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Evidence-Based Gynaecology: Part II Multiple Choice Questions for Vol. 20, No. 6
Best Practice & Research Clinical Obstetrics and Gynaecology Vol. 20, No. 6, pp. A1eA8, 2006 doi:10.1016/j.bpobgyn.2006.10.005 available online at http://www.sciencedirect.com
Evidence-Based Gynaecology: Part II Multiple Choice Questions for Vol. 20, No. 6
1. Concerning the menopause, the following statement(s) is/are true: (a) The menopause occurs demonstrably earlier in smokers compared to nonsmokers (b) There is an increase in inhibin A from the dominant follicle in the sixetwelve months prior to the last period (c) Serum FSH levels are a predictable guide to the timing of the menopause (d) Oestrodiol levels are usually maintained up to a few months prior to the last period (e) There is good evidence of a decline in quality of life in women with severe menopausal symptoms compared to mild symptoms 2. The following statement(s) is/are true concerning the available evidence base for management of the menopause: (a) The risk of breast cancer with long term HRTuse is applicable to all women who use it (b) Women with premature ovarian failure who receive HRT gain proven cardiovascular protection (c) Multiple studies have shown the prevalence of hot flushes to be in excess of 50% in the immediate post-menopausal period (d) There is a well recognized placebo effect in trials on the management of vasomotor symptoms (e) Clonidine has been shown to be an effective non-hormonal treatment for vasomotor symptoms that is popular with users 3. A 42 year-old woman requests advice about her disruptive hot flushes. She has not had a menstrual period for 8 months, her FSH is found to be 84. Her family history is positive for osteoporosis in her mother. Her aunt had breast cancer at age 68. Which of the following is/are both appropriate and have been shown to be beneficial for her vasomotor symptoms? (a) Evening primrose oil (b) Conjugated oestrogens 1521-6934/$ - see front matter
A2 Appendix
(c) Trans-dermal oestrogen plus progesterone (d) Venlafaxine (e) Black Cohosh 4. In counselling a patient with respect to the effect of menopausal hormone therapy and the breast, the following statements is/are true? (a) The risk of breast cancer is 1 in 38 after 5 years of use of oestrogen- progestin therapy (b) Oral oestrogen and progestin therapy is associated with an increase in sensitivity and specify of mammography (c) The risk of breast cancer returns to normal after discontinuing hormones (d) The risk of breast cancer increases after 18 months of hormone therapy (e) The addition of a progestin reduces the risk of breast cancer associated with hormone therapy 5. The following is/are true with regard to menopausal symptoms and their management: (a) Low-dose vaginal oestrogen is effective for atrophic symptoms and appears to have a safe endometrial profile (b) Loss of libido appears to be mostly related to reduced testosterone levels in the menopausal transition period and post-menopausally (c) Oestrogen therapy has been shown to be beneficial with regard to sexual function (d) Studies have shown no good evidence for a benefit for depression with HRT (e) The Mirena IUCD has been shown to provide adequate endometrial protection when used as the method of progestagen delivery 6. With regard to surgical treatments for menorrhagia, the following statement(s) is/ are true: (a) The overall complication rates for endometrial ablation are considerably lower than those associated with hysterectomy (b) Laser ablation and TCRE appear to be equally as effective in terms of patient satisfaction rates (c) Laser ablation appears to be superior to TCRE in terms of need for repeat surgery in the first 12 months (d) Laser ablation appears to be significantly quicker to perform compared to TCRE (e) The overall complication rates for laser ablation and TCRE appear to be similar 7. Evidence concerning the second generation endometrial ablation techniques has shown: (a) Microwave ablation to be superior to bipolar radiofrequency ablation in terms of efficacy (b) Thermal balloon ablation to be superior in terms of patient quality of life measures compared to bipolar radiofrequency ablation (c) Bipolar radiofrequency ablation to be superior in terms of amenorrhoea rates compared to thermal balloon ablation
Appendix A3
(d) The risk of fluid overload is significantly lower than for women undergoing first-generation endometrial ablation (e) An equivalent risk of uterine perforation compared with first-generation endometrial procedures 8. Evidence concerning endometrial ablation techniques has shown: (a) Overall improved quality of life scores for women when compared to hysterectomy (b) A lower incidence of peri-operative haemorrhagic complications when compared to hysterectomy (c) A lower incidence of peri-operative infective complications when compared to hysterectomy (d) A higher rate of requiring repeat surgery for menorrhagia when compared to hysterectomy (e) A large reduction in cost that remains over time when compared to hysterectomy 9. Evidence on the management of endometriosis has shown: (a) A large number of randomized trials favouring laparoscopic management over open laparotomy in terms of improved symptoms (b) Reduced postoperative pain and more rapid recovery with laparoscopic treatment compared with laparotomy for endometriomata (c) Strong support for a benefit for laparoscopic laser ablation for pelvic pain associated with mild-to-moderate endometriosis (d) An increased on-going pregnancy rate after laparoscopic treatment of minimal and mild endometriosis compared to diagnostic laparoscopy only (e) An increased live birth rate after laparoscopic treatment of minimal and mild endometriosis compared to diagnostic laparoscopy only 10. In the management of benign ovarian cysts (a) Laparoscopic ovarian cystectomy is associated with decreased postoperative adhesion formation compared with laparotomy (b) Laparoscopic ovarian cystectomy was associated with both less postoperative pain and shorter hospital stay than laparotomy (c) Ovarian cystectomy by laparotomy is associated with higher rates of haemorrhagic and thromboembolic complications compared to laparoscopy (d) Cost analysis has shown no difference in direct surgical cost between laparoscopy and laparotomy (e) Laparotomy for benign ovarian disease has been shown to increase intraoperative time compared to laparoscopy 11. When comparing methods of hysterectomy, the current evidence shows that: (a) Vaginal hysterectomy (VH) is associated with less intraoperative and postoperative complications than abdominal hysterectomy (AH) (b) VH should always be performed in preference to AH for benign indications (c) Laparoscopic hysterectomy usually takes a longer duration than AH
A4 Appendix
(d) Where VH is feasible, there are significant advantages to performing the procedure assisted by laparoscopy (e) Subtotal hysterectomy is both faster to perform than total abdominal hysterectomy and leads to improved sexual function due to retention of the cervix 12. In a woman with bleeding and pain in early pregnancy (<12 gestational weeks according to the last menstrual period) the following ultrasound finding(s) make(s) normal pregnancy unlikely: (a) An empty intrauterine gestational sac with a diameter (mean of three diameters) of 4 mm (b) Intrauterine gestational sac with a diameter (mean of three diameters) of 18 mm without a yolk sac and without an embryo (c) Intrauterine gestational sac with a diameter of 15 mm (mean of three diameters), a yolk sac of 4 mm, and a 3 mm embryo without a heart beat (d) No visible gestational sac (e) Intrauterine gestational sac with a diameter (mean of three diameters) of 10 mm without a yolk sac and without an embryo 13. In a woman with postmenopausal bleeding (a) Endometrial thickness as measured by transvaginal ultrasound 4 mm is associated with a low risk (1:100) of endometrial cancer (b) Absence of focal lesions at hydrosonography is associated with a low risk of endometrial pathology (c) It is possible to discriminate accurately between endometrial polyps and endometrial cancer by using subjective evaluation of gray scale and Doppler ultrasound findings at transvaginal ultrasound examination (d) Results of hydrosonography and hysteroscopy agree very well with regard to the presence/absence of focal lesions in the uterine cavity (e) The risk of endometrial cancer is lower if the woman is currently using hormone replacement therapy 14. In the developing world, as a population based strategy for preventing vaginal acquisition of sexually transmitted infections (STIs) by women from men; use of Nonoxynol-9 is associated with: (a) (b) (c) (d) (e)
A reduction in gonorrheal infection An increase in trichomoniasis infection An increase in genital warts An increase in genital ulceration A reduction in bacterial vaginosis
15. In a primigravida undergoing termination of pregnancy (TOP) at 10 weeks gestation. Vacuum aspiration as compared to dilatation & curettage (D&C) is associated with: (a) reduced blood loss (b) less need for blood transfusion (c) less chance of incomplete evacuation of products
Appendix A5
(d) shorter duration of operation (e) less chance of febrile morbidity 16. Visual inspection with acetic acid application (VIA) is low cost intervention to detect high-grade precancerous lesion. The following is/are true about its diagnostic value for high-grade lesions: (a) (b) (c) (d) (e)
the results are available in 24 hrs sensitivity of 46e64% specificity of 64e98% positive predictive value of 46e64% negative predictive value of 70e80%
17. The following is/are true about genital fistulae repair: (a) Evidence for fistulae repair is based on extensive numbers of studies (b) The prevalence of obstetric fistulae is well defined in most developing countries (c) Surgery is usually deferred for 3 months to allow adequate time for the injured tissue to heal (d) Successful results in excess of 50% have been reported with conservative bladder drainage for fistulae (e) The first surgical procedure offers the best chance of a successful outcome 18. Which of the following statement(s) concerning HIV is/are true? (a) (b) (c) (d) (e)
HIV contains three genes Non-syncytial HIV is CXCR4 tropic Reverse transcriptase uses RNA as a template for building of DNA HIV only mutates once exposed to insufficient amounts of antiretroviral drugs Replication of HIV DNA occurs in the host cell nucleus
19. Which of these further following statement(s) concerning HIV is/are true? (a) Blood transfusion is not a route of HIV transmission anymore in the developed world (b) The most common route of HIV acquisition in the UK is through heterosexual intercourse (c) An HIV test is reported as positive only if reactive on repeat EIA and confirmatory western blot assays (d) Positive results with rapid HIV assays do not need a confirmatory test (e) Each HIV infected patient has had an average of four medical encounters within 12 months prior to their diagnosis 20. Which of the following statement(s) is/are true? (a) During acute HIV illness patients will have a high CD4 count and do not develop AIDS defining illnesses (b) The viral set point is an arbitrary value after the sero-conversion illness against which patients’ viral load is measured
A6 Appendix
(c) Invasive cervical cancer is an AIDS-defining illness (d) The current antiretroviral drugs are not able to eradicate the infection (e) Once on highly active antiretroviral therapy, patients do not need further monitoring of their CD4 counts 21. Which of the following statement(s) is/are true of chlamydial infection? (a) Chlamydial elementary bodies replicate through binary fission (b) In the UK, one in 10 women younger than 25 years are infected with chlamydial infection (c) Chlamydia testing is a reliable proxy marker for the diagnosis of PID (d) All women with PID become symptomatic at some stage if left for long enough (e) Ciprofloxacin is an effective antibiotics choice for chlamydial infection 22. Which of the statement(s) below is/are correct: (a) Clinical diagnosis of PID is generally regarded as non-specific (b) The duration of treatment of PID is at least two weeks (c) Male partners of patients treated for PID but with negative chlamydial and gonococcal test results do not need to be treated (d) There is evidence that chlamydial screening reduces complications of PID (e) Chlamydia serovars C-D are responsible for genital infection 23. Which of the following on chlamydia is/are correct? (a) Lymphogranuloma venereum in UK is most common amongst women (b) Use of Azithromycin is not licensed in pregnancy (c) Multiple partners and failure to use condoms are both independent and codependent risk factors associated with chlamydial infection (d) Gene probe is a very sensitive method for detection of chlamydial infection (e) Not all nucleic acid amplification tests (NAATS) can use non-invasive specimens 24. Which of the following is/are true? (a) Ambulatory hysteroscopy uses sophisticated technology and hence the incidence of serious complications is substantial (b) Ambulatory hysteroscopy has a much higher failure rate compared to inpatient hysteroscopy (c) Ambulatory hysteroscopy’s failure rate is unaffected by menopausal status (d) Ambulatory hysteroscopy has a tendency toward improved diagnostic accuracy for both endometrial cancer and benign disease compared to inpatient procedures (e) The Versapoint bipolar system is safer than monopolar electrosurgery for hysteroscopy 25. The following statements are true about fluids as distension media: (a) Electrolytic solutions (Normal Saline or Lactated Ringer’s) can be used in conjunction with monopolar electrosurgical devices
Appendix A7
(b) Electrolytic solutions (Normal Saline or Lactated Ringer’s) can be used in conjunction with laser or bipolar energy (c) Glycine is used in conjunction with monopolar electrosurgical energy (d) Glycine 1.5% and Manitol 5% can increase the risk to patients for developing hyponatremia (e) Compared to inpatient hysteroscopic procedures, the likelihood of fluid overload to occur is more in ambulatory procedures
26. Concerning outpatient endometrial ablation, the following is/are true: (a) The approved devices have patient satisfaction rates of more than 80% (b) The Thermachoice UBT System rarely needs cervical dilatation prior to insertion (c) With microwave endometrial ablation (MEA) failure is more likely to occur when uterine cavity is greater than 12 cm (d) MEA is the only device that can be used when intrauterine fibroids exist (e) Endometrial priming is an absolute requirement 27. Concerning Ovarian cancer the following is/are true: (a) The incidence is significantly greater than for endometrial cancer (b) Ovarian cancer is a more aggressive cancer than cervical (c) The overall five year survival from ovarian cancer is less than for endometrial cancer (d) Ovarian cancer is usually diagnosed at a late stage (e) The most common type of ovarian cancer is squamous carcinoma 28. Concerning screening and early diagnostic tests for ovarian cancer: (a) CA 125 is only raised in ovarian cancer (b) CA 125 can be combined with CA 19-9 to improve the detection of ovarian cancer (c) The risk of malignancy index (RMI) uses menopausal status, ultrasound findings and CA125 scores (d) Testosterone has been used in combination with other blood tests to determine between epithelial ovarian cancer and disease free states (e) An ultrasound scan showing a multiloculated cyst is more likely to be benign than one showing a uniloculated cycst 29. In the treatment of gynaecological cancers, the following is/are true: (a) Well-differentiated stage 1 epithelial ovarian tumours generally do not receive adjuvant treatment (b) Poorly-differentiated stage 1 epithelial ovarian tumours appear to benefit from adjuvant treatment in terms of survival (c) Evidence on ‘‘optimum debulking’’ for advanced ovarian disease is based on homogenous studies in terms of residual tumour size (d) Interval debulking is usually performed after completion of chemotherapy (e) Interval debulking has been shown to improve survival in women whose cancers have already demonstrated some degree of chemosensitivity
A8 Appendix
30. In the treatment of gynaecological cancers, the following further statement(s) is/ are true: (a) The majority of evidence for the use of paclitaxel for advanced ovarian cancer shows a survival benefit when used with platinum compounds compared to platinum only regimes (b) Stage 1A1 cervical cancers may be safely treated with loop excision only (c) For stage 1A2, and 1B1 cervical disease, adjuvant radiotherapy for positive lymph nodes has been shown to increase survival (d) Where there is >50% myometrial invasion with endometrial cancer, there is evidence of a clinical benefit with adjuvant radiotherapy (e) In vulval squamous carcinoma, a depth of stromal invasion >3 mm, dictates the need for inguinal lymphadenectomy
Evidence-Based Gynaecology: Part II Multiple Choice Questions for Vol. 20, No. 6
1. Concerning the menopause, the following statement(s) is/are true: (a) The menopause occurs demonstrably earlier in smokers compared to nonsmokers (b) There is an increase in inhibin A from the dominant follicle in the sixetwelve months prior to the last period (c) Serum FSH levels are a predictable guide to the timing of the menopause (d) Oestrodiol levels are usually maintained up to a few months prior to the last period (e) There is good evidence of a decline in quality of life in women with severe menopausal symptoms compared to mild symptoms 2. The following statement(s) is/are true concerning the available evidence base for management of the menopause: (a) The risk of breast cancer with long term HRTuse is applicable to all women who use it (b) Women with premature ovarian failure who receive HRT gain proven cardiovascular protection (c) Multiple studies have shown the prevalence of hot flushes to be in excess of 50% in the immediate post-menopausal period (d) There is a well recognized placebo effect in trials on the management of vasomotor symptoms (e) Clonidine has been shown to be an effective non-hormonal treatment for vasomotor symptoms that is popular with users 3. A 42 year-old woman requests advice about her disruptive hot flushes. She has not had a menstrual period for 8 months, her FSH is found to be 84. Her family history is positive for osteoporosis in her mother. Her aunt had breast cancer at age 68. Which of the following is/are both appropriate and have been shown to be beneficial for her vasomotor symptoms? (a) Evening primrose oil (b) Conjugated oestrogens 1521-6934/$ - see front matter
A2 Appendix
(c) Trans-dermal oestrogen plus progesterone (d) Venlafaxine (e) Black Cohosh 4. In counselling a patient with respect to the effect of menopausal hormone therapy and the breast, the following statements is/are true? (a) The risk of breast cancer is 1 in 38 after 5 years of use of oestrogen- progestin therapy (b) Oral oestrogen and progestin therapy is associated with an increase in sensitivity and specify of mammography (c) The risk of breast cancer returns to normal after discontinuing hormones (d) The risk of breast cancer increases after 18 months of hormone therapy (e) The addition of a progestin reduces the risk of breast cancer associated with hormone therapy 5. The following is/are true with regard to menopausal symptoms and their management: (a) Low-dose vaginal oestrogen is effective for atrophic symptoms and appears to have a safe endometrial profile (b) Loss of libido appears to be mostly related to reduced testosterone levels in the menopausal transition period and post-menopausally (c) Oestrogen therapy has been shown to be beneficial with regard to sexual function (d) Studies have shown no good evidence for a benefit for depression with HRT (e) The Mirena IUCD has been shown to provide adequate endometrial protection when used as the method of progestagen delivery 6. With regard to surgical treatments for menorrhagia, the following statement(s) is/ are true: (a) The overall complication rates for endometrial ablation are considerably lower than those associated with hysterectomy (b) Laser ablation and TCRE appear to be equally as effective in terms of patient satisfaction rates (c) Laser ablation appears to be superior to TCRE in terms of need for repeat surgery in the first 12 months (d) Laser ablation appears to be significantly quicker to perform compared to TCRE (e) The overall complication rates for laser ablation and TCRE appear to be similar 7. Evidence concerning the second generation endometrial ablation techniques has shown: (a) Microwave ablation to be superior to bipolar radiofrequency ablation in terms of efficacy (b) Thermal balloon ablation to be superior in terms of patient quality of life measures compared to bipolar radiofrequency ablation (c) Bipolar radiofrequency ablation to be superior in terms of amenorrhoea rates compared to thermal balloon ablation
Appendix A3
(d) The risk of fluid overload is significantly lower than for women undergoing first-generation endometrial ablation (e) An equivalent risk of uterine perforation compared with first-generation endometrial procedures 8. Evidence concerning endometrial ablation techniques has shown: (a) Overall improved quality of life scores for women when compared to hysterectomy (b) A lower incidence of peri-operative haemorrhagic complications when compared to hysterectomy (c) A lower incidence of peri-operative infective complications when compared to hysterectomy (d) A higher rate of requiring repeat surgery for menorrhagia when compared to hysterectomy (e) A large reduction in cost that remains over time when compared to hysterectomy 9. Evidence on the management of endometriosis has shown: (a) A large number of randomized trials favouring laparoscopic management over open laparotomy in terms of improved symptoms (b) Reduced postoperative pain and more rapid recovery with laparoscopic treatment compared with laparotomy for endometriomata (c) Strong support for a benefit for laparoscopic laser ablation for pelvic pain associated with mild-to-moderate endometriosis (d) An increased on-going pregnancy rate after laparoscopic treatment of minimal and mild endometriosis compared to diagnostic laparoscopy only (e) An increased live birth rate after laparoscopic treatment of minimal and mild endometriosis compared to diagnostic laparoscopy only 10. In the management of benign ovarian cysts (a) Laparoscopic ovarian cystectomy is associated with decreased postoperative adhesion formation compared with laparotomy (b) Laparoscopic ovarian cystectomy was associated with both less postoperative pain and shorter hospital stay than laparotomy (c) Ovarian cystectomy by laparotomy is associated with higher rates of haemorrhagic and thromboembolic complications compared to laparoscopy (d) Cost analysis has shown no difference in direct surgical cost between laparoscopy and laparotomy (e) Laparotomy for benign ovarian disease has been shown to increase intraoperative time compared to laparoscopy 11. When comparing methods of hysterectomy, the current evidence shows that: (a) Vaginal hysterectomy (VH) is associated with less intraoperative and postoperative complications than abdominal hysterectomy (AH) (b) VH should always be performed in preference to AH for benign indications (c) Laparoscopic hysterectomy usually takes a longer duration than AH
A4 Appendix
(d) Where VH is feasible, there are significant advantages to performing the procedure assisted by laparoscopy (e) Subtotal hysterectomy is both faster to perform than total abdominal hysterectomy and leads to improved sexual function due to retention of the cervix 12. In a woman with bleeding and pain in early pregnancy (<12 gestational weeks according to the last menstrual period) the following ultrasound finding(s) make(s) normal pregnancy unlikely: (a) An empty intrauterine gestational sac with a diameter (mean of three diameters) of 4 mm (b) Intrauterine gestational sac with a diameter (mean of three diameters) of 18 mm without a yolk sac and without an embryo (c) Intrauterine gestational sac with a diameter of 15 mm (mean of three diameters), a yolk sac of 4 mm, and a 3 mm embryo without a heart beat (d) No visible gestational sac (e) Intrauterine gestational sac with a diameter (mean of three diameters) of 10 mm without a yolk sac and without an embryo 13. In a woman with postmenopausal bleeding (a) Endometrial thickness as measured by transvaginal ultrasound 4 mm is associated with a low risk (1:100) of endometrial cancer (b) Absence of focal lesions at hydrosonography is associated with a low risk of endometrial pathology (c) It is possible to discriminate accurately between endometrial polyps and endometrial cancer by using subjective evaluation of gray scale and Doppler ultrasound findings at transvaginal ultrasound examination (d) Results of hydrosonography and hysteroscopy agree very well with regard to the presence/absence of focal lesions in the uterine cavity (e) The risk of endometrial cancer is lower if the woman is currently using hormone replacement therapy 14. In the developing world, as a population based strategy for preventing vaginal acquisition of sexually transmitted infections (STIs) by women from men; use of Nonoxynol-9 is associated with: (a) (b) (c) (d) (e)
A reduction in gonorrheal infection An increase in trichomoniasis infection An increase in genital warts An increase in genital ulceration A reduction in bacterial vaginosis
15. In a primigravida undergoing termination of pregnancy (TOP) at 10 weeks gestation. Vacuum aspiration as compared to dilatation & curettage (D&C) is associated with: (a) reduced blood loss (b) less need for blood transfusion (c) less chance of incomplete evacuation of products
Appendix A5
(d) shorter duration of operation (e) less chance of febrile morbidity 16. Visual inspection with acetic acid application (VIA) is low cost intervention to detect high-grade precancerous lesion. The following is/are true about its diagnostic value for high-grade lesions: (a) (b) (c) (d) (e)
the results are available in 24 hrs sensitivity of 46e64% specificity of 64e98% positive predictive value of 46e64% negative predictive value of 70e80%
17. The following is/are true about genital fistulae repair: (a) Evidence for fistulae repair is based on extensive numbers of studies (b) The prevalence of obstetric fistulae is well defined in most developing countries (c) Surgery is usually deferred for 3 months to allow adequate time for the injured tissue to heal (d) Successful results in excess of 50% have been reported with conservative bladder drainage for fistulae (e) The first surgical procedure offers the best chance of a successful outcome 18. Which of the following statement(s) concerning HIV is/are true? (a) (b) (c) (d) (e)
HIV contains three genes Non-syncytial HIV is CXCR4 tropic Reverse transcriptase uses RNA as a template for building of DNA HIV only mutates once exposed to insufficient amounts of antiretroviral drugs Replication of HIV DNA occurs in the host cell nucleus
19. Which of these further following statement(s) concerning HIV is/are true? (a) Blood transfusion is not a route of HIV transmission anymore in the developed world (b) The most common route of HIV acquisition in the UK is through heterosexual intercourse (c) An HIV test is reported as positive only if reactive on repeat EIA and confirmatory western blot assays (d) Positive results with rapid HIV assays do not need a confirmatory test (e) Each HIV infected patient has had an average of four medical encounters within 12 months prior to their diagnosis 20. Which of the following statement(s) is/are true? (a) During acute HIV illness patients will have a high CD4 count and do not develop AIDS defining illnesses (b) The viral set point is an arbitrary value after the sero-conversion illness against which patients’ viral load is measured
A6 Appendix
(c) Invasive cervical cancer is an AIDS-defining illness (d) The current antiretroviral drugs are not able to eradicate the infection (e) Once on highly active antiretroviral therapy, patients do not need further monitoring of their CD4 counts 21. Which of the following statement(s) is/are true of chlamydial infection? (a) Chlamydial elementary bodies replicate through binary fission (b) In the UK, one in 10 women younger than 25 years are infected with chlamydial infection (c) Chlamydia testing is a reliable proxy marker for the diagnosis of PID (d) All women with PID become symptomatic at some stage if left for long enough (e) Ciprofloxacin is an effective antibiotics choice for chlamydial infection 22. Which of the statement(s) below is/are correct: (a) Clinical diagnosis of PID is generally regarded as non-specific (b) The duration of treatment of PID is at least two weeks (c) Male partners of patients treated for PID but with negative chlamydial and gonococcal test results do not need to be treated (d) There is evidence that chlamydial screening reduces complications of PID (e) Chlamydia serovars C-D are responsible for genital infection 23. Which of the following on chlamydia is/are correct? (a) Lymphogranuloma venereum in UK is most common amongst women (b) Use of Azithromycin is not licensed in pregnancy (c) Multiple partners and failure to use condoms are both independent and codependent risk factors associated with chlamydial infection (d) Gene probe is a very sensitive method for detection of chlamydial infection (e) Not all nucleic acid amplification tests (NAATS) can use non-invasive specimens 24. Which of the following is/are true? (a) Ambulatory hysteroscopy uses sophisticated technology and hence the incidence of serious complications is substantial (b) Ambulatory hysteroscopy has a much higher failure rate compared to inpatient hysteroscopy (c) Ambulatory hysteroscopy’s failure rate is unaffected by menopausal status (d) Ambulatory hysteroscopy has a tendency toward improved diagnostic accuracy for both endometrial cancer and benign disease compared to inpatient procedures (e) The Versapoint bipolar system is safer than monopolar electrosurgery for hysteroscopy 25. The following statements are true about fluids as distension media: (a) Electrolytic solutions (Normal Saline or Lactated Ringer’s) can be used in conjunction with monopolar electrosurgical devices
Appendix A7
(b) Electrolytic solutions (Normal Saline or Lactated Ringer’s) can be used in conjunction with laser or bipolar energy (c) Glycine is used in conjunction with monopolar electrosurgical energy (d) Glycine 1.5% and Manitol 5% can increase the risk to patients for developing hyponatremia (e) Compared to inpatient hysteroscopic procedures, the likelihood of fluid overload to occur is more in ambulatory procedures
26. Concerning outpatient endometrial ablation, the following is/are true: (a) The approved devices have patient satisfaction rates of more than 80% (b) The Thermachoice UBT System rarely needs cervical dilatation prior to insertion (c) With microwave endometrial ablation (MEA) failure is more likely to occur when uterine cavity is greater than 12 cm (d) MEA is the only device that can be used when intrauterine fibroids exist (e) Endometrial priming is an absolute requirement 27. Concerning Ovarian cancer the following is/are true: (a) The incidence is significantly greater than for endometrial cancer (b) Ovarian cancer is a more aggressive cancer than cervical (c) The overall five year survival from ovarian cancer is less than for endometrial cancer (d) Ovarian cancer is usually diagnosed at a late stage (e) The most common type of ovarian cancer is squamous carcinoma 28. Concerning screening and early diagnostic tests for ovarian cancer: (a) CA 125 is only raised in ovarian cancer (b) CA 125 can be combined with CA 19-9 to improve the detection of ovarian cancer (c) The risk of malignancy index (RMI) uses menopausal status, ultrasound findings and CA125 scores (d) Testosterone has been used in combination with other blood tests to determine between epithelial ovarian cancer and disease free states (e) An ultrasound scan showing a multiloculated cyst is more likely to be benign than one showing a uniloculated cycst 29. In the treatment of gynaecological cancers, the following is/are true: (a) Well-differentiated stage 1 epithelial ovarian tumours generally do not receive adjuvant treatment (b) Poorly-differentiated stage 1 epithelial ovarian tumours appear to benefit from adjuvant treatment in terms of survival (c) Evidence on ‘‘optimum debulking’’ for advanced ovarian disease is based on homogenous studies in terms of residual tumour size (d) Interval debulking is usually performed after completion of chemotherapy (e) Interval debulking has been shown to improve survival in women whose cancers have already demonstrated some degree of chemosensitivity
A8 Appendix
30. In the treatment of gynaecological cancers, the following further statement(s) is/ are true: (a) The majority of evidence for the use of paclitaxel for advanced ovarian cancer shows a survival benefit when used with platinum compounds compared to platinum only regimes (b) Stage 1A1 cervical cancers may be safely treated with loop excision only (c) For stage 1A2, and 1B1 cervical disease, adjuvant radiotherapy for positive lymph nodes has been shown to increase survival (d) Where there is >50% myometrial invasion with endometrial cancer, there is evidence of a clinical benefit with adjuvant radiotherapy (e) In vulval squamous carcinoma, a depth of stromal invasion >3 mm, dictates the need for inguinal lymphadenectomy