GYNAE

Question 1

where do LHRH and FSHRH come from?

Answer 1

hypothalamus

Question 2

where to LH and FSH come from ?

Answer 2

ant pituitary

Question 3

which day do progesterone levels peak?

Answer 3

21

Question 4

average amount of blood loss in period

Answer 4

30-40ml

Question 5

management of abnormal uterine bleeding no pathology

Answer 5

1. IUS
2. TXA, mefanamic acid (during menses only) or COCP
3. noresthisterone days 5-26 of cycle or implant/depot
4. surgery - ablation, hysterectomy, myomectomy etc

Question 6

management of dysmenorrhoea (primary)

Answer 6

NSAIDs eg ibuprofen, mefanamic acid, naproxen (+/- patacetomol)
COCP for 3-6 trial
hot water bottle
TENS
stop smoking

Question 7

risk factors for endometrial cancer

Answer 7

PCOS, obesity, FHx (breast, ovary, colon), DM, nulliarity, late menopause/early menarche, unopposed oestrogen, pelvic irradiation hx, tamoxifen, HTN

Question 8

definition of amenorrhoea

Answer 8

not started by 16 yrs

Question 9

definition of oligomenorrhoea

Answer 9

occurs every 36 days-6 months

Question 10

which criteria is used to diagnoise PCOS

Answer 10

rotterdam consensus criteria

Question 11

imaging signs of PCOS (2)

Answer 11

> 12 follicles OR

increased ovarian volume

Question 12

if 17-hydroxyprogesterone is raised what is this indicative of? (amenorrhoea)

Answer 12

congenital adrenal hyperplasia

Question 13

diagnosis of menopause

Answer 13

12 months of amenorrhoea

Question 14

mean age of menopause

Answer 14

51

Question 15

4 things menopause increases risk of

Answer 15

CVD
stroke
osteoporosis
atrophic changes in vagina or bladder

Question 16

when do you do an FSH blood test to diagnose menopause (3)

Answer 16

> 45yrs with atypical symptoms
40-45 with menopausal symptoms
<40 yrs if suspect premature menopause

Question 17

age of premature ovarian insufficiency

Answer 17

<40yrs

Question 18

how to diagnose premature menopause

Answer 18

menopausal symptoms + 2x elevated FSH taken 4-6 weeks apart

Question 19

what is anti-mullerian hormone testing

Answer 19

see how many eggs have left

Question 20

how long after menopause are you still fertile

Answer 20

2yrs after LMP if <50 and 1 yr if >50

Question 21

3 common places for endometriosis in pelvis

Answer 21

uterosacral ligaments, pouch of douglas, on or behind ovaries

Question 22

what are chocolate cysts

Answer 22

endometriosis

Question 23

2 protective factors for endometriosis

Answer 23

muliparity, OCP

Question 24

management of PID when low risk of gonorrhoea

Answer 24

ofloxacin + metro PO for 14 days

Question 25

management of PID when high risk gonorrhoea or acutely unwell

Answer 25

IV cef + doxy THEN PO doxy + metro

Question 26

threatened miscarriage

Answer 26

bleeding but foetus still alive. os closed. only 25% will miscarry. little/no pain

Question 27

inevitable miscarriage

Answer 27

heavy bleeding + clots + pain, os open

Question 28

incomplete miscarriage

Answer 28

os open. products of conception partially expelled

Question 29

complete miscarriage

Answer 29

all foetal tissue has been passed form confirmed intrauterine pregnancy. cervical os closed

Question 30

missed miscarriage

Answer 30

foetus is dead but retained. uterus smaller than expected for dates and os closed hx of threatened miscarriage

Question 31

septic miscarriage

Answer 31

endometriosis

Question 32

signs of ectopic

Answer 32

abdo pain and tenderness, cervical excitation. blood loss is less heavy and darker than miscarriage

Question 33

ectopic: indications for methotrexate injection

Answer 33

no significant pain, unruptured ectopic with adnexal mass <35mm and no visible heartbeat, no IU preg seen on TVS, serum hcg <1500 IU

Question 34

management of ectopic

Answer 34

``` ABCDE either medical (methotrexate) or sugical (laprascopic salpingectomy unless other infertility RFs) ```

Question 35

what is a complete molar pregnancy?

Answer 35

all genetic material comes from father. no foetal tissue

Question 36

what is a partial molar pregnancy?

Answer 36

1 oocyte fertilised by 2 sperm, triploid. foetal tissue or blood cells present