Acute Gynaecological Conditions

Question 1

What are the symptoms of an ectopic pregnancy?

Answer 1

Unilateral pain, positive pregnancy test, hypotensive, tachycardic, collapse, apyrexial

Question 2

What investigations are done for a suspected ectopic pregnancy?

Answer 2

FBC and group & save

US = FAST scan or trans-vaginal

Question 3

What is the appearance of an ectopic pregnancy on a USS?

Answer 3

Doughnut sign

Question 4

Where do ectopic pregnancies occur?

Answer 4

98% occur in fallopian tubes

Also get C-section scar, cervical, ovarian or cornual ectopics

Question 5

Can ectopic pregnancies be heteroscopic?

Answer 5

Yes = one in tube and one in uterus

Question 6

What are the risk factors for an ectopic pregnancy?

Answer 6

Previous ectopic, tubal damage (e.g endometriosis), smoking, infertility and its treatment, extremes of reproductive age, intrauterine contraceptive devices

Question 7

What is the management for an ectopic pregnancy?

Answer 7

Resuscitation and ABCDE
Laparotomy or laparoscopy = laparoscopy is better
Salphingetomy or salphingotomy
Anti-D if rhesus negative = due to presence of paternal rhesus positive blood in foetus

Question 8

What are some features of a pregnancy of unknown location?

Answer 8

Static HCG and clinically well

May give methotrexate to lower hormone levels

Question 9

How does ovarian torsion present?

Answer 9

Unilateral pain, apyrexial, normotensive, tachycardia, nausea/vomiting, HCG negative

Question 10

What investigations are done for ovarian torsion?

Answer 10

FBC, CRP, group & save

Do US if palpable mass on vaginal examination

Question 11

What are some features of ovarian torsion?

Answer 11

More likely in cysts >5cm
Dermoid cysts more likely to twist
10% are dermoid, 25% adnexal torsion occurs in children

Question 12

How does the prognosis change for ovarian torsion depending on age?

Answer 12

Premenopausal more likely to be benign

Postmenopausal more likely to be malignant

Question 13

How is ovarian torsion managed?

Answer 13

Resuscitation and ABCDE
Laparoscopy = remove cyst through umbilical cord
Laparotomy if large cyst
Oophrectomy or cystectomy
May do hysterectomy if postmenopausal

Question 14

What are the symptoms of appendicitus?

Answer 14

Gradual onset RIF pain, anorexia, nausea/vomiting, diarrhoea, HCG negative, normal HR and BP, Rosving’s positive, rebound and guarding, raised WCC and CRP

Question 15

Why do you do a USS in suspected appendicitus?

Answer 15

To rule out gynaecological cause

Question 16

What are the symptoms of a cyst accident?

Answer 16

Sudden onset unilateral pain occurring after sex, HCG negative, tachycardic, hypotensive, apyrexial

Question 17

What investigations would be done for a cyst accident?

Answer 17

FBC, CRP, group & save, USS

Question 18

What cysts tend to be implicated in cyst accidents?

Answer 18

Commonly occur in functional cysts = may also be dermoid or endometrioma

Question 19

What causes cyst accidents?

Answer 19

May be spontaneous or due to trauma (e.g sport, sex) = have potential for haemorrhage

Question 20

What is the management of a cyst accident?

Answer 20

Conservative management if stable
Laparoscopy if patient needed resuscitation
Lavage and stop bleeding

Question 21

What are the symptoms of pelvic inflammatory disease?

Answer 21

Gradual onset lower abdominal pain, anorexia, intermenstrual and post-coital bleeding, discharge, HCG negative, normal BP and HR, pyrexial

Question 22

What investigations are done for pelvic inflammatory disease?

Answer 22

FBC and CRP
2x genital swabs = for chlamydia and gonorrhoea
LFTs = to look for Fitz-Hugh Curtis syndrome

Question 23

What causes pelvic inflammatory disease?

Answer 23

Ascending infection from endocervix = chlamydia, gonorrhoea, gardenella, anaerobes

Question 24

What occurs in pelvic inflammatory disease?

Answer 24

Endometritis, salphingitis and tubo-ovarian abscess

Question 25

What can pelvic inflammatory disease lead to?

Answer 25

Infertility, chronic pelvic pain or ectopic pregnancy

Question 26

What is the management of pelvic inflammatory disease?

Answer 26

Need to take 6 swabs 14 days metronidazole and doxycycline = IV if vomiting May need to remove IUD Laparoscopy if not cleared by antibiotics

Question 27

Do you need to do contact tracing for pelvic inflammatory disease?

Answer 27

Yes

Question 28

What reduces the incidence of pelvic inflammatory disease?

Answer 28

Use of barrier contraception

Question 29

What are the menstrual causes of acute bleeding?

Answer 29

Anovulatory cycle, fibroids, anticoagulation, Von-Willebrand's disease (especially if young)

Question 30

What are the non-menstrual causes of acute bleeding?

Answer 30

Miscarriage, cervical cancer, endometrial cancer, vaginal trauma

Question 31

What investigations are done for acute bleeding?

Answer 31

FBC, coagulation screen, CRP, group & save HCG, LFTs, ferritin, US Endometrial or cervical biopsy Look for prolapsed fibroid = won't stop bleeding

Question 32

What is the management for acute bleeding?

Answer 32

``` Resuscitation and ABCDE Tranexamic acid = anti-fibrinolytic Mefenamic acid = reduces prostaglandins Norethisterone, IUS, COCP GnRH analogues = for fibroids/uncontrolled bleeding ```

Question 33

What are some causes of a painful vulva?

Answer 33

HSV infection = due t infection with HSV 1 or 2 Bartholin's gland abscess = due to blocked duct

Question 34

What are the symptoms of HSV infection?

Answer 34

Pain, ulceration, discharge, dysuria, urinary retention, inguinal lymphadenopathy

Question 35

How is HSV infection diagnosed?

Answer 35

Do viral swab for PCR

Question 36

What is the management for HSV infection?

Answer 36

Aciclovir, bladder catheter, local anaesthetic gel

Question 37

What are Bartholin's glands?

Answer 37

Bilateral glands at 5 and 7 o'clock positions = located within vagina, produce vaginal lubrication

Question 38

What are the symptoms of a Bartholin's gland abscess?

Answer 38

Infection, pain, swelling

Question 39

How are Bartholin's gland abscesses managed?

Answer 39

``` Do swab to diagnose Conservative if not severe Broad spectrum antibiotics Drainage with Word catheter Marsupialisation = recurrent/not cleared with antibiotics ```