Gynae 1&2

Question 1

Endometriosis is Prostgesterone / Oestrogen dependent

Answer 1

Endometriosis is Oestrogen Dependent

Question 2

What’re the symptoms of endometriosis?

Answer 2

Secondary Dyspareunia

Pelvic pain inbetween periods

Menstrual irregularity

Bladder and bowel symptoms

Question 3

What does a balck gun metal appearance on laperscopy indicate?

Answer 3

Endometriosis

Question 4

What’s the management of endometriosis?

Answer 4

NSAIDs for pain relief

Suppression of cyclical hormone production therefore menstruation (OCP)

Surgery

Question 5

What is Adenomyosis?

Answer 5

Ectopic glandual tissue found in muscle

Hyperplasia and fibrous tissue

Question 6

What’re the symptoms of Adenomyosis?

Answer 6

Worsening Heavy Periods

Secondary Dysmonorrhoea (period pain)

Gradually enlarging tender uterus

Question 7

What is Adenomyosis difficult to differenterate from?

Answer 7

Fibroids and DUB (Dysfunctional Uterine Bleeding)

Question 8

How do you treat Adenomyosis?

Answer 8

Hysterectomy with conservation of the ovaries

Question 9

Answer 9

Endometriosis of the ovary

Question 10

Answer 10

Endometriosis

Question 11

What’s the definition of infertility?

Answer 11

Inibility to conceieve after 2 years, with regular inprotected sex

Question 12

What’re the main causes of infertility?

Answer 12

Unexplained (30%)

Ovulatory (27%)

Male factor (19%)

Tubal (14%)

Question 13

Indications for early referral?

Answer 13

>25

Amenorrhoea / Oligomenorrhoea

Previous abdo/ pelvic surgery

Previous PID

Abnormal pelvic examination

Question 14

What’s the commonest cause of oligo/azoospermia?

Answer 14

Primary testicular failure

Question 15

What’re the important factors in increasing female feritlity

Answer 15

Fertility declines with age

Decline in oocyte number

Increased rate in higher aneuploidy and mascarriage rates

Question 16

What female assesments are done?

Answer 16

Day 2 - FSH, LH and oestrogen

Ovulation - regular menstrual cycles, ovulation kits

Mid luteal progesterone (>30 nmol/L) - evidence for ovulation

USS follicular tracking is more reliable but costly and labour intensives

Question 17

How do you differentiate PCOS and Premature Ovarian Failure?

Answer 17

PCOS (high LH, lower FSH, high testosterone)

Premature ovarian failure (high FSH, Low LH)

Question 18

How do you diagnose tubal patency?

Answer 18

Hysterosalpingogram

Question 19

What’re some uterine abnormalities?

Answer 19

Adhesions, Polyps, Submucus Fibroids

Question 20

Cystocele

Answer 20

Bladder Herniates into the Vagina

Occurs after childbirth

Question 21

What is a Rectocele?

Answer 21

Rectal herniation into the vagina

Question 22

What’re the causes of prolapse?

Answer 22

Pregnancy and delivery

Menopause

Pressure - ovarian mass, straining

Question 23

Answer 23

Uterine Prolapse

Question 24

Answer 24

Valt Prolapse

Question 25

What's the symptoms of prolapse?

Answer 25

Prolapse Symptoms (Lump down below, Bearing Down, Fullness / Heaviness) Urinary Symptoms (urgency, voiding dysfunction, stress incontinence) Bowel Symptoms (obstructed, incontinence) Sexual Dysfunction Pain (backache)

Question 27

What's the treament of Prolapse?

Answer 27

No symptoms don't treat Pessary Surgery

Question 28

What're the different types of pessary?

Answer 28

Ring Gellhorn Replace every 3-9 months Pts who can't have surgery

Question 29

The anterior repair is an operation to correct?

Answer 29

Cystocele

Question 30

Posterior vaginal wall prolapse

Answer 30

Rectocele

Question 31

Posterior repair is an operation to correct?

Answer 31

Rectocele

Question 32

Vaginal Hysterectomy treats?

Answer 32

Uterine Prolapse

Question 33

Sacrospinous Fixation treats?

Answer 33

Treats a vault prolapse due to previous hysterecomy

Question 34

Urinary Incontinence

Answer 34

Stress Urgency Overflow Nocturnal Enuresis

Question 35

What causes of Stress Incontinence?

Answer 35

Pregnancy and child bearing Menopause Pressure - bearing, smoking, high BMI

Question 36

What're the investigations for stress incontinence?

Answer 36

Urodynamics: Cystometry / Pas test / Residual volume

Question 37

What's the conversative management of urinary incontinence?

Answer 37

Pelvic floor muscle training Smoking cessation Weight loss HRT / Local Oestrogen

Question 38

What's the surgical management of stress incontinence?

Answer 38

Mid-urethral tapes Urethral bulking agents Colposuspension Autologous sling

Question 39

What're the symptoms of an Overactive Bladder?

Answer 39

Nocturia Urinary Incontinence Frequency

Question 40

What're the causes of an overactive bladder?

Answer 40

Menopause Irritants (smoking / caddiene / alcohol) Masses (pressure) Neurogenic spinal cord / parkinsonism

Question 41

What does a bladder drill treat?

Answer 41

An overactive bladder

Question 42

What's the conservative management of an overactive bladder?

Answer 42

Fluid advice Bladder drill Weight loss HRT / Local oestrogen Medication

Question 43

What medication is used to treat an overactive bladder?

Answer 43

Anticholinergics - Oxybutinin B-3 agonist - Mirabegron

Question 44

What surgical intervation is used in an overactive bladder?

Answer 44

Botulinum toxin A bladder wall injection Tibial nerve stimulation Detrusor myotomy

Question 45

Topical vaginal oestrogen is a treatment of?

Answer 45

Overactive bladder