General Gynaecology (SBA AND EMQ)- General Gynaecology part2

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A 17-year-old girl is brought to the gynaecology outpatient department with a history of
primary amenorrhoea. On questioning, she admits to having cyclical abdominal pain
and increasing difficulty with, not in voiding urine and defecation

2) Which of the following is a selective progesterone receptor modulator?


A 24-year-old woman presents to the gynaecology clinic with painful periods. She takes
a fibre supplement for managing constipation. She also mentions that her GP specifically
asked her to discuss her repeated need to see the GP about low mood lasting a week or
fortnight that gets better after she has the period pain. The GP had advised her to see a
counsellor, but she is not keen to discuss this with anyone else

4) .Combined oral contraceptive pill (COCP)

5) What proportion of women who have treatment with gonadotropin-releasing hormone (GnRH) analogues for the symptoms of premenstrual syndrome (PMS) will report an improvement in symptoms?




2 A 21-year-old patient presents to the gynaecology OPD with complaints of not having
periods after her premature delivery of twins 15 months ago. She did not have lactation
at all, and the baby has been fed with formula milk throughout. Her GP has recently
recommended a thyroxine supplementation due to her weight gain and abnormal
thyroid results. She mentions that she does not like coffee anymore as she cannot
perceive, not bear its aroma.


A 23-year-old university student presents to the gynaecology OPD with prolonged
bleeding lasting for 8 days during her period, although not particularly heavy. On
questioning, she admits to having intermenstrual and post-coital bleeding intermittently.
She uses the combined oral contraceptive pill for contraception.

8) Danazol

9) What is the most common congenital abnormality of fusion in the female genital tract?


What is the primary aim of medical interventions in the management of heavy

menstrual bleeding?


A 24-year-old woman is brought to the hospital with complaints of abdominal pain
and spotting. Her period was 2 weeks ago, and the pregnancy test is negative. She is
afebrile, has no gastrointestinal symptoms, examination is normal and recovers with
simple analgesia


A 52-year-old woman presents with severe hot flushes. She takes tablets for
hypertension that has been well managed for the past 6 years. She had a hysterectomy
when she was 49.

13) Tranexamic acid

14) A healthy 40-year-old woman presents to the gynaecology clinic with heavy

menstrual bleeding. History, examination and an ultrasound scan suggest the

presence of adenomyosis, but no other pathology.

What would be considered the first-line treatment?


15) A 35-year-old woman presents to the gynaecology clinic with heavy menstrual


bleeding and opts to have an LNG-IUS inserted. She is warned of the possibility of


changes to her bleeding pattern.

For how long should she be advised to persevere with any unwanted changes to

her bleeding pattern in order to see the maximum benefits of treatment?



A 24-year-old woman presents to the gynaecology OPD with irregular periods. She has
a 6-month history of amenorrhoea. Her periods have been irregular for the last 2 years.
She is not in a relationship currently. She has been advised weight loss by the GP and is
trying to maintain a healthy diet and active lifestyle.


A 52-year-old woman presents with complaints of low libido. She attained menopause
5 years ago and is taking estrogen and progesterone HRT.

18) Obstetric outcomes in pregnancy after uterine artery embolisation—which of

the following is not true?

19) Luteal phase progestogens (days 15-25)


An 18-year-old girl presents to the OPD with cessation of her period that commenced
at 15 years of age. It has been increasingly infrequent over the last 2 years and she has
not had a period for more than a year now. On examination, it was found that she has a
wide carrying angle.

21) The commonest pathology identifi ed at diagnostic laparoscopy in patients with chronic pelvic pain is:


A 35-year-old woman with a BMI of 22 presents to the fertility clinic. She has irregular
cycles once in 2–3 months and is anxious to conceive. Her ultrasound reveals polycystic


A 19-year-old girl presents to the GP with intermittent lower abdominal pain and
persistent vaginal discharge with no itching or foul smell. She mentions that she is
nulliparous and uses an IUD for contraception. It was inserted a year ago


The most common cause of postmenopausal bleeding is atrophic vaginitis/endometritis. What is the second most common cause?



A 25-year-old woman presents to the hospital with abdominal pain and vomiting.
She had nausea for more than 24 hours. She is pyrexial and has tenderness with cervical
movement. Urine pregnancy test is negative.

26) A 38-year-old woman presents to the gynaecology clinic with a 6-month history

of amenorrhoea and hot flushes. A pregnancy test is negative. Her serum follicle stimulating hormone (FSH) is measured and found to be 45 IU/l.

What further result would confirm a diagnosis of premature ovarian insufficiency (POI)?


27) Medical management of fi broids is best indicated when:

28) .A 14-year-old girl presents in the gynaecology OPD with a history of irregular bleeding per vaginam for the last 4–5 months. She has been rather stressed out with her school and theatre group activities which is adversely affecting her routine life and cannot recollect her dates or menstrual pattern well.

She was on the pill for the past year. Of late she has loss of appetite with nausea and vomiting and fullness of the lower abdomen. She has lost weight in the last 3 months due to poor food intake. On examination vesicles are seen in the vagina close to the external cervical os.

What is the most likely clinical diagnosis?


A 54-year-old woman presents with spotting of blood vaginally on wiping over the last
few weeks on and off. She went through the menopause 3 years ago and is otherwise
well. She is more active since her recent knee replacement surgery. Her Pap smear
2 years ago was normal as were her other smears.

30) Which one of the following is correct in relation to polycystic ovarian syndrome,



Where in the vagina is a transverse vaginal septum most commonly found?



32) Which pharmacological treatment is most commonly used as a first-line therapy in the treatment of endometriosis in women with chronic pelvic pain?



A 13-year-old girl is brought to the gynaecology OPD by her mother. She attained
menarche a year ago but has had only two cycles in the year. She weighs 48 kg. Her BMI
is normal. The mother is concerned as she has polycystic ovary syndrome (PCOS).


A 40-year-old woman who has recently come from Turkey presents with intermenstrual
bleeding. She has not had any investigations so far

35) Which hormone is implicated in the development of endometrial polyps in obese postmenopausal women?


36) Ms. XY, 22 years old, has recently been diagnosed with PCOS. Her BMI is 23.

Her modifi ed GTT was normal. She has very irregular oligomenorrheic cycles. She is

extremely anxious about her general health and the risk of cancer.

She is not plan ning a pregnancy in the near future.

She suffers from migraines. Which of the fol lowing treatment options are best suited to her?



A 32-year-old parous woman presents to the gynaecology clinic as she is unable to lose
weight. She was diagnosed with PCOS but has never had any menstrual irregularity

38) The preferred period for intervention for an ovarian mass in pregnancy is:



A 22-year-old woman is brought to the Accident and Emergency department with
complaints of diarrhoea with sudden onset of abdominal pain and fainting spell.
She uses the minipill but is noncompliant. She has irregular periods

40) The incidence of chronic pelvic pain in women of reproductive age group is:



A 39-year-old woman presents with severe puffiness of the feet and bloating 10 days
before her period every month. Her weight increases marginally and she struggles
to fit into her well-fitted clothes periodically. She works as a stewardess and finds it
distressing. She has no mood changes to report.


A 48-year-old woman presents with amenorrhoea for 10 months. She is concerned
about her family history of osteoporosis and a recent DEXA scan showed a low T score
with osteopenia globally. Her mum and aunt have been operated for breast cancer
Polycystic ovarian syndrome

43) The incidence of adnexal pathology detected for the fi rst time in pregnancy is:

44) Gestrinone


A 23-year-old woman presents with lower abdominal pain which is bilateral. She has
diffuse tenderness on examination, is febrile and her period was 3 weeks ago. A urine
pregnancy test is negative. Speculum examination reveals a congested cervix and
cervical excitation


A 13-year-old girl is brought to the gynaecology OPD by her mother. Her mother is
concerned that she has not had her periods regularly. She attained menarche at 12 years
and had been having periods once in 2 months or sometimes 3 months. She has a
normal BMI and plays sport regularly.


A 43-year-old woman presents to the gynaecology OPD with complaints of severe
mood swings prior to her 24-day cycle lasting more than a week. This is very recent,
and she admits to worsening of mood cyclically, but work has also been stressful of late.
She explains that she feels a total lack of control and is prone to episodes of feeling tearful.
She wants to know if this is due to her hormonal cyclical changes or work stress alone.


.An 18-year-old girl presents to the gynaecology clinic with severe mood swings and delay
for a week before the onset of her period. She also feels drained due to heavy bleeding
during her periods. This affects her relationship with her boyfriend with whom she is in a
stable cohabiting relationship. It also affects her University performance as a new student.


A 56-year-old woman presents to the urogynaecology clinic with dysuria and vaginal
irritation. This has been a problem for many months. Urine routine and culture are
negative for bacterial presence. Local examination shows a urethral caruncle.

Your score is