Gynaecology

Question 1

What are risk factors for miscarriage?

Answer 1

Increasing age
Previous miscarriage
Chronic condition eg diabetes
Uterine/cervical problems
Smoking
Alcohol
Underweight or overweight
Invasive prenatal tests
Cervical cone biopsy

Question 2

What is the most common place for an ectopic?

Answer 2

Ampulla of fallopian tube

Question 3

What is the most common place for an ectopic to rupture?

Answer 3

Isthmus of the fallopian tube

Question 4

What are the methods for a termination of pregnancy?

Answer 4

<9 weeks = PO Mifepristone followed by vaginal Misoprostol 48 hours later
<13 weeks = surgical dilation and suction
<15 weeks = surgical dilation + evacuation

Question 5

What is the medical management of miscarriage? When might it be considered?

Answer 5

Vaginal misoprostol

If mother has coagulation problems
If expectant management has failed
if late in to first trimester

Question 6

Induction of ovulation in patients with PCOS?

Answer 6

1. Lifestyle measures e.g. weight loss
2. Clomifene
3. Metformin

Question 7

How to manage menorrhagia?

Answer 7

First check that theres no underlying pathology

FIRST LINE = Mirena IUS
If does not want contraception= Tranexamic acid/NSAIDs

Question 8

How to manage dysmenorrhoea?

Answer 8

1. Mefenamic acid/NSAIDs

2. COCP

Question 9

What are complications of PID?

Answer 9

Infertility
Chronic pelvic pain
Fitz-Hugh-Curtis syndrome (Perihepatitis ) - RUQ pain

Question 10

How is endometriosis managed?

Answer 10

First line = NSAIDs and/or paracetamol
Second line = COCP
Third line = Referral to secondary care for consideration of GnRH analogues
Fourth line = surgery

Question 11

What is the management of endometrial hyperplasia?

Answer 11

No atypia found on biopsy –> High dose progesterone

Atypia found on biopsy –> Hysterectomy

Question 12

What are risk factors for endometrial cancer?

Answer 12

Obesity
Nulliparity
Early menarche
Late menopause
Unopposed oestrogen
DM
Tamoxifen
PCOS
HNPCC

Question 13

What are the two most common ovarian cysts?

Answer 13

Follicular

Corpus luteum

Question 14

How do ovarian cysts present?

Answer 14

Usually asymptomatic but if large can cause bloating, fullness, pelvic pain

Question 15

How are ovarian cysts investigated?

Answer 15

1. Transvaginal ultrasound - if less than 5cm then no further investigation required.
2. If post-menopausal consider CA125

Question 16

How are ovarian cysts monitored?

Answer 16

<5cm = no further management
5-7cm = yearly monitoring
>7cm = consider MRI

Question 17

What is Meig’s syndrome?

Answer 17

Triad

1. Ovarian fibroma
2. Pleural effusion
3. Ascites

Question 18

How does ovarian cyst rupture present? What is seen on ultrasound?

Answer 18

Shock
Fever
Severe abdominal pain (Iliac fossa)
Ultrasound = free fluid in the pouch of Douglas

Question 19

What is ovarian torsion and how does it present?

Answer 19

Ovary twists - usually when there is an ovarian mass
Sudden onset severe iliac fossa pain
Nausea and vomiting

Question 20

What is seen on ultrasound in ovarian torsion?

Answer 20

Whirlpool sign

Question 21

What are signs on examination of ectopic pregnancy?

Answer 21

Abdominal tenderness

Cervical motion tenderness

Question 22

What is seen on ultrasound in a complete hydatidiform mole?

Answer 22

Snowstorm appearance

Question 23

What does the bHCG have to be to allow for expectant management of an ectopic?

Answer 23

Less than 1000

Question 24

What bHCG means that you need surgical management for an ectopic?

Answer 24

OVer 5,000

Question 25

First line management for hyperemesis?

Answer 25

ORal cyclising or oral promethazine

If ketones/weight loss –> admission may be needed

Question 26

How to treat infertility caused by fibroids?

Answer 26

Go straight to myomectomy

Question 27

What might be seen on examination in fibroids?

Answer 27

x

Question 28

What is Mittelschmerz pain?

Answer 28

transient pain in the middle of their cycle secondary to ovulation

Question 29

What is the management of fibroids?

Answer 29

First line = Mirena unless there is uterine distorsion

Second line = Tranexamic acid/Mefenamic acid