Menstrual / Gynae conditions

Question 1

contraceptions contraindications

Answer 1

distorted fibrous uterus= do not give IUD. give levongesterol

IUD contraindicated in pregnancy, current/recurrent PID, active trophoblastic disease, breast cancer, endometrial/ovarian/cervical cancer, postpartum endometritis, septic abortion or miscarriage in 3 months

Question 2

PID symptoms

Answer 2

Deep dyspareunia
Chronic lower abdomen pain
Menorrhagia
Dysmenorrhea
Irregular bleeding
Purulent vaginal discharge.
Cervicitis and adnexal and cervical tenderness on bimanual examination
Fever, haemodynamic instability.

Question 3

PID investigations and management

Answer 3

Investigation: pregnancy test to rule out ectopic
Urinalysis to rule out UTI
Cervical swabs for STI
Pelvic ultrasound to detect adhesions / pelvic abscess
Definitive investigation: laproscopic exploration
Abs usually resolves the attack

1g ceftrixone IM, metronidazole 400mg twice daily, doxycycline 100mg twice daily for 14 days

Question 4

Androgen insensitivity syndrome

Answer 4

Resistance to testosterone produced by the male gonads in ueteruo 46 XY male

Question 5

Endometriosis clinical features

Answer 5

Chocolate cyst- thickened uterosacral ligaments on laparoscopy. Tissue resembles the endometrium outside of the endometrial cavity (pelvis) pain, worse immediately before and during the day of menstruation. Colicky dysmenorrhea, heavy menstrual loss, the passage of clots.

Question 6

Endometriosis investigations

Answer 6

Investigations:

1. transvaginal ultrasound. May show ovarian endometriosis or involvement of structures such as the uterosacral ligament.
   * transabdominal if TVUS cannot be done

Definitive: diagnostic laparoscopy

Laparotomies are rarely used

MRI not requested in first instances but considered if suspicion of affecting other organs (bowel/bladder)

Question 7

total abdominal hysterectomy.

Answer 7

• Guarantees amenorrhea
• Appropriate in treatment of pelvic pathologists like fibroids or adenomyosis
• Broad-spectrum abx is given during the operation (co-amoxiclav IV)

Question 8

cystocele

Answer 8

Prolapse of the bladder into the vagina
The weakening of the pelvic muscles
Frequent UTI 
Dragging sensation in lump/ vagina
Vague, constant lower pain

Question 9

PMS

Answer 9

Cyclic behaviour
Emotional and physical changes
Late luteal phase of the menstrual cycle
Depression, irritability, emotional lability.
Fluid retention, weight gain, breast tenderness.
Decreased progesterone and increased prolactin, oestrogen, aldosterone, prostaglandins
Hypoglycaemia and serotonin

Severe- SSRI (fluoxetine)

Question 10

Vulovodynia

Answer 10

Pain in vulvovaginal region <3 months with no identifiable cause. Sharp and burning
Following sexual interourse, tampon insertion
Provoked in clinic
Minus / days

Unprovoked- chronic pain in the absence of a provoking action

Question 11

ovarian torsion

Answer 11

Sudden occlusion of the ovarian arteries
Ischaemia and infarction
Severe sudden onset of sharp adnexal pain and tenderness
Internal pelvic beleeding

Question 12

PCOS

Answer 12

Hyperanndrogenisation and chronic anovulation in the absence of a specific underlying adrenal or pituitary disease

• Oligoovulation or anovulation
• Excess androgen activity (biochemical/clinical)
• PCOS (US)

symptoms 'PCOS PAL'
Polycytis ovarian
Cycles are erratic
Obesity/ hirtusim
Sub fertility
Prolactin raise
Androgens raised
LH raised

Ovaries normally synthesise androgens, in PCOS this increase. Androgen to oestrogen in the liver. Adipose tissue inhibits FSH but stimulates LH. Elevated LH.
Hirsutism, acne, menstrual irregularities, obesity,

Question 13

PCOS treatment for periods, hirutism and acne

Answer 13

Co cyprinidol is a combo of cyproterone acetate and ethinylestradiol. ‘Dinette’ used extensively in women with hirsutism and acne. Anti-androgen and blocks the action of androgens on pilosebaceous glands= reduction in sebum priductin= reduces acne and hair growth. Inhibitors ovulation (coco)

Question 14

FSH, LH levels in

1. pregnancy
2. PCOS
3. turners
4. anorexia
5. hyperprolactinaemia

Answer 14

Pregnancy FSH low, LH high, BCG positive, testosterone normal

PCOS FSH low, LH high, testosterone high

Turner FSH high, LH high, primary ovarian failure

Anorexia FSH low, LH low functional amenorrhea

Hyperprolactinaemia ash low, LH low prolactin high

Question 15

mittelschmerz

Answer 15

German for ‘middle pain’

Mid-cycle pain
Fluid in a pouch- recent ovation

Question 16

Lichen Sclerosis symptoms

Answer 16

causes itchy white patches on the vagina, penis or bottom (anus).

Unknown aetiology
Chronic inflammatory condition
Pruritus and skin irritation
Hypo-pigmentation and atrophy (thinning)
Skin looks shiny
Healing, scarring, inflammation

Question 17

Lichen Sclerosis treatment

Answer 17

1. High potency steroids= clobetasol propionate
   3-month trial
2. Topical calcineurin inhibitors tacrolimus immunosuppressant which reduces inflammation
   Increases the risk of vulvar carcinoma

Question 18

Toxic shock syndrome

Answer 18

Period 
Sepsis
LP - not meningitis
AKI, WBC 
Retained tampon
Board spectrum antibiotics- penicillin, clindamycin