Gynaecology Breast1. A 48-year-old woman has typical vasomotor flushes and night sweats for 8 months. Periods are irregular. She asks for an FSH blood test to 'confirm the menopause'. What does NICE NG23 advise?A. Do not use serum FSH to diagnose menopause in women aged 45 or over with menopausal symptomsB. FSH is mandatory before any HRT can be prescribed in this NHS general-practice settingC. Two raised LH results 6 weeks apart are required at this age for this presentation in this NHS general-practice settingD. AMH is first-line to diagnose menopause in primary care in this NHS general-practice settingCheck
Gynaecology Breast2. A 51-year-old with an intact uterus wants systemic HRT for flushes. What is the appropriate oestrogen/progestogen strategy? The most appropriate action is: Oestrogen-only patches because they are 'weaker' in this NHS general-practice settingTRUE. TrueFALSE. FalseCheck
Gynaecology Breast3. A 54-year-old had a total hysterectomy for fibroids (no endometriosis). She wants HRT for flushes. What is first-line systemic HRT type? Select TWO correct statements.Select all that apply.A. Most appropriate: Oestrogen-only HRTB. The following is not the most appropriate next step: Continuous combined HRT for lifeC. Most appropriate: Sequential combined HRT as if the uterus remainedD. Most appropriate: Progestogen-only HRT as monotherapyCheck
Gynaecology Breast4. A 49-year-old with BMI 34 kg/m² wants systemic HRT. She has no personal VTE. What does NICE advise about route?A. Oral combined HRT is preferred specifically because BMI is raised for this presentation in this NHS general-practice settingB. HRT is absolutely contraindicated at BMI 34 in this NHS general-practice settingC. Injectable depot oestrogen is first-line in GP in this NHS general-practice settingD. Offer transdermal rather than oral oestrogen because of VTE risk with oral therapy at higher BMICheck
Gynaecology Breast5. A 34-year-old reports a new unexplained 2 cm firm breast lump. Examination confirms a discrete mass. What is the NICE NG12 referral?A. Suspected cancer pathway (2-week wait) for unexplained breast lump at age 30 or overB. Routine review in 6 months if the lump is painless for this presentation in this NHS general-practice settingC. Mammography in GP before any referral in this NHS general-practice settingD. Reassure that lumps under 40 cannot be cancer in this NHS general-practice settingCheck
Gynaecology Breast6. A 58-year-old has persistent bloating and early satiety. Abdominal examination is otherwise normal. CA125 is 48 IU/ml. What next (NICE NG12)? Select TWO correct statements.Select all that apply.A. Most appropriate: Arrange ultrasound of the abdomen and pelvis (typically transvaginal) promptlyB. The following is not the most appropriate next step: Repeat CA125 in 12 months with no imaging in this NHS general-practice settingC. Most appropriate: Routine CA125 screening every year for all women over 50 for this presentation in this NHS general-practice settingD. Most appropriate: Start HRT to treat 'menopausal bloating' without imagingCheck
Gynaecology Breast7. A 50-year-old with a uterus wants oestrogen patches for flushes. She already has a 52 mg LNG-IUS for contraception. What is an acceptable HRT regimen? The most appropriate action is: Remove the IUS immediately because IUS and HRT cannot be combinedTRUE. TrueFALSE. FalseCheck
Gynaecology Breast8. A 29-year-old has cyclical pelvic pain, dysmenorrhoea affecting work and deep dyspareunia. Pregnancy is not desired. Examination is unremarkable. What is appropriate first-line GP management (NICE NG73)?A. Trial of hormonal treatment (e.g. combined hormonal contraception or a progestogen) without waiting for laparoscopyB. Mandatory diagnostic laparoscopy before any hormonesC. Immediate GnRH analogue from the GP store cupboardD. Reassure that endometriosis cannot be treated in primary care for this presentation in this NHS general-practice settingCheck
Gynaecology Breast9. A 71-year-old with a symptomatic uterine prolapse prefers to avoid surgery. What is an appropriate conservative option in primary care (with fitting skills or referral for fitting)? Select TWO correct statements.Select all that apply.A. Most appropriate: A vaginal pessary (e.g. ring) plus pelvic floor advice, with planned reviewB. The following is not the most appropriate next step: Oestrogen-only systemic HRT as sole treatment of prolapse for this presentationC. Most appropriate: Immediate hysterectomy in the GP treatment roomD. Most appropriate: Lifelong bed rest in this clinical contextCheck
Gynaecology Breast10. A 47-year-old still has occasional periods and wants combined HRT for flushes. What bleed pattern is typically used?A. Continuous combined HRT from day one in all women under 50 for this presentationB. Oestrogen-only because periods continueC. Progestogen only on Mondays in this clinical contextD. Sequential (cyclical) combined HRT while still perimenopausalCheck