Gynaecology Practice Questions

Question 1

A 43-year-old woman presents with fatigue, weight gain, and cold intolerance. TSH is 22 mU/L, free T4 is low. Anti-TPO antibodies are positive. She is trying to conceive. What is the TSH target?

Accepted Answer

$< 2.5 \mathrm{mU} / \mathrm{L}$

Answer

$< 1.0 \mathrm{mU} / \mathrm{L}$

Answer

$< 4.0 \mathrm{mU} / \mathrm{L}$

Answer

$< 6.0 \mathrm{mU} / \mathrm{L}$

Answer

$< 10.0 \mathrm{mU} / \mathrm{L}$

Question 2

A 30-year-old woman presents with amenorrhea, hirsutism, and acne. She has gained 10kg over the past year. Ultrasound shows multiple ovarian cysts. Testosterone and LH are elevated, FSH is normal. What is the most likely diagnosis?

Accepted Answer

Polycystic ovary syndrome

Answer

Congenital adrenal hyperplasia

Answer

Ovarian tumor

Answer

Cushing's syndrome

Answer

Hypothyroidism

Question 3

A 35-year-old woman with a 16-month history of heavy menstrual bleeding reports that her periods last 9 days and she passes large clots. She has tried tranexamic acid and mefenamic acid with minimal improvement. She has two children and does not wish for future pregnancy. Examination is normal and transvaginal ultrasound shows a normal uterus (8 cm length) with no fibroids and endometrial thickness of 6 mm on day 5 of cycle. Full blood count shows haemoglobin 101 g/L. She declines hormonal treatment. What is the most appropriate next management option?

Accepted Answer

Offer endometrial ablation

Answer

Prescribe oral norethisterone for cycle regulation

Answer

Arrange hysterectomy

Answer

Increase dose of tranexamic acid and mefenamic acid

Answer

Offer trial of levonorgestrel intrauterine system despite preferences

Question 4

A 26-year-old woman presents to the emergency department with sudden onset severe left-sided pelvic pain, nausea, and one episode of syncope 2 hours ago. She has 7 weeks amenorrhoea. On examination, she is alert with heart rate 102 bpm, blood pressure 104/68 mmHg, and temperature 36.8°C. Abdominal examination reveals left iliac fossa tenderness with mild guarding but no rigidity. Transvaginal ultrasound shows an empty uterus, a 35 mm left adnexal mass with a hyperechoic ring, and a small amount of free fluid in the pouch of Douglas. Serum beta-hCG is 5600 IU/L. What is the most appropriate management?

Accepted Answer

Diagnostic laparoscopy with decision for salpingectomy or salpingotomy at surgery

Answer

Emergency laparoscopy

Answer

Intramuscular methotrexate

Answer

Admit for observation with 4-hourly observations and repeat ultrasound in 24 hours

Answer

Arrange urgent MRI pelvis to better characterise the adnexal mass

Question 5

A 41-year-old woman with a 10-month history of heavy menstrual bleeding undergoes hysteroscopy which reveals a 3 cm type 2 submucosal fibroid partially extending into the myometrium (>50% intramural component). She wishes to preserve her fertility. Transvaginal ultrasound confirms no other significant fibroids and normal endometrial cavity. What is the most appropriate initial management?

Accepted Answer

Abdominal myomectomy

Answer

Hysteroscopic myomectomy

Answer

Trial of levonorgestrel intrauterine system

Answer

Uterine artery embolisation

Answer

GnRH agonist therapy for 6 months

Question 6

A 31-year-old woman presents to the emergency department with left-sided pelvic pain and 7 weeks amenorrhoea. Transvaginal ultrasound demonstrates an empty uterus and a 20 mm left adnexal mass. Initial serum beta-hCG is 1450 IU/L. She is clinically stable. Repeat beta-hCG 48 hours later is 1380 IU/L. What is the most appropriate management?

Accepted Answer

Expectant management with weekly beta-hCG monitoring

Answer

Intramuscular methotrexate

Answer

Diagnostic laparoscopy

Answer

Repeat beta-hCG in 48 hours to confirm declining trend

Answer

Arrange MRI pelvis to confirm ectopic location

Question 7

What is the primary mechanism by which endometrial ablation reduces menstrual bleeding in women with heavy menstrual bleeding?

Accepted Answer

Destruction of the endometrial basalis layer preventing regeneration

Answer

Reduction in endometrial blood vessel density through thermal injury

Answer

Decreased prostaglandin production from damaged endometrium

Answer

Hormonal suppression of endometrial proliferation

Answer

Formation of intrauterine adhesions reducing cavity volume

Question 8

A 38-year-old multiparous woman with heavy menstrual bleeding has had a levonorgestrel intrauterine system in situ for 3 years. Initially, her bleeding improved significantly, but over the past 6 months, she has noticed gradually worsening menstrual bleeding returning to pre-treatment levels. She wishes to continue with hormonal management. Pelvic examination is normal. Transvaginal ultrasound shows the IUS in correct position with a normal uterine cavity and no fibroids. What is the most appropriate management?

Accepted Answer

Remove and replace the levonorgestrel intrauterine system

Answer

Add tranexamic acid during menstruation

Answer

Switch to combined oral contraceptive pill

Answer

Arrange endometrial ablation

Answer

Continue current IUS for remaining 2 years of licensed duration

Question 9

A 34-year-old woman presents to the emergency department with sudden onset severe right-sided abdominal pain and syncope. She has 6 weeks amenorrhoea. On examination, she is pale with heart rate 118 bpm and blood pressure 88/54 mmHg. Abdominal examination reveals generalised tenderness with guarding. A bedside urine pregnancy test is positive. What is the most appropriate immediate management?

Accepted Answer

Insert two large-bore intravenous cannulae, cross-match 4 units blood, commence fluid resuscitation, and arrange emergency laparoscopy

Answer

Perform urgent transvaginal ultrasound to confirm diagnosis before proceeding to theatre

Answer

Administer intramuscular methotrexate and commence fluid resuscitation

Answer

Request urgent serum beta-hCG and proceed to laparoscopy only if levels are above 1500 IU/L

Answer

Arrange CT abdomen and pelvis with contrast to localise the ectopic pregnancy

Question 10

A 52-year-old woman presents with a 6-month history of irregular vaginal bleeding occurring approximately every 2-3 weeks. She also reports a single episode of postcoital bleeding 2 months ago. She has never had an abnormal cervical smear and her last smear 18 months ago was normal. On speculum examination, the cervix appears healthy with no visible lesions. Bimanual examination reveals a bulky uterus. What is the single most important initial investigation?

Accepted Answer

Colposcopy

Answer

Cervical smear

Answer

Transvaginal ultrasound

Answer

Hysteroscopy and endometrial biopsy

Answer

Pipelle endometrial sampling

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