Gynae

Question 1

Differentials for Menorrhagia

Answer 1

Uterine Fibroids 
Hormonal imbalance - PCOS, Diabetes, Thyroid dysfunction, & obesity 
Polyps 
Adenomyosis 
IUD 
Malignancy 
Bleeding disorders - VWB
Medications - oestrgens/progestins & anticoagulants

Question 2

How would you investigate menorrhagia?

Answer 2

FBC
TV USS
Endometrial biopsy if >45 and not responding to Rx
Hysteroscopy if abnormal scan and ?ablation

Question 3

What type of medication is Tranexamic acid and when is it used?

Answer 3

Tranexamic acid is a antifibrinolytic and it reduces menorrhagia and IMB

Question 4

A 33 year old presents to you complaining of menorrhagia and dysmenorrhoea but she is wanting to try for her 1st child. What treatment would you give start her on?

Answer 4

NSAID - Mefenamic acid (good for both heavy and pain full periods)
or Tranexamic acid

Question 5

What would you offer a patient who has suffered from menorrhagia & has already tried Tranexamic acid, NSAIDS, Progestogens, COCP and Mirena (LNG - IUS)

Answer 5

Already tried…Tranexamic acid, NSAIDS, Progestogens, COCP and Mirena (LNG - IUS) for menorrhagia.
Ablation with Novasure

Question 6

What is the most common type of ovarian cancer?

Answer 6

Epithelial ovarian cancer

Question 7

If you suspect an ovarian cancer what blood tests can you do?

Answer 7

Ca 125

is <40 - alphafetoprotein, hCG and Lactase dehydrogenase

Question 8

What other pathology causes an increase in CA125?

Answer 8

Fibroids, PID, pregnancy, liver disease, pancreatitis

Question 9

What surgical treatment do you do for early ovarian cancer?

Answer 9

Total hysterectomy with bilateral slapping-oophrectomy and partial omentectomy

Question 10

What is included in the triple assessment?

Answer 10

Clinical assessment
Imaging USS or mammogram if <50
Biopsy

Question 11

What is the breast screening age group in the uk?

Answer 11

47-73 mammogram every 3 years

Question 12

What is the cervical screening program in the UK?

Answer 12

Smears
25-49 every 3 years
50-64 every 5 years

Question 13

A 28 year old goes for a routine smear. She is found to have mild dyskaryosis - what happens next?

Answer 13

Mild - look for HPV
HPV +ve –> colposcopy
HPV -ve routine recall

Question 14

What surgical procedure can you do for cervical cancer?

Answer 14

Loop electorsurgical excision procedure

Radical trachelectomy