Gynaecology

Question 1

contraception changes perioperatively

Answer 1

Oestrogen-containing contraceptives should preferably be discontinued 4 weeks before major elective surgery and all surgery to the legs, abdomen or surgery which involves prolonged immobilisation of a lower limb. A progestogen-only contraceptive may be offered as an alternative and the oestrogen-containing contraceptive restarted after mobilisation.

Question 2

What are Gonadotrophin releasing hormone antagonists used for?

Answer 2

For patients with uterine fibroids, GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment

Question 3

What is a Rokitansky protuberance?

Answer 3

single or multiple white shiny masses projecting from the wall toward the centre of dermoid cysts (teratoma). Usually, hair, teeth other appendages are attached to the Rokitansky protuberance.

Question 4

Mx of Abnormal cervical smear

Answer 4

Mild dyskaryosis - if HPV positive colposcopy, if not then routine recall.
Moderate or severe dyskaryosis - consistent with CIN II and III respectively, urgent colposcopy
suspected invasive cancer - urgent colposcopy
inadequate sample - repeat smear

Question 5

Contraceptives - time until effective (if not first day period):

Answer 5

instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

Question 6

Contraception options for postpartum

Answer 6

COCP is contraindicated if breastfeeding
POP is fine
LARCs are fine
Lactational amenorrhea is up to 98% effective for first 6 months

Question 7

Mx of fibroids

Answer 7

• symptomatic management with a levonorgestrel-releasing intrauterine system is recommended by CKS first-line
• other options include tranexamic acid, combined oral contraceptive pill etc
• GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment
• surgery is sometimes needed: myomectomy (may improve fertility), hysteroscopic endometrial ablation, hysterectomy
  uterine artery embolization

Question 8

What to do if FGM found

Answer 8

report to the police

Question 9

Causes of recurrent miscarriage

Answer 9

antiphospholipid syndrome (most common)
endocrine disorders: poorly controlled diabetes mellitus/thyroid disorders. Polycystic ovarian syndrome
uterine abnormality: e.g. uterine septum
parental chromosomal abnormalities
smoking

Question 10

Combined oral contraceptive pill MOA

Answer 10

Inhibits ovulation

Question 11

Progestogen-only pill (excluding desogestrel) MOA

Answer 11

Thickens cervical mucus

Question 12

Desogestrel-only pill MOA

Answer 12

Primary: Inhibits ovulation
Also: thickens cervical mucus

Question 13

Injectable contraceptive (medroxyprogesterone acetate) MOA

Answer 13

Primary: Inhibits ovulation
Also: thickens cervical mucus

Question 14

Implantable contraceptive (etonogestrel) MOA

Answer 14

Primary: Inhibits ovulation
Also: thickens cervical mucus

Question 15

Intrauterine contraceptive device MOA

Answer 15

Decreases sperm motility and survival

Question 16

Intrauterine system (levonorgestrel) MOA

Answer 16

Primary: Prevents endometrial proliferation

Question 17

What to do if missed pill (progesterone)

Answer 17

If more than 3 hours late (or 12 hours if cerezette (desogestrel))
take the missed pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day
continue with rest of pack
extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours

Question 18

first line investigation for postmenopausal bleeding

Answer 18

transvaginal ultrasound

Question 19

Ectopic pregnancy locations and liklihood

Answer 19

tubal ectopic: 93-97%
ampullary ectopic: most common :65% of all ectopics
isthmal ectopic: :11% of all ectopics
fimbrial ectopic: :10% of all ectopics
interstitial ectopic/cornual ectopic: 3-4%; also essentially a type of tubal ectopic

ovarian ectopic/ovarian pregnancy; 0.5-1%

cervical ectopic/cervical pregnancy; rare <1%

scar ectopic: site of previous Caesarian section scar; rare

abdominal ectopic: rare; ~1.4%