Gynaecology MCQs for AMC Part 1 Exam

ByAMC Wise

Question 3011

A 25-year-old woman presents to her healthcare provider with complaints of a malodorous vaginal discharge and itching. On examination, there is a thin, grayish-white discharge with a characteristic fishy odor. The patient denies any symptoms of urinary tract infection or pelvic pain. Microscopic examination of high vaginal swab clue cells. What is the most appropriate initial step in managing this patient?

  • A) Prescribe a course of oral doxycycline 100mg BD for 7 days
  • B) Recommend over-the-counter antifungal suppositories
  • C) Initiate treatment with oral ciprofloxacin 500mg BD for 5 days
  • D) Administer a course oral metronidazole 400mg BD for 7 days
  • E) Perform a pelvic ultrasound

Answer: D) Administer a course oral metronidazole 400mg BD for 7 days

The patient’s clinical presentation, including malodorous discharge, itching, and the presence of clue cells, is indicative of bacterial vaginosis (BV). The most appropriate initial step in managing this patient is to administer a course of oral metronidazole, as it is the recommended first-line treatment for BV. This helps eliminate the overgrowth of anaerobic bacteria and alleviate symptoms.

Clinical diagnosis of BV is made using Amsel criteria (see below). If 3 or 4 of the following criteria are present, presumptive treatment can be offered.

  1. Thin white/grey homogenous discharge on speculum examination
  2. Elevated vaginal pH (pH > 4.5)
  3. Whiff test: malodour with addition of potassium hydroxide to vaginal secretions, or if not available, genital malodour on examination
  4. Clue cells on microscopy of Gram stain of high vaginal swab.

Question 3012

A 20 year old female asks you about emergency contraception methods available in Australia, which of the following statements is true when comparing Levonorgestrel and Ulipristal acetate (EllaOne®)?

  • A) Levonorgestrel has a longer window of effectiveness, up to 120 hours after unprotected intercourse, compared to Ulipristal acetate.
  • B) Levonorgestrel is available over-the-counter, while Ulipristal acetate requires a prescription.
  • C) Levonorgestrel is a progestin-only emergency contraceptive, while Ulipristal acetate is a combination of estrogen and progestin.
  • D) Ulipristal acetate is recommended for use in individuals under 18 years old, while Levonorgestrel is not.
  • E) Ulipristal acetate is more effective in preventing pregnancies when compared to Levonorgestrel.

Answer: E) Ulipristal acetate is more effective in preventing pregnancies when compared to Levonorgestrel.

Both are available over the counter in Australia. Levonorgestrel is effective within 72 hours of unprotected sex while Ulipristal acetate is effective up to 120 hours and is also more effective than Levonorgestrel in preventing unwanted pregnancies. Any female in childbearing age can have both these drugs and there is no age requirements to use either of them.

Levonorgestrel is a progestin-only emergency contraceptive pill, while Ulipristal acetate is a selective progesterone receptor modulator.

Question 3013

A 60-year-old postmenopausal woman presents with a three-month history of intermittent postmenopausal bleeding. She reports no history of hormone replacement therapy and has an unremarkable physical examination. Her last PAP smear was negative 6 months ago. Transvaginal ultrasound shows an endometrial thickness of 4mm. What is the most appropriate next step in managing this patient?

  • A) Initiate hormonal replacement therapy
  • B) Repeat the transvaginal ultrasound in 3 months
  • C) Perform endometrial biopsy
  • D) Order pelvic CT scan for further evaluation
  • E) Reassure and send home

Answer: B) Perform endometrial biopsy

Postmenopausal bleeding is a concerning symptom that requires further evaluation as 10% will have endometrial carcinoma. The most appropriate next step in managing this patient is to perform an endometrial biopsy to assess the endometrial lining. Normal endometrial thickness (4-8mm) on USS doesn’t exclude endometrial cancer.

References

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