Gynaecology

Question 1

What are some causes of female subfertility? (5)

Answer 1

Anovulation e.g. PCOS, hypopituitarism, Turner’s iatrogenic
Endometriosis
Tubal factor
Unexplained

Question 2

What investigations are required for subfertility?

1. Hormones
2. Other bloods
3. Imaging
4. Microscopy

Answer 2

1. FSH, LH, oestrodiol, progesterone (7 days before menses), AMH, Prolactin, testosterone
2. Rubella serology
3. TVS
4. Cervical smear if at scheduled time, Semen

Question 3

What imaging is available to test for tubal occlusion?

Answer 3

Hysterosalpinography

Question 4

What lifestyle advice would you give to a couple trying to conceive? (5)

Answer 4

Drink no more than 1 or 2 units per week (unless a man, stick to normal limits)
Stop smoking
Gain/lose weight
Regular sexual intercourse
Woman take regular folic acid

Question 5

What are the management options for subfertility?

1. Improving fertility
2. Assisted production

Answer 5

Clomifene +/- metformin for PCOS
Laparascopic ovarian drilling
Dopamine agonists if hyperprolactinaemia
Surgery for tubal disease

IVF, intracytoplasmic sperm injection, artificial insemination

Question 6

What is included in the Rotterdam criteria for diagnosing PCOS?

Answer 6

Irregular or absent cycles
Clinical or biochemical signs of hyperandrogenism
Polycystic ovaries on USS

Question 7

Which genes are most commonly associated with ovarian cancer? (2)

Answer 7

BRCA 1

HNPCC

Question 8

What should be calculated in those with ovarian cancer before referring to MDT?

Answer 8

Risk of malignancy index

Question 9

How can ovarian cancer present? (6)

Answer 9

Abdominal distention
Pelvic mass
Urinary symptoms
Change in bowel habit
Abnormal vaginal bleeding
Increased girth

Question 10

What investigative tools are available when diagnosing female incontinence?

Answer 10

Examination
Urine dipstick
Post-voidal residual volume bladder scan
Urodynamic testing

Question 11

What medical treatments are available for female urinary incontinence?

Answer 11

Oxybutynin, desmopressin if nocturia, PV oestrogen

Duloxetine

Question 12

What question is important to ask before initiating treatment for menorrhagia?

Answer 12

Are they planning on having children?

Question 13

What are the surgical options for managing menorrhagia? (4)

Answer 13

Uterine artery embolisation
Hysterectomy
Myomectomy
Endometrial ablation

Question 14

When should you consider imaging for menorrhagia? (4)

Answer 14

Suspected adenomyosis, submucosal fibroids, endometrial pathology, significant dysmenorrhoea

Question 15

Which variants of HPV are associated with cervical cancer?

Answer 15

16, 18, 31, 33

Question 16

What is the area called where the ectocervix meets the endocervix?

Answer 16

Transformation zone

Question 17

What stains using the following dyes during colposcopy?

1. Acetic acid
2. Lugol’s iodine

Answer 17

1. Abnormal tissue appears white

2. Normal tissue appears brown

Question 18

What are the risks of a loop biopsy? (6)

Answer 18

Haemorrhage, infection, anxiety, vaso-vagal reaction, cervical stenosis, premature delivery in future pregnancies

Question 19

What age group of women are offered cervical screening?

How often is the screening?

Answer 19

25 to 64

If 25 to 49, every 3 years
If 50 to 64, every 5 years

Question 20

What investigations are required to test for PID? (4)

Answer 20

Cervical swabs
USS
Pregnancy test to exclude ectopic
Urine dip to exclude UTI

Question 21

What is the treatment for PID?

What advise should you give a person who is being treated for PID?

Answer 21

Ceftriaxone, metronidazole, doxycycline

No sexual intercourse until treatment completed and partner has been treated

Question 22

What are the complications of PID? (5)

Answer 22

Subfertility
Ectopic
Chronic pelvis pain
Perihepatitis
Tubo-ovarian abscess