Gynaecology

Question 1

Follicle cyst

Answer 1

follicle cysts form when the follicle doesn’t break open to release the egg each month - this causes the follicle to continue growing into a cyst

No symptoms - go away in 1-3 months

Question 2

Corpus luteum cysts

Answer 2

once the follicle breaks open and releases the egg the empty follicle sac shrinks into a mass of cels called corpus luteum
corpus luteum makes hormones to prepare for the next egg of the menstrual cycle
corpus luteum cysts form if the sac doenst shrink
instead the sac reveals itself after the egg is released, and then fluid builds up inside
most corpus luteum cysts go away after a few weeks
they can grow to 4 inches wiede
they may bleed or twist the ovary and cause pain

Question 3

Most common cause of ovarian cysts

Answer 3

1. Hormonal problems
2. Endometriosis
3. Pregnancy
4. Severe pelvic infections

Question 4

Signs and symptoms of ovarian cysts

Answer 4

pressure, bloating, swelling or pain in the lower abdomen on the side of the cyst, pain may be sharp or dull and may come and go
if a cyst ruptures: it can cause sudden severe pain
if a cyst causes twisting of an ovary you may have pain along with nausea and vomiting
less common symptoms: pelvic pain, dull ache in lower back and things, problems emptying the bladder or bowel completely, pain during sex, unexplained weight gain, pin during your period, unusual vaginal bleeding, breast tenderness, needing to urinate more often

Question 5

Eitiologies to exclude in the diagnosis of PCOS

Answer 5

congenital adrenal hyperplasia, androgen secreting tumours, Cushing syndrome, thyroid dysfunction and hyperprolactinaemia

Question 6

Rotterdam Diagnostic criteria for PCOS

Answer 6

Two of the following three criteria are required:

oligo/anovulation
hyperandrogenism
clinical (hirsutism or less commonly male pattern alopecia) or
biochemical (raised FAI or free testosterone)
polycystic ovaries on ultrasound

Question 7

First line treatment for PCOS

Answer 7

A lifestyle program that addresses a healthy diet with caloric restriction, behaviour change support and exercise to aid in weight loss and prevention of future weight gain

Question 8

Medical management of infertility in PCOS

Answer 8

Clomiphene citrate

also metformin

Question 9

Criteria for PID diagnosis

Answer 9

One of

adnexal tenderness, uterine tenderness, or cervical motion tenderness

Question 10

bartholin’s glands

Answer 10

re 2 pea sized compound racemose glands located slightly posterior to the left and right of the opening of the vagina.
they secrete mucous to lubricate the vagina and are homologous to bulbourethral glands in males
located in the superficial perineal pouch

Question 11

What levels are raised in PCOS?

Answer 11

Raised Free Androgen Index
Raised DHEAS
(Hyperandrogenemia)

Question 12

Most common pelvic configuration

Answer 12

Gynecoid

Question 13

Shape of an anthropoid pelvis

Answer 13

Heart shaped with a wider AP diameter than transverse

Question 14

Android pelvis shape

Answer 14

Narrower and taller than the Gynecoid

Question 15

What is the major blood supply to the pelvic organs

Answer 15

Internal iliac artery

Question 16

Blood supply to the cervix

Answer 16

Cervical branch of the uterine artery

Question 17

Stress Incontinence

Answer 17

Involuntary loss of urine with increased intra abdominal pressure (coughing, laughing, sneezing, walking, running)

Question 18

Urge Incontinence

Answer 18

Urine loss associated with an abrupt sudden urge to void

Question 19

Neurological causes of urge incontinence

Answer 19

Multiple Sclerosis
Herniated Disc
Diabetes Mellitus

Question 20

Risk Factors for stress incontinence in women

Answer 20

pelvic prolapse
pelvic surgery
childbirth
hypoestrogenic state (post menopause)
age
smoking
neurological/ pulmonary disease

Question 21

Treatment for stress Incontinence

Answer 21

TVT - Tension free vaginal tape

Question 22

Treatment for urge incontinence

Answer 22

behaviour modification
Kegel exercises
Medications - anticholinergics; ocybutynin

Question 23

prolapse

Answer 23

herniation due to failure of muscular and connective tissue supports of
pelvic floor
uterus and cervix

Question 24

avulsion of which ligament is most likely to cause an anterior compartment prolapse

Answer 24

arcus tendineus fascia pelvis (ATFP)

Question 25

Which 3 muscles make up the levator ani?

Answer 25

Pubococcygeus
Puborectalis
Iliococcygeus

Question 26

which nerve innervates the levator ani?

Answer 26

Pudendal nerve

Question 27

where does the pudendal nerve run in relation to the ischial spine

Answer 27

beneath and lateral to

Question 28

What does a stage 4 prolapse indicate

Answer 28

complete eversion of the genital tract

everything is out

Question 29

Risk Factors for prolapse

Answer 29

Obesity
lifestyle
occupational
medical conditions: respiratory, menopause
iatrogenic factors
age
parity

Question 30

4 main things prolapse affects

Answer 30

Bladder
Bowel
Sex
Psyche

Question 31

main causes of prolapse

Answer 31

direct trauma

pelvic neuropathy

Question 32

most common presenting symptom of vaginal prolapse?

Answer 32

Pelvic heaviness

Question 33

Structural causes of vaginal prolapse

Answer 33

Pudenal neuropahty
avulsion of the pubococcygeus muscle
tearing of the arcus tendineus fascia pelvis
elongation of the uterosacral ligament

Question 34

in women with prolapse of the posterior vaginal compartmnet which symptom is pathognomic

Answer 34

digitation

Question 35

In a woman with stage IV vaginal prolapse requiring surgery, which one of the following is most appropriate regarding medical management of warfarin taken for controlled AF

Answer 35

Aim for INR of 1

Question 36

a deficient perineal body is most likely associated with

Answer 36

a wide genital hiatus

Question 37

Dysfunctional Uterine Bleeding

Answer 37

excessive, heavy, prolonged or frequent bleeding that is not due to pregnancy or any recognisable pelvic or systemic disease

Question 38

Name 3 drugs that interfere with the OCP

Answer 38

Phenytoin, Rifampicin and carbamazepine

Question 39

What mediates the increased risk of thromboembolic disease with OCPs

Answer 39

oestrogen stimulates production of clotting factors: VII and X and decreases levels of antithrombin III

Question 40

What is breakthrough bleeding due to on OCP

Answer 40

Atrophic endometrium

- increase oestrogen dose

Question 41

what is the OCP metabolised by

Answer 41

cytochrome P450
Drugs including anticonvulsants, antibiotics and some antriretrovirals all induce liver enzymes and result in faster metabolism

Question 42

Treatment for candida

Answer 42

single dose of fluconazole

Question 43

Lymphogranuloma venereum

Answer 43

caused by chronic infection with Chlamydia trachomatis

Question 44

Granuloma Inguinale

Answer 44

Donovonosis