Benign gynae Flashcards
Fibroids: All of the following statements are true except:
a - >20% of fibroids have a chromosomal abnormality
b - on cytogenetics a single fibroid comes from one single cell (not pleomorphic)
c - 20% of women develop a fibroid
d - Medroxy progesterone acetate most commonly inhibits fibroid mitotic activity
d - Medroxy progesterone acetate most commonly inhibits fibroid mitotic activity
Studies show progestogens actually increase mitotic activity
Red degeneration of a fibroid:
a - causes an elevation of the ESR
b - causes leukopaenia and lymphocytosis
c - only occurs in pregnancy
d - occurs due to embolisation of the major blood vessels supplying the myoma
a - causes an elevation of the ESR
O
Dermoid cysts
A - are the commonest ovarian neoplasms detected in pregnancy
B - are malignant in 10% of cases
C - are bilateral in 40-60% of cases
D - often have a 46, XY chromosomal composition
A - are the commonest ovarian neoplasms detected in pregnancy
O
A 15 yr old girl presents with pelvic pain and an US shows a 4 cm ovarian cyst. What is the commonest cause?
A - Dermoid cyst B - Follicular cyst C - Corpus luteal cyst D - Serous adenoma E - Endometrioma
B - Follicular cyst
Follicular cysts are most common type in adolescents (UTD).
What is the rate of amenorrhoea in patients with intrauterine synechiae?
A - 10% B - 20% C - 40% D - 60% E - 80%
C - 40%
As per UpToDate
Can be caused by TB
Rx: hysteroscopic resection
What is the most common symptom of benign breast disease?
A - pain B - tender lump C - change in breast size D - discharge E - change in menses
B - tender lump
*CHECK as other answer says A
Advantages of GnRH agonist for the treatment of fibroids include all of the following EXCEPT:
A - allow vaginal hysterectomy
B - allow return of patient Hb towards normal before surgery
C - diagnostic test to distinguish between fibroid and leiomyosarcoma
D - allows hysteroscopic resection of fibroid
E - reduced intraoperative blood loss
C - diagnostic test to distinguish between fibroid and leiomyosarcoma
What percentage of fibroids will shrink with GnRH analogues?
A - 10% B - 25% C - 50% D - 75% E - 90%
C - 50%
Cochrane review states 47% reduction in volume
After 6 months of GnRH analogues, how much reduction in uterine size would you expect?
A - 10% B - 25% C - 50% D - 75% E - 90%
C - 50%
The most frequent cause of dyspareunia is
a - inadequate lubrication b - retroverted uterus c - vaginismus d - endometriosis e - pelvic inflammatory disease
a - inadequate lubrication
O
30 yo para 1 with a 3 yo child presents with menorrhagia and on VE there is a 12 week fibroid uterus palpable. She would like another child in the future. Management:
a - TAH b - Myomectomy abdominally c - GnRH analogue for 6/12 d - Continuous provera for 9/12 e - Hysteroscopic resection
b - Myomectomy abdominally
?
Can’t confirm hysteroscopic resection unless know fibroids are submucosal.
No benefit from progestogen only therapy
Which of the following is correct in regard to premenstrual syndrome?
A - it is due to low progesterone level
B - bromocriptine is more effective than cyclical synthetic progesterone in treating PMS
C - cyclical progesterone showed no advantage over placebo in treating PMS
D - it is due directly to endogenous endorphin withdrawal
E - it is related to HLA B27 typing
C - cyclical progesterone showed no advantage over placebo in treating PMS
A woman had a NVD with an episiotomy and has been BF for 8 weeks. She presented complaining of dyspareunia. O/E the episiotomy is well healed. What is the most likely diagnosis?
A - suture granuloma
B - atrophic vaginitis
C - PND
D - Narrowed introitus
B - atrophic vaginitis
A woman has a regular 24 day cycle and is experiencing midcycle bleeding. Which of the following is correct?
a. Oestrogen breakthrough
b. Oestrogen withdrawal
c. Progesterone breakthrough
d. Progesterone withdrawal
e. Inadequate androgens
b. Oestrogen withdrawal
Physiologic intermenstrual bleeding at the time of expected ovulation is secondary to the brief abrupt decline in estradiol that follows its preovulatory surge.
Milford
A 46 yo lady presented with severe menorrhagia for six months and clinical evidence of a tender enlarged uterus. What is your first investigation?
A - hysteroscopy and D&C B - FBC C - LH and FSH D - Coagulation profile E - Serum progesterone
B - FBC
Milford
A woman presented to you with lack of sexual excitement. What is the most likely reason?
A - fear of pregnancy B - poor coital techniques C - marital discordance D - endometriosis E - pelvic congestion syndrome
C - marital discordance
25 yo. O/E 5 cm simple cystic R adnexal mass confirmed on US. Mx?
A - repeat exam in 3/12
B - give OCP and repeat US in 1/12
C - laparotomy
D - laparoscopy and aspiration of cyst
A - repeat exam in 3/12
<50mm diameter - do not require f/u
- Likely physiological and almost always resolved within
50-70mm - yearly USS f/u
25 yo, 1 yr history of acute virilizing symptoms and normal pelvic exam. LH 2 (low) FSH 3 (low-normal) Testosterone 2-3x normal DHEAS normal 17 OHP Normal
A - Cushing’s syndrome B - PCOS with insulin resistance C - Late onset CAH D - Sertoli-Leydig cell tumour E - Adrenal cortical adenoma
D - Sertoli-Leydig cell tumour
O
43 yo rapid onset virilizing symptoms, normal pelvic exam
LH 2 L (4-25) FSH 3 N Test 12.3 H (0.5-2.5) DHEAS 25 H (0.9-11.7) 17 HOP N
A - Cushing syndrome
B - Polycystic ovarian syndrome with insulin resistance
C - Late onset congenital adrenal hyperplasia
D - Sertoli-leydig tumour
E - Adrenal cortical adenoma
E - Adrenal cortical adenoma
O
22 yo, long Hx irregular menses and hirsuitism. Short stature, OE borderline clitoromegaly. LH 12 (N) FSH 6 (N) Test 3 (1.5x normal) DHEAS 21 (1.5x normal) 17 HOP 16.5 (2x normal)
A - PCOS
B - Late onset CAH
C - Androgen secreting tumor of the ovary
D - Androgen secreting tumor of the adrenal
E - Ovarian hyperthecosis
B - Late onset CAH
*Isolated DHEAS would suggest androgen secreting tumor of the adrenals
O
22 yo long Hx irregular menses and hirsuitism LH 1.9 FSH 6 Test 1.5x normal DHEAS 1.5x normal 17 HOP normal
A - Cushing’s syndrome B - PCO C - Late onset CAH D - Sertoli-leydig tumour E - Adrenal cortical adenoma
B - PCO
47 yo has progressive menorrhagia with regular cycles. O/E uterus normal anteverted with no adnexal masses. Hysteroscopy – regular cavity, no pathology.
D&C – secretory normal endometrium.
Management?
A - Cyclic Progesterone
B - OCP
C - NSAIDS
D - Advise endoablation, compared to TAH is more effective and less complications
E - Advise endoablation is adequate contraception
A - Cyclic Progesterone
*CHECK as other answer says C
How long does it take to stop heavy bleeding with GnRH analogues?
A - 12 hrs
B - 18 hrs
C - 1 week
D - 4 weeks
D - 4 weeks
Begins to work after 2 weeks
Which of the following is true concerning uterine fibroids?
A - characteristically cause pain
B - associated with nulliparity
C - 1% undergo sarcomatous change
D - should be removed at caesarean section if larger than 2cm diameter
B - associated with nulliparity
O
0.02-0.3% undergo sarcomatous change