Single Best Answer (SBA) Questions – Part Two

A 48-year-old woman reports symptoms of uterine prolapse and urinary incontinence which have developed over time following the births of her three children. On examination, she is noted to have laxity of her pelvic floor muscles. Which of the levator ani muscles inserts into the perineal body?

• a)

  Ischiococcygeus

• b)

  Iliococcygeus

• c)

  Puborectalis

• d)

  Obturator internus

• e)

  External anal sphincter

A 35-year-old woman wishes to have a laparoscopic sterilization. When performing this procedure, which portion of the fallopian tube should be occluded?

• a)

  The ampulla

• b)

  The isthmus

• c)

  The mesosalpinx

• d)

  The infundibulum

• e)

  The mesovarium

A 7-year-old girl has developed secondary sexual characteristics and is being investigated for precocious puberty. Which of the following statements is true of precocious puberty?

• a)

  Investigations and follow-up can be managed by the child’s own general practitioner (GP).

• b)

  All children require treatment, as symptoms can progress quickly.

• c)

  A multicystic appearance to the ovaries on ultrasound suggests constitutional puberty.

• d)

  Café-au-lait skin pigmentation can be a sign of a common cause of precocious puberty.

• e)

  Long-bone radiological skeletal survey is the first-line investigation.

A 12-year-old girl and her mother are concerned as she has not shown any signs of puberty. Which of the following statements is most correct for delayed puberty?

• a)

  Delayed puberty is defined as the absence of physical manifestations of puberty by 14 years of age.

• b)

  Short stature is not a typical sign of constitutional delay.

• c)

  X-ray for bone age is a first-line investigation.

• d)

  Induction of puberty may not be indicated when constitutional delay is the cause.

• e)

  Anorexia is not a known cause of hypogonadotropic hypogonadism.

A 35-year-old woman is being investigated for primary subfertility. Which of the following statements is not an appropriate first-line investigation?

• a)

  Day 21 progesterone

• b)

  Measure Body Mass Index

• c)

  Hysteroscopy

• d)

  Hysterosalpingography

• e)

  Measure Anti-Mullerian Hormone

A couple are being investigated for possible male factor infertility. Which of the following statements is the single best answer?

• a)

  A testicular biopsy is purely for diagnostic purposes.

• b)

  Donor insemination (DI) at the time of ovulation has a chance of live birth of 6% per cycle.

• c)

  Multivitamins have been associated with an improvement in sperm parameters.

• d)

  Varicocele correction surgery is associated with an improvement in fertility.

• e)

  If a vasectomy is reversed 12 years after the original procedure, pregnancy rates are around 10%.

A 37-year-old para 2 woman presents with heavy menstrual bleeding. An ultrasound scan is performed which shows the presence of a single fibroid (leiomyoma) measuring 2 cm which does not distort the endometrial cavity. What is the most appropriate treatment option?

• a)

  Myomectomy

• b)

  Total abdominal hysterectomy

• c)

  Uterine artery embolization

• d)

  Levonorgestrel-releasing intrauterine system (LNG-IUS)

• e)

  Gonadotropin releasing hormone (GnRH) analogue

Taking tranexamic acid during menstruation reduces blood loss by around 50%; therefore, it is a drug used often in the management of heavy menstrual bleeding. What is the mode of action of this drug?

• a)

  Suppresses the effects of progesterone withdrawal on the endometrium.

• b)

  Inhibits cyclo-oxygenase, which is required for the synthesis of prostaglandins.

• c)

  Inhibits the binding of adenosine diphosphate to its platelet receptor.

• d)

  Inhibits plasminogen activator.

• e)

  Suppresses ovulation.

A 22-year-old para 0 + 0 woman presents with a 9-month history of increasing pain during menstruation. The pain typically occurs 3 to 4 days before menstruation and lasts throughout. She also reports deep dyspareunia, and wishes to continue using condoms with her new partner. What is the most appropriate initial management?

• a)

  A trial of the progesterone-only pill

• b)

  A trial of the LNG-IUS

• c)

  An ultrasound of the pelvis

• d)

  High vaginal swab, including tests for chlamydia and gonorrhoea

• e)

  Diagnostic laparoscopy