gynae summary

Question 1

SMOCC history

Answer 1

S exual history
M enstrual history
O bstetric histroy
C contraception/HRT
CST - date of last test, results and any treatment arising

Question 2

investigations for hevy menstrual bleeding

Answer 2

bedside: urine bHCG, urinalysis to rule out UTI
micro: CST, STI screen (FPU for chlamydia PCR)
bloods: FBC, iron studies +/- coags, vWF, TFTs

TVUSS: polyps, fibroids, retained products of conception, adenomyosis, hyperplasia

Question 3

management of heavy menstrual bleedings

Answer 3

treat inron deficiency anaemiaa with Fe supplimentation
analgesia
antifibrinolytics (tranexamic acid)
hormonal: COCP, progestogens

Question 4

surgical manaagement of eavy menstrual bleedings

Answer 4

endometrial ablation
uterine artery ambolism
hysterectomy
polyps/polyectomy
fibroids/fibroidectomy

Question 5

causes of intramestrual and post coital bleeding

Answer 5

pregnancy related: miscarriage, ectopic
midcycle bleeding with ovulation
breakthrough bleedinng on hormonal contreception
cervical cancer
cervicitis (chlamydia?), PID

Question 6

causes of irregular menstruaal cycles

Answer 6

normal in first year after menarche
pregnancy
PCOS
anovulation due to immature HPO axis
thyroid disease
hyperprolactinaemia
premature menopause
cushing’s syndrome

Question 7

symptoms of PCOS

Answer 7

acne
weight gain and trouble losing weight
extra facial and body hair
thinning scalp hair
irregular periods
fertility problems
anxiety and depression

Question 8

complicaations of PCOS

Answer 8

metabolic syndrome, obseity, insulin resistance, T2DM, gesstational diabetes, OSA and increased CVD risk
increased risk of endometrial cancer
infertility - most women will be able to concieve but will need assistance
depression and anxiety

Question 9

PCOS diagnostic criteria

Answer 9

1. clinical or biochemical signs of hyperandrogensim
2. oligo or anovulation
3. polycystic ovaries

Question 10

management of PCOS

Answer 10

nutrition, physical activity, weight management
manaagement of irregular bleeding: oral contraceptive pill, intermittant progestogens to induce bleed
metformin

Question 11

causes of post menopausal abnormal uterine bleeding

Answer 11

malignancy - endometrial or cervcal cancer
endometrial hyperplasia
endometrial or vaginal atrophy
HRT
PALM COEIN causes, polyps are common
PID, STIs, cervicitis

Question 12

PALM-COEIN

Answer 12

Polyps
Adenomyosis
Leiiomyomas
Malignancy

Cogulopathies
Ovulatory
Endometrial hyperplasia
Iatrogenic

Question 13

risk factors for endometrial cancer

Answer 13

inceasing age
unopposed oestrogen
tamoxifen therapy
early menarche (<12)
late menopause (>55)
nulliparity
PCOS
obesity
diabetes
genetic syndrome

Question 14

investigations for endometrial cancer

Answer 14

bedside: urinalysis - rule out UTI
micro - CST, STI screen
bloods - FBC, iron studies, coags, TFTs
imaging: traansvaginal US, hysteroscopy D&C or pipeline endometrial sampling

Question 15

what is D&C

Answer 15

hysteroscopy dilation and currettage
involves hysteroscope being inserted into the uterus through the vagina to visualise the uterus and dilation and curette to scrappe away a sample of the endometrium

Question 16

pipelle sampling

Answer 16

less sensitive
done without anaesthetic in clinic
a thin tube (pipelle) is inserted into the uterus and aspirates a small sample of cells

Question 17

management of endometrial cancer

Answer 17

total abdominal hysterectomy with bilateral sapling-oopherectomy
other treatment depends on individual presentation but may innclude radiotherapy, chemotherapy, progesterone