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MRCOG PART 2 SBAs and EMQs

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Week 6 - Pelvic pain

Week 6 - Pelvic pain Posted by PAUL A.

Question1

 

Endometriosis affects

 

A.     Up to 10% of infertile women

 

B.     About 1% of the general female population

 

C.     About 1% of women with chronic pelvic pain

 

D.     Up to 50% of infertile women                      

 

E.     About 2-10% of women with chronic pelvic pain

 

Question2

 

Which one is not a recognized symptom of endometriosis?

 

A.     Fatigue

 

B.     Dysmenorrhea

 

C.     Deep dyspareunia

 

D.     Dyschezia

 

E.     All are recognized symptoms of endometriosis                                    

 

Question3

 

Which one is not predictive of a diagnosis of endometriosis among women seeking help from their general practitioner?

 

A.     Post-coital bleeding

 

B.     Rectal bleeding                   

 

C.     Infertility

 

D.     Heavy menstrual bleeding

 

E.     All are predictive of a diagnosis of endometriosis

 

 

Question4

 

A healthy 33 year old woman attends the gynaecology clinic with a 9 months history of worsening pelvic pain, painful periods and pain on sexual intercourse. Her LMP was 3 weeks ago and she has a regular 30 days cycle. Her symptoms have not responded to NSAIDs. Abdominal and pelvic examination are normal. She has 2 children and is not currently trying for a pregnancy.

 

A.     Offer diagnostic lapararoscopy

 

B.     Offer combined oral contraceptive pill                    

 

C.     Offer laparoscopy +/- treatment of endometriosis

 

D.     Offer MRI

 

E.     Offer serum CA-125 and if raised offer diagnostic laparoscopy

 

 

Question5

 

With respect to the value of laparoscopy in diagnosing endometriosis

 

A.     A negative laparoscopy is poor at excluding endometriosis

 

B.     A positive laparoscopy without histology is diagnostic of endometriosis in over 90% of cases

 

C.     In the absence of histology, a positive laparoscopy is less informative than a negative laparoscopy         

 

D.     Speculum examination is not part of laparoscopic assessment

 

E.     Peritoneal biopsies should be taken to confirm negative laparoscopy

 

Question6

 

The ultrasound characteristics of ovarian endometrioma include

 

A.     Cyst of 4-7 cm in diameter

 

B.     Presence of 5-8 locules within the cyst

 

C.     Ground glass echogenicity of cyst fluid                   

 

D.     Presence of papillary areas with venous blood flow

 

E.     Presence of papillary areas with arterial blood flow

 

Question7

 

With respect to the use of magnetic resonance imaging (MRI) for the diagnosis of peritoneal endometriosis

 

A.     MRI should be offered as a first line investigation in all women

 

B.     MRI should be offered as a first line investigation in women below the age of 20 years

 

C.     MRI should be offered if laparoscopy is declined

 

D.     The sensitivity of MRI is about 70%                         

 

E.     The sensitivity of MRI is over 90%

 

Question8

 

A healthy 32 year old woman is referred to the gynaecology clinic with a 6 months history of progressively painful periods. Her symptoms have not improved following treatment with NSAIDs. She has 3 previous vaginal births and is not trying for a pregnancy. Her husband had a vasectomy 3 years ago.  Clinical examination is normal. With respect to the use of combined hormonal contraceptives

 

A.     The combined oral contraceptive pill has not been shown to reduce endometriosis-associated dysmenorrhea in clinical trials

 

B.     The transdermal combined contraceptive patch is less effective at reducing endometriosis-associated dysmenorrhea compared to the oral pill

 

C.     The vaginal contraceptive ring is more effective at reducing endometriosis-associated dysmenorrhea than the contraceptive patch

 

D.     The oral contraceptive pill, vaginal ring or trans-dermal patch may all be offered without diagnostic laparoscopy to diagnose endometriosis                    

 

E.     Continuous use of the combined oral contraceptive pill is not recommended in women over the age of 30 years

 

Question9

 

Which one is not a progestogen that has been shown to reduce pelvic pain associated with endometriosis?

 

A.     Medroxyprogesterone acetate

 

B.     Desogestrel

 

C.     Gestrinone                            

 

D.    Levonorgestrel IUS

 

E.     Depo-medroxyprogesterone acetate

 

Question10

 

Which one is not a recognized side-effect of danazol?

 

A.     Acne

 

B.     Vaginal spotting

 

C.     Muscle cramps

 

D.    Amenorrhoea                      

 

E.     All are recognized side-effects

 

 

Question11

 

GnRH analogues

 

A.     Are more effective than the levonorgestrel IUS in relieving endometriosis-associated pain

 

B.     Are as effective as the levonorgestrel IUS in relieving endometriosis-associated pain

 

C.     Are less effective that the levonorgestrel IUS in relieving endometriosis-associated pain                            

 

D.    Have not been compared with the levonorgestrel IUS for the treatment of endometriosis-associated pain

 

E.     Are effective in treating endometriosis-associated dysmenorrhea but not effective in treating non-cyclical pelvic pain

 

 

Question12

 

Which one is an aromatase inhibitor?

 

A.     Nafarelin

 

B.     Leuprolide

 

C.     Gestrinone

 

D.    Anastrozole                          

 

E.     Cyproterone acetate

 

Question13

 

Recognised side-effects of aromatase inhibitors include

 

A.    Multiple pregnancy and vaginal dryness                      

 

B.    Hirsutism and hot flushes

 

C.    Loss of bone mineral density and endometrial hyperplasia

 

D.    Acanthosis nigricans and vaginal dryness

 

E.     Galactorrhoea and endometrial hyperplasia

 

Question14

 

With respect to the use of aromatase inhibitors to treat endometriosis-associated pelvic pain

 

A.    Aromatase inhibitors are an alternative to combined hormonal contraceptives

B.    Aromatase inhibitors have a similar side-effect profile to progestogens

 

C.    Aromatase inhibitors have a similar side-effect profile to anti-progestogens

 

D.    Aromatase inhibitors should only be offered if medical and surgical treatment options have been exhausted                   

 

E.     Aromatase inhibitors are recommended as an alternative to surgery in women with deep endometriosis in whom other medical therapies have failed

 

Question15

 

With respect to surgical treatment for endometriosis-associated pelvic pain

 

A.     Laparoscopy is more effective than laparotomy

 

B.     Laparotomy is more effective than laparoscopy

 

C.     Diagnostic laparoscopy is associated with an improvement in symptoms at 3 months                                   

 

D.    Laparoscopic treatment is not better than diagnostic laparoscopy at 6 months

 

E.     Laparoscopic treatment is no better than diagnostic laparoscopy at 12 months

 

Question16

 

A 33 year old woman is having laparoscopy + /- treatment because of chronic pelvic pain that has not responded to empirical treatment. At laparoscopy, she is found to have peritoneal endometriosis.

 

A.     Ablation should be undertaken as it is more effective than excision

 

B.     Excision should be undertaken as it is more effective than ablation

 

C.     Excision should be undertaken because it is associated with a lower risk of recurrence

 

D.    Ablation should be undertaken because it is associated with a lower risk of recurrence

 

E.     Excision and ablation are equally effective in treating endometriosis-associated pain                 

 

Question17

 

With respect to surgical treatment for endometriosis-associated pelvic pain, laparoscopic utero-sacral nerve ablation (LUNA)

 

A.     Does not offer additional benefit as an adjunct to conservative surgery                                 

 

B.     Is associated with a reduction in pain symptom at 3 months

 

C.     Is associated with a reduction in pain symptom at 6 months but not at 3 months

 

D.    Is associated with a reduction in pain symptom at 12 months but not at 3 or 6 months

 

E.     Is associated with a reduction in pain symptoms 9 months but not at 3 or 6 months

 

Question18

 

Recognised complications of presacral neurectomy include

 

A.     Diarrhoea

 

B.     Urinary stress incontinence

 

C.     Painless first stage of labour                        

 

D.    Premature labour

 

E.     Foot drop

 

 

Posted by PAUL A.

Answers

 

1)   D

2)   E

3)   B

4)   B

5)   C

6)   C

7)   D

8)   D

9)   C

10)                  D

11)                  C

12)                  D

13)                  A

14)                  D

15)                  C

16)                  E

17)                  A

18)                  C