gynae

Question 1

When is the most appropriate time to measure serum progesterone levels? (infertility)

Answer 1

7 days before next period

Question 2

Congenital adrenal hyperplasia has the following biochemical abnormalities;
________ plasma 17-hydroxyprogesterone levels
__________ plasma 21-deoxycortisol levels
____________urinary adrenocorticosteroid metabolites

Answer 2

Increased plasma 17-hydroxyprogesterone levels
Increased plasma 21-deoxycortisol levels
Increased urinary adrenocorticosteroid metabolites

Question 3

how does CAH present? What is the pattern of inheritance?

Answer 3

early menarche, large stature, facial hair
autosomal recessive

Question 4

Malignancy + raised CK → ?

Answer 4

polymyositis

Question 5

most common ovarian cyst:
most common epithelial cell tumour:

Answer 5

most common ovarian cyst: folicular cyst
most common epithelial cell tumour: serous cystadenoma

Question 6

which cyst, if it ruptures, may cause pseudomyxoma peritonei?

Answer 6

Mucinous cystadenoma

Question 7

which hormonal contraception is least likley to be affected by enzyme inducers

Answer 7

Depo-provera

Question 8

syphilis vs herpes - how to differentiate?

Answer 8

herpes: multiple, painful ulcers + lymphadenopathy
syphilis: single, non-tender ulcer + lymphadenopathy

Question 9

Stereotypical PCOS results:

Answer 9

raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low

Question 10

17-hydroxyprogesterone is required to distinguish between

Answer 10

late-onset CAH and PCOS

Question 11

Women should be encouraged to take folic acid 400mcg OD __________________________

Answer 11

3 months before conception up to 12 weeks gestation

Question 12

combined contraceptive patch: If the delay in changing the patch is less than 48 hours, __________________

Answer 12

it should be changed immediately and no further precautions are needed

Question 13

The only effective treatment for large fibroids causing problems with fertility is

Answer 13

myomectomy

Question 14

is past Hx of breast cancer a C/I to COCP?

Answer 14

yes

Question 15

All patients with secondary dysmenorrhoea _____________

Answer 15

need to be referred to gynaecology for investigation

Question 16

galactocele vs breast abscess

Answer 16

Galactoceles can be clinically differentiated from a breast abscesses because they are painless and non-tender on examination, and there will be no local or systemic signs of infection.

Question 17

Premature ovarian failure can be diagnosed in women less than 40 years of age with menopausal like symptoms and_____________

Answer 17

increased levels of FSH measured twice with at least a month between measurements

Question 18

Pregnant women with blood pressure________mmHg are likely to be admitted and observed

Answer 18

≥ 160/110

Question 19

Bladder still palpable after urination, think

Answer 19

overflow incontinence

Question 20

An 80 year-old woman presents to her GP with a 1.5cm ulcerated lesion on her left labium majus. Dx?

Answer 20

Vulval carcinomas

Question 21

what will be normal/raised in PCOS

Answer 21

LH and FSH will usually be normal or raised. Anti-Mullerian hormone (AMH) if measured will also be high due to anovulation

Question 22

, LH and FSH will usually be normal or raised. Anti-Mullerian hormone (AMH) if measured will also be high due to anovulation

Question 23

Menorrhagia, anaemia, bulk-related symptoms e.g. bloating/urinary frequency →

Answer 23

? uterine fibroids

Question 24

Ankylosing spondylitis features - the ‘A’s

Answer 24

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis

Question 25

cerebellar ataxia, and without limb ataxia (i.e. finger-nose ataxia) the lesion is more likely to be in the cerebellar vermis

Answer 25

Cerebellar hemisphere - finger-nose ataxia

Question 26

otitis externa Tx

Answer 26

topical cipro + dexamethasome

Question 27

Blood stained discharge is most likely to be associated with

Answer 27

a papiloma

Question 28

how would duct ectasia present

Answer 28

green-brown discharge and an abscess with puss discharging from the nipple. The latter will also be associated with red, swollen, warm skin of the breast.

Question 29

What advice do you give him with regards to vasectomy as a form of contraception?

Answer 29

Vasectomy isn’t an immediate form of contraception; semen analysis must be performed and azoospermia confirmed before used as contraception

Question 30

__________is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds

Answer 30

Whole breast radiotherapy

Question 31

RF for ectopic?

Answer 31

endometriosis

Question 32

Invitations for cervical cancer screening

Answer 32

are sent every three years between the ages of 25 and 49, and every 5 years between the ages of 50 and 64.

Question 33

do you use beta-histines for vestibular neuritis?

Answer 33

No

Question 34

To confirm ovulation:

Answer 34

Take the serum progesterone level 7 days prior to the expected next period

Question 35

Micrometastases or 2 macrometastases on sentinel lymph node biopsy during breast-conserving surgery →

Answer 35

Close, don’t dissect.

Question 36

A 22 year female who is 24 weeks pregnant presents with frank haematuria. She is sexually active. She has had a previous pregnancy resulting in caesarean section.

Answer 36

Pregnancy and frank haematuria, especially if there is a history of placenta previa or prior caesarean section, should indicate this diagnosis. There is invasive placental implantation into the myometrium, which can rarely extend into the bladder causing severe bleeding.

Question 37

[genital warts Mx]
multiple, non-keratinised warts:
solitary, keratinised warts:

Answer 37

multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy

Question 38

Painless genital pustule → ulcer → painful inguinal lymphadenopathy → proctocolitis =

Answer 38

lymphogranuloma venereum

Question 39

_____________typically have normal AFP and HCG. These are usually raised in teratomas and yolk sac tumours

Answer 39

Seminomas

Question 40

Ix to do before starting woman on Herceptin? (trastuzumab)

Answer 40

Echo - cardiotoxicity