Gynaecology

Question 1

Risk factors for prolapse (5)

Answer 1

Increasing age High BMI Vaginal delivery High parity Spina bifida

Question 2

Management of prolapse

Answer 2

Pelvic floor exercises Vaginal pessary Surgery

Question 3

Risk factors for endometriosis (3)

Answer 3

Oestrogen exposure (late menopause, early menarche, delayed child-bearing/nullip) Obstruction to vaginal outflow Genetic

Question 4

Protective factors against endometriosis (2)

Answer 4

Multiparity Oral contraceptives

Question 5

Common sites for endometriosis (6)

Answer 5

Pelvic cavity Uterosacral ligaments Pouch of Douglas Bladder Colon Scar sites

Question 6

Causes of post-menopausal bleeding

Answer 6

Vaginal atrophy HRT Endometrial cancer (and others) Polyps Trauma Non-gynae causes - bleeding disorders

Question 7

Most common sites for ectopic pregnancy

Answer 7

Ampulla Isthmus

Question 8

Risk factors for ectopic pregnancy (4)

Answer 8

PID Fertility treatment Failure of IUD Previous ectopic

Question 9

Management of ectopic pregnancy

Answer 9

Admit urgently if suspected Methotrexate if painless or small Surgery if painful, large or high hCG

Question 10

Causes of intermenstrual bleeding (4)

Answer 10

Polyp/ectropion Cancer Infection Fibroids

Question 11

Causes of postcoital bleeding

Answer 11

Infection Polyp/ectropion Cancer Trauma

Question 12

When to refer urgently for abnormal PV bleeding

Answer 12

Abnormal cervix Polyp not easily removed Pelvic mass High risk of endometrial cancer

Question 13

Management of primary dysmenorrhoea

Answer 13

Once secondary cause ruled out: NSAIDs COCP

Question 14

Management of secondary dysmenorrhoea

Answer 14

Gynae referral for management of pathology

Question 15

Cervical screening regime

Answer 15

Begins at age 25 3 yearly until 49 5 yearly until 65

Question 16

Management of cervical screening results

Answer 16

Borderline/mild dyskaryosis - HPV testing (if negative, back to routine, if positive, colposcopy) Moderate or severe dyskaryosis - colposcopy Inadequate - repeat smear

Question 17

Management of urge incontinence (overactive bladder)

Answer 17

6 weeks bladder training Medication (antimuscurinics) Surgery

Question 18

Management of stress incontinence

Answer 18

Pelvic floor muscle exercises Surgery

Question 19

Identify menstrual cycle hormones

Answer 19

A - Oestrogen

B - LH

C - FSH

D - Progesterone