Benign gynae Flashcards Preview

Past MCQs > Benign gynae > Flashcards

Flashcards in Benign gynae Deck (55)
Loading flashcards...
1

Fibroids: All of the following statements are true except:

a - >20% of fibroids have a chromosomal abnormality
b - on cytogenetics a single fibroid comes from one single cell (not pleomorphic)
c - 20% of women develop a fibroid
d - MPA decreased mitotic activity in fibroids

a - >20% of fibroids have a chromosomal abnormality

MPA - medroxyprogesterone acetate

2

Red degeneration of a fibroid:

a- causes an elevation of the ESR
b - causes leucopaenia
c - only occurs in pregnancy
d- occurs due to embolisation of the feeding vessels

a- causes an elevation of the ESR

3

Regarding dermoid cysts:

A - the most common ovarian mass in pregnancy
B - 10% are malignant
C - 40-50% are bilateral
D - oophorectomy required for adequate removal

A - the most common ovarian mass in pregnancy

4

A 15 yr old girl presents with pelvic pain and an US shows a 4 cm ovarian cyst. What is the commonest cause?

A - Dermoid cyst
B - Follicular cyst
C - Corpus luteal cyst
D - Serous adenoma
E - Endometrioma

C - Corpus luteal cyst


Range in size from 2-5cm

5

A woman with PCO. LMP 25 days ago. Usually has 3 periods a year. Heavy flow day 10-12. Endometrium is likely to show?

A - subnuclear vascuolisation
B - haemorrhagic and necrotic glands
C - crowding of straight glands

C - crowding of straight glands

6

What is the rate of amenorrhoea in patients with intrauterine synechiae?

A - 10%
B - 20%
C - 40%
D - 60%
E - 80%

C - 40%

As per UpToDate

Can be caused by TB
Rx: hysteroscopic resection

7

What is the most common symptom of benign breast disease?

A - pain
B - tender lump
C - change in breast size
D - discharge
E - change in menses

B - tender lump

8

Advantages of GnRH agonist for the treatment of fibroids include all of the following EXCEPT:

A - allow vaginal hysterectomy
B - allow return of patient Hb towards normal before surgery
C - diagnostic test to distinguish between fibroid and leiomyosarcoma
D - allows hysteroscopic resection of fibroid
E - reduced intraoperative blood loss

C - diagnostic test to distinguish between fibroid and leiomyosarcoma

9

What percentage of fibroids will shrink with GnRH analogues?

A - 10%
B - 25%
C - 50%
D - 75%
E - 90%

C - 50%

10

After 6 months of GnRH analogues, how much reduction in uterine size would you expect?

A - 10%
B - 25%
C - 50%
D - 75%
E - 90%

C - 50%

11

The commonest cause of dyspareunia is

a- inadequate lubrication
b - thrush
c- psychosexual issues

a- inadequate lubrication

12

30 yo para 1 with a 3 yo child presents with menorrhagia and on VE there is a 12 week fibroid uterus palpable. She would like another child in the future. Management:

a - TAH
b - Myomectomy abdominally
c - GnRH analogue for 6/12
d - Continuous provera for 9/12
e - Hysteroscopic resection

d - Continuous provera for 9/12

Symptomatic management initially

13

Which of the following is correct in regard to premenstrual syndrome?

A - it is due to low progesterone level
B - bromocriptine is more effective than cyclical synthetic progesterone in treating PMS
C - cyclical progesterone showed no advantage over placebo in treating PMS
D - it is due directly to endogenous endorphin withdrawal
E - it is related to HLA B27 typing

C - cyclical progesterone showed no advantage over placebo in treating PMS

14

A woman had a NVD with an episiotomy and has been BF for 8 weeks. She presented complaining of dyspareunia. O/E the episiotomy is well healed. What is the most likely diagnosis?

A - suture granuloma
B - atrophic vaginitis
C - PND
D - Narrowed introitus

B - atrophic vaginitis

15

Midcycle spotting
A - E breakthrough
B - E withdrawal

B - E withdrawal

16

A 46 yo lady presented with severe menorrhagia for six months and clinical evidence of a tender enlarged uterus. What is your first investigation?

A - hysteroscopy and D&C
B - FBC
C - LH and FSH
D - Coagulation profile
E - Serum progesterone

B - FBC

17

A woman presented to you with lack of sexual excitement. What is the most likely reason?

A - fear of pregnancy
B - poor coital techniques
C - marital discordance
D - endometriosis
E - pelvic congestion syndrome

C - marital discordance

18

25 yo. O/E 5 cm simple cystic R adnexal mass confirmed on US. Mx?

A - repeat exam in 3/12
B - give OCP and repeat US in 1/12
C - laparotomy
D - laparoscopy and aspiration of cyst

A - repeat exam in 3/12

<50mm diameter - do not require f/u
- Likely physiological and almost always resolved within
50-70mm - yearly USS f/u

19

25 yo, 1 yr Hx acute virilizing symptoms
LH 2
FSH 3
Testosterone 2-3x normal
DHEAS normal
17 OHP Normal

A - Cushing’s syndrome
B - PCO
C - Late onset CAH
D - Sertoli-leydig tumour
E - Adrenal cortical adenoma

D - Sertoli-leydig tumour

20

43 yo, recent onset virilizing symptoms
LH 1
FSH 1
Test 2x normal
DHEAS 1.5x normal
17 HOP normal

A - Cushing’s syndrome
B - PCO
C - Late onset CAH
D - Sertoli-leydig tumour
E - Adrenal cortical adenoma

E - Adrenal cortical adenoma

21

22 yo, long Hx irregular menses and hirsuitism
LH 12
FSH 6
Test 1.5x normal
DHEAS 1.5x normal
17 HOP 2x normal

A - Cushing’s syndrome
B - PCO
C - Late onset CAH
D - Sertoli-leydig tumour
E - Adrenal cortical adenoma

C - Late onset CAH

22

22 yo long Hx irregular menses and hirsuitism
LH 1.9
FSH 6
Test 1.5x normal
DHEAS 1.5x normal
17 HOP normal

A - Cushing’s syndrome
B - PCO
C - Late onset CAH
D - Sertoli-leydig tumour
E - Adrenal cortical adenoma

B - PCO

23

47 yo has progressive menorrhagia with regular cycles. O/E uterus normal anteverted with no adnexal masses. Hysteroscopy – regular cavity, no pathology.
D&C – secretory normal endometrium.
Mx:

A - cyclic Progesterone
B - OCP
C - NSAIDS
D - Advise endoablation, compared to TAH is more effective and less complications
E - Advise endoablation is adequate contraception

A - cyclic Progesterone

24

How long does it take to stop heavy bleeding with GnRH analogues?

A - 12 hrs
B - 18 hrs
C - 1 week
D - 4 weeks

D - 4 weeks

Begins to work after 2 weeks

25

A woman has a regular period every 28 days. She has spotting around day 14 of her cycle. Which of the following is correct?

A - oestrogen BTB
B - progesterone BTB
C - oestrogen withdrawal bleeding
D - progesterone withdrawal bleed

C - oestrogen withdrawal bleeding

Fall in estrogen levels just before ovulation --> spotting

26

Fibroids. Which is true?

A - generally cause pain
B - increased in nulliparous women
C - 1% become sarcomatous

B - increased in nulliparous women

27

A 35 yo with menorrhagia and a 6 cm intramural fibroid wishes to become pregnant. Should she?

A - ignore fibroid and attempt to conceive
B - 3/12 of GnRH agonist then attempt to conceive
C - undergo myomectomy at laparotomy after GnRH analogue
D - undergo hysteroscopic resection of fibroid

A - ignore fibroid and attempt to conceive

There is insufficient evidence to determine whether myomectomy for IM fibroids improves fertility outcomes
>8cm associated with infertility, <5cm not major role

28

You have been asked to see a 22yo nulligravida who has oligomenorrhoea and idiopathic hyperprolactinemia. She desires pregnancy. Her physician initiated 2.5mg bromocriptine BD, and she is experiencing orthostatic symptoms and moderate nausea. Serum bHCG is negative, TSH normal and MRI normal. The most appropriate next step in her management is to

a. Advise her to continue bromocriptine and she will eventually become tolerant of the medication
b. Discontinue the bromocriptine
c. Reduce the dose to ½ tablet at bedtime until she becomes tolerant of the medication
d. Tell her to take an extra dose at bedtime

c. Reduce the dose to ½ tablet at bedtime until she becomes tolerant of the medication


1.25mg nocte for 5 nights, and gradually up titrate to 7.5mg daily in 2-3 divided doses over about 3 weeks

Common adverse effects:
- N/v, headache, postural hypotension, vertigo, GI disturbance
- Minimised by taking at night and then taking tablets with food

29

A 22yo woman has had severe hirsutism for 7 years and oligomenorrhoea since menarche. Her sister has mild hirsutism and uses the COCP. She is 1.5 metres tall and weighs 50kg. Pelvic examination shows borderline clitoromegaly but is otherwise normal. Hormone profile shows
LH 19 [5-25]
FSH 6 [4-22]
Testosterone 3 [0.5-2.6]
DHEAS 21 [0.9-11.7]
17-OH progesterone 16 [0.8-8.0]

The MOST LIKELY diagnosis is:
a. PCOS
b. Ovarian hyperthecosis
c. Late onset CAH
d. Androgen secreting adrenal tumour
e. Androgen secreting ovarian tumour

c. Late onset CAH

30

Which of the following drugs is NOT associated with non-androgen dependent hair growth (hypertrichosis)

a. Phenytoin
b. Cyclosporin A
c. Ranitidine
d. Diazoxide

c. Ranitidine