will conceive within 1 year with regular
unprotected sexual intercourse
D. 20% will conceive within 1 year with regular
unprotected sexual intercourse
E. 96% will conceive within 1 year with regular
unprotected sexual intercourse

A

B. 84% of couples will conceive within one year if the woman is under 40 years old and they have regular unprotected sexual intercourse.

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5
Q 
Which of the following is NOT known to cause subfertility in either the male or the female partner?
A. Chlamydia infection
B. Polycystic ovarian syndrome (PCOS)
C. Epididymo-orchitis
D. Endometriosis
E. Varicose veins
A

E, Varicose veins of the legs do not affect fertility.

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6
Q

Which of the following investigations should ideally be performed before a patient attends for a hysterosalpingogram?
A. Rubella immunity
B. Full blood count
C. Pelvic infection screen (high vaginal and endocervical swabs)
D. Thyroid function tests E. Day 21 progesterone

A
  1. C. It is important to exclude infections such as Chlamydia, which can lead to secondary infertility
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7
Q 
Which of the following is NOT a risk factor for cervical cancer?
A. Human papilloma virus
B. Smoking
C. Multiple sexual partners
D. Early age of first intercourse
E. History of endometriosis
A

E, Endometriosis may increase CA125 levels, and most commonly affects the ovaries, pouch of douglas, uterosacral ligaments and ovarian fossae. However, it does not increase the risk of cervical cancer.

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8
Q

Mary is 55-years-old and has not had a period for 4 years. She had an ultrasound because she was feeling bloated which showed bilateral multilocular cysts and her CA125 was 80. What is her risk of malignancy index?
A. 240 B. 80 C. 0 D. 720 E. 411

A

D, RMI is calculated by multiplying the CA125 level by menopausal status and ultrasound score.

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9
Q 
Agatha is 66 and underwent her last period over 15 years ago. Over the last week she has noted some blood spotting on her underwear. She has a body mass index of 34 and her GP organized an ultrasound, which showed an endometrial thickness of 12 mm. What is the most important investigation she should have next?
A. MRI pelvis
B. Chest X-ray
C. Hysteroscopy and endometrial biopsy
D. CT abdomen and pelvis
E. Cervical smear
A

C, Hysteroscopy and Biopsy is important to visualise the endometrial cavity and obtain a tissue sample to exclude endometrial cancer.

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10
Q 
Which of the following examination findings is most suggestive of endometriosis?
A. Cervical excitation
B. Adnexal mass
C. Nodules in the posterior fornix
D. Generalized tenderness
E. Uterine tenderness
A

C, All the other options are not specific to endometriosis. Nodular deposits in the posterior fornix are highly suggestive of endometriosis and should be sought at speculum examination and digital vaginal examination within the context of a consistent clinical history.

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11
Q 
Which of the following aspects of the history is most suggestive of endometriosis?
A. Deep dyspareunia
B. Vaginal discharge
C. Cyclical pelvic pain
D. Subfertility
E. Gastrointestinal symptoms
A

C, All the other options are recognized features of several differential diagnoses, e.g. PCOS, PID. Cyclical pelvic pain is unique to endometriosis, reflecting the hormonal influence of the menstrual cycle on disease activity.

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12
Q

A patient presents with right iliac fossa pain
and cervical excitation. Her last menstrual period was 6 weeks ago. What is the most likely cause?
A. Tubo ovarian abscess
B. Ovarian cyst
C. Appendicitis
D. Fib r o id
E. Ectopic pregnancy

A

E, Although all the other options have these symptoms, an ectopic pregnancy is relatively more common and a life-threatening condition that must be ruled out first. Always work on the assumption that all women of child-bearing age with pelvic pain have an ectopic pregnancy until proven otherwise. The presence of cervical excitation suggests peritonism, which makes the diagnosis most likely.

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13
Q 
A patient gives a history of cyclical pelvic pain associated with secondary dysmenorrhoea. What is the most likely diagnosis?
A. PID
B. Endometriosis
C. Fib r o id
D. Adhesions
E. Vulval dystrophy
A

B, Cyclical pelvic pain is characteristic of endometriosis.

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14
Q 
A 27-year-old woman with a known benign ovarian cyst is admitted to Accident and Emergency department with an acute abdomen. What is the most important
test to do?
A. Full blood count
B. Group and save
C. Mid-stream urine
D. Pregnancy test
E. Pelvic ultrasound scan
A

D, It is essential to rule out ectopic pregnancy in the first instance in a woman of child-bearing age with an acute abdomen. Other possible gynaecological differentials include miscarriage, sepsis or cyst accident/ haemorrhage.

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15
Q

How is the RMI (risk of malignancy index) calculated?
A. U(ultrasound score) x M (menopause score) x Ca125 level
B. U(ultrasound score) þ M (menopause score) þ Ca125 level
C. U(ultrasound score) / M (menopause score) x Ca125 level
D. U(ultrasound score) x M (menopause score) / Ca125 level
E. U (ultrasound score) þ M (menopause score) / CA19-9 level

A

A, Risk of malignancy index is an important tool used to triage women with ovarian cysts to the most appropriate place for further investigation and management.

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16
Q 
A woman diagnosed with a benign epithelial tumour presented with irregular vaginal bleeding. What is the likely diagnosis?
A. Serous cystadenoma
B. Mucinous cystadenoma
C. Brenner tumours
D. Endometrioid tumours
E. Dermoid cyst
A

C. Brenner tumours can secrete oestrogen, causing irregular vaginal bleeding.

17
Q 
Which of the following examination findings is most suggestive of malignancy in a woman with vaginal discharge?
A. Raised temperature
B. Cervical excitation
C. Tachycardia
D. Generalized lymphadenopathy
E. Cachexia
A

E. All the other options are not specific to malignancy and may be seen in cases of sepsis. Cachexia is more specific to malignancy and other catabolic states.

18
Q 
Which of the following is not a pathological cause of vaginal discharge?
A. Cervical carcinoma
B. Cervical ectropian
C. Candida albicans
D. Chlamydia trachomatis
E. Fist u la
A

B. An ectropian is not pathological. It is simply an extension of endocervical columnar epithelium, which bleeds easily, onto the ectocervix and is common in pregnancy due to the influence of oestrogen. No treatment is necessary unless a co-existing infection is proven.

19
Q 
A patient has been diagnosed with candida infection. Which of the following supports this diagnosis?
A. Grey, fishy-smelling discharge
B. Thick, itchy, white discharge
C. Dysuria
D. Urinary frequency
E. Lower abdominal pain
A

B. The thick, white discharge of Candida infection has a typical appearance of ‘cottage cheese’ noted on speculum examination. It is treated easily with Clotrimazole pessary or cream.

20
Q 
A patient presents with abnormal vaginal discharge. Which aspect of her history is most helpful to rule out an infective cause?
A. Ag e
B. Weight loss
C. Irregular vaginal bleeding
D. Anorexia
E. Sexual history
A

E. A detailed sexual history is imperative to exclude sexually transmitted infections.

21
Q

Which of the following in a patient’s history is known to predispose them to Pelvic Inflammatory Disease (PID)?
A. Monogamous relationship
B. >25yearsofage
C. Use of Mirena IUS
D. History of sexually transmitted infection (STI)
E. Later onset of sexual activity

A

D. Most common organisms held responsible for PID are Chlamydia and Gonorrhoea neisseria, both sexually transmitted infections. Hence any history of previous STI would predispose a patient to PID.

22
Q

A patient with pelvic inflammatory disease (PID) presents with offensive, fishy smelling par vagina discharge. High vaginal swab confirms:
A. Chlamydia
B. Gonorrhoea
C. Anaerobes including Gardnerella and Mycoplasma
D. Candida
E. Trichomonas vaginosis

A

C. This describes Bacterial vaginosis, which is treated with a course of antibiotics (metronidazole).

23
Q 
Which of these is not an appropriate
first-line investigation for pelvic inflammatory disease (PID)?
A. White cell count (WCC)
B. C-reactive protein (CRP)
C. Erythrocyte sedimentation rate (ESR)
D. Laparoscopy
E. STD screen
F. Pelvic ultrasound scan
A

D. Although described as a gold standard investigation for making the diagnosis of PID – it is not the first- line investigation in view of surgical risks. There are less invasive, effective alternatives available as listed above. The aim should be to effectively diagnose and treat PID without going into the operating theatre, unless it is absolutely necessary, e.g. diagnosis not clearly defined (possibility of ectopic pregnancy/ appendicitis), clinical condition deteriorating, failed initial medical management.

24
Q 
A patient is diagnosed with acute PID.
Which of the following signs does NOT support that diagnosis?
A. Raised temperature > 37.5 C
B. Tachycardia
C. Vulval pruritis
D. Abdominal tenderness
E. Adnexal mass
A

C. Vulval pruritis is not characteristically associated with PID.

25
Q 
Which of the following are not recognised risk factors for genital prolapse?
A. Connective tissue disorders
B. Prolonged labour
C. Diarrhoea
D. Increasing parity
E. Chronic cough
A

C. Diarrhoea is not a recognized risk factor for genital prolapse. Constipation is. Options B&E cause prolonged periods of raised intraabdominal pressure hence risk of prolapse. Options A&D cause laxity in the pelvic floor supporting the pelvic organs.

Gine (4 decks)

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