Question 1 Which one of the above is a recognised treatment option in a healthy 35 year old woman

with menorrhagia?

Options for Questions 1-1

A Dilatation & curettage

B Large loop excision of the transformation zone (LLETZ)

C Endometrial ablation

D Cervical cautery

E Bilateral salpingo-oophrectomy

(Correct answer: C)

Explanation

SURGICAL TREATMENT
Endometrial resection / ablation
Effective in treating menorrhagia. Amenorrhoea rates 20-40%. Associated with lower morbidity
and quicker recovery compared to hysterectomy with a significant improvement in Hb and
quality of life. Long term satisfaction rates ~80%
Hysterectomy
Surgical excision of the uterus. Established effective treatment for menorrhagia. Discuss route -
vaginal / abdominal / laparoscopic
Discuss total / sub-total hysterectomy (Conservation of the cervix). If the cervix is conserved,
cervical screening should continue
Discuss conservation versus removal of the ovaries
D&C does not treat menorrhagia but may be used as investigation. Diathermy loop excision is
used to treat cervical intra-epithelial neoplasia. Bilateral salpingo-oophrectomy will induce the
menopause but is not a treatment for menorrhagia

Question 2 Which one of the above is a recognised cause of secondary amenorrhoea?

Options for Questions 2-2

A Endometriosis

B Endometrial cancer

C Polycystic ovary syndrome

D The Cu IUCD
 E Adenomyosis

(Correct answer: C)

Explanation

Secondary amenorrhoea
Obstetric causes

Pregnancy
Breastfeeding
Sheehans syndrome pituitary necrosis secondary to post-partum haemorrhage
Gynaecological causes

Polycystic ovary syndrome

Premature ovarian failure
Contraception depo-provera or levonorgestrel IUS (MIRENA). NOT COCP
Ashermans syndrome rare. Intra-uterine adhesions usually following post-partum D&C
Cervical stenosis rare
Question 3 A 33 year old woman has been diagnosed with ovarian hyperstimulation syndrome. Which
one of the above features would suggest severe OHSS?

Options for Questions 3-3

A Haematocrit > 45%

B Ultrasound evidence of ascites

C Ovarian size of 8 12 cm

D Urine output of 650 mls over 24 hrs

E Mild abdominal pain

(Correct answer: A)

Explanation

Severe OHSS
Clinical ascites +/- hydrothorax
Oliguria
Haemoconcentration (haematocrit > 45%)
Hypo-proteinaemia
Ovarian size usually > 12cm

Question 4 A 19 year old university student is concerned that she might have Chlamydia infection.
Which one of the above is not a sign / symptom of Chlamydia infection?

Options for Questions 4-4

A Intermenstrual bleeding
 B Joint pains

C Cervical excitation

D Exophytic Cervical mass

E Mucupurulent vaginal discharge

Correct answer: D)

Explanation

70% of women are asymptomatic. If symptoms are present, they include: Lower abdominal pain, Dyspareunia,
Abnormal vaginal bleeding e.g. postcoital bleeding, intermenstrual bleeding, Abnormal vaginal or cervical discharge.
May be mucupurulent. Dysuria.
Rarely, patients can present with right upper quadrant pain (peri-hepatitis) and joint pains (reactive arthritis).
Signs: The following may be present: Pyrexia, Lower abdominal tenderness, Cervical excitation, Contact bleeding
cervix.

Question 5 Which one of the above infections is linked to appropriate treatment?

Options for Questions 5-5

A Chlamydia ampicillin

B Gonorrhoea cefixime

C Candida metronidazole

D Syphilis clindamycin

E Genital warts acyclovir

(Correct answer: B)

Explanation

Chlamydia - Oral Doxycycline or Oral Azithromycin or oral ofloxacin. Oral Erythromycin if pregnant.
Syphilis - Benzathine penicillin or Procaine penicillin G. Doxycycline if penicillin allergy.
Gonorrhoeaa - Intramuscular Inj. Ceftriaxone OR Oral Cefixime 400mg oral as a single dose.
Candida - Topical or oral azole compounds e.g. clotrimazole, miconazole give a cure rate of over 80%.
Genital warts - Podophyllin, 5-fluorouracil and interferon. Cryotherapy, Electro-cautery & Laser treatment are
alternatives

Question 6 Vasectomy is associated with which one of the above complications?

Options for Questions 6-6

A An increased risk of coronary heart disease

 B An increased risk of prostate cancer

C A 10% risk of developing anti-sperm antibodies

D An increased risk of epididymo-orchitis

E A failure rate of 1:20,000

(Correct answer: D)

Explanation

Complications of vasectomy
1) Local Anaesthetic complications
Pain, Bleeding, Infection
Ischaemic necrosis - rarely
2) Surgical complications
Intraoperative bleeding
Early post operative - Infection (wound, epidydimytis), Scrotal haematoma, Post operative pain
Late post operative - Chronic testicular pain, Anti sperm antibodies nearly 75% will develop antibodies
Failure of method rate is 1 in 2,000

Question 7 Which one of the above is not a contraindication to the use of depo-medroxyprogesterone
acetate?

Options for Questions 7-7

A History of stroke

B Active viral hepatitis

C Suspicious vaginal bleeding

D Healthy 38 year old smoker

E Diabetic retinopathy

(Correct answer: D)

Explanation

Progesterone-only injectables: Contraindications:

UKMEC 3 risks outweighs the benefits of using the method.
Multiple risk factors for arterial cardiovascular risk e.g. older age, diabetes, hypertension, smoking.
Vascular disease
Current or history of IHD. On anticoagulants.
Current or history of stroke
Past history of breast cancer & NO evidence of current disease for 5 yrs
Unexplained vaginal bleeding or suspicious before investigations
Retinopathy, nephropathy, neuropathy or diabetes > 20 yrs duration
Active viral hepatitis
 UKMEC 4 unacceptable health risks or absolute contraindications

Current breast cancer UKMEC 4

Question 8 Which one of the above definitions relating to urinary incontinence is correct

Options for Questions 8-8

A Urinary frequency voiding more than once every 4 hours

B Urinary urgency sudden desire to urinate that is difficult to defer

C Nocturia urinary incontinence occurring at night

D Urge urinary incontinence involuntary urinary leakage on coughing or straining

E Urinary stress incontinence urinary incontinence provoked by anxiety or stress

(Correct answer: B)

Explanation

Symptoms
Stress urinary incontinence: Involuntary urinary leakage on effort or exertion or on coughing, sneezing or laughing
Dysuria: Pain on passing urine
Urgency: a sudden compelling desire to urinate that is difficult to defer
Urge urinary incontinence is involuntary urine leakage accompanied or immediately preceded by urgency
Mixed urinary incontinence is involuntary urine leakage associated with both urgency and exertion, effort, sneezing or
coughing
Urinary Frequency: Voiding more than once every 2 hours or more than 7 times per day
Nocturia: Desire to void causes patient to wake. Rare before the age of 60, above 60 years, one episode of nocturia
per decade of life is not abnormal

Question 9 Which one of the above statements is true?

Options for Questions 9-9

A Cervical ectropion is a pathological process resulting from eversion of the lower cervical canal

B Cervical ectropion is a risk factor for developing CIN

C Cervical ectropion in early pregnancy is an indication for termination

D Cervical ectropion is associated with adolescence

E Cervical ectropion is pre malignant

(Correct answer: D)

Explanation