O&G: Just gynae Viva questions Flashcards
Postcoital bleeding in a young woman: Differentials?
- Cervical Ectropion
- Chalmydia or other STIs
- Cervical malignancy
- Complication of the COCP
- Endocervical Polyp
Missed miscarriage: Management?
Expectant:
-Wait and observe for spontaneous delivery of foetus.
Medical:
- Medication to pass the products from the womb:
- Give Misoprostal (Intravaginal or oral).
Surgical:
-Evacuation of retained products
Miscarriage: Counselling?
- Express sympathy
- Offer futher counselling
- Reassure it’s not their fault
- Explain: Over 60% of fetal losses are due to random chromosomal abnormalities
- There is still a very good chance that the patient will have a normal pregnancy in the future (Unless >3 miscarriages)
Drugs that cause Hyperprolactinaemia?
Metaclopromide
Phenothiazines
Reserpine
Methyldopa
Omeprazole
Menorrhagia: Management?
- Exclude anaemia
- Exclude systemic causes
- Exclude malignancy
- Symptom relief:
- Tranexamic acid
- Progestogen IUS, COCP or POP
Secondary Amenorrhoea: Management?
Principle:
-Treat underlying cause
Hypothalamic causes
-eg stress
Pituitary causes
-eg pituitary adenoma (Causing hyperprolactinaemia)
Gonadal causes
-eg premature ovarian insufficiency
Menorrhagia: Differentials?
- Dysfunctional Uterine Bleeding (DUB)
- IUCD in situ (Intrauterine Contraceptive Device)
- Fibroids
- Polyps
- Pelvic infection
- Hypothyroid
- Endometriosis
- Adenomyosis
- Coagulation disorder (eg FV Leiden)
- If >45 + all else ruled out: Condsider endometrial cancer
Mennorrhagoea: Management?
- 1st line: Mirena IUS
- 2nd line:
- Antifibrinolytics: Tranexamic Acid
- NSAIDs: mefenamic acid
- The COCP is also effective
- 3rd Line treatment: IM Progestogens
- Also consider treating underlying cause (eg surgical resectino of fibroid).
Endometrial Hyperplasia: Management?
- simple endometrial hyperplasia without atypia: high dose progestogens with repeat sampling in 3-4 months.
- The levonorgestrel intra-uterine system may be used
- atypia: hysterectomy is usually advised
In the case of subfertility for ~2 years, what investigation would you order to test for ovulation?
Day 21 progesterone
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“day 21” aka “7 days before next period”
Case of subfertility: How to counsel?
Key counselling points
- Folic acid
- Aim for BMI 20-25
- Advise regular sexual intercourse every 2 to 3 days
- Reduce smoking/drinking
Smear test result:
Mild dyskaryosis and negative HPV.
What is the best course of management?
Return to normal 3 yearly smears
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When do you perform LLETZ?
After colposcopy, when cervical intraepithelial neoplasia (CIN) 2 or 3 has been detected.
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- CIN 1 often goes back to normal on its own, and therefore does not require treatment.
- CIN 2 and 3 are much more likely to undergo cancerous change, hence why treatment is initiated.
Management of prolactinoma?
Medical:
- Cabergoline
- Maintain prolactin levels below 1000mu/L to initiate menstruation
- Can be continuted indefinitely or until pregnancy is achieved, depending on presenting complaint
Surgical:
-Surgery is rarely indicated
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Cobergoline is a Dopamine agonist that acts of D2 receptors.
So is bromocriptine.
Causes of postmenopausal bleeding?
- Endometrial cancer
- Endometrial/ endocervical polyp
- Endometrial hyperplasia
- Arophic vaginitis
- Iatrogenic (Anticoagulants, IUSs, HRT)
- Infectie (Eg vaginal candidiasis)
