Gynea conditions

Question 1

Who gets fibroids?

Answer 1

Black,
Older
Nulliparity

Question 2

What is a fibriod?

Answer 2

Lieomyoma

Question 3

What % are incidental findings?

Answer 3

50%

Question 4

What is red degeneration?

Answer 4

Fibroid torsion - lack of blood supply - necrosis

Pain

Question 5

Treatment of fibroids?

Answer 5

Watch and wait
Surgery ……myomectomy, hysterectomy, endometrial ablation, uterine artery embolisation

Medical
IUS - for menorrhagia (or tranexamic acid or COCP)

Question 6

What is adenomyosis?

Answer 6

Endometrial tissue in myometrium

Medical management- contraception

Surgical - hysterectomy

Question 7

What symptoms might you get with endometriosis?

Answer 7

Cyclical pain!
Painful viscera - bowel and urine 
Extra bleeding 
Deep dyspyrunia
Sub fertility 
Chocolate cysts
(Rare- haemopneumothorax)

Dx- lap. Biopsy.
Lap plus ablation

Question 8

Gold standard for fibroid removal?

Answer 8

Myomectomy

Question 9

How would you diagnose someone with PCOS?

Answer 9

Rotterdam criteria: 2/3 must be present

• polycyctis ovaries (>12 follicles or volume >10cm on us)
• oligo- ovulation or anovulation
• clinical or biochemical signs of hyperadrogenism

Question 10

How do you decide which type of TOP (termination) is used?

Answer 10

Gestation and woman’s choice

<9 weeks - medical: mifepristone (orally) and misoprostol (orally 400mcg or if later pv/buccally 800mcg)

9-13 weeks - mifepristone (orally) and misoprostol 800mcg (vaginally) plus further misoprostol if needed

13-24 weeks - mifepristone (orally) and misoprostol 800mcg (pv) then 3hourly dose of misoprostol.

After 21+6 - fetocide - 3ml intracardiac potassium chloride

Surgical -
7-14 weeks vacuum aspiration
13-24 weeks - dilation and evacuation (surgical forceps)

Question 11

Wha are the types of miscarriage?

Answer 11

Missed
Inevitable
Threatened
Incomplete

Question 12

What are associated with recurrent miscarriage?

Answer 12

BV infection - 2nd trimester loss 
Parental chromosomal abnormality 
Underinvestment abnormalities 
Antiphospolipid syndrome 
Thrombophillia

Question 13

Where are the major of ectopic pregnancies located?

Answer 13

Ampulla (tubes)
Isthmus
Ovary
Peritoneum

Rx- mexotrxate (don’t get pregnant until 3 months after)
Surgical - laparoscopy - salpigectomy

Question 14

What is lichen sclerosis?

Answer 14

Bruised purpuric signs -
Elastic tissue become collagen
Vulva becomes white flat and shiny

Rx- clobetasol propionate

Question 15

When can a TOP happen post 24weeks?

Answer 15

Risk to mothers life
Permanent injury to mothers physical/mental health
Child would be severely handicapped

Question 16

What is the treatment for genital warts (aka condylomata accumulate)?

Answer 16

Multiple non-keratinised - topical podophyllum

Solitary keratinised - cryotherapy

2nd line : imiquimond

Question 17

What do you see a whirlpool sign in?

Answer 17

Ovarian torsion

Or Bowel volvulus

Question 18

What is the treatment for symptomatic cervical ectropium?

Answer 18

Silver nitrate or diathermy

Question 19

What are this causes of a lobulated uterus?

Answer 19

Fibroids, pregnancy

Question 20

Itching vuvla, white shiny appearance?

Answer 20

Lichen sclerosis

Question 21

What is goserelin and what’s it used for?

Answer 21

GnRH analogue, used prior to fibriod surgery to shrink then

Not for >6m use due to demineralisation of bone

Fibriods worse when preg and on cocp

Question 22

How might ovarian torsion present?

Answer 22

Unilateral pain and tender mass

N&V

Question 23

How do you diagnose fibroids?

Answer 23

Transvaginal ultrasound

Question 24

How can atrophic vaginitis present?

Answer 24

Vag bleeding, dyspareunia, urinary infection, stress incontinence or prolapse

No oestrogen - thinner, loss of structure

Question 25

Most common cause of clear wet non itchy vaginal discharge?

Answer 25

Ectropium (extension of columnar zone which is secretory )