GYNAE

Question 1

Non-surgical management of prolapse

Answer 1

lifestyle: weight loss, smoking cessation, treat chronic cough/constipation
topical oestrogen
vaginal pessary

Question 2

What are some differentials for IMB?

Answer 2

hormonal contraception
cervical ectropion 
STI
polyps/fibroids
endometrial or cervical cancer
vaginal trauma
peri-menopause

Question 3

Investigate IMB

Answer 3

STI screen

TVUSS +/- endometrial biopsy

Question 4

Manage a cervical polyp

Answer 4

small risk of malignant transformation so remove in clinic and send to histology

Question 5

What are some differentials for menorrhagia?

Answer 5

endocrine: HPO axis dysfunction, thyroid disease, excess oestrogen (obesity/ liver disease)
structural: fibroids or polyps

clotting disorder

PID

endometrial cancer

Question 6

Investigate menorrhagia

Answer 6

FBC, clotting screen, TFTs

US for fibroids/polyp

+/- endometrial biopsy

Question 7

Medical management of menorrhagia

Answer 7

1. tranexamic acid
2. mirena coil
3. add NSAID to tranexamic acid
4. COCP

Question 8

What are some non-gynae causes of pelvic mass?

Answer 8

bowel: constipation, abscess, tumour
urological: retention, pelvic kidney

Question 9

What are some gynae causes of pelvic mass?

Answer 9

pregnancy
uterus: fibroids, endometrial cancer (rare)
cervical cancer (late)
ovarian cyst
ectopic pregnancy if acute
ovarian cancer

Question 10

How is ? ovarian cancer investigated?

Answer 10

Ca125
TVUSS
menopause status

biopsy not done as hard to obtain
may need further imaging with MRI

Question 11

Which form of HRT is given to menopausal women?

Answer 11

continuous

Question 12

Which form of HRT is given to perimenopausal women?

Answer 12

cyclical

Question 13

Which form of HRT is given to a woman with a uterus?

Answer 13

combined

Question 14

Which form of HRT is given to a woman without a uterus?

Answer 14

oestrogen only, continuous

Question 15

Manage patient on LARC with dysmenorrhoea

Answer 15

mefanamic acid

Question 16

Manage large fibroid which is affecting fertility

Answer 16

myomectomy

Question 17

What is the definitive management of adenomyosis?

Answer 17

hysterectomy

Question 18

What is the most common form of endometrial malignancy?

Answer 18

adenocarcinoma

Question 19

Manage endometrial hyperplasia

Answer 19

if typical use progestogens
premenopause –> IUS

atypical needs hysterectomy

Question 20

What is a leiomyoma?

Answer 20

fibroid

benign proliferation of myometrium

Question 21

What is the most common type of ovarian tumour?

Answer 21

serous epithelial tumour

Question 22

What is the most common type of cervical cancer?

Answer 22

Squamous cell carcinoma (CIN is precancer)

Question 23

when can vaccum aspiration abortion be carried out until?

Answer 23

14 weeks

Question 24

If one missed pop how long should barrier contraception be used?

Answer 24

48hrs

Question 25

Manage PID

Answer 25

IM ceftriaxone, oral metronidazole and doxycycline

Question 26

When can ARM be carried out?

Answer 26

> 1cm dilation

Question 27

What type of cancer is a patient with lynch syndrome at highest risk of developing?

Answer 27

1 endometrial

2 ovarian

Question 28

How should foetal development be monitored in obese women?

Answer 28

growth scans not fundal height

Question 29

A 28-year-old woman is attending for a repeat ultrasound scan to assess viability of a pregnancy after being diagnosed with a threatened miscarriage. In the waiting room she becomes unwell – she collapses and an ABCDE assessment reveals a patent airway, heart rate of 56, BP of 97/49, she is peripherally cold and appears sweaty and pale. You are called to help and find on arrival that oxygen and IV fluids have not made any improvement in her condition. What is the definitive treatment?

Answer 29

Speculum examination and removal of products of conception

–> likely cervical shock due to miscarriage has caused vagal stimulation

Question 30

A 34-year-old woman complains of intermittent pain in the left iliac fossa for the past 2 months. The pain is often worse during intercourse. She also reports urinary frequency and feeling bloated. There is no dysuria or change in her menstrual bleeding. What is the most likely diagnosis?

Answer 30

ovarian cyst

Question 31

What condition are woman with PCOS at increased risk of?

Answer 31

ovarian torsion

Question 32

How long after unprotected sex can an IUD be inserted?

Answer 32

5 days

Question 33

Investigate sub-fertility with ? problem of tubal patency due to PID

Answer 33

laparoscopy

Question 34

What age group are fibroids seen?

Answer 34

pre-menopausal

fed by oestrogen

Question 35

A cyst of what size should be offered surgery?

Answer 35

> 7cm due to risk of ovarian torsion

Question 36

Are postmenopausal cysts normal?

Answer 36

always abnormal

calculate rmi
US features x menopausal status x Ca125

Question 37

How is a postmenopausal cyst with
a) low risk
b) high risk
managed?

Answer 37

a) if simple repeat US in 3 months
if not simple ?surgery

b) gyn onc MDT, CT chest abdo pelvis

Question 38

A 34 year old nulliparous woman has chronic pelvic pain.Bimanual examination of the pelvis reveals a fixed retroverted uterus, with tender nodules on the uterosacral ligaments.

Which is the most likely diagnosis? 
A. Adenomyosis 
B. Endometriosis 
C. Inflammatory bowel disease  
D. Ovarian carcinoma 
E. Pelvic inflammatory disease

Answer 38

B endometriosis

Question 39

A 29 year old woman visits her GP with a heavy sensation in her vagina when exercising. She is aware of a bulge in her vagina, sometimes associated with a desire to void urine. She had a vaginal delivery 2 years ago.There is some laxity of the anterior vaginal wall, but this does not descend to the introitus on straining. Urine culture is negative.

Which is the most appropriate management plan? 
A. Oxybutinin hydrochloride 
B. Pelvic floor exercises 
C. Refer for urodynamic testing  
D. Refer to urogynaecology clinic 
E. Ultrasound scan of pelvis

Answer 39

B. pelvic floor exercises