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Question 1
Correct
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A 23-year-old woman complains of a tender lump that is smooth and mobile in her left breast measuring 1-2 cm. What is the most likely diagnosis?
Your Answer: Fibroadenoma
Explanation:Fibroadenoma usually occurs in younger women. These non-tender masses can be removed for aesthetic purposes. Breast cysts are common shifting masses inside the breast tissue more common in women over the age of 35.
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This question is part of the following fields:
- Women's Health
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Question 2
Correct
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A 20-year-old female is suffering from amenorrhea. She has a BMI of 14 but still thinks that she needs to lose weight. She watches her food intake obsessively. Choose the most likely diagnosis.
Your Answer: Anorexia nervosa
Explanation:Anorexia is consistent with the symptoms described.
Anorexia is an eating disorder characterised by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives.
Some people who have anorexia binge and purge, similar to individuals who have bulimia. But people with anorexia generally struggle with an abnormally low body weight, while individuals with bulimia typically are normal to above normal weight.
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This question is part of the following fields:
- Women's Health
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Question 3
Correct
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A 43-year-old woman complains of a greenish foul smelling discharge from her left nipple. She has experienced the same case before. What is the most likely diagnosis?
Your Answer: Duct ectasia
Explanation:Mammary duct ectasia occurs when the lactiferous duct becomes blocked or clogged. This is the most common cause of greenish discharge. Mammary duct ectasia can mimic breast cancer. It is a disorder of peri- or post-menopausal age.
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This question is part of the following fields:
- Women's Health
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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:
- Women's Health
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Question 5
Correct
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A 32-year-old female presented with a lump in the upper outer quadrant of her left breast, which is 1.5cm in size and tender. What is the initial investigation to be done?
Your Answer: Ultrasound
Explanation:Tenderness is usually suggestive of a benign breast mass such as a breast abscess. Ultrasound is used to distinguish solid from cystic structures and to direct needle aspiration for abscess drainage.
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This question is part of the following fields:
- Women's Health
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Question 6
Correct
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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: 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:
- Women's Health
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Question 7
Correct
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A 47-year-old woman diagnosed with oestrogen receptor positive breast cancer three months back was started on treatment with tamoxifen. Which of the following is most likely a complaint of this patient during her review today?
Your Answer: Hot flushes
Explanation:The most likely complaint of this patient would be hot flushes.
Alopecia and cataracts are listed in the BNF as possible side-effects. They are however not as prevalent as hot flushes, which are very common in pre-menopausal women.
Tamoxifen is a Selective Oestrogen Receptor Modulator (SERM) which acts as an oestrogen receptor antagonist and partial agonist. It is used in the management of oestrogen receptor-positive breast cancer
Adverse effects:
Menstrual disturbance: vaginal bleeding, amenorrhoea
Hot flushes – 3% of patients stop taking tamoxifen due to climacteric side-effects.
Venous thromboembolism.
Endometrial cancer
Tamoxifen is typically used for 5 years following the removal of the tumour.Raloxifene is a pure oestrogen receptor antagonist and carries a lower risk of endometrial cancer.
Although antagonistic with respects to breast tissue tamoxifen may serve as an agonist at other sites. Therefore the risk of endometrial cancer is increased cancer.
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This question is part of the following fields:
- Women's Health
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Question 8
Correct
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A 22-year-old female presents to the ER with a respiratory infection for which the physician prescribes her azithromycin. She, however, is currently on combined oral contraceptive pills. Regarding her contraception, what should be advised to this patient?
Your Answer: No extra precaution
Explanation:Rifampicin is the only antibiotic that has been reported to reduce plasma oestrogen concentrations. When taking Rifampicin, oral contraceptives cannot be relied upon and a second method of contraception is mandatory. Amoxicillin, ampicillin, griseofulvin, metronidazole and tetracycline have been rarely associated with contraceptive failure. When these agents are used, the clinician should discuss the available data with the patient and suggest a second form of birth control. Other antibiotics are most likely safe to use concomitantly with oral contraceptives.
The danger with COCP is enzyme inducers which can lower the levels of the hormone in he blood, azithromycin is not an enzyme inducer. No additional precautions are required to maintain contraceptive efficacy when using antibiotics that are not enzyme inducers with combined hormonal methods for durations of 3 weeks or less. The only proviso would be that if the antibiotics (and/or the illness) caused vomiting or diarrhoea, then the usual additional precautions relating to these conditions should be observed.Inducers: RASAG
– Rifampicin
– Anticonvulsants, particularly phenytoin, carbamazepine, phenobarbitone and primidone
– Spironolactone, St Johns wort
– Alcohol, long term
– Griseofulvin -
This question is part of the following fields:
- Women's Health
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Question 9
Incorrect
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A 48-year-old woman presented to you with a breast mass. On examination, it is hard, irregular and ill defined. The surface of the breast is slightly bruised however, there is no discharge. The most probable diagnosis is?
Your Answer: Ca breast
Correct Answer: Fat necrosis
Explanation:Fat necrosis is often a result of a trauma or surgery. In fat necrosis the enzyme lipase releases fatty acids from triglycerides. The fatty acids combine with calcium to form soaps. These soaps appear as white chalky deposits which are firm lumps with no associated discharge. The given case has a bruise which indicates prior trauma.
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This question is part of the following fields:
- Women's Health
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Question 10
Incorrect
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A lactating mother has developed a breast abscess. Which organism is the most common?
Your Answer: Group B streptococcus
Correct Answer: Staph aureus
Explanation:Staph aureus is the most common causative organism of skin and soft tissue infections.
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This question is part of the following fields:
- Women's Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
