Gynaecology

Question 1

Gynae cancers in order of most to least common

Answer 1

1st: Endometrial
2nd: Ovarian
3rd: Cervical
4th: Vulval

Question 2

Endometrial cancer

- Pathophys, presentation, investigation, risks, PF

Answer 2

Endometrial hyperplasia
Presents with PMB
USS: more than 4mm, hysteroscopy and biopsy
Risks: Unopposed oestrogen: PCOS, obesity, HRT, tamoxifen
Protective: COCP, smoking

Question 3

Ovarian cancer

- cause, investigations, rf, pf

Answer 3

Cysts
CA125 + US - surgery
RF: ovulations, BRACA1/2, NHNPCC, endometriosis, obesity
PF: COCP

Question 4

Lifetime risk of ovarian cancer

Answer 4

1/60 lifetime risk

usually 60yrs old

Question 5

Cervical cancer

- Pathophys, RF

Answer 5

Cervical intraepithelial neoplasia CIN

RF: HPV, COCP, smoking

Question 6

Incidence of cervical cancer

Answer 6

30/80

common under 35 yrs

Question 7

Vulval cancer

- Pathophys, RF

Answer 7

Vulval intraepithelial neoplasia (VIN) causes multifocal appearance
RF: HPV, Lichen sclerosis, Immunosupression, Pagets

Question 8

% of genital tract cancers caused by vulval cancer

Answer 8

5%

Question 9

What strains of HPV is the vaccination for?

Answer 9

16 and 18

Question 10

What age are children immunised?

Answer 10

12-13 years

Question 11

Cervical screening programme timelines

Answer 11

25-49 years: Every 3 years

50-64 years: Every 5 years

Question 12

When would you screen an over 65 year old

Answer 12

If abnormal screens or no screening since age 50

Question 13

% of cervical cancers that screening prevents?

Answer 13

75%

Question 14

When would you screen if pregnant?

Answer 14

12 weeks after birth

Question 15

What happens to the cells?

Answer 15

Cervical cytology > liquid-based cytology and PCR to detect common HPV

Question 16

What would you do with …

- Normal smear

Answer 16

Repeat in 3 years

Question 17

What would you do with …

- Inflammatory

Answer 17

Repeat in 6 months

If CN III then colopscopy

Question 18

What would you do with …

Borderline/mild dyskaryosis

Answer 18

High risk HPV test

• Negative: Repeat after 3 years
• Positive: Colposcopy

Question 19

What would you do with …

Moderate or severe dyskaryosis

Answer 19

Urgent colopscopy (2ww)

Question 20

What would you do with …

- Inadequate sample

Answer 20

Repeat

3 inadequate –> colposcopy

Question 21

Epidemiology of chlamydia

Answer 21

Most common in ages 15-24 years

48% of new STI diagnosis

Question 22

Epidemiology of gonorrhoea

Answer 22

Most common in 15-30 years

Common with chlamydia

Question 23

Epidemiology of trichomoniasis

Answer 23

3-5% of females in north america

co-factor for HIV transmission

Question 24

Epidemiology of syphilis

Answer 24

Common in MSM, black
Associated with HIV
Most common in 20-30 years

Question 25

Most common type of HSV

Answer 25

HSV1

Question 26

Epidemiology of HIV

Answer 26

70% in SSA

Usually through heterosexuals, then MSM then IVDU

Question 27

Epidemiology of HPV

Answer 27

Common in 16-25 years

Prevalence around 42%

Question 28

4 methods of sexual health promotion

Answer 28

Contraception
Programs
Peer educators
Abstinence/ condom use

Question 29

What must the local CCG have for the community

Answer 29

Comprehensive sexual health services including HIV testing

Question 30

Aim of sexual health services

Answer 30

Target homosexuals and black people, IVDU, sex workers, prisoners.
Reduce stigma
Unintended vertical transmission (unintended pregnancy rates)

Question 31

7 methods to prevent HIV

Answer 31

• media campaigns
• education in school
• testing HIV and counselling
• ART
• condom use
• contraception reduces the risk man to woman by 50%.
• treat chlamydia and gonorrhea as these facilitate HIV transmission during sex.