Gynaecology and Breast Flashcards
1
Q
A 35-year-old woman complains of heavy menstrual bleeding. Her periods are regular each month and last for about a week. She has no intermenstrual or postcoital bleeding. Pelvic examination is normal.
Which is the SINGLE MOST appropriate INITIAL investigation as part of your assessment of her heavy menstrual bleeding?
A. Luteinising hormone (LH)/ follicle stimulating hormone (FSH) levels
B. Clotting screen
C. Ferritin level
D. Full blood count
E. Thyroid function tests
A
Answer: D. Full blood count
Justification and Feedback: A full blood count should be checked in all women with menorrhagia as part of first line tests. Given that the history and pelvic examination do not suggest any underlying abnormality, guidelines suggest treatment can be started without further investigations.
Resource: NICE. Heavy menstrual bleeding: assessment and management. NG88. 2018 (updated 2021).
2
Q
A 28-year-old woman is on the progesterone-only pill (POP) but forgot to take it on holiday. She had unprotected intercourse and took ulipristal acetate. She asks when she can restart her POP.
What is the SINGLE MOST appropriate option?
A. Start seven days later
B. Start two days later
C. Start immediately
D. Start five days later
E. Discuss alternative contraception
A
Answer: D. Start five days later
Justification and Feedback: After ulipristal acetate, the POP should be restarted five days later. Progesterone might reduce emergency contraception efficacy. Use barrier methods for five days, plus two more after starting POP.
Resource: Yusuf Z, Evans C, Forsythe A. The progesterone-only pill. InnovAiT 2019; 12(8): 425–443.
3
Q
Women of a particular age group in the UK are eligible for routine breast screening.
Which of the following options correctly identifies this age range?
A. 45–65 years
B. 55–75 years
C. 40–60 years
D. 50–70 years
E. 47–73 years
A
Answer: D. 50–70 years
Justification and Feedback: Breast screening is offered to women aged 50 up to their 71st birthday in England. AgeX trial extended this to 47–73 but is paused.
Resource: NHS Breast Screening Programme.
4
Q
Which ONE of the following statements is TRUE about cancer antigen 125 (CA125)?
A. Women over 50 are screened with a serum CA125 every five years
B. A level >100 U/ml makes a germ cell tumour the most likely diagnosis
C. It is only raised if an epithelial ovarian tumour is present
D. The level is reduced if the patient has diabetes
E. It is an important parameter in the ovarian risk of malignancy index (RMI)
A
Answer: E. It is an important parameter in the ovarian risk of malignancy index (RMI)
Justification and Feedback: The RMI combines ultrasound findings, CA125, and menopausal status. CA125 is nonspecific and can be raised in other conditions.
Resource: NICE guidance; RCGP learning.
5
Q
During her periods, a 39-year-old woman has rectal pain and bleeding with defaecation. No change in bowel habit, weight loss or anorexia.
Which is the SINGLE MOST likely diagnosis?
A. Proctalgia fugax
B. Cervical cancer
C. Crohn’s disease
D. Diverticular disease
E. Endometriosis
A
Answer: E. Endometriosis
Justification and Feedback: Endometriosis may cause cyclical gastrointestinal symptoms, including rectal pain and bleeding during menstruation.
Resource: RCGP learning.
6
Q
A 21-year-old woman presents with primary dysmenorrhoea unresponsive to paracetamol and ibuprofen. No PMH. No current wish to conceive. BP 120/80, BMI 22.
Which SINGLE medication is MOST appropriate and safe?
A. Depot contraceptive injection
B. Combined oral contraceptive pill
C. Paracetamol
D. Codeine phosphate
E. Mefenamic acid
A
Answer: B. Combined oral contraceptive pill
Justification and Feedback: The COC is appropriate for women with no contraindications. It reduces frequency and intensity of pain. Depot injection is third line due to bone health risks.
Resource: NICE dysmenorrhoea guidance; RCGP learning.
7
Q
A 28-year-old woman develops a tender red quadrant on her right breast 10 days postpartum. Temp 37.6°C. She is breastfeeding.
Which is the SINGLE MOST appropriate management?
A. Start co-amoxiclav and stop breastfeeding
B. Start flucloxacillin and continue breastfeeding
C. Avoid antibiotics since she is breastfeeding
D. Start doxycycline and continue breastfeeding
E. No antibiotics and advise to stop breastfeeding
A
Answer: B. Start flucloxacillin and continue breastfeeding
Justification and Feedback: Continue breastfeeding if possible. Flucloxacillin is first-line for mastitis. Express if breastfeeding is too painful.
Resource: NICE; local antibiotic guidance.
8
Q
A 51-year-old woman has menopausal symptoms including low mood, hot flushes and anxiety. No diagnosis of depression.
What is the MOST appropriate treatment?
A. Oral hormone replacement therapy
B. Evening primrose oil
C. Clonidine
D. St John’s wort
E. Fluoxetine
A
Answer: A. Oral hormone replacement therapy
Justification and Feedback: HRT or CBT are recommended for menopausal low mood in women without depression. SSRIs are not first line unless there is diagnosed depression.
Resource: Short H. Menopause and HRT. InnovAiT 2015; 8(4): 204–212.
9
Q
Young woman presents out of hours with what appears to be acute pelvic infection. Awaiting swab results.
What is the SINGLE MOST appropriate empirical treatment?
A. Ofloxacin 400 mg twice daily + oral metronidazole 400 mg twice daily
B. Erythromycin 500 mg QDS + ciprofloxacin 500 mg BD
C. Cefalexin 500 mg QDS + metronidazole 400 mg BD
D. Amoxicillin 500 mg TDS + erythromycin 500 mg QDS
E. Trimethoprim 200 mg BD + metronidazole 400 mg TDS
A
Answer: A. Ofloxacin 400 mg twice daily + oral metronidazole 400 mg twice daily
Justification and Feedback: This is one of the recommended first-line regimens for empirical PID treatment.
Resource: BASHH PID guideline 2019.
10
Q
A 78-year-old woman complains of urinary incontinence on laughing. Four children. No other symptoms. Examination unremarkable.
What is the first line treatment?
A. Pelvic floor muscle training
B. Oxybutynin
C. Urgent urology referral
D. Watch and wait for three months
E. Bladder training
A
Answer: A. Pelvic floor muscle training
Justification and Feedback: First line treatment for stress incontinence is supervised pelvic floor training for at least three months.
Resource: NICE. Urinary incontinence and pelvic organ prolapse in women: NG123. 2019.
11
Q
A 32-year-old woman attends for her postnatal check. Cervical smear is due.
How long after delivery should cervical screening be done?
A. 6 weeks
B. 1 week
C. 12 weeks
D. Immediately post-delivery
E. 2 weeks
A
Answer: C. 12 weeks
Justification and Feedback: Cervical screening should be delayed until 12 weeks post-partum due to increased risk of inadequate smear results.
Resource: NHS Cervical Screening Programme.
12
Q
A 47-year-old woman is taking combined hormonal contraception (CHC).
Which TWO of the following are potential non-contraceptive benefits?
A. Improved libido
B. Prevention of bone mineral density loss
C. Reduced risk of myocardial infarction
D. Reduced risk of breast cancer
E. Improved menopausal vasomotor symptoms
A
Answers: B and E
Justification and Feedback: CHC can help with menopausal vasomotor symptoms and preserve bone mineral density in women under 50. CHC does not reduce breast cancer risk and may slightly increase it.
Resource: FSRH guidance.
13
Q
A 27-year-old has subfertility, regular cycles, severe dysmenorrhoea, rectal pain and urinary urgency.
A 31-year-old has bloating, constipation alternating with diarrhoea, and no cycle-related pain.
A 29-year-old has bloating, LIF pain, and a palpable LIF swelling.
Match each case with diagnosis:
Options: Endometriosis, Irritable bowel syndrome, Follicular ovarian cyst
A
Answers:
1 – Endometriosis
2 – Irritable bowel syndrome
3 – Follicular ovarian cyst
Justification and Feedback: Symptoms match textbook presentation of each diagnosis.
14
Q
A 26-year-old woman has had bilateral mastalgia for six months. Unremarkable examination.
How soon after referral should she be seen in the breast clinic?
A. Within six months
B. Within two weeks
C. Within 16 weeks
D. Within four weeks
E. Same day
A
Answer: B. Within two weeks
Justification and Feedback: All patients with symptomatic breast disease should be seen within two weeks of referral.
Resource: NHS England. Going Further on Cancer Waits: symptomatic breast standard.
15
Q
In a perimenopausal woman with intact uterus, for which symptom is systemic HRT MOST indicated?
A. Flushes
B. Vaginal dryness
C. Poor concentration
D. Incontinence
E. Altered sexual function
A
Answer: A. Flushes
Justification and Feedback: Vasomotor symptoms such as hot flushes respond best to systemic HRT. Vaginal dryness is treated with topical oestrogen.
Resource: Ridley-Davies F. Postmenopausal bleeding. InnovAiT 2018; 11(7): 387–390.
16
Q
A 55-year-old woman has postmenopausal vaginal bleeding. Last period 15 months ago. Cervix healthy.
What is the SINGLE MOST appropriate management?
A. Insert a Mirena coil
B. Repeat cervical smear
C. Urgent suspected cancer gynaecology referral
D. Arrange pelvic ultrasound scan
E. Trial reduction in oestrogen
A
Answer: C. Urgent suspected cancer gynaecology referral
Justification and Feedback: All postmenopausal bleeding should be referred for urgent two-week review.
Resource: Ridley-Davies F. InnovAiT 2018; 11(7): 387–390.
17
Q
Which drug is MOST likely associated with amenorrhoea?
A. Chlorpromazine
B. Cyclizine
C. Paracetamol
D. Betahistine
E. Quetiapine
A
Answer: A. Chlorpromazine
Justification and Feedback: Dopamine antagonists like chlorpromazine can cause hyperprolactinaemia and amenorrhoea.
Resource: Robinson A. Amenorrhoea. InnovAiT 2012; 5(9): 528–540.
18
Q
A 21-year-old presents with right-sided severe abdominal pain, nausea, discharge.
Which test is MOST useful immediately?
A. Urine pregnancy test
B. Urine dipstick
C. Temperature
D. Abdominal and pelvic ultrasound
E. Chlamydia swab
A
Answer: A. Urine pregnancy test
Justification and Feedback: Rule out ectopic pregnancy immediately. This test guides urgent referral.
Resource: NICE. Early pregnancy loss and ectopic pregnancy guidelines.
19
Q
Which patient requires urgent breast referral?
A. 35-year-old, tender lumpy breasts, worsening tenderness on right
B. 28-year-old, 2 cm mobile lump, on COCP, grandmother had breast cancer at 60
C. 30-year-old with eczematous rash on both breasts
D. 35-year-old with unilateral nodularity
E. 30-year-old nulliparous with bilateral serous nipple discharge
A
Answer: D. 35-year-old with unilateral nodularity
Justification and Feedback: Solitary asymmetrical nodularity requires urgent referral.
Resource: NICE suspected cancer guidance.
20
Q
A 60-year-old woman has overactive bladder with urge incontinence unresponsive to bladder training.
What drug should be tried first line?
A. Duloxetine
B. Oxybutynin hydrochloride
C. Trospium chloride
D. Propiverine hydrochloride
E. Deleted
A
Answer: B. Oxybutynin hydrochloride
Justification and Feedback: NICE recommends oxybutynin as first line for urge incontinence, with caution in older women.
Resource: NICE. Urinary incontinence and pelvic organ prolapse in women: NG123. 2019.
21
Q
During her periods a 22-year-old woman sometimes has dysuria, frequency and haematuria. Her periods are painful but regular. Urinalysis is positive for blood and negative for nitrites and leucocytes.
Which is the SINGLE MOST likely diagnosis?
A. Vulvovaginal candidiasis
B. Endometriosis
C. Polycystic kidney disease
D. Interstitial cystitis
E. Ureteric stone
A
Answer: B. Endometriosis
Justification and Feedback: Endometriosis may cause period-related or cyclical urinary symptoms, e.g. haematuria and dysuria.
22
Q
A 53-year-old woman has significant hot flushes. She had breast cancer treatment nine months ago and takes tamoxifen 20 mg once daily.
Which is the SINGLE MOST appropriate treatment for her hot flushes?
A. Testosterone gel
B. Refer to a menopause specialist
C. Black cohosh capsules
D. Medroxyprogesterone acetate tablets
E. Oestrogen patches
A
Answer: B. Refer to a menopause specialist
Justification and Feedback: NICE recommends referral for specialist advice when managing menopause symptoms in women with breast cancer. SSRIs/SNRIs or clonidine may be options.
Resources: NICE NG23 (2019); RCGP EKU18 (2022).
23
Q
A 57-year-old woman has deep dyspareunia and a feeling of incomplete bowel emptying. On vaginal exam, a posterior wall bulge increases with straining.
What is the SINGLE MOST likely diagnosis?
A. Varicocele
B. Urethrocele
C. Rectocele
D. Rectal prolapse
E. Cystocele
A
Answer: C. Rectocele
Justification and Feedback: A rectocele causes a posterior vaginal bulge. Cystocele/urethrocele = anterior. Rectal prolapse = external. Varicocele = male condition.
24
Q
A 31-year-old woman has 6 months of dyspareunia, pelvic pain, and dysmenorrhoea. Analgesics have failed.
Which investigation is the SINGLE MOST likely to confirm the diagnosis?
A. Colposcopy
B. Ultrasound scan of pelvis
C. Laparoscopy
D. MRI pelvis
E. Serum CA-125
A
Answer: C. Laparoscopy
Justification and Feedback: Laparoscopy is the gold standard for diagnosing endometriosis. Ultrasound/MRI may help but do not confirm diagnosis.
Resource: NICE NG73 (2024).
25
The risk of which ONE of the following cancers is reduced in women taking combined hormonal contraception (CHC)?
A. Thyroid
B. Breast
C. Pancreas
D. Endometrial
E. Cervical
Answer: D. Endometrial
Justification and Feedback: CHC reduces risk of endometrial, ovarian, and colorectal cancers. Slight increase in breast and cervical cancer risk.
Resource: NICE; RCGP learning.
26
A 50-year-old woman on POP, BMI 35, T2DM, has had amenorrhoea for 3 years and now presents with 3 episodes of vaginal bleeding.
What is the SINGLE MOST appropriate management?
A. Switch to a different POP
B. Add CHC for 3 cycles
C. Reassure this is normal
D. Take a cervical smear
E. Refer using suspected cancer pathway
Answer: E. Refer using suspected cancer pathway
Justification and Feedback: Bleeding after amenorrhoea in a woman >45 with risk factors (obesity, diabetes) needs urgent investigation.
Resource: NICE guidelines; FSRH. UKMEC 2019.
27
A 32-year-old woman at 28 weeks gestation has vaginal discharge. HVS shows clue cells.
Which is the SINGLE MOST appropriate oral antibiotic?
A. Erythromycin
B. Metronidazole
C. Azithromycin
D. Doxycycline
E. Cefalexin
Answer: B. Metronidazole
Justification and Feedback: Clue cells suggest bacterial vaginosis. Metronidazole is the treatment of choice in pregnancy.
Resource: BASHH guidelines.
28
A 60-year-old woman has urinary frequency, urgency, and both urge and stress incontinence. She has failed lifestyle changes.
What is the SINGLE MOST appropriate initial management?
A. Refer for electrical stimulation
B. Trial of duloxetine
C. Refer to gynaecology for TVT
D. Further adapt lifestyle
E. Refer for bladder training
Answer: E. Refer for bladder training
Justification and Feedback: Bladder training is first-line for urge and mixed urinary incontinence after lifestyle measures fail.
Resource: NICE NG123 (2019).
29
A 78-year-old woman with vaginal prolapse and cognitive impairment has signs of vaginal atrophy.
What is the MOST appropriate management?
A. Fit vaginal pessary
B. Refer for surgery
C. Vaginal oestrogen cream
D. Vaginal oestrogen-releasing ring
E. Pelvic floor exercises
Answer: D. Vaginal oestrogen-releasing ring
Justification and Feedback: Best for frail women who may not comply with regular cream use. Pessary may worsen atrophy.
Resources: NICE NG123 (2019); InnovAiT 2023.
30
Which ONE of the following patients requires INCREASED surveillance in the NHS Cervical Screening Programme?
A. 44F on tacrolimus post-renal transplant
B. 58F on chlorambucil for lymphoma
C. 48F on tamoxifen post-breast cancer
D. 54F on long-term prednisolone
E. 36F with HIV
Answer: E. 36F with HIV
Justification and Feedback: Women with HIV need annual cytology and initial colposcopy due to higher risk of cervical cancer.
Resource: Public Health England (2023).
31
A 74-year-old with heart failure develops bilateral breast pain after starting new medications.
Which SINGLE medication is MOST likely responsible?
A. Candesartan
B. Spironolactone
C. Bisoprolol
D. Aspirin
E. Ramipril
Answer: B. Spironolactone
Justification and Feedback: Spironolactone has anti-androgen and oestrogen-like effects which can cause breast pain and gynaecomastia.
Resource: Ahmed N. Breast pain. InnovAiT 2023; 16(7): 327–331.
32
Which condition is MOST likely to coexist with chronic pelvic pain?
A. Eczema
B. Gluten enteropathy
C. Interstitial cystitis
D. Migraine
E. OCD
Answer: C. Interstitial cystitis
Justification and Feedback: 38–84% of women with chronic pelvic pain report bladder symptoms; IC is a frequent comorbidity.
Resources: RCOG GTG 41 (2012); Clemons et al. 2002.
33
A 29-year-old with cyclical pelvic pain suggestive of endometriosis has normal exam and scans.
What is the MOST appropriate next step?
A. COC
B. Danazol
C. Diagnostic laparoscopy
D. MRI
E. Spironolactone
Answer: A. COC
Justification and Feedback: Trial of hormonal therapy (e.g. COC) is first-line in suspected endometriosis.
Resource: RCOG GTG 41 (2012).
34
A 38-year-old woman with heavy, irregular periods, BMI 35, smokes. Normal exam.
What is the MOST appropriate first-line treatment?
A. COC
B. Copper IUD
C. Levonorgestrel-releasing IUD
D. Progestogen-only implant
E. Tranexamic acid
Answer: C. Levonorgestrel-releasing IUD
Justification and Feedback: Mirena is preferred first-line for menorrhagia if long-term contraception is acceptable.
Resource: FSRH UKMEC 2019.
35
Cervical screening plans:
1. 48F post-hysterectomy for fibroids
2. 67F with last 3 smears normal, last one at 62
What is the correct screening recommendation?
Answers:
1 – No screening required
2 – No screening required
Justification and Feedback: Post-hysterectomy for benign reason and age >64 with 3 normal smears = no further screening.
Resources: PHE 2021; NHS Scotland 2022.
36
A 64-year-old woman has a vaginal bulge >1 cm beyond the hymenal ring.
What is the MOST appropriate management?
A. Watch and wait
B. Pelvic floor muscle exercises
C. Refer to secondary care
D. Vaginal oestrogen
E. Vaginal pessary
Answer: C. Refer to secondary care
Justification and Feedback: Stage 3 symptomatic prolapse requires specialist referral.
Resource: InnovAiT 2023; NICE NG123.
37
Which of the following MOST increases breast cancer risk?
A. Early menarche
B. Breast feeding
C. Being underweight
D. Young age at first birth
E. Increased parity
Answer: A. Early menarche
Justification and Feedback: Early menarche increases cumulative oestrogen exposure, increasing risk.
Resource: Cancer Research UK. Breast cancer risk. 2018.
38
A 22-year-old woman has fever, dyspareunia, and a 4 cm tender, fluctuant labial swelling.
What is the MOST appropriate management?
A. Routine gynaecology referral
B. Emergency admission for I&D
C. Flucloxacillin for 2 weeks
D. Flucloxacillin for 1 week
E. Clarithromycin for 1 week
Answer: B. Emergency admission for I&D
Justification and Feedback: Large, fluctuant Bartholin's abscesses require incision, drainage and possible marsupialisation.
Resource: RCGP learning.
39
A 32-year-old pregnant woman has breast fullness. Her aunt had breast cancer.
Which feature warrants breast clinic referral?
A. Bilateral pain
B. Bilateral nodularity
C. Pain with fever
D. Diffuse erythema
E. Discrete lump
Answer: E. Discrete lump
Justification and Feedback: A discrete lump in women aged 30+ meets NICE 2WW referral criteria.
Resource: NICE NG12 (2023).
40
A woman with suspected endometriosis has normal TVUS and swabs.
Which is the most appropriate first-line treatment?
A. MRI pelvis
B. Laparoscopy
C. Danazol
D. Combined oral contraceptive
E. Spironolactone
Answer: D. Combined oral contraceptive
Justification and Feedback: Hormonal trial (e.g. COC) is appropriate before invasive testing.
Resource: RCOG Chronic Pelvic Pain GTG 41.
41
You see a 28-year-old patient who is not currently lactating and presents with a two-day history of right sided breast pain.
What is the SINGLE MOST appropriate management option?
A. Start flucloxacillin 500mg QDS for 10–14 days
B. Start clarithromycin 500mg BD for 10–14 days
C. Advise hot compresses and milking of the breast and review in 48 hours
D. Start erythromycin 250–500mg QDS for 10–14 days
E. Start co-amoxiclav 500/125mg TDS for 10–14 days
Answer: E. Start co-amoxiclav 500/125mg TDS for 10–14 days
Justification and Feedback: In non-lactational mastitis, oral antibiotics are recommended. Co-amoxiclav is first line. Alternatives for penicillin allergy include erythromycin or clarithromycin with metronidazole.
Resource: NICE CKS. Mastitis and breast abscess in non-lactating women. 2024.
42
A 32-year-old woman requests some information regarding smear tests.
In which ONE of the following scenarios is unscheduled cervical screening appropriate?
A. 26F with abnormal cervix, up to date with screening
B. 31F 6 weeks postnatal and overdue for screening
C. 44F with irregular bleeding, up to date with screening
D. 66F with normal prior smears
E. Unscheduled cervical screening is not recommended for any scenario
Answer: E. Unscheduled cervical screening is not recommended for any scenario
Justification and Feedback: If smear is up to date, symptoms should prompt referral rather than early screening. Postponed smears after pregnancy should be performed 12 weeks post-partum.
Resource: NHS Cervical Screening Guidelines (2023).
43
A woman starts continuous combined HRT for menopausal symptoms.
How soon after starting HRT should she be advised to return for a review?
A. 1 month
B. Only if she has any bleeding
C. 6 months
D. 3 months
E. 12 months
Answer: D. 3 months
Justification and Feedback: Review at 3 months is advised to assess response and side effects. Vaginal bleeding within first 3 months is common, but should be reviewed if it persists beyond that.
Resources: NICE NG23; RCGP EKU 18.
44
A 58-year-old woman presents with vaginal dryness and dyspareunia.
What is the SINGLE MOST appropriate first-line treatment option?
A. Hormone replacement therapy
B. Steroid ointments
C. Local oestrogens
D. Emollients
E. Prasterone
Answer: C. Local oestrogens
Justification and Feedback: Local oestrogens are recommended for GSM presenting with vaginal dryness and dyspareunia. Long-term use can be continued with annual review.
Resource: InnovAiT 2021; 14(10): 607–614.
45
A 39-year-old woman has rectal pain and bleeding only during menstruation.
Which is the SINGLE MOST likely diagnosis?
A. Diverticular disease
B. Crohn’s disease
C. Cervical cancer
D. Endometriosis
E. Proctalgia fugax
Answer: D. Endometriosis
Justification and Feedback: Endometriosis can cause cyclical GI symptoms like rectal pain and bleeding during menses.
Resource: RCGP Clinical Topic Guides.
46
A 19-year-old sexually active woman presents with lower abdominal pain and dyspareunia.
What is the SINGLE MOST likely diagnosis?
A. Ovarian torsion
B. Appendicitis
C. Pelvic inflammatory disease
D. Ectopic pregnancy
E. Endometriosis
Answer: C. Pelvic inflammatory disease
Justification and Feedback: Features include fever, adnexal tenderness, discharge, and risk factors (young age, IUCD).
Resource: NICE CKS and RCGP guidance.
47
A 30-year-old woman has overactive bladder symptoms not responding to bladder training.
Which ONE medication is first-line?
A. Mirabegron
B. Oxybutynin extended release
C. Oxybutynin immediate release
D. Vaginal oestrogen
E. Any of the above
Answer: C. Oxybutynin immediate release
Justification and Feedback: NICE recommends anticholinergics with lowest acquisition cost. Immediate-release oxybutynin fits this.
Resource: NICE NG123 (2019).
48
Up to what age does starting combined HRT NOT increase a woman’s atherosclerotic CVD risk?
A. 40
B. 55
C. 50
D. 45
E. 60
Answer: E. 60
Justification and Feedback: NICE confirms HRT does not increase CVD risk if started under 60.
Resources: NICE NG23; British Menopause Society 2023.
49
A 58-year-old woman has post-coital bleeding and dry, pale vaginal walls. Cervix is healthy.
What is the MOST appropriate initial management?
A. Cervical smear
B. Ultrasound scan
C. Urgent suspected cancer referral
D. Topical oestrogen
E. IUCD
Answer: D. Topical oestrogen
Justification and Feedback: This is typical of GSM. First treat with topical oestrogen. Refer if no improvement.
Resources: NICE NG12; InnovAiT 2018.
50
A 49-year-old woman with intact uterus has menopausal symptoms. LMP was 3 months ago.
What is the MOST appropriate HRT choice?
A. Oestrogen-only patches
B. Sequential combined tablets
C. Tibolone
D. Continuous combined patches
E. Oestrogen-only tablets
Answer: B. Sequential combined tablets
Justification and Feedback: Sequential HRT is recommended for perimenopausal women with intact uterus.
Resources: NICE NG23; British Menopause Society 2022.
51
A 48-year-old woman with irregular periods due to perimenopause requests help.
What is the SINGLE MOST appropriate option for endometrial protection?
A. Tibolone
B. Depo-medroxyprogesterone acetate
C. Levonorgestrel-releasing IUD
D. Clonidine
E. Etonogestrel implant
Answer: C. Levonorgestrel-releasing IUD
Justification and Feedback: Mirena provides endometrial protection in HRT regimes and is licensed for 5 years.
Resource: NICE NG23 (2019); BMS guidance.
52
A 38-year-old woman has hot flushes and infrequent periods.
What is the SINGLE MOST appropriate diagnostic investigation?
A. Oestradiol x2 six weeks apart
B. Single FSH
C. Single progesterone
D. FSH x2 six weeks apart
E. Single oestradiol
Answer: D. FSH x2 six weeks apart
Justification and Feedback: POI is diagnosed with elevated FSH levels on two occasions six weeks apart.
Resource: NICE NG23 (2019).
53
Which is most useful for assessing severity of heavy menstrual bleeding?
A. Menstrual diary
B. Menstrual pictogram
C. Impact on quality of life
D. Sanitary product consumption
E. Family history
Answer: C. Impact on quality of life
Justification and Feedback: NICE defines HMB by its effect on physical, social, and emotional wellbeing.
Resource: NICE NG88 (2018, updated 2021).
54
A 49-year-old woman declines HRT for menopausal hot flushes.
What is the MOST appropriate non-hormonal treatment?
A. Carbamazepine
B. Lamotrigine
C. Fluoxetine
D. Evening primrose oil
E. St John’s Wort
Answer: C. Fluoxetine
Justification and Feedback: SSRIs and SNRIs can be used as alternatives to HRT for vasomotor symptoms.
Resources: InnovAiT 2019; NICE CKS (2024).
55
A 37-year-old woman with vaginal itch and thick white non-smelly discharge.
What is the MOST likely diagnosis?
A. Candidiasis
B. Lichen planus
C. Gonorrhoea
D. Bacterial vaginosis
E. Herpes simplex
Answer: A. Candidiasis
Justification and Feedback: Classic presentation includes vulval itch, thick white discharge without odour.
Resource: BASHH Candidiasis Guideline (2007).
56
Match diagnoses:
1. Frothy discharge, odour, 'strawberry cervix'
2. Mucopurulent discharge, gram-negative diplococci
3. Vulval itch, red vulva, copious white discharge
Answers:
1 – Trichomonas vaginalis
2 – Gonorrhoea
3 – Vulvovaginal candidiasis
Resource: RCGP Curriculum Topic Guides: Gynaecology and Breast. 2019.
57
A 28-year-old woman had unprotected sex.
What is the maximum window for emergency contraception?
A. 24 hours
B. 168 hours
C. 72 hours
D. 120 hours
E. 48 hours
Answer: D. 120 hours
Justification and Feedback: Cu-IUD and ulipristal acetate are effective up to 120 hours post-intercourse.
Resource: FSRH Emergency Contraception Guidelines (2017, updated 2023).
58
Which of the following is NOT associated with increased genital prolapse risk?
A. Ehlers–Danlos
B. Menopause
C. Nulliparity
D. Obesity
E. Previous colposuspension
Answer: C. Nulliparity
Justification and Feedback: Childbirth increases prolapse risk; nulliparity reduces it.
Resource: InnovAiT 2022; NICE NG123.
59
A 26-year-old woman has heavy painful periods for 8 months affecting her life.
What is the SINGLE MOST appropriate next step?
A. Cervical smear
B. Laparoscopy
C. Midstream urine
D. CA-125
E. Bimanual pelvic examination
Answer: E. Bimanual pelvic examination
Justification and Feedback: Dysmenorrhoea with HMB warrants pelvic exam before imaging.
Resource: NICE NG88 (2018).
60
A 59-year-old woman has stage 2 ulcerated vaginal prolapse and voiding issues.
What is the SINGLE MOST appropriate management?
A. Refer for surgery
B. Pelvic floor exercises
C. Start solifenacin
D. Ring pessary
E. Urodynamic studies
Answer: A. Refer for surgery
Justification and Feedback: Indications for surgery include stage 2 prolapse, ulceration, voiding symptoms.
Resource: InnovAiT 2022; NICE NG123.
61
Which of the following statements regarding polycystic ovary syndrome is CORRECT?
A. It is associated with an increased risk of type 1 diabetes
B. It is associated with a reduced risk of metabolic syndrome
C. It is associated with a reduced risk of cardiovascular disease
D. It is associated with an increased risk of ovarian malignancy
E. It is associated with an increased risk of endometrial carcinoma
Answer: E. It is associated with an increased risk of endometrial carcinoma
Justification and Feedback: Prolonged anovulation leads to unopposed oestrogen, increasing endometrial carcinoma risk.
Resource: Robinson A. Amenorrhoea. InnovAiT 2012; 5(9): 528–540.
62
In which ONE of the following relatives is a history of breast cancer LEAST likely to predict a womanʼs risk of breast cancer?
A. Aunt
B. First cousin
C. Half-sister (same mother)
D. Mother
E. Niece
Answer: B. First cousin
Justification and Feedback: Cousins are third-degree relatives, so carry less predictive risk than first- or second-degree relatives.
Resource: Cancer Research UK. Family history of breast cancer and inherited genes. 2023.
63
A 7-year-old girl’s mother has had a clitoridectomy and they plan to visit Gambia for an extended holiday.
What is the SINGLE MOST appropriate INITIAL action?
A. Ring the police
B. Refer to a paediatrician
C. Discuss your concerns with her parents
D. Contact social services
E. Notify the school nurse
Answer: C. Discuss your concerns with her parents
Justification and Feedback: Unless there’s imminent risk, raise concerns sensitively with parents and escalate if not reassured.
Resource: GOV.UK. Multi-Agency Statutory Guidance on Female Genital Mutilation. 2016.
64
A 28-year-old epileptic patient on carbamazepine needs emergency contraception.
What is the SINGLE MOST appropriate first-line option?
A. Ulipristal
B. The copper intra-uterine device
C. Levonorgestrel-releasing intrauterine system
D. Desogestrel
E. Levonorgestrel
Answer: B. The copper intra-uterine device
Justification and Feedback: Enzyme inducers like carbamazepine reduce efficacy of oral EC. Copper IUD is unaffected.
Resource: Patel T, Patel K. The annual epilepsy review. InnovAiT 2022; 15(5): 286–293.
65
A 32-year-old woman on combined hormonal contraception has worsening dysmenorrhoea during the hormone-free interval.
Which one regime is LEAST likely to improve her symptoms?
A. Shortening the hormone-free interval
B. Continuous CHC with 4-day breaks for breakthrough bleeding
C. Continuous use of CHC
D. Switching to CHC with a different progestogen
E. Tricycling of CHC
Answer: D. Switching to CHC with a different progestogen
Justification and Feedback: Tailored regimes reduce withdrawal bleeds and improve symptoms. Switching progestogen has limited impact.
Resource: FSRH. Combined Hormonal Contraception. 2019.
66
When is cervical screening appropriate following delivery in a woman overdue for her smear test?
A. Three months postpartum
B. Four weeks postpartum
C. Six weeks postpartum
D. Straight away
E. Six months postpartum
Answer: A. Three months postpartum
Justification and Feedback: Postpartum cervical screening should be done at 3 months unless otherwise indicated.
Resource: Ramesh P, Munjal P. Colposcopy and cervical cancer screening. InnovAiT 2023; 16(1): 7–13.
67
A 28-year-old on COCP presents with postcoital bleeding. Cervix appears red with superficial vessels that bleed on contact.
What is the SINGLE MOST appropriate management option?
A. Cauterisation
B. Stop the combined oral contraceptive pill
C. Doxycycline 100mg BD for 7 days
D. Start vaginal oestrogen
E. Surgical excision
Answer: B. Stop the combined oral contraceptive pill
Justification and Feedback: Likely cervical ectropion; stopping COCP may reduce bleeding.
Resource: Ahmed N. Postcoital bleeding. InnovAiT 2023; 16(5): 254–258.
68
A 31-year-old woman presents with a 4cm firm, mobile, rubbery breast lump and a palpable axillary node.
What is the SINGLE MOST appropriate management?
A. Review in 1 month
B. Reassurance
C. Urgent referral to breast clinic
D. Referral for mammography
E. Non-urgent referral to breast clinic
Answer: C. Urgent referral to breast clinic
Justification and Feedback: Suspected phyllodes tumour requires urgent assessment and excision.
Resource: van der Zanden E et al. Benign breast pathology. InnovAiT 2022; 15(11): 644–651.
69
A year’s supply of 10mcg topical vaginal oestrogen is equivalent to how many oral 1mg oestradiol tablets?
A. 56
B. 84
C. 7
D. 28
E. 1
Answer: E. 1
Justification and Feedback: One year of topical vaginal oestrogen equals roughly one 1mg oral HRT tablet.
Resource: NICE NG23; RCGP EKU18; Balance Menopause. HRT Prescribing Guide 2023.
70
A 65-year-old woman has 12 weeks of bloating and abdominal swelling. Exam normal, FBC normal.
What is the SINGLE MOST appropriate next investigation?
A. CA125
B. Coeliac antibody blood screen
C. Flexible sigmoidoscopy
D. Abdominal X-ray
E. Stool antigen for H. pylori
Answer: A. CA125
Justification and Feedback: First-line investigation for suspected ovarian cancer in women >50 with bloating/distension.
Resource: NICE. Ovarian Cancer: CG122. Updated 2023.
71
A pregnant woman presents with vulvovaginal itching, soreness, dysuria, and thick cheesy discharge.
What is the SINGLE MOST appropriate management?
A. Intravaginal clotrimazole
B. Doxycycline 100mg BD for 7 days
C. Oral fluconazole 150mg single dose
D. Topical corticosteroid ointment
E. Intravaginal oestrogen
Answer: A. Intravaginal clotrimazole
Justification and Feedback: Oral fluconazole is contraindicated in pregnancy. Intravaginal clotrimazole is appropriate for candidiasis.
Resource: Freeman NEA. Vulval pruritus. InnovAiT 2023; 16(5): 242–247.
72
What is the most important determinant of prognosis in invasive ductal breast cancer?
A. Size of tumour
B. Age of patient
C. Oestrogen receptor status
D. Site of tumour
E. Axillary lymph node positivity
Answer: E. Axillary lymph node positivity
Justification and Feedback: Node involvement is the most significant prognostic factor in invasive breast cancer.
Resource: NICE Breast Cancer Guidelines.
73
Which HRT has the lowest risk of venous thromboembolism (VTE)?
A. Oral conjugated equine oestrogen + medroxyprogesterone
B. Transdermal estradiol alone
C. Oral estradiol alone
D. Oral estradiol + dydrogesterone
E. Oral conjugated equine oestrogen alone
Answer: B. Transdermal estradiol alone
Justification and Feedback: Transdermal oestradiol is not associated with increased VTE risk.
Resource: Vinogradova Y et al. BMJ 2019; 364.
74
A 42-year-old woman has heavy regular periods and an enlarged uterus. FBC normal, smear normal 2 years ago.
What is the SINGLE MOST appropriate next investigation?
A. Pictorial blood loss chart
B. Cervical smear
C. Hysterosalpingogram
D. Thyroid function test
E. Pelvic ultrasound
Answer: E. Pelvic ultrasound
Justification and Feedback: For HMB with uterine enlargement, a pelvic ultrasound is appropriate to evaluate structural causes.
Resource: NICE NG88. Heavy menstrual bleeding. 2021 update.
75
Which SINGLE investigation is diagnostic for endometriosis?
A. Laparoscopy
B. Transvaginal ultrasound
C. MRI
D. Day-21 progesterone
E. Serum prolactin
Answer: A. Laparoscopy
Justification and Feedback: Laparoscopy is the gold standard for diagnosis and treatment of endometriosis.
Resource: Nicolson K, Gillespie G. InnovAiT 2022; 15(4): 209–216.
76
A 21-year-old has acute right-sided abdominal pain, vomiting, and vaginal discharge.
Which test is MOST likely to help guide immediate management?
A. Temperature
B. Abdominal and pelvic ultrasound
C. Urine pregnancy test
D. Chlamydial swab
E. Urine dipstick
Answer: C. Urine pregnancy test
Justification and Feedback: In acute abdominal pain, ectopic pregnancy must be excluded first.
Resource: NICE Early Pregnancy Loss Guidance.
77
Which TWO are non-contraceptive benefits of combined hormonal contraception?
A. Improved menopausal vasomotor symptoms
B. Reduced risk of breast cancer
C. Improved libido
D. Reduced risk of MI
E. Prevention of BMD loss in perimenopausal women
Answers: A and E
Justification and Feedback: CHC helps vasomotor symptoms and prevents BMD loss under age 50, but may increase MI and breast cancer risk.
Resource: BMS/WHC 2020–2021 recommendations.
78
Which of the following is FIRST-LINE for managing stress urinary incontinence in a postmenopausal woman?
A. Oestrogen cream
B. Pelvic floor muscle exercises
C. Oxybutynin
D. Duloxetine
E. Botulinum toxin
Answer: B. Pelvic floor muscle exercises
Justification and Feedback: PFMT is first line for stress incontinence.
Resource: NICE NG123. Urinary incontinence and pelvic organ prolapse. 2019.
79
Which bladder diary values are considered normal?
A. 2L total voided per day
B. 400ml per void
C. Passing urine up to 8 times per day
D. Waking once at night
E. All of the above
Answer: E. All of the above
Justification and Feedback: These all fall within normal bladder diary values.
Resource: NICE NG123. Urinary incontinence. 2019.
80
Testosterone therapy is contraindicated in women with a history of which cancer?
A. Thyroid
B. Cervix
C. Colon
D. Hepatocellular
E. Lung
Answer: D. Hepatocellular
Justification and Feedback: Testosterone is contraindicated in liver cancer due to potential for tumour stimulation.
Resource: BMS Testosterone Therapy Guidelines.
81
A 55-year-old woman presents with incontinence when she laughs or sneezes, despite lifestyle changes.
What is the SINGLE MOST appropriate initial management option?
A. Refer for bladder training
B. Refer for Burch colposuspension
C. Refer for pelvic floor muscle training
D. Refer for tension-free vaginal tape (TVT)
E. Commence a trial of duloxetine
Answer: C. Refer for pelvic floor muscle training
Justification and Feedback: This is stress incontinence. After lifestyle modifications, PFMT is the first-line management.
Resource: NICE. Urinary incontinence and pelvic organ prolapse in women: NG123. 2019
82
A 39-year-old woman presents with prolonged heavy menstruation, pelvic heaviness, and prior miscarriages.
What is the SINGLE MOST likely diagnosis?
A. Polycystic ovarian syndrome
B. Cervical carcinoma
C. Endometrial carcinoma
D. Cervical polyp
E. Myometrial fibroids
Answer: E. Myometrial fibroids
Justification and Feedback: Classic presentation of uterine fibroids includes menorrhagia, pelvic pain, and infertility.
Resource: Castronovo G. Heavy menstrual bleeding. InnovAiT 2019; 12(8): 442–446.
83
What is the MOST appropriate initial test in a patient with symptoms consistent with endometriosis?
A. Cancer antigen 125 (CA-125)
B. Chlamydia testing
C. Transvaginal ultrasound
D. Laparoscopy
E. Pelvic MRI
Answer: C. Transvaginal ultrasound
Justification and Feedback: Though laparoscopy is gold standard, TVUS is a practical, non-invasive first-line investigation.
Resource: NICE. Endometriosis: NG73. 2024
84
Which ONE of the following features is a risk factor for breast cancer?
A. Nulliparity
B. Menarche aged 17 years
C. Menopause aged 45 years
D. BMI 24
E. Non-smoker
Answer: A. Nulliparity
Justification and Feedback: More oestrogen exposure increases breast cancer risk — nulliparity is a risk factor.
Resource: Cancer Research UK
85
A 42-year-old woman with a 1 cm fibroid and prior PE needs treatment for menorrhagia.
What is the MOST appropriate first-line treatment option?
A. Combined oral contraceptive
B. Tranexamic acid
C. Levonorgestrel IUS (Mirena)
D. Hysterectomy
E. Copper coil
Answer: C. Levonorgestrel IUS (Mirena)
Justification and Feedback: Mirena is first-line for HMB with small fibroids and is safe in prior VTE.
Resource: Castronovo G. InnovAiT 2019; 12(8): 442–446.
86
A 68-year-old woman presents with postcoital bleeding and pale, dry vaginal mucosa.
What is the SINGLE MOST likely diagnosis?
A. Vaginal cancer
B. Lichen sclerosis
C. Contact dermatitis
D. Vulvovaginal atrophy
E. Lichen planus
Answer: D. Vulvovaginal atrophy
Justification and Feedback: Vaginal atrophy presents with dryness and bleeding in postmenopausal women.
Resource: Ahmed N. Postcoital bleeding. InnovAiT 2023; 16(5): 254–258.
87
A 55-year-old woman presents with 3 months of abdominal pain and distension.
What is another RISK FACTOR for ovarian cancer?
A. Asian ethnicity
B. First child before 25
C. Late menopause
D. Multiple pregnancies
E. Prolonged use of COCP
Answer: C. Late menopause
Justification and Feedback: Risk increases with uninterrupted ovulation — late menopause is a known factor.
Resource: Target Ovarian Cancer
88
What is the eligible age range for routine NHS breast screening in the UK?
A. 40–60 years
B. 47–73 years
C. 45–65 years
D. 50–70 years
E. 55–75 years
Answer: D. 50–70 years
Justification and Feedback: Routine breast screening is for women aged 50–70 in the UK.
Resource: NICE CKS. Breast screening. Revised 2022.
89
What is the MINIMUM recommended duration for a bladder diary in assessing incontinence?
A. Three days
B. One week
C. Two weeks
D. One month
E. Three months
Answer: A. Three days
Justification and Feedback: NICE recommends a minimum of 3 days including varied activity.
Resource: NICE. Urinary incontinence NG123. 2019
90
A 67-year-old woman with urge incontinence failed bladder training.
Which is a contraindication to oxybutynin?
A. Neurogenic bladder instability
B. Nocturnal enuresis
C. Renal impairment
D. Urinary retention
E. Hepatic impairment
Answer: D. Urinary retention
Justification and Feedback: Oxybutynin is contraindicated in patients with urinary retention.
Resource: BNF. Oxybutynin hydrochloride.
91
Match each patient with the MOST likely diagnosis:
Patient 1: 26F, LIF pain, amenorrhoea, rebound tenderness
Patient 2: 20F, fever, cervical excitation, adnexal tenderness
Patient 3: 40F, post-coital & intermenstrual bleeding, smoker
Options:
- Bacterial vaginitis
- Breakthrough bleeding
- Cervical carcinoma
- Dysfunctional uterine bleeding
- Ectopic pregnancy
- Pelvic inflammatory disease
- Threatened abortion
Answers:
Patient 1: Ectopic pregnancy
Patient 2: Pelvic inflammatory disease
Patient 3: Cervical carcinoma
Justification and Feedback: Classic presentations for each diagnosis.
Resource: RCGP Learning, April 2025.
92
A 32-year-old who moved from Scotland asks about cervical screening frequency in England.
What is the MOST appropriate interval?
A. Every 3 years
B. Every 5 years and if symptomatic in between
C. Every 5 years
D. No screening until age 49
E. Annually
Answer: A. Every 3 years
Justification and Feedback: In England, screening is every 3 years until age 49, then every 5 years to 64.
Resource: InnovAiT 2023; 16(1): 7–13.
93
A 29-year-old woman with BMI 35 plans to conceive.
What is the MOST appropriate folic acid advice?
A. 400mcg until 20 weeks
B. 400mcg until 12 weeks
C. 400mcg throughout pregnancy
D. 5mg throughout pregnancy
E. 5mg until 12 weeks
Answer: E. 5mg until 12 weeks
Justification and Feedback: Women with BMI ≥30 should take 5mg folic acid daily until 12 weeks.
Resource: NICE CKS. Pre-conception management. 2023.
94
A 34-year-old with regular, painful periods and deep dyspareunia.
What is the MOST likely diagnosis?
A. Endometriosis
B. PID
C. Cervical polyp
D. Fibroids
E. Ectropion
Answer: A. Endometriosis
Justification and Feedback: Triad of chronic pelvic pain, dysmenorrhoea, and dyspareunia.
Resource: NICE NG73 (2024).
95
A 26-year-old with dysmenorrhoea and deep dyspareunia, normal pelvic exam.
What is the MOST appropriate first investigation?
A. Laparoscopy
B. Transabdominal US
C. CA-125
D. MRI
E. Transvaginal ultrasound
Answer: E. Transvaginal ultrasound
Justification and Feedback: TVUS is first-line before considering laparoscopy.
Resource: NICE. Endometriosis NG73. 2024.
96
32F with 12mm fibroid, no cavity distortion, doesn't want more children.
What is the MOST appropriate first-line treatment for HMB?
A. COCP
B. Tranexamic acid
C. Levonorgestrel IUS
D. Cyclical oral progestogen
E. Hysterectomy
Answer: C. Levonorgestrel IUS
Justification and Feedback: LNG-IUS is first-line for fibroids <30mm with no distortion.
Resource: NICE NG88. 2021.
97
29F breastfeeding with mastitis, unresponsive to flucloxacillin after 2 days.
What is the MOST appropriate next step?
A. Change to co-amoxiclav
B. Refer for mammogram
C. Change to metronidazole
D. Continue flucloxacillin
E. Refer for ultrasound
Answer: A. Change to co-amoxiclav
Justification and Feedback: If no response in 48h, switch to co-amoxiclav and send breast milk for MC&S.
Resource: NICE CKS. Mastitis and breast abscess. 2024.
98
39F wants to start contraception, has IHD.
Which is the MOST appropriate choice of progesterone-only pill?
A. Current breast cancer
B. Hepatocellular carcinoma
C. Ischaemic heart disease
D. Severe liver cirrhosis
E. Previous breast cancer
Answer: C. Ischaemic heart disease
Justification and Feedback: UKMEC classifies IHD as category 2 — POP acceptable.
Resource: Yusuf Z. InnovAiT 2019; 12(8): 425–443.
99
55F with hot flushes, mood swings, no PMH or surgeries.
What is the SINGLE MOST appropriate treatment?
A. Unopposed oestrogen
B. Black cohosh
C. Amitriptyline
D. Sertraline
E. Combined HRT
Answer: E. Combined HRT
Justification and Feedback: Combined HRT is recommended if uterus is intact.
Resource: NICE Menopause NG23. Updated 2019.
100
38F smoker with severe dysmenorrhoea and dyspareunia. Normal exam.
What is the MOST appropriate first-line treatment?
A. Danazol
B. Desogestrel
C. Goserelin
D. COCP
E. Copper IUD
Answer: B. Desogestrel
Justification and Feedback: Progestogen-only contraceptives preferred in smokers >35.
Resource: NICE. Endometriosis NG73. 2024.
101
A 52-year-old woman with six children attends complaining of stress incontinence.
On examination she is found to have stage 1 uterine prolapse. She states she is not keen for surgery at present.
What is the most appropriate initial treatment?
A. Refer to secondary care
B. Vaginal ring pessary
C. Desmopressin
D. Pelvic floor muscle exercises
E. Duloxetine
Answer: D. Pelvic floor muscle exercises
Justification and Feedback: Pelvic floor muscle exercises are most likely to be beneficial for this woman's urinary incontinence.
They may not improve existing prolapse but may prevent deterioration.
Resource: NICE NG123. Urinary incontinence and pelvic organ prolapse in women: management. 2019.
102
The UK government has implemented a mandatory duty for GPs to report female genital mutilation (FGM) directly to the police.
This mandatory duty applies to which ONE of the following groups?
A. Pregnant women who require surgical intervention
B. Adult women who disclose FGM during consultation
C. Girls under 18 years of age who are considered to be at risk of FGM
D. Adult women in whom FGM is suspected during clinical examination
E. Girls under 18 years of age who disclose FGM during an unrelated consultation
Answer: E. Girls under 18 years of age who disclose FGM during an unrelated consultation
Justification and Feedback: Mandatory reporting applies when FGM is disclosed by or visually confirmed in a girl under 18.
'Suspected' or 'at risk' cases should follow safeguarding procedures.
Resources: DoH 2017, Multi-agency Statutory Guidance on FGM 2016.
103
A 29-year-old woman complains of vulval and vaginal itching for the past month.
On examination: reddened mucosa and ‘strawberry cervix’.
What is the SINGLE MOST appropriate treatment?
A. Oral azithromycin
B. Oral metronidazole
C. Refer to gynaecologist
D. Clotrimazole pessary
E. Advice and reassurance
Answer: B. Oral metronidazole
Justification and Feedback: Strawberry cervix is pathognomonic for Trichomonas vaginalis.
Metronidazole (or tinidazole) is first-line treatment.
Resource: RCGP Learning.
104
A 29-year-old woman has a missed miscarriage confirmed by ultrasound scan.
She agrees to expectant management.
According to NICE, what is the maximum time for expectant management?
A. 3 days
B. 5 days
C. 7 days
D. 10 days
E. 14 days
Answer: E. 14 days
Justification and Feedback: Expectant management is first-line up to 14 days if stable and asymptomatic.
Resource: NICE NG126. Ectopic pregnancy and miscarriage. 2023.
105
A mother attends with her 13-year-old daughter asking about the Gardasil® vaccine.
Which types of HPV does this vaccine protect against?
A. HPV types 1, 2 and 3
B. HPV types 16 and 18
C. HPV types 12 and 13
D. HPV types 17 and 18
E. HPV types 6, 11, 16 and 18
Answer: E. HPV types 6, 11, 16 and 18
Justification and Feedback: Gardasil® protects against four strains, covering both cervical cancer and genital warts.
Resource: RCGP Learning; DoH Immunisation Guidelines.
106
A 45-year-old woman had a hysterectomy and BSO for menorrhagia.
She now has hot flushes and night sweats. BMI 30 kg/m².
Which is the SINGLE MOST appropriate treatment?
A. Tibolone tablets
B. Estradiol and norethisterone transdermal patch
C. Estradiol and norethisterone tablets
D. Estradiol implant
E. Estradiol transdermal patch
Answer: E. Estradiol transdermal patch
Justification and Feedback: After hysterectomy, unopposed oestrogen is appropriate.
Patches are preferred due to fewer thromboembolic risks.
Resource: NICE NG23. Menopause: diagnosis and management. Updated 2019.
107
Which is the SINGLE MOST appropriate INITIAL treatment for stress urinary incontinence?
A. Perineometry
B. Electrical stimulation with biofeedback
C. Pelvic floor electromyography
D. Bladder training
E. Supervised pelvic floor muscle training
Answer: E. Supervised pelvic floor muscle training
Justification and Feedback: PFMT for 3 months is first-line. Biofeedback is reserved if PFMT fails.
Resource: NICE NG123. Urinary Incontinence. 2019.
108
A 26-year-old woman has chronic pelvic pain that varies with her menstrual cycle.
Symptoms include dysmenorrhoea, dyspareunia, and diarrhoea during menstruation.
What is the SINGLE MOST likely diagnosis?
A. Endometriosis
B. Irritable bowel syndrome
C. Ovarian cyst
D. Pelvic inflammatory disease
E. Uterine fibroids
Answer: A. Endometriosis
Justification and Feedback: Cyclical pelvic pain with GI/GU symptoms is classic for endometriosis.
Resource: NICE NG73. Endometriosis. 2024; RCOG Chronic Pelvic Pain GTG 41.
109
A 36-year-old with amenorrhoea, hot flushes, and high FSH and LH.
Prolactin and testosterone are normal.
What is the SINGLE MOST appropriate management option?
A. Refer to menopause advisor
B. Offer clomid
C. Refer to gynaecology
D. Refer to endocrinology
E. Start metformin
Answer: C. Refer to gynaecology
Justification and Feedback: Suggestive of premature ovarian failure. Requires gynaecology referral for confirmation and management.
Resource: RCOG GTG; NICE NG23.
110
A 44-year-old with PCOS has impaired glucose tolerance on 2h OGTT.
What is the SINGLE MOST appropriate management plan?
A. No further action
B. Fasting glucose every 6 months
C. Repeat OGTT only if pregnant
D. Repeat OGTT every 6 months and during pregnancy
E. Repeat OGTT annually and during pregnancy
Answer: E. Repeat OGTT annually and during pregnancy
Justification and Feedback: PCOS increases diabetes risk. Annual OGTT and testing at 26–28 weeks gestation is recommended.
Resources: RCOG GTG 33; Thornton E. InnovAiT 2023.
111
A 27-year-old woman has bilateral cyclical breast pain for 6 months.
No other symptoms. Breast exam normal.
What is the SINGLE MOST appropriate INITIAL management?
A. Danazol
B. Routine referral to breast clinic
C. Ibuprofen
D. Progestogen-only pill
E. Pyridoxine
Answer: C. Ibuprofen
Justification and Feedback: First-line for cyclical mastalgia includes NSAIDs and reassurance.
Resource: RCGP Breast Pain Guidance.
112
A 54-year-old woman has severe vasomotor symptoms but HRT is contraindicated.
What is the FIRST-LINE non-hormonal treatment option?
A. Sertraline
B. Menopause-specific CBT
C. Clonidine
D. Gabapentin
E. Venlafaxine
Answer: B. Menopause-specific CBT
Justification and Feedback: NICE recommends CBT for vasomotor symptoms when HRT is not appropriate.
Resource: NICE NG23; InnovAiT 2021.
113
A 43-year-old woman has amenorrhoea for 6 months and hot flushes.
FSH = 43 mIU/ml.
What is the SINGLE MOST appropriate additional investigation?
A. Anti-Müllerian hormone
B. Repeat FSH in 4-6 weeks
C. Oestradiol
D. Prolactin
E. No further investigation
Answer: B. Repeat FSH in 4–6 weeks
Justification and Feedback: For diagnosis of early menopause in 40–45 age group, repeat FSH confirms perimenopause.
Resource: NICE NG23; BMS Standards 2022.
114
A 44-year-old sex worker presents with post-coital bleeding, heavy discharge.
Exam: erythematous, friable cervix. STI tests negative.
What is the SINGLE MOST likely diagnosis?
A. Dysfunctional uterine bleeding
B. Ovarian carcinoma
C. Cervical polyps
D. Cervical carcinoma
E. Endometrial carcinoma
Answer: D. Cervical carcinoma
Justification and Feedback: High-risk profile and suspicious cervix → urgent investigation for cervical cancer.
Resources: Cancer Research UK; Connolly A. InnovAiT 2018.
115
Which is the SINGLE MOST appropriate lifestyle intervention for overactive bladder in women?
A. Core body strength exercises
B. Caffeine reduction
C. Daily cranberry juice tablets
D. Increased dietary fibre
E. Daily cranberry juice drinks
Answer: B. Caffeine reduction
Justification and Feedback: NICE recommends caffeine reduction, weight loss, fluid management as first-line lifestyle strategies.
Resource: NICE NG123. Urinary Incontinence. 2019.
116
Which organism is LEAST likely to cause pelvic inflammatory disease (PID)?
A. Candida albicans
B. Neisseria gonorrhoea
C. Chlamydia trachomatis
D. Mycoplasma genitalium
E. Bacteroides species
Answer: A. Candida albicans
Justification and Feedback: Candida is not an STI and does not cause PID.
Resource: RCGP Sexual Health in Primary Care. Reviewed 2022.
117
A 61-year-old woman has postmenopausal vaginal dryness, irritation and dyspareunia.
Exam: fragile, thin introitus.
What is the SINGLE MOST appropriate management?
A. Topical vaginal oestrogen
B. Steroid ointment
C. Hormone replacement therapy
D. Antifungal cream
E. Antibiotics for UTI
Answer: A. Topical vaginal oestrogen
Justification and Feedback: Genitourinary syndrome of menopause responds well to local oestrogen therapy.
Resource: NICE NG23. Menopause. 2019.
118
A 23-year-old woman with heavy periods and dyspareunia. Family history of endometriosis.
What is the gold-standard diagnostic investigation?
A. CT
B. Pelvic ultrasound
C. Serum gonadotrophins
D. Endometrial biopsy
E. Laparoscopy
Answer: E. Laparoscopy
Justification and Feedback: Laparoscopy is the definitive investigation to diagnose endometriosis.
Resource: NICE NG73. Endometriosis. 2024.
119
Match each pelvic pain case to the most likely diagnosis:
Case 1: 27F, dysmenorrhoea, infertility, urinary urgency
Case 2: 31F, bloating, alternating constipation and diarrhoea
Case 3: 29F, transient LIF pain, LIF swelling on exam
Options: Endometriosis, IBS, Follicular ovarian cyst
Answers:
Case 1 – Endometriosis
Case 2 – IBS
Case 3 – Follicular ovarian cyst
Justification and Feedback: Typical presentations guide differential diagnosis of pelvic pain.
Resource: RCGP Learning.
120
A 38-year-old with PCOS has mild chin hair growth.
What is the MOST appropriate initial management option?
A. Dutasteride
B. Combined contraceptive pill
C. Metformin
D. Eflornithine cream
E. Cyproterone acetate
Answer: D. Eflornithine cream
Justification and Feedback: Topical eflornithine is effective for mild hirsutism and well-tolerated.
Resource: Thornton E. InnovAiT 2023; RCOG GTG 33.
121
A 37-year-old lady comes to see you with pelvic pain, dysmenorrhoea and deep dyspareunia.
What is the GOLD STANDARD investigation for this clinical presentation?
A. Follicle stimulating hormone (FSH) and luteinising hormone (LH) assay
B. Laparoscopy
C. Immunological biomarkers
D. Cancer antigen 125 (CA 125) blood test
E. Ultrasound of the abdomen and pelvis
Answer: B. Laparoscopy
Justification and Feedback: Laparoscopy and histological confirmation are considered the gold standard to diagnose endometriosis.
Ultrasound is only useful for ruling out alternative diagnoses.
Resource: RCGP Learning
122
A 33-year-old woman has bilateral intermittent generalised breast pain for 3 months.
What is the SINGLE MOST appropriate first-line management option?
A. Flaxseed
B. Topical diclofenac
C. Changing her oral contraceptive pill
D. Vitamin B6
E. Diet low in fat and caffeine
Answer: B. Topical diclofenac
Justification and Feedback: Topical NSAIDs are first-line for cyclical breast pain. Limited evidence supports other listed interventions.
Resource: Ahmed N. Breast pain. InnovAiT 2023; 16(7): 327–331.
123
A 26-year-old woman presents with a 5-month history of secondary amenorrhoea.
Lab results: LH 46, FSH 59, Oestradiol 73, Testosterone 1.3, Prolactin 198
What is the SINGLE MOST likely diagnosis?
A. Prolactinoma
B. Adrenal gland tumour
C. Polycystic ovarian syndrome
D. Pregnancy
E. Premature ovarian failure
Answer: E. Premature ovarian failure
Justification and Feedback: Defined as menopause before age 40 with hypergonadotrophic hypogonadism.
Resource: RCGP Learning
124
A 31-year-old woman has had no periods for 6 months. She has acne and a BMI of 29.
Hormones: Normal FSH, mildly elevated LH and testosterone
What is the MOST likely diagnosis?
A. Premature ovarian failure
B. Hypopituitarism
C. Hyperprolactinaemia
D. Hypothyroidism
E. Polycystic ovarian syndrome
Answer: E. Polycystic ovarian syndrome
Justification and Feedback: Common cause of amenorrhoea. Diagnosis requires 2 of: oligomenorrhoea, hyperandrogenism, or PCO on scan.
Resource: Munjal P, Nair M. Amenorrhoea. InnovAiT 2021; 14(10): 599–606.
125
What is the SINGLE MOST common gynaecological cancer in the United Kingdom?
A. Ovarian cancer
B. Endometrial cancer
C. Vulval cancer
D. Vaginal cancer
E. Cervical cancer
Answer: B. Endometrial cancer
Justification and Feedback: Endometrial cancer is the most common gynaecological malignancy in the UK.
Resource: Knapp S et al. InnovAiT 2021; 14(7): 449–457.
126
A 35-year-old woman has painful periods, pelvic pain, and dyspareunia.
She also has pain on defecation with blood during menstruation.
What is the SINGLE MOST likely diagnosis?
A. Endometriosis
B. Pelvic inflammatory disease
C. Fibroids
D. Ovarian cancer
E. Retroverted uterus
Answer: A. Endometriosis
Justification and Feedback: Classic triad: pelvic pain, deep dyspareunia, dyschezia during menstruation.
Resource: RCGP Learning
127
A 53-year-old lady on tamoxifen presents with post-menopausal bleeding.
What is the SINGLE MOST appropriate next management option?
A. Referral for hysteroscopy and endometrial biopsy
B. Transvaginal ultrasound scan
C. CA 125 blood test
D. Total hysterectomy
E. Transabdominal ultrasound scan
Answer: A. Referral for hysteroscopy and endometrial biopsy
Justification and Feedback: Tamoxifen can mimic endometrial thickening on ultrasound. Direct sampling is needed.
Resource: Knapp S et al. InnovAiT 2021; 14(7): 449–457.
128
A 22-year-old woman with regular, heavy menstrual bleeding and a 2cm intramural fibroid.
What is the recommended first-line treatment according to NICE?
A. Combined oral contraceptive
B. Mefenamic acid
C. No significant difference in efficacy
D. Levonorgestrel intrauterine system
E. Tranexamic acid
Answer: D. Levonorgestrel intrauterine system
Justification and Feedback: First-line for women with no cavity distortion and fibroids <3cm.
Resource: NICE NG88. Heavy menstrual bleeding. 2018 (updated 2021).
129
A 29-year-old woman with irregular periods and infertility for 18 months.
LH: 18, FSH: 6
What is the SINGLE MOST likely diagnosis?
A. Polycystic ovarian syndrome
B. Ovarian failure
C. Fibroids
D. Endometriosis
E. Hyperthyroidism
Answer: A. Polycystic ovarian syndrome
Justification and Feedback: Elevated LH:FSH ratio is typical. PCOS is a leading cause of infertility.
Resource: Lafferty K et al. InnovAiT 2020; 13(7): 394–401.
130
A 51-year-old woman has insomnia and night sweats but declines HRT.
What is the SINGLE MOST appropriate management option?
A. Cognitive behavioural therapy (CBT)
B. Isoflavones
C. Reflexology
D. Black cohosh
E. Red clover extract
Answer: A. Cognitive behavioural therapy (CBT)
Justification and Feedback: CBT is effective for vasomotor and mood symptoms when pharmacological options are declined.
Resource: Taylor A. InnovAiT 2019; 12(12): 703–705.
131
Which of the following is an indication for urgent ‘suspected cancer’ referral in women over 45?
A. Persisting UTI without haematuria
B. Visible haematuria without UTI
C. Visible haematuria with UTI
D. Non-visible haematuria with UTI
E. Recurrent UTI without haematuria
Answer: B. Visible haematuria without UTI
Justification and Feedback: NICE NG12 recommends urgent referral for unexplained visible haematuria.
Resource: NICE NG12. Suspected cancer. Updated 2023.
132
A 28-year-old has a 6-month history of heavy menstrual bleeding.
What is the SINGLE MOST appropriate initial test?
A. Full blood count
B. Serum iron
C. Renal function
D. Prolactin
E. Coagulation screen
Answer: A. Full blood count
Justification and Feedback: To assess for iron deficiency anaemia, FBC is the most appropriate first-line investigation.
Resource: RCGP Learning
133
Which speculum is MOST appropriate for examining anterior and posterior vaginal walls in prolapse?
A. Bivalve speculum
B. Pederson speculum
C. Huffman speculum
D. Sims’ speculum
E. Graves’ speculum
Answer: D. Sims’ speculum
Justification and Feedback: Best suited for assessment of vaginal walls and prolapse.
Resource: Morris C et al. InnovAiT 2022; 15(7): 394–401.
134
What is the routine breast cancer screening interval in the UK for women over 50?
A. Six years
B. Five years
C. Four years
D. Two years
E. Three years
Answer: E. Three years
Justification and Feedback: NHS screening offers mammograms every 3 years for women aged 50–70.
Resource: RCGP Learning
135
Which clinical symptom is MOST likely to be associated with endometrial cancer?
A. Irregular vaginal bleeding
B. Menorrhagia
C. Postcoital bleeding
D. Postmenopausal bleeding
E. Vaginal discharge
Answer: D. Postmenopausal bleeding
Justification and Feedback: Most strongly associated with endometrial cancer.
Resource: Walker S et al. BJGP 2013; 63(614): e643–e648.
136
A 55-year-old woman has vaginal bleeding 15 months after her last period.
Cervical exam is normal.
What is the SINGLE MOST appropriate management?
A. Insert Mirena coil
B. Urgent gynaecology referral
C. Repeat cervical smear
D. Trial reduction in oestrogen
E. Arrange pelvic ultrasound
Answer: B. Urgent gynaecology referral
Justification and Feedback: All postmenopausal bleeding requires urgent referral.
Resource: Ridley-Davies F. InnovAiT 2018; 11(7): 387–390.
137
54F with pelvic organ prolapse and stress urinary incontinence, not keen on surgery.
What is the MOST appropriate pessary?
A. Gellhorn
B. Shelf
C. Donut
D. Ring
E. Ring with knob
Answer: E. Ring with knob
Justification and Feedback: Designed for POP and stress incontinence; knob provides urethral support.
Resource: Karavadra B et al. InnovAiT 2023; 16(2): 65–72.
138
56F post-menopausal with vaginal bleeding and mixed incontinence. Exam: grade 2 prolapse.
What is the SINGLE MOST appropriate management?
A. Urgent cancer referral
B. Start solifenacin
C. Start vaginal oestrogen
D. Refer for PFMT
E. Routine gynaecology referral
Answer: A. Urgent cancer referral
Justification and Feedback: Symptoms suggest malignancy → 2WW referral required.
Resource: NICE NG12. Suspected cancer. 2023.
139
31F with irregular, heavy periods. Normal pelvic US.
What is the MOST likely diagnosis?
A. PID
B. Fibroids
C. Adenomyosis
D. Dysfunctional uterine bleeding
E. Endometriosis
Answer: D. Dysfunctional uterine bleeding
Justification and Feedback: Diagnosis of exclusion; common in absence of structural pathology.
Resource: Castronovo G. InnovAiT 2019; 12(8): 442–446.
140
39F has rectal pain and bleeding during menstruation.
No weight loss or anorexia.
What is the MOST likely diagnosis?
A. Crohn’s disease
B. Cervical cancer
C. Endometriosis
D. Proctalgia fugax
E. Diverticular disease
Answer: C. Endometriosis
Justification and Feedback: Period-related rectal bleeding and pain is typical for endometriosis.
Resource: RCGP Learning
141
A 32-year-old woman has endometriosis. She has dysmenorrhoea which interferes with work and daily activities.
She is looking at trying to conceive after her holiday in 2 months' time.
According to national guidance, which is the SINGLE MOST appropriate treatment for her?
A. Desogestrel
B. Danazol
C. Codeine
D. Combined oral contraceptive pill
E. Mefenamic acid
Answer: E. Mefenamic acid
Justification and Feedback: NSAIDs and paracetamol are first-line treatments for pelvic pain caused by endometriosis.
Hormonal treatments are not recommended for women trying to conceive.
Resource: NICE. Endometriosis: NG73. Updated 2024.
142
A 45-year-old woman complains of painful and heavy periods. No underlying cause is found and a diagnosis of dysfunctional uterine bleeding is made.
Which is the SINGLE MOST appropriate treatment?
A. Norethisterone
B. Levonorgestrel-releasing intrauterine system (Mirena)
C. Danazol
D. Medroxyprogesterone acetate injection (Depo-Provera)
E. Tranexamic acid
Answer: B. Levonorgestrel-releasing intrauterine system (Mirena)
Justification and Feedback: Mirena is the first-choice treatment for heavy menstrual bleeding where no underlying pathology is found.
Resource: NICE. NG88. Heavy Menstrual Bleeding. 2018 (updated 2021).
143
A 28-year-old develops a tender red quadrant on her right breast 10 days following the birth of her first child.
Her temperature is 37.6°C. She is breastfeeding.
Which ONE of the options below represents the SINGLE MOST appropriate management plan?
A. Offer no antibiotics and advise to stop breastfeeding
B. Start flucloxacillin and continue breastfeeding
C. Start doxycycline and continue breastfeeding
D. Avoid all antibiotics since she is breastfeeding
E. Start co-amoxiclav and temporary cessation of breastfeeding
Answer: B. Start flucloxacillin and continue breastfeeding
Justification and Feedback: Mastitis treatment includes continued breastfeeding and antibiotics (flucloxacillin first-line).
Resource: NICE CKS. Mastitis. 2023.
144
A 21-year-old woman presents with primary dysmenorrhoea. Paracetamol and ibuprofen were ineffective.
She has no significant PMH and no plans to conceive.
Which SINGLE medication is MOST appropriate and safe to help with her pain?
A. Codeine phosphate
B. Combined oral contraceptive pill
C. Paracetamol
D. Depot contraceptive injection
E. Tranexamic acid
Answer: B. Combined oral contraceptive pill
Justification and Feedback: COCP is a first-line hormonal treatment for dysmenorrhoea in non-conceiving women.
Resource: NICE CKS. Dysmenorrhoea. 2023.
145
A 51-year-old woman presents with amenorrhoea for the past year. The main symptom is low mood.
She does not have a diagnosis of anxiety or depression.
Which SINGLE management option is MOST appropriate?
A. Tricyclic antidepressants
B. SSRIs
C. Hormone replacement therapy
D. SNRIs
E. MAO inhibitors
Answer: C. Hormone replacement therapy
Justification and Feedback: HRT is first-line for low mood due to menopause when depression is not diagnosed.
Resource: NICE NG23. Menopause: 2019.
146
A 51-year-old woman has menopausal symptoms including low mood, hot flushes and anxiety.
Which SINGLE treatment is MOST appropriate, assuming no contraindications?
A. Evening primrose oil
B. Clonidine
C. Fluoxetine
D. St John's wort
E. Hormone replacement therapy
Answer: E. Hormone replacement therapy
Justification and Feedback: HRT or psychological treatments like CBT are recommended for mood/anxiety symptoms of menopause.
Resource: InnovAiT 2015; 8(4): 204–212.
147
A 54-year-old woman presents with vulval itching and superficial dyspareunia.
Examination reveals ivory-white atrophic vulva.
What is the SINGLE MOST appropriate management?
A. Clotrimazole 1%
B. Clobetasol proprionate 0.05%
C. Estriol 0.01%
D. Vaginal dilator
E. Permethrin 5%
Answer: B. Clobetasol proprionate 0.05%
Justification and Feedback: Lichen sclerosus is treated with potent topical steroids, tapered over time.
Resource: BAD Guidelines 2018; PCDS.
148
A 25-year-old hasn’t had a period in 3 months. She has brown axillary pigmentation and mild hirsutism.
What is the MOST likely diagnosis?
A. Hyperthyroidism
B. Polycystic ovarian syndrome
C. Premature menopause
D. Hyperprolactinaemia
E. Congenital adrenal hyperplasia
Answer: B. Polycystic ovarian syndrome
Justification and Feedback: PCOS presents with oligomenorrhoea and hyperandrogenism; pigmentation likely acanthosis nigricans.
Resource: Thornton E. InnovAiT 2023; 16(5): 249–253.
149
What is the SINGLE MOST common potential adverse effect of continuous use of CHC without a pill-free interval?
A. Delay in return to fertility
B. Increased risk of ectopic pregnancy
C. Increased risk of endometrial hyperplasia
D. Increased failure rate
E. Unscheduled bleeding
Answer: E. Unscheduled bleeding
Justification and Feedback: Unscheduled bleeding is common in the early months of continuous CHC use.
Resource: FSRH. Combined Hormonal Contraception. 2019 (updated 2020).
150
A 31-year-old woman with PCOS complains of worsening facial hair.
Which ONE of the following drugs is the SINGLE LEAST likely to improve her symptoms?
A. Topical eflornithine
B. Oral spironolactone
C. Laser treatment
D. Oral norethisterone
E. Oral co-cyprindiol
Answer: D. Oral norethisterone
Justification and Feedback: Progestogens like norethisterone may worsen hirsutism.
Resource: NICE CKS. Hirsutism. 2020.
151
Which patient should be referred urgently?
A. 35F with tender lumpy breasts, worsening on the right
B. 28F with 2cm mobile lump, family history at 60
C. 30F with bilateral eczema
D. 35F with nodularity in right breast only
E. 30F with bilateral nipple discharge
Answer: D. 35F with nodularity in right breast only
Justification and Feedback: Asymmetrical nodularity requires urgent referral to rule out malignancy.
Resource: RCGP Breast Guidelines.
152
24F with known irritant contact dermatitis has excoriation and hypopigmentation of the vulva.
What is the SINGLE MOST likely diagnosis?
A. Vulvovaginal atrophy
B. Lichen simplex chronicus
C. Vulval carcinoma
D. Lichen planus
E. Lichen sclerosus
Answer: B. Lichen simplex chronicus
Justification and Feedback: Chronic scratching in contact dermatitis can cause lichen simplex chronicus.
Resource: Freeman NEA. InnovAiT 2023.
153
22F with postcoital bleeding, swab confirms chlamydia. Not pregnant, no allergies.
What is the MOST appropriate first-line management?
A. Ofloxacin
B. Doxycycline
C. Ceftriaxone
D. Metronidazole
E. Azithromycin
Answer: B. Doxycycline
Justification and Feedback: Doxycycline 100mg BD for 7 days is first-line for uncomplicated chlamydia.
Resource: Ahmed N. InnovAiT 2023.
154
65F with uterine prolapse and cervix at level of hymen.
What is the POP-Q stage?
A. Stage 0
B. Stage 3
C. Stage 1
D. Stage 2
E. Stage 4
Answer: D. Stage 2
Justification and Feedback: POP-Q Stage 2 includes prolapse within 1 cm of hymenal ring.
Resource: Persu C. Journal of Medicine and Life 2011.
155
61F with ivory-white plaques and bruising of the vulva.
What is the SINGLE MOST appropriate management?
A. Advice and reassurance
B. Clotrimazole pessary and cream
C. Oral azithromycin
D. Oral metronidazole
E. Topical clobetasol propionate 0.05%
Answer: E. Topical clobetasol propionate 0.05%
Justification and Feedback: This presentation is typical of lichen sclerosus. Treat with potent steroids.
Resource: BAD Guidelines 2018.
