common gynae presentations

Question 1

What are the main categories of primary amenorrhea?

Answer 1

Genetic causes (e.g., Intersex, hormonal deficiencies)
Congenital anatomical abnormalities:
- Mullerian agenesis
- Mullerian anomalies (e.g., imperforate hymen)
- Ovarian dysgenesis/agenesis

Question 2

What are the physiological causes of secondary amenorrhea?

Answer 2

Pregnancy
Lactation
Perimenarchal period
Perimenopausal period

Question 3

What are the contraception-related causes of amenorrhea?

Answer 3

Oral contraceptives
Injectable contraceptives
IUCD-induced amenorrhea
Post-cessation IMI (up to 9 months)

Question 4

What are the central causes of amenorrhea?

Answer 4

Tumors/lesions compressing hypothalamus/pituitary/stalk
Hypothalamic causes:
- Stress
- Under-nutrition
- Post infarction/surgery/irradiation

Pituitary causes:
- Hyperprolactinemia (with galactorrhea)
- Pharmacological (e.g., antipsychotics)
- Functional pituitary tumors

Question 5

What are the pregnancy-related causes of abnormal vaginal bleeding?

Answer 5

Miscarriage
Ectopic pregnancy
Gestational trophoblastic disease

Question 6

What are the types of dysfunctional uterine bleeding?

Answer 6

Anovulatory:
- Perimenarchal
- Perimenopausal

Ovulatory:
- Abnormal prostaglandin system
- Abnormal fibrinolytic system in endometrium

Question 7

What are the genital tract pathologies that can cause abnormal bleeding?

Answer 7

Congenital uterine abnormalities
Trauma
Infection
Endometriosis/adenomyosis
Benign tumors:
- Polyps
- Fibroids
- Endometrial hyperplasia

Malignancies:
- Endometrial
- Cervical
- Uterine sarcoma
- Hormone-secreting tumors

Question 8

What are the benign causes of post-menopausal bleeding?

Answer 8

Atrophic vaginal epithelium
Polyps (cervical/endocervical/endometrial)
HRT
Infections (e.g., TB/schistosomiasis)

Question 9

What are the malignant causes of post-menopausal bleeding?

Answer 9

Cervical cancer
Endometrial cancer
Sarcoma

Question 10

What are the gynecological causes of pelvic/abdominal pain?

Answer 10

Congenital: haematocolpos
Trauma: coital injury
Iatrogenic: post-surgery problems (adhesions)
Contraception-related: IUCD-induced dysmenorrhea or displacement
Functional ovarian cysts: torsion, hemorrhage, rupture
Infective: PID, Bartholin cyst abscess
Endometriosis

Question 11

What are the non-gynecological causes of pelvic/abdominal pain?

Answer 11

Medical causes:
- UTI/pyelonephritis
- Irritable bowel syndrome
- Porphyria
- DKA

Surgical causes:
- Appendicitis
- Diverticulitis
- Volvulus
- Mesenteric thrombosis

Question 12

What are the types of normal and infectious vaginal discharge?

Answer 12

Physiological:
- Normal daily discharge
- Increased during ovulation

Infectious:
- STIs: PID/cervicitis (chlamydia/gonorrhea/trichomonas)
- Vaginitis (bacterial vaginosis)
- Candida
- Infected vulval warts

Question 13

What malignant condition should be considered with postmenopausal discharge?

Answer 13

Infected cervical/vaginal cancer

Question 14

What are the main categories of causes for infertility?

Answer 14

Anatomical defects (congenital or acquired)
Genital tract infection (especially PID)
Psychological factors (stress, depression, relationship problems)
Medication (antidepressants, drugs causing hyperprolactinemia)
Substance abuse (smoking, alcohol, drugs)
Previous surgery (abdominal or pelvic adhesions)
Medical conditions:
- Endocrine dysfunction (thyroid, adrenals, pituitary, PCOS)
- Chronic renal/liver disease
- Hypothalamic pathology

Question 15

What are the pregnancy-related causes of pelvic mass?

Answer 15

Intrauterine pregnancy
Ectopic pregnancy
Gestational Trophoblastic Disease

Question 16

What are the gynecological causes of pelvic mass?

Answer 16

Ovarian:
- Benign: Functional ovarian cyst, endometrioma
- Malignant: Ovarian carcinoma

Uterine:
- Benign: Fibroid
- Malignant: Sarcoma

Other:
- Tubal carcinoma (rare)
- Pelvic wall endometriosis

Question 17

What are the non-gynecological causes of pelvic mass?

Answer 17

Benign:
- Distended bladder
- Impacted feces
- Diverticular disease
- Appendix abscess
- Hydatid disease
- Pelvic kidney

Malignant:
- Bowel cancer
- Bladder cancer

Question 18

What are the psychological and medical causes of sexual dysfunction?

Answer 18

Psychological:
- Depression
- Marital/relationship discord
- Stress
- Poor body image
- Negative attitudes to sex

Medical:
- Peripheral neuropathy (e.g., diabetes)
- Spinal cord disease/trauma
- Post-radiation for pelvic cancer
- Endocrine disorders (thyroid, pituitary)
- Conditions causing pelvic pain/dyspareunia
- Menopause (vaginal atrophy and dryness)
- Pregnancy-related issues
- Post-partum problems

Question 19

What are the types of infective vulval lesions?

Answer 19

Raised lesions:
- Warts (condylomata accuminata - HPV)
- Syphilis (gumma, condylomata lata)
- Molluscum contagiosum

Ulcerative:
- Herpes simplex
- Syphilitic chancre
- Lymphogranuloma venereum

Question 20

What are the causes of vulval pruritus?

Answer 20

Infective:
- Tinea
- Candida
- Scabies
- Threadworm
- UTI

Non-infective:
- Skin disorders (allergic/irritant dermatitis, psoriasis, lichen planus)
- Vulval dystrophy (lichen sclerosis, squamous cell hyperplasia)
- Atrophy (post-menopausal)
- Premalignant/malignant conditions (VIN, carcinoma, melanoma)
- Other (foreign body, psychological causes)