fibroids

Question 1

what

Answer 1

benign tumours of smooth muscle of uterus

oestrogen sensitive

Question 2

more common in

Answer 2

black women

Question 3

intramural

Answer 3

within myometrium

as they grow they change shape and distort the uterus

Question 4

subserosal

Answer 4

just below outer lining of uterus

Question 5

submucosal

Answer 5

just below endometrium

Question 6

pedunculated

Answer 6

on a stalk

Question 7

presentation

Answer 7

HMB
prolonged menstruation 
abdo pain 
bloating
urinary or bowel symptoms due to pressure
dyspareunia 
reduced fertility

Question 8

OE

Answer 8

palpable pelvic mass

enlarged firm non-tender uterus

Question 9

initial Ix for submucosal fibroids with HMB

Answer 9

hysteroscopy

Question 10

Ix for larger fibroids

Answer 10

pelvic USS

Question 11

medical Mx for fibroids < 3cm

Answer 11

1. mirena coil

NSAIDS, tranexamic acid
COCP
cyclical oral progestogens

Question 12

surgical Mx options for smaller fibroids with HMB

Answer 12

endometrial ablation
resection (of submucosal fibroids during hysteroscopy)
hysterectomy

Question 13

Mx fibroids >3cm

Answer 13

gynae referral 
NSAIDs, tranexamic acid 
mirena coil depending shape and size 
COCP 
cyclical oral progestogens

Question 14

Mx surgical options for larger fibroids

Answer 14

uterine artery ablation
myomectomy
hysterectomy

Question 15

reducing size of fibroid before surgery

Answer 15

GnRH agonists e.g. goserelin

Question 16

myomectomy

Answer 16

removing fibroid

Question 17

complications of fibroids

Answer 17

HMB
reduced fertility 
pregnancy complications 
constipatios
urinary outflow obstruction 
red degeneration 
torsion

Question 18

red degeneration of fibroids

Answer 18

ischaemia, infarction and necrosis of fibroid due to inturupted blood supplt

Question 19

red degeneration of fibroids - when most likely to happen

Answer 19

bigger fibroids >5cm

during 2nd and 3rd trimester pregnancy - fibroid enlarged during pregnancy and may outgrow its bloodsupply

Question 20

red degeneration of fibroids - presentation

Answer 20

severe abdo pain
fever
tachycardia
vomit

Question 21

red degeneration of fibroids - features

Answer 21

supportive

- rest and analgesia