General Gynaecology

Question 1

Which cells release FSH?

Answer 1

Granulosa cells

Question 2

Which cells release LH?

Answer 2

Theca cells

Question 3

What is the action of FSH?

Answer 3

Binds to granulosa cells to stimulate follicle growth, permit conversion of androgens to oestrogen and stimulate inhibin secretion

Question 4

What is the role of LH?

Answer 4

The production and secretion of androgens

Question 5

What are the two phases the ovarian cycle called?

Answer 5

Follicular

Luteal

Question 6

What changes occur during the follicular phase?

Answer 6

Follicles begin to mature and prepared to release oocyte
Low steroid and inhibin levels means less negative feedback therefore increased FSH and LH
These stimulate the follicular growth and oestrogen production
One dominant follicle selected
LH surge causes ovulation

Question 7

For how long is an egg viable?

Answer 7

24 hours

Question 8

Describe the changes in the luteal phase

Answer 8

Corpus luteum is formed at the sight of the ruptured follicle
Produces oestrogen, progesterone and inhibin to maintain conditions for fertilisation and implantation
Spontaneously regresses after 14 days if no fertilisation

Question 9

What are the phases of the uterine cycle?

Answer 9

Proliferative
Secretory
Menses

Question 10

Describe the proliferative phase

Answer 10

This occurs alongside the follicular phase of the ovaries
Preparation for implantation
Oestrogen initiates fallopian tube formation, thickening of the endometrium, increased growth and motility of myometrium and production of thin, alkaline cervical mucus

Question 11

Describe the secretory phase

Answer 11

This occurs alongside the luteal phase
Progesterone stimulate further thickening of endometrium into glandular secretory form, increased thickening of the myometrium, decreased nativity of myometrium, thick, acidic cervical mucus production and changes in mammary tissue

Question 12

What occurs during menses?

Answer 12

Corpeus luteum breaks down

Internal lining of uterus shed

Question 13

Define menorrhagia

Answer 13

Periods with such heavy bleeding that it causes a significant impact on the women’s life
>80ml per cycle

Question 14

Name some causes of menorrhagia

Answer 14

Abnormal clotting: vW disease, thrombocytopenia, leukaemia, platelet disorders
Pathology: fibroids, adenomyosis, endometriosis, IUD, PID, polyps
Medical disorders: hypothyroidism, liver disease, SLE, cancer, progesterone contraception

Question 15

What is the management of menorrhagia?

Answer 15

Tranexamic acid
NSAIDs
IUS
Management of the cause

Question 16

What is the basic MoA of tranexamic acid?

Answer 16

Anti fibrinolytic

Question 17

How do NSAIDs work in menorrhagia?

Answer 17

Reduce the production of prostaglandins and therefore decrease the bleeding

Question 18

Define endometriosis

Answer 18

Function endometrial glands and storms outside of the uterine cavity

Question 19

What percentage of reproductive age women have endometriosis?

Answer 19

5-10%

Question 20

What are the symptoms of endometriosis?

Answer 20

Pelvic pain - cyclic, deep dyspareunia
Pain with defaecation
Infertility

Question 21

What are the commonest findings in a patient with endometriosis?

Answer 21

Fixed, retroverted uterus
Nodularity of uretosacral ligaments
Enlarged, tender adnexa

Question 22

What is the management of endometriosis?

Answer 22

NSAIDs - pain and menstrual flow
Oral contraceptives
GnRH agonist
Surgical = Laser/excise endometriosis and hysterectomy

Question 23

What is adenomyosis?

Answer 23

Endometrial glands and storms within the myometrium

Question 24

What are the symptoms of adenomyosis?

Answer 24

Dysmenorrhea
Menorrhagia
Dyspareunia

Question 25

What is the examination finding for adenomyosis?

Answer 25

Smoothly enlarged, boggy uterus

Question 26

How do we diagnose adenomyosis?

Answer 26

Suggested by pelvic US/MRI | histological diagnosis

Question 27

What is the management of adenomyosis?

Answer 27

Continuous oral contraceptives IUS/injections Hysterectomy

Question 28

What are the causes of pelvic prolapse?

Answer 28

``` Vaginal births/pregnancy Race - more common in white women Oestrogen deficiency Chronic conditions - obesity, COPD, constipation Connective tissue disease ```

Question 29

What are the symptoms of prolapse?

Answer 29

Feeling of something coming down Bulge at vaginal introitus Incomplete bladder/bowel emptying

Question 30

What is the management of prolapse?

Answer 30

Pessaries Pelvic floor training Hysterectomy Fixations

Question 31

What ix are appropriate for suspected PCOS?

Answer 31

Testosterone, LH, FSH | US

Question 32

What would FSH and LH levels show in PCOS?

Answer 32

Raised LH | Decreased FSH

Question 33

What are the symptoms of PCOS?

Answer 33

Amenorrhoea/oligo menorrhoea Hirsutism Obesity Infertility

Question 34

What is the management of PCOS?

Answer 34

Oral contraceptives Metformin Clomiphene citrate or ovarian drilling for fertility

Question 35

What do we call the 2 holes in the pelvic floor?

Answer 35

Urogenital hiatus | Rectal hiatus

Question 36

What are the functions of the pelvic floor?

Answer 36

Support the viscera Resistance to increased pressure Urinary and faecal continence

Question 37

The levator ani consists of which 3 muscles?

Answer 37

Pubococcygeus Iliococcygeus Puborectalis

Question 38

What is the nerve supply to levator ani?

Answer 38

Pudendal nerve | S2-4

Question 39

Define the stages of uterine prolapse

Answer 39

I - uterus in upper half of vagina II - uterus has descended almost to intoroitus III - uterus protrudes out of vagina IV - uterus completely out of vagina

Question 40

What are the complications specific to hysterectomy?

Answer 40

Damage to bladder, ureter or bowel | Pelvic abscess or infection

Question 41

High vaginal swab is used to detect ...

Answer 41

Bacterial vaginosis Trichomonas vaginalis Candida Group B strep

Question 42

Endocervical swabs can detect ...

Answer 42

Gonorrhoea | Chlamydia

Question 43

What is the treatment for atrophic vaginitis?

Answer 43

Topical or oral oestrogen

Question 44

What is lichen sclerosus?

Answer 44

Atrophic change/thinning of the epidermis of the vulva

Question 45

What is the main sx of lichen sclerosus (if any)?

Answer 45

Itching

Question 46

What is the management of lichen sclerosus?

Answer 46

Topical testosterone | Or topical corticosteroid

Question 47

What is lichen planus?

Answer 47

Chronic inflammatory dermatitis of unknown aetiology causing multiple, small, shiny, purple papules

Question 48

What can cause a rapid increase in size of fibroids?

Answer 48

Progestins Clomiphene Pregnancy

Question 49

How do we classify fibroids?

Answer 49

Based on location: Subserosal Intramural Submucosal

Question 50

Define threatened miscarriage

Answer 50

Uterine bleeding before 20 weeks with a closed cervical os and confined viable intrauterine pregnancy

Question 51

Define cervical ectropion

Answer 51

Eversion of the endocervix exposing the columnar epithelium

Question 52

What cells line the endo and ectocervix?

Answer 52

Endo - simple columnar | Ecto - stratified squamous non-keratinised

Question 53

What are the risk factors for cervical ectropion?

Answer 53

Use of COCP pregnancy Adolescence Menstruating age

Question 54

What is the management of cervical ectropion?

Answer 54

Normal variant, does not require mx unless symptomatic Stop oestrogen containing medications Ablation