Best Examination Questions: Part 2 MRCOG – The EMQ Bank No 1

  • Wednesday, January 9th, 2013

Updated on 30.10.2016.

Exam pic 2

How to use the EMQ Bank

This is a comprehensive collection of EMQs for Part 2 MRCOG Examination. An attempt has been made to include most of the possible responses for each topic to make the EMQ Bank as comprehensive as possible.

The candidates are advised to solve the EMQs first before checking the answers, which have been included after each set of questions. The answers have been provided along with the EMQs for easy reference and to make it easy to remember. This is a novel technique devised by Dr Sudipta Paul that has been found to be very useful for hundreds of candidates rather than providing only the answers without the EMQs on the same page.

If you want to test your performance, write down 1-45 on a piece of paper and note the answer from A-O against them when you read the EMQs. Then mark the correct answers with a tick (√) when you check the answers for that section. After you complete the whole paper count the number of correct answers and check your total marks out of 45 in percentage.

The candidates are also advised to try solving the EMQs repeatedly until 100% could be answered correctly.

Number of EMQs = 45

Example of EMQs

Options for Questions 16-30

A. Imperforate hymen

B. Uterine perforation

C. Endometriosis

D. Uterine fibroids

E. Urinary tract infection

F. Ectopic pregnancy

G. Complete androgen insensitivity syndrome

H. Premature menopause

I. Asherman’s syndrome

J. High transverse vaginal septum

K. Retained products

L. Menopause

M. Turner’s syndrome

N. Pre-menstrual syndrome

O. Failure of Mullerian duct development

Instructions: For each woman described below choose the single most likely diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

Questions

16. A 27-year-old, P0+0, lady requests for hysterectomy because of irritability, depression, mood swings, insomnia, mastalgia, abdominal cramps and abdominal bloating associated with her menstrual periods for last 10 years.

[expand title=”Answers”]

Answer: N – Pre-menstrual syndrome

[/expand]

Important Notes from themedideas.com

This is the EMQ Bank for Part 2 MRCOG Examination published by themedideas.com to help the candidates improve their understanding of the NHS practice in the UK. It is not guaranteed that the candidates would pass the Part 2 MRCOG Examination by reading this EMQ Bank only. The questions and answers are not exhaustive on the topics covered. These aim to highlight the important relevant aspects of the topics rather than every minute detail, which is outside the scope of this EMQ Bank.

While every effort has been made to provide updated information, as Medicine is a constantly evolving science, the candidates are advised to consult recent literature as well.

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Part 2 MRCOG EMQ Bank – No 1

 

Set 1

 

Options for Questions 1-15

 

A. Cyproterone acetate

B. Pelvic ultrasound scan

C. Finasteride

D. Karyotype

E. Dexamethasone suppression test

F. Clomifene

G. Psychotherapy

H. COC

I. Levothyroxine

J. Progestogen challenge test

K. Short Synacthen test

L. MRI of adrenal and ovary

M. Bleaching

N. Laparoscopic ovarian drilling

O. Shaving

 

Instructions: For each clinical scenario described below choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

 

Questions

 

1. A 24-year-old, P0+0, lady presents with absence of periods, excessive growth of facial and body hairs, hoarsening of voice and male pattern baldness for last 6 months. Examination reveals Modified Ferriman-Gallwey score of 64 (0-76) and clitoromegaly. The endocrine profile includes LH 7.1 IU/L, FSH 2.6 IU/L, Testosterone 8.8 nmol/l, SHBG 44 nmol/l, free androgen index 20, Androstenedione 19.1 nmol/L, DHEAs 25 nmol/l  and 17-hydroxyprogesterone 2.7 nmol/l. The dexamethasone suppression test is negative.

 

Answer:

 

2. A 32-year-old, P2+0, lady is seen with increased weight gain, excessive growth of facial and body hairs and infrequent menstrual period (every 2-3 years) for last 16 years. She has also been trying for a baby for last 3 years without success. An ultrasound scan done 10 years ago showed PCO appearance. She has tried several treatments in the past including OCP, Cyproterone acetate, Metformin without success. Examination reveals Modified Ferriman-Gallwey score of 61 (0-76) and BMI of 34.

 

Answer:

 

3. A 16-year-old girl is seen with excessive growth of facial and body hairs for 2 years. She has not started having menstrual periods yet. One of her elder sisters also had similar problems at the age of 15 and is on regular medication. Her endocrine profile includes LH 6.4 IU/L, FSH 1.7 IU/L, Testosterone 7 nmol/l, SHBG 28 nmol/l, free androgen index 25, Androstenedione 10.1 nmol/L, DHEAs 6.3 nmol/l  and 17-hydroxyprogesterone 14.9 nmol/l. The pelvic ultrasound scan shows PCO appearance.

 

Answer:

 

4. An 18-year-old girl presents with growth of facial hair for last 2 years. She has not started having menstrual periods yet. She is quite embarrassed about the facial hair and requesting for treatment. She is very passionate about looking attractive. Her BMI is 18. Her endocrine profile includes LH 2.4 IU/L, FSH 1.2 IU/L, Testosterone 1.5 nmol/l, SHBG 51 nmol/l, free androgen index 3, Androstenedione 2.1 nmol/L, DHEAs 1.3 nmol/l  and 17-hydroxyprogesterone 1.9 nmol/l.

 

Answer:

 

5. A 35-year-old, P2+1, lady presents with excessive growth of facial hairs for 3 years. Her periods are regular. The endocrine profile is normal. Her mother and two sisters have similar problems. She has used bleach and shaving for her facial hair growth problem, but has had skin reactions.

 

Answer:

 

6. A 34-year-old, P0+0, lady is seen with complains of inability to conceive, amenorrhoea and excessive weight gain for 7 months after stopping dianette. She was taking dianette for excessive growth of facial hairs that started 16 years ago. Her family history includes PCOS, hypothyroidism and diabetes. The endocrine profile includes LH 8.2 IU/L, FSH 2.3 IU/L, Prolactin 583 mIU/L, Testosterone 2 nmol/l, SHBG 25 nmol/l, free androgen index 8, TSH 8.94 mIU/L, Androstenedione 2.3 nmol/L, DHEAs 1.5 nmol/l and 17-hydroxyprogesterone 2.1 nmol/l.

 

Answer:

 

7. A 19-year-old girl presents with some growth of facial hair that has been causing distress to her because of cosmetic reasons. Her menstrual periods are regular. The endocrine profile includes LH 4.1 IU/L, FSH 3.4 IU/L, Testosterone 1.2 nmol/l, SHBG 40 nmol/l, free androgen index 3, TSH 3.4 mIU/L, Androstenedione 2.1 nmol/L, DHEAs 1.2 nmol/l and 17-hydroxyprogesterone 1.5 nmol/l. She is not keen to use any treatment on a daily basis.

 

Answer:

 

8. A 25-year-old, P0+2, lady presents with excessive growth of facial and body hairs for 8 years. Her menstrual periods have become more frequent since last 6 months that has been causing disturbance in her personal relationship and work. She has had two termination of pregnancy in the past and is not planning to have baby in near future.

 

Answer:

 

9. A 19-year-old girl presents with excessive growth of facial and body hairs for 3 years and no menstrual periods for 9 months. Her endocrine profile includes LH 5.3 IU/L, FSH 3.8 IU/L, Testosterone 8 nmol/l, SHBG 20 nmol/l, free androgen index 30, Androstenedione 12.2 nmol/L, DHEAs 7.5 nmol/l and 17-hydroxyprogesterone 2.7 nmol/l. The pelvic ultrasound scan is normal.

 

Answer:

 

10. A 30-year-old, P0+0, lady presents with excessive growth of facial hairs for 12 years, deep dyspareunia for 3 years and inability to conceive for 2 years. Her periods are infrequent (every 2-3 months). Her sister has PCOS. The endocrine profile includes LH 8.2 IU/L, FSH 2.2 IU/L, Prolactin 410 mIU/L, Testosterone 2.2 nmol/l, SHBG 24 nmol/l, free androgen index 9, TSH 3.2 mIU/L, Androstenedione 2.5 nmol/L, DHEAs 1.4 nmol/l and 17-hydroxyprogesterone 1.6 nmol/l. The semen analysis is normal.

 

Answer:

 

11. A 25-year-old, P0+1, lady presents with inability to conceive and no menstrual periods for 8 months since stopping dianette that she was taking for hirsutism. She is a known case of PCOS for 8 years. The endocrine profile includes LH 9.1 IU/L, FSH 2.7 IU/L, Prolactin 415 mIU/L, Testosterone 1.9 nmol/l, SHBG 27 nmol/l, free androgen index 7, TSH 1.6 mIU/L, Androstenedione 3.6 nmol/L, DHEAs 1.7 nmol/l and 17-hydroxyprogesterone 2.1 nmol/l. The HSG is normal and the semen analysis shows 65% abnormal sperm.

 

Answer:

 

12. A 32-year-old, P2+0, lady presents with excessive growth of facial and body hairs for 10 years. Her menstrual periods have been infrequent (every 6-8 weeks) for last 2 years since insertion of Mirena IUS. She shaves once everyday and has used bleaching in the past. She is quite distressed about her hair growth problem and requesting for treatment. The endocrine profile includes LH 10.1 IU/L, FSH 3.9 IU/L, Prolactin 402 mIU/L, Testosterone 2.5 nmol/l, SHBG 19 nmol/l, free androgen index 13, TSH 2.5 mIU/L, Androstenedione 2.8 nmol/L, DHEAs 2.9 nmol/l  and 17-hydroxyprogesterone 2.3 nmol/l.

 

Answer:

 

13. A 24-year-old, P0+1, lady presents with inability to conceive and no menstrual periods for 8 months since termination of pregnancy. The endocrine profile includes LH 3.4 IU/L, FSH 3.2 IU/L, Prolactin 320 mIU/L, Testosterone 1.1 nmol/l, SHBG 37 nmol/l, free androgen index 33, TSH 2.1 mIU/L. The semen analysis is normal.

 

Answer:

 

14. A 30-year-old, P0+0, lady is seen with increased weight gain, excessive growth of facial and body hairs and infrequent menstrual periods (every 6-8 weeks) for last 10 years. She is extremely anxious about the hair growth problem that has been affecting her life significantly. PCOS was confirmed 8 years ago. She was advised to try dianette that she stopped after 3 months because of side effects. She is not very keen to try any medications or chemicals.

 

Answer:

 

15. A 16-year-old girl is seen, as she has not started her menstrual periods. Her secondary sexual characteristics are absent but the external genitalia are normal female. The endocrine profile includes LH 25.4 IU/L, FSH 35.2 IU/L, Prolactin 320 mIU/L and TSH 2.1 mIU/L. Pelvic ultrasound scan shows a small uterus but ovaries could not be detected.

 

Answer:

 

[expand title=”Answers”]

Options for Questions 1-15

 

A. Cyproterone acetate

B. Pelvic ultrasound scan

C. Finasteride

D. Karyotype

E. Dexamethasone suppression test

F. Clomifene

G. Psychotherapy

H. COC

I. Levothyroxine

J. Progestogen challenge test

K. Short Synacthen test

L. MRI of adrenal and ovary

M. Bleaching

N. Laparoscopic ovarian drilling

O. Shaving

 

Instructions: For each clinical scenario described below choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

 

Questions

 

1. A 24-year-old, P0+0, lady presents with absence of periods, excessive growth of facial and body hairs, hoarsening of voice and male pattern baldness for last 6 months. Examination reveals Modified Ferriman-Gallwey score of 64 (0-76) and clitoromegaly. The endocrine profile includes LH 7.1 IU/L, FSH 2.6 IU/L, Testosterone 8.8 nmol/l, SHBG 44 nmol/l, free androgen index 20, Androstenedione 19.1 nmol/L, DHEAs 25 nmol/l  and 17-hydroxyprogesterone 2.7 nmol/l. The dexamethasone suppression test is negative.

 

Answer: L – MRI of adrenal and ovary

 

2. A 32-year-old, P2+0, lady is seen with increased weight gain, excessive growth of facial and body hairs and infrequent menstrual period (every 2-3 years) for last 16 years. She has also been trying for a baby for last 3 years without success. An ultrasound scan done 10 years ago showed PCO appearance. She has tried several treatments in the past including OCP, Cyproterone acetate, Metformin without success. Examination reveals Modified Ferriman-Gallwey score of 61 (0-76) and BMI of 34.

 

Answer: N – Laparoscopic ovarian drilling

 

3. A 16-year-old girl is seen with excessive growth of facial and body hairs for 2 years. She has not started having menstrual periods yet. One of her elder sisters also had similar problems at the age of 15 and is on regular medication. Her endocrine profile includes LH 6.4 IU/L, FSH 1.7 IU/L, Testosterone 7 nmol/l, SHBG 28 nmol/l, free androgen index 25, Androstenedione 10.1 nmol/L, DHEAs 6.3 nmol/l  and 17-hydroxyprogesterone 14.9 nmol/l. The pelvic ultrasound scan shows PCO appearance.

 

Answer: K – Short Synacthen test

 

4. An 18-year-old girl presents with growth of facial hair for last 2 years. She has not started having menstrual periods yet. She is quite embarrassed about the facial hair and requesting for treatment. She is very passionate about looking attractive. Her BMI is 18. Her endocrine profile includes LH 2.4 IU/L, FSH 1.2 IU/L, Testosterone 1.5 nmol/l, SHBG 51 nmol/l, free androgen index 3, Androstenedione 2.1 nmol/L, DHEAs 1.3 nmol/l  and 17-hydroxyprogesterone 1.9 nmol/l.

 

Answer: G – Psychotherapy

 

5. A 35-year-old, P2+1, lady presents with excessive growth of facial hairs for 3 years. Her periods are regular. The endocrine profile is normal. Her mother and two sisters have similar problems. She has used bleach and shaving for her facial hair growth problem, but has had skin reactions.

 

Answer: C – Finasteride

 

6. A 34-year-old, P0+0, lady is seen with complains of inability to conceive, amenorrhoea and excessive weight gain for 7 months after stopping dianette. She was taking dianette for excessive growth of facial hairs that started 16 years ago. Her family history includes PCOS, hypothyroidism and diabetes. The endocrine profile includes LH 8.2 IU/L, FSH 2.3 IU/L, Prolactin 583 mIU/L, Testosterone 2 nmol/l, SHBG 25 nmol/l, free androgen index 8, TSH 8.94 mIU/L, Androstenedione 2.3 nmol/L, DHEAs 1.5 nmol/l and 17-hydroxyprogesterone 2.1 nmol/l.

 

Answer: I – Levothyroxine

 

7. A 19-year-old girl presents with some growth of facial hair that has been causing distress to her because of cosmetic reasons. Her menstrual periods are regular. The endocrine profile includes LH 4.1 IU/L, FSH 3.4 IU/L, Testosterone 1.2 nmol/l, SHBG 40 nmol/l, free androgen index 3, TSH 3.4 mIU/L, Androstenedione 2.1 nmol/L, DHEAs 1.2 nmol/l and 17-hydroxyprogesterone 1.5 nmol/l. She is not keen to use any treatment on a daily basis.

 

Answer: M – Bleaching

 

8. A 25-year-old, P0+2, lady presents with excessive growth of facial and body hairs for 8 years. Her menstrual periods have become more frequent since last 6 months that has been causing disturbance in her personal relationship and work. She has had two termination of pregnancy in the past and is not planning to have baby in near future.

 

Answer: H – COC

 

9. A 19-year-old girl presents with excessive growth of facial and body hairs for 3 years and no menstrual periods for 9 months. Her endocrine profile includes LH 5.3 IU/L, FSH 3.8 IU/L, Testosterone 8 nmol/l, SHBG 20 nmol/l, free androgen index 30, Androstenedione 12.2 nmol/L, DHEAs 7.5 nmol/l and 17-hydroxyprogesterone 2.7 nmol/l. The pelvic ultrasound scan is normal.

 

Answer: E – Dexamethasone suppression test

 

10. A 30-year-old, P0+0, lady presents with excessive growth of facial hairs for 12 years, deep dyspareunia for 3 years and inability to conceive for 2 years. Her periods are infrequent (every 2-3 months). Her sister has PCOS. The endocrine profile includes LH 8.2 IU/L, FSH 2.2 IU/L, Prolactin 410 mIU/L, Testosterone 2.2 nmol/l, SHBG 24 nmol/l, free androgen index 9, TSH 3.2 mIU/L, Androstenedione 2.5 nmol/L, DHEAs 1.4 nmol/l and 17-hydroxyprogesterone 1.6 nmol/l. The semen analysis is normal.

 

Answer: B – Pelvic ultrasound scan

 

11. A 25-year-old, P0+1, lady presents with inability to conceive and no menstrual periods for 8 months since stopping dianette that she was taking for hirsutism. She is a known case of PCOS for 8 years. The endocrine profile includes LH 9.1 IU/L, FSH 2.7 IU/L, Prolactin 415 mIU/L, Testosterone 1.9 nmol/l, SHBG 27 nmol/l, free androgen index 7, TSH 1.6 mIU/L, Androstenedione 3.6 nmol/L, DHEAs 1.7 nmol/l and 17-hydroxyprogesterone 2.1 nmol/l. The HSG is normal and the semen analysis shows 65% abnormal sperm.

 

Answer: F – Clomifene

 

12. A 32-year-old, P2+0, lady presents with excessive growth of facial and body hairs for 10 years. Her menstrual periods have been infrequent (every 6-8 weeks) for last 2 years since insertion of Mirena IUS. She shaves once everyday and has used bleaching in the past. She is quite distressed about her hair growth problem and requesting for treatment. The endocrine profile includes LH 10.1 IU/L, FSH 3.9 IU/L, Prolactin 402 mIU/L, Testosterone 2.5 nmol/l, SHBG 19 nmol/l, free androgen index 13, TSH 2.5 mIU/L, Androstenedione 2.8 nmol/L, DHEAs 2.9 nmol/l  and 17-hydroxyprogesterone 2.3 nmol/l.

 

Answer: A – Cyproterone acetate

 

13. A 24-year-old, P0+1, lady presents with inability to conceive and no menstrual periods for 8 months since termination of pregnancy. The endocrine profile includes LH 3.4 IU/L, FSH 3.2 IU/L, Prolactin 320 mIU/L, Testosterone 1.1 nmol/l, SHBG 37 nmol/l, free androgen index 33, TSH 2.1 mIU/L. The semen analysis is normal.

 

Answer: J – Progestogen challenge test

 

14. A 30-year-old, P0+0, lady is seen with increased weight gain, excessive growth of facial and body hairs and infrequent menstrual periods (every 6-8 weeks) for last 10 years. She is extremely anxious about the hair growth problem that has been affecting her life significantly. PCOS was confirmed 8 years ago. She was advised to try dianette that she stopped after 3 months because of side effects. She is not very keen to try any medications or chemicals.

 

Answer: O – Shaving

 

15. A 16-year-old girl is seen, as she has not started her menstrual periods. Her secondary sexual characteristics are absent but the external genitalia are normal female. The endocrine profile includes LH 25.4 IU/L, FSH 35.2 IU/L, Prolactin 320 mIU/L and TSH 2.1 mIU/L. Pelvic ultrasound scan shows a small uterus but ovaries could not be detected.

 

Answer: D – Karyotype

 

[/expand]

 

Set 2

 

Options for Questions 16-30

 

A. Imperforate hymen

B. Uterine perforation

C. Endometriosis

D. Uterine fibroids

E. Urinary tract infection

F. Ectopic pregnancy

G. Complete androgen insensitivity syndrome

H. Premature menopause

I. Asherman’s syndrome

J. High transverse vaginal septum

K. Retained products

L. Menopause

M. Turner’s syndrome

N. Pre-menstrual syndrome

O. Failure of Mullerian duct development

 

Instructions: For each woman described below choose the single most likely diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

 

Questions

 

16. A 27-year-old, P0+0, lady requests for hysterectomy because of irritability, depression, mood swings, insomnia, mastalgia, abdominal cramps and abdominal bloating associated with her menstrual periods for last 10 years.

 

Answer:

 

17. A 17-year-old tall girl is seen, as she has not started her menstrual periods. Her secondary sexual characteristics are normal with normal female external genitalia with Tanner’s stage 2 pubic hair growth. Serum Testosterone concentration is 3.1 nmol/l. Pelvic ultrasound scan cannot detect the presence of the uterus or ovaries. One of her sisters has similar problem.

 

Answer:

 

18. A 14-year-old girl is admitted with retention of urine. She complains of recurrent abdominal pain for last 1 year. She has not started having menstrual periods, but has developed secondary sexual characteristics. She does not use any contraception and denies having sexual intercourse. On gentle inspection the lower vagina looks normal. A pelvic ultrasound scan shows an enlarged uterus with significant free fluid in the pouch of Douglas.

 

Answer:

 

19. A 32-year-old, P2+1, lady is admitted with lower abdominal pain for 2 days, 2 weeks after surgical termination of pregnancy at 8 weeks’ gestation. She was well following the termination till she started the pain 2 days ago. On examination she is pale with a pulse of 108/m, BP 102/60 mm Hg, temperature 37.10 C, and muscle guard, tenderness and rebound tenderness are present on abdominal examination.

 

Answer:

 

20. A 41-year-old, P3+1, lady presents with no menstrual periods for 18 months since stopping combined oral contraceptive pill that she took for 10 years. She stopped the latter as she was a heavy smoker. She has a Mirena IUS since then. She has started having irritability, dyspareunia, and insomnia 12 months ago. She thinks these problems are related to the Mirena IUS that she wants to get rid off. Her GP has checked her serum FSH and LH that are 43 IU/L and 23 IU/L respectively.

 

Answer:

 

21. A 25-year-old, P1+1, lady is admitted with 8 weeks amenorrhoea and lower abdominal pain for 2 days. She has also noticed increased frequency of micturition for 5 days. She does not complain of any excessive vaginal discharge or bleeding. Her urinary pregnancy test is positive with protein+ and nitrite, Hb is 10.8 g/dl and WBC 14X 10 9 / L.

 

Answer:

 

22. A 26-year-old, P1+1, lady is seen with no menstrual periods for 6 months since termination of pregnancy. The endocrine profile includes LH 5.2 IU/L, FSH 3.2 IU/L, Prolactin 320 mIU/L and TSH 1.5 mIU/L. Her GP has given her combined oral contraceptive pill to induce menstrual period without success.

 

Answer:

 

23. A 15-year-old girl is admitted with retention of urine and recurrent abdominal pain for last 2 year. She has not started having menstrual periods, but has developed secondary sexual characteristics. She also complains of pain during sexual intercourse. On examination there is a tense bluish cystic swelling in the vagina.

 

Answer:

 

24. A 14-year-old, 150 cm tall, girl is seen, as she has not started her menstrual periods. Her secondary sexual characteristics are normal with normal female external genitalia. The endocrine profile includes LH 4.2 IU/L, FSH 3.5 IU/L, Prolactin 360 mIU/L, Testosterone 1.2 nmol/l and TSH 1.2 mIU/L. Pelvic ultrasound scan cannot detect the presence of the uterus or ovaries.

 

Answer:

 

25. A 30-year-old, P4+2, lady is admitted with abdominal pain and vaginal bleeding 4 days following surgical termination of pregnancy at 14 weeks’ gestation. Her last child was delivered by emergency caesarean section. She started the pain and vaginal bleeding since the termination of pregnancy was done. The pain is getting worse. She also vomited twice, does not feel well, has not been able to eat or drink normally and has not opened bowel yet. On examination she is slightly dehydrated with a pulse of 118/m, BP 118/76 mm Hg, temperature 37.10 C, and slight abdominal distension, muscle guard, tenderness and rebound tenderness are present on abdominal examination. The bowel sounds are absent.

 

Answer:

 

26. A 39-year-old, P4+1, lady complains of pain during sexual intercourse, irritability and depression for 4 months. Her GP has advised her antidepressant. She has had total abdominal hysterectomy with conservation of ovaries at the age of 34 for painful heavy irregular menstrual periods.

 

Answer:

 

27. A 17-year-old girl presents with no menstrual periods for 5 months. She started her menstrual periods at the age of 13. Her secondary sexual characteristics are normal with normal female external genitalia. The endocrine profile includes LH 32.2 IU/L, FSH 40.5 IU/L, Prolactin 360 mIU/L, Testosterone 1.1 nmol/l and TSH 1.3 mIU/L. Pelvic ultrasound scan shows normal uterus and ovaries.

 

Answer:

 

28. A 15-year-old girl presents with intermittent pain abdomen and vaginal bleeding for 6 weeks following 3 months of no menstrual periods. She denies having sexual intercourse. Her previous menstrual periods were regular but painful. The examination findings are normal except slight vaginal bleeding and slightly tender uterus. The urinary pregnancy test is negative. Pelvic ultrasound scan shows some echogenic shadows in the uterus and slightly bulky ovaries.

 

Answer:

 

29. A 32-year-old, P0+ 0, lady presents with excessive vaginal bleeding for 1 day and pain abdomen for 3 months. Her menstrual periods have been irregular and heavy for last 12 months since she stopped COC. She has not been using any contraception since then. Her LMP was 6 weeks ago. On examination she is slightly pale with a pulse of 106/m, BP 106/66 mm Hg, temperature 36.80 C, and tenderness on abdominal examination. The vaginal examination shows bulky and tender uterus and excessive vaginal bleeding. Her Hb is 8.9 g/dl.

 

Answer:

 

30. A 34-year-old, P0+0, lady presents with inability to conceive for 4 years. Her menstrual periods have been infrequent (5-6 weeks) but painful for last 2 years. She also complains of pain during sexual intercourse for last 3 years. The endocrine profile includes LH 5.1 IU/L, FSH 9.2 IU/L, Prolactin 341 mIU/L and TSH 2.3 mIU/L. The vaginal examination shows bulky and tender uterus, and tenderness in the right and posterior fornices. Pelvic ultrasound scan shows slightly bulky uterus and left ovary, but the right ovary could not be detected.

 

Answer:

 

[expand title=”Answers”]

Options for Questions 16-30

 

A. Imperforate hymen

B. Uterine perforation

C. Endometriosis

D. Uterine fibroids

E. Urinary tract infection

F. Ectopic pregnancy

G. Complete androgen insensitivity syndrome

H. Premature menopause

I. Asherman’s syndrome

J. High transverse vaginal septum

K. Retained products

L. Menopause

M. Turner’s syndrome

N. Pre-menstrual syndrome

O. Failure of Mullerian duct development

 

Instructions: For each woman described below choose the single most likely diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

 

Questions

 

16. A 27-year-old, P0+0, lady requests for hysterectomy because of irritability, depression, mood swings, insomnia, mastalgia, abdominal cramps and abdominal bloating associated with her menstrual periods for last 10 years.

 

Answer: N – Pre-menstrual syndrome

 

17. A 17-year-old tall girl is seen, as she has not started her menstrual periods. Her secondary sexual characteristics are normal with normal female external genitalia with Tanner’s stage 2 pubic hair growth. Serum Testosterone concentration is 3.1 nmol/l. Pelvic ultrasound scan cannot detect the presence of the uterus or ovaries. One of her sisters has similar problem.

 

Answer: G – Complete androgen insensitivity syndrome

 

18. A 14-year-old girl is admitted with retention of urine. She complains of recurrent abdominal pain for last 1 year. She has not started having menstrual periods, but has developed secondary sexual characteristics. She does not use any contraception and denies having sexual intercourse. On gentle inspection the lower vagina looks normal. A pelvic ultrasound scan shows an enlarged uterus with significant free fluid in the pouch of Douglas.

 

Answer: J – High transverse vaginal septum

 

19. A 32-year-old, P2+1, lady is admitted with lower abdominal pain for 2 days, 2 weeks after surgical termination of pregnancy at 8 weeks’ gestation. She was well following the termination till she started the pain 2 days ago. On examination she is pale with a pulse of 108/m, BP 102/60 mm Hg, temperature 37.10 C, and muscle guard, tenderness and rebound tenderness are present on abdominal examination.

 

Answer: F – Ectopic pregnancy

 

20. A 41-year-old, P3+1, lady presents with no menstrual periods for 18 months since stopping combined oral contraceptive pill that she took for 10 years. She stopped the latter as she was a heavy smoker. She has a Mirena IUS since then. She has started having irritability, dyspareunia, and insomnia 12 months ago. She thinks these problems are related to the Mirena IUS that she wants to get rid off. Her GP has checked her serum FSH and LH that are 43 IU/L and 23 IU/L respectively.

 

Answer: L – Menopause

 

21. A 25-year-old, P1+1, lady is admitted with 8 weeks amenorrhoea and lower abdominal pain for 2 days. She has also noticed increased frequency of micturition for 5 days. She does not complain of any excessive vaginal discharge or bleeding. Her urinary pregnancy test is positive with protein+ and nitrite, Hb is 10.8 g/dl and WBC 14X 10 9 / L.

 

Answer: E – Urinary tract infection

 

22. A 26-year-old, P1+1, lady is seen with no menstrual periods for 6 months since termination of pregnancy. The endocrine profile includes LH 5.2 IU/L, FSH 3.2 IU/L, Prolactin 320 mIU/L and TSH 1.5 mIU/L. Her GP has given her combined oral contraceptive pill to induce menstrual period without success.

 

Answer: I – Asherman’s syndrome

 

23. A 15-year-old girl is admitted with retention of urine and recurrent abdominal pain for last 2 year. She has not started having menstrual periods, but has developed secondary sexual characteristics. She also complains of pain during sexual intercourse. On examination there is a tense bluish cystic swelling in the vagina.

 

Answer: A – Imperforate hymen

 

24. A 14-year-old, 150 cm tall, girl is seen, as she has not started her menstrual periods. Her secondary sexual characteristics are normal with normal female external genitalia. The endocrine profile includes LH 4.2 IU/L, FSH 3.5 IU/L, Prolactin 360 mIU/L, Testosterone 1.2 nmol/l and TSH 1.2 mIU/L. Pelvic ultrasound scan cannot detect the presence of the uterus or ovaries.

 

Answer: O – Failure of Mullerian duct development

 

25. A 30-year-old, P4+2, lady is admitted with abdominal pain and vaginal bleeding 4 days following surgical termination of pregnancy at 14 weeks’ gestation. Her last child was delivered by emergency caesarean section. She started the pain and vaginal bleeding since the termination of pregnancy was done. The pain is getting worse. She also vomited twice, does not feel well, has not been able to eat or drink normally and has not opened bowel yet. On examination she is slightly dehydrated with a pulse of 118/m, BP 118/76 mm Hg, temperature 37.10 C, and slight abdominal distension, muscle guard, tenderness and rebound tenderness are present on abdominal examination. The bowel sounds are absent.

 

Answer: B – Uterine perforation

 

26. A 39-year-old, P4+1, lady complains of pain during sexual intercourse, irritability and depression for 4 months. Her GP has advised her antidepressant. She has had total abdominal hysterectomy with conservation of ovaries at the age of 34 for painful heavy irregular menstrual periods.

 

Answer: H – Premature menopause

 

27. A 17-year-old girl presents with no menstrual periods for 5 months. She started her menstrual periods at the age of 13. Her secondary sexual characteristics are normal with normal female external genitalia. The endocrine profile includes LH 32.2 IU/L, FSH 40.5 IU/L, Prolactin 360 mIU/L, Testosterone 1.1 nmol/l and TSH 1.3 mIU/L. Pelvic ultrasound scan shows normal uterus and ovaries.

 

Answer: M – Turner’s syndrome (mosaic)

 

28. A 15-year-old girl presents with intermittent pain abdomen and vaginal bleeding for 6 weeks following 3 months of no menstrual periods. She denies having sexual intercourse. Her previous menstrual periods were regular but painful. The examination findings are normal except slight vaginal bleeding and slightly tender uterus. The urinary pregnancy test is negative. Pelvic ultrasound scan shows some echogenic shadows in the uterus and slightly bulky ovaries.

 

Answer: K – Retained products

 

29. A 32-year-old, P0+ 0, lady presents with excessive vaginal bleeding for 1 day and pain abdomen for 3 months. Her menstrual periods have been irregular and heavy for last 12 months since she stopped COC. She has not been using any contraception since then. Her LMP was 6 weeks ago. On examination she is slightly pale with a pulse of 106/m, BP 106/66 mm Hg, temperature 36.80 C, and tenderness on abdominal examination. The vaginal examination shows bulky and tender uterus and excessive vaginal bleeding. Her Hb is 8.9 g/dl.

 

Answer: D – Uterine fibroids

 

30. A 34-year-old, P0+0, lady presents with inability to conceive for 4 years. Her menstrual periods have been infrequent (5-6 weeks) but painful for last 2 years. She also complains of pain during sexual intercourse for last 3 years. The endocrine profile includes LH 5.1 IU/L, FSH 9.2 IU/L, Prolactin 341 mIU/L and TSH 2.3 mIU/L. The vaginal examination shows bulky and tender uterus, and tenderness in the right and posterior fornices. Pelvic ultrasound scan shows slightly bulky uterus and left ovary, but the right ovary could not be detected.

 

Answer: C – Endometriosis

 

[/expand]

 

Set 3

 

Options for Questions 31-45

 

A. Damage to bowel

B. Total abdominal hysterectomy

C. Premature menopause

D. Uterine perforation

E. Vaginal bleeding

F. Wound dehiscence

G. Damage to ureter

H. Cervical incompetence

I. Urinary tract infection

J. Oophorectomy

K. Damage to bladder

L. Failed procedure

M. Laparotomy

N. Dyspareunia

O. Urinary retention

 

Instructions: For each case described below choose the single most likely relevant complication that must be discussed prior to taking consent from the above list of options. Each option may be used once, more than once, or not at all.

 

Questions

 

31. A 30-year-old woman is booked for removal of dermoid cyst measuring 16X12 cm.

 

Answer:

 

32. A 61-year-old woman is scheduled for tension-free vaginal tape procedure for genuine stress incontinence.

 

Answer:

 

33. A 48-year-old, P3+1, lady is booked for vaginal hysterectomy for heavy menstrual periods because of fibroids.

 

Answer:

 

34. A 42-year-old woman is booked for total abdominal hysterectomy and bilateral salpingo-oophorectomy for stage IV endometriosis.

 

Answer:

 

35. A 41-year-old woman is scheduled for posterior colpoperineorrhaphy.

 

Answer:

 

36. A 28-year-old nulliparous woman is scheduled for myomectomy.

 

Answer:

 

37. A 52-year-old woman booked for laparotomy to remove a 20X18 cm ovarian tumour.

 

Answer:

 

38. A 29-year-old, P4+1, lady has been admitted for evacuation of molar pregnancy. She has had an emergency caesarean section in her second pregnancy.

 

Answer:

 

39. A 32-year-old woman is booked for total abdominal hysterectomy for menorrhagia.

 

Answer:

 

40. A 54-year-old woman is scheduled for vaginal hysterectomy and repair of cystocele. She has had one caesarean section and cone biopsy in the past.

 

Answer:

 

41. A 25-year-old woman is scheduled for diagnostic laparoscopy to investigate pelvic pain.

 

Answer:

 

42. A 35-year-old woman is scheduled for total abdominal hysterectomy for a 17X15 cm left sided broad ligament fibroid.

 

Answer:

 

43. A 20-year-old nulliparous woman is scheduled for cone biopsy to treat CIN III.

 

Answer:

 

44. A 79-year-old lady is scheduled for hysteroscopy to investigate ?pyometra.

 

Answer:

 

45. A 29-year-old woman is booked for laparoscopy to investigate dyspareunia. Her BMI is 48.

 

Answer:

 

[expand title=”Answers”]

 

Options for Questions 16-30

 

A. Damage to bowel

B. Total abdominal hysterectomy

C. Premature menopause

D. Uterine perforation

E. Vaginal bleeding

F. Wound dehiscence

G. Damage to ureter

H. Cervical incompetence

I. Urinary tract infection

J. Oophorectomy

K. Damage to bladder

L. Failed procedure

M. Laparotomy

N. Dyspareunia

O. Urinary retention

 

Instructions: For each case described below choose the single most likely relevant complication that must be discussed prior to taking consent from the above list of options. Each option may be used once, more than once, or not at all.

 

Questions

 

31. A 30-year-old woman is booked for removal of dermoid cyst measuring 16X12 cm.

 

Answer: J – Oophorectomy

 

32. A 61-year-old woman is scheduled for tension-free vaginal tape procedure for genuine stress incontinence.

 

Answer: O – Urinary retention

 

33. A 48-year-old, P3+1, lady is booked for vaginal hysterectomy for heavy menstrual periods because of fibroids.

 

Answer: M – Laparotomy

 

34. A 42-year-old woman is booked for total abdominal hysterectomy and bilateral salpingo-oophorectomy for stage IV endometriosis.

 

Answer: A – Damage to bowel

 

35. A 41-year-old woman is scheduled for posterior colpoperineorrhaphy.

 

Answer: N – Dyspareunia

 

36. A 28-year-old nulliparous woman is scheduled for myomectomy.

 

Answer: B – Total abdominal hysterectomy

 

37. A 52-year-old woman booked for laparotomy to remove a 20X18 cm ovarian tumour.

 

Answer: F – Wound dehiscence

 

38. A 29-year-old, P4+1, lady has been admitted for evacuation of molar pregnancy. She has had an emergency caesarean section in her second pregnancy.

 

Answer: D – Uterine perforation

 

39. A 32-year-old woman is booked for total abdominal hysterectomy for menorrhagia.

 

Answer: C – Premature menopause

 

40. A 54-year-old woman is scheduled for vaginal hysterectomy and repair of cystocele. She has had one caesarean section and cone biopsy in the past.

 

Answer: K – Damage to bladder

 

41. A 25-year-old woman is scheduled for diagnostic laparoscopy to investigate pelvic pain.

 

Answer: M – Laparotomy

 

42. A 35-year-old woman is scheduled for total abdominal hysterectomy for a 17X15 cm left sided broad ligament fibroid.

 

Answer: G – Damage to ureter

 

43. A 20-year-old nulliparous woman is scheduled for cone biopsy to treat CIN III.

 

Answer: H – Cervical incompetence

 

44. A 79-year-old lady is scheduled for hysteroscopy to investigate ?pyometra.

 

Answer: D – Uterine perforation

 

45. A 29-year-old woman is booked for laparoscopy to investigate dyspareunia. Her BMI is 48.

 

Answer: L – Failed procedure

 

[/expand]

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