Sexual health gynae

Question 1

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

Answer 1

D - change to IV cefotaxime plus oral doxycycline

Question 2

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 2

E - reassure the patient

If asymptomatic, don’t need to remove

• Smears in asymptomatic women reveal Actinomyces-like organisms (ALO) in ~7% of IUC users
• If pelvic pain present with ALO on smear, consider other infective causes and do formal culture for Actinomyces

Question 3

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%

Answer 3

D - 70%

Question 4

A patient has antenatal booking bloods performed. The result is Hep B core antigen positive, Hep B surface Antigen negative, Hep B surface antibody negative. The most likely explanation is:

a. The result is a false positive
b. The patient is a chronic carrier of Hepatitis B infection
c. The surface antibody will become positive soon
d. The patient is immune to Hepatitis B infection

Answer 4

c. The surface antibody will become positive soon

Question 5

A 14yo girl comes requesting the combined oral contraceptive pill for period pain. During the consultation you discover that she is in an apparently consensual sexual relationship with her mother’s boyfriend, who is 39. Her mother is not aware of the relationship. Your NEXT STEP is to

a. Contact the Child Health Service (CYF in NZ / DOCS in Australia)
b. Contact the social worker
c. Contact the mothers partner
d. Prescribe her the pill

Answer 5

a. Contact the Child Health Service (CYF in NZ / DOCS in Australia)

Question 6

Which of the following statements concerning needle stick injuries is LEAST CORRECT

a. Hepatitis C transmission will occur in approximately 2% of cases where the patient is Hep C positive
b. Hepatitis B transmission will occur in approximately 30% of cases where the patient is hepatitis B S Ag positive and the health worker has not been immunised.
c. HIV transmission will occur in approximately 0.3% of cases where the patient is HIV positive and no chemoprophylaxis is administered
d. The risk of contracting Hepatitis C from a blood transfusion is approximately 1 in a million

Answer 6

a. Hepatitis C transmission will occur in approximately 2% of cases where the patient is Hep C positive

Question 7

Which of the following antibiotics is LEAST effective in the treatment of infections caused by bacterial vaginosis

a. Cefoxitin
b. Clindamycin
c. Gentamicin
d. Metronidazole

Answer 7

c. Gentamicin

Question 8

All of the following regarding Chlamydia are true EXCEPT

a. The organism is transmitted primarily by intercourse
b. The majority of infected women are symptomatic
c. The organism may cause acute salpingitis
d. Infertility may follow acute or chronic infections

Answer 8

b. The majority of infected women are symptomatic

Question 9

Which organism causes lymphogranuloma venereum

a. Haemophilus ducreyi
b. Calymmatobacterium granulomatis (Klebsiella)
c. Chlaymdia trachomatis
d. Corynebacterium donovaniae

Answer 9

c. Chlaymdia trachomatis

Small asymptomatic skin lesions, followed by regional lymphadenopathy in groin or pelvis

Question 10

A 40 year old Indian woman presents for a routine Pap smear. On examination you notice a small group of vesicles on her right buttock. On questioning she claims that this is a problem she has intermittently on and off for many years. The MOST LIKELY diagnosis is

a. Dermatitis artifacta
b. Drug eruption
c. Recurrent HSV2
d. Lymphogranuloma venereum

Answer 10

c. Recurrent HSV2

Question 11

All of the following regarding genital herpes are TRUE, EXCEPT:

a. The acquisition of HSV type I offers some protection against HSV type II
b. HSV type II is more common of genital herpes than HSV type I
c. Acyclovir treatment of the acute disease significantly reduces the recurrence (recrudescence) rate
d. Women with cervical cancer have a higher prevalence of HSV antibodies

Answer 11

c. Acyclovir treatment of the acute disease significantly reduces the recurrence (recrudescence) rate

Question 12

Which statement about actinomycosis is INCORRECT

a. It is associated with Toxic Shock Syndrome
b. It can be recognised by cervical cytology
c. It occurs with Lippes Loop IUCDS
d. It is best treated by intramuscular penicillin

Answer 12

a. It is associated with Toxic Shock Syndrome

Question 13

Which is NOT TRUE of Hepatitis C

a. Sexual transmission is rare (<1%)
b. After seroconversion, approximately 50% will become carriers
c. Vertical transmission is rare with breastfeeding
d. Vertical transmission occurs in approximately 5% of carriers

Answer 13

b. After seroconversion, approximately 50% will become carriers

Significant risk (80%) of chronic infection 
With treatment, cure rates of >95%

Question 14

The treatment of choice for secondary syphilis is

a. Procaine penicillin 5 million units IV
b. Benzanthine penicillin, 2.4 million units IM
c. Ampicillin 500mg QID for 7 days
d. Doxycycline 100mg QID for 7 days
e. Ofloxacin 400mg BD for 7 days

Answer 14

b. Benzanthine penicillin, 2.4 million units IM

Question 15

All of the following statements about Treponema pallidum are true except

a. Syphilis can be transmitted from the skin lesions of secondary syphilis
b. Lesions of tertiary syphilis largely result from an immune response to Treponema and it’s products
c. The VDRL (Venereal Disease Research Laboratory) test is specific for Treponema pallidum infection
d. Secondary syphilis can cause loss of scalp hair and eyebrows

Answer 15

c. The VDRL (Venereal Disease Research Laboratory) test is specific for Treponema pallidum infection

Non-specific - Detect antibodies that bind to antigens that are, or similar to, those expressed by Treponema pallidum or expressed on host tissues during infection

• VDRL
• RPR
• High false positive rate

Specific - Detect antibodies that bind to proteins derived from T. pallidum

• TPPA
• TPHA
• FTA test
• EIA

Question 16

Which of the following is the MOST APPROPRIATE treatment

a. Erythromycin for a 28 week pregnant patient with syphilis
b. Ampicillin for a 15yo with PID
c. Ketoconazole for a 25yo with Trichomonas
d. Tetracycline for a recent immigrant with granuloma inguinale

Answer 16

d. Tetracycline for a recent immigrant with granuloma inguinale

rare sexually transmitted disease caused by the bacteria Klebsiella granulomatis
It leads to chronic inflammation and scarring of the genital

Question 17

Should pregnancy occur after use of the Yuzpe post coital contraception regime (100mcg Ethinyloestradiol with 500mcg levonorgestrel repeated at 12 hours) the particular concern about the resulting pregnancies is that

a. The rate of miscarriage is increased
b. An ectopic pregnancy is more likely than usual
c. The child, if a boy, is more likely to have hypospadias
d. The chance of molar pregnancy is increased

Answer 17

b. An ectopic pregnancy is more likely than usual

Question 18

Which of the following is LEAST TRUE of depot provera

a. Amenorrhoea is expected in 50% at 12 months
b. Amenorrhoea is expected in 95% at 24 months
c. There may be a reduction in bone mineral density compared to controls
d. DMPA is good contraception for women with epilepsy
e. A satisfactory regime is 150mg DMPA Intramuscular every 12 weeks

Answer 18

b. Amenorrhoea is expected in 95% at 24 months

Question 19

A 62yo woman comes to see you requesting sterilisation of her 20yo daughter who has Down Syndrome. Her daughter is having unprotected sex. She lives at home with her parents. You tell her

a. This can be performed if reversible options fail
b. This can only be done with her daughters consent
c. This can be done as LARC is not appropriate
d. State guardianship approval or a court order would be necessary for this to be done

Answer 19

d. State guardianship approval or a court order would be necessary for this to be done

Question 20

Advantages of Depot provera include everything EXCEPT

a. No significant effect on coagulation
b. No significant effect on BP
c. Low incidence of menstrual disturbance
d. No suppression of lactation when used post partum
e. No reported deaths directly attributable to the drug

Answer 20

c. Low incidence of menstrual disturbance

Question 21

The Pearl Index is expressed as the

a. Percentage of women who become pregnant using a particular contraceptive
b. Percentage of women who become do not become pregnant using a particular contraceptive
c. Number of pregnancies per 100 women-years use of a particular contraceptive
d. Number or pregnancies per 1000 woman years use of a particular contraceptive

Answer 21

c. Number of pregnancies per 100 women-years use of a particular contraceptive

Question 22

A 17yo sexually active high school student on the combined oral contraceptive starts to complain of spotty vaginal bleeding. She has been on the pill for 12 months without any problems. She should

a. Have her prescription changed to a brand with a higher oestrogen dose
b. Have her prescription changed to a brand with a higher progestogen dose
c. Come to the office to be evaluated for evidence of Sexually transmitted infection
d. Be given supplementary oestrogen (1.25mg conjugated oestrogens) daily for the next two menstrual cycles

Answer 22

c. Come to the office to be evaluated for evidence of Sexually transmitted infection

Question 23

Oral contraceptives are associated with a decreased rate of each of the following EXCEPT

a. PID
b. Ectopic pregnancy
c. Cervical cancer
d. Endometrial cancer
e. Endometriosis

Answer 23

c. Cervical cancer

Lower rates of PID because change in mucous at cervix

Question 24

Which is INCORRECT?

a. Norethisterone and Norethynodrel are first generation progestogens
b. Levonorgestrel is a second generation progestogen and more potent than norethisterone
c. Triphasic OCP’s containing second generation progestogens are associated with a less favourable lipid profile than monophasic preparations containing the same progestogens
d. Desogestrel, gestodene and norgestimate are third generation progestogens and are less androgenic than levonorgestrel
e. OCP’s containing third generation progestogens have been associated with an increase in HDL cholesterol
f. OCP’s containing third generation progestogens have been associated with a two fold increase in venous thromboembolism, although this may have been due to prescription bias.

Answer 24

c. Triphasic OCP’s containing second generation progestogens are associated with a less favourable lipid profile than monophasic preparations containing the same progestogens

Question 25

The failure rate among typical users of which contraception method is <1%

a. Combined oral contraceptives
b. Depot Medroxyprogesterone acetate
c. Progesterone only contraceptives
d. Condoms

Answer 25

b. Depot Medroxyprogesterone acetate

Question 26

Danazol causes all of the following EXCEPT

a. Exacerbation of fibrocystic disease of the breasts
b. Clitoral hypertrophy in female fetuses when given to the mother during pregnancy
c. Labial fusion in female fetuses when given to the mother during pregnancy
d. Acne
e. Fluid retention

Answer 26

a. Exacerbation of fibrocystic disease of the breasts

While danazol is effective at treating endometriosis-related pain, it is not commonly used because of androgenic side effects

Question 27

Which of the following is FALSE

a. The risk of VTE in a healthy young woman is approximately 1:10 000 woman years
b. Progesterone only contraceptives increase the risk of VTE by 50%
c. Obesity (BMI>30) approximately doubles the risk of VTE
d. Smoking increases the risk of VTE by approximately 50%

Answer 27

b. Progesterone only contraceptives increase the risk of VTE by 50%

Question 28

Which of the following is FALSE

a. The risk of VTE in pregnancy is approximately 60:100 000 woman-years
b. The risk of VTE with the COCP is approximately 15:100 000 woman-years
c. The risk of VTE with the COCP is greater in a pill with 50mcg rather than 30mcg of ethinyoestradiol
d. The risk of VTE with the COCP is less with the pills that contain gestodene or desogestrel

Answer 28

d. The risk of VTE with the COCP is less with the pills that contain gestodene or desogestrel

Question 29

Concerning medically induced abortion with mifepristone (RU486), which of the following is LEAST CORRECT

a. An established regimen is mifepristone 600mg orally, followed by 800mcg vaginal misoprostol 36-48 hours later
b. Mifepristone has been used for medically induced termination of pregnancy in Europe for over 15 years
c. Mifepristone has been approved for use by the FDA in the United States
d. Most trials indicate that mifepristone and misoprostol is less acceptable to a majority of women than surgical termination

Answer 29

d. Most trials indicate that mifepristone and misoprostol is less acceptable to a majority of women than surgical termination

NZF and MEDSAFE say 600mg mifepristone is OK, can also do 200mg

Question 30

A 22yo patient is seen for evaluation one week after a pregnancy TOP at 6 weeks gestation. A pregnancy test is still positive and her uterus is 6-7 week size as determined by pelvic examination. She reports no abnormal uterine bleeding or abdominal/pelvic pain. Her medical records indicate that a suction curettage was performed to terminate the pregnancy with minimal tissue, and was otherwise uneventful. The pathology report indicated that the tissue is decidual. The next step in the evaluation of this patient is:

a. Repeat a curettage
b. Exploratory laparotomy
c. Transvaginal ultrasound
d. Progesterone challenge test

Answer 30

c. Transvaginal ultrasound