Gynaecological disease

Question 1

What is 3rd degree uterine prolapse?

Answer 1

Uterine descent with cervical protrusion beyond the introitus

Question 2

Is 3rd degree uterine prolapse painful?

Answer 2

No. Unless ulcerated

Question 3

Does 3rd degree uterine prolapse cause difficulty defecating?

Answer 3

Yes by pressure on the anterior wall of the rectum.

Question 4

Can 3rd degree uterine prolapse cause urinary incontinence?

Answer 4

Yes.

Or retention

Question 5

Possible symptoms of endometriosis

Answer 5

Ovulation pain
Mid cycle lower abdominal pain
Heavy menstruation
Dysmenorrhoea 
Dysparunia
Dysuria 
Haematuria

Question 6

What is primary vulvodynia?

Answer 6

Chronic vulval pain of more than 3 months dating from 1st sexual experience or tampon use

Question 7

What is secondary vulvodynia?

Answer 7

Chronic vulval pain of more than 3 months developing after previous pain free sexual intercourse

Question 8

Associations with vulvodynia

Answer 8

Change in sexual partner
Thrush
STI
Depression

Question 9

Most common cause of vaginal discharge

Answer 9

Bacterial vaginosis

Question 10

Effect of bacterial vaginosis (BV) on vaginal PH

Answer 10

Loss of normal vaginal acidity.

PH increases to greater than 4.5.

Question 11

Symptoms of BV

Answer 11

50% are asymptomatic.

Fishy-smelling vaginal discharge

Question 12

Non infective causes of abnormal vaginal discharge?

Answer 12

Retained foreign body, 
Iflammation due to allergy or irritation, 
Tumours, 
Atrophic vaginitis,
Cervical ectopy,
Cervical polyps

Question 13

Drugs for heavy menstrual bleeding

Answer 13

Mefenamic acid
Tranexamic acid
Norethisterone day 15 or 19 - 26
Levornagesterel IUD
Danazol

Question 14

How frequent should HIV +Ve women have cervical smears?

Answer 14

Yearly.

Despite CD4 count

Question 15

What is the recommended frequency of cervical smears for women aged 25-49?

Answer 15

3 yearly

Question 16

What is the recommended frequency of cervical smears for women aged 50-64?

Answer 16

5 yearly

Question 17

What is Ashermans syndrome?

Answer 17

Interuterine adhesions ranging from complete obliteration to minimal adhesions

Question 18

What is Sheehan syndrome

Answer 18

Intrapartum pituitary haemorrhage

Question 19

Does smoking affect the menopause?

Answer 19

Yes, makes it earlier

Question 20

Define postmenopausal bleeding

Answer 20

PV bleeding occurring at least 12 months after the cessation of menstruation

Question 21

Causes of postmenopausal bleeding include

Answer 21

Vaginal atrophy
Endometrial carcinoma
Endometrial hyperplasia
Cervical cancer
Ovarian cancer
Liver cirrhosis

Question 22

A retroverted uterus may be associated with what symptoms

Answer 22

none
Backache
dyspareunia

Question 23

Characteristics of lichen sclerosis

Answer 23

Thickened skin and accentuated markings of the vulva

Itching and pain

Question 24

What is the malignant potential of lichen sclerosis in %

Answer 24

Potential of squamous cell carcinoma of the vulva in 2 - 5%

Question 25

Treatment of lichen sclerosis

Answer 25

Topical steroids Bland emollient Avoid irritants, heat and allergens

Question 26

What may koilocites on a cervical smear suggest

Answer 26

Human papilloma virus infection

Question 27

Possible presentation of antiphospholipid syndrome

Answer 27

``` Recurrent miscarriage Arterial or venous thrombosis Livedo reticularis rash Stroke Adrenal haemorrhage Migraine Myelitis Myocardial infarction Multi-infarct dementia ```

Question 28

Antibodies found in antiphospholipid syndrome

Answer 28

Anti-cardiolipin antibodies

Question 29

What is premenstrual syndrome

Answer 29

Physical and/or psychological symptoms affecting some women up to 10 days prior to menstruation. Acne, breast tenderness, bloating, fatigue, nervousness, irritability, emotional disturbance, headache, mood changes. Usually resolves with or after menstruation .

Question 30

When and how often is cervical smear screening offered

Answer 30

25-49 3 yearly | 49-64 5 yearly

Question 31

What happens to CIN on colposcopy when acetic acid and iodine are applied

Answer 31

Aceto-white change | Failure of iodine staining

Question 32

Symptoms of cervical ectropion

Answer 32

Asymptomatic Mucoid discharge PCB

Question 33

Causes of dysparunia

Answer 33

``` Vulvovaginitis (esp thichomoniasis and candida) Vaginal cysts Infected bartholins gland Post menopause Congenitally small ostium / thick hymen Deep retroverted uterus Chronic pelvic infection Endometriosis Adenomyosis Pelvic tumours Ectopic pregnancy ```