gynae finals

Question 1

what are the symptoms of fibroids ?

Answer 1

Asymptomatic
Menorrhagia
bulk related symptoms like lower abdominal pain, cramps, urinary symptoms

Question 2

How are uterine fibroids managed ?

Answer 2

Medical : GnRH agonists to reduce the size of fibroids - short term use
Surgical : Myomectomy, hysteroscopic endometrial ablation, hysterectomy

Question 3

what is a common complication of fibroids during pregnancy

Answer 3

Red degeneration where the fibroid haemorrhages into tumour.

Question 4

How do you manage cervical cancer by stage ?

Answer 4

1A : gold standard is hysterectomy and lymph node of clearance
to maintain fertility : Cone biopsy with negative margins

1B :
1B1 : Radiotherapy with concurrent chemotherapy ( cisplatin)
1B2 : radical hysterectomy with pelvic node dissection

II,III : radiation with chemotherapy

IV :Radiation and / or chemotherapy
palliative chemotherapy

Question 5

what are the side effects of GnRH agonists

Answer 5

menopausal symptoms : Hot flushes, vaginal dryness
loss of bone mineral density

Question 6

management of cervical smears : hrHPV +ve but cytologically normal

Answer 6

repeat after 12 months
normal : normal recall
still hrHPV : repeat after 12 months
normal : normal recall
still hrHPV +ve : colposcopy

Question 7

management of cervical smears : ‘‘inadequate’’ sample

Answer 7

repeat sample in 3 months
2 consecutive inadequate samples –> colposcopy

Question 8

what is the HPV first system ?

Answer 8

a sample is tested for high-risk strains of human papillomavirus (hrHPV) first and cytological examination is only performed if this is positive.

Question 9

___________________is the most common treatment for cervical intraepithelial neoplasia.

Answer 9

Large loop excision of transformation zone (LLETZ)

Question 10

what is the lifestyle advice for PMS ?

Answer 10

regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates

Question 11

What is the most common complication of myomectomy

Answer 11

Adhesions

Question 12

how do you menorrhagia if

1. Patient does not require contraception
2. Patient requires contraception

Answer 12

1. Mefenamic acid 500 mg tds ( if dysmenorrhoea) / tranexamic acid tds

2 IUS : Mirena
COCP

Question 13

what is adenomyosis ? What are its features ?

Answer 13

It is the presence of endometrial tissue within the myometrium.

features include -
dysmenorrhoea
menorrhagia
enlarged, boggy uterus

Question 14

what is the first line investigation for adenomyosis ?

Answer 14

TV USS

Question 15

what is the management of adenomyosis

Answer 15

tranexamic acid : menorrhagia
GnRH agonists
uterine artery embolisation
hysterectomy - definitive

Question 16

what symptoms are suggestive of ectopic pregnancy ?

Answer 16

Pain and abdominal tenderness
pelvic tenderness
cervical motion tenderness

Question 17

how do you manage bleeding in the fist trimester ?

Answer 17

> = 6 weeks

refer to EPAU
TVUSS

< 6 weeks

if no pain or risk factors of ectopic - expectant management

• return if bleeding continues
  repeat urinary pregnancy to test after 7-10 days
• negative pregnancy test : miscarriage

Question 18

What is Fitz Hugh Curtis syndrome ?

Answer 18

Peri-hepatic inflammation secondary to chlamydia presenting with RUQ discomfort

Question 19

what is the medical management of MTP

Answer 19

Mifepristone and Misoprostol followed by a pregnancy test in 2 weeks to confirm the pregnancy has ended ( multi-level pregnancy test)

Question 20

what are the risk factors for vaginal candidiasis ?

Answer 20

Diabetes mellitus
Drugs : Antibiotics / steroids
pregnancy
Immunosuppression : HIV

Question 21

what are the features of vaginal candidiasis

Answer 21

cottage cheese non offensive discharge
vulvitis : superficial dyspareunia, dysuria
itch
erythema

Question 22

what is the management of vaginal candidiasis

Answer 22

• Oral Fluconazole 150 mg as single first dose
  -Clotrimazole 500 mg intravaginal pessary single dose

Question 23

What are the features of a complete hydatidiform mole ?

Answer 23

vaginal bleeding
uterus size greater than expected for gestational age
abnormally high serum hCG
ultrasound shows snow storm appearance

Question 24

what is the most common site of ectopic pregnancy ?

Answer 24

Ampulla of fallopian tube

Question 25

whats the most common benign ovarian tumour in women < 25

Answer 25

Dermoid cyst ( teratoma)

Question 26

what is the most common type of ovarian pathology associated with Meigs syndrome?

Answer 26

Fibroma

Question 27

what is the most common cause of ovarian enlargement in a woman of reproductive age

Answer 27

Follicular cyst

Question 28

what are the 2 types of physiological cysts ?

Answer 28

Follicular cysts and Corpus luteum cysts

Question 29

what is a risk factor for women with PCOS undergoing IVF

Answer 29

Ovarian Hyperstimulation syndrome

Question 30

what are the risk factors for endometrial cancer ?

Answer 30

Nulliparity
Early menarche
late menopause
unopposed oestrogen
obesity
diabetes
PCOS
tamoxifen
HNPCC

Question 31

what are protective factors for endometrial cancer?

Answer 31

multiparity
COCP
Smoking

Question 32

how is an ectopic pregnancy managed expectantly and what is the criteria ?

Answer 32

Size < 35 mm
Unruptured
asymptomatic
no fetal heart beat
hCG < 1000 IU/L
- management is close monitoring over 48h to see if symptoms persist / b-hcg rises

Question 33

how is an ectopic pregnancy managed medically and what is the criteria ?

Answer 33

Size < 35 mm
Unruptured
no significant pain
no fetal heart beat
hCG < 1500 IU/L

• methotrexate + follow up

Question 34

how is an ectopic pregnancy managed surgically and what is the criteria ?

Answer 34

size > 35 mm
can be ruptured
pain
visible fetal heartbeat
hCG > 5000 IU/L
salpingectomy : first line
salpingotomy : risk factors for infertility

Question 35

what is the most common ovarian cancer

Answer 35

serous carcinoma

Question 36

what are the risk factors for HPV ?

Answer 36

Smoking
HIV
early first intercourse + many sexual partners
high parity
low socioeconomic status
COCP

Question 37

which type of cancer presents with Rokitansky’s protuberance ?

Answer 37

Teratoma ( dermoid cyst)

Question 38

what is the first line management of
urge incontinence
stress incontinence

Answer 38

bladder retraining
pelvic floor muscle training

Question 39

what is ovarian hyperstimulation syndrome and how does it present

Answer 39

In OHSS, ovarian enlargement with multiple cystic spaces form, and an increase in the permeability of capillaries leads to a fluid shift from the intravascular to the extra-vascular space, which has the potential to result in multiple life-threatening complications including:
Hypovolaemic shock
Acute renal failure
Venous or arterial thromboembolism

Question 40

What is the referral criteria for nausea and vomiting in pregnancy ?

Answer 40

Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics
Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics
A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)

Question 41

what is the triad for the diagnosis of hyperemesis gravidarum ?

Answer 41

5% pre-pregnancy weight loss
dehydration
electrolyte

Question 42

what score is used to classify severity of NVP

Answer 42

Pregnancy-Unique Quantification of Emesis (PUQE)

Question 43

what are the risk factors for hyperemesis gravidarum ?

Answer 43

increased levels of beta-hCG
multiple pregnancies
trophoblastic disease
nulliparity
obesity
family or personal history of NVP