acute gynae condition

Question 1

what are the three types of cyst accident?

Answer 1

haemorrhage
torsion
rupture

Question 2

features and treatment of a haemorrhagic ovarian cyst?

Answer 2

pain relieved by NSAIDs

treated conservatively

Question 3

features of ovarian torsion?

Answer 3

acute, severe pain not relieved by NSAIDS
diagnosed via laparoscopic surgery
risk of ovary infarct

Question 4

which cyst is most likely to be in torsion?

Answer 4

> 5cm

dermoid cyst

Question 5

which type of cyst most commonly ruptures?

Answer 5

functional cyst in young women after trauma/contact sports

Question 6

most common benign ovarian masses?

Answer 6

functional cyst
endometriotic cyst
dermoid cyst
fibroma 
borderline ovarian tumour

Question 7

triad seen in meigs syndrome?

Answer 7

benign cyst (fibroma)
ascites
pleural effusion

transudate (protein <30g/L)*

Question 8

describe what is meant by cervical excitation?

Answer 8

acute pain is felt when the cervix is moved during a bimanual vaginal exam

Question 9

main investigations for a pelvic mass?

Answer 9

abdominal and bi manual exam
serum Ca125
pelvic transvaginal USS

Question 10

what is a heterotopic pregnancy?

Answer 10

twins - one is in the uterus and one is ectopic

Question 11

which drug is used in the medical management of an ectopic/PUL?

Answer 11

methotrexate

Question 12

what are the two surgical options for managing a tubal ectopic?

Answer 12

salpingotomy (remove ectopic only)

salpingectomy (remove ectopic and tube)

Question 13

is ovarian torsion a surgical emergency?

Answer 13

yes - risk of ovarian infarct

Question 14

features of pelvic inflammatory disease?

Answer 14

bilateral lower abdominal pain
deep dyspareunia
abnormal PV bleeding and discharge
N&V in 50% of PID cases

Question 15

differential diagnosis for PID?

Answer 15

appendicitis

Question 16

treatment for PID?

Answer 16

14 days metronidazole + doxycycline

remove IUD if patient is not better in 7 days

Question 17

which HSV types cause genital ulcers?

Answer 17

HSV 1 - oral ulcers
HSV 2 - genital ulcers

but there is considerable overlap

Question 18

features of genital herpes?

Answer 18

multiple painful ulcers, urinary retention, dysuria

Question 19

treatment of genital herpes?

Answer 19

oral aciclovir
catheterisation
local anaesthetic gel

Question 20

when should a pregnant woman with HSV be advised to have an elective C-section?

Answer 20

if her primary herpes attack occurs at >28 weeks of gestation

Question 21

features of HSV on a pap smear?

3 M’s

Answer 21

Multinucleated giant cells
Margination of chromatin
Moulding of the nuclei