Gynae General

Question 1

According to RANZCOG 2024 statement on abortion care, do women with pregnancy <10 weeks need blood group or Hb?

Answer 1

no - provided dates are certain (risk of alloimmunisation low if Rh neg prior to 10 weeks)

Question 2

Who needs to have an US pre abortion?

Answer 2

If dates uncertain, clinical features concerning for ectopic - clinician discretion <14 weeks
>14 week - US recommended

Question 3

Recommended regimen for medical abortion up to 63 days

Answer 3

MS 2 step mife/miso

Question 4

From what gestation should fetocide be performed in the setting of TOP

Answer 4

22+

Question 5

Contraindications for MS2step

Answer 5

lack of access to emergent medical care
Uncertain GA
Suspected ectopic
IUD
Adrenal failure/corticosteroid failure
Anticoagulants/bleeding disorder
Allergy to mife of miso

Question 6

Analgesic options for EMA?

Answer 6

ibuprofen (can use loading dose 1600mg a time of miso, max daily dose 2400mg)
Paracetamol

Question 7

Follow up post clinical expulsion in EMA?

Answer 7

urine BHCG neg 14-21 days post
Serum BHGC drop 80% within 8-16 days.

Question 8

What proportion of pregnancies in Aus are unplanned?

Answer 8

Approx 40%

Question 9

What proportion of abortions are performed >14 weeks world wide?

Answer 9

10%
(However 2/3 of complications seen in this group)

Question 10

Embryological origin of fallopian tubes, uterus and upper vagina?

Answer 10

paramesonephric (mullerian ducts)

Question 11

Emybryological origin of labia minora

Answer 11

urogenital folds (ectoderm)

Question 12

Embyryological origin of the problem in cloacal exstrophy

Answer 12

failure of division of cloaca into urogential and anal tracts (endoderm)

Question 13

Emybryological origin of labia majora

Answer 13

labioscrotal swellings

Question 14

Emybryological origin of clitoris

Answer 14

genital tubercle

Question 15

Innervation of vulva

Answer 15

pudendal nerve (S2-4)
illioinguinal L1
Genital branch of genitofemoral (L1-2)
Perineal branch of femoral cutaneous nerve of thigh

Question 16

Lymphatic drainage of vulva

Answer 16

inguinal -> deep pelvic -> para-aortic

Question 17

Key clinical features distinguishing vulval lichen planus from lichen sclerosis

Answer 17

LS - doesn’t involve vagina, can occur in children, malignant transformation risk

Question 18

What is the absolute risk of breast cancer in women using cMHT (E+P)

Answer 18

1 Additional case in 1200 per year (equivalent to the risk of having 2 std alcoholic drinks daily) - WHI follow up study actually concluded that there was no increased risk in all cause mortality

Question 19

What is the average age of menarche?

Answer 19

12.8y

Question 20

What is the usual sequence of pubertal change in women?

Answer 20

thelarche -> pubarche -> menarche

Question 21

Define precocious puberty

Answer 21

appearance of secondary sexual characteristics prior to 8y old

Can be gonadortophin dependent (central) vs independent (peripheral egl gonads, adrenals, function cyst

Question 22

Causes of vulvovaginitis in pre-pubertal girls

Answer 22

poor perineal hygiene
Lack of oestrogen
Chemical irriation from soaps/detergent, can have secondary bacterial infections -> rx these base on mirco. Candida rare in pre pubertal girls

Question 23

Labial adhesions are not associated with other congenital abnormalities T/F

Answer 23

T

Question 24

Mx of pre-pubertal labial fusion

Answer 24

reassurance
Spont resolution
Topical oestrogen can be trialled for 1 month period, esp if urinary syx or vulvovaginitis, though fusion may recur

Question 25

Incidence of labial fusion

Answer 25

3.3% of prepubertal girls Peak incidence in 1st year Not present at birth

Question 26

Irregular periods are normal in first 2 years from menarche T/F

Answer 26

T, anovulatory cycles, HPA establishing cycles

Question 27

What is the most common cause of ambiguous genitalia?

Answer 27

congenital adrenal hyperplasia Often secondary to 21 hydroxylase deficiency -> unable to convert precursors to cortisol Effect is of increased androgenic hormones, high ACTH and low aldosterone (addisons)

Question 28

What is androgen insensitivity?

Answer 28

X linked recessive disorder, defect in androgen receptor -> XY karyotype, male gonads and normal testosterone levels, but female phenotype.

Question 29

Describe some of the specific treatment required for people with Androgen insensitivity

Answer 29

open disclosure, psychosocial support Gonadectomy post puberty (risk of malignancy) + HRT post and monitoring BMD Vaginal atresia -> dilators + surgical options

Question 30

Kallman’s syndrome (hypogonadortophic hypogonadism) Aeitology

Answer 30

Genetic syndrome resulting in failure of migration of olfactory neurons and GnRH producing neurons in brain -> hypothalamic hypogonadism -> amennorheoa and anosmia

Question 31

POI incidence

Answer 31

1%

Question 32

Is Imperforate hymen associated with other congenital abnormalities?

Answer 32

no

Question 33

Incidence of primary amenorhoea

Answer 33

0.3% (failure to commence menstruation by 15y or no secondary sexual characteristics by 13)

Question 34

WHO classification of amenorrhoea

Answer 34

Group 1 -> low E, low FSH, no hypothalamic/pit pathology -> hypogonadotrophic hypogonadism Group 2 -> normal E, normal FSH, normal PRL -> PCOS Group 3 -> low E, high FSH -> ovarian failure