Gynae

Question 1

What is a prolapse ?

Answer 1

A descent of the uterus and or vaginal walls from their normal anatomical confines.

Due to a weakness of the supporting structures.

Question 2

Who are prolapses com on in? 2 groups

Answer 2

Parous

Old people

Question 3

What two ligaments support the upper 1/3rd of the vagina and the uterus?

Answer 3

1. Cardinal ligaments

2. Uterosacral ligaments

Question 4

What are the following types of prolapse?

Urethrocele 
Cystocele 
Apical prolapse 
Entercocele 
Rectrocele

Answer 4

Urethrocele: prolapse of the lower anterior vaginal wall (involves urethra)
Cystocele (prolapse of the bladder)
Apical prolapse of the uterus, cervix and upper vagina
Entercocele prolapse of the small bowel loops
Rectrocele prolapse of the rectum

Question 5

What grading scale is used to grade prolapse?

Answer 5

Braden Walker Classification

Question 6

Give 3 aetiology causes of prolapses?

Answer 6

1. Vagina delivery and pregnancy
2. Constipation
3. Pelvic Surgery

Question 7

What are the general symptoms of the different types of prolapse?

Answer 7

Cystocele: urinary frequency and urgency, incomplete bladder emptying.

Dragging down sensation, feeling of a lump falling down or generalised ache.

tends to be worse with standing and as the day goes on.

Question 8

What are 3 ways to manage prolapses?

Answer 8

1. Pelvic Floor exercises
2. Vaginal Pessaries
3. Surgery i.e. anterior or posterior repair. If an apical prolapse a vaginal hysterectomy may be indicated.

Question 9

What is a genital tract fistula ?

Answer 9

An abnormal opening between the vagina and another organ i.e. bladder or bowel

Question 10

How does a genital tract fistula occur? What are 2 causes?

Answer 10

Pregnancy

IBD

Radiotherapy

Question 11

How does a genital tract fistula present?

Answer 11

1. Vaginal or UTI infection
2. Stool, urine or gas leak through the vagina
3. Irritated or inflamed skin and/or abscess/

Question 12

How can you heal a genital tract fistula involving the bladder?

Answer 12

1. But a Catheter in until the bladder can repair

However, most of the time they just need surgery

Question 13

What are the 4 pathophysiology processes behind PCOS?

Answer 13

1. Excessive androgen production by theca cells
2. Insulin resistance leads to increased androgen + sHBG production leading to higher levels of testosterone.
3. Higher LH from anterior pituitary.

Question 14

What investigations would you do on someone with PCOS?

Answer 14

1. Basal Days 2-5 (LH and FSH) + testosterone + SHBG

2. Pelvic US

Question 15

What are 5 symptoms of PCOS?

Answer 15

Irregular periods <9 in a year 
Infertility/Sub fertility 
Acne 
Hirsutism 
Mood swings, depression or anxiety

Question 16

What are 3 signs of PCOS?

Answer 16

Acanthosis Nigricans
Central obesity
Male pattern balding
Hirsutism

Question 17

What is the name of the criteria used for PCOS?

Answer 17

Rotterdam Criteria

Question 18

What are the 3 criteria in the Rotterdam Criteria that need to be satisfied?

Answer 18

1. Irregular/absent ovulation
2. Clinical hyperandrogenism (alopecia, hirsutism and acne)
3. Poly cystic ovaries on pelvic USS.

Question 19

What are the 4 levels fo management for PCOS?

Answer 19

1. Weight loss, exercise and low sugar
2. COCP
3. Metformin
4. Co-cyprindrol for hirsutism

Question 20

What two medications can be used to improve fertility in PCOS?

Answer 20

Metformin

Clomifene

Question 21

How do COCP work?

Answer 21

They inhibit ovulation
Reduces LH and prevents surge that comes with ovulation.

Thickens the cervical mucosa and prevents proliferation of the endometrium.

Question 22

What are 3 SE of the COCP

Answer 22

Breast tenderness

Mood Swings

Worse BP

Question 23

What are 4 CI of COCP?

Answer 23

BMI > 35
Smoker over 35
Breast Feeding
Breast cancer

Question 24

How does the progesterone only pill work?

Answer 24

Thickens the cervical mucosa

Thins the endometrium inhibiting implantation. 
Inhibits ovulation (no potentially no periods)