Acute Gynaecology

Question 1

What is an ectopic pregnancy?

Answer 1

Pregnancy outwit the endometrial cavity - majority are in the tube

Question 2

State the risk factors for an ectopic pregnancy

Answer 2

Previous ectopic, tubal damage, IUD, smoking (kills microvilli), infertility/IVF (fluid can travel past the uterus and into the tubes), extremes of age and sterilisation

Question 3

What investigations should be done in suspected ectopic pregnancy?

Answer 3

FBC, Group and save

US/FAST - donut sign due to thickening of sac, free fluid

Question 4

How is an ectopic pregnancy managed?

Answer 4

Resuscitation, laparoscopy, better
- salpingectomy if other tube is normal
- salpingostomy if worries over fertility
Anti-D vaccine

Question 5

What dictates the management in pregnancy of unknown location?

Answer 5

HCG - will decrease in miscarriage, normally will double but can be static

Question 6

How is a pregnancy of unknown location treated medically?

Answer 6

Methotrexate

Question 7

What surgery can be done in pregnancy of unknown location?

Answer 7

Diagnostic laparoscopy - uterus can be washed out simultaneously

Question 8

At what size of cyst is ovarian torsion likely?

Answer 8

> 5cm

Question 9

Is an ovarian cyst likely to be benign or malignant?

Answer 9

Premenopause - benign

Postmenopause - malignant

Question 10

Describe the investigations in ovarian torsion

Answer 10

Palpable mass on examination
FBC, CRP, group and save
Ultrasound - arterial gorging
AXR - mass, calcification in dermoid cyst

Question 11

What is a dermoid cyst?

Answer 11

Cyst with hair/teeth can have any cell from the body

Question 12

How are ovarian torsions managed?

Answer 12

Laparoscopy, bag and take out via umbilicus (detort without bursting)

Question 13

How does a cyst rupture present?

Answer 13

Unilateral pain often bleeding after sex/contact sport

Question 14

What kind of cyst commonly ruptures?

Answer 14

Functional
Dermoid
Endometrioma

Question 15

What investigations are done in cyst rupture?

Answer 15

FBC, CRP, Ultrasound - free fluid in pelvis

Question 16

How is a cyst rupture managed?

Answer 16

Conservative

Laparoscopy - lavage and stop bleeding with diathermy

Question 17

What is PID?

Answer 17

Pelvic Inflammatory Disease - caused by ascending infection from the endocervix

Question 18

What are the causes of PID?

Answer 18

Endometritis 
Abscess
Chlamydia 
Gonorrhoea 
Gardenella 
Anaerobes

Question 19

What are the consequences of PID?

Answer 19

Infertility
Chronic pelvic pain
Ectopic pregnancy

Question 20

State the investigations that should be carried out in PID

Answer 20

FBC, CRP, LFT, cervical motion tenderness, gonorrhoea and chlamydia swabs

Question 21

How is PID managed?

Answer 21

Ceftriaxone, metronidazole and doxycycline

Question 22

What are the menstrual related causes of acute bleeding?

Answer 22

Anovulatory
Fibroids
Anticoagulant
Van Willebrands Disease

Question 23

What are the non-menstrual related causes of acute bleeding?

Answer 23

Miscarriage
Cervical cancer
Endometrial cancer
Vaginal trauma

Question 24

What investigations should be done in acute gynae bleeding?

Answer 24

FBC, CRP, HCG, coagulation, GandS
LFT, ferritin 
Endometrial/cervical biopsy 
Ultrasound 
Examine pad

Question 25

How is acute gynae bleeding managed?

Answer 25

ABCDE
Tanexamic acid - fibrinolytic
Mefanamic acid - NSAID reduces blood supply
Norethisterone - progesterone stabilises endometrium
IUS - stabilises lining to stop period
COCP
GnRH analogue - temporary menopause

Question 26

How will an infected Bartholin’s abscess present?

Answer 26

Painful swelling - unable to sit down

Question 27

What causes bartholin’s abscess?

Answer 27

E.coli

Anaerobes

Question 28

How can Bartholin’s abscess be treated?

Answer 28

Conservative
Broad Spec antibiotics
Incision and drainage with word catheter
Marsupialisation - suture backwards to drain freely