Gynaecology

Question 1

Features of uterine fibroids

Answer 1

Can be asymptomatic
Menorrhagia - may result in iron deficiency

Bulk related symptoms: lower abdo pain e.g. cramping often during menstruation
Bloating
Urinary symptoms e.g. frequency

Subfertility

Question 2

How are uterine fibroids diagnosed

Answer 2

Transvaginal ultrasound

Question 3

Management of uterine fibroids

Answer 3

Assympomatic? - no treatment- review to monitor size and growth

Manage menorhagia:
Levonorgestrel interfering system
Mefanamic acid
Tranexamic acid
Cocp
Oral or injectable progesterone

To reduce/shrink
Short term GnRH - menopause symptoms

Surgery - myomectomy to remove fibroids

Hysterectomy

Question 4

What is the Rotterdam criteria for pcos

Answer 4

2 of the 3 present:

Polycystic ovaries on uss >=12 cyst
Infrequent or no ovulation
Signs of hyperandrogenism - e.g. acne, hirituism,

Question 5

Signs and management of pcos

Answer 5

Weight gain,
Menstrual disturbance (oligomenorrhoea, amenorrhoea)
Hirituism, acne
Acantyhosis nigricans (insulin resistance)
Infertility

Risk of developing diabetes

Manage symptoms:
Weight reduction if appropriate
If require contraception COCP may help regulate cycle and manage hirituism and acne

Metformin- if obese
Gonadotropins

Regular monitor weight, blood pressure, lipids and hba1c
Safetynet- mental health support

Question 6

Investigation for pcos

Answer 6

Pelvic USS

Bloods: hba1c, lipids,

Question 7

PID complications

Answer 7

Infertility
Perihepatitis - fitzhugh curtis syndrome, inflammation of liver capsule