Gynae

Question 1

what is Sheehan’s syndrome

Answer 1

ischaemic necrosis of the pituitary gland in the post partum period often due to blood loss and hypovolaemic shock.

Question 2

signs of Sheehans syndrome

Answer 2

Features of hypopituitarism:

• hypothyroidism (fatigue, cold intolerance, constipation, weight gain, hair loss),
• hypoadrenalism (fatigue, weight loss, hypoglycemia, hyponatremia, confusion),
• hypogonadism (amenorrhea, hot flashes, loss of libido)
• growth hormone deficiency (fatigue and reduced muscle mass).

Question 3

Diagnostic investigation for ovarian torsion

Answer 3

• diagnostic laparoscopy - allows for treatment straight away.
• Transvaginal USS used 1st line - shows whirlpool sign, oedema of ovary or free fluid in pelvis

Question 4

signs of ovarian torsion on USS

Answer 4

• Whirlpool sign
• Free fluid in pelvis
• Oedema of ovary.

Question 5

what symptom is associated with pain in ovarian torsion

Answer 5

N+V

Question 6

what drugs are used in termination of pregnancy + how do they work

Answer 6

• mifepristone: anti-progestogen that stops progression of the pregnancy.
• misoprostol: PG analogue that stimulates uterine contractions to expel the foetus.

Question 7

typical presentation of vulval cancer.

Answer 7

• persistent soreness and itching of the vulva
• ulcerated lesion MC on the labia majora
• abnormal vaginal discharge

Question 8

PMS Mx

Answer 8

• conservative: exercise, CBT, diet modification, Vitamin B
• Meds: COCP is useful for women with PMS however some suffer progestogenic side effects during the pill-free period. Therefore choosing a regime that has a shorter break, or no pill-free period may be more effective

Question 9

ovarian cancer Ix and when each is done

Answer 9

• Ca-125 done in older women with new abdominal Sx
• TVUSS: done when Ca-125 >35

Question 10

The most commonly used medication for infertility in women with PCOS is…

Answer 10

clomifene

Question 11

medical Mx for PCOS in women not bothered about fertility

Answer 11

• co-cyprindiol - Reduces hirsutism and promotes regular menstruation.
• COCP - regulates period
• metformin - helps reduce acne + hirsutism and regulates period

Question 12

medical Mx for women with PCOS trying to conceive

Answer 12

• clomifene
• metformin
• Gonadotrophins: Utilised to induce ovulation if clomiphene and metformin prove ineffective

Question 13

HRT regimens and who gets what

Answer 13

HRT can be given continuously (for postmenopausal women not having periods) or cyclically (for perimenopausal women still having some periods).

Question 14

T/F
PID causes menorrhagia

Answer 14

true

Question 15

compressive Sx seen with fibroids

Answer 15

• urinary frequency
• constipation
• pedal oedema due to compression of the veins.

Question 16

1. what is fibroid red degeneration
2. when does it happen
3. how does it present
4. how is it managed

Answer 16

1. Ischaemia, infarction + necrosis of the fibroid due to disrupted blood supply.
2. Happens in larger fibroid >5cm, during 2nd or 3rd trimester as the fibroids grows fast and outgrows it’s supply or kinking of blood supply.
3. Presents with severe abdo pian, low-grade fever, tachycardia ±vomiting.
4. Management is supportive, with rest, fluids and analgesia

Question 17

red velvet halo around the cervical os is…

Answer 17

a cervical ectropion

• Often asymptomatic. May present with post-coital bleeding or vaginal discharge
• may require further Ix with colposcopy to rule out cervical cancer if suspicious

Question 18

HRT contraindications

Answer 18

• Undiagnosed vaginal bleeding
• Pregnancy
• Breastfeeding
• Oestrogen receptor-positive breast cancer
• Acute liver disease
• Uncontrolled hypertension
• History of breast cancer or venous thromboembolism (VTE)
• Recent stroke, myocardial infarction or angina

Question 19

overactive bladder syndrome Vs urge incontinence

Answer 19

• Overactive bladder causes a person to urinate more frequently and to feel a sudden and intense need to urinate.
• Urge incontinence on the other hand occurs when this urge to urinate causes urine to leak involuntarily

Question 20

cause of overactive bladder syndrome

Answer 20

overactivity of the detrusor muscle, the smooth muscle of the bladder, which contracts to allow urinary flow through the urethral sphincter.

Question 21

cause of urge incontinence

Answer 21

overactivity of the detrusor muscle, the smooth muscle of the bladder, which contracts to allow urinary flow through the urethral sphincter

Question 22

cause of stress incontinence

Answer 22

weak pelvic floor muscles + weakness of the bladder, sphincters and urethra

Question 23

criteria for PCOS Dx

Answer 23

Rotterdam criteria

• hyperandrogegism: acne or hirsutism
• polycystic ovaries - string of pearls
• ovulatory dysfunction - oligo/an-ovulation

Question 24

criteria for BV

Answer 24

Amsel criteria

• clue cells on microscopy
• thin white/grey discharge
• +ve whiff test
• pH >4.5

Question 25

In women under 40 with unexplained amenorrhoea and menopausal symptoms, raised Follicle-stimulating hormone (FSH) levels suggests…

Answer 25

premature ovarian insufficiency.

Question 26

define premature ovarian insufficiency

Answer 26

a medical condition characterised by the onset of menopause (ovarian insufficiency) in a woman aged below 40 years

Question 27

how is premature ovarian insufficiency diagnosed

Answer 27

FSH levels: two samples taken 4-6 weeks apart, showing raised FSH levels is required for diagnosis

Question 28

Mx for premature ovarian insufficiency

Answer 28

The primary management strategy for women with POI is to offer hormone replacement therapy (HRT) until at least the expected age of menopause, unless the risks of HRT treatment outweigh the benefits.