General Gynaecology Extra Questions Batch B – MCQ

1. What proportion of the female adult population will complain of chronic pelvic pain?

2. A 19 year old has been seen in the gynaecology clinic with abdom- inal pain, which improves with defecation. It is associated with change in frequency of stool and change in form, for at least 3 days per month in the past 3 months. What are the criteria used to define IBS?

3. A 21 year old presents to the gynaecology outpatient clinic with pelvic pain. The general practitioner referral suggests possible endometriosis. What is the estimated prevalence of endometriosis in women of reproductive age?

4. A 15-year-old girl is seen in the paediatric gynaecology clinic due to persistent vaginal discharge.
Examination reveals the following: Partial removal of the clitoris and the prepuce is noted. The hymen is intact. The possibility of female genital mutilation (FGM) is raised. What type of FGM is this?

5. A 21 year old who complains of superficial dyspareunia is seen in the gynaecology clinic. She has just started her first ever sexual relationship.
On examination, the following features are noted:
Normal vulva and vagina. Clitoris is intact. A piercing is noted in the right labium minorum.
What type of FGM is this?

6. A 33-year-old woman is newly arrived in the United Kingdom from Africa and is complaining of dyspareunia. How many women undergo FGM each year according to WHO estimates?

7. A 24 year old has been seen in the antenatal clinic and is known to have undergone FGM. The lead midwife and health visitor are aware that any female offspring will be at risk of undergoing FGM. What is the estimated number of children in the United Kingdom that are considered to be at risk of this each year?

8. 13 year old attends the Accident & Emergency department with bleeding, pain and urinary retention following a recent FGM. Which vaccine would you advise the patient to receive?

9. What is the most common cause of central precocious puberty (CPP) in girls?

10. A 47-year-old Para 3 who has had three previous vaginal deliv- eries presents with a history of HMB that has not responded to medical treatment or the levonorgestrel-containing intrauterine system (LNG-IUS). The patient was offered endometrial ablation but declined.

On examination, the uterus is bulky, no masses palpable in the adnexa and the cervix descends to about 2 cm above the hymenal ring. An ultrasound confirms the physical examination findings. What is the most appropriate treatment option?

11. An asymptomatic postmenopausal woman is diagnosed with a simple unilateral unilocular cyst with a diameter of 4.5 cm. Her serum CA125 is 10 iu/l.

What is the most appropriate first line of management?

12. Theprevalenceofovariancystsinpremenopausalwomanishigher than that in postmenopausal women; 35% versus 17% respectively.A premenopausal woman presents with an asymptomatic 4.5 cm simple cyst in the left ovary with a serum CA125 of 18 iu/l.

What would be the recommended management plan?

13. A 40-year-old woman complains of burning and stinging in the vulva. There is no clinically identifiable neurological condition and there are no relevant visible findings.

What is the most likely clinical diagnosis?

14. A women diagnosed with localised unprovoked vulvodynia has had no relief from her symptoms despite practising good vulval care and using topical treatments which included lidocaine oint- ment and gabapentin.

What is the next line of management?

15. Community-based surveys indicate that about one-fifth of women have significant vulval symptoms.Symptoms and signs of vulval skin disorders are common and include pruritus, pain and changes in skin colour and texture. What is the most common vulval disorder seen in a hospital setting?

16. Lichen sclerosus accounts for at least 25% of the women seen in dedicated vulval clinics, with estimates of incidence quoted as 1 in 300 to 1 in 1000 of all patients referred to dermatology departments. What is the pathognomonic histologic feature of lichen sclerosus?

17.A 60-year-old woman presents with vulval itching with no relief with scratching. On examination the skin appears fragile, with well demarcated white plaques. There is no involvement of the vagina or the oral mucosa. What is the most likely diagnosis?

18. A woman with biopsy-proven lichen sclerosus is not responding to topical ultra-potent steroids. What is the second line of treatment?

19. A 25-year-old smoker is diagnosed to have mild dyskariosis in her index smear at the GP surgery. The smear is HPV negative. What is the ideal management?

20. A 40-year-old woman attends for a consultation in primary care complaining of HMB. She is otherwise fit and well and examina- tion is unremarkable.

What investigation should be undertaken?

21. Following referral to secondary care for HMB, a 38-year old woman undergoes pelvic examination, which confirms that the uterus is palpable abdominally. What is the first line diagnostic test to identify structural abnor- malities in this situation?

22. A 39-year-old woman presents to the gynaecology clinic with HMB and dysmenorrhoea. She is otherwise fit and well.Pelvic examination is unremarkable. She is not keen on hormonal methods of treatment. What treatment would you initially recommend?

23. A 38-year-old woman is seen in the gynaecology clinic. She pre- sented with HMB.

History and examination are unremarkable and she is commenced on tranexamic acid, to be taken during menstruation only. Should this treatment ultimately prove to be ineffective, for how many cycles should she have tried it to come to this conclusion?

24. During investigation for HMB, a 42-year-old woman is found to have a 3 cm submucus fibroid. She is otherwise fit and well. Her husband has had a vasectomy. She does not wish to try pharmaceutical treatments.
What would you recommend?

25. A 55-year-old woman attends the general practitioner surgery with abdominal distension, low abdominal pain and urinary urgency. Abdominal examination is unremarkable and urine dipstick is negative. What investigation should be performed?

26. What screening test should be offered to all sexually active women who present to the gynaecology clinic with chronic pelvic pain?

27. 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?

28. Following a diagnosis of anogenital lichen sclerosus, a 70-year-old woman returns to clinic as topical potent steroids have not been effective in controlling her symptoms. The recommended second-line treatment is Tacrolimus. Which cell type of the immune system has its response suppressed by this drug?

29.Which progestogen has been shown to be effective in cases of PMS?

30. A 58-year-old postmenopausal woman presents for HRT counselling. While questioning her about her health, you ask her about the risk factors for osteoporosis from the fracture risk assessment (FRAX) tool, which is used to determine which individuals warrant further evaluation for osteoporosis by bone mineral density testing.

Which of the following is not part of the FRAX tool?

31. A 56-year-old woman with a BMI of 38 and type 2 diabetes mellitus presents with daily dark brown staining on her underwear for the past week. She underwent menopause at age 53 and has had no further bleeding or discharge since that time. ere has been no vaginal or vulval trauma, and her cervical smear test 6 months previously was normal. On examination her cervix appears normal and there is no evidence of external haemorrhoids. A urine dipstick test is negative for blood.

What is the next best step in the management of this patient?

32. A 39-year-old para 2 presents with a 3-year history of heavy painful periods in a 7/28 cycle. e onset of the heavy bleeding started a er her laparoscopic tubal occlusion. She has a BMI of 39 and currently smokes 10 per day. She is also known to have type 2 diabetes and is hypertensive on beta blockers.

What is the most appropriate management option?

33. A 35-year-old para 3 underwent a TAH+BSO for severe pelvic endometriosis that had not responded to medical and conservative surgical treatment. She attends for her follow-up appointment complaining of hot ushes and sweating.

Which HRT regime should you consider?

34. A 17-year-old girl presents with crampy lower abdominal pain which radiates to her legs. For the past year the pain has coincided with the rst 3 days of her menses. She is not sexually active. Her history and general examination are unremarkable.

What is the optimum management approach?

35. A 25-year-old patient presents with sudden-onset LIF pain associated with nausea and vomiting. She is sexually active, uses the Mirena intrauterine contraceptive device for contraception and is otherwise healthy. On examination she is tachycardic, and abdominal examination demonstrates tenderness over LIF with no rebound. Pelvic examination shows a normal cervix with no abnormal discharge, but

fullness and tenderness on the le urine pregnancy test is negative.
What is the most likely diagnosis?

36. A 28-year-old para 3 presents with vulval pruritus and burning. She reports dyspareunia and copious foul-smelling green vaginal discharge. On examination there is erythema of the vulva as well as petechiae of the upper vagina and cervix.

What is the most likely diagnosis?

37. A 25-year-old para 0, who has recently become sexually active, is complaining of new onset vulval pain. She describes pain with light touch, particularly on intercourse and when using tampons, and she localizes it to around the vulva. e pain is not present at other times. She does not report any itching, soreness or unusual discharge.

What is the most likely diagnosis?

38. You are seeing a 62-year-old patient for a follow-up visit. You evaluated her for fracture risk 2 weeks ago and, given that she has high risk for fracture, you sent her for a DEXA scan. Her T score for bone mineral density in the hip was less than −2.5 and the thoracic spine less than −2.0. She has no secondary causes of osteoporosis, has not been on glucocorticoids recently, is a nonsmoker, and does not drink alcohol.

ere is no dysphagia, and she is able to sit upright for 1 hour a er taking medications. It is determined that she should be placed on a bisphosphonate for treatment of her osteoporosis of the hip.
Whichofthefollowingdoesnota ecttheriskoffractureofthehip?

39. 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.Atransvaginalultrasoundshowsanormaluterusandle ovary,butthe right ovary measures 7 × 5 cm with cystic and solid components as well as with calci cation. Colour ow Doppler is inconclusive.

What is the next best step in the management of this patient?

40. Which of the following has been shown to contribute to surgical patients’ enhanced recovery?

41. Considering prophylactic oophorectomy at the time of hysterectomy for benign disease: Atwhatageistherenosigni cantdi erenceinsurvivalinwomenatlow/ average risk for ovarian cancer?

42. A 25-year-old patient su ers 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 a er menstruation ceases.

Which of the following would be the best rst-line management?

Explanation: Second-generation combined oral contraceptive pills do not show any improvement in premenstrual syndrome (PMS) symptoms, because the daily progestogen in the second-generation pills (e.g. levonorgestrel or norethisterone) reproduces PMS-type symptoms. Fluoxetine is associated with a more rapid improvement but, at follow-up, CBT has been associated with better maintenance of treatment e ects compared with uoxetine. Luteal phase and continuous dosing with SSRIs can be recommended, and there are data to suggest that improvement of symptoms with luteal-phase dosing continues into the postmenstrual phase. B6-related peripheral neuropathy can occur with high doses of B6 so the daily dose should be limited to 10 mg. Danazol is e ective, although its use is limited because of its potential irreversible virilizinge ect.

Reference: Royal College of Obstetricians and Gynaecologists (2007). Management Green-top Guideline No. 48. Premenstrual syndrome. London

43. A 29-year-old patient is undergoing a laparoscopic ovarian cystectomy for endometriosis. She is 170 cm tall and weighs 70 kg. Which antibiotic regime should be adopted to reduce surgical site infection?

44. A 24-year-old patient presents with vulval itching, soreness, vaginal discharge, and occasional dysuria. She has had thrush treatment at least five times over the previous 12 months for similar symptoms, with genital swabscon rmingthediagnosis.Avaginalswabofvaginaldischarge collected from the anterior fornix showed spores/pseudohyphae.The recommended management approach is?

45. A 16-year-old girl presents with primary amenorrhoea. She has reached Tanner V breast and pubic hair development and, on pelvic examination, there is a blind ending vagina. e karyotype shows 46XX.
What is the most likely diagnosis?

46. A 12-year-old girl presents to the A&E department with lower abdominal pain. On examination there is a large pelvi-abdominal mass. Transabdominal ultrasound scan shows bilateral solid ovarian tumours.
What is the most likely diagnosis?

47. In operative hysteroscopy, fluid distension is preferred above gas so that :

48. In operative hysteroscopy, which of the following distension mediahas a risk of hyperglycaemia in fluid overload?

49. A 70-year-old Caucasian patient was referred with a 2-year history of vulval and vaginal soreness unrelieved by vaginal oestrogen. She also reports recent onset dyspareunia, both superficial and deep. On further questioning she describes constipation, dysuria and both oral inflammation and ulceration. e examination con rmed oral ulceration and a white lacy pattern on the vulva. e vagina was very erythematous with a narrowed introitus and thin lmy adhesions to the mid-third.The examination was extremely painful.What is the most likely diagnosis?

50. A 25-year-old para 2 presents with a 4-year history of progressive facial hirsutism and increasingly irregular periods. She had menarche at the age of 8. On examination she has moderately severe hirsutism on the face and chin and was not Cushingoid in appearance. Her BP was

136/83 mm Hg and her BMI was 23.3 kg/m . She reports that she was a tall child and volunteered that she has always had a small vaginal introitus with clitoromegaly and, since puberty, a high libido.

What are you likely to nd in her laboratory blood tests?