SBA

Case 1
Donna Tyrrell is a 35 year old woman who previously used the oral
contraceptive pill for contraception and experienced 3 months of post-pill
amenorrhoea. She now presents with primary infertility for 2 years and
gives a history of dyspareunia and dysmenorrhoea. Laparoscopy reveals
minimal endometriosis affecting the left ovary and an endometriotic cyst of
the right ovary. There were no other abnormalities found.
Question 1.1
Which of the following sexually transmitted organisms is most likely to be associated
with dyspareunia?
A) Gardnerella vaginalis
B) Molluscum contagiosum
C) Ureaplasma urealyticum
D) Chlamydia trachomatis

Question 1.2
All of the following factors have evidence to support the observation that they are
associated with reduced fertility, EXCEPT one. Which one has no supportive
evidence?
A) Psychological stress
B) Maternal age greater than 35 years
C) Severe deposits of endometriosis with tubal distortion
D) Previous complicated intrauterine contraceptive device

Question 1.3
Which one of the following statements concerning endometriosis is correct?
A) Its peak incidence occurs in women in their twenties
B) It has no genetic predisposition
C) Endometriotic deposits resemble normal endometrium on microscopy
D) It mostly affects post-menopausal women

Question 1.4
Which of the following is correct regarding the menstrual cycle?
A) A mid-cycle surge of progesterone initiates ovulation
B) Follicle stimulating hormone is secreted in the second half of the cycle
C) Progesterone stimulates proliferation of secretory endometrium
D) Prolactin secretion varies substantially during the menstrual cycle

A pelvic ultrasound is performed on day 22 of Mrs Tyrrells 30 day cycle, and

demonstrates a corpus luteal cyst 3 cm in diameter on the right ovary.
Question 1.5
Which one of the following statements is correct with respect to the corpus luteum?
A) Corpus luteal cysts are not seen in ectopic pregnancies
B) The presence of a corpus luteal cyst indicates that Mrs Tyrrell is pregnant
C) Human chorionic gonadotrophin is produced by the corpus luteum throughout
pregnancy
D) The corpus luteum has a lifespan of approximately 14 days in the absence of
pregnancy

Question 1.6
Which one of the following statements regarding the female genital tract is NOT
correct?
A) The ovary is attached by a ligament to the uterus
B) The blood supply to the ovaries arises from the abdominal aorta
C) The ovaries lie in the lower abdominal cavity
D) The ovaries are connected to the posterior aspect of the broad ligament

Question 1.7
The uterine tube is supplied with blood from the:
A) Uterine artery alone
B) External iliac arteries
C) Ovarian artery alone
D) Ovarian and uterine arteries

Case 2
Michelle Girgis has been trying unsuccessfully to fall pregnant for 2 years.
She is 32 years old, has a Body Mass Index (BMI) of 32, and a history of
previous termination of pregnancy aged 18. She sometimes experiences
deep pain with intercourse. Her partners semen analysis is normal.
Question 2.1
What is the most appropriate next investigation for her infertility?
A) Laparoscopy
B) Hysterosalpingogram
C) Ovulation assessment
D) Post-coital test

Ms Girgis is subsequently diagnosed with polycystic ovary syndrome

(PCOS).
Question 2.2
What is the most appropriate first step in her management?
A) Commence Metformin treatment
B) Advice about weight loss & exercise
C) Advice about timing of intercourse during menstrual cycle
D) Conduct glucose tolerance test

Question 2.3
All of the following factors have been shown to be associated with reduced fertility,
EXCEPT one. Which one has no supportive evidence?
A) Psychological stress
B) Maternal age greater than 35 years
C) Severe deposits of endometriosis with tubal distortion
D) Previous complicated intrauterine contraceptive device

Question 2.4
Indicate the best answer regarding the location of the ovaries. In a woman who has
not borne children, the ovaries are situated:
A) On the lower posterior wall of the abdominal cavity
B) On the lateral wall of the pelvic cavity
C) In the pouch of Douglass
D) Superior to the bladder at the pelvic inlet

Question 2.5
The uterine tube is supplied with blood from the:
A) Uterine artery alone
B) External iliac arteries
C) Ovarian artery alone
D) Ovarian and uterine arteries

Question 2.6
Which one of the following statements is correct with respect to the corpus luteum?
A) Corpus luteal cysts are not seen in ectopic pregnancies
B) The presence of a corpus luteal cyst would indicate that Ms Girgis is pregnant
C) Human chorionic gonadotrophin is produced by the corpus luteum throughout
pregnancy
D) The corpus luteum has a lifespan of approximately 14 days in the absence of
pregnancy

Question 2.7
Which one of the following statements concerning endometriosis is correct?
A) Its peak incidence occurs in women in their twenties
B) It has no genetic predisposition
C) Endometriotic deposits resemble normal endometrium on microscopy
D) It mostly affects post-menopausal women