Reproductive Health Practice Questions

Question 1

A 26-year-old woman presents with amenorrhea, galactorrhea, and headaches. Visual field defects are noted. What is the appropriate initial treatment?

Accepted Answer

Cabergoline

Answer

Transsphenoidal surgery

Answer

Radiotherapy

Answer

Observation

Answer

Bromocriptine

Question 2

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 3

A 34-year-old woman presents with recurrent miscarriages and a history of DVT. Blood tests show prolonged APTT not correcting with mixing studies, and positive anticardiolipin antibodies. What is the most likely diagnosis?

Accepted Answer

Antiphospholipid syndrome

Answer

Factor V Leiden

Answer

Protein C deficiency

Answer

Lupus anticoagulant

Answer

Von Willebrand disease

Question 4

A 54-year-old woman who had a total abdominal hysterectomy with conservation of ovaries for fibroid-related menorrhagia 6 years ago presents with a 12-month history of troublesome vasomotor symptoms, mood disturbance, and poor concentration affecting her work as a teacher. She also reports reduced libido which is causing relationship difficulties. She has no other medical history, BMI is 24 kg/m², and she does not smoke. Her blood pressure is 118/76 mmHg. What is the most appropriate HRT regimen to address all her symptoms?

Accepted Answer

Transdermal estradiol patches with trial of testosterone supplementation if symptoms persist

Answer

Transdermal estradiol patches 50 mcg twice weekly

Answer

Oral estradiol 2 mg daily plus testosterone supplementation

Answer

Transdermal estradiol patches plus oral micronised progesterone

Answer

Tibolone 2.5 mg daily

Question 5

A 41-year-old parous woman requests contraception following the birth of her third child 4 weeks ago. She is not breastfeeding and is considering the combined oral contraceptive pill, which she used successfully between her previous pregnancies. She had an uncomplicated vaginal delivery with estimated blood loss of 400ml. She is a non-smoker with BMI of 26 kg/m² and no medical history of note. According to UKMEC criteria, when can she safely commence the combined oral contraceptive pill?

Accepted Answer

At 6 weeks postpartum

Answer

At 3 weeks postpartum

Answer

At 2 weeks postpartum

Answer

Immediately, as she is not breastfeeding

Answer

At 12 weeks postpartum

Question 6

A 58-year-old woman with type 2 diabetes mellitus and a BMI of 31 kg/m² presents requesting continuation of her HRT. She was diagnosed with premature ovarian insufficiency at age 39 and has been taking continuous combined HRT (oral estradiol 2 mg with dydrogesterone 10 mg) since then. She currently has good glycaemic control (HbA1c 48 mmol/mol) on metformin alone and has no microvascular or macrovascular complications. She has no other cardiovascular risk factors and does not smoke. What is the most appropriate advice regarding HRT continuation?

Accepted Answer

Continue current HRT as benefits outweigh risks given her premature ovarian insufficiency

Answer

Switch to transdermal HRT as oral preparations are contraindicated in diabetes

Answer

Discontinue HRT immediately as she has now reached the age of natural menopause

Answer

Continue HRT but add aspirin for cardiovascular protection

Answer

Reduce to the lowest dose of HRT and plan to stop within 6 months

Question 7

A 35-year-old woman with a history of previous ectopic pregnancy treated by laparoscopic salpingectomy 2 years ago presents requesting long-acting reversible contraception. She is in a new relationship and wishes to avoid pregnancy. She has regular periods, BMI of 25 kg/m², no other medical history, and is a non-smoker. She is particularly concerned about the risk of another ectopic pregnancy. What is the most appropriate contraceptive method to recommend?

Accepted Answer

Etonogestrel subdermal implant

Answer

Copper intrauterine device

Answer

52 mg levonorgestrel intrauterine system

Answer

Combined oral contraceptive pill

Answer

Depot medroxyprogesterone acetate injection

Question 8

A 49-year-old woman commenced on sequential combined HRT (transdermal estradiol 50 mcg patches changed twice weekly plus oral micronised progesterone 200 mg for 14 days each month) 6 months ago for troublesome vasomotor symptoms. She reports good symptom control but has persistent irregular bleeding throughout the month, not just during the expected withdrawal bleed. Her last menstrual period before starting HRT was 14 months ago. Pelvic examination is normal. What is the most appropriate next step in management?

Accepted Answer

Arrange transvaginal ultrasound to assess endometrial thickness

Answer

Continue current regimen and reassure that irregular bleeding is expected in the first year

Answer

Switch to continuous combined HRT regimen

Answer

Stop HRT for 3 months then restart with a different preparation

Answer

Add tranexamic acid during bleeding episodes

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