MCCQE1 Gynaecology Questions With Complete Solutions
"Penny, nickel, dime, quarter" ENDOMETRIAL
HYPERPLASIA Correct Answers simple hyperplasia w/o
atypia = 1% progression to cancer
complex hyperplasia w/o atypia = 3-5% simple hyperplasia w/
atypia = 8-10% complex hyperplasia w/ atypia = 25-30%
1-4 Prolapse Correct Answers 1° prolapse: in upper 2/3 of
vagina
2° prolapse: down to introitus
3° prolapse: protrudes outside vagina (partial)
4° prolapse: entire structure outside vagina (complete)
1st trimester abortion management Correct Answers suction
D+C (MC), manual vacuum extraction, medical abortion (≤7
wk)
1st trimester abortion methods Correct Answers Suction D+C:
90% of all abortions, safest method, most effective 7-13 wk
Medical abortion: indicated ≤7 wk only, requires f/u in 2 wks for
β-HCG levels
Mifepristone (RU-486): blocks progesterone stimulation →
embryo detachment Methotrexate: blocks DHF reductase →
↓cell division → blocks placental proliferation Misoprostol:
ripens cervix; use w/ MTX or RU-486 to ↑efficacy rates
2 step discrepancy Correct Answers (e.g. HGSIL on pap but
normal bx)
diagnostic cone bx
,2nd trimeser abortion methods Correct Answers 2nd trimester
abortion: D+E or induction of labor (IOL is better, since intact
fetus can be used for autopsy)
2nd trimester abortion induction Correct Answers Induction:
cervical ripening w/ misoprostol (Cytotec) → amniotomy →
induction w/ high-dose oxytocin (Pitocin) Complications:
trauma, infx, retained tissue
2nd trimester abortion management Correct Answers D+E or
induction of labor (IOL is better, since intact fetus can be used
for autopsy)
D+E: like D+C, but requires wider cervical dilation + use of
special forceps to extract fetal parts
Induction: cervical ripening w/ misoprostol (Cytotec) →
amniotomy → induction w/ high-dose oxytocin (Pitocin)
2ndary amenorrhea test? Correct Answers Progesterone
challenge test: give P for 1-2 wks and check for withdrawal
bleeding afterwards (checks to see if endometrium is
estrogenized)
3nd trimester abortion Correct Answers illegal ≥24 wk, unless
necessary for preservation of maternal life
Acute mastitis: Correct Answers breastfeeding women get
Staph/Strep infection through cracks in nipple w/ yellowish
discharge, Tx dicloxacillin + continue breastfeedin
AGC
, atypical glandular cells on PAP Correct Answers Colposcopy.
apocrine cyst tx Correct Answers I+D or excision
Appearance of complete mole (90%) Correct Answers 46/xx
(both paternal)
enlarged uterus + "grape cluster" villi ± bilateral theca-lutein
cysts
Apperance of partial mole Correct Answers egg + 2 sperm
69/XXY
normal-sized uterus, fetal parts found on autopsy of abortion
prodcuts
ASCUS? what do we do? Correct Answers HPV DNA testing
→• ASC-US + LSIL→ repeat test in 6months,
ASH- h (atypical squamous cells, cannot rule out high grade)
Correct Answers colpo + cervical bx
atrophic vaginitis tx Correct Answers topical estrogen
AUB investigations Correct Answers Dx labs (β-HCG, TSH,
prolactin, FSH) + endometrial bx (>35 or obese) + pelvic U/S;
Tx the underlying cause
average age for menopause Correct Answers 51
"Penny, nickel, dime, quarter" ENDOMETRIAL
HYPERPLASIA Correct Answers simple hyperplasia w/o
atypia = 1% progression to cancer
complex hyperplasia w/o atypia = 3-5% simple hyperplasia w/
atypia = 8-10% complex hyperplasia w/ atypia = 25-30%
1-4 Prolapse Correct Answers 1° prolapse: in upper 2/3 of
vagina
2° prolapse: down to introitus
3° prolapse: protrudes outside vagina (partial)
4° prolapse: entire structure outside vagina (complete)
1st trimester abortion management Correct Answers suction
D+C (MC), manual vacuum extraction, medical abortion (≤7
wk)
1st trimester abortion methods Correct Answers Suction D+C:
90% of all abortions, safest method, most effective 7-13 wk
Medical abortion: indicated ≤7 wk only, requires f/u in 2 wks for
β-HCG levels
Mifepristone (RU-486): blocks progesterone stimulation →
embryo detachment Methotrexate: blocks DHF reductase →
↓cell division → blocks placental proliferation Misoprostol:
ripens cervix; use w/ MTX or RU-486 to ↑efficacy rates
2 step discrepancy Correct Answers (e.g. HGSIL on pap but
normal bx)
diagnostic cone bx
,2nd trimeser abortion methods Correct Answers 2nd trimester
abortion: D+E or induction of labor (IOL is better, since intact
fetus can be used for autopsy)
2nd trimester abortion induction Correct Answers Induction:
cervical ripening w/ misoprostol (Cytotec) → amniotomy →
induction w/ high-dose oxytocin (Pitocin) Complications:
trauma, infx, retained tissue
2nd trimester abortion management Correct Answers D+E or
induction of labor (IOL is better, since intact fetus can be used
for autopsy)
D+E: like D+C, but requires wider cervical dilation + use of
special forceps to extract fetal parts
Induction: cervical ripening w/ misoprostol (Cytotec) →
amniotomy → induction w/ high-dose oxytocin (Pitocin)
2ndary amenorrhea test? Correct Answers Progesterone
challenge test: give P for 1-2 wks and check for withdrawal
bleeding afterwards (checks to see if endometrium is
estrogenized)
3nd trimester abortion Correct Answers illegal ≥24 wk, unless
necessary for preservation of maternal life
Acute mastitis: Correct Answers breastfeeding women get
Staph/Strep infection through cracks in nipple w/ yellowish
discharge, Tx dicloxacillin + continue breastfeedin
AGC
, atypical glandular cells on PAP Correct Answers Colposcopy.
apocrine cyst tx Correct Answers I+D or excision
Appearance of complete mole (90%) Correct Answers 46/xx
(both paternal)
enlarged uterus + "grape cluster" villi ± bilateral theca-lutein
cysts
Apperance of partial mole Correct Answers egg + 2 sperm
69/XXY
normal-sized uterus, fetal parts found on autopsy of abortion
prodcuts
ASCUS? what do we do? Correct Answers HPV DNA testing
→• ASC-US + LSIL→ repeat test in 6months,
ASH- h (atypical squamous cells, cannot rule out high grade)
Correct Answers colpo + cervical bx
atrophic vaginitis tx Correct Answers topical estrogen
AUB investigations Correct Answers Dx labs (β-HCG, TSH,
prolactin, FSH) + endometrial bx (>35 or obese) + pelvic U/S;
Tx the underlying cause
average age for menopause Correct Answers 51
