Exam 2- early pregnancy bleeding, dyfunctional uterine bleeding

Question 1

What is dysfunctional uterine bleeding and what are the two subtypes?

Answer 1

Heavy and/or abnormal bleeding in the absence of known pathology

Ovulatory (luteal phase deficiency)
Anovulatory- occurs at the extremes of reproductive life

Question 2

Systemic organic causes of menorrhagia (2)

Answer 2

Hypothyroidism

Coagulation defects

Question 3

Medical therapy for dysfunction uterine bleeding (5)

Answer 3

Mirena
COC
Antifibrinolytics (e.g. tranexamic acid)
Antiprostaglandins (e.g. mefanamic acid)
GnRH analogues e.g. Buserelin

Question 4

Definition of miscarriage

Answer 4

Expulsion of the products of conception before 24 weeks pregnancy

Question 5

Commonest aetiology of miscarriage

Answer 5

Chromosomal abnormalities

Question 6

Management of inevitable/incomplete miscarriage (5)

Answer 6

Allow evacuation
Pain relief
Blood transfusion if shocked
Misoprostol (prostaglandin analogue)
Mifepristone (antiprogestogen)

Question 7

Definition of recurrent miscarriage

Answer 7

Miscarriage on 3 or more consecutive occasions

Question 8

Factors which predispose to ectopic pregnancy (4)

Answer 8

Salpingitis
Previous tubal surgery
Endometriosis
Cu-ICD

Question 9

Clinical features of ectopic pregnancy (3)

Answer 9

Amenorrheoa
Vaginal bleeding
Pain (lower abdo, shoulder tip)

Question 10

Signs on examination which suggest ectopic pregnancy (3)

Answer 10

Peritonism
Adnexal mass
Cervival excitation

Question 11

Investigation of a suspected ectopic pregnancy (4)

Answer 11

Pregnancy test
Paired hCCG (should double every day, suboptimal in ectopic)
Ultrasound
Diagnostic/treatment laparoscopy

Question 12

Systemic drug given in ectopic pregnancy

Answer 12

Methotrexate

Question 13

What kind of cancer can hydatidiform moles develop into?

Answer 13

Choriocarcinoma

Question 14

Clinical features suggesting hydatidiform mole (3)

Answer 14

Vaginal bleeding after period of amenorrheoa
Large for dates uterus
Hyperemesis

Question 15

Investigations and findings suggesting molar pregnancy (2)

Answer 15

Markedly elevated urinary/serum hCG

Ultrasound- “snowstorm” appearance, theca lutein cysts

Question 16

Management of molar pregnancy (2)

Answer 16

Suction curettage

Follow-up monitoring of hCG

Question 17

Rationale for screening for chlamydia prior to abortion?

Answer 17

Carries risk of post-op salpingitis

Question 18

Two stages involved in medical abortion

Answer 18

Oral mifeprostone (antiprogestogen)
Vaginal/oral misoprostol (PG analogue)

Question 19

Surgical methods of abortion and weeks gestation they are used up until

Answer 19

Vacuum aspiration (up to 14 weeks)
Dilatation and evacuation (14-24 weeks)

Question 20

How does the late medical abortion procedure differ from early?

Answer 20

Late- second stage takes place at home and repeated doses of prostaglandin may be required

Question 21

What do Leydig cells produce?

Answer 21

Testosterone

Question 22

What do Sertoli cells produce?

Answer 22

Androgen-binding globulin

Question 23

Roles of FSH and LH within the testicle

Answer 23

FSH stimulates spermatogenesis, LH stimulates testosterone release

Question 24

Role of the a) seminal vesicles and b) prostate gland

Answer 24

a) fructose, prostaglandins, finbrinogen

b) alkaline fluid, clotting enzymes

Question 25

Recommendations prior to starting assisted conception therapy: a) BMI a) alcohol c) folic acid

Answer 25

a) 19-29 b) fewer than 4 units/week c) 0.4mg/day

Question 26

Assisted conception options (3)

Answer 26

In vitro fertilization Intracytoplasmic sperm injection Intrauterine insemination

Question 27

Basic timeline of IVF treatment schedule (7)

Answer 27

``` Downreg. with Buserelin (starting day 21 of cycle) 2-3 weeks of downreg. then baseline scan FSH injections- 8/9 days Action scan hCG injection Egg collection 36 hours after hCG Fertilization and implantation Cyclogest pessary for two weeks ```

Question 28

Abdominal pain, nausea and vomiting after FSH stimulation

Answer 28

Ovarian hyperstimulation syndrome