Gynaecology

Question 1

Enlarged ‘boggy’ uterus

Answer 1

Adenomyosis

Question 2

Mx. Adenomyosis

Answer 2

Hysterectomy

Question 3

Hypothalamic amenorrhoea may be caused by:

Answer 3

Stress, anorexia and excessive exercise

Question 4

Androgen insensitivity syndrome mode of inheritance:

Answer 4

X-linked recessive

Question 5

Symptoms suggestive of ectopic pregnancy and > 6 weeks gestation:

Answer 5

Urgent referral to early pregnancy service

Question 6

Symptoms suggestive of atopic pregnancy and < 6 weeks gestation:

Answer 6

if NO pain or risk factors for ectopic, they can be managed expectantly:
Repeat urine pregnancy test after 7-10 days and return if positive

Question 7

Most cervical cancers are what kind of carcinoma:

Answer 7

Squamous cell (80%)

other 20% are adenocarcinoma

Question 8

Delay of cervical screening postpartum:

Answer 8

3 months

Question 9

Treatment of CIN

Answer 9

Large loop excision of transformation zone (LLETZ)

Cryotherapy

Question 10

Stage 1A cervical cancer treatment:

Answer 10

Cone biopsy - will preserve fertility

Question 11

Stage IB, II, III cervical cancer tx.

Answer 11

Radiation w/ concurrent chemotherapy

Question 12

Complications of radiotherapy in cervical cancer

Answer 12

Diarrhoea, vaginal bleeding, radiation burns, pain on micturition

Long-term: Ovarian failure, fibrosis of bowel/skin/bladder/vagina

Question 13

Uterus size greater than expected for dates:

Answer 13

Complete hydatidiform mole

Question 14

Primary dysmenorrhoea tx.

Answer 14

NSAIDS such as mefanamic acid and ibuprofen - effective in 80%
COCP used second line

Question 15

Management of secondary amenorrhoea

Answer 15

Refer ALL patients to gynaecology for investigation

Question 16

Abdominal tenderness, cervical excitation and adnexal mass

Answer 16

ECTOPIC pregnancy

Question 17

1st line investigation in suspected ectopic pregnancy:

Answer 17

Transvaginal ultrasound

Question 18

HNPCC is a risk factor for which female cancer

Answer 18

Endometrial cancer

Question 19

Endometrial cancer tx.

Answer 19

Total abdominal hysterectomy w/ bilateral salpingo-oophorectomy
Pts. w/ high risk disease may receive post op RADIOTHERAPY

Progestogen therapy for old, frail women who are not candidates for surgery

Question 20

Management of simple endometrial hyperplasia without ATYPIA

Answer 20

High dose progestogens w/ repeat sampling in 2-3 months. IUS may be used

Question 21

Management of simple endometrial hyperplasia WITH ATYPIA

Answer 21

Hysterectomy

Question 22

Management for endometriosis

Answer 22

NSAIDs and paracetamol first line

COCP second-line

Question 23

Non gynaecological symptoms of endometriosis

Answer 23

Urinary: dysuria, urgency, frequency, haematuria

Dyschezia - painful bowel movements

Question 24

Endometriosis: If analgesia/hormonal treatment doesn’t work:

Answer 24

GnRH analogues - induce pseudomenopause

Question 25

Fibroid degeneration presentation:

Answer 25

Low-grade fever, pain and vomiting

Question 26

PID: Peri-hepatic inflammation secondary to chlamydia:

Answer 26

Fitz-Hugh Curtis syndrome)

Question 27

Menorrhagia primary investigation:

Answer 27

Trans-vaginal ultrasound | FBC

Question 28

short term medication to rapidly terminate heavy menstrual bleeding:

Answer 28

Norethisterone

Question 29

When is hyperemesis gravidarum most common:

Answer 29

8-12 weeks | May persist up to 20 weeks

Question 30

Hyperemesis gravidarum first-line tx. Second line tx.

Answer 30

Oral CYCLIZINE or promethazine Ondansetron and metoclopramide (should not be used for more than 5 days) Admissions may be needed for IV hydration

Question 31

Long term complications of hysterectomy:

Answer 31

Enterocele and vaginal vault prolapse

Question 32

Infertility investigations: Serum progresterone -> when should it be tested

Answer 32

7 days prior to next expected period (Day 21 in a regular 28 day cycle)

Question 33

Key counselling points for infertility:

Answer 33

Folic acid Aim for both partners BMI 20-25 Advise regular intercourse every 2-3 days smoking/drinking advice

Question 34

Contraindications to HRT:

Answer 34

Current or past breast cancer Any oestrogen-sensitive cancer Undiagnosed vaginal bleeding Untreated endometrial hyperplasia

Question 35

Non HRT management of menopausal symptoms: | Vasomotor symptoms:

Answer 35

Fluoxetine, citalopram or venlafaxine

Question 36

Commonest type of ovarian cyst:

Answer 36

Follicular cyst

Question 37

Benign ovarian germ cell tumours:

Answer 37

Dermoid cyst - most common benign ovarian tumour in women < 30 years

Question 38

Benign ovarian epithelial tumours:

Answer 38

Serous cystadenoma Mucinous cystadenoma Serous cystadenoma = most common benign epithelial tumour Mucinous cystadenoma = Second most common Typically massive and may cause pseudomyxoma peritonea

Question 39

Imaging in ovarian cysts:

Answer 39

Ultrasound

Question 40

Ultrasound free fluid - Whirlpool sign:

Answer 40

Ovarian torsion

Question 41

Ovarian torsion management:

Answer 41

Laparoscopy is both diagnostic and therapeutic

Question 42

Ovarian tumours: psammoma bodies

Answer 42

Serous cystadenocarcinoma

Question 43

Most common Ovarian germ cell cancer

Answer 43

Dysgerminoma

Question 44

Other term for teratoma:

Answer 44

Dermoid cysts (most common germ cell tumour)

Question 45

Schiller-Duval bodies on histology and increased AFP

Answer 45

Yolk-sac tumour

Question 46

Sex-cord stromal tumours: often produce

Answer 46

Hormones

Question 47

3 sex-cord stromal tumours: | Which of these if malignant

Answer 47

Granulosa cell tumour (MALIGNANT) Sertoli-Leydig Fibroma

Question 48

Granulosa cell tumour produces:

Answer 48

Excess oestrogen

Question 49

Sertoli-leydig tumour produces:

Answer 49

Androgens -> masculinising effects | associated w. Peutz-Jeghers syndrome

Question 50

Name for ovarian tumour which metastasises from a GI primary

Answer 50

Kruckenberg tumour

Question 51

Most common cause of pelvic inflammatory disease:

Answer 51

Chlamydia trachomatis Other causes: Neisseria Gonorrhoea Mycoplasma genitalum Mycoplasma hominis

Question 52

Pelvic inflammatory disease mx.

Answer 52

Oral OFLOXACIN + oral METRONIDAZOLE or IM CEFTRIAXONE + oral DOXYCYCLINE + oral METRONIDAZOLE

Question 53

PCOS investigations:

Answer 53

Pelvic ultrasound FSH, LH, Prolactin, TSH and testosterone. Raised LH:FSH ratio is classical Check for impaired glucose tolerance

Question 54

Premature ovarian insufficiency mx.

Answer 54

HRT or COCP should be offered to women until menopause age (51 yrs)

Question 55

Management of premenstrual syndrome:

Answer 55

Lifestyle advice (small regular meals rich in complex carbohydrates) Moderate symptoms may benefit from new generation COCP Severe symptoms = SSRI (taken continuously or just during the luteal phase

Question 56

How long should bladder retraining last in urge incontinence :

Answer 56

Minimum 6 weeks

Question 57

Alternative for urge incontinence for older people at risk of anti-cholinergic side-effects from Oxybutinin

Answer 57

MIRABEGRON - b3 agonist

Question 58

Prolapse management: Cystocele/cystourethrocele

Answer 58

Anterior colporrhaphy or colposuspension

Question 59

Prolapse management: Uterine prolapse

Answer 59

Hysterectomy or sacrohysteropexy

Question 60

Prolapse management: rectocele

Answer 60

Posterior colporrhaphy

Question 61

Vaginal candidiasis mx: If oral therapy contraindicated If pregnant

Answer 61

Oral fluconazole 150 mg as single dose first-line Clotrimazole 500 mg vaginal pessary Only topical preparations can reused in pregnancy

Question 62

Asymptomatic fibroids tx.

Answer 62

No treatment needed other than periodic review and monitor size and growth.