Multichoice Questions (Milford - gynae) Flashcards
Prev Qs - not my answers
1
Q
Pubourethral ligament contains?
a. collagen
b. collagen, elastin
c. collagen, elastin, muscle
A
Histologically the ligaments consist of smooth muscle, elastin, collagen, nerves and, blood vessels (from journal article - Petros)
Answer: C (K says A)
2
Q
In anatomical position, the angle of the vagina is upwards and backwards**
a. 90 degrees
b. 135 degrees
c. 260 degrees
d. 310 degrees
A
Answer: B (TeLindes)
3
Q
Where does the paravaginal fascia insert?
a. Arcus tendineus fascia pelvis
b. Iliopectineal line
c. Urogenital diaphragm
d. Perineal body
e. Sacrospinous ligament
A
Answer: A
4
Q
The structure posterior to the external iliac artery and vein and would dissect medially off the psoas muscle is:
a. Superior gluteal artery
b. Obturator nerve
c. Ureter
d. Uterine artery
A
Probably ureter as the obturator nerve lies very deep to the external iliac artery, despite the ureter not being truly posterior to the external iliac artery.
Answer: C
5
Q
How many oocytes are left by the time a woman reaches puberty?
a. 4000
b. 15,000
c. 30,000
d. 100,000
e. 400,000
A
Answer: E (my notes)
6
Q
What histological change occurs in the post-menopausal ovary?
a. Increased number of granulosa cells
b. Increased immature oocytes
c. Increased stromal cells
d. Increased theca interna cells
A
Answer: C
7
Q
Cystic glandular hyperplasia associated with?
a. cyclical HRT
b. depot MPA
c. NIDDM
d. COCP
A
Answer: C (unopposed oestrogen)
8
Q
Which of the following conditions require urgent surgical treatment?
a. acute appendicitis
b. acute cholecystitis
c. acute pancreatitis
d. acute pyelonephritis
e. acute osteomyelitis
A
Answer: A
9
Q
60 yo with several year history of LIF pain. Temp 38, raised WBC (15,000), few WBC in urine, unwell. Most likely diagnosis?
a. acute appendicitis
b. acute cholecystitis
c. acute diverticulitis
A
Answer: C
10
Q
Effect of electrosurgical waveform with high current, low voltage and increase tissue temperature rapidly (>100 degrees to result in vaporization)**
a. Cut
b. Fulguration
c. Coagulation
d. Blend
e. Desiccate
A
Answer: A
11
Q
After a vaginal hysterectomy, the patient is brought back to theatre for primary haemorrhage. In ligating the internal iliac arteries, which of the following structures is most likely to be injured?
a. external iliac arteries (lateral and should not come into play)
b. external iliac veins (most likely answer - will sit just infero-lateral to internal iliac and is bulbous at level of bifurcation)
c. ureters (always in play even with a gynaecologist doing neurosurgery, but crosses internal iliac from medial to lateral and should be below it at level of internal iliac)
d. obturator nerve (you are going medial to psoas and so are far enough away from the nerve)
e. common iliac arteries (should be below it at level of internal iliac)
A
D/W Naven : Lesson from this question is get onto the artery, you can pull up on obliterated umbilical to pull artery up and pass your right angle from lateral to medial, sticking right on artery.
Answer: B (Brad votes C)
ilford
12
Q
Difficult endometriosis TAH. Sudden profuse bleeding from L paracervical tissue. Mx?
a. large clamp laterally
b. pack and call for help
c. clamp aorta above pelvic brim
d. clamp common iliac
e. finger to occlude common iliac then identify ureter
A
Answer: B
13
Q
Day 1 post TAH for benign pathology, the patient is SOB and has severe central chest pain. O/E - T 36.7, PR 110, RR 28, BP normal. CXR shows bibasal atelectasis, WCC 11, pO2 66 mmHg. Next step?
a. Antibiotics
b. V/Q
c. Pulmonary angiogram
d. Blood transfusion
A
Answer: B
14
Q
Raised temp 12-24 hrs following TAH?
a. vault cellulitis
b. septicaemia
c. DVT
d. Reaction to transfusion
A
Answer: B
15
Q
A 30 yo with TAH for intraepithelial Ca of the cervix. Flushed, temp 39 C, PR 140/min, RR 24, clear chest. Most likely diagnosis?
a. PE
b. Pelvic sepsis secondary to bacteroides fragilis
c. Beta Strep
d. Pelvic vein thrombosis
e. Reaction to blood
A
Answer: B
16
Q
A 100kg woman had a routine TAH for uterine fibroid. On post operative day 5, temp 38, there was profuse watery discharge from the wound. What is your management?
a. return to theatre
b. commence on antibiotics
c. apply pressure dressing
d. perform an IVP
e. no treatment needed
A
Answer: D
17
Q
5 days post TAH, vertical incision, serous ooze, Mx?
a. nothing
b. Steristrip
c. antibiotics
d. probe
A
Answer: D (K says A or C) SG agree with D
18
Q
A TAH, BSO was performed for extensive endometriosis. The operation took approximately 2 hours. On day 1 post op review, the patient c/o numbness on the anterior aspect of the right thigh and weakness on flexion of the right hip. Which of the following is most likely?
a. patient has a psoas haematoma
b. pressure effect of the retractor during the long operation
c. patient has a pelvic haematoma
d. your assistant has been leaning on the thigh
e. Duplex Doppler to exclude DVT
A
Answer: B
19
Q
Difficult hysterectomy with endometriosis, significant blood loss of 2 litres throughout the procedure. At the end of the procedure is noted to have a haemostatic suture too close to what you thought was the ureter. Your next options are:
a. Do nothing but closely observe in the next couple of days
b. Remove the suture
c. IV indigo carmine and watch the dye through the ureter
d. Do a cystotomy at the operation and pass some catheters up the bladder to make sure the ureter is patent
A
Answer: K says D but cystoscopy is probably more appropriate
20
Q
Difficult TAH for endometriosis, difficulty with haemostasis. Finally haemostasis secured but stitch uncomfortably close to left ureter at top of vaginal vault.
a. Do nothing, observe closely post-op
b. Ureterotomy at level of pelvic brim and insert ureteric stent
c. Cystotomy and insert stent into left ureter
d. Injection of indigo carmine IV and follow dye flow through ureter
e. Remove suture
A
Answer: C
21
Q
At end of TAH there is fluid in pelvis that looks like urine. What do you do?
a. Sterile milk into bladder
b. Dissect out ureters
c. Ask anaesthetist to give IV indigo carmine
d. Redivac drain and close
e. IDC x 10 days and close
A
Answer: C
22
Q
During a TAH for severe endometriosis a 1cm longitudinal laceration is made in the sigmoid colon. Your management would be:
a. Anterior resection
b. Hemicolectomy
c. Repair defect in colon
d. Repair defect and form transverse loop colostomy
e. Repair defect and form caecostomy
A
Answer: C
23
Q
The proven benefits of subtotal hysterectomy include:
a. Reduced hospital stay
b. Better sexual function
c. Reduced risk of vault prolapse
d. All of the above
e. None of the above
A
Answer: E (TeLindes)
24
Q
You are performing a laparoscopy for infertility and when inserting the Verres needle get a constant stream of blood coming out of it. You remove the needle and the anaesthetist says her HR/BP etc are stable. Do you?
a. Abandon laparoscopy and discharge patient home
b. Observe for 48 hrs
c. Laparoscopy with Hassan entry
d. Laparoscopy with Verres in LUQ
e. Do laparotomy
A
Answer: E
25
The highest mortality with laparoscopic tubal ligation is due to
a. Vascular injuries
b. Perforation of abdominal viscus
c. General anaesthetic
d. Air embolism
e. Infection
Answer: C (TeLindes)
26
When would neo-uretero-cystotomy be the most appropriate procedure?
a. ureter divided closer to the trigone
b. ureter divided at the pelvic brim
c. ureter ligated and immediately recognised
d. ureter ligated and recognised just prior to peritoneal closure
e. ureter clamped for 30 secs
Answer: A (UTD)
27
When would re-anastomosis with splint be most appropriate?
a. ureter divided closer to the trigone (close to trigone assume not enough distal ureter for primary anastomosis and would suggest hitch and reimplantation)
b. ureter divided at the pelvic brim (most likely answer- but I would prefer a Boari flap at this level)
c. ureter ligated and immediately recognised (this dose tell us where injury has occured, so not the most appropriate answer also ligating it would disrupt blood supply so I would resect before anastomosis)
d. ureter ligated and recognised just prior to peritoneal closure (presume ligated for a while so woud require resection of likely avascular area prior to anastomosis)
e. ureter clamped for 30 secs (crushing injury from clamp--> resect before ansstomosis)
Reimplantation is treatment of choice due to the high chance of stenosis with reanastomosis but there are limited options with high injuries. D/W Naven: Some people could suggest that uretreoureterostomy in the pelvis should always be accompanied by psoas hitch and reimplantation. But ureteroureterostomy OK in abdo and pelvis above cardinal ligament.
Answer: B as per Naven as above (K says D - if divided for prolonged time a splint is needed)
28
When is uretero-ureteral anastomosis most appropriate?
a. ureter divided closer to the trigone
b. ureter divided at the pelvic brim
c. ureter ligated and immediately recognised
d. ureter ligated and recognised just prior to peritoneal closure
e. ureter clamped for 30 secs
Answer: B (as above)
29
Ten days after a vag hyst a patient developed a watery vaginal discharge. IVP demonstrated an uretero-vaginal fistula 3cm above the ureterovesical junction. What is the appropriate treatment?
a. Uretero-ureteral reanastamosis
b. Reimplantation of the ureter
c. Perform a Boari flap
d. End to end reanastomosis
e. Insertion of a suprapubic catheter and await spontaneous closure
Answer: B
30
You are performing an endo-cervical curettage, which of the following is correct?
a. Dilate internal os, uterine curettage then endocervical
b. Dilate internal, endocervical curette, uterine curette
c. Endocervical curette, dilate internal os then uterine
d. Uterine curette, dilate internal os, endocervical curette
Answer: C (UTD)
31
Suction curettage for missed abortion at 10/40. What size suction catheter should you use?
a. 6
b. 8
c. 10
d. 12
e. 14
Should be 1mm less than the weeks of gestation from last menses, although some use smaller (TeLindes). UTD states suction size should equal gestation.
Answer: C
32
Perforated uterus at D&C with haemorrhagic shock. Most likely site of perforation?
a. fundal
b. anterior
c. posterior
d. cervical
e. lateral
Answer: E (location of vessels)
33
While performing a suction TOP, the uterus is perforated and omentum pulled down to the external os. Management?
a. observe
b. AXR and observe
c. Hysterectomy
d. Laparoscopy
e. Laparotomy and oversew defect
Answer: D (K says E), SG agrees with D
34
During TOP, uterus is perforated. Safest option is:
a. hysterectomy
b. observe
c. laparoscopy
d. laparotomy
Answer: C
35
A woman had a termination of pregnancy at 8/40 gestation at a local clinic under LA. The cervix was difficult to dilate and the uterus appeared to be perforated during this dilation. There was no bleeding or pain. A TVS was performed and showed a viable 8/40 fetus with an intact sac. What is the most appropriate management?
a. Continue with the termination
b. Transfer to hospital and continue termination under GA
c. Insert a cervagem vaginally and wait 4 hrs then attempt the suction termination
d. Perform a laparotomy and repair the defect, continue with suction termination with hysterotomy and removal of POC if necessary
e. Stop the procedure and wait 1-2 weeks then reconsider
TeLindes and UTD state that if perforation occurred with blunt instrument (sound or dilator) then the procedure can be continued under ultrasound guidance. If concerns exist around bleeding laparoscopy is done and the procedure can be finished under laparoscopic guidance
Answer: E
36
ND YAG laser hysteroscopy. Which medium?
a. CO2
b. Glycine
c. Dextrose
d. Sorbitol
e. N Saline
Answer: E (TeLindes)
37
You are doing a hysteroscopic resection of uterine septum and no complications. Just about to remove gloves when note brisk PV bleeding with no obvious vaginal or cervical lesion. Mx?
a. pack vagina and cervix with betadine gauze
b. laparotomy
c. look with hysteroscope
d. foley catheter in uterus
e. blood product Tx - packed cells/FFP/ cryoprecipitate
Answer: D (TeLindes)
38
Operative hysteroscopy - when are you most likely to perforate?
a. Dividing septum
b. Submucous fibroid resection
c. Rollerball
Answer: A (TeLindes)
39
Advantages of hysteroscopic scissors tha slipt over scope but in sheath.
a. Cost
b. Flexible distance between scope and scissors
c. Heavier more robust rigid scissors possible
d. Scissors only take up 1/4 of view
Answer: C (TeLindes)
40
The patient had a radical hysterectomy and in the immediate post-operative period has difficulty walking and the next day she has paraesthesia over her left thigh as well as an absent patella jerk. Which of the following nerves would be appropriate?
a. Obturator
b. Femoral
c. Internal pudendal
d. Sciatic
Answer: B
41
When you are doing a radical hysterectomy you make a hole in the external iliac vein. What is you immediate management?
a. put a finger over the hole
b. put a sponge over the hole
c. put a Kelly clamp over the hole
d. put a Kelly clamp distal to the hole
e. put a Kelly clamp proximal and distal to the hole
Answer: A (Kelly clamp is similar to an artery clip)
42
During a radical hysterectomy the uterine artery is divided at which of the following:
a. At its origin adjacent to the hypogastric artery
b. Adjacent to the ureter
c. Where it meets the uterus
d. In the wall of the uterus
Answer: A
43
A 35 yo decided on hysterectomy and bilateral BSO for intractable chronic PID. She has heard that hysterectomy is associated with change in sexual function, decreased energy and loss of a sense of well-being. You counsel her that?
a. It will not affect her orgasm
b. She will experience no changes to sexual function as long as one ovary is left
c. Her sexual response will be affected by her and her partner's response to the operation
d. Her energy levels will be unchanged as long as she takes oestrogen
Answer: C
44
Small cyst found in midline at the fourchette. Most likely
a. Bartholin's cyst
b. Epidermal inclusion cyst
c. Sebaceous cyst
d. Gartner's duct cyst
Answer: B
45
A small lump is noted in the vagina in the region of the posterior fourchette. It is most likely to be:
a. Epidermoid cyst
b. Sebaceous cyst
c. Gartner's duct cyst
d. Bartholin's cyst
Answer: A
46
Accepted time of resting for a girl who has sustained genital trauma?
a. 20 mins
b. 6 hrs
c. 24 hrs
d. 3 days
e. 4 days
```
24 Hours (UTD)
Answer: C
```
47
The amount of time before surgery that clear fluids should be stopped in paediatric patients is?
a. 2 h
b. 6 h
c. 12 h
d. 24 h
e. Can eat up till time of surgery
Answer: A
48
Normal menstrual cycle exhibits the following hormonal changes. Which of the following is correct?
a. LH surge occurs 12 h before ovulation
b. LH surge is due to a positive feedback from relatively high oestrogen levels in the late follicular phase
c. Short pulses of GnRH occur during REM sleep
d. Maximum rate of oogenesis occurs at the trough of gonadotrophin secretion
e. In puberty, there is rise of LH before FSH
Ovulation occurs 10-12 hours after the LH peak but the surge begins 34-36 hours prior to ovulation; LH surge is due to a positive feedback from relative high levels of oestrogen in the late follicular phase; FSH rises before LH during puberty; GnRH pulses during awake according to Kate. A, E are definitely incorrect, D is probably incorrect. Maximal oogenesis is fetal?
Answer: B
49
What enables a follicle to become dominant over others?
a. Production of progesterone during luteal phase
b. Production of inhibin by those follicles destined for atresia
c. Production of oestradiol
d. Induction of prolactin receptors
e. Ooph-hypophyseal reflex
From my understanding, probably C; although oestrogen produced by the dominant follicle causes negative feedback at the pituitary withdrawing FSH support for other follicles
Answer: C
50
Oestrogen receptor present on all except?
a. Rectum
b. Uterosacral ligament
c. Vagina
d. Urethra
Answer: A
51
Blood Assay steroid - Which is direct measure of adrenal androgen activity?
a. Androstinedione
b. Cortisol
c. DHEAS
d. Testosterone
Answer: C
52
What will lower the SHBG?
a. Pregnancy
b. Weight loss
c. Oestrogen
d. Hyperinsulinaemia
Pregnancy, hyperthyroidism and oestrogen increase SHBG whilst corticoids, androgens, progestins, groeth ormoness, insulin and IGF-I decrease SHBG
Answer: D
53
Main hormone secreted by the PCO ovary?
a. Testosterone
b. Androstenedione
c. Oestrone
d. Oestradiol
e. DHEAS
Answer: B (Kenny agrees)
54
Which steroid has the most effect on serum concentration of lipoproteins:
a. Testosterone
b. Oestrogen
c. Natural progesterone
d. Synthetic progesterone
e. Glucocorticoids
Answer: B
55
Subcut oestradiol therapy exhibits the following differences when compared with oral oestrogen:
a. A physiological ratio of estradiol to estrone is achieved
b. Rarely causes endometrial hyperplasia
c. Leads to more abnormal changes in clotting factors
d. Is less likely to increase serum level of renin substrate
e. Is more effective in the prevention of osteoporosis
From Kenny - estradiol to estrone ratio is higher with non oral routes - this is not "physiological" in the post menopausal state where estrone is predominant, but I'm not sure if this is the question they're asking.
Answer: D (Kenny), questions say A
56
In an obese postmenopausal woman the commonest hormone is
a. Oestriol
b. Oestradiol
c. Oestrone
d. Androstenedione
Answer: C
57
Time after ovulation for eggs to reach uterine cavity?
a. 5 hours
b. 36 hours
c. 1 day
d. 4 days
e. 7 days
The egg reaches the uterus four days after ovulation. (My notes)
Answer: D
58
For how long does an unfertilised ovum remain viable after ovulation?**
a. 12-24 hrs
b. 24-48
c. 72 hrs
d. 4 days
Most estimates range between 12-24 hours although retrieved eggs can be fertilised up to 36 hours of incubation. (Speroff)
Answer: A
59
What are the characteristics of beta hCG in early pregnancy?
a. enhances placental-fetal adrenal steroidogenesis
b. supports the corpus luteum
c. enhances the effects of maternal blocking antibodies
d. maternal serum level rises to a peak at 14w
e. is chemically and functionally similar to ACTH
HCG is produced by the syncytiotrophoblast to promote progesterone production by the corpus luteum until placental progesterone supply is established (after 6 weeks). HCG also plays a role in spiral artery angiogenesis (UTD). The alpha subunit is identical to that of TSH, LH and FSH. HCG levels peak at 8-11 weeks gestation.
Answer: B
60
Young sexually active female with non-offensive white PV discharge. PH < 4.5. What is the cause?
a. Gardeneralla
b. Thrush
c. Physiological
d. Gonorrhoea
Answer: C
61
Which of the following is the earliest sign of female sexual response?
a. Increased HR
b. Uterine contraction
c. Vaginal transudation
d. Vasocongestion of the outer third of the vagina
e. Erection of nipples
Answer: A; SG think this is a dodgy question
62
The first sign of sexual arousal in a woman is?
a. Enlargement of the clitoris
b. Enlargement of the labia majora
c. An increase in vaginal length
d. An increase in vaginal moisture
e. Skin flushing
Answer: D
63
The most common cause of inhibition during the excitement phase of arousal in marital sex is?
a. Menopause
b. Hysterectomy
c. Fear of pregnancy
d. Marital discord
e. Empty nest syndrome
Answer: D
64
A woman presented to you with lack of sexual excitement. What is the most likely reason?
a. Fear of pregnancy
b. Poor coital techniques
c. Marital discordance
d. Endometriosis
e. Pelvic congestion syndrome
Answer: C
65
Match drug with effect in endometriosis
a. GnRH agonist
b. Danazol
c. Both
d. Neither
Delays return of ovulation after cessation
Hot flushes
An increase in LDL-cholesterol
Delays return of ovulation after cessation
Answer: D
Hot flushes
Answer: C
An increase in LDL-cholesterol
Danazol s LDL and total cholesterol and s HDL (Speroff)
Answer: B
66
Which medication is not used in treatment of menorrhagia?
a. neostigmine bromide
b. oestrogen
c. GnRH agonist
d. Progesterone
e. Methyl testosterone
Answer: A
67
Danazol is associated with all EXCEPT
a. Fluid retention
b. Acne
c. Virilisation
d. Exacerbation of fibrocystic disease of breasts
Answer: D
68
Which action of the following anti androgens is the least accurate?
a. Cyproterone acetate acts on the 5 alpha reductase receptor
b. Spironolactone acts on the DHT receptor as well as 5AR receptor
c. Cimetidine acts as a weak binder to DHT receptor
d. Flutamide is a non-steroidal anti-androgen
e. Finasteride 5AR blocker
Cyproterone and spironolactone bind to androgen receptor and exert mixed agonism-antagonism. Flutamide is a pure antiandrogen and bocks receptors with competitive inhibition (Speroff). Spironlactone competitively inhibits DHT and 5AR. Cyproterone competitively inhibits DHT. Flutamide inhibits nuclear binding of androgens but has weaker affinity than cyproterone or spironolactone. Cimetidine has a weak anti-androgenic effect on DHT receptors. Finasteride is a specific inhibitor of 5AR with some activity on DHT (Novak). Testosterone by 5 AR (ketoconazole/spironolactone/finasteride) DHT by androgen receptor complex (flutamide, cyproterone, spironolactone)
Answer: A
69
The most effective anti-androgen available is?
a. Danazol
b. MPA
c. Dexamethasone
d. Spironolactone
e. Cyproterone
Answer: E
70
Hormones with antiandrogen action include the following, except:
a. Spironolactone
b. Cyproterone acetate
c. Cimetidine
d. Flutamide
e. Tamoxifen
Answer: E
71
Tamoxifen has been proven to?
a. Reduce hospital admissions with cardiac disease
b. Reduce bone fracture
c. Be associated with hyperplasia
d. All of them
e. Lower total and LDL cholesterol
The effects of tamoxifen are uncertain with prevention of bone loss in postmenopausal women but premenopausal women experienced substantial bone loss; reduces total cholesterol and LDL cholesterol; less coronary heart disease; association with endometrial hyperplasia and cancer
Answer: D
72
Drugs which cause haemolytic anaemia
a. Penicillin
b. Methyldopa
c. Cefoxitin
d. All of the above
e. None of the above
Answer: D
73
All of the following drugs are associated with impotence except?
a. cimetidine
b. Aldomet
c. Salzopyrine
Answer: C (UTD)
74
All of the following are associated with impotence except?
a. Spinal cord lesion
b. Methyldopa
c. Salazopyrine
d. Hyperprolactinaemia
e. Chronic renal disease
Answer: C
75
What is the most common factor associated with ejaculatory impotence?
a. Alcohol
b. Diabetes
c. Methyldopa
d. Marital discordance
e. Peyronie's disease
Answer: D
76
Which is right?
a. Medroxyprogesterone acetate and virilisation of female fetus
b. Clomid and alopecia
Answer: A
77
Select the correct option regarding side effects of hormone drugs
a. Depo Provera is well documented to cause congenital abnormalities in infants
b. Medroxyprogesterone acetate causes virilisation of male infants
c. Clomid is associated with hair loss
d. Bromocriptine is associated with hypertension
Clomid can rarely cause hair loss, bromocriptine occasionally causes both hypertension and hypotension. Quite difficult to virilise a male infant.
Answer: C
78
Select the correct option regarding the side effects of hormonal agents:
a. Depo-provera is well documented to cause congenital abnormalities
b. Medroxyprogesterone acetate causes fetal virilisation
c. Clomiphene is associated with hair loss
d. Bromocriptine is associated with hypertension
e. Venous thrombosis is associated with oestradiol implants
The responses to medroxyprogesterone, clomiphene, bromocriptine and oestradiol are all correct. Should the question be asking for the incorrect option?
Answer: any of the above depending on the question
79
Severe acne, before Rx with retinoic acid needs?
a. HCG
b. FSH
c. Oestrogen
Answer: A
80
What is the recognised clinical action of the antiprogestins?
a. Endometriosis
b. Post coital contraception
c. Hot flushes
d. Endometrial hypoplasia
Mifepristone can be used for emergency contraception and to a lesser extent endometriosis
Answer: B
81
The most common side effect that causes discontinuation of selective serotonin reuptake inhibitors is?
a. Cardiac dysfunction
b. Sexual dysfunction
c. Pulmonary hypertension
d. Anticholinergic effects including dry mouth and constipation
e. Sedation and lethargy
Answer: B
82
Starting dose of bromocriptine?
a. 1.25 mg nocte increasing to 2.5 mg BD with food over 2/52
b. 1.25 mg nocte increasing to 10mg /day over 2/52
c. 1.25 mg tds initially and increase
Answer: A (Novak)
83
Reason for failure of bromocriptine treatment?
a. Under dosage
b. Non-compliance
c. Intolerance of symptoms
Answer: C
84
What is the most common symptom of benign breast disease?
a. Pain
b. Tender lump
c. Change in breast size
d. Discharge
e. Change in menses
Answer: A
85
Woman with chronic pelvic pain. All Ix normal. She finally says she does not know if she can cope with her husband's physical abuse of her for much longer. Is this form of abuse
a. Easy to treat with counselling once recognised
b. Usually first picked up by physicians
c. Gets better in pregnancy
d. Women/the victims fear being left alone
Answer: D
86
You are seeing a 20 yo in ED who presents within 3 hrs of a sexual assault. In giving her psychological counselling as to what she can expect you explain that she is likely to experience?
a. Anger and aggression followed by a rapid return to normal function
b. Anger and aggression followed by a long period before full recovery
c. Fear and somatic symptoms followed by a rapid return to normal function
d. Fear and somatic symptoms followed by a long period before full recovery
Answer: D (K)
87
You are asked to assess a woman who was raped 6 hrs ago. Which of the following is least likely?
a. She will develop fear and anxiety with restlessness
b. Somatic symptoms of headaches, fatigue and sleep disturbance
c. Emotional reactions of anger, self-blame and humiliation
d. Those with severe somatic symptoms tend to recover faster
Answer: D
88
You examine a woman who has been raped. 24 hrs afterwards her attorney phones to say there was no sperm or acid phosphatase on the specimens collected. Your reply?
a. You did not want to make a statement anyway
b. Both tests were probably showing false negatives
c. About 1 in 3 rapists have some form of sexual dysfunction
d. The man probably had a vasectomy
Answer: B (K says C)
89
Which of the following scenarios constitutes aggravated criminal sexual assault?
a. Sexual assault where the woman is not the wife
b. Where the penis penetrates the vagina
c. Where consent is not given
d. Where the victim has been coerced by the display or use of a weapon
e. Where force is used
Answer: D
90
The most common cause of injury in women is?
a. Automobile accidents
b. Domestic violence
c. Muggings
d. Rape
e. Athletic injuries
Answer: B
| Contraception
91
The Pearl index (formula) is expressed in the:
A. percentage of women who become pregnant using a particular contraceptive.
B. percentage of women who do not become pregnant using a particular contraceptive.
C. number of pregnancies per 100 woman-years' use of a particular contraceptive.
D. number of pregnancies per 1000 woman-years' use of a particular contraceptive.
C. number of pregnancies per 100 woman-years' use of a particular contraceptive.
92
The most effective post coital contraception is:
a. Ethinyloestrodiol 50mg for 5 days
b. Ethinylestradiol 100mcg and norethisterone 500mcg repeat in 12 hours
c. Provera 10mg for 5 days
d. Danazol 200mg for 5 days
Current recommendations are levonorgestrel 0.75mg 12/24 apart or 1.5mg as a single dose (89% of pregnancies prevented). Other options include Yuzpe regime (E+P) as above (75-80% of pregnancies prevented, more side effects). Copper IUD within 120 hours of intercourse (90%) and mifepristone 600mg (100%) were other options. The Cochrane review on the topic discussed Danazol and the five day E approach and said that they didn't hold any advantage over Yuzpe. Speroff says danazol is not effective. Additionally the 5mg E dose is 5mg not 50mg.
Answer: B; SG agree
93
You are seeing a rape victim 12 hrs after the event. She is on day 13 of a 28-30 day cycle and wants the best advice re contraception. The options are:
d. Nothing
e. 10 mg of progesterone for 5 days
f. Oral contraceptive pill for five days
g. Vaginal douching
h. Intrauterine saline wash out
Answer: K says C
94
Sex 24 hrs ago but condom broke. Which is true?
a. Ethynyl oestradiol plus norgestrel should be given within 96 hrs after unprotected sex
b. Ethynyl oestradiol 5mg/day for 5 days within 96 hrs
c. After 1 unprotected midcycle intercourse, pregnancy rate about 15% can be expected
d. Pregnancy rate after postcoital contraception is about 5%
e. 90% of women after postcoital hormone treatment get withdrawal bleed within 14 days
Emergency contraception should be used within 72 hours of unprotected intercourse; unprotected midcycle intercourse is about 20%, although Speroff says 8% after single act of intercourse; pregnancy rate following emergency contraception is less than 5%; 90% get a period on time or early
Answer: E
95
What is the concern about the pregnancy after failed morning after pill?
a. Multiple pregnancy
b. Abnormal fetus
c. Increased risk of ectopic
d. Increased risk of miscarriage
e. Higher risk of premature labour
Ectopic pregnancies have been reported anecdotally following emergency oral contraception. In theory progestational agents may inhibit tubal mobility and predispose to ectopic implantation, but none of the emergency oral contraceptive regimens in use increase the risk. (Speroff). Discussed with study group.
Answer: C
96
All effective post-coital contraception except?
a. Yuzpe regime
b. levonorgestrel
c. IUCD
d. RU 486
e. Single dose danazol
Answer: E
97
What is the least correct statement regarding contraception or MAP (they weren't sure which)
a. RU486 plus misoprostol 400mg oral 48/24 later
b. RU 486 plus misoprostol 800 mg PV 48/24 later
c. Mifepristone had been approved for the use in the USA as contraception (or maybe TOP)
All are correct if the question refers to TOP. If using mifepristone as a morning after pill a single dose of 600mg is effective. It is not licensed as contraception or MAP; only licensed for TOP
Answer: C
98
Which is most effective contraception?
a. OCP
b. Depot Provera
c. Condoms
d. Minipill
OCP - 0.1/7.6; depot - 0.3/0.3; condoms - 3.0/13.9; minipill - 0.5/3.0
Answer: B
99
The failure rate among typical users of which of the following methods of contraception is LESS THAN 1%?
A. Combined oral contraceptives
B. Depot medroxyprogesterone acetate
C. Progestogen only contraceptive pills
D. Condoms
Answer: B
100
In typical users, which has a pregnancy rate below 1%?
a. Depot MPA
b. Condoms
c. POP
d. COCP
Answer: A
101
Largest drop out rate in first year of use?
a. Micronor (POP)
b. Norplant
c. Progesterone coated IUD
d. Depo Provera
e. No difference
Continuing use at one year - OCP/POP - 68%, norplant - 84%, LNG-IUD - 81%, depo provera - 70% (Novak)
Answer: A (K says D)
102
The contraceptive with greatest continuation at one year is:
a. Progesterone only pill
b. Mirena IUCD
c. Depo Provera
d. Norplant / implanon
Answer: D (as above)
103
Regarding contraception. Which is true?
a. Principle action of POP is to suppress ovulation
b. More females using IUD have ectopics than females using no contraception
c. More females with Cu IUD have ectopics than inert IUD
d. Epileptics can't use OCP
e. Mucus method has Pearl index < or equal to 5 preg/100 years if couple abstain 2 days prior to ovulation
f. Unilateral tuboovarian abscess is associated with IUD
Answer: F
104
37 yo woman expresses concern about developing ovarian cancer. She took OCP for 1 yr at age 25 and asks whether the use of OCP's has increased her risk of ovarian cancer. You explain that?
a. OCP use as described by the patient does not alter the risk of ovarian ca
b. OCP use as described decreased the risk of ovarian cancer
c. OCP use as described offer a protective effect for 5-7 yrs
d. OCP use decreased the risk but only if taken for 3 yrs or longer continuously
e. OCP use does not protect against epithelial tumours
The protective effect increases with duration of use and continues for 20 years after stopping the medication. The protection is seen in women who use it for as little as 3-6 months although use for at least 3 years is required for a noticeable impact. (Speroff)
Answer: B
105
Benefits of OCP are all except:
a. Reduce menorrhagia
b. Reduce PID
c. Reduce benign breast disease
d. Reduce ovarian cancer
e. Reduce cervical cancer
Answer: E
106
In regard to the OCP
a. Older women (>35yo) are at increased risk of arterial thromboembolism regardless of whether they smoke
b. The principle action of the POP is to inhibit ovulation
c. Diane 35 is likely to take over as the most frequently used OCP in well asymptomatic young women
d. OCP containing the new progesterones gestodene and desogesteral have been shown to be more effective at preventing pregnancy than the older formulations
e. Phenytoin does not affect the efficacy of 30-35 microgram OCP formulations
Answer: A
107
An 18 yo epileptic comes to you requesting OCP. She is on phenytoin. You would prescribe:
a. 30 ug OCP formulation
b. 50 ug OCP formulation
c. POP
d. IUCD
e. Barrier methods
Answer: B
108
17 yo presents with vaginal spotting. She is sexually active and has been on OCP for 1 yr without trouble. What do you do?
a. Increase E dosage of OCP
b. Increase P dosage of OCP
c. Ask her to come in to do a swab for Chlamydia
d. Give her a 1 week course of ?E with the OCP too
Answer: C
109
Woman who constantly forgets to take oral contraceptive pill. You should:
a. Consider she has dementia praecox...(it would improve on oestrogen Rx)
b. Consider she has covert intentions
c. Change her from the 28 days pill
d. Consider she secretly desire pregnancy
e. Consider she has hidden guilt regarding contraception as a bad thing
Answer: C
110
Progesterone only pills work by all except?
a. thickens cervical mucus
b. sperm toxicity
c. inhibits ovum transport
d. inhibits ovulation (50%)
e. endometrial atrophy
Answer: B
111
After Depo Provera usage number of women who conceive after 15 months?
a. 90%
b. 75%
c. 50%
d. 25%
90% by 18 months (Speroff)
| Answer: B
112
Depo Provera is noted for all except:
a. Useful for those on phenytoin
b. No increased risk of VTE
c. No change in menstrual pattern
Answer: C
113
Which of the following is not true of depo provera
a. Has no significant effect on lactation
b. Is safe during lactation
c. Does not cause troublesome PV bleeding
d. Is effective contraception for a patient with epilepsy
Answer: C
114
LEAST TRUE depot
a. Causes bone loss
b. Amenorrhoea 50% at 12 months
c. Amenorrhoea 95% at 24 months
d. CI in breastfeeding
Answer: C (KT thinks D)
115
What is the cumulative pregnancy rate of a woman using norplant for 5 yrs?
a. <1%
b. 1%
c. 3%
d. 5%
e. 8%
0.2% per year (Speroff)
| Answer: B
116
Who is most likely to have an ectopic pregnancy. One who conceives while using?
a. condoms
b. diaphragm
c. minipill
d. OCP
e. No contraception
Absolute rate without contraception would be higher
| Answer: E (K says C)
117
Risk of ectopic highest with?
a. COCP
b. Condoms
c. No contraception
d. POP
e. Diaphragm
Answer: C
118
A 25yo P2 has an IUCD for contraception. She developed increasing dysmenorrhoea and heavier menstrual periods. Management:
a. commence NSAIDS
b. removal of IUCD
c. removal of IUCD and start antibiotics
d. removal of IUCD and perform laparoscopy
e. removal of IUCD and perform hysteroscopy
Answer: A (Speroff)
119
IUCD (copper)?
a. increased PID with increased use
b. increased PID in multiparas
c. increased unilateral tuboovarian infection
d. copper virtually eliminates actinomycoses
e. treat uncomplicated actinomycoses
Increased risk of PID around time of use (20d); rate of actinomyces is much lower with copper IUD (less than 1%) but still higher than LNG IUD.
Answer: C
120
Regarding contraception?
a. The risk of PID increases with the duration of use of an IUD
b. Unilateral tubo-ovarian abscess is more common when an IUD is insitu
c. A copper containing IUD rapidly loses efficacy after 2 yrs as the copper is degraded
d. An IUD should not be removed in the event of a pregnancy as removing it may cause miscarriage
e. The natural family planning method in which ovulation is predicted by the presence of cervical and vaginal fluid has a Pearl index of < 5 pregnancies per year providing abstinence commences at least 2 days prior to ovulation
A pearl index of <5 is unlikely for natural methods
| Answer: B
121
Actinomycosis on routine Pap with IUCD in situ. Management?
a. Remove the IUCD
b. Give antibiotics
c. Remove the IUCD and give penicillin
d. Repeat the smear
UTD suggests that if the patient is asymptomatic the finding may reflect colonisation rather than infection and in this situation there is no evidence for ABx or removal.
Answer: D
122
A patient presents after a Pap smear showing Actinomycoses on Gram stain. Your immediate management plan would include.
a. Treat with antibiotics with the IUCD in situ
b. Remove the IUCD and resmear in 3 months
c. Repeat the Pap smear
d. Remove the IUCD and treat with antibiotics
e. Reassure the patient
Answer: E
123
Patient has IUCD for 2 yrs and now actinomycosis detected on routine pap smear. Pelvic exam was normal. What is the next most appropriate treatment?
a. Leave IUCD in, treat with penicillin
b. Remove IUCD, treat with penicillin for 2 weeks and then reinsert another IUCD
c. Remove IUCD, treat with oral penicillin for 2 weeks. IUCD contraindicated in future
d. Remove IUCD, treat and no further treatment required
e. No treatment needed if asymptomatic
Answer: E
124
Pelvic actinomycosis infection
a. Should be treated with streptomycin
b. Is a Gram negative fungus
c. Is usually R sided
d. May occur secondary to uterine colonisation which occurs with 5% of plastic IUD users
Actinomyces is found in up to 30% of plastic IUD users; is a gram positive bacilli and should be treated with oral penicillin although tetracycline can be used.
Answer: A
125
In a woman who is 8 weeks pregnant with an IUD in situ the correct management is?
a. Immediate removal of the IUD
b. Advise termination of pregnancy
c. Remove the IUD only if there is evidence of infection
d. If the strings are visible cut them as high up in the cervical canal as possible
e. Immediate laparoscopy to exclude ectopic pregnancy
Answer: A
126
In a woman who conceives with an IUD inset, all of the following are associated EXCEPT:
a. Miscarriage
b. Prematurity
c. Low birth weight
d. Fetal abnormalities
e. Chorioamnionitis
Answer: D
127
Tubal sterilisation (diathermy) risk of failure per 1000?
a. 0.1
b. 0.7
c. 3
d. 7
Answer: D (Speroff - 0.75% 10 year cumulative failure rate)
128
G3P3 had TL. Presents with ectopic in one tube. Mx?
a. bilateral salpingectomy
b. salpingostomy
c. reclip tubes after removing ectopic
Answer: A
129
The most common emotional response after a termination is
a. severe depression
b. shame
c. relief
d. anxiety
e. psychosis
Answer: C
130
After which procedure is the decay rate of BHCG the fastest?
a. Vacuum curette for termination of pregnancy
b. Vacuum curette for spontaneous abortion
c. Resection of ectopic pregnancy
d. Linear salpingotomy for ectopic pregnancy
e. BHCG decays at the same rate for all procedures
Answer: E
131
What is the smallest fetal pole that a competent ultrasonologist would confidently diagnose as nonviable due to absence of cardiac activity?
a. 5 mm
b. 9mm
c. 13mm
d. 17mm
e. 21mm
When there is a visible fetus with a CRL of 7mm or more but no fetal heart movements can be demonstrated (ASUM)
Answer: B
132
What is the smallest fetal sac size that a competent ultrasonologist would confidently diagnose as a blighted ovum because of lack of fetal pole?
a. 11mm
b. 15mm
c. 19mm
d. 23mm
e. 27mm
When no live fetus is visible in a gestation sac and the mean sac diameter is 25mm or greater (ASUM)
Answer: E
NOTE guidelines have changed since this question was written so answer is not D anymore
133
Patient presents 6 weeks pregnant. PVB and pain. US live IU pregnancy. Normal FH. Chance of ongoing pregnancy?
a. 90%
b. 70%
c. 50%
d. 30%
e. 10%
Answer: A (Kerridge notes)
134
Threatened miscarriage at 6 weeks shows cardiac activity and appropriate for dates. Risk of miscarriage?
a. <10%
b. 50%
c. 25%
d. 90%
Answer: A
135
Least valuable predictor of missed abortion
a. 5mm sac with no heart beat
b. 15 mm sac with no fetal pole
c. 20 mm sac and no fetal heart beat
Answer: A
136
A patient is 16 days late for her period and BHCG is 140,000. The most likely diagnosis is?
a. Multiple pregnancy
b. Molar pregnancy
c. Miscarriage
d. Ectopic pregnancy
e. Gestational trophoblastic disease
UTD states that HCG > 100 000 in early pregnancy is strongly suggestive of molar pregnancy
Answer: B
137
A woman is 6 weeks late for her period and her BHCG was noted to be 140,000 mIU/ml. The most likely diagnosis is:
a. Single IU pregnancy
b. Tubal ectopic pregnancy
c. IU pregnancy and dysgerminoma
d. Multiple pregnancy
e. Ovarian pregnancy
Answer: A
138
Percentage of chromosomal abnormalities in 1st trimester spontaneous miscarriage?
a. 20%
b. 30%
c. 40%
d. 50%
e. 60%
50% of all 1st trimester losses, 30% of 2nd trimester lossess and 3% of stillbirths are karyotypically abnormal. (Speroff)
Answer: D
139
Spontaneous ab, correct option:
a. Increased in women > 40
b. DES associated with many pregnancy problems but not with spontaneous miscarriage
c. Most common chromosomal abnormality is triploidy
d. Genetic abnormality in aborted fetuses are similar to those occurring in term fetuses
Answer: A
140
A 28 yo has had 2 miscarriages 8w and 10w and presents for advice:
a. She should be labelled recurrent miscarriage
b. She does not warrant pre-conception counselling
c. If one more miscarriage then chance of livebirth <6%
d. Chance of another miscarriage = 40%
e. 50-60 % spontaneous abortuses are chromosomally abnormal
After one miscarriage - 14-21% chance; two - 24-29%; three - 31-33% (UTD); 75% of abortuses are karyotypically abnormal (Speroff)
Answer: E
141
Miscarriage at 18/40 but 12/40 size, best Rx?
a. nothing
b. suction curettage
c. prostaglandins
d. intra amniotic saline/PG
Answer: B
142
A woman had 3 consecutive first trimester miscarriages. What is the likelihood of miscarriage in the next pregnancy?
a. 5%
b. 10%
c. 30%
d. 50%
e. 70%
If one previous liveborn infant - 32%; if no previous liveborn infants - 40-45%
Answer: C
143
What is the percentage of patients with recurrent miscarriage that have chromosome abnormality?
a. 1%
b. 3%
c. 10%
d. 30%
e. 50%
The incidence of chromosomal abnormalities in this group is 2.9% (UTD). 50% balanced reciprocal translocation, 25% Robertsonian translocation and 10% sex chromosome mosaicism in females
Answer: B
144
One partner of a couple with recurrent miscarriage has a balanced reciprocal translocation - the most correct is:
a. Phenotypically normal offspring in 50% of conceptions
b. Major anomalies with trisomy in 25%
c. Phenotypically normal in 10% if husband has translocation
d. Phenotypically normal in 70% if mother has translocation
e. All offspring will have a balanced translocation
Theoretically - 25% of gametes should be normal, 25% abnormal but balanced; this yields 50% chance of a normal pregnancy (normal or balanced) and 50% chance of abnormal (miscarriage or anomalous fetus). If Robertsonian (questions above is reciprocal) - 1/6 normal, 1/6 abnormal but balanced, 2/3 abnormal and unbalanced; this yields 33% chance of normal pregnancy and 67% of abnormal pregnancy. (Speroff) There is a parental sex influence with the risk for unbalanced progeny higher if the female parent carries the gene (C&R). If diagnosed after the birth of an abnormal child they have a 5-30% chance of having a liveborn offspring with unbalanced chromosomes as compared to 5% risk is carriers identified for other reasons. (Williams)
Answer: A
145
Patient with a history of recurrent abortion now 6-7 weeks pregnant. Investigation performed in past could reveal no cause for recurrent Abs. Management:
a. Progesterone until 28 weeks
b. Anti-prostaglandins
c. Serial hCG measurements
d. Pelvic USS
e. Reassurance
No good evidence for progesterone
| Answer: D
146
A woman with 4 previous 1st trimester miscarriages has been fully investigated and no cause found. Management in next pregnancy?
a. Progesterone supplement empirically or test serum progesterone levels
b. Aspirin and heparin
c. Serial BhCG
d. US at 6/40
Answer: D
147
37 yo with recurrent miscarriage. Most likely diagnosis is
a. Obstetric Lupus
b. Luteal phase deficiency
c. Uterine anomaly
d. Idiopathic
Acquired and congenital uterine abnormalities are responsible for 10-50% of RPL. Congenital uterine abnormalities are present in 10-15% of women with RPL. Luteal phase defects are present in up to 25%, APLS in 5-15%. No cause is found in 50%.
Answer: D
148
Recurrent miscarriage x 4. Most likely cause?
a. lupus
b. idiopathic
c. chromosomal abnormalities in parents
Answer: B
149
Patient has had 3rd miscarriage and karyotype on products was abnormal. What is the most likely abnormality?**
a. Autosomal trisomy
b. Triploidy
c. Chromosomal translocation
d. Sex chromosome abnormality
Autosomal trisomies > monsomy X > polyploidies. In women with recurrent pregnancy loss the karyotype is more likely to be normal, especially under the age of 35. If the karyotype is abnormal it follows the same pattern as seen in the general population. (Speroff)
Answer: A
150
A woman who is G3P0 with 3 previous miscarriages all requiring D&C. After the last D&C she developed 6 months of irregular light menstrual periods. Hysterosalpinogram was performed. Which of the following likely to be? (4 HSG's were shown)
a. T-shaped uterus after DES exposure
b. Bicornuate uterus
c. Single IU filling defect - endometrial polyp/fibroid
d. Multiple IU synechiae
Answer: D
151
A woman has LNMP 7w ago, pv bleeding. bhCG positive and TVUS 7w viable fetus and left adnexal mass. Laparoscopy revealed a haemorrhagic CL. Which of the following is correct?
a. oral oestrogen
b. oral progesterone
c. IM depot progesterone
d. IM hCG
e. No hormone needed
Answer: E
152
What is the most common chromosomal abnormality found in abortuses?
a. Trisomy 16
b. Trisomy 21
c. 45, X
d. Trisomy 18
e. XXXX
Chromosomal abnormalities account for approximately 50% of miscarriages; increased at earlier gestations. Breakdown is - autosomal trisomies 52%, monosomy X 19%, polyploides 22% and others 7%. Trisomy 16 is the most common autosomal trisomy (UTD). Does XO have > than trisomy 16? - No
Answer: C
153
At 12 weeks gestation the corpus luteum is removed for bleeding, the most appropriate pregnancy support with the least fetal risk is:
a. Duphaston
b. Depo Provera
c. Norethisterone
d. Progesterone and oestrogen
e. No hormones
Answer: E
154
What is of proven value as treatment for recurrent 2nd trimester miscarriages associated with uterine contractions?
a. Erythromycin
b. Transfusing wife with husbands WBC
c. Strassmann operations
d. McDonald cerclage
Answer: C
155
TOP at 6w. One week later, no bleeding or pain but BHCG remains positive. There is a 6-7 week size uterus. The path showed scanty decidual tissue, no fetal parts. Next?
a. Qualitative BHCG
b. Ultrasound
c. Repeat curette
d. Laparotomy
Answer: B
156
At 7 weeks gestation, which of the following findings is most likely to be consistent with a tubal ectopic pregnancy?
a. Abdo US empty uterus + BHCG <600
b. Abdo US empty uterus + BHCG <1000
c. Abdo US empty uterus + BHCG >7000
d. Abdo pain and negative culdocentesis
Answer: C
157
A woman presents with abdominal pain and vaginal spotting at 6 weeks amenorrhoea, βhCG is 6000, US empty uterus. O/E tender adnexa. Best next step:
a. Serial BCHG
b. Rpt US in 1 week
c. Laparoscopy
d. Laparotomy
Answer: C
158
6/52 pregnant, 3 days of abdo pain and 2 days of PV bleeding. Bilateral adnexal tenderness. US - complex adnexal mass and free fluid in POD. Next?
a. Culdocentesis
b. Laparotomy
c. Quantitative BHCG
d. Laparoscopy
Answer: D
159
Regarding ectopic pregnancy:
a. Continuing US and BHCG delays intervention and leads to greater risk of rupture
b. Recurrence risk about 10%
c. Better chance of subsequent live birth with salpingostomy vs salpingectomy
Recurrence risk 10-27% (Speroff)
Answer: B
160
Ectopic pregnancy
a. Increased after legal TOP
b. Increased on progesterone only pill more than without contraception
c. Rate is higher with copper IUD's than plastic ones
d. Increased with IUD more than normal population
e. None of the above
Answer: E
161
Woman at 6/52 amenorrhoea with PV bleeding and lower abdominal pain. HCG 3000 and US empty uterus. Options?
a. Do nothing
b. Serial HCG
c. Laparoscopy
Answer: C
162
A lady 12 weeks pregnant with a bicornuate uterus presents to A&E with pain and bleeding. US shows an empty uterus and 8 cm adnexal mass. Obs BP 90/60, PR 110:
a. Get A&E to organise laparoscopy with probable salpingostomy
b. Get A&E to organise laparoscopy with probable laparotomy
c. Do nothing until you arrive in 30 mins
d. Have a culdotomy tray ready for you
Answer: B
163
A G1 P0 woman with an ectopic pregnancy. At laparotomy, the right tube is found to be bound down with adhesions. There is a 1 cm bluish fimbrial mass on the left tube. Best option.
a. Salpingectomy and repair of the other tube.
b. Fimbriectomy
c. Milk the lesion from the tube.
d. Methotrexate
Ideal management would be salpingostomy and later laparoscopy and dye studies +/- dye studies. Is fimbriectomy an appropriate substitute, or milking lesion or MTX?
Answer: D (Kenny!)
164
12 weeks pregnant. HCG positive at 6 weeks. No other antenatal care. Feels pregnant. One-week history of PCB without cramping. Speculum reveals bright red 3 cm mass on the ectocervix. Which test will give a definite diagnosis?
a. Real time US
b. Tissue biopsy
c. Colposcopy and biopsy
d. Stain with Lugold's iodine
Answer: A
165
A routine obstetric ultrasound showed a viable singleton fetus outside the uterine cavity with measurements consistent with 18/40. No fetal abnormality detected. What is appropriate Mx?
i. Expectant management
ii. Wait until fetal viability, deliver electively and remove the placenta
iii. Wait until fetal viability, deliver electively
iv. Immediate delivery of fetus only
v. Immediate delivery of fetus and placenta
Answer: D
166
Do CS and find an unanticipated abdominal pregnancy with placenta involving left broad ligament and sigmoid. Management:
a. Attempt to remove all placenta doing colostomy
b. Remove as much of the placenta as you can
c. Leave placenta behind
Answer: C
167
A patient presented to casualty: 8 weeks of amenorrhoea with vaginal bleeding. Pelvic US by LMO showed numerous small, cystic and fluid containing spaces in the uterus with characteristic "snowstorm" appearance and no fetus detected. Histology showed hydropic degeneration, swelling of the villous stroma and abundant avascular villi. Which of the following is correct?
a. it is not associated with choriocarcinoma
b. karyotypically is either 69XXY and 69XYY
c. chromosomal composition completely of paternal origin
d. it has a chromosomal pattern of 69XXX or 46XX
These histological findings are consistent with a complete molar pregnancy. Choriocarcinoma usually doesn't have villi (Robbins) but the findings above can be associated with choriocarcinoma. It has a normal karyotype (46 XX) but both chromosomes are derived from paternal origin. Partial moles are usually triploid.
Answer: C
168
The most common presenting symptom of molar pregnancy is:
a. Abnormal bleeding
b. Hyperemesis
c. Larger than expected fundus
d. Thyrotoxicosis
e. Pre-eclampsia
Answer: A
169
Concerning partial moles, all true except:
a. Fetus may be alive
b. Mostly triploidy
c. Same follow up as complete moles
d. More often go on to choriocarcinoma than complete moles
e. Preeclampsia occurs most commonly with partial moles
Answer: D (most incorrect although C and D aren't correct either)
170
Hydatidiform mole - which is correct?
a. Choriocarcinoma can be associated with hyperthyroidism
b. Incidence decreases after age 40
c. Rhesus blood group is prognostic indicator
d. Persistent in <5%
Choriocoarcinoma can be associated with hyperthyroidism, incidence increases with increasing maternal age, Rh is not a prognostic factor and persistence occurs in 15%
Answer: A
171
Regarding hydatidiform mole, which statement is correct:
a. <3 % progress to choriocarcinoma
b. Choriocarcinoma can be associated with thyrotoxicosis
c. Commonest karyotype is 45 XO
d. Association between prognosis and rhesus blood group
e. Less common in older women
Choriocarcinoma occurs following 2.5% of molar pregnancies; usually 46XX karyotype, not association with blood group, commoner in older women
Answer: B
172
A 30yo lady, diagnosed to have hydatidiform mole at 14 weeks amenorrhoea, which of the following is the management of choice?
a. Suction curette
b. Sharp curette
c. Hysterectomy
d. Methotrexate
e. Hysterectomy
Answer: A
173
176. 32 yo G2P2 with molar pregnancy. Fundal height 28 weeks. Best method of evacuation?
a. IOL
b. Abdominal hysterotomy
c. Suction curettage
d. D&C
e. TAH
Answer: C
174
Treatment of non metastatic gestational trophoblastic tumour in a 21yo who had D&C 8 weeks earlier is:
a. single agent chemotherapy
b. multi agent chemotherapy
c. radiotherapy
d. hysterectomy
e. D&C
Answer: A
175
Patient presents 4 months after a term delivery with daily pv bleeding. Serum bhCG 104,000IU. CXR shows multiple opacities. CT head and abdo normal. LFTs normal. Management:
a. methotrexate
b. hysterectomy to debulk disease
c. suction curette
d. combined chemotherapy
e. lumbar puncture
Answer: E (as per revision course)
176
Patients with hyperthyroidism with trophoblastic tumours have?
a. High total T4 +T3
b. High free T4 + T3
c. Decrease TSH
d. All of the above
Answer: D
177
Who is less likely to have high concentrations of lactobacillus in vaginal flora?**
a. Neonate
b. Premenopausal
c. Postmenopausal
d. Pregnant
e. Non-pregnant reproductive age
Answer: C
178
The percentage of woman who experience at least one episode of vaginal candidiasis in their reproductive years:
a. 20%
b. 35%
c. 50%
d. 70%
e. 90%
75% by menopause (UTD)
| Answer: D
179
Regarding candida?
a. ketoconazole is safe in pregnancy
b. typical thrush spots seen in 20% candida vaginitis
c. antifungal treatment to vulva reliably eradicates candida vulvitis
d. low oestrogen favours candida
e. diabetics are prone to candida and often present with it prior to diagnosis of DM
Occurs in increased oestrogen states; ketoconazole is contra-indicated in pregnancy
Answer: E
180
Which of the following is not an acceptable treatment for Candida vulvovaginitis?
a. Ketoconazole
b. Fluconazole
c. Itraconazole
d. Terazole
Answer: D
181
The most common sexually transmitted disease in Australia?
a. Gonorrhoea
b. Chlamydia
c. Syphilis
d. HSV 1
e. HSV 2
Answer: E (K says B)
182
Herpes -which is wrong?
a. HSV1 confers some protection against HSV2
b. HSV2 generally affects genitals
c. Most have recurrence within 6 months of primary attack
d. Acyclovir with primary infection reduces no & severity of recurrences
Answer: D
183
HSV, all true except:
a. HSV1 offers some protection against HSV 2
b. HSV 2 > genital infection than HSV 1
c. Acyclovir for acute attack decreases recurrences
d. HSV 2 most recur in 6 months
e. Women with cervical cancer have increased incidence of HSV
Answer: C
184
What is the most common organism to cause septic shock in gynaecology?
a. E. coli
b. Bacteroides
c. Beta haemolytic Streptococci
d. Staphylococcus
e. Clostridium
Most commonly gram negative bacteria cause septic shock. TeLindes states that E.coli (50%), Klebsiella, Serratia and Enterobacter (30%), Bacteroides, Peptostreptococcus, Clostridium, Fusobacterium (5%)
Answer: A
185
12 hrs after a TAH + BSO a patient developed a temperature of 39.4 degrees, tachycardia and BP 90/50. A diagnosis of septic shock was made. The most likely organism is:
a. E.coli
b. Clostridium
c. Bacteroides
d. GBS
e. S. Aureus
Answer: A
186
Necrotising fasciitis caused by all except
a. Staph
b. Proteus
c. Bacteroides
d. E. Coli
e. Clostridium
Answer: B (UTD)
187
All of the following are the characteristics of toxic shock syndrome except?
a. temp > 39C
b. multi-system involvement
c. S aureus in blood culture
d. Diffuse erythematous rash
e. S aureus on vaginal swab
80-90% of patients have S.Aureus isolated from wound or mucosal sites whilst only 5% will have S.Aureus isolated on blood cultures
Answer: C
188
For Bacteroides fragilis the least effective antibiotic is
a. Cefotaxime
b. Clindamycin
c. Chloramphenicol
d. Gentamicin
e. Metronidazole
d. Gentamicin
189
What organism will metronidazole and gentamicin not cover?
a. Gram positive aerobe
b. Gram positive anaerobe
c. Gram negative aerobe
d. Gram negative anaerobe
e. Trichomonas
Answer: A
190
Of following antibiotics the one not recommended as a first line agent of choice for UTI in young children is?
a. Sulfonamide
b. Nitrofurantoin
c. Trimethoprim
d. Amoxicillin
e. Cephalosporins
Answer: B (eTG)
191
A 38yo woman with ph of chronic PID presents to you with increasing pelvic pain, unwell, rigors. Temp 40 degrees, HR 100. VE: 8cm tender mass protruding onto upper half of rectovaginal septum in midline. WCC 24,000. Diagnosis of pelvic abscess made. Which is correct?
a. Colpotomy and drainage of abscess and antibiotics
b. TAH, BSO and ABx
c. Abdominal drainage of abscess and ABx
d. Conservative treatment with iv ABx
Now laparoscopic drainage may be the appropriate answer. Either colpotomy or laparotomy are reasonable. Colpotomy if access is easy
Answer: A
192
Regarding tubo-ovarian abscess?
a. Can be visualised by US
b. Causes eosinophilia
c. Positive Chlamydia on cervical swab
d. Associated with leucopenia
Answer: A
193
The organism most likely to be grown from culture of a tubo-ovarian complex is:
a. Group D enterococci
b. Mixed anaerobes
c. Neisseria gonorrhoea
d. Chlamydia trachomatis
e. Escherichia coli
Answer: B
194
PID with temp. 39 degrees and bilateral pelvic tenderness. Chlamydia on swabs. Best therapy:
a. IM Cephalothin and PO doxy
b. PO doxy alone
c. IV cefoxitin and PO doxy
d. IV clindamycin
e. IV penicillin + erythromycin
Answer: C
195
A 27 yr old lady with a diagnosis of PID. She was treated with oral doxycycline. After 3 days there was no improvement. A 8cm swelling was found on ultrasound in POD. What is the appropriate management?
a. Laparoscopy
b. Laparotomy
c. Culdotomy
d. Change to IV cefotaxime plus oral doxycycline
e. Transvaginal ultrasound guided aspiration
Probably OK to trial medical management first but probably will need surgical drainage, definitely if signs of rupture or if systemically unwell.
Answer: D
196
A woman at 8w is diagnosed with Chlamydia on endocervical swab. The appropriate management would be:
a. no treatment needed
b. oral doxycycline
c. oral erythromycin
d. oral penicillin
e. no treatment needed now but repeat swabs at 28w
The optimal treatment for chlamydia is azithromycin 1gm orally once or doxycycline 100mg BD for 7 days. Given that the patient is pregnant the treatment would be erythromycin although a Cochrane review suggests that amoxycillin is better tolerated and just as effective.
Answer: C
197
26 yo at 26 weeks gestation with PV discharge and Chlamydia on swab?
a. penicillin
b. cephalosporin
c. doxycycline
d. erythromycin
e. metronidazole
Answer: D (as above)
198
Which of the following is most likely to be associated with offensive post coital discharge?
a. Chlamydia
b. Gonorrhoea
c. Gardnerella
d. Candidiasis
e. HPV
Answer: C
199
Chlamydia:
a. Cervix usually looks irritated or inflamed
b. Incidence <1% in antenatal, family planning or general gynae population
c. If low incidence population, Microtrac false +ve ~ 50%
d. Cefoxitin/metronidazole is adequate treatment
e. At first infection 50% of women have symptomatic salpingitis
Answer: C
200
Chlamydia:
a. Is in <1% of O&G and FPA clinics
b. Diagnosis is by posterior vaginal fornix swab
c. Cervix usually looks abnormal
d. In a low risk population has a 50% PPV on ELISA
e. Treatment is with cefoxitin and Flagyl
f. 50% will clinically develop PID
Although the S&S of testing for chlamydia is 95% inhigh risk populations it falls significantly in lower risk populations (less than 75%)
Answer: D
201
A 16 yo woman presents asking for an STD check. Partner recently diagnosed with NGU, most appropriate management?
a. Cervical swabs and review
b. Doxycycline bd for 10/7
c. Cervical swabs and oral doxycycline for 10 days
d. Counsel and test for HIV
Answer: C
202
A 24 yo not sexually active woman presents with a history of an intermittent white vaginal discharge, is not pruritic, the pH is less than 0.45.
a. Candidiasis
b. Trichomonas
c. Gardnerella
d. Physiological vaginal discharge
Answer: D
203
A woman with known Gardnerella vaginal infection is to have a vaginal hysterectomy. Which antibiotic would be most cost effective for pre-op prophylaxis?
a. Ceftriaxone
b. Piperacillin
c. Cephazolin
d. Chloramphenicol
e. Clindamycin and gentamicin
Best options would be metronidazole, tinidazole or clindamycin
Answer: K says C
204
Sexually active 27 yo has 2/52 history of urgency and dysuria. Came to casualty, MSU collected and commence on Keflex. There was no growth on the MSU. Her symptoms persist. Next?
a. Repeat MSU
b. Quantitative analysis of urine WBC's
c. Uretheroscopy
d. Chlamydia swabs of urethra and cervix
Answer: D
205
A 37 yo woman, previous TAH for micro-invasive Ca cervix. Thinks the man she slept with 2 weeks ago has developed gonorrhoea. Best way to establish the diagnosis?
a. Culture urethra
b. Culture vaginal vault
c. Culture rectum
d. Gram stain of vaginal secretions
e. Gonozyme assay
Answer: A
206
With respect to Actinomyces, which is incorrect
a. Causes toxic shock syndrome
b. Can be detected on Pap smear
c. Is associated with IUD
d. Can be treated with IM penicillin
Can be detected on pap smear; is associated with an IUD; treated with pencillin or doxycyline
Answer: A
207
A Somali woman presents for a routine pelvic exam. While doing the pap smear you notice a cluster of small vesicles of her right buttock. She says she has had this problem on and off over several years. the likely diagnosis is:**
a. Condyloma lata
b. Herpes (HSV2)
c. Eczema
Answer: B
208
Which of the following combinations is correct?
a. Syphilis is satisfactorily treated with erythromycin
b. Ampicillin to treat PID
c. Lindane to treat molluscum contagiosum
d. Tetracycline to treat LGV (Lymphogranulosum venereum) patient newly migrated to Australia
e. Sulphonamide to treat granuloma inguinale
Syphilis is treated with penicillin, PID is treated with multiple antibiotics, molluscum contagiosum resolves spontaneously, granuloma inguinale (Donovanosis) is treated with azithromycin. (eTG)
Answer: D
209
Which combination is correct?
a. Erythromycin - syphilis in pregnancy
b. Penicillin/ampicillin for teenager with PID
c. Tetracycline for recent migrant with LGV
d. Lindane for molluscum contagiosum
Answer: D
210
Which viral class does Molluscum Contagiosum belong to
a. Pox virus
b. Herpes virus
c. Adenovirus
d. Papilloma virus
Answer: A
211
What organism causes Donavanosis?
a. Gardenerella vaginalis
b. Chlamydia trachomatis
c. Corynebactium donavoneias
d. Haemophilus ducreyi
e. Calymmatobacterium granulomatis
Gardenerella vaginalis causes bacterial vaginosus, chlamydia trachomatis causes lymphogranuloma venereum, corynebacterium donavoneias (made up), haemophylis ducreyii causes chancroid and calymmatobacterium granulomatis (Klebsiella granulomatis / granuloma inguinale) causes donovanosis. Treat with azithromycin.
Answer: E
212
What organism causes Chancroid
a. Gardenerella vaginalis
b. Chlamydia trachomatis
c. Corynebacterium donavoneias
d. Haemophilus ducreyi
e. Calymmatobacterium granlumatis
f. Treponema Pallidum
d. Haemophilus ducreyi
As above; treat with azithromycin or ceftriaxone
213
Which organism causes Lymphogranuloma venereum?
a. Calymmatobacterium granulomatis
b. Haemophilus ducreyi
c. Gardnerella vaginalis
d. Chlamydia trachomatis
e. Calymmatobacterium donovae
Calymmatobacterium granulomatis - donovanosis; Haemophilus ducreyi - chancre; gardnerella vaginalis - BV; chlamydia trachomatis - lymphogranuloma venereum; calymmatobacterium donovae - made up. Treat with doxycycline or azithromycin.
Answer: D
214
Regarding pelvic tuberculosis:
a. Its origin is usually bovine
b. First line treatment is streptomycin
c. It affects the tubes more often than the uterus
Fallopian tube and endometrium are the two commonest sites of infection. (UTD)
Answer: C
215
Female with painless vulval ulcer, 1 cm, indurated base. Definitive/first Ix?
a. TPHA
b. Dark field illumination
c. VDRL
d. Herpes immuno fluorescence
VDRL has poor sensitivity in primary syphilis (60-87%), dark field microscopy is better (70-95%) but is operator dependent, TPHA is probably the best. These days PCR swap for treponema would be ideal
Answer: A (K says B) SG say B
216
A 20 yo Aboriginal woman presents with 3/52 of a labial ulcer - painless, firm, indurated: also has inguinal lymphadenopathy. RPR 1/64, TPHA - pos, FTA-Abs - pos, Darkfield microscopy - neg. What is the most likely diagnosis?
a. Primary syphilis
b. Secondary syphilis
c. Chancroid
d. Donovanosis
Syphilitic ulcers last up to six weeks and are associated with lymphadenopathy. Regarding darkfield microscopy see above. Chancroid is painful; donovanosis essentially requires biopsy.
Answer: A
217
Which true about syphilis?
a. VDRL is a specific Ab for syphilis
b. Condyloma of secondary syphilis is not sexually transmitted
c. Tertiary syphilis require weeks of penicillin
Answer: C
218
Condyloma lata are caused by:
a. HSV 1
b. HPV
c. Treponema pallidum
d. Haemophilus ducreyii
e. Chlamydia
Condyloma lata are caused by syphilis (treponema pallidum). HSV 1 causes cold sores, HPV causes genital warts (condyloma accuminata), haemophilus dureyii causes chancroid.
Answer: C
219
Appropriate treatment for secondary syphilis?
a. Benzathine penicillin IM x1
b. Procaine penicillin IV x1
c. Cefoxitin
d. Doxycycline
Answer: A (eTG)
220
The most effective management strategy in the treatment of somatization disorders is?
a. Strict limits on the duration and number of early appointments
b. Mandatory psychiatric referral
c. An exhaustive battery of complex, expensive and invasive investigations to rule out organic disease
d. Treatment of the somatic symptoms including any analgesia required
e. Negotiate to reduce the symptoms without promising a cure
Answer: E
221
The best treatment for premature ejaculation is?
a. Sensate focus
b. Kegel exercises
c. Squeeze technique
d. Bridge manoeuvre
e. Tranquillisers
Answer: C
222
21 yo G0P0 comes for contraceptives. Had in utero DES exposure. VE -> small cervix, flush with vaginal fornices, and anterior cervicovaginal ridge. Best Mx of DES exposed patient?
a. Patients with adenosis should be treated with CO2 laser
b. Need a pap smear every 6/12
c. The CO2 laser is the most appropriate Rx of high grade CIN in DES exposed patients
d. DES patients are increased risk of infertility
Answer: D
223
60 yo who took DES in 2 pregnancies for 4 months. What to advise her - all except?
a. She has increased risk of breast cancer
b. Her daughter age 30 has 1% chance of clear cell cancer and risk increased with age
c. Her son might have abnormalities of the reproductive tract
d. Her daughter may have fertility problems related to abnormal uterus
Small increased risk of breast cancer in women who took DES; 1:1000-2000 risk of clear cell cancer in women exposed in utero; fertility problems due to uterine malformations occur; males to have increased risk of genitourinary abnormalities if exposed.
Answer: B
224
A 55 year-old woman seeks your advice regarding exposure to DES. She used DES during both of her pregnancies. All of the following statements are true except:
a. Her daughter has an increased risk of infertility
b. Her daughter has an increased risk of developing clear cell CA of the vagina
c. Her daughter has an increased risk of cervical dysplasia
d. Her son has an increased risk of genital tract abnormalities
e. She has an increased risk of breast cancer
Answer: C (although technically all are true)
225
A 55yr old woman seeks advice regarding exposure to DES. She used DES during both her pregnancies. She has a 30year old daughter and a 25year old son. All of the following are correct except
a. Her daughter has an increased risk of infertility
b. Her daughter has an 1% risk of developing clear cell Ca of vagina
c. Her daughter has increased risk of CIN and VAIN
d. Her son has increased risk of genital tract abnormalities
e. She has an increased risk of breast Ca
Answer: B
226
Progesterone in premenstrual tension?
a. Rx corpus luteal defect
b. Placebo effect
Speroff states the progesterone is no better than placebo
| Answer: B (K says A)
227
Which is not required for a diagnosis of PMS
a. Symptoms consistent with the diagnosis
b. There is a luteal phase pattern
c. Symptoms cause a disruption to her life
d. There are objective findings to support the diagnosis
Answer: D
228
Least common symptom of PMS
a. Bloating
b. Breast tenderness
c. Headache
d. Increased appetite
e. Urinary frequency
Answer: E
229
Which of the following is correct in regard to premenstrual syndrome?
a. It is due to low progesterone level
b. Bromocriptine is more effective than cyclical synthetic progesterone in treating PMS
c. Cyclical progesterone showed no advantage over placebo in treating PMS
d. It is due directly to endogenous endorphin withdrawal
e. It is related to HLA B27 typing
Answer: C
230
Which of the following have been proven more effective than placebo in treatment of premenstrual dysphoria?
a. Combined oral contraceptive
b. Progesterone pessaries
c. Synthetic oestrogens
d. Micronised oral progesterone
e. Serotonergic antidepressants
Answer: E
231
The most common sexual dysfunction in women is?
a. Stress
b. Depression
c. Guilt
d. Lack of knowledge
e. Gender identity
Answer: A
232
What is the most common cause of dyspareunia?
a. Endometriosis
b. Lack of lubrication
c. Adenomyosis
d. Vulvovaginitis
e. PID
The leading cause in women under the age of 50 is localized vulvodynia. In women over the age of 50, urogenital atrophy is the leading cause of sexual dysfunction.
Answer: B
233
What is the MOST COMMON cause of introital dyspareunia?
A. Monilial vulvo-vaginitis
B. Herpes genitalis
C. Inadequate arousal
D. Vaginismus
C. Inadequate arousal
234
A 27 yo woman presents with increasing dyspareunia. She has a past history of 'woman's infections" but cannot remember if these were treated with topical or systemic therapy. The situation is becoming an increasing source of frustration to her and her husband, but both are mutually supportive. Pelvic examination reveals only mild unilateral adnexal tenderness. Next step?
a. Diagnostic laparoscopy
b. Relaxation therapy to reduce the anxiety component of the problem
c. Reassure the findings are normal
d. Marital therapy to relieve the frustration
e. Trial of antibiotics
Answer: A
235
Most common cause of deep dyspareunia?
a. 'oestrogen'
b. retroversion of uterus
c. uterine prolapse
Answer: A
236
The most likely cause of dyspareunia after vaginal delivery is?
a. Uncomfortable stitches
b. Lack of sleep
c. Having intercourse too soon after delivery
d. Atrophic vaginitis
Answer: D
237
With regard to pelvic pain
a. 25% of women will experience it 5 days/month or one full day/month
b. It will have significant impact on work or home life in 2-5% of women
c. It is the reason for 10% of laparoscopies
d. It is the reason for 5% of hysterectomies
e. A full history and examination is rarely helpful in identifying the cause
Pelvic pain is the indicated reason for 40% of laparoscopies and 20% of hysterectomies. It will impact on the work life of 4% of women.
Answer: B
238
Mild symptomatic endometriosis in young married woman. Rx
a. Danazol 12/12
b. GnRH 3/12
c. Nothing
d. Laparoscopic ablation
Answer: D
239
Endometriosis?
a. Most severe disease have worst symptoms
b. Affected peritoneum almost always seen with naked eye at laparoscopy
c. Most have immunological defect which explains their infertility
d. Medical treatment OK for endometriomas provided they are < 3cm
Severe disease does not necessarily correlate with symptoms; 'Naked eye' laparoscopy is the gold standard for diagnosis; there is no immunological defect that describes infertility; medical treatment is only effective for endometriomas < 1cm
Answer: B - (KT thinks D)
240
With endometriosis
a. Peritoneal implants are usually visible to the naked eye at laparoscopy
b. Many women with endometriosis have an associated autoimmune condition which may contribute to the associated infertility
c. Danazol and GnRH derivatives are curative so long as the biggest endometrioma is < 3cm
d. Commonest finding is an ovarian endometrioma
Answer: A (KT thinks C)
241
A woman has a regular 24 day cycle and is experiencing midcycle bleeding. Which of the following is correct?
a. Oestrogen breakthrough
b. Oestrogen withdrawal
c. Progesterone breakthrough
d. Progesterone withdrawal
e. Inadequate androgens
Physiologic intermenstrual bleeding at the time of expected ovulation is secondary to the brief abrupt decline in estradiol that follows its preovulatory surge.
Answer: B
242
A woman has a regular period every 28 days. She has spotting around day 14 of her cycle. Which of the following is correct?
a. Oestrogen BTB
b. Progesterone BTB
c. Oestrogen withdrawal bleeding
d. Progesterone withdrawal bleed
Answer: C
243
Treat DUB with all except?
a. Aminocaproic acid
b. Mefanamic acid
c. Transexamic acid
d. Clomiphene
e. Neostigmine
Answer: E
244
A 40yo with premenstrual spotting, menorrhagia and dyspareunia with mid-cycle pain. What is the most likely diagnosis?
a. Adenomyosis
b. Endometriosis
c. Luteal phase deficiency
d. Fibroids
e. Endometrial polyp
Endometrial polyps and fibroids may cause the bleeding symptoms but are unlikely to cause pain. Endometriosis may cause pain but will not cause the bleeding symptoms. Adenomyosis is the most likely culprit although luteal phase deficiency is hard to quantify (discussed in association with infertility, may cause premenstrual spotting).
Answer: A SG
245
Fibroids. Which is true?
a. Generally cause pain
b. Increased in nulliparous women
c. 1% become sarcomatous
Answer: B (UTD)
246
Fibroids?
a. Arise from single clone
b. Has capsule
c. Made from fibrous tissue
Fibroids are monoclonal tumours arising from smooth muscle and are largely composed of extracellular matrix (collagen, proteoglycan and fibronectin) and are surrounded by a thin pseudo-capsule of areolar tissue and compressed muscle fibres.
Answer: A
247
Uterine fibroids. MOST TRUE:
a. Are usually painful
b. Should be removed in pregnancy
c. Associated with nulliparity
d. 1% undergo sarcomatous change
Answer: C
248
Which of one of the following is FALSE concerning uterine fibroids?
A. Major chromosomal abnormalities are identified in more than 20% of fibroids.
B. Medroxy progesterone acetate most commonly inhibits fibroid mitotic activity.
C. Fibroids develop in approximately 50% of women.
D. Genetic studies indicate all cells in a fibroid arise from a single cell.
B. Medroxy progesterone acetate most commonly inhibits fibroid mitotic activity.
Progesterone increases mitotic activity.
Fibroids are clinically apparent in 25% of women and 80% on pathological examination of uteri. Monoclonal as above; 60% have an abnormal karyotype;
249
Regarding red degeneration of a fibroid, all are false except:
a. Causes an elevation of the ESR
b. Causes leucopaenia
c. Only occurs in pregnancy
d. Occurs due to embolisation of the feeding vessels
Answer: A
250
A 6 month course of GnRH analogues used to treat fibroids will reduce uterine size by:
a. 10%
b. 20%
c. 33%
d. 50%
e. 66%
30-64% after 3-6 months of treatment (Speroff); 40-60% (Novak);
Answer: D
251
What percentage of fibroids will shrink with GnRH analogues?
a. 10%
b. 25%
c. 50%
d. 75%
e. 90%
Probably the incorrect questions - see above; but from Kenny....... 24% will decrease by <25%, 50% will decrease by 25-50%, 21% will decrease by >50% = 90%
Answer: E
252
Advantages of GnRH agonist for the treatment of fibroids include all of the following EXCEPT:
a. Allow vaginal hysterectomy
b. Allow return of patient HB towards normal before surgery
c. Diagnostic test to distinguish between fibroid and leiomyosarcoma
d. Allows hysteroscopic resection of fibroid
e. Reduced intraoperative blood loss
Answer: C
253
A 24yo primigravid woman was treated by LMO for pelvic pain with OCP 4 years ago. Now she presents with dysmenorrhoea. Which of the following is correct?
a. Incorrect initial treatment and diagnosis
b. Change to a monophasic pill will cure her symptoms
c. Laparoscopy will show evidence of PID
d. Cyclical progesterone is the preferred treatment
Probable initial diagnosis of primary dysmenorrhoea correct treatment; cyclical progesterones thin the endometrium and reduce the amount of arachidonic acid released. May have new PID but probably should examine and swab rather than scope.
Answer: B (general verdict from past papers - don't know why)
254
After removal of an ovarian endometrioma, once haemostasis achieved and ovarian cortex edges are opposed, best way to minimise adhesions is?
a. Catgut
b. Interrupted dexon
c. Continuous dexon
d. Surgical glue
e. Leave alone
Answer: E
255
25 yo. O/E 5 cm simple cystic R adnexal mass confirmed on US. Mx?
a. Repeat exam in 3/12
b. Give OCP and repeat US in 1/12
c. Laparotomy
d. Laparoscopy and aspiration of cyst
Answer: A (K says B)
256
A 14 yo girl presents with pelvic pain and US shows a 4cm ovarian cyst. What is the commonest cause?
i. Dermoid cyst
ii. Follicular cyst
iii. CL cyst
iv. Serous adenoma
v. Endometrioma
Answer: B
257
You are performing a laparotomy for a ruptured right ectopic pregnancy in a 17 yo. A 10cm right ovarian cyst is noted. Left ovary appears normal. Optimal management is:
a. RSO
b. Aspiration of cyst
c. Cystectomy
d. Cystectomy and biopsy of other ovary
e. R oopherectomy
Answer: C
258
27 yo female at 7/40 pregnant with 8 cm unilocular cyst presents with LIF pain. Mx?
a. Operative laparoscopy
b. Cystectomy via Pfannensteil
c. Oophorectomy via midline incision and washings
d. Laparoscopy and aspiration of cyst
e. Repeat US in 6 weeks
Answer: E
259
37 yo at 20/40 on routine anomaly US is found to have 11cm complex left ovarian cyst. Mx?
a. Operative laparoscopy
b. Cystectomy via Pfannenstiel
c. Oophorectomy via midline incision and washings
d. Laparoscopy and aspiration of cyst
e. Repeat US in 6 weeks
Answer: C
260
Regarding dermoid cysts, which is true?
a. Most common ovarian tumour in pregnancy
b. 10% risk of malignancy
c. 40-50% bilateral
10-17% are bilateral and almost all are benign. Functional cysts most common adnexal mass, but dermoid is most common tumour
Answer: A
261
Previous normal BP in a 42 year old woman, Diastolic BP 95mmHg, most appropriate next step
a. Recheck in two weeks
b. Recheck in 1 year
c. Begin thiazide
d. Begin ACE inhibitor
Answer: A (I think someone got mixed up and sat a physician exam)
262
A lady presents to you for investigation of metromenorrhagia with regular cycles. She is 45 years old and G4P4. Which investigation would give you most information regarding her diagnosis?
a. FBE
b. Dilation and curettage
c. Hysterosalpingogram
d. Office hysteroscopy
e. Pelvic US
In the absence of irregular bleeding the most likely diagnoses are going to be structural causes such as polyps and fibroids. Therefore hysteroscopy is most useful. If it was the real world it would be FBE, USS and H, D&C
Answer: D
263
A 46 yo lady presented with severe menorrhagia for six months and clinical evidence of a tender enlarged uterus. What is your first investigation?
a. Hysteroscopy and D&C
b. FBE
c. LH and FSH
d. Coagulation profile
e. Serum progesterone
Answer: B
264
48 yo woman experienced increasing menorrhagia and cramping pelvic pain in the last 3 months. On spec, a 2cm red beefy lesion was found in the cervical os. What is the most likely cause?
a. endocervical polyp
b. prolapsed endometrial polyp
c. submucous fibroid
d. prolapsed pedunculated fibroid
e. clear cell adenocarcinoma
The lesion is in the cervical os and 2cm in size making a submucous fibroid and endocervical polyp unlikely. Endometrial polyps are not usually large enough to prolapse. Clear cell carcinoma is unlikely in this age group with no history of DES exposure.
Answer: D
265
50yo G4P4. LMP 12 months ago. PV spotting for 2 weeks. D&C shows atrophic endometrium. Next step in management?
a. Progesterone
b. Oestrogen
c. Hysteroscopy
d. Hysterectomy
e. HRT (combined)
Probably nothing is the appropriate answer
| Answer: E
266
Perimenopausal patient with endometrial hyperplasia
a. HPV
b. Fibroids
c. Diabetes
d. PCOS
Most likely association with endometrial hyperplasia is PCOS (RR 3) although diabetes (RR 2) is also a risk factor. (UTD)
Answer: D
267
A 48 yo lady presented with 6 months of increasing menorrhagia and dysmenorrhoea. On examination the uterus was anteverted, bulky, tender and consistent with a 10-week size. Office hysteroscopy revealed a secretory endometrium and no evidence of submucous fibroids. Pelvic US showed an enlarged uterus but no evidence of adnexal mass. Which of the following is correct about her condition?
a. Requires the presence of endometrial glands two high powered fields below the basement membrane
b. Responds to cyclical progesterone
c. Responds to OCP
d. NSAIDS reduce the symptoms
e. Often successfully treated by endometrial ablation
The diagnosis is adenomyosis. The pathognomonic feature is the presence of endometrial tissue within the myometrium at a distance of at least one low power field (some say two) from the endo-myometrial junction. It does respond to progestins whilst the effect of OCP is not clear. Ablation can be helpful. NSAIDs, OCP and LNG-IUD are effective.
Answer: D
268
A 47 year-old woman has progressive menorrhagia with regular cycles. On examination, normal anteverted uterus, no adnexal masses. At hysteroscopy, regular cavity, no pathology found. Secretory endometrium. What is the best management?
a. Cyclic progesterone
b. OCP
c. NSAIDS
d. Advise endometrial ablation cf TAH is more effective and less cancer
e. Advise endometrial ablation is adequate contraception
UTD states that low dose OCP are as effective as NSAIDs and that both are more effective than cyclic progesterone. Speroff says that OCP is best and Novak agrees. However OCPs have risks and need to be taken all the time. Speroff also states that NSAIDs are first line treatment in ovulatory women with no demonstrable pathology
Answer: C
269
45 yo regular periods, G4 P3 T1. Increasing menorrhagia, no IMB or PCB. Normal pelvic exam, hysteroscopy and endometrial biopsy normal. To reduce the blood loss?
a. Aspirin with menses
b. OCP
c. Cyclic progestins
d. Ponstan with periods
Answer: D
270
You have just made the diagnosis of atypical endometrial hyperplasia in a 32 year-old woman with PCO who wants to retain her fertility. She is concerned about developing carcinoma. Which of the following is true about this patient's condition?
a. Her risk of developing cancer approaches 50%
b. If cancer occurs it is likely to be grade 2 or 3
c. If cancer occurs it is likely to be deeply invasive
d. Her risk of cancer will be reduced if she becomes ovulatory
Answer: D
271
A 47 yo woman with irregular heavy bleeding has a curette. Pathology shows atypical adenomatous hyperplasia. Best treatment?
a. Medroxyprogesterone acetate 100mg IM monthly
b. TAH
c. NSAIDS
d. Hysteroscopy to rule out cancer then rollerball diathermy
e. YAG laser endometrial ablation
Answer: B
272
46 yo woman with 5 months of menorrhagia referred to you following D&C by LMO where inadequate sample was collected. ? further Mx
a. Commence progesterone
b. Commence oestrogen
c. Coagulation profile
d. Hysteroscopy D&C
e. Endometrial ablation
Answer: D
273
Endometrial cystic hyperplasia most likely to be associated with?
a. Maturity onset diabetes
b. Adenomyosis
c. Biphasic OCP
d. Combined HRT
e. Tamoxifen
Answer: E
274
Treatment of menorrhagia with GnRH. How long does it take to work?
a. 24/24
b. 48/24
c. 1/52
d. 3/52
e. 7/52
Produce a hypogonadtropic hypogonadal state in 1-3 weeks. Three cycles for amenorrhoea (30% of patients)
Answer: D
275
Most common clinical indication for GnRH agonist in Australia at present:
a. Prostatic cancer
b. Fibroids
c. IVF
d. Endometriosis
e. Abnormal uterine bleeding
Answer: A
276
PMB x 3 3/12 ago EUA, hysteroscopy D&C NAD, next Mx?
a. Rpt D&C
b. TAH
c. Nothing
Up to 20% may have endometrial cancer or hyperplasia, even with negative biopsy. (UTD)
Answer: B
277
A 40 yr old woman has been taking the OCP for the last 5 yrs with no notable problems. How much longer can she continue with the pill?
a. 5 yrs
b. 10 yrs
c. Till menopause
d. Should cease now
Answer: C
278
With regards to the cOCP, a woman of 35 years who is a non smoker and has a serum cholesterol of 5.8 should:
a. Cease and use alternative contraceptive methods
b. Continue to 38yo then cease
c. Continue to 40 yo
d. Continue to 45 yo
e. Continue to menopause
Answer: E
279
A post-menopausal woman presents with several episodes of PV bleeding over 9 months. Negative pap smear, hysteroscopy NAD curettage. Next Rx?
a. repeat curette
b. TAH / BSO
Answer: B
280
Risk of cardiac disease in a patient aged 35 who undergoes surgical castration compared to a normal woman of the same age
a. Less than control
b. Equal to control
c. 2 x control
d. 3 x control
e. 4 x control
Hazard ratio of 1.34 if BSO occurs at age less than 45
| Answer: C (only slightly exaggerated)
281
45 yo with 2 family members with ovarian cancer who is booked for elective TAH for menorrhagia. Best option?
a. Oophrectomy
b. HRT
Answer: A
282
Severity of menopausal hot flushes altered by all except?
a. Younger age of menopause (? worse)
b. Thin female (? worse)
c. High oestrogen (better)
d. Low oestrogen bound to Non SHBG (worse)
e. Low GnRH (better)
Hot flushes are worst in women who are obese or smoke. (UTD and Speroff). Asked Kathy Scott - hot flushes relate to thermoregulatory dysfunction in the low oestrogen environment; she wasn't sure if age of menopause made much difference, those with low GnRH or higher oestrogen may have less symptoms; does low oestrogen bound to non-SHBG mean unbound oestrogen? Kenny's thoughts in the parenthesis; apparently high GnRH causes worse symptoms
Answer: Probably A (1 in 5 chance!)
283
A postmenopausal woman should be told that HRT may benefit the following areas of her health except
a. Cardiovascular
b. Osteoporosis
c. Wrinkles
d. Hot flushes
e. Vaginal dryness
Answer: A
284
Beneficial effects of oestrogen replacement in elderly women is LEAST proven in the literature for prevention of:
a. Osteoporosis
b. Skin wrinkling
c. Urge incontinence
d. Recurrent UTI
Answer: B
285
Vasomotor irritability found in post-menopausal women is due to:
a. The level of oestrogen
b. Alternation in temperature regulation
c. LH surge
d. Elevated FSH
e. The level of progesterone
Answer: B
286
Least likely to help hot flushes
a. Fluoxetine
b. Phytoestrogens
c. Venlafaxine
d. Clonidine
Answer: B
287
A 50yo well woman attends for regular check up. Hysterectomy for fibroids at 35yo. No symptoms. FSH 60. What regime of HRT would you prescribe?
a. continuous EE 30mcg and cyclic NE 10mg
b. continuous Premarin, cyclic Primolut
c. continuous low dose conjugated E, 2.5mg Provera daily
d. no clinical need for HRT
Answer: D
288
Woman had a pelvic clearance for an ovarian cancer at the age of 37. Severe flushes 6/52 post surgery. Mother had a Colle's fracture. Sister had a mastectomy. BP130/90. Options:
a. Clonidine
b. Recommence OCP
c. Oestrogen alone
d. Oestrogen/progesterone
Answer: C
289
34 yo pelvic clearance for ovarian Ca develops hot flushes at 6 weeks visit. Previously on OCP. Mother has past history of Colles fracture, sister of breast Ca. Normal breast examination. Therapeutic options include:
a. Initiate clonidine
b. Oestrogen alone
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