Sba 2 Gynecology Flashcards by Siba Kherbek

A22-year-old woman was seen in the GUM clinic with Chlamydia trachomatis infection.
What would be regarded as the most suitable treatment for this patient?

Appropriate antimicrobial therapy such as a single dose of oral azithromycin 1g, partner
notification, advice to abstain from sex (including oral) until both index case and current
partner have been treated and for 1 week thereafter even when treated at the same time
and relevant health education
* no need for re-testing

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A23-year-old woman presents with acute onset of
lower abdominal pains of 5days duration. These symptoms started 5days after unprotected sexual intercourse. Shealso complained of a vaginal discharge and right upper abdominal pain. Shehas a temperature but does notsuffer from rigors. You examine and find lower abdominal tenderness and cervical motion tenderness. You suspect that she has Chlamydia salpingitis and perihepatitis and have sent swabs for testing. What firstline treatment should she be prescribed?

Doxycycline 100mg bd and metronidazole 400mg four times a day for 14days
* An alternative
to this regimen is combining metronidazole with ofloxacin (400mg twice daily)

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You have seen a 23-year-old woman presenting to the Gynaecology Emergency Unit
of your hospital with dysuria and a urethral discharge. You suspect that she may have
Chlamydia trachomatis genital infection. What would be the most appropriate action to
take in her management?
A. Give her 1g azithromycin as a single dose after obtaining specimens for NAAT and culture
B. Obtain endocervical swabs for NAAT and culture and sensitivity and then give 1 g
azithromycin as a single dose but review with sensitivity result
C. Obtain urethral swabs for diagnosis with NAAT and then give 1g azithromycin as a single
dose
D. Obtain urine sample for NAAT and await rapid result and then give 1g azithromycin as a
single dose
E. Obtain vaginal swab for diagnosis with NAAT and then give 1g azithromycin as a single dose

Give her 1g azithromycin as a single dose after obtaining specimens for NAAT and culture
* Itis recommended that treatment is initiated without waiting for laboratory confirmation of infection in patients with symptoms and signs of chlamydia infection and their sexual partners.

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What is the risk of laparotomy following a laparoscopic tubal occlusion procedure?
A. Up to 1in 1000
B. Up to 2in 1000
C. Up to 3in 1000
D. Up to 4in 1000
E. Up to 5in 1000

Up to 3in 1000

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What is the definition of UKMEC Category 2?

Acondition where the advantage of using the method generally outweighs the theoretical
or proven risks

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What is the definition of UKMEC Category 4?

A condition in which the risks of using the contraceptive method are minimal
but acceptable to the woman provided she understands the risks involved.)

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A45-year-old mother of three had a copper intrauterine device (Cu-IUD) inserted 4 months
ago for contraceptive purposes. Since then, she has suffered from spotting and sometimes
heavier and longer bleeding periods. Shehas attended because she is frustrated and wants
to have the device removed. What would be the most appropriate step to take in this woman?

Reassure her and reassess in 2months if the bleeding continues

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A51-year-old woman who is on the combined oral contraceptive pill (COCP) is seen for
follow-up. Shehas been on the combined pill for the past 7years. What advice will you
give her?
A. To change to another method such as the Mirena®, POP or implant
B. To change to a barrier method
C. To continue with this for another 2years if she is using a low-dose COCP
D. To stop and check her estradiol levels
E. To stop and check her FSH levels

To change to a barrier method
* women over 50years should be advised to switch to an alternative method such as POP, LNG-IUS or barrier method until the age of 55years or until menopause can be confirmed

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A 48-year-old woman was seen in the Gynaecology Clinic with severe menopausal
symptoms. Shehad been amenorrhoeic for 6months. Following counselling she opted
for HRT in the form of estrogens only tablets but chose the LNG-IUS for endometrial
protection. How long is this device licensed for use in endometrial protection in this
woman?

4years
* but may be used off license for up to 5years.

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4years
* but may be used off license for up to 5years.

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What percentage of those presenting to Early Pregnancy Units have ectopic
pregnancies?

2-3%
* the incidence of ectopic pregnancy is approximately 11/1000 pregnancies

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A30-year-old woman presents with symptoms highly suggestive of an ectopic pregnancy.
Atransvaginal ultrasound scan is performed. What is the most common ultrasound finding in those with an ectopic pregnancy?

An inhomogeneous or non-cystic adnexal mass ( 50-60%)
* An empty extrauterine gestational sac will be present in around 20%–40% of cases

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Adiagnosis of a cervical pregnancy has been made in a 36-year-old woman who had two
previous normal deliveries. Serum β-hCG has been quantified to help plan for her management. Atwhat β-hCG level will there be a decreased chance of successful treatment
with methotrexate?

Greater than 10000IU/L

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Alaparoscopic salpingotomy was performed on a 32-year-old woman who has a fertilityreducing factor (previous ectopic pregnancy treated by salpingotomy). What follow-up
monitoring will you recommend for this woman?

Serum β-hCG on days 7 after surgery and then weekly until negative
* No day 4 testing

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A24-year-old woman diagnosed with an ectopic pregnancy has elected to have treatment
with methotrexate. Shehas been given 50mg/m2 of the cytotoxic drug. What would be the
estimated success rate of a single-dose injection of methotrexate in this woman?

65%–95%
* with 3%–27% of women requiring a second dose

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What is the most common gynaecological cancer in the UK?
A. Cervical
B. Choriocarcinoma
C. Endometrial
D. Ovarian
E. Vaginal

Endometrial

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You performed an endometrial biopsy on a 60-year-old postmenopausal woman who was
referred to the Gynaecology Clinic by her GP with a 1 week history of vaginal bleeding. Thehistology report is negative for pathology. Inapproximately what percentage of
women like her will the diagnosis of endometrial hyperplasia be missed with outpatient
endometrial biopsy?

2%
* Outpatient endometrial biopsy is convenient and has a high overall accuracy for diagnosing endometrial cancer. Theaccuracy for hyperplasia is more modest

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A38-year-old woman who is known to have polycystic ovary syndrome is seen in the
clinic with 9months amenorrhoea. Atransvaginal ultrasound scan shows a 6-mm-thick
but regular endometrium. What recommendation would you offer this patient?
A. Commence on progestogens
B. Commence on the combined oral contraceptive pill
C. Hysteroscopy and biopsy
D. Outpatient endometrial biopsy
E. Reassure and rescan in 6months

Commence on progestogens
* Studies have failed to identify pathology in women with endometrial thickness of less than 7mm

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You saw a 63-year-old woman with postmenopausal bleeding of 1 week duration in the
gynaecology clinic. Apipelle endometrial biopsy was performed and reported as hyperplasia without atypia. An ultrasound was ordered, and the report is as follows: ‘normal
size uterus with a thickened endometrium, which measures 5mm in its widest diameter.
Thereis a right ovarian cyst, which measures 6×7 cm. Thereis no increased vascularity
around the cyst wall on colour Doppler’. What will be the next step in her management?
A. Arrange a diagnostic laparoscopy
B. Arrange insertion of the levonorgestrel intrauterine system
C. Commence her on progestogens– oral
D. Discuss a hysterectomy and bilateral salpingo-oophorectomy
E. Obtain blood for ovarian tumour markers test

Obtain blood for ovarian tumour markers test
* possibility of an oestrogen secreting granulosa tumour of the ovary.
If an ovarian cyst is detected on pelvic USS, then blood for tumour markers should be obtained.

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What will you recommend as the first-line treatment for a 55-year-old woman diagnosed with endometrial hyperplasia without atypia following a pipelle endometrial
biopsy?
A. Dihydrogesterone 10–20mg daily
B. Medroxyprogesterone acetate 10–20mg daily continuously
C. Norethisterone acetate 10–15mg daily
D. Sequential medroxyprogesterone acetate 10mg
E. Thelevonorgestrel intrauterine system (Mirena)

Thelevonorgestrel intrauterine system (Mirena)

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A48-year-old woman presents with irregular and heavy bleeding of 6months duration.
Her BM is 32kg/m2. An endometrial biopsy is performed and this has been reported as
hyperplasia with atypia. What will be the first treatment option you will recommend for
this patient?
A. Hysterectomy and bilateral salpingectomy
B. Thelevonorgestrel intrauterine system
C. Thelevonorgestrel intrauterine system and sixmonthly endometrial biopsies
D. Total hysterectomy
E. Total hysterectomy and bilateral salpingo-oophorectomy

Total hysterectomy and bilateral salpingo-oophorectomy

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You are running a routine Gynaecology Clinic when a couple attend with fertility problems. Approximately what proportion of heterosexual couples in the UK present with
infertility?

1:7

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You have seen a 28-year-old woman with her 30-year-old partner in the clinic complaining of difficulties in achieving a pregnancy despite 2years of unprotected sexual intercourse. Inwhat proportion of such couples will the infertility be unexplained?
A. 10%
B. 20%
C. 25%
D. 30%
E. 40%

25%

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. A30-year-old woman is seen in the clinic having tried for 12months to become pregnancy unsuccessfully. Sheand her partner are investigated and no obvious cause for the
infertility is found. What would the recommendation for this couplebe?
A. Consider inducing ovulation and artificial insemination with husband’s semen
B. Consider inducing ovulation with clomifene citrate
C. Consider inducing ovulation with gonadotrophins
D. Refer for IVF
E. To continue trying for another 12months after which they will be referred for IVF

To continue trying for another 12months after which they will be referred for IVF
* 2 years before referral to IVF

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A couple visited the Infertility Clinic for counselling and management. The man is unable to have penetrative sexual intercourse and it was decided that they would best be managed by artificial insemination. Which type of insemination will give the best outcome (in terms of pregnancy) for the couple? A. Intracervical insemination with fresh sperm B. Intracervical insemination with frozen-thawed sperm C. Intrauterine insemination with fresh sperm D. Intrauterine insemination with frozen-thawed sperm E. Intravaginal insemination with either fresh or frozen-thawed sperm

Intrauterine insemination with fresh sperm

A 38-year-old woman presents with suprapubic pain related to her bladder and associated with urgency and nocturia. The pain is described as burning in nature. A urine sample is obtained for dipstick test and the result is positive for protein and leucocytes. A sample of the urine is sent for culture and this yields sterile pyuria. What would be the next investigation for this woman? A. Biopsy of the bladder for histology B. Cystoscopy C. Repeat urine culture D. Ultrasound scan of the kidneys and bladder E. Urine culture for acid-fast bacilli

Urine culture for acid-fast bacilli * To confirm a diagnosis of TB or other mycobacterial infection. But it takes 6-8 weeks to grow enough bacteria

A 40-year-old woman is referred by her GP to the urogynaecology unit with what is most likely bladder pain syndrome. What factor at her first consultation is likely to have the greatest impact on her chances of complete recovery at follow-up? A. A favourable rating of the initial consultation B. Counselling on the course of the condition C. Effectiveness of the treatment offered and accepted D. The duration of her symptoms E. The thoroughness of the history and investigations

. A favourable rating of the initial consultation

A 37-year-old woman was diagnosed with bladder pain syndrome (BPS) 9 months ago and started on conservative measures. She has had various combinations of these measures including paracetamol for her pain but remains refractory to treatment. What would be the next approach to her management? A. Intravesical injection of botulinum toxin A (Botox) B. Intravesical lidocaine C. Neuromodulation D. Oral cimetidine E. Oral amitriptyline

Oral amitriptyline Also cimetidine is considered to be a first line treatment but is not licenced

What is the estimated proportion of women in the reproductive age who suffer from premenstrual syndrome (PMS)?

40% (2 in 5)

A 30-year-old woman has been suffering from depression and mood swings which she feels are related to her periods for the past few years. These issues have a significant impact on the quality of her life. The GP has referred her to the Gynaecology Clinic for assessment and treatment. What is required to help make the diagnosis of PMS in this patient? A. A detailed history demonstrating the relationship of the symptoms with the luteal phase of the menstrual cycle and how these impact on her daily activity B. Completing the premenstrual Symptoms Screening Tool (PSST) over a 2-month period C. Prospective recording of symptoms in a diary such as the Daily Record of Severity of Problems (DRSP) over two cycles D. Retrospective diary of her symptoms at the clinic visit E. Thorough history to exclude other causes of her symptoms prior to making a diagnosis, which is based on exclusion

Prospective recording of symptoms in a diary such as the Daily Record of Severity of Problems (DRSP) over two cycles

A young Librarian has been referred to the clinic with symptoms suspicious of PMS. A review of her 2 months prospectively completed symptom diary is not conclusive with respect to the diagnosis of PMS. What should be the next step in her evaluation? A. Commence her on the combined oral contraceptive pill (if there are no contraindications) for 3 months and then reassess her symptoms B. Commence her on Danazol 200 mg daily for 3 months and then reassess her symptoms C. Commence her on a GnRH agonist for 2 months and then reassess her symptoms D. Commence her on a GnRH agonist for 3 months and then reassess her symptoms E. Give a diagnostic trial of an SSRI for 3 months and review her response to the treatment

Commence her on a GnRH agonist for 3 months and then reassess her symptoms * Symptom diaries can sometimes be confusing and inconclusive * These should be used for 3 months to establish a definite diagnosis. This is to allow a month for agonist to generate a complete hormonal suppressive effect as well as providing a 2 months’ worth of symptom diaries

What is the estimated incidence of ovarian cysts in postmenopausal women?

5% -17%

A 60-year-old woman presents with a sudden onset lower abdominal pain for the past 24 h. She has otherwise been well. She has had two normal vaginal deliveries, the last of which was 20 years ago. She was examined and suspected to have a right ovarian cyst. What would be the initial assessment of this woman?

Pelvic ultrasound scan and CA125 (T) * No need to other Tumer markers

GP sees a 59-year-old postmenopausal woman in the surgery with lower abdominal pain of sudden onset. She examines her and suspects a pelvic mass. When should she refer this woman urgently to specialist services? A. An adnexal mass is palpated to be approximately 6 cm in diameter B. An adnexal mass is palpated to measure approximately 10 cm in diameter C. She is confirmed on clinical examination to have an abdominal mass D. She is confirmed on clinical examination to have a pelvic mass E. She is confirmed on clinical examination to have a mass with fixed nodularity

She is confirmed on clinical examination to have a mass with fixed nodularity

What is the estimated percentage of the calculated typical blood volume lost in the acute phase of severe OHSS in a 30-year-old woman who has undergone ovarian hyperstimulation and egg retrieval?

20 %

A 32-year-old woman underwent superovulation with a gonadotrophin and developed OHSS. When will this OHSS be classified as early onset?

Onset within 7 days of hCG trigger * ( Not 24h)

You are operating with your consultant and a Foundation Year 1 doctor on a difficult abdominal hysterectomy for endometriosis. The uterus has been removed but you stick the needle accidentally into the finger of the Foundation Year doctor. PEP has been prescribed for him. How long should he or she take PEP for?

post exposure prophylaxis should be continued for 28 days * within 72 hours (3 days) after a possible exposure to HIV to prevent HIV

You have seen a 19-year-old girl with a history highly suspicious of a pelvic inflammatory disease. What is the most common organism for PID in such young girls?

Chlamydia trachomatis * Neisseria gonorrhoea and Chlamydia trachomatis have been identified as causative agents

A 26-year-old woman presents with bilateral lower abdominal pain and a vaginal discharge of 3 days duration. She also has a temperature of 37.8°C. She had a copper intrauterine device inserted 2 years ago for contraception. You have taken swabs for microbiology and provisionally think she has acute PID. What would be the advice with respect to the IUD?

Removal of the IUD should be considered as it may be associated with better short-term clinical outcomes

A 37-year-old woman presents with urinary incontinence associated with coughing and when she is doing her aerobic exercises. Following examination, what will be the next stage in her management? A. Assess pelvic floor muscle contractions B. Categorize her urinary incontinence C. Refer for urodynamics D. Request for a 3-day voiding diary E. Send a mid-urine sample for microscopy, culture and sensitivity

Categorize her urinary incontinence

A 40-year-old woman has been diagnosed with an overactive bladder and you decide to commence her on drug treatment. What discussion should take place prior to starting the treatment? A. That failure to respond by 6–8 weeks indicates failure of medical treatment B. That the adverse side effects such as dry mouth and constipation may indicate that the treatment will not be effective C. That the full benefits may not be seen until they have been taking the treatment for 4 weeks D. That treatment is only effective for 6–9 months E. That urodynamics is essential to assess the response to treatment

That the full benefits may not be seen until they have been taking the treatment for 4 weeks * The fact that they have not responded by 6–8 weeks is not indicative of failure of treatment and treatment can be maintained as long as possible

51-year-old woman, with a BMI of 30 kg/m2, presents with severe vasomotor symptoms for the past 12 months. These symptoms have been gradually getting worse. How will you manage her vasomotor symptoms?

Combined oestrogen-progesterone HRT for 5 years * Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and clonidine should not be used as the first-line treatment for vasomotor symptoms .

What treatment should be offered to a 55-year-old woman who attained menopausal 4 years ago and is now presenting with a dry vagina, loss of libido and irritation? She has not had any surgery and has no medical problems. A. Cognitive behavioural therapy and moisturizers for as long as needed to relieve symptoms B. Combined oestrogen and progestogen hormone replacement therapy C. Combined oestrogen and progestogen and moisturizers hormone replacement therapy for as long as needed to relieve symptoms D. Vaginal oestrogen and moisturizers for as long as needed to relieve symptoms E. Vaginal oestrogen for 6 months

Vaginal oestrogen and moisturizers for as long as needed to relieve symptoms

A 27-year-old woman presents in primary care with heavy menstrual bleeding (HMB) for 3 years. Her periods are regular. She has had two normal vaginal deliveries and was sterilized 3 years ago. She is otherwise healthy. What investigation should be carried out in primary care prior to commencing her on pharmacological treatment? A. A full blood count B. Measurement of endometrial thickness C. Physical examination D. Thyroid function test E. Transabdominal ultrasound scan

A full blood count * pharmacological treatment can be started without carrying out a physical examination or other investigations at the initial consultation in primary care unless the treatment chosen is the levonorgestrel-releasing intrauterine system (LNG-IUS).

Which symptom will be suggestive of a histological abnormality in a 36-year-old woman presenting with heavy menstrual bleeding of 2 years duration? A. Bleeding associated with intermenstrual bleeding B. Bleeding associated with pain C. Bleeding associated with superficial dyspareunia/loss of libido D. Bleeding associated with symptoms of anaemia E. Bleeding associated with the passage of clots

Bleeding associated with intermenstrual bleeding

A 38-year-old woman presents to her primary care physician with heavy menstrual bleeding of 2 years duration. When should performing a physical examination prior to commencing medical treatment be considered? A. She gives a family history of uterine fibroids B. The bleeding is heavy enough to affect the quality of life C. The levonorgestrel intrauterine system is being considered as a treatment option D. The patient has had two mid-trimester miscarriages E. There are associated premenstrual symptoms severe enough to warrant treatment

The levonorgestrel intrauterine system is being considered as a treatment option

What is the most effective method of emergency contraception (EC)?

The copper intrauterine device (Cu-IUD)

For about how long are viable sperms present in the upper genital tract after unprotected sexual intercourse?

5 days (120 h)

What proportion of uterine malignancies are due to sarcomas?

2%–7%

A 47-year-old woman presents with an abdominal mass that has been increasing in size associated with pressure symptoms and heavy menstrual bleeding. You examine her and suspect a uterine fibroid; however, the increasing size suggests the need to exclude a leiomyosarcoma. What first investigation will you offer this woman? A. Computed tomographic scan (CT scan) B. Magnetic resonance imagining (MRI) C. MRI spectroscopy and dynamic contrast-enhanced MRI D. Positron emission tomography (PET/CT) with fluorodeoxyglucose (FGD) E. Ultrasound scan with colour Doppler

Ultrasound scan with colour Doppler ( first)

What is the estimated number of lives per year that the cervical cancer screening programme saves in England?

4500

A 56-year-old woman had a routine cervical cytology that was reported as high-grade squamous dyskaryosis. She was offered colposcopy and treatment for CIN 3. At her 6 months follow-up cytology, she was found to have low-grade squamous dyskaryosis. An HPV test of cure was therefore performed and reported as negative. What would be the plan for this woman’s follow-up?

Follow-up cytology at 3 years and then every 5 years * after 6 months: A sample is reported as negative, borderline change (of squamous or endocervical type) or lowgrade dyskaryosis is offered an HR-HPV test. * Those who are HR-HPV positive are referred back to colposcopy * Women whose cytology is reported as high-grade dyskaryosis or worse are referred straight to colposcopy without an HR-HPV test.

A 43-year-old woman attended for her 6-month follow-up cytology and test of cure following the treatment for CIN 2. The result is borderline changes (squamous) and HPV positive. What should be offered to this woman?

Colposcopy and follow-up cytology and test of cure at 6 months

What would be a reliable means of assessing current ovarian function and therefore prediction of fertility in a childhood survivor of cancer treatment?

Anti-Müllerian hormone (AMH) * can be used in the assessment of ovarian function in both pre-pubertal and post-pubertal girls

A 17-year-old childhood survivor of cancer is seen with primary amenorrhoea. Various investigations are performed, and she is then offered what is considered adequate cyclical hormone replacement. She, however, fails to have a withdrawal bleed. What is the implication of this response?

That her uterine function has been compromised by the treatment

You see a 55-year-old woman with symptoms of bladder storage consisting of urgency with urge incontinence, frequency and nocturia. You suspect that she has an overactive bladder. She does not have any signs of prolapse, and her BMI is 26 kg/m2. What would be the first-line treatment for this patient’s symptoms? A. Antimuscarinic drugs B. Bladder retraining C. Pelvic floor exercises D. Vaginal oestrogen E. Weight loss

Bladder retraining * lifestyle changes and behavioural therapies should be the first-line treatment for an overactive bladder * include reduction in caffeine intake, modification of fluid intake, bladder retraining and weight loss in those with a BMI greater than 30 kg/m2

A 65-year-old woman has been assessed and offered botulinum toxin for the treatment of her refractory overactive bladder. What must she be trained to do before this treatment can be started?

To undertake intermittent self-catheterization * only 10%–15% of women on this treatment will actually need to perform intermittent self-catheterization.

A 68-year-old woman with refractory overactive bladder was seen and assessed to be suitable for Botulinum toxin. What important investigation must be performed before she is commenced on this treatment? A. Cystoscopy B. Culture of urine C. Examination under anaesthesia D. Frequency and volume chart (voiding diary) E. Urodynamics

Urodynamics * must be performed in all cases prior to treatment with Botulinum toxin

What is the main advantage of robotic surgery over laparoscopic surgery? A. Better precision and microsurgical dissection B. Decreased hospital stay C. Improved cosmesis D. Less pain after surgery E. Quicker recovery for the patient

Better precision and microsurgical dissection

A 46-year-old woman underwent a subtotal hysterectomy as a treatment for heavy menstrual bleeding. In approximately what percentage of women who have had a subtotal hysterectomy will persistent cyclical bleeding be a symptom?

5 % Will have continuing cyclical light bleeding.

You see a 40-year-old woman with heavy menstrual bleeding and uterine fibroids to discuss treatment options. Which is the most cost-effective treatment option that will guarantee amenorrhoea in this woman? A. Endometrial ablation B. GnRH agonist C. Hysterectomy D. The levonorgestrel intrauterine system (Mirena) E. Uterine artery embolization

Hysterectomy

A hysterectomy was offered to a 37-year-old woman with heavy menstrual bleeding that was refractory to medical treatment. What would be the main advantage of a subtotal hysterectomy over a total hysterectomy? A. Better sexual/orgasmic satisfaction B. Lower morbidity C. Reduced impact on ovarian function D. Reduced incidence of bladder dysfunction E. The surgical expertise required to perform it is less than that for a total hysterectomy

Lower morbidity * Randomized trials have failed to demonstrate any difference in sexual satisfaction

What is the commonest cause of vulval itching in children?

Atopic vulvitis

What is the definition of recurrent vulvovaginal candidiasis?

Recurrent candidiasis infection of more than six attacks per year

What is the British Association of Dermatologists recommended treatment regimen for lichen sclerosus?

Clobetasol propionate (0.05%) over 3 months * ( Not topical steroid/ not with baths/ not 6 months)

Approximately what proportion of women affected by tubo-ovarian abscess are nulliparous?

60 %

What is the most common cause of tubo-ovarian abscess (TOA) in women of reproductive age ?

Ascending pelvic inflammatory disease

A 25-year-old woman is admitted with lower abdominal pain associated with a fever and diarrhoea. She also had a history of painful micturition and a purulent urethral discharge a week before. When she is examined, there is localized tenderness to the left lower abdomen with a suspicious mass. A diagnosis of a tubo-ovarian abscess (TOA) is suspected, and an ultrasound scan is ordered. What finding from blood investigations is the most sensitive predictor of TOA? A. High blood lactate B. High C-reactive protein C. High erythrocyte sedimentation rate (ESR) D. Raised interleukin 6 E. Raised white blood cell count

High C-reactive protein

What proportion of patients admitted into an acute medical ward in hospitals in the UK may lack mental capacity to make a decision relevant to the episode of admission?

30 %

A 30-year-old woman with learning disability is seen in the gynaecology clinic with significant menstrual disturbances. What will be useful in determining mental capacity in this woman? A. The ability of the assessor (clinician) to determine whether there is any disturbance in the functioning of her mind B. The ability of the assessor (clinician) to determine whether there is any impairment in the functioning of her mind C. The ability of the assessor to determine whether the patient is able to comprehend D. The principle of the two-stage test of capacity (diagnostic and functional components) E. The rationality of patient to make a decision considered logical by the clinician (assessors)

The principle of the two-stage test of capacity (diagnostic and functional components)

37-year-old woman had treatment for cervical cancer by trachelectomy 2 years ago. She presents with active bleeding after 8 weeks amenorrhoea. An ultrasound scan is performed, and there is an irregular gestational sac measuring 30 mm in diameter and a 10-mm fetal pole with no obvious fetal heart activity. A diagnosis of a missed miscarriage is made. What would be the recommended treatment? A. Expectant management B. Hysterotomy C. Medical management D. Removal of the cervical cerclage and evacuation E. Surgical evacuation

Medical management * without having to remove the cerclage. Surgical management can be performed through the isthmic cerclage with neo-cervical dilation to Hegar size of 7 if required,

A 35-year-old woman has had trachelectomy as a treatment for cervical cancer stage 1A2. What advice should she be given with regard to contraception and the timing of trying to conceive?

She should commence contraception and continue for at least 6 months before she starts trying for a baby * conceiving within 2–3 months of the conization procedure is associated with a high risk of preterm

Approximately what proportion of women who conceive after trachelectomy do so after assisted reproduction?

60 %

A 33-year-old woman has been diagnosed with carcinoma of the cervix stage 1A2. She has been offered fertility-sparing surgery in the form of trachelectomy. What does this procedure entail?

Removal of the cervix, upper vagina and parametrium * Without lymph nodes 🚫

What is the difference in action between Levonelle (levonorgestrel) and EllaOne (ulipristal acetate – UPA) as emergency contraceptives?

UPA works only up to the LH peak, while Levonelle works up to the pre-ovulatory surge * Levonorgestrel (LNG) is a progestogen derived from nortestosterone, while ulipristal acetate (UPA) is a progesterone receptor modulator.

What is the failure rate of female sterilization?

1:200

A 45-year-old woman is on the progesterone-only pill containing desogestrel. What would be considered a missed pill in this woman?

Delay in taking the pill by more than 12 h ( containing desogestrel ) * Other progesterone-only pill : Delay in taking the pill by more than 3 h

A 45-year-old woman whose periods are regular has been referred by her GP for counselling on effective contraception. What basic examination and investigations should be performed prior to commencing her on the combined hormonal contraception?

Check cervical smear history, measure BP and BMI and offer STI screening and then perform a pregnancy test * no need for : examine breast or serum cholesterol levels or Pelvic examination .

A 24-year-old woman has attended the clinic following a serious sexual assault. Which type of sexual intercourse poses the greatest risk for HIV transmission in this woman? A. Penetrative anal intercourse where there is interruption of ejaculation B. Penetrative unprotected anal intercourse C. Penetrative unprotected vaginal intercourse D. Penetrative vaginal intercourse where there is interruption of ejaculation E. Unprotected oral intercourse

Penetrative unprotected anal intercourse

You have seen a 21-year-old student who was a victim of rape. What recommendation will you offer with respect to HIV post-exposure prophylaxis post-sexual assault (PEPSE)?

This must be commenced as soon as possible but within 72 h and for 4 weeks

You have just seen a 19-year-old girl in the Accident and Emergency who reports a sexual assault. She is found to have minor injuries that do not require suturing. What would be the most appropriate step to take in her management?

Not to clean until samples have been taken for DNA evidence

A 20-year-old girl has been seen with a report of sexual assault. She is considering a forensic medical examination. What advice should she be given prior to evidence being collected?

Not to wash or wipe herself and not to drink or pass urine

What is the average age at menopause in the UK?

50–51 years

What will you consider postmenopausal bleeding in a woman who has been referred to the gynaecology clinic for investigations?

Vaginal bleeding that occurs 1 year after the menopause regardless of the cause but excluding bleeding that occurs with sequential hormone replacement therapy * Not 6 months

Approximately what percentage of women who go through physiological menopause experience hot flushes?

70%–80%

What is the current recommendation for the use of vaginal meshes in pelvic organ prolapse? A. Anterior repair B. Apical repairs C. Enterocele repair D. Posterior repair E. Recurrent prolapse where other procedures have failed

Recurrent prolapse where other procedures have failed

A 58-year-old woman has been diagnosed with endometrial cancer following investigations that included histology on an endometrial biopsy. She had surgery and has returned for review 2 weeks after the surgery. What will be the most important factor in providing a guide to prognosis? A. Depth of myometrial invasion B. Histological type of the malignancy C. Lymphovascular space invasion D. Stage of the disease E. Volume of the tumour

Lymphovascular space invasion

A 55-year-old woman has been diagnosed with cervical cancer. She was offered surgery as this was staged as IIA. What would be an indication for adjuvant radiation with or without chemotherapy? A. Grade 3 disease and lymph node involvement B. Lymphovascular space invasion C. Parametrial extension D. Stromal invasion of 50% E. Tumour size of 2 cm

Grade 3 disease and lymph node involvement

A 45-year-old woman presents with irregular vaginal bleeding, a foul-smelling vaginal discharge and coital bleeding. At pelvic examination, she was suspected to have cervical cancer, which has been confirmed on biopsy. What will be the modality of choice for local staging of the cervical cancer?

Magnetic resonance imaging

A woman who underwent treatment for a gynaecological cancer is admitted with bowel obstruction. What type of gynaecological cancer is most commonly associated with bowel obstruction? A. Cervical cancer post-radiotherapy B. Epithelial ovarian cancer C. Endometrial cancer post-radiotherapy D. Germ cell ovarian cancer E. Stroma ovarian cancer

Epithelial ovarian cancer

What is the 5-year survival of ovarian cancer in the UK?

20%–30%

What is the main cause of death in women with epithelial ovarian cancer?

Bowel obstruction and its complications

What is the best investigation to identify extrapelvic disease in patients being considered for exenterative surgery for recurrent gynaecological cancer?

Positron emission tomography (PET) – CT scan

A 60-year-old had a vaginal hysterectomy 3 years ago and now presents with vault prolapse that is having a significant impact on her quality of life. What is the best approach to treat this patient?

Sacrocolpopexy * involves suspending the vaginal apex to the anterior longitudinal ligaments of the sacrum. It is considered the best surgical treatment for apical prolapse with a success rate of 78%–100%

Sexual exploitation is defined as the exploitation sexually of children and young people involving exploitative situations, contexts and relationships where the young people (or a third person or persons) receive something (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing and/or another or others performing on them sexual activities. What is the age limit within this definition?

Less than 18 years

Who does the GMC consider responsible for protecting children from sexual exploitation? A. All doctors B. All general practitioners C. All general practitioners and paediatricians D. All paediatricians E. All paediatricians, general practitioners and emergency physicians

All doctors

What is the estimated prevalence of child sexual exploitation in children under the age of 16 years in the UK?

5%–15%

A 17-year-old girl has been referred by her GP for labioplasty as she is unhappy with its appearance and complaints of feeling depressed about it. The GP says that she is Fraser competent. What would be your approach to her management following the consultation? A. As she is under the age of 18 years, female genital cosmetic surgery is not allowed B. Ask for an assessment by a psychiatrist prior to offering surgery if her mental state is indeed thought to be affected by the appearance of the vulva C. Confirm that she is Fraser competent and place on the list for this procedure if it is thought to be appropriate D. Proceed to perform the procedure as this is in the interest of her mental health E. Refer her for the assessment to ensure that her physical or mental state is safeguarded before considering surgery

As she is under the age of 18 years, female genital cosmetic surgery is not allowed

A couple has been diagnosed with unexplained infertility of 2 years duration. The woman is a smoker. What may be the effect of the smoking as a contributor to their infertility?

Alteration of tubal function

A couple has been diagnosed with unexplained infertility of 2 years duration. The woman is a smoker. What may be the effect of the smoking as a contributor to their infertility?

Alteration of tubal function

A couple has been diagnosed with unexplained infertility of 2 years duration. The man is a smoker. What may be the effect of the smoking as a contributor to their infertility?

Increases DNA damage in sperms

What age group in women in the UK has the highest prevalence of Chlamydia trachomatis infection?

15 - 19 years

A 25-year-old student was seen in the GUM clinic with a urethral discharge and following investigations, was diagnosed with Chlamydia trachomatis infection. What is the ideal treatment you will recommend for this patient?

A single dose of 1 g of azithromycin ( considering compliance with therapy ) * doxycycline 100 mg twice daily for 7 days

You are counselling a 35-year-old who has requested for tubal occlusion. What would you tell her about the additional benefit of the procedure with regard to prevention/reduction of risk of disease?

It is associated with a reduction in the incidence of ovarian cancer

A 42-year-old whose periods remain regular wishes to start the oral combined hormonal contraception (CHC). She smokes 6 cigarettes per day. What is the UK Medical Eligibility Criteria (UKMEC) category for this woman with respect to prescribing the combined oral contraceptive pill?

UKMEC 3 * For women over the age of 35 years and who smoke less than 15 cigarettes per day, use of the CHC is a UKMEC 3 * for those who smoke at least 15 cigarettes per day, use of the CHC is UKMEC 4. * former smoker over the age of 35 years, the use of CHC becomes less restrictive a year after stopping (UKMEC 2).

A 42-year-old woman who smoked approximately 20 cigarettes per day but stopped 2 years ago wishes to start the combined oral contraceptive pill. What advice would you give her?

Advise that she can go on the pill as has been off smoking for at least 1 year

A 20-year-old woman is seen in the Emergency Department complaining of vague lower abdominal pain. She has never been pregnant, though having unprotected sexual intercourse. A pregnancy test is performed and is positive. She is examined and found to be clinically stable with a BP of 115/70 mmHg and a pulse of 76 bpm. The abdomen is mildly tender, but there is no guarding. The only positive finding on bimanual examination is mild adnexal tenderness. An ultrasound is performed and shows the presence of echogenic fluid in the pouch of Douglas. What is the most likely explanation for this fluid in this patient?

Slowly leaking tubal ectopic (leakage of blood from the fimbrial end) * ( Not 🚫 Ruptured ectopic pregnancy)

A 33-year-old woman has been admitted through the Gynaecology Assessment Unit (GAU) with mild lower abdominal pain. What on ultrasound scan will make you diagnose a cervical pregnancy?

An empty uterus with ballooning of the cervix with a gestational sac and a negative sliding sign * + and blood flow around the gestational sac using colour Doppler

An ultrasound is performed on a 30-year-old woman who presented with lower abdominal pain and a dark brown vaginal discharge. This shows an intrauterine gestational sac with no obvious fetal pole but with a yolk sac and an inhomogeneous left adnexal mass measuring 40 mm in diameter and a small echoic fluid in the pouch of Douglas. A diagnosis of a heterotopic pregnancy is made from these findings. What would be the best approach to the management of this patient who is haemodynamically stable?

Laparoscopic surgical removal

A 33-year-old woman nursing assistant has been diagnosed with an ectopic pregnancy on the basis of an ultrasound scan finding of an inhomogeneous mass measuring 25 mm in the right adnexum with no fluid in the POD and a β-hCG level of 1200 IU/L 48 h after an initial reading of 1500 IU/L. What would be the recommended management option for this woman who is asymptomatic? A. Expectant management B. laparoscopic salpingectomy C. laparoscopic salpingostomy D. Local methotrexate injection and aspiration of the sac E. Methotrexate injection at a dose of 50 mg/m2

Expectant management * 1- clinically stable 2- no evidence of haemoperitoneum on ultrasound scan 3- ectopic pregnancy measuring less than 30 mm in diameter with no evidence of embryonic cardiac activity 4- serum β-hCG of less than 1500 IU/L.

A diagnosis of endometrial hyperplasia was made on a biopsy taken from a 48-year-old patient who presented to the Gynaecology clinic. What is the most common symptom she is likely to have presented with? A. Abnormal uterine bleeding B. Heavy menstrual bleeding C. Intermenstrual bleeding D. Irregular vaginal bleeding E. Unscheduled bleeding on hormone therapy

Abnormal uterine bleeding

You have seen a 59-year-old P2, all normal vaginal deliveries in the Gynaecology clinic with a 2-month history of irregular postmenopausal bleeding. What will be the indication for performing a diagnostic hysteroscopy and biopsy in this patient? A. A polypectomy is being contemplated for the same procedure B. A suspicion of endometrial cancer C. A thickened endometrium (>5 mm on transvaginal ultrasound scan) D. There is a suspicion of an intrauterine structural abnormality E. You are considering starting her on progestogens or inserting the levonorgestrel intrauterine system (Mirena)

There is a suspicion of an intrauterine structural abnormality * C is also correct

A woman is referred to the outpatient clinic with postmenopausal bleeding. A transvaginal ultrasound scan is performed, and the endometrial thickness is found to be 4 mm. This is described as having an irregular profile at the fundus and a double layer in the body. No polyps are present. What would be the next step in the management of this woman? A. Arrange an endometrial biopsy B. Commence on progestogens and arrange follow-up at 3 months C. Discharge with the advice to report back if any further bleeding D. Offer a follow-up ultrasound scan at 6 months or earlier if persistent bleeding E. Reassure and rescan at 3 months

Arrange an endometrial biopsy * A TVU : that detects an irregularity of the endometrial profile or an abnormal double-layer endometrial thickness measurement would further give reason to perform an endometrial biopsy in women with postmenopausal bleeding

A couple has been referred for pre-pregnancy counselling. The man is 36 years old and the woman is 30 years old. You have spoken to them and feel that there are no obvious issues that they should be concerned about. What will be their approximate chances of achieving a pregnancy in the next 12 months if they have regular unprotected sexual intercourse?

80% If the woman is under 40 y

A lesbian couple attend for counselling about pre-pregnancy. They are both 28 years old and would like to use artificial insemination. Assuming that there are no factors in their history to negatively affect fertility, what would be their approximate chance of achieving a pregnancy after 6 cycles of intrauterine insemination?

>50% * And about half will do so within a further six cycles for a cumulative pregnancy rate of over 75%

A 41-year-old woman is seen by her GP complaining of a burning sensation with voiding associated with urgency and nocturia. She also suffers from severe dyspareunia and as such is averse to sexual approaches from her husband. On examination, there is significant tenderness over the urethra. What is the first investigation her GP should request for assuming that bladder pain syndrome (BPS) is a suspected diagnosis? A. Bladder diary for 3 days B. Food diary for 3 days to identify possible trigger factors C. Post-void bladder scan D. Urinalysis E. Urine culture and sensitivity

Urinalysis : to rule out UTI * Investigations for urinary Ureaplasma and Chlamydia can be considered in symptomatic patients with negative urine cultures and pyuria

What are the criteria that have been adopted by several expert panels for a symptombased diagnosis of bladder pain syndrome (BPS)? A. Pain related to the bladder and nocturia B. Pain related to the bladder and nocturia of between 6 weeks and 6 months C. Pain related to the bladder and at least one other urinary symptom of minimum duration of 6 weeks to 6 months D. Pain related to the bladder, at least one other urinary symptom, absence of identifiable causes and minimum duration of symptoms of 6 weeks to 6 months E. Pain related to the bladder, nocturia and frequency, absence of identifiable causes and minimum duration of symptoms of 6 weeks

Pain related to the bladder, at least one other urinary symptom, absence of identifiable causes and minimum duration of symptoms of 6 weeks to 6 months

What initial assessment should be undertaken on a 30-year-old who is diagnosed with bladder pain syndrome in the gynaecology clinic? She has been screened for urinary tract infection, and the result is negative. A. Bladder diary B. Cystoscopy C. Mid-stream urine for Ureaplasma and Chlamydia D. Mid-urine for tuberculosis E. Urodynamics

Bladder diary * A 3-day fluid diary with input and output is useful for initial assessment of patients BPS. Patients with BPS classically void small volumes

The GP has been treating a 30-year-old colleague with suspected PMS. When should referral to a Gynaecologist be considered? A. If cognitive behavioural therapy has failed B. PMS is confirmed and treatment with SSRIs has yielded variable results C. When the diagnosis is confirmed D. When treatment with simple numerous measures has failed E. When the symptoms are non-cyclical and an underlying psychiatric disorder has been excluded

When treatment with simple numerous measures has failed

A 35-year-old woman has been referred to the Gynaecologist following diagnosis of severe PMS by her GP. What team should be involved in her care?

Multidisciplinary team of GP, mental health professional, gynaecologist and nutritionist * Not 🚫 clinical psychologist

What is the placebo response rate in the treatment of PMS? A. 10%–15% B. 16%–25% C. 26%–35% D. 36%–45% E. 46%–55%

36%–45%

In approximately over what proportion of women with epithelial ovarian cancers is CA125 increased above 30 IU/mL? A. 65% B. 70% C. 75% D. 80% E. 85%

80% ( but not in most primary mucinous ovarian cancers) * If a cut-off value of 30 IU/mL is used, the test has a sensitivity of 81% and a specificity of 75% for the detection of ovarian cancer in a postmenopausal woman.

A 65-year-old woman is referred to the Gynaecology Clinic with a suspicious abdominal mass that is thought to be of ovarian origin. The mass is clinically examined to measure 120 × 120 mm in diameter. What would be single most effective way of evaluating the ovarian cyst? A. A combined transvaginal and transabdominal ultrasound scan B. A transabdominal ultrasound scan C. CA125 and transvaginal ultrasound scan D. MRI of the abdomen and pelvis E. PET scan

A combined transvaginal and transabdominal ultrasound scan

A 60-year-old woman had an ultrasound scan for mild lower abdominal discomfort. The findings were as follows ‘multicystic loculated mass on the right measuring 6 × 7 cm with a small solid intracystic area and areas of papillary projections into the largest of the cyst. The uterus is atrophic with a thin endometrium that measures 1 mm. The contralateral ovary was not seen, and there is no fluid in the abdomen or pelvis’. A quantified CA125 was reported as 50 IU/mL. What is the risk of malignancy index (RMI) in this

450 * The risk of malignancy index (RMI) is calculated as the product of UxMxCA125; where U is the ultrasound scan score (U = 1 for an ultrasound scan score of 1; 3 for ultrasound score of 2–5 – where each of these parameters scores 1 – multilocular, solid areas, metastases, ascites and bilateral lesions), and M is the menopausal status – 1 for premenopausal and 3 for postmenopausal. In this patient, her USS score is 2; hence, the RMI is 3 × 3 × 50 = 450.

What is the estimated incidence of mild ovarian hyperstimulation syndrome (OHSS) in conventional IVF cycles? A. 1:2 B. 1:3 C. 1:4 D. 1:5 E. 1:6

1:3 * while the combined incidence of moderate-to-severe OHSS varies from 3.1% to 8%

A 30-year-old woman is undergoing controlled ovarian hyperstimulation for in vitro fertilization. What factor will be associated with a decreased risk of ovarian hyperstimulation syndrome (OHSS) in this woman? A. Her age B. High antral follicle count C. Low AMH D. Known case of PCOS E. Previous OHSS

Low AMH

When is ovarian hyperstimulation syndrome (OHSS) likely to occur in an assisted reproduction programme involving a 30-year-old woman? A. Agonists have been used in the ovulation regimen B. Antagonists have been used in the ovulation regimen C. Embryo replacement was performed on day 5 (i.e. blastocyst replacement) D. Pregnancy has occurred E. Progesterone was used for luteal phase support

Pregnancy has occurred ( as well as in those resulting in multiple pregnancies ) * reduced risk of OHSS in IVF cycles using gonadotrophin-releasing hormone (GnRH) antagonist compared with cycles where GnRH agonist

In the investigation of a 20-year-old woman with suspected acute pelvic inflammatory disease (PID), which test result has the best negative predictive value? A. A normal C-reactive protein B. A negative endocervical swab culture C. A normal ESR D. Absence of endocervical or vaginal pus cells E. A negative anal swab

Absence of endocervical or vaginal pus cells ( has a good negative predictive value (95%) for a diagnosis of PID, but their presence is non-specific (poor positive predictive value – 17%) * The absence of infection at this site (endocervical) does not exclude PID

You have seen a 23-year-old woman with features of acute pelvic inflammatory disease. She has been commenced on antibiotics. What advice will you give her about sexual intercourse? A. Avoid sexual intercourse for 7 days B. Avoid sexual intercourse until she and her partner have completed treatment and follow-up C. Avoid sexual intercourse until she has completed treatment and follow-up D. Avoid unprotected sexual intercourse until treatment is completed E. Avoid unprotected sexual intercourse until treatment and follow-up of her and her partner(s) are completed

Avoid unprotected sexual intercourse until treatment and follow-up of her and her partner(s) are completed

You see a 55-year-old woman with urinary incontinence (UI). Following your initial assessment, you feel that she would benefit from referral to supervised pelvic floor muscle training. What assessment should be made prior to this referral? A. A 3-day bladder diary B. Digital assessment to confirm pelvic floor muscle contractions C. The degree of prolapse if any D. The impact of the UI on her daily activities E. Urethral mobility

Digital assessment to confirm pelvic floor muscle contractions * as the absence of this will suggest a poor response to the training

A 48-year-old woman presents with urgency, urgency urinary incontinence (UUI) and stress urinary incontinence (SUI). You have assessed and found that the predominant symptom is stress urinary incontinence (SUI). What approach will you take in her management? A. Commence her on overactive bladder (OAB) drugs B. Discuss the benefits of conservative management including OAB drugs before offering surgery C. Offer surgery for SUI and then OAB treatment D. Refer for pelvic floor muscle contraction exercises prior to offering surgery for SUI E. Treat her SUI first and see whether the symptoms of OAB improve and if not, then commence her on OAB drug treatment

Discuss the benefits of conservative management including OAB drugs before offering surgery

When will you consider screening a 26-year-old woman presenting with heavy menstrual bleeding for coagulation disorders? A. Pharmacological treatment with the LNG-IUS has not been effective B. She has a family history of heavy menstrual bleeding in her sister and mother C. The HMB is associated with flooding D. The HMB started since menarche and her sister suffers from a coagulation disorder E. The HMB is associated with the passage of clots

The HMB started since menarche and her sister suffers from a coagulation disorder

What would be the indication for histological biopsy in a 45-year-old woman presenting with regular heavy menstrual bleeding (HMB) to secondary care? A. Persistent heavy bleeding after 3 months on the combined contraceptive pill B. Physical examination has shown a multiple fibroid uterus C. The endometrium is 7 mm thick on ultrasound scan D. The HMB started with menarche E. There is associated persistent intermenstrual bleeding

There is associated persistent intermenstrual bleeding * Persistent heavy bleeding after 3 months on the combined contraceptive pill : is not considered ineffective ( short period of time)

A 25-year-old woman who has never been pregnant and is not sexually active is seen in the Gynaecology Clinic having been referred with severe dysmenorrhoea and heavy periods of 2 years duration. She is not keen to go on hormonal treatment. What would be the treatment of choice for this patient? A. Danazol B. Etamysylate C. Non-steroidal anti-inflammatory drugs (NSAIDs) D. Tranexamic acid E. Ulipristal acetate

Non-steroidal anti-inflammatory drugs (NSAIDs)

What treatment will you recommend for a 33-year-old woman who presents with heavy menstrual bleeding and on examination, is found to have a uterus that is approximately 8 weeks in size. An ultrasound scan shows two fibroids – one measuring 5 cm in diameter and causing a mild distortion of the endometrial cavity and the other a 3 cm intramural fibroid? Her Hb is 102 g/L. A. Combined oral contraceptive pill B. Gonadotrophin-releasing hormonal agonist (GnRHa) C. The levonorgestrel intrauterine system (LNG-IUS) D. Tranexamic acid E. Ulipristal acetate 5 mg up to 4 courses

Ulipristal acetate 5 mg up to 4 courses ( Esmya) { each course 3 months} should be offered to women with heavy menstrual bleeding and fibroids of 3 cm or more in diameter and a haemoglobin level above 102 g/L or below

A 50-year-old woman has been on the combined hormone replacement therapy since the age of 47 years. How will you diagnose menopause in this woman? A. Amenorrhoea of at least 24 months from stopping the HRT B. Amenorrhea for 3 months with discontinuation of the HRT C. Presence of menopausal symptoms involving the vasomotor system, mood changes, musculoskeletal and sexual difficulties D. Serum FSH on two occasions 6 weeks apart E. Serum FSH values of >30 IU/L

Amenorrhoea of at least 24 months from stopping the HRT * For women under the age of 50 years, a period of 24 months of amenorrhoea and for those over 50 years 12 months should lead to the diagnosis of menopause * Otherwise, serum FSH of more than 35 IU/L on two occasions 6 weeks apart should be considered

A 42-year-old presents with severe vasomotor symptoms highly suggestive of perimenopause. You have examined and found nothing abnormal. Her family and personal history are not significant. You suspect premature ovarian failure and have confirmed the diagnoses by FSH performed on two occasions 6 weeks apart. What treatment will you offer this woman? A. Black cohosh for 5–8 years B. Combined estrogen-progesterone HRT for approximately 8 years C. Clonidine for 5–8 years D. Estrogen only HRT for 5 years E. Non-pharmaceutical treatment such as cognitive behaviour therapy (CBT) for 8 years

Combined estrogen-progesterone HRT for approximately 8 years

A 45-year-old woman has been placed on the waiting list for a hysterectomy for abnormal uterine bleeding. What lifetime risk of pelvic organ prolapse after a hysterectomy will you quote for this woman during counselling? A. <1% B. 1%–2% C. 3%–4% D. 5%–6% E. 7%–8%

1%–2% ( for benign diseases) * And 11.6% of hysterectomies performed for prolapse

A 40-year-old woman who presented with vague intermittent lower abdominal pain of 3 months duration has been diagnosed with a simple ovarian cyst on ultrasound scan. What is the approximately risk of this cyst being malignant?

1:1000

. A 50-year-old woman whose BMI is 26 kg/m2 and has been on HRT underwent a total abdominal hysterectomy for heavy menstrual bleeding. What is the recommended duration of thromboprophylaxis for this woman after surgery? A. A single dose of dalteparin at the time of surgery B. Dalteparin for 24 h after surgery C. Dalteparin for 5–7 days after surgery D. Dalteparin for 10 days after surgery E. Dalteparin for 14 days after surgery

Dalteparin for 5–7 days after surgery * This woman is low risk as there are no other factors that will increase her risk of VTE. In such patients, the recommendation is to continue with thromboprophylaxis until she is fully mobilized. This could take between 5 and 7 days

A 57-year-old woman who suffers from multiple sclerosis (MS) is referred to the clinic with voiding difficulties. How will you manage this patient?

Intermittent self-catheterization

You have seen a 56-year-old woman with symptoms of urinary incontinence. You take a history and examine her. She had kept a voiding diary prior to the visit to the clinic. You suspect that she has an overactive bladder syndrome (OAB). What would be the first line of management for this woman? A. Bladder training B. Mid-stream urine for microscopy culture and sensitivity C. OAB drugs such as anticholinergic drugs D. Pelvic floor muscle training E. Urodynamics

Bladder training * should be offered for a minimum of 6 weeks as the firstline treatment to women with urgency or mixed urinary incontinence * the combination of OAB drugs with bladder training should be considered if frequency is a troublesome symptom

A 50-year-old woman presents with symptoms of voiding difficulties. A urine dipstick test is negative. What will be the first investigation to perform on this woman? A. Assessment of residual urine by ultrasound scan of the bladder B. Urinalysis C. Urine for microscopy culture and sensitivity D. Urodynamics E. Voiding diary – 3 days

Assessment of residual urine by ultrasound scan of the bladder * it is recommended In women presenting with symptoms suggestive of voiding dysfunction or recurrent UTI

What is the most common site for uterine perforation at evacuation of the uterus for retained products of conception?

Anterior wall * followed by the cervical canal with the fundus being the least

During a diagnostic laparoscopy you inadvertently injure the inferior epigastric artery requiring a figure-of-8 stitch to stop the bleeding. What is the origin of this vessel?

External iliac artery

You are counselling a 46-year-old woman who wishes to have uterine artery embolization for her fibroids. What is the risk of early ovarian failure following the procedure in this woman?

1%–2% * Around 80%–90% of patients will be asymptomatic or have significantly improved symptoms at 1 year with an associated 40%–70% reduction in fibroid volume

An obese woman aged 53 years and who smokes 20 cigarettes per day complaints of mild hot flushes and night sweats associated with sleep disturbance. What would be the best treatment option for this woman? A. Behavioural modification B. Combined hormonal contraception with estradiol C. Estrogen and the levonorgestrel intrauterine system D. Estrogen only E. Transdermal patch

Behavioural modification

A total hysterectomy is performed on a 39-year-old woman for heavy menstrual bleeding that failed to respond to medical treatment. The histology report reveals CIN 1 with fully excised margins. What would be the recommended management for this woman?

Follow-up smear at 6 and 18 months after the hysterectomy * incompletely excised CIN (or uncertain excision), follow up should be as if their cervix remained in situ : - CIN 1: vault cytology at 6 , 12 and 24 months: - CIN 2/3 – vault cytology at 6 and 12 months, followed by nine annual vault cytology samples. Follow up for incompletely excised CIN continues to 65 years or until 10 years after surgery (whichever is later)

What is the most common type of ureteric injury at laparoscopic surgery?

Thermal (Diathermy) { 1 - 2 %}

What is the most common and lethal subtype of epithelial ovarian cancer?

Serous ( 68% of the ovarian cancers ) * 90% of ovarian cancers are epithelial

What proportion of woman with ovarian cancer have a positive family history?

10 %

What is The lifetime risk of developing ovarian cancer is in those with BRCA1 mutation ? And with BRCA 2 mutation ?

BRCA1 mutation: 25%–50% with BRCA 2 mutation : 10%- 20%

A 25-year-old woman has been referred for genetic counselling and screening for the mutations associated with ovarian cancer. Her mother and sister both had ovarian cancer at the ages of 45 and 55 years, respectively. She has been screened and has BRCA1 mutation. What will be the effect of prophylactic salpingo-oophorectomy on her cancer risk?

. An approximately 80% reduction in the risk of ovarian, fallopian and peritoneal cancer * in BRCA1 and BRCA2 carriers

couple has been trying for a baby for two and a half years. Following referral to the hospital, they are investigated thoroughly and apart from minimal peritoneal endometriosis, nothing else is found. What would be the best approach to managing this couple’s infertility?

In vitro fertilization and embryo transfer (IVF-ET) * unexplained infertility of 2 years or more 👉 IVF * in this case has minimal endometriosis, she would be classified as unexplained.

A 53-year-old woman presents with urgency, frequency and haematuria. On examination, she is found to have an anterior hard 3 mm bulge, which is approximately 2 cm from the inside of the introitus. What single investigation will you undertake to confirm the diagnosis of urethral diverticulum? A. Examination under anaesthesia B. Ninety (90)-degree endoscopy C. Sixty (60)-degree endoscopy D. Thirty (30)-degree endoscopy E. Zero-degree endoscopy

Zero-degree endoscopy ( urethroscopy ) * Also : urodynamics , CT , MRI , US , micturating cystogram and double balloon urethrogram are useful investigations.

A 70-year-old woman diagnosed with urethral diverticulum is being counselled for surgery. What investigation should she have that will help identify if she is likely to have the complication of post excision incontinence? A. Conventional enhanced CT scan B. Cystometry C. T2-weighted MRI D. Transvaginal ultrasound E. Video urodynamics

Video urodynamics * to differentiate between stress incontinence and an overactive bladder and post micturition dribbling.

What is the main disadvantage of transvaginal ultrasound scan in the assessment of suspected urethral diverticulum? A. It has a false negative rate of more than 20% B. It has a false positive rate of more than 20% C. It is invasive and poorly tolerated by the patients D. Poor sensitivity where the diverticulum is less than 30 mm E. The risk of the probe directly compressing the urethra

The risk of the probe directly compressing the urethra * Otherwise: TVU has an excellent sensitivity

A 38-year-old woman has been offered a total abdominal hysterectomy with preservation of the ovaries as treatment of her endometriosis-associated chronic pelvic pain. What is the main disadvantage of leaving her ovaries behind? A. She has a greater risk of developing an endometrioma B. She has a six-fold greater risk of developing recurrent pain C. She has a four times risk of ovarian endometroid cancer D. She has a four times greater risk of re-operation E. She is at an increased risk of trapped ovary syndrome

She has a six-fold (6) greater risk of developing recurrent pain * She has a 8 times greater risk of re-operation

When and how should HRT be started on a 45-year-old woman who has had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis-associated pain? A. Commence her on combined HRT as soon as possible B. Commence her on continuous combined HRT approximately 6 months after surgery C. Commence her on estrogen-only HRT as soon as possible D. Commence her on estrogen-only HRT approximately 6 months after surgery E. Commence HRT in the form of tibolone 3 months after surgery

Commence her on combined HRT as soon as possible * or tibolone for treating menopausal symptoms in women with surgically induced menopause because of endometriosis, at least up to the age of natural menopause

What is the main advantage of drainage over ovarian cystectomy for an ovarian endometrioma that measures 40 × 40 mm and is associated with dysmenorrhea and dyspareunia? A. Ovarian reserve is less likely to be compromised B. Recurrence is less C. The procedure has less complications D. The risk of adhesion formation is less E. The risk of compromising future fertility is greater with drainage

Ovarian reserve is less likely to be compromised

An endometrioma has been diagnosed in a 28-year-old woman with chronic unilateral cyclical lower abdominal pain and dyspareunia. When will you consider performing surgery on this patient? A. She has not responded to medical options for the pain B. The endometrioma is at least 3 cm C. There is associated dyspareunia D. There is associated infertility E. There is associated minimal endometriosis in the pelvis

The endometrioma is at least 3 cm * Laparoscopy is the recommended treatment for endometriomas associated with dysmenorhoea, dyspareunia and non-menstrual pain if the cyst is at least 3 cm in diameter

What is the mean interval from presentation to their GP to the diagnosis of endometriosis in the UK?

8 years

Polycystic ovary syndrome is considered the most common endocrine condition affecting women of the reproductive age group. What is the estimated prevalence of this condition in this age group?

10%–15%

What is the best predictor of cardiovascular risk in a 37-year-old who has been diagnosed with PCOS?

Her waist circumference

What proportion of anovulatory infertility is accounted for by PCOS? A. 50%–60% B. 60%–70% C. 70%–80% D. 80%–90% E. >90%

80%–90%

You have seen a 28-year-old woman with a BMI of 30 kg/m2 in the clinic with primary infertility. Following investigations, you find that she has anovulatory infertility secondary to PCOS. What would be the first approach to her management? A. Commence her on folic acid 400 µg daily B. Induce ovulation with clomifene citrate C. Offer metformin D. Optimize health before commencing therapy E. Perform a diagnostic laparoscopy to assess the pelvis and test for tubal patency

Optimize health before commencing therapy * Then induce regular unifollicular ovulation . * A semen analysis + an assessment of tubal patency should be performed before ovulation induction therapy is commenced.

A woman on clomifene citrate (CC) for induction of ovulation has been undergoing follicular tracking. Ovulation has been confirmed. What proportion of women who are on CC that ovulate will become pregnant by the sixth ovulatory cycle?

60%–70% * ( >50% for artificial insemination)

Approximately what proportion of gynaecological outpatient referrals are for chronic pelvic pain? A. 10% (1 in 10) B. 15% (1 in 6) C. 20% (1 in 5) D. 25% (1 in 4) E. 30% (1 in 3)

20% (1 in 5)

A 26-year-old woman is seen in the Emergency Gynaecology Unit with symptoms and signs of an ectopic pregnancy. She is investigated and found to have a caesarean scar pregnancy (CSP). She has been counselled and wishes to have medical treatment with methotrexate as she is haemodynamically stable. When is this treatment most likely to be successful?

Pregnancy is less than 8 weeks and hCG < 5000 IU/L

A 30-year-old woman has been referred for an early ultrasound scan, and she books for antenatal care on account of a previous emergency CS complicated by massive haemorrhage and blood transfusion. She is 7 weeks pregnant according to her last menstrual period (LMP). An ultrasound scan is performed and suggests a caesarean scar pregnancy (CSP). Assuming that this diagnosis is correct, what would be the most appropriate initial treatment?

Systemic methotrexate ( Pregnancy is less than 8 weeks)

A 50-year-old woman has had debulking surgery for ovarian cancer. What will be the standard adjuvant treatment that would be recommended for this patient?

Paclitaxel and carboplatin for 6 cycles * Without radiotherapy

A 60-year-old who has been suffering from vague abdominal symptoms was diagnosed with ovarian cancer following various investigations. It is suspected that she had advanced disease that cannot be optimally resected. In addition, she has liver metastases. What would be the best approach to managing this patient?

Neoadjuvant chemotherapy followed by delayed primary surgery

A 60-year-old attends the Gynaecology Clinic with a 9-month history of a dragging sensation in the vagina. You examine and find that she has uterine-vaginal prolapse. You have discussed all the treatment options and she opts for pelvic floor muscle training. What information should she be given about the value of this treatment option in remedying her symptoms and the anatomical problems causing the prolapse?

The exercises have been shown from a randomized trial to significantly improve symptoms but not the anatomy of the prolapse

What is the recommended management of a 64-year-old who has just had a vaginal hysterectomy and the vaginal vault prolapse is at the introitus at the end of the surgery? A. Closure of the peritoneum of the cul-de-sac B. McCall culdoplasty C. Moschcowitz procedure D. Sacrocolpopexy E. Sacrospinous fixation

Sacrospinous fixation * should be performed if at the time of a vaginal hysterectomy for prolapse, the vaginal vault is at the introitus at the end of the vaginal hysterectomy

A 70-year-old, frail and diabetic obese woman presents with troublesome procidentia. She is not sexually active and has been assessed to be fit to withstand prolonged surgery. A colpocleisis is therefore offered as the treatment of choice. What is the main disadvantage of this procedure? A. A high recurrent rare B. Less patient satisfaction than with corrective surgery C. Loss of access to the cervix and uterus D. Loss of sexual function E. The need to have drainage channels for the passage of vaginal and cervical secretions

Loss of access to the cervix and uterus * Satisfaction rates that have been reported are much better than those of reconstructive surgery

A 40-year-old Ghanaian woman who presents with difficulties in conceiving and heavy periods is found on examination to have uterine fibroids of approximately 16 weeks size. An ultrasound scan has shown these to be multiple, the largest measuring 10 × 8 cm and located on the right body and extending to the corneum. She is not keen to have surgery and therefore has been offered either a GnRHa for 6 months or ulipristal acetate for 13 weeks. What advantage other than side effects does GnRHa have over ulipristal acetate? A. It has less impact on fertility B. It is more effective C. Its duration of action is much longer after discontinuation D. The reduction in blood loss at menstruation is greater E. The reduction in uterine volume is greater

1- The reduction in uterine volume is greater 2- no difference in the control of menstrual bleeding 3- The reduction with is shorter lasting 4- myomectomy could be more difficult following GnRHa

A 39-year-old woman has been diagnosed with multiple uterine fibroids and heavy menstrual periods. She has been offered various treatment options including surgery and medical treatment. She wishes to have uterine artery embolization (UAE) as she has completed her family but would like to know the major difference between this and a hysterectomy? A. Long-term ovarian failure is greater with UAE than with hysterectomy B. Patient satisfaction is greater with hysterectomy than with UAE C. UAE is associated with a five-fold increase in the likelihood of further intervention within 2–5 years D. UAE is associated with a similar risk of major complications compared with hysterectomy E. UAE is associated with fewer minor complications than hysterectomy

UAE is associated with a five-fold increase in the likelihood of further intervention within 2–5 years * satisfaction is similar . * UAE was associated with more minor complications * there is no difference in ovarian failure rates.

A 40-year-old woman is on the waiting list for hysteroscopic resection of Grade 2 submucous fibroids. What is the most important factor in determining safety of this resection?

The thickness between the fibroid and the serosa

What are the grades of submucous fibroids ?

1- G0 is a pedunculated intrauterine myoma. 2- G1 has its largest part (>50%) in the uterine cavity. 3- G2 has its largest part (>50%) in the myometrium. * Grade 0 and 1 fibroid can easily be removed hysteroscopically, but difficulties are likely to be encountered with Grade 2 fibroids

What proportion of heterosexual couples in the UK experience delayed conception despite regular unprotected sexual intercourse for 1 year?

1:7 (14%) * Not 20%

What is the advantage of pituitary downregulation in an assisted reproductive technology (ART) regimen? A. Ensures a better planning of oocyte retrieval B. Minimizes the risk of multiple follicular maturation C. Suppression of endogenous gonadotrophin release, thus decreasing the rate of OHSS D. Suppression of endogenous gonadotrophin release ensuring that oocytes are available for retrieval E. Suppression of endogenous gonadotrophin release, thus preventing recruitment of multiple antral follicles

Suppression of endogenous gonadotrophin release ensuring that oocytes are available for retrieval . ( premature ovulation ).

What is the main difference between ART cycles where GnRH-agonist are used and those where GnRH-antagonist are used? A. GnRH-agonist cycles are associated with a lower OHSS B. In GnRH-agonist cycles, follicular recruitment is as a result of endogenous gonadotrophins C. In GnRH antagonist cycles, follicular recruitment is as a result of endogenous gonadotrophins D. Pregnancy rates are higher with the agonist protocol E. Pregnancy rates are higher with the antagonist protocol

In GnRH antagonist cycles, follicular recruitment is as a result of endogenous gonadotrophins * incidence of OHSS is significantly less with antagonist protocols * pregnancy and live birth rates are not significantly different * in GnRH-antagonist treatment cycles, the initial recruitment and selection of follicles occur as a result of endogenous gonadotropins, but their development is augmented by exogenous gonadotrophins

What is the best step to take in reducing the risk of OHSS in a woman undergoing GnRH antagonist-controlled ovarian stimulation for IVF with intact hypothalamic-pituitarygonadal axis?

Administer GnRH agonist for maturation trigger ( ensures more physiological release of endogenous gonadotrophins) * Instead of recombinant hCG

When should an ultrasound scan be performed on a 30-year-old woman who has never been pregnant before and has had IVF-ET?

Five weeks after ER ( at 7 weeks of gestation ) * An early ultrasound is offered to women with a previous history of ectopic pregnancy or recurrent miscarriage or who have symptoms of bleeding or pain

A 27-year-old woman has been admitted with severe OHSS. What monitoring should be recommended for this woman? A. Daily fluid intake and output and full blood count and urea and electrolytes B. Daily fluid intake and output, liver function test, urea and electrolytes and full blood count C. Daily measurements of weight, abdominal girth and fluid intake and output and blood tests for full blood count, electrolytes and liver and renal function tests D. Daily measurement of weight, abdominal girth and fluid intake and output and twicedaily blood tests for full blood count, electrolytes and liver and renal function tests E. Daily measurements of weight, abdominal girth and fluid intake and alternate day blood tests for full blood count, electrolytes and liver and renal function tests

Daily measurements of weight, abdominal girth and fluid intake and output and blood tests for full blood count, electrolytes and liver and renal function tests

Compared to natural conception, what is the difference in monochorionic pregnancy rates with that following ART where elective single embryo transfer (eSET) is performed? A. The rate in ART conception is up to four times higher than that in natural conception B. The rate is marginally higher in natural conception than in ART conception C. The rate in natural conception is double than in ART conception D. The rate in natural conception is half that in ART conception E. The rate is the same in both natural and ART conception

The rate in ART conception is up to four times higher than that in natural conception * increased incidence of monozygotic twin following eSET compared to cleavage stage embryo transfer (ET)

A 32-year-old woman who has previously been pregnant is on the waiting list for ART. What in her past reproductive history will be associated with a better outcome of the ART treatment? A. Previous pregnancy after ART B. Previous pregnancy after ART and live birth C. Previous pregnancy irrespective of whether this was spontaneous or followed ART D. Previous spontaneous pregnancy E. Previous spontaneous pregnancy and live birth

Previous pregnancy after ART and live birth

What proportion of pregnancies in the UK are unplanned?

1:3

27-year-old woman has just had a spontaneous vaginal delivery following an uncomplicated pregnancy at term. She wishes to breastfeed exclusively for 6 months. What would be the success rate of this form on contraception assuming that she fulfils the criteria for lactational amenorrhea as a method of contraception?

95%–98% * there must be amenorrhoea, breastfeeding must be exclusive and last less than 6 months

A 30-year old woman who has had a spontaneous vaginal delivery and is breastfeeding wishes to start the combined hormonal contraception (CHC). How soon after birth can she start the CHC?

Six weeks * the available data do not indicate a harmful effect.

What is considered postpartum immediate intrauterine contraception (PPIUC)? A. Insertion of an intrauterine device within 48 h of caesarean delivery B. Insertion of an intrauterine contraceptive device (copper or levonorgestrel) within 48 h of vaginal delivery C. Insertion of an intrauterine contraceptive device (copper or levonorgestrel) within 48 h of vaginal or caesarean delivery D. Insertion of an intrauterine contraceptive device (copper or levonorgestrel) 48 h to 2 weeks after vaginal or caesarean delivery E. Insertion of an intrauterine contraceptive device (copper or levonorgestrel) 48 h to 2 weeks after vaginal delivery

Insertion of an intrauterine contraceptive device (copper or levonorgestrel) within 48 h of vaginal or caesarean delivery

A 57-year-old underwent a hysteroscopic resection of grade 2 submucous fibroids and has been admitted because of hypervolaemia (the fluid deficit was over 2500 mL), but she is asymptomatic. Blood sodium level indicates hyponatremia. What will be the recommended first-line management? A. Restriction of fluid intake and consider starting a diuretic B. Restriction of fluid intake, diuretics and a small dose of an antihypertensive drug C. Restriction of fluid intake but commence on hypertonic normal saline at a rate of 1000 mL/h D. Restriction of fluid intake to 1 L of Ringer’s lactate every 6–8 h E. Restriction of fluid intake to 1 L of dextrose saline with potassium chloride

Restriction of fluid intake and consider starting a diuretic ( Because the patient is asymptomatic / with or without hyponatraemia ) * No need to commence any kind of fluids

In a 40-year-old woman undergoing hysteroscopic resection of a large fibroid, what is the most important step to take to reduce the risk of fluid overload? A. Intracervical injection of vasopressin B. Maintenance of intrauterine pressure to just above the mean arterial pressure level C. Pre-treatment with a GnRH agonist D. Use of bipolar as opposed to unipolar electrocautery E. Use of hypertonic distension medium

Pre-treatment with a GnRH agonist * Intracervical injection of vasopressin can be considered before dilatation of the cervix. * The intrauterine pressure needed for distension should be maintained as low as possible to allow adequate visualization and kept below the mean arterial pressure.

A 32-year-old woman who has been on the contraceptive patch for the past 12 months presents for advice saying that her patch has been partly detached for the past 36 h. She has had unprotected sexual intercourse for the past two days. What advice would you offer to this woman? A. Reassure and discharge from follow-up B. To have a pregnancy test and emergency contraception with Cu-IUD C. To have a pregnancy test and emergency contraception with the LNG D. To have a pregnancy test and emergency contraception with UPA E. To reattach the patch if still sticky or replace if not and no need for additional or emergency contraception

To reattach the patch if still sticky or replace if not and no need for additional or emergency contraception * If the patch has been off for less than 48 h before its replaced it, it remains effective in protecting against pregnancy as long as the patch was on properly for 7 days before it came off

. A 30-year-old woman attends for counselling having delayed applying her contraceptive patch for 3 days (i.e. she forgot to take the patch off on time and applied the next patch after 72 h) – 1 week into the cycle. What would be your recommendation for this woman? A. Apply new patch and offer emergency contraception (EC) in the form of the levonorgestrel emergency contraception (LNG-EC) and continue with patch cycle B. Apply new patch and consider as Day 1 of patch cycle and use barrier method for 7 days C. Apply new patch and consider as Day 1 of patch cycle and offer LNG-EC and barrier method for 7 days D. Apply new patch and consider as Day 1 of patch cycle – no additional contraception needed E. Offer a barrier method for 7 days and restart the new patch cycle

Apply new patch and consider as Day 1 of patch cycle and use barrier method for 7 days ( More than 48 h : not effective) * If she has had UPSI in the previous few days, she may need emergency contraception. In this scenario, there is no given information about UPSI

A 36-year-old housewife forgot to take her patch off after week 3 . She attends the clinic for advice. What would be your recommendation for this woman? She has been having UPSI during the last few days. A. Take it off as soon as possible, perform a pregnancy test and levonorgestrel emergency contraception (LNG-EC) and then start a new patch cycle B. Take it off as soon as possible, start a new patch cycle and no need for additional contraception C. Take it off as soon as possible, start a new patch cycle and offer barrier contraception for the next 7 days D. Take it off as soon as possible, start a new patch cycle but perform pregnancy test and offer Cu-IUD EC E. Take it off as soon as possible, start a new patch cycle, perform a pregnancy test and offer UPA-EC

Take it off as soon as possible, start a new patch cycle and no need for additional contraception * She should start a new patch on the usual start day, even if they are bleeding. This means that she will not have a full week of patch-free days

A 30-year-old woman who suffers from epilepsy that has been well controlled with carbamazepine and who also has an unknown allergy attends for emergency contraception. She had unprotected sexual intercourse (UPSI) 12 days into her regular 28-day cycle. What treatment option will consider in this woman? A. Levonelle – 1.5 mg B. Levonelle – 3.0 mg C. Cu-IUD D. Ulipristal acetate (UPA) – 30 mg E. UPA – 60 mg (double dose)

Levonelle – 3.0 mg * UPA-EC is not recommended with liver enzyme-inducing drugs. In this patient with an unknown allergy unless copper allergy has been excluded, the best option is LNG-EC at a double dose of 3 mg.

A 28-year-old woman reports missing two Micronor® (norethisterone 350 µg) tablets and having had UPSI during this period. She does not wish to conceive. What emergency contraception (EC) if any will you recommend for her? A. Cu-IUD B. LNG – 1.5 mg C. LNG – 3.0 mg D. UPA – 30 mg E. UPA – 60 mg

Cu-IUD * EC is indicated if a progestogen only pill (minipill) is late or missed (>27 h for non-desogestrel containing and >36 h for desogestrel containing POPs * Because the POP has been used in the last 7 days, the efficacy of UPA-EC could theoretically be reduced * consideration should be given to the use of the LNG-EC. But CU-IUD is the most effective EC, and in this case, can be used up to 5 days after the UPSI

A 30-year-old woman attended for EC following an episode of UPSI 3 days ago. She was counselled and offered the Cu-IUD. What is the primary mechanism by which this method prevents pregnancy? A. Inhibition of fertilization B. Inhibition of fertilization and implantation C. Inhibition of implantation D. Inhibition of ovulation and fertilization E. Inhibition of sperm and ovum transport and implantation

Inhibition of fertilization ( primary ) *If fertilization does occur : Inhibition of implantation

A 30-year-old who presented with a troublesome vaginal discharge had a cervical smear, which has been reported as inadequate. She returned for follow-up. What recommendation will you offer her with respect to the management of her smear result? A. Offer HPV test to triage subsequent management B. Reassure and refer for routine recall cytology C. Refer for colposcopy and treatment D. Repeat cytology at 3 months E. Repeat cytology at 6 months

Repeat cytology at 3 months * Referral for colposcopy is indicated after 3 inadequate smears

You are seeing a 40-year-old who had a low-grade dyskaryosis on her routine cervical smear 2 weeks ago. HPV testing, was therefore performed and reported as inadequate/ unreliable. What would be your next step in her management? A. Refer for colposcopy B. Refer for repeat cytology at 12 months C. Refer for repeat cytology at 3 months with HPV testing if indicated D. Repeat cytology and HPV testing now E. Repeat cytology and HPV testing at 6 months

Refer for colposcopy

A 30-year-old woman had CGIN-treated and at follow-up, she was found to have an abnormal cytology. She was therefore referred for colposcopy where treatment was offered. What follow-up should be offered to this woman after treatment? A. 6 months for 3 years and then back to routine recall B. 6 month for 3 years and then yearly for 10 years C. 6 month follow-up and then yearly for 10 years D. 6 month follow-up and then yearly for three followed by three yearly until the age of 55 years E. 12 months follow-up cytology and HPV testing and if negative, yearly for 3 years and then back to routine recall

6 month follow-up and then yearly for 10 years * follow-up cytology and {test of cure} should be offered at 6 months. If this comes back as abnormal, cytology referral should be done for colposcopy after which yearly follow-up is recommended to complete 10 years of cytology follow-up.

42-year-old presents with stress urinary incontinence and features of urinary tract infections. A pelvic examination is performed and there are no features of prolapse. A urinalysis shows the presence of nitrites and leucocytes. What will be your plan for this patient’s urinalysis findings? A. Commence her on antibiotics as soon as possible as these findings indicate an infection B. Refer her for urodynamics and ignore this finding as she is asymptomatic C. Send a mid-stream urine (MSU) and discuss options with the patient D. Send an MSU and await results before commencing her on antibiotics E. Send an MSU sample but commence her on antibiotics

Send an MSU sample but commence her on antibiotics

Sba 2 Gynecology Flashcards

(203 cards)