PASSMED

Question 1

SHORT STATURE AND AMEONNORHEA”?

Answer 1

TURNERS

Question 2

FSH AND LH levels in amenorrhea

Answer 2

both will be raised

Question 3

Menorrhagia, anaemia, bulk-related symptoms e.g. bloating/urinary frequency?

Answer 3

uterine fibroids

Question 4

cocp are ci with ?

Answer 4

migraines with aura

Question 5

how to differentiate between endometriosis and fibroids

Answer 5

endo pain is cyclical - ie before and during period
fibroids can be all the time and more likely to feel a palpable mass

Question 6

typical history of ectopic pregnancy patient

Answer 6

female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding
Shoulder tip pain and cervical excitation may be seen

Question 7

typical history of UTI patient

Answer 7

Dysuria and frequency are common but women may experience suprapubic burning secondary to cystitis

Question 8

typical history of PID patient

Answer 8

Pelvic pain, fever, deep dyspareunia, vaginal discharge, dysuria and menstrual irregularities may occur
Cervical excitation may be found on examination

Question 9

typical history of ovarian torsion patient

Answer 9

Usually sudden onset unilateral lower abdominal pain. Onset may coincide with exercise.
Nausea and vomiting are common
Unilateral, tender adnexal mass on examination

Question 10

typical history of patient with miscarriage

Answer 10

vaginal bleeding and crampy lower abdominal pain following a period of amenorrhoe

Question 11

Chronic pelvic pain
Dysmenorrhoea - pain often starts days before bleeding
Deep dyspareunia
Subfertility

?

Answer 11

endometriosis

Question 12

typical history of patient with ovarian cyst

Answer 12

Unilateral dull ache which may be intermittent or only occur during intercourse. Torsion or rupture may lead to severe abdominal pain
Large cysts may cause abdominal swelling or pressure effects on the bladder

Question 13

most common side effect of progesterone only pill

Answer 13

irregular vaginal bleeding

Question 14

why is the cocp CI in post natal women

Answer 14

in women whoa re breastfeeding increased DVT risk in 6-8 weeks

Question 15

Stereotypical PCOS results

Answer 15

raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low

Question 16

what happens with mirena coil

Answer 16

initially irregular bleeding followed by light menses or amenorrhea

Question 17

what is first line drug for infertility in PCOS

Answer 17

clomifine

Question 18

what is a common cause of recurrent first trimester miscarriage

Answer 18

anti phospholipid syndrome

Question 19

PCOS should be diagnosed if 2/3 of the following criteria are present:

Answer 19

-infrequent or no ovulation (thus oligomenorrhoea is the correct answer in this scenario)
-Clinical or biochemical signs of hyperandrogenism or elevated levels of total or free testosterone (no mention of ‘low levels of oestrogen’)
-Polycystic ovaries on ultrasonography or increased ovarian volume

Question 20

what is androgen insensitivity

Answer 20

genetically XY but are phenotypically female due to reduced/absent testosterone receptors in target tissues.

Question 21

features of androgen insensitivity

Answer 21

‘primary amenorrhoea’
undescended testes causing groin swellings
breast development may occur as a result of conversion of testosterone to oestradiol

Question 22

management of androgen insensitivity

Answer 22

counselling - raise child as female
bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
oestrogen therapy

Question 23

how to diagnose androgen insensitivity

Answer 23

buccal smear or chromosomal analysis to reveal 46XY genotype

Question 24

effects of the COCP on cancer

Answer 24

increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer