Mini Mock Test 2- module Part 2
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1) 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
2) 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 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.
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 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 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?
7) what is the most common cause of premature menppuse in the UK ??
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 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?
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?
11) 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 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 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 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?
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?
16) 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
17) After birth the proximal portion of umbilical arteries will become?
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?
19) Human Chorionic Gonadotrophin (HCG) is structurally similar to which of the following hormones?
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
Brooks C, Supramaniam PR, Mittal M. Preconception health in the
well woman. The Obstetrician & Gynaecologist 2022;24:58–66.
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?
22) MRSA respond to all except
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 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?
25) Which of the following hormones are stimulated by somatostatin?
26) All the following are correct on the ruptured uterus except:
The management options include total or subtotal hysterectomy or a simple repair of
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 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 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?
30) 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.
Your score is