Gynaecology

Question 1

Mittelschmerz

Answer 1

Mid-cycle pain (unilateral lower abdominal), occurs during ovulation, 14 days before start of menstruation? (fluid in the cul-de-sac/pouch of douglas)

Question 2

Anti-hypertensive & anti-androgen medication (used in PCOS)

Answer 2

Spironolactone

Question 3

Clomiphene

Answer 3

SERM (selective oestrogen receptor modulator) - antagonist at oestrogen receptors in hypothalamus. Incr LH & FSH –> stimulates ovulation

Question 4

Girl w normal external female genitalia, normal secondary sexual characteristic development. Primary amenorrhoea, absence uterus, inguinal masses

Answer 4

Androgen insensitivity syndrome (AIS) –> phenotypically female, genotypically male

Question 5

What does the broad ligament contain?

Answer 5

Fold of peritoneum containing the mesosalphinx, mesometrium, mesovarium. Contains the ovaries, fallopian tubes & round ligaments

Question 6

Most common type of incision for Caesareans

Answer 6

suprapubic incision (aka bikini incision / Pfannensteil incision) made at the pubic hairline

Question 7

Short stature, webbed neck, broad shield-like chest w/o breast development

Answer 7

Turners syndrome (45 X) –> primary ovarian failure & no secondary sexual characteristics

Question 8

Adult woman, virilisation, bilaterally enlarged solid-appearing ovaries, associated w insulin resistance

Answer 8

ovarian stromal hyperthecosis

Question 9

3 main causes of virilisation in adult women:

Answer 9

1. Ovarian stromal hyperthecosis
2. Adrenal tumours
3. Androgen-secreting ovarian tumours (Sertoli-Leydig cell tumour, luteoma of pregnancy)

Question 10

elevated serum 17-hydroxyprogesterone concentration

Answer 10

Congenital adrenal hyperplasia (CAH)

Question 11

Most common cancers to metastasise to the ovaries

Answer 11

GIT (stomach & colon)

Question 12

Kruckenberg tumours

Answer 12

gastric tumours that metastasise to the ovary, contain signet ring cells

Question 13

47XXY

Answer 13

Klinefelter’s syndrome (phenotypically male, may have undescended testes & develop secondary female sexual characteristics ie gynacomastia)

Question 14

45X

Answer 14

Turner’s syndrome (phenotypically female, short-stature, POF, webbed neck, lymphedema of hands & feet, bicuspid aortic valve, preductal coartication, high arched palate, streak ovaries, no secondary sexual characteristics)

Question 15

Streak ovaries

Answer 15

Turner’s syndrome

Question 16

Severe morning sickness + symptoms of hyperthyroidism

Answer 16

Molar pregnancy (due to high lvls of bHCG)

Question 17

Snowstorm appearance on USS

Answer 17

Molar pregnancy

Question 18

Low urine unconjugated estriol levels

Answer 18

Suggestive of Down’s syndrome

Question 19

Increased LDH (lactate dehydrogenase)

Answer 19

associated w dysgerminomas

Question 20

AFP

Answer 20

Alpha-fetoprotein (markers of NTDs, hepatocellular carcinoma, endodermal sinus tumours)

Question 21

Irregular, unpredictable bleeding w/i year of menarche

Answer 21

anovulatory dysfunctional uterine bleeding

Question 22

Dyschezia

Answer 22

pain on defecation

Question 23

Metromenorrhagia

Answer 23

irregular & unpredictable uterine bleeding

Question 24

HELLP syndrome

Answer 24

Complication of pre-eclampsia (Haemolysis, Elevated Liver enzymes & Low Platelets). Characterised by high BP & proteinuria. Cx: placental abruption –> DIC

Question 25

Painless 3rd trimester bleeding - top differential

Answer 25

placenta previ

Question 26

Painless 3rd trimester bleeding - top differential

Answer 26

placenta abruption

Question 27

Dysmenorrhoea, deep dyspareunia, dyschezia & adenexal tenderness

Answer 27

endometriosis

Question 28

Mutations in nuclear testosterone receptor

Answer 28

AIS (androgen insensitivity syndrome)

Question 29

Foetal hydantoin syndrome

Answer 29

Caused by antiepileptic agents (phenytoin, carbamazepine). CFs: intrauterine growth restriction (IUGR), microcephaly, cleft lip/palate, mental retardation, hypoplastic fingernails, distal limb deformities

Question 30

Omphalocele

Answer 30

Viscera begin growing outside of the foetal body. Assoc w trisomy 13 & 18 + Beckwith-Wiedemann syndrome (exomphalos-macroglossia-gigantism syndrome)

Question 31

Meningomyelocele

Answer 31

NTD assoc w sodium valproate & folate deficiency

Question 32

Tocolytics

Answer 32

Drugs used to delay preterm labour: nifedipine (CCB), atosiban (oxytocin receptor antagonist)

Question 33

Primary amenorrhoea, normal growth & development, normal secondary sexual characteristics, normal external genitalia. Shortened vaginal canal, normal ovaries, uterine remnants

Answer 33

Mullerian agenesis

Question 34

Normal external female genitalia, blind short vaginal pouch, dysgenetic intra-abdominal testes, no uterus or fallopian tubes

Answer 34

17alpha hydroxylase deficiency

Question 35

Chocolate cysts

Answer 35

Endometrial ovarian deposits (Cx of endometriosis). NB: endometriosis can cause elevated Ca-125

Question 36

Anorexia, weight loss, hyperpigmentation of skin in sun-exposed area

Answer 36

Chronic adrenal insufficiency (addison’s disease)

Question 37

Kallmann syndrome

Answer 37

Hypogonadotropic hypogonadism –> sexually juvenile women w normal XY karyotype.

Question 38

Pathophys of breathlessness in pregnant women

Answer 38

increased minute ventilation (due to increased tidal volume)

Question 39

Dysgerminomas

Answer 39

Assoc w Turner’s. “Fried egg” appearance. Sheets of large malignant cells w clear cytoplasm & round nuclei

Question 40

Spindle-shaped cells w collagen deposits

Answer 40

fibroadenoma

Question 41

Most common type of breast cancer

Answer 41

infiltrating ductal carcinoma (often assoc w fibrosis –> immobile & hard)

Question 42

Peri-hepatic adhesions

Answer 42

Fitz-Hugh-Curtis lesions - complication of PID