FCPS Part 2-Written Mega Mock-Paper B

1. A 49 year old lady well complaint with Sequential HRT due to troublesome post-menopausal symptoms  attended gynecology clinic with the complaint of Heavy  breakthrough bleeding in >2 cycles, her TVS revealed endometrial thickness of 7mm what would be the next step

2.A 20-year-old girl presents with recurrent abdominal pain and primary amenorrhea. On examination, both breast development and pubic hair distribution are noted to be Tanner Stage V. An abdominal mass is detected on palpation. Speculum examination showing a pinkish colour at the end of the speculum, you suspect that she is having transverse vaginal septum of lower third of vagina, what would be her chances of successful spontaneous conception in the future?

3. A 48 year old lady presents with h/o 12 months amenorrhoea with vaginal dryness and extremely distressing night sweats. She is otherwise well and has no significant medical or family history. What tests would you order prior to prescribing HRT

Q4. A 32-year-old lawyer attends the gynaecology clinic with complaints of irritability, depression and feeling out of control Other symptoms include breast tenderness, bloating and headaches. These occur premenstrually and improve as each period starts; symptoms resolve by the end of menstruation. She has kept a menstrual diary for the last 3 months. She is anxious because this is causing her to take time off work and is affecting her quality of life. She has started drinking heavily because of this.What is the best initial management?

Q5. What proportion of women with PMS can benefit from gnrh?

Q6. A 25-year-old patient suffers with headaches, mood swings, irritability, depression and feeling out of control just before, and during, her menses. She also reports physical symptoms including breast tenderness, bloating and headaches. Her physical and psychological symptoms resolve completely after menstruation ceases. Which of the following would be the best first-line management? Options

Q7. What percentage of women experience severe premenstrual symptoms?

Q8. The aetiology of premenstrual syndrome (PMS) remains unclear but appears to be related to the effect of cyclical ovarian activity on neurotransmitters.Which neurotransmitters are considered to have a key role?

Q9. Which progestagen has been shown to be effective in cases of PMS?

10.A 24-year-old para 1 presents with a 6-hour history of right lower quadrant (RLQ) pain described as intermittent, severe in nature and associated with nausea and vomiting. She denies a change in bowel habits, and she is currently menstruating. On examination she is mildly tachycardic and has tenderness in the RLQ. Her urine pregnancy test is negative, and urine dipstick is negative for both blood and white cells. On pelvic examination she has a normal looking cervix, normal-sized and nontender uterus and no cervical motion tenderness. ere is a palpable mass in the right adnexa which is tender to palpation and somewhat reproduces her pain. A transvaginal ultrasound shows a normal uterus and le ovary, but the right ovary measures 7 × 5 cm with cystic and solid components as well as with calcification. Colour flow Doppler is inconclusive.What is the next best step in the management of this patient?

11. A 38-year-old woman presents with an ultrasound scan report showing a unilocular anechoic left ovarian cyst measuring 5.6 x 5.2 x 5 cm.The CA-125 is 25.What is the risk of malignancy index?

12. Ms. XY is 64 years old and is postmenopausal. She has recently been diagnosed with a 4 cm ovarian cyst on a transabdominal scan. The scan could not identify the other ovary as the bowel obscured it. The scan was being undertaken for suspected gallstones with the cyst being an incidental fi nding. Ms. XY is very anxious that this may represent ovarian cancer. Which of the following investigations are best suited to her to further investigate the ovarian cyst?

13. Ms. XY is 32 years old, otherwise fit and well and using the progesterone-only pill for contraception. She has recently been diagnosed (incidentally) with a 55 mm simple right ovarian cyst with anechoic fluid.Her CA-125 results are 5 u/ml. She is very anxious about the prospect of surgery. She has been risk assessed for VTE and is at low risk for using the COCP.Which of the following treatment options are best suited to her?

14. A 28-year-old woman presents with mild lower abdominal pain and frequency in micturition. An ultrasound scan notes a solid adnexal mass. Her serum lactate dehydrogenase (LDH) and human chorionic gonadotropin (hCG) levels are raised with normal alpha- feto protein.Which of the following tumours is the most likely cause of her symptoms?

Q15. Detection rates of endometrial cancer with the Pipelle in postmenopausal women are:

Q16. An endometrial Pipelle biopsy result that you have performed a week ago has shown endometrial hyperplasia with atypia. The patient is a 55-year-old para 0 who has a previous history of breast cancer.When counselling the patient, what would be the chance of her also having an endometrial cancer, if a hysterectomy is performed in the next few weeks?

Q17. A 48-year-old woman attends the gynaecology clinic complaining of heavy menstrual bleeding (HMB) and occasional intermenstrual bleeding. Her haemoglobin level is 112 g/l. An ultrasound scan demonstrated no obvious abnormality. What other investigation is required?

18.An 18-year-old woman presents with primary amenorrhea. She has normal thelarche and pubarche. On examination, external genitalia are normal. Ultrasound shows normal ovaries but uterus not visualised. You suspect that she is a case of Mayer Rokitansky syndrome.Which of the following statement is correct regarding MRKH?

19. A 38-year-old para 3 with previous 3 cesarean section,  who has completed her family presents with a history of heavy menstrual bleeding for 1 year. Her BMI is 44. She is currently on iron supplements for anemia. She is otherwise fit and well. Abdominopelvic examination is unremarkable. Pelvic ultrasound shows an endometrial thickness of 12 mm with a bulky uterus and normal ovaries with no pelvic pathology. Her report of histopathology was unremarkable, patients wants minimally invasive treatment option. Which of the endometrial ablation procedure is safest for her

20.  A 12 year old girl presented to accident and emergency department with an ongoing moderate lower abdominal pain, negative pregnancy test and tachycardia which settled down after analgesia.her emergency abdomio-pelvic scan revealed Bilateral 5 cm ovarian cyst with multiple solid component of >10 mm. what would be the best course of action for her

21. A 65-year-old woman is referred to the two-week-wait general gynaecology clinic because her general practitioner observed an irregular vulval ulcer with raised edges while he was performing a rectal examination for suspected haemorrhoids.What will you do next?

Q22. Vulval cancer spreads by direct extension to adjacent structures, by embolization to the regional inguinal and femoral lymph nodes, or by haematogenous spread.

What proportion of the women with vulval cancer who are operable have nodal spread?

Q23. A 70-year-old woman is diagnosed with vulval cancer. The tumour involves the vagina and the urethra. The pelvic nodes are negative. What is the most likely stage of her disease?

24. A 72-year-old woman is diagnosed with verrucous vulval cancer. The lesion is 3 cm in diameter and 2 cm lateral to the left labia majora. What is the most appropriate management?

25. Recently, the prevalence of HPV-related VIN has increased significantly and consequently the incidence of vulval cancer in young women is rising. What are the most common HPV serotypes found in vulval cancers?

26. Vulval cancers are relatively rare cancers with surgery as the main- stay of treatment. In recent years, a lot of emphasis has been given to sentinel node biopsy to decide management.What is the role of sentinel node biopsy in the management of early vulval cancer?

27.  A 42-year-old woman with abnormal vaginal bleeding has an endometrial Pipelle biopsy. The histology shows endometrial hyperplasia. To treat her appropriately the following need to be determined except for

28. A 57-year-old woman presents following two episodes of postmenopausal bleeding. What is her risk of endometrial polyps or endometrial hyperplasia?

29.A 54 year old lady had PMB. On evaluation her endometrium was 6mm and she underwent a outpatient hysteroscopic endometrial biopsy which shows EH without atypia. What would you tell her regarding risk of progression to endometrial cancer:

30.First line treatment for EH without atypia is:

31. A 42 year old P3 lady who is generally fit and well, non smoker, presented with AUB 1 year back and on evaluation was diagnosed to have EH without atypia. She opted for LNG IUS, as she does not want to have more children, however last 2 endometrial biopsies at 6 monthly intervals have shown no regression. What should the next option be?

32. A 45-year-old woman presents to GP with abdominal bloating. A blood test was performed for Ca125 which measures 1000 units/mL. She is referred to rapid access clinic (gynaecological oncology). A CT scan (chest, abdomen and pelvis) reveals a large abdominal mass possibly filled with mucin. The findings are suggestive of mucinous carcinoma. She undergoes staging laparotomy which reveals pre-operative rupture of the cyst with ascites and mucinous substance filling the abdomen. The histology is reported as mucinous carcinoma of the left ovary with rupture of cyst.What is the International Federation of Gynecology and Obstetrics (FIGO) stage in her case?

33.A 62-year-old woman is referred to rapid access clinic (gynaecological oncology) for postmenopausal bleeding (PMB). An ultrasound scan reveals thickened endometrium. Hysteroscopy and endometrial biopsy show Grade 1 endometrial cancer. A magnetic resonance imaging (MRI) scan was performed for staging which reveals cervical involvement. She undergoes total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO). The final histology reveals Grade 1 endometrioid carcinoma with less than half myometrial invasion and involvement of cervical glands.What is the FIGO stage in her case?

34. A 55-year-old woman is referred to rapid access clinic (gynaecological oncology) for PMB. An ultrasound scan reveals thickened endometrium and a solid ovarian mass on the left side. An endometrial Pipelle biopsy shows grade 1 endometrioid carcinoma. She undergoes TAH+BSO. Her Ca125 (150 units/mL) and inhibin B levels (100 ng/L) are elevated. She undergoes staging laparotomy (TAH+BSO, omentectomy, peritoneal biopsies and peritoneal washings and look around inside the abdomen).What would be the likely histological diagnosis of ovarian mass in her case?

35. A20-year-oldwomanpresentstoGPwithabdominaldistension.Sheisreferred to rapid access clinic (gynaecological oncology). Her Ca125 is 100, CEA, AFP, ß-HCG, LDH are normal. CT scan reveals a large solid mass arising from the left ovary with normal right ovary. She undergoes staging laparotomy with fertility preservation. The histology reveals immature grade 2 neural tissue. What is the histological diagnosis in this case?

36.A patient is noted to have symmetrical bilateral ovarian tumours which are removed. The histopathology report reveals tumour cells show signet ring morphology and raise the possibility that these represent metastasis rather than primary ovarian malignancy. Which is the most likely primary site?

37.CA-125 is tumour marker for Serous epithelial ovarain cancer . In what percentage of early stage disease , CA-125 is raised

38. postmenopausal lady presents with abdominal distension , early satiety, blasting sensation , loss of weight as well as vague pelvic pain .These symptoms are suspicious of ovarian cancer if they are persistent and frequent . What’s the frequency to tell them that these symptoms are frequent?

39. All are true regarding CA-125 except

40.What is the underlying etiology for proteinuria that is seen with preeclampsia?

41.Which of the following physiological responses is typically seen in preeclamptic patients?

42. In patient with preeclampsia, limited blood volume expansion  during pregnancy affects maternal cardiac function by which mechanism?

43.Which of the following leads to increased uric acid level in patients with preeclampsia?

44. What salutary effect does dexamethasone possibly have when used in the treatment of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome?

45. Antenatal use of nitroglycerin to control severe maternal hypertension can lead to whichof the following complication?

46. Which of the following is highest associated relative risk for placental abruption?

47. Which obstetrical condition can lead to significant consumptive coagulation?

48. All except which of the following are electrocardiogram changes seen in normal pregnancy?

49. A pregnant patient of 13 weeks gestation has known heart disease. All except which of following are predictive of poor outcomes in pregnancy?

50. An 18years old girl presented with c/o secondary amenorrhea. She previously had regular menses. She is also diagnosed with anorexia nervosa from last 1 year. Which of following is likely to be seen in this patient?