O&G Cases

Question 1

A 21 year old female presents with a 2 year history of painful periods. Her cycles are 5/28. She has severe cramp like pain on the first 2 days of her periods.
DDx?
What questions will help distinguish between the differential diagnoses?

What medications can she try?

Answer 1

DDx: Primary Dysmenorrhoea
Secondary Dysmenorrhoea - Endometriosis

Qns to ask include:

• Does she experience deep dyspareunia?
• Does she experience cyclical bleeding in other areas? Such as her rectum.
• Are her periods heavy with clots? Does the pain ease with passing of clots?

Rx:
Mefenamic acid or Tranexamic acid (can help in heavy periods too)
Depo
Mirena coil

Question 2

A 24 year old lady presents with a 3 month history of IMB and intermittent PCB. Her periods are regular, on the COCP.
DDx?
What questions to ask to narrow the scope of DDx down?
What signs may you find on examination with some of the conditions listed?

Answer 2

DDx:

• STI
• COCP poor compliance
• Ectropion bleed
• Cervical polyp or cancer

Qns asked: Sexual history, pill compliance, smear history.

Ectropion, cervical polyp and tumour can be seen on examination.

Question 3

A 30 year old lady presents with a 6 month history of amenorrhoea.
DDx

What investigations are done?

Answer 3

Stress, anorexia, excessive exercise		
Prolactinoma - Hyperprolactinaemia			
Hyperthyroidism			
Pregnancy				
Ovarian insufficiency			
PCOS					
Severe medical illness

Ix: Prolactin levels, TFT, betaHCG +/- USS, FSH and LH, Oestradiol,

Question 4

A 34 year old P0 lady presents with cyclical pelvic pain. Her cycle is 6/28. She starts getting lower abdominal and pelvic pain from day 25 of her cycle and this peaks during her period.
She takes paracetamol, naproxen and occasionally tramadol. She also complains of deep dyspareunia with her partner of 8 years. They use condom for contraception.
Which is the top diagnosis?
- Endometriosis/adenomyosis
- PID
- IBS with hormonal influence
- Primary dysmenorrhoea

Answer 4

Endometriosis or Adenomyosis

Question 5

A 28 year old lady P1 who had a normal vaginal delivery 4 months ago, has been referred with superficial dyspareunia.
DDx?

Answer 5

Scar tissue from previous episiotomy
Vaginismus
Vulval cyst or recurrent infection

Question 6

A growth scan is performed at 32 weeks. This identifies a small baby with evidence of intracranial and hepatic calcification. The patient reports no history of symptomatic illness to date. What is a possible infection?
A) Hepatitis B
B) Toxoplasmosis
C) Rubella
D) CMV

Answer 6

D) CMV

CMV infection in pregnancy is commonly asymptomatic and classically causes the described findings. Toxoplasmosis may cause intracranial abnormalities but is rare in the UK.

Question 7

A woman develops a mild febrile illness with a macular rash at 9 weeks of pregnancy. After serology is performed, she is offered, and accepts, a termination of pregnancy.
A) Group B Streptococcus
B) Rubella
C) Malaria
D) Toxoplasmosis

Answer 7

B) Rubella

This illness describes classic Rubella, which is very rare in developed countries due to widespread immunisation. At 9 weeks, the risk of congenital abnormalities is 90%; with no other infection having a risk this high.

Question 8

A late booker from sub-Saharan Africa presents with severe anaemia and a baby below the 3rd centile for growth.
A) Listeriosis
B) Syphilis
C) Toxoplasmosis
D) Malaria

Answer 8

D) Malaria

Malaria is rare in the UK but is a major cause of perinatal as well as infant mortality in Africa.

Question 9

A French woman presents with a non-specific, febrile illness. On ultrasound, her fetus has cerebral ventriculomegaly.
A) CMV
B) Parvovirus
C) Toxoplasmosis
D) Syphilis

Answer 9

C) Toxoplasmosis

Toxoplasmosis is more common in mainland Europe. Ventriculomegaly is typical. However, occasionally, CMV and even parvovirus could cause these findings.

Question 10

A 42yo F is referred to breast clinic due to a solid lesion in her right breast. What method is best to obtain a histology from this mass?
A) Needle biopsy
B) Does not require histology
C) Fine needle aspiration
D) Core biopsy

Answer 10

D) Core biopsy

http://teachmesurgery.com/breast/presentations/triple-assessment/

Question 11

A patient is scored P4 following examination of their breast lump. What does this correlate to?
A) Normal
B) Benign
C) Uncertain/likely benign
D) Suspicious of malignancy

Answer 11

D) Suspicious of malignancy.

Examination of breast lumps score from P1-P5.
P1: Normal
P2: Benign
P3: Uncertain/likely benign
P4: Suspicious of malignancy
P5: Malignant