Gynaecology

Question 1

Define Heavy Menstrual Bleeding

Answer 1

Excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life

Question 2

What percentage of women are affected by HMB?
A - 10-20%
B - 15-25%
C - 20-30%
D - 25-35%
E - 30-40%

Answer 2

C

Question 3

What are the four main areas to ask about during history for HMB?

Answer 3

Age (over 45 = high risk of pathology)
Is the bleeding regular? Irregular bleeding need to rule out malignancy
Associated symptoms - heaviness in pelvis, urinary problems
Other issues with history such as clotting disorders, thyroid dysfunction or anti-coagulant medication

Question 4

Match the types of fibroid
(Intramural, Subserosal, Submucosal, Pedunculated) with the location of development (perimetrium, myometrium, endometrium, attached via stalk)

Answer 4

Intramural = myometrium
Subserosal = perimetrium
Submucosal = endometrium
Pedunculated = via stalk

Question 5

How many cycles should a patient wait before seeing results after the insertion of Levonorgestrel-releasing IUS?

Answer 5

6

Question 6

What six subjects should you discuss with the patient when considering hysterectomy for treatment of fibroids?

Answer 6

Sexual feelings
Fertility
Bladder function
Expectations
Psychological impact
further treatment & complications

Question 7

What are the 3 main risks to discuss with a patient regarding hysterectomy?

Answer 7

Damage to abdominal organs
Intraoperative haemorrhage
Loss of ovarian function and consequences of this

Question 8

What treatments are offered for fibroids less than 3cm if LNG-IUS declined?

Answer 8

tranexamic acid
NSAIDS
combined pill
cyclical progestogens

Question 9

What are the 7 RED FLAGS for heavy menstrual bleeding?

Answer 9

Age >45
Persistent intramenstrual bleeding
Post-coital bleeding
Enlarged uterus
Pelvic mass
Lesion on cervix
Post-menopausal bleeding

Question 10

What are the side effects of Mirena?

Answer 10

risk of ovarian cysts
acne
mood changes
breast soreness

Question 11

What are the statistics linked to endometrial ablation?

Answer 11

90% of patients it reduces HMB
50% of patients it stops menstrual bleeding completely
1% risk of uterine perforation and/or infection

Question 12

A 49 year old woman presents to her GP with a six months history of HMB. What should the GP do?
A - insert mirena IUD
B - Arrange ultrasound scan and check her haemoglobin
C - Prescribe tranexamic acid and review in 3 months
D - Refer to gynaecologist for hysteroscopy and biopsy

Answer 12

D

Question 13

A 35 year old has HMB, is trying to conceive and has a normal US. Should the GP do?
A - reassure the scan is normal and should not have treatment as trying to conceive
B - Prescribe tranexamic acid and mefanemic acid to be taken during her period
C - refer for hysteroscopy
D - Prescribe norethisterone 5mg tds between days 41-25 of her cycle

Answer 13

B

Question 14

What are the three main symptoms of an ectopic pregnancy?

Answer 14

Abdominal or pelvic pain
Amenorrhoea
vaginal bleeding

Question 15

Name three other reported symptoms of ectopic pregnancy

Answer 15

breast tenderness
GI symptoms
Dizziness or syncope
shoulder tip pain
urinary symptoms
pain of defecation

Question 16

What are the non-sexually transmitted infection causes of vaginal discharge?

Answer 16

Bacterial vaginosis

Candida

Question 17

Name the sexually transmitted infection causes of vaginal discharge?

Answer 17

Chlamydia trachomatis
Neisseria gonorrhoeae
Trichomonas vaginalis
Herpes simplex virus

Question 18

What are the non-infection causes of vaginal discharge?

Answer 18

Foreign bodies e.g. tampons, condoms
Cervical polyps
Genital tract malignancy
Fistulae

Question 19

What is the medical terminology for pain during sexual intercourse?

Answer 19

Dyspareunia

Question 20

During a Colposcopy, when staining with acetic acid there are some patches of white - what does this show?

Answer 20

CIN = Cervical interepithelial neoplasia