DRCOG – Module 6 – Emergency & Urgent Gynaecology – SBA Questions

What is the second most common vulval malignancy?

A 70 year old woman is referred to a rapid access gynaecology clinic with a suspicious vulval lesion. She has a background of lichen sclerosus but has not used topical corticosteroids for several years.  On examination, there is a irregular 2.5cm ulcerated vulval lesion on the right labia majora which bleeds on contact and is friable.  What is the most appropriate next step?

A 46-year-old woman is referred to colposcopy following an abnormal cervical smear test and has a LLETZ procedure. The histology confirms CGIN with clear excision margins. A test of cure (TOC) is taken 6 months after treatment and is positive for HPV. What is the most appropriate management?

A 42-year-old woman with a previous history of treated CIN3 has a follow-up smear that is cytology negative but still HPV positive. What is the most appropriate management?

A 40-year-old woman with a history of treated CIN3 has a follow-up smear showing negative cytology and negative HPV testing. What is the most appropriate management?

A 35-year-old nulliparous woman has had a recent smear test which shows high grade dyskaryosis. She is otherwise fit and well with no significant past medical history. What is the most appropriate management?

A 50-year-old woman undergoing routine screening is found to have an inadequate smear due to insufficient squamous cells. What is the most appropriate management?

A 47-year-old woman with no history of previous cervical abnormalities has a smear showing glandular cells. She is postmenopausal and has a BMI of 45. What is the most appropriate management?

A 33-year-old nulliparous woman has had a cervical smear test result showing low grade dyskaryosis and positive high risk HPV. She has regular menstrual cycles and no significant past medical history. What is the most appropriate management?

A 60 year old woman presents to her GP with a single episode of postmenopausal bleeding and is referred as a two-week wait referral for transvaginal pelvic ultrasound and Gynaecology review. Pelvic ultrasound confirms a thickened cystic endometrium measuring 9mm and outpatient endometrial sampling is performed however the histology reports confirms that the sample was inadequate.   What is the most appropriate management?

A 60 year old woman presents to her GP with a single episode of postmenopausal bleeding and is referred as a two-week wait referral for transvaginal pelvic ultrasound and Gynaecology review. Pelvic ultrasound confirms a thickened cystic endometrium measuring 9mm and outpatient endometrial sampling is performed.  Which of the following is the most significant risk of outpatient endometrial sampling?

A 60 year old woman presents to her GP with a single episode of postmenopausal bleeding and is referred as a two-week wait referral for transvaginal pelvic ultrasound and Gynaecology review. What endometrial thickness cut-off should be used for further investigation?

A 60 year old woman presents to her GP with new onset of watery vaginal discharge and occasional episodes of blood-stained urine. What is the most appropriate investigation?

A 40 year old woman with known Lynch syndrome has a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy for risk reduction and subsequently develops debilitating menopausal symptoms. What is the most appropriate management option?

A 25 year old is referred to Gynaecology clinic by her geneticist following a recent diagnosis of Lynch syndrome with a mutation in the MSH2 gene identified. What should be recommended to reduce her risk of cancer?

A 40 year old woman has platinum-based chemoradiotherapy and brachytherapy for Stage IIA2 cervical squamous cell carcinoma and subsequently develops significant dyspareunia. What is the most appropriate management option?

A 40 year old woman has a total abdominal hysterectomy and bilateral salpingo-oophorectomy for Type 2 endometrial cancer and subsequently develops debilitating menopausal symptoms. What is the most appropriate management option?

A 40 year old woman has a total abdominal hysterectomy and bilateral salpingo-oophorectomy for Stage IB cervical adenocarcinoma and subsequently develops debilitating menopausal symptoms. What is the most appropriate management option?

A 65 year old woman has primary cytoreduction surgery for Stage 3A1 ovarian cancer and receives adjuvant paclitaxel and carboplatin chemotherapy. What percentage of patients with ovarian cancer initially respond to first-line chemotherapy?

A 65 year old woman has primary cytoreduction surgery for Stage 3A1 ovarian cancer. What is the most frequently used first line adjuvant chemotherapy following primary surgery for ovarian cancer?

What is the prevalence of Lynch Syndrome in women with endometrial cancer?

A woman is referred for genetic counselling after a diagnosis of breast cancer with BRCA1 germline mutation. Which of the following characteristics are less suggestive of an underlying BRCA1 mutation?

What is the inheritance pattern for BRCA1 and BRCA2 germline mutations?

A 65 year old woman is investigated for severe lower back pain by her GP and is referred for an MRI Spine.The MRI is reported as follows:

“Moderate osteoporotic changes of the lumbar spine.  A left ovarian cyst is seen which appears simple in nature and measure 6cm in diameter.  Gynaecological referral is advised.”

The GP refers the patient urgently to gynaecology and arranges further investigations.  What is the most appropriate investigation?

A 27 year old attends her GP with a painful left vulval swelling for the past two days. On examination, there is an erythematous fluctuant vulval lump at the left introitus, measuring approximately 3cm in diameter.  Her GP refers her as an emergency to gynaecology and she has an incision and drainage with marsupialisation.  She represents on three occasions to her GP subsequently with recurrence of her symptoms.  What is the next appropriate management?

A 27 year old attends her GP with a painful left vulval swelling for the past two days. On examination, there is an erythematous fluctuant vulval lump at the left introitus, measuring approximately 3cm in diameter.  Her observations are as follows: RR 24, Sats 99% on room air, P 129, BP 98/54, Temp 39.9.  What is the next appropriate management?

A 27 year old attends her GP with a painful left vulval swelling for the past two days.  On examination, there is an erythematous fluctuant vulval lump at the left introitus, measuring approximately 3cm in diameter.  Her observations are as follows: RR 14, Sats 99% on room air, P 82, BP 128/87, Temp 36.5.  What is the next appropriate management?

A 30 year old woman has a laparoscopic ovarian cystectomy and the histology confirms a diagnosis of borderline ovarian tumour. Which of the following is not associated with a reduced risk of borderline ovarian tumours?

GP is reviewing some blood test results after clinic and notes the following result:

Clinical details: 24 year old, lower abdominal pain

CA-125: 75

Which of the following is not a cause of an elevated CA-125 level?

A 24 year old woman attends her GP with persistent lower abdominal pain which is relieved by opening her bowels.Her GP arranges a transvaginal ultrasound scan which is reported as follows:

Normal appearance of anteverted uterus with regular endometrium measuring 4mm.  Complex septated left ovarian cyst measuring 75 x 51 x 68 mm in diameter.  Normal right ovary.  No free fluid.

What is the next appropriate management?

A 24 year old woman attends her GP with persistent lower abdominal pain which is relieved by opening her bowels.Her GP arranges a transvaginal ultrasound scan which is reported as follows:

Normal appearance of anteverted uterus with regular endometrium measuring 4mm.  Simple anechoic left ovarian cyst measuring 25 x 21 x 28 mm in diameter.  Normal right ovary.  No free fluid.

What is the next appropriate management?

A 67 year old presents to her GP with symptoms of lower abdominal pain, fatigue and persistent bloating.  She is concerned that she may be at increased risk of developing ovarian cancer.  Which of the following is not a risk factor for ovarian cancer?

A 67 year old presents to her GP with symptoms of lower abdominal pain, fatigue and persistent bloating.  She is concerned that she may be at increased risk of developing ovarian cancer.  Which of the following is associated with an increased risk of developing for ovarian cancer?

A 67 year old presents to her GP with symptoms of lower abdominal pain, fatigue and persistent bloating. She is concerned that she may be at increased risk of developing ovarian cancer.  Which of the following is not a risk factor for ovarian cancer?

A 65 year old woman presents to her GP with symptoms of lower abdominal pain, fatigue and persistent bloating.  She is worried that she has developed irritable bowel syndrome.  On examination, the GP is concerned because there is moderate ascites and a palpable pelvic mass which feels craggy and fixed on bimanual examination.  What is the next appropriate management?

A 65 year old woman presents to her GP with symptoms of lower abdominal pain, fatigue and persistent bloating.She is worried that she has developed irritable bowel syndrome.  Abdominal and pelvic examination is unremarkable.  The GP requests some blood tests including a CA-125.  The results are shown below:

What is the most appropriate next management?

A 65 year old woman presents to her GP with symptoms of lower abdominal pain, fatigue and persistent bloating.She is worried that she has developed irritable bowel syndrome.  Abdominal and pelvic examination is unremarkable.  The GP requests some blood tests including a CA-125.  The results are shown below:

What is the most appropriate next management?

A 65 year old woman presents to her GP with symptoms of lower abdominal pain, fatigue and persistent bloating.  Abdominal and pelvic examination is unremarkable.  What is the most appropriate next investigation?

A 67 year old presents to her GP as she has recently read a newspaper article about women’s health and is concerned that she may have symptoms suggestive of ovarian cancer.  Which of the following are not potential symptoms or signs of ovarian cancer?

A 71 year old woman presents to her GP as she is very worried that she may have endometrial cancer.  She is asymptomatic but her sister has recently died of endometrial cancer.  She is otherwise fit and well with a normal BMI and no significant past medical history.  Which of the following statements regarding screening for endometrial cancer is correct?

A 71 year old woman presents to her GP with a single episode of post-menopausal bleeding. She is very worried as her sister has recently died of endometrial cancer.  She is otherwise fit and well with a normal BMI and no significant past medical history.  Abdominal and speculum examination is unremarkable.  Her GP arranges a transvaginal pelvic ultrasound scan which shows a normal size anterverted uterus with a 12mm endometrial polyp arising at the fundus of the uterus with endometrial thickness of 3mm.  What is the next most appropriate management?

A 71 year old woman is being investigated for a recent change in bowel habit by her GP and undergoes a CT Colon with contrast.  The CT is reported as showing no obvious bowel pathology but comments that there is evidence of a thickened endometrium.  The GP contacts the patient who reports that she has not had any post-menopausal bleeding and is otherwise asymptomatic.  The GP arranges a transvaginal pelvic ultrasound scan which shows an anteverted uterus with cystic appearance of the endometrium measuring 12mm in thickness.  What is the next most appropriate management?

A 71 year old woman is being investigated for a recent change in bowel habit by her GP and undergoes a CT Colon with contrast. The CT is reported as showing no obvious bowel pathology but comments that there is 8mm homogenous endometrium.  The GP contacts the patient who reports that she has not had any post-menopausal bleeding and is otherwise asymptomatic.  What is the next appropriate management?

A 71 year old woman presents to her GP with a single episode of post-menopausal bleeding.  She is very worried as her sister has recently died of endometrial cancer.  She is otherwise fit and well with a normal BMI and no significant past medical history.  Abdominal examination is unremarkable and speculum examination reveals atrophic vaginal mucosa but no other obvious abnormality.  Her GP arranges a transvaginal pelvic ultrasound scan which shows a normal size anteverted uterus with homogenous endometrium with thickness of 8mm and no other abnormality seen.  What is the next most appropriate management?

A 71 year old woman presents to her GP with a single episode of post-menopausal bleeding. She is very worried as her sister has recently died of endometrial cancer.  She is otherwise fit and well with a normal BMI and no significant past medical history.  Abdominal examination is unremarkable and speculum examination reveals atrophic vaginal mucosa but no other obvious abnormality.  Her GP arranges a transvaginal pelvic ultrasound scan which shows a normal size anterverted uterus with endometrial thickness of 2mm and no other abnormality seen.  What is the next most appropriate management?

A 71 year old woman presents to her GP with a single episode of post-menopausal bleeding. She is very worried as her sister has recently died of endometrial cancer.  She is otherwise fit and well with a normal BMI and no significant past medical history.  Abdominal and speculum examination is unremarkable.  What is the next most appropriate investigation?

A 71 year old woman presents to her GP with a single episode of post-menopausal bleeding. She is very worried as her sister has recently died of endometrial cancer.  Which of the following is not associated with an increased risk of endometrial cancer?

A 26 year old woman is readmitted to hospital five days after laparoscopic adhesiolysis and salpingectomy for hydrosalpinx. She complains of worsening abdominal pain and vomiting and is pyrexial.  What is the most important investigation?

You are asked to review a 45 year old woman on the Gynaecology Ward who had an abdominal hysterectomy for large uterine fibroids yesterday. The nurses are concerned that there has been reduced urine output post-operatively.  On examination, the patient is complaining of severe left sided back pain and there is minimal blood stained urine in the urinary catheter.  Observations are all within normal limits.  What is the next most appropriate investigation?

You are asked to review a 45 year old woman on the Gynaecology Ward who had an abdominal hysterectomy for large uterine fibroids yesterday. The nurses are concerned that there has been reduced urine output post-operatively despite 3 litres of intravenous fluids over the last 12 hours.  On examination, the patient is complaining of severe left sided back pain and there is minimal blood stained urine in the urinary catheter.  Observations are all within normal limits.  What is the next most appropriate management?

You are asked to review a 70 year old patient on the Gynaecology Ward who had a vaginal hysterectomy two days ago with an estimated blood loss of 250ml. Her pre-operative haemoglobin was 109. The woman is complaining of feeling generally unwell and short of breath.  There is no abdominal tenderness but there is reduced air entry at the right lung base. Her pulse is 120, her blood pressure is 80/50, her temperature is 39.5°C, her respiratory rate is 25 and her oxygen saturations are 94% on 10L of oxygen.  What is the next most appropriate investigation?

You are asked to review a 70 year old patient on the Gynaecology Ward who had a vaginal hysterectomy yesterday with an estimated blood loss of 250ml. Her pre-operative haemoglobin was 109. On examination, the woman is complaining of severe abdominal pain but there is no evidence of peritonism. Her pulse is 120, her blood pressure is 80/50.  She is afebrile and her respiratory rate and oxygen saturations are normal.  What is the most appropriate investigation?

You are asked to review a patient on the ward who had an open myomectomy yesterday with an estimated blood loss of 1000ml. She has a wound drain inserted and it has drained approximately 300ml of serosanguinous fluid.  Her observations are otherwise normal and her post-operative haemoglobin is 104.  What is the most appropriate management?