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A. MLA Map Obstetrics and Gynaecology > Menstrual Disorders > Flashcards

Menstrual Disorders Flashcards

1
Q

What point in the menstrual cycles determines the beginning of the next cycle and the end of the previous cycle?

1 - first day of bleeding
2 - ovulation
3 - peak progesterone level
4 - luteal phase

A

1 - first day of bleeding
- typically lasts 3-7 days
- around 30-40ml of blood

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2
Q

What is the best time point to measure progesterone as a measure if ovulation has occurred. When is the best time to measure this?

1 - day 3
2 - day 14
3 - day 21
4 - day 28

A

3 - day 21

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3
Q

How does hormone contraception work?

1 - increases hormones levels and increases negative feedback loop
2 - reduces gonadotropin releasing hormone, FSH and LH
3 - inhibit follicular development and ovulation
4 - increases mucus thickness at cervix
5 - thins endometrial layer
6 - all of the above

A

6 - all of the above

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4
Q

When performing a history on a patient with menstrual problems, there re 4 big red flags. Which of these is NOT one of these red flags?

1 - post-coital bleeding
2 - vaginal discharge
3 - dyspareunia
4 - dysmenorrhea (painful periods)
5 - intermenstrual (bleeding between periods)

A

2 - vaginal discharge

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5
Q

Pressure symptoms are those where patients feel a pressure within their pelvic cavity due to an abnormality. Which 2 of the following are examples of something that could cause pressure symptoms?

1 - fibroids
2 - polyps
3 - pelvic inflammatory disease
4 - gonorrhoea

A

1 - fibroids
2 - polyps

  • pressure symptoms are essentially anything causing a pelvic mass
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6
Q

In a patient with menorrhagia what is the first line hormonal treatment that should be tried for patients?

1 - Depo-Provera (contraceptive injection) lasting 12 weeks
2 - Levonorgestrel intrauterine system (progesterone only)
3 -Intrauterine copper device
4 - Nexplanon implant (progesterone only)

A

2 - Levonorgestrel intrauterine system (progesterone only)

  • Combined oral contraception can also be useful in reducing menorrhagia if patient doesnt want implant
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7
Q

In a patient with menorrhagia what is the first line medication that should be tried for patients?

1 - tranexamic acid
2 - alteplase
3 - mefanamic acid
4 - clopidogrel

A

3 - mefanamic acid
- this is an NSAID

  • 2nd treatment option would be tranexamic acid if the 1st line fails
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8
Q

If a patient continues to have menorrhagia and hormonal and drug treatment has failed, we can perform surgery. Which 2 of the following are the most common forms of surgery?

1 - blood vessel ligation
2 - endometrial ablation
3 - balloon inflation
4 - hysterectomy

A

2 - endometrial ablation
4 - hysterectomy

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9
Q

In a patient with menorrhagia which of the following blood tests is not super important to measure straight away in comparison with the rest?

1 - FBC
2 - TFTs
3 - coagulation profile
4 - U&Es

A

4 - U&Es
- typically done, but least important of the 4

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10
Q

In a patient >45 y/o with menorrhagia that is not responding to treatment, what investigation should they have?

1 - bimanual and speculum
2 - laparoscopy
3 - hysteroscopy and endometrial biopsy
4 - pelvic ultrasound

A

3 - hysteroscopy and endometrial biopsy

  • bimanual and speculum and pelvic ultrasound are done on all patients
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11
Q

In a patient with abnormalities in her menstrual cycle, which is often the 1st line for taking a biopsy?

1 - hysteroscopy
2 - colposcopy
3 - large loop excision of the transformation zone (LLETZ)
4 - pipelle biopsy

A

4 - pipelle biopsy

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12
Q

All of the following are benign gynaecological causes of menorrhagia, EXCEPT which one?

1 - Abnormal (Dysfunctional) uterine bleeding (no structural or pathology found)
2 - Fibroid uterus
3 - Adenomyosis
4 - Clear cell Tumour
5 - Endometrial polyp
6 - Cu intrauterine device
7 - Atrophic vagina

A

4 - Clear cell Tumour
- malignant cause

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13
Q

All of the following are malignant gynaecological causes of menorrhagia, but which is most common?

1 - Endometrial cancer
2 - Cervical cancer
3 - Vaginal cancer
4 - Ovarian cancer

A

1 - Endometrial cancer

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14
Q

Non gynaecological causes of menorrhagia can include endocrine disorders. Which 2 of the following can lead to menorrhagia?

1 - hyperthyroidism
2 - hypothyroidism
3 - cushing syndrome
4 - prolactinoma

A

1 - hyperthyroidism
2 - hypothyroidism
- others typically cause amenorrhea

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15
Q

Non gynaecological causes of menorrhagia can include bleeding disorders, but which of the following is most common?

1 - hemophilia A (factor VIII deficiency)
2 - hemophilia B (factor IX deficiency)
3 - von Willebrand disease (VWD)
4 - all equally common

A

3 - von Willebrand disease (VWD)

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16
Q

Fibroids are benign smooth muscle tumours of the uterus, also referred to as leiomyomas. Are caucasian or black-ethnic background more likely to have fibroids?

A
  • black-ethnic background
    = 50% of women
  • caucasians women = 20-60%, but not as high as black-ethnic women
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17
Q

Fibroids, also called leiomyomas, are benign smooth muscle tumours of the uterus that are responsive to a specific hormone. Which hormone is this?

1 - FSH
2 - oestrogen
3 - LH
4 - progesterone

A

2 - oestrogen
- fibroids increase/decrease with levels of estrogen

  • i.e. meopause = decrease in size
    pregnancy = increase in size
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18
Q

Although incredibly rare, what % of fibroids can become malignant and become leiomyosarcomas?

1 - 90%
2 - 60%
3 - 25%
4 - 1%

A

4 - 1%

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19
Q

Fibroids are names based on thir positions in the pelvic cavity. Which of the following descriptions describes a Submucosal fibroid?

1 - the fibroid is situated in the myometrium, the uterine smooth muscle.
2 - these fibroid have a stalk attaching to the uterus
3 - the fibroid is situated below the serosal layer of the uterus, protruding into the abdominal cavity.
4 - the fibroid is situated below the endometrium, protruding into the endometrial cavity.

A

4 - the fibroid is situated below the endometrium, protruding into the endometrial cavity.

  • these fibroids are typically responsible for bleeding
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20
Q

Fibroids are names based on thir positions in the pelvic cavity. Which of the following descriptions describes a intramural fibroid?

1 - the fibroid is situated in the myometrium, the uterine smooth muscle.
2 - these fibroid have a stalk attaching to the uterus
3 - the fibroid is situated below the serosal layer of the uterus, protruding into the abdominal cavity.
4 - the fibroid is situated below the endometrium, protruding into the endometrial cavity.

A

1 - the fibroid is situated in the myometrium, the uterine smooth muscle.

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21
Q

Fibroids are names based on thir positions in the pelvic cavity. Which of the following descriptions describes a Subserosal fibroid?

1 - the fibroid is situated in the myometrium, the uterine smooth muscle.
2 - these fibroid have a stalk attaching to the uterus
3 - the fibroid is situated below the serosal layer of the uterus, protruding into the abdominal cavity.
4 - the fibroid is situated below the endometrium, protruding into the endometrial cavity.

A

3 - the fibroid is situated below the serosal layer of the uterus, protruding into the abdominal cavity.

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22
Q

Fibroids are names based on thir positions in the pelvic cavity. Which of the following descriptions describes a Pedunculated fibroid?

1 - the fibroid is situated in the myometrium, the uterine smooth muscle.
2 - these fibroid have a stalk attaching to the uterus
3 - the fibroid is situated below the serosal layer of the uterus, protruding into the abdominal cavity.
4 - the fibroid is situated below the endometrium, protruding into the endometrial cavity.

A

2 - these fibroid have a stalk attaching to the uterus

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23
Q

Do fibroids always cause symptoms?

A
  • no can be asymptomatic and incidental finding on a scan for something else
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24
Q

Fibroids can be asymptomatic, but can cause symptoms as well. Which of the following is NOT a common symptom of a fibroid?

1 - menorrhagia
2 - abdominal pain/bloating
3 - pressure symptoms
4 - urinary and bowel changes
5 - ascites
6 - fertility issues
7 - dyspareunia
8 - complication during pregnancy

A

5 - ascites
- common in ovarian cancer

25
Q

Both fibroids and endometriosis and adenomyoisis can cause menorrhagia. Which of these would be associated with heavy periods and/or pressure symptoms BUT not dysmenorrhea?

A
  • fibroids
26
Q

If we suspect a fibroid is present, which of the following examinations is NO typically performed?

1 - General examination
2 - Abdominal examination
3 - Digital rectal examination
4 - Speculum examination
5 - Bimanual examination: Firm enlarged uterus

A

3 - Digital rectal examination
- can be performed if suspecting GIT cause

27
Q

If we suspect a fibroid is present, there are 3 main blood tests that should be performed, which of these is NOT one of the 3?

1 - LFTs
2 - TFTs
3 - coagulation profile
4 - FBCs

A

1 - LFTs

28
Q

What is typically the first line imaging for fibroids?

1 - abdominal/transvaginal ultrasound
2 - MRI
3 - CT
4 - hysteroscopy

A

1 - abdominal/transvaginal ultrasound

  • hysteroscopy if fibroid is submucosal
  • MRI used peri-operatively to plan surgery
29
Q

If we suspect fibroids, we must also consider other diagnoses. Which of the following is NOT a realistic differential?

1 - Fibroid uterus
2 - Adenomyosis
3 - Endometriosis
4 - Abdominal hernia
5 - Endometrial polyp
6 - Endometrial cancer

A

4 - Abdominal hernia

30
Q

What size fibroids are treated medically rather than surgically?

1 - <1cm
2 - <3cm
3 - <5cm
4 - <10cm

A

2 - <3cm

  • non-hormonal = mefanamic acid and tranexamic acid
  • hormonal = mirena coil insertion provided uterine cavity is not distorted
    Combined oral contraceptive
    Cyclical oral progesterone
31
Q

What surgical treatments are available for fibroids that are small but >3cm?

1 - Endometrial ablation
2 - Transcervical resection of the submucous fibroid
3 - Hysterectomy if other measures fail
4 - all of the above

A

4 - all of the above
- but all depend on if woman wants to maintain fertility

32
Q

What treatments are available for large fibroids?

1 - Myomectomy
2 - Hysterectomy
3 - Uterine artery embolisation
4 - all of the above

A

4 - all of the above

  • GnRH agonist can be used to shrink the fibroid prior to surgery
33
Q

All of the following are complications of fibroids, EXCEPT which one?

1 - Iron deficiency anaemia due to menorrhagia
2 - Subfertility
3 - Urine Retention
4 - Peritonitis
5 - Pregnancy complication
6 - Leiomyosarcoma

A

4 - Peritonitis

  • Red degeneration is a hemorrhagic infarction of the uterine leiomyoma,
34
Q

Adenomyosis is when endometrial tissue is found in the myometrium of the uterus. Is this more common in multiparous or nulliparous women?

A
  • multiparous
    typically towards the end of their reproductive years.
35
Q

Adenomyosis is when endometrial tissue is found in the myometrium of the uterus. What % of women are affected by adenomyosis?

1 - 1%
2 - 10%
3 - 30%
4 - 70%

A

2 - 10%

36
Q

Patients with suspected adenomyosis can present with all of the following, EXCEPT which one of the following?

1 - Asymptomatic
2 - Pressure symptoms
3 - Menorrhagia
4 - Dysmenorrhoea
5 - Dyspareunia
6 - Fertility issues

A

2 - Pressure symptoms
- common when masses are present

37
Q

Patients with suspected adenomyosis will need a pelvic examination. The uterus will typically be which of the following?

1 - enlarged, boggy uterus
2 - enlarged, bulky, mass present

A

1 - enlarged, boggy uterus
- pelvic may be tender as well

38
Q

Can adenomyosis exist with endometriosis and fibroids?

A
  • yes
39
Q

What is the firs line imaging for a patient with suspected adenomyosis?

1 - MRI
2 - CT
3 - pelvic X-ray
4 - transvaginal ultrasound

A

4 - transvaginal ultrasound
- MRI may be appropriate if surgery is discussed

40
Q

What is the gold standard for diagnosing adenomyosis?

1 - histology from biopsy
2 - hysterectomy
3 - MRI
4 - transvaginal ultrasound

A

1 - histology from biopsy

41
Q

Which of the following is NOT a medical management approach to adenomyosis?

1 - non-hormonal = mefanamic acid and tranexamic acid
2 - hormonal = mirena coil insertion provided uterine cavity is not distorted
3 - Combined oral contraceptive or Cyclical oral progesterone
4 - endometrial ablation

A

4 - endometrial ablation

  • this with hysterectomy would be a surgical option
42
Q

All of the following are complications of adenomyosis, EXCEPT which one?

1 - Subfertility
2 - Miscarriage
3 - Preterm labour
4 - Ovarian cysts
5 - Postpartum haemorrhage

A

4 - Ovarian cysts

  • postpartum haemorrhage is because uterus doesnt contract effectively causing uterine atony
43
Q

If we suspect adenomyosis, we must also consider other diagnoses. Which of the following is NOT a realistic differential?

1 -Endometriosis
2 - Fibroid uterus
3 - Endometrial polyp
4 - Endometrial cancer
5 - Abdominal hernia

A

5 - Abdominal hernia

44
Q

Intramenstrual bleeding is bleeding in between periods, and is a red flag and what must be ruled out?

1 - endometriosis
2 - adenomyosis
3 - gynaecological cancer
4 - polyps

A

3 - gynaecological cancer

45
Q

In the image match A-D with the following:

  • Intramenstrual bleeding
  • menorrhagia
  • amennorhea
  • normal
A

A = normal
B = amennorhea
C = menorrhagia
D = Intramenstrual bleeding (>7 days in duration)

46
Q

Which of the following is NOT a benign cause of Intramenstrual bleeding?

1 - Endometrial / cervical polyps​
2 - Clear cell tumour
3 - Cervical ectropion
4 - Atrophic vagina
5 - Hormonal contraceptives​
6 - Ovulatory disorder
7 - Sexually transmitted disease
8 - Pregnancy

A

2 - Clear cell tumour

47
Q

Which of the following is NOT a malignant cause of Intramenstrual bleeding?

​1 - Endometrial cancer
2 - Endometrial hyperplasia
3 - Cervical cancer
4 - Vaginal cancer
5 - Ovarian cancer

A

5 - Ovarian cancer
- is malignant but typically does not cause intramenstrual bleeding

48
Q

what aged women should have a hysteroscopic guided endometrial biopsy if intramenstrual bleeding is present?

1 - >25
2 - >35
3 - >45
4 - >55

A

3 - >45
to rule out malignancy
- BUT if bleeding is persistent hysteroscopic guided endometrial biopsy should be performed regardless of age

49
Q

In intramenstrual bleeding is an abdominal or transvaginal ultrasound more accurate?

A
  • transvaginal ultrasound
50
Q

If a patient has intramenstrual bleeding and has a history of cervical hyperplasia, which test is best?

1 - Transvaginal ultrasound
2 - Hysteroscopy
3 - Endometrial biopsy
4 - Colposcopy

A

4 - Colposcopy
- can be diagnostic and curative

  • management of all intramenstrual bleeding is dependent on the cause
51
Q

Postcoital bleeding refers to vaginal bleeding after sexual intercourse in the absence of menstrual period. is this dangerous?

A
  • yes
  • this is a red flag and must be investigated as soon as possible
52
Q

Which of the following is NOT a typical benign causes of post-coital bleeding?

1 - Adenomyosis
2 - Cervical/ Endometrial polyps​
3 - Cervical Ectropion​
4 - Infection (Chlamydia)​
5 - Atrophic vagina
6 - Cervical dysplasia

A

1 - Adenomyosis
- causes bleeding, but not typically post-coital bleeding

53
Q

Which of the following is NOT a typical malignant causes of post-coital bleeding?

1 - Cervical intraepithelial neoplasia
2 - Cervical cancer
3 - Vaginal cancer
4 - Ovarian cancer
5 - Endometrial cancer

A

4 - Ovarian cancer

54
Q

In a patient with post-coital bleeding, which of the following would NOT be a first line investigation?

1 - Bimanual and speculum
2 - MRI
3 - Cervicalswabs​: Endocervical and high vaginal swab
4 - STI screening
5 - Colposcopy +/- biopsy
6 - Transvaginal ultrasound
7 - Hysteroscopy
8 - CT Scan

A

2 - MRI

  • management of patients with post-coital bleeding is dependent on the diagnosis
55
Q

In a patient with post-coital bleeding, which of the following would NOT be a sensible differential?

1 - Cervical/ Endometrial polyps​
2 - Cervical Ectropion​
3 - Uterine prolapse
4 - Infection (Chlamydia)​
5 - Cervical cancer / Cervical intraepithelial neoplasia
6 - Endometrial cancer
7 - Vaginal cancer primary / secondary

A

3 - Uterine prolapse

56
Q

Atrophic vagina is a common cause of post-coital sex and inter-menstrual bleeding if the patient is not menopausal. Low levels of which hormone cause this?

1 - FSH
2 - oestrogen
3 - LH
4 - progesterone

A

2 - oestrogen

57
Q

Atrophic vagina is a common cause of post-coital sex and inter-menstrual bleeding if the patient is not menopausal. Which of the following is NOT a common presentation of atrophic vagina?

1 - Itching
2 - Purulent discharge
3 - Dryness
4 - Dyspareunia
5 - Vaginal bleeding

A

2 - Purulent discharge

58
Q

Topical oestrogen can be very helpful for patients with atrophic vaginas, such as:
- Topical oestrogen cream
- Oestrogen pessary
- Vaginal lubricant can help with dryness

But these are all contraindicated in which of the following?

1 - breast cancer
2 - angina
3 - thromboembolism
4 - all of the above

A

4 - all of the above

A. MLA Map Obstetrics and Gynaecology (29 decks)

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