Gynaecology - 204

Question 1

What is DUB (dysfunctional uterine bleeding)?

Answer 1

Menorrhagia that is not associated with organic disease of the genital tract

Question 2

What are uterine leiomyomas?

Answer 2

Fibroids - benign growths in the uterus that can cause heavy regular periods.

Question 3

What is endometriosis?

Answer 3

A condition where endometrial tissue is found outside the uterus -> this can cause painful periods, persistent pain in the pelvic area and infertility.

Question 4

What does adenomyosis refer to?

Answer 4

Ectopic endometrial tissue within the myometrium

Question 5

What investigations would you do in a women presenting with menorrhagia?

Answer 5

FBC -> to exclude anaemia
USS -> to see if the uterus is normal sized
Outpatient endometrial biopsy -> usually performed on women over 45 years.

Question 6

If a women with menorrhagia is also anaemic what would you treat with?

Answer 6

Fe supplements, e.g ferrous sulphate 200mg bd

Question 7

What are the medical options for menorrhagia?

Answer 7

• Tranexamic acid (antifibrinolytic) 1g tis, during menstruation only
• Mefenamic acid (NSAID)
• OCC
• Oral progestogens
• Mirena IUS, Levonorgestrel -> v. good, reduces blood loss by 90%

Question 8

Name the surgical options for menorrhagia

Answer 8

Endometrial ablation (nova sure and thermal balloon) and hysterectomy

Question 9

Hyperemesis gravidarum, vaginal bleeding, abdominal pain, miscarriage and ectopic pregnancy are all what?

Answer 9

Common problems in early pregnancy

Question 10

How long can hCG levels take to return to normal following a miscarriage?

Answer 10

2-3 weeks

Question 11

A lady presenting to A&E in early stages of pregnancy with continual abdominal pain and persistent vaginal bleeding is suggestive of what?

Answer 11

Ectopic pregnancy.

Question 12

Name some risk factors for ectopic pregnancy

Answer 12

Chlamydia, mirena coil, infection

Question 13

How do you manage an ectopic pregnancy medically? How do you manage it surgically?

Answer 13

Methotrexate injection.

Laparoscopy/laparotomy

Question 14

What is methotrexate? What must be checked before it is given?

Answer 14

An antimetabolite that kills the pregnancy.

Liver and kidney function must be checked

Question 15

What drugs are used for the evacuation and termination of pregnancy?

Answer 15

• Mifepristone tablets are taken first - 200mg. These start the evacuation process and ripen cervix
• Misoprostol taken 1-2 days later at 400mg. Ripens the cervix

Question 16

Where is the most common site for an ectopic pregnancy?

Answer 16

Ampulla of the tube

Question 17

What is a molar pregnancy?

Answer 17

A benign tumour that develops in the uterus, it occurs when there is an extra set of paternal chromosomes in a fertilised egg.

Question 18

If untreated, what can molar pregnancies lead to?

Answer 18

Choriocarcinoma -> this is due to the hCG levels staying high. Very rare

Question 19

In what demographic are fibroids more common?

Answer 19

Afro-carribean women, women approaching menopause.

They are found in 1:3 women >30 years

Question 20

Name some factors that increase the risk of fibroids

Answer 20

Tamoxifen, Ethnicity, Hypertension, FH, Obesity, Null Parity

Question 21

What tumour markers would be assessed in a women with fibroids?

Answer 21

Ca125, CEA

Question 22

How can fibroids be treated medically?

Answer 22

• Esyma (ulipristal acetate) tablets
• GnRH agonists
• Mirena

Question 23

What % of sub fertility is due to unexplained failure with absence of pathology?

Answer 23

25%

Question 24

What is an example of an ovulatory disorder that has a hypothalamic cause?

Answer 24

Eating disorders, stress, excessive exercise

Question 25

What is an example of an ovulatory disorder that has a pituitary cause?

Answer 25

Sheehans syndrome, prolactinomas, radiotherapy, idiopathic

Question 26

What is an example of an ovulatory disorder that has an ovarian cause?

Answer 26

PCOS, primary ovarian failure

Question 27

What are the 3 criteria for PCOS. How many of them must be true for someone to have PCOS?

Answer 27

2

• Hyperandrogenism
• Oligo-ovulation or anovulation
• Polycystic ovaries on scan

Question 28

What medication can be used to induce ovulation?

Answer 28

• Oestrogen antagonists, e.g. Clomifene citrate, tamoxifen

- Gonadotrophins, FSH + LH

Question 29

What are some treatment options for sperm dysfunction?

Answer 29

Intrauterine Insemination (IUI) -> for mild dysfunction
Donor insemination
IVF + ICSI

Question 30

What drug is used in IUI (intrauterine insemination) to induce ovulation?

Answer 30

Clomiphene

Question 31

At what day of the menstrual cycle does ovulation usually take place?

Answer 31

Day 14

Question 32

What is the most common cause of post-menopausal bleeding? In 10% of cases what is the cause?

Answer 32

Atrophic vaginitis

10% cause = endometrial cancer/hyperplasia

Question 33

What is a cystocele?

Answer 33

Prolapse of bladder into vagina

Question 34

What is a rectocele?

Answer 34

Rectal tissue herniates into vagina

Question 35

98% of abortions are carried out under what act?

Answer 35

1a - pregnancy under 24 weeks, continuation would result in risk to mother or existing children

Question 36

What does act 1b of the 1967 abortion act state?

Answer 36

Termination is necessary to prevent physical or mental damage to the women

Question 37

What does act 1c of the 1967 abortion act state?

Answer 37

Continuing pregnancy would be of greater risk to mother than terminating it

Question 38

1% of abortions are carried out under this act, what is it? What does it state?

Answer 38

Act 1d. States that if the child was born there is great risk it would suffer from serious mental or physical abnormalities

Question 39

The HRT regimen E2 only is for what category of women?

Answer 39

Hysterectomised women