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MFSRH Part 2 2025 > General Gynaecology > Flashcards

General Gynaecology Flashcards

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1
Q

What are the three main groups of lichen planus?

A
  1. Classical
  2. Hypertrophic
  3. Erosive
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2
Q

What is the most common subtype of lichen planus to cause vulval symptoms?

A

Erosive

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3
Q

What are the main symptoms in women with peritoneal endometriosis deposits?

A
  1. Chronic pelvic pain
  2. Deep dysparaunia
  3. Dysmenorrhoea
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4
Q

Where in the vagina is a vaginal septum most likely to occur?

A

Upper vagina

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5
Q

In obese women, what is most likely to be the cause of endometrial polyp growth/hyperplasia etc.?

A

Oestrone

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6
Q

What features on ultrasound score as part of the RMI calculation?

A
  1. Multilocular cyst
  2. Solid areas
  3. Mets
  4. Presence of ascites
  5. B/L lesions
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7
Q

What is the lifetime risk of fibroids?

A

30%

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8
Q

What are the most common benign tumours in women?

A

Fibroids

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9
Q

What is the rate of improvement of PMS symptoms with GnRH analogues?

A

60-75%

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10
Q

What does PATSS stand for?

A

Post-ablation tubal sterilisation syndrome

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11
Q

What are the main symptoms of PATSS?

A

Cyclical pelvic pain and vaginal spotting (thought to occur as a result of retrograde menstruation)

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12
Q

What is the incidence of PATSS?

A

6-8%

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13
Q

To what depth should the myometrium be ablated to prevent endometrial ablation treatment failure?

A

5mm (destruction of basal endometrial glands)

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14
Q

What is the most common abnormality of uterine fusion?

A

Septate uterus (90%)

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15
Q

What are the causes of PMB?

A

Atrophy - 60-80%
Exogenous oestrogens - 15-25%
Endometrial carcinoma - 10%
Endometrial hyperplasia - 5-10%
Endometrial/cervical polyps - 2-12%

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16
Q

How do the appearances of an imperforate hymen and transverse vaginal septum differ?

A

Imperforate hymen = blueish bulge
Transverse vaginal septum = pink bulge

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17
Q

Teenager with primary amenorrhoea, karyotype 46XY, WITHOUT a uterus:

A

AIS

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18
Q

Teenager with primary amenorrhoea, karyotype 46XY, WITH a uterus:

A

Swyer Syndrome - develop streak gonads - don’t make androgens and so phenotypically female, don’t make Mullerian inhibitory factor, and so do have a uterus

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19
Q

What would be the biopsy findings of lichen sclerosis?

A
  • Thinned epidermis
  • Subepidermal hyalinisation
  • Deeper inflammatory infiltrate
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20
Q

What proportion of women have co-existing cervical and endometrial polyps?

A

24-27%

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21
Q

The ovary produces what % of circulating testosterone?

A

25%

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22
Q

What is the risk of laparotomy following laparoscopic tubal occlusion?

A

3 in 1000

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23
Q

What is the incidence of ectopic pregnancies in women attending early pregnancy units?

A

2-3%

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24
Q

What is the most common finding on US in ectopic pregnancy?

A

An inhomogenous or non-cystic adnexal mass? (50-60%)

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25
A beta-hCG greater than what is associated with failure of MTX Mx?
>10,000
26
Following salpingotomy, how should follow-up take place?
B-hCG on D7 post-op and then weekly until negative
27
What is the overall success rate of MTX Mx for tubal pregnancy?
65-95%
28
What percentage of women with a negative Pipelle will still have an endometrial hyperplasia?
2%
29
If using GnRH to aid PMS diagnosis, how long should it be used for?
3/12
30
What proportion of post menopausal women have ovarian cysts?
5-17%
31
When will the full treatment effects of oxybutinin not be seen until?
4 weeks
32
Uterine sarcomas account for what proportion of malignant uterine lesions?
2-7%
33
What type of cysts are associated with molar pregnancy?
Theca lutein cysts
34
What are theca lutein cysts usually caused by?
Excessive hCG response - e.g. in GTD, multiple pregnancy and OHSS
35
What do haemorrhagic cysts look like on USS?
Reticular (fishnet) pattern due to blood clot
36
What do endometriomas look like on USS?
Ground-glass echogenicity
37
With what type of cyst may you see a rokitansky nodule?
Mature cystic teratoma/dermoid cyst
38
What is the triad of Meig's syndrome?
1. Ovarian fibroma 2. Ascites 3. Pleural effusion
39
What are the categories of malignant ovarian tumours?
Epithelial - 90% Sex-cord stromal - 5% Germ cell - 5%
40
What are the different types of epithelial ovarian cancer?
1. Serous carcinoma (high and low grade) 2. Mucinous carcinoma 3. Brenner/ transitional cell carcinoma 4. Clear cell carcinoma 5. Endometrioid carcinoma
41
What are the different types of sex-cord stromal ovarian cancers?
1. Sertoli-Leydig tumour 2. Granulosa cell tumour
42
What are the different types of germ cell ovarian cancer?
1. Dysgerminoma 2. Yolk sac (endodermal sinus) tumour 3. Immature teratoma 4. Embryonal carcinoma 5. Choriocarcinoma
43
What is the most common type of ovarian cancer?
High-grade serous carcinoma
44
What is the second most common type of ovarian cancer?
Endometroid carcinomas
45
What are the characteristics of Krukenberg tumours (a primary GI tumour that manifests on the ovary)?
Appearance of mucin-secreting signet-ring cells
46
What is the histological appearance of yolk sac tumours?
Schiller-Duval bodies
47
What investigations should be carried out in women <40 with a complex ovarian mass?
LDH, AFP, hCG; Ca-125
48
When should a simple cyst 5-7cm be rescanned in a pre-menopausal woman?
Annually
49
What additional investigations should take place if a simple cyst in a pre-menopausal women is >7cm?
MRI or surgical intervention - with pre-operative assessment with RMI or IOTA rules
50
What is the sensitivity/specific of the IOTA rules?
Sensitivity - 95% and Specificity - 91%
51
In post-menopausal woman with an ovarian mass, what is the ONLY tumour marker that should be tested for?
Ca-125
52
How can simple cysts <5cm in assympto post-menopausal woman be managed?
Ca-125 Repeat scan 4-6 months Discharge after 1 year if cyst unchanged/reduced and normal Ca-125
53
If the a <5cm cyst in a post-menopausal women is symptomatic, what needs to happen?
Surgical evaluation
54
What should happen should the RMI >200 in a post-menopausal woman with a cystic structure?
CTAP Onward referral to a gyn-onc MDT
55
When would hysteroscopy be a first line investigation/management in HMB according to NICE?
If Hx suggests endometrial pathology: SM fibroid / polyp / endometrial pathology because they have persistent IMB or RF (high BMI / PCOS / Tamoxifen use / treatment for HMB has been unsuccessful)
56
TXA reduces HMB to what degree?
40-50%
57
LNG-IUS reduces HMB to what degree?
80-90%
58
POP and COCP reduce HMB to what degree?
40-50%
59
GnRH antagonists reduced HMB and fibroids to what degree?
Bleeding - 100% Fibroids - 50-70%
60
What is the recurrence rate of fibroids after myomectomy?
30-60%
61
How is AIS inherited?
X-linked recessive
62
What proportion of women with primary amenorrhoea have AIS?
5%
63
In AIS, when should the testes be removed?
End of growth spurt, to prevent testicular Ca
64
What level of free testosterone would make you seek alternative causes of hyperandrogenism?
Raised testosterone levels of 2-5nmol/l are commonly seen in PCOS. Levels >5 nmol/L should prompt exclusion of androgen secreting tumours and congenital adrenal hyperplasia
65
Mutations in what gene causes Kallman syndrome?
KAL1, FGFR1, PROKR2, and PROK2
66
For how long is their evidence of improvement in endo on the implant?
Up to 1 year of use
67
When can coil be fitted in the community in patients taking apixaban etc.?
After 2 weeks of starting

MFSRH Part 2 2025 (14 decks)

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