SBA Pharmacology 10 Single Best Answer (SBA)
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1. A 22-year-old woman presents with crampy lower abdominal pain starting a day before her menstrual periods and resolving after 2 days. She denies heavy bleeding or other symptoms. Examination and ultrasound are normal. What is the most appropriate initial treatment?
Answer: Nonsteroidal anti-inflammatory drugs (NSAIDs)
Primary dysmenorrhoea is best managed initially with NSAIDs for pain relief. Hormonal therapies like COCPs can be added if needed.
2. A 19-year-old woman presents with primary amenorrhea and no secondary sexual characteristics. Ultrasound shows a normal uterus and ovaries. What is the most appropriate initial investigation?
Answer: Serum FSH and LH levels
Assessing gonadotropin levels is crucial to determine if the amenorrhoea is due to primary ovarian failure (high FSH/LH) or central/hypothalamic-pituitary causes (low/normal FSH/LH).
3. What is the most common cause of menorrhagia in premenopausal women?
Answer: Fibroids
Uterine fibroids are the leading structural cause of menorrhagia in reproductive-aged women.
4. A 52-year-old woman presents with hot flashes and night sweats affecting her sleep and quality of life. She has no contraindications to hormonal therapy. What is the most appropriate management?
Answer: Hormone replacement therapy (HRT)
In the absence of contraindications, HRT is the best option for troubling menopausal vasomotor symptoms.
5. A 34-year-old woman and her partner present with a 2-year history of infertility. Her menstrual cycles are regular, and she reports no significant past medical history. What is the most appropriate initial investigation?
Answer: Semen analysis for the partner
Male factor infertility accounts for up to 30-40% of infertility cases. Semen analysis is a quick, non-invasive test that should be done first.
6. A 28-year-old woman presents with irregular periods, acne, and hirsutism. Ultrasound shows multiple ovarian follicles. What is the most likely biochemical finding?
Answer: Elevated testosterone and LH levels
PCOS is characterised by hyperandrogenism (elevated testosterone) and often an increased LH:FSH ratio.
7. What is the most common complication associated with untreated endometriosis?
Answer: Infertility
Endometriosis can distort pelvic anatomy, damage ovarian reserve, and significantly hinder fertility if unaddressed.
8. A 60-year-old woman presents with bloating, early satiety, and weight loss. What is the most appropriate next step?
Answer: CA-125 measurement and pelvic ultrasound
Persistent bloating and early satiety in older women raises suspicion for ovarian cancer. CA-125 testing and ultrasound are the standard initial investigations.
9. A 25-year-old woman presents with sudden severe pelvic pain. Ultrasound shows a large ovarian cyst with free fluid in the pelvis. What is the most appropriate next step?
Answer: Immediate referral for emergency surgery
Sudden severe pelvic pain plus free fluid suggests rupture or torsion of an ovarian cyst, requiring urgent surgical intervention.
10. A 70-year-old woman with metastatic breast cancer refuses further treatment. She has capacity and understands the risks. What is the most appropriate course of action?
Answer: Respect her decision and provide palliative care
A competent patient may refuse treatment, even if life-sustaining. The best approach is to respect her wishes and offer palliative support.
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