Gynae 4

Question 1

when should you measure progesterone levels in a woman?

Answer 1

regardless of the length of a woman’s cycle, always carry out progesterone levels 7 days before the end of the cycle

Question 2

outline the menstrual cycle

Answer 2

follicular phase (0-14)
luteal phase (14-28)

FSH will stimulate the primary follicles to mature into secondary follicles.
Secondary follicles release oestrogen which causes negative feedback on GnRH.
Eventually, oestrogen rises so much that positive feedback occurs = LH surge = oocyte released.
Corpus luteum is now formed = oestrogen, progesterone and inhibin are released.

inhibin = inhibits FSH 
progesterone = inhibits GnRH and maintains endometrial lining

Question 3

what are the features of turner’s syndrome?

Answer 3

45X
webbed neck
low set ears
low hairline
widely spaced nipples
bicuspid aortic valve/coarctation of aorta
amenorrhoea
no pubic hair

Question 4

what are the features of a bartholin gland abscess and what is the treatment?

Answer 4

commonest in 20’s
tender swelling of labia with erythema
mixed anaerobic and aerobic growth (e coli, staph, strep)

treatment: incision and drainage, marsupialisation, amoxicillin and clindamycin

Question 5

what is a nabothian cyst?

Answer 5

small mucus filled cyst on surface of cervix

squamous epithelium of ectocervix grows over columnar epithelium of endocervix

Question 6

how does PID present?

Answer 6

low bilateral abdominal pain
deep dyspareunia
vaginal discharge
abnormal vaginal bleeding

STI, miscarriage, post partum or instrumentation causes endometritis which leads to PID. PID can lead to chronic PID, acute salpingitis, or tubo-ovarian abscesses

Question 7

what are the investigations and treatment of PID?

Answer 7

investigations: FBC, CRP, triple swabs, pelvic USS, laparoscopy

treat with single dose IM ceftriaxone 500mg (to cover for gonorrhoea), then oral doxycycline (100mg) bd and metronidazole 400mg bd for 14 days