GP (Womens)

Question 1

DDx for Pelvic pain. List 3 Sx for each.

Answer 1

• Ectopic pregnancy (no period, abnormal PV bleeding, intense acute pain + haemodynamic instability after rupture)
• PID (fever, cervical redness & excitation, sexually active)
• Endometriosis (Infertility, Dysmenorrhoea, menorrhagia, deep dyspareunia)

Question 2

The triad of endometriosis?

Answer 2

Dyspareunia, Dysmennorhoea, Infertility

Other Sx dyschezia, chronic pelvic/back pain

Question 3

Mx of endometriosis

Answer 3

• Analgesia (NSAIDs e.g. naproxen)
• OCP
• Mirena
• Surgical excision of endometriosis

Question 4

SMOG every patient! What is a SMOG Hx?

Answer 4

• Sexual (activity, pain, STI screening, PID, barrier contraception)
• Menstrual Hx (Menarche, regular, cycle length, pain, bleeding)
• Obstetric (Pregnancies, delivery, complications, miscarriage, terminations)
• Gynae (Endometriosis, pap smears, prev. Ix)

Question 5

When do you advise against falling pregnant?

Answer 5

• Severe CKD (Cr > 265-requires transplant before proceeding)
• Pulmonary fibrosis (>50% mortality)
• Teratogenic medications need to be altered or ceased

Question 6

Main forms of contraception

Answer 6

• Barrier contraception (ONLY CONDOMs PREVENT STIs)
• OCP (combined/prog. only)
• IUD (Mirena) (risk of actinomycosis)
• Implanon