Gynaecology

Question 1

What is androgen insenstivity syndrome?

Answer 1

When a phenotypical female has XY (male chromosomes- genetically male)
There is an insenstivity to testosterone which results in no inhibition of femal gonadal development.

Question 2

In male gonadal development sertoli cells stimulate gonadal ridge cells to form what?

Answer 2

Leydig cells - these secrete testosterone

Question 3

In male gonadal development what do Sertolli cells secrete?

Answer 3

Anti-mullerian hormone

This degenerates the paramesonephric/muellerian duct

Question 4

What does the paramesonephric/mullerian duct give rise to?

Answer 4

Uterine tubes
Uterus
Superior vagina

Question 5

In embryonic development, when does gonadal differentiation begin?

Answer 5

Week 7

Question 6

Where does the urogenital system originate from?

Answer 6

Intermediate mesoderm

Question 7

What is the chromosmal abnormality in Turner’s Syndrome & what does it consist of?

Answer 7

45,XO
Phenotypically female
Webbed neck, short stature & streak gonads

Question 8

What is the chromosmal abnormality in Klinefelter’s Syndrome & what does it consist of?

Answer 8

47, XXY
Phenotypically male
Atrophic testes, Azoospermia, wide set nipples, female distribution body hair & mild mental retardation.

Question 9

What does the genotype XXY entail?

Answer 9

Phenotypically male

aggressive behaviour, mild mental retardation. Fertility intact

Question 10

What are the recommended contraceptives for women taking liver enzyme inducers? (phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine)

Answer 10

UKMEC 3: the COCP and POP
UKMEC 2: implant
UKMEC 1: Depo-Provera, IUD, IUS

Question 11

What are the recommended contraceptives for women taking Lamotrigine?

Answer 11

UKMEC 3: the COCP

UKMEC 1: POP, implant, Depo-Provera, IUD, IUS

Question 12

What are the UKMEC 4 contraindications to the COC?

Answer 12

Migraine with aura
Thromboembolism risk
Postpartum (<6 weeks)

Question 13

What are the UKMEC 3 contraindications to the COC?

Answer 13

Diabetes mellitus diagnosed >20 yrs ago UKMEC 3/4 depending on severity.
>35yrs old & smoking less than 15 cigarettes/day
BMI > 35
Family history of thromboembolic disease
Controlled hypertension
Immobility e.g. wheel chair use
Carriers of known gene mutations associated with breast cancer
Current gallbladder disease

Question 14

Which cancers does COC REDUCE the risk of?

Answer 14

Ovarian & endometrial (due to progesterone element) cancer

Question 15

Which cancer does COC INCREASE the risk of?

Answer 15

Breast (oestrogen stimulation)

Question 16

Why is the injectable method (Depo-Provera) only used in adolescents if no other method is available?

Answer 16

Osteopenia is a recognised side effect

Question 17

When can Levonorgestrel be used?

Answer 17

Within 72 hours of unprotected sex

Question 18

When can Ulipristal/Ella one be used?

Answer 18

no later than 120 hours after intercourse

Question 19

What effect does ellaone/ Ulipristal have on contraceptive methods?

Answer 19

Ulipristal may reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period