Medical Gynaecology

Question 1

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

Answer 1

e) Combined oral contraceptives

Question 2

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

Answer 2

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

Question 3

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

Answer 3

c) Prescribe clotrimazole cream

Question 4

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

Answer 4

d) may have abnormal vaginal bleeding as one of the signs

Question 5

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

Answer 5

b) is more often caused by non-gonococcal infection than by gonorrhoea

Question 6

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

Answer 6

c) this will decrease in size post menopause

Question 7

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

Answer 7

a) perform a full sexual transmitted infection screen

Question 8

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

Answer 8

b) Levonorgestrel IUS, oral progestagen (day5-25), Anti-fibrinolytics,Combined Contraceptive Pill, Non-steroidal anti-inflammatory drug

Question 9

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

Answer 9

d) Surgical treatment improves subsequent pregnancy rates for mild to moderate endometriosis

Question 10

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

Answer 10

c) Transvaginal ultrasound scan for endometrial thickness

Question 11

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

Answer 11

d) Mirena intrauterine device

Question 12

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)

Answer 12

a) Oral contraceptives

Question 13

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

Answer 13

c) Night sweats and hot flushes can commonly occur before menstruation stops

Question 14

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.

Answer 14

c) Sequential therapy should be used for perimenopausal women

Question 15

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

Answer 15

c) Clobetasol propionate

Question 16

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

Answer 16

b) There is an increased risk of heart attack

Question 17

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

Answer 17

a) estrogens are produced in tissues other than the ovaries

Question 18

Serum CA125 is commonly raised in association with:

a) Candidal vaginitis

b) Down syndrome

c) Endometriosis

d) Spina bifida

e) Vulvar carcinoma

Answer 18

c) Endometriosis

Question 19

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

Answer 19

c) Cervical infection with “high risk” HPV is normally transient lasting less than 12 months

Question 20

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

Answer 20

d) Approximately 70% of eligible women in New Zealand have had a smear in the last 3 years

Question 21

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

Answer 21

b) She has had a hysterectomy, without evidence of CIN and has a normal smear history

Question 22

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

Answer 22

d) The test should not be associated with potential harm

Question 23

Which of the following statements is correct?

a) Screening for cervical cancer needs to be offered to lesbian women

b) Women who have had early sexual intercourse before the age of 20 should be offered cervical screening

c) Mortality for Maori women from cervical cancer is similar to that in the general population

d) New Zealand has a population based cervical screening programme

e) Without screening 1 out of 500 women in NZ will die from cervical cancer

Answer 23

a) Screening for cervical cancer needs to be offered to lesbian women

Question 24

Which of the following is NOT associated with heavy menstrual bleeding?

a) Fibroids

b) Inherited blood disorders

c) Endometriosis

d) Thyroid disease

e) Endometrial cancer

Answer 24

c) Endometriosis

Question 25

Which of the following statements regarding polycystic ovarian syndrome (PCOS) is correct?

a) Women with PCOS are infertile and do not require contraception

b) Women with PCOS have a higher mortality from cardiovascular disease

c) Type II diabetes is only increased in obese women with PCOS

d) Women with PCOS are at an increased risk of endometrial hyperplasia

e) Second generation pills are not helpful for the symptoms of PCOS

Answer 25

d) Women with PCOS are at an increased risk of endometrial hyperplasia

Question 26

In a woman with chronic pelvic pain which of the following is not an indicator of malignancy

a) Dyspareunia

b) Postcoital bleeding

c) Mass felt on pelvic examination

d) Rectal bleeding

e) Intermenstrual bleeding

Answer 26

a) Dyspareunia

Question 27

For which one of the following treatments is there good randomised evidence of effectiveness for Pre Menstrual Syndrome (PMS)?

a) Evening Primrose oil

b) Oral contraceptives

c) Vitamin B6

d) Calcium carbonate

e) Progesterone cream

Answer 27

d) Calcium carbonate

Question 28

Deidre is 23 years old. She and Mark have been in a sexual relationship now for 2 years. Recently Deidre had swabs taken prior to an IUD insertion. Her Chlamydia test came back positive. Which of the following statements is true?

a) Mark’s test result is negative so he does not require treatment

b) Deidre should be retested in 3 months

c) One of them must have had another partner during the relationship

d) If they are both treated with azithromycin stat today they can resume sex tomorrow

e) Because of this result Deidre should never use an IUD

Answer 28

b) Deidre should be retested in 3 months

Question 29

30. Marlene is seeking a termination of pregnancy (TOP). One of her pre TOP swabs has shown the presence of clue cells consistent with bacterial vaginosis. Marlene does not have any symptoms. Which of the following statements is correct?

a) You do not need to treat this as Marlene is asymptomatic

b) When you treat Marlene you should also treat her partner

c) The pH of the vagina is likely to be increased

d) Vaginal douching will be helpful to decrease reoccurences

e) One of the common symptoms is vulval inflammation

Answer 29

c) The pH of the vagina is likely to be increased

Question 30

Which of the following statements is true regarding candidiasis?

a) It is common in postmenopausal women

b) Use of intravaginal yogurt is helpful for symptom relief

c) The incidence rises with initiation of sexual activity

d) Only women with symptoms should be treated prior to IUD insertion

e) Candidiasis is associated with use of the combined pill

Answer 30

c) The incidence rises with initiation of sexual activity

Question 31

Which one of the following vulvar conditions requires treatment

a) Fordyce spots

b) Epidermoid cyst

c) Angikeratoma

d) Tinea cruris

e) Vulval papillae

Answer 31

d) Tinea cruris

Question 32

Which statement is true regarding herpes simplex II?

a) The virus is often passed on even when there are no visible symptoms

b) Herpes is associated with the development of cervical cancer

c) Condom use eliminates the risk of passing on the virus

d) Topical antivirals are of benefit

e) Antibodies will only be present with past symptomatic herpes

Answer 32

a) The virus is often passed on even when there are no visible symptoms

Question 33

Maude is 23 years old and has a painful vulva for which there is no obvious cause. Which of the treatments would you initially recommend?

a) Amitriptyline

b) Biofeedback

c) Gabapentin

d) lignocaine gel

e) Surgical vestibulectomy (modified perineoplasty)

Answer 33

a) Amitriptyline

Question 34

Marianna is 33 years old and has consulted you with a 2-day history of vulvar ulceration and generalised malaise. She has shooting pains down her legs and is having difficulty passing urine. Your clinical diagnosis is primary herpes simplex virus (HSV) infection. Which of the following is true:

a) Acyclovir will decrease the risk of recurrence

b) 30% of cases are caused by HSV type II

c) A Caesarean delivery would be recommended if Marianna has a baby in the future

d) Long term Acyclovir should be prescribed because of the severity of the primary attack

e) Serology should be ordered to test if HSV type I or II

Answer 34

b) 30% of cases are caused by HSV type II

Question 35

A 25 year old woman currently not sexually active complains of a milky white discharge which has been present on and off for the past few years. The discharge is not associated with any vulvar itch. The Ph of the discharge is <4.5. The most likely cause is:

a) Candida albicans infection

b) Gardnerella vaginalis infection

c) A normal physiological discharge

d) Chlamydia trachomatis infection

e) Trichomoniasis

Answer 35

c) A normal physiological discharge

Question 36

The following is true of chlamydia

a) It is an obligate intracellular protozoan

b) It is an obligate intracellular bacterium

c) It is an obligate intracellular anaerobic bacterium

d) It contains elementary bodies and flagellae

e) It is not a cause of lymphogranuloma venereum (LGV)

Answer 36

b) It is an obligate intracellular bacterium

Question 37

A 20 year old girl presents to the STI clinic with severe vulval pain of 2 days duration. Examination reveals small vesicles and ulcers over the vulva that are tender to touch. What will be the appropriate management.

a) Take a swab and await results before you institute treatment.

b) Do a blood test for HSV antibodies.

c) Treat with topical Acyclovir agents

d) Start treatment with oral Acyclovir irrespective of swab results

e) Start treatment with a broad spectrum antibiotic such as Doxycycline

Answer 37

d) Start treatment with oral Acyclovir irrespective of swab results

Question 38

A 35 year old lady who is currently 28 weeks pregnant in her 3rd pregnancy presents with vulval swelling. On examination the vulva is swollen with a bluish discoloration. There is no tenderness. The most likely diagnosis is:

a) Barthlolins cyst

b) Vulval varicosities

c) Pagets disease

d) Melanoma

e) Thrombosis of vulval veins

Answer 38

b) Vulval varicosities

Question 39

Regarding the Menopause

a) Raloxifene does not increase the risk of deep vein thrombosis

b) Intermittent dosing regimes of selective serotonin reuptake inhibitors are more effective than continuous regimes for control of premenstrual syndrome symptoms

c) In controlled trials, less than 35% of women randomised to placebo treatment alone experienced a reduction in hot flushes

d) Progestogens should be prescribed to women with an intact uterus using low dose local vaginal estrogen for vaginal atrophy

e) Estrogen replacement therapy is not an effective treatment for loss of libido in post menopausal women

Answer 39

e) Estrogen replacement therapy is not an effective treatment for loss of libido in post menopausal women

Question 40

Which one of these statements regarding sequential l hormone therapy is true

a) Sequential therapy is taking both the estrogen and progestogen tablets daily

b) Sequential therapy should be prescribed if the woman had her last period less than one year ago

c) Sequential therapy should be prescribed if a woman had her last period more than one year ago

d) Sequential therapy will provide contraception if needed

e) Sequential therapy will mean that the woman has no vaginal bleeding

Answer 40

b) Sequential therapy should be prescribed if the woman had her last period less than one year ago

Question 41

Ms Wong aged 33 has debilitating menstrual periods. Apart from the severe lower abdominal pain and dysmenorrhoea she suffers from an alternating bowel habit with painful defecation that lasts for at least a week in the peri-menstrual phase. Choose the most likely diagnosis.

a) Premenstrual syndrome

b) Pelvic inflammatory disease

c) Endometriosis

d) Irritable bowel

e)Ulcerative colitis

Answer 41

c) Endometriosis

Question 42

The accepted medical options for management of heavy menstrual bleeding are all of the following except

a) Progestogens given 3 weeks out of 4

b) Mefenamic acid

c) Depo Provera

d) Combined oral contraceptive pill

e) Progestogens given in the luteal phase

Answer 42

e) Progestogens given in the luteal phase

Question 43

Which of the following statements regarding endometriosis is true?

a) When mild, probably has no effect on fertility

b) Often obstructs the fallopian tubes

c) Pregnancy chances can be improved by suppressive medical therapy for 6 months

d) Is best diagnosed by MRI scan

e) Surgical treatment improves subsequent pregnancy rates for mild to moderate endometriosis

Answer 43

e) Surgical treatment improves subsequent pregnancy rates for mild to moderate endometriosis

Question 44

Screening for Chlamydia is appropriate in which of the following people?

a) A 35 year old married woman who is 8 weeks pregnant

b) A 25 year old asymptomatic woman having an IUD inserted for contraception

c) A 30 year old woman having her first surgical termination of pregnancy

d) A 20 year old male partner of a woman diagnosed with Chlamydia a week ago

e) All of the above

Answer 44

e) All of the above

Question 45

Which one of the following statements is true? Following the menopause:

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

Answer 45

a) estrogens are produced in tissues other than the ovaries

Question 46

A 40 yr para 2 attends your clinic for a routine smear test. She has normal regular cycles and does not complain of any other problems i.e. dysmenorrhoea, urinary or bowel complaints. Abdominal & pelvic examination reveals a 12-week size uterus that is uniformly enlarged in shape. Ultrasonography reveals a single 7cm by 8cm leiomyoma and normal looking ovaries.

The optimal course of management is:

a) Surveillance with annual pelvic ultrasound scans

b) Abdominal myomectomy

c) Laparoroscopic myomectomy

d) Hysteroscopic resection of myoma

e) Vaginal hysterectomy

Answer 46

a) Surveillance with annual pelvic ultrasound scans

Question 47

Which of the following statements is correct? The New Zealand Guidelines for Breast Cancer screening state:

a) All women aged 45- 69 years should be offered an annual mammogram

b) All women aged 45 to 65 should be offered a annual mammogram

c) All women aged 45 to 69 years should be offered a mammogram every two years

d) A woman with an aunt with breast cancer should have a mammogram every year from the age of 35 years.

e) A woman who has had a hysterectomy should have a mammogram every year from the age of 40 years.

Answer 47

c) All women aged 45 to 69 years should be offered a mammogram every two years

Question 48

Mrs Brown, age 55 years, who has no personal or family past history of note, had a recent BMD. The t score was -2. Which one of the following statements regarding bone health in the

menopause is correct?

a) All woman should have a BMD (bone mineral density) screening carried out at menopause

b) Mrs Brown should be started on bisphosponates.

c) Mrs Brown’s next follow up BMD should be done using the same machine.

d) Quality of research data for vertebral fracture reduction is better for hormone therapy than alendronate.

e) Osteopenia is defined as a BMD score between -1 and -2 SD

Answer 48

c) Mrs Brown’s next follow up BMD should be done using the same machine

Question 49

Joanna is a 49 year old woman who has flushes and irregular periods. She is considering starting hormone therapy but she is concerned about the risks. You tell her:

a) There is an increased risk of breast cancer

b) There is an overall increased risk of a heart attack

c) There is a decreased risk of a stroke in the next 4 years

d) There is a decrease in gall bladder disease in the next year.

e) There is an increased risk in colorectal cancer

Answer 49

a) There is an increased risk of breast cancer

Question 50

A 42 year old woman has annual smears because she had a high grade lesion 8 years ago. Her smears have been normal and she asks if she can have her next smear in 3 years’ time. You tell her:

a) She can have her next smear in 3 years

b) She should continue annual smears

c) She can replace her smear with an HPV test

d) Request HPV test with smear and if normal return to screening in 3 years

e) Request HPV test with smear and if normal, request a further HPV with smear in 12 months, then return to screening in 3 years

Answer 50

e) Request HPV test with smear and if normal, request a further HPV with smear in 12 months, then return to screening in 3 years

Question 51

A 32 yr nulliparous lady complains of pelvic pain that has worsened over the last 2 years. Her menstrual cycles are of normal length with no change in pain intensity over the course of the cycle. She complains of severe dyspareunia with each attempt at intercourse. On pelvic examination the vulva & vagina are normal, uterus anteverted, no palpable adnexal masses. A diagnostic laparoscopy is negative. The patient on further discussion reveals a childhood history of sexual abuse. The most appropriate management option for this lady is:

a) Antidepressant medication

b) Vaginal lubricants

c) Psychological counselling

d) Oral progesterone

e) Evening primrose oil

Answer 51

c) Psychological counselling

Question 52

A 16 yr nulliparous girl complains of worsening dysmenorrhoea which starts on the first day of bleeding. She attained menarche at the age of 13 yrs and since then has had regular cycles. Her dysmenorrhoea is not relieved by standard doses of several nonsteroidal anti-inflammatory drugs (NSAIDS). Her medical history is non-contributory and she has never been sexually active. On general examination she is normotensive with a BMI of 23. A pelvic ultrasound is normal. The next step in the management of this girl is:

a) Increased doses of NSAIDS

b) Oral contraceptives

c) Tranexemic acid (Cyklokapron)

d) Diagnostic laparoscopy

e) Fluoxetine hydrochloride (Prozac)

Answer 52

b) Oral contraceptives

Question 53

A 30 yr nulliparous woman presents with recurrent episodes of pre-menstrual oedema, lethargy, irritability, low mood and mastalgia. A menstrual symptoms diary which the woman has kept for the last 6 months demonstrates worsening of symptoms a few days before the onset of periods and resolution of symptoms within 2-3 days of the onset of menstruation. The most appropriate next step in the management of this patient is:

a) Oral progesterone

b) Combined oral contraceptive pill

c) Gonadotrophic releasing hormone agonist

d) Evening primrose oil

e) Selective serotonin uptake inhibitor

Answer 53

e) Selective serotonin uptake inhibitor

Question 54

A 16-year-old girl has heavy irregular menstrual periods with flooding, but minimal discomfort. Her menarchy was at age 14 years. Cycle lengths vary between 30 and 40 days. The most likely reason for her pattern bleeding is:

a) Anovulation

b) Von Willebrand’s disease

c) A vaginal neoplasm

d) An endometrial polyp

e) Chlamydia

Answer 54

a) Anovulation

Question 55

Mrs Brown, aged 54 years, used combined hormone therapy for four years for her hot flushes. She stopped it four years ago and wishes to know which of the risks and benefits of the therapy is still present. You tell her:

a) The increased risk of VTE is still present

b) The decreased risk of fracture has disappeared

c) There is still an increased risk of breast cancer

d) The increased risk of colorectal cancer is still present

e) The increased risk of stroke is still present

Answer 55

c) There is still an increased risk of breast cancer