clinical gynaecology

Question 1

describe cervical screening

Answer 1

PAP smear

- effective screening test for cervical cancer

Question 2

what does clinical gynecology include

Answer 2

the female genital tract

• discomfort/disease
• prevention of disease
• reproduction/contraception

Question 3

when a patient comes in with gynecological symptoms what is the next step?

Answer 3

• take a proper history
• do a gynecological examination
• order further investigations

Question 4

describe gynecologic history taking

Answer 4

presenting complaint

• onset, duration, course, severity
• lifestyle impact

specific complaint related history

• cervical smear
• sexual health
• obstetric history
• menstrual bleeding

Question 5

questions to ask when a patient comes in with heavy menstrual bleeding

Answer 5

• last menstrual period
• cycle regularity
• flow
• inter-menstrual bleeding
• postcoital bleeding
• medications

Question 6

describe gynecological examination

Answer 6

• general & abdominal examination (breast >40yrs)

- pelvic exam e.g. speculum & bimanual

Question 7

describe gynaecological investigations

Answer 7

• urine
• cervical smear
• vaginal swabs
• biopsy (pipelle)
• ultrasound
• blood test

Question 8

what are structural causes of heavy menstrual bleeding

Answer 8

P= Polyps
A= adenomyosis
L = leiomyoma
M = malignancy & hyperplasia

Question 9

what are the non-structural causes of heavy bleeding

Answer 9

C = coagulopathy
O = ovulatory dysfunction
E = endometrial
I = iatrogenic
N = not yet classified

Question 10

define uterine fibroids and the symptoms present

Answer 10

benign leiomyomata arising from the uterine myometrium

• no pain
• pelvic discomfort
• abnormal uterine bleeding

Question 11

treatment of uterine fibroids

Answer 11

conservative

medical

• NSAIDS during menstrual bleeding
• GnRH analogues
• mirena if fibroids are small and not submucosal

invasive

• Myomectomy
• hysterectomy
• uterine artery embolism

Question 12

treatment for heavy menstrual bleeding

Answer 12

initially:

• progesterones (high dose / 10 days)
• tranexamic acid

followed by:

• oral contraceptive (depending on Aage and BMI)
• progesterone

Question 13

describe tranexamic acid

Answer 13

anti-fibrinolytic that prevents plasminogen activation

Question 14

what are surgical procedures for heavy menstrual bleeding

Answer 14

endometrial ablation (balloon method)

hysterectomy

Question 15

types of incontinence

Answer 15

• overflow
• stress
• urge

(common in overweight women)

Question 16

describe endometriosis and how it is diagnosed

Answer 16

• a disease characterized by functional extra-uterine endometrium
• diagnosed by laparoscopy

Question 17

treatment for endometriosis

Answer 17

• explanation and multidisciplinary approach
• pain managment
• hormonal supression of endometrial cells
• (mirena)
• surgical e.g. laparoscpoic excision