Gynae: Corrections 2

Question 1

What condition should be suspected in patients with continuous dribbling incontinence after prolonged labour and from a country with poor obstetric services?

Answer 1

Vesicovaginal fistulae

Question 2

1st line investigation for a vesicovaginal fistulae?

Answer 2

Urinary dye studies - the dye stains the urine and hence identifies the presence of a fistula.

Question 3

What investigations may be required in urinary incontinence when there is diagnostic uncertainty (e.g. a bladder diary is inconclusive)?

Answer 3

Urodynamic studies

Question 4

What investigations should women with suspected PCOS have?

Answer 4

1) Pelvic US

2) FSH & LH

3) Prolactin

4) TSH

5) Testosterone

6) Sex hormone-binding globulin (SHBG)

Question 5

Atrophic vaginitis is a diagnosis of exclusion.

What must be ruled out first?

Answer 5

Endometrial cancer (use TVUS)

Question 6

What should women with pruitus vulvae be advised to clean the vulval area with?

Answer 6

An emollient such as Epaderm or Diprobase

Question 7

How soon after taking ulipristal acetate can women start hormonal contraception?

Answer 7

5 days after

Question 8

What UKMEC is a first degree relative with VTE for the COCP?

Answer 8

3

Question 9

Why can patients who have had a gastric sleeve/bypass/duodenal switch not have oral contraception ever again?

Answer 9

Due to lack of efficacy, including emergency contraception.

Question 10

1ary mechanism of the desogestrel-only pill?

Answer 10

Inhibits ovulation

Question 11

1ary mechanism of depot injection (medroxyprogesterone acetate)?

Answer 11

Inhibits ovulation (& thickens cervical mucus)

Question 12

1ary mechanism of implant (etonogestrel)?

Answer 12

Inhibits ovulation

Question 13

1ary mechanism of IUS (levonorgestrel)?

Answer 13

Prevents endometrial proliferation.

Question 14

What 2 cancers in women is obesity a risk factor for?

Answer 14

1) endometrial
2) breast

Question 15

Risk factors for cervical cancer?

Answer 15

1) HPV 16, 18 & 33

2) Smoking

3) HIV

4) Early first intercourse, multiple sexual partners

5) High parity

6) Lower socioeconomic status

Question 16

Main mechanism of the progestogen-only pill (excluding desogestrel)?

Answer 16

Thickens cervical mucus

Question 17

Why should oxybutynin not be used in the frail elderly population?

What is a safer alternative?

Answer 17

Due to increased risk of falls.

Safer alternative - solifenacin.

Question 18

When is cervical screening delayed until in pregnancy?

Answer 18

Delayed until 3 months post-partum (unless missed screening or previous abnormal smears).

Question 19

How does ovarian cancer initially spread?

Answer 19

By local invasion

Question 20

Give some causes of endometrial hyoperplasia

Answer 20

• Taking oestrogen unopposed by progesterone
• Obesity
• Late menopause & early menarche
• Age >35
• Being a current smoker
• Nulliparity
• Tamoxifen

Question 21

Stepwise investigations in suspected ovarian cancer (i.e. symptomatic women)?

Answer 21

1) Ca125

2) US

Question 22

Should a Ca125 be used for ovarian cancer screening in asymptomatic women?

Answer 22

No

Question 23

What can be given for the management of vasomotor symptoms of menopause (e.g. flushing)?

Answer 23

Fluoxetine (SSRI), citalopram (SSRI) or venlafaxine (SNRI)

Question 24

1st line management of endometriosis?

Answer 24

NSAIDs and/or paracetamol

Question 25

In fertility testing, when is the most appropriate time to measure serum progesterone levles?

Answer 25

7 days prior to next expected period (to confirm ovulation).

Question 26

What are the 2 basic investigations in fertility testing?

Answer 26

1) Semen analysis

2) Serum progesterone (7 days prior to expected next period)

Question 27

What is a potential side effect of ovulation induction?

Answer 27

Ovarian hyperstimulation syndrome

Question 28

What is ovarian hyperstimulation syndrome (OHSS)?

Answer 28

A complication seen in some forms of infertility treatment.

Whilst it is rarely seen with clomifene therapy is more likely to be seen following gonadotropin or hCG treatment.

Question 29

Classic features of ovarian hyperstimulation syndrome?

Answer 29

Mild: abdo pain, ascites

Moderate: + N&V, ascites

Severe: + oliguria, raised haematocrit, hypoproteinaemia

Critical: + VTE, ARDS, anuria, tense ascites

Question 30

How is haematocrit affected in ovarian hyperstimulation syndrome?

Answer 30

High

Question 31

1st line management of cervical intraepithelial noeoplasia (CIN)?

Answer 31

Large loop excision of transformation zone (LLETZ)

Question 32

What is the investigation of choice for ectopic pregnancy?

Answer 32

TV USS

Question 33

What is the most common complication following a surgical TOP?

Answer 33

Infection (up to 10% cases)

Question 34

1st line investigation in patients with urinary incontinence?

Answer 34

Urinalysis - rule out UTI & diabetes

Question 35

Ectopic in which location is most associated with an increased risk of rupture?

Answer 35

Isthmus

Question 36

Management of Trichomonas vaginalis?

Answer 36

Oral metronidazole

Question 37

What is the recommendation for a pill free period in the COCP?

Answer 37

There is no no medical indication for the pill free interval or withdrawal bleed whilst taking the COCP

Question 38

What is the most common benign ovarian tumour in women under the age of 25 years?

Answer 38

Dermoid cyst (teratoma)

Question 39

What is the most common cause of ovarian enlargement in women of a reproductive age?

Answer 39

Follicular cyst

Question 40

In cases of raised FSH/LH in primary amenorrhoea, what should you consider?

Answer 40

Gonadal dysgenesis (e.g. Turner’s syndrome)