General Gynaecology Extra Questions Batch A – MCQ

1. Which of the following is a selective progesterone receptor modulator?

2. Medical management of fibroids is best indicated when

3. The incidence of chronic pelvic pain in women of reproductive age group is:

4. The commonest pathology identified at diagnostic laparoscopy in patients with chronic pelvic pain is:

5. The incidence of adnexal pathology detected for the first time in pregnancy is:

6. The preferred period for intervention for an ovarian mass in pregnancy is:

7. Pick the correct statement regarding management of ovarian cysts in pregnancy.

8. A 45-year-old woman presents with right-sided nipple discharge. Clinical examina- tion and mammography showed no abnormalities. Which one of the following is the next most appropriate action?

9. Which one of the following is correct in relation to polycystic ovarian syndrome, PCOS?

10. Obstetric outcomes in pregnancy after uterine artery embolisation—which of the following is not true?

11. A 14-year-old girl presents in the gynaecology OPD with a history of irregular bleeding per vaginam for the last 4–5 months. She has been rather stressed out with her school and theatre group activities which is adversely affecting her routine life and cannot recollect her dates or menstrual pattern well.She was on the pill for the past year. Of late she has loss of appetite with nausea and vomiting and fullness of the lower abdomen. She has lost weight in the last 3 months due to poor food intake. On examination vesicles are seen in the vagina close to the external cervical os. What is the most likely clinical diagnosis?

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 finding. 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?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. XY, 22 years old, has recently been diagnosed with PCOS. Her BMI is 23. Her modified GTT was normal. She has very irregular oligomenorrheic cycles. She is extremely anxious about her general health and the risk of cancer. She is not plan- ning a pregnancy in the near future. She suffers from migraines. Which of the fol- lowing treatment options are best suited to her?

15. XY is 35 years old with a Mirena IUD in situ. She presents to the colposcopy clinic with her latest smear showing Actinomyces-like organisms (ALO). She com- plains of pelvic pain, deep dyspareunia and vaginal discharge for a week. She is not sexually active presently.

Which of the following treatment options are best suited to her?

16. Which of the following statements is true about endometrial polyps?

17. A 45-year-old woman with a BMI of 48 is requesting for a hysterectomy in order to have a permanent solution to her menorrhagia. She has been having heavy bleeding since the last 5–6 months and her haemoglobin is 100 g/L. Her colleague at work had a hysterectomy 6 months back for long-standing menorrhagia, and she is relieved after the surgery, so she also wants to have the operation as soon as possi- ble. You are reluctant to plan a surgery right away as there are serious risks associ- ated with surgery in obese women. Which of the following approach is not recommended?

18. A 26-year-old woman presents to her OPD with complaints of dyspareunia. She has been having a painful period for the past 1 year, and the pain has increased lately. She has some vaginal discharge which is not foul smelling or associated with pruri- tus. She also complains of becoming irritable during her periods in the past few months. Speculum examination reveals the presence of blue nodules in the vagina. What is the most likely diagnosis?

19. During embryological development of the normal female reproductive system in humans, which of the following does not occur

20. Some procedures are recommended while conducting a routine gynaecological examination. Which of the following is not appropriate?

21. The reported incidence of psychosexual disorders in women attending gynaecology clinics is around:

22. Women with premature ovarian insufficiency are not at increased risk of:

23. A 26-year-old woman presents to her GP complaining of new onset vaginal discharge. She is sexually active and uses condoms for protection against STIs although she has been regularly using the pill for the last 6 months. She has had 2 partners in the last 6 months. She is particularly worried because she has had spotting per vaginam after sexual intercourse in the last few weeks. Her Pap smear done last year was normal. Speculum examination reveals the presence of an erythematous raw-looking cervix.What is the most likely diagnosis?

24. From an outflow tract perspective, the only uterine anomaly that may cause a prob- lem is:

25. A worried mother gets her 16-year-old girl to her GP. She is concerned that her daughter has not as yet commenced her periods. On examination there is poor development of secondary sexual characters, cubitus valgus, evidence of webbed neck and short stature. Which of the following investigations will help you confirm the diagnosis?

26. In the use of SSRI/SNRIs for treatment of severe PMS, all of the following statements are true except:

27. A 43-year-old woman is having a diagnostic hysterolaparoscopy as part of the investigations for abnormal uterine bleeding. During laparoscopy, you see an ovarian cyst in the left ovary which is possible for an endometrioma.

You have taken consent only for diagnostic hysterolaparoscopy. What is the most appropriate course of action?

28. Of the following complementary therapy options, choose the one with evidence of effect in the treatment of premenstrual syndrome:

29. Of the following complementary therapy options, choose the one with evidence of effect in the treatment of premenstrual syndrome:

30. A 53-year-old woman who is amenorrheic for the past 1 year complains of vaginal dryness, superficial dyspareunia and urinary urgency. She has been treated for uri- nary infection 2 months back, and there is no active urinary infection now although symptoms persist. She has been on HRT for the past 6 months due to severe palpita- tions, hot flushes and night sweats, and she is relieved of those symptoms.

Which of the following statements is appropriate for her?

31. 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?

32. A 40-year-old woman with BMI 32 kg/m2 is referred to the gynae- cology clinic with secondary amenorrhoea. She has two children and her partner had a vasectomy 5 years ago.
An ultrasound scan is performed, which shows a normal uterus with endometrial thickness 6 mm. Both ovaries have a typical polycystic appearance. What would be the recommended management?

33. A 55-year-old woman attends the gynaecology clinic. She is suffer- ing with terrible menopausal symptoms and cannot sleep because of the frequency of hot flushes. She is requesting hormone replacement therapy (HRT) for symp- tom relief. She is currently healthy but has a history of a deep venous thrombosis in her calf following a fractured femur as a result of an accident 10 years ago.

Her last menstrual period was 2 years ago and her uterus is intact. What would you recommend?

34. A woman opts to take oral continuous combined HRT for 5 years after the menopause. In which year of HRT use will her risk of venous thromboembolism (VTE) be greatest?

35. What is the karyotype of a woman with Mayer–Rokitansky– Kuster–Hauser (MRKH) syndrome (mullerian agenesis)?

36. A 20-year-old girl attends the gynaecology clinic with her mother. She presents with primary amenorrhoea. On examination she is tall with a BMI of 19 kg/m . She has normal breast development, but a short blind-ending vagina. There is no axillary or pubic hair.

What is the most likely diagnosis?

37. 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?

38. A 42-year-old woman with oligomenorrhoea and hirsutism presents to the gynaecology clinic. She recently had a prolonged episode of vaginal bleeding, but an ultrasound scan and endome- trial biopsy performed in primary care both reported normal results. She is obese with a BMI of 40kg/m . She has mild hypertension but does not require antihypertensive therapy. She has no other medical problems. Her father suffered from Type 2 Diabetes mellitus. What further investigation is required?

39. A 35-year-old woman attends the gynaecology clinic complaining of worsening HMB. Investigations have been performed in primary care. Her haemoglobin level is 123 g/l and a pelvic ultrasound scan showed no obvious abnormality. What is the most appropriate first-line pharmacological treatment?

40. What percentage of women experience severe premenstrual symptoms?

41. 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?

42. 70-year-old woman undergoes a dual-energy X-ray absorptiom- etry (DXA) scan to assess her bone mineral density. What T score is diagnostic of osteoporosis?

43. What is the mode of action of bisphosphonates?

44. What is the most common side effect of bisphosphonates?

45. Raloxifene is a selective oestrogen receptor modulator.

What kind of action does this drug have on the endometrium, breast and bone?

46. A 29-year-old woman presents with a constant ongoing pain in the pelvis.

The pain does not occur exclusively with menstruation or inter- course and the woman is not pregnant.For what minimum duration should the pain occur before it is deemed chronic?

47. An 18-year-old girl presents with chronic lower abdominal pain. In what percentage of patients attending a gynaecology outpatient clinic with lower abdominal/pelvic pain would you expect to find irritable bowel syndrome (IBS)?

48. A 24-year-old girl attends the gynaecology clinic with persistent pain over her Pfannenstiel scar that has not settled since her cae- sarean section of 6 months.

What is the incidence of nerve entrapment (defined as highly localised, sharp, stabbing or aching pain, exacerbated by particular movements and persisting beyond 5 weeks or occurring after a pain free interval) after one Pfannenstiel incision?

49. A 22-year-old girl presents with lower abdominal pain, which is cyclical in nature.Which modality is the only way to reliably diagnose peritoneal endometriosis?

50. An 18-year-old girl with pelvic pain presents to the gynaecology outpatient clinic.
An ultrasound scan is arranged, which demonstrates a normal pelvis. Hormonal treatment is discussed with the girl.How long should she persist with this therapy before contemplat- ing a laparoscopy?