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Question 1
Incorrect
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A 20-year-old woman who is sexually active is having deep dyspareunia and vaginal discharge. She has a negative smear for Gonococcus. Which of the following is the most likely diagnosis?
Your Answer: Chlamydial trachomatis
Correct Answer:
Explanation:This case is highly suggested of PID or Pelvic Inflammatory disease with chlamydia as the more common infective agent. Tetracyclines are used for treatment.
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This question is part of the following fields:
- Genitourinary
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Question 2
Incorrect
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A 40-year-old female presented with chronic pelvic pain for 6 months, which was aggravated by standing and walking. The pain was worst at the end of the day, during the pre-menstrual period and following sexual intercourse. Which of the following can be the most likely cause of this presentation?
Your Answer: Endometriosis
Correct Answer: Pelvic congestion syndrome
Explanation:The pelvic pain which is aggravated by changes in posture, during the pre menstrual period and towards the end of the day favours the diagnosis of pelvic congestion syndrome. Pelvic congestion syndrome is a condition of pelvic varicosities in women with unexplained pelvic pain. PID, endometriosis and adenomyosis are causes for chronic pelvic pain but they don’t match with the given clinical picture.
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This question is part of the following fields:
- Genitourinary
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Question 3
Correct
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A newly married female presented with fever, dysuria, frequency and lower abdominal pain for 2 days duration. On examination, she was febrile with lower abdominal tenderness. Urine microscopy reveals 20-30 pus cells/hpf and 10-20 red cells/hpf. Which of the following would be the most probable cause for this presentation?
Your Answer: Cystitis
Explanation:The patient has what is known as ‘honeymoon cystitis’.
Most common presentation of schistosomiasis is haematuria.
Patients with kidney trauma also present with haematuria following a positive history for such injury.
Pain due to calculi are colicky in nature and severe. -
This question is part of the following fields:
- Genitourinary
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Question 4
Correct
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A 27-year-old woman was admitted with vaginal bleeding and left sided pelvic pain for 2 days. There was no history of fever. She gave a history of absent periods for past 8 weeks. Abdominal examination revealed guarding and rebound tenderness in left iliac region. There was left sided cervical excitation on vaginal examination. What is the most probable diagnosis?
Your Answer: Ectopic pregnancy
Explanation:The history of amenorrhoea, pelvic pain and vaginal bleeding with peritonism and cervical excitation is more suggestive of an ectopic pregnancy. Endometriosis usually has a chronic presentation and dysmenorrhoea. Salpingitis usually presents with a fever. Ovarian torsion and ovarian tumours have different clinical presentations including increased abdominal size and persistent bloating.
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This question is part of the following fields:
- Genitourinary
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Question 5
Correct
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A 18 year old male complained of scrotal pain following a game of football. He couldn't recall any trauma to groin. Which of the following is the best investigation to confirm the diagnosis?
Your Answer: USG of the scrotum
Explanation:USG of the scrotum is important to exclude any abnormality with testicles, epididymis and scrotum. This presentation can be acute epididymo-orchitis or testicular torsion. USG of the scrotum will help to confirm the diagnosis.
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This question is part of the following fields:
- Genitourinary
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Question 6
Incorrect
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A 70-year-old male came to the OPD with complaints of nocturia, difficulty in initiating urination and continuous dribbling of urine afterwards. A transrectal US guided biopsy was performed and the diagnosis of BPH was made. His TURP was planned. Which of the following electrolyte imbalance is most likely to occur?
Your Answer: Hypokalaemia
Correct Answer: Hyponatremia
Explanation:In a TURP procedure, fluid is used to irrigate the bladder and to remove blood clots. IV fluids are also given to the patient post-operatively. These factors will lead to dilutional hyponatremia.
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This question is part of the following fields:
- Genitourinary
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Question 7
Correct
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A 45-year-old female presented with heavy vaginal bleeding for two weeks. After the initial assessment, a transvaginal U/S scan was done and found to be normal. What is the next most appropriate investigation that can be done?
Your Answer: Coagulation profile
Explanation:As the U/S scan is normal, there is no point of doing an endometrial biopsy and hysterectomy. Complete blood count is not helpful with the diagnosis. A high vaginal swab is for patients with vaginal discharges to determine the causative organism. So from the given responses, a coagulation profile is the suitable answer as this will help to diagnose any bleeding tendencies.
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This question is part of the following fields:
- Genitourinary
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Question 8
Correct
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A 70-year-old male patient with hypertension complains of acute urinary retention. He provides a history of urinary frequency for the past 18 months and has been taking Nifedipine and Propranolol for blood pressure control. Which of the following is the most probable cause for his acute presentation?
Your Answer: Drug induced
Explanation:Calcium channel blockers decrease smooth-muscle contractility in the bladder and this can cause urinary retention.
An enlarged prostate gland could be the reason if he gave a history of obstructive symptoms.
Diabetes presents with polyuria.
Bladder cancer commonly presents with painless haematuria. -
This question is part of the following fields:
- Genitourinary
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Question 9
Incorrect
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A 19 year old female presented with irregular menstrual cycles for 4 months. On examination her weight was 85 kg and height was 145 cm. She was not on any medications. Which of the following is the most appropriate investigation to arrive at a diagnosis?
Your Answer: Serum FSH/LH
Correct Answer: Pelvic ultrasound
Explanation:Oligomenorrhoea and BMI of 40.4 is suggestive of Polycystic ovary syndrome (PCOS). To diagnose PCOS 2 out of following 3 criteria should be present : oligo/anovulation, hyperandrogenism, clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone) and polycystic ovaries on ultrasound.
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This question is part of the following fields:
- Genitourinary
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Question 10
Incorrect
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A 14-year-old girl complains of a paravaginal mass. Biopsy was taken which confirmed a diagnosis of rhabdomyosarcoma. The likely cell of origin is a?
Your Answer:
Correct Answer:
Explanation:Rhabdomyosarcoma originates from skeletal muscle cells. A biopsy is needed for grading according to microscopy. Most patients are adult females.
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This question is part of the following fields:
- Genitourinary
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Question 11
Incorrect
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A 23 year old woman comes for the advice regarding contraceptives. Her mother passed away due to cervical cancer and she worries about cervical cancer. Which of the following is the most suitable contraceptive method for her?
Your Answer:
Correct Answer: Barrier method
Explanation:Cervical cancer results from genital infection with HPV. PV infections can be transmitted via nonsexual routes, but the result from sexual contact. So the best contraceptive method in relation to prevention of cervical cancer is the barrier method. But it will not prevent cervical cancer a 100%.
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This question is part of the following fields:
- Genitourinary
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Question 12
Incorrect
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A 30 year old female went to her local doctor's surgery for a follow-up to a cervical smear test. The smear was sent to histology and was identified as CIN2. Choose the most appropriate management for this patient.
Your Answer:
Correct Answer: Refer for colposcopy
Explanation:Screening for cervical carcinoma helps to prevent the development of the disease. According to NICE, the screening interval using liquid-based cytology (as opposed to PAP) is 3 years for women less than 50 years old and 5 years for women over 50 years old. If a smear test is conducted and it shows no endocervical cells then it should be conducted again. This is because there was either inadequate preparation or sampling, or the sampling was done at the wrong point in the menstrual cycle. For severe dyskaryosis or carcinoma in situ, the patient needs treatment and should, therefore, be referred for a colposcopy. Clue cells are vaginal epithelial cells that are fuzzy (i.e.. without distinct edges) when looking at through a microscope. When bacterial vaginosis is present, over 20 per cent of the sample cells are clue cells. Bacterial vaginosis is treated with metronidazole therapy. Although trichomoniasis is treated with metronidazole too, the patient should be tested for other sexually transmitted diseases.
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This question is part of the following fields:
- Genitourinary
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Question 13
Incorrect
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A 38-year-old male complained of painless, right sided testicular enlargement for 4 months. The size has been gradually increasing. On examination, there was no tenderness or redness. It was firm in consistency and not transiluminating. The most likely diagnosis is?
Your Answer:
Correct Answer: Testicular tumour
Explanation:History is suggestive of testicular tumour due to the gradual onset, non tender, firm mass. Hydroceles transiluminate and a varicocele has a bag of worms texture. Epididymo-orchitis is tender and often red or inflamed. An ependymal cyst is confined to the epididymis.
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This question is part of the following fields:
- Genitourinary
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Question 14
Incorrect
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A 23-year-old female visited the OPD with a complaint of postcoital bleeding as well as excessive vaginal discharge. Her past medical history is positive for oral contraceptive pills. Which of the following investigations would you recommend in this case?
Your Answer:
Correct Answer:
Explanation:A speculum test is necessary in order to visualize the cervix to rule out cervical ectropion that may be responsible for the post-coital bleeding. A smear is not necessary if the cervix is adequately visualized, however, it can rule out infection as well.
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This question is part of the following fields:
- Genitourinary
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Question 15
Incorrect
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A 39 year old female has been told by her doctor that her PAP smear test shows borderline changes. Her last smear test was conducted three years ago and was reported to be completely normal. Choose the most appropriate management for this patient.
Your Answer:
Correct Answer:
Explanation:The usual management for patients with one borderline sear test is to repeat the test in 6 months time. However, if this persists then the patient should be referred for a colposcopic assessment.
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This question is part of the following fields:
- Genitourinary
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Question 16
Incorrect
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A 45 year old male suffers multiple injuries in a road traffic accident. He complains of inability to urinate for the past 4 hours. Radiological examination reveals a fractured pelvis. Which of the following will be the most appropriate step in the management of this patient?
Your Answer:
Correct Answer: Suprapubic catheter
Explanation:When faced with urethral trauma, initial management decisions must be made in the context of other injuries and patient stability. These patients often have multiple injuries, and management must be coordinated with other specialists, usually trauma, critical care, and orthopaedic specialists. Life-threatening injuries must be corrected first in any trauma algorithm. Initial emergent treatment remains controversial, but mainstays of therapy include drainage of the urinary bladder, often with placement of a suprapubic catheter (SPT) and primary endoscopic realignment of the urethra if possible.
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This question is part of the following fields:
- Genitourinary
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Question 17
Incorrect
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A 45-year-old female presented with the complaint of menorrhagia for the last 2 years. No pharmacological treatment has worked. She has had all the children she wants but refuses any open surgical procedure. Which of the following is the most suitable option for her?
Your Answer:
Correct Answer: Uterine artery embolization
Explanation:Uterine artery embolization does not require open surgery or GA.
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This question is part of the following fields:
- Genitourinary
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Question 18
Incorrect
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A middle-aged male presented in the OPD with scrotal swelling that is cystic in nature and painless. It is located on the posterior part of the testis. What is the most likely diagnosis?
Your Answer:
Correct Answer: Epididymal Cyst
Explanation:Epididymal cysts present as a swelling is behind the testis and are non-tender/painless in nature.
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This question is part of the following fields:
- Genitourinary
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Question 19
Incorrect
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An 19 year old pregnant woman wants to terminate her pregnancy. She's in her 12th week of gestation and she's never been pregnant before. What is the most appropriate management?
Your Answer:
Correct Answer: Suction curettage
Explanation:Between 9-12weeks of gestation, suction curettage is usually the most appropriate method of termination of pregnancy. Termination of pregnancy must be decided and performed as early as possible. An abortion after 24 weeks of gestation is illegal in the UK.
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This question is part of the following fields:
- Genitourinary
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Question 20
Incorrect
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A 40 year old male returning from an African country, presented with lower abdominal pain and haematuria. Bladder calcifications were detected on abdominal x-ray. Which of the following is the most probable cause?
Your Answer:
Correct Answer: Schistosoma haematobium
Explanation:Schistosoma haematobium characteristically causes urinary tract disease. S.mansoni, S. mekongi, S. intercalatum, and S. japonicum cause intestinal tract and liver disease.
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This question is part of the following fields:
- Genitourinary
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Question 21
Incorrect
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A 35-year-old female is complaining of bad odour and discharge from her genitals. A smear was taken showing many epithelial cells and clue cells. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Bacterial vaginosis
Explanation:Trichomonas vaginalis is the most probable organism as it causes the foul smelling discharge. However, clue cells (irregular squamous epithelial cells with sheets of bacteria on its borders) are associated with bacterial vaginosis. Both cases should be treated with metronidazole.
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This question is part of the following fields:
- Genitourinary
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Question 22
Incorrect
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A 69 year old female presents to the clinic with complaint of vaginal bleeding that has been present for 3 months. Pipelle endometrial sampling and curettage reveals adenocarcinoma. Which of the following treatment options would be the most suitable for this patient?
Your Answer:
Correct Answer:
Explanation:Endometrial cancer is the most common cancer of the female genital tract in the US, with a peak incidence between 60 and 70 years of age. Endometrial cancers can be divided into two types based on histological characteristic; type I cancers account for 75% of all endometrial cancers and are of endometrioid origin, while type II cancers originate from serous or clear cells.
Several risk factors are associated with the development of endometrial cancer, of which the most important is long-term exposure to increased oestrogen levels, especially in type I cancer. The main symptom is often painless, vaginal bleeding, which presents at an early stage. Later stages may manifest with pelvic pain and a palpable mass, whereby pelvic exams are often normal.
The diagnosis is made primarily via an endometrial biopsy, which shows endometrial hyperplasia and atypical cells. Additional imaging studies (e.g., ultrasonography, abdominal CT, X-ray) are usually required for the detection and staging of metastases. Treatment of early stage endometrial cancer involves hysterectomy with adnexectomy and may also require additional lymph node removal. Radical hysterectomy according to the Wertheim-Meigs method is performed in cases of advanced carcinomas and can be combined with radiotherapy and progestin treatment. The prognosis is usually favourable in cancers diagnosed at an early stage.
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This question is part of the following fields:
- Genitourinary
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Question 23
Incorrect
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A 48 year old male presents to the clinic complaining of a swelling in his left groin that disappears on lying down. He also reports occasional haematuria and a mass in his left loin. On examination, the swelling is bluish in colour and has an appearance and consistency like that of a 'bag of worms'. What is the most likely diagnosis?
Your Answer:
Correct Answer: Left sided renal cell carcinoma
Explanation:Renal cell carcinoma (RCC) may remain clinically occult for most of its course. The classic triad of flank pain, haematuria, and flank mass is uncommon (10%) and is indicative of advanced disease. A varicocele, usually left sided, is due to obstruction of the testicular vein.
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This question is part of the following fields:
- Genitourinary
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Question 24
Incorrect
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A 20 year old boy presented with left hemi scrotal pain and fever for 2 days. He denied any history of trauma. On examination he was febrile. There was redness and tenderness of the left hemiscrotum. Which of the following is the most appropriate management for this patient?
Your Answer:
Correct Answer: Give antibiotics
Explanation:The history is suggestive of acute Epididymo-orchitis. The treatment option is antibiotics.
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This question is part of the following fields:
- Genitourinary
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Question 25
Incorrect
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A 43 year old female had a cervical smear test. The results came back showing only normal findings. What is the most appropriate management for this patient?
Your Answer:
Correct Answer:
Explanation:Screening for cervical carcinoma helps to prevent the development of the disease. According to NICE, the screening interval using liquid-based cytology (as opposed to PAP) is 3 years for women less than 50 years old and 5 years for women over 50 years old. If a smear test is conducted and it shows no endocervical cells then it should be conducted again.
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This question is part of the following fields:
- Genitourinary
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Question 26
Incorrect
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A 38 year old female presented with absent menstruation for the past 8 months. Her mother also has had early menopause at a similar age. Which of the following is the most appropriate initial investigation for her?
Your Answer:
Correct Answer: Serum FSH/LH
Explanation:Menopause happening at less than 40 years of age is known as premature menopause (or premature ovarian insufficiency). Provided that the pregnancy has been excluded, The concentrations of gonadotrophins in the premature menopausal range are necessary to establish a diagnosis of ovarian failure. Because of the intermittent presentation of the disease, repeated assays may be required at intervals of 2-4 weeks. Women with FSH levels above 40 mIU/ml may be regarded as having undergone permanent ovarian failure.
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This question is part of the following fields:
- Genitourinary
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Question 27
Incorrect
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A 30-year-old female admitted with pelvic pain, fever and vaginal discharge was diagnosed with PID. She was treated with IV antibiotics for 8 days. However, despite the antibiotics she continued to have a fever and lower abdominal pain. What is the most appropriate management that can be done at this stage?
Your Answer:
Correct Answer: US
Explanation:Persistent fever and lower abdominal pain is suggestive of resistant conditions secondary to PID such as abscess formation. An US scan should be performed to rule out those possible conditions.
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This question is part of the following fields:
- Genitourinary
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Question 28
Incorrect
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A 30 year old nulliparous woman presented with a report of a cervical biopsy which was suggestive of CIN III. What is the most appropriate management for this patient?
Your Answer:
Correct Answer: Cone biopsy
Explanation:Loop electrosurgical excision procedure (LEEP) and Cold knife cone biopsy (conization) are recommended treatments for this patient as she is nulliparous. Hysterectomy is offered for someone who has completed their family or menopaused.
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This question is part of the following fields:
- Genitourinary
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Question 29
Incorrect
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A 38-year-old male presented to the outpatient clinic complaining of a right sided groin mass just above and lateral to the pubic tubercle. It is non-tender and reducible. There is no cough impulse. What is the most likely diagnosis?
Your Answer:
Correct Answer: Direct inguinal hernia
Explanation:The patient is showing the symptoms of a hernia. The position of the hernia indicates an inguinal hernia. The absence of expansive impulse on cough by blocking the internal ring signifies a direct inguinal hernia.
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This question is part of the following fields:
- Genitourinary
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Question 30
Incorrect
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A 50-year-old woman visited her gynaecologist complaining of heavy menstrual bleeding for the last two months. She reports to have had her menopause 7 months before consultation. How will you investigate the condition of this patient?
Your Answer:
Correct Answer:
Explanation:This patient is 48 years old and has had amenorrhea which could be a sign of menopause. She then experienced heavy menstrual bleeding, the source of which could be the endometrium. Thus to assess the uterine lining, hysteroscopy seems the best of all the choices mentioned.
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This question is part of the following fields:
- Genitourinary
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SESSION STATS - PERFORMANCE PER SPECIALTY
