96 of 162 | Embryology A Mesonephric ducts D Sinovaginal bulbs G Urethral folds of the cloaca B Paramescnephrie duct E Genital tubercle H Genital ridge C Milllerian system F Genital folds For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all, 1 Develop(s) into the uterus, cervix and proximal 2/3 of the vagina. 2 Form(s) the ovary. H 3. Develop(s) into the distal one third of the vagina. D 4 Develop(s) into the labia minora. 2 Anatomy and physiology A Aorta D Vena cava G Para-aortic nodes B Internal iliac vein E Superficial inguinal and femoral nodes H External iliac vein © Renal vein F Obturator, internal and external iliac nodes For each description below, choose the SINGLE most appropriate answer from the above list of options, Each option may be used once, more than once, or not at all. 1 Lymphatic drainage of the ovary. S 2. Lymphatic drainage of the lower vagina and vulva. E 3. Lymphatic drainage of the upper vagina and cervix. F 4 Venous drainage from the left ovarian vein. c97 of 162 3 Normal and abnormal sexual development and puberty A Cloacal cells D Testosterone G SRY region B. I7-Hydronyprogesterone E Dihydrotestosterone H Sertoli cells C Wolffian duct F Leydig cells For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all. 1. Responsible for the production of testicular development factor (TDI 2 Responsible for the production of Milllerian inhibitor. 3. Responsible for the production of testosterone. 4. Hormone responsible for the development of the vas deferens, epididymis and seminal vesicles. ay A Adenomyosis D. Malignancy of the cervix G Endometrial malignancy B Stress incontinence E Fibroids H Uterine prolapse C Endometrial polyp F Pelvic inflammatory disease For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all. I Intermenstrual bleeding, 2 Post-coital bleeding. 3. Post-menopausal bleeding. 4 Painful periods, SpRieeyereemermy rPooo A Transcervical resection of © Endometrial ablation F Myomectomy the endometrium D Hysteroscopy and curettage G Abdominal hysterectomy B Vaginal hysterectomy E Manchester repair H Mirena For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all. 1A procedure for the investigation of menorrhagia but not a treatment, D 2 An outpatient procedure that destroys the endometrium and fibroids up to 4em in diameter. c 3 A procedure for women with fibroids who want to retain their fertility. 4/4 definitive treatment for menorthagia refractive to other treatments, ifthe uterus isnot enlarged and fe ovarian conservation is required. B 6 Disorders of the menstrual eycle A Cyclical norethisterone D Mefenamic acid G Danazol B Combined oral E Tranexamic acid H Gestrinone contraceptive pill F Gonadotrophin-releasing LNG-IUS hormone analogues For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all. D 1 The five-year prolonged exposure of the endometrium to progesterone to cause thinning of the endometrium and lighter menses. 2 ‘This reduces production of prostaglandin E2 and reduces loss by up to 25 per cent. 3. This is to be taken from days 5 to 26 in anovulatory dysfunctional uterine bleeding; it regulates Perce andi 98 of 162 1 The five-year prolonged exposure of the endometrium to progesterone to cause thinning of the endometrium and lighter menses. 2 This reduces production of prostaglandin E2 and reduces loss by up to 25 per cent, 3 This isto be taken from days 5 to 26 in anovulatory dysfunctional uterine bleeding; it regulates the cycle and promotes secretory endometrium in the second half of the cycle. 4 This promotes coagulation and reduces menstrual loss by 40 per cent. A Clomid D Azoospermia G Androgen-secreting tumour B Anovulation E Polycystic ovary syndrome H Puregon © Oligospermia F Chlamydia 1s. Each For each description below, choose the SINGLE most appropriate answer from the above list of opti ‘option may be used once, more than once, or not at all, 1. This isassociated with a raised free androgen index, low sex hormone-binding globulin and raised testosterone. 2. The most common cause of tubal disease in the Western world. 3. The only treatment is donor insemination. 4 Anoral treatment for anovulation, A Threatened miscarriage D Ectopic pregnancy G Choriocarcinoma B Silent miscarriage E_ Hydatidiform mole H Septic miscarriage C Incomplete miscarriage F Heterotropie pregnancy For each description below, choose the SINGLE most appropriate answer from the above list of options. Each “option may be used once, more than once, or not at al E ronm 1 The abnormal proliferation of trophoblastic tissue with or without embryonic tissue. 2. The partial expulsion of products of conception with products of conception seen measuring 65 mm in di-- G ameter on ultrasound scan. 3. Bleeding in pregnancy, <24 weeks’ gestation with fetal heart visible on ultrasound scan and clased cervical os. AX. 4 Light bleeding, pelvic pain, shoulder-tip pain, 7 weeks’ gestation, empty uterus on ultrasound and fluid in pouch of Douglas. 9 Benign diseases of the cervix A Squamous metaplasia D Severe dyskaryosis G Glandular atypia B_ Columnar epithelium E Borderline nuclear change H Arias-Stella change Moderate dyskaryosis F Mild dyskaryosis For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all. 1 CIN1. 2 CIN2, 3 CIN3. 4 CGIN, 10 Benign diseases of the uterus goon A. Leiamvasarcama D. Adenamvasis, G Brenner's tumour4 CGIN. 99 of 162 10 Benign diseases of the uterus A Leiomyosarcoma D Adenomyosis G Brenner's tumour B_ Pedunculated leiomyoma. E Red degeneration H Caleified degeneration © Hyaline degeneration F Endometriosis For each description below, choose the SINGLE most appropriate answer from the above list of options, Each option may be used once, more than once, of not at all. 1 This occurs as a result of disruption of blood supply (typically pregnancy related). 2 Necrosis and cystic formation due to outgrowth of blood supply. 3. Fibroid change that is usually a post-menopausal manifestat 4. Malignant change that accounts for >1 per cent of fibroids. rProm A. Transcervical resection of the endometrium E Combined oral contraceptive pill B Laser ablation to endometrial deposits F Vaginal hysterectomy C Hydrothermal ablation G Conservative management D Total abdominal hysterectomy and bilateral H Surgical drainage and post-operative salpingo-oophorectomy gonadotrophin-releasing hormone (GnRH) antagonist treatment For each description below, choose the SINGLE most appropriate answer from the above list of options, Each option may be used once, more than once, or not at all. 1 Treatment for minimal endometriosis to improve chances of conception in patient with infertility. 2. Definitive treatment for Stage IV endometriosis, obliterated rectovaginal septum and bilateral endometriomas. 3. Asymptomatic endometriosis found on routine laparoscopy for sterilization. 4 Symptomatic endometriosis in a twenty three-year-old woman who wants children but is currently not con® templating pregnancy. 12 Benign eases fhe ovary Quon A Fibroma D Endometroid tumour G Brenner's tumour B Serous cystadenoma E Clear cell tumour H_Mucinous cystadenoma © Teratoma F Granulosa cell tumour dae description Belong case the SINGLE sa appopiate answer fia the shove et nF options Rach BB option may be used once, more than once, or not at all. 1 Aunilocular cyst with papiiiloms processes usually occurring unilaterally. H 2 Alarge unilateral multiloculated cyst lined by columnar epithelium and complicated with pseudomyxoma peritonii. 3 A large cyst usually containing unclotted blood with a ground-glass appearance on ultrasound, D 4 This has a solid appearance with islands of transitional epithelium in dense fibrotic stroma. atesDisorders of the menstrual cycle 1 NICE guidelines would recommend the best treatment of a forty-year-old woman with regular, heavy periods who smokes 20 cigarettes a day, has a BMI of 40 and has a normal-size, anteverted uterus on ultrasound scan and who is sexually active. a) TAH. b) TAH/BSO. ©) TCRE, 4) Combined oral contraceptive pill 8 Mirena, Genital infections in gynaecology 2 Apatient presents with vulval itching, sore vagina amd a profuse white, curdy discharge with erythema and redness at the introitus. The likely diagnosis 1a) Bacterial vaginosis. b) Trichomonas vaginalis. @ candida. d) Chlamydia. e) HPV. Fertility control, contraception and abortion 3. Choose from below the single best contraceptive method for a forty five-year-old woman with a BMI of 40, smoker with multiple fibroids, wh stable relationship, whose family is complete and who has had a peritonitis secondary to appendicitis in the past. a) Combined oral contraceptive pill. 1b) Laparoscopic clip sterilization. <) Mirena, Progesterone-only pill. '®) Hysteroscopic sterilization,100 of 162 A Subtotal abdominal hysterectomy E Pelvic exenteration B Cold coagulation F Bilateral salpingo-oophorectomy © Wertheim's hysterectomy G Palliative treatment D LLETZ (large loop excision of the transformation zone) H_ Wertheim’s hysterectomy and radiotherapy For each description below, choose the SINGLE most appropriate answer from the above list of options. Each ‘option may be used once, more than once, oF not at all. 1 CIN2. 2 Ectopy. 3. Stage IB cervieal cancer. 4 Stage 2 cervical cancer. | 4 Guphtommotticeraryamnicatopns roao A Laser laparoscopy E Unilateral salpingo-cophorectomy and peritoneal B Vaginal hysterectomy washings © Total abdominal hysterectomy (TAH), bilateral F TCRE salpingo-oophorectomy (BSO) and omentectomy G Wertheim’s hysterectomy D Subtotal hysterectomy carboplatin H_ Debulking surgery and subsequent or cisplatin/ paclitaxel chemotherapy For each description below, choose the SINGLE most appropriate answer from the above list of options. Each ‘option may be used once, more than once, or not at all. 1 Stage 1B ovarian cancer. c 2. Stage 3 epithelioid tumour. H 3 Unilateral borderline tumour. 4 Endometriosis. = A 15 Infections in gynaecology A Candida D Trichomoniasis G Human immunodeficiency virus (HIV) B Chlamydia E Herpes H Gonorthoea C Bacterial vaginosis F Syphilis For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all 1 A sexually transmitted disease typified by genital ulcers and painful vesicles. - 2 Anon-sexually transmitted infection typified by itchy, sore vagina with a white ‘curdy’ discharge. A 3. Anon-sexually transmitted disease typified by an offensive fishy discharge. c 4 A sexually transmitted disease typified by Gram-negative diplococci, and colonizing columnar and cuboidal epithelium; 50 per cent are found asymptomatically. HInstagram atl 3G ya) GS @ fF 26% 4 € Back @MedicalBooksStore_2012_Self_ Gynaecology A Urodynamic stress incontinence D Bladder diverticulum G Detrusor overactivity B_ Normal bladder function E Sensory urgency H_Detrusor-sphincter dyssynergia © Poor detrusor contraction F Bladder outflow obstruction For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, oF not at all, 1 Det 2. A voiding detrusor pressure of 10cm of water and flow rate o! 3. Leakage on coughing in the absence of detrusor contraction. or pressure rise of >15em of water during filling associated with urgency nl per second. 4 Voiding detrusor pressure of >70cm of water and peak flow rate of 5mL second, 17 Userovegralprotapse 1™>O0O0 A. Anterior repair D Posterior repair G Ring pessary B Shelf pessary E Vaginal hysterectomy H Manchester repair € Sacrospinous fixation F Sacrocolpopexy For each description below, choose the SINGLE most appropriate answer from the above list of options. E option may be used once, more than once, or not at all. sain a nek mai ea ps HMA Od NaS RRS B of the cervical stump and plication of the uterosacral and cardinal 2--Amputa 3 The treatment of choice for a symptomatic eystocele with no history of incontinence in a fitty-year-old, HH sexually active woman, 4: Treatment of vault prolapse in an elderly wonian with multiple previous abdominal surgery who isnot. AM sexually active. c 18 Thelmenopause A Tibolone D Norplant G Vagifem B Medroxyprogesterone acetate E Conjugated equine oestrogen H_Implanon © Transdermal patch containing 50mg of F Echinacea oestrogen For each description below, choose the SINGLE most appropriate Each swer from the above list of optio option may be used once, more than once, or not at all 1 An oral hormone replacement therapy (HRT) preparation that is converted to oestrone by hepatic enzymes resulting in a plasma oestradiol (E2)/oestrone ratio of 1:2. Cc 2. A lipid-soluble preparation maintaining an E2/oestrone ratio of 2:1, which is similar to pre-menopausal physiological status. 3 An HRT with mild androgenic side effects, which may have a beneficial effect on low libido. A 4. Anessential part of HRT to reduce the risk of endometrial hyperplasia in women with au Extended matching questions 97 19 Common gynaecological procedures and medicolegal aspects of gynaecologyJ instagram atl 3G bey S @ Ff 26% @Qinstag < Back @MedicalBooksStore_2012_Self_... Wi 102 0f1c2 Extended matching questions 97 19 Common gynaecological procedures and medicolegal aspects of gynaecology Surgical complications A TCRE D Posterior repair G Abdominal hysterectomy for extensive B Tension-free vaginal tape (TVT) E Cystoscopy endometriosis C Marsupialization of Bartholin’s abscess. F Laparoscopy H Flexible hysteroscopy For each description below, choose the SINGLE most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all. injury. 3 Damage to the bladder. 4 Uterine perforation, PouoOoT Gynaecologya) Combined oral contraceptive pill 1b) Laparoscopic clip sterilization ©) Mirena. 4) Progesterone-only pill. €) Hysteroscopic sterilization Subfertility 4 The hormone best used as a measurement of ovarian reserve is: a) FSH. b) Oestradiol. ©) LH d) Inhibin, @ AMH. Problems in early pregnancy 5. Aninetcen year-old: girl is admitted with pelvic pain, a positive pregnancy test and a 3m viabe ectopic pregnancy seen in the right fallopian tube on ultrasound, She has already had a left saplingectomy for a previous ectopic. The best management would be: a) Laparoscopic salpingectomy. @) Laparoscopic salpingostomy. ‘) Conservative management with serial PHCGs. 4) Laparotomy. ) Methotrexate. Benign diseases of the uterus and cervix 6 A twenty five-year-old girl presents with mid-cycle pain on a regular monthly basis. She is sexually active and does not take any contraception. The pain quickly resolves after 24 hours, She has a regular 28-day cycle. The likely cause of the pain is: a) PID. b) Endometriosis. @ Mitelschmertz syndrome. 'd) Adenomyosis. ©) Polycystic ovaries. Endometriosis and adenomyosis 7 The most suitable treatment for a thirty four-year-old woman with minimal endometriosis on laparo- scopy, who has been trying to conceive for two years and has pelvic pain, is: Laser ablation to endometriosis/excision of the endometriosis. b) GnRH analogues. ©) Danazol. d) Progesterone. ) Combined oral contraceptive pill. Diseases of the ovary 8 Asseventeen-year-old girl who is not sexually active presents with left iliac fossa pain. An ultrasound scan123 of 162 Diseases of the ovary 8 Aseventeen-year-old girl who is not sexually active presents with left iliac fossa pain. An ultrasound scan shows a 5cm cyst on the left ovary which is complex in nature, with solid, calcified elements and fatty deposits noted on MRI. The likely diagnosis is: a) Thecal huteal cyst. b) Tubo-ovarian abscess, ©) Serous cystadenoma, @) Fibroma. @ Dermoid cyst. Malignant disease of the uterus 9 The most appropriate treatment option for an eighty-year-old woman with a BME of 25 presenting with post-menopausal bleeding and found to have Stage 1a endometrial adenocarcinoma on MRI and hysteroscopy a) Polypectomy and Mirena. 1@ TAH/BSO in alocal centre. ) TAH/BSO in acancer centre. d) TAH/BSO and radiotherapy. e) Radiotherapy alone. Pre-malignant and malignant disease of the cervix 10 Management of a cervical smear showing moderate dyskaryosis is: a) Repeat smear in six months. b) HPV vaccination. @ Colposcopy and biopsy. 4) LLETZ procedure. ) Wertheim’s hysterectomy. Urogynaecology 11 The management of a thirty eight-year-old woman whose family is complete, with a BMI of 30 and who has urodynamically proven stress incontinence and a 4/5 score on the Oxford Grading Scale, would be: a) Pelvic floor exercises. 'b) Bladder neck injections. Pelvic organ prolapse 12 Management of an eighty nine-year-old woman with ischaemic heart disease who is not sexually active but presents with a procidentia of the uterus is: @ Shelf pessary. b) Pelvic floor exercises. ©) Vaginal hysterectomy. ) Hysteroscopy. ©) Total vaginal mesh procedure.124 of 162 I b) Pelvic floor exercises. «) Vaginal hysterectomy. d) Hysteroscopy. ) Total vaginal mesh procedure. ‘Common gynaecological procedures 13 The procedure most suitable for the investigation of pelvie pain ist a) Cystoscopy. b) Hysteroscopy.. ‘c) Hysterosalpingogram, }) Laparoscopy. e) Hysterectomy,