The following is/are true regarding risk factors for the development of and severity of uterine fibroids?

• a)
  

  Increasing parity is associated with reduced risk

  
  
• b)
  

  African-American ethnicity is the single biggest recognized risk factor

  
  
• c)
  

  There is a recognized association with later age of menarche

  
  
• d)
  

  There is no recognized association with smoking

  
  
• e)
  

  Vitamin D deficiency has been shown to increase the risk of fibroids

Which of the following is/are considered modulators of the pathology associated with uterine leiomyomas but have yet to be proven as a causal agent in their genesis?

• a)
  

  MicroRNAs

  
  
• b)
  

  Methylation

  
  
• c)
  

  Demethylation

  
  
• d)
  

  Mediator complex subunit 12 (MED12)

  
  
• e)
  

  RE1 transcription factor (REST)

The following is/are true regarding African American women and fibroids

• a)
  

  They have an observed six-fold greater prevalence of fibroids from 18–30 years of age compared to Caucasian women

  
  
• b)
  

  They have been observed to develop symptoms 10–15 years earlier than Caucasian women of similar age

  
  
• c)
  

  They are less likely to undergo hysterectomy due to cultural differences

  
  
• d)
  

  They are less likely to undergo a minimally invasive approach

  
  
• e)
  

  They are more likely to experience postoperative complications following surgery for uterine fibroids

Which of the following strategies has been shown to arrest uterine fibroid growth?

• a)
  

  Oestrogen antagonist action

  
  
• b)
  

  Progesterone antagonist action

  
  
• c)
  

  Ovarian removal

  
  
• d)
  

  The combined oral contraceptive pill

  
  
• e)
  

  Gonadotropin-releasing hormone analogues

Which of the following factors inhibits leiomyoma cell proliferation?

• a)
  

  Platelet-derived growth factor (PDGF)

  
  
• b)
  

  Kruppel-like transcription factor 11 (KLF11)

  
  
• c)
  

  Transforming growth factor β3 (TGFβ3)

  
  
• d)
  

  Serine/threonine protein kinase B (AKT)

  
  
• e)
  

  Epidermal growth factor (EGF)

The following can be considered abnormal with which of the following bleeding patterns?

• a)
  

  21 day cycle

  
  
• b)
  

  38 day cycle

  
  
• c)
  

  Menses lasting 8 days

  
  
• d)
  

  Monthly blood loss of 100ml

  
  
• e)
  

  Excessive bleeding that interferes with maternal quality of life

Regarding PALM COEIN – there is commonality with regard to risk factors for fibroids with which of the following other causes of AUB?

• a)
  

  Polyps

  
  
• b)
  

  Adenomyosis

  
  
• c)
  

  Malignancy

  
  
• d)
  

  Coagulopathy

  
  
• e)
  

  Ovulatory dysfunction

Factors identified in the literature to date as potentially contributing to AUB in the context of fibroids include which of the following?

• a)
  

  Increased vascular flow

  
  
• b)
  

  Increased plasminogen-activator inhibitor-1 (PAI-1)

  
  
• c)
  

  Increased transforming growth factor-beta (TGF-β)

  
  
• d)
  

  Submucosal fibroids

  
  
• e)
  

  Increased anti-thrombin III

Regarding growth factors, which of the following is/are true?

• a)
  

  Activin-A is a member of the EGF family of growth factors

  
  
• b)
  

  They are not influenced by ovarian hormones

  
  
• c)
  

  They are expressed differently in normal myometrium and uterine leiomyomas

  
  
• d)
  

  They take part in the regulation of inflammation

  
  
• e)
  

  They take part in the regulation of fibrosis

Which of the following is/are true regarding medical treatments for uterine leiomyomas?

• a)
  

  They have anti-proliferative effects

  
  
• b)
  

  They have anti-fibrotic effects

  
  
• c)
  

  They reduce extracellular matrix production

  
  
• d)
  

  They target growth factors and their signaling

  
  
• e)
  

  They regulate angiogenesis

At Ultrasound examination which of the following is/are typical of fibroid appearance?

• a)
  

  Round solid lesions

  
  
• b)
  

  Inhomogenous echotexture

  
  
• c)
  

  Characteristic stripes

  
  
• d)
  

  Acoustic shadowing

  
  
• e)
  

  Poor peripheral vascularization

Which parameters are considered fundamental in the evaluation of submucous myomas?

• a)
  

  Grading

  
  
• b)
  

  Minimal free myometrial margin

  
  
• c)
  

  Percentage of intra-cavity growth

  
  
• d)
  

  The presence of a spiral feeding vessel

  
  
• e)
  

  The presence of acoustic shadowing

Which features would be suspicious of a leiomyosarcoma?

• a)
  

  Large solid myometrial mass

  
  
• b)
  

  Rapid interval growth

  
  
• c)
  

  Anechoic areas without shadowing

  
  
• d)
  

  Myometrial lesion with radial stripes and vascular spaces

  
  
• e)
  

  Rich vascularization

Which of the following is/are indications for Magnetic Resonance Imaging?

• a)
  

  Uncertain anatomical origin of the mass

  
  
• b)
  

  Uncertain histological origin of the mass

  
  
• c)
  

  Uterus subverted by multiple myomas

  
  
• d)
  

  Prior to embolization

  
  
• e)
  

  When fertility preservation is the major issue

Uterine fibroids increase the risk of fetal malpresentation by:

• a)
  

  1.25 times

  
  
• b)
  

  2.5 times

  
  
• c)
  

  5 times

  
  
• d)
  

  7.5 times

  
  
• e)
  

  10 times

The impact on pregnancy outcome is greater in cases with which of the following?

• a)
  

  Submucous fibroids

  
  
• b)
  

  Intramural fibroids

  
  
• c)
  

  Subserous fibroids

  
  
• d)
  

  Pedunculated fibroids

  
  
• e)
  

  Ovarian fibroids

Which of the following agents for medical treatment of fibroids has/have been shown to decrease bone mineral density if used long term?

• a)
  

  Combined Oral Contraceptive Pills

  
  
• b)
  

  LNG-IUS

  
  
• c)
  

  GnRH analogues

  
  
• d)
  

  Somatostatin analogues

  
  
• e)
  

  Ulipristal acetate

Which of the following forms of medical management have NOT been demonstrated to cause a reduction in leiomyoma size?

• a)
  

  GnRH analogues

  
  
• b)
  

  GnRH antagonists

  
  
• c)
  

  Ulipristal acetate

  
  
• d)
  

  LNG-IUS

  
  
• e)
  

  Danazol

Ulipristal acetate (UPA) is used for the preoperative management of reproductive aged women with symptomatic leiomyomas. Which of the following is/are true about UPA?

• a)
  

  It reduces menstrual blood loss

  
  
• b)
  

  It decreases fibroid volume

  
  
• c)
  

  It causes physiologic endometrial changes

  
  
• d)
  

  It is a synthetic steroid derived from 19-norprogesterone

  
  
• e)
  

  It is approved in the U.S., Canada and Europe for the management of leiomyomas

Which of the following forms of medical management for leiomyomas is/are classified as a selective progesterone receptor modulator (SPRM)?

• a)
  

  Mifepristone

  
  
• b)
  

  Asoprisnil

  
  
• c)
  

  Telepristone

  
  
• d)
  

  Ulipristal acetate

  
  
• e)
  

  Pirfenidone

Prior to laparoscopic myomectomy, gonadotropin releasing hormone (GnRH) can be administrated 3 to 4 months before for which of the following reasons?

• a)
  

  To reduce surgical difficulty

  
  
• b)
  

  To reduce fibroid volume

  
  
• c)
  

  To improve pre and post-operative haemoglobin

  
  
• d)
  

  To change the initially predicted surgical route

  
  
• e)
  

  To shorten operative time

Regarding hysteroscopic myomectomy procedures, which of the following is/are true?

• a)
  

  Cervical preparation with Misoprostol is associated with less operative complications

  
  
• b)
  

  GnRH use is associated with a higher rate of complete resection of submucous myomas

  
  
• c)
  

  The use of monopolar energy is associated with a higher rate of adverse events than bipolar energy

  
  
• d)
  

  The use of anti-adhesion barriers following procedures is associated with a higher pregnancy rate

  
  
• e)
  

  Resection of myomas over 6 cm in diameter is associated with more two-step resections

Which is considered the gold standard treatment for symptomatic uterine fibroids?

• a)
  

  UAE

  
  
• b)
  

  MRgFUS

  
  
• c)
  

  Myomectomy

  
  
• d)
  

  Vaginal occlusion of uterine arteries

  
  
• e)
  

  Laparoscopic occlusion of uterine arteries

Which of the following is/are true regarding uterine artery embolization?

• a)
  

  It was first used in 2008

  
  
• b)
  

  It is not yet approved by the United States FDA

  
  
• c)
  

  It is indicated for pedunculated uterine fibroids

  
  
• d)
  

  It is performed just in selected cases

  
  
• e)
  

  It is suitable for all the patients that want to preserve their uterus

The progressive shrinkage of a myomas treated with cryo-ablation goes up to how long post-procedure?

• a)
  

  1 month

  
  
• b)
  

  3 months

  
  
• c)
  

  6 months

  
  
• d)
  

  9 months

  
  
• e)
  

  12 months

Which of the following is a contraindication for MRgFUS?

• a)
  

  Intramural fibroids

  
  
• b)
  

  Being more than 40 years old

  
  
• c)
  

  Abnormal uterine bleeding

  
  
• d)
  

  Desire of future pregnancies

  
  
• e)
  

  Less than three uterine fibroids

Which of the following is/are true regarding case reports and series describing pregnancy following MRgFUS?

• a)
  

  Of women treated less than 50% achieve pregnancy

  
  
• b)
  

  The mean time to conception was >12 months

  
  
• c)
  

  Live birth rates were in the order of 40%

  
  
• d)
  

  The miscarriage rate was between 25–30%

  
  
• e)
  

  Delivery was by LSCS in >50% of cases

Which of the following is/are true regarding MRgFUS?

• a)
  

  The effectiveness of the MRgFUS procedure can be determined by the non-perfused volume (NPV) ratio

  
  
• b)
  

  The non-perfused volume (NPV) appears to correlate well with the volume of histological necrosis

  
  
• c)
  

  MRI hypo-intense fibroids were associated with a reduced treatment success compared with hyper-intense fibroids

  
  
• d)
  

  Relief of symptoms at 12 months follow up has been reported at over 85%

  
  
• e)
  

  The most important limitation to its use is side effects

Which of the following is/are considered a common complication after UAE?

• a)
  

  Post-embolization syndrome

  
  
• b)
  

  Septicaemia

  
  
• c)
  

  Death

  
  
• d)
  

  Mis-embolization

  
  
• e)
  

  Haematoma

Which of the following is/are features of post-embolization syndrome?

• a)
  

  It occurs in over 50% of cases

  
  
• b)
  

  Nausea without vomiting is a key feature

  
  
• c)
  

  Low grade fever is a key feature

  
  
• d)
  

  Leucocyte suppression is the key haematological finding

  
  
• e)
  

  It will resolve within 48–72 hours in the majority