Gynae

Question 1

Structure of gynae history

Answer 1

• Intro + confidentiality
• PC + HPC
• ICE
• Menstrual
• Obstetric
• Sexual
• Contraception + Cervical smear
• PMH, PSH, Past gynae
• FHx
• SHx
• ICE

Question 2

Causes of amenorrhoea

Answer 2

• Pregnancy / Contraception / Breastfeeding
• Starvation
• Anorexia
• Stress
• PCOS
• Hyperprolactinaemia

Question 3

Causes of menorrhagia

Answer 3

• Structural → Polyps / Endometriosis / Adenomyosis / Fibroids
• Other → Coag / Ovarian dysfunction / IUD / Cancer

Question 4

Causes of IMB

Answer 4

• Malignancy
• Infection
• Polyps
• Fibroids
• Pregnancy

Question 5

Causes of post-coital bleeding

Answer 5

• Cervical cancer
• Polyps
• Ectropion
• Cervical trauma

Question 6

Causes of dysmenorrhoea

Answer 6

• Fibroids
• Adenomyosis
• Endometriosis
• PID
• IUD

Question 7

Acute causes of pelvic pain

Answer 7

• Ectopic pregnancy
• UTI
• Appendicitis
• PID
• Ovarian torsion
• Miscarriage

Question 8

Chronic causes of pelvic pain

Answer 8

• Endometriosis
• IBS
• Ovarian cyst
• Urogenital prolapse
• Adenomyosis
• Fibroids

Question 9

Psychological causes of pelvic pain

Answer 9

• Physical + Sexual abuse
• Child abuse / Rape
• Depression / Anxiety
• Personality disorders

Question 10

Gynae Assessment work-up

Answer 10

1. Full history
2. Examination → abdominal, PR, PV + smear
3. Bedside → pregnancy / urine dip mc+s
4. Bloods → FBC / FSH, LH / Prolactin / TFTs / androgens / Ca-125
5. Imaging → pelvic USS / CT
6. Special tests → laparoscopy / hysterosocpy / cystoscopy / biopsy

Question 11

Menorrhagia management

Answer 11

1. Mirena IUS
2. Tranexamic acid / Mefanamic acid
3. COCP / Progestogens
4. GnRH
5. Endometrial ablation
6. Myomectomy
7. Hysterectomy (?fertility)

Question 12

Endometriosis management

Answer 12

• First → NSAIDs / paracetamol
• Second → COCP (60d), POP, mirena coil, GnRH analogues
• Surgical → laser / hysterectomy

Question 13

COCP CIs

Answer 13

• > 35yrs + > 15 cigs/day
• Migraine with aura
• Current breast cancer
• Stroke / VTE / AF / HTN
• SLE
• Liver disease
• Enzyme inducing medications

Question 14

COCP SEs

Answer 14

• SEs → Headaches / Nausea / Breast tenderness / Mood swings
• D+V may affect effectiveness
• Other drugs may affect effectiveness
• Increase risk of VTE + stroke
• Breast cancer risk
• Does not protect from STIs

Question 15

POP CIs

Answer 15

• Breast cancer
• Undiagnosed PV bleeding
• Severe decompensated liver disease
• Severe arterial disease

Question 16

POP SEs

Answer 16

• Periods → irregular / light / stop / more frequent / spotting
• SEs → acne / breast tenderness / mood / headache / nausea
• Need to remember to take it same time every day

Question 17

Implant features

Answer 17

• Small plastic rod 4cm under skin in upper arm
• Inhibits ovulation, thickens mucus + thins endometrium
• Lasts for 3 years, can be taken out sooner
• Procedure risks → bruising, infection

Question 18

IUD vs IUS mechanism

Answer 18

• IUD kills sperm
• IUS thickens mucus + thins lining

Question 19

IUS features

Answer 19

• Jaydess (3 years) or Mirena (5 years)
• Reduces heavy menstruation but can be irregular first 6m
• Procedure is painful
• Can be expelled from uterus
• Ectopic risks

Question 20

IUD features

Answer 20

• Last for 10 years
• No hormones
• Works immediately
• Can cause heavier, longer + painful menstruation
• Risk of ectopics