Gynae

Question 1

Endometriosis symptoms

Answer 1

Dysmenorrhoea (cyclical, just before start of bleed)
Menorrhagia
Deep dyspareunia

Infertility

Dyschezia
Urinary symptoms

Many incidental findings

Question 2

Endometriosis demographics

Answer 2

Reproductive age

Nulliparous

Question 3

Endometriosis investigations

Answer 3

TvUSS
Laparoscopy is gold standard
Endoscopic rectal US is good too

Question 4

Endometriosis non-fertility sparing Mx

Answer 4

Treat if symptomatic.
Conservative - Mefanamic acid + paracetamol

Induce menopause:

COCP
IUS
POP
GnRH agonist

Question 5

Endometriosis fertility sparing

Answer 5

GnRH agonists to shrink lesions + laparoscopic surgery for mild disease improves fertility.

Scarce evidence to suggest it helps fertility in more severe disease.

Question 6

Endometriosis complications and prognosis

Answer 6

Most therapies help symptoms

35% remain infertile

Increased risks of:
Ovarian cancers
adhesions (esp. if surgical Mx)
IBD

Question 7

Endometriosis definition

Answer 7

Endometrial stroma and glands found outside the uterus.

Question 8

Common sites for endometriosis

Answer 8

Fallopian tubes!!
Ovaries (endometrioma)
Pouch of Douglas
Ligaments, colon, bladder, ureter.

Question 9

Definition of fibroids

Answer 9

Leiomyoma - benign tumours of smooth muscle and connective tissue

Question 10

Fibroids patient demographics

Answer 10

30-50
Afro-Caribbean
Overweight and early menarche (raised Oest exposure)

Question 11

Fibroids classifications

Answer 11

Intramural (majority)

Submucosal - growing into uterine cavity (may be pedunculated or poke through cervix)

Subserosal - Growing outwards from uterus

Question 12

Fibroids presentation

Answer 12

Most asymptomatic

30% - menorrhagia
dysmenorrhoea
central pelvic mass
bloating

uncommonly: infertility(submucosal), urinary symptoms, pain (if torted/degenerating)

Question 13

Investigations for fibroids

Answer 13

TvUSS (assess distortion of uterine cavity!)
pelvic USS
MRI
Endometrial biopsy

Question 14

Mx of fibroids - non fertility sparing

Answer 14

Conservative - Tranexamic acid + paracetamol

Hormonal:

1) IUS (if no distortion of cavity on USS)
COCP
UPA

2) GnRH agonist

Surgical:

UAE
Hysterectomy

Question 15

Mx of fibroids for fertility

Answer 15

1) Hysteroscopic removal of submucosal fibroids if <3cm

2) Laparoscopic myomectomy

Question 16

Complications of fibroids

Answer 16

IDA
Infertility

Red degeneration - Due to inadequate blood supply. Commonly during pregnancy.

Question 17

Malignant form of fibroids

Answer 17

Leiomyosarcoma - 0.1% of fibroids

Question 18

What is adenomyosis?

Answer 18

Presence of endometrial tissue within the myometrium

Question 19

Presentation of adenomyosis?

Answer 19

Enlarged, tender uterus
Menorrhagia
Dysmenorrhoea

Question 20

Ix adenomyosis

Answer 20

MRI is the best

Question 21

Mx adenomyosis

Answer 21

IUS or COCP

Hysterectomy if severe/fertility not an issue

Question 22

Endometritis can occur after?

Answer 22

Post partum - especially C section
Prolonged rupture of membranes
Manual removal of placenta
TOP
Uterine surgery

Question 23

Presentation of endometritis?

Answer 23

Fever
Abdo pain
Foul smelling lochia/discharge
PV bleeding
Tachycardia

Question 24

Management of menorrhagia

Answer 24

Conservative: tranexamic acid (and mefanamic if painful)

Hormonal:

1) IUS
2) COCP
3) Progestogens (oral or IM)

Question 25

Causes of primary amenorrhoea

Answer 25

``` Turner's - short, webbed neck, wide spaced nipples Constitutional delay PCOS AIS Mullerian abnormalities Chronic illness ```

Question 26

Causes of secondary amenorrhoea

Answer 26

Hypothalamic - anorexia, excess exercise Pituitary - prolactinoma, Sheehan's Hypo/hyperthyroid CAH Ovarian - PCOS, POI

Question 27

Types of amenorrhoea?

Answer 27

Primary - never menstruated secondary - no periods for 6 months Oligomenorrhoea - cycle varies between 35 days and 6 months

Question 28

Causes of post-coital bleeding

Answer 28

Cervical carcinoma Cervical polyps Cervicitis (STI) Ectropion - Most common. More when pregnant or on COCP

Question 29

Treatment of ectropion?

Answer 29

Cryotherapy

Question 30

Causes of PMB

Answer 30

Most common - atrophic vaginitis Endometrial hyperplasia Endometrial Ca Ovarian Ca Polyps

Question 31

Investigations for PMB

Answer 31

All women with abnormal PV bleed after age of ?40 TvUSS for endometrial thickness

Question 32

Above what thickness endometrium do you Ix further?

Answer 32

Hysteroscopy with pipelle biopsy if >4mm

Question 33

Symptoms of PMS

Answer 33

Psychological - depression, anxiety, mood swings Physical - Bloating, mastalgia Symptoms free week before ovulation! Symptoms worse during luteal phase

Question 34

Ix of PMS

Answer 34

Daily Record of Severity of Problems (DSRP) for 2 cycles. Exclude organic cause: FBC, TFT, vit D

Question 35

Mx of PMS

Answer 35

Exercise helps 1) COCP - continuous regimen CBT or SSRI for severe psychological sx Danazol - mastalgia

Question 36

PID presentation

Answer 36

Lower abdominal pain Deep dyspareunia PV bleeding Purulent discharge

Question 37

classic exam finding in PID

Answer 37

Cervical excitation (!!!)

Question 38

Organisms in PID

Answer 38

Chlamydia trachomatis Neisseria gonorrhoea Mycoplasma genitalium

Question 39

Ix of PID

Answer 39

Endocervical swabs for chlam/gonorr | Pelvic USS- exclude cysts or abscess

Question 40

Mx of PID

Answer 40

IM cef 250mg + PO metro 500mg + PO doxy 100mg

Question 41

Complications of PID

Answer 41

Tubal damage Adhesions Hydro/pyosalpinx due to obstruction Subfertility

Question 42

Ix for amenorrhoea

Answer 42

You BETTER GO PRO AND check EAST THYROID! - BETA-HCG - GOnadotrophins - PROlactin - ANDrogens - oESTradiol - THYROID function