Gynecology

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Vaginal Estradiol

Vaginal estradiol tablets are unlikely to affect the risk of recurrent ischemic stroke in women with prior ischemic stroke.

  • True
  • False
Volume 41.1 - Question 12

Ferric Derisomaltose vs Iron Sucrose in Pregnancy

When ferric derisomaltose is used for treatment of iron deficiency anemia in pregnancy, as opposed to iron sucrose, which one of the following statements is false?

  • IV infusion times per visit are shorter.
  • Patients treated receive a higher total dose of IV iron.
  • Mean treatment cost per patient per pregnancy is higher.
  • There is a higher incidence of adverse reactions.
Volume 41.1 - Question 10

Cervical Polyps

Which one of the following statements regarding cervical polyps is false?

  • Asymptomatic cervical polyps should be removed.
  • The risk of dysplasia on cervical polyp pathology is less than 1%.
  • Patients with a cervical polyp and post-coital bleeding should be referred to gynecology.
  • The positive predictive value of post-coital bleeding as a cardinal symptom of cervical cancer is low.
Volume 40.6 - Question 1

Supporting Teenagers With Dysmenorrhoea

Which one of the following statements regarding dysmenorrhea in teenagers is false?

  • Exercise has not been shown to be an effective intervention.
  • Congenital anomalies are associated with a higher likelihood of endometriosis.
  • Transcutaneous electrical nerve stimulation machines can be beneficial.
  • Non-steroidal anti-inflammatories are an evidence-based treatment.
Volume 40.4 - Question 16

Prediction of Preeclampsia

Among pregnant people who develop preterm preeclampsia, compared to those who do not, soluble fms-like tyrosine kinase 1 (sFlt-1) levels are significantly lower when measured before 13 weeks gestation.

  • True
  • False
Volume 40.4 - Question 15

Oral Glucose-Lowering Agents vs. Insulin in Gestational Diabetes

Treatment of gestational diabetes with metformin and additional glyburide, if needed, is noninferior when compared with insulin with respect to the proportion of infants born large for gestational age.

  • True
  • False
Volume 40.4 - Question 14

Diagnosis of Perimenopause

An elevated follicle-stimulating hormone (FSH) level is required in order to make the diagnosis of perimenopause.

  • True
  • False
Volume 40.4 - Question 12

Uterine Fibroids II

Which one of the following statements regarding the diagnosis and evaluation of uterine fibroids is false?

  • Pelvic ultrasonography is the most cost-effective imaging method for the diagnosis of fibroids.
  • Computed tomography is useful for imaging fibroids.
  • Magnetic resonance imaging is useful when there is suspicion of uterine sarcoma.
  • If submucosal fibroids are suspected, saline-infusion sonography can be useful.
Volume 40.4 - Question 11

Uterine Fibroids

Which one of the following statements regarding uterine fibroids is false?

  • Fibroids affect 70 to 80% of persons with a uterus during their lifetime.
  • Up to 50% of persons with fibroids have symptoms.
  • The incidence is higher among Black persons than White persons.
  • Black persons present with less severe disease than White persons.
Volume 40.4 - Question 10

Early Pregnancy Loss

Which one of the following statements about early pregnancy loss is false?

  • As many as half of all patients with early pregnancy loss will spontaneously pass all pregnancy tissue within one week of miscarriage.
  • Expectant management compared with medical treatment with vaginal misoprostol increases the risk of pelvic infections.
  • The combination of oral mifepristone with oral misoprostol is considered first-line treatment for medical management.
  • Surgical management requires the fewest health care interactions for the patient.
Volume 40.4 - Question 2

Endometrial Thickening

Postmenopausal women without bleeding or risk factors do not require further investigations if they are found to have endometrial thickness < 11 mm on ultrasound.

  • True
  • False
Volume 40.3 - Question 14

Female Genitourinary Schistosomiasis

For suspected female genitourinary schistosomiasis, an empiric treatment course of praziquantel in exposed serology-positive women with clinically compatible and unexplained genitourinary signs and symptoms could be beneficial.

  • True
  • False
Volume 40.2 - Question 10

BV Treatment with Dequalinium Chloride vs Metronidazole

Which one of the following statements regarding treatment of bacterial vaginosis with vaginal dequalinium chloride compared to oral metronidazole is false?

  • It is better tolerated.
  • It has inferior cure rates.
  • It results in lower rates of candidiasis.
  • It has no clinically relevant reports of resistance.
Volume 39.6 - Question 17

Bartholin’s Gland Cysts or Abscesses

Marsupialization results in a lower risk of recurrence of Bartholin’s gland cyst or abscess compared to Word catheter placement. 

  • True
  • False
Volume 39.5 - Question 14

Polycystic Ovarian Syndrome

Which one of the following statements about polycystic ovary syndrome (PCOS) is false? 

  • Androgen levels cannot be measured reliably while a patient is on combined hormonal contraceptives.   
  • The addition of metformin to combined hormonal contraceptives can be considered in patients with PCOS in high metabolic risk groups.   
  • The risk of endometrial cancer is 2–6 times higher among people with PCOS than the general population and often presents before menopause. 
  • With assisted reproduction, the cumulative probability of childbirth is lower in patients with PCOS than those without.
Volume 39.5 - Question 10

Tetanus Diphtheria and Acellular Pertussis Vaccine

Immunization with tetanus, diphtheria, and acellular pertussis (Tdap) vaccine early in the third trimester is associated with the highest neonatal concentrations of pertussis toxin antibodies.

  • True
  • False
Volume 35.61 - Question 23

Missing Intrauterine Device Strings

Which one of the following statements about missing intrauterine device (IUD) strings is false?

  • It may be possible to locate the strings by passing a cytobrush into the external os and twirling to trap the strings and pull them down.
  • Ultrasonography can be used to confirm the presence and position of the IUD.
  • A pregnancy test may be warranted.
  • Abdominal radiography is not useful to identify a perforation.
Volume 35.61 - Question 21

Difficult Intrauterine Device Insertion

Which one of the following statements about difficult intrauterine device (IUD) insertion is false?

  • Using misoprostol to soften the cervix has been shown to be beneficial.
  • Smaller diameter IUDs should be considered in nulliparous women.
  • Gentle dilation of the endocervical canal using both ends of a plastic uterine sound may be helpful.
  • Insertion under ultrasound guidance may be necessary in patients with fibroids.
Volume 35.61 - Question 20

Hirsutism

Volume 39.4 - Question 43

Semaglutide Treatment

Semaglutide treatment is associated with the normalization of menstrual cycles in polycystic ovary syndrome patients. 

  • True
  • False
Volume 39.4 - Question 13

Adenomyosis

Which one of the following statements about adenomyosis is false?

  • Up to one-third of patients can be asymptomatic.
  • Less common symptoms include dyspareunia and chronic pelvic pain.
  • Dysmenorrhea occurs in most patients.
  • Diagnosis is based on clinical suspicion as well as imaging.
Volume 37.3 - Question 8

Umbilical Cord Clamping After Preterm Birth

Which one of the following umbilical cord clamping strategies for preterm births has the greatest effect in reducing infant death?

  • Immediate clamping and milking of the cord.
  • Short delayed clamping (≥15 s to <45 s).
  • Medium delayed clamping (≥45 s to <120 s).
  • Long delayed clamping greater than (≥120 s).
Volume 39.3 - Question 13

Endometriosis

Which one of the following statements about endometriosis is false?

  • It affects 30-40% of women with infertility.
  • Risk factors include high body mass index.
  • Hormonal therapies have a comparable efficacy of 60-80%.
  • Surgery for pain symptoms is associated with a 40-50% recurrence rate at 5 years.
Volume 39.3 - Question 8

Hormonal Contraception

Which one of the following statements about initiating hormonal contraception is false? 

  • Most patients can safely begin using hormonal contraception at any point in their menstrual cycle.   
  • Women do not require a pelvic examination before they are prescribed oral contraceptive medications.   
  • Those who use ulipristal for emergency contraception should wait five days before starting hormonal contraception.   
  • There are more menstrual pattern disruptions for those who start between menses than for those who wait until starting with next menses. 
Volume 36.6 - Question 6

Gabapentin and Chronic Pelvic Pain 

Gabapentin significantly lowers pain scores in women with chronic pelvic pain with no obvious pelvic pathology at laparoscopy.  

  • True
  • False
Volume 36.4 - Question 6

Trichomoniasis

Which one of the following statements about trichomoniasis is false?

  • It is the most common non-viral sexually transmitted infection.
  • Vaginal infection is often asymptomatic and can last years.
  • Both penile and vaginal infections should be treated with a seven-day course of metronidazole 500 mg twice per day.
  • Persistent infection should be treated with increased dosing of 2 grams of metronidazole for seven days.
Volume 37.6 - Question 16

HPV Screening

Offering non-speculum clinician-taken HPV (human papillomavirus) sampling and self-sampling substantially increases uptake in lapsed attendee women aged 50-64.

  • True
  • False
Volume 37.6 - Question 14

Fertility after Stopping Contraception

Which one of the following about the average time to return to normal fertility after stopping contraception is false? 

  • Delay after using injectable contraceptives is five to eight menstrual cycles.   
  • Delay after using patch contraceptives is four cycles on average.   
  • Delay after oral contraceptive use is three cycles on average.   
  • Delay after implant contraceptive use is more than six cycles. 
Volume 36.3 - Question 8

Endometrial Cancer

Which one of the following statements about endometrial cancer is false? 

  • Obesity is a risk factor.   
  • Reduced risk from prolonged oral contraceptive use does not persist after discontinuation.   
  • For early cancers, the use of a progestin-containing intrauterine device is an alternative to hysterectomy.   
  • Lifetime risk is at least 40% in women with Lynch syndrome. 
Volume 36.3 - Question 7

Lichen Sclerosis

Which one of the following statements about lichen sclerosis is false? 

  •  A definitive diagnosis should be confirmed with a biopsy.     
  • High dose topical steroids should be avoided.   
  • It is associated with hypoestrogenic states such as prepuberty and postmenopause.   
  • Topical calcineurin inhibitors are acceptable treatments. 
Volume 36.3 - Question 6

Postpartum LARC and Pregnancy Interval

Immediate postpartum long-acting reversible contraception may reduce short interpregnancy interval rates by > 50%.

  • True
  • False
Volume 36.3 - Question 5

Prevention of Bacterial Vaginosis with Probiotics

The use of Lactin-V (Lactobacillus crispatus CTV-05) after treatment of bacterial vaginosis with vaginal metronidazole resulted in a significantly lower incidence of recurrence of bacterial vaginosis at 12 weeks. 

  • True
  • False
Volume 36.2 - Question 10

Vasomotor Menopausal Symptoms 

Which one of the following statements about the treatment of vasomotor menopausal symptoms is false? 

  • Systemic estrogen is the most effective treatment.   
  • Women with an intact uterus treated with a systemic estrogen should receive a progestogen to reduce the risk of endometrial cancer.   
  • A combination of conjugated estrogens and the selective estrogen receptor modulator bazedoxifene is approved for the treatment of mild symptoms.   
  • There is no evidence that bioidentical hormones are more effective than conjugated hormones.  
Volume 36.2 - Question 9

Menopause Treatment

Which one of the following statements about menopausal treatment is false?

  • Women treated with levothyroxine and oral estrogen may require lower dosing.
  • Custom-compounded, bioidentical hormones are no more effective than commercially available preparations.
  • In women prescribed estrogen-only systemic hormonal treatment (HT), the risk for breast cancer is lower than combined HT.
  • Gabapentin is associated with a reduction hot flashes.
Volume 37.2 - Question 17

Human Papillomavirus

Which one of the following statements about human papillomavirus (HPV) is false?

  • The prevalence of HPV peaks in the mid-20s and early 30s in women.
  • HPV infection which occurs in postmenopausal women may be associated with a combination of new and persistent infection.
  • The immune system clears the virus within two years in most of the high-risk HPV infections.
  • There is insufficient data to recommend screening for anal HPV infection.
Volume 37.2 - Question 15

Prescribed Mifepristone in Canada

Which one of the following statements about normally prescribed mifepristone as compared to when it was unavailable in Canada is false?

  • The abortion rate has continued to increase.
  • The proportion of abortions provided by medication increased rapidly.
  • There was a small increase in ongoing intrauterine pregnancy continuing to delivery.
  • Adverse results remain stable.
Volume 37.4 - Question 26

Sexual Medicine

What group of women who have sex with women should complete cervical cancer screening?

  • Women with previous heterosexual contact.
  • Women with no previous sexual contact.
  • Women with only previous homosexual contact.
  • All women who have sex with women, per guidelines for heterosexual women.
Volume 37.4 - Question 11

Bariatric Surgery and Pregnancy

Which one of the following statements about bariatric surgery and pregnancy is false?

  • It decreases the risk of gestational diabetes mellitus.
  • It is associated with fewer caesarian deliveries.
  • It reduces the risk of preeclampsia.
  • It reduces the risk of postpartum hemorrhage.
Volume 37.4 - Question 9

COVID-19 and Fertility

Compared with unvaccinated females, women who received at least one dose of COVID-19 vaccine before a given menstrual cycle had a lower probability of conceiving during that cycle.

  • True
  • False
Volume 37.4 - Question 8

Non-Hormonal Menopausal Treatments

Which one of the following statements about non-hormonal treatment for vasomotor menopausal symptoms is false? 

  • Escitalopram reduces the frequency of hot flashes.   
  • Venlafaxine reduces the frequency of hot flashes. 
  • Evidence supporting the use of pregabalin is lacking. 
  • Long-term use of oxybutynin is recommended.  
Volume 36.1 - Question 7

Treatment of Chronic Hypertension in Pregnancy

 Which one of the following statements about antihypertensive treatment for pregnant women with chronic hypertension is false? 

  • Amlodipine is associated with a lower rates of preeclampsia.  
  • Atenolol is associated with a higher risk of small-for-gestational-age infants.   
  • Nifedipine is associated with a lower incidence of severe hypertension. 
  • Methyldopa is associated with lower rates of placental abruption.
Volume 36.1 - Question 3

Recurrent Vulvovaginal Candidiasis

For frequent recurrences of vulvovaginal candidiasis, 3 doses of oral fluconazole followed by 6 months of weekly suppressive maintenance therapy has been recommended. 

  • True
  • False
Volume 38.1 - Question 36

Lesions of the Ovary and Fallopian Tube

Which one of the following statements about lesions of the ovary and fallopian tube is false?

  • Transvaginal ultrasound is the imaging modality of choice in the initial workup of adnexal lesions.
  • Biopsy of an adnexal lesion should almost always be avoided.
  • MRI is the test of choice for clinical staging of a known ovarian cancer.
  • Up to 20% of women with metastatic ovarian or tubal cancers have a normal CA-125 level.
Volume 38.2 - Question 4

Polycystic Ovary Syndrome

Which one of the following statements regarding Polycystic Ovary Syndrome (PCOS) is false?

  • Menstrual cycle irregularity in the first 3 years post-menarche is uncommon outside of PCOS.
  • Unopposed estrogen increases the risk of endometrial cancer.
  • Pregnant patients with PCOS have an increased risk of gestational diabetes.
  • Screening for cardiovascular disease in this population should follow general population recommendations.
Volume 37.5 - Question 13

Estetrol/Drospirenone

Which one of the following statements about the combination oral contraceptive containing estetrol and drosipirenone is false?

  • Estetrol is the first new estrogen to become available in Canada in 50 years.
  • Estetrol has a shorter half-life than estradiol.
  • Weight gain is one of the most common adverse effects.
  • Women not currently using a hormonal contraceptive should take the first active tablet on the first day of menses.
Volume 37.5 - Question 11

Pelvic Organ Prolapse

Ureteral obstruction occurs in 3-30% of patients with severe untreated pelvic organ prolapse. 

  • True
  • False
Volume 39.1 - Question 19

Primary Ovarian Insufficiency

Which one of the following statements about primary ovarian insufficiency is false?

  • Laboratory evaluation includes thyrotropin levels.
  • If a first-degree relative is affected, the likelihood of a genetic disorder is increased by a factor of 6 to 12.
  • Autoimmune disorders account for about one-third of cases.
  • Ongoing contraception is recommended if pregnancy is not desired.
Volume 38.3 - Question 4

Postcoital Bleeding

Which one of the following statements about patients presenting with postcoital bleeding is false?

  • Transvaginal ultrasonography is indicated if no cause is identified on physical examination.
  • Women with cervical ectropion require referral to gynecology.
  • Postcoital bleeding is attributable to cervical cancer in 3%–5% of affected patients.
  • Endometrial biopsy is recommended in patients older than 40 years.
Volume 39.2 - Question 10

Adenomyosis

Dienogest is one of the first-line medical options for pain and heavy menstrual bleeding from adenomyosis.

  • True
  • False
Volume 39.2 - Question 9

Nonpharmacologic Treatments for Menopause

All of the following treatments have been shown to be effective for vasomotor symptoms of menopause except:

  • Cognitive behavior therapy
  • Clinical hypnosis
  • Yoga
  • Black cohosh
Volume 39.2 - Question 8

NSAID and Emergency Contraception

Oral piroxicam 40 mg co-administered with levonorgestrel improved efficacy of emergency contraception.

  • True
  • False
Volume 39.2 - Question 2

Posthumous Reproduction

Which one of the following statements about posthumous assisted reproduction is false?

  • It is most frequently conducted in biological females.
  • Oocytes can be retrieved through follicular aspiration.
  • One method of sperm retrieval is testicular biopsy.
  • It should occur within 24 – 36 hours after death.
Volume 39.1 - Question 2

Postcoital Bleeding

In patients with postcoital bleeding, transvaginal ultrasonography is indicated in the patients who have no identified cause on physical examination.

  • True
  • False
Volume 39.1 - Question 1

Endocrine Therapy and Attempted Pregnancy after Breast Cancer

Among select women with previous hormone receptor–positive early breast cancer, temporary interruption of endocrine therapy to attempt pregnancy does not confer a greater short-term risk of breast cancer events.

  • True
  • False
Volume 38.6 - Question 16

Menstrual Cups

Which one of the following statements regarding menstrual cups is false?

  • They can be inserted for up to 12 hours at a time.
  • There is no risk of toxic shock syndrome.
  • Bacterial vaginosis may be less common than with a sanitary pad or tampon.
  • Dislodgement of intrauterine devices has been reported with their use.
Volume 38.6 - Question 15

Early Pregnancy Loss

Which one of the following statements about early pregnancy loss (in the first trimester) is false?

  • Expectant management is safe for patients without signs of infection or hemorrhage who have ready access to emergency care.
  • Anticoagulation use is a contraindication to managing early pregnancy loss with medications.
  • Hemoglobin less than 9 g/dL is not a contraindication to medication management.
  • Human chorionic gonadotropin may take several weeks to reach undetectable levels following pregnancy.
Volume 38.6 - Question 14

Progestin-Only Oral Contraceptives

Which one of the following statements about progestin-only oral contraceptives is false?

  • They are less effective than combination oral contraceptives.
  • They are used predominantly when estrogen is contraindicated.
  • Backup contraception is recommended for women who start treatment > 5 days after menses onset.
  • They have been associated with a risk of developing breast cancer.
Volume 38.6 - Question 8

Oral Contraceptives

Which one of the following statements about combination oral contraceptives is false?

  • Formulations that contain ≤ 20 mcg of ethinyl estradiol are less effective than those containing higher doses.
  • Those that contain drospirenone have been shown to improve premenstrual dysphoric disorder symptoms.
  • Those that contain drospirenone rarely cause hyperkalemia.
  • The risk of venous thromboembolism may be lower with those that contain estetrol than with those containing ethinyl estradiol.
Volume 38.6 - Question 7

PCOS Comorbidities

Patients with polycystic ovary syndrome have routine screening for the following comorbidities except:

  • Depression
  • Hypertension
  • Obstructive sleep apnea
  • Endometrial cancer
Volume 38.6 - Question 6

IUDs in Canada

Which one of the following statements about intrauterine devices (IUDs) is false?

  • They may reduce the risk of cervical cancer.
  • Their presence increases the risk of pelvic inflammatory disease.
  • Systemic levonorgestrel exposure is significantly lower with hormonal IUDs than with oral formulations.
  • Fertility returns rapidly upon removal.
Volume 38.5 - Question 20

Vaginal Estrogen and Recurrent UTIs

Hypoestrogenic women with recurrent urinary tract infection who use vaginal estrogen can expect a greater than 50% reduction in urinary tract infection frequency in the following year.

  • True
  • False
Volume 38.5 - Question 19

Dry High Risk HPV Self-Sampling Kits

Which one of the following statements regarding dry high risk human papillomavirus self-sampling kits is false?

  • They are highly acceptable to patients.
  • Over 90% of samples are of sufficient quality to analyze correctly.
  • Over 80% of those performing the test will not need a medical visit for cervical cancer screening.
  • Current kits allow for reflex cytology on HPV positive results.
Volume 38.5 - Question 2

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