Gynae Qs

Question 1

What is menorrhagia?

Answer 1

Loss greater than 80ml which is affecting the quality of daily living

Question 2

Name 6 differentials for menorrhagia

Answer 2

Fibroids, Endometrial polyps, Infections (cervicitis), iatrogenic (COCP, obesity), Dysfunctional uterine bleeding, clotting disorders

Question 3

Name treatment for menorrhagia 1st-4 line

Answer 3

1st-Tranxaemic acid, mirena
2nd-TCRF, removal polyp
3rd-Endometrial ablation
4th-Hysterectomy

Question 4

Name differentials for post-menopausal bleeding

Answer 4

atrophic vaginitis, endometrial cancer, polyps, HRT oestrogen only, tamoxifen, hypoplasia

Question 5

What is tamoxifen?

Answer 5

oestrogen selective receptor modulator

Question 6

What is the normal thickness of the endometrium?

Answer 6

<4mm

Question 7

Name 6 types of prolapse

Answer 7

uterine, vault, cystocele, urethrocele, rectocele, enterocele

Question 8

What does Procidentia mean?

Answer 8

everything has moved outside

Question 9

What tool is used to determine what is going up and down in prolapse?

Answer 9

POP-Q

pelvic organ prolapse quantitator

Question 10

What is the difference between an ovarian cyst and PCOS?

Answer 10

ovarian cyst-on the ovary

PCOS-inside the ovary

Question 11

What is an ovarian cyst?

Answer 11

fluid filled sac on the surface

Question 12

What can be used to determine the risk of malignancy?

Answer 12

RMI

Question 13

What is the RMI?

Answer 13

CA125 (cancer tumour marker)
Menopausal status
Ultrasound findings (size, solid components, multiple septae, daughter cells)

Question 14

What is the criteria used for PCOS?

Answer 14

Rotterdam criteria
need to have 2 of the 3 findings
-->ultrasound findings (large ovary, lots of follicles)
-->high androgens 
-->anovulation or very irregular periods

Question 15

How do you determine high androgens?

Answer 15

blood test testosterone
male pattern hair growth
serum binding gobulin

Question 16

Why is obesity significant in menorrhagia?

Answer 16

Adipose tissue releases aromatase which converts androgens into oestrogen

Question 17

Complications of PCOS?

Answer 17

subfertility

diabetes

Question 18

How many periods should there be minimum in a year and why?

Answer 18

3 periods a year to allow endometrial protection otherwise there is a risk of hyperplasia and malignancy

Question 19

What is the definition of infertility?

Answer 19

regular sexual intercourse (vaginal) 2-3 times a week for 12 months

Question 20

What are the 3 causes of infertility?

Answer 20

Her: is there an egg being produced
Him: sperm analysis
Tube patency

Question 21

How do we know if someone is ovulating?

Answer 21

mid-luteal day 21 progesterone
(if raised they have ovulated)
May need to check LH, FSH to check HPO axis

Question 22

If semen analysis comes back abnormal, what do you do and why?

Answer 22

repeat the test in 3 months if abnormal as the life cycle of sperm is 70 days

Question 23

If the semen analysis comes back azoospermic what do you do?

Answer 23

lack of vas deferens
retrograde ejaculation in urine sample
Pituitary axis investigations

Question 24

What is the treatment for anovulation?

Answer 24

1st: Clomiphene
2nd: Ovarian drilling

Question 25

Causes of recurrent miscarriage

Answer 25

1. acquired thrombophilias
2. Uterine abnormalities (uterine septum)
3. Chromosomal (aneuploidy)-too many chromosomes in each cell

Question 26

What is antiphospholipid syndrome?

Answer 26

antiphospholipid antibodies, blood prone to clotting therefore in a hypercoagulable state
associated with thrombosis and complications of pregnancy

Question 27

What is pre-menstrual disorder and why does it happen?

Answer 27

occurs in the luteal phase

fluctuation in oestrogen and progesterone and increased sensitivity to progesterone

Question 28

How is pre-menstrual disorder managed?

Answer 28

Lifestyle management 
COCP 
SSRI 
CBT 
GnRH analogues-induces menopausal state
Pain management

Question 29

Why is danazole and tamoxifen used in pre-menstrual syndrome?

Answer 29

reduce cyclical breast pain

Question 30

What is the side effect of GnRH analogues?

Answer 30

osteoporosis, therefore require HRT to add back the hormones and mitigate the effects

Question 31

What is Sheehan Syndrome?

Answer 31

Rare complication of post partum haemorrhage, drop in circulating blood volume leads to avascular necrosis of the pituitary gland
Low blood pressure, low perfusion to anterior pituitary gland leads to ischaemia and cell death.
Leads to reduced lactation, (secondary) amenorrhoea, adrenal insufficiency
Hypothyroidism

Question 32

How is Sheehan Syndrome managed?

Answer 32

Oestrogen and Progesterone
Hydrocortisone
Levothyroxine
Growth hormone

Question 33

What is Asherman’s syndrome?

Answer 33

Adhesions within the uterus form following damage to the uterus
usually happens after a pregnancy related dilatation and curettage procedure for the treatment of retained products of conception or uterine surgery, pelvic infection (endometritis)

Question 34

How does Asherman’s syndrome present?

Answer 34

secondary amenorrhoea
lighter periods
dysmenorrhoea

Question 35

How do you check for tube patency?

Answer 35

HSG- Hysterosalpingography

Lap and dye

Question 36

HPO axis what cells does LH and FSH stimulate?

Answer 36

Theca and Granulosa cells

Question 37

HPG axis what cells does LH and FSH stimulate?

Answer 37

Leydig and sertoli cells

Question 38

What does the anterior pituitary release?

Answer 38

thyroid stimulating 
adrenocortiocotrophic 
FSH, LH 
GH 
prolactin

Question 39

What does the posterior pituitary release/

Answer 39

Oxytocin

Antidiuretic hormone

Question 40

What is the introitus?

Answer 40

Opening of the vagina