Single Best Answer (SBA) Questions – Part One

In which of the following scenarios can a woman be diagnosed as postmenopausal?

• a)

  When her periods become irregular or lighter

• b)

  When she develops symptoms such as hot flushes, mood swings and vaginal dryness

• c)

  When there is more than 3 months between periods

• d)

  When it has been more than 6 months since her last period

• e)

  When it has been more than 12 months since her last period

In obstetric vaginal assessment in labour, which anatomical landmark is used to define the station of the presenting part?

• a)

  The vaginal opening

• b)

  The anterior superior iliac spine

• c)

  The anterior inferior iliac spine

• d)

  The ischial spine

• e)

  The pubic symphysis

A 21-year-old nulliparous women presents to her general practitioner (GP) with 2 days of crampy left iliac fossa (LIF) pain. She is currently on day 14 of her menstrual cycle and has no associated symptoms and no abnormal discharge. Her observations are normal on examination and her abdomen is soft, with some mild LIF tenderness. Urinalysis and human chorionic gonadotropin (hCG) are both negative. On further questioning, she reports she had a similar episode 4 weeks ago. What is the most likely cause of her pain?

• a)

  Ovarian torsion

• b)

  Endometriosis

• c)

  Ectopic pregnancy

• d)

  Mittelschmerz pain

• e)

  Pelvic inflammatory disease

In the menstrual cycle, a surge of which hormone mid-cycle is the main trigger for ovulation?

• a)

  Gonadotrophin-releasing hormone

• b)

  Estrogen

• c)

  Progesterone

• d)

  Follicle-stimulating hormone

• e)

  Luteinizing hormone

A 14-year-old girl attends her GP with her mother. The mother is concerned that the girl has not yet started her periods like the rest of her friends have. On assessment, she has a normal body weight and normal secondary sexual characteristics. Her mother reports that her own menarche was at age 17 years. What is the recommended management?

• a)

  Reassurance

• b)

  5 days of oral progestogen to induce a withdrawal bleed

• c)

  A pelvic ultrasound scan to ensure that her anatomy is normal

• d)

  Referral to gynaecology for further investigation

• e)

  Advise her to try gaining weight and exercising less

A 35-year-old woman with a history of polycystic ovarian syndrome presents to her GP due to not becoming pregnant after 1 year of trying to conceive. She is having regular unprotected sex with her male partner and is otherwise fit and well. She has a regular 28-day cycle. You decide to test her progesterone levels to confirm whether she is ovulating. On which day of her menstrual cycle would you arrange for her to have a blood test?

• a)

  Day 1

• b)

  Day 7

• c)

  Day 14

• d)

  Day 21

• e)

  Day 28

What is the definition of a missed miscarriage?

• a)

  Passage of some but not all of the pregnancy tissue

• b)

  All pregnancy tissue expelled from the uterus

• c)

  A miscarriage that occurs with no pain or bleeding

• d)

  Pain and bleeding with a closed cervical os

• e)

  Three or more consecutive miscarriages

A 34-year-old woman attends a recurrent miscarriage clinic following 3 consecutive early miscarriages. She has had no other pregnancies. On further investigation, she is found to have lupus anticoagulant and anti-cardiolipin antibodies, with all other tests returned as normal. What treatment would be recommended to her in her next pregnancy to reduce complications?

• a)

  Progesterone pessaries

• b)

  Low molecular weight heparin (LMWH) and aspirin

• c)

  High-dose folic acid

• d)

  Vitamin D supplementation

• e)

  Wearing compression stockings

A 28-year-old primigravida attends the early pregnancy assessment centre with vaginal spotting at an estimated 6 weeks’ gestation. An ultrasound scan shows a suspected ectopic pregnancy measuring 20 mm in diameter and an empty uterus. She is haemodynamically stable and her hCG shows a fall over the preceding 48 hours from 1200 to 800IU/L. She tells you that she wishes to avoid intervention if possible. What would be your recommended management?

• a)

  Conservative management with hCG monitoring

• b)

  Medical management with methotrexate

• c)

  Medical management with misoprostol

• d)

  Surgical management with salpingectomy

• e)

  Surgical management with salpingotomy

A 24-year-old nulliparous woman presents to her GP with chronic pelvic pain and deep dyspareunia and a diagnosis of endometriosis is suspected. What is the gold standard diagnostic investigation that could confirm this diagnosis?

• a)

  Pelvic ultrasound

• b)

  Pelvic MRI

• c)

  Endometrial biopsy

• d)

  Hysteroscopy

• e)

  Diagnostic laparoscopy

What is the most common contributing risk factor in pelvic organ prolapse?

• a)

  Pregnancy and childbirth

• b)

  Chronic constipation

• c)

  Chronic cough

• d)

  Obesity

• e)

  High-impact exercise

A 78-year-old multiparous woman presents with a feeling of a lump in her vagina associated with a dragging sensation. On examination, you find that she has a uterine prolapse with the cervix reaching <1 cm below the plane of the hymen. According to the pelvic organ prolapse quantification system (POP-Q), which stage of prolapse does she have?

• a)

  Stage 0

• b)

  Stage I

• c)

  Stage II

• d)

  Stage III

• e)

  Stage IV