March 2015 recall

Question 1

Male who was previously fertile now is azoospermic with low FSH and low testosterone, most likely cause?

Answer 1

Anabolic steroids

Question 2

What is the best fertility management for a patient with bilateral hydrosalpinges

Answer 2

B/L salpingectomy and IVF
(the salpingectomy will improve chances of IVF)

Question 3

What is the definition of WHO class 3 ovulaton disorder?

Answer 3

Hypergonadotrophic, hypoestrogenic
(High FSH and LH, low estrogen)
- premature ovarian failure
5%

Question 4

What is the definition of WHO class 1 ovulation disorder?

Answer 4

Hypogonadotrophic, hypoestrogenic
-pituitary failure, hyperprolactinaemia
15%

Question 5

What is the definition of WHO class 2 ovulation disorder?

Answer 5

Hypogonadotrophic, normoestrogenic
Axis/ pituitary dysfunction
80%

Question 6

What scoring system is used to evaluate hirsuitism?

Answer 6

Ferrimen Gallwey
0-4
9 areas
Score >8 defines hirsuitism

Question 7

What is the rotterdam criteria?

Answer 7

<9 cycles a year or over 35 days between cycles
Hyperandrogenism eg. Hirsuitism or biochemical (free andogen index >5)
Polycystic ovaries (>12 in one ovary, or 1 ovary >10cm3 in volume)

Question 8

How do you calculate free androgen index?

Answer 8

Total testosterone x 100
Divided by SHBG

Question 9

If testosterone is >5, what does this suggest?

Answer 9

More likely to represent an androgen secreting tumour.
PCOS testosterone is usually <5

Question 10

Ultrasound features of corpus luteum?

Answer 10

Simple to complex cystic lesion
Thick walled
Colour doppler, surrounded with ‘ring of fire’

Question 11

Ultrasound features of follicular cyst?

Answer 11

2.5-6cm, thin walled
Anechoic cyst

Question 12

Ultrasound features of dermoid cyst?

Answer 12

Solid, hyperechoic lines- ‘dermoid mesh’
Rokitansky nodule, dermoid plug
Ectodermal

Question 13

What percentage of dermoids are bilateral?

Answer 13

10-15%

Question 14

Ultrasound features of endometrioma?

Answer 14

low level internal homogeneous internal echoes- ‘ground glass’ appearance
Unilocular

Question 15

How common is the corpus luteum ipsilateral to the ectopic pregnancy side?

Answer 15

70-85%

Question 16

What clinical picture is given in klinefelter infertility?

Answer 16

Oligospermia
Gynaecomastia
Small testes

Question 17

Risk of breast cancer in Klinefelters?

Answer 17

4%

Question 18

Women with recurrent UTI + bladder pain has a cystoscopy and shows multiple small haemorrhagic areas, diagnosis?

Answer 18

Interstitial cystitis/ bladder pain syndrome

Question 19

What bacteria is the syphillis chancroid caused by?

Answer 19

Haemophillus ducreyi

Question 20

Risk of uterine perforation during surgical mx of miscarriage

Answer 20

1/1000, up to 15/1000

Question 21

Risk of infection in surgical mx of miscarriage

Answer 21

40/1000
Same as risk of RPOC

Question 22

What are the absolute contraindications to UAE

Answer 22

Acute infection
Wish to maintain fertility
Absolute refusal of hysterectomy
Pregnancy
Asymptomatic fibroids

Question 23

What is the common bacteria assoc with IUCD infection? And characteristics?

Answer 23

Actinomyoces
Gram pos
Sulphur granules

Question 24

Histology of granuloma cell tumour?

Answer 24

Call-Exener bodies

Question 25

Histology of krukenberg tumour?

Answer 25

Signet ring cells

Question 26

Histology of serous epithelial tumours?

Answer 26

Psamomma bodies

Question 27

How does letrozole work?

Answer 27

Aromatase inhibitor

Question 28

Risk of recurrence of BV?

Answer 28

58%

Question 29

What are the features of mayer rokitansky syndrome (MRKH syndrome)

Answer 29

Underdeveloped vagina and uterus- congenital abnormality Usually present with primary amenorrhoea

Question 30

What is the emergency contraception choice in a patient with epilepsy if copper IUD is not acceptable?

Answer 30

Double dose of lenovelle

Question 31

How long before an operation do you need to stop warfarin?

Answer 31

5 days

Question 32

When to stop rivaroxaban/ dabigatran pre op?

Answer 32

24 hrs

Question 33

If a woman is lost to follow up for colposcopy what sort of investigation should take place?

Answer 33

Incident report Then report to clinical governance Then root cause analysis

Question 34

How soon after CIN treatment are you followed up?

Answer 34

6 months

Question 35

What is the management option of an incompletely excised CIN after LLETZ?

Answer 35

Under 50- Over 50- repeat LLETZ (unless CGIN in which case they need a cone biopsy)

Question 36

How do you follow up a patient who has hysterectomy with incomplete excised CIN?

Answer 36

CIN 1, vault sample at 6,12, 24mth CIN 2/3 vault sample at 6,12 and annually for 9 more years.

Question 37

How long can you conservatively manage CIN 2 for?

Answer 37

24 months. Can't be present in more than 2 quadrants. Colposcopy must have been adequate enough to rule out CIN 3/ invasive lesion. Must agree to 6 monthly repeat colp. If present at 24 months needs LLETZ