General Gynaecology (Platinum) – SBA

1. Mrs. X 28 years old sexually active presented with chronic abdominal pain, bloating which aggravated during menstrual cycles. She passes stool several times per day usually just after the meal. Pain always get relieved with passage of stool; she is currently on combined pill for contraception which was prescribed by her GP. Her cervical smear is up to date. No past history of STI. On examination -uterus is normal sized, fornices are free. Which of the following toll will be helpful for its diagnosis?

2. Mrs. X is 51-year-old woman with hot flushes. She has no significant past medical or family history. You prescribe hormone replacement therapy (HRT). During her appointment you counsel her regarding the risks of estrogen and progestogen HRT. How many estimated additional cases of breast cancer are there per 1000 women using HRT for five years?

3. Ms.X, 30 years old woman undergoes laparoscopic resection of deep infiltrating endometriosis x Grade 4. If she does receive a thermal injury, due to diathermy when would you expect her to present?

4. A 16-year-old girl presents to the gynaecology outpatient clinic with primary amenorrhea. She is 152 cm tall and weighs 50Kg.Breast development is assessed as Tanner stage 3and her pubic hair is noted to be sparse. Further examination identifies she has inguinal swelling and short blind ending vagina. She has no other dysmorphic features.
What is the most likely diagnosis?

5. 45years old Lisa presented to you with Heavy menstrual bleeding. It is affecting her quality of life. She is requesting for conservative mangement.Aftercounseling, she chooses Tranexamic acid. What is the mechanism of action of Tranexamic acid ?

6. Mr.Briganza,58 years old post-menopausal woman has an ovarian cyst. Transvaginal ultrasound shows unilocular right ovarian cyst measuring 6cm x4x3cm, with no solid components. Left ovary normal. Her CA125 is 50. What is the most appropriate management?

7. You are seeing 56 year oldpostmenopusal Amy, at the clinic, who has been referred for uncontrollable vulval itch & soreness, which is worse at night. She has visited her GP andhe has given her some lubricants which was of no benefit.On examination thinning of skin, labial adhesions seen. Skin looks like cigarette paper, vulval biopsy showed thinned epidermis with sub-epidermal hyalinizationand deeper inflammatory infiltrate.imag e is enclosed.

Choose correct diagnosis

8. Anna is a 15-year-old girl who presents with a history of painful periods since menarche. She is now missing at least a day of school a month. Her mother is concerned that she may have endometriosis as she was diagnosed with mild endometriosis in her 20s whilst trying to conceive Anna, although her periods were never painful. During the consultation Anna becomes tearful and reveals that she is very anxious about her exams. MOST appropriate management for her is.

9. 22years old Tina, has come with painful sex, difficulty having sex. She has history of childhood abuse, after examination you conclude this is a case of primary vaginismus.You advise her vaginal dilators. Vaginal dilators help in relieving this reflex. 

10. Mrs.Lucy has brought her 8year child with premature sexual hair development. On X-ray she has advanced bone age and rapid growth velocity. On further evaluation her 17 hydroxy progesterone levels are increased with normal DHEAs.
What is the probable diagnosis?

11. Which Bisphosphonate used in treatment for osteoporosis reduces both hip and vertebral fractures?

12. Mrs.Adams, 56years old lady presented with hirsutism and features of virilisation. Her testosterone levels are 8.7 n mol/L with normal DHEAS and normal urinary 17- keto steroids. The probable reason for her hirsutism is

13. Which selective estrogen receptor modulators is effective and licensed for use in vulvovaginal atrophy ?

14. A 55 years old woman has presented with hot flushes. She has been treated for breast cancer and on tamoxifen,she is looking for non-hormonal alternative treatment,which one of the following drugs she can take

15. Mrs. Georgia Adams, is primigravida who is now 39weeks 4days low risk pregnancy. She is requesting for induction of labour as her husband is posted abroad; he is in the armed forces. He has to leave in 10 days. What would you advise her?

16. What’s the best time to do post-vasectomy semen analysis?

17. 42 years old woman presented with menorrhagia. Ultrasoundshowed endometrial polyp with increase vascularity. On further evaluation with hysteroscopy, showed surface irregularity with necrotic areas which is suspicious of malignancy. What is the prevalence of malignancy in polyps?

18. A 65 years old patient BMI 35 kg/m² has an outpatient endometrial pipelle biopsy due to post- menopausal bleeding. The biopsy was reported as insufficient tissue for diagnosis. What would be the best next step in her management?

19. A 22-year-old medical student presents with a request for contraception. Her menstrual cycle is irregular and she complains of acne and hirsutism. Previous investigation has diagnosed polycystic ovary syndrome (PCOS). She wishes to have a combined oral contraceptive with the best risk profile and most impact on her androgenic symptoms. Which one of the following is the best available option to recommend for her?

20. Ms.Suzy, 14year old girl is presented with excessive facial hair,irregularcycle.In adolescent girls to diagnose PCOS all are considered except

21. A 25-year-old woman with a history of chronic pelvic pain has recently had an USS of her pelvis, which has been reported as normal. She is sad and upset and has told the nurse that she feels like no one is taking her concerns seriously. You are meeting her in the gynaecology outpatient clinic today for the first time. The woman reports that the doctor who did ultrasound made a comment about her ovaries during the USS, and she is worried there is something seriously wrong.
What is the most appropriate approach during your consultation?

22. 30 year old woman presents with lower abdominal pain since 9 months. Pain typically worsens during the premenstrual period and associated with fatigue and exacerbated by standing, walking, and gardening. Pain worsens after intercourse resulting in throbbing ache afterwards. What is the definitive investigation to establish the diagnosis?

23. A 34 years nulliparous women is seen at menstrual disorders clinic for HMB. She is a known PCOS with BMI 34. A histological report received after office biopsyshows numerous glands packed back to back with stroma in between with increased mitotic figures and alteration in the nuclear cytoplasmic ratio. What is this suggestive of?

24. A 44-year-old white woman is referred to the rapid-access gynaecologic clinic with PMB. Speculum examination reveals a stenosed cervical os and two failed attempts at endometrial pipelle biopsy. A transvaginal ultrasound shows an endometrial thickness of 6 mm. She claims to be fit and well.

25. 45 years old Mrs.Lucy is diagnosed with endometrial hyperplasia with Atypia, but she is not willing to undergo hysterectomy. How should she be managed?