Acute Gynae

Question 1

What are investigations for unilateral abdo pain in female with suspicion of ectopic?

Answer 1

FBC, G&S, USS - FAST scan versus transvaginal

Question 2

What is presentation of ectopic pregnancy? (8)

Answer 2

shoulder tip pain, bleeding, LMP, dyschezia, vomiting and diarrhoea, faint, hypotensive, tachycardia

Question 3

Ectopic pregnancy risk factors (7)

Answer 3

previous ectopic, tubal damage, IUS/IUD, smoking, infertility, infertility treatment, odler reproductive age

Question 4

Initial management of ectopic

Answer 4

resus, ABCDE

Question 5

What are surgical managements options for ectopic

Answer 5

laparoscopic, laparotomy, salphingectomy, salphingotomy, anti D if necessary

Question 6

Pregnancy of unknown location presentation in terms of HCG levels?

Answer 6

static HCG - if goes down then failing, if static then unknown location, if rising then normal pregnancy. , clinically well

Question 7

What are management options for PUL?

Answer 7

expectant management, medical: methotrexate, consider surgical

Question 8

Cyst presentation (4)

Answer 8

sudden onset unilateral fossa pain,
faint,
tachycardia,
normotensive

Question 9

Cyst investigations? (3)

Answer 9

Bloods (FBC, CRP, G&S), palpable mass on vaginal exam, transvaginal ultrasound

Question 10

Torsion is more likely with a cyst of what size?

Answer 10

more likely with a cyst >5cm

Question 11

What percent of ovarian torsion are caused by dermoid cysts?

Answer 11

10%

Question 12

What percent of adnexal torsions occur in children?

Answer 12

25%

Question 13

Premenopausal ovarian torsion most likely ____ whereas postmenopausal ovarian torsion most likely ___

Answer 13

benign, malignant (shouldn’t be producing follicles)

Question 14

Ovarian torsion treatment (5)

Answer 14

resus and ABCDE, 
laparoscopy/laparotomy, 
detorsion, 
cystectomy, 
oophrectomy (if necrotic)

Question 15

Cyst accident presentation? (6)

Answer 15

sudden onset unilateral fossa pain, 
may be precipitated by sex, sports or spontaneous, 
tachycardic, 
hypotensive, 
apyrexial,
 HCG negative

Question 16

Cyst accident investigations?

Answer 16

Bloods (FBC, CRP, G&S), peritonism, ultrasound

Question 17

How does fluid in peritoneum appear on USS in cyst rupture in comparison to ectopic rupture?

Answer 17

Cyst rupture all black, watery fluids as opposed to different colours in ectopic pregnancy ruputre

Question 18

Cyst rupture commonly occurs in what type of cyst and rarely in which?

Answer 18

common in functional cysts, rarely in dermoid or endometrioma

Question 19

Management cyst accident?

Answer 19

Conservative if not that unwell. If unwell resus, laparoscopy, lavage, stop bleeding, oophrectomy if needed

Question 20

Presentation PID? (7)

Answer 20

gradual onset generalised lower abdo pain, 
discharge, 
dyspareunia, 
intermenstrual & post coital bleeding, 
anorexia, 
n&v (but more likely with appendicitis) 
normal HR, BP, temp and HCG neg

Question 21

PID investigations

Answer 21

Bloods: FBC, CRP, LFT (PIDs can irritate liver), Cervical motion tenderness, genital swabs x2

Question 22

What is another word for cervical excitation?

Answer 22

cervical motion tenderness

Question 23

What is PID and what can it cause inflammation of?

Answer 23

An ascending infection from endocervix that can cause endometritis, salphingtitis and tubo-ovarian abscess

Question 24

List 4 organisms that can cause PID

Answer 24

Chlamydia, gonorrhoea, gardenella, anaerobes

Question 25

What are some long term complications of PID? (3)

Answer 25

Infertility, chronic pelvic pain and ectopic pregnancy

Question 26

Management of PID?

Answer 26

14 days metronidazole and doxycycline, IV if needed, remove IUD if can, laparoscopy if needed to drain abscess

Question 27

What are 4 menstrual causes of acute bleeding?

Answer 27

If you get anovulatory periods e.g. puberty or premenopause, fibroids, on anticoagulant, von willebrand's disease

Question 28

What are 4 non menstrual causes of acute bleeding?

Answer 28

miscarriage, cervical causes, endometrial cancer, vaginal trauma

Question 29

Why do fibroids cause acute bleeding?

Answer 29

Fibroids increase surface area of uterus so more area to bleed from

Question 30

Acute vaginal bleeding investigations?

Answer 30

Bloods (FBC, CRP, Coag, G&S, HCG, LFTs, Ferritin), consider: endometrial biopsy (in 40s,50s), cervical biopsy, examine pad, ultrasound ( for thickened endometrium, fibroids)

Question 31

What are management options for acute bleeding?

Answer 31

resus, tranexamic acid (antifibrinolytic to prevent clot breakdown), mefanamic acid (NSAID to reduce blood supply), norethisterone (synthetic progesterone, stabilises endometrium), IUS (stabilises endometrium), COC, GnRH analogues (overload system so downregulation of FSH and LH)

Question 32

HSV Presentation?

Answer 32

vulval pain, ulceration, discharge, dyrsuria, urinary retention

Question 33

Investigations HSV?

Answer 33

Viral swab

Question 34

Treatment HSV?

Answer 34

aciclovir, consider bladder catheter if urinary retention, local anaesthetic gel

Question 35

Bartholin's glands are at 5 and 7 o clock. Bartholins gland cyst presentation?

Answer 35

Infection signs, swelling, pain, waddle into clinic and sit on one buttcheek

Question 36

Bartholins abscess investigations?

Answer 36

swab

Question 37

Bartholins cyst treatment?

Answer 37

Conservative if not infected (will drain itself), antibiotics - broad spectrum, incision and drainage, word catheter, marsupialisation

Question 38

4 other considerations of acute gynae presentation causes?

Answer 38

retained tampon, foreign body in vagina, procidentia (prolapse), post colposcopy infection

Question 39

Negative swabs exclude PID. True/false?

Answer 39

False - they don't exclude

Question 40

What is another name for fibroid?

Answer 40

Leiomyoma

Question 41

How can anovulation cause acute bleeding?

Answer 41

Get a build up of a couple months of period coming out at once