Gynae

Question 1

What are the 2 main types of incontinence and their symptoms?

Answer 1

stress - involuntary leakage due to sudden increase in intra-abdominal pressure with bladder neck slipped below pelvic floor
overactive/urge - urgency

(mixed, neurogenic)

Question 2

How would you treat incontinence?

Answer 2

stress - physio, surgery

overactive - bladder drill, botox, bypass (catheters), drugs (atropine)

Question 3

What are the tests for incontinence?

Answer 3

FVC - frequency volume chart 
MSU - urinalysis 
RU - residual urine 
ePAQ - electronic personal assessment questionnaire
urodynamics

Question 4

What is it?

Multiparous woman comes in with dysmenorrhea, heavy bleeding, dysparunia

Answer 4

Adenomyosis

Question 5

What would you find on TVUS of adenomyosis?

Answer 5

large asymmetrical uterus, distorted myometrium, thickened junctional zone

Question 6

What is it?
Nullparious, family history
Dysmenorrhea, dyschezia, dysparunia, fixed and tender retroverted uterus, cervical excitation, uterosacral ligament nodularity

Answer 6

Endometriosis

• chronic cyclical pelvic pain
• infertility

Question 7

What would you use to diagnosis endometriosis?

Answer 7

Laparoscopy

Question 8

What is it?

Bilateral lower abdo pain, deep dysparunia, abnormal bleeding, cervical motion tenderness, adnexal tenderness

Answer 8

PID - inflammation of upper genital tract

Question 9

What is it?

Infertility, heavy periods, pelvic pain, irregular firm mass

Answer 9

Fibroids

• benign neoplasm of smooth muscle in myometrium
• menorrhagia + IMB, dysmenorrhoea, subfertility

Question 10

What is the largest RF of fibroids?

Answer 10

High BMI

nearer menopause, afro-carribean

Question 11

What is it?

Post-coital bleeding , HPV positive

Answer 11

Cervical cancer

Question 12

How would you test for cervical cancer?

Answer 12

Colposcopy and biopsy

Question 13

What is the most common type of cervical cancer?

Answer 13

90% squamous

Question 14

What is it?

Obese, diabetic, nullparious patient, HRT, postmenopausal bleeding

Answer 14

Endometrial cancer

Question 15

How would you test for endometrial cancer?

Answer 15

TVUS = endometrial thickness >4mm

Hysterscopy and endometrial biopsy

Question 16

What is the most common type of endometrial cancer?

Answer 16

adenocarcinoma

Question 17

What is it?

BRCA, early menarche, nulliparous, bloating, CIBH

Answer 17

Ovarian cancer

Question 18

How would you test for ovarian cancer?

Answer 18

CA125 - high

TVUS - multiocular, solid, metastases, ascites, bilateral lesions

Question 19

What is it?

Infertility, amenorrhoea, acne, hirsutism, deep voice, alopecia, acanthosis migricans, increased muscle mass

Answer 19

PCOS

-obese, acne, hirsutism, oligo/amenorrhoea, subfertility, miscarriage

Question 20

Which conditions are a risk in PCOS?

Answer 20

T2DM, acne, sleep apnoea, endometrial hyperplasia, hirturism, GDM

Question 21

What are the diagnostic criteria for PCOS?

Answer 21

Rotterdam criteria
2/3 of olgio/amennhorea, polycystic ovaries, and clinical/biochemical signs of hyperandrogenism
Tests - US

Question 22

What differentials of acute pelvic pain could you use an US to differentiate between?

Answer 22

Ectopic pregnancy, miscarriage, ovarian torsion, ovarian cyst rupture, appendicitis, subchorionic haemorrhage

Question 23

What on US would indicated malignant ovarian cyst?

Answer 23

multiocular, thickened walls, abnormal contents, projections

Question 24

What on US would indicate ovarian torsion?

Answer 24

increased ovarian size - oedema, impaired venous drainage

Question 25

What would you use to test for migrated IUD?

Answer 25

XR

Question 26

What can elevate CA125?

Answer 26

Ovarian cancer, ovarian cyst rupture, infection, menstruation, endometriosis, haemorrhage, peritonitis

Question 27

When would you do conservative management of ovarian cyst?

Answer 27

Simple cyst <10cm, normal CA125, postmenopausal | do serial US monitoring

Question 28

What on bimanual examination would indicate endometriosis?

Answer 28

cervical excitation, adnexal tenderness, uterine ligament abnormality

Question 29

How would you treat endometriosis?

Answer 29

Progesterone only - pill, coil, injection COCP* GnRH agonist (triptorclin) and HRT mefenamic acid as pain relief Trial exclusion diets of diary and wheat, exercise, psychological therapes Ablation, excision of extrauterine endometrial tissue, oophorectomy, hysterectomy

Question 30

How do you treat stress incontinence?

Answer 30

lifestyle pelvic floor muscle training surgery Duloxetine

Question 31

How do you treat urge incontinence?

Answer 31

conservative bladder training - first line anticholinergics (oxybutynin)

Question 32

What are the three types of prolapse?

Answer 32

Anterior wall - cystocele, urethrocele, cystourethrocele Posterior wall - enterocele, rectocele Apical - uterovaginal, vault

Question 33

What are risk factors of prolapse?

Answer 33

Weak pelvic floor - vaginal delivery and pregnancy - congenital - abnormal collagen metabolism - chronic predisposing factors - iatrogenic factors - e.g. pevlic surgery

Question 34

What are the symptoms of prolapse?

Answer 34

incontinence, heaviness, pain, dyspareunia, dragging sesnsation

Question 35

How do you prevent and treat prolapse?

Answer 35

Prevent - weight reduction, smoking, treat chronic triggers, pelvic floor exercises Treat - Pessaries, estrodial cream, surgery (e.g. manchester repair, vaginal hysterectomy)

Question 36

How do you treat fibroids?

Answer 36

tranexamic acid, NSAIDs, progestogens, IUS, COCP GnRH agonist uterine artery embolization hysteroscopic resection, open/laparoscopic myomectomy, hysterectomy/endometrial ablation

Question 37

What would the tests for PCOS show?

Answer 37

Elevated - LH, AMH, serum testosterone, insulin Low - serum sex hormone binding globulin TVUSS - polycystic ovaries

Question 38

How do you treat PCOS?

Answer 38

Conservative - lose weight, exercise, diet, smoking cessation COCP, metformin Anti-androgens - cyproterone acetate, spironolactone, vaniga facial cream Fertility treatment

Question 39

What are some complications of PID?

Answer 39

ectopic pregnancy, infertility, tubo-ovarian abscess, adhesions

Question 40

How would you treat PID?

Answer 40

IM cefriaxone | PO doxycycline or metronidazole

Question 41

What are some causes of PCB?

Answer 41

Infection, cervical ectropion, cervical or endometrial polyps, vaginal or cervical cancer, trauma or sexual abuse, vaginal atrophic change

Question 42

What are some causes of IMB?

Answer 42

Pregnancy related (ectopic, GTB), pysiological, Vaginal causes (adenosis, vaginitis, tumours), cervical (infection, cancer, polyps, ectropian), uterine (fibroids, polyps, cancer, adenomyosis, endometriosis), missed pills, following smear

Question 43

How would you investigate PCB/IMB?

Answer 43

TVUS | smear test

Question 44

What is marsupialization?

Answer 44

surgical technique of cutting slit into cyst and suturing the edges

Question 45

What is Asherman's syndrome?

Answer 45

scar tissue in uterus or on cervix