Gynae

Question 1

definition of acute pelvic infection

Answer 1

STI affecting pelvic organs including uterus, fallopian tubes and ovaries

Question 2

what causes PID

Answer 2

ascending infections from vagina and cervix sexually transmitted, or iatrogenically from resident bacteria through instrumentation and procedures

Question 3

what is perihepatitis

Answer 3

infection/adhesions between uterus and liver, causing RUQ pain

Question 4

clinical features of PID

Answer 4

asymptomatic
bilateral lower abdominal pain
deep dyspareunia
vagina discharge
bleeding

Question 5

examination findings of PID

Answer 5

tachycardia in severe
pyrexia
lower abdominal peritonism
bilateral adnexal tenderness
cervix excitation
palpable abscess

Question 6

differential diagnoses of PID

Answer 6

appendicities
ovarian cyst accidents (unilateral pain)
ectopic pregnancy (+ve pregnancy test and unilateral pain)

Question 7

how to investigate PID

Answer 7

endocervical swabs for chlamydia and gonorrhea

blood cultures

WBC, CRP

pelvic US to exclude abscess/cyst

laparoscopy with fimbrial biopsy is diagnostic

Question 8

what is diagnostic for PID

Answer 8

laparoscopy with fimbrial biopsy is diagnostic

Question 9

how to treat PID

Answer 9

analgesics

antibiotics

Question 10

complications of PID on fertility

Answer 10

reduced fertility

increased ectopic risk

Question 11

What is the definition of menopause

Answer 11

12 months after cessation of menstrual bleeding

Question 12

What is the definition of perimenopausal

Answer 12

Someone with the symptoms of menopause but still bleeding, albeit intermittently

Question 13

What is the median age for menopause

Answer 13

51

Question 14

What is the definition for premature menopause

Answer 14

Before 40

Question 15

What is the definition of postmenopausal bleeding

Answer 15

Any bleeding that occurs after menopause

Question 16

What can cause PMB

Answer 16

endometrial cancer
endometrial hyperplasia
cervical cancer
endometrial or cervical polyps
Withdrawal bleed during sequential HRT
Atrophic vaginitis
Cervicitis

Question 17

How is atrophic vaginitis diagnosed

Answer 17

Diagnosis of exclusion after investigating for malignancy, masses, cysts, hyperplasia

Question 18

How is PMB investigated (1st, 2nd, 3rd line)

Answer 18

Speculum, smear, bimanual

TVUS - endometrial thickness, masses

Hysteroscopy + biopsy

Question 19

What does TVUS look for in PMB investigation

Answer 19

Thickness of endometrium and any masses, or cysts

Question 20

What thickness is abnormal in postmenopausal endometriums

Answer 20

> 4mm

Question 21

What can a mass seen during TVUS in PMB bleed be?

Answer 21

Fibroid, polyp, cyst

Question 22

When should hysteroscopy and biopsis be done in PMB investigation

Answer 22

If endometrial lining is >4mm

Question 23

What are some vasomotor symptoms of menopause

Answer 23

Hot flushes, night sweats

Question 24

What are some urogenital symptoms in menopause

Answer 24

Itchy, dry, burning, dyspareunia,

Frequency, urgency, nocturia, incontinence, recurrent UTIs

Question 25

What sexual problems occur in menopause

Answer 25

Loss of desire Loss of arousal Pain during sex Loss of ability to achieve orgasms

Question 26

What are risk factors for osteoporosis

Answer 26

``` Family hx Low bmi Smoking/alcohol Early menopause Low calcium intake Sedantary lifestyle Long term corticosteroid use Other bone homeostasis disrupting diseases ```

Question 27

What blood markers are useful in investigating menopause

Answer 27

FSH, AMH High FSH and low AMH is typical in menopause

Question 28

Biochemical markers in blood are not used for diagnosis osteoporosis - t or f

Answer 28

True

Question 29

What is the HRT regiment for someone without a uterus

Answer 29

Continuous oestrogen

Question 30

Why is progesterone required in HRT for women with uteruses

Answer 30

To prevent endometrial hyperplasia

Question 31

What happens in unopposed oestrogen therapy?

Answer 31

Increased endometrial cancer risk.

Question 32

What is the regime of HRT for perimenopausal women with uterus

Answer 32

Estrogen + progesterone either combined daily or sequentially.

Question 33

What is the regime for postmenopausal women with uterus

Answer 33

Combined estrogen and progesterone, can be given in IUS

Question 34

Benefits and risks of HRT

Answer 34

Benefits: reduces symptoms, reduces osteoporosis and colorectal cancer Risks: increases breast cancer risk, VTE and gallbladder diseases.

Question 35

How long is HRT regime stayed on for

Answer 35

5 years for perimenopausal women and then review on needs Postmenopausal for osteoporosis risk - life long Premature menopausal women - till median menopause age and then reviewed on needs

Question 36

What non-hormonal medication can be given to reduce osteoporosis

Answer 36

Biphosphonates

Question 37

what are 5 ways of assisted conception

Answer 37

``` IUI IVF ICSI oocyte donation surrogacy ```

Question 38

when is an ovarian cyst significant or insignificant

Answer 38

if premenopausal: >55mm is significant | if postmenopausal: any sized cyst is significant

Question 39

5 common types of ovarian cancer

Answer 39

``` serous cystadenoma endometroid carcinoma mucinous cystadenoma clear cell carcinoma others ```

Question 40

is PID pain unilateral or bilateral?

Answer 40

bilateral

Question 41

what is color discharge is characteristic of vaginosis?

Answer 41

grey watery discharge

Question 42

what is purulent vaginal discharge suggestive of?

Answer 42

gonorrhea, PID

Question 43

what color discharge is chlamydia?

Answer 43

yellow or milky white

Question 44

what causes a chracteristic cottage cheese discharge?

Answer 44

candida

Question 45

symptoms of ovarian cancer

Answer 45

abdominal bloating and/or distension urinary frequency weight loss

Question 46

symptoms of endometrial cancer

Answer 46

post coital bleeding post menopausal bleeding pelvic pain

Question 47

most common cause of PMB?

Answer 47

vaginal atrophy