Menopause -General Gynaecology module part2

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A 55-year-old patient presents with severely debilitating vasomotor symptoms. She
was declined HRT treatment by her general practitioner as her mother had had a PE while
taking the combined oral contraceptive pills. She is otherwise t and well with no signi cant
previous medical or surgical history and has never had any gynaecologic surgery.
Which HRT would give her the lowest risk of VTE?
Options

A) . Screen for thrombophilia.

B) . LNG-IUS

C) . Oral combined continuous HRT.

D) Oral combined sequential HRT.

E) Transdermal combined HRT preparation

A 50-year-old patient is due to have a major abdominal surgery. She is currently
taking combined continuous HRT for vasomotor symptoms.
When should she stop HRT before surgery?
Options

A) 2 weeks.

B) 4 weeks.

C) 6 weeks.

D) 8 weeks.

E) 10 weeks

A 35-year-old para 3 underwent a TAH+BSO for severe pelvic endometriosis that had
not responded to medical and conservative surgical treatment. She attends for her followup appointment complaining of hot ushes and sweating.
Which HRT regime should you consider?
Options

A) Combined continuous oestrogen/progestogen.

B) Oestradiol patches.

C) Oral oestradiol valerate.

D) Progesterone-only HRT.

E) Topical oestriol.

A 50-year-old patient is due to have a major abdominal surgery. She is currently
taking combined continuous HRT for vasomotor symptoms.
When should she stop HRT before surgery?
Options

A) . 2 weeks.

B) . 4 weeks.

C) 6 weeks.

D) 8 weeks.

E) 10 weeks.

A woman opts to take oral continuous combined HRT for 5 years after the
menopause.
In which year of HRT use will her risk of venous thromboembolism (VTE) be greatest?

A) 1st year

B) 2nd year

C) 3rd year

D) 4th year

E) 5th year

A 45-year-old woman approaches you in the menopause clinic. Her mother died at
the age of 48 from acute myocardial infarction.
She wants more information on the use of HRT and other medications to prevent coronary
heart disease (CHD).
Which of the following statements is correct?

A) A. Aspirin should be taken regularly after the age of 50 years to prevent CHD

B) B. Oestrogen does not reduce the risk of CHD in women with premature menopause

C) Oestrogen may have a protective role in CHD prevention in women aged 50–59 years

D) New evidence is available regarding the use of lipid lowering agents to prevent CHD in menopausal women

E) Pharmacotherapy is as good as the combination of lifestyle measures and pharmacotherapy in the prevention of CHD in menopausal diabetic women

A) Screen for thrombophilia.

B) LNG-IUS

C) . Oral combined continuous HRT.

D) Oral combined sequential HRT.

E) Transdermal combined HRT preparation.

10)

A 52-year-old woman is referred by her GP to the menopause clinic with hot flushes
and night sweats. She is concerned about the risk of breast cancer following the use of
HRT.
Which of the following statements regarding HRT and breast cancer is true?

A) Continuous combined HRT accounts for three extra cases in every 1000 women who use it for 2 years between the ages of 50 and 59

B) Continuous combined HRT accounts for five extra cases in every 1000 women who use it for 2 years between the ages of 50 and 59

C) Continuous combined HRT accounts for three extra cases in every 1000 women who use it for 5 years between the ages of 50 and 59

D) The use of estrogen-only HRT is associated with a higher risk compared with combined HRT

E) The use of tibolone is associated with the highest risk

11)

A 55-year-old woman attends the gynaecology clinic. She is suffer- ing with terrible
menopausal symptoms and cannot sleep because of the frequency of hot flushes.She is
requesting hormone replacement therapy (HRT) for symptom relief. She is currently
healthy but has a history of a deep venous thrombosis in her calf following a fractured
femur as a result of an accident 10 years ago.
Her last menstrual period was 2 years ago and her uterus is intact. What would you
recommend?

A) All HRT is contraindicated in this situation

B) Oestrogen and testosterone implants

C) Oral continuous combined HRT

D) Raloxifene

E) Transdermal continuous combined HRT

13)

A 56-year-old woman with a BMI of 38 and type 2 diabetes mellitus presents with
daily dark brown staining on her underwear for the past week. She underwent menopause
at age 53 and has had no further bleeding or discharge since that time. ere has been no
vaginal or vulval trauma, and her cervical smear test 6 months previously was normal. On
examination her cervix appears normal and there is no evidence of external
haemorrhoids. A urine dipstick test is negative for blood.
What is the next best step in the management of this patient?

A) Dilatation and curettage. .

B) Outpatient hysteroscopy.

C) . Pipelle biopsy.

D) Transvaginal ultrasound.

E) Vabra biopsy

14) Q18. Which of the following statements regarding premature ovarian failure (POF) is true?

A) Incidence of POF is 1 in 300 women

B) 90% of the cases have an autoimmune cause or a chromosomal disorder

C) 20% of the women diagnosed with POF may resume ovarian activity

D) Premature ovarian failure is confirmed if two tests are repeated at least 3–4 weeks apart show raised gonadotrophin levels

E) Risk of using HRT before the age of 50 years in women with POF includes breast and ovarian cancer

16) What is the mode of action of bisphosphonates?

A) Calcitonin antagonist

B) Decreased bone resorption

C) Increased bone formation

D) Inhibition of release of parathyroid hormone

E) Vitamin D agonist

17)

What proportion of epithelial ovarian cancers are diagnosed in women who are not
postmenopausal?

A) 5–10%

B) 10–15%

C) 15–20%

D) 20–25%

E) . 25–30%

18)

Which of the following statements regarding osteoperosis management in
menopausal women is true?

A) Bisphosphonates should be taken daily

B) Denosuab is now licensed for use in postmenopausal women with osteoporosis

C) Raloxifene is associated with an increased risk of uterine but not breast cancer

D) Raloxifene use is associated with a reduced risk of coronary heart disease as it reduces cholesterol levels

E) Strontium should be taken with calcium supplements for best effect

19)

You are seeing a 62-year-old patient for a follow-up visit. You evaluated her for
fracture risk 2 weeks ago and, given that she has high risk for fracture, you sent her for a
DEXA scan. Her T score for bone mineral density in the hip was less than −2.5 and the
thoracic spine less than −2.0. She has no secondary causes of osteoporosis, has not
been on glucocorticoids recently, is a nonsmoker, and does not drink alcohol.
ere is no dysphagia, and she is able to sit upright for 1 hour a er taking medications. It is
determined that she should be placed on a bisphosphonate for treatment of her
osteoporosis of the hip.
Which of the following does not affect the risk of fracture of hip?

A) Alendronate.

B) Etidronate.

C) Risendronate.

D) Zoledronic acid.

E) None of the above.

20) What is the most common side effect of bisphosphonates?

A) Diarrhoea and vomiting

B) Flu-like illness

C) Oesophageal irritation

D) Osteonecrosis of the jaw

E) Urinary frequency

21)

A 58-year-old postmenopausal woman presents for HRT counselling. While
questioning her about her health, you ask her about the risk factors for osteoporosis from
the fracture risk assessment (FRAX) tool, which is used to determine which individuals
warrant further evaluation for osteoporosis by bone mineral density testing.
Which of the following is not part of the FRAX tool?

A) Past smoking history.

B) Prior fracture as an adult.

C) Alcohol intake.

D) History of type 1 diabetes mellitus.

E) Paternal or maternal history of hip fractures.

22)

A 70-year-old woman undergoes a dual-energy X-ray absorptiom- etry (DXA) scan to
assess her bone mineral density.
What T score is diagnostic of osteoporosis?

A) +2.5

B) +1.0

C) . −1.0

D) −2.5

E) −5.0

23)

A 49-year-old woman approaches you in the clinic as she has been having regular,
troublesome hot flushes for past 6 months. Her last period was 2 weeks ago and they are
regular.
Which is the most suitable type of HRT to start her on?

A) Continuous combined HRT

B) . Estrogen only HRT - oral tablets

C) . Estrogen only HRT - patches

D) Sequential combined HRT

E) Tibolone

Your score is