General Gynaecology (Platinum) – EMQ

Option List

A. Interstitial cystitis
B. Hunner ulcer
C. Bladder tuberculations
D. Glomerulation
E. Cancer of bladder
F. Bladder pain syndrome
G. Nodular lesions

Each of the following Options describes various clinical diagnosis in woman presenting for cystoscopy.

For each patient select the single most appropriate diagnosis from the list above. Each option may be used once, more than once or not at all

1. Mayada, 42 year old woman presents with pelvic pain, pressure or discomfort from lasting at least 6 months, and accompanied by persistent urge to void or frequency, on detailed history -she says her pain is worsened with spicy food with bladder filling. Relieved by urination.Her cystoscopy finding is enclosed

2. 37 year old woman presents with presented with pelvic pain,and urgency lasting at least 6 months, and accompanied by persistent urge to void or frequency, all other tests seems to be negative. She underwent cystoscopy. Following finding is seen.

3. Julie , 55 year old presents with presented with vague pelvic pain. History of weight loss+ . microscopic hematuria+ .

4. Sara, 44year old presented with dysuria, hematuria and vague pelvic pain.Cystoscopy findings are suggestive of

Option List

A. Interstitial cystitis
B. Pelvic Inflammatory disease
C. Chronic pelvic pain
D. Endometriosis
E. Leiomyoma
F. Adenomyosis
G. Endometrial polyp
H. Appendicitis
I. Torsion of ovarian cyst

Each of the above options describes different diagnosis for pelvic pain. For each patient select the single most appropriate clause for termination from the list above. Each option may be used once, more than once or not at all

5. A 18 year old complaining of persistent lower abdominal pain with no vaginal discharge. When about to do pelvic exam she became agitated & admitted history of child abuse in past

6. Young 16 year old, sexually active, complaining of lower abdominal pain associated with fever, profuse discharge.

7. 40 year old complains of congestive dysmenorrhoea with menorrhagia. She gives family history of similar complaints in mother. On examination -globular,uniformly enlarged uterus present

Option List

A. Trial of SSRI
B. HRT is contraindicated
C. Complementary therapies
D. Continuous COC with levonorgestrol containing pills
E. Cyclical oestrogen and progesterone
F. Continuous COC with Drospironone containing Pills
G. Luteal Phase SSRI in high doses
H. Trial of Gabapentin
I. Transdermal estrogen patches with luteal phase micronized Progesterone
J. Progesterone containing IUD
K. Transdermal estrogen patches with LNG-IUD
L. Cognitive behavioural therapy
M. GnRH analogue with tibolone
N. Hysterectomy with bilateral salpingooophorectomy

The options above shows various management options to manage Premenstrual Syndrome. Following scenarios

8. 29 year old nulliparous woman is referred to the gynaecology unit for distressing physical and psychological symptoms of PMS. The GP has tried lifestyle modifications, cognitive behavioural therapy, hormonal pills and also SSRI’s but with no relief of her symptoms. She has regular heavy menstrual cycles not affecting her quality of life.She is at present not contemplating on pregnancy as she wants a complete relief for her symptoms. The best management option is

9. 49 year old woman who has irregular periods for the past 6 months is complaining of severe vasomotor symptoms. She has presented with 2 months amenorrhoea and was worried whether she could have fallen pregnant. the vasomotor symptoms are affecting her quality of life and she wishes to have the effective treatment that would be advantageous to her. the most appropriate HRT

10. 42 year old women treated for breast cancer was found to be estrogen receptor positive and is on tamoxifen. She has debilating vasomotor symptoms. The most appropriate treatment is

Option List
A. Weight related amenorrhoea
B. Fragile X syndrome
C. Mayer Rokitansky kusterhauser syndrome
D. Kallmanns syndrome
E. Androgen insensitivity syndrome
F. Swyers syndrome
G. Non-classical Congenital adrenal hyperplasia

Choose the most appropriate option from the list given above. Each option may be used once or more than once or not at all.

11. A 17 year old is presented with primary amenorrhoea. Her BMI is 18 and She is found to have anosmia and colour blindness. The diagnosis is

12. 35 year old women who presented with irregular periods for the past 3 years and now complaining of amenorrhoea for about 6 months. She has long face with prominent jaw. She is found to have reduced intellectual capacity. Pregnancy test was negative. The diagnosis is

13. 19 year old presented with primary amenorrhoea with good development of secondary sexual characters. On ultrasound is found to have absent uterus. The diagnosis is

Option List

A. Polycystic ovarian syndrome
B. Ovarian hyperthecosis
C. Classical adrenal hyperplasia
D. Androgen secreting tumours
E. Non-classical adrenal hyperplasia
F. Androgen secreting adrenal tumours
G. Wilsons disease
H. Non-androgen cause – Drug induced
I. Serum Prolactin

Choose the most appropriate diagnosis for the scenario given below. The option may be used once, more than once or not at all.

14. A 21 year old woman presents with excessive facial hair suddenly over the past few weeks, was found to have a Ferriman-Gallaway score of 16. The free testosterone values was 1.89ng/dl. She was further investigated with dehydroepiandrosterone Sulphate which was elevated. The diagnosis is

15. A 17-year-old girl presents with a recent onset of moderate facial hair growth and 4 months’ history of secondary amenorrhoea. Investigations by her GP showed a negative pregnancy test and normal LH, FSH and thyroid function test results. Pelvic ultrasound and blood glucose were normal. Serum androgen was elevated. Serum 17 –hydroxyprogesterone is elevated markedly. The diagnosis is

16. A 25year old women has attended the GP clinic for excessive facial hair growth. She was diagnosed to have wilsons disease a year ago and was started on penicillamine . She is complaining of irregular cycles for the past few months. The cause of her hirsutism is

17. 72 year old postmenopausal women has presented with an excessive hair growth and had noticed that her voice has deepened over last two years. Serum testosterone is elevated at 7.2 nmol/L and DHEAS (dehydroepiandrosterone) and urinary 17 ketosteroids are normal. The cause of hirsutism is

Option List
A. Colposcopy
B. Local silver nitrate application
C. Change dose of pill
D. Insert Copper T
E. Endometrical biopsy
F. Gnrhanalogue
G. Tranexamic acid
H. Novasure endometrical ablation
I. Add to waiting list of lap hysterectomy
J. Insert mirena and follow up in 6months
K. Perform endometrical sampling with hysteroscopy
L. Reinsert mirena coil
M. Tranexamic acid with mirena
N. Total abdominal hysterectomy with bilateral salpingo-oophrectomy.

Each of the above options describes various woman presenting with abnormal uterine bleeding.

For each patient select the single most appropriate management option from the list

18. Ms Lucy, 27-year-old nulliparous, presents with a history of post-coital bleeding for 6 months. Bleeding is often unpredictable and is affecting her relationship. She is otherwise fit and well. She is using a COCP over the last year for contraception. BMI is 21kg/m2.Gynaecological examination is within normal limits with the exception of a cervical ectropion. Swabs for Chlamydia and an HVS are negative. Pelvic USS shows an endometrial thickness of 10 mm with a normal uterus, rest of the pelvic anatomy being normal. What treatment is most suited to her?

19. Mrs, Brown 46-year-old mutiparous , who has completed her family presents with a history of painful heavy menstrual bleeding with infrequent cycles (every 2–3 months) for 1 year. Her BMI is 44. She is currently on iron supplements for anaemia and is prescribed proton pump inhibitors for GORD. She is otherwise fit and well. Abdominopelvic examination is unremarkable. Pelvic ultrasound shows an endometrial thickness of 12 mm with a bulky uterus and normal ovaries with no pelvic pathology. A pipelle biopsy suggests a proliferative endometrium.

20. You review a 48-year-old woman in the menstrual disorders clinic who complains of a 3-year history of heavy menstrual bleeding. She is a mother of four children, all born by normal vaginal deliveries. Her menstrual cycle is every 30 days and the bleeding lasts for 6 days. However, recently it has become associated with clots.
Cervical smears are up-to-date and her BMI is 39. You perform atransvaginal scan which reveals a bulky uterus of 8 mm endometrial thicknessand three intramural fibroids of 1, 3and 5 cm size respectively. On vaginal examination you find stage I cystocele, stage I rectocele and stage II uterine descent.The current waiting list for benign gynaecological surgery in your hospital is 4 months.

21. Mrs. Leslie , 50-year-old woman had a Mirena IUS inserted 2 years ago for heavy menstrual periods. She was initially amenorrhoeic but has now developed heavy menstrual bleeding again. Endometrial biopsy shows complex endometrial hyperplasia with atypia.

Option List:
A. TSH
B. Prolactin levels
C. Pregnancy test
D. FSH
E. Ultrasound
F. Karyotyping
G. MRI
H. CT scan
I. Serum DHEA -S levels
J. Testosterone

Choose the most appropriate investigation for the following questions once or more than once or not at all:

22. Ms Anne 15-year-old, has presented with primary amenorrhoea, on examination, her BMI was 29 and was found to have absent secondary sexual characteristics. The investigation of choice is

23. Ms Mary, 15-year-old, has presented with failure of onset of puberty with a height of about 130and is weighing 54kgs. She was examined and found to have tanners stage 1 breast development with widely spaced nipples. She also has cubitus valgus

24. Ms.Mary 15-year-old has presented with primary amenorrhoea. She gives a history of weight gain, lethargy and tiredness. She has nausea and vomiting. There is no history of cyclical abdominal pain, visual disturbances. The appropriate investigation is

25. Ms Sweetie, A 16-year-old girl presents with recurrent abdominal pain and primary amenorrhea. On examination, both breast development and pubic hair distribution are noted to be Tanner Stage V. An abdominal mass is detected on palpation. Speculum examination showing a bluish colour at the end of the speculum