Mini Mock Test 2- module Part 2
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1) Which of the following hormones are stimulated by somatostatin?
2) After birth the proximal portion of umbilical arteries will become?
3) 1-A healthy 45-year-old, parous woman had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for heavy menstrual bleeding. She presents to her GP 6 months after her surgery with vaginal dryness, dyspareunia and reduced ability to orgasm. What is the most appropriate treatment for her symptoms?
A fall in estradiol levels can result in vaginal smooth muscle atrophy and increased vaginal acidity, leading to discomfort. Systemic HRT in isolation may not always address these problems, and vaginal estrogen may still be required.
4) what is the most common cause of premature menppuse in the UK ??
5) MRSA respond to all except
6) A 23-year-old woman who presented with a long history of dysmenorrhoea is undergoing a pelvic magnetic resonance imaging (MRI) scan.
What feature on MRI is always found with an accessory cavitated uterine malformation?
A 25-year-old woman had a normal delivery at term 4 months ago. She is exclusively breastfeeding and had an episode of unprotected sexual intercourse. She takes ulipristal acetate for emergency contraception. What breastfeeding advice would you give her?
Express and discard breast milk for 7 days after dose Mullin S, Burden C, Standing J, Neuberger F. Breastfeeding and drugs. The Obstetrician & Gynaecologist 2021;23:94–102
A 21-year-old nulliparous woman requires radiotherapy as part of her treatment for cervical cancer. What fertility-sparing treatment will you recommend as giving the best chance of future pregnancy?
9) A 25-year-old woman with Mayer–Rokitansky–Küster–Hauser syndrome attended the local tertiary reproductive medicine service with her partner to discuss parenthood options. After extensive counselling she consented to uterine transplantation and this was performed 2 weeks ago. She is anxious to proceed with in vitro fertilisation (IVF). How soon after the transplant can IVF be attempted?
A 21-year-old woman is referred to the gynaecology clinic with postcoital bleeding. Examination reveals a normal cervix. What investigation would you perform next?
11) Human Chorionic Gonadotrophin (HCG) is structurally similar to which of the following hormones?
A 39-year-old woman has a 5-month history of vague lower abdominal pain, anorexia and weight loss. Pelvic examination reveals a possible mass in the right adnexa. What is the most appropriate investigation to request to diagnose ovarian malignancy?
According to the World Health Organization, 8% of pregnant women worldwide have inadequate zinc intake. What benefit does zinc supplementation have on pregnancy outcome?
9Reduced risk of preterm delivery – this is the only benefit demonstrated. Brooks C, Supramaniam PR, Mittal M. Preconception health in the well woman. The Obstetrician & Gynaecologist 2022;24:58–66.
A 49-year-old woman is scheduled for total laparoscopic hysterectomy and bilateral salpingo-oophorectomy for severe menorrhagia resistant to medical treatment. There are no known drug allergies. What antibiotic prophylaxis is required?
A 25-year-old woman with Mayer–Rokitansky–Küster–Hauser Syndrome undergoes uterine transplantation and subsequently conceives with in vitro fertilisation. The pregnancy progresses satisfactorily and fetal and maternal monitoring is reassuring. At 34 weeks’ gestation, ultrasound scan confirms cephalic presentation, the baby’s estimated weight is on the 50th centile, umbilical artery Dopplers show normal end-diastolic flow, amniotic fluid index is 15 cm and the placenta is normally sited, anteriorly. What will you advise regarding her delivery?
16) A 56-year-old postmenopausal woman has a cystocele, stress urinary incontinence and dyspareunia. What prolapse treatment would you offer this patient to improve her sexual satisfaction?
Source : Investigation and management of postcoital bleeding
A 55-year-old woman attends the one-stop clinic with postmenopausal bleeding. She is fit and well with a body mass index of 32 kg/m2. She had 5 days of heavy bleeding about 6 weeks previously. Examination was unremarkable. Transvaginal ultrasound revealed an endometrial thickness of 7 mm, with no obvious polyps. Endometrial biopsy showed no evidence of hyperplasia, atypia or malignant change. She is relieved to receive the results though does still have occasional spotting. What management option do you recommend for this patient next?
-A 34-year-old woman had an emergency caesarean section at 38 weeks’ gestation for fetal bradycardia in the first stage of labour. She had a history of type 1 diabetes and was induced for reducing insulin requirements. She was admitted on day four post-delivery with signs of wound infection. Wound swabs grew methicillin-resistant Staphylococcus aureus. What antibiotics would you recommend for this patient, who is breastfeeding?
This is safe in breastfeeding and the drug of choice for treating MRSA. Mullin S, Burden C, Standing J, Neuberger F. Breastfeeding and drugs. The Obstetrician & Gynaecologist 2021;23:94–102.
A 41-year-old woman presents with painless vaginal bleeding at 27 weeks’ gestation in her third pregnancy. Preliminary investigations suggest squamous carcinoma of the cervix. What imaging is now indicated to stage the cancer?
A 36-year-old woman presents at 23 weeks’ gestation in her first pregnancy with painless vaginal bleeding. Subsequent investigations confirm the diagnosis of stage 1B2 cervical cancer. What treatment should now be offered to this patient?
A 52-year-old woman is scheduled for a total abdominal hysterectomy and bilateral salpingo-oophorectomy for stage 1A1 endometrial cancer. In order to reduce her risk of surgical site infection, what would you recommend with regard to preoperative pubic hair removal?
A 38-year-old multiparous woman presents with upper abdominal pain at 33 weeks’ gestation. She has acute onset of pain, radiating through to her back, and a history of gallstones and cholecystitis prior to pregnancy. She presents within a couple of hours of onset of pain. Acute pancreatitis is suspected. Her amylase is four times the upper limit of normal. What imaging would you recommend to confirm the diagnosis?
10-Ultrasound scan of upper abdomen If diagnostic uncertainty or possible necrosis, MRI without contrast may be used. CT is safe but is second-line investigation after ultrasound, if necessary. AXR is not helpful to diagnose stones. O’Heney JL, Barnett RE, MacSwan RM, Rasheed A. Acute and chronic pancreatitis in pregnancy. The Obstetrician & Gynaecologist 2021;23:89–93.
23) All the following are correct on the ruptured uterus except:
The management options include total or subtotal hysterectomy or a simple repair of the dehiscence.
Lower uterine segment rupture is the most common site and it may extend to the bladder or laterally into the broad ligament. Posterior rupture of the uterus is uncommon.
A 50-year-old woman is referred with vaginal bleeding 18 months after her last menstrual period. She has two adult children and works as a personal trainer. Her body mass index is 24 kg/m2. She is a non-smoker with no family history of note. The pelvic exam is unremarkable except for slight vaginal bleeding. Transvaginal ultrasound reveals an endometrial thickness of 6 mm but no irregularities or polyps are seen. An endometrial biopsy is taken but the sample is inadequate. When you call her to inform her of the result she says the bleeding has stopped. What is the next stage you would recommend for this patient’s management?
A 23-year-old woman is having a planned elective caesarean section at 39 weeks’ gestation for breech presentation. She is fit and well with no known drug allergies. What antibiotic treatment would you recommend to reduce her risk of postoperative endometritis?
A 35-year-old patient presents with severe abdominal pain at 22 weeks’ gestation. Serum amylase is raised, consistent with acute pancreatitis. What do you advise with regard to her nutrition?
A 35-year-old woman has severe dysmenorrhoea. Ultrasound and MRI confirm the diagnosis of accessory cavitated uterine malformation (ACUM). What treatment is most likely to cure the pain caused by ACUM?
This represents the best chance of cure, the other treatments may control the pain but are not curative.
A 49-year-old woman is scheduled for total laparoscopic hysterectomy and bilateral salpingo-oophorectomy for endometriosis resistant to medical treatment. What preoperative fasting advice would you recommend?
29) A 22-year-old woman presents at 12 weeks’ gestation, unable to tolerate diet or fluids. Her body mass index is 17.3 kg/m2. Routine blood tests are as follows:
Na: 147 (136–145 mmol/L) K: 2.8 (3.5–5.0 mmol/L) Cl: 97 (98–106 mmol/L) Bic: 29 (23–30 mmol/L) Urea: 7 (3.6–7.1 mmol/L) What is the most appropriate immediate investigation?
This is very low potassium and the patient is at risk of cardiac dysrhythmia
A 22-year-old woman requires chemotherapy as part of her treatment for Hodgkin’s lymphoma. Which class of chemotherapy agents are most likely to cause future ovarian failure?
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