Gynae Emergencies

Question 1

what are the main risk factors for developing pelvic inflammatory disease

Answer 1

age <25
multiple sexual partners contracting STIs
recent uterine instrumentation eg hysteroscopy, colposcopy, IUD insertion

Question 2

how does PID present

Answer 2

lower abdominal pain 
fever 
change in bleeding - intermenstrual, postcoital and menorrhagia 
offensive vaginal discharge 
deep dysparenunia

Question 3

what are the 2 main examination findings with PID

Answer 3

cervical motion tenderness

adnexal tenderness

Question 4

what are the main investigations for PID

Answer 4

vulvovaginal swab for chlamydia and gonorrhoea
if acutely unwell check FBC
if tubo-ovarian abscess suspected, TVS

Question 5

how is PID managed

Answer 5

doxycycline, metronidazole and ceftriaxone

if acutely unwell, manage via sepsis 6 guidelines

Question 6

what are the main complications of PID

Answer 6

fitz-hugh-curtis syndrome 
recurrent abscess 
ectopic pregnancy 
subfertility from tubal blockage 
chronic PID causing fibrosis

Question 7

what are the main types of ovarian cyst and who typically gets them

Answer 7

functional - young child-bearing age women
germ cell tumours - young women
benign epithelial tumours - older women

Question 8

what are 3 concerning features of an ovarian cyst

Answer 8

increasing size
thick wall septa or papillary projections
presence of tumour markers such as AFP, b-HCG, CA125

Question 9

what causes a functional ovarian cyst to occur

Answer 9

dominant follicle fails to rupture and failure of atresia in non-dominant follicle

Question 10

how is an asymptomatic functional ovarian cyst managed

Answer 10

observe for changes with regular US, only intervene if there are changes

Question 11

what type of cyst is a dermoid cyst

Answer 11

a benign germ cell tumour

derived from epithelial tissue so can contain hair and teeth

Question 12

how does an ovarian cyst present

Answer 12

asymptomatic
chronic pain, dull ache, dysparenunia, cyclical pain
acute bleeding if rupture
hormonal effects eg androgenic features

Question 13

which tumour marker is most important for ovarian cysts in over 40s

Answer 13

CA125 as increased risk of malignancy

Question 14

which tumour markers are important for ovarian cysts in women under 40

Answer 14

AFP
b-HCG
CEA

Question 15

what are the main investigations for ovarian cysts

Answer 15

bloods
TVS
MRI for staging of cyst if malignant

Question 16

how is an ovarian cyst in pre-menopausal women managed

Answer 16

if <5cm and asymptomatic rescan in 6 weeks

cystectomy if larger and symptomatic

Question 17

how is an ovarian cyst in post-menopausal women managed

Answer 17

calculate risk of malignancy
if low risk, manage conservatively
if moderate risk bilateral oophrectomy
if high risk urgent cancer referral

Question 18

what is an ovarian torsion

Answer 18

ovary containing a cyst turns in on itself and venous return of the ovary is occluded

Question 19

what are the clinical features of ovarian torsion

Answer 19

severe unilateral abdo pain
nausea, vomiting
pain improves after 24 hours as the ovary starts to die
adnexal tenderness and acute abdomen

Question 20

what are the ultrasound features of ovarian torsion

Answer 20

classical whirlpool sign

Question 21

how is ovarian torsion managed

Answer 21

laparoscopy to untwist ovary and remove cyst

remove ovary if necrotic

Question 22

what is the function of Bartholins glands

Answer 22

to provide lubrication to the vagina

Question 23

where are Bartholins glands located

Answer 23

next to the vagina around 5 and 7 o’clock

normally the size of a pea

Question 24

what are the features of Bartholin’s cysts

Answer 24

soft painless lump

gland slightly enlarged from normal

Question 25

how does Bartholin’s abscess present

Answer 25

red, swollen, tender lump

may be painful during sex

Question 26

what are the two main management options for Bartholin’s abscess

Answer 26

antibiotics

surgical procedure called marsupilisation

Question 27

what is an ectopic pregnancy

Answer 27

when embryo implants in a location outwith the endometrial cavity

Question 28

where are the common sites for an ectopic pregnancy to implant

Answer 28

majority are tubal eg ampulla 
ovary 
c-section scar 
peritoneum 
pouch of douglas