Acute Gynaecology

Question 1

1. Unilateral pelvic pain and HCG positive is a characteristic presentation of what?
2. What are the key investigations?
3. How is it managed?

Answer 1

1. Ectopic pregnancy
2. FBC and Ultrasound and G&S
3. Resus, ABCDE, laparoscopy (visualise) Laparotomy/salphingectomy

Question 2

1. Define ectopic pregnancy
2. Where does it most commonly occur?
3. If the location of the pregnancy is unknown what is the best option?

Answer 2

1. Pregnancy outwith the endometrial cavity.
2. Fallopian tubes
3. If patient clinically well, watch or wait/ medical management with methotrexate.

Question 3

1. Unilateral pelvic pain, HCG negative with no signs of infection- what are the possible diagnosis?
2. What investigations would you consider?
3. With the above presentation occuring after trauma what would be your most likely diagnosis?

Answer 3

1. Ovarian torsion, ovarian cyst accident, fibroids, renal calculi
2. FBC, G&S, CRP, Ultrasound, Bimanual examination
3. Cyst rupture

Question 4

1. How would you treat ovarian torsion?

2. Unilateral pelvic pain, HCG negative, signs of infection: diagnosis?

Answer 4

1. Resus, ABCDE, Laparoscopy(visualise), laparotomy/detorsion/cystectomy/oophorectomy.
2. Appendicitis

Question 5

1. How would you manage a Bartholin’s abscess

Answer 5

1. Conservative
Antibiotics- broad spectrum
Incision and drainage
Word catheter
Marsupialization

Question 6

What are considered the red flag symptoms of an ectopic pregnancy?

Answer 6

Recurrent abdominal/pelvic pain or with pain that requires opiates in a woman with known pregnancy

Question 7

1. Define Molar Pregnancy
2. How does it appear on ultrasound?
3. What is the clinical significance of a complete molar pregnancy?

Answer 7

1. a rare complication of pregnancy in which abnormal placental tissue is accompanied by either the absence of fetal tissue or by impaired fetal tissue that cannot survive.
2. ‘snowstorm’ appearance of placental vesicles
3. Risk of developing into a choriocarcinoma

Question 8

1. What is chorionic haematoma?

2. How does it present and how is it managed?

Answer 8

1. Pooling of blood between endometrium and the embryo due to separation
2. Bleeding, cramping, threatened miscarriage, usually self-resolving

Question 9

1. Define Hyperemesis Gravidarum
2. What are the possible effects of this
3. How might it be managed?

Answer 9

1. Excessive/protracted/life-altering vomiting during pregnancy.
2. Dehydration, electrolyte/nutritional imbalance, ketosis, weight loss, psych issues
3. Rehydration, NG tube feeding, antiemetics