Gynae Core Conditions

Question 1

What causes atrophic vaginitis?

Answer 1

Lack of oestrogen during the menopause (genitourinary syndrome of menopause)

Question 2

Causes of post menopausal bleeding

Answer 2

Endometrial carcinoma
Endometrial hyperplasia
Cervical carcinoma
Atrophic vaginitis
Cervicitis
Ovarian carcinoma
Cervical polyps

Question 3

What is the menopause?

Answer 3

Permanent cessation of menstruation resulting from loss of ovarian follicular activity (recognised after 12 consecutive months of amenorrhoea)

Question 4

What is the median age at which the menopause occurs at?

Answer 4

51

Question 5

What is premature menopause?

Answer 5

Menopause before 40 years old

Question 6

What is the perimenopause?

Answer 6

The time preceeding the menopause where menstruation is often erratic

Question 7

Early features of the menopause

Answer 7

Hot flushes
Insomnia
Psychological symptoms

Question 8

Late features of the menopause

Answer 8

Skin and breast atrophy
Hair loss
Atrophic vaginitis
Prolapse
Urinary symptoms
Osteoporosis
Cadiovascular disease

Question 9

How is the menopause investigated?

Answer 9

Usually clinical diagnosis
Low anti-mullerian hormone (AMH)
Raised FSH

Question 10

Symptoms of atrophic vaginitis

Answer 10

Discomfort
Dyspareunia
Cessation of sexual activity
Itching
Burning
Dryness

Question 11

Treatment of atrophic vaginitis

Answer 11

Topical oestrogens (oestriol cream/pessary or oestradiol tablets/ring)
Oral ospemifene (selective oestrogen receptor modulator - SERM)
Lubricants and moisturisers

Question 12

Atrophic vaginitis may make _____________ so a hysteroscopy may have to be performed under ___________

Answer 12

Vaginal access difficult; general anaesthetic

Question 13

How is atrophic vaginitis diagnosed?

Answer 13

Diagnosis of exclusion

Question 14

Urinary symptoms of genitourinary syndrome of menopause

Answer 14

Frequency
Urgency
Nocturia
Incontinence
Recurrent infection

Question 15

What is the most common cause of vaginal discharge in women of reproductive age?

Answer 15

Bacterial vaginosis (Gardnerella/anaerobic vaginosis)

Question 16

Is bacterial vaginosis an STI?

Answer 16

No

Question 17

What is bacterial vaginosis?

Answer 17

Loss of normal lactobacilli and an increase in anaerobic and highly fastidious BV associated bacteria in the vagina

Question 18

What are distinctive features of bacterial vaginosis?

Answer 18

Malodour
Worse with intercourse
Not usually associated with vulvovaginitis

Question 19

BV bacteria produce __________ which break down vaginal peptides into volatile, ___________

Answer 19

Proteolytic enzymes; malodorous amines

Question 20

The rise in pH in BV facilitates adherence of ____________ and ____________ to exfoliating epithelial cells and development of a ________ which adheres to the epithelium

Answer 20

G. vaginalis; atopobium vaginae; biofilm

Question 21

Clinical features of bacterial vaginosis

Answer 21

Grey-white discharge
Fishy odour
No vulvovaginitis

Question 22

How is bacterial vaginosis diagnosed?

Answer 22

Raised vaginal pH
Typical discharge
‘Whiff’ test
Presence of ‘clue cells’ on microscopy

Question 23

Wat is the ‘Whiff’ test for BV?

Answer 23

Fishy odour when 10% potassium hydroxide added to secretions

Question 24

What are ‘clue cells’ for BV?

Answer 24

Epithelial cells studded with gram-variable coccobacilli

Question 25

How is symptomatic bacterial vaginosis treated?

Answer 25

Metronidazole or clindamycin cream

Question 26

BV bacteria can cause secondary infection in __________________

Answer 26

Pelvic inflammatory disease

Question 27

BV is associated with __________

Answer 27

Preterm labour

Question 28

What are Bartholin’s glands?

Answer 28

2 glands behind the labia minora that secrete lubricating mucus for coitus

Question 29

What causes a Bartholin’s gland cyst?

Answer 29

A blockage of the duct

Question 30

What causes Bartholin’s abscess?

Answer 30

Infection of a Bartholin’s gland cyst with S. aureus or E. coli

Question 31

Symptoms of Bartholin’s abscess

Answer 31

Large, tender, red swelling that is acutely painful

Question 32

Treatment for Bartholin’s abscess

Answer 32

Incision and drainage

Marsupialisation (incision is sutured open to reduce the risk of reformation)