Medical Gynaecology Flashcards
What one of the following risk factors is significantly different between breast and ovarian cancer?
a) Age
b) Family history
c) Age at menopause
d) Age at menarche
e) Combined oral contraceptives
e) Combined oral contraceptives
A 25-year-old sexually active woman who has had her first cervical screen. It was reported as normal. Which of the following statements is true?
a) She should have her next screen in 3 years
b) She should have another screen in 12 months and then every 3 years if this is normal
c) She should have another screen in one year and then every 5 years if this is normal
d) If she ends her relationship and is no longer sexually active, she doesn’t need another smear until she resumes sexual activity
e) She should have another screen in 5 years
e) She should have another screen in 5 yearsb) She should have another smear in 12 months and then every 3 years if this is normal
A 22-year-old woman suffers from superficial dyspareunia for one month. She is taking a modern low dose combined oral contraceptive pill, which has not caused any difficulties. A vaginal swab has grown candida albicans. Indicate the most suitable initial option
a) Recommend a single Fluconazole tablet
b) Prescribe metronidazole tablet for 3 days
c) Prescribe clotrimazole cream
d) Refer for psychosexual counselling
e) Progesterone only pill
c) Prescribe clotrimazole cream
Pelvic Inflammatory disease
a) is diagnosed correctly clinically in over 80% of cases
b) is always sexually transmitted
c) causes infertility in 5% of women after two episodes of infection
d) may have abnormal vaginal bleeding as one of the signs
e) should be treated with amoxcycillin and metronidazole
d) may have abnormal vaginal bleeding as one of the signs
Acute Salpingitis
a) occurs in approximately 40% of patients with untreated endocervical gonorrhoea
b) is more often caused by non-gonococcal infection than by gonorrhoea
c) commonly has unilateral symptoms
d) may be excluded if the pregnancy test is positive
e) should be treated with an oral penicillin and probenecid
b) is more often caused by non-gonococcal infection than by gonorrhoea
A 40-year-old para 3 has an orange-sized fibroid of the body of the uterus. Which of the following statements is correct?
a) this could be a cause of amenorrhoea
b) myomectomy carries a lower morbidity than hysterectomy
c) this will decrease in size post menopause
d) such fibroids always cause menorrhagia
e) is likely to degenerate if she becomes pregnant
c) this will decrease in size post menopause
Joanna is 25 years old and attends your surgery with a first episode vulvar warts. What is your management plan?
a) perform a full sexual transmitted infection screen
b) organise contact tracing and treatment of Joanna’s recent partners
c) perform viral cultures to confirm the diagnosis
d) treat cervix with podophyllotoxin
e) advise 6 monthly cervical smears
a) perform a full sexual transmitted infection screen
The NZ guidelines into the management of regular heavy menstrual periods listed the following medical therapies from most to least preferred based on their efficacy for reduction of blood loss
a) Levonorgestrel IUS, Combined Contraceptive Pill, Danazol, Anti-fibrinolytics, Non-steroidal anti-inflammatory drug
b) Levonorgestrel IUS, oral progestagen (day5-25), Anti-fibrinolytics,Combined Contraceptive Pill, Non-steroidal anti-inflammatory drug
c) Combined Contraceptive Pill, Levonorgestrel IUS, Non-steroidal anti-inflammatory drug, Anti-fibrinolytics, Danazol
d) Levonorgestrel IUS, Danazol, Non-steroidal anti-inflammatory drug, Anti-fibrinolytics, Combined Contraceptive Pill
e) None of the above
b) Levonorgestrel IUS, oral progestagen (day5-25), Anti-fibrinolytics,Combined Contraceptive Pill, Non-steroidal anti-inflammatory drug
A 32 year old woman with mild endometriosis wants to know if she will need treatment to conceive. What will you tell her?
a) Endometriosis often obstructs the fallopian tubes
b) Pregnancy chances can be improved by suppressive medical therapy for 6 months
c) IVF is recommended if not conceived 6 months after diagnosis
d) Surgical treatment improves subsequent pregnancy rates for mild to moderate endometriosis
e) GnRH agonist should be given for 12 months
d) Surgical treatment improves subsequent pregnancy rates for mild to moderate endometriosis
A 46 yr para 3 presents to the clinic with heavy periods worsening over the last 6 months. Her cycles currently occur every 30 days with bleeding lasting for 8 – 10 days. She has no associated dysmenorrhoea or intermenstrual bleeding. On pelvic examination, the uterus is anteverted, normal sized and mobile with no palpable adnexal masses. A recent Hb is 78g/dl. The most appropriate immediate investigation would be:
a) Hysteroscopy, D & C
b) Diagnostic laparoscopy
c) Transvaginal ultrasound scan for endometrial thickness
d) Serum CA 125
e) Test for coagulative disorder
c) Transvaginal ultrasound scan for endometrial thickness
A 40 yr para 4 attends the clinic with heavy periods for one year. Her cycles occur every 25-30 days with heavy bleeding lasting for 6-8 days. No dysmenorrhoea or intermenstrual bleeding. They use condoms for contraception. She has essential hypertension and takes hydrochlorothiazide. General & pelvic examination is unremarkable. Investigations include an Hb of 120g/dl, and ‘pelvic ultrasound scan that reveals endometrial thickness to be 10 mm with no endometrial/ adnexal pathology’. Most appropriate management option would be:
a) Danazol
b) Oral contraceptive pill
c) Ponstan
d) Mirena intrauterine device
e) Gonadotrophin releasing hormone agonist
d) Mirena intrauterine device
A 16 yr nulliparous girl complains of worsening dysmenorrhoea which starts on the first day of bleeding. Menarche at the age of 13 yrs and since then has had regular cycles. Her dysmenorrhoea is not relieved by standard doses of Mefenamic acid and nonsteroidal anti-inflammatories. Her medical history is non-contributory. She has never been sexually active. BMI 23. A pelvic ultrasound is normal. The next step in the management of this girl is:
a) Oral contraceptives
b) Diagnostic laparoscopy
c) Tranexemic acid (Cyklokapron)
d) Increased doses of NSAIDS
e) Fluoxetine hydrochloride (Prozac)
a) Oral contraceptives
Which one of the following statements is true about perimenopausal symptoms?
a)A decrease in libido is a common symptom at this time.
b) Irregular, heavy, or prolonged uterine bleeding are common but of little medical concern in the peri-menopausal period
c) Night sweats and hot flushes can commonly occur before menstruation stops
d) Skin changes seen in the postmenopausal women are related solely to age rather than to hypo-estrogenemia.
e) Depression and irritability occurring in the peri-menopausal period are almost always related to low estrogen levels
c) Night sweats and hot flushes can commonly occur before menstruation stops
Which one of the following statements is true about hormone therapy for a woman with a uterus:
a) Transdermal estrogen therapy does not require additional progesterone
b) Medroxyprogesterone acetate is by far superior to other available progestogens
c) Sequential therapy should be used for perimenopausal women
d) Androgen therapy should be considered whenever hormone replacement therapy is prescribed.
e) Oral estrogen is superior to the vaginal route for genito urinary symptoms.
c) Sequential therapy should be used for perimenopausal women
A 71 year old woman has severe vulvar itching of 18 months duration. She has no medical condition. Examination revealed atrophic labia minora and whitish, wrinkled skin below the posterior forchette and around the anus. Biopsies are taken of the most abnormal areas and show lichen sclerosis. Which one of the following topical preparations is the most appropriate to prescribe?
a) Estrogen cream
b) Progesterone cream
c) Clobetasol propionate
d) Oral Estrogen and progesterone
e) Testosterone 1% in petrolatum
c) Clobetasol propionate
According to the results of the Women’s Health Initiative Trial which one of the following statements is incorrect concerning the risks of using combined HRT for 5 years.
a) There is an increased risk of breast cancer
b) There is an increased risk of heart attack
c) There is an increased risk of stroke
d) There is an increase in gall bladder disease
e) There is a decrease risk of hip fracture
b) There is an increased risk of heart attack
Which one of the following statements is true: During the Climacteric:
a) estrogens are produced in tissues other than the ovaries
b) there is a decreased secretion of follicle stimulating hormone
c) there is an increased secretion of testosterone
d) the vaginal pH is decreased
e) the endometrium becomes unresponsive to the action of estrogen
a) estrogens are produced in tissues other than the ovaries
Serum CA125 is commonly raised in association with:
a) Candidal vaginitis
b) Down syndrome
c) Endometriosis
d) Spina bifida
e) Vulvar carcinoma
c) Endometriosis
The following statement is true regarding cervical HPV infection.
a) A minority of sexually active women contract cervical HPV infection in their lifetime
b) The peak incidence of HPV infection is in the 30 –35 yr age group
c) Cervical infection with “high risk” HPV is normally transient lasting less than 12 months
d) smoking does not influence the likely hood of development of CIN in HPV positive women
e) All of the above are correct
c) Cervical infection with “high risk” HPV is normally transient lasting less than 12 months
Cervical cytological screening in New Zealand
a) The primary aim is to detect early cancers
b) Cytology is proven to prevent more cervical cancers than HPV-testing, as it is a more sensitive test
c) Cytology is required prior to colposcopy for HPV 16 and 18.
d) Approximately 70% of eligible women in New Zealand have had a smear in the last 3 years
e) All of the above are correct
d) Approximately 70% of eligible women in New Zealand have had a smear in the last 3 years
According to National Cervical Screening guidelines a woman may discontinue smears when.
a) She is age 65
b) She has had a hysterectomy, without evidence of CIN and has a normal screening history
c) Has a history of CIN but recently had a hysterectomy that showed no evidence of CIN
d) Has not been sexually active for 20 years
e) Under any of the above circumstances
b) She has had a hysterectomy, without evidence of CIN and has a normal smear history
The National Health Committee in NZ has issued recommendations regarding screening. Which of the following statements is not true?
a) There need to be a suitable test
b) There is an effective and accessible treatment or intervention for the condition
c) There is high quality evidence a screening programme is effective in reducing death and illness
d) The test should not be associated with potential harm
e) The health sector should be capable of supporting diagnosis, follow-up and programme evaluation
d) The test should not be associated with potential harm
