204 Gynea - HMB

Question 1

What is primary dysmenorrhoea?

Answer 1

Not associated with an organic cause

Question 2

What is secondary dysmenorrhoea?

Answer 2

There is an organic cause

Question 3

What is adenomyosis?

Answer 3

Ectopic endometrial tissue in myometrium

Question 4

What are the symptoms fibroids?

Answer 4

Mainly - HMB 
Associated symptoms:
Painful sex
Increased urinary frequency and urgency
Can cause miscarriages and pre term labour

Question 5

What is the medical treatment for fibroids?

3 listed

Answer 5

GnRH analogues
Mirena
Esmya

Question 6

How does esmya help with the treatment of fibroids?

Answer 6

Block progesterone receptors, inhibit cel prolif and stimulate apoptosis
Selectively blocks progesterone activity at pituitary

Question 7

Which tumour markers should be requested when dealing with HMB? (3 listed)

Answer 7

CA19-9 - Ovarian and pancreatic ca
Ca125 Ovarian Ca
CEA - Colon and breast Ca

Question 8

What is the criteria for endometrial biopsy?

Answer 8

Women over 40 and younger women who have failed to respond to treatment

Question 9

What are the 2 surgical options for HMB?

Answer 9

Endometrial ablation

Hysterectomy (90% long term satisfaction)

Question 10

What are the surgical options for treatment of fibroids?

3 listed

Answer 10

Myomectomy
Hysterectomy
Uterine artery embolisation

Question 11

What are the complications of fibroids?

4 listed

Answer 11

Degeneration- hyaline change/calcification
Torsion
Infection with pyometra
Malignancy - leiomyosarcoma

Question 12

Which antifibrinolytic is used in the treatment of HMB?

When should it be taken?

Answer 12

Tranexamic acid - take only during menstruation. Decreases by 50%

Question 13

Which NSAID can be used in conjunction with tranexamic acid to treat HMB?

Answer 13

Mefenamic acid

Question 14

When should oral progestogens be used in the treatment of HMB?

Answer 14

It shouldn’t be used - it can be used to regulate bleeding

Question 15

What is another name for levonorgestrel?

Answer 15

Mirena coil

Question 16

Which medical treatment decreased HMB by 90%?

Answer 16

Mirena coil

Question 17

What are leuprorelin acetate and triptorelin examples of?

Answer 17

GnRH antagonists- i.e. downregulate the release of LH and FSH which inhibits the release of oestrogen from ovary

Question 18

What is the typical P/C of endometrial cancer?

Answer 18

Post menopausal bleeding

Question 19

What is the commonest cause of post menopausal bleeding?

Answer 19

Atrophic vaginitis

Question 20

What is the treatment of atrophic vaginitis?

Answer 20

Topical oestrogen

Question 21

What surgical treatment should be considered in the management of endometrial cancer?

Answer 21

TAH +/- RTx = if there is more than 50% of the myometrium involved

Question 22

What are the 3 different types of HRT?

Answer 22

1. E2 only for hysterectomised women
2. Sequential - E2 daily + prog for 14 days of month
3. Continuous - E2 and prog daily

Question 23

What is the most important indicator of subfertility?

Answer 23

Woman’s age

Question 24

What is the contents of seminal plasma?

Answer 24

Glucose
Fructose
PGs
Proteins

Question 25

What is Sheehans syndrome?

Answer 25

Hypopituitarism caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth. Can cause subfertility

Question 26

What is Kallman's syndrome?

Answer 26

Genetic condition - failure of onset of puberty - one cause of subfertility

Question 27

What is the assisted conception technique for mild sperm dysfunction when a couple is trying to conceive?

Answer 27

IUI

Question 28

What is the assisted conception technique of choice for severe tubular damage?

Answer 28

IVF - have to remove the damaged tube prior to IVF as risk of toxins affecting the pregnancy

Question 29

What is a threatened miscarriage?

Answer 29

Bleeding but cervical os still closed - 25% go on to miscarry

Question 30

What is a molar pregnancy?

Answer 30

Non viable fertilised egg implants into the endometrium

Question 31

What is a complete molar pregnancy?

Answer 31

diploid/paternal origin

Question 32

What is the level of beta-hCG in an non-pregnant woman?

Answer 32

<5 UI/mL

Question 33

What is ovarian hypersensitivity syndrome?

Answer 33

Risk of ovarian induction - massive ovarian cysts, ascites, pleural and pericardial effusions, Hypovolaemia.

Question 34

What are the risks to the offspring in ovarian induction?

Answer 34

Premature birth, Epigenetic disorders

Question 35

What is asthenospermia?

Answer 35

Normal morphology but lack motility

Question 36

What is teratozoospermia?

Answer 36

Abnormally high number of abnormal forms

Question 37

What is oligozoospermia?

Answer 37

Decreased sperm count

Question 38

What are the signs and symptoms of a molar pregnancy?

Answer 38

PV spotting, uterus large for gestational age

Question 39

What are the maternal causes of molar pregnancy? (7 listed)

Answer 39

``` Müllerian duct abnormalities Obesity Alcohol Smokers Systemic disease DM Thyroid dysfunction ```

Question 40

What are the complications of a molar pregnancy? | 4 listed

Answer 40

Infection or haemorrage of retained PoC Uterine perforation at time of ERCP Ashermans syndrome Cervical incompetence

Question 41

What is Ashermans syndrome?

Answer 41

Adhesions / fibrosis of endometrium out curettage or retained PoC

Question 42

When was the abortion act commissioned?

Answer 42

1967

Question 43

What are the 4 methods of therapeutic abortion?

Answer 43

Suction curettage + prostaglandin pessary to dilate cervix Antoprogestogen tabs + prostaglandin tabs Dilation of cervix and evacuation of uterine contents Prostaglandin induction +/- oxytocin infusion

Question 44

How many weeks into pregnancy can a suction curettage be performed to complete a therapeutic abortion?

Answer 44

12-14 weeks

Question 45

Up to how many weeks into pregnancy can antiprogestogen tabs be given for a therapeutic abortion?

Answer 45

Up to 9 weeks

Question 46

What is percentage of ectopic pregnancies are tubular (usually in ampulla)?

Answer 46

98%

Question 47

How is an ectopic pregnancy confirmed?

Answer 47

Nil seen on USS of abdomen with a βhCG of >1500

Question 48

What is the treatment of an acutely-presenting ectopic pregnancy?

Answer 48

Surgical laparoscopy and salpingectomy of affected tube as long as the other is healthy

Question 49

What is the risk when an ovarian cyst reaches >5cm in size?

Answer 49

Torsion

Question 50

What are the typical S&S of an ectopic pregnancy? | 4 listed

Answer 50

Amenorrhea for 4-6 weeks Pain Scanty brown discharge PV Empty uterus on USS

Question 51

What are the types of benign ovarian cysts? | 2 listed

Answer 51

Serous/ mucinous cystadenoma | Endometrioma ( chocolate cyst)

Question 52

What are the 2 types of malignant ovarian cysts?

Answer 52

Cystadenocarcinoma | Gonadoblastoma

Question 53

What produces beta-hCG?

Answer 53

Embryo and later the syncitiotrophoblast

Question 54

What type of drug is mifepristone and when is it used?

Answer 54

Competitive progesterone receptor antagonist. It causes decidual degeneration of the endometrium and cervical softening/dilation in a therapeutic abortion

Question 55

What type of drug is misoprostol and when is it used?

Answer 55

Synthetic prostaglandin-E2 analogue which causes contractions and softens the cervix in a therapeutic abortion

Question 56

What is an adnexal mass?

Answer 56

A mass associated with the uterine appendages

Question 57

What are fibroids?

Answer 57

Benign tumour of SM of the uterus