Gynecology Exam Questions with
Answers Latest Update
What cancer does polycystic ovarian syndrome (PCOS) increase the long term risk
of? - Correct Answer endometrial cancer
What conditions complicate PCOS? - Correct Answer -chronic an ovulation
-hyperandrogenism
What are the long term complications of PCOS? - Correct Answer -Subfertility
-diabetes mellitus
-stroke and TIA
-Coronary artery disease
-obstructive sleep apnea
-endometrial cancer
these complications are further increased in patients who are obese
What is the reason for increased endometrial hyperplasia and carcinoma in women
with PCOS - Correct Answer it is due to olio/amenorrhea in the presence of pre-
menopausal levels of oestrogen
this risk is greatest in women with menstrual cycle lengths of >3months
How can the risk of endometrial cancer be reduced in women with PCOS? - Correct
Answer by inducing a withdrawal bleed every 1-3 months (using a combined
contraceptive pill or cyclical medroxyprogestrone or with insertion of a Mirena coil
Optimizing BMI in overweight patients will help to regulate menstrual cycles thereby
reducing the risk of endometrial hyperplasia
Is there increased risk of osteoporosis in PCOS? - Correct Answer No because
there is no oestrogen deficiency
What is PCOS? - Correct Answer It is a complex condition of ovarian dysfunction
thought to affect 5-20% of women of reproductive age
,the etiology is not fully understood
both hyperinsulinaemia and high levels of LH are seen in PCOS and there appears
to be some overlap with the metabolic syndrome
What are the features of PCOS - Correct Answer -subfertility and infertility
-menstrual disturbances: oligomenorrhea and amenorrhea
-hirsutism, acne (due to hyperandrogenism)
-obesity
-Acanthosis Nigerians (due to insulin resistance)
What investigations will you do for PCOS? - Correct Answer -pelvic ultrasound:
multiple cysts on the ovaries
-FSH, LH , prolactin, TSH and testosterone are useful investigations: raised LH:FSH
ratio are a 'classical' feature but is no longer thought to be useful in diagnosis.
Prolactin may be normal or mildly elevated. Testosterone may be normal or mildly
elevated - however, if markedly raised consider other causes
-check impaired glucose tolerance
A 19-year-old primigravida at 9 weeks presents with vaginal bleeding and
suprapubic pain. Tissue has passed through her vagina. The cervix is closed and
blood is pooled in the vagina. Ultrasound shows an empty uterine cavity. What is the
diagnosis?
inevitable miscarriage
incomplete miscarriage
threatened miscarriage
complete miscarriage
ectopic pregnancy - Correct Answer complete miscarriage
What is a complete miscarriage - Correct Answer it is a spontaneous abortion with
expulsion of the entire foetus through the cervix
pain and uterine contractions stop after foetus has been expelled
diagnosis: ultrasound shows empty uterus
What are the different types of miscarriages - Correct Answer -threatened
miscarriage
,-missed (delayed) miscarriage
-inevitable miscarriage
-incomplete miscarriage
-complete miscarriage
What is a threatened miscarriage - Correct Answer painless vaginal bleeding
occurring before 24 weeks but typically occurs at 6-9 weeks
the bleeding is often less than menstruation
cervical os is closed
complicates up to 25% of all pregnancies
What is a missed (delayed) miscarriage? - Correct Answer a gestational sac which
contains a dead foetus before 20 weeks without the symptoms of expulsion
mother may have light vaginal bleeding/discharge and the symptoms of pregnancy
which disappear
pain is not usually a feature
cervical os is closed
when the gestational sac is >25mm and no embryonic/fetal part can be seen is
sometimes described as a 'blighted ovum' or 'an embryonic pregnancy'
What is an inevitable miscarriage - Correct Answer heavy bleeding with clots and
pain
cervical os is open
What is an incomplete miscarriage - Correct Answer not all products of conception
have been expelled
pain and vaginal bleeding
cervical os is open
What is the management of cervical cancer - Correct Answer simple hysterectomy
is the preferred treatment choice for early stage disease in postmenopausal women
, What is Wertheim's hysterectomy - Correct Answer it involves pelvic node
clearance, hysterectomy, removal of parametric and upper third of vagina
What is a subtotal hysterectomy - Correct Answer removal of the uterus but not the
cervix
What is the epidemiology of cervical cancer - Correct Answer around 50% of cases
of cervical cancer occur in women under the age of 45 years with incidence rates for
cervical cancer in the UK are highest in people aged 25-29 years according to
Cancer Research UK
What types can cervical cancer be divided into - Correct Answer -squamous cell
cancer (80%)
-adenocarcinoma (20%)
What are the features of cervical cancer - Correct Answer -may be detected during
routine cervical cancer screening
-abnormal vaginal bleeding: post-coital, inter menstrual or postmenopausal bleeding
-vaginal discharge
What are the risk factors for cervical cancer - Correct Answer -HPV particularly
serotypes 16, 18 and 33 is by far the most important factor in the development of
cervical cancer
-smoking
-HIV
-early first intercourse, many sexual partners
-high parity
-lower socioeconomic status
-combined oral contraceptive pill
What is the mechanism for HPV causing cervical cancer? - Correct Answer HPV 16
and 18 produces the oncogenes E6 and E7 genes respectively
E6 inhibits the p53 tumour suppressor gene
E7 inhibits RB suppressor gene
Answers Latest Update
What cancer does polycystic ovarian syndrome (PCOS) increase the long term risk
of? - Correct Answer endometrial cancer
What conditions complicate PCOS? - Correct Answer -chronic an ovulation
-hyperandrogenism
What are the long term complications of PCOS? - Correct Answer -Subfertility
-diabetes mellitus
-stroke and TIA
-Coronary artery disease
-obstructive sleep apnea
-endometrial cancer
these complications are further increased in patients who are obese
What is the reason for increased endometrial hyperplasia and carcinoma in women
with PCOS - Correct Answer it is due to olio/amenorrhea in the presence of pre-
menopausal levels of oestrogen
this risk is greatest in women with menstrual cycle lengths of >3months
How can the risk of endometrial cancer be reduced in women with PCOS? - Correct
Answer by inducing a withdrawal bleed every 1-3 months (using a combined
contraceptive pill or cyclical medroxyprogestrone or with insertion of a Mirena coil
Optimizing BMI in overweight patients will help to regulate menstrual cycles thereby
reducing the risk of endometrial hyperplasia
Is there increased risk of osteoporosis in PCOS? - Correct Answer No because
there is no oestrogen deficiency
What is PCOS? - Correct Answer It is a complex condition of ovarian dysfunction
thought to affect 5-20% of women of reproductive age
,the etiology is not fully understood
both hyperinsulinaemia and high levels of LH are seen in PCOS and there appears
to be some overlap with the metabolic syndrome
What are the features of PCOS - Correct Answer -subfertility and infertility
-menstrual disturbances: oligomenorrhea and amenorrhea
-hirsutism, acne (due to hyperandrogenism)
-obesity
-Acanthosis Nigerians (due to insulin resistance)
What investigations will you do for PCOS? - Correct Answer -pelvic ultrasound:
multiple cysts on the ovaries
-FSH, LH , prolactin, TSH and testosterone are useful investigations: raised LH:FSH
ratio are a 'classical' feature but is no longer thought to be useful in diagnosis.
Prolactin may be normal or mildly elevated. Testosterone may be normal or mildly
elevated - however, if markedly raised consider other causes
-check impaired glucose tolerance
A 19-year-old primigravida at 9 weeks presents with vaginal bleeding and
suprapubic pain. Tissue has passed through her vagina. The cervix is closed and
blood is pooled in the vagina. Ultrasound shows an empty uterine cavity. What is the
diagnosis?
inevitable miscarriage
incomplete miscarriage
threatened miscarriage
complete miscarriage
ectopic pregnancy - Correct Answer complete miscarriage
What is a complete miscarriage - Correct Answer it is a spontaneous abortion with
expulsion of the entire foetus through the cervix
pain and uterine contractions stop after foetus has been expelled
diagnosis: ultrasound shows empty uterus
What are the different types of miscarriages - Correct Answer -threatened
miscarriage
,-missed (delayed) miscarriage
-inevitable miscarriage
-incomplete miscarriage
-complete miscarriage
What is a threatened miscarriage - Correct Answer painless vaginal bleeding
occurring before 24 weeks but typically occurs at 6-9 weeks
the bleeding is often less than menstruation
cervical os is closed
complicates up to 25% of all pregnancies
What is a missed (delayed) miscarriage? - Correct Answer a gestational sac which
contains a dead foetus before 20 weeks without the symptoms of expulsion
mother may have light vaginal bleeding/discharge and the symptoms of pregnancy
which disappear
pain is not usually a feature
cervical os is closed
when the gestational sac is >25mm and no embryonic/fetal part can be seen is
sometimes described as a 'blighted ovum' or 'an embryonic pregnancy'
What is an inevitable miscarriage - Correct Answer heavy bleeding with clots and
pain
cervical os is open
What is an incomplete miscarriage - Correct Answer not all products of conception
have been expelled
pain and vaginal bleeding
cervical os is open
What is the management of cervical cancer - Correct Answer simple hysterectomy
is the preferred treatment choice for early stage disease in postmenopausal women
, What is Wertheim's hysterectomy - Correct Answer it involves pelvic node
clearance, hysterectomy, removal of parametric and upper third of vagina
What is a subtotal hysterectomy - Correct Answer removal of the uterus but not the
cervix
What is the epidemiology of cervical cancer - Correct Answer around 50% of cases
of cervical cancer occur in women under the age of 45 years with incidence rates for
cervical cancer in the UK are highest in people aged 25-29 years according to
Cancer Research UK
What types can cervical cancer be divided into - Correct Answer -squamous cell
cancer (80%)
-adenocarcinoma (20%)
What are the features of cervical cancer - Correct Answer -may be detected during
routine cervical cancer screening
-abnormal vaginal bleeding: post-coital, inter menstrual or postmenopausal bleeding
-vaginal discharge
What are the risk factors for cervical cancer - Correct Answer -HPV particularly
serotypes 16, 18 and 33 is by far the most important factor in the development of
cervical cancer
-smoking
-HIV
-early first intercourse, many sexual partners
-high parity
-lower socioeconomic status
-combined oral contraceptive pill
What is the mechanism for HPV causing cervical cancer? - Correct Answer HPV 16
and 18 produces the oncogenes E6 and E7 genes respectively
E6 inhibits the p53 tumour suppressor gene
E7 inhibits RB suppressor gene
