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1.18-year-old nulliparous girl presents as a gynaecological emergency with severe left-sided pelvic pain, tachycardia and vomiting. A pregnancy test is negative. An ultrasound scan is performed in the emergency department, which appears to demonstrate a left adnexal cyst. In theatre, a laparoscopy is performed which shows an ovarian torsion that has twisted three times on its pedicle. The left tube and ovary appear purple and congested. What is the most appropriate surgical management?CorrectIncorrect
- A woman had a total abdominal hysterectomy in the past using a lower transverse incision. She has now developed a persistent ovarian cyst and is due to have a laparoscopic bilateral salpingo-oophorectomy. What will be the incidence of adhesions in the region of the umbilicus in this scenario?
3. After a year of 4-monthly follow-up, a healthy 75-year-old woman with a 5 cm simple unilocular ovarian cyst and a normal serum CA-125 level decides that she would prefer to have surgical treatment. What treatment would you recommend?CorrectIncorrect
4. It is recommended that ‘risk of malignancy index’ (RMI) should be used to triage post-menopausal women with an ovarian cyst to assess low, moderate or high risk of malignancy. This is calculated as U (ultrasound score) X M (menopausal status) X CA125. What is the RMI of a post-menopausal woman with a CA125 of 15, ultrasound showing 6 cm bilateral, multiloculated cyst?CorrectIncorrect
5. It is recommended that RMI should be used to triage postmenopausal women with ovarian cyst to assess low, moderate or high risk of malignancy. This is calculated as U (ultrasound score) × M (menopausal status) × CA125. What is the risk of ovarian cancer in a woman who has an RMI of 25–250 (moderate risk)?CorrectIncorrect
6. Following a spontaneous miscarriage at 8/40 gestation, a woman is referred to the gynaecology clinic with persistent irregular vaginal bleeding. What initial investigation should be performed?CorrectIncorrect
7. A woman has undergone surgical management of miscarriage and the histology confirms Gestational Trophoblastic Disease (GTD). What is the expected incidence of GTD in the United Kingdom?CorrectIncorrect
8. A woman has been diagnosed with high-risk gestational trophoblastic neoplasia (GTN) and is about to receive multiagent chemotherapy. What is the expected cure rate?CorrectIncorrect
9. A woman underwent medical management of miscarriage but no specimen was sent for histological analysis. What would be the advice to the patient following this procedure?CorrectIncorrect
10. A 30-year-old woman attends the early pregnancy unit with a positive pregnancy test and some lower abdominal pain. Her last menstrual period was approximately 8 weeks ago, but her menstrual cycle is irregular. A transvaginal ultrasound scan is organised, which demonstrates an intrauterine gestation sac with fetal pole and yolk sac, but no fetal heartbeat is identified. The crown-rump length (CRL) is 6 mm. What is the correct course of action?CorrectIncorrect
11. A woman who has had a left salpingectomy previously for ectopic pregnancy has now been diagnosed with an ectopic pregnancy in the right fallopian tube. A laparoscopy is performed and the surgeon opts for a salpingotomy as the woman still wishes to become pregnant. What is the possibility that she will require further treatment (methotrexate or salpingectomy)?CorrectIncorrect
12. A woman who has blood group A Rh negative undergoes a laparoscopic salpingectomy for a ruptured ectopic pregnancy. What anti-D rhesus prophylaxis is required?CorrectIncorrect
13. A 22-year-old woman with a past history of Chlamydia attends the emergency department complaining of severe abdominal pain. She has mild vaginal bleeding. Her pulse rate is 120 beats per minute, with a blood pressure of 60/40mmHg and she has a distended tender abdomen. What is the most likely diagnosis?CorrectIncorrect
14. You are asked to review a 20-year-old woman in the emergency department. She has a positive pregnancy test, and is unsure of her last menstrual period. On examination, her pulse is 70 beats per minute and her blood pressure is 110/70mmHg. Her abdomen is soft and non-tender. Speculum examination reveals a closed cervix and mild bleeding. What is the most appropriate plan of management?CorrectIncorrect
15) Administration of tamoxifen is a cornerstone in the treatment of breast cancer, but it has a weak estrogenic effect on the endometrium. A woman who is taking Tamoxifen presents with post-menopausal bleeding (PMB).
What is her risk of developing endometrial cancer when compared to the general population?CorrectIncorrect
16) PMB is defined as uterine bleeding occurring after at least one year of amenorrhea. The main purpose of investigating a woman with PMB is to rule out endometrial cancer.
What is the risk that a women presenting with PMB will have endometrial cancer?CorrectIncorrect
17) A 60-year-old woman presents with a first episode of PMB. What is the most appropriate first line of investigation?CorrectIncorrect
18) A 55-year-old woman presents with a first episode of PMB. A transvaginal ultrasound scan showed an endometrial thickness of 3.8mm.
What is the most appropriate management plan?CorrectIncorrect
19) A 60-year-old undergoes hysterectomy and bilateral salpingooophorectomy for grade 1 endometrial cancer. The final histology report confirms tumor invading the uterine serosa.
As per the new FIGO staging of endometrial cancer, what is the stage?CorrectIncorrect
20) A 45-year-old woman complains of intermenstrual bleeding for the past 6 months. Past history includes 6 normal vaginal deliveries and hypertension, and last smear was over 5 years ago. On speculum examination, there is a raised 2 cm friable area on the cervix.
What is the most likely diagnosis?CorrectIncorrect
21) A 40-year-old woman with severe dyskariosis on smear underwent colposcopy and large loop excision of transformation zone (LLETZ). Histology confirmed a moderately differentiated squamous cell carcinoma 4mm deep and 6mm wide. Clinical and radiological examination confirmed organ confined disease.
What stage of cervical cancer is this?CorrectIncorrect
22) A 53-year-old woman is diagnosed with stage IA1 cervical squamous cell carcinoma after histological, clinical and radiological assessment.
What is the most appropriate management plan?CorrectIncorrect
23) A 35-year-old woman is diagnosed with stage IB1 cervical squamous cell carcinoma of the cervix on histological and clinical assessment.
What is the most appropriate radiological investigation for this patient?CorrectIncorrect
24) A 42-year-old multipara has negative screening Pap test and positive human papillomavirus (HPV)DNA test results. These were repeated 1 year later with the same results. She is a long-time cigarette smoker and has had six lifetime sexual partners. She has not had a new sexual partner for 7 years. What is her strongest risk factor for cervical cancer?CorrectIncorrect
25) A 39-year-old patient presents with symptoms of leakage of urine upon coughing, sneezing and during exercise. The symptoms started following the birth of her second child 18 months ago. What would be the first line of management?CorrectIncorrect
26) A 39-year-old para 1 patient presents with stress incontinence with no other urinary symptoms.
What would be the first line of management?CorrectIncorrect
27) A 38-year-old patient is suffering with stress incontinence. Her BMI is 32 kg/m2 and the patient is interested in lifestyle management for her incontinence. What is the most important lifestyle change that you would recommend?CorrectIncorrect
28) A 32-year-old multiparous woman has confirmed urodynamic stress incontinence and admits that she has not completed her family.
What management would you propose for this patientCorrectIncorrect
29) A 28-year-old woman presents with a history of pelvic pain, urinary urgency, increased frequency and nocturia. The pelvic pain tends to occur during bladder filling and is relieved by voiding and you suspect that the patient has interstitial cystitis.
What other mandatory investigation is required in order to make an accurate diagnosis?CorrectIncorrect
31) A 64-year-old patient presents with a history of increased urinary frequency, nocturia, urgency and occasional urgency incontinence.
What would be the next line of management?CorrectIncorrect
31. A 60-year-old woman presents to the gynaecology outpatient clinic with a 6 month history of urinary urgency, day time frequency every hour and night time frequency of 3-4 times. She has no urge or stress urinary incontinence. She has had three proven urinary tract infections over the past 6 months. She is postmenopausal and is not on HRT. She has had two vaginal deliveries in the past.
Her general and abdominal examination was unremarkable. Vaginal examination showed atropic external genitalia with a grade 1 cystocele and a grade 1 rectocele. There was no uterine descent. Her cervix was healthy and the uterus was anteverted and small. No adnexal masses felt.
Urine analysis showed + of RBC and + of leukocytes.
What is the most appropriate next management step?CorrectIncorrect
31. A 50-year-old woman who has had TAH BSO for endometrial cancer is referred to the menopausal clinic for HRT advice.What options are available to this woman for the management of menopausal symptoms?CorrectIncorrect
33. A 45-year-old woman underwent a hysterectomy and bilateral salpingo-oophorectomy for severe endometriosis. She has been advised to use HRT. What type of HRT would you recommend?CorrectIncorrect
34. A 45-year-old woman attends Gyne OPD after saline cystometry has demonstrated urodynamic stress incontinence. She is contemplating undergoing a transvaginal midurethral tape procedure but requests further investigations as she is concerned about the risk of failure. What is success rate of procedure?CorrectIncorrect
35. A 45-year-old woman attends Gyne OPD after saline cystometry has demonstrated urodynamic stress incontinence. She is contemplating undergoing a transvaginal midurethral tape procedure but requests further investigations as she is concerned about the risk of failure. Which investigation could you offer her to give extra information on prognosis?CorrectIncorrect
36. A 15 year old girl presenting with negative pregnancy test and generalised lower abdominal pain is feeling feverish and unwell with a temperature of 37.6° C. She gives history of multiple sexual partners. What is best management option?CorrectIncorrect
37.A 25 year old woman recently returned from holiday abroad, presents with signs and symptoms of PID. What is most appropriate management.CorrectIncorrect
38. A 22 year old woman had severe PID including lower abdominal and right upper quadrant pain. She had 48 hours of IV antibiotics in the hospital. But she is still pyrexial and unwell. Transvaginal ultrasound shows bilateral tuboovarian abscesses what will you do next?CorrectIncorrect
39. A 23 year old woman had recurrent visits to GP with intermenstrual bleeding while being on Combined Oral Contraceptive pills. She had been treated repeatedly for Urinary Tract Infection though urine cultures were always negative. What is most appropriate?CorrectIncorrect
40. A 35 year old lady presents with severe PID following TOP that was not covered by antibiotics. Her cervical smear report 6 weeks ago shows ‘clue cells.’ What do you think is wrong with pt?CorrectIncorrect
41.An 18 year old presenting with multiple vesicles on perineum , retention of urine and non-specific lower abdominal pain and vaginal discharge with lymphadenopathy. Which organism is responsible?CorrectIncorrect
42. A 32 year old woman who uses tampons for her heavy periods is brought to A&E with pyrexia, hypotension and an erythematous rash. Blood cultures are negative. What is most likelyCorrectIncorrect
43. A 54 year-old woman complains of postcoital bleeding. She has regular periods and does not have any significant gynaecological history. She has spotting after every episode of intercourse. Her last cervical smear was 3 months ago and was normal.CorrectIncorrect
44. A 78 year-old woman presented with 1 episode of postmenopausal bleeding. The ultrasound scan is normal and shows an endometrial thickness of 2.5 mm. The pipelle biopsy is normal. What is most likely wrong with pt?CorrectIncorrect
45. A 35 year-old nulliparous woman presents with multiple sexual partners has presented with foul smelling discharge and irregular bleeding for 4 months. She gives history of passing small foul smelling lumps and has bleeding after every episode of intercourse and irregularly almost every day. She has not had any cervical smears in the past. Wwhat can be most likely?CorrectIncorrect
46. A 28 year old woman has been admitted in emergency with ectopic pregnancy and needs laparoscopic salpingectomy. She gives history of previous midline laparotomy for bowel surgery.
What would be the best method for verress needle insertion?CorrectIncorrect
47. A 21 year old young woman is booked for diagnostic laparoscopy for chronic pelvic pain. Her BMI is 19. Her highest risk of complication is:CorrectIncorrect
48. A 36-year-old woman with known hypothyroidism has been taking levothyroxine 100 micrograms once a day. Her most recent thyroid function tests performed 3 months ago were normal with a thyrotropin (TSH) of 2.5 mU/L. She has come to the early pregnancy unit with abdominal pain and a positive pregnancy test. Transvaginal ultrasound confirmed an intrauterine pregnancy. How would you advise with regards to her levothyroxine dosage?CorrectIncorrect
49. A 25-year-old woman known to have hyperthyroidism is going for radioactive iodine therapy. She has been trying to conceive for the last 6 months. How long should she avoid pregnancy after this treatment?CorrectIncorrect
50. A 30-year-old woman attends the gynaecology clinic with discomfort in the left iliac fossa and clinical examination suggests a pelvic mass. An ultrasound scan is arranged, which demonstrates a simple cyst in the left ovary with a diameter of 45 mm. The right ovary and uterus appear normal. What other investigation is required?CorrectIncorrect