pass med Q's - Gynae

Question 1

how does the combined contraceptive pill work

Answer 1

inhibits ovulation

Question 2

increased risks with combined contraceptive

Answer 2

increased risk

• blood clots
• MI / strokes
• breast + cervical cancer

Question 3

how does the IUS (Mirena coil) work

Answer 3

prevents endometrial proliferation + thickens cervical mucus

Question 4

side effect of IUS

Answer 4

irregular bleeding

- many patients become amenorrhoeic

Question 5

how longer after insertion can an IUS be relied on

Answer 5

7 days

Question 6

how does the IUD (copper coil) work

Answer 6

decreases sperm motility + survival

Question 7

side effect of IUD

Answer 7

heavier, longer, more painful periods

Question 8

how long after insertion can an IUD be relied on

Answer 8

immediately

Question 9

when is contraception required from post partum

Answer 9

contraception required from 21 days post partum

Question 10

for how long post partum is the contraceptive pill contraindicated for

Answer 10

6 weeks

Question 11

what emergency contraceptives are available?

how long after UPSI are they effective for?

Answer 11

levonorgestrel - 72 hours UPSI
ulipristal (Ella one) - 120 hours UPSI
IUD - 5 days USPI

Question 12

symptoms of endometriosis

Answer 12

chronic pelvic pain
dysmenorrhoea
dyspareunia
sub fertility

Question 13

how does the uterus feel on examination in endometriosis

Answer 13

decreased motility

tender nodularity in posterior fornix

Question 14

gold standard investigation of endometriosis

Answer 14

laparoscopy

Question 15

tx of endometriosis

Answer 15

NSAIDS / paracetamol

combined contraceptive pill

Question 16

what is endometriosis a risk factor for

Answer 16

ectopic pregnancy

Question 17

risk factors for ectopic pregnancy

Answer 17

endometriosis 
damage to tubes -- pelvic inflammatory disease
previous ectopic 
progesterone pill 
IVF

Question 18

most common site of ectopic pregnancy

Answer 18

ampulla

Question 19

most common site of a ruptured ectopic pregnancy

Answer 19

isthmus

Question 20

classical presentation of an ectopic pregnancy

Answer 20

6-8 weeks since last period, abdominal pain, small PV bleed dark blood, cervical excitation, high beta-HCG

Question 21

Ix of an ectopic

Answer 21

pregnancy test + transvaginal USS

Question 22

medical management of an ectopic

Answer 22

IM methotrexate

Question 23

when is surgical management of an ectopic needed

Answer 23

size > 35 mm
severe pain / haemodynamic compromise
visible fetal heart beat
beta -HCG > 1500

Question 24

options for surgical ectopic management

Answer 24

salpingectomy

– salpingotomy if there is contralateral tube damage

Question 25

1st line management of heavy periods

Answer 25

``` Mirena coil (IUS) - Tranexamic acid if they don't want/need contraception ```

Question 26

1st line management of painful periods

Answer 26

Mefenamic acid / ibuprofen | - COC 2nd line

Question 27

1st line management of a fibroid

Answer 27

if < 3cm and not distorting cavity a Mirena coil is first line - other options : COC, tranexamic acid

Question 28

surgical management of fibroids

Answer 28

indicated if > 3cm or distorting the cavity or if definite management wanted by patient - myomectomy if they still want to preserve fertility - hysterectomy if they don't

Question 29

what drug can be given prior to surgery to shrink fibroid size

Answer 29

GnRh agonists e.g. leuprolide

Question 30

what drug is used to induce ovulation in patients with PCOS

Answer 30

letrozole (aromatase inhibitor)

Question 31

PCOS patients who undergo IVF are at risk of what

Answer 31

ovarian hyperstimulation syndrome

Question 32

presentation of ovarian torsion

Answer 32

deep abdominal pain -- onset may occur with exercise nausea + vomiting unilateral tender adnexal mass

Question 33

USS findings ovarian torsion

Answer 33

free fluid | whirlpool sign

Question 34

tx ovarian torsion

Answer 34

laparoscopy

Question 35

most common ovarian cyst

Answer 35

follicular cyst

Question 36

features of a complex cyst | how should these be managed ?

Answer 36

solid mass multiloculated - measure CA 125, aFP, beta HCG + cystectomy to exclude malignancy

Question 37

features of a simple cyst | how should these be managed ?

Answer 37

thin walled non- located < 5cm - reassurance, repeat USS in 8 weeks UNLESS symptomatic -- then offer cystectomy

Question 38

high voiding detrusor pressure + low peak flow suggests what type of incontinence

Answer 38

overflow

Question 39

management of urge incontinence

Answer 39

bladder retraining antimuscarinics -- oxybutinin / tolterodine (mirabegron can be given if can't take antimusc)

Question 40

management of stress incontince

Answer 40

pelvic floor muscle training

Question 41

investigations of incontinence

Answer 41

bladder diary vaginal examination for prolapse urodynamic studies if there is diagnosis uncertainty / plans for surgery

Question 42

presentation of a vesicovaginal fistulae

Answer 42

continuous dribbling often after a prolonged labour | - investigate with urinary dye studies

Question 43

what is a rokitansky protuberance seen in

Answer 43

``` a teratoma (dermoid cyst) - most common benign tumour in patients < 25 ```

Question 44

treatment of pelvic inflammatory disease

Answer 44

oral ofloxacin + oral metronidazole | or IM ceftriaxone + oral doxycycline + oral metronidazole

Question 45

what lymph nodes do endometrial + ovarian tumours spread to

Answer 45

para aortic nodes

Question 46

what lymph nodes do cervical carcinomas spread to

Answer 46

pelvic nodes