gyn1

Question 1

what is stress incontinence?

Answer 1

occurs in patients with weak urethral sphincter.

anything that increases abdo pressure - coughing, laughing, causes leakage of urine

Question 2

give 2 non-pharma treatments of stress incontience?

Answer 2

1. lifestyle changes - weight loss, smoking, caffeine, avoid straining
2. pelvic floor exercises (physio)

(duloxetine can be used alongside physio)

Question 3

how do pelvic floor exercises work?

Answer 3

pelvic floor muscle contraction -> urethral compression -> increased urethral pressure -> reduced leakage

Question 4

what surgical options for stress incontinence?

Answer 4

sling

suspension - restores pressure to the urethra and supports urethra

Question 5

what causes overactive bladder?

Answer 5

involuntary contractions of detrusor muscle -> urgency

Question 6

3 symptoms of Oab

Answer 6

Urgency
frequency
nocturia
key in door urgency

Question 7

epithelium of detrusor?

Answer 7

smooth muscle with transitional epithelium

Question 8

innervation of detrusor?

Answer 8

sacral parasympathetic innervation

Question 9

investigations for incontinence?

Answer 9

bladder diary
urinalysis
residual urine measuremen
ePAQ questionnaire

Question 10

what info is obtained from bladder diary?

Answer 10

freq
quantity
fluid intake
diurnal variation

Question 11

non pharma treatments of oab?

Answer 11

lifestyle changes
bladder drill
pads

Question 12

what drugs are used for oab

Answer 12

oxybutynin
mirabegron
botox

Question 13

how does oxybutynin work

Answer 13

Anticholinergic - M2/3 receptor antagonist. reduces detrusor innervation

Question 14

what are side effects of oxybutynin

Answer 14

1. dry mouth
2. constipation
3. blurred vision
4. cognitive impairments

Question 15

how does mirabegron work?

Answer 15

beta 3 agonist. relaxes detrusor and increases capacity of bladder

Question 16

how does botox work in oab?

Answer 16

blocks aCH and so reduces detrusor muscle contraction

Question 17

give 3 symptoms of prolapse

Answer 17

pain
lump
discomfort
sexual symptoms

Question 18

what is the treatment for prolapse?

Answer 18

reassurance
symptom mgmt
vaginal pessaries
surgery if symptoms severe

Question 19

symptoms of cystocele?

Answer 19

incontinence, straining and hesitancy

Question 20

symptoms of rectocele

Answer 20

• difficulty opening bowels, constipation, straining

Question 21

what is the treatment for a genital tract fistula?

Answer 21

surgery
can affect bladder colon or rectum
symptoms foul discharge, gas pus stool leaking from vag

Question 22

what are fibroids?

Answer 22

benign smooth muscle tumours of the uterine myometrium

Question 23

what hormone stimulates fibroid development?

Answer 23

oestrogen

Question 24

how are fibroids classified?

Answer 24

according to their position
intramural
submucosal
subserosal

Question 25

what type of fibroid is most common?

Answer 25

intramural (confined to myometrium)

Question 26

where are subserosal fibroids?

Answer 26

outwards from uterus

Question 27

where are submucosal fibroids

Answer 27

growing into the uterine cavity

Question 28

4 risk factors for fibroids?

Answer 28

obesity early menarche fam hx inc age

Question 29

4 symptoms of fibroids

Answer 29

``` menorrhagia pain subfertility pressure symptoms on bladder etc can cause anaemia ```

Question 30

investigations for fibroids

Answer 30

pelvic USS | hysteroscopy

Question 31

what is the treatment for fibroids?

Answer 31

conservative: watch and wait medical: hormone: GnRH, POP surgical: hysteroscopic resection, myomectomy, hysterectomy

Question 32

what is the gold standard tr for fibroids?

Answer 32

hysterectomy - if young and wants kids, myomectomy

Question 33

what class of drug is duloxetine?

Answer 33

snri

Question 34

how are endometrial polyps investigated?

Answer 34

TVUSS

Question 35

how are endometrial polyps removed?

Answer 35

hysteroscopy + polypectomy