Gynaecology 4

Question 1

Urogenital Prolapse

What clinical features are seen?

Answer 1

heaviness, bearing-down sensation

uringary symptoms: frequency, urgency incontinence

Question 2

Uterine Fibroids

1. What are they?
2. Who are they more common in?
3. What main clinical feature is seen?
4. a) How is it diagnosed?
   b) What can rarely be seen on the bloods?
5. How are the following managed:
   a) menorrhagia
   b) removal / shrink fibroids

Answer 2

1. smooth muscle tumours of the uterus
2. afro-caribbean women
3. menorrhagia

4.

a) TVUS
b) polycythaemia - as rarely tumour can release EPO

5. a) hormone contraception or mefenamic or tranexamic acid
   (but IUS should be given if there distortion of the uterine cavity)

b) GnRH analogues can be given short term but often surgery performed

Question 3

Vaginal Candidiasis

1. What clinical features are seen?
2. What investigation is done?
3. How is it managed?
4. Recurrent candidiasis
   a) How is this managed?
   b) What should be checked?

Answer 3

1. • cottage cheese, non-offensive discharge
   • itch
   • superficial dyspareunia
     +/- satellite lesions
2. NONE if clinical evidence is significant enough
   could do high vaginal swab if unsure
3. 1st line: oral fluconazole

2nd line: clotrimazole pessary

+ topical imidazole if vulval involvement
oral therapy contraindicated in pregnancy

4. a) induction and then maintenance regime of oral fluconazole

b) check glucose as diabetes predisposes to candida

Question 4

1. What clinical features are seen in
   a) Trichomonas vaginalis
   b) Bacterial vaginosis
2. How are they treated?

Answer 4

1. a) offensive frothy green/yellow discharge
   - strawberry cervix
   - vulvovaginitis
   - flagellated protozoa on microscopy

b)

• offensive thin white/grey “fishy” discharge
• vaginal pH >4.5

2. metronidazole

Question 5

Vulval carcinoma

1. What are the risk factors for it?
2. What clinical features are seen?

Answer 5

1. • HPV
   • immunosuppression
   • lichen sclerosus
2. • lump / ulcer on labia majora
     may be associated with:
   • itch
   • inguinal lymphadenopathy

Question 6

Tamoxifen

1. What is its mechanism of action?
2. What are its side effects?

Answer 6

1. selective oestrogen receptor modulator
2. • period disturbance: amenorrhoea, vaginal bleeding
   • hot flushes
   • increased risk of breast cancer
   • VTE

Question 7

What ovarian tumour causes endometrial hyperplasia?

Answer 7

granulosa cell tumour