Gynaecology

Question 1

Symptoms of uterine fibroids?

Answer 1

Asymptomatic

• Menorrhagia
• Lower abdominal pain (cramps or pressure) or dysmenorrhea
• Urinary changes - increased frequency
• Subfertility
• Bloating

Question 2

Investigations for uterine fibroids

Answer 2

Transvaginal & transabdominal Ultrasound

Question 3

Management of uterine fibroids?

symptomatic (1+2, 1) & surgical (4)

Answer 3

Symptomatic - levonorgestrel releasing IUS +- COCP and tranexamic acid

GnRH agonist can reduce size short term

Surgical management = myomectomy, uterine artery embolization, endometrial ablation, hysterectomy

Question 4

Risk factors for uterine fibroids?

Answer 4

• Afrocarribean women,
• Older age
• Obesity
• Early menstruation
• Family history

Question 5

Complications of uterine fibroids?

Answer 5

• Compression of adjacent organs - pain, constipation, urine changes (freq and retention) and hydronephrosis
• Infertility
• Complicates pregnancy: malpresentation, pre-term, miscarriage, pain
• Torsion of a pedunculated fibroid
• Haemorrhage

Question 6

Investigations for endometrial cancer?

Answer 6

Transvaginal Ultrasound and if more than 4mm thickness, do pipelle biopsy (best) or during hysteroscopy

Question 7

Management for endometrial cancer?

Answer 7

Total abdominal hysterectomy with bilateral salpingo-oophorectomy.

Question 8

Risk factors for endometrial cancer? [10]

Answer 8

Oestrogen exposure so:

• early menarche & late menopause & nulliparity
• Older
• Tamoxifen or HRT
• T2DM + obesity
• Polycystic ovarian syndrome (PCOS)
• Granulosa-theca tumour (@ kids)

Question 9

Differentials for menorrhagia? [9]

Answer 9

• Dysfunctional uterine bleeding or anovulatory cycle
• Endometrial polyps, hyperplasia or cancer.
• Fibroids & adenomyosis
• Normal copper coils
• Hypothyroidism
• Clotting abnormalities (warfarin, Von Willebrand)
• Pelvic inflammatory disease

Question 10

Investigations for heavy bleeding?

Answer 10

Bedsides: Obs, abdominal and vaginal examination

Bloods: FBC (anaemia), coag studies, TFTs

Imaging: transabdominal/vaginal ultrasound or hysteroscopy

Question 11

Management for heavy bleeding? (standard)

Answer 11

Levonorgestrel IUS then:

Hormonal: COCP or POPs (norethisterone)
GnRH analogues (buserelin or leprorelin)

Non-hormonal: Tranexamic Acid or NSAIDs (mefenamic acid, ibuprofen or naproxen)

Surgical: Endometrial ablation –> hysterectomy

Question 12

How does NSAID [1] and Tranexamic Acid work [1] ?

Answer 12

NSAID: inhibits prostaglandin

T.Acid: inhibits fibrinolysis

Question 13

What is Meig’s Syndrome?

Answer 13

Fibroma (benign ovarian tumour) w ascites and pleural effusion.

Question 14

Commonest type of ovarian cyst?

Answer 14

Follicular Cyst

Question 15

Cyst associated w intraperitoneal bleeding?

Answer 15

Corpus luteum cyst

Question 16

Most common cyst in women under 30?

Answer 16

Dermoid cyst (teratoma)

Question 17

If a woman is fat and has PCOS what management could u offer to help w infertility?

Answer 17

Weight loss first then clomifene with or without metformin

Question 18

Causes of intertility by groups?

Answer 18

1) Anovulation: PCOS, Ovarian Failure, Hyperprolactinaemia, thyroid dysfunction, hypothalamic hypogonadism

2) Male factor: idiopathic, varicocele, antibodies …
3) Tubal factors: endometriosis, infection, surgery
4) Others: fibroid

Question 19

Investigations to check infertility:

Answer 19

Bloods: Serum progestogen (for ovulation), FSH & LH, TSH, testosterone and prolactin
Others: Laparoscopy and dye, hysterosalpingogram.

Question 20

Features of PCOS?

Answer 20

Infertility problems
Amenorrhoea or oligomenorrhoea
Hirsutism and acne (due to androgens)
Obesity
Acanthosis Nigricans (due to insulin resistance)

Question 21

Investigations for PCOS?

Answer 21

• Raised LH:FSH ratio
• Normal/Raised prolactin
• Normal/Raised testosterone

Imaging: pelvic ultrasound (multiple cyst on ovaries)

Question 22

What are the managements for these causes of infertility?

a) PCOS
b) Hyperprolactinaemia
c) Hypogonadism
d) Tubal problems

e) Male factor

Answer 22

a) PCOS - Weight loss, Clomifene (1st) and Metformin. Maybe gonadotrophin.
b) Hyperprolactinaemia: bromocriptine or cabergoline
c) Hypogonadism: restore weight then gonadotrophin
d) Tubal: Laparoscopic surgery if endometriosis, IVF if severe.
e) Male: intrauterine insemination, IVF with or without sperm injection, donor insemination