Mount Kenya University · School of Medicine · Gynaecology
Paper details
- Unit: MBOG 6511, Year 6 MBChB Gynaecology CAT 1, Mount Kenya University Medical School.
- Sitting: 13 December 2019, time allowed 1 hour 20 minutes. By the timetable this is Trimester 1 (September to December).
- Structure: Section A has 4 short answer questions. Section B has 16 MCQs at 1 mark each.
- Topics tested: pelvic inflammatory disease and its classification, recurrent miscarriage, ovarian ectopic pregnancy, abnormal uterine bleeding, vulval neoplasia, fertilisation, the menstrual cycle, endometriosis, genital herpes, bacterial vaginosis, toxic shock syndrome, fibroids, galactorrhoea and amenorrhoea.
- Note: the scan is a student's marked script. The handwritten answers and marks were ignored.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Questions that need care: Q3, Q5, Q11 and Q12 are loosely worded or have more than one defensible option. The explanation says which option is best and why.
Multiple choice questions
1. You will suspect pelvic inflammatory disease in all EXCEPT:
- A. Early coitarche
- B. Previous abortion
- C. Previous contraceptive use
- D. Previous ectopic pregnancy
2. Which of the following does NOT develop from the endodermal embryonic layer?
- A. Lining of the urethra and bladder
- B. Reproductive system
- C. Liver
- D. Thymus
3. Regarding vulval intraepithelial neoplasia (VIN), which is true?
- A. Presents usually after sustained immobility
- B. Usually ipsilateral
- C. Can be reduced by oral contraceptives
- D. It is commonly asymptomatic
4. Regarding fertilisation, which of the following is incorrect?
- A. The process lasts 24 hours
- B. A zonal reaction occurs when sperm comes into contact with the corona radiata
- C. The secondary oocyte completes its second meiotic division after entry of the sperm head
- D. The zygote is formed from the fusion of male and female pronuclei
5. During the menstrual cycle, the following is correct:
- A. The proliferative phase is relatively constant
- B. Ovulation coincides with menstruation
- C. Anovulatory cycles are characteristically painless
- D. Menstrual blood loss is usually 150 ml
6. Choose the correct answer. Mucinous cysts of the vulva:
- A. Originate from the urogenital sinus
- B. Are lined by stratified squamous epithelium
- C. Are usually symptomatic requiring early intervention
- D. Are malignant
7. A 30-year-old woman has primary infertility and dysmenorrhoea, and ultrasound shows a 6 cm endometrioma in the left ovary. What is the most appropriate initial management?
- A. Gonadotrophin releasing hormone agonist for six months
- B. In-vitro fertilisation
- C. Laparoscopic drainage of the endometrioma
- D. Laparoscopic excision of the endometrioma
8. In regard to genital herpes, identify the correct statement:
- A. Can be caused by HSV 1
- B. Present as painful vesicles
- C. Treatment is via administration of trichloroacetic acid
- D. Relapses are progressively symptomatic
9. Which of the following does NOT form part of Amsel's criteria for the diagnosis of bacterial vaginosis?
- A. Vaginal pH above 4.5
- B. Positive amine (whiff) test
- C. Identification of Tzanck bodies on microscopy
- D. Vaginal discharge
10. Which of the following is NOT a common source of toxic shock syndrome?
- A. Contaminated surgical site
- B. Long-term tampon use
- C. Skin abscess
- D. Contaminated tattoo site
11. The following apply to a pelvic abscess EXCEPT:
- A. Can be caused by Neisseria gonorrhoeae
- B. Can cause multiple organ failure
- C. Can cause chronic pelvic pain
- D. Can cause amenorrhoea
12. The following statements refer to uterine fibroids. Determine which is true:
- A. Infertility is a common presentation
- B. Around 1% of fibroids are leiomyosarcomata which may result in malignant change
- C. 25% are asymptomatic
- D. Can cause amenorrhoea
13. Regarding galactorrhoea, which statement is false?
- A. Lactation requires oestrogen and progesterone
- B. Diagnosis is aided by microscopy showing fat globules and scanty cellular material
- C. Mammography is useful in making a diagnosis
- D. Is treatable by thyroid hormone replacement
14. A patient has amenorrhoea. Her FSH and LH levels are elevated. What structure is most likely responsible?
- A. Thyroid
- B. Ovaries
- C. Pituitary
- D. Hypothalamus
15. What is oligomenorrhoea?
- A. Prolonged or excessive uterine bleeding that occurs at regular intervals
- B. Irregular menstrual bleeding
- C. Regular bleeding that occurs more frequently than every 21 days
- D. Menstrual cycle lengths greater than 35 days
16. A 34-year-old woman complains of heavy periods. She is trying to get pregnant, so you suggest mefenamic acid, knowing it is very effective in reducing blood flow. What type of drug is this?
- A. Cyclo-oxygenase inhibitor
- B. Gonadotropin releasing hormone agonist
- C. Plasminogen activator inhibitor
- D. Synthetic steroid hormone
Section A: short answer questions
1. Question 1. (a) What is pelvic inflammatory disease (PID) (2 marks)? (b) Describe briefly the Gainesville classification of PID (5 marks). (c) List protective factors against PID (3 marks).
(a) Pelvic inflammatory disease
(b) The Gainesville (Monif) classification
(c) Protective factors
2. Question 2. (a) Define recurrent miscarriage (2 marks). (b) List 3 fetal causes of miscarriage (3 marks).
(a) Recurrent miscarriage
(b) Fetal causes of miscarriage
3. Question 3. (a) Describe Spiegelberg's criteria for ovarian ectopic pregnancy (4 marks). (b) Describe 2 serological test findings that are suggestive of an ectopic pregnancy (2 marks). (c) What investigation is regarded as the gold standard for the diagnosis of ectopic pregnancy and why (2 marks)?
(a) Spiegelberg's criteria for an ovarian pregnancy
(b) Serological findings suggesting an ectopic pregnancy
(c) Gold standard: diagnostic laparoscopy
4. Question 4. (a) What is abnormal uterine bleeding (AUB) (2 marks)? (b) List structural causes of AUB (4 marks). (c) Briefly describe the medical treatment options for AUB (5 marks).
(a) Abnormal uterine bleeding
(b) Structural causes (PALM)
(c) Medical treatment options